ABSTRACT
BACKGROUND: Asthma is a chronic condition that results in the inflammation and narrowing of airways, often clinically presenting as wheeze and shortness of breath. Little is known of the mechanisms of action (MOA) of herbs used to treat asthma. The aim of this study is to review existing data regarding known MOA of traditional Chinese medicine which will aid in the understanding of possible interactions between Western drugs and Chinese herbs as well as the standardization of management via a proposed guideline to improve patient safety and possible synergism in the long term. METHODS: We searched through 5 databases for commonly prescribed herbs and formulas for asthma and narrowed down the search to identify the underlying MOA of individual herbs that could specifically target asthma symptoms. We included studies that stated the MOA of individual herbs when used for treating symptoms of asthma, excluding them if they are described as part of a formula. RESULTS: A total of 26 herbs commonly prescribed for asthma with known mechanism of action were identified. Herbs used for asthma were found to have similar MOA as that for drugs. Based on existing GINA guidelines, a guideline is proposed which includes a total of 5 steps depending on the severity of asthma and the herbs' MOA. 16 formulas were subsequently identified for the management of asthma, which consist of 12 "stand-alone" and 4 "add-on" formulas. "Stand-alone" formulas used independently for asthma generally follow the GINA guidelines but do not proceed beyond step 3. These formulas consist mainly of beta-agonist and steroid-like effects. "Add-on" formulas added as adjunct to "stand-alone" formulas, however, mainly act on T helper cells or have steroid-like effects. CONCLUSION: Through the understanding of MOA of herbs and their respective formulas, it will ensue greater patient safety and outcomes.
ABSTRACT
Oculogyric crisis (OGC), frequently caused by medications such as antiemetics, antidepressants, and anti-epileptics, is an acute dystonic reaction of the ocular muscles. It consists of wide-staring gaze (lasting variably from seconds to minutes), seizures, and a widely-opened mouth. To date, there have been no reports of anti-tuberculosis medications such as rifampicin, isoniazid, pyrazinamide or ethambutol inducing OGC. It is of utmost importance to recognize this adverse reaction, which could be incorrectly diagnosed as an anaphylactic-like reaction. In this paper, we highlight a case of a 66-year-old Indian man who presented with OGC induced by anti-tuberculosis medications which was initially suspected to be an anaphylactic reaction and was subsequently halted with the administration of diphenhydramine.
ABSTRACT
BACKGROUND: Normal blood pressure (BP) follows a circadian rhythm, with dipping of BP at night. However, knowledge is limited in how the nocturnal dipping in hypertensive patients changes with the seasons. The study aims to examine the pattern of seasonal changes of nocturnal dip in an Irish population and furthermore, to compare it to the pattern observed near the equator where such seasonal variations are minimal, by also studying a Singaporean population. METHODS: Ambulatory Blood Pressure Monitor recordings were obtained from 220 patients, half were from Mercy University Hospital, Cork, Ireland and half from the National Heart Centre, Singapore during the summer period from May to June and the winter period from October to December. RESULTS: Irish seasonal changes resulted in an increase in nocturnal dipping in the hypertensive patients, especially for diastolic pressure (95% CI, 0.72 to 6.03, 3.37mmHg; p<0.05) and a change in the duration of dipping at night (95% CI, 0.045 to 1.01, 0.53h; p < 0.05). In Singapore, slight differences in dipping in systolic pressure were apparent despite the presence of only minor alterations in temperature (95% CI, 0.38 to 4.83, 2.61mmHg; P<0.05) or duration of daylight. CONCLUSION: Seasonal changes not only affected the daily blood pressure but also the night time dipping status in hypertensive patients by mean value of 1.99mmHg and 3.38mmHg for systolic and diastolic pressure dip respectively. This has implications on how hypertensive patients should be treated during different seasons and when they are traveling to countries of different climatic environment.
