Gene/Protein Disease Symptom Drug Enzyme Compound
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Sexually transmitted diseases are the most common infectious diseases in the United States. Physicians, nurses, and other health care providers are uncomfortable discussing sexual issues with their clients. Therefore many health care needs are not addressed, and many opportunities for education aimed at preventing STDs are missed. In the periodic health history, the health care provider must elicit information about sexual practices (vaginal,oral, or anal intercourse), sexual orientation (heterosexual, homosexual, or bisexual), sexual risk behaviors (ie, unprotected intercourse with multiple partners), contraceptive use (particularly condoms), and prior STDs. Based on this information, the health care practitioner moves to more specific questions regarding sexual health. The health care practitioner asks about sores on the penis, dripping or discharge from the penis, staining of the underwear, testicular pain, and scrotal swelling. For the client who engages in oral sex, the health care practitioner asks about sore throat. For the client who engages in anal intercourse ask about diarrhea, rectal bleeding, anal itching, and pain. Probe the desire phase, the arousal phase (erection), and the ejaculation phase. Ask about the desire for fatherhood and concerns about fatherhood. An important part of health care is prevention. Culturally specific and sensitive information should be available for patients. Patient education should not consist of simply handing a brochure to a man. Using the brochure as a guide for including all the necessary information and ascertaining the man's understanding may be a very effective method of patient education. For men who are at increased risk for STDs or who present with symptoms of STDs, offering diagnostic testing is necessary. Men who have multiple sexual partners especially need diagnostic testing and prevention counseling. The CDC recommends annual HIV and hepatitis C testing for men who have sex with men and other men who have increased risk for contracting HIV. Another important consideration at the periodic screening examination is the vaccinations that are to be recommended. Men who have sex with men should receive hepatitis A and hepatitis B vaccine. Additionally, it is recommended that all adolescents should receive hepatitis B vaccine.
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PMID:Sexually transmitted diseases in men. 1515 85

Infliximab is a tumour necrosis factor (TNF)-alpha antagonist that has revolutionised the treatment of Crohn's disease and rheumatoid arthritis. However, infliximab therapy can be complicated by a variety of adverse reactions. Acute infusion reactions occur during or shortly after infusion and typically consist of fever, chills, nausea, dyspnoea and headaches. Delayed reactions, characterised by myalgias, arthralgias, fever, rash, pruritus, facial, hand or lip oedema, dysphagia, urticaria, sore throat and headache may occur 3-12 days after infusion. Although the mechanisms of these reactions are not yet clearly defined, emerging evidence indicates that these reactions may be associated with the immune response against infliximab and the development of antibodies to infliximab.A number of studies have identified protective factors that may minimise adverse reactions, presumably related to the immune response against infliximab. Factors that may be protective by helping to establish immune tolerance for the foreign infliximab protein include concomitant administration of immunomodulators or corticosteroids, starting infliximab therapy with a 0, 2, 6-week induction regimen, maintenance dose administration with infusions every 8 weeks or less, and avoiding long periods between infusions. Infliximab therapy also may have other immunological consequences. There is evidence that infliximab may impede the appropriate immune response to a number of pathogens, prohibiting its use in patients with active infections. In addition, patients should be screened and appropriately treated for tuberculosis before initiating infliximab therapy. The development of autoantibodies, such as antinuclear antibody or anti-ds-DNA, has also been described with infliximab therapy, although the development of clinical lupus-like syndrome is rare. While there is a theoretical risk of increased rate of malignancies due to antagonism of TNFalpha, to date there is no clear evidence of such an effect. In addition, cardiac and neurological adverse events associated with infliximab therapy have been described. The mechanism for these adverse events is unclear. In summary, infliximab therapy can be an effective treatment for Crohn's disease; however, a number of immunological consequences and adverse events may complicate the infusion of this agent. Appropriate prophylaxis and therapy of these adverse reactions will allow infliximab to be used safely in the vast majority of patients.
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PMID:Managing immunogenic responses to infliximab: treatment implications for patients with Crohn's disease. 1530 61

The characteristic rash of systemic juvenile idiopathic arthritis is a transient erythematous eruption associated with a quotidian spiking fever. Usually asymptomatic, it can be pruritic, with dermatographism at sites of scratching or pressure. An illness similar to this entity in adults is designated adult-onset Still disease. The relationship between the pediatric and adult disease is uncertain and differences in case definition have evolved. Specifically, a sustained arthritis for at least 6 weeks is required for a diagnosis of systemic juvenile idiopathic arthritis, whereas transient arthritis and arthralgia are accepted criteria in adult-onset Still disease. We describe five patients less than 16 years of age who presented with an acute illness characterized by fever and a distinctive skin eruption. Intense pruritus and linear erythematous lesions flared with a spiking fever, usually in the late afternoon and evening. Periorbital edema/erythema and nonlinear urticarial lesions were also seen. Two children had splinter hemorrhages of the nail beds and one girl developed a fixed, scaling, pigmented, linear eruption. Severe malaise, myalgia, arthralgia, and leukocytosis were present in every patient. Other systemic manifestations included sore throat, transient arthritis, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, hyperferritinemia, and hepatic dysfunction. No patient had a sustained arthritis. The course of the disease was variable. One patient, diagnosed with macrophage activation syndrome, recovered on oral naproxen. Two patients responded to systemic corticosteroid therapy. One girl developed status epilepticus and died from aspiration and asphyxia. A boy with severe hepatitis developed renal failure and thrombotic thrombocytopenic purpura and was treated with plasmapheresis, dialysis, and systemic corticosteroids; he had recurrent episodes of rash and fever into adult life. These children did not fulfill the case definition of systemic juvenile idiopathic arthritis because they lacked a persistent arthritis. Adolescent and adult patients with the same clinical and laboratory findings are described under the rubric of adult-onset Still disease. Recognition of the distinctive urticarial skin eruption and spiking fever is important in the diagnosis of a disease with severe morbidity and potentially life-threatening complications.
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PMID:A pruritic linear urticarial rash, fever, and systemic inflammatory disease in five adolescents: adult-onset still disease or systemic juvenile idiopathic arthritis sine arthritis? 1546 68

The relationship between extent of pesticide use and signs and symptoms of illnesses due to exposure was assessed in a cross-sectional survey of 631 farmers (537 men and 94 women) in South India. Responses to questionnaires showed that 433 farmers (68.6%) sprayed pesticides themselves and were thus directly exposed. More than 75% used moderately or highly hazardous pesticides; 88% used no protection while handling pesticides. About 50% of sprayers mixed different brands. Retailers were the source of information about pesticides for 56%. The farmers reported excessive sweating (36.5%), burning/stinging/itching of eyes (35.7%), dry/sore throat (25.5%), and excessive salivation (14.1%), all more prevalent among sprayers. Among men, excessive sweating and eye and throat problems were significantly associated with exposure. There is a need to raise farmers' and authorities' awareness of the need to use protective gear when handling pesticides.
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PMID:Use of pesticides and its impact on health of farmers in South India. 1696 29

A 4-year-old boy presented with mildly itchy, linear, skin lesions over the trunk, arms, and face of 3 months' duration. He had previously been admitted to a private hospital for generalized exfoliation of the skin following drug intake for fever and throat pain. The nature of the drugs was not known. The exfoliative dermatitis was treated with oral prednisolone, 10 mg daily, tapered over 3 weeks. No further topical or oral medication was given. The present skin lesions started 1 month after the cessation of the steroids. There was no family history of skin lesions, voice changes, or systemic complaints. Cutaneous examination showed multiple violaceous, linear, reticulate ridges with adherent scaling over the chest, back, and neck. There were scaly, flat-topped papules over the extensor aspects of both upper arms and the buttocks, and scaly plaques over the cheeks (Figs 1a-d and 2a,b). The scalp showed diffuse greasy scaling. There were no oral, genital, axillary, or eye lesions. The nails were normal. Systemic examination did not reveal any abnormal finding. Routine hematologic investigations, liver and kidney function tests, tests for hepatitis B and C, and enzyme-linked immunosorbent assay (ELISA) for HIV were normal. Histopathology from skin lesions on the back revealed hyperkeratosis, patchy parakeratosis, follicular plugging, alternating irregular acanthosis and epidermal thinning, basal cell degeneration, and a band-like inflammatory infiltrate of lymphocytes, histiocytes, and a few plasma cells (Fig. 3). Based on the classical clinical features and histopathology, keratosis lichenoides chronica was diagnosed, and topical 1% hydrocortisone acetate cream, twice daily, was prescribed. There was slight relief of pruritus at a follow-up visit after 3 weeks; however, the patient was subsequently lost to follow-up.
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PMID:Keratosis lichenoides chronica in an Indian child following erythroderma. 1831

'Benifuuki', a tea (Camellia Sinensis L.) cultivar in Japan, is rich in anti-allergic epigallocatechin-3-O-(3-O-methyl) gallate (EGCG3''Me). 'Benifuuki' green tea and simultaneous addition of ginger extract remarkably suppressed cytokine (TNF-alpha and MIP-1alpha) secretion from mouse bone marrow-derived mast cells after antigen stimulation and, as expected, suppressed delay-type allergy. After drinking 'benifuuki' green tea containing 43.5 mg of EGCG and 8.5 mg of EGCG3''Me, the AUC (area under the drug concentration time curve; min mug/ml) of EGCG was 6.72 +/- 2.87 and EGCG3''Me was 8.48 +/- 2.54 in healthy human volunteers. Though the dose of EGCG was 5.1 times the dose of EGCG3''Me, the AUC of EGCG3''Me was higher than that of EGCG. A double blind clinical study on subjects with Japanese cedar pollinosis was carried out. At the 11th week after starting the study, in the most severe cedar pollen scattering period, symptoms, i.e., blowing the nose and itching eyes, were significantly relieved in the 'benifuuki' intake group compared with the placebo group, and blowing the nose, itching eyes and nasal symptom score, and at the 11th and 13th weeks, stuffy nose, throat pain and the nasal symptom medication score were significantly relieved in the 'benifuuki' containing ginger extract group compared with the placebo group. These results suggested that over one consecutive month, drinking 'benifuuki' green tea was useful to reduce some of the symptoms from Japanese cedar pollinosis, and did not affect any normal immune response in subjects with seasonal rhinitis, and the ginger extract enhanced the effect of 'benifuuki' green tea.
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PMID:In vitro and in vivo anti-allergic effects of 'benifuuki' green tea containing O-methylated catechin and ginger extract enhancement. 1900 3

We studied a web-based triage system which was accessible to the general public in the Netherlands. In a retrospective analysis we investigated the type of complaints that were submitted and the kind of advice provided. Over a period of 15 months, 13,133 different people began using the web-based triage system and 3812 patients went right through the triage process to the end. The most frequent complaints were common cold symptoms, such as cough and a sore throat (22%), itch problems (13%), urinary complaints (12%), diarrhoea (10%), headache (8%) and lower back pain (8%). Most commonly, the system generated the advice to contact a doctor (85%) and in 15% of the cases the system provided fully automated, problem-tailored, self-care advice. A total of 192 patients participated in a prospective study and completed an online survey immediately after the delivery of advice. A follow-up questionnaire on actual compliance was completed by 35 patients. Among these, 20 (57%) had actually complied with the advice provided by the system. A regression analysis revealed that intention to comply was strongly related to actual compliance. In turn, intention to comply was strongly related to attitude towards the advice (P < 0.001). Web-based triage can contribute to a more efficient primary care system, because it facilitates the gatekeeper function.
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PMID:Patient use and compliance with medical advice delivered by a web-based triage system in primary care. 2008 60

The aim of the present research was to analyze the epidemiological and clinical characteristics of the novel influenza A (H1N1) in China. We retrospectively analyzed the epidemiological information and clinical characteristics of 150 patients with the novel influenza A (H1N1) virus infection by descriptive epidemiology. There were 82 males and 68 females in this group. The median age of the 150 patients was 34.4 years (range, 4 to 77 years). There were 145 imported cases among the patients and most of these cases came from Australia, America and Canada. The main symptoms included fever, cough and sore throat. Other symptoms included: expectoration, runny nose, throat itching, sniffles, dry pharynx, headache, muscular ache, etc. CD4(+) T cell counts of 48% of the patients were lower than normal. Computed tomography (CT) of the chest in 32 cases was abnormal, including: increased bronchovascular shadows, pneumonia, pleural thickening and pleurisy, etc. Oseltamivir was the first choice for treatment of A (H1N1) influenza and it was safe and well tolerated. The symptoms were minor and the prognosis was good. All patients recovered fully after treatment. Considering the fact that the flu is highly infectious and can be carried through human to human contact rapidly, local Centers for Disease Control and prevention (CDC) should strengthen monitoring and take some measures in view of an influenza A (H1N1) onslaught.
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PMID:Clinical analysis of 150 cases with the novel influenza A (H1N1) virus infection in Shanghai, China. 2010 36

The antithyroid drugs mainly include thioimidazole (carbimazole, methimazole=thiamazole) and propylthiouracil. After absorption, carbimazole is rapidly metabolized to methimazole and thus switching between these two drugs should not be considered in case of side effects. Furthermore, in case of side effects, sometimes even cross reactions between thioimidazoles and propylthiouracil occur. Common and typical adverse reactions of antithyroid drugs include dose dependent hypothyroidism and thus thyroid function should be repeatedly checked while the patient is on antithyroid drugs. Furthermore, pruritus and rash may develop. In this case, one might try to switch from thioimidazoles to propylthiouracil or vice versa. Antithyroid drugs may cause mild dose dependent neutropenia or severe allergy-mediated agranulocytosis, which typically occurs during the first three months of treatment, has an incidence of 3 per 10,000 patients and cross reactivity between thioimidazoles to propylthiouracil may occur. Rarely, antithyroid drugs can cause aplastic anemia. Mainly propylthiouracil, but sometimes also methimazole may lead to an asymptomatic transient increase in liver enzymes or to severe, even lethal liver injury of cholestatic or hepatocellular pattern. Since propylthiouracil associated liver injury was observed increasingly among children and adolescent, it has been suggested to prefer thioimidazoles for these patients. Because of these potential serious adverse effects, physicians should advise patients to immediately seek medical help if they get a fever or sore throat or malaise, abdominal complaints or jaundice, respectively. Furthermore, arthralgias may develop in 1-5% of patients under both antithyroid drugs. Since arthralgias may be the first symptom of more serious immunologic side effects, it is recommended to stop the antithyroid drug in this case. Drug induced polyarthritis mainly develops during the first month of therapy, whereas ANCA-positive vasculitis is generally observed only after long term exposure to propylthiouracil or very rarely with the thioimidazoles. The teratogenic risk of the thioimidazoles is somewhat higher (Aplasia cutis congenita), that is why one generally recommends preferring propylthiouracil during pregnancy. During breast feeding both, thioimidazoles or propylthiouracil, may be administered. Nowadays, perchlorate is only used short term in case of latent hyperthyroidism before administering iodine-containing contrast agents. Therefore, the known side effects, which usually are only observed after long term treatment, are not an issue any more.
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PMID:[Pharmacotherapy of hyperthyreosis--adverse drug reactions]. 2165 88

A 16-year-old young man presented with intensely itchy erythematous dermatitis on the body for 1 week and vesicular lesions on the palms and soles for 4 to 5 days. Lesions on the palms and soles were accompanied by severe burning and itching. The patient gave a history of sore throat and fever, 1 week prior to the onset of lesions. A general physical examination was normal, and cutaneous examination revealed multiple, well-defined erythematous scaly plaques with collaret scaling on the trunk and extremities (Figure 1). Vesicular lesions were seen on the palms and soles (Figure 2). The differential diagnoses we considered were pityriasis rosea and secondary syphilis. The possibility of dermatophytid, vesicular pityriasis rosea, and pompholyx was limited to the palms and sole lesions. Complete blood cell count was within normal limits. Results from antistreptolysin O titer, potassium hydroxide mount, and venereal disease research laboratory were negative. Skin biopsies were taken from the back and left palm. The biopsy specimen from the back revealed focal spongiosis, lymphocyte exocytosis, vacuolar changes in the basal layer, and perivascular lymphocytic infiltrate in the dermis (Figure 3). The biopsy obtained from the vesicular lesion on the left palm revealed an intraepidermal vesicle with no evidence of acantolytic process (Figure 4). A diagnosis of pityriasis rosea was made and the patient was started on clarithromycin 500 mg once a day for 7 days, along with antihistamines and emollients. The lesions faded dramatically in a very short period, and there was significant involution of almost all of the lesions after 7 days of clarithromycin. During the 6 months of follow-up, no recurrence was observed.
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PMID:Vesicular palmoplantar pityriasis rosea. 2254 32


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