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By: Jin Hui Joo, M.A., M.D.

  • Assistant Professor of Psychiatry and Behavioral Sciences

https://www.hopkinsmedicine.org/profiles/results/directory/profile/4516813/jin-hui-joo

Prevalence of and risk factors for gallbladder polyps detected by ultrasonography among healthy Chinese: analysis of 34 669 cases gastritis diet 0 carbs cheap 40 mg nexium visa. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review jenis diet gastritis buy generic nexium 40 mg on-line. The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans gastritis diet order 20 mg nexium with amex. Cross-calibration of eightpolar bioelectrical impedance analysis vs dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21-82 years gastritis diet generic nexium 20 mg. Prevalence of sarcopenia and sarcopenic obesity in the Korean population based on the Fourth Korean National Health and Nutritional Examination Surveys. Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis. Estimation of Skeletal Muscle Mass and Visceral Adipose Tissue Volume by a Single Magnetic Resonance Imaging Slice in Healthy Elderly Adults. Association of lower limb muscle mass and energy expenditure with visceral fat mass in healthy men. Analysis of risk factors for polypoid lesions of gallbladder among health examinees. Prevalences of and risk factors for biliary stones and gallbladder polyps in a large Chinese population. Accuracy of segmental multi-frequency bioelectrical impedance analysis for assessing whole-body and appendicular fat mass and lean soft tissue mass in frail women aged 75 years and older. Comparison of Abdominal Visceral Adipose Tissue Area Measured by Computed Tomography with That Estimated by Bioelectrical Impedance Analysis Method in Korean Subjects. Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population. Fatty liver and gallbladder polyps 34 Ida S, Watanabe M, Yoshida N, Baba Y, Umezaki N, Harada K, Karashima R, Imamura Y, Iwagami S, Baba H. Sarcopenia is a Predictor of Postoperative Respiratory Complications in Patients with Esophageal Cancer. Practice guidelines for the diagnosis and management of nonalcoholic fatty liver disease. There is also greater access and availability of immunosuppressive and biological agents, which increase the risk of opportunistic infection despite improving the quality of life and promoting mucosal healing. Tuberculosis in inflammatory bowel disease study design, manuscript revision, supervision of the study and full access to all of the data in the study, responsible for the integrity of the data. Key Words: Inflammatory bowel disease; Therapy; Tumor necrosis factor alpha; Relative risk; Tuberculosis; Latent tuberculosis ©The Author(s) 2020. Institutional review board statement: the Roberto Santos General Hospital Research Ethics Committee approved this research under the opinion number 1935. Informed consent statement: All study participants identities were anonymized and details that might disclose their identities were omitted. Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author atraquelrocha2@yahoo. Core Tip: We evaluated the relative risk of developing active tuberculosis in patients receiving treatment for inflammatory bowel disease. A total of 301 patients with inflammatory bowel disease were evaluated, and an interview was conducted using a standard questionnaire and a review of the medical record. We identified the treatment during the diagnosis of active tuberculosis and the screening and past treatment for latent tuberculosis. Active tuberculosis in inflammatory bowel disease patients under treatment from an endemic area in Latin America. However, the number of cases is increasing in Latin American countries, including Brazil. A recent systematic review of studies in Latin America and the Caribbean showed an increased incidence in Brazil from 0. The airway is a gateway for the bacilli, which translocate to the respiratory tract after inhalation, where it finds the macrophage alveoli[12]. These granulomas are essential for the control of Mbt, but they also provide an environment for the survival, multiplication, latency and dissemination of Mbt[16]. A standardized questionnaire was used for each patient under direct interviews and a review of medical charts. The Roberto Santos General Hospital Research Ethics Committee approved this research under the opinion number 1935. However, the Ministry of Health changed the treatment of latent tuberculosis in March 2020 to rifapentine associated with isoniazid, with a weekly dose for 3 mo[23].

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Prudent management of patients on zonisamide should include adequate hydration to gastritis diet effective nexium 40 mg maintain good urine flow gastritis symptoms back order nexium with amex. Rash was the predominant allergic type reaction reported gastritis diet 5 meals order nexium once a day, with at least four individuals (one with Stevens­Johnson syndrome) in these studies being discontinued due to gastritis diet dairy discount 40mg nexium otc dermatologic reactions. Because zonisamide is chemically related to sulfonamide drugs, caution should be taken when using zonisamide in patients who note a prior allergic reaction to these agents. The exact cross-reactivity in patients known to be allergic to sulfonamides has not been determined. Oligohidrosis can occur with zonisamide, and is marked by decreased sweating and hyperthermia. Postmarketing surveillance indicates that oligohidrosis occurs primarily in children, with all reported cases in individuals 18 years of age. The estimated rate of incidence is approximately 12 cases per 10,000 patient-years (79). When zonisamide is used in children, parents should be instructed to carefully monitor for decreased sweating and increased body temperature. Children on zonisamide should not be exposed for prolonged periods of time to extreme heat. Individuals with impaired pulmonary or renal function are especially at risk for this side effect, and serum electrolytes should be monitored. Zonisamide doses were calculated to maintain plasma concentrations of 15 to 40 g/mL, and a battery of neuropsychological tests were administered prior to starting and after 12 weeks of zonisamide therapy. When plasma concentrations of zonisamide exceeded 30 g/mL the acquisition and consolidation of new information, especially verbal learning, were impaired. There were significantly more men than women with psychosis, and this group was younger than the general population of patients with epilepsy. Hirai and colleagues reported on 27 children in a prospective clinical trial of zonisamide monotherapy and two displayed behavioral disturbances (82). One child presented with selective mutism and the other child developed obsessive­compulsive disorder. It is difficult to truly assess the incidence of these effects, because none of the reports accounted for the number of individuals taking zonisamide. Chapter 59: Zonisamide 729 Few data are available on the teratogenic effects of zonisamide. Only two women exposed to zonisamide during pregnancy bore children with major malformations. Zonisamide has been used in a variety of age groups, seizure types, and as monotherapy. The adverse effect and pharmacokinetic profile of zonisamide is favorable with few severe adverse effects reported and a long half-life that allows once-daily dosing. Individuals who are concerned about weight gain or desire to lose weight may benefit from zonisamide therapy. Care should be exercised when using zonisamide in patients with a history of renal calculi and true sulfa allergies. However, these items do not constitute absolute contraindications to zonisamide use. Zonisamide has been used safely and effectively in pediatrics, but children need to be monitored carefully for oligohidrosis. Zonisamide blocks T-type calcium channel in cultured neurons of rat cerebral cortex. Interaction between Ca2, K, carbamazepine and zonisamide on hippocampal extracellular glutamate monitored with a microdialysis electrode. Inhibitory effects of the antiepileptic drug ethosuximide on G protein-activated inwardly rectifying K channels. Zonisamide: electrophysiological and metabolic changes in kainic acid-induced limbic seizures in rats. Regional accumulation of 14C-zonisamide in rat brain during kainic acid-induced limbic seizures. Protective effect of zonisamide, an antiepileptic drug, against transient focal cerebral ischemia with middle cerebral artery occlusion-reperfusion in rats. Rat liver microsomal cytochrome P-450 responsible for reductive metabolism of zonisamide. Pharmacokinetics of zonisamide; saturable distribution into human and rat erythrocytes and into rat brain. Binding of sulfonamides to erythrocyte proteins and possible drug-drug interaction. Steady-state pharmacokinetics of zonisamide, an antiepileptic agent for treatment of refractory complex partial seizures.

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The irritative zone does not always necessarily overlap with the epileptogenic zone (34 gastritis diet 4 believers buy nexium uk,36 gastritis diet x1 order 20mg nexium fast delivery,37) gastritis diet generic 20mg nexium fast delivery. This patient may have interictal left occipital discharges that disappear after tumor resection gastritis rare symptoms order generic nexium from india. The Epileptic Lesion the epileptic lesion is a lesion on neuroimaging or pathology that is considered to cause the seizures. Tumors and vascular malformations often have a perilesional epileptogenic zone that is responsible for seizure generation. In other cases, even a partial lesion resection limited by eloquent cortex may render a patient seizure-free. However, history and other investigations may suggest that frequently only one tuber is the epileptic lesion. The Symptomatogenic Zone the symptomatogenic zone is the eloquent area that produces the clinical symptoms when activated during an epileptic seizure. The seizure may start in a clinically silent area and then propagate into eloquent cortical areas. Therefore, the symptomatogenic zone is frequently close to the epileptogenic zone but there may be no direct overlap. The epileptogenic zone is "the area of cortex indispensable for the generation of clinical seizures" (31). The ictal-onset zone is a smaller region within the epileptogenic zone where seizures are generated. The irritative zone is the region that produces interictal epileptiform discharges. This is a lesion on neuroimaging or pathology that is considered to cause the seizures. The symptomatogenic zone is the eloquent area overlapping with the epileptogenic zone that produces the clinical symptoms when activated during an epileptic seizure. The functional deficit zone is the region that functions abnormally during the interictal period. Eloquent cortex is important for generating particular functions, including motor, sensory, language, memory, and other higher cortical functions. In this example, only some motor cortex, somatosensory cortex, visual cortex, and language areas are depicted. The goal of epilepsy surgery is to remove the epileptogenic zone, while at the same time preserving eloquent areas. The Functional Deficit Zone the functional deficit zone is the region that functions abnormally during the interictal period. The functional deficit may be related to interictal epileptiform discharges or to an underlying structural lesion. The functional deficit zone may also be related to functional abnormalities, without structural abnormalities. These authors concluded that interictal epileptiform discharges and seizure spread may influence speech reorganization (46). Binnie showed that frequent interictal spike discharges can lead to impairment during neu- ropsychological testing (44). A "secondary" ictal-onset zone is a different cortical region that is dependent on the primary ictal-onset zone. It is associated with a network of seizure propagation and has potential epileptogenic properties. However, this secondary epileptic focus may disappear after removal of the primary focus. At times, it may also be "independent," and present as a new epileptic focus (47,48). Patients with a prolonged history of seizures before epilepsy surgery have a poorer seizure outcome after resection of the primary focus when compared to individuals with a shorter history of seizures (49). This suggests that secondary epileptogenesis at sites located elsewhere in the brain may develop with persistence of uncontrolled seizures (49). Therefore, it is important to identify the ictalonset zone as well as the associated "epileptic network. Ictal-onset Chapter 72: the Epileptogenic Zone 821 zone and potential ictal-onset zone are part of the epileptogenic zone. History Taking Taking a history may assist in the delineation of the symptomatogenic zone and functional deficit zone, and therefore provides additional information on the potentially adjacent epileptogenic zone. Detailed descriptions of the seizures by the patient and ideally also by a witness of the events are necessary. Clinical features, such as potential triggers, timing and diurnal patterns, warning including auras and prodromes, and sequence of clinical seizure presentation including motor features, loss of consciousness, secondary generalization, and lateralizing signs provide important clues to determine the symptomatogenic zone (Table 72. Clues to etiology can also be provided by ante- and perinatal history, past medical history (including history of head trauma or infections and history of neonatal or febrile seizures), and developmental history. Family history can add important information, especially in the diagnosis of genetic forms of epilepsy or certain epilepsy syndromes.

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The long-term efficacy (after the eighth week of treatment) of the kava extract was superior to gastritis and gas buy cheap nexium on line that of placebo gastritis diet soy milk generic 40 mg nexium visa. In addition gastritis nsaids generic 40 mg nexium overnight delivery, kava extract was not associated with depressed cognitive function gastritis etiology order nexium without prescription, drowsiness, or impairment in mental reaction time, problems found in the side-effect profile of benzodiazepines. In this regard, a drug interaction between kava and the benzodiazapine alprazolam that caused a semicomatose state in a patient has been reported. However, in May 2005, the German government repealed the ban on kava products, pending evaluation of new data. An article by Anke and Ramzan in 2004 reviewed the kava hapatotoxicity controversy and summarized the major theories advanced to explain the case reports of liver failure but reached no satisfactory conclusion. Harmala-type indole alkaloids, including harman, harmine, harmaline, and harmalol, have been reported in subtherapeutic amounts (up to 0. These and related activities could not be attributed to the flavonoids or the alkaloids in the extract. Hops Another popular herbal sleep aid is hops, the dried strobile with its glandular trichomes of Humulus lupulus L. The herb contains about 15­30 percent of a resin that accounts for its bitter taste and for its well-established use as a preservative in the brewing of beer. On the other hand, the sedative properties of hops are not well established, and much misinformation exists in the literature. However, a single effective dose of methylbutenol would require all of that compound contained in 150 g of hops. Modern scientific investigations have generally employed ethanolic extracts of macerated plant material, filtered and evaporated to dryness under vacuum. The Bacopa preparation significantly reduced anxiety as well as improved mental performance, concentration and immediate memory; also noted was a reduction in mental fatigue, a general feeling of well-being, improved sleep quality and appetite, and increased body weight. A Bacopa extract, standardized to 25 percent bacoside A, exerted anxiolytic activity comparable to Lorazepam, a common benzodiazepine anxiolytic drug, but without the amnesic side effect associated with the pharmaceutical; rather, it had a memory-enhancing influence. Traditionally, extracts of the plant have been used topically and internally for wound healing and treating leprosy. Since the nineteenth century, the plant and its extracts have been recommended in India for skin conditions associated with eczema, lupus, and psoriasis and for varicose ulcers. The active principles are viewed as triterpenoids, mainly asiatic acid, madecassic acid, asiaticoside, and medacassoside. Antidepressant activity was also indicated and an analgesic effect demonstrated, along with a reduction in the adrenocortical response. Forty healthy subjects (twenty-one men and nineteen women), aged eighteen to forty-five years, were administered orally a single 12-g dose of powdered dried leaf mixed in 300 mL of grape juice (n = 20) or 300 mL of plain grape juice (n = 20) matched for color, taste, and smell. The startle response was statistically significantly lower thirty and sixty minutes after ingestion of gotu kola as compared to placebo, with an affect size of 0. There was no difference between placebo and treatment at baseline and at later times, as was the case with heart rate, blood pressure, and mood response, except for self-rated energy level. The effect of different extracts on cognition and markers of oxidative stress in rats has been studied. Only the aqueous extract of whole plant (200 mg/kg for fourteen days) showed an improvement in learning and memory in both shuttle box and step-through paradigms; the indication was that an antioxidant mechanism was involved. One interesting double-blinded clinical trial in India in 1977 observed a significant enhancement of mental abilities in thirty "developmentally disabled" children (seven girls and twenty-three boys, aged seven to eighteen years) treated with a gotu kola preparation. After six months, the children exhibited better overall adjustment, were more attentive, and were better able to concentrate on assigned tasks. That organization had used a new genetically engineered bacterium to produce the l-Tryptophan and had also modified the customary purification procedure. One contaminant has now been identified as 1,1i-ethylidenebis(l-Tryptophan); another was found to be 3-(phenylamino)-l-alanine. Certainly, additional research into the safety and efficacy of pure l-Tryptophan as a potentially valuable therapeutic agent is needed. Until the time when safety of the marketed product can be ensured, the consumption of manufactured l-Tryptophan in any form must be avoided. Melatonin Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced in the pineal gland of all mammalian species and for commercial purposes by chemical synthesis. In humans, melatonin synthesis and secretion are increased during the dark period of the day and maintained at low levels during the daylight hours. The retina of the eye is connected to the pineal gland via a multineuronal pathway that involves the suprachiasmatic nucleus of the hypothalamus and then by preganglionic neurons in the upper thoracic spinal cord that innervate the superior cervical ganglia-the site of origin of the postganglionic sympathetic neurons that secrete norepinephrine. Nocturnal melatonin levels are highest in early childhood, drop through adolescence, remain fairly constant until late adult life, and then show a decline. This impairment in melatonin production may contribute to the increased frequency of sleep disorders in the elderly, and melatonin replacement therapy may be effective in improving sleep quality in this population. A limited study investigating the effect of a 2-mg controlledrelease formulation of melatonin on sleep quality over three weeks in twenty-three elderly subjects who complained of insomnia found that sleep efficiency was significantly greater after melatonin than after placebo and wake time after sleep onset was significantly shorter. Either dose given at any of the three time points decreased sleep onset latency and latency to stage 2 sleep.

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Long-term follow-up studies demonstrated sustained efficacy of gabapentin (75­80) gastritis nuts order generic nexium on-line. Tolerability was generally good diet gastritis adalah nexium 20mg free shipping, with the majority of side effects occurring at doses 1800 mg/day (66) gastritis y sintomas purchase nexium 20 mg with amex, often being self-limited and mild to gastritis symptoms patient.co.uk generic nexium 40mg line moderate in intensity. Monotherapy Trials Gabapentin does not have an indication for use in monotherapy in the United States. Reduction to monotherapy with gabapentin involved 275 outpatients with refractory partial and generalized tonic­clonic seizures (31). After an 8-week baseline, gabapentin was titrated to 600, 1200, or 2400 mg/day, and other medications were discontinued over 8 weeks. Although 15% to 26% converted successfully to monotherapy, there was no significant difference among the three doses. In the open-label extension, some patients taking 4800 mg/day were able to remain on monotherapy with gabapentin (82). Gabapentin therapy was associated with improved cognitive function, mood, and psychosocial adjustment in this dose-controlled study without a placebo group (82,86). A randomized, placebo-controlled monotherapy study lasting 8 days compared gabapentin 300 mg/day with gabapentin 3600 mg/day in 82 hospitalized patients whose other medications had been stopped during video monitoring for diagnostic purposes or presurgical evaluation (32). Rapid titration to 3600 mg/day was well tolerated and no patient discontinued because of side effects. Seventeen percent of the group randomized to 300 mg/day and 53% of those randomized to 3600 mg/day completed the 8-day study (P 0. Brief inpatient trials lend insight into the short-term tolerability and efficacy of a medication, but they do not provide evidence for long-term effectiveness. In the first trial, Chadwick and associates randomized 292 patients with newly diagnosed and previously untreated partial epilepsy to monotherapy with gabapentin (300, 900, or 1800 mg/day; blinded arms) or carbamazepine (600 mg/day; open-label treatment) for 6 months (83). Roughly equal percentages of patients taking gabapentin 900 or 1800 mg/day and carbamazepine 600 mg/day remained in the study at 6 months. Time to exit based on worsening seizures was significantly longer in patients receiving gabapentin 900 or 1800 mg/day, compared with those receiving gabapentin 300 mg/day. Study withdrawal rates because of adverse events were higher for patients receiving carbamazepine. These results suggest a role for gabapentin monotherapy in the newly diagnosed patient with infrequent seizures. In the second double-blind, randomized, comparative trial, Brodie and colleagues (84) evaluated gabapentin and lamotrigine in a group of newly diagnosed patients with partial and/or generalized tonic­clonic seizures (N 309). Patients were titrated to gabapentin doses between 1800 and 3600 mg/day, or lamotrigine up to 300 mg/day. By study end (30 weeks), there was no significant difference in time to exit, proportion of patients that were seizure free, or time to first seizure, indicating that gabapentin was comparable to lamotrigine in this population. The majority of patients randomized to the gabapentin arm who completed the study were receiving 1800 mg/day (74. Similar proportions of patients in both study arms withdrew as result of adverse events. The most common adverse events reported in this study were dizziness, asthenia, and headache. Patients were randomized to receive monotherapy with lamotrigine (N 200, target dose 150 mg/day); gabapentin (N 195, target dose 1500 mg/ day, highest dose 3600 mg/day); or carbamazepine (N 198, target dose 600 mg/day). The difference between lamotrigine and gabapentin for this endpoint did not reach statistical significance. Although carbamazepine was the most efficacious agent, discontinuation rates were significantly higher in carbamazepine-treated versus gabapentin-treated patients. Patients with porphyria have been seizure free or nearly so with gabapentin monotherapy (86­88). In one study, refractory generalized tonic­clonic, but not absence or myoclonic, seizures responded to gabapentin, but the results were not statistically significant compared with the placebo group (89). Pediatric Trials A study of benign rolandic epilepsy with centrotemporal spikes demonstrated the efficacy of gabapentin over placebo (90). Gabapentin has been studied as add-on therapy for refractory partial seizures (91­94). Appleton and colleagues (92) conducted a large, 12-week, double-blind, placebocontrolled trial of gabapentin (25 to 35 mg/kg/day) as adjunctive treatment for 247 patients aged 3 to 12 years with refractory partial seizures. The median frequency of seizures was reduced by 35% for complex partial seizures and by 28% for secondarily generalized seizures. Five percent of gabapentin-treated patients withdrew from the study because of adverse events. The safety and tolerability of 24 and 70 mg/kg/day of gabapentin were also noted in a smaller study involving 52 children (2 to 17 years of age) with refractory partial seizures (93).

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References:

  • http://www.fao.org/3/a0443e/a0443e.pdf
  • https://archives.drugabuse.gov/sites/default/files/monograph149.pdf
  • https://mn.gov/mnddc/parallels2/pdf/70s/72/72-COF-NIO.pdf

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