Purpose This simulator was originally written to allow the testing of a MODBUS RTU serial driver without having to get 254 little MODBUS PLCs into one office. It, however, grew and is growing to support other protocols (open-mbus TCP/IP, Allen-Bradly DF1 slave+master) as well.
Business/retailJanuary 15, 2019 - 3:09am. January 14, 2019. He went to Waffle. Lifestyle/healthJanuary 14, 2019 - 2:03pm. January 9, 2019. Pork goes into the. Get your reward now.download blindscanner pro 3.18 serial numbershare and open access to a scanner.blindscanner. Standard 2.4 blindscanner 1.18 blindscanner 1.15 blindscanner 1.9 blindscanner 1.9.blindscanner pro 3 18download at 4shared.advanced uninstaller pro.nitro pro 9 serial number.
Soegijanto Padmo – Gerakan Pembaharuan Islam Indonesia dari Masa ke Masa. Key words: sosial, politik, penindasan, kemiskinan, organisasi, pendidikan. Membaca buku termasuk tafsir Al Manar-nya. Muhammadiyah percaya pentingnya penguasaan ilmu umum serta ilmu agama. (buku) PDF, file-file ini bisa. Download Ebook. Kesempurnaan ajaran Islam, dikarenakan Islam mengatur seluruh aspek kehidupan manusia, tidak saja aspek ibadah ritual semata, tetapi juga aspek mu’amalah yang meliputi sosial, politik, budaya, hukum, ekonomi, dan sebagainya.
Video of Shadowhunters 3x11 Sneak Peek "Lost Souls" (HD) Season 3 Episode 11 Sneak Peek - Malec Here's the full episode synopsis. 'In the emotional midseason premiere, everyone is dealing with the loss of Clary and are trying to move on best they can.
The first update pack for Windows 7 is now available to be downloaded or installed. Windows 7 SP1 64 bits compiles all the updates that have appeared for Windows 7 and installs it in our system in one go. The improvements and optimizations that have appeared for Windows 7 are also included in this Service Pack.
Refox_xii_full_portableb99327zip Desperate Housewives S08E12 480p WEB DL x264 mSD Founded in 1995 by Chris Milanko and proudly South Australian based, we are a client-driven chartered accounting firm. ReFox XII 12 1. Visual FoxPro baixar keygen autocad civil 3d 2012 To create more accurate search results for Refox Xii 12. 1 try to exclude using commonly used keywords such as: crack, download, serial, keygen, rapidshare Apr 22, 2014.
Demikian ulasan mengenai macam transistor final amplifier atau transistor audio terbaik lengkap beserta dengan spesifikasinya. Dengan adanya info daftar transistor tadi diaharapkan anda bisa memilih transistor mana yang cocok digunakan untuk amplifier rakitan anda. Jangan lupa share jika memang info ini bermanfaat. Jan 22, 2011 - Disini Saya mau membahas tentang class pada power amplifier. Kelas dipilih berdasarkan topologi penempatan transistor, feedback yang.
C8d: N-Age NE-TIT.pm5 2THIS PAGE ISBLANKC8d: N-Age NE-TIT.pm5 3NEW AGE INTERNATIONAL (P) LIMITED, PUBLISHESNew Delhi Bangalore Chennai Cochin Guwahati HyderabadJalandhar Kolkata Lucknow Mumbai RanchiDr. MukherjeeMSFormer Professor of Upgraded Department of Ophthamology,Pt.
Jan 27, 2018 - Programe De Vazut Tv Pe Pciol. Neaparat trebuie sa fie HDMI 1.4, a.i. Fie capabil sa suporte cantitatea mare de informatii care trebuie.
Case: 72 year old male patient present with chief complains of Gradual decrease in vision and mild discomfort in left eye over the period of 1 week. His past ocular history is suggestive for Cataract extraction in left eye and PCIOL (posterior chamber intraocular lens) implantation in that eye 4 months before.It was a low grade inflammation so topical steroids started and the inflammation responded well. After discontinuing treatment the symtomes return and patiend develops granulomatous anterior chamber inflammation including small hypopyon. Discussion: (1)Examination of white plaque present at equater of posterior capsule will most likey reveal what organism and pathology? Answer: This is the typical case of Chronic postoperative endopthlmitis.
The organisms responsible for it are Staphylococcus epidermidis, propionibacterium acnes,and candida. Endopthlmitis caused by p.acne present within 3 months to 2 years. Endopthlmitis caused by staph.
Epidermidids present within 6 weeks. Endopthlmitis caused by candida present within 3 months. White plaques are suggestive of propionibacterium acne. (2)Treatment of choice?
Answer: Pars plana vitrectomy with posterior capsulotomy with intravitreal injection of vancomycin. Telaprevir in combination with peginterferon alfa associate degreed antiviral agent is usually recommended as an choice for the treatment of genotype one chronic viral hepatitis in adults with remunerated liver disease: WHO area unit antecedently untreated or in whom previous treatment with antiviral agent alfa interferon(pegylated or non-pegylated) alone or in combination with antiviral agent ribavirin has failed, as well as folks whose condition has relapsed, has partially responded or didn't respond.
How does glycopyrronium bromide (NVA237), a once-daily, long-acting muscarinic antagonist, affect exercise tolerance in patients with moderate to severe COPD? Answer: Immediate and significant improvement, even on Day 1. A recent study found that this was accompanied by sustained reductions in lung hyperinflation and meaningful improvements in trough FEV1 and dyspnea. Improvements in exercise endurance increased over time. What is glycopyrrolate?
Glycopyrrolate inhibit cholinergic transmission by blocking muscarinic receptors. Uses:. Anesthesia: preoperative medication,to reduce salivary, tracheo-bronchial, and pharyngeal secretions, and lowering the acidity of stomach. Used in conjunction with neostigmine, to stop neostigmine's muscarinic effects like arrhythmia. It is additionally accustomed cut back excessive secretion (sialorrhea). It decreases acid secretion within the abdomen and so may be used for treating gastric ulcers, in combination with different medications.
Use in treating asthma and COPD has been described. It has been used locally and orally to treat excessive perspiration. (4)Anti-cyclic citrulllinated peptide (anti-CCP) Answer: Anti-cyclic citrulllinated peptide (anti-CCP).
Anti-CCP, RF, and anti-MCV autoantibodies are all useful in the differential diagnosis of RA. However, the anti-CCP antibody was found to have a superior diagnostic value compared with the other autoantibodies.
The anti–mutated citrullinated vimentin (anti–MCV) antibodies detected by the anti– MCV–248 kit appear a lot of reliable than the anti–MCV antibodies detected by the anti–MCV–548 kit in medical diagnosis of autoimmune disease (RA) because of their high sensitivity and specificity. These findings recommend that totally different industrial kits might exhibit different performances. What is Anti-cyclic citrulllinated peptide (anti-CCP)?. They are auto-antibodies. Deteected in blood of patients of RA. Epitope mainly in protein filaggrin.
Inflammation causes arginine residue in vimentin protein to change into Citrulline Reference ranges: Normal: Low/weak positive:20-39 EU Moderate positive:40-59 EU High/strong positive:60 EU. Recent study about efficacy of danshen dripping pill (DSP) to isosorbide dinitrate (ISDN): Study details: Randomized Controlled Trials revealed between 1994 and 2009 on DSP versus ISDN in treating heart disease for four or a lot of weeks were retrieved from major databases, as well as PubMed, Chinese National data Infrastructure, and WanFang information. Meta-analysis was performed on the general effects on symptomatic and diagnostic technique (ECG) enhancements. The sixty eligible RCTs indicate that Danshen Dripping Pill( DSP) is outwardly More effective than medicament Isosorbide dinitrate(ISDN) in treating heart disease. However, more RCTs of larger scale, multi-centre/country, longer follow-up periods, and better quality area unit still needed to verify the effectiveness of DSP over all anti-anginal therapies.
Jia Y, et al. Int J Cardiol. 2012;14(3):330-340 What is Danshen Dripping pill?
The demonstration of useful effects of this herb on anemia diseases has revolutionized the management of cardiopathy, myocardial infarct or stroke in Chinese society. It's a very important weapon against coronary cardiopathy. It's become a routine seasoning medication for acute cardiopathy. Additionally it's effective for dyslipidemia, blood hypervisicosity syndrome, peripheral pathology (superficial phlebitis, thrombosis, allergic arteriolitis), pneumocardial sickness, diabetes, progressive hyperosteogeny, liver disease and it's conjointly used for hypoxia. Danshen has been used for discharge issues, to treat liver disease, and to alleviate bruising and to assist in granulation.
A 47 year old woman present with: Chief complain of FATIGUE She was promoted to senior post in job 10 months ago. She has to give more time and attention to her work. Patient reports that for the last 8 weeks she has been waking up at 3 AM every night and unable to go back to sleep. She dreads the day and have stress at the workplace. As consequences she could not eat well and lost 8% of her weight in last 4 months.
She also break down crying due to her stressful condition. She felt less motivated and lost interest in daily activities and recreation. The patient had history of depressive episode after divorce. Medical workup done for complete blood count, Thyroid function tests, lipid profile and not found any abnormality in that.
She is Hypertensive and taking Hydrochlorothiazide and propranolol for it. What can be the possible diagnosis? What will be drug of choice? Is that drug will cause interaction with antihypertensive drugs? Answer: (1)What can be the possible diagnosis?
Major depressive disorder (2) Drug of choice: Fluoxetine( 20-60 mg/d) (3)Interactions: Its is CYP2D6 and CYP3A4 inhibitor Can increase the level of b-blockers. (4) Helpful therapy: Cognitive behavioral psychotherapy. A 27-year-old male was admitted with a history of jaundice. He was well until about 2 weeks ago, when he developed myalgia and headaches, followed by nausea and vomiting. He denies being in contact with people who were ill. He drinks 1-3 beers a day and a 7-pack of beer on weekends.
He has a history of IV drug abuse, but quit 7 months ago and joined a rehabilitation program. There is no prior history of liver disease. On physical exam his vital signs are normal.
The liver and spleen are not palpable. His labs one week prior revealed an aspartate aminotransferase (AST) of 1210, alanine aminotransferase (ALT) of 2350, alkaline phosphatase of 205 and bilirubin of 5.6 mg/dL.
Which of these is the most likely cause of his liver disease?. Choledocholithiasis Answer: Acute viral hepatitis B. Explanation: This patient is presenting clinically with acute hepatitis. The marked elevation in transaminases that is out of proportion to the alkaline phosphatase indicates a hepatocellular pattern of injury.
As for the other answer choices:. Choledocholithiasis is likely to present with a predominantly cholestatic pattern while any of the other conditions can present with hepatocellular pattern of injury. Alcoholic hepatitis in isolation is unlikely to be associated with transaminases over 400 IU/ml. Moreover, while most conditions causing hepatocellular pattern of injury presents with ALT greater than AST, alcoholic hepatitis is associated with an AST to ALT ratio of greater than 2.
Hemochromatosis does not present with acute hepatitis. The differentials for acute hepatitis include viral hepatitis (hepatitis A, B, E and less likely C), non-hepatitic viruses including cytomegalovirus and Herpes simplex virus, Wilson's disease, autoimmune hepatitis and drug-induced liver injury. Funny Medical school laws:. Medical education is not completed at the medical school, it is just begun!.
To steal ideas from one person is plagiarism, to steal from many is research. Every theory you study has an exception. And the progress of science is in that if you find exception to that exception;). The complications and side effects have more pages in text books than a procedure itself.
Only errors exists. One man's error is another man's new data to start!. Never let your professor know that you exists in the medical school. If you don't know the answer, your attending doctor will ask you the question. No one is listening to you until you make an huge mistake.
The teacher is never absent on the day of your practical viva. The Dumbest professor of you turn to be a genius on the day of viva. Class schedules are designed so that every student waste maximum time between classes.
The most attractive student in class will sit next to you for the first time only on the day of your final exam!. The library your school have dose not have the books you want. Most final exams contains that questions that you missed reading. It is impossible to learn that which we thinks we already know.
When it is your turn, they change the rules!. What we learn after we know it all is what counts. Stress during exam is directly proportional to the big reference books you have read in past!. The size of your textbook will progressively decrease with the time reach the 'date of exam':the doomsday!. The anatomy dissection hall having the highest density of people in the world.
Most patients having increased leptin levels but do not have mutations of leptin or it's recepto.This state is associated with LEPTIN RESISTANCE. (4) What are the consequences of obesity?. Insulin resistance and type 2 diabetes mallitus. Male hypogonadism.
female oligomenorrhea and polcystic overian syndrome. Cardiovascular disease like coronary artery disease,congestive heart failure and stroke. Sleep apnea and obesity hyperventilation syndrome. Non-alcoholic fatty liver disease,rarely carcinoma of liver.
Higher mortality in cancer (5) Are genes responsible for Obesity? Answer: Yes, genes are responsible. “Every morning I wake up at 4.30-5.00, and it takes me a while to get up in the morning but it’s the Olympics, you have to. I need to recover as much as I can and it is crucial for the coming events,” – Michael Phelps As Frederick Douglas one said, “If there is no struggle, there is no progress.” Celebrate the struggle.
Accept it if you want to move onwards and upwards. For better or worse, your future is determined in large part by what you dream of, and the steps you take and struggle you go through to make them come true. The Desire To Win. “I hate to lose. When you lose a race like that, it motivates me even more to try to swim faster.” – Michael Phelps “Four years ago I wanted to race and I hated to lose, getting third in the 200m freestyle and when I do lose in races like that it motivates me to swim faster,” -Michael Phelps The will to win means the passion to have it, the desire to get it. But it dose not mean getting MEDALS in game.
Bhagavad Gita (Holy book for hindus ) – 'Do your duty But don't expect for results' It means result is byproduct! You should concentrate only on PRODUCT not BYPRODUCT! Prepare the best. Qualified for Junior Nationals Set a record in the 200 butterfly 2000 Makes first Olympic appearance at Sydney Games.becomes youngest male swimmer on the U.S. Team at age 15. Finishes fifth in the 200-meter butterfly.
2001 First world record Becomes the youngest male (15 years, 11 months) to set a world record when he breaks the mark in the 200 fly, and takes the mark even lower at the world championship in Fukuoka, Japan, for the first of 26 long-course world titles. 2003 Won four events at the world championships in Barcelona and became the only swimmer in history to set world records in different events on the same day. August 2004 Comes up short in attempt to break Mark Spitz's record of seven gold medals, winning six golds and two bronzes at the Athens Olympics. Nevertheless, IOC president Jacques Rogge declares Phelps 'the icon of the Games.' November 2004 Arrested for drunken-driving in Maryland at age 19. Pleads guilty to driving while impaired, pays fine and serves probation.
2007 Joins Spitz as the only swimmer to win seven events at a major international swimming competition during the world championships in Melbourne, Australia. Phelps has a shot at eight victories, but the heavily favored U.S. Team is disqualified from the 4x100 medley relay in the preliminaries while Phelps is resting up for the final.
2008 Surpasses Spitz's iconic Olympic record with eight gold medals at the Beijing Games, setting seven world records in what is dubbed 'The Great Haul of China.' Becomes a major international star, even doing a stint as host of 'Saturday Night Live.' 2009 Suspended for three months by USA Swimming after photo emerges in a British tabloid of him inhaling from a pipe used to smoke marijuana. Phelps apologizes and accepts the penalty.
2011 Wins four golds at world championships in Shanghai, but is beaten by fellow American Ryan Lochte in their two head-to-head meetings. 2012 Claims four gold medals and two silvers at the London Olympics, which he says will be his final swim meet.Phelps retires with 18 gold medals and 22 overall medals. O’Byrne PM - Several studies have demonstrated that making asthma treatment decisions based on minimizing airway eosinophil numbers can reduce the risks of severe exacerbations. In addition, treatment of patients with severe asthma with an anti–IL-5 mAb also reduces the number of severe asthma exacerbations, demonstrating a central role of eosinophils in many exacerbations. Asthma exacerbations can occur in patients with all degrees of asthma severity. They generally develop over 5 to 7 days and are most often initiated by an upper respiratory tract infection (usually with human rhinovirus) or by environmental allergen exposure in atopic subjects. Inhaled corticosteroids (ICSs) taken on a regular basis are very effective in reducing the risk of asthma exacerbations, and the combination of ICSs and long-acting inhaled (beta)2-agonists further reduces this risk.
In addition, use of the combination of the ICS budesonide and the long-acting inhaled (beta)2-agonist formoterol, both as maintenance asthma treatment and also as rescue treatment (instead of a short-acting inhaled (beta)2-agonist), has a significant further beneficial effect on asthma exacerbation risk. Other therapies that have been demonstrated to reduce severe asthma exacerbations are leukotriene receptor antagonists, which have been demonstrated to be effective most consistently in this regard in children, and anti-IgE mAbs, which are effective in subjects with difficult-to-treat allergic asthma. Approximately 50% of severe asthma exacerbations are eosinophilic in nature, whereas many of the remaining are neutrophilic.
Facts about ASTHMA: What Causes Asthma? Extrinsic factors:. Allergies (allergens) are common cause of asthma. These allergic reactions are often associated with IgE-related immunologic mechanisms.Pollen,food or aspirin are profound examples for this. Occupational asthma: occurs in about 10% of asthmatics and results from exposure to offending dusts, gases, fumes, and vapors that are present in the workplace.
These materials are high molecular-weight compounds and low molecular-weight compounds.Examples: Animal products (e.g. Veterinarians), seafood (e.g. Oyster farmers), insects (e.g. Entomologists), plants (e.g. Bakers), biological enzymes (e.g. Detergent industry workers), gums (e.g.
![]()
Printers), and latex (e.g. Health care workers). Examples of low molecular-weight compounds that cause asthma include drugs (e.g. Antibiotics), wood dust (e.g. Saw-mill workers), diisocyanates (e.g.
Workers with polyurethane), epoxy compounds (e.g. Epoxy resin workers), fluxes (e.g. Aluminum solderers), and fixatives (e.g.
![]()
Hospital workers). Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) can cause asthma in sensitive patients. Samter's triad: This problem usually takes time to develop and is characterized by aspirin sensitivity, nasal polyps, and asthma. Intrinsic factors include:. Upper Respiratory tract infections, especially viral infections, are very common causes of exacerbations of asthma.
Exercise: Exercise usually induces an increase in respiratory rate and depth of breathing and increases the inhalation of atmospheric air which is cooler than the body temperature air in the lungs. This cooler air appears to stimulate receptors in the lung in susceptible patients to induce bronchospasm and an asthmatic attack. Genetic factors have been proposed as causes of asthma. The ADAM-33 gene sets on the short arm of chromosome 20 and has been significantly associated with asthma, being called the asthma gene. Emotional factors like stress have been suspected to cause asthma. 70-year-old male Patient hospitalized with ST-segment elevation acute myocardial infarction(STEMI). Culprit lesions in which coronary artery would yield the lowest cardiac enzyme levels compared with the other two(From LAD,LCX,RCA)?
ANSWER: LAD and LCX ' Distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention: In a study containing,1533 patients with mean age 61±12 years,all patients treated wi ith primary percutaneous coronary intervention and underwent 2D echocardiography less than 48 h after admission. The majority of the culprit lesions were located in: left anterior descending coronary artery (LAD)- 45% the right coronary artery (RCA) -38% left circumflex coronary artery (LCX,) - 14% Subanalysis demonstrated that patients with a culprit lesion in the LAD and LCX had significantly higher-peak cardiac enzymes compared with patients with culprit lesions in the RCA. Patients with proximal LAD and LCX lesions had significantly worse left ventricular function compared with patients with mid or distal lesions.
Plaque rupture resulting in acute myocardial infarction is more likely to occur in the proximal parts of the LAD and RCA. In addition, the location of culprit lesions was related to infarct size.
If you answer affirmatively to above questions along with CAGE questions you are probably an Alcohol ADDICT. A standard drink is equal to 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in. 12-ounces of beer.
8-ounces of malt liquor. 5-ounces of wine. 1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey). What does it mean to be above the legal limit for drinking? The legal limit for drinking is the alcohol level above which an individual is subject to legal penalties (e.g., arrest or loss of a driver's license). Legal limits are measured using either a blood alcohol test or a breathalyzer. Legal limits are typically defined by state law, and may vary based on individual characteristics, such as age and occupation.
All states in the United States have adopted 0.08% (80 mg/dL) as the legal limit for operating a motor vehicle for drivers aged 21 years or older. However, drivers younger than 21 are not allowed to operate a motor vehicle with any level of alcohol in their system. What are the recommended safe limits of alcohol?
(1 unit=10 ml or 8 grams of pure alcohol). Men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week. Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week.
Pregnant women. 'pregnant women or women trying to conceive should not drink alcohol at all.
If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk'. There are one and a half units of alcohol in:. a small glass (125 ml) of ordinary strength wine (12% alcohol by volume); or. a standard pub measure (35 ml) of spirits (40% alcohol by volume). Case: 51 year old female present to emergency department having, (1)Sudden onset of right side eye pain with sever headache (2)Blurring of vision (3)vomiting and prostrastion (4)photophobia and lacrimation Onset,duration and progress: These symptoms began 2 hours ago without any inciting event.
The patient was watching television when the symptoms began. She developed sudden headache and SEVERE pain in the right eye which was RADIATING in nature. Along with this she also having nausea and vomiting sensation.She can't look at the bright light sources Patient also reports seeing rainbow colored halos around lights.This was also associated with lacrimation. There is no history of trauma, flashing lights, curtains, metamorphopsia or diplopia. The patient should remain in the supine position as long as possible.
The urge to wear eye patches, covers, or blindfolds should be resisted. By maintaining the conditions that cause pupillary dilation, these articles help perpetuate the attack.
Hospital care: Carbonic anhydrase inhibitor: Acetazolamide should be given as a stat dose of 500 mg IV followed by 500 mg PO. Topical beta-blocker: A dose of a topical beta-blocker (ie, carteolol, timolol) will also aid in lowering IOP.
An alpha-agonist can be added for a further decrease in IOP. Topical steroids: Topical steroids decrease the inflammatory reaction and reduce optic nerve damage. The current recommendation is for 1-2 doses of topical steroids.
Analgesics for pain and antiemetics for nausea and vomiting, which can drastically increase IOP beyond its already elevated level.so if used with much care. Placing the patient in the supine position may aid in comfort and reduce IOP. It is also believed that, while supine, the lens falls away from the iris decreasing pupillary block. Pilocarpine use. Pilocarpine must be used with caution. By constricting the ciliary muscle, it has been shown to increase the axial thickness of the lens and to induce anterior lens movement. This could result in reducing the depth of the anterior chamber and worsening the clinical situation in a paradoxical reaction.
Satisfactory reduction as IOP less than 35 mm Hg or a reduction greater than 25% of presenting IOP. Hyperosmotic agents: If the IOP is not reduced 30 minutes after the second dose of pilocarpine, an osmotic agent must be considered. An oral agent like glycerol can be administered in nondiabetics.
In diabetics, oral isosorbide is used to avoid the risk of hyperglycemia associated with glycerol. Patients who are unable to tolerate oral intake or do not experience a decrease in IOP despite oral therapy are candidates for IV mannitol. Hyperosmotic agents are useful for several reasons. They reduce vitreous volume, which, in turn, decreases IOP. The decreased IOP reverses iris ischemia and improves its responsiveness to pilocarpine and other drugs. Osmotic agents cause an osmotic diuresis and total body fluid reduction.
They should not be administered in cardiovascular and renal patients. Surgical: When medical therapy proves to be ineffective, corneal indentation (CI) can be used as a temporizing measure to reduce IOP until definitive treatment is available. As the cornea is indented, aqueous humor is displaced to the periphery of the anterior chamber, which serves to temporarily open the angle.
This leads to immediate reduction of IOP and occasionally may completely abort the attack.Done by gonioprism. Laser peripheral iridotomy (LPI), performed 24-48 hours after IOP is controlled, is considered the definitive treatment for AACG. Furthermore, LPI may be offered prophylactically to individuals anatomically predisposed to AACG if identified before the first acute attack. While LPI is the current definitive treatment, evidence suggests that argon laser peripheral iridoplasty (ALPI) and anterior chamber paracentesis (ACP) may have increasing roles in the management of AACG. In ALPI, burns are made in the peripheral iris resulting in iris contraction and opening of the angle.
Postmenopausal OSTEOPOROSIS CASE: A 59-year-old postmenopausal Caucasian woman is seeing you for her annual checkup. She has been in good general health for the past several years.
She experienced menopause in her early 50s She is currently not on any chronic medication. Although the patient has no personal history of fractures, her older sister experienced a hip fracture. She is 5’7” and weighs 112 lbs.
She smokes cigarettes, drinks several cups of coffee a day, and rarely exercises. Her height has remained stable over the past 4 years. Now,she is concerned about osteoporosis is postmenopausal women. And need some drugs to prevent the onset. Will you prefer using ALENDRONATE 35 mg tablet once a week to her? What are the side effects and How long she should continue taking the drug?
Answer: Major Risk Factors for Osteoporosis and Related Fractures in Caucasian and Postmenopausal Women:. Personal history of fracture as an adult. History of fragility fracture in a first-degree relative. Low body weight (2drinks per day So, she is among the HIGH RISK GROUP as she is smoking and drinking. Also there is positive history of hip fracture in first degree relative.
So she is the ideal candidate,who must need steps to prevent postmenopausal osteoporosis. So, We can start with ALENDRONATE 35mg post oral once a week treatment in her. Now, the question is how long she should continue treatment? As it is known that alendronate is associated with following adverse effects and contraindication: May cause local irritation of the upper GI mucosa Risk of esophageal adverse effects, including esophagitis, esophageal ulceration/erosion, or esophageal bleeding with strictures or perforation Risk of osteonecrosis of jaw Not recommended in severe renal impairment CrCl 5 years So, it was thought not to continue therapy for prevention more than a year. But recent studies unable to correlate the risk with the use.Also, the RISK:BENEFIT ratio is concerned,Benefit is more using a drug. So, Life-long treatment with the drug may be prescribed now. Still, patients who continue drug more than 5 years need to be evaluated for adverse effects of the drugs Some precautions and guidelines always be followed by patients to get results.
Administration Take only in the morning, NOT at bedtime or before arising Take tablet at least 30 minutes before first food or drink of day with full glass of water (6-8 oz) in upright position Swallow with plain water ONLY, coffee or juice severely reduces bioavailability Swallow tablet whole, do not suck or chew Oral solution: drink 60 mL (2 oz) water following administration Do NOT lie down for 30 minutes following taking drug, sit or stand upright ALENDRONATE is one of drugs with the longest half life. Despite long terminal half-life (10 years), bone-incorporated drug is not pharmacologically active. Question: Among hypertensive type 2 diabetic patients with chronic kidney disease and stable glycemic control, which had significant decreases in a recent study among patients receiving aliskiren compared with patients receiving Amlodipine (calcium channel blocker)? Answer: Urinary albumin/creatinine ratios Urinary albumin/creatinine ratios, along with 8-hydroxy-2’-deoxyguanosine and liver-type fatty acid-binding protein levels decrease with treatment of both aliskiren and telmisartan. The aliskiren group also had significant reductions in plasma aldosterone levels. Adding aliskiren to the maximum recommended dose of the angiotensin II receptor blocker telmisartan is more effective to reduce albuminuria and oxidant stress than increasing the amlodipine dose.
ALISKIREN FACTS. (2)The Mitchell method involves adopting body positions that are opposite to those associated with anxiety (fingers spread rather than hands clenched, for example). In autogenic training, patients concentrate on experiencing physical sensations, such as warmth and heaviness, in different parts of their bodies in a learned sequence. Other methods encourage the use of diaphragmatic breathing that involves deep and slow abdominal breathing coupled with a conscious attempt to let go of tension during exhalation.
Hypnosis is used successfully for treatind depression and insomnia.One of the strongest factors contributing to hypnosis is the patient’s expectancy of therapeutic outcomes. Positive expectancy, or positive belief, leads patients to believe that the procedure implemented by the therapist will produce a desired therapeutic result. Positive expectancies involve many perceptions, e.g.
The clinician is seen as credible, the procedure seems to have a plausible rationale, etc. Thus, by educating patients on hypnosis, expectations are established that the associated procedures will have a potentially therapeutic benefit, increasing the likelihood of them actually doing so.
DENGUE VACCINE INVENTION: 1st breakthrough Dengue is a viral infection transmitted by the bite of an infected female Aedes mosquito. There are four distinct serotypes of the dengue virus (DEN 1, DEN 2, DEN 3 and DEN 4). Symptoms appear in 3–14 days (average 4–7 days) after the infective bite. Dengue fever is a flu-like illness that affects infants, young children and adults. Why it's hard to invent a vaccine against dengue virus?
'DENVs are arboviral flaviviruses transmitted by Aedes mosquitoes causing a spectrum of clinical disease. DENV infections are a significant global health problem; the WHO estimates that more than 120 countries have endemic DENV transmission resulting in 70-500 million infections, 2.1 million clinically severe cases, and 21 000 deaths annually. There are currently no licensed antivirals or vaccines to treat or prevent dengue.
The DENV-host interaction of infection is unique with severe disease a consequence of sequential dengue infection, viral immune evasion, host antibody enhancement, host immune activation, and genetic predisposition. This unique pathogen-host interaction complicates dengue vaccine development and creates provocative questions in vaccine development such as identifying markers of protective immunogenicity, the potential role of antibody in vaccine failures, and the possible impact of large-scale vaccination on the evolution of wild-type DENV.' RAY OF HOPE: The world's first vaccine against dengue fever, being developed by French drugmaker Sanofi SA, protected against three of the virus's four strains in a keenly awaited clinical trial in Thailand 'I am not at all concerned about the lack of protection against all four serotypes.
Based on what we know about the immune response to dengue viruses, if the vaccine protects against three serotypes, recipients will be protected against severe disease,' Duane Gubler of the Duke-N.U.S. Graduate Medical School said in an emailed exchange. It's a surprise,' company spokesman Pascal Barollier said. 'We need to get to the bottom of the data to find out why it is reacting this way and wait for ongoing Phase III trials to see if it is linked to some specific situation in Thailand.'
Sanofi's vaccine generated an antibody response for all four dengue virus types, but evidence of protection was only demonstrated against three of the four strains circulating in Thailand. Facts about dengue:. Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3—14 days after the infective bite.
Dengue fever is a febrile illness that affects infants, young children and adults. Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue.
It is important to maintain hydration. Use of acetylsalicylic acid (e.g. Aspirin) and non steroidal anti-inflammatory drugs (e.g. Ibuprofen) is not recommended. Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients. Fast Facts.
African Americans are the racial/ethnic group most affected by HIV. In 2009, African Americans comprised 14% of the US population but accounted for 44% of all new HIV infections. Young African American gay and bisexual men are especially at risk of HIV infection. Prevention Challenges: African Americans face a number of challenges that contribute to the higher rates of HIV infection.
The greater number of people living with HIV (prevalence) in African American communities and the fact that African Americans tend to have sex with partners of the same race/ethnicity means that they face a greater risk of HIV infection with each new sexual encounter. African American communities continue to experience higher rates of other sexually transmitted infections (STIs) compared with other racial/ethnic communities in the US.
The presence of certain STIs can significantly increase the chance of contracting HIV. Additionally, a person who has both HIV and certain STIs has a greater chance of infecting others with HIV. The socioeconomic issues: poverty, including limited access to high-quality health care, housing, and HIV prevention education, directly and indirectly increase the risk for HIV infection and affect the health of people living with and at risk for HIV infection. Lack of awareness of HIV status Approximately 1 in 5 adults and adolescents in the US living with HIV are unaware of their HIV status.
This translates to approximately 116,750 persons in the African American community. Late diagnosis of HIV infection is common, which creates missed opportunities to obtain early medical care and prevent transmission to others. The sooner an individual is diagnosed and linked to appropriate care, the better the outcome. Stigma, fear, discrimination, homophobia, and negative perceptions about HIV testing can also place too many African Americans at higher risk. Many at risk for infection fear stigma more than infection and may choose instead to hide their high-risk behavior rather than seek counseling and testing. An interesting study was to investigate the association between thyroid function tests and sonographic as well as enzymatic criteria of liver status in a large population-based study, the Study of Health in Germany (SHIP).
Hepatic steatosis was defined as the presence of a hyperechogenic ultrasound pattern of the liver and increased serum alanine transferase concentrations. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) concentrations were associated with hepatic steatosis using multinomial regression models adjusted for sex, age, physical activity, alcohol consumption, waist circumference, and food intake pattern. No consistent association of serum TSH(thyroid stimulating hormone) and FT3(triiodothyronin) concentrations with hepatic steatosis. In contrast, serum FT4 concentrations were inversely associated with hepatic steatosis in men.
Quote: PC GAMES Blazblue Calamity Trigger F1 2013 PES 2014 Syndicate Total War Rome 2 Trine 2 Movie 1080p Ace Ventura - Pet Detective (1994) Adore (2013) After Earth (2013) Behind the Candelabra (2013) Black Swan (2010) Dark Skies (2013) Evidence (2013) Hick (2011) Jackie Brown (1997) Killing Season (2013) Mama (2013) Only God Forgives (2013) R.I.P.D.
|
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |