Immunosuppression is obviously a complex beast, but two things that stand out:
1) Different organs have different immunogenecity which means one can 'get away' with different levels of immunosuppression.
For example, the mismatch (i.e. difference in HLA) between a donor and recipient for a liver can be much greater than for a pancreas (one of the most immunogenic organs). The liver is pretty good at mopping up circulating antibodies.
Consequently, the amount of immunosuppression needed varies. Whereas a recipient of a pancreas might be on an antimetabolite (azathioprine, mycophenalate), a glucorcitcoid (i.e. steroi, eg prednisolone), and a calcineurin-inhibitor (i.e. anti-T cell, e.g. tacrolimus, ciclosporin), recipients of a liver may end up getting by on just a glucocorticoid.
2) Side Effects of the Immunosuppression
In addition to the general effects (bone marrow suppression, increased infection risk, and malignancy), perhaps the most 'ironic' side effect is that of renal/graft-failure. The calcineurin inhibitors are notoriously nephrotoxic (bad for kidneys), and so it's not uncommon for a renal or liver transplant recipient to require renal transplantion as a result of renal failure due to immunosuppressants.
though i'm not sure why a hypertensive like dexamethasone would be prescribed if HACE were the result of increased capillary pressure and vasoconstriction. seems like it would make more sense to prescribe a hypotensive like clonidine
Dexamethasone is a steroid. It's a stop-gap, not definitive treatment, for raised intercranial pressure. Generally you can use it once and it buys you around 6hrs.
In my experience with patient concordance to prescriptions (NB: 'concordance' is the new PC term for 'compliance'), patients don't take their medicine because of poor communication on the part of the doctor.
With increasing patient loads, and consequentially reduced consultation times, doctors often don't take enough time to explain why the patient needs to take the medicine, how to take it, and how often. Also, by appearing to be rushed/stressed, doctors don't give patients the opportunity to ask questions about their medication regime.
Wrong. fMRI uses blood-flow as an endogenous marker of brain activity, so all it can detect is how active one brain area is with respect to another. It does not (and cannot) have sufficient resolution to determine blood flow, and therefore activity, to specific neurones or clusters of neurones.
O Negative is the preferred donor type, as (IIRC) anyone can accept it, but no other blood type works for us poor O Neg's. O Rhesus +ve will work for O negs once. You're born with ABO antibodies but for all other antigens (including Rhesus antigen), you need an initial exposure to trigger antibody development. Therefore, anyone who's Rhesus negative can receive _one_ transfusion of Rhesus positive blood (providing its ABO crossmatched) without major risk of reaction. It's exceedingly bad practice to do this, but can be lifesaving in an emergency (i.e. no other Rhesus negative blood around).
Although ABO and RhD grouping systems are the most well-known and the most important, there are a myriad of other blood groups (about 29 last time I checked) that are of relevance when it comes to crossmatching blood for a patient.
Whilst this potentially is a great step forward, as always with biomedical headlines, it's not the be-all and end-all.
One issue that frequently crops up with testing for HD is confidentiality.
As it is an autosomal dominant condition, with no cure and little in the way of treatment, by testing oneself, one is also indirectly testing one's parents and/or children. If you test positive, then you know that either your mother or father must be positive too. In the majority of cases, the parent(s) already know, but there are cases where parents of patients have not wanted to know.
Whilst this is true of any autosomal dominant inherited condition, it is a particular issue in Huntingdon's due to the nature of the disease which is why in the UK, best practice is to not only get the consent of the patient, but also the patient's parents and children (if they're old enough).
Lawyers ought to have a hippocratic oath, just like doctors.
Doctors don't take the traditional Hippocratic Oath these days, as it forbids abortion or surgery.
At least in the UK, the guiding principles are nonmaleficence; beneficence; respect for autonomy; and justice.
Re:Sensationalist Journalism?
on
A Flu Pandemic?
·
· Score: 5, Insightful
Whilst this sort of thing has happened before saying it's definitely going to mutate is an overstatement.
Hardly - influenza viruses display both antigenic shift and drift: they are gentically one of the more unstable family of viruses. It is inevitable that H5N1 will mutate. What is debatable is whether it will mutate to a form where it is more infectious to a human host, or maybe some other (e.g. porcine).
Whilst sensationalist journalism is never good, it is important not to sideline flu - there will be a pandemic sometime in the near future, maybe not with H5N1, but we are 'due for one'.
Slashdot Mirror
Was trying to work out why they named there subsidary H211.
Are they referring to the Hydrogen line, which has a wavelength of 21.1cm?
http://shimmer.sourceforge.net/
Adds another layer of security if you've got SSH running.
Immunosuppression is obviously a complex beast, but two things that stand out:
1) Different organs have different immunogenecity which means one can 'get away' with different levels of immunosuppression.
For example, the mismatch (i.e. difference in HLA) between a donor and recipient for a liver can be much greater than for a pancreas (one of the most immunogenic organs). The liver is pretty good at mopping up circulating antibodies.
Consequently, the amount of immunosuppression needed varies. Whereas a recipient of a pancreas might be on an antimetabolite (azathioprine, mycophenalate), a glucorcitcoid (i.e. steroi, eg prednisolone), and a calcineurin-inhibitor (i.e. anti-T cell, e.g. tacrolimus, ciclosporin), recipients of a liver may end up getting by on just a glucocorticoid.
2) Side Effects of the Immunosuppression
In addition to the general effects (bone marrow suppression, increased infection risk, and malignancy), perhaps the most 'ironic' side effect is that of renal/graft-failure. The calcineurin inhibitors are notoriously nephrotoxic (bad for kidneys), and so it's not uncommon for a renal or liver transplant recipient to require renal transplantion as a result of renal failure due to immunosuppressants.
Not necessarily - depends where you are. In Britain, death is defined as absence of brain stem _activity_ (IANAL/IANAD)
though i'm not sure why a hypertensive like dexamethasone would be prescribed if HACE were the result of increased capillary pressure and vasoconstriction. seems like it would make more sense to prescribe a hypotensive like clonidine
Dexamethasone is a steroid. It's a stop-gap, not definitive treatment, for raised intercranial pressure. Generally you can use it once and it buys you around 6hrs.
In my experience with patient concordance to prescriptions (NB: 'concordance' is the new PC term for 'compliance'), patients don't take their medicine because of poor communication on the part of the doctor.
With increasing patient loads, and consequentially reduced consultation times, doctors often don't take enough time to explain why the patient needs to take the medicine, how to take it, and how often. Also, by appearing to be rushed/stressed, doctors don't give patients the opportunity to ask questions about their medication regime.
There are exactly 10 kinds of people: those who know trinary, those who don't, and those who mistake it for binary.
Wrong. fMRI uses blood-flow as an endogenous marker of brain activity, so all it can detect is how active one brain area is with respect to another. It does not (and cannot) have sufficient resolution to determine blood flow, and therefore activity, to specific neurones or clusters of neurones.
Although ABO and RhD grouping systems are the most well-known and the most important, there are a myriad of other blood groups (about 29 last time I checked) that are of relevance when it comes to crossmatching blood for a patient.
Whilst this potentially is a great step forward, as always with biomedical headlines, it's not the be-all and end-all.
One issue that frequently crops up with testing for HD is confidentiality.
As it is an autosomal dominant condition, with no cure and little in the way of treatment, by testing oneself, one is also indirectly testing one's parents and/or children. If you test positive, then you know that either your mother or father must be positive too. In the majority of cases, the parent(s) already know, but there are cases where parents of patients have not wanted to know.
Whilst this is true of any autosomal dominant inherited condition, it is a particular issue in Huntingdon's due to the nature of the disease which is why in the UK, best practice is to not only get the consent of the patient, but also the patient's parents and children (if they're old enough).
Lawyers ought to have a hippocratic oath, just like doctors. Doctors don't take the traditional Hippocratic Oath these days, as it forbids abortion or surgery. At least in the UK, the guiding principles are nonmaleficence; beneficence; respect for autonomy; and justice.
Whilst this sort of thing has happened before saying it's definitely going to mutate is an overstatement.
Hardly - influenza viruses display both antigenic shift and drift: they are gentically one of the more unstable family of viruses. It is inevitable that H5N1 will mutate. What is debatable is whether it will mutate to a form where it is more infectious to a human host, or maybe some other (e.g. porcine).
Whilst sensationalist journalism is never good, it is important not to sideline flu - there will be a pandemic sometime in the near future, maybe not with H5N1, but we are 'due for one'.
Do any AJAX clients work with Google Talk though?
I had a play with jwchat but with no joy.