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Vaccinations against other bacteria or viruses prevents the death of millions of people yearly order 20 mg omeprazole fast delivery symptoms of gastritis flare up. This is why the development of new vac- cines is a permanent aim of medical research generic omeprazole 40mg otc hemorrhagic gastritis definition. This interest grew because scientists have understood that vaccines can be used not only for prevention of infectious diseases but also for therapy buy discount omeprazole 20mg line gastritis hiv symptom, leading to the concept of therapeutic vaccines. Classical vaccines pioneered by the discoveries of Jenner, Pasteur, and Ramon was based on the principle of inactivation of pathogenicity of a microbe without altering its capacity to induce a protective immune response. Developments during the past decades in biochemistry, molecular biology, and immunology have provided new tools for the development of a new generation of vac- cines. Biochemistry and Immunochemistry contributed to the identification of epitopes endowed with protective capacities. The identification of such antigenic determinants, also called epitopes, on antigens of protein origin allowed for preparation of synthetic peptides or subunit vaccines in the case of antigens of nonprotein origin. Immunology provided the framework for understanding the mechanisms responsible for the activation of lymphocytes fol- lowing vaccination as well as functional analysis of various epitopes that induce a pro- tective immune response. This is particularly important as antibodies mediate the protection against some bacteria; cellular immune responses are prevalent against obligatory intracellular microbes. The differences between B- and T-cells are not only func- tional but are also seen in the mechanism of recognition of antigens. The B-cells, via the Ig receptor, recognize both conformational and linear epitopes directly on the surface of native macromolecules. In certain cases the recognition of epitopes leads to activation and differentiation of B-cells directly, i. Whereas Th1 cells polarize the response to IgG2, the collaboration with Th2 leads to IgG1 and IgE (1). Antibodies exert their protective capacity by blocking the microbial receptor through which they bind to the cellular receptor of permissive cells, promoting phagocytosis via opsonins and complement- dependent lysis. In contrast to B-cells, T-cells are unable to recognize the antigens on the surface of native macromolecules. The peptides are derived from endogenous proteins, including proteins of intracellular microbes. Table 1 depicts the major functions of cells involved in host response to vaccines. It should exhibit a constant antigen specificity without being the subject of genetic variation 4. The preparation of inactivated vaccines is based on a golden rule emerging from Pasteur and Ramons studies leading to prepa- ration of anti-rabies and toxoid vaccines, respectively: a vaccine should be devoid of pathogenicity but should preserve intact its immunogenicity. The killing of bacteria can be achieved by physical means (heat) or by chemical agents. For example, currently used influenza and Salk polio vaccines are produced by inactivation with formalin. Similarly, the conversion of toxins to toxoids was obtained by treatment with formalin. Functional antibodies are pro- duced subsequent to recognition by the Ig receptor of B-cells of a protective epitope on the bacterial membrane or secreted toxins. Can be administered as combined vaccines such as trivalent or quatrivalent vaccines, e. Com- bined vaccines induce similar responses, as do monovalent vaccines, indicating that is no antigen competition. Poor antibody response is seen owing to weak generation of memory B-cells; several boosts are often required. The antibody-mediated response against the protective epitope can be diluted by production of antibodies against the multitude of bacterial macromolecules bearing nonprotective epitopes. There is an inability to stimulate the cell-mediated immune responses that contribute to recovery from disease or alter the course of disease in the case of therapeutic vaccines. These vaccines can eas- ily be developed when the disease is caused by a single or a few serotypes of infectious agents (e. They cannot be generated when multiple serotypes are involved in path- ogenicity, as in the case of the nosocomial infection caused by Klebsiella pneumoniae. Subunit vaccines are produced by purification from bacteria of antigens bearing pro- tective epitopes or by molecular methods of expression and purification of recombi- nant proteins. With the exception of the hepatitis B subunit vaccine (which is of a protein nature), these are bacterial polysaccharides Immunity Polysaccharide vaccines are generally poor immunogens and induce T-independent responses dominated by IgM. Mutation of this gene, as in Wiscott-Aldrich syndrome, makes such patients unrespon- sive to subunit polysaccharide vaccines. Disadvantages Antibody response is generally weak, requires several boosts, and is dominated by low-affinity IgM antibodies. Generally, the vaccines are inefficient in newborns and infants because of the ontogenic delay of expression of a B-cell subset responding to polysaccharide antigens. Induction of high-affinity IgG antibodies can be obtained by coupling the polysaccharide to a protein bearing strong T-cell epitopes. Live Attenuated Vaccines The possibility of preparation of live attenuated vaccines is based on Enders (5) dis- covery of a method of culturing viruses in vitro in permissive cells. Live attenuated vaccines are produced by culturing the microbe in special conditions, leading to loss of pathogenicity without altering immunogenicity. The infected cells can produce peptides subsequent to fragmentation of endogenous viral or microbial proteins. Live attenuated vaccines elicit a long-lasting immunity comparable to that induced during natural infection. Disadvantages The preparation of live attenuated vaccines requires a tedious procedure to select the microbes that are devoid of pathogenicity, and manufacturing is costly. Internal Image Idiotype Vaccines Idiotypes are phenotypic markers of antigen receptors of lymphocytes. Idiotype are immunogenic and able to induce antiidiotypic antibodies (Ab2s), which in turn express their own idiotypes. As a statistical necessity, Jerne (6) introduced the concept that the idiotypes of antiidiotype antibodies could mimic the antigen recognized by antibody-Ab1.

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These include Americans defined as having high blood pressure (tra- sedentary lifestyle purchase omeprazole 20mg amex gastritis diet herbs, obesity buy omeprazole 40mg line gastritis nutrition diet, and diets high in total and ditionally defined as a reading of 140/90 mm Hg as saturated fats omeprazole 20 mg for sale gastritis nursing diagnosis. Initial medical studies of antihypertensive treat- as less than 40 mg/dl for men but a level less than ments clearly demonstrated a benefit of treatment in 50 mg/dl is considered a marginal risk factor for women men as well as elderly women with insignificant effect and frequently is a marker of the metabolic syndrome. This was Dietary modification by reducing fat intake and likely because most trials did not include sufficient increasing fiber content is often the first step in therapy numbers of women to come to a reliable conclusion. In for those with elevated cholesterol levels and should fact, 3 of the 10 major older clinical trials (a type of be used in conjunction with drug therapy when this medical study) excluded women. Highly effective and potent medications, recent studies that clear benefit for women was demon- namely, the statin class of drugs, are now available strated. Western societies contains between 50 and 100 g of fat Most recently, the Heart Protection Study enrolled and 0. Patients treated with sim- lipoproteins lead to elevated levels of cholesterol and vastatin had a 27% reduction in major coronary events. While some individuals have This benefit was similar in both sexes and was, inter- genetic abnormalities that lead to impaired metabolism estingly, irrespective of initial cholesterol level. As is the case in patients with male patients can significantly reduce cardiovascular diabetes, management of those with the metabolic syn- complications. This is largely due to the increasing prevalence Cigarette smoking is the most important pre- of obesity as well as the aging of the population. It remains the major pre- morbidity and mortality of diabetes is mostly due to ventable cause of early death, disability, and health atherosclerosis. Estimates suggest that 11% appears that diabetes confers a higher degree of risk on of deaths in women are attributable to smoking and females than males. The number of ciga- betes have an absolute risk for coronary events similar rettes smoked per day is directly related to cardiovas- to diabetic men. Smoking as few as 14 or 514 cigarettes The metabolic changes in diabetes are complex a day increases the risk of coronary events two- to and a major reason for the increased risk is the alter- threefold. In addition, smoking is a major contribu- diabetes have a more abnormal lipid profile, which may tor to the incidence of stroke and peripheral vascular explain their particular susceptibility to atherosclerosis. Along with aggressive con- The need and benefits of smoking cessation cannot trol of the blood glucose level, other risk factors such be overemphasized. Stopping cigarette smoking is a dif- as hypertension and lipid abnormalities should be opti- ficult task and often requires a multifaceted approach mized. The target blood pressure in a patient with dia- including patient education, pharmacologic agents as betes is no more than 130/80 mm Hg as measured with well as a close partnership between the patient and the a blood pressure cuff. This is particularly important since A syndrome in which multiple cardiac risk factors data suggest that smoking cessation techniques are less are present, so-called syndrome X or insulin resis- effective in women and that women have higher tance syndrome, is marked by truncal obesity (waist of relapse rates. The National that this protein serves simply as a marker of the pres- Institutes of Health Consensus Panel on Physical ence and extent of atherosclerosis instead of playing Activity and Cardiovascular Health recommends that a a causative role. Some of the same medications used person accumulate at least 30 minutes of moderate in the treatment of elevated cholesterol levels also intensity physical activity on a daily basis. Smoking, hypertension, between elevated levels of homocysteine in the blood and diabetes were associated with a 2. This could be one of the major reasons why Hypertension, Nutrition, Smoking people seek plastic surgery. Both men and women feel the pressure to look their best, and more men are seek- Suggested Reading ing plastic surgery because of this very fact. How we feel about our- Expert Panel on Detection, Evaluation, and Treatment of High Blood selves affects how we relate to others. Journal of the American Medical many people who might be considered homely are per- Association, 285, 24862497. Mayo Clinic Proceedings, with ones self-image and allow healthy self-confidence 73, 157165. Risk factors that attenuate a psychological evaluation may be suggested prior to the female coronary disease advantage. The choice of surgeon can be the most important prevention of coronary heart disease in women. If the plastic surgeon is board eligi- Risks and benefits of estrogen plus progestin in healthy post- ble, it means that he/she has completed education, but menopausal women. In addition, a lot of the plastic surgeons have their own webpage, which can educate you about that particular person. Cosmetic Surgery Cosmetic surgery (also called Asking other patients about your surgeon can provide plastic surgery) is used both to correct true deformities very valuable information. In our culture, not cover cosmetic surgery, so checking with your there is a tremendous emphasis placed on our personal insurer is very important as well. No one ever sees a should carefully consider the risks and benefits before 200 Couples Therapy undergoing any procedure. Undergoing cosmetic assess how strong the boundaries are around the couple surgery involves a large commitment on the part of and around each individual. Suggested Resources Intergenerational Therapy as developed by Murray Website: www. Goals of therapy are to help the couple through insight, understand their family of origin issues so they are less Couples Therapy All individuals have a basic likely to repeat them. At the same time, we also have a basic need such theorists as Albert Ellis and Neil Jacobson focuses to be separate and develop our individual potential. The cognitive therapist helps Balancing these conflicting needs is the central issue of the couple pinpoint how they act toward each other to intimate relationships and helping couples establish or try to control each other in order to get their needs met. This is addressed by understanding how the destructive behavior and the beliefs that support that couple manages, respects, and accepts differences. Accepting differences supports individual development Solution-Focused Therapy as developed by Steve and frees partners to be truly intimate by reducing the DeShazer and his colleagues proposes that a couple inevitable power struggles which emerge when chang- does not need to understand a problem to develop a ing a partner takes precedence over acceptance. The focus of the work is identifying Couples therapy can address the needs of married strengths and resources to be adapted to create a solu- couples, same-sex couples, premarital couples, or cou- tion. Goal setting is central to the approach and is ples in a committed relationship who have chosen not accomplished by identifying specific behaviors and to marry. It is indicated when one or both partners feel interactions that the couple would like to increase. Couples ples previous attempts at developing solutions and therapy is not indicated if domestic violence is an issue. Often couples come for counseling at tran- arating from parents, and increasing the opportunity for sition points in their lives such as the birth of child, job developing autonomy.

P. Gorok. Northern Illinois University.