ليس لدي شئ سوى تهنئه ومن اعماق قلبي لاخوتي واخواتي الاعزاء الذين احتفلو بعيد ميلادهم هذا اليوم

يارب ينعاد عليهم بالف خير بظل اهلهم واحبابهم....................

والف الف شكر الى اخوتي واخواتي الذين شاركونا افراحنا الذين جعلو الفرحه مضاعفه ..............

ادام الله ايامنا كلها اعياد ومناسبات

(اختكم)

موضوع اليوم

Definition of Hyperlipidemia

.
Hyperlipidemia is an excess of fatty substances called lipids, largely cholesterol and triglycerides, in the blood. It is also called hyperlipoproteinemia because these fatty substances travel in the blood attached to proteins. This is the only way that these fatty substances can remain dissolved while in circulation.
Hyperlipidemia, in general, can be divided into two subcategories:
hypercholesterolemia, in which there is a high level of cholesterol
hypertriglyceridemia, in which there is a high level of triglycerides, the most common form of fat
Description of Hyperlipidemia

The fat-protein complexes in the blood are called lipoproteins. The best-known lipoproteins are LDL (low density lipoprotein) and HDL (high density lipoprotein).
Excess LDL cholesterol contributes to the blockage of arteries, which eventually leads to heart attack. Population studies have clearly shown that the higher the level of LDL cholesterol, the greater the risk of heart disease. This is true in men and women, in different racial and ethnic groups, and in all adult age groups. Hence, LDL cholesterol has been labeled the “bad” cholesterol.
In contrast, the lower the level of HDL cholesterol, the greater the risk of coronary heart disease. As a result, HDL cholesterol is commonly referred to as the “good” cholesterol.
Low HDL cholesterol levels are typically accompanied by an increase in blood triglyceride levels. Studies have shown that high triglyceride levels are associated with an increased risk of coronary heart disease.
Causes and Risk Factors of Hyperlipidemia

Common secondary causes of hypercholesterolemia (specifically, high LDL cholesterol) include hypothyroidism (that is, low thyroid hormone levels), pregnancy, and kidney failure.
Common secondary causes of hypertriglyceridemia include diabetes, excess alcohol intake, obesity, and certain prescription medications (such as glucocorticoids and estrogen).
Hyperlipidemia, along with diabetes, hypertension (high blood pressure), positive family history, and smoking are all major risk factors for coronary heart disease.
Symptoms of Hyperlipidemia

Hyperlipidemia usually has no noticeable symptoms and tends to be discovered during routine examination or evaluation for atherosclerotic cardiovascular disease. However, deposits of cholesterol (known as xanthomas) may form under the skin (especially around the eyes or along the Achilles tendon) in individuals with familial forms of the disorder or in those with very high levels of cholesterol in the blood. Individuals with hypertriglyceridemia may develop numerous
pimple-like lesions across their body. Extremely high levels of triglycerides may also result in pancreatitis, a severe inflammation of the pancreas that may be life-threatening.
Diagnosis of Hyperlipidemia

Diagnosis is typically based on medical history, physical examination, and blood tests (done after overnight fasting) in order to determine the specific levels of LDL cholesterol, HDL cholesterol, and triglycerides.
Treatment of Hyperlipidemia

It is necessary to first identify and treat any potential underlying medical problems, such as diabetes or hypothyroidism, that may contribute to hyperlipidemia. Treatment of hyperlipidemia itself includes dietary changes, weight reduction and exercise. If lifestyle modifications cannot bring about optimal lipid levels, then medications may be necessary.
Current national guidelines suggest a LDL cholesterol goal of <100 mg/dl for individuals already with heart disease or diabetes, <130 mg/dl for those with moderate risk of heart disease, and <160 mg/dl for everyone else. Your doctor can calculate your “risk score” for heart disease. This score can then be used to determine whether you need to start taking medications to lower your LDL cholesterol.
Although there are no firm treatment targets for HDL cholesterol or triglycerides, most experts agree that optimal HDL cholesterol and triglyceride levels are >40 mg/dl and <200 mg/dl, respectively.
Medications most commonly used to treat high LDL cholesterol levels are statins, such as atorvastatin (Lipitor) or simvastatin (Mevacor). These medications work by reducing the production of cholesterol within the body. Although safe and effective, statins very rarely cause muscle damage, typically when used in combination with other medications. Thus, it is important to let your doctor know whether you develop any generalized body ache or start a new medication when you are taking statins.
Other medications used to treat high LDL cholesterol levels include ezetimibe (Zetia), which decreases the absorption of cholesterol from the gut; bile-acid sequestrants (Questran), which eliminate cholesterol from the body; and nicotinic acid (Niacin), which, in addition to lowering LDL cholesterol, raises HDL cholesterol.
Hypertriglyceridemia is typically treated with a class of medications called fibrates. Included in this class are gemfibrozil (Lopid) and fenofibrate (Tricor). Similar to statins, fibrates are safe and effective but may cause muscle damage, usually when used in combination with other medications.
Questions To Ask Your Doctor About Hyperlipidemia

How serious is it?
What type of hyperlipidemia is it?
Is there an underlying cause of the hyperlipidemia?
What is its relationship to diabetes?
What treatment do you recommend?
If the treatment involves drugs, what side effects should I watch for?
What dietary changes do you recommend?

What weight reduction goals are reasonable?

موضوع اليوم

Choosing Drug Therapy for Patients with

Hyperlipidemia

TABLE 1Determining Patient-Specific LDL Goals Through Risk Factors
Risk-factor score*
LDL goal, by risk-factor score†
Age: men > 45 years; women >55 years or postmenopausal without ERTCurrent smokerHypertensionDiabetesCHD in first-degree relative (male relative <55>60 mg per dL
0 to 1 point: <160 color="#33cc00">more points: <130 color="#33cc00">Patients with history of CHD: <100>)
LDL = low-density lipoprotein; ERT = estrogen replacement therapy; CHD = coronary heart disease; HDL = high-density lipoprotein.*--Score 1 point for each positive factor

.
TABLE 2 Outcomes of Studies Involving Statins

Drug
Outcome

Simvastatin
Decreased cardiac morbidity and mortality in patients with CHD and elevated cholesterol levels

Pravastatin
Decreased coronary morbidity and mortality in hypercholesterolemic men with no clinical evidence of CHD

Pravastatin
Significantly reduced incidence of subsequent MI, death from CHD, stroke and need for revascularization procedure in patients with recent MI and normal cholesterol levels

Pravastatin
Reduced overall mortality and incidence of MI and stroke in patients with CHD and a broad range of cholesterol levels.

Fluvastatin
Slowed progression of artherosclerotic lesions in patients with CHD

Lovastatin
Significantly reduced incidence of first acute major coronary events in patients without CHD, but with normal to mildly elevated total and LDL cholesterol levels and low HDL cholesterol levels
CHD = coronary heart disease; MI = myocardial infarction; LDL = low-density lipoprotein; HDL= high-density lipoprotein.
..
TABLE 3 Niacin (Nicotinic Acid)
Drug
Dosage
Adverse effects
Patient information
Monitoring
Nonprescription niacin
50 to 100 mg twice daily for the first week. Double the dosage every week to 1,000 to 1,500 mg daily, in 2 or 3 divided doses.If response is inadequate after 4 to 8 weeks, increase dosage slowly to maximum of 3,000 mg daily.If patient switches brands, restart from low dosage and titrate up to minimize risk of hepatic necrosis.
Flushing, pruritus, abdominal pain, nausea, vomiting, elevated liver enzyme levels, glucose intolerance, rare reversible acanthosis nigricans
To decrease flushing, take in p.m.; take aspirin 30 minutes before, avoid concomitant ingestion of alcohol or hot beverage.To decrease gastrointestinal distress, take daily in 2 or 3 divided doses; take after a low-fat snack.
Check lipid levels before and 4 weeks after reaching desired dosage, and 4 weeks after every dosage increase.Perform LFTs, uric acid determination and fasting glucose test before initiating therapy and 6 weeks after target dose is reached. Repeat LFTs every 12 weeks thereafter for first year, then every 6 to 12 months.Discontinue drug if serum transaminase levels exceed 3 times normal level.
Extended-release niacin tablets (Niaspan)*
Take daily at bedtime: 500 mg--weeks 1 through 4 1,000 mg--weeks 5 through 8 1,500 mg--after week 8Maximum dosage: 2,000 mg
Flushing, pruritus, abdominal pain, nausea, vomiting, elevated liver enzymes, glucose intolerance
To decrease flushing, take in p.m.; take aspirin 30 minutes before; avoid concomitant ingestion of alcohol or hot beverage.To decrease gastrointestinal distress, take after a low-fat snack.
Check lipid levels 4 weeks after starting and 4 weeks after every dosage increase.Obtain uric acid level and fasting glucose levels before initiating therapy and 6 weeks after target dose is reached. Perform LFTs before initiating therapy and every 12 weeks thereafter for first year, then every 6 to 12 months.Discontinue if serum transaminase levels exceed 3 times normal level.
LFTs = liver function tests.

*--Pregnancy category C: adverse effects in animals, no human data.
TABLE 4 National Cholesterol Education Program (NCEP) Guidelines: Serum Triglyceride Action Limits
Triglyceride value
Intervention
< mg per dL (<2.25 mmol per L)
Normal value. Some recommend a lower normal value of 150 mg per dL (1.70 mmol per L).
to 400 mg per L (2.25 to 4.50 mmol per L)
Primary treatment is lifestyle modification: weight control, low-fat, low-cholesterol diet, regular exercise, smoking cessation and (in selected patients) alcohol restriction. Medication may be considered in patients with established CHD, family history of premature CHD, concomitant total cholesterol level of >=240 mg per dL (>=6.20 mmol per L) and HDL value of <35 mg per dL (<1.0 mmol per L), genetic form of hypertriglyceridemia (e.g., dysbetalipoproteinemia or familial combined hyperlipidemia) or multiple risk factors.
400 to 1,000 mg per dL (4.50 to 11.30 mmol per L)
Treatment as in previous category but with an emphasis on controlling causes of secondary hypertriglyceridemia. Medication is recommended by some authorities and certainly should be used if the patient has a history of acute pancreatitis.
>1,000 mg per dL (>11.30 mmol per L)
Vigorous triglyceride-lowering efforts are required because of increased risk for pancreatitis. Treat causes of secondary hypertriglyceridemia (e.g., diabetes mellitus). Institute very-low-fat diet, curtail alcohol; if triglyceride level of <1,000 mg per dL (<11.30 mmol per L) is not achieved, use medications.
CHD = coronary heart disease; HDL = high-density lipoprotein..
34
TABLE 5 Fibric Acid Derivatives (Fibrates)
Drug
Dosage
Adverse effects
Patient information
Monitoring
Gemfibrozil (Lopid)*
mg twice daily, 30 minutes before morning and evening meals.Maximum dosage: 600 mg twice daily
Dyspepsia, diarrhea, fatigue, nausea, vomiting, abdominal pain, eczema, rash, vertigo
Take with meals.Report any muscle pain, tenderness or weakness.
Perform LFTs before initiating therapy and repeat periodically during first year of therapy.
Micronized fenofibrate (Tricor)*
67 mg (1 tablet) daily, taken with main meal.Increase dosage at 4-week intervals as tolerated.Maximum dosage: 201 mg daily (may be taken at one time)
Dyspepsia, diarrhea, fatigue, headache, nausea, vomiting, muscle or joint pain, rash, vertigo
Take with meals.Report any muscle pain, tenderness or weakness.
Perform LFTs before initiating therapy and repeat periodically during first year of therapy.Drug contraindicated in patients with severe liver or renal disease.
LFTs = liver function tests.

1. *--Pregnancy category C: adverse effects in animals, no human data.
   
   TABLE 6 Bile Acid Sequestrants
   Drug
   Dosage
   Adverse effects
   Patient information
   Monitoring
   Cholestyramine (LoCholest) powder
   Initially, 4 g daily in 2 or 3 divided dosesIncrease dosage at 4-week intervals as tolerated.Maximum dosage: 24 g daily
   Constipation
   Take 1 hour before or 4 hours after other medications.Take with meals.Mix with 3 to 6 oz of water, fruit juice or pulpy fruit (applesauce or crushed pineapple).Mixing a dose the night before and refrigerating it will improve palatability. Stir well.Increase fluid intake to avoid constipation.
   Check lipid profile at 2 to 4 weeks and monitor for constipation.If constipation occurs, increase fluid and fiber intake, consider stool softener.Some patients require a laxative to prevent constipation.
   Colestipol (Colestid) granules*
   Initially, 5 g daily in 2 or 3 divided doses (granules) or 2 g daily (tablets)Increase dosage at 4-week intervals as tolerated.Maximum dosage: 30 g daily
   ConstipationFlavored products contain aspartame.Avoid in phenyketonuric patients.
   Same as above
   Same as above
   *--Pregnancy category B: no adverse effects in animals, no human data..

أن أحببتم الأطلاع والأستفاده


كما سبق وذكرنا فإن السعرات الحرارية اللازمة تختلف من شخص للآخر وتطبيق ريجيما معينا يعتمد على احتياج الجسم للسعرات وعلى قاعدة طبية تنصح بأن يتم إنقاص الوزن بمقدار 1 كجم أسبوعيا فقط. لذلك يجب استشارة الطبيب المختص لتحديد الريجيم المناسب بالإضافة للتثقيف والتوجيه السلوكي الضروري.الجداول التالية توضح كمية السعرات الحرارية المتوفرة في بعض أنواع الأغذية:

مجموعة الفواكه
الصنف
السعرات لكل 100 جرام
جريب فروت29
برتقال46
مشمش48
أناناس49
شمام53
تفاح58
مانجو65
عنب70
موز92
تمر270

مجموعة الحليب ومشتقاتها
الصنف
السعرات لكل 100 جرام
حليب منزوع الدسم35
حليب قليل الدسم50
لبن رائب51
لبن زبادي61
الحليب62
قشدة عادية215
جبن أبيض268
جبنة موزاريلا285
جبن شرائح370
جبن كرافت375

مجموعة الخضار
الصنف

السعرات لكل 100 جرام
جزر20
طماطم20
الكرنب23
سبانخ23
ليمون29
بطاطس100

مجموعة الخبز والحبوب
الصنف
السعرات لكل 100 جرام
رز مسلوق128
مكرونة140
توست أبيض260
توست أسمر260
خبز أبيض260
خبز بر260
كورنفلكس390
دونت400

مجموعة اللحوم
الصنف
السعرات لكل 100 جرام
ربيان مسلوق99
تونة بالماء130
كبدة دجاج150
سمك مشوي151
دجاج مسحّب مطبوخ165
صدر دجاج مشوي165
دجاج مشوي190
تونة بالزيت191
لحم غنم بدون شحم191
كبدة مقلية217
صدر دجاج مقلي260
لحم بقري أحمر263
فخذ دجاج مقلي268
لحم غنم قليل الشحم276
مرتديلا313
جناح دجاج مقلي324
نقانق362
حلم بقري بالشحم363
لحم مفروم بالشحم364

مجموعات أخرى
الصنف
السعرات لكل 100 جرام
الشاي بدون سكر0
القهوة بدون سكر0
دايت كولا1
الكولا أو البيبسي40
عصير الليمون40
بياض البيض51
الفول60
بيض مسلوق150
بيض مقلي200
صفار البيض368
معمول430
بقلاوة550
كنافة580
لوز سوداني590
فستق620
بندق630
صنوبر665
تقليل الاستفادة من الغذاءهناك ثلاث طرق لهم دوراً حقيقياً في منع الاستفادة من الغذاء وهم:
o منع الاستفادة من الكربوهيدرات (النشويات) عن طريق منع نشاط الأنزيمات الهاضمة للنشويات والتي تفرز من الغدد اللعابية والبنكرياس وذلك عن طريق إعطاء الشخص مواد (اكتشفت في البقوليات) تمنع هذا النشاط وهذه المواد توجد على صورة حبوب ومن أشهرها المسماة Carbo-lite وهذه المواد ليس لها أضرار صحية ذات أهمية إلى أنها تكون غازات مزعجة وذلك نتيجة أن النشويات الغير ممتصة تتخمر بفعل البكتريا في القولون.
o استخدام الألياف الغذائية التي توجد في النخالة والخضراوات والفواكه (لذلك ينصح أكلها دون تقشير) كما أنها توجد على شكل أقراص في الصيدليات، وهذه الألياف تمنع امتصاص الطعام من الأمعاء بالإضافة إلي أن تناولها قبل ومع الطعام تشعر الإنسان بالشبع مما يقلل تناوله للطعام.
o حديثا تم استخدام بعض الأدوية التي تمنع امتصاص الدهون من الأمعاء وبالتالي تقليل الاستفادة منها مثل مركب يدعى أورليستات orlistat.

Does omeprazole (Prilosec) improve respiratory function in asthmatics with gastroesophageal reflux?

Received: 1 October 1993 Revised: March 1994 Accepted: 28 March 1994

Abstract Gastroesophageal reflux (GER) is common among patients with asthma, and it has

been speculated that high GER may exacerbate asthma in some. This study was designed to determine if suppression of acid reflux in patients with asthma would improve pulmonary function. A double-blind, placebo-controlled crossover study design was used to determine the effect of GER suppression with omeprazole (20 mg twice daily) on pulmonary function among asthmatic patients with esophagitis. Four of 15 (27%) asthma patients with GER were shown to have a20% net improvement in pulmonary function (FEV1) after treatment for six weeks with omeprazole. These results indicate that some patients with asthma and GER will have improved pulmonary function when acid GER is treated with omeprazole

Dopamine
Generic Name: Dopamine (DOE-pa-meen)Brand Name: Generic only. No brands available.
adArray = new Array(['first_ad_unit',3]);
Dopamine is used for:
Treating shock and low blood pressure due to heart attack, trauma, infections, surgery, and other causes. It is also used to help improve heart function when it is unable to pump enough blood. It may also be used for other conditions as determined by your doctor.
Dopamine is a vasopressor and inotropic agent. It works by increasing the pumping strength of the heart and the kidney blood supply.
Do NOT use Dopamine if:
· you are allergic to any ingredient in Dopamine
· you are taking droxidopa or have taken furazolidone or a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the past 21 days
· you have adrenal gland tumors or an uncorrected irregular heartbeat
Contact your doctor or health care provider right away if any of these apply to you.
Before using Dopamine :
Some medical conditions may interact with Dopamine . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
· if you are pregnant, planning to become pregnant, or are breast-feeding
· if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
· if you have allergies to medicines, foods, or other substances (eg, sulfites)
· if you have diabetes, a history of high blood pressure or heart attacks, a history of blood vessel disease (arteriosclerosis, Raynaud disease, Buerger disease), or a decreased amount of blood in the body (hypovolemia)
Some MEDICINES MAY INTERACT with Dopamine . Tell your health care provider if you are taking any other medicines, especially any of the following:
· Catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone) because the side effects of Dopamine may be increased
· Cyclopropane, droxidopa, ergot derivatives (eg, methylergonovine), furazolidone, halogenated hydrocarbon anesthetics (eg, halothane), or MAO inhibitors (eg, phenelzine) because the risk of side effects, such as irregular heartbeat, heart attack, or seizures, may be increased
· Alpha-blockers (eg, prazosin), beta-blockers (eg, propranolol), butyrophenones (eg, haloperidol), hydantoins (eg, phenytoin), or phenothiazines because the effectiveness of Dopamine may be decreased
· Bromocriptine or tricyclic antidepressants (eg, amitriptyline) because their side effects may be increased
· Guanadrel or guanethidine because their effectiveness may be decreased by Dopamine
This may not be a complete list of all interactions that may occur. Ask your health care provider if Dopamine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.



How to use Dopamine :
Use Dopamine as directed by your doctor. Check the label on the medicine for exact dosing instructions.
· Dopamine is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Dopamine at home, carefully follow the injection procedures taught to you by your health care provider.
· If Dopamine contains particles or is discolored (darker than slightly yellow), or if the vial is cracked or damaged in any way, do not use it.
· Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.
· If you miss a dose of Dopamine , contact your doctor right away.
Ask your health care provider any questions you may have about how to use Dopamine .
Important safety information:
· Some of these products contain sulfites, which can cause allergic reactions in certain individuals (eg, asthma patients). If you have previously had allergic reactions to sulfites, contact your pharmacist to determine if the product you are taking contains sulfites.
· LAB TESTS, including urine output, heart function, blood pressure, and thyroid tests, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
· PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Dopamine , discuss with your doctor the benefits and risks of using Dopamine during pregnancy. It is unknown if Dopamine is excreted in breast milk. If you are or will be breast-feeding while you are using Dopamine , check with your doctor or pharmacist to discuss the risks to your baby.
Possible side effects of Dopamine :
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Fast heartbeat; headache; nausea; vomiting.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; dizziness; irregular heartbeat; pain, redness, or swelling at the injection site; severe headache.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. .
If OVERDOSE is suspected:
or emergency room immediately. Symptoms may include fast or irregular heartbeat; inability to urinate; nausea; severe headache; vomiting.
Proper storage of Dopamine :
Dopamine is usually handled and stored by a health care provider. If you are using Dopamine at home, store Dopamine as directed by your pharmacist or health care provider.

Dopamine
Generic Name: Dopamine (DOE-pa-meen)Brand Name: Generic only. No brands available.
adArray = new Array(['first_ad_unit',3]);
Dopamine is used for:
Treating shock and low blood pressure due to heart attack, trauma, infections, surgery, and other causes. It is also used to help improve heart function when it is unable to pump enough blood. It may also be used for other conditions as determined by your doctor.
Dopamine is a vasopressor and inotropic agent. It works by increasing the pumping strength of the heart and the kidney blood supply.
Do NOT use Dopamine if:
· you are allergic to any ingredient in Dopamine
· you are taking droxidopa or have taken furazolidone or a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the past 21 days
· you have adrenal gland tumors or an uncorrected irregular heartbeat
Contact your doctor or health care provider right away if any of these apply to you.
Before using Dopamine :
Some medical conditions may interact with Dopamine . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
· if you are pregnant, planning to become pregnant, or are breast-feeding
· if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
· if you have allergies to medicines, foods, or other substances (eg, sulfites)
· if you have diabetes, a history of high blood pressure or heart attacks, a history of blood vessel disease (arteriosclerosis, Raynaud disease, Buerger disease), or a decreased amount of blood in the body (hypovolemia)
Some MEDICINES MAY INTERACT with Dopamine . Tell your health care provider if you are taking any other medicines, especially any of the following:
· Catechol-O-methyltransferase (COMT) inhibitors (eg, tolcapone) because the side effects of Dopamine may be increased
· Cyclopropane, droxidopa, ergot derivatives (eg, methylergonovine), furazolidone, halogenated hydrocarbon anesthetics (eg, halothane), or MAO inhibitors (eg, phenelzine) because the risk of side effects, such as irregular heartbeat, heart attack, or seizures, may be increased
· Alpha-blockers (eg, prazosin), beta-blockers (eg, propranolol), butyrophenones (eg, haloperidol), hydantoins (eg, phenytoin), or phenothiazines because the effectiveness of Dopamine may be decreased
· Bromocriptine or tricyclic antidepressants (eg, amitriptyline) because their side effects may be increased
· Guanadrel or guanethidine because their effectiveness may be decreased by Dopamine
This may not be a complete list of all interactions that may occur. Ask your health care provider if Dopamine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.



How to use Dopamine :
Use Dopamine as directed by your doctor. Check the label on the medicine for exact dosing instructions.
· Dopamine is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Dopamine at home, carefully follow the injection procedures taught to you by your health care provider.
· If Dopamine contains particles or is discolored (darker than slightly yellow), or if the vial is cracked or damaged in any way, do not use it.
· Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.
· If you miss a dose of Dopamine , contact your doctor right away.
Ask your health care provider any questions you may have about how to use Dopamine .
Important safety information:
· Some of these products contain sulfites, which can cause allergic reactions in certain individuals (eg, asthma patients). If you have previously had allergic reactions to sulfites, contact your pharmacist to determine if the product you are taking contains sulfites.
· LAB TESTS, including urine output, heart function, blood pressure, and thyroid tests, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
· PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Dopamine , discuss with your doctor the benefits and risks of using Dopamine during pregnancy. It is unknown if Dopamine is excreted in breast milk. If you are or will be breast-feeding while you are using Dopamine , check with your doctor or pharmacist to discuss the risks to your baby.
Possible side effects of Dopamine :
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Fast heartbeat; headache; nausea; vomiting.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; dizziness; irregular heartbeat; pain, redness, or swelling at the injection site; severe headache.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. .
If OVERDOSE is suspected:
Symptoms may include fast or irregular heartbeat; inability to urinate; nausea; severe headache; vomiting.
Proper storage of Dopamine :
Dopamine is usually handled and stored by a health care provider. If you are using Dopamine at home, store Dopamine as directed by your pharmacist or health care provider

Head injury

HEAD INJURY

DEFINITION
Head injury refers to any damage to the scalp, skull, or brain. There are two general categories of head injuries: closed and penetrating. A closed head injury is one in which the skull is not broken open. For example, a boxer who receives a blow to the head may experience brain damage even though the skull is not damaged. This is a closed head injury. In a penetrating injury, the skull is broken open. For example, a bullet wound to the brain causes damage to the skull as well as to the brain. It is classified as a penetrating head injury. Both closed and penetrating head injuries can cause damage that ranges from mild to very serious. In the most severe cases, head injury can result in death.
DESCRIPTION
Head injuries can take many forms. These include skull fractures (broken bones in the skull), blood clots between the brain and the skull, and damage to the brain itself. Brain damage can occur even if the skull itself is undamaged. The brain may move around inside the skull with enough force to cause bruising and bleeding.
Most people have had some type of head injury at least once in their lives, but these events are usually not serious enough to require hospital care.. Brain injuries are most likely to occur in males between the ages of fifteen and twenty-four. The most common causes of these injuries are car and motorcycle accidents. About 70 percent of all accidental deaths are due to head injuries, as are most disabilities resulting from accidents.
CAUSES AND SYMPTOMS
The most common causes of head injuries are traffic accidents, sports injuries, falls, workplace accidents, assaults, and bullet wounds. The head may be damaged both from direct physical injury to the brain and from secondary factors. Secondary factors include lack of oxygen, swelling of the brain, and loss of blood flow to the brain. Both closed and penetrating head injuries can cause tearing of nerve tissue and widespread bleeding or a blood clot in the brain. Swelling may cause the brain to push against the skull, blocking the flow of blood and oxygen to the brain.
Trauma (sudden shock) to the head can cause a concussion (pronounced kun-KUH-shen). A concussion often causes loss of consciousness without visible damage to the skull. In addition to loss of consciousness, initial symptoms of brain injury include:
Memory loss and confusion
Vomiting
Dizziness
Partial paralysis or numbness
Shock
Anxiety
After a head injury, a person may experience a period when his or her brain does not function normally. The person may become confused, have partial memory loss, and lose the ability to learn normally. Other people experience amnesia (memory loss) that may last for a few weeks, months, or even years. As the patient recovers from the head injury, memory normally returns slowly.
A less common aftereffect of head injury is epilepsy (see epilepsy entry). Epilepsy is a seizure disorder characterized by shaking and loss of control over one's muscles. Epilepsy occurs as a result of 2 to 5 percent of all head injuries.
Closed Head Injury
Closed head injury is any head injury in which the skull is not broken open. A common cause of closed head injury is a direct blow to the head. Sudden starts and stops in a motor vehicle may also cause a closed head injury. In such cases, the brain is suddenly thrown with great force against the skull, causing damage to the brain.
Penetrating Head Injury
Penetrating head injuries occur when some object passes through the skull into the brain. The object itself may cause damage to the brain. A bullet wound to the head is an example. Pieces of the skull can also be pushed into the brain by the object. These pieces can damage the brain. An open wound to the brain may also lead to an infection that can cause further brain damage.
Skull Fracture
A skull fracture is an event in which one or more of the bones that make up the skull are broken. Skull fractures are serious accidents and require immediate medical attention. Some skull fractures are visible. Blood and bone fragments may be obvious. In some cases, however, there are no visible signs of a skull fracture. In such cases, other symptoms may indicate the possibility of a skull fracture. These include:
Blood or clear fluid leaking from the nose or ear
Pupils in the eyes having unequal sizes
Bruises or discoloration around the eyes or behind the ears
Swelling or a dent on any part of the head
Intracranial Hemorrhage
Bleeding inside the skull may accompany a head injury and may cause additional damage to the brain. A blood clot may also form between the brain and the skull. A blood clot is a mass of partly solidified blood that forms in the body. The clot can press against the brain and interrupt the flow of blood and oxygen through the brain. A reduced flow of oxygen prevents the brain from functioning normally.
COMPUTERIZED AXIAL TOMOGRAPHY
The discovery of X rays in the late 1890s changed the course of medicine. X rays gave doctors a way of seeing into a patient's body. Hard materials, like bone and teeth, show up clearly in an X-ray photograph.
But X-ray photographs have some serious disadvantages. They provide only a two-dimensional ("flat") view. They may not show cuts, breaks, lumps, and other disorders behind a bone or some other object. The problem is similar to trying to find out what the back of a person's head is like by looking at a photograph of his or her face.
In the 1960s, scientists found another way to use X rays that solved this problem. The technique is known as axial tomography. In axial tomography, X-ray photographs are taken of thin slices of an object. The X-ray camera is aimed at one part of the body, and a photograph taken. Then the camera is moved just slightly, and another photograph is taken. This process is repeated over and over again. Eventually, the researchers has a whole set of photographs of a part of the patient's body.
The problem is that it takes a long time to examine all these photographs and to see how they fit together. The obvious solution to that problem is to let a computer do the work. Today, the X-ray photographs can be fed into a computer, which assembles them into a three-dimensional photograph called a computerized axial tomography (CAT) scan or a computed tomography (CT) scan. The final product provides a much more detailed image of the body part being studied.
Bleeding can also occur deep within the brain. Wherever it occurs, bleeding in the brain is a very serious condition. It can lead to unconsciousness and death. The symptoms of bleeding within the brain include:
Nausea and vomiting
Headache
Loss of consciousness
Pupils in the eyes having unequal sizes
Listlessness
Postconcussion Syndrome
Up to 60 percent of patients who sustain a head injury experience these symptoms for an even longer period of time. The symptoms can last as long as six months or a year after the injury. This condition is known as postconcussion syndrome.
Postconcussion syndrome is often difficult to diagnose. The symptoms include:
Headache
Dizziness
Mental confusion
Behavior changes
Memory loss
Loss of ability to think clearly
Depression
Sudden changes in mood


DIAGNOSIS
It is often difficult, however, to know how serious a head injury is. The fact that a person has a headache following a head injury, for example, does not really indicate how serious that injury is.
The extent of a head injury can be determined in a number of ways. The Glasgow Coma Scale is based on a patient's ability to open his or her eyes, give answers to questions, and respond to physical stimuli, such as a doctor's touch. A score of less than eight points on the scale suggests the presence of serious brain damage.
Patients who are suspected of having severe brain damage should be referred to a medical specialist. The specialist will usually recommend a series of tests. The most common of these tests are the computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and electroencephalogram (EEG, pronounced ih-LEK-tro-in-SEH-fuh-lo-gram). These tests provide visual images of the brain and of the electrical activity taking place within the brain. They are often helpful in discovering damage to the brain.
TREATMENT
The first step in treating most forms of head injury is to keep the patient quiet in a darkened room. The patient's head and shoulders should be raised slightly on a pillow or blanket.
The next step in treatment depends on the nature of the injury. In the case of a penetrating wound, for example, surgery may be necessary. In a closed head injury, surgery may also be required to drain blood from the brain or to remove a clot. Surgery may also be needed to repair severe skull fractures.
Hospitalization is often necessary following head injuries. Medical workers will observe a patient to watch for any change in his or her condition. In addition, drugs can be given to prevent seizures. A tube can also be inserted into the brain to drain off excess fluid.A person with a severe head injury may require long-term treatment. This treatment may be needed to help the person recover mental functions lost as a result ofthe injury. Long-term treatment can sometimes be conducted in day treatment programs. People with the most severe forms of head injury may need to be cared for in a special institution.
CAT scan of a skull fracture. (Reproduced by permission of
Custom Medical Stock Photo
)
PREVENTION
Severe head injuries can often be prevented by some simple steps. People who take part in contact sports or ride bicycles or motorcycles, for example, should always wear helmets. Seat belts and airbags have prevented many head injuries in car accidents. People who work in dangerous occupations should also wear protective headgear on the job.