Small changes could save structures, lives during tornadoes: Safe rooms, quality garage doors critical

 

Dr. Andrew Graettinger, a University of Alabama researcher, examines a safe room that survived the tornado that struck Moore, Oklahoma, in May 2013.

Surviving a tornado in a wood-frame residential home is enhanced by an intact roof and standing walls, but light-weight garage doors can be the weak link to allowing high winds and pressure changes into a home that can lead to the removal of the roof and collapsed walls, according to a study of damage left behind by a powerful tornado in Moore, Oklahoma, in 2013 by researchers from The University of Alabama and other institutions.

"Once the roof over the garage is blown off, there usually is a significant hole into the main portion of the house," said Dr. Andrew J. Graettinger, associate professor of civil, construction and environmental engineering and lead author of a report by a team of researchers.

Researchers from six institutions traveled to Moore at the end of May 2013 as part of the National Science Foundation Rapid Response Grant for Exploratory Research awarded to UA to investigate and gather data about the damage to, and performance of, woodframe structures in the affected areas due to strong winds.

As part of the grant, the research team also studied whether social media and engineering can combine to influence future building practice. Other NSF grants funded work by researchers at three other institutions, and their work is included in the final report.

"We need to consider the building components that are the starting points for damage that lead to loss of life, injuries and economic loss during a tornado," Graettinger said. "If we engineer for these weak areas, we can start keeping these buildings together during all but the strongest winds a tornado can produce."

Besides the findings on garage doors, the team found more use of residential shelters in Moore than found in similar studies in Tuscaloosa and Joplin, Missouri, after strong tornadoes hit both cities in 2011. This is likely because the tornado in Moore a year ago was the third major tornado to strike the city since 1999. The conclusion of the study is simple: below-ground storm shelters and above-ground safe rooms protect against the worst storms and save lives.

"They all performed very well," Graettinger said of the shelters observed in Moore. "That's important because while progress is made toward crafting building codes to protect against smaller tornadoes, in large storms or when retrofitting existing homes, a safe room is the best option to save lives."

The EF 5 tornado that struck Moore May 20, 2013, created a 17-mile long damage swath destroying more than 12,000 buildings mostly in residential and light commercial areas. More than 350 people were injured, and 24 people died as a result of the tornado. The total economic loss from this single event was estimated at $3 billion.

Several members of the team worked together in 2011 to study damage left in the wake of massive tornadoes in Tuscaloosa and Joplin. The researcher's goal after all three events is to better understand the forces generated by large tornadoes and the distribution of wind force across a tornado's path, as well as make recommendations for design code improvements and general safety guidelines.

From the data collected in 2011, the researchers concluded that light-frame wood structures will not be able to withstand a direct hit from the forces of powerful EF4 or EF5 tornadoes which produce winds stronger than 166 mph. However, based off the three studies, it's estimated 85 percent of the damage area left behind by an EF4 or EF5 tornado experience winds from EF0-EF2 tornadoes, or winds less than 135 mph.

These areas on the edges of those systems could see dramatic improvements in safety and overall structure through better engineering design and construction practices. The study of the tornadoes in 2011 concluded that applying techniques to build homes against hurricanes is probably the easiest, low-cost solution to strengthening homes against lower-windspeed tornadoes, and safe rooms and shelters are needed to save lives for those in the center of a tornado.

The study of the tornado in Moore reinforced that conclusion, and it vindicates recent research methods of tornadoes in laboratories and numerical analysis. It also led to further investigation of garage doors, especially on garages that extend from the house. In the areas with lower wind speeds, the root for failure of residential structures was often the garage, according to the Moore damage assessments.

When the garage door is breached during a tornado, it typically leads to pressurization of the garage, subsequent loss of roof over the garage and collapse of the garage walls. The biggest difference between the damage assessments in Moore with those in Tuscaloosa and Joplin was the prevalence of storm shelters. In 2011, shelters were not commonly observed by the research team in Tuscaloosa or Joplin.

At the time of the tornado in 2013, the city of Moore had 3,236 registered residential shelters, an estimated 16 percent of housing units in Moore based of 2010 U.S. Census data. In the damage area, researchers examined 75 residential shelters. Of the 75 shelters observed in Moore, 68 were below ground, and all served their purpose, often times with neighbors of the home with the shelter, the team observed. Only one of the 75 shelters, an above-ground safe room, was penetrated by high-flying debris, a result of errors in building the safe room, the team concluded.

During the research in Moore, social media was used to identify locations to survey damage. It was a novel approach that helped locate the best places to study structural damage, said Dr. Laura Myers, senior research social scientist at The Center for Advanced Public Safety at UA.

"Not only does this assist with the research process, but it also helps establish a community network for storm damage recovery," Myers said. "Once recovery begins, this community network becomes integral in documenting what the infrastructure strengths were, such as storm shelters, and what needs to change, such as better building codes, to help the rebuilding process."

The team consists of the following researchers:

- Dr. Andrew Graettinger, principal investigator of the project and associate professor of civil, construction and environmental engineering at The University of Alabama -- Dr. Thang Dao, assistant professor of civil, construction and environmental engineering at UA -- Dr. Jim Richardson, associate professor of civil, construction and environmental engineering at UA -- Dr. Laura Myers, senior research social scientist at The Center for Advanced Public Safety at UA -- Dr. David O. Prevatt, assistant professor of civil and coastal engineering at the University of Florida -- Dr. Rakesh Gupta, professor of wood science and engineering at Oregon State University -- Dr. Arthur G. Cosby, the William L. Giles Distinguished Professor and director of the Social Science Research Center at Mississippi State University -- Dr. Robert Emerson, associate professor of structural engineering at Oklahoma State University -- Dr. Fred Haan, associate professor of mechanical engineering at Rose-Hulman Institute of Technology

Several students were also part of the research team including an undergraduate and three graduate students from UA.

Alcoholism

 

Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop drinking. If you have alcoholism, you can't consistently predict how much you'll drink, how long you'll drink, or what consequences will occur from your drinking.

It's possible to have a problem with alcohol, even when it has not progressed to the point of alcoholism. Problem drinking means you drink too much at times, causing repeated problems in your life, although you're not completely dependent on alcohol.

Binge drinking — a pattern of drinking where a male consumes five or more drinks in a row, or a female downs at least four drinks in a row — can lead to the same health risks and social problems associated with alcoholism. The more you drink, the greater the risks. Binge drinking, which often occurs with teenagers and young adults, may lead to faster development of alcoholism.

If you have alcoholism or you have a problem with alcohol, you may not be able to cut back or quit without help. Denying that you have a problem is usually part of alcoholism and other types of excessive drinking.

What is nanotechnology about?

 

• 22 April 2014

 

There has been an unprecedented multidisciplinary convergence of scientists dedicated to uncover the secrets of a world so small, we can’t see it – even with a conventional light microscope. This world is the field of nanotechnology, the realm of atoms, molecules and nanostructures. Nanotechnology is such a new field that no one is quite sure of what will come of it. Even so, predictions range from the capability to reproduce things like diamonds and food to the world being devoured by self-replicating nanorobots.

In order to get a better understanding the unusual world of nanotechnology, we need to get an idea of the units of measure involved. A centimeter is one-hundredth of a meter, a millimeter is one-thousandth of a meter, and a micrometer is one-millionth of a meter, but all of these are still huge compared to the nanoscale. A nanometer (nm) is one-billionth of a meter, smaller than the wavelength of visible light and a hundred-thousandth the width of a human hair.

As small as a nanometer is, it’s still large compared to the atomic scale. An atom has a diameter of about 0.1 nm. An atom’s nucleus is much smaller — about 0.00001 nm. Atoms are the building blocks for all matter in our universe. You and everything around you are made of atoms. Nature has perfected the science of manufacturing matter molecularly. For instance, our bodies are assembled in a specific manner from millions of living cells. Cells are nature’s nanomachines. Cells are capable of functioning autonomously from the rest of the organism. At the atomic scale, elements are at their most basic level. On the nanoscale, we can potentially put these atoms together to build almost anything. The nanoscale is the first point where we can assemble something -it’s not until we start putting atoms together that we can make anything useful.

 

source:

www.nanolinen.org

Nanotechnology in medicine

 

• 22 April 2014

If there is one industry in which the use of nanotechnology has been considered more advantageous than harmful, it is the medical industry. The use of nanotechnology in medicine is very recent and offers some exciting opportunities to doctors and medical researchers alike. Some techniques are only imagined, while others are at various stages of development and testing, or actually being utilized in the field today. Nanotechnology in medicine involves the applications of various nanoparticles that are currently being developed, as well as long term research that involves the use of robots manufactured on a microscopic scale to make repairs at the cellular level. The use of nanotechnology in the field of medicine could potentially revolutionize the way that we detect and treat damage to the human body and disease in the years to come, and many techniques only imagined a few years ago are making remarkable progress towards becoming realized.

One application of nanotechnology in medicine that is currently being developed involves the use of nanoparticles to deliver drugs, heat, light or other substances to a specific typeof cell (such as cancer cells). These nano-particles are engineered in such a way that they are attracted only to diseased cells, which allows targeted treatment of those cells. This technique reduces damage to healthy cells in the body and allows for earlier detection and treatment of disease ridden cells.

Researchers have now started using nanoparticles to deliver vaccines of various sorts. The nanoparticles serve the purpose of protecting the vaccine, allowing the vaccine time to trigger a stronger immune response than possible through the conventional method of delivery. Targeted heat therapy is being developed to destroy breast cancer tumors. This method involves using antibodies that are strongly attracted to proteins produced by one type of breast cancer cell, which are attached to nanotubes, causing the nanotubes to accumulate at the tumor. Infrared light from a laser is absorbed by the nanotubes producing heat which incinerates the cancerous cells.

source:

http://nanolinen.org

Antibiotic Resistance Is Now Rife across the Entire Globe

 

A first-ever World Health Organization assessment of the growing problem calls for rapid changes to avoid the misery and deaths of a potential "post-antibiotic era" 

Apr 30, 2014 |By Dina Fine Maron

Image: FDA

Dangerous antibiotic-resistant bacteria and other pathogens have now emerged in every part of the world and threaten to roll back a century of medical advances. That’s the message from the World Health Organization in its first global report on this growing problem, which draws on drug-resistance data in 114 countries.
“A post antibiotic-era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” wrote Keiji Fukuda, WHO’s assistant director general for Health Security, in an introduction to the report. The crisis is the fruit of several decades of overreliance on the drugs and careless prescribing practices as well as routine use of the medicines in the rearing of livestock, the report noted.

Antibiotic resistance is putting patients in peril in both developing and developed countries, as bacteria responsible for an array of dangerous infections evolve resistance to the drugs that once vanquished them.
Gonorrhea, once well treated by antibiotics, is once again a major public health threat due to the emergence of new, resistant strains. Drugs that were once a last resort treatment for the sexually transmitted disease—which can lead to infertility, blindness and increased odds of HIV transmission if left untreated—are now the first-line treatment and are sometimes ineffective among patients in countries such as the U.K., Canada, Australia, France, Japan, Norway, South Africa, Slovenia and Sweden.
Drugs to treat Klebsiella pneumoniae—a common intestinal bacteria that can cause life-threatening infections in intensive care unit patients and newborns—no longer work in more than half of patients in some countries. And fluoroquinolones, drugs used to treat urinary tract infections, are also ineffective in more than half of sufferers in many parts of the world. Efforts to limit the spread of multidrug-resistant tuberculosis, malaria and HIV are also all under threat due to increasing bacterial resistance.
Although the development of resistance is to be expected over time, overuse of the drugs has accelerated the process by supplying additional selective pressure, noted the report, which was authored by an extensive team of researchers with WHO. And there are few drugs to replace the ones that are now ineffective: The last entirely new class of antibacterial drugs was discovered 27 years ago, according to the report.
WHO warns that the situation could have sweeping effects on global medicine, economics and societies unless global actions are taken swiftly. A dearth of effective antibiotics will mean that infected patients will need more extensive care, require longer hospital stays and die in greater numbers.
To tackle the problem, the report calls for global, coordinated actions on the scale of those that nations are taking to mitigate and adapt to climate change.
The report recommends a multipronged approach. In many cases, WHO noted, available diagnostic tests can already be used to help identify the bacteria that fueled an infection—allowing doctors to select more targeted drug treatments instead of resorting to broad-spectrum medications that exacerbate drug resistance. The problem is that such tests take time to run and thus prescribers often forgo the tests and migrate toward those broad-spectrum drugs. Developing faster tests is therefore crucial, according to the report. The agency also proposes renewed focus—and standardized methods—to track resistant strains across the globe. There is currently no global consensus on methodology and data collection in this area.
There are also essential everyday solutions that communities and clinicians should adopt—including better hygiene practices by health care workers, such as washing hands more frequently and vaccinating populations against key diseases to reduce the need for antibiotics in the first place. Patients, too, have a vital part to play by using antibiotics only when they are prescribed, WHO said.
The assessment, collected information on nine particularly troublesome bacteria from 114 countries that track data on at least one of the microorganisms and the antibiotics used to treat them.
Although limited by significant data gaps, the report noted that in the case of many of these bacteria, resistance levels to first-line drugs have reached 50 percent or more in at least half of the countries analyzed. As a result, health care providers must frequently rely on last-resort drugs. “It is terrifying in scope. This is a massive public health problem that is just starting to bubble to the surface,” says Brad Spellberg, associate professor of medicine at the Los Angeles Biomedical Research Institute at Harbor–U.C.L.A. Medical Center. As the global usage of last-resort drugs grows, resistance to these drugs also accelerates, compounding the crisis. With fewer drug options, the WHO report points out, patients who live in poverty or lack health insurance have nowhere to turn for effective treatments.
“We are already seeing this,” says Stuart Levy, director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine, who assisted with the WHO report. “For respiratory diseases in Uganda, we had a multidrug-resistant pneumococcus being treated with recommended drugs—but the bacteria were already 90 percent resistant.” Alternative drugs, in that setting, were not readily available.

Nanotechnology and Dermatology - The Role of Nanotechnology in Dermatology Research

 

by Dr Adam Friedman

Introduction

Cutaneous drug delivery offers many advantages over alternative routes of administration with regards to target specific impact, decreased systemic toxicity, avoidance of first pass metabolism, variable dosing schedules, and broadened utility to diverse patient populations.

A complicating factor is that the skin has evolved mechanisms to impede exogenous molecules, especially hydrophilic ones, from safe passage. The horny layer of the stratum corneum (the top most layer of the skin) is tightly bonded to an intercellular lipid matrix making the passage of therapeutics a serious challenge¹. This strong barrier to molecular activity is quite effective at blocking large drugs (molecular mass > 500 Da), which of course make up the majority of active therapeutics².

Mechanical abraders and micro-needles can open a limited number of relatively wide (≥ 10³ nm) pores in the skin barrier, that can allow for transient passage of small and even large molecules (or even bacteria)³. Disruption with either ultrasound (phonopheresis) or high-voltage electrical pulsing (electroporation) has been used to force larger materials through this complex barrier. Chemical penetration enhancers are also utilized in order to perturb the epidermal barrier, though safety concerns have limited their efficacy^4-6.

Furthermore, many substances that could, in theory, be used as topical therapeutics have several disadvantages in that they are:

1. weakly or not soluble in water;
2. degraded or inactivated prior to reaching the appropriate target;
3. nonspecifically distributed to tissues and organs, resulting in undue adverse side effects and limited efficacy at the target site

Nanotechnology and Delivery Vehicles

Novel delivery vehicles generated through nanotechnology is raising the exciting prospect for controlled and sustained drug delivery across the impenetrable skin barrier. Particles 500 nm and smaller exhibit a host of unique properties that are superior to their bulk material counterparts^7-9. Small size is a necessary feature but other properties are needed for nanomaterials to achieve efficacy as a topical delivery vehicle.

Optimally these nanoparticles should:

1. carry drugs through cutaneous pores in the primary skin barrier;
2. release the transported drug spontaneously once penetration is achieved; and
3. exhibit low rates of cutaneous drug clearance allowing for deep/targeted deposition and prolonged action of the carrier-transported drugs.

Additionally, these products should be able to adjust to relevant physiologic variations as part of their design and targeting.

Nanotechnology Becoming a Major Focus in Dermatology Research

Given the potential significant therapeutic benefits listed above, it is no surprise that nanotechnology is becoming a major focus of dermatologically oriented product development^{7, 10-14}. The sixth largest patent holder of nanotechnology in the United States is a cosmetics company^15,16. In fact, cosmetic companies are above the curve with respect to their nanotechnology research efforts as compared to industry giants like Motorola and Kodak. While nano-manufacturing can be costly and require sophisticated facilities, mass production, decreasing prices, and exponential growth are expected control costs in the future and allow this science to blossom. Some estimates place nanotechnology by 2012 to be a $2 trillion industry, employing two million in the United States alone⁷. Applications are underway in medicine and dermatology for the early detection, diagnosis, and targeted therapy of disease^{7,9,10,12,13,17-24}.

As can be expected with any technology in its infancy, of the potential and excitement must be tempered with the realization that there are still pitfalls and remaining concerns regarding safety^23,25-35. The skin is the first point of contact for most environmental nanomaterials, regardless of medium in which they are delivered. The risks of nanomaterials in the world of dermatology are therefore extensive, ranging from irritant or allergic contact dermatitis to foreign body reactions to tissue death²⁷.

Theoretically speaking, the toxic potential of any material can be predicted to be exponentially proportional to a decrease in particle size. First, smaller size allows for deeper penetration of encapsulated chemicals, and for enhanced intracellular penetration and systemic absorption. Second, just as a greater surface area to volume ratio confer nanomaterials with significant advantages over their macromolecular counterparts, so too does it dramatically increase the availability of surface groups for interaction with tissues and cells. If the surface groups are chemically reactive and are capable of generating reactive oxygen species, the potential for reactivity increases with decreasing particle size²⁸. Lastly, the toxicity of both insoluble and inert nanoparticles in mammalian cells can be directly related to their cellular uptake. Some cells, such as keratinocytes, have the ability to phagocytose small molecules, and when nanomaterial are internalized, they can accumulate in cells and ultimately result in DNA damage and cytotoxicity through the generation of oxidative stress³⁶.

Therefore, it is of the utmost importance that the toxicology of nanotechnologies be appropriately elucidated to both protect the public from potentially harmful materials, but also to allay public fears and media speculation that can prevent this promising technology from being cultivated and utilized.

 

The Current State of Nanotechnology in Dermatology

Many areas of medicine, such as oncology³⁷ and diagnostic radiology³⁸ have been incorporating nanotechnology into their teaching, education, and research. Dermatology has been lagging in this area despite the seemingly paradoxical observation that a significant proportion of new developments in nanotechnology have been in consumer skin care. Recent data from a pilot study (Friedman and Nasir, unpublished) revealed that there is a strong agreement among dermatologists nationwide that nanotechnology teaching, education, and research are both necessary and important facets of Dermatology.

Furthermore, respondents indicated that there is a need for improved and more rigorous oversight and regulation of these technologies, though it was unclear either how this could be accomplished or how dermatologists can get involved. In fact, until recently, there have not been any dermatology organizations or groups in the United States dedicated to addressing these issues.

 

The Nanodermatology Society (NDS)

The Nanodermatology Society was founded in 2010 to bring together individuals from a broad array of linked disciplines who share a common interest in nanotechnology as it relates to dermatology.

The society and members are charged with the following mission:

1. to closely monitor developments in nanotechnology as they relate to dermatology;
2. to meet informally and formally at congresses, scientific conferenceand teaching events with the purpose of educating and informing members on developments in nanotechnology and dermatology;
3. to exchange research and ideas on nanotechnology advances;
4. to sponsor research and education in nanotechnology; and
5. to develop policies and positions to benefit consumers, academia, regulatory bodies, and industry¹¹.

The primary focus of the NDS will be monitoring nanotechnology, studying new developments in the field, and evaluating their potential. The NDS will focus on potential beneficial uses of this new technology, as well as potential dangers. NDS members will critically question the suggested benefits and risks of available and developing nanotechnologies based on the latest available data. The impact on consumers, workers, medical personnel, society, and the environment will all be considered. Most importantly, findings will be shared and distributed as part of the NDS's educational mission through various outlets.

As part of its regulatory mission, the NDS will develop safety guidelines based on current medical and dermatologic understanding and reports from toxicology testing agencies. The NDS will communicate these findings to the society, regulatory bodies, and to law and policy makers.

The dermatologic community is not yet aware of all the benefits and drawbacks to nanotechnology. Yet, dermatology is a vibrant discipline poised to yield new discoveries in the diagnosis and management of disease utilizing nanotechnology. This is the perfect time to educate dermatologists, colleagues, consumers, and workers about nanotechnology.

 

Hybrid Nanoparticles as a Vehicle for the Delivery of Nitric Oxide

Interest in the therapeutic potential of nitric oxide (NO) has been growing exponentially over the past few decades^39-51. This interest is a direct result of findings demonstrating an ever-expanding range of functionalities associated with NO under physiological conditions. These established properties not only have direct therapeutic implications for the treatment of infections, modulation of vasoactivity, angiogenesis, and wound healing, but also provide a basis for our understanding of many diseases ranging from asthma to psoriasis^52-55.

Harnessing this potential has proven difficult as reflected by the intense but relatively unsuccessful efforts to develop therapeutically useful NO delivery devices/vehicles⁵⁶. Clinical use of these materials has been limited due to cost, cytotoxicity, instability of the chemical compounds, potential carcinogenicity, and development of tolerance to the NO releasing substances⁵⁶. The hybrid nanoparticles overcomes many of the existing limitations associated with the current NO releasing strategies.

It combines the beneficial features of two distinct materials. Firstly, polysaccharide-derived glassy matrices that support the conversion of nitrite to NO as well as retention of NO within the matrix⁵⁷; Secondly, silane-derived, porous hydrogel that provides a relatively rigid skeleton. Alone, glassy matrices suffer from the limitation that they rapidly dissolve following exposure to water. The hydrogel matrix, though more stable in water, is highly porous, allowing a rapid escape of contents. The hybrid platform overcomes these limitations by using the glassy matrix not only to generate the NO, but also to plug the pores of the hydrogel. The hydrogel component provides structure and stability, slowing the breakdown of the glass in solution⁵⁸

The nanoparticle skeleton is formed using alkoxysilanes, which have two key benefits. First, they are already widely used in the production of self-forming nanoparticles. That is, products based on alkoxysilanes do not require any particle size reduction steps in order to create the nanoparticle: they are created during the manufacturing process itself. Second, the physical structure of these types of nanoparticles is that of a highly porous network or skeleton^59-63. The NO glassy matrix is a unique concept that capitalizes on well-known chemistries and comprises three main components. Sodium nitrite in the presence of glucose in a glassy matrix undergoes a redox reaction that generates NO gas^57,64,65.

In the current platform, the glassy properties are believed to be derived from the strong hydrogen bonding network forged from the interaction between chitosan, a cationic polysaccharide, and the anionic hydrogel side chains. It is this strong hydrogen bonding network that both allows for the glucose-mediated generation of NO, as well as the entrapment of the NO gas. Polyethylene glycol (PEG) polymers of different molecular weights are used to regulate the rate of NO release. As mentioned previously, upon exposure to an aqueous environment, the glassy matrix dissolves allowing release of the NO.

The composition of the nanoparticles allows both for retention of the NO within the dry particles, as well as for slow sustained release of therapeutic levels of NO over long time periods when exposed to moisture/water⁵⁸. Unlike many of the current NO releasing materials, NO release from nps requires neither chemical decomposition nor enzymatic catalysis. Instead, release of NO from the nps requires only exposure to water⁵⁶. The release profile for the NO is found to be easily tuned through straightforward manipulation of the relative concentrations of the components used in preparing the hydrogel/glass composites that is basis for the np platform⁵⁸.

 

The Application of Nitric Oxide as a Drug Delivery Vehicle

The potential for broad applicability for this NO releasing nanoparticulate platform is emerging though a series of translational projects^a. First and foremost, cutaneous penetration and safety of the hybrid nanoparticles in vivo has thus far been demonstrated. Penetration of fluorescent nanoparticles was visualized both using total body infrared imaging up to twenty four hours following initial application and by histologic sectioning of involved skin in animal models as well nails from human subjects . Repeated applications of the nanoparticles to murine skin demonstrated no pathologic changes to the involved skin, such as thickeneing of the epidermis or increased inflammatory infiltrate. Though these initial studies are promising, continued investigations are underway to fully appreciate any issues with safety.

Because the role of NO in wound healing and antimicrobial activity is well established^42,54,66-70, it is a major focus of this work. Treatment with NO-nps results in accelerated wound closure both in fibroblast migration assays and in vivo splinted murine wound model^71-73. Antimicrobial in vitro efficacy against Methicillin Resistant S aureus (MRSA)⁷⁴, Mycobacterium tuberculosis, Acenitobacter baumannii⁷⁵ has been established .

Topical application of NO nanoparticles to in vivo MRSA and A. baumannii infected excision models results in acceleration of wound healing and clearance of bacterial burden as compared to controls clinically and histologically^74,75. To extend these results further, topical application of NO nps in an induced in vivo MRSA abscess model, demonstrating a dose dependent impact on lesion resolution based on wound size, histology, and cytokine profiling from abscess sites⁷⁶. Therapeutic comparative studies are underway, and preliminary studies have demonstrated that topical and intralesional treatment with NO nps in the MRSA abscess model was significantly more effective than topical Retapamulin and intravenous Vancomycin following four days of treatment based on clinical assessment and wound cultures.

The important role of NO in maintaining vascular health lead to our testing the efficacy of NO nps in addressing conditions associated with endothelial dysfunctions. NO nps increased erectile function when applied topically to the penis of rats that were developed as a model of erectile dysfunction⁷⁷. In a dose-dependent manner, intravenously (IV) administered, circulating NO nps increased exhaled NO concentrations, decreased mean arterial blood pressure (MAP) and increased microvascular flow over several hours, without inducing an inflammatory response as compared to control nanoparticles⁷⁸.

When compared to two well known NO donors, DETA NONOate and DPTA NONOate, similar decreases in MAP were witnessed. However, the impact on vascular tone following NONOate use was highly inefficient as compared to NO nps, requiring 30 times more NO release to induce a similar physiological response. This pitfall manifested as a significant effect on methemoglobin formation by NONOate administration with subsequent decrease in hemoglobin oxygen carrying capacity.

Translating these findings, the potential role of the NO-nps in vascular disorders of hemodynamic distress has been investigated. Intravenously administered NO nps are observed both to counteract systemic hypertension following infusion of an NO scavenging hemoglobin based oxygen carrier, improving systemic and microvascular function. Furthermore, IV NO-nps were able to correct the negative, potentially life threatening hemodynamic changes during hemorrhagic shock - the continuous NO released by the NO-nps reverted arteriolar vasoconstriction, recovered functional capillary density and microvascular blood flows, and prevented cardiac decompensation. These data suggests that the NO nps have a clear potential to replenish NO in situations were NO production is impaired, insufficient or consumed (e.g. endothelial dysfunction, metabolic disorders and hemolytic diseases).

Together these data demonstrate the clear potential of the NO nps not only as a therapeutic agent for inflammatory, infectious, and vascular/cardiovascular, but also as a promising tool to promote our understanding of NO signaling mechanisms.

Albuterol Inhalation

 

Generic Name: albuterol inhalation
Brand Names: Accuneb, ProAir HFA, Proventil, Proventil HFA, ReliOn Ventolin HFA, Ventolin HFA

What is albuterol inhalation?

Albuterol is a bronchodilator that relaxes muscles in the airways and increases air flow to the lungs. Albuterol inhalation is used to treat or prevent bronchospasm in people with reversible obstructive airway disease. Albuterol is also used to prevent exercise-induced bronchospasm. Albuterol inhalation may also be used for purposes not listed in this medication guide.

 

Important information

It is important to keep albuterol on hand at all times. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing attacks. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor. An increased need for medication could be an early sign of a serious asthma attack.

How to prevent and treat an asthma attack.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of albuterol can be fatal. Extreme heat can cause the medicine canister to burst. Do not store your inhaler in your car on hot days. Do not throw an empty canister into open flame.

 

Before using albuterol inhalation

You should not use this medication if you are allergic to albuterol.

To make sure you can safely use albuterol, tell your doctor if you have any of these other conditions:

• heart disease, high blood pressure, or congestive heart failure;

• a heart rhythm disorder;

• a seizure disorder such as epilepsy;

• diabetes; or

• overactive thyroid.

FDA pregnancy category C. It is not known whether albuterol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether albuterol passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using albuterol. An inhaler should not be given to a child younger than 4 years old. Albuterol solution in a nebulizer should not be given to a child younger than 2 years of age.

See also: Pregnancy and breastfeeding warnings (in more detail)

 

How should I use albuterol inhalation?

Use albuterol inhalation exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Use only the prescribed dose of this medicine and follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits of using albuterol.

When using the albuterol inhaler device for the first time, prime it by spraying 4 test sprays into the air, away from your face. Shake well before priming. Also prime the inhaler if you have not used it for 2 weeks or longer, or if you have dropped the inhaler.

The instructions below are for standard use of the inhaler and nebulizer devices. Your doctor may want you to use your device differently. Use only the inhaler device provided with your medicine or you may not get the correct dose.

To use the albuterol inhaler:

• Shake the canister well just before each spray.

• Uncap the mouthpiece of the albuterol inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Breathe in slowly while pushing down on the canister. Hold your breath for 10 seconds, then breathe out slowly.

• If you use more than one inhalation at a time, wait at least 1 minute before using the second inhalation and shake the inhaler again.

• Keep your albuterol inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Shake out the excess water and allow the parts to air dry completely before putting the inhaler back together.

To use the albuterol solution with a nebulizer:

• Measure the correct amount of albuterol using the dropper provided, or use the proper number of ampules. Place the liquid into the medication chamber of the nebulizer.

• Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor.

• Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Turn on the compressor.

• Breathe in slowly and evenly until you have inhaled all of the medicine (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

• Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing attacks. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

An increased need albuterol could be an early sign of a serious asthma attack.

It is important to keep albuterol inhalation on hand at all times. Get your prescription refilled before you run out of medicine completely. Keep using all of your other medications as prescribed by your doctor.

Store albuterol inhalation at room temperature away from moisture and heat. Extreme heat can cause the medicine canister to burst. Do not store it in your car on hot days. Do not throw an empty canister into open flame.

 

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

 

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of albuterol can be fatal.

Overdose symptoms may include nervousness, headache, tremor, dry mouth, chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, dizziness, seizure (convulsions), feeling light-headed or fainting.

 

What should I avoid?

Avoid getting this medication in your eyes. If this does happen, rinse the eyes with water and seek medical attention.

 

Albuterol inhalation side effects

Get emergency medical help if you have any of these signs of an allergic reaction to albuterol: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

• chest pain and fast, pounding, or uneven heart beats;

• tremor, nervousness;

• low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

• dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious albuterol side effects may include:

• headache, dizziness;

• sleep problems (insomnia);

• cough, hoarseness, sore throat, runny or stuffy nose;

• mild nausea, vomiting;

• dry mouth and throat;

• muscle pain; or

• diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

 

Albuterol inhalation Dosing Information

Usual Adult Albuterol Dose for Asthma -- Acute:

Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
Nebulizer: 2.5 mg every 6 to 8 hours as needed. (2.5 to 5 mg once followed by 2.5 mg every 20 minutes for acute bronchospasm).

Usual Adult Albuterol Dose for Chronic Obstructive Pulmonary Disease -- Acute:

Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
Nebulizer: 2.5 mg every 6 to 8 hours as needed. (2.5 to 5 mg once followed by 2.5 mg every 20 minutes for acute bronchospasm).

Usual Adult Albuterol Dose for Bronchospasm Prophylaxis:

Metered-dose inhaler: 2 puffs (180 or 216 mcg) 15 minutes before exercise.
Inhalation capsules: 200 mcg inhaled 15 minutes before exercise.

Usual Adult Albuterol Dose for Asthma -- Maintenance:

Metered-dose inhaler: 2 puffs every 4 to 6 hours. More frequent administration or a large number of inhalations is not recommended.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
Tablets: 2 to 4 mg orally 3 to 4 times a day. May increase stepwise to a maximum of 8 mg orally 4 times a day.
Extended-release tablets: 4 to 8 mg orally every 8 hours. May increase to a maximum of 16 mg orally twice a day.
Syrup: 2 to 4 mg orally 3 to 4 times a day. Doses > 4 mg should be given 4 times a day. May increase up to 8 mg orally 4 times a day.

Usual Adult Albuterol Dose for Chronic Obstructive Pulmonary Disease -- Maintenance:

Metered-dose inhaler: 2 puffs every 4 to 6 hours. More frequent administration or a large number of inhalations is not recommended.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
Tablets: 2 to 4 mg orally 3 to 4 times a day. May increase stepwise to a maximum of 8 mg orally 4 times a day.
Extended-release tablets: 4 to 8 mg orally every 8 hours. May increase to a maximum of 16 mg orally twice a day.
Syrup: 2 to 4 mg orally 3 to 4 times a day. Doses > 4 mg should be given 4 times a day. May increase up to 8 mg orally 4 times a day.

Usual Pediatric Albuterol Dose for Asthma -- Acute:

Less than 1 year:
Nebulizer: 0.05 to 0.15 mg/kg/dose every 4 to 6 hours with subsequent doses titrated based on clinical response.
1 year to 4 years:
Nebulizer: 1.25 to 2.5 mg every 4 to 6 hours with subsequent doses titrated based on clinical response.
5 years or older:
Metered-dose inhaler (HFA): 2 puffs (216 mcg) every 4 to 6 hours as needed.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
5 years to 11 years:
Nebulizer: 2.5 mg every 4 to 6 hours with subsequent doses titrated based on clinical response.
12 years or older:
Nebulizer: 2.5 to 5 mg every 6 hours as needed.
Metered dose inhaler (non-HFA): 2 puffs every (180 mcg) every 4 to 6 hours.

Usual Pediatric Albuterol Dose for Bronchospasm Prophylaxis:

Over 4 years:
Metered-dose inhaler (HFA): 2 puffs (216 mcg)15 minutes before exercise.
Inhalation capsules: 200 mcg inhaled 15 minutes before exercise.
12 years or older:
Metered-dose inhaler (non-HFA): 2 puffs (180 mcg) 15 minutes before exercise.

Usual Pediatric Dose for Asthma -- Maintenance:

2 years to 5 years:
Syrup or tablets: 0.1 to 0.2 mg/kg 3 times daily. Do not exceed 12 mg a day.
Over 4 years:
Metered-dose inhaler (HFA): 2 puffs (216 mcg) every 4 to 6 hours. More frequent administration or a large number of inhalations is not recommended.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
6 years to 11 years:
Syrup or tablets: 2 to 6 mg orally 3 to 4 times a day. May increase stepwise to a maximum of 24 mg/day in divided doses.
Extended-release tablets: 4 to 12 mg orally every 12 hours. May increase to a maximum of 12 mg orally twice a day.
12 years or older:
Syrup or tablets: 2 to 8 mg orally 3 to 4 times a day. Doses > 4 mg should be given 4 times a day. May increase up to 8 mg orally 4 times a day.
Extended-release tablets: 4 to 8 mg orally every 8 hours. May increase to a maximum of 16 mg orally twice a day.
Metered-dose inhaler (non-HFA): 2 puffs (180 mcg) every 4 to 6 hours. More frequent administration or a large number of inhalations is not recommended.

What other drugs will affect albuterol inhalation?

Tell your doctor about all other medicines you use, especially:

• a diuretic (water pill);

• digoxin (digitalis, Lanoxin);

• a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), propranolol (Inderal, InnoPran), sotalol (Betapace), and others;

• an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan, Silenor), nortriptyline (Pamelor), and others;

• an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or

• other bronchodilators such as levalbuterol (Xopenex), pirbuterol (Maxair), terbutaline (Brethine, Bricanyl), salmeterol (Advair, Serevent), metaproterenol (Alupent, Metaprel), or isoproterenol (Isuprel Mistometer).

This list is not complete and other drugs may interact with albuterol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Allergy Medications: Which Drugs Treat Which Symptoms

 

 

Credit: yellowj | Shutterstock

 

When spring is in the air, as the millions of people who suffer from seasonal allergies know, so are pollen, mold and other microscopic annoyances.

Seasonal allergies are caused by an errant immune reaction. Mistaking common environmental elements for a health threat, the body sends out antibodies via white blood cells, which release protein substances to neutralize the “invaders.” These proteins — the best known is called histamine — usually settle in vulnerable and important areas such as the respiratory tract, stimulating the swelling, itching and mucous production we associate with common allergies.   

Luckily for sufferers, a number of both over-the-counter and prescription remedies are readily available. They come in a variety of formats and work in different ways, however. Let’s have a look.

 

Over-the-counter medications

Pills

Most allergy sufferers first reach for basic, over-the-counter antihistamine pills, which work by blocking the excitable chemical histamine from going to town on your sinuses. Oral antihistamines contain the active drugs loratadine or cetirizine, marketed at the drugstore as Claritin and Zyrtec, respectively. When ingested, the chemicals in the pill bind to the natural histamines in the body and block them from agitating your system, providing relief from the all-over itching and congestion.

But beware! Some oral antihistamines, such as Benadryl, contain ingredients that cause drowsiness. Other over-the-counter pills commonly used to combat allergies are decongestants, which contain the ingredient pseudoephedrine (Sudafed is one brand name). Pseudoephedrine provides quick relief for sinus congestion but is known for its side effects, including dizziness, anxiety and irregular heartbeat.

Nasal sprays

Nasal remedies attack allergies head-on. Most over-the-counter nasal sprays are decongestant in medical make-up and are very effective in relieving sinus pressure specifically because they send their active ingredients straight to the source, quickly constricting irritated blood vessels in the nose. Examples of over-the-counter nasal decongestants are Neo-Synephrine (containing phenylephrine) and Afrin (oxymetazoline).

Eye drops

Itchy, watery eyes are a hallmark of allergy season, and that can make it difficult to focus at work and in your personal life. Decongestant eye drops soothe sufferers with active ingredients tetrahydrozoline and naphazoline, which shrink inflamed blood vessels in the eyes. Overuse of these drugs — sold under the brand names Visine, Clear Eyes, and others — may have the opposite effect, however, so they’re meant as short-term solutions. Some antihistamine eye drops (Alaway, Zaditor) are also available over the counter. Employing the drug ketotifen, these tend to treat allergy symptoms in the eyes in a more sweeping way, but need to be applied more frequently.

 

Prescription medications

Pills

Allergy sufferers in need of serious relief may turn to their doctor for prescription medications. Prescription allergy pills can cause stronger side effects than their over-the-counter counterparts and so are usually taken for short stretches of time. Examples of prescription allergy medication include Clarinex, an oral antihistamine containing desloratadine, and Singulair, a montelukast drug targeted especially to asthmatics with allergies. These pills function in the same way as over-the-counter medications in relieving the painful sinus congestion, itching and sneezing associated with seasonal allergies.

Nasal spray

Prescription nasal sprays are usually offered to patients with chronic allergic rhinitis or — in layman’s terms — a clogged-up nose that just won’t stop running. Chronic rhinitis is a staple of seasonal allergies, but can affect some people worse than others. Many prescription nasal sprays deploy a combination of antihistamine and decongestant properties, and occasionally a stronger corticosteroid element, to attack the swelling, itching, running and postnasal drip in one shot. Astelin (azelastine), Flonase (fluticasone) and Nasonex (mometasone) are all well-known brands.

Eye drops

Allergic conjunctivitis is a severe reaction to airborne allergens and causes extreme redness, itchiness and inflammation of the eye. To treat it, sufferers often turn to prescription antihistamine eye drops, which are usually combined with decongestants for maximum effect. Active ingredients found in these drops include emedastine (sold as Emadine) and olopatadine (Patanol).

 

Allergy shots and immunotherapies

Allergy shots are sometimes prescribed to allergy sufferers who have adverse reactions to medications that are ingested, as well as for people who want to be more aggressive with their treatment plans. With this option, doctors inject small amounts of actual extract from the allergen in the hopes of making the patient more tolerant to the allergen over time. The process may take years, but can be especially effective for those allergic to dust or cat dander, and for preventing the development of asthma in children.

 

Natural allergy remedies

Many people who take allergy medications complain that the side effects make them feel drowsy, buzzy or anxious. Short of moving to a barren desert, sufferers looking for relief from environmental allergens without the help of drugs have a few options.

Both drinking a cup of hot tea and breathing steam may loosen congested mucous membranes. Homeopaths suggest a cocktail of supplements, acupuncture and plenty of rest and fluids. Some studies have also touted the benefits of butterbur, an herb with natural anti-inflammatory properties; other dataindicate that it is no better than placebo.

Note: This article is for general health information only. This information is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. Readers should not rely on information for their own health problems. Any questions regarding your own health should be addressed to your own physician or other healthcare provider.