By L. Ingvar. California Institute of the Arts.

The most popular historical herbal treatment of asthma involved the use of Ephedra sinensis (ma huang) in combination with herbal expectorants purchase 50 mg clomiphene visa menstrual migraine headaches. This approach appeared to have considerable merit generic clomiphene 25mg women's health center jackson wy, as ephedra and its alkaloids have proved effective as bronchodilators in treating mild to moderate asthma and hay fever. Ivy (Hedera helix) In Europe, herbal preparations containing extracts from the leaves of ivy (Hedera helix) enjoy great popularity for the relief of coughing as well as asthma. In 2007, more than 80% of herbal expectorants prescribed in Germany included ivy extract, amounting to nearly 2 million prescriptions nationwide. Ivy leaf contains saponins (alpha-hederin and hederacoside C) that show expectorant, mucolytic, spasmolytic, bronchodilatory, and antibacterial effects. The reviewers concluded that ivy leaf extract preparations improve a variety of respiratory functions in children with chronic bronchial asthma, but noted the data were meager. In the only placebo-controlled, double-blind study reviewed, 24 children with asthma between the ages of 4 and 12 were given a dry ivy leaf extract (35 mg) in cough drops or a placebo for three days with a washout of three to five days before crossing over to the other treatment. Superiority of the ivy leaf extract over the placebo was noted by small improvements in airway resistance, residual volume, and breathing capacity when the baseline measurements were compared with the third day at three hours after the morning dose. Licorice Licorice (Glycyrrhiza glabra) root has a long history of use as an anti-inflammatory and antiallergic agent, and there is considerable documentation in the scientific literature. The primary active component of licorice root in this application is glycyrrhetinic acid, a compound that has shown cortisol-like activity. In particular, glycyrrhetinic acid has been shown to inhibit phospholipase A 2, the enzyme responsible for cleaving arachidonic acid from the phospholipid membrane pool and initiating the formation of inflammatory prostaglandins and leukotrienes. Capsaicin from Cayenne Pepper Experimental evidence has shown that capsaicin, the major active component of cayenne pepper (Capsicum frutescens), desensitizes airway mucosa to various mechanical and chemical irritants. Because of the location of substance P and its physiological action, it is believed to play an important role in atopic conditions such as asthma and atopic dermatitis. Jujube Plum The jujube plum (Zizyphi fructus) has been used extensively in Chinese medicine for the treatment of asthma and allergic rhinitis. Tylophora The leaves of tylophora (Tylophora asthmatica) have been used extensively in ayurvedic medicine for asthma and other respiratory tract disorders. Tylophora’s mode of action is unknown but is thought to be due to its alkaloids, especially tylophorine, which have been reported to possess antihistamine and antispasmodic activity, as well as inhibition of mast cell degranulation. Several double-blind clinical studies have shown tylophora to produce good results. In another double-blind study of 103 patients, those receiving 40 mg of the dry alcoholic extract of Tylophora indica per day for only six days demonstrated significant improvement in symptoms of asthma compared with a placebo group. The incidence of side effects such as nausea, partial diminution of taste for salt, and slight mouth soreness was 16. These results, as well as the results from an additional study, indicate that the benefits of tylophora are short-lived. The antiasthmatic effects of orally administered or inhaled ginkgolides have been shown to produce improvements in respiratory function and reduce bronchial reactivity in several double- blind studies. Aloe Vera Administration of aloe vera preparations may be effective for patients who are not dependent on corticosteroids. In one study, the oral administration of an aloe vera extract for six months was shown to produce good results in the treatment of asthma in some individuals of various ages. Subjecting the leaves to dark and cold results in an increase in the polysaccharide fraction—1 g of crude extract obtained from leaves stored in cold and dark produced 400 mg neutral polysaccharide compared with only 30 mg produced from leaves not subjected to cold or dark. The dosage was 5 ml of a 20% solution of the aloe vera extract in saline twice per day for 24 weeks; 11 of 27 patients (40%) without corticosteroid dependence felt much better at the study’s conclusion. The mechanism of action is thought to be restoration of protective mechanisms, plus augmentation of the immune system. Coleus Coleus forskohlii extract may be particularly useful in asthma, as its active component, forskolin, has been shown to have remarkable effects in relaxing constricted bronchial muscles in asthmatics.

Lowering the vascular tone of the efferent arteriole with angiotensin converting enzyme inhib- itors or angiotensin receptor blockers may further decrease glomerular filtration pressure and thus glomerular filtration rate safe clomiphene 50mg women's health clinic cork. Thrombotic microangiopathy can be induced by platelet aggregation inhibitors buy clomiphene 25mg fast delivery women's health magazine birth control article, calcineurin inhibitors, chemothera- peutics, interferon, quinine, and cocaine [76, 81]. Renal vasculitis may be induced by penicillamine, allopurinol, and phenytoin and hyaline arteriolopathy can be induced by calcineurin inhibitors. Agents most frequently implied in tubular toxicity are radio- contrast, antimicrobials such as aminoglycosides and amphotericin B; chemothera- peutics such as cisplatin and ifosfamide; and antiviral agents such as adefovir, cidofovir, and foscarnet [72, 73, 82]. Cocaine and heavy metals may also cause tubular damage by means of direct toxicity. The mechanism by which osmotic agents induce tubular injury is different: uptake of hyperosmolar molecules in the tubular cell causes an oncotic gradient entailing cell swelling and tubular 4 Etiology and Pathophysiology of Acute Kidney Injury 51 obstruction. This type of tubular injury is described for mannitol, immunoglobu- lins, dextrans, and starches [76]. This mechanism is generally pH-dependent and is described for antibiotics such as sulfonamides and triamterene and for antiviral agents such as acyclovir and indinavir [76]. Chemotherapeutic agents causing tumor lysis syndrome may cause precipitation of uric acid and calcium phosphate crystals. Rhabdomyolysis can be elicited by a great number of drugs and may induce tubular obstruction by causing intratubular myoglobin precipitation [83]. Urinary obstruc- tion can also be caused by substances inducing retroperitoneal fibrosis, such as dopamine agonists and derivatives of ergot alkaloids such as ergotamine [84 ]. Acute interstitial nephritis is most commonly induced by a non-dose- dependent allergic response to a drug or toxic substance: the substance elic- its the production of antibodies against components of the tubular basement membrane, either by acting as a haptene or by mimicking an antigen normally present in the basement membrane. Most severe renal injury occurs in patients with a baseline hazard such as chronic kidney disease or diabetes mellitus in combination with inflammatory or ischemic injury and nephrotoxin exposure. Prevention is therefore of paramount importance, and insight into the pathogenesis is essential to the development of appropriate interventions. Unfortunately, despite a wealth of experimental evidence in animal models, there are so far no specific therapeutic interventions in humans, beyond avoidance of hemodynamic instability, minimization of nephrotoxin exposure, and best sup- portive care. Key Notes • Etiologic factors for the development of acute kidney injury are ischemia and reperfusion, inflammation, and toxic injury. Acute renal failure in critically ill patients: a multina- tional, multicenter study. Renal blood flow and function during recovery from experimental septic acute kidney injury. Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury. Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C. Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Measurement of renal blood flow by phase-contrast magnetic resonance imaging during septic acute kidney injury: a pilot investigation. Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function.

In a group of postmenopausal women discount 100mg clomiphene otc women's health center uga, supplementation with 250 to 750 mg per day of magnesium for 6 months followed by 250 mg per day for 6 to 18 months resulted in an increase in bone density in 71% of the women buy clomiphene 50mg with amex menstrual dysphoric disorder. Low zinc levels have been found in the serum and bone in people with osteoporosis. Manganese also stimulates the production of important compounds in the collagen matrix that provides a framework for the mineralization process. In animals, silicon-deficient diets have produced abnormal skull development and growth retardation,118 and supplemental silicon partially prevented bone loss in female rats that had their ovaries removed. Folic Acid, Vitamin B6, and Vitamin B12 Accelerated bone loss in menopausal women may in part be due to increased levels of homocysteine, a breakdown product of methionine that will be elevated if folic acid, vitamin B6, or vitamin B12 levels are insufficient. Homocysteine has the potential to promote osteoporosis if it is not eliminated adequately. In a prospective study, women with high homocysteine levels had almost twice as high a risk of nonvertebral osteoporotic fractures as women with low homocysteine levels. Restoration of the proper status of these B vitamins will bring elevated homocysteine levels down. Deficiencies of at least one of these nutrients are common in postmenopausal women. Vitamin C Vitamin C promotes the formation and cross-linking of some of the structural proteins in bone. Animal studies have shown that vitamin C deficiency can cause osteoporosis,122 and it has been known for decades that scurvy, a disease caused by vitamin C deficiency, is also associated with abnormalities of bone. Vitamin K Vitamin K, as discussed above, is required for the production of the bone protein osteocalcin, a key component in the matrix of bone. Studies of the effects of vitamin K supplementation on bone health have produced mixed results. Strontium Strontium is a nonradioactive earth element physically and chemically similar to calcium. Strontium ranelate is the specific strontium salt used in clinical trials for osteoporosis, but this form of strontium is not available in the United States. In a two-year trial, 353 postmenopausal women with osteoporosis and a history of at least one vertebral fracture received a placebo or one of three different doses of strontium: 170 mg per day, 340 mg per day, or 680 mg per day. In addition, since there are potential adverse effects with strontium, including rickets, bone mineralization defects, and interference with vitamin D metabolism, it makes sense to use the lowest dosage possible. There are many questions to be answered about strontium, including whether strontium chloride (the most common form of strontium used in U. Until these questions are answered, our advice is to consider supplementation with any strontium salt only as a last resort for elderly women who are at extremely high risk for fractures or who have a significant history of fractures. Ipriflavone Ipriflavone is a semisynthetic isoflavonoid, similar in structure to soy isoflavones, that has been approved in Japan, Hungary, and Italy for the treatment and prevention of osteoporosis. The compound, ipriflavone, has shown impressive results in a number of clinical studies. For example, in one study, ipriflavone (200 mg three times per day) increased bone density measurements by 2% and 5. Given the protective effect of soy isoflavones against breast cancer, the regular consumption of soy foods is encouraged. The mechanism of action appears to involve the enhancement of the effect of calcitonin on calcium metabolism (see above), as ipriflavone exerts no estrogen-like effects.

If you choose to use ipriflavone buy 25 mg clomiphene otc womens health consultants ob gyn, monitor blood lymphocyte levels on a quarterly basis to detect any adverse effect buy clomiphene 25 mg line women's health clinic yakima wa. Botanical Medicines Green Tea Population-based studies as well as experimental studies have demonstrated that consumption of green tea (Camellia sinensis) may offer significant protection against osteoporosis. In order to take advantage of this protection you need to drink three to five cups per day, providing a minimum of 250 mg per day of polyphenols (also referred to as catechins); alternatively, take a green tea extract providing the same level of polyphenols. In the experimental studies, the basic mechanism of green tea polyphenols was to impair bone resorption while at the same time stimulating osteoblast activity. The risk of developing osteoporosis may be reduced by optimizing peak bone mass in the younger years and minimizing subsequent bone loss with aging. In order to maximize peak bone mass (even in the context of hereditary and other nonmodifiable risk factors), a healthful lifestyle, proper nutrition, and moderate exercise should begin during childhood and adolescence and continue into adulthood. For women (and men) who have already been diagnosed with osteoporosis, drug therapies can serve as a short-term adjunct to the recommendations in this chapter if required. But there is no question that the nutritional and lifestyle factors recommended here should serve as the primary approach to slow bone loss and decrease the risk of fractures. Lifestyle • Weight-bearing exercise four times a week plus strength training two or more times a week • Fewer than seven alcoholic drinks per week; no more than two per day • Avoidance of smoking and secondhand smoke Diet The guidelines discussed in the chapter “A Health-Promoting Diet” are very much indicated in helping to build strong healthy bones. A key area of attention is getting adequate protein, soy isoflavones, and green leafy vegetables each day while limiting the intake of factors that promote calcium excretion, such as salt, sugar, excessive protein, and soft drinks. Parkinson’s disease affects more than 7 million people worldwide and at least 1 million in the United States, where about 50,000 new cases are reported annually. The average age of onset is approximately 60 and the prevalence increases with age. The damaged cells are the ones needed to produce the neurotransmitter called dopamine. In the early stages the tremors are more apparent while the person is at rest, such as while sitting or standing, and are less noticeable when the hand or limb is being used. A typical early symptom of Parkinson’s disease is “pill rolling,” in which the person appears to be rolling a pill back and forth between the fingers. In many cases, the disease causes a permanent rigid, stooped posture and an unblinking, fixed expression. Many of the underlying issues in Parkinson’s disease are discussed in the chapter “A Cellular Approach to Health,” and that chapter also provides a deeper understanding of the preventive and therapeutic strategies that are important in Parkinson’s disease. The first biochemical abnormality in Parkinson’s disease is a decrease in the level of glutathione, the brain cell’s primary antioxidant. Low glutathione makes the cells more susceptible to oxidative damage, such as that caused by environmental toxins. Population-based studies and animal experimental models have identified an association between Parkinson’s disease and a number of environmental factors, including living in a rural area, farming, drinking well water, exposure to pesticides, and long-term occupational exposure to copper, iron, lead, and manganese. In other words, it may be the total load of neurotoxins—instead of any single agent—that matters in the development of Parkinson’s. What all of these environmental toxins have in common is that they cause depletion of glutathione and disruption of the mitochondrial function. By the time Parkinson’s disease is typically diagnosed, more than 50% of the substantia nigra has been destroyed. Therapeutic Considerations At this point in time, Parkinson’s disease is best treated with drug therapy along with key dietary, nutritional, and herbal recommendations to address the underlying disease process and/or enhance the effectiveness of drug therapy. The most popular drug used in Parkinson’s disease is Sinemet, which contains two key ingredients: levodopa and carbidopa. Levodopa, or L-dopa, is the “middle step” in the conversion of the amino acid tyrosine into dopamine. Carbidopa is a drug that works by ensuring that more L-dopa is converted to dopamine within the brain, where it is needed, and not within the other tissues of the body.

Effects of boswellic acids extracted from a herbal medicine on the biosynthesis of leukotrienes and the course of experimental autoimmune encephalomyelitis buy clomiphene 100mg cheap obama vs romney women's health issues. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study buy clomiphene 50 mg online womens health day. Effectiveness of acupressure in improving dyspnoea in chronic obstructive pulmonary disease. Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children—United States, 2003 and 2007. The genetics of attention-deficit/hyperactivity disorder: a literature review of 2005. Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults. Potential adverse effects of amphetamine treatment on brain and behavior: a review. Meta-analysis of suicide-related behavior events in patients treated with atomoxetine. Journal of the American Academy of Child and Adolescent Psychiatry 2008 Feb; 47(2): 209–218. Further evidence of an association between attention-deficit/hyperactivity disorder and cigarette smoking: findings from a high-risk sample of siblings. Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Lead, attention, and impulsive behavior: changes in a fixed-ratio waiting-for-reward paradigm. Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Organophosphorus pesticide exposure of urban and suburban preschool children with organic and conventional diets. The Feingold diet: an assessment of the reviews by Mattes, by Kavale and Forness and others. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry 2011 Oct; 50(10): 991–1000. The impact of polyunsaturated fatty acids in reducing child attention deficit and hyperactivity disorders. Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect. Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Food allergy in children with hyperactivity, learning disabilities and/or minimal brain dysfunction. Foods and food additives are common causes of the attention deficit hyperactivity disorder in children. Topographic mapping of brain electrical activity in children with food- induced attention deficit hyperkinetic disorder. Parental report of sleep problems in children with attentional and learning disorders.