Homemade Skin Care Recipes
Teinase K augments the sensitivity of anti-vimentin antibodies. HIER also augments staining intensity (16). Strong cytoplasmic staining can be identified within mesenchymal cells in the normal skin. This quality can be used as an appropriate positive internal control. In normal conditions, keratinocytes do not express vimentin, allowing for a good internal negative control.
Entirely absorbed from the gut and paraquat a highly toxic herbicide figure 316 Sufficient paraquat is absorbed from
Of the transport systems for both of these compounds are currently unknown although carrier-mediated transport is perhaps the most likely (see Chapter 7). Carrier-mediated transport systems important for foreign, toxic compounds are known to operate in the gastrointestinal tract. For example cobalt is absorbed via the system that transports iron and lead by the calcium uptake system. Large molecules and particles such as carrageenen and polystyrene particles of 22 *m diameter may also be absorbed from the gut, presumably by phagocytosis. The bacterial product botulinum toxin, a large molecule (molecular weight 200 000-400 000) is sufficiently well absorbed after oral ingestion to be responsible for toxic and often fatal effects.
Surgical Excision with a 0.5 cm margin of surrounding normal skin for discrete nodular or cystic nodules in patients under 60 years Mohs' micrographic surgery, which includes careful review of tissue excised under frozen section, is the treatment of choice for large tumours (1 cm diameter) and lesions near the eyes, nose and ears. Excision and skin flap coverage may be necessary. Radiotherapy Useful in basal cell carcinomas involving structures that are difficult to surgically reconstruct (e.g. eyelids, tearducts). Repeated treatments may be necessary as there is risk of side-effects such as radiation dermatitis, ulceration, depilation.
In some circumstances bacteria spread between the fascial planes, along fibrous and fatty connective tissues, which separate muscle bundles. This results in necrotising fasciitis (Plate 1), where connective tissues become inflammed and rapidly necrotic. In several recent series necrotising fasciitis has accounted for approximately 6 of all invasive GAS cases (Davies etal. 1996 Ben-Abraham etal. 2002). Streptococcal necrotising fasciitis often arises because of bacteraemic seeding into fascia underlying otherwise quite normal-looking skin. In some cases there is history of prior blunt trauma to an infected region. In other cases there is an obvious portal of entry, such as recent surgery or varicella. It is useful to distinguish streptococcal necrotising fasciitis from synergistic or mixed-infection necrotising infections. Streptococcal necrotising fasciitis often occurs as a pure infection and may arise in previously healthy individuals, often affecting the limbs, resulting in extreme...
Other main clinical features include bullae and erosions on a background of normal skin with atrophic scars from healed previous lesions. Small milia may also be present. Patients may develop hypertrichosis and sclero-dermatous changes on the face. The diagnosis is made by history, clinical features and elevated urinary porphyrins and the treatment includes the discontinuation of exacerbating factors, phlebotomy or low-dose chloroquine, 125 mg twice a week.
Most post operative problems, assuming that laser treatment has been appropriately undertaken, result from poor skin care. Redness or erythema is to be expected and may take up to three months or more to settle. Hyper- or rarely hypo-pigmentation can occasionally occur. The former can be managed with topical skin bleaching agents or steroid preparations but there is relatively little that can be offered for hypo-pigmentation.
Hospital infection control measures may prevent a proportion of nosocomial infections. Handwashing plays a central role, reducing transmission of pathogens between individuals and from the hands of a given individual to vulnerable sites such as wounds and dialysis catheters. Perioperative antibiotic prophylaxis is also important in preventing surgical sepsis, together with good skin preparation before surgery and aseptic and surgical techniques. There is a wide range of other possible measures, implementation of which will be dictated by the global setting and healthcare infrastructure. Affluent nations can implement hospital infection control through an infection control team who devise policies, monitor hospital infections from a diagnostic microbiology laboratory or by active ward-based surveillance and implement outbreak procedures where necessary. An infection control manual containing policies detailing the approach to a wide range of issues from antibiotic use, to dealing with...
Which the lower branches of the nerve can grow to re-innervate orbicularis oculi resulting in ptosis with movement (or even resting tone) of the muscles of facial expression of the lower face.The ptosis which develops following a facial palsy when the patient moves the lower facial muscles, for example, blows out the cheeks or simulates chewing, the upper lid droops. Abolition of the ptosis requires division of the levator muscle and brow suspension or levator transposition. The aberrant activity in the facial nerves may be reduced with cautious botulinum toxin injections to the orbicularis muscle.
In addition, any physical treatment plan needs to be clearly demonstrated and time spent with the mother discussing her concerns. Nurse-led clinics have been shown to be very effective in terms of improving the mother's understanding of the child's condition and her use of prescribed treatment (Cork et al., 2003) and this in turn can lead to improved management of the condition and reduced severity of the condition. Several studies have indicated high levels of dissatisfaction about the conventional medical treatment offered to children with skin problems, and this leads to low levels of adherence to prescribed treatments and expensive use of alternative or complementary treatments (Ernst, 2000). Skin care routines are complex and can be time consuming, and it is essential to ensure that enough guidance is given at the time treatment is prescribed if it is to be used effectively. There is good evidence that caring for a child with a skin condition, such as eczema, places additional...
Picture that can include high fever, chills, myalgia and headache. Edematous inflammatory plaques clearly demarcated from normal skin are seen. Occasionally, vesicles, ulcers and hyperpigmenta-tion may also be noted (Dreyer and Piessesns, 1999). There is often a history of trauma, burns, radiation, insect bites, punctiform lesions or chemical injury. Entry lesions, especially in the interdigital area, are common (Dreyer and Piessesns, 2000).
Lation of mRNA and protein for most of the cofactors in prostate cancer is not well understood. SRC-1 is a mitogen-activated protein kinase (MAPK) phosphorylation substrate and has a role in ligand-independent activation of the AR by interleukin (IL)-6, a multifunctional cytokine involved in regulation of prostate cancer cell proliferation, apoptosis, and differentiation (102). Similar changes in the expression of another p160 coactivator, transcriptional intermediary factor 2 (TIF-2), were also observed in patients with recurrent prostate cancer (98). Posttranscriptional increase in TIF-2 expression was found in prostate cancer cells in response to epidermal growth factor (EGF) (103). Phospho-rylated TIF-2, thus, contributes to the potentiation of ligand-dependent AR activity by EGF. The levels of the p160 coactivator, ras-related C3 botulinum substrate 3 (RAC3), also correlate with prostate tumor grade and stage (104).
Nitrite has also been shown to exert significant anti-botulinal effects in cured meat 37-42 . Initially, this anti-botulinal activity was thought to be due to the interaction of nitrite as nitrous acid with thiol-containing constituents of the bacterial cell 43 . However, in clostridia, nitrite was found to directly interact with pyruvate-ferredoxin oxidoreductase, an iron-sulfur cluster that contains enzymes necessary for botulinal energy production in some clostridial vegetative cells. The interaction of nitrite with pyruvate-ferredoxin oxidoreductase was found to inhibit the phosphoroclastic system in Clostridium sporogenes and Clostridium botulinum 44,45 . In terms of an action mechanism for this effect, Reddy et al. (1983) reported that iron-sulfur proteins in vegetative cells of C. botulinum reacted with nitrite to form iron-NO complexes, resulting in destruction of the iron-sulfur clusters. Inactivation of iron-sulfur enzymes (e.g. ferredoxin) by NO binding was shown to inhibit...
It is logical to speculate that the high intrinsic HAT and HDAC activities detected in ODC-overexpressing skin might influence the overall level of acetylated histones in the tissue chromatin. Western analyses using antibodies specific for acetylated histones revealed some modest differences in the acetylation of histones isolated from K6 ODC transgenic skin as compared with normal littermate skin (34). Although noticeable differences in acetylation were not always detected, whenever observed, the differences were consistent between independent preparations of isolated histones. In those cases, fewer acetylated histones H3 and H4 were detected in K6 ODC epidermis, whereas acetylation of histones H3 and H4 was increased in K6 ODC dermis and total skin as compared with histones in normal skin. Moreover, changes in the extent of acetylation of Lys-12 in histone H4 paralleled those observed for hyperacetylated histone H4. These modest changes in overall acetylation suggest that elevated...
FIGURE 2.7 Effect of treating an adult rat deep (1 cm) incisional wound with TGF-P3, viewed 84 days post-wounding. (a) surface view (top) and histology (bottom) of placebo-treated wound. Scar tissue is the result (arrows). (b) Surface view (top) and histology (bottom) of TGF-P3 treated wound. No scar is visible in the surface view and dermal histological organization is similar to that of normal skin. Reproduced with permission from Ferguson and O'Kane, Scar-free healing from embryonic mechanisms to adult therapeutic intervention. Phil Trans R Soc Lond B 359 839-850. Copyright 2004, The Royal Society. FIGURE 2.7 Effect of treating an adult rat deep (1 cm) incisional wound with TGF-P3, viewed 84 days post-wounding. (a) surface view (top) and histology (bottom) of placebo-treated wound. Scar tissue is the result (arrows). (b) Surface view (top) and histology (bottom) of TGF-P3 treated wound. No scar is visible in the surface view and dermal histological organization is similar to that...
A wide variety of topical agents have been tested for their efficacy in accelerating repair of acute wounds in normal skin. The growth factors TGF-P, FGF-2, EGF, GH, and IGF-1 can accelerate the repair of acute wounds in experimental animals. FGF-2 and GH have this effect in human patients. Other agents reported to accelerate the repair of skin wounds are extract of the Celosia argentea leaf, vanadate, oxandrolone, the opoid fentanyl, ketanserin, oleic fatty acids, pig enamel matrix, and the peptide HB-107. These agents increase the rate and extent of re-epithelialization, angiogenesis, and cellularity of granulation tissue. Removal of eschar from burn wounds by debriding agents such as papain urea improves repair. Still other topical agents act to reduce scarring by decreasing levels of TGF-P, thus mimicking a fetal wound environment more closely. Chitosan, the COX-2 inhibitor celicoxib, HGF, and anti-TGF-P antibodies all reduce TGF-P in wounds promote healing with less scarring, as...
Thyroid cancer patients who had been treated with radiation were almost twice as likely to report an overall effect on their health as those who had not received radiation. Almost a quarter of the sample described symptoms that could be associated with thyroid dysregulation, for example dry skin hair loss poor concentration sleep disturbance fatigue weight change palpitations heat cold intolerance diarrhea constipation depression anxiety. Thyroid cancer survivors reported psychological problems, memory loss, and migraine headaches more frequently than survivors of other types of cancer. The authors conclude that the morbidity associated with a diagnosis of thyroid cancer is significantly more pronounced than generally understood 13 .
It is important for teachers and parents to help dispel some of the fears that other children or parents may have about the child's skin condition. Common mis-perceptions are that the condition may be contagious or may be very painful if the skin looks red or inflamed. Before the child starts at school it is important for the parent to meet with the child's teacher to explain the condition and to provide information about it, particularly if it is very rare or if the condition may be affected by factors within the school, such as temperature or sitting on a carpet. If appropriate, the teacher can spend some time with the whole class helping them to understand the condition and promoting friendships.
This type of response may be caused by several mechanisms. For instance, the muscle relaxation induced by succinylcholine, discussed in more detail in Chapter 7, is due to blockade of neuromuscular transmission. Alternatively, acetylcholine antagonists such as tubocurarine may compete for the receptor site at the skeletal muscle end plate, leading to paralysis of the skeletal muscle. Botulinum toxin binds to nerve terminals and prevents the release of acetylcholine the muscle behaves as if denervated and there is paralysis.
Than in normal skin, and the level of chondroitin-4-sulfate PG is much higher. The organization of the ECM is also different. The number of elastin fibers is reduced in scar tissue. Instead of the random basket-weave organization of normal dermis, type I collagen fibers in scar are broken down by MMPs and cross-linked by the enzyme lysyl oxidase into thick bundles oriented parallel to the surface of the wound. The MMPs appear to be produced by both the epidermis and fibroblasts of the granulation tissue. MMP synthesis by the fibroblasts appears to require an interaction with the epidermis, since synthesis is much reduced in vitro in the absence of epidermis (Grillo and Gross, 1967). Growth factors do not influence the cross-linking process itself, only the amounts of collagen available to be cross-linked (Mast, 1992). As the scar matures, the density of the vascular and neural networks in the granulation tissue returns to normal and there is a reduction in the number of fibroblasts by...
A wide variety of topical agents have been employed to accelerate the normal repair process and produce stronger scar tissue in acute wounds of normal skin. Application of healing accelerants as early as possible after wounding is desirable, because of the cascade effects that carry through to later stages of healing. TABLE 4.1 summarizes some of the many topical agents that have been used to accelerate the repair of wounded TABLE 4.1 Agents That Have Been Found, Singly or in Combination, to Accelerate the Repair of Normal Skin Wounds When Applied Topically normal skin. What is usually measured in animal experiments is how rapidly the diameter or area of a wound decreases with respect to controls. This measure is correlated to biochemical and structural parameters of repair such as collagen synthesis and accumulation and histological appearance of repair tissue.
In some couples, unaffected partners can deepen psychological distress in their loved one by passing insensitive comments about their appearance. Off-the-cuff remarks such as 'what happened to your face ' or those said in the heat-of-the-moment, such as 'your skin looks awful', can lead to relationship tension. Anxious-ambivalent individuals are particularly sensitive to criticism, thus a situation of high reactivity may evoke counter-attacking arguments in which partners begin to use each other's imperfections as weapons for war. Such conflict increases the likelihood of misunderstandings and, if it escalates, relationship distress will undermine the emotional security of both partners. Conversely, partners' who show unconditional acceptance, demonstrate respect, sensitivity, use humour and make their loved one feel valued and attractive, despite the skin condition, can have a powerful effect on adjustment. Richards et al. (2004) examined illness representations in patients with...
These toxins, as well as all bacterial protein toxins with intracellular targets, penetrate cells with a four-step mechanism (a) binding, (b) internalization, (c) membrane translocation, and (d) cytosolic target modification. The 50-kDa carboxyl-terminal part of the H chain appears to be responsible for the neurospecific binding at the presynaptic membrane of the neuromuscular junction.1 3 Neuronal receptors involved in such a specific and high-affinity binding have not been identified, but different receptors are involved in the binding of the different neurotoxins.5'6 After binding, the neurotoxins are internalized into endosome-like vesicular organelles, and at this stage they cannot be neutralized by antitoxin antibodies.6-7 For the toxins to reach their cytosolic targets, they must move across the intracellular vesicle membrane, and there is evidence that this step requires acidifica' L. L. Simpson (ed.), Botulinum Neurotoxins and Tetanus Toxin. Academic Press, New York, 1989.
M Medical Nifedipine or verapamil (calcium channel antagonists) or isosorbide mononitrate as needed (for short-term relief). Endoscopic balloon dilatation of lower oesophageal sphincter (80 success rate, but small risk of perforation). Endoscopic injection of botulinum toxin may be promising. Surgery Heller's cardiomyotomy of lower oesophageal sphincter via an abdominal or thoracic approach to relieve obstruction. This can cause future reflux oesophagitis, so it may be combined with a fundoplication procedure.
Actin is an intermediate filament that is expressed by myocytes. It is a cytoskeletal protein that works in conjunction with myosin to stimulate cellular contraction (17). Actin also plays a role in cellular motility and may facilitate tumor invasion (18). It is also expressed by myoepithelial cells (19). Focal actin expression has been demonstrated in apocrine decapitation formations and in the microvilli system in sweat glands (17). In normal skin, arrector pili muscles and the smooth muscle surrounding dermal blood vessels normally express smooth muscle actin (Fig. 2). Multiple antibodies to actin have been developed and are commercially available. The most commonly used varieties are anti-smooth muscle actin and muscle-specific actin.
Orbicularis which causes corneal irritation and secondary muscle spasm. Correction of any lid laxity and repair of the loss of contact between lid retractors, tarsal plate and skin is all that is usually required. If there is a primary spastic problem, then use of botulinum toxin is a possible temporary measure to be followed by limited excision of orbicularis oculi if a more permanent solution is required. Involutional entropion, often incorrectly termed spastic, is dependent on ageing change allowing tone to relax in the retractors and orbicularis muscles. Canthal ligaments stretch and the tarsal plates develop a less rigid structure with the deposit of more elastin. The sheer size of the tarsal plate is thought to determine whether the tarsus everts or inverts in such circumstances.
Some studies have obtained less positive results (reviewed by Greenalgh, 1996). FGF-2 was reported to have no effect on the rate of re-epithelialization, wound closure, or scarring at donor sites of partial-thickness skin grafts in burned children (Greenalgh and Rieman, 1994) and Cohen et al. (1995) found no effect of EGF on the rate of epithelial closure. On balance, the evidence would suggest that TGF-P, FGF-2, HGF, EGF, GH, and IGF-I are able to accelerate the repair of acute wounds in normal skin (Fu et al., 2005).
Armstrong MWJ, Mountain RE, Murray JAM. Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy. Clin Otolaryngol 1996 21 15-20. Kirkness CM, Adams GG, Dilly PN, Lee JP. Botulinum toxin A-induced protective ptosis in corneal disease Ophthalmology 1988 95 473-80. May M. Croxson GR, Klein SR. Bell's palsy management of sequelae using EMG, rehabilitation, botulinum toxin and surgery. Am J Otol 1989 10 220-9.
Sunscreen is not generally advised for children under 6 months of age, and the infant should be either shaded or have covering clothes to prevent sunburn. Older children should use sunscreen with a sun protection factor (SPF) of 15-30 this provides a 93-96 reduction in exposure to ultraviolet B light (Kim et al., 1997). Blistering sunburn during childhood is a major risk factor for malignant skin problems later in life.
Multiple attempts of surgical releases can create more scar tissue which develops and further compresses the nerve. The epineural surface of the nerve is surrounded by scar tissue and stressed by strenuous work or a new injury. The result is a chronic neuropathy, called a traction neuropathy and the optimal treatment may be a combination of procedures. Mobilization of the nerve followed by internal neuroly-sis cannot alleviate these problems, due to recurrent scar. Most authors agree that soft tissue coverage is necessary to prevent this phenomenon, and several options have been suggested for this purpose. For recurrent carpal tunnel syndrome the hypothenar fat pad flap can produce good results and is uncomplicated in most cases. Pedicle or free flaps, including the groin flap, lateral arm flap, posterior interosseous flap, provide excellent protection of the nerve, but the technique is complex and the results not always satisfying. Small local flaps such as the abductor digiti...
Lowest power setting to produce a visible whitening of the skin after laser impact, one had to depend on this visual signal which reflected not vascular obliteration alone but that plus coagulation of the dermis and perhaps even the epidermis with a change in light reflectance, so-called blanching. Thus, an inside-out second-degree burn injury was produced. The necrotic collagen as well as the obliterated vessel had to be replaced by new collagen, which might end up as transparent as normal collagen or which frequently, even without excess elevation, became dense enough so that the area became opacified and lighter than normal skin color.
On a practical level, dermatology deals with an organ that can be readily seen and touched. From intrusive questions to rude comments, relationship issues to depression, cutaneous conditions can have a devastating on the life of many sufferers. Chapter 8 will examine the use of counselling in addressing the issues faced by skin disease patients and will review the most frequently used psychological treatments. Their efficacy will be critically evaluated and recommendations for treatment will be made that take into account the potential challenges faced by people with skin problems. This chapter is contributed by Dr Linda Papadopoulos, a Reader in Psychology at London Metropolitan University and Co-editor of this book. Dr Papadopoulos uses her considerable research and clinical experience to highlight the potential benefits of psychotherapy to dermatology patients. Papadopoulos, L., & Walker, C.J. (2003). Understanding Skin Problems. John Wiley & Sons Ltd. Chichester.
'I remember a few months back, when I used to see his knuckles, how they were dry, cracked and bloody, and then I noticed his arm, and when I gently inquired he would retreat and change the subject. This was also before we became close. He has slowly grown more comfortable and one night, after cuddling and holding each other for a while, he asked me if I'd like to see and I said please. He took off his shirt and I saw the extent of his condition. His entire back, arms and parts of his legs were red, with patches of dry skin and blood. It struck my heart, and I suddenly felt very close to him. I wasn't shocked or afraid, and I think he sensed that because he seemed to relax a little. I reached up and touched his shoulders and lightly stroked his back. He later told me he was grateful for how accepting I was, and how he hadn't been touched in a long time. His condition does not bother me, in fact, I admire him. He has a tremendous amount of strength. We have since been intimate, and...
SkinCare Physicians of Chestnut Hill, Chestnut Hill and Clinical Professor ofDermatology, Harvard Medical School, Massachusetts, and Clinical Professor of Dermatology, Yale University School of Medicine, Connecticut, USA Jeffery S. Dover, M.D. F.R.C.P.C. SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetts and Associate Clinical Professor of Dermatology, Yale University School of Medicine, Connecticut, USA Vivek Iyengar, M.D. SkinCare Physicians of Chestnut Hill, Massachusetts, USA Arielle N. B. Kauvar, M.D. New York Laser & Skin Care, Department of Dermatology, New York University School of Medicine and Department of Dermatology, SUNY Downstate Medical Center, New York, New York, USA Richard J. Ort, M.D. SkinCare Physicians of Chestnut Hill and Department of Dermatology, Beth Israel Deaconess Medical Center, Massachusetts, USA Kucy Pon, M.D. SkinCare Physicians of Chestnut Hill, Massachusetts, USA Thomas Rohrer, M.D. SkinCare Physicians of...
The chronic urogenital manifestations of lymphatic filariasis include lymphedema and elephantiasis, lymph scrotum, hydrocele, chylocele and chyluria. The principles of treatment of scrotal and penile lymphedema are similar to those described above for lymphedema of the leg, although the prognosis is more guarded. Attention to hygiene and skin care are essential to prevent secondary bacterial infections. Additional treatment for fungi, especially candidiasis, is particularly important. The results of surgical intervention are less than ideal.
The in vivo role of Rho proteins in agonist regulation of PLD has been explored using the C3 exoen-zyme of Clostridium botulinum, which ADP-ribosy-lates and inactivates Rho proteins. The exoenzyme interacts preferentially with Rho rather than Rac and Cdc42Hs in vitro, and in vivo is selective for Rho also. Treatment of many cell types with C3 exoenzyme markedly inhibits agonist activation of PLD, although other cells may show little or no effect. These results indicate that Rho plays a major role in mediating agonist activation in PLD in some, but not all, cells. Dominant negative and dominant active forms of Rho proteins have also been utilized in a limited number of studies. These have shown that Rho and Rac play a role in the activation of PLD by growth factors and agonists linked to heterotrimeric G proteins (Gq and G13) in several cell lines. In summary, there is evidence that Rho proteins are important mediators of agonist activation of PLD in many, but not all, cells.
Medical Chemical sphincterotomy by the topical application of 0.2 glyceryl trinitrate ointment. This releases local nitric oxide that mediates smooth muscle relaxation, reducing spasm and allowing healing (major side-effect is headache). Other agents that have been shown to be effective are topical calcium channel blocker, diltiazem and injections of botulinum toxin. Pain relief is given in the form of local anaesthetic gel (1 lignocaine) applied before defecation. Laxatives may be necessary (stool softeners or bulk laxatives) to relieve straining. General advice on the avoidance of constipation should be given (e.g. a high-fibre diet, water intake and appropriate exercise).
Although children born preterm are vulnerable to all types of CP, the most common type is spastic diplegia (Hack et al., 2000 Hagberg et al., 1996 Wood et al., 2000). Spasticity is characterized by tight muscle tone, increased reflexes, and limited movement around one or more joints. Spasticity of both lower extremities but no or very little involvement of the arms constitutes spastic diplegia. Although most children with spastic diplegia require physical therapy and medical interventions (e.g., orthopedic surgery, orthoses, or Botulinum Toxicum injections), many children with spastic diplegia are quite functional by school age. In a study of children born at less than 26 weeks gestation, 43 percent with spastic diplegia were unable to walk and 43 percent had an abnormal gait at 6 years of age (Marlow et al., 2005).
Kangaroo care provides skin-to-skin care by placing the naked preterm infant in an upright position between the mother's breasts and allows unlimited breast-feeding. This concept of caring for preterm infants originated in Bogota, Columbia, as a low-cost way to assist preterm infants with temperature regulation, nutrition, and stimulation (Charpak et al., 1996). Kangaroo care is initiated after a routine period of stabilization after birth. A number of studies from developing countries, including a few randomized controlled trials, suggest that kangaroo care improves weight gain (an additional 3.6 grams per day), reduces the incidence of nosocomial (i.e., hospital-acquired), infections and reduces the incidences of severe illness and respiratory disease up to 6 months of age (Conde-Agudelo et al., 2003). Mothers who provided kangaroo care were more likely to continue to breast-feed and were more satisfied with the care that their infants received in the NICU.
Lack of oxygen in the tissues may be due to respiratory or circulatory failure or absence of oxygen. Thus, the first situation may arise if a toxic compound affects breathing rate via central control, such as the drug dextropropoxyphene when taken in overdoses, or by effecting respiratory muscles such as Botulinum toxin. The second situation arises when a toxic compound inhibits oxygen transport. The classic example of this is carbon monoxide which binds to haemoglobin in place of oxygen (see Chapter 7 for more details). Another example is the oxidation of haemoglobin by nitrite the methaemoglobin produced does not carry oxygen.
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