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Exercise testing in diabetes
Published in R. C. Richard Davison, Paul M. Smith, James Hopker, Michael J. Price, Florentina Hettinga, Garry Tew, Lindsay Bottoms, Sport and Exercise Physiology Testing Guidelines: Volume II – Exercise and Clinical Testing, 2022
Rob C. Andrews, Parth Narendran, Emma Cockcroft
There are several approaches to minimising the risk of hypoglycaemia during or after an exercise test (see Figure 5.3.1). Subcutaneous injections of insulin should avoid areas of lipohypertrophy, because this can result in variation in insulin absorption. Patients should also avoid injecting into the part of the body engaged in performing an exercise test, such as avoiding injection into legs for a cycling test. This is because there will be increased blood flow to these body parts, and this results in faster insulin absorption at the start of of hypoglycaemia. exercise and greater risk
Immunomodulatory Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Interferon γ-1b (ImmukinTM) is approved to reduce the frequency of serious infection in severe malignant osteopetrosis and chronic granulomatous disease. Given by subcutaneous injection, the main side effects include GI symptoms (e.g., nausea, vomiting, diarrhea, abdominal pain), headache, fatigue, fever, chills, depression, myalgia, arthralgia, rash, and injection-site reactions. Confusion and systemic lupus erythematosus have occurred less commonly, and raised liver enzymes thrombocytopenia neutropenia and proteinuria have also been reported. It is not recommended for use during conception or pregnancy.
Vaccine Adjuvants in Immunotoxicology
Published in Mesut Karahan, Synthetic Peptide Vaccine Models, 2021
The most important side effect of aluminum-derived adjuvants is the formation of local granulomas at the injection site. This situation develops especially when an intradermal or subcutaneous injection is administered instead of intramuscular. Local pain, inflammation, swelling, ulcer, and necrosis at the injection site may also be observed (Maughan, Preston, and Williams 2015). Other important side effects are tendency to allergy and potential neurotoxicities with increased IgE production. Aluminum is usually excreted from the body through the kidneys. In kidney dysfunction, aluminum accumulates in the body. High levels of aluminum affect the brain and bone tissues in particular. Aluminum intoxication has also been associated with Alzheimer’s disease. Magnesium hydroxide (Mg(OH)2), zinc sulphate (ZnSO4), calcium phosphate (Ca3(PO4)2), and iron and zirconium salts are used as alternative mineral salts (Yurdakök and İnce 2008; Maughan, Preston, and Williams 2015).
Histone deacetylase inhibitors as a potential new treatment for psoriatic disease and other inflammatory conditions
Published in Critical Reviews in Clinical Laboratory Sciences, 2023
Jehan Mohammad Nazri, Katerina Oikonomopoulou, Elvin D. de Araujo, Dziyana Kraskouskaya, Patrick T. Gunning, Vinod Chandran
Briefly, the human skin is composed of three layers: the epidermis, dermis, and subcutis. The epidermis is the topmost epithelial layer of the skin that is mainly composed of cells such as keratinocytes (skin cells that are also involved in psoriasis), melanocytes (cells responsible for producing a pigment called melanin), and Langerhans cells (immune cells for recognizing antigens). The dermis layer, also known as the supportive layer of the skin, consists of fibers such as collagen and elastin as well as cells like fibroblasts, neutrophils, lymphocytes, eosinophils, and monocytes. The subcutis, also called subcutaneous layer, is the fatty layer below the epidermis and dermis. Usually, in healthy, normal human skin, the presence of an invading foreign pathogen and/or allergen detected by cells in the epidermis and dermis will initiate a pro-inflammatory immune response via the activation of signaling pathways like the nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), Janus kinase/signal transducers and activators of transcription (JAK/STAT), and mitogen-activated protein kinase (MAPK) pathways [36]. Additionally, depending on what is required next for clearance of the foreign invasion, specific adaptive immune responses may also follow before resolution of the inflammation. However, when psoriasis is triggered, aberrant activation of the innate and adaptive immune responses follows and support the initiation as well as subsequent maintenance of psoriatic inflammation [37,38] (Figure 1).
Patient preferences for treatment in steroid resistant ulcerative colitis – a discrete-choice experiment
Published in Scandinavian Journal of Gastroenterology, 2022
Nyantara Wickramasekera, Elizabeth Coates, Amy Barr, Matthew J. Lee, Sue Blackwell, Hugh Bedford, Nicola Dames, Shaji Sebastian, Christopher Probert, Phil Shackley, Alan J. Lobo
This is the first DCE study to focus on patients with steroid-resistant ulcerative colitis conducted in the UK, though other studies have used DCEs to quantify patient preferences for IBD treatments [13–15,33,34]. Our finding, that treatments with fewer side effects are most important to patients, contrasts with the study by Bewtra, where patients with IBD were prepared to accept relatively high risks of lymphoma to avoid a disease relapse over the next 5 years [35]. Almario et al. also found that efficacy was the most important attribute for patients with ulcerative colitis, but that side effects were the key priority for patients with Crohn’s disease [15]. Boeri et al. reported that symptom improvement and risk of malignancy were the two most important attributes. Similar to our study, Boeri et al. reported that patients preferred oral modes of administration compared to subcutaneous or intravenous administration [14]. Our results also showed that less frequent administration of subcutaneous injections were preferred. Feedback from a patient panel indicated that frequent injections could be intrusive or a reminder of their illness.
Biopredictive tools for the development of injectable drug products
Published in Expert Opinion on Drug Delivery, 2022
Mônica Villa Nova, Kennard Gan, Matthias G. Wacker
Injectable drug products cover a wide variety of potential injection sites involving different physiologies and formulations. Most frequently, intravenous, subcutaneous, intramuscular, and intradermal injections are being used. Additionally, there are several less common injection sites including the intracranial [46], intrathecal [47–49], intra-articular [50], or intraosseous [51] route of administration. A formulation-centric approach requires the material and quality attributes of the delivery system to be considered. Most injectables are liquids with the drug being dissolved or dispersed in a vehicle. Their absorption kinetics is affected by a variety of physiological parameters responsible for the distribution of the drug after the injection. They include the vascularization and structure of the injection site as well as the access to other tissues, such as the lymphatic system [52]. Regarding the subcutaneous route of administration, the preferred injection site varies between Asian and Western countries, leading to differences in the absorption rate as well [6].