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Asthma care should also be evaluated. In this regard, patients should know the goals and reasonable expectations associated with their therapy. Component 2: Control of Factors Contributing to Asthma Severity This section of the NAEPP II Guidelines discusses the identification and management of asthma triggers. Triggers are categorized as inhalant e.g., outdoor and animal allergens, dust mites, cockroaches, fungi ; , occupational e.g., chemicals or dusts ; , irritants e.g., tobacco smoke and pollution ; , and other e.g., gastroesophageal reflux disease, some medications, infections, rhinitis sinusitis ; . It is important to identify a patient's triggers so that exposure can be avoided or minimized whenever possible. Should a patient be exposed to a known trigger, treatment with a short-acting beta agonist prior to, or soon after exposure, may help minimize symptoms. Patients with asthma should not smoke and exposure to second-hand smoke should be minimized ; , since tobacco smoke can decrease pulmonary function, increase the need for asthma medication, and increase the development of asthma in infancy. Patients should avoid exercising during periods of high-level air pollution e.g., ozone warning or poor air quality days ; . It is recommended that patients with persistent asthma undergo skin testing for perennial indoor allergens. The Report also provides recommendations for minimizing exposure to indoor allergens e.g., reducing humidity levels; using air conditioners; methods to control dust mites; and minimizing exposure to pet allergens, cockroaches and fungi ; . Allergen immunotherapy may be considered in some patients whose symptoms are not controlled with environmental or pharmacologic management, and when there is a clear correlation between asthma symptoms and the allergen. Beta blockers, including topical ophthalmic agents, may aggravate asthma. However, some patients with asthma may tolerate cardioselective beta blockers. Sulfites may be a trigger for some asthma patients. They are used as a preservative in foods and beverages e.g., beer, wine, and dried fruit ; . Bronchoconstriction can be seen in response to aspirin. Those with this type of aspirin sensitivity should also avoid other nonsteroidal anti-inflammatory agents, as there is a cross-reaction with those agents. The prevalence of aspirin sensitivity increases with age and severity of asthma, and is often seen in patients who also have nasal polyps. Exposure to these agents may cause potentially life-threatening bronchoconstriction in sensitive patients. Crosssensitivity is usually not seen with acetaminophen and non-acetylated salicylates e.g., salsalate ; . Treatment of other conditions, such as rhinitis or sinusitis, may improve asthma control. Treatment with intranasal corticosteroids is preferred to antihistamine-decongestant combinations or nasal cromolyn, since they reduce nasal inflammation, obstruction, and discharge and lower airway hyperresponsiveness and asthma symptoms. Patients with asthma who also complain of frequent heartburn and nocturnal asthma symptoms may show improvement with treatment of gastroesophageal reflux disease. Both the usual non-drug e.g., elevation of the head of the bed, avoiding large meals close to bedtime, etc. ; and pharmacologic therapies can be used e.g., histamine2 blockers and omeprazole ; . Patients with asthma should also receive an annual influenza vaccine to minimize the frequency or severity of viral upper respiratory infections, which can also serve as an asthma trigger.
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According to data released in January 2003 by the Parent's Resource Institute for Drug Education PRIDE ; , 6th through 12th grade students who smoke marijuana are more likely to engage in harmful behaviors and have less exposure to protective factors than those who did not smoke marijuana. Of students who reported using marijuana, 11.2% said they had carried a gun while at school, 29.3% said they had participated in gang activity, and 62.9% said they had stolen something worth $5.00 or more while not at school. Of the students who reported using marijuana, 44.9% reported seldom or never participating in school activities and 46.5% said their parents seldom or never talked to them about problems related to alcohol and drugs. By comparison, 24.2% of students who do not use marijuana reported seldom or never participating in school activities and 33.9% said their parents seldom or never talked to them about alcohol and drugs.
3, 6, 7, ; . Before August 2002, healthcare providers did not routinely obtain bacterial identification and sensitivities on skin infections, possibly delaying effective treatment in some cases. Once aware that MRSA was prevalent among recruits, healthcare providers improved treatment by culturing skin lesions whenever possible and prescribing appropriate antimicrobial agents for MRSA infections. Thus, the primary interventions used were recommending improved hygiene practices for recruits and implementing aggressive clinical protocols. These control measures, along with the onset of cooler weather, likely played important roles in ending the outbreak. This outbreak occurred in a previously healthy military training population and was associated with close contact, limited opportunity for practicing good personal hygiene, warm weather, and physical stress. Reducing MRSA infections was related to implementing interventions to improve personal hygiene, aggressive evaluation and treatment of people with soft tissue injuries and infections, and cooler weather and desmopressin.
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Compared with placebo in multiple parameters of asthma control including: daytime asthma symptoms cough, wheeze, trouble breathing, and activity limitation overnight asthma symptoms cough the percentage of days with asthma symptoms; the percentage of days without asthma; the need for -agonist or oral corticosteroids; physician global evaluations; and peripheral blood eosinophils. The clinical benefit of montelukast was evident within 1 day of starting therapy. Improvements in asthma control were consistent across age, sex, race, and study center, and whether or not patients had a positive radioallergosorbent test. Montelukast demonstrated a consistent effect regardless of concomitant use of inhaled nebulized corticosteroid or cromolyn therapy. Caregiver global evaluations, the percentage of patients experiencing asthma attacks, and improvements in quality-of-life scores favored montelukast, but were not significantly different from placebo. There were no clinically meaningful differences between treatment groups in overall frequency of adverse effects or of individual adverse effects, with the exception of asthma, which occurred significantly more frequently in the placebo group. There were no significant differences between treatment groups in the frequency of laboratory adverse effects or in the frequency of elevated serum transaminase levels. Approximately 90% of the patients completed the study. Conclusions. Oral montelukast 4-mg chewable tablet ; administered once daily is effective therapy for asthma in children aged 2 to 5 years and is generally well tolerated without clinically important adverse effects. Similarly, in adults and children aged 6 to 14 years, montelukast improves multiple parameters of asthma control. Thus, this study confirms and extends the benefit of montelukast to younger children with persistent asthma. Pediatrics 2001; 108 3 ; . URL: : pediatrics cgi content full 108 3 e48; asthma, cysteinyl leukotrienes, leukotriene receptor antagonist, montelukast, preschool children and decadron.
Latanoprost and trichiasis Two cases of trichiasis in patients treated with latanoprost for glaucoma has been reported to the Medical Products Agency. In total, the MPA has received 43 reports for latanoprost of which 17 concerned eye reactions. Of these 17 reports, 11 referred to longer, darker and more marked eyelashes, for example, cronolyn na.
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Concern for the potential impact on the aquatic system fkom the presence of antibiotics has prompted many studies McKeon et al., 1995 and Miranda, 1998 ; . Assessing the potential impacts of antibiotics to aquatic receptors is different than assessing other PPCPs because the bacteria in the environment are the target organisms that antibiotics were created to destroy. Endpoints that are normally studied are genetic changes in the bacteria that have caused them to become resistant to the antibiotics. It has been found that antibiotic resistance is favoured by low-level concentrations of antibiotics Jorgenson and Halling Sorensen, 2000 ; . Despite these findings such endpoints are not suitable for comparison in this particular assessment, as the concentrations that cause bacteria resistance are not easily converted into an ECso or LCs0.Thus, although the assessment of the significance of antibiotic resistance in the environment must be considered, it does not fall within the realm of this SLRA and divalproex.
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We thank W.G. Kaelin, Jr. and E. Flemington for helpful discussions and critical reading of this manuscript. We thank P. Tontonoz for providing wild-type and mutant forms of PPAR expression vectors, E. Flemington for providing plasmids and A33 DP-1 antibody. S.A. was supported by fellowships from the Swiss National Fonds, the CIBA Research Foundation, and the American Heart Association Massachussets Affiliate. This work was supported by the National Institutes of Health grant DK31405 to B.M.S. The publication costs of this article were defrayed in part by payment of page charges. This article must therefore be hereby marked ``advertisement'' in accordance with 18 USC section 1734 solely to indicate this fact and gliclazide and cromolyn, for example, cromolyn asthma.
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Acknowledgments Scholarship for R F J was provided by Research Higher degrees, University of Newcastle and contributed by Professors Roger Smith and David Smith. Funding Funding was provided by the National Health and Medical Research Council of Australia, The University of Newcastle and the Mothers and Babies Research Centre. Support was also provided from NSW Health through the Hunter Medical Research Institute. The authors declare that there is no conflict of interest that would prejudice the impartiality of this scientific work. References.
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