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Patients should be warned against vigorous scratching since electron microscopy conrms hair shaft damage from excoriation buy 5 mg crestor. Antipruritics By reducing the Malassezia-driven inammation of dandruff and seborrheic dermatitis purchase crestor 5mg line, most effective antimicrobial shampoos are expected to also reduce scalp itch purchase crestor 20 mg without prescription. Anti-Malassezia Agents The majority of effective treatment shampoos have in common their activity against Malassezia yeast. In general, their antidandruff effect parallels their antimicrobial potency (81 83). Coal Tar Coal tar s antifungal effect has been demonstrated in vitro against Malassezia strains isolated from dandruff, seborrheic dermatitis, and pityriasis versicolor (84). While it is a weak antifungal, tar has additional antiproliferative (85) and anti-inammatory effects making it a rst-line choice Dandruff and Seborrheic Dermatitis: Use of Medicated Shampoos 81 for psoriatic scalp treatment. Patients with light-colored hair may notice yellow or yellowish-red staining from tar. Safety concerns regarding carcinogenicity exist since coal tar was historically recognized as a carcinogenic agent. Biopsy study of hair follicles following four days of tar shampoo use showed induction of enzyme activity critical to cancer induction (P-450-dependent aryl hydrocarbon hydroxylase) (87). After use of coal tar shampoo, urinary excretion of polycyclic aromatic hydrocarbons metabolites can be detected in humans (88). An epidemiological study in southeastern Arizona showed a slight increase over expected squamous cell skin cancers in users of tar and antidandruff sham- poos (89). Regulations in California have required labeling about possible carcinogenic risk for dermatology products containing tar. In normal use, however, tar shampoo contact with the scalp is brief, limiting safety concerns. Zinc pyrithione interferes with fungal membrane transport and inac- tivates copper-containing enzymes of bacteria and yeasts (91 93). The bioavailability rather than simply the percent present determines the efcacy. Clinical testing to date has demonstrated that an optimum particle size and shape for distribution and retention on the scalp is a thin platelet with diameter of 2. Since dandruff is a chronic condition and recolonization with Malassezia occurs readily, the long-term use of treatment shampoos is necessary. Thus, the cosmetic qualities of the sham- poo and its effect on hair texture become important compliance issues. Selenium Sulde Selenium sulde is also an effective antimicrobial against Malassezia (94). Selenium sulde in micronized particles outper- forms higher concentration coarse grade products. The distinctive odor of selenium sulde limits its acceptability to some patients. Ketoconazole Ketoconazole also has both 1% over-the-counter and 2% prescription strengths available. Both effectively eliminate Malassezia from the ake samples and improve dandruff and seborrheic 82 Hickman dermatitis with the 2% shampoo more effective than the 1% (99 101). The mechanism of action for its antifungal activity is inhibition of cell membrane ergosterol synthesis (102). Ketoconazole has also been shown to have some direct anti-inammatory activity separate from its antimicro- bial action (103), to inhibit leukotriene biosynthesis (104) and to reduce fungal antigen-induced lymphocyte-mediated immune responses (105). Ketoconazole binds to the keratin of the hair shaft and scalp, allowing persistence of its effect between shampoos (106). Shampooing once weekly as prophylaxis has been demonstrated to be effective after treatment of dandruff and seborrheic dermatitis (107). This is an advantage for patients who because of age, illness, or choice of hairstyle shampoo less frequently. On the other hand, prolonged use with frequent shampooing (5 to 10 times per week) has been demon- strated to be safe with no signicant systemic absorption of ketoconazole (108 110). Ciclopirox Ciclopirox 1% shampoo is a more recent addition to the prescription shampoo choices (111). It is a hydroxypyridone antifungal agent with a broad spectrum of fungicidal activity. Ciclopirox shampoo is effec- tive in treating seborrheic dermatitis used once or twice a week (113,114) and even showed a decreased relapse rate with prophylactic shampooing every two weeks (115). Other Other agents active against Malassezia are available as antidandruff shampoos. Tea tree oil (Melaleuca oil) is reported to have broad-spectrum antimicrobial activity and has been used in shampoo base for dandruff (116,117). The action of sulfur-containing shampoos may be par- tially explained as anti-Malassezia effect (118,119). The antidandruff effect of sulfur is enhanced in formulas containing salicylic acid (120). Sulfur- or sulfacetamide-containing shampoos and lotions may also be helpful where bacterial overgrowth on the scalp is heavy. Climbazole is an effective antimycotic agent available in antidandruff shampoos in Europe but not currently marketed in the United States (121,122). Shampoo Comparison Studies A few direct comparison studies have been done to compare results with different brands or formulations of shampoos (123 126). Results in comparison studies can vary depending on the exact formulations tested. Gels, Lotions, Creams When shampoo alone is not sufcient to clear dandruff or seborrheic dermatitis and in cases where frequent shampooing is not possible or desirable anti-Malassezia leave-on products can be employed. Note that propylene glycol, a common vehicle component, is an effective treatment for Malassezia when applied in high concentration (131 135). Gels can substitute for styling pomades in African-American hair or be applied to the scalp prior to using a hair dressing on the ends of the hair. Some gels contain ammable vehicles; patients should avoid re, ame, or smoking during and immediately after application (136). Ketoconazole and ciclopirox creams and gels are also helpful when the seborrheic dermatitis involves other areas of the face or body (137 139). Benzoyl peroxide is another antimicrobial agent reported to be useful in the treatment of facial seborrheic dermatitis (140 142).

Some authors recommend increasing the contribution of an tioxidants such as vitamin C cheap crestor 10mg without a prescription, retinol buy 20mg crestor with visa, vitamin E purchase crestor with a visa, beta-carotene and selenium. The minimum requirement of vitamin E related to the consumption of fatty acids with a high degree of unsaturation can be calculated with a specific formula that must take into account the peroxibility of polyunsaturated fatty acids is based on the results of animal experiments. Therefore, further studies are needed to establish the requirement of vitamin E when intake of unsaturated fatty acids of longer chain increases. For this purpose it is necessary to use functional techniques based on the measurement of in vivo lipid peroxidation. However it is likely that higher levels are necessary for vitamin fats are rich in fatty acids containing more than two double bonds (Valk, 2000). As a result, the diet was significantly lower in total fat and satu rated fat, but containing equal amounts of n-6 essential fatty acids and n-3. Today this ratio is about 10 to 1 or 20 and 25 to 1, indicat ing that Western diets are deficient in n-3 fatty acids compared with the diet that humans evolved and established patterns genetic. The n-3 and n-6 are not interconvertible in the human body and are important components of practically all cell membranes. The n-6 fatty acids and n-3 influence eicosanoid metabo lism, gene expression, and intercellular communication cell to cell. The polyunsaturated fat ty acid composition of cell membranes is largely dependent on food ingestion. Therefore, appropriate amounts of n-6 fatty acids and n-3 in the diet should be considered in making dietary recommendations. A balanced n-6/n-3 ratio in the diet is essential for normal growth and development and should lead to reduced car diovascular disease and other chronic diseases and improve mental health. The final recommendations are for Western societies, reduce the consumption of n-6 fatty acids and increased intake of n-3 fatty acids. Food sources in Mexico The main sources of ascorbic acid are presented in Table 1. The results of vitamin C are shown as the mean and correspond to the official tables of composition of Mexican foods. Fruits and vegetables Vitamin C is a major constituent of fruits and vegetables, which also contain citric acid, oxa lates and substances such as anthocyanins, coloring agents and carotenoids that are difficult to quantify when using colorimetric methods. Currently there is great interest in relation to consumption of natural foods and mainly on the content of nutrients in fruits, vegetables and vitamin C. This interest is due in part to vitamin C is probably one of the most widely used nutrients in the food and pharmaceutical industry. Used as a supplement, additive, preservative, as an antioxidant in processed foods. Acid content of ascorbic acid in different foods and different presentations 458 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants In Table 3 shows the analysis of vitamin C in different parts of the food such as edi ble portion thereof, the seed or plant center and the shell and stalks that are normally discarded. Distribution of ascorbic acid (mg/100g) in some fruits and vegetables produced in Mxico Below the edible portion the moisture (%) is indicated in parenthesis. The data shown in Tables 3 through 6 are original and have not been published yet. It shows that even the concentration of vitamin C is lower in the edible portion in the shells report ed in Table 5. Content of ascorbic acid in the shell of some fruits and vegetables Table 6 shows the values of ascorbic acid in some plant species used as flavoring for Mexi can dishes. In most cases the amount used for the preparation of food is very low and some times do not amount to more than 2% by weight of the end plate. However their presence in cooked food gives organoleptic properties suitable for the acceptance of it and especially the potential of the flavors of food. For this reason, it may partially destroyed in foods during processing, if exposed to air during storage or if treated with water. The addi tion of ascorbic acid as an antioxidant should be appropriately marked in the list of ingredi ents on the label of the final product Ascorbic acid and its salts are practically insoluble in lipids (fats), for this reason that is often used in the food industry as an antioxidant and preservative greasy foods, in order to avoid rancid. Their salts are usually used with a solubilizing agent (usually a monoglyceride) to improve its implementation. Sodium ascorbate is a sodium salt of ascorbic acid (vitamin C) and formula C H NaO. This form is used in the food industry for their functions antiseptic, antioxidants,6 7 6 and preservatives. Ascorbyl palmitate is an ester formed by ascorbic acid (vitamin C) and palmitic acid creating a liposoluble form of vitamin C. It is wrong to think that is a natural antioxidant Use as a preservative Is usually used as a food preservative and as antioxidant in the food industry, a typical case is found as a bread improver additive. In industry collecting fruit prevents the color oxida tive change known browning. Is often added to foods treated with nitrite in order to reduce the generation of nitrosamines (a carcinogen), so commonly found in sausages and cold cuts. Ascorbic acid and its sodium, potassium and calcium salts are used widely as antioxidants and additives. These compounds are soluble in water, so that fats do not protect against oxi dation. For this purpose may be used ascorbic acid esters with fat soluble long chain fatty acids (palmitate and ascorbyl stearate). Signs and symptoms A frank deficiency of vitamin C causes scurvy, a disease characterized by multiple hemorrhag es. The diagnosis of scurvy, is achieved by testing plasma ascorbic acid, low concentration indicates low levels in tissues. It is generally accepted that ascorbic acid concentration in the layer of coa gulated lymph (20-53 ug/10 leukocytes) is the most reliable indicator of nutritional status re8 garding vitamin C and its concentration in tissues. Deficiencies secondary and association with other diseases Severe deficiency of vitamin C leads to Scurvy. By deficiency of collagen, the wounds do not heal scars and wounds of previous rupture and may lead to secondary infections. Neurotic disorders are common, consisting of hyste ria and depression, followed by decreased psychomotor activity. In addition to "rebound scurvy," gastric intolerance and kidney, its use decreases the cobalamin (vitamin B ), a substance synthesized by the body. The daily requirement in an adult male is 90 mg/d and a woman of 75 mg/d (mg/day), although there are always situations where it is necessary to increase the dose of vitamin A through supplementation.

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If you have chronic bronchitis cheap 5mg crestor free shipping, do not expect much improvement as long as tobacco smoke is in the home discount 10 mg crestor overnight delivery. Bronchitis often hangs on because people think it is about over and begin going about their everyday duties order generic crestor line. Drinking goldenseal tea is helpful with this condition, as well as with other types of bronchitis. Hold the breath again and then breathe in slowly, to avoid non-productive coughing. Place hands in ice water for 1-2 minutes; maintain skin circulation by dry rubbing. After hemorrhage ceases, graduated cold treatment to increase resistance and combat the disease causing the hemorrhage. In bacterial pneumonia, it comes suddenly and the cough is dry at first; then a rust-colored sputum is produced, and breathing becomes rapid and labored. The tiny sacs in the lungs (which look somewhat like grapes hanging from their stems) are where the oxygen and carbon dioxide exchange is made. In children, the pain of pneumonia is frequently located in the abdomen, and cause others to think there is acute indigestion or appendicitis. Give short, hot fomentations to the chest and upper back, with short cold between each hot application. These should consist of fruit juices (diluted pineapple juice or orange juice) or lemon and water (without sugar), etc. Then give strained vegetable broths, whole grains (best in dry form, so it will be chewed well). It is well to have him sit in a tub with a small amount of hot water while a Cold Pail Pour is given, followed by vigorous rubbing and wrapping in dry blankets in bed. Provide him with an abundance of pure warm air; have a supply of oxygen at hand for immediate use if required. Lengthen the period between fomentations and change the compress less frequently as the temperature is lowered, the pain less, and the stage of the disease more advanced. Several Ice Bags may be used in place of the Cold Compress, but the bags should be removed at least every half hour and the chest should be rubbed until red and warm, to maintain surface circulation and skin reflexes. Steam Inhalation 15 minutes, every hour; sipping half a glass of hot water when inclined to cough; careful protection of neck and shoulders from chilling by contact with wet bed clothing. Prolonged Neutral Bath with Ice Bag over heart, Cold Pail Pour to back of head and upper spine at the end of the bath. Fomentation to the chest followed by Heating Compress or Chest Pack, to remain in place an hour or until thoroughly warmed. Keep the temperature down by carefully managed hydrotherapy measures such as the Heating Pack, the Hot Blanket Pack, followed by Cold Mitten Friction and like measures rather than Cold Full Baths and Cooling Packs, which aggravate lung congestion by producing retrostasis. Promote vital resistance by frequently repeated partial Cold Frictions, and thus sustain the vital powers until opportunity has been afforded for the development of antitoxins and the suppression of the disease by the natural healing processes. The cough is at first not too productive, but later increasing amounts of phlegm are coughed up. The sharp chest pain one may feel might be the pleurisy (which see) It is spread by coughing. So once you are on your feet again and appear to be well, you must continue a program of careful eating, living, outdoor activity; all the while obtaining adequate rest every night. Rest in the horizontal position until the daily evening temperature becomes nearly normal. The intensity of the application should be steadily increased from day to day in order to secure good results. In making the cold applications, care must be taken to avoid chilling him; for this would immediately aggravate his cough. The neck veins often stand out from the effort, and he breathes through the mouth in order to try to get enough air in and out. Eventually his chest becomes barrel-shaped, his face ruddy, and he speaks with short, broken phrases. As emphysema progresses and there is more obstruction to airflow, the lungs enlarge with trapped air. The most frequent cause is smoking, but air pollution also receives some of the blame. Live in the country and do not have tobacco in your home, and you should be able to avoid this problem. Needing a continual exchange of air to survive, we use about a thousand cubic feet of air each day. It passes over lung surfaces which, if laid flat, would be as large as a tennis court. In emphysema, a large portion of the alveoli (the grape-like sacs where the air exchange occurs) are destroyed, and the blood is not properly aerated. Try using 1- or 2-pound hand weights and work the muscles in the neck, upper shoulders, and chest. Prolonged digestion requires more oxygen and blood to the stomach, and away from other parts of the body which also need them. Strengthen your respiration muscles by blowing out slowly through pursed lips for 30 minutes a day. Inhale slowly and deeply, exhale through pursed lips, and cough in short huffing bursts rather than vigorously. Avoid perfumes, gas stoves, carpeting, curtains and draperies which cannot easily be cleaned. This will help prevent mucous from accumulating in the lower part of the lungs during the night. It is difficult to find remedial solutions, but here is one: Several years ago, a Christian mother visited her neighbors, and met a woman with emphysema. This was the treatment: Place a plastic sheet on the bed, both above the bottom sheet and beneath the top sheet and covers. Dip another sheet in very cold water, and wring it out somewhat quickly, to keep in the cold.

Perineal lacerations usually require treatment during the rst postparturient represent a problem that may be noticed immediately or week cheap crestor amex. A fetid odor and vaginal discharge are present and not recognized until routine prebreeding examination purchase crestor 20mg. The offensive odor may cause the recognized until routine prebreeding examination order 5 mg crestor with mastercard. Treatment starts with careful cleansing of the usually are moveable, and often are multiple. Abscesses perineum and vulva followed by gentle manual vaginal tend to be uctuant to rm, rounded, and tense. Regions of muco- diffuse pelvic hematoma occurring from perivaginal sal pressure necrosis are obvious, and opportunistic infec- hemorrhage can be compared with perimetritis because tion with A. Careful douching of the vagina with mild Firm swelling throughout the pelvic inlet prevents mean- disinfectants should be followed by application of oily ingful rectal palpation. Overt anemia may be present in antiseptic or antibiotic ointments that have antimicrobial these cattle, and the condition is differentiated from peri- and lubricant properties to deter side-to-side mucosal metritis by absence of fever coupled with anemia. Fibrinous adhesions of Delayed or chronic consequences of birth trauma in- mucosa to mucosa may need to be gently broken down. Perivaginal hematomas usually are incidental nd- ings during routine physical or reproductive examina- Treatment tions in cows fresh less than 30 days. These lesions are Acute injuries to the caudal reproductive tract may re- most common in rst-calf heifers, do not require specic quire immediate attention when hemorrhage is severe or therapy, and usually resolve by 40 to 60 days postpar- persistent and when lacerations that may have future tum. Rare instances of large perivaginal hematomas or impact on reproduction are present. Severe vaginal pelvic hematomas that result in massive pelvic swelling bleeding occurring immediately after delivery of a calf and blood loss anemia may require blood transfusion to may require isolation and ligation of the bleeding vessel. Retraction of the vulva by sutures, lead to pelvic abscessation, a condition with a grave instruments, or retractors may allow viewing of the site. Perivaginal or pelvic abscesses represent de- Ligatures of absorbable suture material or clamping layed manifestations of vaginal injury, laceration, or ne- with a hemostat that is subsequently removed in 24 to crosis. Affected cows may be asymptomatic or have 48 hours sufces for hemostasis in most cases. Diagnosis is suspected hemorrhage is associated with vaginal or vulvar mucosal on routine rectal palpation and may be conrmed by lacerations, hemostasis and repair of the mucosal defect ultrasonography or aspirates obtained through the vagi- both may be accomplished with absorbable suture ma- nal wall. Prolapse of perivaginal fat may or may not require wall may be surgically drained into the vagina. Dbridement of prolapsed fat and closure drainage usually is curative unless multiple abscesses or of mucosal defects are indicated for large lacerations. When indicated unless perivaginal abscesses are identied and palpation or ultrasound fails to conrm a distinct attach- require drainage. Because Vaginitis such abscesses usually are retroperitoneal, the cow shows no signs of peritonitis, but attempts at drainage are ana- Etiology tomically difcult. Drainage sometimes has been tried Vaginitis may appear as an acute or chronic condition. As through the area lateral to the vulva and anus or using previously discussed, birth trauma is a common cause of laparotomy. Complications and recurrence are com- acute, necrotic, and chronic vaginitis that is either a pri- mon. Conservative therapy likewise has poor success, mary condition or secondary to chronic endometritis but long-term systemic antibiotic therapy, iodide ther- and cervicitis. Necrotic tipped vulva, urovagina, and chronic vaginitis will be vaginitis has a fetid odor that accompanies discharge and discussed in the treatment of vaginitis. Conditions that result from dystocia and alter the normal caudal reproductive tract anatomy predispose to Other Vaginal Injuries vaginitis. Windsucking, perineal lacerations, and urine Etiology pooling are the major primary conditions. Alteration of Although parturient injuries are the most common cause the normal perineal anatomy encourages vaginal con- of vaginal trauma, rare cases of vaginal laceration or irri- tamination. This is true for cattle with tipped vulvas or tation can follow natural breeding, injuries caused by perineal lacerations. Natural breed- air to be trapped in the vagina causes irritation that pro- ing of small heifers to adult bulls occasionally can lead to motes opportunistic infection by organisms normally cranial vaginal perforations or laceration at intromission. Urine pooling or urovagina may ments can occur when inexperienced or rough neophyte result from birth trauma, partial bladder paralysis from inseminators attempt breeding cows or heifers. Unfortu- birth trauma, or chronic tension on the cranial vagina by nately sadism also must be considered especially when a heavy uterus and cervix. Urine pooling in the cranial more than one animal on a given premises is affected. Urea is irritating to the tissue Clinical Signs and Diagnosis and may allow secondary opportunistic infection. Extreme pelvic laxity as observed in chronic breeding injuries with full-thickness laceration of the cystic ovaries tends to worsen both pneumovagina and cranial vagina result in typical signs of peritonitis with urovagina. Similar signs are Histophilus somni, infectious b ovine rhinotracheitis virus present when sadism has caused vaginal lacerations. Such organisms can cause en- Vaginal speculum examination is necessary to identify demic or epidemic vaginitis in dairy cattle and will be the site and extent of the vaginal injury. More recently an outbreak of vulvo- or localized infection can lead to perivaginal adhesions, vaginitis caused by Porphyromonas levii was reported, but abscesses, or tenesmus. Clinical Signs and Diagnosis Subacute or chronic vaginitis without anatomic distor- Treatment tion of the caudal reproductive tract is most likely Treatment includes sexual rest for 30 to 60 days and residual from traumatic consequences of dystocia or systemic antibiotics to control retroperitoneal or perito- infection following parturition. Antibiotic therapy may need to be con- or cervicitis is common in these conditions. Treatment Therapy of subacute or chronic vaginitis unassociated with anatomic disorders necessitates local therapy in- cluding douching of the vagina with dilute antiseptic solutions and treatment of concurrent metritis or cervi- citis. Chronic cases may benet from local antibiotic infusion of the vagina and uterus following cleansing douches. Antibiotic therapy is best used when a culture has identied a specic organism and susceptibility test- ing has been completed.