No abstract

We examine the respiratory, bronchomotor, cardiac, and vascular responses to histamine and ragweed allergen delivered to the bronchi or alveoli compartments and the potential role of sensory nerves and reflexes mediating the histamine-induced responses. The masses of aerosols deposited in the bronchi and alveoli were quantitated using radioaerosol techniques. Activation of sensory nerves and/or histamine-induced mediator release were characterized by depositing nedocromil sodium aerosol prior to histamine challenge. The histamine-induced responses due to vagosympathetic transmission were determined by performing bilateral vagotomy. Both histamine and ragweed increased respiratory rate, ventilation, and bronchomotor tone whether deposited in the bronchial or alveolar regions. However, these responses were not elicited when histamine was administered intravenously. Precipitous allergen-induced decreases in heart rate and systolic and diastolic pressure were maximal 72 sec following ragweed deposition in alveolar regions of the lungs. Increases in respiratory rate were mediated via the vagus whether delivered to the bronchi, alveoli, or vasculature. Histamine-induced increases in respiratory rate and bronchomotor tone were attenuated by nedocromil. When histamine was delivered to the alveolar regions, increases in lung resistance appeared to be mediated primarily via the vagus and when delivered to the bronchial airways primarily by its action on smooth muscle or local reflexes. Histamine-induced hypotension and bradycardia appear to be mediated by the direct action of histamine on the cardiovascular system rather than through a vagally mediated reflex.

Objective. Diagnosis of systemic lupus erythematosus (SLE) made by standard diagnostic laboratory tests (SDLTs) has sensitivity and specificity of 83% and 76%, respectively. A multivariate assay panel (MAP) combining complement C4d activation products on erythrocytes and B cells with SDLTs yields a sensitivity and specificity of 80% and 86%, respectively, presumably enabling earlier SLE diagnosis at lower severity, with associated lower health care costs compared with SDLT diagnoses. We compared the payer budget impact of diagnosing SLE using MAP (incremental cost of $108) versus SDLTs. Methods. We modeled a health plan of 1 million enrollees. SLE diagnosis among suspected patients was 9.2%. The MAP arm assumed 80%/20% of patients were tested with MAP/SDLTs, versus 100% tested with SDLTs in the SDLT arm. Prediagnosis direct costs were estimated from claims data, and postdiagnosis costs were obtained from the literature. Based on improved MAP performance, the assumed hazard ratio for diagnosis rate compared with SDLTs was 1.74 (71%, 87%, 90%, and 91% of patients who develop SLE are diagnosed in years 1 to 4 compared with 53%, 75%, 84%, and 88% of patients diagnosed with SDLTs). Results. Total 4-year pre-and postdiagnosis direct costs for patients with suspected SLE tested with MAP were $59 183 666 compared with $61 174 818 tested by SDLTs, with lower costs in the MAP arm due primarily to prediagnosis savings related to reduced hospital admissions. Conclusion. Incorporating MAP into SLE diagnosis results in estimated 4-year direct cost savings of $1 991 152 ($0.04 per member per month). By facilitating earlier diagnosis of SLE, MAP may enhance patient outcomes. This study was supported by Exagen Inc. The funding agreement ensured the authors' independence in designing and performing the claims analysis, designing and analyzing the budget impact model, interpreting results, and writing the report.

<p class="abstract"><strong>Background:</strong> The aim of the study was to study the etiopathogenesis, age and sex distribution and management, chemical cautery, anterior and posterior nasal packing, nasal septal surgery, blood transfusion and arterial ligation.</p><p class="abstract"><strong>Methods:</strong> It is simple random sampling study undertaken to know the etiopathogenesis and management of epistaxis at government general hospital for 2 years.  </p><p class="abstract"><strong>Results:</strong> The incidence of epistaxis was 1.5%. It was more in males with a male to female ratio of 1:9:1. The age incidence was more in the first and second decades and then increased from the fourth onwards with almost 60% cases belonging to this category. The seasonal incidence was more during cold, dry, winter months (70%). The commonest etiological factor was trauma (42%), followed by the hypertension (24%). 72% of patients had anterior nasal bleeding. The treatment options were divided onto non- surgical and surgical modalities. 86% of the patients were managed by conservative measures like medical treatment (42%) cautery (6%), anterior nasal packing (30%) and posterior nasal packing (4%). 14% of the patients required surgical intervention like septoplasty (2%), excision of bleeding nasal polypus (2%), nasal bone fracture reduction (2%), excision of adenoid cystic carcinoma of nose (2%), removal of rhinolith (92%), excision of angiofibroma of nose (4%).</p><p><strong>Conclusions:</strong> Anterior bleeding is more common and trauma is an important etiological factor. Majority cases of epistaxis are managable by conservative measures and only few require surgical intervention. </p>