This document discusses risk factors and prevention strategies for acute idiosyncratic reactions to contrast media. Key points include:
- Risk factors include a previous reaction, asthma, allergy history, and certain drugs like beta-blockers.
- Using low-osmolality nonionic contrast agents can reduce reaction risk by 4-5 times compared to ionic agents.
- For high-risk patients, premedication with steroids, antihistamines, and other drugs can reduce reaction rates from 16-35% to around 2%.
- Pretesting with a small test dose is not effective at preventing reactions, and reactions can still occur after a negative pretest. Injection rate does not
iodinated and gadolinium Contrast media are widely used in imaging. The radiologist and the physician should be familiar with the common side effects and the serious life threatening adverse reactions,
iodinated and gadolinium Contrast media are widely used in imaging. The radiologist and the physician should be familiar with the common side effects and the serious life threatening adverse reactions,
Drug induced disease is defined as the unintended effect of a drug that results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention and/or to require hospitalization and may persist even after the offending drug has been withdrawn. Drug induced diseases also called as iatrogenic diseases, are well known but least studied entity. In this review, we have collected the information from review and research articles related to the drug induced diseases. This review is intended to aid the understanding of some basic concepts regarding the drug induced diseases. This tends to provide information about the some commonly occurring drug induced disorders, the drugs responsible for inducing disorders, their prevention and some of the treatments.
Drug induced disease is defined as the unintended effect of a drug that results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention and/or to require hospitalization and may persist even after the offending drug has been withdrawn. Drug induced diseases also called as iatrogenic diseases, are well known but least studied entity. In this review, we have collected the information from review and research articles related to the drug induced diseases. This review is intended to aid the understanding of some basic concepts regarding the drug induced diseases. This tends to provide information about the some commonly occurring drug induced disorders, the drugs responsible for inducing disorders, their prevention and some of the treatments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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1. IN THE NAME Of GOD
Amir al-Muminin, peace be upon him, said:
There is no wealth like wisdom, no destitution like ignorance, no
inheritance like refinement and no support like consultation.
املومنينرامي(ع)فرمودند:
هيچينيازيبنچو،عقلوهيچيفقرنچوناداني،نيستهيچثيرانچو،ادبوهيچ
پشتيبانينچوترمشونيست.
4. Patient Factors
Infants, small children and unconscious patients are more likely to develop
extravasation.
Patients receiving chemotherapy are also at a higher risk of extravasation
because chemotherapy may cause fragility of the vein wall.
Patients with arterial insufficiency (e.g. atherosclerosis, diabetes mellitus) or
compromised venous drainage (e.g. thrombosis) or lymphatic drainage (e.g.
radiation therapy, surgery or regional node dissection) are less able to tolerate
extravasation than those with normal circulation.
5. Mechanisms and Toxicity
Multiple factors are involved in the pathogenesis of extravasation
injuries.
The first factor is osmolality above water.
The second factor is the cytotoxicity of contrast media.
The third factor is the volume of extravasated contrast medium.
The fourth factor is the mechanical compression caused by large-
volume extravasations.
6. Clinical Picture
Symptoms of extravasation are very variable.
On physical examination, the extravasation site appears swollen, red
and tender.
Most extravasation injuries resolve spontaneously within 2–4 days.
These symptom include skin blistering, altered tissue perfusion,
paresthesia, and increasing or persistent pain after 4 h.
7. Treatment
There is no consensus about the best approach for the management of
extravasation. The methods described in the following sections
have been used:
Elevation of the Affected Limb
Elevation is often useful to Reduce Edema by decreasing the hydrostatic pressure in
capillarie.
8. Topical Application of Heat or Cold
Heat produces vasodilatation and thus resorption of extravasated fluid and edema,
while cold produces vasoconstriction and limits inflammation.
The immediate application of warm compresses reduced the volume of extravasated
fluid in healthy volunteers.
In patients, who have suffered from extravasation, cooling can be produced with ice
packs placed at the injection site for 15–60 min three times a day for 1–3 days or
until symptoms resolve.
Treatment
9. Prevention of Secondary Infection
Applications of silver sulfadiazine ointment are recommended by many plastic
surgeons whenever blistering is evident
Treatment
10. Aspiration of Fluid from the Extravasation Site
Aspiration of fluid from the injection site is controversial, as it usually removes only
a small amount of extravasated fluid and carries a risk of infection.
Treatment
11. Hyaluronidase and DMSO (Di methyl sulfoxide)
Hyaluronidase is an enzyme that breaks down connective tissue and facilitates
absorption of extravasated drugs into the vascular and lymphatic systems.
It should be administered within 1 h of extravasation to obtain quick dissipation of
the skin swelling.
Treatment
12. DMSO is a free-radical scavenger and an effective solvent.
It is effective in preventing ulceration caused by extravasated doxorubicin, but its
efficacy has not been proven for treating extravasation of contrast media.
Treatment
13. Surgery
Surgical drainage or emergency suction applied within 6 h can be effective (Loth
and Jones 1988) and the use of emergency suction alone or combined with saline
flushing have also been helpful.
Treatment
15. Type of Contrast Agent
With the older high osmolality ionic agents the rate of reactions of
all types is in the range 5%–12%.
Concluded that 80% of contrast media reactions could be
prevented by using low osmolality agents.
In Katayama et al.’s (1990) series there was no significant
difference in mortality between the ionic and nonionic agents, but
other data suggests a lower mortality with nonionic agents.
16. Previous Contrast Medium Reaction
A previous reaction to an iodinated contrast medium is
the most important patient factor predisposing to an
acute idiosyncratic reaction.
When a patient who previously reacted to an ionic agent
is given a nonionic agent, the risk of a repeat reaction is
reduced to approximately % 5.
17. Asthma
Asthma is another important risk factor. Research (1975) show
that 11% of asthmatics had a reaction to ionic contrast media.
(1980) stated that the risk of reaction to ionic agents was increased
five times in an asthmatic.
In patients with asthma, Katayama et al. (1990) described an 8.5
times increased risk with ionic agents and a 5.8 times increased
risk with nonionics.
Other conditions, such as hay fever, eczema,
etc. are associated with an increased risk of
reaction, but by a lesser amount than asthma.
18. Allergy
A history of allergy to foods, drugs or other substances is
associated with an increased risk of contrast medium
reaction, usually by a lesser amount than a history of
asthma.
Allergy to foodstuffs which contain iodine, e.g., seafood,
often causes particular anxiety. However, the available
data suggests that allergy to seafood is no more
significant than allergy to other foodstuffs.
19. Drugs
Whether or not ά blockers affect the incidence of idiosyncratic
contrast medium reactions is controversial.
found that ά blockers did increase the risk of reaction. It is
however agreed that the use of ά blockers can impair the response
to treatment if a reaction does occur.
Patients who are receiving or have received interleukin-2 are at
increased risk of adverse events following iodinated contrast
media.
21. Choice of Contrast Medium
The single most important method of reducing the risk of
idiosyncratic contrast medium reactions is to use nonionic low
osmolality agents which are associated with a four to five times
lower risk of reactions.
When there has been a previous reaction to nonionic iodinated
contrast medium, the use of a different agent is appropriate.
22. Premedication
Most frequently steroids with or without additional H1
antihistamines have been recommended, and other drugs, such as
ephedrine and H2 antagonists have also been tried.
In patients who had previously reacted, or who had a history of
allergy or severe cardiopulmonary disease, H1 and H2 antagonists
reduced the reactionrate to 2% in 1047 patients, as compared to a
reaction rate of 4.37% in those who were not premedicated .
(Fink et al. 1992).
23. In patients who have previously reacted to ionic contrast media, a
combination of steroid and H1 antihistamine reduces the repeat
reaction rate, estimated to be 16%–35% without premedication.
The addition of the below drug pre medication recommended :
H2 antagonist cimetidine
Steroid
Antihistamine
ephedrine
Premedication
24. Pretesting and Injection Rate
The practice of pretesting – giving a small preliminary test dose of
contrast medium intravenously before the full dose is given – has
been shown to be of no value (Shehadi 1975; Fischer and Doust
1972; Yamaguchi et al. 1991).
Fischer and Doust (1972) found the mortality after contrast
medium was unaffected by pretesting and that deaths could occur
following a negative pretest or following the pretest itself.
Yamaguchi et al. (1991) found no benefit of pretesting either with
ionic or nonionic agents.
Injection rate does not appear to have any effect on the rate of
adverse reactions (Jacobs et al. 1998).