Foods That Reduce Inflammation

Reduce Inflammation

This eBook from professional trainer and nutritionist Thomas DeLauer and Dr. Mike Brookins shows you all of the secrets to reducing inflammation all through your body. These body hacks are secrets to the way that your body works that you would never have thought of. You will learn the foods that you will need to avoid in order to have a really healthy life. You will learn to reset your body in 7 days or less just by eating organic, really healthy foods. Food affects they way that your body works so much more than people tend to believe. You will learn how to cut through all the nonsense that you will read on the internet and get right to the part that heals your inflammation and other health problems. Inflammation is only a symptom If you are not healthy and eating well, your whole body will suffer. We give you a way to reverse that! Read more...

Organic Health Protocol Summary


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The Cholinergic Anti Inflammatory Pathway

Tracey et al. (25,26) using vagotomized animals or electrical stimulation of the vagus nerve have shown that efferent activity in this nerve inhibits TNF production and has anti-inflammatory actions. This pathway has been termed the cholinergic anti-inflammatory pathway because inhibition of TNF synthesis is mediated by acetylcholine acting on

Prostaglandins and Cyclic AMP

In fact, prostaglandin E2 is another very important feedback inhibitor of TNF production (and that of other cytokines) because inhibitors of prostaglandin synthesis augment cytokine production in most models ranging from in vitro systems (17) to human volunteers injected with LPS and in vivo tests (18,19). (The cyclooxygenase inhibitors are also known as nonsteroidal anti-inflammatory drugs, or NSAIDs.) This effect demonstrates that prostaglandin E2 endog-enously produced during inflammation effectively switches off TNF synthesis.

Of Lipidlowering Drugs that may Benefit PAD Patients

Statins increase nitric oxide (NO) production and improve endothelial function (e.g. increased flow-mediated dilatation). They have antioxidant properties and they inhibit the migration of macrophages and smooth muscle cell proliferation, leading to an antiproliferative effect and the stabilization of atherosclerotic plaques. Statins have anti-inflammatory effects including a reduction in the circulating levels of CRP, inflammatory and proinflammatory cytokines e.g. interleukin-6 (IL-6), IL-8 , adhesion molecules e.g. intercellular adhesion mol-ecule-1 (ICAM-1), vascular cellular adhesion molecule-1 (VCAM-1) and other acute phase proteins. They reduce tissue factor expression and platelet activity, whereas fi-brinolysis can be enhanced. Statins improve microalbu-minuria, renal function, hypertension and arterial wall stiffness. A significant reduction of the carotid and femoral intima-media thickness was also reported early after statin treatment.

Amniotic Membrane Transplantation

Amniotic membrane transplants (AMT) were first used in ophthalmology by De Rotth in 1940, who reported partial success in the treatment of conjunctival epithelial defects after symble-pharon 4 . Human amniotic membrane is derived from placenta, which consists of the inner amniotic membrane made of a single layer of amnion cells fixed to collagen-rich mes-enchyme six to eight cells thick loosely attached to chorion. It is composed of three layers a single epithelial layer, thick basement membrane, and avascular stroma. Human amniotic membrane is nonimmunogenic and has a unique combination of anti-inflammatory proteins and growth factors that promote wound healing.

Modes Of Vectorborne Disease Transmission

Rejection does not occur, or is milder, when ticks feed on natural hosts. On the other hand, in the case of Phlebotomus sandflies, repeated feeding in mice results in delayed type hypersensitivity that causes sandflies to probe and feed faster in these animals. These immune responses, however, have a deleterious effect on some pathogens transmitted by vectors. Immune responses to Ixodes scapularis in natural and non-natural hosts result in protection against Borrelia burgdorferi infection. Similarly, immune responses to sandflies result in protection against Leishmania major infection, and a strong correlation exists between individuals generating immune responses to the sandfly Lutzomyia longipalpis and being protected against Leishmania chagasi infection. Therefore, in some vector-borne diseases, previous exposure to vector saliva may result in immune responses capable of preventing parasite transmission. It should be emphasized that probably not all immune responses to vector bites...

Preoperative Planning

The patient's medical status must be evaluated preopera-tively, and all documented preoperative measures to prevent peri-operative ischaemia need to be taken. Initiation of -blockers and platelet inhibitors is particularly important, as are smoking cessation and the implementation of preoperative optimal regulation of blood pressure and blood glucose. Also, the use of statins seems to be associated with reduced peri-operative mortality in major non-cardiac surgery, probably due to their anti-inflammatory, plaque-stabilizing effects 57, 65 .

Postoperative Pain Treatment

In the immediate postoperative period, epidural analgesia with bupivacaine and morphine are associated with lower postoperative morbidity than on demand general opiate analgesia, especially after surgery involving the abdominal or thoracic aorta 73 . It is considered obligatory postoperative pain treatment to apply a base of paracetamol, and in patients without manifest or imminent renal insufficiency, a nonsteroidal anti-inflammatory drug. Since vascular patients are at particular risk of cardiac ischaemia, cyclooxygenase-2 (COX-2) antagonists should be avoided.

Review Of Preclinical Data 521 Studies on Animals

In acute toxicity tests, Ayush-64 was given orally to mice at a dose of 10 g kg, and the treatment exhibited negative isotropic and chronotropic effects on the isolated frog heart. Treatment depressed the tone and amplitude of contraction of the isolated rabbit ileum. Ayush-64 was given orally to albino mice infected with P. berghei at doses of 100, 250, 500, and 750 mg kg of body weight and did not exhibit any toxic effect in different tissues of the experimental animals, but showed significant anti-inflammatory effects.

Cerebral Embolization during CEA and CAS

Perioperative cerebral embolization during CEA or CAS is a potentially devastating complication and is probably correlated with the embolic potential of the plaque (Table 2.1.4). Echolucent plaques as measured by grey-scale median (GSM), obtained from standardized preoperative ultrasonography Duplex, seem to have increased plaque cellularity and a larger embolic potential 4, 11 . Some plaques also show thrombus associated with plaque rupture, indicating a possible vulnerable state 25 . This has been associated with an increased risk of stroke in both the preoperative and intraoperative period. Using ex vivo flow models, the highest embolic potential seems to be in the most severe stenoses. The use of preoperative statin treatment may reduce the amount of embolization, possibly by a stabilizing and anti-inflammatory effect 5 .

Cutaneous Leukocytoclastic Angiitis

Most patients suffer a single episode, with resolution occurring over a few months. About 10 suffer recurrent disease at varying intervals. Symptomatic relief from cutaneous irritation and associated arthralgia and myalgia is possible with antihistamines and nonsteroidal antiinflammatory drugs. Treatment of severe cutaneous disease is with corticosteroids.

Immunomodulatory Properties

The effects of neem on the immune system are complex and have not been fully elucidated some evidence points to an immunostimulant effect, while other evidence suggests it can also act as an anti-inflammatory. The latter may be partly explained by inhibition of prostaglandin synthetase (Van der Nat et al., 1991 Okpanyi and Ezeukwu, 1981 Obaseki et al., 1985). However, Kroes et al. (1993) showed that in a classical Ayurvedic preparation for gout, nimba arishta, the anti-inflammatory activity is almost entirely attributable to ingredients other than neem.

Treatment Medical Treatment

When clinically diagnosed, uterine myomata are frequently asymptomatic and rarely represent malignancy, therefore treatments are reserved for symptomatic patients. Primary therapy for bleeding (which accounts for the bulk of symptoms) is medical, and includes the use of hormonal agents such as progestins, combined oral contraceptives, and (less commonly, and for short term treatment) gonadotrophin release hormone analogues (GnRHa's). Non-hormonal treatments include non-steroidal anti-inflammatory agents (NSAID's), and in the U.K., though not in the U.S. where they lack FDA approval, anti-fibrinolytics agents. Progestin releasing intra-uterine devices (lUD's) are used in the U.K. and other countries to treat menorrhagia, but in the U.S. their use remains rare.

Principles Of Pain Management Pathophysiology of pain

Damaged tissues release a number of chemicals or excitatory neurotransmit-ters, including prostaglandins, bradykinin, serotonin (5HT), substance P and histamine, which facilitate the transduction of pain impulses along the AS and C nerve fibres. The non-steroidal anti-inflammatory (NSAID) group of drugs work by interfering with the production of prostaglandins, thereby assisting in reducing pain experienced by the individual.

Stefano Chimenti Eleonora Carlo Serge Masson Antonio Bai and Roberto Latini

Among the cardiovascular pathologies, ischemic heart disease is the leading cause of congestive heart failure as well as permanent premature disabilities. Reperfusion of a previously ischemic heart is a standard clinical procedure. Even if beneficial, reperfusion triggers an inflammatory response that contributes to the acute extension of ischemic injury and later participates in the reparative processes of the damaged myocardium. Occlusion of a major coronary artery in small rodents, followed or not followed by reperfusion, has proven to be a good model to assess the relevance of pathophysiological processes and drug effects in the setting of myocardial ischemia. Models involving reperfusion appear to be particularly suitable to study the inflammatory response, which is much more marked than with permanent ischemia. Ischemia reperfusion of the myocardium in wild-type and transgenic animals (mostly mice) allows the possibility of testing the vast array of mediators that orchestrate...

Relative Potencies Of Systemic Adrenocortical Steriods

Table 9-1 below compares some of the systemic adrenocortical steroids in the areas of anti-inflammatory potency, sodium retaining potency, and equivalent dose. This chart allows you to compare some of the most commonly used adrenocortical steroids in these important areas. Table 9-1 below compares some of the systemic adrenocortical steroids in the areas of anti-inflammatory potency, sodium retaining potency, and equivalent dose. This chart allows you to compare some of the most commonly used adrenocortical steroids in these important areas. Anti-Inflammatory Potency

Cooperativity and Gene Dependence in Oncogenesis

However, other genes influence polyp formation. It has been possible to test candidate genes by combining them with the ApcMin or Apc knockout mutations. The nonsteroidal antiinflammatory drugs (NSAIDs) target cyclooxygenase (Cox) enzymes and have been shown to inhibit polyp formation in ApcMin + mice (87). By combining both the Cox2 knockout mutation with an Apc mutant allele, called ApcA716, it was possible to demonstrate that the action of NSAIDs probably involves suppression of Cox-2 activity, since this knockout combined with ApcA716 yielded substantially fewer polyps than were seen in control ApcA716 + Cox2+f+ mice (88). These sorts of data have allowed drug design efforts to focus on Cox proteins as a target for colorectal cancer prevention or treatment as well as for other malignancies (66,89).

Incomplete Evidence

Estrogen is another treatment approach for AD, with incomplete evidence supporting its use. It may be beneficial to some brain functions and may enhance the effectiveness of cholinesterase inhibitors. Preliminary evidence suggests a beneficial role of estrogen for AD patients, with the notable exception of one placebo-controlled randomized clinical trial 181 . Results from large-scale trials are required before definitive conclusions may be drawn. However, given the recent finding of increased ovarian cancer risk with ERT (186), the methodological design of studies to determine whether estrogen will benefit AD patients will require careful consideration. Theoretical and epidemiological support exists for an inflammatory response in AD. Clinical trials are underway to explore the effectiveness of various anti-inflammatory regimens. Published trials with gingko biloba suggest a modest effect in AD patients on measures of cognition. Replication of these findings with more robust results...

Significance of VFO for Advanced and Terminal Stage OA in Middle Aged Patients

Before summarizing this paper, I present a very interesting case. In 1977, a 64-year-old patient came to me. She had very severe pain and I recommended THR (Fig. 17a). While plans were being made, an nonsteroidal antiinflammatory drug (NSAID) was given on a pro re nata (PRN) basis, and I instructed her to start using crutches. In the meantime, the pain was relieved. Five years later, almost all orthopedic surgeons must think that THR was definitely necessary with this condition (Fig. 17b). However, this was only a radiologic finding, and she was no longer complaining of much pain.

Mechanisms For Protection Against Emphysema By Vitamin A

Vitamin A has been found to exert anti-inflammatory properties within the lung in a number of different animal models. In one such model, mono-crotaline, a pyrrolizadine alkaloid, is injected subcutaneously in rats to induce pulmonary inflammation. When monocrotaline-treated rats are fed a diet with eight times the amount of retinol of the control diet, the inflammatory response is significantly inhibited in the lung parenchyma and pulmonary arterioles (Swamidas et al., 1999). Dietary retinol used in this study decreases the inflammatory responses within the alveolar septa, the vasculature, and the cardiac tissue, indicating a common anti-inflammatory effect of retinol on the response to monocrotaline toxicity. Another anti-inflammatory role for vitamin A was reported (Redlich et al., 1998), in which vitamin A reduced lung inflammation after thoracic radiation. Other studies have shown that high doses of retinol are anti-inflammatory in the lung of rats treated with 1-nitronaphthalene...

IL10 Causes Scarring in a Model of Fetal Wound Repair

Fetal wound healing is characterized by rapid reepithelialization, minimal inflammation, and scar-free repair (reviewed in ref. 76). Fetal wounds also show diminished expression of the proinflammatory cytokines IL-6 and IL-8, a phenomenon that was hypothesized to be owing to their negative regulation by the antiinflammatory cytokine IL-10. To test this hypothesis, Liechty et al. (77) wounded embryonic skin from IL-10 null mice that had been grafted onto strain-matched adult mice. Wounds of control embryonic skin grafts showed little inflammation and normal restoration of dermal architecture. However, wounded IL-10 null grafts showed significantly higher inflammatory cell infiltration and collagen deposition more akin to the scarring associated with adult repair. This study suggests that IL-10 plays an important role in regulating the expression of proinflammatory cytokines at the fetal wound site, and thus modulates downstream matrix deposition that leads to scar-free repair.

Local Control Substances

Inflammatory agent of the group of compounds known as NSAlDs, or nonopioid analgesics. Most of its therapeutic and adverse effects appear to be related to the inhibition of prostaglandin synthesis. Nonsteroidal antiinflammatory drugs inhibit the activity of the enzyme cyclooxygenase which mediates the conversion of arachidonic acid to prostaglandins that are involved in pain, fever, and inflammation. Aspirin may produce irritation and ulceration of the gastrointestinal (GO tract, an adverse effect that is about equal to other salicylates. It also inhibits platelet aggregation. Acetaminophen, like aspirin, has analgesic and antipyretic properties, but it does not have clinically significant anti-inflammatory activity and is not irritating to the GI tract. 346, The answer is h. (Hardman, pp 631-633.) All of the drugs listed, except acetaminophen, are usually considered NSAIDs, a large group of structurally dissimilar compounds. These drugs share the pharmacologic properties of the...

Basic Functions of MALT

In contrast to this term, lymphoid cells have important functions for the preservation of the tissue integrity. Mucosal immunoglobulins (IgA) from local plasma cells are distinctly antiinflammatory and perform immune exclusion , i.e. the inhibition of antigen penetration into and the removal of penetrated antigens from the mucosal tissue 4 . Recent advances in immunology have furthermore shown that T-lymphocytes per se are not inflammatory cells but that there are different types of T-lympho-cytes with differential functions (Fig. 6.4). Even those which support a cellular inflammatory immune answer require, in addition to the mere presence of antigen, distinct and highly regulated activation procedures in the context of accessory professional antigen presenting cells together with co-stimulatory signals (Fig. 6.4).

TRPV1 ligands and the airway inflammatory response

Recent studies have suggested a role for the TRPV1 antagonists as a novel class of analgesic, anti-inflammatory agents. For example, studies utilizing animal models have shown that the thermal hyperalgesia response to bradykinin seen in wildtype mice was absent in mice lacking TRPV1 92 . This study led to Ferreira et al. 93 investigating the role of TRPV1 channels in the nociceptive response induced by peripheral activation of kinin B2 receptors. They found that bradykinin-induced nociception is induced by TRPV1 receptor stimulation via phospholipase C-path-way activation and the production of lipoxygenases.

Medications for Inflammatory Conditions of the Bladder Causing Storage Failure

Interstitial cystitis (IC) is a syndrome whose pathogenesis and etiology remain a mystery. Even the diagnosis of this entity is difficult and considered one of exclusion. There are four currently proposed etiologies for this syndrome inflammation, vascular insufficiency, epithelial leak, and deficiency of proteoglycans (i.e., glycosaminoglycans-GAG-). Dimethysulfoxide (DMSO), after being approved for use in 1977, has been shown to induce remission in 35-40 of the patients (128) and is a mainstay of treatment (129). However, no controlled clinical studies have been performed. DMSO is a derivative of lignin, which is a product of the wood-pulp industry. Its therapeutic properties include anti-inflammatory properties, analgesic properties, collagen dissolution, muscle relaxation, and mast-cell histamine release. The usual dose is a 50 solution instilled for 5-10 min. This therapy can be used as a one time dose, repeated weekly for 6-8 wk, or continued weekly for 4-6 mo. Some even...

Fruits And Vegetables A Population Studies

The many flavonoids in fruit and vegetables have extensive biological properties that reduce the risk of cardiovascular disease. Flavonoids are among the most potent antioxidants. They protect LDL cholesterol from oxidation inhibit the formation of blood clots and have vasopressive and hypolipidemic effects and anti-inflammatory action.49,50 Some polyphenols have hypocholesterolemic effects mediated by reduced intestinal cholesterol absorption and increased bile acid excretion. European studies have found flavonoid intake to be inversely associated with heart disease mortality, and the incidence of heart attack and stroke over a 5-year Anthocyanin pigments, the water-soluble, reddish pigments found in fruits such as strawberries, cherries, cranberries, raspberries, blueberries, grapes, and black currants, are reported to be antioxidants and are very effective in scavenging free radicals, inhibiting LDL cholesterol oxidation and platelet aggregation, and protecting against...

Mechanism of renal excretion

For example, OAT proteins are involved in active renal secretion of substrates such as cimetidine, methotrexate, cidofovir, and adefovir. Other drugs, such as probenecid, p-lactam antibiotics, and nonsteroidal antiinflammatory drugs, are also known to interact with this transporter 96 .

Neuroendocrine modulation of immune responses

The interplay between the neuroendocrine and immune systems is bi-directional, as exemplified by the control of Cortisol release from the adrenal glands during stress. Cortisol has well-known anti-inflammatory properties and it also suppresses the immune system. The signal for the release of cortisol originates in the brain. Electrical signals generated in the brain, and also IL-1 and IL-6 synthesized in brain cells, stimulate the hypothalamus to produce corticotrophin-releasing hormone (CRH), which induces the anterior lobe of the pituitary gland to release adrenocorticotrophic hormone (ACTH). CRH can also induce lymphocytes to produce their own ACTH. The ACTH is released into the bloodstream and, on reaching the target organ (adrenal glands), stimulates the adrenal cells to secrete cortisol. At excessive concentrations, ACTH inhibits the release of CRH and ACTH by negative feedback to the hypothalamus and anterior pituitary gland.

The Glucocorticoids Hydrocortisone Cortisol And Others

Physiological, Actions of the Glucocorticoids. The glucocorticoids regulate blood brain glucose levels. They also inhibit the inflammatory process. The glucocorticoids also decrease the immunological responses of the body by decreasing antibody formation. About 90 percent of the glucocorticoids produced is hydrocortisone (cortisol). One of the most significant metabolic actions of glucocorticoids is gluconeogenesis. Gluconeogenesis involves the formation of glycogen or glucose from noncarbohydrates such as fat or protein. This, of course, can act to raise the concentration of glucose in the blood. Glucocorticoids can also raise the concentration of glucose in the blood by decreasing the use of glucose by skeletal muscle. Glucocorticoids play an important role in the body's reaction to stress, although the specific mechanism for this role is not understood. Glucocorticoids also pay an important role as anti-inflammatory agents. As anti-inflammatory agents, they decrease the ability...

Pre and Postoperative Gut Function and Nutrition

The postoperative dysfunction may be caused by an inflammatory response due to reperfusion injury of the intestines, e.g. in aortic surgery, but other trauma, hypoxia or infection may also induce this inflammatory response 11 . Analgesics, mainly opioids, used during and after anaesthesia may contribute to a relative gut paralysis 40 . Newer drugs with selective peripheral opioid antagonist effects have demonstrated earlier resolutions of ileus after intra-abdominal surgery, with effects on the quality of postoperative analgesia 62 . Pain itself may also contribute to postoperative gastrointestinal tract dysfunction, either directly through noxious stimuli affecting gut perfusion, or indirectly by gut pain contributing to delayed mobilization, delayed eating and breathing difficulty 27, 39 . Postoperative gastrointestinal tract dysfunction may be induced more easily upon a reduction in circulating blood volume, as in acute aortic surgery with bleeding 29 , whereas replacement with...

Prostate Brachytherapy

Almost all patients develop urethritis of variable intensity which may last for 3 months. Symptoms may be helped by alpha-blockers and nonsteroidal antiinflammatory drugs. A minority of patients (15 ) develop acute retention either immediately or in the few days following implantation. This is usually due to postimplant edema and requires catheterization. In most patients, micturition resumes within 2 weeks as edema resolves, although recovery may occasionally take longer. Long-term effects include persistent cystitis and prostatitis (3 ), proctitis (2 ), and impotence (25 ). The risk of urinary incontinence is small ( 1 ) unless patients have had a previous TURP.

Prospects For Prevention Of Dementia

With AD, genetic factors are clearly of great importance, but environmental factors also play some role. Reducing exposure to possible environmental factors like head trauma is an obvious approach, although this is already a public health goal in its own right, quite apart from any possible association with AD. The greatest interest currently is in the possible protection factors like anti-inflammatory drugs, estrogen replacement therapy and education. Controlled trials will be necessary to confirm whether anti-inflammatory drugs and estrogen replacement therapy have a protective effect. Any preventive effect on AD will have to be balanced against the side effects of these drugs. If education and intelligence are confirmed to be protection factors, this will have important implications for the future incidence of dementia, because levels of education and IQ test scores are rising over successive generations. The possibility of immunization against AD has now emerged 35 . This is...

The Immunology Contribution

Lymphocytes are the most prevalent player in the immune response. They produce T cells, so called because they are produced in the thymus gland. One of these types of T cells, THi cells, along with macrophages, attack the offending antigen, promoting inflammation by producing three proinflammation chemicals, interleukin-i (IL-i), IL-2, and tumor necrosis factor-alpha (TNF-alpha). TH2 cells, on the other hand, produce the anti-inflammatory chemicals IL-4, IL-10, transforming growth factor-beta (TGF-beta), and IL-i receptor antagonists (IL-ira), which slow down the inflammatory response after the antigen has been destroyed.

Venous Ulcers Associated with Deep Venous Insufficiency

A 46-year-old female schoolteacher and non-smoker presented with an ulcer on the medial side of the ankle. The ulcer had persisted for the past year despite compressive dressings at a hospital wound care center. Ulcers in the same general area had occurred intermittently in the past but had healed with local wound care and dressings. The ulcer was very painful, particularly with dependency of the leg (7 10 over a visual analogue scale) and frequently at night. The patient had made a habit of elevating her legs during the day whenever feasible, and to sleep with her legs elevated on a pillow at night. She had been using a nonsteroidal anti-inflammatory drug once or twice a day at work for pain relief, but lately a narcotic prescribed by her physician was required for sleep at night. Even so, on some nights, she had to walk off the pain for twenty to thirty minutes before she could fall asleep.

Role of capsaicinsensitive nociceptive neurons

Recent data have revealed a further 'unorthodox' 12 role of these TRPV1-expressing sensory neurons. Somatostatin released from these endings reaches into the circulation and elicits systemic analgesic and antiinflammatory effects 12, 77, 83, 84 . This novel endocrine-like systemic neurophumoral response mediated by somatostatin released from the activated capsaicin-sensitive nociceptors was denoted as 'sensocrine' role of these sensors 84 . Somatostatin agonism at sst4 receptors has turned out to be a promising target for development of new antiinflammatory analgesic drugs 77, 83, 84 . Furthermore, the unique multiple function of the capsaicin-sensitive, TRPV1-expressing neurons in respect of tissue responses of enhanced mircocirculation evoked by CGRP and systemic antiinflammatory effects due to somatostatin release is seen already at subnoxious level of stimulation of these sensors. For example, 0.1 Hz stimulation of capsaicin-sensitive afferents, which in humans does not evoke...

Answers and Case Discussion

You may have been initially disquieted to see Mrs. Anderson's ECG. She has an intraventricular conduction delay because the QRS is 0.12 s or greater, and it is of the LBBB type. Her axis is approximately -70 degrees. We know that most bets are off with regard to diagnosing AMI in the presence of LBBB, so we are not very reassured by this electrocardiogram. We therefore look for an old ECG in her chart and find that she has had a LBBB for at least two years. We note that her current ECG is unchanged from the one on file. Now we can breathe easier. There is no evidence of AMI, and the history and physical examination are clearly compatible with biceps tendonitis. A week of rest and antiinflammatory medication and Mrs. Anderson will be back in the kitchen.

Duodenal and Gastric Ulcer

The most obvious disease associated with H. pylori is peptic ulceration (Fig. 24-4). More than 90 of duodenal ulcers are associated with toxin-producing H. pylori.56 When a patient with a duodenal ulcer does not have H. pylori infection, etiologic factors such as Zollinger-Ellison syndrome or nonsteroidal anti-inflammatory drug (NSAID) use are likely.57

Difficulttotreat hypertension

The patient may be taking too much sodium and or inadequate diuretics. Certain medications or diets may interfere with blood pressure medicines (Table 13.1) 2. One in ten individuals uses non-steroidal anti-inflammatory drugs (NSAIDs), and two meta-analyses have found that NSAIDs raise the blood pressure by an average of 3.3-5 mmHg in individuals with hypertension.18,19

Streptococcal Toxic Shock Syndrome

The most common sites of infection resulting in Strep TSS are soft tissue infections (necrotizing fasciitis, myonecrosis), pneumonia, postpartum sepsis, septic joint, peritonitis, and empyema. For soft tissue infection, the portals of entry are surgical site, chickenpox, insect bites, slivers, burns, and minor abrasions. The portal of entry of streptococci could not be ascertained in 45 of cases. Many of these occurred at the exact site of minor local nonpenetrating traumas (muscle strain, ankle sprain, subcutaneous hematoma, etc.). Early on, the only symptoms may be fever and severe pain. In adults, a virus-like prodrome suggestive of influenza precedes the onset of Strep TSS by several days. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain or suppress fever may mask the presenting symptoms or predispose the patient to more severe complications such as shock.

Lacrimal Keratoconjunctivitis Inflammation

Dysfunction of the lacrimal functional unit leads to ocular surface epithelial disease, which has been traditionally called keratoconjunctivitis sicca. We feel that the newly introduced term, lacrimal keratoconjunctivitis (LKC), more completely describes the array of pathological features associated with this syndrome (Table 2.3). Although our view of ocular surface pathology resulting from secretory dysfunction is incomplete, changes in tear fluid composition are clearly central in its development. As the lacrimal functional unit fails, tear concentrations of growth factors for example, epidermal growth factor EGF) and anti-inflammatory factors decrease 28 , and concentrations of proin-flammatory cytokines, that can originate from diseased lacrimal glands, meibomian glands, or ocular surface epithelia, increase 32, 40 . Tear concentrations of the soluble mucin, MUC5AC, are decreased in Sjogren's patients. Increased levels of proteases, including plasmin and matrix metalloproteinases...

Ovulation And Corpora Lutea Formation

Ovulation is frequently compared to an inflammatory response. Follicular hyperemia and edema occur within a few hours of the gonadotropin surge, and are probably mediated by vasoactive agents such as histamine, kinins, and prostaglandins (102). In response to the gonadotropin surge and inflammatory mediators, serine proteases and metallo-proteinases, such as plasminogen activator and collagenases, also increase in ovulatory follicles, suggesting a biochemical mechanism for follicular rupture. Indomethacin, a potent nonsteroidal anti-inflammatory agent, can block ovulation potentially through

Treatment And Control

In trachoma-endemic regions, the goal of trachoma intervention programs is the elimination of trachoma as a blinding disease. The new programs are based on four components, the SAFE strategy surgery to correct inturned eyelids antibiotics to eliminate the reservoir of chlamydial infection in the community and to reduce inflammation in individuals promotion of personal hygiene, with emphasis on facial cleanliness in young children and environmental changes to reduce transmission of trachoma through the elimination of human fecal material and provision of pure water supplies.40

Pharmacotherapy For Alzheimers Disease Ad

Pharmacological interventions in these areas are at various developmental stages. For example, cholinesterase inhibitors and the antioxidant vitamin E are the mainstays of therapy, while anti-inflammatory therapies and hormonal treatments are not the therapeutic standard of care. Pharma-cotherapeutics for behavioural disturbances in demented patients are based in part on clinical trials and on treatment approaches for these conditions in non-demented patients.

Acute Retinal Necrosis

Anti-inflammatory molecules are still under discussion in ARN syndrome. Vitritis and retinal vasculitis are due to secondary inflammation and not to cytopathic effects. The use of an-tivirals without the management of secondary inflammation may control viral inflammation with irreversible inflammatory macular or optic nerve damages. However, ophthalmologists should be aware of a possible activation of virus by corticosteroids leading to increased viral replication and further ocular complications. Corticosteroids should not be administered in the absence of antivirals. Steroids have been used in different atypical cases of ARN syndrome when the diagnosis was unknown for a few days or weeks, inducing major complications leading to blindness despite further aggressive antiviral therapy. This highlights the importance of a rapid confirmation of a viral agent and initiation of antiviral therapy. Steroids may be initiated at 0.5-1 mg kg day with progressive tapering. In some cases,...

Human Chorionic Gonadotropin HCG

Cortisol is the most abundant glucocorticoid hormone secreted by the adrenal cortex. Glucocorticoid hormones play an important role in maintaining blood glucose levels, metabolizing food, and functioning as antiinflammatory agents. Cortisol stimulates the liver to produce glucose, inhibits the effect of insulin, and decreases the rate at which cells use glucose. Measuring blood Cortisol levels is the best way to evaluate adrenal activity. Under normal circumstances Cortisol secretion is higher in the morning and lower in late afternoon and early evening.

Dementia the Public Health Challenge

Promising pharmacological strategies, such as the use of anti-inflammatory drugs, estrogen and vitamin E also seem to offer some potential for prevention. But we must temper our enthusiasm until better data are available. Perhaps the most realistic and practical approach to prevention is for the vascular dementias, where we already possess the capability to alter vascular risk factors such as hypertension, diet, exercise, smoking and hyperlipidemias.

Areas Still Open to Research

In AIDS dementia, antiviral agents may be beneficial in delaying but not preventing cognitive decline. Therapies aimed at the virus may offer some palliation, but evidence that cognitive decline is not fully explained by direct HIV effects on the brain has led to investigation of anti-inflammatory agents, antioxidants, and neuroprotective agents as potential treatments.

Dementia the Challenge for the Next Decade

Most importantly, Henderson and Jorm address prevention, commenting upon the interesting reports of a potential beneficial effect of anti-inflammatory drugs and estrogens upon the chances of dementia. As they comment, a random controlled trial will be necessary, as the evidence so far is post hoc. It is, therefore, pleasing to report that the UK's Medical Research Council has recently funded a cognitive dementia substudy within its WISDOM trial, in which very large samples of women in their 50s are being recruited from primary care for a random controlled trial of hormone replacement regimes. The dementia substudy begins at entry, but of course it will be a decade or more before any semblance of a result will be manifest, in view of the likely low incidence of dementia in the next decade for this cohort. The evidence of a protective factor of some form of innate ability'' has contributed to the brain reserve theory'', which hypothesizes that the more one has of some as yet undefined...

Pharmacotherapy For Aids Dementia

Investigational treatments for AIDS dementia include adjuvant use of anti-inflammatory and neuroprotective agents 251 . This effort is based on evidence that human immunodeficiency virus (HIV) is not the direct cause of CNS damage. Loss of neurons appears related to viral infection of brain macrophages and microglia. A valuable predictor of neurological impairment following HIV infection is the absolute number of immune competent macrophages rather than the level of viral involvement in brain tissue. Additional focus has been on the role of excitatory aminoacids, cytokines, glutamate and oxidative stress.


(94), though whether IL-6 itself is proinflammatory or anti-inflammatory in adipose tissue is still unclear (95). Both higher circulating levels of IL-6 and increased adipose tissue concentrations are associated with obesity. Furthermore, weight loss results in a decrease in IL-6 serum concentrations (96). Importantly, in obesity, unlike other situations, IL-6 is chronically elevated, and this chronic elevation may result in detrimental alterations in systemic metabolism. In summary, adipose tissue and serum levels of IL-6 increase with obesity. There is evidence that IL-6 has some anti-inflammatory actions, perhaps as a brake to inflammatory states. In certain situations, IL-6 has been suggested to have beneficial effects on systemic metabolism. However, obesity is associated with chronic elevations of IL-6 that may promote adipocyte lipolysis, insulin resistance, and other metabolic alterations.


Unlike chemotherapy, the time taken to respond to interferons may be prolonged and varies widely. Most patients who are going to respond will have done so by 3 to 4 months, and it is unusual for patients who progress on interferons to subsequently respond. However, there are reports of responses only starting to occur at 6 and 9 months. There is also the question of treatment duration in patients with either stabilization of disease or a partial or complete remission. Our current practice is to continue treatment indefinitely for those patients with stable disease or in remission, provided they are able to tolerate the side effects and treatment is stopped as soon as progressive disease occurs. Toxicity associated with interferon therapy includes flu-like symptoms, rashes, gastrointestinal complaints, liver dysfunction, neurological complaints, and fatigue, and are highly dose and schedule dependent. It is possible to alleviate some symptoms by administration at night and by the use...


The evidence suggests that moderate wine consumption is associated with reduced rates of ARMD. Taken together, the combination of the antioxidant effect of wine, its effect on platelet aggregability, intracellular calcium and its anti-inflammatory property may all be involved. Nonetheless, the exact

Anterior Uveitis

No codified treatment has been used on clinical trials. Topical antiviral therapy is of little benefit during viral anterior uveitis and keratou-veitis. Acyclovir and valacyclovir are active on herpes simplex and varicella zoster virus but inactive on other herpes viruses. Oral administration of antivirals is proposed in the majority of cases. In immunocompetent patients, treatment of herpes zoster ophthalmicus in the first 3 days is able to reduce the occurrence of keratouveitis and uveitis from 50 to 29 30 . Intravenous acyclovir (10 mg kg per day) may be proposed occasionally in severe forms of anterior uveitis and must be proposed to all immunocompro-mised hosts. It is important to respect a 48-h period of antiviral therapy before proposing topical corticosteroids during herpetic uveitis. Anti-inflammatory therapy should be started with high dose topical dexamethasone for a period of 8-10 days followed by a gradual tapering to be evaluated on an individual basis when inflammation...

Serum lipids

In the Cardiovascular Health Study, the use of statins is associated with a decreased risk of cardiovascular events in older women and men aged 65 or older and with no known previous CHD.19 In another large primary prevention study, therapy with lovastatin reduced the risk of first major coronary event by 54 in women and by 34 in men.20 The major benefit of statin therapy is probably due to its LDL-lowering and HDL-elevating effects. Statin-treated individuals have less CHD than patients with the same cholesterol levels not being treated with statins.21-23 Statins also inhibit smooth-muscle proliferation and platelet aggregation (important steps in the atherogenic process), enhance endothelial function, and provide anti-inflammatory actions.24

The Meglitinides

The hypoglycemic action of the glinides can be potentiated by nonselective -blockers, salicylates, monoamine oxidase inhibitors, and nonsteroidal anti-inflammatory drugs, whereas steroids, thyroid hormones, sympathomimetic agents, and thiazide diuretics may reduce the effects of the glinides.


Aspirin (acetylsalicylic acid) was first prepared by Hoffman at Bayer and introduced into clinical medicine in 1899 as an antiinflammatory agent. It had been preceded by sodium salicylate, which had been used since 1875 for its antipyretic and uricosuric as well as anti-inflammatory properties. This in turn had been preceded in previous centuries by the use of willowbark (salicylate-containing) as an antipyretic for ague. Aspirin consists of benzoic Its use as an analgesic (for integumental but not visceral pain), anti-inflammatory drug, antipyretic and antiplatelet agent are well known.

Endocrine System

421, Of the following mechanisms of anti-inflammatory and immunosuppressive effects of glucocorticoids, which one is uniformly observed 433, Glucocorticoids are powerful anti-inflammatory agents. Which of the following is not an anti-inflammatory mechanism of action of glucocorticoids


The answer is c. (Braunwald, 15 e, p 1369.) The history and physical are consistent with post-cardiac injury syndrome (in the past also known as Dressler syndrome or postmyocardial infarction syndrome). This generally benign self-limited syndrome comprises an autoimmune pleuritis, pneumonitis, or pericarditis characterized by fever and pleuritic chest pain, with onset days to 6 weeks post cardiac injury with blood in the pericardial cavity, as after a cardiac operation, cardiac trauma, or MI. Therefore the most effective therapy is a nonsteroidal anti-inflammatory drug or occasionally a glucocorticoid. Infection such as bacterial pneumonia, which would require antibiotics, would typically cause dyspnea, cough with sputum production, and rales on lung auscultation. Pulmonary embolus, which would require anticoagulation, would cause dyspnea and tachypnea, often in conjunction with physical findings of heat, swelling, and pain in the leg consistent with deep vein thrombosis. Angina...

Electrolyte Tests

Drugs that may cause an increase in chloride levels are androgens, cortisone preparations, estrogens, and nonsteroidal anti-inflammatory drugs. Decreased chloride levels can be associated with corticosteroids, hydrocortisone, and diuretics containing thiazide or mercury.


A 42-year-old woman complains of a burning pain in the upper middle region of her abdomen. The pain usually occurs about 2 hours after a meal and frequently awakens her at night. Antacids can usually relieve the pain within a few minutes. An x-ray film reveals a typical duodenal ulcer identified as a discrete crater in the proximal portion of the duodenal bulb. Because the woman does not have a history of chronic use of aspirin or other nonsteroidal antiinflammatory drugs (NSAlDs), the bacterium Helicobacter pylori is assumed to be the major factor in the etiology of the ulcer. Which of the following is likely to be normal in this woman


The answer is c. (Fauci, 14 e, p 1363-1364.) The history and physical are consistent with post-myocardial infarction syndrome (Dressler syndrome) rather than infection, pulmonary embolus, angina, or anxiety. This syndrome represents an autoimmune pleuritis, pneumonitis, or pericarditis, characterized by fever and pleuritic chest pain, with onset days to 6 wk post myocardial infarction. Therefore the most effective therapy is a nonsteroidal anti-inflammatory drug.


Adiponectin also inhibits vascular smooth muscle cell proliferation, as well as inhibiting expression of scavenger receptor class A proteins (58), which are thought to recruit atherogenic lipid particles into macrophages. The antiatherogenic capabilities of adiponectin may also be due in part to its anti-inflammatory properties. By inhibiting myocardial expression of tumor necrosis factor (TNF)-a, adiponectin decreases expression of monocyte adhesion molecules in the vascular wall and inhibits the transformation of macrophages to foam cells. Furthermore, adiponectin inhibits plaque formation by downregulating adhesion molecules such as vascular cell adhesion molecule (VCAM) (63).


Sulphasalazine is a prodrug that is metabolized by commensal bacteria in the colon or in the liver into two products 5-aminosalicylic acid (5-ASA) and sulphapyridine. There is some controversy as to which of these two products is responsible for the activity of sulphasalazine. Whereas it is known that 5-ASA is therapeutical-ly effective, it is not clear whether sulphapyri-dine adds any further benefit. In the colon, the products created by the breakdown of sulpha-salazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulphasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immunosuppres-sive effect as well. Following oral administration, 33 of the sulphasalazine, all of the sulphapyri-dine and about 33 of the 5-ASA are resorbed.


For patients with mild to moderately active OCP, we generally begin therapy with diamin-odiphenylsulfone (Dapsone), provided there are no contraindications (sulfa allergy, glucoses-phosphate deyhydrogenase deficiency). Dapsone is a synthetic sulfone with both antiinflammatory and antimicrobial activity. The drug interferes with neutrophil chemotaxis and prevents lysosomal enzyme release and phagocytosis. While Dapsone is highly effective when used short term, Fern and associates 8 have demonstrated this benefit to be temporary, with disease recurrence within weeks to months while on therapy. Patients who demonstrate a positive response can be maintained on a reduced dose. Methotrexate is a folic acid antagonist with an exceptional safety and efficacy record. It has both anti-inflammatory and immunosuppres-sive actions we employ methotrexate at an initial dose of 7.5 mg once a week, with a maximum of 35 mg once a week. The weekly dosing reduces the likelihood of potential adverse...


The mechanism of action of recombinant IFN-a2a treatment is not yet fully understood. The effect may include a modulation of the immune system. NK (natural killer) cells and NKT cells, a cell population bearing NK receptors as well as T-cell receptors (of restricted variability), are stimulated with IFN-a. The original hypothesis was based on reports that the NK NKT cell activity is impaired and their number decreased in several autoimmune animal models and human diabetes 81 . NKT cells have an important regulatory function in the innate as well as the adaptive immune response 73 . The deficiency of NK cells could be corrected with IFN-a treatment. Later, IFN-a was described as an inductor of circulating IL-1 receptor antagonists. In this case, induction of an anti-inflammatory status was suggested through modulation of the IL-1 IL-1 receptor antagonist balance. Recent results suggest that host immunity is an important factor in the response to interferon therapy 61 .


Numerous studies, together with the therapeutic response of LKC to anti-inflammatory drugs, underscore the importance of inflammation in its pathogenesis. Cellular and soluble mediators act in a number of ways in a series of complex interactions to promote and modulate ocular surface inflammation. Some mediators act as chemokines, stimulating chemotaxis of migrating inflammatory cells to sites of inflammation on the ocular surface. Other mediators stimulate expression of adhesion molecules such as ICAM-1 on conjunctival vasculature and epithelial cells. These act by binding proteins called in-tegrins on the surfaces of chemoattracted inflammatory cells to help retain them at sites of inflammation. Certain cytokines and other mediators activate inflammatory cells once they arrive to begin a proinflammatory program of gene expression, secretion of more mediators, and other functions. Other activities of inflammatory mediators include alteration of epithelial proliferation and...

ANKTM1 channel

It is known that the plant-derived cannabinoid, A9-tetrahydrocannabinol (THC), has analgesic and anti-inflammatory properties, which may be mediated by CB1 receptors present on primary afferent sensory neurons. However, THC appears to retain an analgesic effect in CBj - - mice. In addition, cannabidiol is anti-inflammatory and analgesic and does not share the ability of THC to bind to and activate CBj receptors. These data raise the possibility of a non-CB1 receptor-mediated action of plant-derived cannabinoids 63 . Furthermore, THC and cannabidiol induce a concentration-related relaxation of arterial segment - an effect that is insensitive to antagonism by CBj receptor antagonists 64 . The relaxant effect is absent in cap-saicin-treated vessels, indicating a role for small-diameter sensory fibers, but is not antagonized by the TRPV1 receptor antagonist capsazepine. The relaxation is abolished by ruthenium red, which is a non-competitive antagonist of vanilloid receptors. This novel...

Combination Therapy

In mild-to-moderate hypertension, ACE inhibitors can reduce diastolic blood pressure by 3-7 mmHg and 4-12 mmHg systolic these effects are enhanced with the addition of thiazide diuretics. The primary side effect of ACE inhibitors is cough, which occurs in at least 15 of the patients. This cough does not respond to a reduction in dose or change of ACE inhibitors. Patients with renal dysfunction or those receiving potassium-sparing drugs, nonsteroidal anti-inflammatory drugs, or -blockers may get concomitant hyperkalemia during ACE-inhibitor therapy. Hyperkalemia usually occurs with serum creatinines of greater than 2.5. ACE inhibitors should be used cautiously in patients with creatinines a greater than 2.5, and only when the benefits exceed the risk. Elderly patients are more likely to have increased risk as a result of arteriosclerotic vascular disease, because the glomerular filtration rate may decrease with age (47). A dreaded, rare complication with ACE inhibitors is angioedema,...


Statins yield a significant decrease in mortality, recurrent MI, recurrent episodes of unstable angina, stroke, the need for revascularization, and hospitalization in patients with established atherosclerosis.43-45 Statins reduce inflammation and stabilize vulnerable plaques and have been shown to benefit

Biological Activity

Cryptolepine has been shown to lower the blood pressure and body temperature of anaesthetised dogs (Gellert et al., 1951). The compound was reported to have anti-inflammatory properties (Noamesi and Bamgbose, 1983). These workers demonstrated that cryptolepine reduced carra-geenan-induced edema in the rat hind paw subplantar tissue. When given orally, the alkaloid significantly lowered glucose levels in the mouse model of diabetes. It was also shown to increase glucose uptake by 3T3-L1 cells (Luo et al., 1998).

The Adrenal Glands

Hormones of the Suprarenal Cortex (Outside Area). Approximately 28 hormones are produced by the suprarenal cortex. These hormones are produced only in the suprarenal cortex and are essential to life. The hormones of the suprerenal cortex are of most importance during times of stress (like trauma and disease). The hormones produced here tend to keep body metabolism stable during such periods of stress. The hormones reduce fluid loss, stabilize blood glucose, reduce inflammation, and prevent shock. Animals that have had their adrenal glands removed die under much less stress than do animals that have their adrenal glands. Occasionally, the suprarenal cortex malfunctions. When its function is reduced, a condition called Addison's disease results. Fatigue, muscle weakness, weight loss, low blood pressure, gastronintestinal upset, and collapse are clinical signs of Addison's disease. When the suprarenal cortex too actively secretes its hormones, a condition called Cushing's disease...


Several techniques have been utilized to decrease the discomfort, which may be perceived as anything from minor transient cramping to intolerable sharp pain. Most women benefit from a dose of short-acting non-steroidal antiinflammatory medications (ibuprofen or naproxen sodium) 30-60 minutes before the procedure. Visual analog pain scores in a randomized, controlled trial comparing intrauterine instillation of 2 lidocaine or saline showed that there was an approximately 50 decrease in pain in women receiving lidocaine with no decrease in ability to interpret histologic specimens.62 A randomized, double-blinded, controlled trial of paracervical block comparing 10 ml 1.5 mepivicaine with saline placebo also found significant reductions in pain and vasovagal reactions to the procedure.63


T cells upregulate their receptor for IL-2 (IL-2R) upon activation. Targeting the a-chain of the high-affinity IL-2R will thus affect only activated T cells, the population that maintains the autoaggressive immune response, while leaving the pool of memory and nai've T cells untouched. In rodent experimental autoimmune uveitis the autoaggressive Th1 cells express large numbers of IL-2R 11 . In a non-human primate model, targeting IL-2 receptors could effectively downregulate experimentally induced intraocular inflammation 26 , offering the rationale for treating the first patients in a non-randomized open-label pilot study 50 . Ten uveitis patients were successfully treated with the humanized antibody specific for the IL-2 receptor (daclizumab) img kg body-weight was infused in 2-week intervals. After 24 weeks the intervals between the infusions were increased to 4 weeks. Within the 1st year patients did not need any other immunosup-pressive or anti-inflammatory therapy besides...


At present very little can be done to modulate the immune response in patients having corneal transplants and at risk of rejection. Reducing inflammation by minimizing microsurgical trauma and generous use of topical corticos-teroids is all that is usually available. However, a strong case can be made for HLA-A, -B and -DR matching, but in many places this would demand a change in eye banking logistics. Conventional systemic immunosuppression, the mainstay of immunomodulation for solid organ grafts, is not readily applicable to corneal transplantation because it is difficult to justify the risks involved. Even where the risk may be justified there is little high level evidence to support the approach or to identify one particular im-munosuppressive regimen as more effective than another. Nor will it be easy to assemble this evidence. The 1-year survival of corneal transplants is around 90 , even in the high-risk groups. Failures come later and often. Clinical trials would have to be...


Because of their high anti-inflammatory potential, corticosteroids are widely used in the management of ocular Behcet's disease. They are indicated to shorten the duration of an acute uveitis attack, but as a monotherapy they are not effective for long-term treatment, probably because the doses necessary for maintenance of remission would be too high, accompanied by unacceptable side effects 77 . Thus in most cases a steroid sparing immunosuppressive agent has to be added. An exception may represent cases in which immunosuppressive drugs are contraindicated, such as during pregnancy 61 .

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