Visceral forms

Leishmaniasis affects some 12 million humans aimuaHy ia an area where 350 million are at risk. It is a complex of at least two protozoan diseases, consisting primarily of cutaneous and visceral forms. A mucocutaneous form is considered by some to be another distinct variety. Clinical manifestations of the disease range from an asymptomatic infection to an infection ia which there is considerable destmction of cutaneous tissue and mucous membranes. Leishmaniasis can often be fatal, especially ia the visceral form. The seriousness of the disease depends on the state of the immunological system of the... 

Leishmaniasis. The causative agents are flagellated protozoa that are transmitted by sand flies to humans. The parasites are taken up into phagocytes, where they remain in phagolysosomes and multiply until the cell dies and the parasites can infect new cells. Symptoms A visceral form, known as kala-azar, and cutaneous or mucocutaneous forms exist (A). An estimated 12 million humans are affected. Therapy is dif cult pen-tavalent antimonial compounds, such as stibogluconate, must be given for extended periods. Adverse effects are pronounced. 

In the adult, both the cutaneous and mucocutaneous forms of leishmaniasis [Leishmania braziliensis and L. mexicana) are treated with stibogluconate. An alternative drug for the visceral form is amphotericin B. 

This disease is caused by a protozoan belonging to the genus Leish-mania. The three variations of the disease are visceral leishmaniasis (kala-azm, black fever, or Assam fever), cutaneous leishmaniasis, and mucocutaneous leishmaniasis. " The visceral form is caused predominantly by L. donovani, whereas the other two forms are caused... 

Leishmaniasis presents as a variety of clinical manifestations - from cutaneous lesions to the visceral form, with the latter being fatal if untreated. The disease is caused by Ldshmania species (e.g., L. major or L. infantum) these intracellular pathogens are widespread over Africa, Asia, and South America, and worldwide... 

In contrast to patients with visceral forms of cancer, those suffering from chronic leukemia or Hodgkins disease have normal blood citrate levels (R5, R9). 

Clinical use Thiabendazole is a drug of choice for visceral forms of larva migrans and is an effective drug for treatment of strongyloidiasis, cutaneous larva migrans, and threadworm infections. Thiabendazole is rapidly absorbed from the gut and is metabolized by liver enzymes. The drug has anti-inflammatory and immunorestorative actions in the host. 

Leishmaniasis. This important human parasite has the widest distribution of the trypanosomal infections, affecting an estimated 10 million people. Its many forms and varied clinical picture make it difficult to characterize. Visceral forms mimic malaria symptoms (i.e. enlarged liver and spleen) and can be highly fatal. Large outbreaks have occurred in recent years, especially in northern and eastern Africa, central Asia and Brazil. Sand fly vectors are difficult to control and no serious vector control campaigns have been mounted as a way of managing this still emerging parasitic disease. 

Physiological Classifications of Contaminants. The physiological classification of air contaminants is difficult, because the type of action of many gases and vapors depends on concentrations (55). For example, a vapor at one concentration may exert its principal effect as an anesthetic but, at a lower concentration, the same vapor may iujure the nervous system, the hematopoietic (blood-forming) system, or some visceral organ (see Toxicology). 

In 1912, however, (201) it was discovered that espundia (American mucocutaneous leishmaniasis) can be cured by tartar emetic. It was soon learned that kala-a2ar (visceral leishmaniasis) and oriental sore (a cutaneous form of the disease occurring in the Middle East) also respond to antimonial therapy, especially when compounds of pentavalent antimony are employed. Treatment of leishmaniasis with the latter type of antimonials is safe and effective in over 90% of the cases (202). In 1918, it was demonstrated that tartar emetic is of value in the treatment of schistosomiasis (203). Pentavalent antimonials proved to be less effective. The introduction of antimony compounds for the treatment of parasitic diseases is undoubtedly one of the important milestones in the history of therapeutics (see Antiparasitic agents). 

Amphotericin B (15) is an antifimgal macioHde antibiotic produced by Streptomjces nodosus that has been used as an alternative, albeit more toxic, dmg to the antimonials. It acts as a leishmanicide against the visceral and mucocutaneous forms of the disease. To overcome its potentially severe nephrotoxicity, the dmg must be adrninistered over an extended period of time. 

Insulin resistance occurs when the normal response to a given amount of insulin is reduced. Resistance of liver to the effects of insulin results in inadequate suppression of hepatic glucose production insulin resistance of skeletal muscle reduces the amount of glucose taken out of the circulation into skeletal muscle for storage and insulin resistance of adipose tissue results in impaired suppression of lipolysis and increased levels of free fatty acids. Therefore, insulin resistance is associated with a cluster of metabolic abnormalities including elevated blood glucose levels, abnormal blood lipid profile (dyslipidemia), hypertension, and increased expression of inflammatory markers (inflammation). Insulin resistance and this cluster of metabolic abnormalities is strongly associated with obesity, predominantly abdominal (visceral) obesity, and physical inactivity and increased risk for type 2 diabetes, cardiovascular and renal disease, as well as some forms of cancer. In addition to obesity, other situations in which insulin resistance occurs includes... 

Symptoms next include dementia, tremor, and ataxia progressing most often to coma and death survivors show severe chronic meningoencephalitis. The American form of trypanosomiasis (Chagas disease) is a common health problem in Central and Southern America and is transmitted by reduviid bugs. Polymyositis, myocarditis and encephalomyelitis are constant features of the disorder but may be accompanied by more widespread visceral involvement. Infection can be confirmed by complement fixation tests but antibodies do not occur in the blood until about two months after infection. 

Visceral organs in general Haematopoietic (i.e. blood-forming system) Nervous system... 

Amino acids are the building blocks of body proteins. There is no excess storage form of protein in the body, so amino acids are an essential component of the PN admixture. Amino acids are provided to preserve or replete lean body mass and visceral proteins and to promote protein anabolism and wound healing. Amino acids are a source of calories with a caloric value of 4 kcal/g. 

The cell bodies of visceral motor neurons are found in the lateral horn. The axons of these neurons form efferent nerve fibers of the autonomic nervous system (ANS). The ANS innervates cardiac muscle, smooth muscle and glands (see Chapter 9). The axons of these neurons exit the spinal cord by way of the ventral root. 

Pain receptors also influence the medullary respiratory center. Pain may cause a reflex increase in ventilation in the form of a "gasp." Somatic pain typically causes hyperpnea and visceral pain typically causes apnea, or decreased ventilation. 

Enteric Neuropathies. Different kinds of familial visceral neuropathies have been described the dominant type 1 [134], the recessive type 2 [135] and a recessive form with calcified basal ganglia [134], Furthermore, aganglionosis of the small bowel (Hirschsprung s disease) [136], hypergan-glionosis (neurofibromatosis) [137], neuronal intestinal dysplasia [138] and Parkinson s disease [139] are neuropathies to consider. The recognition of the pacemaker cells of the small bowel, the interstitial cells of Cajal, has prompted studies to detect abnormalities of these cells, another possible cause of pseudoobstruction [140],... 

Epilepsy is a chronic brain disease of diverse etiology it is characterized by recurrent paroxysmal episodes of uncontrolled excitation of brain neurons. Involving larger or smaller parts of the brain, the electrical discharge is evident in the electroencephalogram (EEG) as synchronized rhythmic activity and manifests itself in motor, sensory, psychic, and vegetative (visceral) phenomena Because both the affected brain region and the cause of abnormal excitability may differ, epileptic seizures can take many forms. Erom a pharmaco-therapeutic viewpoint, these may be classified as ... 

Acetaminophen (paracetamol) has good analgesic efficacy in toothaches and headaches, but is of little use in inflammatory and visceral pain. Its mechanism of action remains unclear. It can be administered orally or in the form of rectal suppositories (single dose,... 

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