In addition to adverse events reported from clinical trials, the following adverse events have been identified during postapproval use of intranasal fluticasone propionate. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, or causal connection to fluticasone propionate or a combination of these factors.
As for aldehydes , the hydrogen atoms on the carbon adjacent ("α to") the carboxyl group in esters are sufficiently acidic to undergo deprotonation, which in turn leads to a variety of useful reactions. Deprotonation requires relatively strong bases, such as alkoxides . Deprotonation gives a nucleophilic enolate , which can further react, ., the Claisen condensation and its intramolecular equivalent, the Dieckmann condensation . This conversion is exploited in the malonic ester synthesis , wherein the diester of malonic acid reacts with an electrophile (., alkyl halide ), and is subsequently decarboxylated. Another variation is the Fráter–Seebach alkylation .
I had these exact same symptoms and mine was related to Lyme disease and a bartonella infection, also spread by ticks. I would find a Lyme literate doctor. Mine was nerve pain secondary to these infections in my body. Most doctors will not be receptive to Lyme as a cause for anything, but I would have given up otherwise bease this tyor of pa in iis brutal. I ruled out every other possible diagnosis. With treatment for Lyme it is starting to improve. There is always hope with these things. For now, ice may help her. It helps me tremendously.