Inflammatory Bowel Disease - A Holistic Perspective

The IBS Miracle

Today to Discover: My unique holistic system to immediately get symptomatic relief and completely cure your condition within 3 to 8 weeks using my powerful 100% natural system. The horrible truth about conventional Ibs treatments. A list of the original hidden research papers (together with all the details you need to locate them yourself) published by scientists and MDs reporting how they cured Ibs using natural methods so you'll see that my system is backed by scientific evidence! 78 different scientific sources to be exact! How simple over the counter products will immediately reduce cramps and abdominal pain. The dietary changes you should make to live an Ibs-free life. How to make your body combat Ibs and re-balance itself. The link between lifestyle and Ibs. The specific foods that trigger Ibs symptoms. Foods that are marketed as being ery healthy that will actually cause your Ibs to get worse. Herbs that are extremely potent in stopping diarrhea, constipation and gas. Simple alternative treatments that will cure your Ibs faster than you ever thought possible. I will show you step by step how to do this. The food items you have to include in your diet if you want to get rid of your Ibs fast. The food items you should limit if you want to get rid of Ibs. Convenient printable charts that will tell you exactly the foods to avoid and the foods to include. The secret 100% natural remedies that you should use, and are guaranteed to make a dramatic impact on your Ibs condition in just a few days! More here...

The IBS Miracle Summary

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Bacterial Agents Of Inflammatory Diarrhea

In the majority of cases, inflammatory diarrhea in the distal small bowel and colon occurs in response to bacterial invasion of the intestinal tissues (Table 34.1). However, in some infections, enterocolitis can be an outcome of bacterial toxicity without invasion. Causative agents of these infections include the following. species include S. dysenteriae, S. flexneri, S. sonnei, and S. boydii. However, techniques such as multilocus enzyme electrophoresis have revealed that all Shigella strains are actually encompassed within the species E. coli. Clinical syndromes of shigellosis include a mild watery diarrhea, which is often followed by severe dysentery with blood, mucus, and inflammatory cells in feces. The incubation period ranges from 6h to 5 days. Epidemiological studies show that Shigella is transmitted by the fecal-oral route or by contaminated food and water. As few as 100 organisms can cause infection in an adult. Watery diarrhea Vomiting Abdominal cramps Watery diarrhea...

Bacterial Agents Of Noninflammatory Diarrhea

The noninflammatory watery diarrhea caused by bacteria is usually associated with the production of an enterotoxin after bacterial colonization of the small intestine or with the presence of preformed enterotox-ins in food. Occasionally, bacteria can cause a drastic effect on intestinal epithelial cells in the absence of an enterotoxin. This category of diarrhea is caused by the following. Vibrio cholerae belongs to the family Vibrionaceae and has been the cause of seven cholera pandemics since 1817. It is transmitted by contaminated food and water. Food-borne transmission often occurs by ingestion of raw or undercooked shellfish. Since the acid-sensitive bacteria must pass through the stomach to colonize the small intestine, a high inoculum of 109 organisms is required to cause disease. The diarrhea can be extremely severe, with characteristic rice water stools, which can lead to rapid dehydration, circulatory collapse, and death. Vibrio cholerae secretes cholera toxin (CT), which is...

Role in inflammatory bowel disease

A large population of macrophages reside in the normal intestinal mucosa where they represent a major APC population. Various studies suggest that intestinal macrophages cannot easily be induced to mediate acute inflammatory responses. In inflammatory bowel disease, however, there is an increase in the mucosal macrophage population where the recruited macrophages are phenotypically disparate from the resident macrophages (Mahida, 2000). These recruited macrophages appear to perform a major role in mediating the chronic mucosal inflammation seen in patients with ulcerative colitis and Crohn's disease. There is evidence that the recruited macrophages release reactive metabolites of oxygen and nitrogen and proteases which degrade the extracellular matrix. There is also evidence that the recruited macrophages may be primarily responsible for the secretion of cytokines which are important in the pro-inflammatory process, including TNF-a, IL-1, IL-6, IL-8, IL-12 and IL-18.

Foodborne Poisonings And Infections 1521 Travelers Diarrhea

The most frequent cause of gastrointestinal disorders among adults is travelers' diarrhea (TD), affecting on average from 12 to 20 million people traveling from industrialized countries to developing tropical and subtropical areas. TD episodes occur during the first three to five days, and usually do not require medical treatment. There are many causes of travelers' diarrhea. Symptoms occur within six to sixteen hours from ingestion of food containing toxins produced by enterotoxigenic and enteropathogenic E. coli, some Salmonella, Shigella, or Vibrio. Toxins produced by Staphylococcus aureus and Bacillus cereus may also be responsible for TD (Butterton and Claderwood, 2001). Salmonella, Shigella, or Campylobacter are isolated in about 15 of poisoning or gastroenteritis cases, occurring with varying frequencies in different regions.

Worsening Diarrhea in a 5Year Old Girl

A 5-year-old girl was brought to her physician for worsening of diarrhea. She was having about six to seven bowel movements of foul-smelling stools per day. The diarrhea seemed to worsen with ingestion of fatty food. The mother described that since infancy, her daughter had failure to thrive, chronic diarrhea, and malabsorption. She was tentatively diagnosed with celiac disease at 18 months of age without a biopsy. A gluten-free diet was started but did not appear to relieve her diarrhea. There was no family history of celiac disease. Inconsistent with celiac disease, the duodenum was found by endoscopy to have normally formed villi, but it had an unusual white frosting appearance. On histologic examination, numerous Oil Red stain-positive vacuoles were observed in the villi consistent with the intracellular fat accumulation that occurs in abetalipoproteinemia. Because of the suspected diagnosis, the patient was referred to an ophthalmologist, who also observed pigmentary degeneration...

Innate immune responses to commensal bacteria in inflammatory bowel disease

Crohn's disease and ulcerative colitis are the two major forms of IBD characterized by acute and chronic inflammation in the absence of a known pathogen. These inflammatory disorders are distinguished by the depth and location of inflammation with ulcerative colitis being limited to the mucosa of the colon and Crohn's disease involving both the small intestine and the colon in a transmural fashion. The patho-genesis of Crohn's disease and ulcerative colitis is multifactorial, resulting from the interplay of genetic predisposition, environmental and immunological factors 21 . Initiation and perpetuation of the intestinal inflammation in this chronic disorder has been thought to result from dysregulated immune response to commensal bacteria in the genetically-susceptible host. For instance, the efficacy of fecal diversion and the recurrence when the fecal stream is restored 22, 23 , the existence of subpopulations who can be improved by antibiotics or probiotic treatment 24 , and the...

Woman with Diarrhea and Anemia

A 48-year-old woman presented to her primary care physician with a one-week history of fatique, weakness, and six to seven bowel movements per day, all of which were watery, greenish-brown, and foul-smelling without any evidence of bleeding. The patient states that the diarrhea was usually associated with abdominal pain and bloating and that the symptoms had been intermittent for over 6 months. The patient had lost 7 lb in the past 2 months. Abdominal exam revealed a soft, flat abdomen with mild diffuse tenderness but no rebound or guarding. A stool specimen tested negative for fecal occult blood and positive for fecal fat. The physician ordered routine laboratory tests and an anemia workup. The results are listed below

Mushrooms Causing Gastrointestinal Disorders

This mushroom was originally classified in the genus Lepiota, and is also known as Lepiota morgani or Lepiota molybditis (false parasol). It is a species often involved in poisonings in the U.S. and throughout the world, but apparently not in Europe. The attractive mushroom grows in grassland and can be distinguished from edible lepiotas by its greenish spores and greenish gills. The toxin was suggested to be a protein of high molecular weight, composed of monomers of 40 to 60 kDa. Symptoms typically start within one to two hours after ingestion, with profuse vomiting and nausea, followed by diarrhea, intestinal cramps, and sweating. In severe cases symptoms may last up to two to three days. Vomiting and diarrhea can cause significant fluid and electrolyte depletion, which must be balanced. No hepatic or renal sequelae are known. (For a review see Augenstein, 1994.) This mushroom is responsible for a significant number of mushroom poisonings in Europe. Symptoms such as vomiting,...

Diarrhea

Diarrhea Frequent passage of loose, watery stools that also may contain pus, mucus, blood, or fat. In addition to frequent trips to the bathroom, a child with diarrhea may complain of abdominal cramps and weakness, nausea, and vomiting. This is a common problem in childhood that usually lasts a day or two and goes away on its own without any special treatment. However, prolonged diarrhea can be a sign of other problems. Infection with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus diarrhea usually resolves in three to nine days. other cases of acute diarrhea are usually caused by eating contaminated food or drinking contaminated water, or from an infectious disease. Diarrhea is not a disease in itself, but simply a symptom of an underlying condition. while it may seem to be more of a nuisance than a serious health problem, untreated severe diarrhea can lead to dehydration and electrolyte imbalance. This means the body lacks enough fluid to function...

Acidfast bacillus See acidfast

Acidophilus Bacteria that help maintain or restore a supportive bacterial environment in an intestinal tract affected by disease and antibiotics. Acidophilus also may be useful in preventing candidiasis (thrush) in the throat, mouth, and vagina. Most HIV-positive people have some form of digestive imbalance at some time. Daily acidophilus supplementation is suggested to prevent or mitigate such problems. Among the benefits of acidophilus are production of significant amounts of folic acid, vitamin B12 and other B-complex vitamins, reduction of intestinal gas and diarrhea and increased production of lactase, leading to improved digestion of dairy products. Acidophilus is found in yogurt and is available in capsule form in health food stores.

Diseases and disorders

For some major diseases, such as inflammatory bowel disease, the aetiological agent has not been identified, despite rapidly advancing genetic and molecular research. Conversely, coeliac disease, another serious and common gastrointestinal inflammatory disease, is caused by a well-characterized immune response to wheat-derived proteins. Clinical assessment, including a focused history and examination, is the foundation of diagnosis. In addition, the gastrointestinal system can be investigated by endoscopy, radiology and specific functional tests. Endoscopy and radiology may also be used therapeutically, and phar-macotherapy and surgery for gastrointestinal disorders exploit many unique features of the structure and function of the system.

Expression of Recombinant LTB Protein in Marine vibrio VSP60

The main toxin of pathogenic Escherichia coli responsible for infant diarrhea and traveler's diarrhea is E. coli heat-labile enterotoxin (LT), and it is the cause of death for several hundred thousand children under 5 yr old every year, particularly in underdeveloped areas (1,2). LT is a bacterial adenosine phosphate (ADP)-ribosylating exotoxin composed of a single A subunit (27 kDa) and five monomeric B subunits (11.6 kDa). Subunit A is the toxin portion, causing diarrhea with ADP-ribosyl-transferase activity. Subunit B (LTB) is the receptor-binding site, which can bind to the GM1 ganglioside present on the eukaryotic cell membrane and has no pathogenic activity (3-5). LT holotoxin and its B subunit are highly immunogenic, invoking neutralizing antibody and blocking the receptor-binding activity and diarrhea-causing activity in immunized individuals (6,7). Furthermore, LTB has been shown to be the most powerful mucosal immunogen and mucosal adjuvant, markedly strengthening the...

Selective Serotonin Reuptake Inhibitors

Potential side effects include nausea, anorexia, more frequent or loose stools, anxiety, restlessness, sleep disturbance (insomnia or hypersomnia), headache, diminished sexual drive, orgasmic dysfunction, and apathy. Sinus bradycardia is an uncommon side effect but is rarely symptomatic. Most of these adverse effects are mild or transient, and thus most patients tolerate SSRIs well in the short term. Over the long haul, however, up to 20 percent of patients will discontinue these drugs because of persistent changes in sexual drive or function, and a smaller number will discontinue use because of apathy, gastrointestinal disturbance, or sleep disturbance. Sertra-line hydrochloride is most likely to cause diarrhea, and paroxetine hy-drochloride to cause hypersomnia.

Nucleotide Analogues

Tenofovir or disproxil fumarate salt is an acyclic nucleoside phosphonate diester analog of adenosine monophosphate with an in vitro the 50 inhibitor concentration for HIV is 0.04-8.5 mol. After diester hydrolysis, tenofovir is phosphorylated to the DP that then inhibits HIV reverse transcriptase by competing with the natural substrate deoxyadenosine 5-TP and, after incorporation into DNA, by DNA chain termination. Tenofovir DP is a weak inhibitor of mammalian DNA polymerases alpha, beta and mitochondrial DNA polymerase gamma. Additive or synergic anti-HIV activity with nucleoside analog, non-nucleoside analog and protease inhibitors has been demonstrated in vitro. Side effects include lactic acidosis, hepatomegaly with steatosis, and diarrhea.

California encephalitis See encephalitis California

Campylobacteriosis A form of food-borne illness first recognized in the 1970s that causes gastroenteritis or traveler's diarrhea. Much more common than either salmonella poisoning or shigellosis, campylobacteriosis is responsible for between 5 and 14 percent of all diarrheal infections in the world. It may affect between two and four million Americans each year. In the 1980s, more than 3,000 residents in Ben-nington, Vermont, became ill with diarrhea when their town's water supply was contaminated with the rod-shaped bacterium C. jejuni. While there are several different forms of Campy-lobacter, the most common is C. jejuni, which accounts for 99 percent of all Campylobacter infections. Campylobacteriosis is caused by eating or drinking food or water contaminated with the bacteria only a small amount is necessary to cause illness. It can survive in undercooked food such as chicken, lamb, beef, or pork, and in water and raw milk. The disease may also be spread by the diarrhea of...

Symptoms and Treatment

Patients may appear to be intoxicated, presenting nausea, vomiting, and diarrhea. They have color hallucinations, slow pulse, hypotension, irritability, and incoordination. Children may develop fever and seizures. Death from A. muscaria is rare, usually occurring only in severely poisoned young children, older patients, or persons with serious chronic illnesses. A. pantherina caused There is no specific treatment for ingestion of ibotenic acid or muscimol rather, treatment is symptomatic and supportive. Anxiety, hysteria, or convulsions can be treated with sedatives, such as diazepam. This should be done cautiously, however, and with the lowest effective dose because animal studies revealed that respiratory arrest may occur. In severe cases, with prolonged nausea, vomiting, or diarrhea, monitoring of fluid and electrolyte status may be required. Recent cases of muscarine poisonings were reported by Benjamin (1992), and Tupalska-Wilczynska et al. (1997).

Chlamydial pneumonia See pneumonia

Cholera An infection of the small intestine characterized by profuse, painless, watery diarrhea. If untreated, severe cases can cause rapid dehydration and death within a few hours. There has been a dramatic increase in cholera in the United States and its territories, and many cases may go undetected by physicians who are not familiar with the disease, according to the National Center for Infectious Diseases. In most years, there are a handful of cases in the United states, usually among people who have traveled to Asia or Africa. A few cases appear in areas bordering the Gulf of Mexico and around the Mediterranean. Usually, the victim has eaten tainted shellfish. From 1961 to 1991 there was an average of five cases per year in the United States, 31 percent acquired abroad. From 1992 to 1994 there were 160 cholera cases reported in the United states (about 53 per year) this is compared to a total of 136 cases reported in the previous 26 years. Experts suggest the reported cases are...

CD8positive CD8 lymphocyte See cd8 cell

Cefuroxime An antibiotic used to treat bacterial infections of the ear, respiratory tract, skin, sinuses, bones and joints, and urinary tract. Cefuroxime belongs to the cephalosporin class of antibiotics. The most common side effects include diarrhea, nausea, vomiting, and abdominal pain these occur more frequently at higher doses. This drug works by preventing susceptible bacteria from building strong cell walls.

Definition of the Disease

Hyperthyroidism and thyrotoxicosis are synonymous terms. Excess thyroid hormone elevates the basal metabolic rate (e.g., causing weight loss) and causes the classic findings exhibited in this patient involving the nervous system (e.g., personality changes, tremor, hyperreflexia), cardiovascular system (tachycardia with a hyperdynamic heart, bounding pulses and wide pulse pressure), and gastrointestinal tract (e.g., loose stools or diarrhea). In extreme cases, high output heart failure can result. Many other systems can be affected such as the tissues of the retroorbital space, the skin, the hair, and the reproductive system. The patient's oligomenorrhea is likely a consequence of her disordered metabolism, the stress of illness and weight loss.

Differential Diagnosis

Failure as well as endocrine conditions such as hyperthyroidism or pheochromocy-toma. Whereas pheochromocytoma is a rare condition (annual incidence per 106), hyperthyroidism is common, affecting up to 1 in 100 women. Loose stools or diarrhea suggest malabsorption or intestinal inflammatory or infectious disease. Rare endocrine causes of secretory diarrheas encompass somatostatinoma, VIPoma, and glucagonoma. Behavioral changes can reflect intrinsic neurologic or psychiatric disease or almost any serious focal or systemic disorder.

Chlamydial infection See chlamydia

In HIV-infected people, chloramphenicol is most frequently used to treat salmonella infections that cause severe diarrhea. Salmonella is more common in people with AIDS than in the general population. In people with healthy immune systems the infection is rarely treated, but symptoms tend to be

Conservatorship See surrogacy

Constitutional symptoms Symptoms caused by the impact of an illness on the entire body or constitution are frequently referred to as constitutional symptoms. These include loss of weight, fatigue, fever, diarrhea, night sweats, and malaise over a period of months. Constitutional symptoms are present in many types of infectious diseases, tumors, and other medical conditions, ranging from the serious to the trivial. For people with HIV infection, constitutional symptoms may be a result of HIV infection itself or the result of such opportunistic illnesses as Pneumocystis carinii pneumonia, tuberculosis, or widespread CMV infection.

Cryptococcal meningitis 125

Cryptaz Brand name for ntz, a drug for treating cryptosporidiosis, an AIDS-defining condition caused by the relatively common, highly infectious protozoan parasite Cryptosporidium parvum. NTZ was the first drug used for treating cryptosporidiosis submitted to the Food and Drug Administration (FDA). Application to the FDA was made in December 1997 by Unimed Pharmaceuticals. unimed requested that the FDA approve NTZ as an agent to reduce cryptosporidiosis-associated diarrhea. The FDA's Antiviral Drugs Advisory committee advised against approving NTZ after a May 6, 1998, meeting to review Unimed's application. weak data were cited as the primary cause of this decision. Drug rejection raised a ruckus among community organizations.

Cultural analysis and AIDS 127

There are no standard treatments, but proposed drug therapies include paromomycin sulfate (Humatin), azithromycin (zithromax), letrazuril, and various forms of concentrated cow and chicken antibodies. Controlling and minimizing diarrhea while maintaining fluid and electrolyte balance and nutritional status are key components of treatment. Intravenous nutrition is commonly required to provide sufficient calories and hydration. Prophylaxis is debatable, since there is no clear indication of effectiveness. However, some have recommended prophylaxis of 250 mg of Humatin twice a day for people with AIDS and fewer than 50 T4 cells, especially those who have diarrhea, weight loss, or previously diagnosed cryptosporidiosis. Cryptosporidium A genus of protozoan parasite (plural Cryptosporidia) that causes severe, protracted diarrhea. In persons with normal immune systems, the diarrhea is self-limiting and lasts one to two weeks. In AIDS patients, the diarrhea often becomes chronic and may lead...

Diaminodiphenylsulfone See dapsone

Diarrhea A disturbance in bowel movements characterized by abnormally frequent, loose, or watery stools. Diarrhea is often related to a disturbance in the gastrointestinal system. diarrhea-wasting syndrome A term sometimes used to refer to the severe diarrhea characteristically associated with hiv infection. The syndrome (diarrhea persisting for at least a month, accompanied by otherwise unexplained weight loss of 10 percent) in conjunction with HIV infection composes an AIDS-defining illness. and abacavir. These drugs are called nucleoside analogs. The body breaks down these drugs into chemicals that prevent HIV from infecting unin-fected cells in the body. Many studies have shown that using ddl with two other drugs can prevent the virus from developing resistance. Public Health Service guidelines recommend taking didanosine with at least one other NRTI and one protease inhibitor. The most common side effects of ddl include stomach pain and diarrhea. Long-term use

Dideoxycytidine ddC See zalcitabine dideoxyinosine ddl See didanosine

Otics and other medications that destroy the body's friendly gastrointestinal bacteria also cause nutrient deficiencies. Gastrointestinal bacteria are necessary for the breakdown and absorption of certain food substances. Without them, foods cannot be digested properly and become useless to the body as a source of nutrients. Moreover, maldigested food may cause other problems, including diarrhea. Gastrointestinal bacteria also produce several different vitamins, including thiamin, riboflavin, niacin, pantothenic acid, vitamin B6, vitamin b12, folic acid, choline, biotin, and vitamin K.

Drug eruption See eruption

Some interactions affect the way drugs are absorbed by the gastrointestinal system. Degree of absorption is highly dependent on stomach acidity and the rate of absorption drugs that are not absorbed well do not achieve sufficient levels in the blood to exert their effects. Malabsorption can be caused by diarrhea, which is a side effect of some drugs it can also occur if a coincident therapy increases or decreases the excretion or metabolism of a drug. Drugs with similar toxic effects usually produce combined toxicity, which may contraindicate taking both drugs together. For HIV-infected persons, the most common drug interactions are among antiretroviral drugs and drugs for Pneumocystis carinii pneumonia and fungal infections. Interactions among toxoplasmosis, TUBERCULOSIS, mycobacterium avivm COMPLEX,

Antigenic Variation Of The Vsp Genes Of Giardia Lamblia

Giardia lamblia, a protozoan parasite inhabiting the small intestine, is a common infection worldwide that frequently results in chronic diarrhea, malabsorption and upper gastrointestinal symptoms. Giardia undergoes surface antigenic variation in humans and animal model infections, a phenomenon that may account for both chronicity of infections and the relatively broad mammalian host specificity with genotypically identical organisms found in humans, cats, beavers, and other mammals. The variant-specific surface proteins (VSPs) are an unusual family of related cysteine-rich proteins, from 50 kD to over 200 kD in size, that coat the surface of the trophozoite. Only one VSP of the estimated 150 or more vsp genes is expressed on an individual at any specific time. However, the repertoires of vsp genes may differ depending on the genetic group. VSPs switch spontaneously every 6-12 generations although some Giardia also switch during encystation excystation. All VSPs have a high cysteine...

Coronavirus S Proteins And Their Receptors

Several coronavirus cell-surface receptors have been identified. Aminopeptidase N (APN, CD 13) was shown to be the receptor for canine coronavirus, feline infectious peritonitis virus, HCoV-229E, porcine epidemic diarrhea virus, and transmissible gastroenteritis virus, all of which are group 1 coronaviruses.39, 40 Members of the pleiotropic family of carcinoembryonic antigen-cell adhesion molecules (CEACAMs) were identified as receptors for the group 2 pathogen murine hepatitis virus,41-43 whereas bovine group 2 coronaviruses bind to 9-O-acetylated sialic acids.44 In 2003, ACE2 was identified as a functional cellular for SARS-CoV.45 The role of ACE2 in HCoV-NL63

Laboratory Tests Ignored

A 75-year-old white female with a past medical history significant for hypertension, Alzheimer's disease, and chronic diarrhea presented to the emergency department (ED) with a complaint of 5 days of watery diarrhea (four to five stools per day), fever, and weakness. She reported that a week ago she had attended a funeral where she had some Lebanese food, and 4 days prior to arrival at the ED she began having loose bowel movements, some with bright red blood in them. The patient denied vomiting, but reported some nausea. The patient denied having shortness of breath or chest pain, but did admit to some diffuse abdominal pain associated with the diarrhea. She has had a fever of 100.9 F, generalized weakness, anorexia, and malaise, and her diarrhea has been sporadic over the past few months. This complaint had been extensively worked up in two previous admissions to the ED, but besides mild chronic inflammation seen on biopsy, no other cause for the symptoms was determined. The past...

Diarrheic Shellfish Poisoning

Okadaic acid is a powerful tumor promoter of a nonphorbol ester type that inhibits protein phosphatase-1 and -2A in vitro (Haystead et al., 1989). Okadaic acid directly stimulates smooth muscle contraction (Haystead et al., 1989) and probably causes diarrhea, either by stimulating the phosphorylation of proteins controlling sodium secretion by intestinal cells or by increasing phosphoryla-tion of elements that regulate permeability to solutes, resulting in a passive loss of fluids (Aune and Yndestad, 1993).

Azaspiracid Shellfish Poisoning

AZP, the most-recently characterized marine seafood poisoning, is associated with eating shellfish contaminated with azaspiracids. The first human intoxications attributed to AZP occurred in the Netherlands, and the symptoms included those similar to DSP (i.e., nausea, vomiting, severe diarrhea, and stomach cramps). However, although chemical analyses did not identify significant levels of the diarrhetic shellfish poisons, they identified a new class of toxins (James et al., 2003a).

Symptoms Treatment and Outcome

Some patients have symptoms of acute HiV infection within days or weeks after infection. These symptoms are similar to those of many viral illnesses and include a nonspecific rash, fever, sore throat, headache, cough, flulike symptoms, mouth ulcers, diarrhea, enlarged lymph nodes, and arthralgia. The acute illness settles spontaneously over a few weeks and is followed by a period, which may last years, during which patients do not have symptoms. As the immune system becomes more severely affected, patients develop symptoms of AIDS such as loss of weight, diarrhea, enlarged lymph nodes, and opportunistic infections (infections that are not common in healthy people).

Food Allergy vs Food Intolerance

Food poisoning should be suspected in any illness that appears suddenly and causes stomach pain, vomiting, and diarrhea. Estimates of the number of food-borne illnesses have been ranged from a low of six million to a high of 81 million cases yearly, with 9,100 deaths, according to the Centers for Disease Control and Prevention. At least one-third of the cases have been traced to poultry and meat. According to the Food and Drug Administration (FDA), just about everyone experiences a food-borne illness at least once a year. Between 21 and 81 million cases of diarrhea related to food-borne illness are treated in the United States each year. The greatest danger from food poisoning is not the toxin itself but the body's natural response to poison vomiting and diarrhea that robs the body of vital fluids. This is especially true in young children. If dehydration becomes serious, food poisoning victims need to be hospitalized and given fluids intravenously. In addition, however, poisoning...

Clinical Aspects of Marine Seafood Toxin Syndromes 7231 General Issues

In general, the clinical presentation of the human diseases associated with the ingestion of marine seafood toxins is similar to that of any other food poisoning disease. However, a number of clinical issues make these diseases particularly difficult to diagnose and treat. For example, the neurotoxic syndromes associated with CFP, PSP, and NSP represent points along a continuum of disease severity rather than clinically exclusive diseases. Even if fish or other seafood is the suspected source of a disease outbreak, diarrhea associated with the outbreak could be misdiagnosed as originating from bacterial rather than from phycotoxin contamination.

Gastric anacidity See achlorhydria

Gastritis The stomach is susceptible to the same disease processes as the esophagus, including infection with cytomegalovirus (CMV). Gastritis, or inflammation of the stomach, may be asymptomatic but often results in severe continuous upper abdominal pain, fever, hemorrhage, or obstruction. CMV infection of the small intestine may result in similar symptoms as well as weight loss and diarrhea. Although CMV may infect any part of the small intestine, it rarely does so without involvement of other gastrointestinal organs.

Genital secretions 197

Biopharming represents another point on the continuum. In general, biopharming appears to be a creature of giant corporations, not family farms. Boosters of biopharming insist that their products will be cheaper than current drugs. Examples include edible vaccines against disorders such as hepatitis B and diarrhea, in the form of genetically modified (GM) bananas, corn, tomato juice, lettuce, and potatoes. These foods must be eaten raw (cooking would destroy the vaccines). The use of edible vaccines to treat autoimmune diseases is currently being studied. Enthusiasts insist that edible vaccines could be valuable in developing countries that lack facilities to refrigerate and deliver standard vaccines. Critics point out that it will be hard to provide consistent doses. In discussions of drugbearing plants, concerns over safety and environmental damage have been and continue to be expressed.

Colon and Rectal Surgery

Nal tract colon, rectum, anus, and peri-anal region. Patients present with a variety of diseases such as colorectal cancer, inflammatory bowel disease, motility disorders, diverticulitis, anal fissures and fistulas, fecal incontinence, and constipation. Colorectal surgeons can perform both endoscopy and major abdominal operations.

Rash on the Soles of the Feet

A 43-year-old male presented to the infectious disease clinic with a 2-month history of worsening skin rash and lesions. The lesions were not painful and were predominantly on his face and forearms, but also covered the palms of his hands and soles of his feet. He was treated one month prior to this presentation with azithromycin, and the rash had improved slightly. In addition to the worsening rash and skin lesions, he noted the development of painless lesions on his penis that were resolving at the time of presentation. He also reported a history of night sweats, which coincided with the appearance of the rash, a sore throat, mild weight loss, headaches without visual alterations, and mild neck stiffness. The day prior to presentation he noted a single episode of anal discharge that was yellow and nonbloody. He had no history of fever, chills, nausea, vomiting, diarrhea, or penile discharge.

Other genes associated with ankylosing spondylitis

Genome-wide linkage screens performed in the UK and the US have revealed suggestive markers of linkage on chromosomes 1, 2, 5, 6, 9, 10, 16 and 19 in one screen 50 and markers of interest on chromosomes 1, 3, 4, 5, 6, 10, 11, 16, 17, and 19 in the other screen 51 . The discrepancies between the two screens is most likely explained by the small contribution ( s

Heatstable enterotoxins

The inability of the heat-stable enterotoxins to enter the host cell or possess catalytic activity differentiates the heat-stable enterotoxins from exotoxins. Several genera of bacteria produce heat-stable enterotoxins, including Escherichia and Yersinia. The heat-stable enterotoxin a (STa) of E. coli is the prototype toxin of this group. E. coli secretes STa into the periplasm as a 72-amino-acid precursor in which three intramolecular disulfide bonds are formed and processed into a 53-amino-acid form. The 53-amino-acid form of STa is exported into the environment, where a second proteolytic cleavage results in the production of an 18-or 19-amino-acid mature STa molecule. The mature STa binds to a protein receptor on the surface of epithelial cells, which results in an increase in the intracellular concentrations of cGMP. The intracellular increase in cGMP results in a stimulation of chloride secretion and net fluid secretion, resulting in diarrhea.

Inborn errors of metabolism 271

The symptoms of inborn errors of metabolism vary a great deal. A baby's symptoms may indicate a problem by showing signs of failure to thrive (not gaining weight, not eating well, or having developmental delays). Vomiting and diarrhea are among other symptoms that may prompt the doctor to test for an inborn error of metabolism. several inborn errors of metabolism cause mental retardation if not controlled.

Infectious parotitis See mumps

Inflammatory bowel disease (IBD) The general name for diseases that cause inflammation of the bowels, including ulcerative colitis and Crohn's disease. Although these two diseases are similar, there are also some important distinctions. Ulcerative colitis is an inflammatory disease of the inner lining of the large intestine, which becomes inflamed and ulcerates. Ulcerative colitis is often most severe in the rectal area and can cause frequent bloody diarrhea. Crohn's disease, on the other hand, affects the last part of the small intestine, although it can also affect any part of the digestive tract. Moreover, Crohn's disease tends to Inflammatory bowel disease (IBD) occurs most often among people aged 15 to 30, but it can affect younger children. There are significantly more reported cases in western Europe and North America than in other parts of the world. Scientists do not yet know what causes inflammatory bowel disease, although they suspect that a number of factors may be...

Irinotecan and UDPGlucuronosyltransferase 1A1

Many irinotecan-treated patients experience severe dose-limiting diarrhea and neutropenia, which can be life-threatening. Results from clinical studies with irinotecan indicate that SN-38 glucuronidation is a major determinant of irinotecan-induced diarrhea (22). The UGT1A1 promoter genotype correlates with irinotecan pharmacokinetics and toxicity, and the presence of the (TA)7 repeat allele is a significant risk factor for developing severe irinotecan-induced adverse reactions. Furthermore, a missense C686A mutation in the coding region of the UGT1A1 gene is also associated with severe toxicity. These findings suggest that individual patients' UGT1A1 genotype could be used to tailor irinotecan dosage and to select chemotherapeutic agents.

Cricetulus griseus Chinese hamster See CHO cells and Mesocricetus auratus

Crohn's disease IBD1 Inflammatory bowel disease that seems to have both genetic and environmental causes not well understood but generally considered likely to be autoimmune. Mutations in the CARD15 gene (caspase recruitment domain-containing protein 15) are associated with susceptibility to Crohn's disease in some families.

Major histocompatibility complex MHC A

Cells in the gastrointestinal (GI) tract are particularly prone to damage during HIV infection, and this results in reduced absorption of nutrients. The HIV virus itself, intestinal parasites, and colitis induced by cytomegalovirus (cmv) are the main sources of tissue damage. The diarrhea connected with these conditions may also result in malabsorption. Fat, carbohydrate, protein, and micronu-trient (vitamin and mineral) malabsorption can occur. Malabsorption may also be present before infection with HIV. Infection by intestinal parasites triggers diarrhea and malabsorption in persons with AIDS by causing atrophy of the villi, the small threadlike projections (on the interior of the small intestines) that absorb nutrients when working properly. The protozoan Cryptosporidium parvum, the most commonly identified parasite in people with AIDS, causes massive secretory diarrhea. microsporidia (Enterocytozoon bieneusi or Septata intestinalis) is a second common GI parasite in people with...

Maletomale transmission See transmission

Malnutrition in AIDS can result from many different factors. Inability to take in a proper amount of nutrients can be the result of impaired swallowing and taste due to infections in the mouth or the esophagus, AIDS medications that have anorexia, nausea, and vomiting as side effects, or limited financial resources that make three meals a day difficult to manage. Diarrhea and changes in absorption caused by bacteria, viruses, or parasites may impair nutritional intake. Some medications, particularly antibiotics, may change the normal bacterial composition of the intestine and interfere with breakdown of food. Finally, an increase in metabolism often occurs in many people with HIV and leads to an increased need for nutrients. The presence of HIV itself as well as some of its associated infections can increase the metabolic rate. These three factors diminished intake, malabsorption, and hypermetabolism usually occur simultaneously to deplete the body of nutrients.

Other foodborne viruses

Norwalk virus is a small round structured virus (SRSV) and was the first virus to be clearly associated with gastroenteritis. Norwalk is a calicivirus and this group of viruses causes disease worldwide and they have been associated with some large outbreaks, often in confined environments, such as cruise ships. Outbreaks have been associated with contaminated drinking water, swimming water, consumption of undercooked shellfish, ice, and salads. As with the other enteric viruses, fecal contamination of food or water is usually found to be the ultimate source. The incubation time following exposure is around 48hrs and the clinical illness usually consists of vomiting and diarrhea. The diarrhea is watery without red cells, leukocytes or mucus. The disease is usually self-limiting, settles in 24 hr, and requires no specific therapy. Specific diagnosis is difficult. A number of assays are available, including electron microscopy, enzyme immunoassays, and RT-PCR. A number of other viruses...

Collaboration With Governmental Public Health Agencies

Performed for self-limiting illnesses like diarrhea, there may be delays in recognizing a disease outbreak. Reduced use of laboratory testing prevents the analyses of pathogenic isolates needed for disease tracking, testing of new pathogens, and determining the levels of susceptibility to antimicrobial agents.

Protozoal Foodborne Pathogens

C. parvum is an apicomplexan protozoan parasite, capable of causing disease in both immunocompetent and immunocompromised individuals. It has gained a reputation in recent years as being a major problem in AIDS patients, but it is important to realize that it can infect normal hosts as well. It is a cause of diarrhea in cattle and so water that is close to cattle pasture may be contaminated with this organism. Other domestic and wild animals are also reservoirs for C. parvum. Both water and food are sources of C. parvum and one of the largest outbreaks, infecting over 400,000 people, was due to contamination of a municipal water supply. Clinically, C. parvum causes watery diarrhea, which may be profuse, abdominal cramping, nausea, and G. lamblia is probably the most frequently found enteric protozoan worldwide. This organism does not cause a dramatic enteric disease or systemic complications, yet infection with it can lead to profound malabsorption and misery in the patient. Like...

Other protozoan infections

A number of other protozoa have been associated with food- and water-borne infections in humans. These include Microsporidium, that causes watery diarrhea and malabsorption, and are becoming an increasingly recognized problem in the immunocompromised. Various microsporida, including Enterocytozoon bieneusi and Septata intestinalis, cause human disease. Isospora belli, another apicomplexan protozoon, is an opportunistic pathogen in immunocompromised patients. Sarcocystosis is a rare zoonotic infection in humans that can, on occasion, cause necrotizing enteritis. Dientamoeba fragilis was originally thought to be a commensal but now appears to be associated with a variety of gastrointestinal symptoms, including abdominal pain, nausea, diarrhea, and anorexia. Balantidium coli is the only ciliate known to parasitize humans. Although most infections are asymptomatic, the disease may present itself as dysentery. Blastocystis hominis is a strict anaerobic protozoon that infects both...

Linking Therapy And Risk

A 65-year-old man with a body mass index (BMI) 30 kg m2, who received irradiation treatment for prostate cancer five years earlier, was found to have a 2 cm3 carcinoma of the cecum during routine colonoscopy. The patient had been suffering from inflammatory bowel disease for many years and has a parent with a history of documented venous thrombosis who tested positive for both heterozygous factor V Leiden and prothrombin 20210A. The patient also had these thrombophilic defects but had never suffered a thromboembolic event. The patient required a laparoscopically assisted colon resection lasting 2 h 30 min. The patient did well postoperatively and was discharged six days later. There are no specific data based on prospective randomized trials on VTE risk and prophylaxis in a group of individuals with this combination of risk factors. That is not to say there are no relevant data because it is known that age 60 years, BMI 30 kg m2, family history of VTE, inflammatory bowel disease, a...

Entamoeba Histolytica

Chronic amoebic colitis is clinically indistinguishable from inflammatory bowel disease and those receiving corticosteroids are at risk for toxic megacolon and perforation and may sometimes necessitate parenteral therapy when patients are unable to tolerate the oral route. Infective trophozoites can migrate hematogenously to the right lobe of the liver, causing abscess formation, abdominal pain, jaundice and fever. Adjacent anatomical structures, such as the pulmonary parenchyma, peritoneum and pericardium can become involved. Amoebae can also disseminate to the brain. Immunosuppressed or malnourished individuals, those at the extremes of age, patients with malignancy, and women during pregnancy and post-partum stages are especially at risk for invasive amebiasis. Metronidazole followed by a luminal agent is the therapy of choice in extraintestinal disease. Since amebomas can mimic adenocarcinoma, a biopsy may be needed to differentiate disease. Indications for surgical drainage of an...

Multicenter AIDS Cohort Study MACS

By studying the outcome of various medications in real clinical practice, MACS provides an observational database that indicates the unsuspected value of available therapies. Important MACS accomplishments and findings the identification of more than 60 HIV-infected men who are long-term nonprogressors, many of whom have served as critical sources of information on this phenomenon in studies conducted at several united States laboratories the discovery that prevention of pneu-mocystis carinii pneumonia can delay the first AIDS-defining illness by six to 12 months the discovery that response of CD4+ t cells to AZT predicts AIDS-free time and survival among HIV-infected patients the finding that risk factors for HIV encephalopathy include anemia, lower body mass, older age, and the presence of such symptoms as fever, fatigue, diarrhea, or thrush before an AIDS diagnosis and the finding that symptoms of depression do not independently predict poorer outcomes to HIV infection. MACS...

Case Study 3 A Puzzling Case of Relentless Emesis

A 5-year-old white child was admitted to the hospital for evaluation of vomiting and diarrhea that had begun 10 days earlier and was, by the parent's testimony, unresponsive to any treatment. The child continued to exhibit symptoms of GI distress while in the hospital. Testing for the most common causes of chronic vomiting was conducted but this patient was negative for stool cultures, stool exam for ova and parasites, and viral stool cultures. Abdominal ultrasound, small bowel biopsy, upper GI contrast study, and other evaluations were all normal. On the 10th hospital day parenteral nutrition was started through a peripheral intravenous line. A nasojejunal tube was employed starting on the 18th day of hospitalization and enteral feedings were begun in place of the parenteral nutrition. Five days later the patient showed tachycardia with an irregular heart rhythm. Blood pressure at that time was 90 50 and heart rate was 130 beats per minute. Chest X-ray showed that the heart was...

OV Statin See nystatin

Sure to high levels of radiation may also cause ovarian cancer. The most common type of ovarian cancer is the epithelial carcinoma in the ovary's outer layer. Frequently there are no symptoms in the early stages of ovarian cancer, making it difficult to obtain an early diagnosis, when there is the greatest chance for effective treatment. An ovarian tumor can grow for some time before pressure or pain can be felt or other problems are noticed. When symptoms do occur, they may include abdominal swelling or bloating, discomfort in the lower part of the abdomen, a full feeling after a light meal, lack of appetite, nausea, vomiting, gas, indigestion, weight loss, constant need to urinate, diarrhea, or constipation, and nonmenstrual bleeding. procedures used in the diagnosis and evaluation of ovarian cancer may include an internal exam of the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum, a pap smear, ultrasound, blood and urine tests, and x rays. Additional procedures that...

Necrotizing enterocolitis

Necrotizing enterocolitis (NEC) This gastrointestinal disease primarily affects premature infants, infecting, inflaming, and eventually destroying part of the infant's bowel. Although it affects only one infant in 2,000 to 4,000 births, (up to 5 percent of neonatal intensive care unit admissions), it is the most common and serious gastrointestinal disorder among hospitalized preterm infants. other symptoms include periodic stoppage of breathing, slowed heart rate, diarrhea, lethargy,

Partner negotiation 365

Paromomycin sulfate An antibiotic used in treating intestinal amebiasis and various tapeworms, cryptosporidiosis in particular. (It should be noted that there is no standard treatment for cryp-tosporidiosis.) It is not effective against extraintestinal infections with amoebae. paromomycin is an antibiotic of the aminoglycoside class, similar in action to neomycin, streptomycin, erythromy-cin, and others. It is poorly absorbed into the bloodstream, so high concentrations stay in the gut where many parasites that cause diarrhea multiply. paromomycin is available in tablet form. paro-momycin generally causes few side effects, but among possible side effects are nausea, abdominal cramps, and diarrhea. (Trade name is Humatin. Other names are Aminosidine AMS.)

Molecular biology of kgf 21 Expression and Regulation

Keratinocyte growth factor expression is significantly upregulated in several epithelial injury conditions, including incisional and excisional skin wounds (12,13), surgical bladder injury (14), lung and kidney chemical injury (15,16), inflammatory diseases such as inflammatory bowel disease (IBD) (17-19), and psoriasis (20). Although KGF does not appear to be important for organogenesis because the KGF knockout mice develop normally (21), this pattern of expression strongly suggests that KGF plays an important role in epithelial homeostasis in adult organs, particularly during epithelial regeneration and repair.

TTPClinical Presentation

The presentation of TTP shares many similarities with hemolytic uremic syndrome (HUS). Both can present with thrombocytopenia and MAHA, but TTP tends to have predominantly neurological symptoms while acute renal insufficiency is dominant in HUS. However, patients presenting with sporadic MAHA and predominantly renal dysfunction should still receive plasma exchange unless they have a prodrome of bloody diarrhea. Patients presenting with MAHA immediately preceded by bloody colitis are typically children and have HUS caused by a Shiga toxin released by enterohemorrhagic Escherichia coli, usually O157 H7. The associated thrombocytopenia and MAHA are seldom severe, and plasma exchange and antibiotic therapy have not been shown to be effective for those patients who typically recover with supportive care. At one point TTP and HUS were thought to be different presentations of the same disease process. However, more recent findings regarding the pathophysiology of TTP may distinguish it as a...

Pneumocystis carinii pneumonia PCP

Most common opportunistic infection in untreated HIV-infected patients in the United States. The onset of pneumocystis pneumonia is insidious with early, nonspecific symptoms of fever, fatigue, weight loss, diarrhea, and malaise. cough, either nonproductive or productive of scant, thin, clear mucous is variable at the onset but becomes more prominent later in disease. Shortness of breath and dyspnea on exertion are suggestive of PCP. Other organs may be involved, and disseminated pneumocystis has been seen. Tachypnea, fever, cyanosis (in severe pcp), wheezes, crackles, or rales may be present in PCP. Generally, CD4 counts are 200 suggest other pathogens. It is important to obtain arterial blood gases in individuals with suspected PCP because the arterial blood gas is often markedly abnormal despite a seemingly comfortable patient. Sputum induction, gallium scan, and bronchoscopy are other means of diagnosis.

Allergy and Immunology

Quent sicknesses or rare diseases, failure to thrive, and vomiting or diarrhea that has not responded to initial treatment. This field also offers leading areas of research, where almost every day new forms of immunotherapy are coming forward to help treat immune-mediated disease. A fellowship in allergy and immunology lasts 2 years and qualifies the subspecialist to treat both adults and children.

The Good in Bad Fish Tacos

A healthy 34-year-old woman presented to the local emergency department with severe vomiting and diarrhea 8 hours after eating what she thought might be a bad fish taco at an outdoor taco stand at the local county fair. She was given fluids and supportive care. The vomiting and diarrhea resolved within 24 hours, and during the course of her hospital stay Clostridium botulinum was isolated from her stool.

Phase i clinical trials in solid tumors

Recently, results of a phase I trial by Aghajanian et al. have been published. In this study, 43 patients in a variety of neoplasms were treated with single-agent bortezomib in doses ranging from 0.13 to 1.56 mg m2 dose. The tumor types included were non-small-cell lung cancer (NSCLC), colon, head and neck, melanoma, ovary, renal, prostate, bladder, cervix, endometrial, esophagus, gastric, and unknown primary. A total of 89 doses were administered, with an average of 2 cycles per patient. The median number of previous chemotherapeutic regimens was four. Reported DLTs were diarrhea and sensory neurotoxicity. Other side effects seen were fatigue, fever, anorexia, nausea, vomiting, rash, pruritus, and headache. There was no dose-limiting hematological toxicity. One partial response was seen in a patient with NSCLC. The maximum tolerated dose (MTD) was established at 1.56 mg m2. Pharmacodynamics studies showed a dose-related inhibition of 20S proteasome activity with increasing dose of...

Pharmacogenomics of Drug Metabolizing Enzymes

Irinotecan is a chemotherapeutic drug that is being used to treat colon, lung, rhabdomyosarcoma, and neuroblastoma cancers. Irinotican is converted to an activate metabolite, SN-38, which inhibits topoisomerase I. SN-38 is eliminated through hepatic glucuronida-tion by UDP-glucuronyltransferase 1A1 (UGT1A1). Toxicities such as diarrhea and leukopenia are associated with increased levels of SN-38.1,3 Treatment efficacy and toxicity of irinotecan has been associated with polymorphisms in UGT1A1. In particular, the UGT1A1*28 allele has been associated with increased risk of toxicity during irinotecan therapy, suggesting that determination of UGT1A1 genotype prior to irinotecan therapy may reduce toxicity by up to 50 .1,3

Butazolidin See phenylbutazone

Side effects common calcitonin injections can cause flushing, headache, nausea, diarrhea, redness at the injection site, and less often, an allergic rash or hypocalcemia (low blood calcium level). The flushing, nausea, and diarrhea can sometimes be overcome by reducing the dose. Nasal calcitonin seldom causes side effects other than mild nasal irritation.

Rheumatoid arthritis juvenile See arthritis

Ness and irritability, and very thin skull bones. older infants may have flattened square skulls whose fontanels (soft spots) on the head may remain open for long periods. other symptoms include diarrhea, bone fractures, respiratory infections, and poor tooth development.

Silybum marianum See silymarin

Silymarin The seeds of milk thistle (Silybum mari-anum) have been cultivated for centuries as a medicinal remedy, and are considered by some to have liver-protecting properties. An extract is available under the name silymarin proponents suggest that it is useful for liver-based problems, including cirrhosis, jaundice, chronic hepatitis, and damage due to drugs, alcohol, and poisoning from chemicals and diarrhea. Some reports have suggested that silymarin may stimulate certain immune functions and may protect the liver during hepatitis. To date, no studies of silymarin in pwas have been conducted. No toxic effects of sily-marin have been reported, although it is possible that because of its purported effect on the liver and kidneys, the compound may effect the absorption of other medications. Silymarin concentrations vary in milk thistle capsules, pills, and teas, and

Severe acute respiratory syndrome 449

Septicemia is characterized by sudden onset of fever, chills, rapid breathing, headache, nausea or diarrhea, and clouding of consciousness. skin rashes and jaundice may occur, and the hands may be particularly warm. If large amounts of toxins are produced by the bacteria the patient may fall into a state of septic shock.

Selective cox2 inhibitors in clinical trials of cancer therapy

In a prospective clinical study reported by Blanke et al. (171), 22 patients with previously untreated unresectable or metastatic colorectal cancer were treated with celecoxib along with a chemotherapy regimen consisting of irinotecan, 5-flurouracil, and leucovorin. Partial tumor response was achieved in 28 of patients, whereas only 17 of patients had obvious tumor progression. Grade 3 and 4 neutropenia occurred significantly less frequently than expected, suggesting that the use of selective COX-2 inhibitors might reduce chemotherapy-related toxicity. Consistent with these findings, Sweeney (172), Trifan (158), and Lin (173) found less myelosuppression, equal or less diarrhea, and less hand and food syndrome when celecoxib was part of the chemotherapy regimen containing irinotecan.

Colonoscopy and flexible sigmoidoscopy

The commonest indications include investigation of altered bowel habit, rectal bleeding, suspected colorectal cancer and inflammatory bowel disease. Colonoscopic screening for colon cancer is advocated for patients at high risk, for example, those with a strong family history of the disease, and there is a debate about introducing population-wide screening.

Tat gene inhibitor See tat inhibitor

It has a long list of side effects, the most serious of which is severe and potentially fatal allergic reactions. Bone-marrow toxicity, resulting in a deficiency of white blood cells called neutropenia, is also common but is manageable and reversible. peripheral neuropathy is the most common neurological side effect. Neuropathy is generally cumulative with repeated doses, and more likely to occur in people at risk for it, for instance those who have experienced neuropathy as a side effect of other therapy. other side effects include irregular heart rhythm, hair loss, diarrhea, skin rashes, nausea, vomiting, stomach irritation, and seizures. Taxol is available as a solution for intravenous injection. (Brand name is Paclitaxal.)

Staphylococcal I ntoxication

Ingestion of semi-liquid, spoiled milk products, such as cream, yogurts, refrozen ice-creams, improperly stored ready-to-eat products, confections with cream, as well as salads, may be a cause of intoxication with staphylococcal enterotoxin. The morbidity rate observed in Poland in 2001 reached 1.6 per 100,000 (647 cases)(Przybylska, 2003a). Predominant symptoms include nausea, frequent vomiting (sometimes bloody), and abdominal cramps, and an accompanying symptom is a non-fever diarrhea. Dehydration may lead to a hypovolemic shock. The presence of enterotoxin in patients' blood and vomits may be diagnosed by means of antibodies using a precipitation method in agarose gels.

Selected Nonbacterial Poisonings 1531 Marine Toxins Poisoning

Consumption of improperly stored scombroid fish may cause symptoms of histamine poisoning due to the outgrowth on their surfaces of microflora excreting histidine. The main symptoms include skin redness, headache, vomiting, diarrhea, lip and throat burning, and tachycardia. Scombrotoxic poisoning begins from two minutes to two hours after ingestion of marine toxins. (Phycotoxins of marine food are exhaustively treated in Chapter 7 of this volume.)

Special considerations

Another way of achieving selective effects is to only apply the medication where it can reach the target tissue. In the gastrointestinal system, this can be achieved by oral administration of non-absorbed drugs that then act locally. The 5-aminosalicylic acid (5ASA, mesalazine) drugs used to treat inflammatory bowel disease (IBD) are delivered this way, either as slow-release preparations that dissolve in the distal intestine or as pro-drugs that are activated by bacterial metabolism in the colon.

Gastrointestinal surgery

In addition, many gastrointestinal disorders are treated jointly by physicians and surgeons, who collaborate to determine the best combined therapeutic approach for individual patients, particularly when managing inflammatory bowel disease (IBD) and hepatobiliary conditions.

Cox2 inhibitors in combination with chemotherapy

Troponin Levels And Mortality

Not only augment the antitumor efficacy of various chemotherapeutic drugs (40) but also improve their antimetastatic efficiency (157). A study by Trifan et. al. (158) showed that celecoxib enhanced antitumor efficacy of irinotecan while reducing diarrhea, a serious side effect of this drug. Thus, as in the case of radiotherapy, combining selective COX-2 inhibitors with chemotherapy has a high potential to increase therapeutic gain. Using human A431 tumor xenografts in mice, we recently reported that celecoxib enhanced the antitumor efficacy of docetaxel or radiation and that the greatest effect was achieved when all three agents were combined (Fig. 5) (159). Mechanistically, the improvement of antitumor efficacy of chemotherapeutic agents by COX-2 inhibitors is commonly attributed to the augmentation of apoptotic cell death. However, other mechanisms, the same or similar to those involved in augmentation of tumor response to radiation, are likely to be involved here as well.

Inherited Syndromes of Low LDLC Abetalipoproteinemia

Abetalipoproteinemia is a rare autosomal recessive disease caused by mutations in the gene encoding microsomal transfer protein (MTP) (11), a protein that transfers lipids to nascent chylomicrons and VLDL in the intestine and liver, respectively. Plasma levels of cholesterol and triglyceride are extremely low in this disorder, and no chylomicrons, VLDL, LDL, or apoB are detectable in plasma (12). Obligate heterozygotes have normal plasma lipid and apoB levels. Abetalipoproteinemia usually presents in childhood with diarrhea and failure to thrive and is characterized clinically by fat malabsorption, spinocerebellar degeneration, pigmented retinopathy, and acanthocy-tosis. The initial neurological manifestations are loss of deep tendon reflexes, followed by decreased distal lower extremity vibratory and proprioceptive sense, dysmetria, ataxia, and the development of a spastic gait, often by the third or fourth decade. Patients with abetalipoproteinemia also develop a progressive...

Mesencephalon See midbrain

Migraine A severe headache with accompanying symptoms of nausea, diarrhea, visual disturbances, and depression that attacks about 8 million Americans 75 percent of them women. The symptoms of migraine can occur at any age, although it is common to see the first headache during the teenage years. Most patients have had the first attack by the time they are 40 years old attacks often recur, but tend to get less severe as a patient ages. Most people with migraine have family members who also have the disorder. Valproate (Depakote) This drug has been used to treat seizures for many years, and has also been approved to treat migraine. It is an oral medication which should be taken daily, usually in two divided doses. Laboratory tests, including the blood level of the drug, liver function testing, and a complete blood count, should be monitored. side effects noted are nausea, diarrhea, hair loss, and weight gain.

Perineal Hygiene Among Older Women

Case reports provide evidence for the effectiveness of barrier creams and hydrogel dressings in treating incontinence dermatitis (187,188). In one case report, applying a commercial barrier cream three times per day prevented dermatitis from postsurgical diarrhea (10-20 stools a day) during a one-month follow-up period (187). In another, a 68-year old woman, who presented with candidiasis secondary to urofecal incontinence and diarrhea, was treated with a regimen of skin cleansing followed by application of an antifungal powder and then a layer of barrier cream. Her dermatitis cleared within three days (187).

Glucose6phosphate dehydrogenase G6PD deficiency 201

It has been suggested that Panax ginseng may increase natural killer cell activity. Panax and Eleutherococcus can produce insomnia, diarrhea, nervousness, depression, and skin rash. Ginseng can amplify the effect of certain antidepressant medications and, due to the small amount of estrogens in the plant, can affect menstruation in women.

Viral load test See viral load

Maintenance of the integrity of intercellular cement in many tissues, especially capillary walls. Deficiency leads to scurvy, a disorder of skin and bone that causes capillary bleeding. Except guinea pigs, primates are the only mammals who cannot make it in their bodies. Few nutrients are as active in human metabolism as ascorbic acid. It is known to be the most important water-soluble antioxidant and cofactor in cellular metabolism. Researchers have clearly demonstrated that the immune system is sensitive to intake levels of vitamin C and that numerous immunological functions are dependent on it for their mediation. Vitamin C is possibly the most often used dietary supplement, particularly by immune-suppressed individuals and those suffering from other degenerative illnesses. Vitamin C can be purchased in tablet, capsule, or powdered form. If vitamin C powder is taken dissolved in water or juice, it should be drunk with a straw, as ascorbic acid can, over time, erode tooth enamel....

Differential Diagnosis of Metabolic Acidoses

In normal anion gap metabolic acidosis (also known as hyperchloremic metabolic acidosis), the loss of bicarbonate is equal to the increase in serum chloride concentration. The most common causes of this type of metabolic acidosis are diarrhea, early renal failure, hypoaldosteronism, and renal tubular acidosis. Other less common causes include carbonic anhydrase inhibitor use and ureteral diversion surgery.

Acute idiopathic polyneuritis The medical name

There is a wide range of addictive drugs. Rapid-acting opiates (including heroin, morphine, and meperidine) provide pain relief, contentment, and emotional detachment long-term effects include weight loss, reduced sex-hormone levels, and physical and psychological dependence. Withdrawal can cause cramps, gooseflesh, and diarrhea.

Myositis and Myopathy

Alcohol can cause acute and chronic muscle problems. Acute myopathy usually occurs in alcoholics after a heavy binge. It causes symptoms of muscle pain, weakness, and elevated enzyme levels. Most muscles are involved, enzyme levels are often very high, and rhabdomyolysis can occur. usually, unless rhabdomyolysis leads to kidney failure, recovery is complete. Alcohol can also cause muscle atrophy and a chronic, painless proximal myopathy. The onset of symptoms is gradual, and muscle enzymes are normal or elevated only a little. The cause of alcoholic myopathy is not known, but direct toxic effects of alcohol on the muscle combined with the effects of poor nutrition may contribute. Also, many alcoholics have diarrhea or vomiting and thus lose potassium and magnesium. This can increase the severity of muscle symptoms. Patients with chronic alcoholic myopathy are more likely to have alcohol-induced heart muscle disease (cardiomyopathy), a condition that can lead to heart failure and...

Villous tumor See papilloma

Vinblastine An anticancer agent used for the treatment of Hodgkin's disease, lymphoma, testicular cancer, and breast cancer. In people with HIV, it is used for the treatment of Kaposi's sarcoma. Vinblastine belongs to a class of cancer drugs called vinca alkyloids, which are naturally occurring chemicals isolated from the periwinkle plant. Vinca alkyloids stop the growth of tumors by preventing cells from dividing. Although vinblastine can be used by itself to treat cancers, it is used more frequently in combination with other chemotherapy drugs. Vinblastine is available as a solution for intravenous injection. The most common side effect is reduction in the number of white blood cells, which occurs, to some extent, in virtually everyone using the drug. Hair loss occurs commonly. Constipation, loss of appetite, nausea, vomiting, abdominal pain, sore mouth, jaw pain, diarrhea, stomach bleeding, and rectal bleeding may occur. In general, side effects occur most frequently when large...

Virucidal Effect Of A Newly Developed Nickel Alloy On Mouse Coronavirus

A newly recognized disease, severe acute respiratory syndrome (SARS), was first reported in China in February 2003. A few months after the first outbreak of SARS, the disease was transmitted worldwide in more than 20 countries of Asia, Europe, and North America. A novel coronavirus (CoV) was detected in patients with SARS and identified as causative agent. Civet cats have been suspected as natural host of SARS CoV, which infects human beings by oral or intranasal route the infected hosts sheds the virus into air through respiratory route and or feces from intestinal tract. The routes of entry and shedding of SARS CoV is similar to those of mouse hepatitis virus (MHV mouse CoV), which causes a variety of diseases such as diarrhea, hepatitis, encephalitis, and wasting syndrome of nude mice.

Enteropathogenic E coli

Coli Enteropathogenic

Enteropathogenic E. coli (EPEC) is an important cause of diarrhea in infants less than 2 years of age. EPEC is transmitted by the fecal-oral route by person-to-person contact. The infection occurs more frequently during the warm seasons. Infection with EPEC is often severe and leads to a high mortality rate in developing countries. The symptoms of the disease include watery diarrhea, vomiting, and fever. All EPEC strains induce a characteristic attaching and effacing (A E) lesion on the brush border of the intestine which can be mimicked in tissue culture (Fig. 34.2). Pedestal-like structures form beneath the intimately adhering bacteria, due to the polymerization of actin. The accumulation of actin beneath the bacteria can be detected by a fluorescent-actin staining (FAS) assay. In addition, EPEC adheres to epithelial cells in tissue culture in a localized pattern, which can be detected by light microscopy. Intimate attachment of EPEC to epithelial cells is mediated by an adhesin...

Asymptomatic infection

Known side effects of atazanavir include diarrhea and elevated levels of bilirubin, a liver enzyme. Diarrhea was experienced by about 30 percent of research subjects. Bilirubin is the liver enzyme that causes jaundice. A person with high levels of bilirubin may experience a yellowing of the eyes, nails, and skin. The high bilirubin levels were not associated with any liver damage in patients. Research has shown that patients with HBV or HCV coinfection did not suffer liver problems from the rise in bilirubin levels. In some studies hyperbilirubinemia was experienced by 50 percent of the patients.

Circulating immune complexes 103

Cidofovir is approved as a systemic treatment for new or relapsing cytomegalovirus (cMV) retinitis. cidofovir is not approved to treat other types of cMV infection or cMV in non-HIV-infected people. cidofovir interferes with the multiplication of cMV, thereby slowing the destruction of the retina (the light-sensitive tissue at the back of the eye) and loss of vision. Note too that it slows, but does not permanently stop, the progression to cMV retinitis. people taking the drug may continue to lose their vision and should have regular eye examinations at least every six weeks to determine whether a change in treatment is required. It may also act against CMV disease in other parts of the body, but there is less clinical evidence to support its use in these cases. Its primary advantage over ganciclovir and foscarnet is that cid-ofovir is administered intravenously on a weekly or a biweekly basis instead of daily, eliminating the need for an in-dwelling...

Toxic Substances From Bacteria

Toxic shock syndrome is a very damaging, often fatal condition caused by toxins from Staphylococcus aureus or Streptococcus pyogenes. First reported in children in 1978, it is manifested by high fever, erythroderma (a skin rash condition), and severe diarrhea.6 Patients may exhibit confusion, hypotension, and tachycardia, and they may go into shock with failure of several organs. Survivors often suffer from skin desquamation (flaky skin).

Alveolar proteinosis See pulmonary alveolar

Amebiasis A parasitic intestinal infection caused by tiny unicellular microorganisms called amoe-bas, especially Entamoeba histolytica. Many patients remain asymptomatic, but the disease is generally characterized by dysentery with diarrhea, weakness, prostration, nausea, vomiting, and pain. one serious complication is amebic hepatitis.

Differential Diagnosis of Erythrocytosis and Thrombocytosis

Polycythemia vera (PV) is the only acquired, clonal, primary cause of erythrocytosis. However, before diagnosing PV, it is essential to rule out other causes for erythrocytosis, which includes both secondary and apparent increases in erythrocyte volume. Apparent polycythemia may result from acute situations in which the plasma volume is greatly depleted (i.e., involving severe dehydration, diarrhea, vomiting, aggressive diuresis, severe burns) and the hematocrit becomes elevated. In addition, some otherwise healthy people will have hematocrits that are slightly above the upper limit of the reference interval, due to decreased plasma volume rather than increased red cell volume (apparent erythrocytosis). This condition is poorly understood, but is associated with obesity, hypertension, and smoking, and does not warrant an evaluation for PV in the absence of other diagnostic features of the disease as discussed below.

Toxins That Attack the Nerve Cell Body

Domoic acid caused a most peculiar form of toxicity. It produced gastrointestinal symptoms and an unusual neurologic syndrome in its victims. Patients experienced severe GI symptoms with nausea, vomiting, and diarrhea within 1 day of mussel consumption and neurologic symptoms within 2 days. The neurologic aspects included coma and seizures but the most persistent finding was memory loss. This memory loss was of long duration and so severe that some patients could not recognize family members. Domoic acid is less potent that many other shellfish poisons and the most severely affected patients in the outbreak had consumed up to 300 mg. No traces of the toxin are found in blood or spinal fluid only 48 hours after ingestion. The toxin, therefore, appears to have a short half-life. Its effects, however, are very long term.

Man with Colitis and Pancytopenia

A 32-year-old Caucasian male presented to the emergency department with complaints of bloody diarrhea 20 times per day and dehydration. A CBC was notable for anemia with normal white blood cell and platelet counts. Past medical history was significant for Crohn's disease diagnosed at age 20 involving the small and large intestines. He underwent ileocecal resection, and had been asymptomatic and required no therapy for the past 5 years. During his 2-day hospital course, anemia and dehydration were corrected, the diarrhea resolved, and immunosuppression with prednisone and azathioprine was started to treat a flare of inflammatory bowel disease.

Increasing Abdominal Girth

A 59-year-old woman, gravida 2 para 1 presented to her primary care physician with a 2-month history of abdominal bloating, early satiety, and increasing abdominal girth. She has a medical history significant only for essential hypertension and depression that have been responding well to medications. She has been postmenopausal for 7 years and has not been on hormone replacement therapy. Prior to menopause she used the copper-T intrauterine device (IUD) for contraception. She denied any vomiting, diarrhea, constipation, or urinary frequency. Screening colonoscopy performed at age 50, routine annual mammography, and annual cytologic screening of the uterine cervix have all been within normal limits. Her only prior operation was a cesarean section. A family history revealed maternal breast cancer, diagnosed at age 62. She does not smoke, drinks occasionally, and does not use any illicit drugs or over-the-counter medications.

Clinical manifestations

Patients with the hypocomplementemic form may have extracutaneous manifestations such as fever, malaise, and myalgia as well as lymph-adenopathy, hepatosplenomegaly, GI symptoms (abdominal pain with or without nausea and or diarrhea), respiratory symptoms (laryngeal edema, dyspnea, chronic obstructive pulmonary disease (COPD)), and or ocular involvement (conjunctivitis, episcleritis, and or uveitis).

Child care centers and infectious disease since

Many studies have shown that if the center staff understand the risks and are supervised and educated about infection control, there is much less infectious illness among the children in their care. simply by emphasizing hand washing, some centers have managed to cut diarrhea in half. Many infections in child-care centers are spread by fecal contamination. When diapers are changed, tiny amounts of feces on hands can be transferred to countertops, toys, and door handles, so that if one child is shedding an infection in the feces, it is not long before the infection spreads. some infectious viruses will appear in feces before diarrhea starts and will remain in feces for more than a week after symptoms disappear. has diarrhea, staff should wear disposable gloves before changing diapers. the common cold, fifth disease, influenza, meningitis, and tuberculosis. Germs can be transmitted by direct contact to cause cold sores, cytomegalovirus, head lice, scabies, and streptococcal infections....

Woman with Abdominal Pain and Thrombocytopenia

How Hyaluronic Acid Works

A 42-year-old African-American woman developed dull crampy abdominal pain without accompanying nausea, fever, or diarrhea. Pain persisted over the next 4 days, and she noticed blurred vision and two bruises on her legs, although she did not recall ever falling or bumping into anything. When her symptoms did not improve, her sister brought her to the hospital. The patient worked as a nurse's aide, took no prescribed or over-the-counter medications, and did not acknowledge consumption of alcohol or illicit drugs. She was not sexually active.

Diagnosis How Physicians Reason

A diagnosis dictates decisions and action. It can be a simple one, easy and quick to make the common cold, sprained ankle, pneumonia, cystitis (bladder infection). Or it can be more complex, requiring substantial thought and time bacterial endocarditis, a complex illness caused by a heart valve infection ulcerative colitis, sometimes beginning as mild diarrhea instead of the more dramatic bloody bowel movements dissecting aortic aneurysm, a tearing of the main artery leading from the heart and often mimicking the symptoms of a heart attack. A diagnosis, even a tentative one the answer to the questions What is wrong or What is going on allows the physician to make decisions and take action. Do you have diarrhea Cramps Have you lost weight How long have you been ill Do you have diarrhea Cramps Does anyone in your family have a similar illness How long have you been ill

Curing Irritable Bowel Syndrome

Curing Irritable Bowel Syndrome

Everyone has an upset stomach from time to time. You probably know the sort of thing I mean – sometimes you’ve got gas and at other times you feel queasy or nauseous. There may be times<br />when you can’t seem to go to the toilet for days, constipated as can be, but there are other days when diarrhea strikes and you can’t stop going!

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