Harry Snyder
 https://publichealth.berkeley.edu/people/harry-snyder/ The lesions include aortitis mood disorder unspecified icd 9 purchase cheapest abilify, aortic value regurgitation depression young males buy genuine abilify on line, aortic aneurysm depression test color buy abilify 5mg free shipping, and coronary artery ostia stenosis depression symptoms university students cheap 20 mg abilify amex. The proximal aorta affected shows a tree -barking appearance as a result of medial scarring and secondary atherosclerosis. Endartereritis and periaortitis of the vasa vasoum in the wall of the aorta, is responsible for aortic lesions and in time, this may dilate and form aneurysm and eventually rupture classically in the arch. Treponemas do not invade the placental tissue or the fetus until the fifth month of gestation (since immunologic competence only commences then) syphilis causes late abortion, still birth or death soon after delivery or It may persist in latent forms to become apparent only during childhood or adult life. In primary and secondary stages, the fetus is heavily infected and may die of hydrops in utero or shortly after birth. After maternal second stage, the effects of congenital syphilis are progressively less severe. Malaria Malaria is caused by the intracellular protozoan parasite called Plasmodium species and plasomodium Faliprium is the worldwide infections that affect 100 million people and kill 1 to 1. Falciparum): Infected humans produce gametocytes that mosquitoes acquire on feeding. Morphology: Spleen enlarged upto 1000gm (normally 150grams) and this splenomegaly can be attributed to increased phagocytosis in splenic reticuloendothelial cells in chronic malaria. Pigmented phagocytes may be dispersed through out bone marrow, lymph nodes, subcutaneous tissues and lungs. Hypoglycemia result from failure of hepatic gluconeogenesis & glucose consumption by the host and the parasite lactic acidosis -due to anaerobic glycolysis, non cardiogenic pulmonary edema, renal impairment, anemias etc 178 P. In other types of malaria only subpopulations of erythrocytes are parasitized, and thus low level parasitemias and more modest anemias occur. Malaria in pregnancy In pregnancy, malaria may be associated with hypoglycemia, fetal distress syndrome and low birth weight. Malaria in children Most of the estimated 1-3 million persons who die of falciparum malaria each year are young African children. Convulsion, coma, hypoglycemia, metabolic acidosis and severe anemia are relatively common. Transfusion malaria Malaria can be transmitted by blood transfusion, needle -stick injury, sharing of needles by infected drug addicts, or organ transplants. Leishmaniasis Definition: Chronic inflammatory disease of skin, mucous membranes or viscera caused by obligate intracellular Kinetoplastid protozoal parasites (Leishmania species) transmitted through infected sand fly. The lesions do not ulcerate but contain vast aggregates of foamy macrophages filled with leishmania. Schistosomiasis It is the most important helmenthic disease infecting 200 million people & killing 250,000 annually. Ghycocalyx that protect the organism from osmotic is shed but it activates complement by alternative pathway. Schistosoms migrate into peripheral vasculature transverse to the lung and little in the portal venous system where they develop into adult male and female schistosomes. Resistance to reinfection by schistosomes after treatment correlates with IgE levels whereas, eosinophile major basic proteins may destroy larvae schistsomula. Eggs release factors that stimulate lymphocytes to secrete a lymphokine that stimulate fibroblast proliferation and portal fibrosis the exuberant fibrosis which is out of proportion to the injury caused by the eggs and granucoma, occurs in 5% of persons infected with schistosomes and cause severe portal hypertension esophageal varicoses and ascites the hallmark of severe schistosomiasis. Japanicum) Colonic pseudopolyps Liver surface is bumpy and its cut section shows granuloma and wide spreading fibrous portal enlargement without distortion of the intervening parenchyma. When the urinary inflammation involves the ureteral orifices, it causes obstructive hydronephrosis and chronic pylonehphritis. Fungal Infections There are 100,000 known fungi and only few infect humans mostly opportunistically. Only few are involved in human diseases because most fungi are destroyed by cell-mediated immune responses however, humoral immunity plays little or no role. Predisposing factors for fungal infections include: Corticosteroid administration, acquired or congenital immunodeficiency states, defects in neutrophillic and macrophage functions Fungal infections are divided into superficial and deep fungal infections (mycosis). Candidiasis (Moniliasis) Normally found in mouth, skin and gastrointestinal tracts. These lesions may contain acute and chronic inflammations with micro abscesses but in their chronic states granulomatous inflammations may develop. Pathogenesis: Found in soil and droppings of birds (peogons): Three factors associated with virulence 1) Capsular polysaccharides 2) Resistant to killing by alveolar macrophages 3) Production of phenol oxidase, which consumes host epinephrine oxidase system. This enzyme consumes host epinephrines in the synthesis of fungal melanin thus, preventing the fungus from epinephrine oxidase system C. Morphology: Lung is the primary site of localization with minor or asymptomatic presentation; here solitary granulomatous lesions may appear. Pathogenesis: Aspargillus species have three toxins: Aflatoxin: Aspargillus species may grow on surfaces of peanuts and may be a major cause of cancer in Africa. Morphology: Colonizing Aspargilosis (Aspargiloma): It implies growth of fungus in pulmonary cavity with minimal or no invasion of the tissues. Morphology: Granulomatous inflammation with areas of solidifications that may liquefy subsequently. Viral tropism -in part caused by the binding of specific viral surface proteins to particular host cell surface receptor proteins. Definition amd Nomenclature Literally, neoplasia means new growth and technically, it is defined as abnormal mass of tissues the growth of which exceeds and persists in the same excessive manner after cessation of the stimulus, evoking the transformation. Nomenclature: Neoplasms are named based upon two factors on the histologic types: mesenchymal and epithelial on behavioral patterns: benign and malignant neoplasms Thus, the suffix -oma denotes a benign neoplasm. They arise from totipotential cells and so are principally encountered in ovary and testis. Differentiation and anaplasia Differentiation refers to the extent to which parenchymal cells resemble comparable normal cells both morphologically and functionally. Thus, well-differentiated tumours 191 cells resemble mature normal cells of tissue of origin. Malignant neoplasms in contrast, range from well differentiated, moderately differentiated to poorly differentiate types. Tumour giant cells and frequent loss of polarity of epithelial arrangements are encountered. Thyroid, adrenal) so also, well differentiated squamous cell carcinoma and well differentiated hepatocellular carcinomas produce keratine and bile respectively. Rate of growth Most benign tumours grow slowly whereas; most malignant tumours grow rapidly sometimes, at erratic pace. Some benign tumours for example uterine leiomyoma increase in size during pregnancy due to probably steroidal effects (estrogen) and regress in menopause. In general, the growth rate of neoplasms correlate with their level of differentiation and thus, most malignant neoplasms grow more rapidly than do benign neoplasms. On occasions, cancers have been observed to decrease in size and even spontaneously disappear. Local invasion Nearly all benign neoplasms grow as cohesive expansile masses that remains localized to their site of origin and do not have the capacity to invade or metastasize to distant sites, as do malignant neoplasms. Thus, such encapsulations tend to contain the 192 benign neoplasms as a discrete, rapidly palpable and easily movable mass that can easily surgically enucleated. Cartilage is probably the most resistant of all tissues to invasions and this is may be due to the biologic stability and slow turnover of cartilage. Malignant cell surface receptors bind to basement membrane components (ex laminin). Metastasis It is defined as a transfer of malignant cells from one site to another not directly connected with it (as it is described in the above steps). The invasiveness of cancers permits them to penetrate in to the blood vessel, lymphatic and body cavities providing the opportunity for spread. Seeding of body cavities and surfaces (transcoelomic spread) this seeding may occur wherever a malignant neoplasm penetrates into a natural open field. These carcinomas fill the peritoneal cavity with a 194 gelatinous soft, translucent neoplastic mass. Lymphatic spread Lymphatic route is the most common pathway for the initial dissemination of carcinomas the pattern of lymph node involvement follows the natural routes of drainage. Occasionally depression definition causes discount abilify 5 mg, by changing the brand or the type depression names buy generic abilify line, you can find a food substitute that does not upset you depression years in usa discount abilify 10mg on line. Then limiting that meal to one food only mood disorder 29696 order abilify mastercard, wit for half an hour after eating and take your pulse again. But if your pulse rises beyond that point, and remains high an hour after the meal, you have found your food allergy. The best way, however, to prevent or overcome allergies is to strengthen the overall physical resistance so as not to fall an easy prey to every allergen that comes along. To start with, the patient should fast on fresh fruit juices for four or five days. Repeated short juice fasts are likely to result in better tolerance to previous allergies. After the fruit juice fast, the patient can take a mono diet of vegetables or fruits such as carrots, grapes or apples, for one week. In case an allergic reaction to a newly introduced food is noticed, it should be discontinued and a new food tried. The many emergencies of acid formation through the day from wrong foods, fatigue, mental stress and lack of sleep can be met by the competency of the alkaline reserves. Boosting the normal body reserve of alkalines by liberal use of alkaline forming foods is essential for those suffering from allergies. The foods which should be excluded from the diet are tea, coffee, chocolate, cola drinks, alcohol, sugar, sweets and foods containing sugar, refined cereals, meats, fish, chicken, tobacco, milk, cheese, butter, smoked, salted, pickled foods and foods containing any chemical additives, preservatives and flavouring. These foods cause either toxic accumulations or over-stimulation of adrenal glands or strain on pancreatic enzymes production or disturb the blood sugar balance. For preventive purposes, the entire C complex vitamins known as the bioflavonoids, are recommended. They gradually strengthen cell permeability to help immunise the body from various allergies, especially hay fever. Often the addition B5, or pantothenic acid brings great relief to allergy sufferers. In such cases liberal amounts of pantothenic acids help cure them, although the recovery will take several weeks. An adequate intake of vitamin E is also beneficial as this vitamin possesses effective anti-allergic properties, as some studies have shown. He found that the use of five drops of castor oil in a little juice or water taken on an empty stomach in the morning, is highly beneficial for allergies in the intestinal tract, skin and nasal passages. Pathak, who is an expert in Chinese medicine, has reported numerous cases of allergic protection by this method. For allergic conditions in which an element of stress is present, it is essential to employ such methods as relaxation, exercise, meditation and mind control. These methods will reduce or remove stress and thereby contribute towards the treatment of allergies. Yogic asanas like yogamudra ardhmatsyendrasana, sarvangasana, shavasana and anuloma-viloma, pranayama are also beneficial. It denotes a shortage of rich red blood cells and colouring matter and usually results from consumption of refined foods. Approximately one trillion (10,000 million) new blood cells are formed in the bone marrow daily. The raw materials required in the production of these cells are iron, proteins, and vitamins, especially folic acid and B12. The red colouring matter, called haemoglobin is a protein which is composed of an organic iron-compound called "heme". The globin is a sulphur -bearing protein which makes up 96 per cent of the molecule. The formation of haemoglobin thus depends on adequate dietary supplies of iron and protein. Red cells have a lifespan of approximately 120 days and are destroyed and replaced daily. Each person should have 100 per cent haemoglobin or about 15 grams to 100 cc of blood, and a blood count of five million red cells per millimeter. A drop in the hemoglobin content results in anaemia and a consequent decreased ability of the blood to carry oxygen to the tissues. Symptoms A haggard look, with lines of strain, premature wrinkles, grayish skin, and dull and tired looking eyes are the main symptoms of anaemia. Other symptoms include poor memory, weakness, dizziness, fatigue, lack of energy, shortness of breath on exertion, slow healing of wounds, headaches, mental depression, pale fingers, lips and ear lobes. The patient usually complaints of weakness, easy fatigue, lack of energy and dizziness. It can result from reduced or low formation of red blood cells either due to defects in the bone marrow or an inadequate intake of iron vitamins, and protein. Heavy loss of blood due to injury, bleeding piles and heavy menstruation may also cause anaemia. A lack of digestive acid of hydrochloric acid needed for digestion of iron and proteins may also result in anaemia. Emotional strain, anxiety and worry usually interfere with the manufacture of hydrochloric acid in the body. Anaemia can also be caused by a variety of drugs which destroy vitamin E or by others which inactivate the nutrients needed in building blood cells. Chronic diseases such as tuberculosis, when accompanied by hemorrhage, may also result in anaemia. Hookworm, pinworms, round worms and tapeworms feed on the blood supply as well as on the vitamins. Twenty-five hookworms can consume fifteen grams of blood every 24 hours; a tapeworm can cause acute shortage of vitamin B12. Symptoms of intestinal worms are itching at the rectum, restlessness at night with bad dreams, diarrhoea, foul breath, dark circles under the eyes and a constant desire for food. After successful treatment for intestinal worms, perfect cleanliness should be observed to prevent recurrence. A liberal intake of iron in the formative years can go a long way in preventing iron-deficiency anaemia. Almost every nutrient is needed for the production of red blood cells, haemoglobin and the enzymes, required for their synthesis. Refined food like white bread, polished rice, sugar, and desserts rope the body of the much -needed iron. Iron should always be taken in its natural organic form as the use of inorganic can. The common foods rich in natural organic iron are wheat and wheat grain cereals, brown rice and rice polishings, green leafy vegetables, cabbage, carrot, celery, beets, tomatoes, spinach; fruits like apples, berries,cherries, grapes, raisins, figs, dates, peaches and eggs. It has been proved that a generous intake of iron alone will not help in the regeneration of haemoglobin. The diet should, therefore, be adequate in proteins of high biological value such as those found in milk, cheese and egg. Copper is also essential for the utilisation of iron in the building of haemoglobin. This vitamin is usually found in animal protein and especially in organic meats like kidney and liver. A heavy meat diet is often associated with a high haemoglobin and high red cell count, but it has its disadvantages. One cause of anaemia is intestinal putrefaction, which is primarily brought on by a high meat diet. Moreover, all meats are becoming increasingly dangerous due to widespread diseases in the animal kingdom. There are, however, other equally good alternative sources of vitamin B12 such as dairy products, like milk, eggs and cheese, peanuts. Vegetarians should include sizeable amounts of milk, milk products and eggs in their diet. For prevention of anaemia, it is essential to take the entire B-complex range which includes B12, as well as the natural foods mentioned above. Eating lacto-avo products, which are complete proteins, and which also contain vitamin B12 is good insurance against the disease. At least two helpings of citrus fruits and other ascorbic acid rich foods should be taken daily. Beet juice contains potassium, phosphorous, calcium, sulphur, iodine, iron, copper, carbohydrates, protein, fat, vitamins, B1, B2, niacin B6, C and vitamin P. Buy discount abilify 10mg. Screening for Depression in Adults.
All estimates in the Statement of Changes in Social Insurance Amounts represent values that are incremental to the prior change anxiety girl purchase abilify 5mg otc. As an example anxiety disorder 3000 cheap 20 mg abilify visa, the present values shown for demographic assumptions represent the additional effect that these assumptions have anxiety from coffee purchase abilify discount, once the effects from the change in the valuation period and projection base have been considered mood disorder not otherwise specified discount 15 mg abilify visa. Period beginning on January 1, 2014 and ending January 1, 2015 Present values as of January 1, 2014 are calculated using interest rates from the intermediate assumptions of the 2014 Trustees Report. All other present values in this part of the Statement are calculated as a present value as of January 1, 2015. Estimates of the present value of changes in social insurance amounts due to changing the valuation period, projection base, demographic assumptions, and law are determined using the interest rates under the intermediate assumptions of the 2014 Trustees Report. Since interest rates are economic assumptions, the estimates of the present values of changes in economic and health care assumptions are presented using the interest rates under the intermediate assumptions of the 2015 Trustees Report. Period beginning on January 1, 2013 and ending January 1, 2014 Present values as of January 1, 2013 are calculated using interest rates from the intermediate assumptions of the 2013 Trustees Report. All other present values in this part of the Statement are calculated as a present value as of January 1, 2014. Estimates of the present value of changes in social insurance amounts due to changing the valuation period, projection base, demographic assumptions, and law are determined using the interest rates under the intermediate assumptions of the 2013 Trustees Report. Since interest rates are economic assumptions, the estimates of the present values of changes in economic and health care assumptions are presented using the interest rates under the intermediate assumptions of the 2014 Trustees Report. Change in the Valuation Period From the period beginning on January 1, 2014 to the period beginning on January 1, 2015 the effect on the 75-year present values of changing the valuation period from the prior valuation period (2014 88) to the current valuation period (2015-89) is measured by using the assumptions for the prior valuation period and applying them, in the absence of any other changes, to the current valuation period. Changing the valuation period removes a small negative net cash flow for 2014 and replaces it with a much larger negative net cash flow for 2089. The present value of estimated future net cash flow (including or excluding the combined Medicare Trust Fund assets at the start of the period) was therefore decreased (made more negative) when the 75-year valuation period changed from 2014-88 to 2015-89. In addition, the effect on the level of assets in the combined Medicare Trust Funds of changing the valuation period is measured by assuming all values projected in the prior valuation for the year 2014 are realized. From the period beginning on January 1, 2013 to the period beginning on January 1, 2014 the effect on the 75-year present values of changing the valuation period from the prior valuation period (2013 87) to the current valuation period (2014-88) is measured by using the assumptions for the prior valuation period and applying them, in the absence of any other changes, to the current valuation period. Changing the valuation period removes a small negative net cash flow for 2013 and replaces it with a much larger negative net cash flow for 2088. The present value of estimated future net cash flow (including or excluding the combined Medicare Trust Fund assets at the start of the period) was therefore decreased (made more negative) when the 75-year valuation period changed from 2013-87 to 2014-88. The change in valuation period decreased the level of assets in the combined Medicare Trust Funds. Change in Projection Base From the period beginning on January 1, 2014 to the period beginning on January 1, 2015 Actual income and expenditures in 2014 were different than what was anticipated when the 2014 Trustees Report projections were prepared. Part A income was very slightly lower and expenditures were very slightly higher than anticipated, based on actual experience. Part B total income and expenditures were also higher than estimated based on actual experience. The net impact of the Part A, B, and D projection base changes is a decrease in the estimated future net cash flow. Actual experience of the Medicare Trust Funds between January 1, 2014 and January 1, 2015 is incorporated in the current valuation and is slightly more than projected in the prior valuation. From the period beginning on January 1, 2013 to the period beginning on January 1, 2014 Actual income and expenditures in 2013 were different than what was anticipated when the 2013 Trustees Report projections were prepared. Part A income was slightly higher and expenditures were lower than anticipated, based on actual experience. Part B total income and expenditures were also lower than estimated based on actual experience. For Part D, actual income and expenditures were both slightly higher on an incurred basis than prior estimates. The net impact of the Part A, B, and D projection base changes is an increase in the estimated future net cash flow. Actual experience of the Medicare Trust Funds between January 1, 2013 and January 1, 2014 is incorporated in the current valuation and is slightly more than projected in the prior valuation. The ultimate demographic assumptions for the current valuation (beginning on January 1, 2015) are the same as those for the prior valuation. However, the starting demographic values and the way these values transition to the ultimate assumptions were changed. Incorporating mortality data obtained from the National Centers for Health Statistics at ages under 65 for 2011 resulted in slightly lower death rates for 2011 and a slightly faster rate of decline in mortality over the next 25 years than were projected last year. The ultimate demographic assumptions for the current valuation (beginning on January 1, 2014) are the same as those for the prior valuation. However, the starting demographic values, and the way these values transition to the ultimate assumptions, were changed. During the period of transition to their ultimate values, the birth rates in the current valuation are generally lower than they were in the prior valuation. These changes slightly lowered overall Medicare enrollment for the current valuation period resulting in a decrease in the estimated future net cash flow, and had a very minor impact on the present value of estimated income and estimated expenditures for Part A, Part B, and Part D. A further assumption change was made that resulted in higher Part D enrollment for the current valuation period. The participation rate represents the percentage of beneficiaries assumed to enroll in a Part D plan out of all eligible and, in prior years, was assumed to stay relatively constant at the same rate as the recent historical period. However, since actual participation has consistently been higher than expected, it was decided to increase the participation rate by 1 percent per year for the first three years of the projection period before leveling out. This assumption change resulted in an increase in the present value of estimated future income and estimated future expenditures for Part D, and had no impact on the Part A and Part B present values. For the current valuation (beginning on January 1, 2015), there was one change to the ultimate economic assumptions. Because these premiums are not subject to the payroll tax, slower growth in these premiums means that a greater share of employee compensation will be in the form of wages that are subject to the payroll tax. However, the starting economic values and the way these values transition to the ultimate assumptions were changed. The net impact of these changes resulted in an increase in the estimated future net cash flow for total Medicare. For Part A, these changes resulted in an increase to the present value of estimated future expenditures and income, with an overall increase in the estimated future net cash flow. For Part B and Part D, these changes decreased the present value of estimated future expenditures (and also income). Otherwise, the ultimate economic assumptions for the current valuation are the same as those for the prior valuation. However, the starting economic values, and the way these values transition to the ultimate assumptions, were changed. This scenario assumes that the physician payment updates required under the current law sustainable growth rate formula will be overridden by lawmakers. The use of these projections increases the present value of estimated future expenditures, compared to the current law projections, for Part B by roughly 11 percent, and for total Medicare by about 5 percent. For Part A, these changes resulted in a decrease to the present value of estimated future expenditures and income, with an overall increase in the estimated future net cash flow. For Part B, these changes increased the present value of estimated future expenditures (and also income). On the other hand, the above-mentioned changes lowered the present value of estimated future expenditures (and also income) for Part D. Changes in Law For the period beginning on January 1, 2014 to the period beginning on January 1, 2015 Although Medicare legislation was enacted since the prior valuation date, some of the provisions have a negligible impact on the present value of the 75-year estimated future income, expenditures, and net cash flow. The Improving Medicare Post-Acute Care Transformation Act of 2014 standardized the collection of data for post-acute providers and aligned the inflation of the hospice aggregate cap with that of hospice reimbursement. Overall these provisions resulted in an increase in the estimated future net cash flow for total Medicare. For Part A, these changes resulted in a decrease to the present value of estimated future expenditures, with an overall increase in the estimated future net cash flow. For Part D, the above-mentioned changes increased the present value of estimated future expenditures (and also income) only very slightly. Avoid excessive alcohol or other depressants Although alcohol and other depressant drugs seem to relieve stress temporarily depression rehab abilify 20 mg line, they change body chemistry ventilatory depression definition generic abilify 20 mg otc. However depression or grief test buy cheap abilify 20 mg line, they also can increase irritability and anxiety and disturb natural sleep-wakefulness cycles bipolar depression symptoms test discount abilify on line. Unless you have a disorder requiring modifcation of your food intake, adopt balanced eating habits as recommended by the Food Guide Pyramid. Most of the calories should come from complex carbohydrates, vegetables, and fruits. Drink enough water, at least 8 glasses of caffeine-free, sugar-free fuids daily, unless your doctor recommends otherwise. Take a few moments to think and write down some of the things you can do this week. Differences between Male and Female depression: Men act out their inner turmoil while women turn their feelings inward. Men were concerned that seeing a mental health professional or going to a mental health clinic would have a negative impact at work; especially if their employer or colleagues found out. Men feared a diagnosis of mental illness would cost them the respect of their family and friends, or their standing in the community. Men are more willing to confess feelings of fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances instead of feelings of sadness, worthlessness, and excessive guilt. Many men with depression do not obtain adequate diagnosis and treatment that may be life saving. Diagnostic Evaluation and Treatment Your tendency is just to wait it out, you know, let it get better. Women are at Greater Risk for Depression than Men Major depression and dysthymia affect twice as many women as men. In fact, rates of depression were shown to be highest among unhappily married women. In some women, these changes are severe, and include depressed feelings, irritability, and other changes. Victimization Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who have been raped as adolescents or adults. Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. Depression in Later Adulthood As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Most do not need formal treatment, but those who are moderately or severely sad appear to beneft from self-help groups or various psychosocial treatments. The frst step in treatment for depression should be a thorough examination to rule out any physical illnesses that may cause depressive symptoms. Since certain medications can cause the same symptoms as depression, the examining physician should be made aware of any medications being used. The exam should be done by the physician or a referral made to a mental health professional. Medications There are several types of antidepressant medications used to treat depressive disorders. If you are not comfortable or satisfed after 2 to 3 months, discuss this with your provider. With treatment, many persons who have been depressed have gone on to enjoy life, be productive, and have good relationships with family and friends. If you have any questions, please contact your mental health provider or call your ValueOptions member service representative. This workbook is not intended to provide and should not be relied upon as providing medical judgement or medical advice. Aminosalicylates have been shown to independently induce and maintain remission in mild to moderate ulcerative colitis. Sulfasalazine is still used, however, some patients experience side effects due to the sulfa component (see below). Approximately 90% of those with intolerance to sulfasalazine can tolerate mesalamine. These agents all use the same mesalamine, but differ in terms of the medication coating. Mesalamine must be coated or placed in special capsules to ensure drug delivery to the intestine or colon. The difference in coating affects where the medication is released in the intestine or colon and how frequently the medication needs to be taken (once, twice, or three times daily). Sometimes patients will notice whole capsules in their stool, which indicates that this drug delivery system may not be the right one for them. Rectal administration permits delivery of high-dose therapy (targeted exactly where it is needed) and avoids systemic (body-wide) exposure. A high proportion of patients with proctitis (inflammation in the rectum) will respond to mesalamine suppositories. A suppository is inserted into the rectum and does not need to be passed or removed. A combination of rectal and oral therapies may be more effective than pills alone. Up to 80% of patients with left-sided colon inflammation benefit from using this therapy once a day. Side Effects and Special Considerations Overall, aminosalicylates are well tolerated and safe. Women wishing to become pregnant on sulfasalazine should take an increased dose of folate 2mg daily. Rare side effects are hair loss, pancreatitis, or inflammation of the tissue surrounding the heart (pericarditis). Drug Interactions People taking several different medicines, whether prescription or over-the-counter, should always be on the lookout for interactions between drugs. Before taking any medication, ask your doctor and pharmacist if there are any reactions to note with your existing medications. Be sure to include over-the counter medications and complementary or alternative therapies (supplements, herbals, vitamins, etc. Even during times of remission, it is important to continue taking your medications as prescribed to prevent asymptomatic inflammation and future flare-ups. We encourage you to review this educational material with your health care professional as this information should not replace the recommendations and advice of your doctor. The Foundation does not provide medical or other health care opinions or services. |
