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Typically permanent teeth with symptomatic or asymptomatic irreversible pulpitis as a result of caries are managed with root canal treatment (RoCT) or extraction. The aim of this review was to assess the success rate of CPT in treating carious vital pulp exposure in permanent posterior teeth with closed root apices. Searches were conducted in the PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Initial screening was carried out independently by 3 authors and data abstraction by 2 authors. Coronal pulpotomy treatment could increase tooth retention by providing a potential option particularly for low-income patients or in under served areas worldwide. While 3 databases were searches the inclusion criteria restricted the included studies to those published in English this could result in relevant studies being excluded. This review suggests that CPT provides reasonable results at 2 years and that MTA may provide a better outcome. Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. Back in February, I blogged about a cohort study published in the New England Journal of Medicine, which concluded that ADHD drugs are not linked with an increased risk of serious cardiovascular events. The last few years has seen heated debate about the use of central nervous stimulants in children and young people. It’s good to see another reliable piece of research to add to the discussion, this time in the BMJ.
The study involved over 1.2 million children and young people (aged 3-18) who entered the cohort when first diagnosed with a mental health condition (such as ADHD) that is commonly treated with a stimulant.
Participants were followed until they lost their Medicaid benefits, their 19th birthday, admission to hospital for longer than 30 days, or death. Transplant patients, those on dialysis and young people with substance misuse problems were excluded from the study, but children with congenital heart disease were included. Treatment of children with central nervous stimulants is not significantly associated with an increase in the short term risk of severe cardiac events. The median follow-up time for this study was about 2 years, so this study cannot tell us anything about the long-term safety of these drugs. The sample size was huge, but despite this, the data cannot tell us anything about the comparative safety of different drugs (e.g. Winterstein, AG et al Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study. He has worked as an Information Scientist in Mental Health since the late nineties; initially at Oxford University's Centre for Evidence-Based Mental Health and since 2002 as the Managing Director of Minervation Ltd.
ABLATION - Surgical removal or destruction of a part of the body, such as amputation of a limb. ACETAMINOPHEN - aka Tylenol®, as well as a boatload of generics, the most popular OTC analgesic drug there is. ACROCYANOSIS - Blueness of the hands and feet, caused by a multitude of possible etiologies.
ACTIVE SITE - the small, 3D pocket in a receptor with which a drug (ligand, substrate) associates to form a drug-receptor (or enzyme-substrate) complex. ACTIVE TRANSPORT - the movement of molecules or ions across a cell membrane, from an area of lower to higher concentration.
ACTIVITY, INTRINSIC - The property of a drug which determines the amount of biological effect produced per unit of drug-receptor complex formed. ACUPUNCTURE - The science of using thin needles to stimulate various specific gates in the meridian system, which, according to Eastern philosophy and practice, carries one's life energy, or qi (e??). ADDICTION - a state defined by compulsive engagement in rewarding stimuli, despite adverse consequences. ADHESION - Abnormal adherence of collagen fibers to surrounding structures during immobilization following trauma or as a complication of surgery which restricts normal elasticity of the structures involved. ADRENAL GLANDS - Each adrenal gland is about the size of the thumb and sits atop each kidney.
ADRENALIN - more correctly known as epinephrine, a primary neurotransmitter in the sympathetic nervous system. ADRENERGIC - Referring to substances which stimulate the sympathetic nervous system, aka sympathomimetic.
ADRENERGIC BLOCKING AGENT - A substance that blocks responses to sympathetic nerve stimulants, more correctly known as an adrenergic antagonist. AFFINITY (DRUG) - A drug's affinity refers to its adherence to a receptor, whether or not a biological response is elicited. AGONIST - a drug which acts similarly to a reference drug, often endogenous; interacts with the same receptor. ALCOHOL - usually refers to ethanol, the least toxic of the simple alcohols; the family includes methyl (wood) alcohol and isopropyl (rubbing) alcohol.
ALCOHOLISM - Alcoholism, or the severe dependency upon alcohol and the inability to stop drinking once one has started, has been, in the last 30 years or so, recognized as a primary disease. ALKALOID - Not used much any more; generally means a natural product which is basic, usually due to the presence of one or more nitrogen atoms in the structure. ALLERGIC REACTION - A reaction to foreign substances (allergens) by the bodya€™s immune system. ALLODYNIA - Extreme pain is produced by any stimuli that would not normally induce pain (such as touch, pressure and warmth).
ALLOSTERIC MODULATOR - A drug that binds to a receptor at a site distinct from the active site. ALZHEIMER'S DISEASE - a progressive neurologic disease of the brain that leads to the irreversible loss of neurons, brain material, and dementia. AMBULATORY SURGERY - Surgery performed either in a special ambulatory care unit or doctor's office. AMINO ACID - one of 20 small organic molecules which form the building blocks for polypeptides, or proteins.
AMITRIPTYLINE - a tricyclic antidepressant (TCA) often used in initial pain Tx - Elavil®. AMPHETAMINE - a class of drugs that stimulate the sympathetic nervous system (and thus are sympathomimetic), and can be very addictive. AMYOTROPHIC LATERAL SCLEROSIS (ALS) - a serious neurological disease that causes muscle weakness, disability and eventually death. ANEMIA - Insufficiency of red blood cells, either in quality or quantity, causing symptoms of low blood oxygen.
ANESTHESIA - Loss of sensation, often produced in order to permit a painless surgical operation. ANESTHESIOLOGIST - A physician who specializes in the administration of anesthesia and in medical procedures that entail the very precise placement of long needles (nerve blocks, etc.).
ANESTHETIC - Drug that is capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. ANKYLOSING SPONDYLITIS - A systemic, inflammatory disease centered in the spine, causing pain and often leading to painful alterations of the vertebral articulations, as well as stiffness of the spine. ANOREXIA - the decreased sensation of appetite which may indicate a serious clinical condition. ANOREXIA NERVOSA - A mental disorder manifested by extreme fear of becoming obese and an aversion to food, usually occurring in young women and often resulting in life-threatening weight loss, accompanied by a disturbance in body image, hyperactivity, and amenorrhea.
ANTAGONIST - A drug which blunts or completely halts the effect of another drug, usually by physically blocking the receptor that the drug would ordinarily have occupied. ANTICHOLINERGIC - the action of a compound that causes antagonism of the NE (norepinephrine) receptors in the body. ANTIDEPRESSANT MEDICATIONS - Those that aid in combating the disease of depression, which can be endogenous (innate, often genetically linked) or situational (in response to factors in one's life). ANTINOCICEPTIVE - lacks the ability to transmit, or blocks, nociceptive pain signals; often applied as an adjective to describe the action of a drug.
ANTIPSYCHOTIC - A drug class that acts to reduce the core symptoms of psychosis, most usually schizophrenia. ANXIETY - An unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict.
ARACHNOIDITIS - An inflammation of the arachnoid, the protective membrane that covers the brain and spinal cord.
ARTHRITIS - Inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. ARTHROSCOPY - A procedure wherein an orthopedist looks into a joint with a specially-designed lighted hollow instrument. ATROPHY - The withering of an organ or tissues which had previously been normally developed due to degeneration of cells. AUTOIMMUNE DISEASE - Autoimmune diseases are any diseases whereby the body suddenly doesn't recognize a part of itself and develops antibodies to fight it, kill it and destroy it. AUTONOMIC NERVOUS SYSTEM - The portion of the nervous system over which there are no voluntary, conscious control, including heart beat, breathing, intestinal movements, sweating, etc. AUTOPSY - a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present. AXON - Nerve fiber that is capable of rapidly conducting impulses away from the neuron cell body.
BACTEREMIA - The presence of bacteria in the bloodstream, as indicated by a true-positive blood culture result. BACTERIA - Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal.
BAKER'S CYST - Localized swelling of a bursa sac in the posterior knee as a result of fluid that has escaped from the knee capsule. BASAL GANGLIA - group of structures which coordinate movement; located in the forebrain (telencephalon). BETA BLOCKER - Drug that tends to slow the heart rate and the force of heart contractions to lower the blood pressure. BINDING SITE - The portion of the receptor to which a ligand (neurotransmitter, drug) actually adheres to.
BIOAVAILABILITY - Also referred to as availability, this is the amount of a drug that is absorbed into circulation after administration of a specific dosage. BIOEQUIVALENCE - Drugs that are bioequivalent provide the same amount of active drug to the body. BIOFEEDBACK - Giving information to an individual, through visual or auditory means, on the state of certain physiological responses such as heart rate, etc.) so that the individual can gain some voluntary control over these procedures. BIOTRANSFORMATION - The chemical change of a drug that happens due to the effects the body has on it. BIPOLAR DISORDER - a mental illness in which the patient alternates between periods of energy and euphoria (manic phase) and times of deep depression and lack of energy (depressive phase).
BLIND EXPERIMENT - A type of experiment in which the participants are unaware of the drug doses or treatments involved, so as not to affect the outcome.
BLOOD-BRAIN BARRIER - the very selective, permeable membrane separating the circulating blood from the cerebrospinal fluid (CSF) that surrounds the spinal cord and brain. BONE SCAN - A process used to check for the presence of damage or changes in the bones which enables them to be seen long before they become visible on an ordinary X-ray. BOUND - This term is used to refer to the binding of a drug or other compound or element to another molecule or element. BOWEL - The large intestine, which is part of the gastrointestinal (GI, digestive) system in the body. BRACHYTHERAPY - A type of radiotherapy in which the source of radiation is placed (or implanted) in or close to the area being treated. BRAIN DEATH - The irreversible cessation of all functions of the entire brain, including the brainstem. BREAKTHROUGH PAIN - A short-term flare of pain of moderate to severe intensity occurring against a background of otherwise controlled pain. BRIEF FATIGUE INVENTORY - A fatigue assessment tool that asks patients to rate, on a scale of 0 (none) to 10 (severe), their current level of fatigue, usual fatigue level in the last 24 hours, worst level of fatigue in the last 24 hours, and how fatigue has interfered with general activity, mood, walking, work, relationships, and enjoyment of life.
BULIMIA - Bulimia nervosa, known simply as bulimia, is an eating disorder that typically consists of binging and purging. BURNOUT - A form of mental distress manifested in normal individuals by decreased work performance, resulting from negative attitudes and behaviors.
BURSA - A fluid- filled sac that is located in areas where friction is\ likely to occur, then minimizes the friction; for example between a tendon and bone. BURSITIS - Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the sub-deltoid bursa.
CACHEXIA - any general reduction in vitality and strength of body and mind resulting from a debilitating chronic disease. CANCER - also known as a malignant tumor or malignant neoplasm, is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. CANNABIDIOL (CBD) - one of the main constituents of marijuana (THC (tetrahydrocannabinol) is #1); it is non-psychoactive. CARBAMAZEPINE - An anticonvulsant used to control grand mal and psychomotor or focal seizures. CARDIAC CACHEXIA - Nonintentional, nonedema weight loss of 7.5% of previous normal weight over a period of 6 months in patients with congestive heart failure or other heart disease. CARDIOLOGIST - A hospital doctor who is concerned with the diagnosis and treatment of diseases of the heart and blood vessels. CAREGIVER - A person who provides direct care to a patient (either at home or in health care settings), whether paid or unpaid. CARPAL TUNNEL SYNDROME - Numbness, weakness and pain in the hand, involving especially the index, middle and ring fingers, due to compression of the medial nerve at the wrist.


CARTILAGE - Smooth, slippery substance preventing two ends of bones from rubbing together and grating. CATECHOLAMINE - A group of neurotransmitters that are structurally related by a catechol nucleus.
CATHETER - A hollow rubber, plastic, or glass tube for passage into a structure, for the purpose of injecting or removing fluid or blood.
CAT SCAN - The acquisition of x-rays from many different depths, thus giving a highly defined, 3D set of pictures of an organ or organs. CAUSALGIA - A burning sensation in the palms, soles or digits, originally thought to be due to irritation or disease in the nerves supplying these areas.
CENTRAL DOPAMINE TYPE 2 (D2) RECEPTOR - Dopamine receptors that control neural signaling modulating many important behaviors, such as spatial working memory. CENTRAL NERVOUS SYSTEM (CNS) - the part of the nervous system consisting of the brain and spinal cord.
CENTRAL PAIN - Pain associated with a lesion of the central nervous system, or which permeates the CNS due to central sensitization. CENTRAL SENSITIZATION - a condition of body-wide allodynia or hyperalgesia, which can precede whole-body RSD. CENTRAL VENOUS CATHETER - A hollow plastic tube inserted into a vein in the arm or neck, and pushed forward until it reaches the vena cava in the chest.
CEREBELLUM - Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. CEREBRAL HEMORRHAGE - Bleeding into the brain tissue from a ruptured blood vessel, also known as a hemorrhagic stroke. CEREBRAL PALSY - a group of non-progressive and non-contagious motor conditions that cause physical disability in human development.
CEREBROSPINAL FLUID (CSF) - The odorless, colorless fluid that surrounds the brain, spinal cord, and all other components to the central nervous system (CNS).
CHEMORECEPTOR TRIGGER ZONE (CTZ) - Functionally outside the blood-brain barrier, the chemoreceptor trigger zone is exposed to toxins in the bloodstream and cerebrospinal fluid that can stimulate vomiting. CHEYNE-STOKES RESPIRATIONS - A rhythmic waxing and waning of both respiratory pattern rate and tidal volumes that includes regular periods of apnea.
CHIROPODIST - A person who is concerned with chiropody, which is the study and care of the foot. CHIROPRACTIC - A system of diagnosis and treatment based on the concept that the nervous system coordinates all of the body's functions, and that disease results from a lack of normal nerve function. CHIROPRACTOR - One who treats disease by a system of healing which employs manipulation and specific adjustment of body structures (primarily the spine). CHLORINE - one of the halogen elements, used in the preparation of, and is part of, many drugs. CHOLESTEROL - The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. CHOLINERGIC - Refers to biological systems that rely on acetylcholine as a neurotransmitter. CHROMOSOME - Self-replicating structures in the nucleus of a cell that carry the genetic information.
CHRONIC FATIGUE - Fatigue present in an individual at least 50% of the time that persists for at least 6 months. CHRONIC FATIGUE SYNDROME (CFS) - An illness predominantly affecting young adults and characterized by disabling fatigue of at least 6 monthsa€™ duration, accompanied by several other symptoms (such as sore throat, adenopathy, muscle pain, multijoint pain, and headache) that cannot be attributed to any alternative condition. CHRONIC PAIN - a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years. CHRONIC RENAL FAILURE - a condition that results in the progressive loss in renal function of a period of months or years.
CIRRHOSIS - Widespread disruption of normal liver structure by fibrosis and the formation of regenerative nodules that is caused by various chronic progressive conditions affecting the liver (such as long-term alcohol abuse or hepatitis). CLINICAL TRIAL - a tightly controlled, statistically valid test of a drug's efficacy, compared to a placebo. CNS - central nervous system - the part of the nervous system consisting of the brain and spinal cord. CODE OF MEDICAL ETHICS - The American Medical Association's Code of Medical Ethics is an ethics guide for practicing physicians that is reviewed and updated over time. CODEINE - An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects.
COGNITION DISORDER - Disorders such as dementia and delirium that involve mental activities associated with thinking, learning, and memory.
COLLAGEN - the main structural protein in connective tissue, and is the most prevalent protein in the body. COMORBIDITY - Disease(s) or conditions that coexist(s) in study participants in addition to the index condition that is the subject of the study. COMPARTMENT SYNDROME - a medical emergency that involves increased pressure in a muscle compartment. COMPENSATION CASE - An injury or disease incurred because of the work one performs; refers to the involvement of Workers Compensation insurance and its associated laws and guidelines.
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) - the term for medical products and practices that are not part of standard care. COMPLEX REGIONAL PAIN SYNDROME (CRPS) - a complicated, multifaceted illness centered in the CNS; the most painful medical condition known.
CONFLICT OF INTEREST - A situation in which an individual or group is involved in multiple interests (concerns), and one or more interests could possibly affect the motivation for an action or interpretation regarding another interest.
CONJUNCTIVITIS - occurs when the eyelid lining swells, which can happen for a number of reasons. CONNECTIVE TISSUE DISORDER - A group of diseases including rheumatoid arthritis, systemic lupus erythematosus, rheumatic fever, scleroderma and other disorders, that are sometimes referred to as rheumatic diseases. CONTINUOUS INFUSION - In the test for intrathecal drug delivery, the slow introduction of the test pain-relieving medicine into the intrathecal space surrounding the spinal cord over a period of time. CONTRACTURE - The shortening of a muscle, tendon or other structure so that it can not be straightened or readily flexed and extended.
CONVULSION - a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body.
CORTEX - The outer layer of an organ or other body structure, as distinguished from the internal substance. CORTISOL - a steroid hormone, more specifically a glucocorticoid, which is produced by the adrenal cortex. COSTOCHONDRITIS - Inflammation and pain in the area where the cartilages join the breastbone (sternum). CROSSOVER EXPERIMENT - A type of experiment in which each participant receives a trial preparation. CRYOANALGESIA - A semi-permanent nerve blocking technique where nerves are destroyed with extreme cold to relieve pain for weeks or months.
CYANOTIC - Bluish color of the skin and mucous membranes, usually due to poor circulation and insufficient oxygen in the bloodstream. CYST - Any closed cavity or sac; normal or abnormal, lined by epithelium, and especially one that contains a liquid or semisolid material. DEAFFERENTATION PAIN - Pain due to loss of sensory input into the central nervous system, as occurs with avulsion of the brachial plexus or other types of lesions of peripheral nerves or due to pathology of the central nervous system. DEEP HEAT THERAPY - The use of heat to treat certain medical conditions including chronic pain with products such as heat packs, paraffin baths and radiant heat, or with a hot bath or towels immersed in hot water.
DEFIBRILLATOR - An electrical device used to reverse an abnormal heart rhythm and re-start a heart, for example following a heart attack, by applying a brief electric shock.
DEGENERATIVE DISK DISEASE - A disease affecting the spine, specifically the spinal discs, the soft cushions that sit between each vertebra of the spine. DELIRIUM - A disturbance of the brain function that causes confusion and changes in alertness, attention, thinking and reasoning, memory, emotions, sleeping patterns and coordination. DELERIUM, HYPERACTIVE - Delirium commonly characterized by restlessness, agitation, hypervigilance, hallucinations, and delusions. DELERIUM, HYPOACTIVE - Delirium that includes psychomotor retardation, lethargy, and reduced awareness of surroundings. Recent events have highlighted the increased risk of abuse faced by people with learning disabilities.
Last year, we posted about a study based on in-depth interviews focusing on the experience of people living independently in the community which suggested that perpetrators of abuse against people with learning disabilities living independently tended to be people in the locality, including neighbours, and often young people and schoolchildren.
A report based on a three year mixed methods study by researchers at the Tizard Centre in Kent suggested that nearly half the people with learning disabilities in their sample reported victimisation experiences. The researchers in this study were interested in offering an opportunity for people with learning disabilities themselves to express their views. They worked with people in Wales, looking particularly at what people themselves thought they needed keep safe. What they did was develop a questionnaire exploring the issues and distributed as a postal survey and also to people attending a residential research event. They got back 107 questionnaires which were completed in a way that made them usable in the study.
What they found was that the respondents identified most strategies that had been raised for keeping safe as useful. It was clear to the authors of the study that the questionnaires responses showed that people with learning disabilities were able to identify personal safety strategies. They recommend that personal safety courses and staff training be influenced and informed by these views and experiences. They conclude that a key component of any effective strategy to reduce abuse and respond appropriately requires the development of effective circles of support.
After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. The researchers in this Dutch study identified that this issue had been little studied in people with learning disabilities. They carried out logistic regression analyses to identify associations of sarcopenia with characteristics of the people in the study, their mobility, physical activity, intake of energy and proteins, body mass index (BMI) and levels of CRP (C-reactive protein the levels of which in the blood might rise in response to inflammation), albumin and vitamin D in serum. In terms of the associations they looked for, Sarcopenia was positively associated with mobility impairment and inflammation and negatively with BMI.
Studies of prevalence of sarcopenia in healthy adults aged over 64 have found rates over over 20%, whereas this study found prevalence rates lower than this, but in a younger age group and that there were particular risk groups including those with low BMI or mobility impairment.
Recently studies assessing the use of coronal pulpotomy treatment (CPT) in permanent teeth have demonstrated promising results. Studies reporting complete coronal pulpotomy ?in permanent posterior teeth with closed root apicies without pulp necrosis were considered. Quality assessment was performed by two authors using the Cochrane Risk of bias tool for randomised controlled trials (RCTs) and the Newcastle–Ottawa scale (NOS) for prospective or retrospective cohort studies. Success was defined as no radiographic abnormality or clinical symptoms, such as spontaneous pain, tenderness to percussion or palpation, resolution (decrease in size or elimination) of an existing radiographic periapical lesion, and no need for further pulpectomy and RCT of the treated teeth.
However, more studies having longer follow-up, larger sample size and including a control group are needed to validate the possibility of performing CPT as an alternative to RCT. Of the included studies only one was a randomised controlled trial and it is not clear how many of the cohort studies were prospective, although the NOS scores were similar and ranged from 4-5.
However, as the bulk of the studies are observational and a greater risk of bias further high quality RCTs are needed to provide a more robust estimation of survival. Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: A systematic review and meta-analysis.
The lack of good quality research in this field has led to various government responses, including black-box warnings and the recommendation of regular electrocardiographies proceeding treatment. It’s a retrospective cohort study and it concludes that short term use of central nervous stimulants is not significantly associated with an increase in the short term risk of severe cardiac events. The patients came from 28 different states in the US and were all eligible for the state Medicaid programmes. He also has established interests in evidence-based healthcare, usability testing and web design. Acetylcholine (ACh) in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. Two agents combining with equivalent sets of receptors may not produce equal degrees of effect even if both agents are given in maximally effective doses; the agents differ in their intrinsic activities and the one producing the greater maximum effect has the greater intrinsic activity.
Formation of nucleic acids, transmission of nerve impulses, muscle contraction, and many other energy-consuming reactions of metabolism are made possible by the energy in ATP molecules. It is common for an antagonist to have a high receptor affinity, although the action of an agonist is blocked by this.
Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss.
Was used for chemical sympathectomies in the treatment of CRPS pain, but this practice has fallen out of favor since it is common for the pain to return with a vengeance. Its two major symptoms are loss of control once drinking has begun, and denial that the person has an alcohol problem, even in the face of irrefutable evidence.
Substances that trigger allergies include pollen, dust mites, animal fur, some medications, and certain foods.
Induces a conformational change in the receptor, which alters the affinity of the receptor for the endogenous ligand. Can be seriously addicting, and is the only benzo known so far whose withdrawal syndrome can be fatal.
ALS is often called Lou Gehrig's disease, after the famous baseball player who died of it in 1941.
It differs from an anesthetic agent in that it relieves pain without loss of consciousness.


It typically causes a number of symptoms including an itchy rash, throat swelling, and low blood pressure.
It may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. It is a common side effect of many serious diseases such as acute viral hepatitis, AIDS, cancer, congestive heart failure, Crohn's disease, depression, and more. Narcan® (naloxone) is an opioid antagonist, and can reverse an opioid overdose in seconds. Since NE is the main neurotransmitter of the sympathetic nervous system, blockage of its receptors causes the drying of most secretory actions, resulting in constipation, drying of the eyes and mouth, blurred vision from lack of tear production, etc. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. Anxiolytics reduce pain-related anxiety, help relax muscles and can help a person cope with pain. Apraxia is an acquired disorder of motor planning, but is not caused by incoordination, sensory loss, or failure to comprehend simple commands (which can be tested by asking the person to recognize the correct movement from a series). Although this condition has no consistent symptom patterns, it commonly affects the nerves connecting the lower back and the legs. There are more than 100 different types of arthritis; the two major types are osteoarthritis and rheumatoid arthritis. The medicines prescribed for asthma are bronchodilators, which release the restrictive forces of restrictive asthma, and corticosteroids to ease inflammations of the inflammatory type.
A Baker's cyst indicates that there is a trauma inside the knee joint that leads to excessive fluid production. Most are C-II, and have been generally replaced by benzodiazepines, since barbiturates are so easy to OD on; suicides using these drugs used to be common, especially when mixed with alcohol. This term is used when comparing the same drug manufactured by two companies, or two different preparations (e.g. Pharmacodynamics involves the chemical effects of a drug on the body; biotransformation involves the chemical effect of the body (primarily the liver) on a drug. It is treated with a variety of drugs, the first successful of which was lithium carbonate (Li2CO3). In a a€?single-blinda€? experiment, one participant a€“ usually the subject a€“ is left uninformed. The membrane is almost impermeable to ionic or inorganic substances, while lipophilic compounds tend to cross easily. Although they can sometimes show the presence of RSD, they do not always successfully detect it.
It is usually the agent of choice for various neural blocks, from epidural to stellate ganglion and many other blocks.
In end-of-life care, burnout often results from stresses that arise from the clinician’s interaction with the work environment.
Its main activity is as an antispasmodic, for which it is starting to be prescribed as cannabis' legal status continues its climb. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. Includes clearing the air passages to the lungs, artificial circulation through rhythmic pressing on the patient’s chest, and artificial respiration.
Its main feature is a lipid bilayer, comprised of long molecules with a hydrophilic head and lipophilic tail, the latter of which points toward the inner part of the membrane. Opioid-induced nausea and vomiting are caused by their effects in the chemoreceptor trigger zone that are largely mediated through central D2 receptors, whereas opioid effects on the stomach producing gastroparesis are mediated through peripheral D2 receptors.
So named because it integrates information it receives from, and coordinates and influences the activity of, all parts of the bodies of bilaterally symmetric animals, and it contains the majority of the nervous system. Can be thought of as the CNS being on high alert, in which various stimuli can cause an over-reaction and great pain.
It can cause abrupt dysfunction of neurologic tissue, leading to neurologic deficits such as hemiparesis, hemisensory loss, aphasia, ophthalmoplegia, and visual field cuts. Click the diagram on the right to see the anatomical features involved in CSF production and circulation.
Chakras are part of the subtle body, not the physical body, and as such are the meeting points of the subtle (non-physical) energy channels called nadiis.
Chiropractic medicine uses manipulation and adjustment of body structures, such as the spine, to relieve pressure on nerves coming from the spinal cord.
Dietary restrictions on cholesterol were just removed, due to new evidence that dietary sources of cholesterol have little bearing on serum cholesterol levels. There are two fundamental neuropharmacologic types of cholinergic neurons: nicotinic and muscarinic. Often, chronic renal failure is diagnosed as a result of screening of individuals who are known to be at a risk for kidney problems, such as those who suffer from high blood pressure, diabetes or those whose blood type is relative with chronic kidney disease. In fact, the chemical is only partially removed from each unit volume of the total volume in which it is dissolved. Systematically developed statements or recommendations to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. In the US, there are three phases of clinical trials, using progressively larger test populations with increasing number if ill patients. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It has a number of possible causes, so it is essentially a symptom rather than an illness, though it causes distinct symptoms of its own.
It can lead to muscle and nerve damage and problems with blood flow, and has been known to precipitate CRPS. Standard care is what medical doctors, doctors of osteopathy and allied health professionals, such as registered nurses and physical therapists, practice. There is no organ or body location that has been shown to be immune to invasion by CRPS, and the syndrome usually becomes chronic.
Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral and abdominal fluid accumulation; the ventricles can be involved together or separately. They probably do not affect solely connective tissues but the diseases are linked in various ways and have interesting immunological features which suggest that they may be autoimmune in origin. In a contusion, blood from the broken vessels accumulates in surrounding tissues, producing pain, swelling, and tenderness.
The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. Depending on how equitably the electrons are shared, one of the atoms can have a partial charge (δ+ vs. The preparations are then crossed between participants in order to calculate the effects of the trial preparations through various participants. Its primary symptom is a production of mucus that is thicker than mucus in individuals without the disease. These symptoms may start suddenly, are due to some type of medical problem, and they may get worse or better multiple times. It is often mistaken for depression and is difficult to differentiate from sedation because of opioids or obtundation in the last days of life. However, they were more likely to identify personal strategies rather than actions to be taken by other people.When they looked at what was important for people when abuse did occur, they found that people said that having a trusted person to speak to and who believed were most important. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. They worked with 884 older people described as having borderline to profound learning disabilities, all aged 50 years and over to identify the prevalence of sarcopenia. Prospective or retrospective studies published in English and having at least ten patients and minimum one-year follow-up period were included. A sensitivity analysis was conducted excluding each data set at a time with no single study appearing to significantly affect the success rate.
The one RCT that was included in this review was considered by the Dental Elf in March 2012. Furthermore, long term effects of slight increases in heart rate or blood pressure are unknown. The authors suggest that given the small overall incidence of severe events, differences are probably subtle.
The downside is that acetaminophen is a cumulative hepatotoxin, and serious liver damage can result from using more than 3g (3,000mg) of acetaminophen per day for an extended period of time.
It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases in the blood, but it is useful in some ophthalmological applications. Denial is an important part of the syndrome, since not to deny the problems with alcohol would mean that the person would have to face and deal with them.
Positive allosteric modulators increase the affinity, while negative allosteric modulators decrease the affinity. Arachnoiditis is characterized by chronic pain, tingling, numbness, muscle spasms and uncontrollable twitching. Common symptoms include: joint pain, joint swelling, reduced ability to move the joint, redness of the skin around a joint, stiffness, especially in the morning, and warmth around a joint. Were commonly used in state-sanctioned murders as part of the three-component lethal drug mixture, until European manufacturers refused to ship the products for uses such as taking a human life.
First believed to be and advertised as non-addictive, we now know that these drugs can be very addictive, especially the long half-life analogs like diazepam.
In a a€?double-blinda€? experiment two participants a€“ usually the subject and observer a€“ are uninformed, and in a a€?triple-blinda€? experiment the subject, the observer, and the person responsible for the actual administration of the drug are left unaware of the nature of the material administered. The triphasic bone scan is one of the best ways to diagnose RSD; the best description is in an online textbook on orthopedics. For example, protein binding of a drug limits the amount of free drug available to induce an effect. It provides a controlled, sterile environment for the CNS, carrying nutrients to the system among other vital functions. There are three basic anatomic divisions of cholinergic neurons: neuromuscular, ganglionic and post-ganglionic. They present indications for performing a test, procedure, or intervention, or the proper management for specific clinical problems. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. It can also be considered an illness if it is chronic and there is no known underlying cause. Treatment includes patient education, diuretics, ACE inhibitors, angiotensin II receptor blockers, I?-blockers, aldosterone antagonists, digitalis, specialized implantable pacemakers and other devices, and correction of the underlying disorder. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. However, occupancy does not imply an effect since antagonists can bind but produce no direct effect as a result of occupancy.
Guidelines may be developed by government agencies, institutions, organizations such as professional societies or governing boards, or by convening expert panels. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. Any swelling in a compartment will lead to increased pressure in that area, which will press on the muscles, blood vessels, and nerves. CRPS usually starts in the foot or hand after an injury, such as a broken bone, or nerve damage from surgery. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site. It produces epinephrine and norepinephrine, which are also called adrenaline and noradrenaline, which are the primary neurotransmitters involved in the sympathetic nervous system. A competitive antagonist binds to the same site as the agonist but does not activate it, thus blocks the agonista€™s action.
The liberated HCl causes fluid accumulation and pulmonary edema, which can cause death rapidly. Examples of the many CAM therapies include acupuncture, low-level laser therapy, meditation, aroma therapy, Chinese medicine, dance therapy, music therapy, massage, herbalism, therapeutic touch, yoga, osteopathy, chiropractic treatments, naturopathy, and homeopathy. People who are elderly, pregnant or have recently had surgery may also develop constipation. A non-competitive antagonist binds to an allosteric (non-agonist) site on the receptor to prevent activation of the receptor. In most cases, the fraction bound to a receptor or an enzyme is considered to be very small relative to the fraction that is not bound.
Other symptoms can include sensitivity to touch, skin changes, swelling, weakness and loss of movement in the hand or foot. A reversible antagonist binds non-covalently to the receptor, therefore can be a€?washed outa€?.
If the pressure lasts long enough, the muscles may die and the limb may need to be amputated.
An irreversible antagonist binds covalently to the receptor and cannot be displaced by either competing ligands or washing.



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Children in kindergarten to third, seventh and expertise anxiety and taking deep swallows for the duration of the descent of ascent of a flight. Also.