Herbal Remedies for Vertigo

Vertigo And Dizziness Program

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Vertigo And Dizziness Program Summary


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Linkage Disequilibrium Mapping

Linkage disequilibrium (LD) is defined as the nonrandom association between two alleles at two different loci on the same chromosome. When a gene mutation first occurs, it forms part of a unique haplotype (Figure 6.12). However, this particular linkage relationship dissipates in successive generations, as recombination events scramble the alleles of the loci surrounding the disease gene. After many generations, the disease gene and only those very closely linked loci from the original chromosome remain together. These close linkages represent examples of linkage disequilibrium, and, in these instances, the

Transmission Disequilibrium Test

The transmission disequilibrium test (TDT) was originally developed to overcome the confounding effect of population stratification encountered with case-control association studies. The method effectively detects linkage with association. The key features of the TDT are tracking the transmission of alleles from heterozygous parents to affected offspring and determining whether the segregation is random or whether one allele is transmitted to an affected offspring more frequently than the other one. A significant difference between the number of transmitted alleles indicates linkage in the presence of association. More specifically, in this case, the recombination frequency (0) is less than 0.5 and linkage disequilibrium (S) is not zero. The possible combinations of transmission and nontransmission of alleles for A1A1, A1A2, and A2A2 genotypes can be depicted with a four-cell table (Figure 10.14). Cells a and d represent the results for homozygotes. Cells b and c denote the two...

ALT See alanine aminotransferase

Amantadine 1-Adamantanamine hydrochlo-ride. A primary symmetrical amine with limited prophylactic activity. Effective (about 70 ) against Influenza virus A but not against Influenza virus B, C nor Measles. Amantadine-resistant influenza virus mutants are readily isolated. The drug does not inhibit viral attachment but acts at an early stage by blocking the function of the influenza M2 protein. It may cause some mental disturbance in patients with a history of psychiatric disorder. Drowsiness, slurred speech, lethargy, dizziness and insomnia are side-effects. The a-methyl derivative, rimantadine, reportedly produces fewer side-effects. See rimantadine hydrochloride.

Application of Association to SLE

Of linkage disequilibrium to detect an association between what is actually a marker polymorphism in a candidate gene and the unobserved true SLE-predisposing variant. Moreover, the complexity of SLE demands studies that have very strong statistical power. The sample sizes of most of the candidate gene studies to date have been inadequate to make conclusive statements about the role of the specific alleles in a complex clinical phenotype.

When to Stop Exercising

Exercise provides many health benefits, but it is important to know when to stop exercising. If you feel any unusual symptoms, such as difficulty breathing, joint pain, dizziness, chest pain, or an irregular heartbeat, stop exercising immediately. Although regular exercise can reduce your risk of heart attack and early death from heart disease, overexercising can also bring on a heart attack, especially in sedentary men who have one or more risk factors for heart disease (see page 204). Become familiar with the warning signs of a heart attack so you recognize them if they ever occur in yourself or in someone else. The most common warning signs of a heart attack include

Management options

Extreme vigilance is necessary when maternal symptoms are abolished by induction of general anaesthesia. During regional anaesthesia for operative delivery, complaints of faintness, dizziness, restlessness and nausea should alert the anaesthetist to the onset of hypotension. Pallor, particularly of the lips, yawning and non-specific feelings of anxiety are also warning signs of aortocaval compression. Continuous fetal monitoring may indicate signs of fetal distress when the mother adopts the supine or semi-supine position, and occasionally this may be the only indicator of the condition. Turning the mother into the full left lateral

How long do the symptoms of MS last

Some of my symptoms have lasted a few days, and some have lasted for 6 months. The symptom that I have had last the longest is vertigo. When I moved certain ways or people and objects moved, it triggered severe dizziness, the room spinning, me feeling like I was spinning, and accompanying nausea. The banners on a TV screen, cars on the road, ceiling fans, and my husband moving his fork at dinner are examples of what I had to avoid seeing. Thus, I stayed indoors. I listened to recorded books. I ate meals next to rather than across from my husband-all compensatory processes. As time went on, the accidental triggers occurred less, but the points at which I felt I could not live with the vertigo occurred more. The vertigo started suddenly and ended quickly. Eight months later, I felt dizzy again. I sobbed, thinking that I was going to have another long bout, but it turned out to be just the flu. When I did have the next episode of vertigo, I thought it would never end. However, like many...

Symptoms And Signs

The mean incubation time is 2 days (1-4). Prodromal symptoms are uncommon. A sudden onset is most typical, with chills and rising fever followed by myalgia (usually back pain in adults). These initial systemic manifestations may later be followed by signs of pharyngitis laryngitis tracheobronchitis. In conjunction with dry cough the patient may complain of substernal pain. Other symptoms may be coryza, flushed face, epistaxis, photophobia, anorexia or vertigo. Croup among small children is a relatively common feature (see also Chapter 11).

How is a diagnosis of MS made

Sister, niece, father, and stepmother live. I taught Legal Ethics at New York University School of Law in the north and University of Miami School of Law in the south. For 3 months I had extreme vertigo that was seemingly caused by an inner ear virus. I reassured myself that when I stopped this crazy schedule, I would heal. By December I was taking large amounts of Antivert, Dramamine, and ginger ale to get through a 3-hour class. If I moved too fast or a student waved a hand or turned a page of a book without warning, I would fight the nausea that comes from vertigo. I memorized my lectures so that I did not have to look down at my notes. I would sometimes have to vomit during the breaks in class, wash my face, and then continue to teach. On the day I picked up the students' exams to grade, I went to see my general doctor. He immediately said that I did not have a virus and refused to let me drive myself to the emergency appointment he made with a neurologist. optic neuritis, acute...

Maintaining A Safe Environment

The practitioner should be aware of the potential risk of a vasovagal episode on taking cervical swabs. Assessment should be made to identify those prone to fainting, particularly women who have experienced a vasovagal episode during a previous examination. A colleague should be informed prior to the examination and emergency equipment (including oxygen) should be readily available. The patient should be observed for signs of pallor, yawning, dizziness, nausea or fainting during and immediately after the examination. After the examination, the practitioner should encourage the patient to remain supine and not to sit up too quickly.

Findings From Genetic Studies In Adhd

The reported odds ratios for the DAT1 480-bp allele from the above studies range from 1.38 to 2.67 and suggest that DAT1 is a gene of small effect in ADHD. Conflicting results may be owing to many factors, such as the lack of statistical power, in individual samples, to find genes of small effect, differences in the diagnostic definition of ADHD, hidden population stratification, genetic heterogeneity, and a variation between samples of linkage disequilibrium with a nearby causal variant. A meta-analysis by Maher et al. (65), in which eleven studies were included, yielded a marginally nonsignificant pooled odds ratio estimate of 1.27 (95 CI 0.99-1.63, p 0.06).

Progressive Supranuclear Palsy

The most striking feature of PSP patients is the fixity of gaze that, resulting from supranuclear ophthalmoplegia, gives the disease its name. However, far from being a purely oculomotor problem, PSP patients' ocular movement difficulties are accompanied by a severe deficit in orienting attention. Rafal (114) has outlined very well the difficulties that PSP patients encounter in everyday life and how these difficulties interact with other components of the disease (gait disorder, dysphagia, and nuchal dystonia). When conversing with others, reaching for objects, eating, or dressing, PSP patients typically tend not to look at what they are doing. This failure to orient spontaneously the lower visual field contributes to gait disequilibrium (the source of falls) and to the ingestion of boluses that are too large to swallow (the source of ab ingestis). Loss of spontaneous social orienting is also a striking

Clinical Characteristics and Diagnosis

RVOT tachycardia appears to be more common in women with 2 1 female predominance 26 . Familial occurrence has not been reported. Symptoms develop typically between the ages of 20 and 50 years, but presentation in childhood and infancy has been observed. Patients may present with palpitations, atypical chest pain, or dizziness. About 10 develop syncope during VT 2,27-31 .

Major Histocompatibility Complex and Multiple Sclerosis

There is a clear association between MS susceptibility and the HLA region and the DR2 haplotype. However, the causative gene or genes within the HLA have not been clearly identified because of the extensive linkage disequilibrium and high gene density within the region. Some studies have attempted to distinguish the effects of DQB1 from DRB1 in Northern Europeans 119, 7, 18 . Taken together, however, the results were inconclusive. Using a multivariate logistic model including the effects of the DRB1*1501, DQA1*0102, and DQB1*0602, Fernandez et al. 42 found that only the DQB1 gene was significantly associated with MS in a Spanish population. The high level of linkage disequilibrium between DQB1*0602 and DRB1*1501 seen in people of European ancestry is not seen in people of African origin, which is more conducive to analyzing the effects of the genes separately. Oksenberg et al. 92 studied the HLA locus in African Americans for an association to MS. They found an association with...

Posterior Fossa Decompression

FIGURE 6.4 (a) Seventy-eight-year-old woman presenting with new onset vertigo and gait unsteadiness. Hypoattenuation of the left cerebellar hemisphere consistent with infarction. (b) Postoperative CT after suboccipital craniectomy and partial resection of the left cerebellar hemisphere.

Mitochondrial Damage in Traumatic CNS Injury

During World War II (WWII) the British army banned the SS terminology in hopes of avoiding another epidemic of these cases, which they may or may not have viewed as physical disorders. However, with the start of the war it became readily apparent that disavowing the existence of this disorder did not prevent another epidemic. In response to the army regulations regarding this disorder, alternative terminology arose in its place, such as post-concussion syndrome (PS) or post-trauma concussion state (coined by Shaller). Eventually, physicians began to realize that many of the soldiers that suffered from this concussed state had been in close proximity of an explosion during battle. This led them to speculate that some force, that had no perceptible outward affect on the body, had a substantial effect on fragile neural tissues. In an attempt to, once again, clarify the etiology of this disorder, Denny-Brown suggested that it was the timeline of symptom presentation within the individual...

MausElberfeld virus A strain of

Mayaro virus (MAYV) A species in the genus Alphavirus. First isolated from febrile humans in Trinidad in 1954, and then from febrile humans and mosquitoes in Brazil. There is a sudden onset of fever, headache, epigastric pain, myalgia, arthralgia, rash, chills, nausea, photophobia and vertigo. The rash begins on the fifth day of the illness in children, less frequently in older persons. Recovery occurs within 10 days, except for some persistence of arthralgia. The disease is widely distributed throughout Central and South America. Associated with an epidemic febrile illness in humans in Uruma colony, Bolivia. Antibodies are found in humans and monkeys, and in rural communities in the Amazon up to 60 of the population have antibodies to MAYV. The principal vector is Haemagogus janthinomys, and the main vertebrate hosts are non-human primates. Birds can act as secondary hosts. There is no vaccine, and prevention is by personal protection against mosquito vectors.

Clinical Presentation

In the majority of patients, ARVC D manifests first with the sporadic occurrence of monomorphic ventricular tachycardia (VT). Other patients present with frequent premature ventricular beats, repetitive ventricular runs, or nonsustained VT. Associated symptoms range from palpitations and paroxysmal tachycardia to dizziness, syncope, or sudden cardiac arrest. Clinical signs of heart failure are usually limited to patients with

Evidence in favor of safety

A review of clinical trials 70 showed that together, 9 of patients showed adverse drug reactions. These reactions included neutropenia, reduced reticulocyte count, anemia, eosinophilia, acute haemolysis, elevated aspartate aminotransferase, ECG abnormalities (w o clinical effect), transient bradycardia, prolongation of the QTc interval, prolonged PR interval (first-degree atrioventricular block), atrial extrasystoles, and non-specific T-wave changes. In all cases, the effects were independent of the artemisinin derivative and route of administration. An additional study 71 showed that when treating uncomplicated falciparum malaria with artemisinin derivatives alone, substantially fewer side effects were observed than with mefloquine-containing combination therapies. Notably, there was significantly less nausea, vomiting, anorexia, and dizziness. Furthermore, studies have shown no adverse effects on mother or fetus if artesunate or artemether are used to treat acute falciparum at...

Neurofibromatosis Type

Neurofibromatosis Type 2 (NF2, central neurofibromatosis) is an autosomal dominant trait affecting about 1 in 40,000 people worldwide. The major clinical features are the formation of tumors of the CNS. The most common NF2 tumor is bilateral vestibular schwannoma (acoustic schwannoma, acoustic neuroma), which forms around both acoustic nerves (cranial nerve VIII, vestibulocochlear nerve) in the brain. A schwannoma is a tumor that originates from the sheath cells of neurons. The acoustic nerves emanate from the junction of the pons and medulla oblongata (pontomedullary junction) in both halves of the brain and proceed to each ear. In each of these nerves, one branch (vestibular division) innervates the balance control center of the ear and the other branch (cochlear division) innervates the part of the ear that receives and transmits auditory signals. In NF2 patients, schwannomas often compress each cochlear branch and cause deafness. In addition to bilateral vestibular schwannomas,...

Neurons are Vulnerable to Oxidative Stress

Neurons of the central nervous system are subject to a number of unique conditions that make them particularly vulnerable to oxidative stress and its sequelae that can culminate in cell death. This vulnerability is a consequence of the excessive oxygen utilization, the high unsaturated lipid content of neuronal membranes as compared to normal plasma membrane, and the postmitotic nature of primary neurons. Due to their unique status, a balance between the production of ROS and antioxidant defenses is of particularly significance in neurons. Under normal physiological conditions, damage produced by oxygen radicals is kept in check by an efficient array of antioxidant systems that display an impressive level of redundancy, which provide multiple lines of defense. However, in cases of age-related neurodegeneration, like that observed in AD, this balance between oxidative radicals and anti-oxidant defenses is altered, allowing various forms of cellular and molecular damage. This...

Multiple Endocrine Neoplasia Type

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant cancer syndrome that features tumors of the parathyroid, pituitary, and the islet cells of the pancreas. These tissues are part of the endocrine system, which produces and secretes various hormones. In response to different hormones, target cells control homeostatic processes, growth, development, and stress. Specifically, with regard to the sites of the MEN1 tumors, the parathyroid glands control levels of calcium and phosphate the pituitary glands regulate metabolic activities of other endocrine glands and growth and the pancreatic islet cells maintain blood glucose concentration. Depending on the site and the extent of the MEN1 tumors, symptoms may include excess calcium in the bloodstream (hypercalcemia), which causes kidney stone formation low blood sugar concentration (hypoglycemia), resulting in dizziness, confusion, weight loss, and glucose intolerance and disruption of the pituitary gland, accompanied by...

Parkinsonism And Movement Disorders

Associated worsening of parkinsonism, dystonia, myoclonus, and gait dysfunction, whereas nonmotor side effects included gastrointestinal complaints, confusion, somnolence, dizziness, and hallucinations. A relative failure or lack of efficacy of dopaminergic therapy in a parkinsonian patient with cortical dysfunction should raise the suspicion of CBD.

Adverse Event Profile Of Tnp470

Treatment-emergent medical events, which include adverse events (AE events considered by the investigator to be possibly, probably, or definitely related to TNP-470 administration, or of unknown relationship) and complaints considered by the investigator to not be related to TNP-470, were reported for 100 of patients. The AEs most frequently (incidence in excess of 15 ) reported by patients include asthenia (42.1 ), nausea (32.2 ), anorexia (18.2 ), and dizziness (15.7 ). It is important to note that the incidence of complaints of anorexia (18.2 ) was not reflected in the incidence of weight loss greater than 10 (grade 2), which occurred in only six of 121 (5.0 ) patients, and complaints of anorexia were recorded in only three of these cases. Overall, 99 of 121 (81.8 ) patients experienced at least one AE, and a total of 408 AEs were recorded. Greater than 70 of AEs were categorized as mild or grade 1 (Common Toxicity Criteria). An additional 20 were moderate or grade 2 in severity,...

Doselimiting Toxicities And Determination Of Maximumtolerated Dose

DLTs were reported for three of 32 prostate cancer patients, two of 21 cervical cancer patients, and five of 68 solid tumor patients. Excepting one report of hemoptysis (grade 1), which occurred in a patient with NSCLC with a history of similar episodes, all were neurological in nature. DLTs involving complaints of gait and coordination disturbances, memory impairment, increased anxiety, and emotional lability were observed in three prostate cancer patients at two dose levels, 70.6 (two patients) and 105.9 (one patient) mg m2. In two cases, the DLTs presented within the first 3 wk of treatment in one case they were delayed and reported after the 2-wk rest period. Two cervical cancer patients experienced DLTs following treatment at 71 mg m2 for 4 wk these consisted of gait disturbance as well as dizziness and nystagmus. In the solidtumor study administering TNP-470 every MWF, a single DLT (grade 1 unsteadiness) was reported in a patient with melanoma after 102 d of treatment at 32.4 mg...

Management of Opioid Adverse Effects

Routine prophylactic administration of an antiemetic is not necessary, except in patients with a history of severe opioid-induced nausea and vomiting, but patients should have access to an antiemetic at the start of therapy if the need for one arises. Anecdotally, the use of prochlorperazine and metoclopramide has usually been sufficient. In patients with more severe or persistent symptoms, the most appropriate antiemetic treatment may be suggested by the clinical features. For nausea associated with early satiety, bloating or postprandial vomiting, all of which are features of delayed gastric emptying, metoclopramide is the most reasonable initial treatment. Patients with vertigo or prominent movement-induced nausea may benefit from the use of an antivertiginous drug such as scopolamine or meclizine. If signs of neither gastroparesis nor vestibular dysfunction are prominent, treatment is usually began with a neuroleptic, such as pro-chlorperazine or metoclopramide. Drug combinations...

Toxic and Side Effects

The absence of side effects in a 1-year clinical trial with ponalrestat was reported by Ziegler et al. (1991), but in this study no therapeutic efficacy was seen A 6-month study with ponalrestat to elucidate the effects on kidney function was also free from side effects (Pedersen et al., 1991). Dizziness, possibly based on a blood pressure-lowering effect, was reported for tolrestat. In addition, hepatocyte lesion accompanied by changes in hepatic parameters within the first 3-6 months of treatment was seen (Ryder et al., 1987). For sorbinil, significant hypersensitivity reactions have been reported (Sarges, 1989).

Entecavir Antiviral [2932

State ranging from 62 to 73 of the administered dose. In two randomized double-blind 1 year cinical studies involving nucleoside-naive patients, 0.5 mg once-daily entecavir was superior to 100 mg once-daily lamivudine on the primary efficacy endpoint of histological improvement. Patients receiving entecavir achieved histologic improvement rates of 70-72 , compared with rates of 61-62 for patients receiving lamivudine (p

Pregabalin Antiepileptic [7881

As a follow-up to its g-aminobutyric acid (GABA) agonist gabapentin, Pfizer has developed and launched pregabalin for the treatment of epilepsy and neuropathic pain. Although pregabalin is a structural analog of GABA, it does not interact with GABA-A or GABA-B receptors or influence GABA uptake. The exact mechanism of action is unclear, but pregabalin may reduce excitatory neurotransmitter release by binding to the a2-8 protein subunit of voltage-gated calcium channels. The resulting inhibition of excess neuronal activity is believed to be the basis for pregabalin's efficacy in epilepsy and neuropathic pain alleviation. Since the activity is attributed to the (S)-enantiomer alone, an efficient asymmetric synthesis is employed for commercial production. The key step is the asymmetric hydrogenation of 3-cyano-5-methyl-3-hexenoic acid using a chiral rhodium catalyst to afford an intermediate that is enriched in the (S)-enantiomer. The cyano group is ultimately reduced by routine...

Ramelteon Insomnia [7378

Evaluation in patients with transient insomnia also supported that 8 mg of ramelteon was sufficient in reducing sleep latency relative to placebo. Since many of the traditional treatments of insomnia have safety concerns, an abuse potential study was conducted in 14 patients with a history of sedative hypnotic drug abuse. Even at doses up to 20 times the recommended therapeutic dose, there were no differences in the subjective responses of ramelteon-treated patients and placebo-treated patients in multiple tests of abuse potential. Based on the result of the clinical trials, the recommended dose of ramelteon is 8 mg taken within 30 min of going to bed. In addition to the precaution of co-administration with CYP inhibitors, it should not be used in patients with severe hepatic impairment. The adverse events, observed in 5 of patients in clinical studies, were somnolence, dizziness, nausea, fatigue, headache, and insomnia.

Transdermal Absorption

The ability of the skin to absorb chemicals makes it possible to administer several medicines as ointments or lotions, or by means of adhesive patches that release the medicine steadily through a membrane. For example, inflammation can be treated with a hydrocortisone ointment, nitroglycerine patches are used to relieve heart pain, nicotine patches are used to help overcome tobacco addiction, and other medicated patches are used to control high blood pressure and motion sickness.

Ionotropic Gaba Receptors And Sleep Disorders

Also in clinical trials for the treatment of sleep disorders is THIP 4, a directly acting GABAA receptor partial agonist that interacts with a GABAA receptor population that is insensitive to benzodiazepines, zolpidem, zaleplon and indiplon 43 . THIP is a moderately potent GABAc receptor antagonist 29 . Unlike GABA, THIP passes the blood-brain barrier on systemic administration and is a potent analgesic 44 . The side effects of THIP (including sedation, dizziness, and blurred vision) meant that it had too low a therapeutic index to be therapeutically useful as an analgesic 45,46 but it is being investigated for sleep therapy. Interestingly, THIP-induced analgesia is not sensitive to bicuculline suggesting that GABAA receptors are not involved 47 . Instead, the GABAc receptor antagonist action of THIP may contribute to its analgesic action 18 as the analgesic action of THIP in rats is blocked by subconvulsant doses of picrotoxinin 48 , a potent GABAc receptor antagonist in addition to...

Inflammation and Immune Response in Human Longevity

Studies performed in mice and humans indicated the effect of polymorphic class I and class II HLA genes on life span and human longevity. In particular, studies on experimental animals argued that certain MHC genes may be associated with shorter life and others with a longer life span however, the effects depend both on genetic background and on the environmental conditions 117-119 . Results of analogous studies in man are confusing and contradictory. Most studies would indicate that the effect of HLA on human longevity might be rather small however, it is not allowed at present to reach clear and definitive conclusions. Thus, when comparing HLA antigen frequencies between groups of young and elderly subjects, the same HLA antigens are increased in some studies and decreased or unchanged in others 120 . The association between heterozygosity at HLA loci and human longevity have also been addressed because it was shown that heterozygote individuals are more fit for survival than...

Orf subgroup viruses Synonym for parapoxvirus

7000 people near Belem in Brazil, and has become a continuing problem in that region, associated with deforestation and increased contact with the principal vector, Culicoides paraensis. The disease is an acute febrile illness with headache, myalgia, arthralgia, photophobia, retro-bulbar pain, nausea and dizziness. The virus has been isolated from the three-toed sloth, Bradypus tridactylus, which appears to be involved in the sylvan cycle of transmission.

Clinical Box 31 Alcohol Sensitivity in East Asian Populations

Both enzymes utilize a coenzyme, NAD+, as the electron acceptor in order to catalyze the oxidation of their substrates. Humans possess multiple forms of both enzymes these are termed isoenzymes. Isoenzymes are related gene products that catalyze similar reactions, but do so with differing affinities for substrates and or with differing rates of catalysis. A common occurrence among individuals with East Asian ancestry (China, Japan, North and South Korea) is intolerance toward the consumption of alcoholic beverages. This ethanol intolerance is characterized by a rapid flushing reaction in which vasodilation of the blood vessels in the face gives rise to a reddened appearance within a few minutes of ethanol consumption. In addition to this external symptom, susceptible individuals also experience nausea, dizziness (syncope), and rapid heart rates (tachycardia) following the consumption of alcoholic beverages (Hurley, Edenberg and Li, 2002). The basis for the physiological reaction to...

Differential Diagnosis

A number of reactions involving the restaurant syndromes have been observed that can mimic anaphylaxis. These include reactions to monosodium glutamate (MSG), sulfites, and saurine. MSG ingestion can cause chest pain, facial burning, flushing, sweating, dizziness, paresthesias, headaches, palpitations, nausea, and vomiting. In children, screaming, chills, irritability, and delirium have been reported. Symptoms typically begin no later than 1 h after ingestion, although they can be delayed in some instances for up to 14 h. The exact mechanism is unknown however, it has been postulated that a transient

Genotyping Single Nucleotide Polymorphisms

Polymorphic marker systems are necessary for genetic linkage and association (allele sharing) studies, determination of disease genes by linkage disequilibrium, and other applications, such as identifying the loss of alleles from a chromosome(s) in tumor cells. With the emergence of PCR and the discovery of the highly polymorphic nature of dinucleotide repeats, the firstgeneration polymorphic markers, restriction fragment length polymorphisms (RFLPs), were replaced by short tandem repeat polymorphisms (STRPs). However, the average spacing between STRPs is approximately 5 X 105bp, which puts a limit on their usefulness. As a result of advances in genome technologies, a third generation of polymorphic markers, single-nucleotide polymorphisms (SNPs), are being developed. An SNP represents a site at which two different nucleotide pairs occur at a frequency of 1 or greater. Preliminary estimates place an SNP every 500 to 1000bp in the human genome. These sites are stable and widely...

Natalizumab Multiple Sclerosis [6874

More common than observed with placebo. Serious hypersensitivity-like reactions were experienced in 1 of the natalizumab group. In these cases, adverse effects usually developed within two hours of the onset of the infusion. The symptoms included urticaria, fever, rash, rigors, dizziness, pruritus, nausea, flushing, dyspnea, hypotension, and chest pain. Antibodies to natalizumab are believed to be responsible, and any patient experiencing hypersensitivity should discontinue further treatment. Since adequate studies have not been performed in the pregnant, pediatric, and elderly, natalizumab is currently contraindicated in these patient populations. In addition, this drug should not be taken concurrent with medications that suppress the immune system, such as, corticosteroids the combination increases the risk for serious infections. With a dose of 300 mg to MS patients, the long half-life of 11 4 days results in a once-a-month trip to the physician for the one-hour infusion....

Differential Diagnosis Of Asthma

Nonasthmatic conditions associated with wheezing Pulmonary embolism Cardiac failure ( cardiac asthma ) Foreign bodiesa Tumors in the central airways Aspiration (gastroesophageal reflux)a Carcinoid syndrome Laryngo-tracheo-bronchomalaciaa Loffler's syndrome Bronchiectasis Tropical eosinophilia Hyperventilation syndrome Laryngeal edema Vocal cord dysfunction Laryngeal or tracheal obstructiona Factitious wheezing a1-Antitrypsin deficiency Immotile cilia syndrome, Kartagener's syndromea Bronchopulmonary dysplasiaa Bronchiolitis, croupa Overlapping diseases

Temporomandibular Disorder

TMD can produce a range of symptoms, most commonly pain in or around the jaw joint. Other symptoms include limited movement or locking of the jaw pain that radiates to the face, neck, or shoulders a painful clicking, popping, or grating sound in the jaw joint when the mouth is opened and a sudden change in the way the upper and lower teeth fit together. Headaches, earaches, hearing problems, and dizziness also may sometimes be linked to TMD.

Under what circumstances is a patient slow to awaken

PONV remains a significant, troublesome postanesthetic problem. It results in delayed PACU discharge and occasional unplanned hospital admissions and is a recurring cause of patient dissatisfaction. Both the surgical procedure and anesthetic agents administered may increase PONV risk. Procedural risks include laparoscopic surgery surgery on genitalia craniotomies and shoulder, middle ear, or eye muscle procedures. Patient factors are female sex, nonsmoker, prior PONV or motion sickness history, and school-age children. Anesthetic agents with a high association with PONV include the opioids, volatile inhalation agents, and nitrous oxide. Propofol has the lowest incidence of any of the induction agents and has been used effectively as a rescue medication. Risk assessment should be made on the basis of these factors, and prophylactic treatment or alteration of the anesthetic plan determined by evidence of efficacy. PONV rescue (treatment once PONV has ensued) requires balancing drug...

Review the alleged benefits and risks of ginkgo

Ginkgo is used for the treatment of dementia, Alzheimer's disease, and conditions associated with cerebral vascular insufficiency, including memory loss, headache, tinnitus, vertigo, difficulty concentrating, mood disturbances, and hearing disorders. Active ingredients of ginkgo leaf and its extracts include flavonoids, terpenoids, and organic acids. Although the mechanism of action is only partially understood, there are several theories about how ginkgo works. Ginkgo may protect tissues from oxidative damage by preventing or reducing cell membrane lipid peroxidation and decreasing oxidative damage to erythrocytes, and it may protect neurons and retinal tissue from oxidative stress. Extracts from the ginkgo leaf competitively inhibit platelet-activating factor, decreasing platelet aggregation, phagocyte chemotaxis, smooth muscle contraction, and free radical production, and prevent neutrophil degranulation. A case of bilateral spontaneous subdural hematomas has been linked to chronic...

The Testicles and the Scrotum

Pain associated with testicular injury is very different from other types of pain. Testicles are organs that are located outside the body. Pain for them is similar to pain sensed by any other internal organ. It tends to be deeper, more intense, and more widespread than pain to the outside of the body. This is why a blow to the testicles can cause pain that is accompanied by sweating, nausea, and dizziness. It is the brain's way of acknowledging that a crucial organ has been hit and that the whole body must respond to this potential emergency.

Diagnostic Difficulties And Diagnostic Accuracy

In the tertiary referral setting, the diagnosis of a patient consulting with a history of early falls and visual disturbances can be obvious, however, the diagnosis of PSP may be challenging at early disease stages when the clinician is not familiar with the condition or does not have a high index of suspicion. This is particularly true since, as discussed, individual clinical features of PSP may occur in other parkinsonian or dementia disorders, and telltale signs may present in midstages of the disease. It can be particularly difficult to distinguish PSP from PD during the first 2-3 yr from symptom onset if patients with PSP do not yet clearly exhibit postural instability or ophthalmoplegia, and when they may still show a levodopa response. This presentation is infrequent, but the presence of only axial or additional symmetric limb signs at onset should raise suspicion that the diagnosis of PD may be incorrect. Patients with PD, DLB, or CBD usually have asymmetric signs. In patients...


Depending on the clinical trial evaluated, but significant improvements are reported at 4 and 8mg 30 . Most common adverse effects noted to date appear minor, i.e., headache (7 ), dizziness (5 ) and somnolence (5 ). The last published clinical trials evaluated the potential effects of ramelteon 16 mg on apenic and hypopneic events in individuals with obstructive sleep apnea, due to the lack of depressant effects on nervous system, demonstrating no worsening of sleep apnea 31 .

Dumping syndrome

Dumping is one of the most common postgastrectomy syndromes and may be divided into an early form and a late form, based on the time interval between food ingestion and onset of symptoms. Both are caused by ingestion of hyperosmolar carbohydrate-rich food. Early dumping begins within 10-30 min of a meal and is characterized by both gastrointestinal manifestations and vasomotor symptoms. The gastrointestinal manifestations include fullness, crampy abdominal pain, nausea, vomiting, and explosive diarrhea. Vasomotor manifestations include diaphoresis, weakness, dizziness, flushing, and palpitations. Patients with dumping tend to decrease their food intake because of the intense discomfort and can become malnourished.

Genetic Analyses

Linkage disequilibrium, which is a statistical association between two or more genetic loci, extends further in a group of related individuals than in a group of unrelated individuals. This is because many of the genomic regions in members of the same family are identical by descent (IBD), i.e., inherited as large segments of DNA from a recent common ancestor. Because the goal of the candidate gene approach is to identify an association between a specific gene and a trait, a population with lower linkage disequilibrium, such as a group of unrelated individuals, is ideal. Studying a population with limited linkage disequilibrium increases the likelihood that observed associations between a gene and a trait are due to the effects of the gene being scrutinized, instead of another linked gene. Since a linkage analysis is typically an exploratory experiment to identify trait-associated regions of the genome, populations with higher linkage disequilibrium, such as families, are ideal for...


The decision to treat patients with idiopathic outflow tract tachycardia is based on clinical information. If symptoms are infrequent and relatively mild, treatment may not be necessary and patients may simply be reassured. However, in presence of presyncope syncope or if frequent ventricular extrasystoles are debilitating, medical therapy or radiofrequency catheter ablation should be indicated. Patients with worsening symptoms and increasing arrhythmia burden during follow-up should be reassessed in order to identify any evolving cardiac functional abnormality.

Vascular Pathologies

A CA is a weak, bulging spot in an artery of the brain. These often result from a weakness in the tunica media (muscle layer) of the vessel that is present from birth. A CA may cause symptoms ranging from headache, drowsiness, neck stiffness, nausea, and vomiting to more severe symptoms such as mental confusion, vertigo (dizziness), and loss of consciousness. A ruptured aneurysm most often results in a severe headache demanding immediate medical attention. A CA can be diagnosed by imaging tests like x-rays, ultrasound, computed axial tomography (CAT), and magnetic resonance imaging (MRI). When detected, brain aneurysms can be treated by microsurgery.

Genome Scans

Genome scans are designed to detect linkage disequilibrium (LD) between a marker site and a QTL. A variety of analytical procedures have been devised for this purpose. Some of the LD tests use estimates of various parameters such as the mode of inheritance, penetrance, and other genetic features, that is, parametric tests. Other tests are model free (nonparametric tests) and detect significant associations between a DNA marker(s) and a chromosome site in affected individuals. The results of genome scans are often presented as LOD scores and plotted as a function of the location in centimorgans (cM) along each chromosome (Figure 10.13). The criterion for significance is problematic, but commonly a LOD score 3.6 is considered significant, 2.2 suggestive, and 1.5 interesting. Regions with suggestive and interesting linkages are examined with additional polymorphic markers in follow-up studies. The human genome appears to be structured into regions (blocks) of high linkage disequilibrium...

What about ginger

Ginger is used for the treatment of arthritis, for a variety of gastrointestinal complaints, for vertigo and motion sickness, and as an antiemetic. It is effective in controlling nausea and vomiting in hyperemesis gravidarum. Its active component is gingerol, and its mechanism of action is unclear, although gingerols are thought to inhibit prostaglandin and leukotriene synthesis. Ginger is believed to inhibit thromboxane synthetase, decreasing platelet aggregation. Like garlic, it may potentiate the effect of medications having anticoagulant properties.


At a frequency of 1 in 10,000 live births, FCMD is one of the most prevalent genetic disorders in Japan, whereas in the rest of the world it is seldom encountered. Linkage disequilibrium mapping indicated that about 80 of the Japanese population carry a mutated FCMD gene that can be traced back 2000 to 2500 years to a common ancestor. Labeled DNA from a cosmid contig that overlapped the FCMD locus was hybridized to restriction endonuclease-digested DNA from FCMD patients and non-FCMD individuals. An 8-kb fragment was present in the DNA samples from FCMD patients, whereas instead of this 8-kb fragment, a 5-kb fragment was observed in the DNA sample from normal control subjects. The difference between these fragments is a 3-kb insert within the 3' untranslated region of the FCMD gene. For most FCMD individuals, both FCMD alleles have the 3-kb insert. However, there are some FCMD patients who are compound heterozygotes for this gene. In these cases, one of the alleles has the 3-kb insert...

Clinical Findings

The clinical manifestations of botulism are related in some measure to age, with considerably less specific symptoms in infants than in older patients. At 18 to 48 hours after ingestion of tainted food, patients with botulism typically present with cranial nerve dysfunction manifested by ptosis, diplopia, dysphagia, and difficulty in speaking (dysarthria). Patients remain lucid, although anxiety and agitation may develop. Generally, fever is absent unless superinfection occurs. Additional signs may include pupillary dilation, vertigo, and tinnitus. Prominent autonomic symptoms include anhydrosis with severe dry mouth and mucous membranes and throat and postural hypotension. In some cases, pharyngeal collapse secondary to cranial nerve paralysis may compromise the airway and require intubation in the absence of respiratory muscle compromise. Cranial nerve palsies may be followed by flaccid, descending, symmetric paralysis of voluntary muscles, affecting (in order) the neck muscles,...

Bloom Syndrome

Both homozygosity and linkage disequilibrium mapping placed the gene for BS, which was designated BLM, to chromosome 15q26.1 and about 2000kb from the nearest marker site. A strategy called somatic crossover point (SCP) mapping was devised to narrow down the region containing the BLM gene. SCP mapping starts by establishing cell lines from BS patients of nonconsan-guineous kindreds because they are likely to be compound heterozygotes. The high rate of chromosome abnormalities in these cell lines can be observed by examining metaphase chromosomes. An exchange between the sites of two BLM mutations on two different chromatids of duplicated homologous chromosomes produces a wild-type BLM gene on one of the chromatids (Figure 16.16). After the original cell lines have been cultured for a number of cell divisions, clones are established, and each is examined for the frequency of chromosome abnormalities. Cell lines with a low-frequency of chromosome abnormalities and little or no SCE...

Side Effects

As discussed above, thalidomide has been used for the treatment of leprosy, graft versus host disease, rheumatoid arthritis, aphthous ulcers associated with AIDS, and various dermatologic disorders. The side effects of thalidomide have been well documented and they include drowsiness, constipation, peripheral sensory neuropathy, swelling of the limbs, erythema of the limbs, hair loss, fever, rash, and amenorrhea. Dizziness and mood changes occurred in 33-100 of all patients. Other frequent adverse effects are xerostomia, increased appetite, loss of libido, nausea, pruritus, and menstruation abnormalities have been occasionally observed. The most serious of these side effects is peripheral neuropathy. Its incidence has been estimated to be approx 1 in patients treated for lepra reactions (81), 12 in rheumatoid arthritis (65), 22 in prurigo nodularis (66), and 25 in patients with discoid lupus erythematosus (67). Based on electrophysiologic studies the incidence was estimated at 21...


Adverse reactions to metronidazole therapy are rare and include CNS toxicity symptoms of peripheral neuropathy, ataxia, vertigo, headaches, and convulsions. Gastrointestinal side effects include nausea, vomiting, metallic taste, anorexia, and diarrhea. Other adverse reactions include neutropenia, which is reversible with discontinuation of the drug, phlebitis at intravenous infusion sites, and drug fever. The tolerance of metronidazole in patients is generally very good.

Polymyxin Therapy

The parenteral form of colistin is colistimethate sodium. Unfortunately, useful data on the pharmacokinetics, pharmacodynamics, and toxicodynamics of colistin are lacking. This is primarily because colistin was originally introduced over 50 years ago, before the implementation of current drug approval requirements. In addition, earlier methods of measuring serum concentrations of the drug were inaccurate and unable to adequately distinguish concentrations of colistimethate (the nonactive pro-drug) from colistin (72). The recommended dosing of colistin depends on the specific product being used. There are inconsistencies among various manufacturers and the labeling of different formulations varies using international units, milligrams (mg) of colistin base activity, or other units. This variation makes it difficult to interpret and compare studies' results, especially when research occurs in different parts of the world and specific formulations are not fully described (72). When the...

Color Vision Defects

Genome scanning of eight multigenera-tional families with high myopia, using 62 polymorphic microsatellite probes, indicated linkage to 18p, and, after haplotype analysis, the site of the locus was localized to 18p11.31. This form of autosomal dominant myopia was called MYP2. At least, one polymorphic site in the transforming growth factor-b-induced factor (TGIF) gene at 18p11.31, which may be the MYP2 gene, is significantly associated with high myopia. The TGIF protein is a transcription repressor, and TGIF gene mutations are responsible for a disorder that entails forebrain, skull, and facial malformations (holoprosencephaly). A third locus, MYP3, was mapped to 12q21-23 in one four-generation family with high myopia. Similar analyses have identified loci for MYP4 and MYP5 at 7q36 and 17q21-q22, respectively. Finally, a haplotype-linkage disequilibrium study with dizygotic twin pairs localized a putative myopia-causing mutation to a nucleotide change within the promoter and or...

Clinical Examination

In contrast, in vascular parkinsonism or normal-pressure hydrocephalus, the arm swing is preserved or even exaggerated (to keep the balance) and the arms are not flexed. In that case, parkinsonism predominates in the lower limbs (thus the name of lower body parkinsonism ). The marche a petits pas described by Dejerine is suitable for the description of these patients. The gait is characterized by short quick steps, initially without dragging or shuffling the feet on the ground (in contrast to PD), with start and turn hesitation (take several steps on turning), slight wide base (but can be narrow), and moderate disequilibrium (described by Nutt and colleagues as frontal gait disorder ) (5). Visual clues (contrasted lines on the ground) do not help these patients (in contrast to PD). The diagnosis of vascular origin (differential diagnosis from degenerative parkinsonism) is made by the company it keeps pyramidal signs, dysarthria and pseudo-bulbar signs, urinary disturbances, cognitive...

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