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1.
Thorax ; 60: 977-978, 2005.
Artigo em Inglês | MedCarib | ID: med-17409

RESUMO

Chronic obstructive pulmonary disease (COPD) is arguably the most common chronic disease of the lungs at present and, by 2020, it will be the third leading cause of death worldwide. COPD is associated with a relentless decline in forced expiratory volume in 1 second (FEV1) and, in the later stages, the condition progresses to pulmonary hypertension and hypoxic respiratory failure. Because so few interventions have been shown to affect mortality and FEV1 decline in COPD, two further outcomes have been studied arising from the observed close association between exacerbation frequency and health related quality of life. In the ISOLDE study (Inhaled corticosteroids in Obstructive Lung Disease in Europe), inhaled corticosteroids were shown to slow the decline in health status over time and also to decrease exacerbation frequency. Further statistical modelling has shown that the effect of inhaled corticosteroids on quality of life is largely due to their effect on exacerbation frequency. Recent studies have closed the loop between exacerbation frequency, mortality, and lung function decline by showing that patients with a history of frequent exacerbations have an accelerated decline in FEV1 and increased mortality from COPD. From these data one would therefore expect that interventions that reduce COPD exacerbations would also reduce COPD mortality.


Assuntos
Humanos , Corticosteroides/administração & dosagem , Corticosteroides/farmacologia , Corticosteroides/fisiologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/mortalidade
2.
Chest ; 121(6): 1833-1840, Jun. 2002. tab
Artigo em Inglês | MedCarib | ID: med-17666

RESUMO

STUDY OBJECTIVES: Following the development of the Caribbean Guidelines for Asthma Care, we examined the utilization of inhaled medications in asthmatic patients in Trinidad, West Indies. SETTING: Chest Clinic, Ministry of Health, Trinidad. PARTICIPANTS: Physician-diagnosed asthmatic patients who attended the Chest Clinic between July 1998 and August 2000. MEASUREMENTS AND RESULTS: A consecutive sample of patients who were > 7 years of age (n = 402) was interviewed about compliance with, understanding of, and use of inhaler medication. The inhaler technique of these patients was directly observed. Inhaled steroid therapy was prescribed in 83% of patients but were prescribed the least in elderly patients (63%) and children (62%). Salbutamol was prescribed in 98% of patients, and ipratropium and sodium cromoglycate were selectively prescribed in elderly men and children, respectively. Only 33% of patients used the inhaler correctly, and children and the elderly were the least efficient in its use. The use of a spacer device was advised in 19% of patients, including only 6% of the elderly patients. Explanations for different inhaler therapies were given to 62% of patients, and 53% of patients could describe these reasons. The reported 40% noncompliance rate among patients in the sample was primarily a result of long waiting periods at the pharmacy (58%) and the personal cost incurred on purchasing the medication (52%). CONCLUSIONS: Educating patients, with a focus on children and the elderly, in inhaler techniques and reinforcing understanding of asthma medications can improve asthma management in Trinidad. Asthma caregivers in the Caribbean should ensure the appropriate dissemination of the guidelines and should outline strategies for their implementation.


Assuntos
Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Humanos , Asma , Corticosteroides , Albuterol , Nebulizadores e Vaporizadores , Trinidad e Tobago , Região do Caribe
3.
West Indian med. j ; 48(Suppl. 3): 18, July 1999.
Artigo em Inglês | MedCarib | ID: med-1544

RESUMO

This presentation will review the different treatments of uveitis. The use of corticosteroids, immunosuppressive medications and the upcoming newer modalities for treatment will be reviewed. The discoveries of the different types of immune reactions, the T helper subset functions (Th1 and Th2), the understanding of ACAID (anterior chamber associated immune deviation), the identification of the intraocular immune cell types, and the role of cytokines in the pathogenesis of inflammation, result in a better understanding of autoimmune diseases such as non-infectious uveitis. This improved understanding has allowed the development of new experimental uveitis treatments that may become the standard of care. For example, processing of specific antigens in the gut was demonstrated to induce tolerance by the release of suppressor cytokines like tumour growth factor-B, interleukin (IL)-4 and IL10. Therapeutic approaches like immune modulation with interferon, the use of soluble tumour necrosis factor receptor, anti-Tac, monoclonal antibodies against cell adhesion molecules, and antisense therapies are becoming useful in the treatment of severe uveitis. Intervitreal sustained release devices for the delivery of drugs like corticosteroids, cyclosporins and other immunosuppressive medications will soon become commercially availble. Gene somatic therapy appears another promising therapeutic approach. The use of viral and non viral vectors, and the host immune response against modifies adenoviruses, are solved.(AU)


Assuntos
Uveíte/terapia , Imunossupressores/uso terapêutico , Corticosteroides/uso terapêutico , Terapia Genética
4.
West Indian med. j ; 47(suppl. 2): 21, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1917

RESUMO

The National Heart, Lung and Blood Institute, NIH, USA, in collaboration with the Global Initiative for Asthma, has published guidelines for the prevention and management of asthma. In May 1997, the Commonwealth Caribbean Medical Research Council (CCMRC) organised a regional workshop to modify these guidelines to suit local Caribbean conditions. Both guidelines clearly emphasize the use of corticosteroids in the management of acute exacerbations of asthma. The aim of this retrospective study was to quantify the use of corticosteroids in the management of acute exacerbations of asthma and thus assess the applicability of these guidelines in the Accident and Emergency (A & E) Department of the Port-of-Spain General Hospital. All acute exacerbations of asthma seen at the A & E Department, Port-of-Spain General Hospital in the period 1/1/97 to 30/6/97 were analysed. Results showed that asthma was the most common problem seen in the A & E Department, accounting for 10 percent of all admissions. An average of 45 percent of patients did not receive a corticosteroid as part of their treatment. Oral and parenteral corticosteroids were used equally, and PEF (peak expiratory flow) was seldom recorded. In conclusion, it is recommended that local guidelines developed by the CCMRC should be implemented in order to achieve better outcomes in a major Public Health problem.(AU)


Assuntos
Asma/tratamento farmacológico , Corticosteroides/uso terapêutico , Guias de Prática Clínica como Assunto
5.
Edinburgh; s.n; 1995. xi,273 p. ilus.
Tese em Inglês | MedCarib | ID: med-16540

RESUMO

Glucocorticoids are the most effective anti-inflammatory agents currently available, but a variety of adverse effects limit their clinical usefulness. This work explores further two facets of their interaction between glucocorticoids and the skin, with the aim of identifying means of reducing glucocorticoid toxicity. (a) Metabolism of glucocorticoids by skin: Human skin is active in the terminal metabolism of corticol to cortisone, but the biological implications of this process in skin are uncertain. BEcause there are technical difficulties in dealing with human skin, an animal model, the nude mouse, has been evaluated for its suitability to the study of the metabolism of corticosterone to IIB-dehydrocorticosterone (the homologous reaction in rodents of cortisol to cortisone conversion in man); a process mediated by IIB-hydroxysteroid dehydrogenase. (b) Skin vasoconstrictor response (blanching) to topical glucocorticoids: Glucocorticoids applied topically to human skin produce vasoconstriction in dermal vessels, the degree of which correlates closely with the potency and clinically efficacy of these compounds (AU)


Assuntos
Adulto , Animais , Humanos , Camundongos , Glucocorticoides/toxicidade , Glândulas Endócrinas/metabolismo , Glândulas Endócrinas/química , Corticosteroides , Testes Cutâneos/métodos , Vasoconstrição/efeitos dos fármacos , Vasoconstrição/fisiologia , Glucocorticoides/fisiologia , Glucocorticoides/história , Glucocorticoides/química
8.
West Indian med. j ; 37(suppl): 39, 1988.1988.
Artigo | MedCarib | ID: med-6596

RESUMO

Between October 1981 and February 1985, the relapse after acute typhoid fever, adequately treated with chloramphenicol (50 mg/Kg/day for 3 days, then 30 mg/Kg/day for 11 days), was 18 percent; this is twice the expected figure of 5-10 percent. On bacteriological confirmation of the diagnosis, adjuvant oral cortico-steroid was given to those cases whose symptoms were slow to resolve, as a tapering course of prednisolone over 5 days with an initial dose of 1 mg/Kg. All patients who relapsed had received cortiosteroids. From March 1985, adjuvant steroids were no longer given. Between March 1985 and September 1987, there were no relapses (p<0.01, Fisher's test). Convalescent carriage was commoner in the no-steroid group. Perhaps oral low-dose steroid converts potential convalescent carriage into relapse which can be a severe illness. Low-dose adjuvant steroids for prolonged "toxicity" in acute typhoid fever should be avoided (AU)


Assuntos
Humanos , Esteroides/diagnóstico , Febre Tifoide/complicações , Corticosteroides/uso terapêutico , Recidiva , Dominica
9.
West Indian med. j ; 34(2): 134-8, June 1985.
Artigo em Inglês | MedCarib | ID: med-11536

RESUMO

Three cases pulmonary nocardiosis in patients receiving corticosteroids are described. Early diagnosis and appropriate therapy produced a favourable response in one case compared with a fatal outcome in 2 patients where the diagnosis was delayed and dissemination had occurred. In none of these 3 cases was a clinical diagnosis of nocardiosis entertained, the organism being detected in each instance by the laboratory. Problems associated with the diagnosis and treatment of nocardiosis in patients recieving immuno-suppressive therapy are discussed (AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Humanos , Masculino , Feminino , Corticosteroides/uso terapêutico , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Jamaica
10.
West Indian med. j ; 30(1): 22-9, Mar. 1981.
Artigo em Inglês | MedCarib | ID: med-11358

RESUMO

Analysis of 98 cases of near-drowning seen at the Queen Elizabeth Hospital, Barbados, during the period 1970 - 1979 is presented. Most of the adults were tourists most of whom near-drowned during the winter season. School children comprised the majority of cases during the summer holidays. Alcohol intake prior to near-drowning was noted in 30 percent of adults, and tourists were particularly at risk of drinking and drowning. In the light of modern ideas on hospital management of near-drowning, close observation and respiratory support emerge as the cornerstones of management. The use of diuretics is inappropriate while antibiotics and corticosteroids have not been shown to be beneficial (AU)


Assuntos
Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Lactente , Afogamento/epidemiologia , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Afogamento/terapia , Barbados
11.
West Indian med. j ; 15(3): 128-33, Sept. 1966.
Artigo em Inglês | MedCarib | ID: med-10778

RESUMO

The normal range of plasma 11-hydroxycorticoid levels in coloured West Indians is defined, by a study of 87 subjects, as 7.1 to 30.2ug./100 ml. (mean 13.0 ug./100 ml.), with 91 percent of the values falling in the range 7.1 to 17.9 ug./100 ml. There is no difference with age, sex, socio-economic status, or as compared to white Europeans and Americans. The probable interpretations of these results are discussed (AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Corticosteroides/sangue , Jamaica , Índias Ocidentais
12.
Lancet ; 1(443): 911-2, Apr. 23 1966.
Artigo em Inglês | MedCarib | ID: med-14797

RESUMO

Descriptions of the pathology of the adrenal glands of severely malnourished children vary widely and it is equally difficult to draw any firm conclusions from studies of adrenal function in infantile malnutrition. We present here a preliminary report of experiments designed to investigate adrenocortical function in severely malnourished Jamaican children (AU)


Assuntos
Humanos , Lactente , Corticosteroides , Glândulas Suprarrenais/fisiopatologia , Distúrbios Nutricionais/fisiopatologia
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