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Although these agents are not considered first-line therapy for asthma buy generic pamelor 25 mg on line, they are certainly not contraindicated in asthma patients who require them for concomitant allergic problems ( 89) 25 mg pamelor visa. Histamine is increased during the early and late airway response after specific allergen provocation and during spontaneous asthma exacerbations discount 25 mg pamelor with mastercard. Many studies have shown that antihistamines are bronchoprotective depending on the stimulus. Several current studies have demonstrated the additive effects of antihistamines and antileukotriene agents in both allergic rhinitis and asthma. Antihistamines serve as important adjuncts in the management of anaphylaxis but should never replace the first-line therapy, which by general consensus is epinephrine (10). Antihistamines are commonly used to treat atopic dermatitis but have limited clinical utility. The sedating first-generation antihistamines, such as diphenhydramine and hydroxyzine, are often more effective than nonsedating agents for controlling pruritus because they allow the patient to sleep. Antihistamines should be used cautiously during pregnancy to avoid the risk for teratogenicity ( 10). Long-term clinical experience using antihistamines during pregnancy has shown that tripelennamine, chlorpheniramine, and diphenhydramine cause no greater risk for birth defects than experienced by the normal population. Antihistamines are excreted in breast milk and therefore infants of nursing mothers who were taking first-generation antihistamines have been reported to experience drowsiness and irritability. Studies evaluating these agents in the treatment of children with otitis media and upper respiratory infections have found they offer no significant benefit when used as solo agents (95,96 and 97). However, children with recurrent otitis media and a strong family history of allergies should be evaluated by an allergist to identify potential environmental triggers. The use of second-generation over first-generation antagonists as first-line agents has previously been considered premature by many experts. If a first-generation agent is taken on a regular basis at bedtime, its sedative side effects are often well tolerated by many patients. However, because a large segment of patients do not tolerate these agents, they require treatment with second-generation nonsedating agents. Impairment of these functions increases indirect costs associated with the treatment of allergic rhinitis. Indirect costs include missed days from work or school and decreased concentration and performance while at work, resulting in overall decreased productivity ( 3,42). However, if individuals have nonallergic rhinitis with or without an allergic component manifested as severe postnasal drainage, it may be necessary to use first-generation antihistamines with or without decongestants to take advantage of their anticholinergic drying effects. In these situations, it is best to dose the sedating antihistamine at bedtime because the sedative carryover effect the following morning of these agents does not usually significantly impair cognitive performance. In general, it is important to educate the patient about the advantages and disadvantages of sedating and nonsedating antihistamines in the management of specific allergic diseases. Some patients become drowsy with even 2 mg of chlorpheniramine, so that second-generation antihistamines should be used instead. Associated anticholinergic side effects include dry mouth, blurred vision, and urinary retention ( 99). First-generation agents also potentiate the effects of benzodiazepines and alcohol ( 10,99). Cyproheptadine, a piperidine, has the unique effect of causing weight gain in some patients (16). Intentional and accidental overdose, although uncommon, has been reported with these drugs ( 10,14). Even with normal doses, it is not unusual for children to experience a paradoxic excitatory reaction. Malignant cardiac arrhythmias have been known to occur with overdoses, emphasizing the need to act expeditiously to counteract the toxic effect of these agents ( 10,14,99). Because these agents are secreted in breast milk, caution should be exercised using these agents in lactating women to avoid adverse effects in the newborn ( 99). Sedation and the side effects associated with first-generation agents have been noted to occur, but to no greater extent than with placebo ( 10,14,101). Astemizole, like cyproheptadine, was associated with increased appetite and weight gain ( 10). Loratadine and fexofenadine have similar side effect profiles and have not been found to cause cardiotoxicity ( 3). Cetirizine is considered a low sedating antihistamine but is generally well tolerated by most patients. This phenomenon has been speculated to occur because of autoinduction of hepatic metabolism, resulting in an accelerated clearance rate of the antihistamine ( 103). Short-term studies evaluating tolerance to second-generation agents have found no change in their therapeutic efficacy after 6 to 8 weeks of regular use ( 108,109). Studies up to 12 weeks found no evidence that second-generation agents cause autoinduction of hepatic metabolism leading to rapid excretion rates and drug tolerance ( 42). The clinical efficacy of these agents in the skin and treatment of allergic rhinitis does not decrease with chronic use. The decongestants used in most preparations today predominantly include phenylpropanolamine hydrochloride, phenylephrine hydrochloride, and pseudoephedrine hydrochloride. These agents have saturated benzene rings without 3- or 4-hydroxyl groups, which is the reason for their weak a-adrenergic effect, improved oral absorption, and duration of action. The early agents, which were developed for their gastric acid inhibitory properties, were either not strong enough for clinical use or hazardous because of serious associated side effects (e. Cimetidine (Tagamet) was introduced to the United States in 1982 and has been proved safe and effective in the treatment of peptic ulcer disease (15). For example, ranitidine (Zantac) has a furan ring, whereas famotidine (Pepcid) and nizatidine (Axid) are composed of thiozole rings ( 15). H2 antagonists act primarily by competitive inhibition of the H 2 receptors, with the exception of famotidine, which works noncompetitively (15). The four available H2 antagonists all have potent H2 antagonistic properties, varying mainly in their pharmacokinetics, and adverse effects such as drug interactions. Numerous studies have been undertaken to examine the clinical utility of H 2 antagonists in allergic and immunologic diseases. Generally, H2 antagonists have limited or no utility in treating allergen-induced and histamine-mediated diseases in humans ( 118,119,120 and 121). One notable exception to this rule may be their use in combination with H 1 antagonists in the treatment of chronic idiopathic urticaria ( 122). The studies evaluating the clinical efficacy of H 2 antagonists in allergic and immunologic disorders are extensively reviewed elsewhere ( 3,117). These actions by histamine could not be suppressed by H 1 or H2 antagonists, leading researchers to postulate the existence of a third class of histamine receptors. They both have demonstrated H 3 receptor selectivity but remain strictly for experimental use (9). Chemical modifications of these early agents have yielded the second-generation antihistamines, which are of equal antagonistic efficacy but have fewer side effects because of their lipophobic structures. Newer nonsedating antihistamines, which are metabolites or isomers of existing agents, are now under development. H 2 receptor antagonists have been found extremely useful in the treatment of peptic ulcer disease. However, they have been disappointing in the treatment of allergic and immunologic disorders in humans. Newer selective nonsedating H1 antagonists and dual-action antihistamines, because of their lower side-effect profiles, have provided therapeutic advantages over first-generation agents for long-term management of allergic rhinitis. Because there are virtually dozens of antihistamine preparations available with or without decongestants, it is recommended that physicians become familiar with all aspects of a few agents from each structural class. Analysis of triggering events in mast cells for immunoglobulin E-mediated histamine release. Blockade of histamine-mediated increased in microvascular permeability by H 1- and H2-receptor antagonists. Medicinal chemistry and dynamic structure-activity analysis in the discovery of drugs acting as histamine H 2-receptors. The pharmacokinetics and antihistaminic of the H 1 receptor antagonist hydroxyzine. Inhibition of histamine release from human lung in vitro by antihistamines and related drugs. Evaluation of sustained-action chlorpheniramine-pseudoephedrine dosage form in humans. In vitro and in vivo binding characteristics of a new long-acting histamine H1 antagonist, astemizole.

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The extent or length of an audiovisual is an optional component of a reference that may provide useful information to the reader cheap 25 mg pamelor free shipping. Provide extent as the total number of physical pieces 25mg pamelor visa, such as 387 slides or 1 videocassette buy pamelor 25mg cheap. Run time (also known as running- time) is the length of the film or program in minutes, such as 2 videocassettes: 140 min. You may provide more physical description details after the extent to give the reader additional information. For example, the size of an audiovisual can affect the equipment needed to view the item. If more information is needed, consult the case housing the audiovisual or any accompanying booklet or other documentation. Note that the rules for creating references to audiovisuals are not the same as the rules for cataloging them. Continue to Citation Rules with Examples for Books and Other Individual Titles in Audiovisual Formats. Continue to Examples of Citations to Books and Other Individual Titles in Audiovisual Formats. Citation Rules with Examples for Books and Other Individual Titles in Audiovisual Formats Components/elements are listed in the order they should appear in a reference. Author/Editor (R) | Author Affiliation (O) | Title (R) | Type of Medium (R) | Edition (R) | Producer, Editor, and other Secondary Authors (O) | Place of Publication (R) | Publisher (R) | Date of Publication (R) | Extent (O) | Physical Description (O) | Series (O) | Language (R) | Notes (O) Author/Editor for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Author/Editor List names in the order they appear on the opening screens or in the text accompanying text Enter surname (family or last name) first for each author/editor Capitalize surnames and enter spaces within surnames as they appear in the document cited on the assumption that the author approved the form used. Books and Other Individual Titles in Audiovisual Formats 697 American College of Surgeons, Committee on Trauma, Ad Hoc Subcommittee on Outcomes, Working Group. Collaborative research with communities: value added & challenges faced [videocassette]. Audiovisuals authors with particles or prefixes in their names (give as provided in the publication) 7. Audiovisuals with organization as author with subsidiary part of organization named 10. Audiovisuals with no authors found Books and Other Individual Titles in Audiovisual Formats 699 12. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Espana becomes Spain Examples for Author Affiliation 12. New York: Society for French American Cultural Services and Educational Aid; 1991. Udalenie doli legkogo pri tuberkuleze [Lung lobe resection in tuberculosis] [motion picture]. Box 16 Audiovisual titles in more than one language If an audiovisual title is written in several languages: Give the title in the first language found on the opening screens of a videocassette, videodisc, or motion picture or the first few slides of a slide set or by listening to an audiocassette If the language cannot be determined there, look to the container of the audiovisual or other accompanying written material for clarification List all languages of publication after the date of publication (and extent if included) Separate the languages by commas End language information with a period Example: A plastic story: a history of plastic surgery [videocassette]. Box 17 Audiovisual titles ending in punctuation other than a period Most titles end in a period. Place the type of medium in square brackets and end title information with a period. Box 19 No audiovisual title can be found Occasionally an audiovisual does not appear to have any formal title; it simply begins with the text. In this circumstance: Create a title from the first few words or concepts expressed on the opening screens Use enough words to make the constructed title meaningful. Place [videocassette], [audiocassette], [motion picture], and similar types inside the period. Box 21 Non-English titles with translations If a translation of a title is provided, place it in square brackets Place the type of medium after the square brackets for the translation Example: Piccoli. Examples: Microhemagglutination assay methods in the diagnosis of syphilis [audiocassette + slide]. Case studies in human growth and development: a flexible instructional module [audiocassette + videocassette]. Case Western Reserve University, 706 Citing Medicine Health Sciences Communication Center, producer. Audiovisuals with more than one type of medium Edition for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Edition Indicate the edition/version being cited after the type of medium when an audiovisual is published in more than one edition or version Abbreviate common words (see Abbreviation rules for editions below) Capitalize only the first word of the edition statement, proper nouns, and proper adjectives Express numbers representing editions in arabic ordinals. Box 25 Both an edition and a version If an audiovisual provides information for both an edition and a version: Give both, in the order presented Separate the two statements with a semicolon End edition/version information with a period 710 Citing Medicine Examples: Epidural anesthesia [videocassette]. Box 26 First editions If an audiovisual does not carry any statement of edition, assume it is the first or only edition Use 1st ed. Box 28 Secondary author performing more than one role If the same secondary author performs more than one role: List all roles in the order they are given in the publication Separate the roles by "and" End secondary author information with a period Example: Baxley N, Dunaway C. Audiovisuals with authors and producer(s), editor(s), or other secondary authors 21. Audiovisuals with no place, publisher, or date of publication found Publisher for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Publisher Record the name of the publisher as it appears in the publication, using whatever capitalization and punctuation is found there Abbreviate well-known publisher names with caution to avoid confusion. Books and Other Individual Titles in Audiovisual Formats 715 When a division or other subsidiary part of a publisher appears in the publication, enter the publisher name first. Tokyo: Medikaru Rebyusha; 716 Citing Medicine Beijing (China): [Chinese Academy of Social Sciences, Population Research Institute]; Taiyuan (China): Shanxi ke xue ji she chu ban she; [Note that the concept of capitalization does not exist in Chinese. Designate the agency that issued the publication as the publisher and include distributor information as a note, preceded by Available from: ". For publications with joint or co-publishers, use the name given first as the publisher and include the name of the second as a note if desired. Box 40 No publisher can be found If no publisher can be found, use [publisher unknown] Kontrastdarstellung des Herzens und der grossen Gefasse im Rontgen-Kinofilm [Demonstration of the heart and large vessels in cine-radiographic film] [motion picture]. Audiovisuals with no place, publisher, or date of publication found 718 Citing Medicine Date of Publication for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Date of Publication Always give the year of publication Convert roman numerals to arabic numbers. Box 42 Non-English names for months Translate names of months into English Abbreviate them using the first three letters Capitalize them For example: mayo = May Books and Other Individual Titles in Audiovisual Formats 719 luty = Feb brezen = Mar Box 43 Seasons instead of months Translate names of seasons into English Capitalize them Do not abbreviate them For example: balvan = Summer outomno = Fall hiver = Winter pomlad = Spring Box 44 Date of publication and date of copyright Some publications have both a year of publication and a year of copyright. Box 45 No date of publication, but a date of copyright A copyright date is identified by the symbol, the letter "c", or the word copyright preceding the date. Confronting racial and gender difference: 3 approaches to multicultural counseling and therapy [videocassette]. Audiovisuals with no place, publisher, or date of publication found Books and Other Individual Titles in Audiovisual Formats 721 Extent for Books and Other Individual Titles in Audiovisual Formats (optional) General Rules for Extent Give the total number of physical pieces on which the audiovisual appears Follow the number with a space and the type of audiovisual. For example, a user may want to know if a videocassette is 15 minutes long or an hour. If run time is not provided, you have the option of timing the audiovisual or omitting run time from the citation. Standard citation to an audiovisual Physical Description for Books and Other Individual Titles in Audiovisual Formats (optional) General Rules for Physical Description Give information on the physical characteristics of an audiovisual, such as color and size Specific Rules for Physical Description Language for describing physical characteristics 722 Citing Medicine Box 49 Language for describing physical characteristics Physical description of a publication in audiovisual format is optional in a reference but may be included to provide useful information. For example, the size of an audiovisual will indicate to the reader what equipment is needed to view it. See Appendix C for a list of commonly used English words in description and their abbreviations. Standard citation to an audiovisual Series for Books and Other Individual Titles in Audiovisual Formats (optional) General Rules for Series Begin with the name of the series Books and Other Individual Titles in Audiovisual Formats 723 Capitalize only the first word and proper nouns Follow the name with any numbers provided. Box 51 Multiple series If an audiovisual is a part of more than one series, include information on all series if desired. Audiovisuals with series with editor Language for Books and Other Individual Titles in Audiovisual Formats (required) General Rules for Language Give the language of publication if not English Capitalize the language name Follow the language name with a period Specific Rules for Language Audiovisuals appearing in more than one language Box 52 Audiovisuals appearing in more than one language If an audiovisual is presented in several languages Give the title in the first language found on the opening screens List all languages of publication after the date of publication (and extent if provided) Separate the languages by commas End the list of languages with a period Examples: A plastic story: a history of plastic surgery [videocassette]. Paranormale heilmethoden auf den Philippinen = Paranormal healing in the Philippines [videocassette]. Books and Other Individual Titles in Audiovisual Formats 725 Follow titles not in English with a translation whenever possible. Audiovisuals published with text in multiple languages Notes for Books and Other Individual Titles in Audiovisual Formats (optional) General Rules for Notes Notes is a collective term for any type of useful information given after the citation itself Complete sentences are not required Be brief Specific Rules for Notes Audiovisual accompanied by a booklet or other material Other types of material to include in notes Box 53 Audiovisual accompanied by a booklet or other material If an audiovisual has supplemental material accompanying it in the form of a manual, booklet, or other type of material, begin by citing the audiovisual. Box 54 Other types of material to include in notes The notes element may be used to provide any information the compiler of the reference feels is useful to the reader. Examples of notes are: If the audiovisual was sponsored by or prepared for a particular organization, give the name Fluoride: the magnificent mineral [motion picture]. Health and the built environment: the effects of where we live, work and play [videocassette]. Audiovisuals with supplemental note included Examples of Citations to Books and Other Individual Titles in Audiovisual Formats 1. Nuclear cardiac imaging: equilibrium and gated first pass radionuclide angiocardiography [videodisc].

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The fellow starts here buy generic pamelor 25 mg on-line, carefully considering a feeling of shock at the sudden loss of a mentor and career plan buy cheap pamelor 25mg line, as Case well as the need for a career focused largely on clinical A fellow is looking forward to moving into an academic medicine purchase pamelor 25 mg on-line. The fellow has been mentored by the department chair, enjoys healthy Strategy 2: Review assumptions. Change can trigger relationships with many of their colleagues, and is con- signifcant anxiety. Pirates rarely win, hurt others along the way, and end up dean specifcally to bring major change to the group. Crew members thrive as part of healthy The fellow had hoped to build a clinical practice and has teams, enjoy personal growth and development, and enjoy a no particular interest in an academic career. Introduction First, the fellow realizes a deep distrust of the university s One way to approach change is to determine where we are in internal politics, given the abruptness of the mentor s de- the cycle of change. However, the fellow also realizes that they may not participation in change and a vertical axis that measures ac- appreciate all the issues involved and that personal feelings ceptance of change. In the frst the mentor, only to discover that he is fully supportive of zone of change, people have a high acceptance of change and the change in leadership, as he is dealing with a terminal a high degree of participation in the change process: these are illness. In the second zone, people have a high acceptance tion during their mentorship meeting early in the coming of change but low participation in the process: these are the week. In the third zone, people have a low acceptance of change and low participation in the change process: these Strategy 3: Seek supports. In the fourth zone, people have a low tivated we are trying to protect ourselves from harm. These acceptance of change but a high rate of participation: these are defences can be positive and constructive, but they can also the pirates. A well-managed change process is mindful of all cause us to deny the legitimacy of alternative perspectives, to four roles, and a well-led process sails the ship through rough misconstrue the truth, and to dismiss our own errors and vul- seas and reaches the destination unharmed (fgure 4). Seeking the perspectives of others can provide a helpful corrective to one-sided perceptions. Friends and family members know us well and can often help us confront issues we might otherwise avoid. Colleagues can also serve in this role, particularly with respect to professional issues and situations. When the skills not particularly healthy, working with a professional (a waves of change are high it can be diffcult to remember that life coach, mentor or therapist) can be of value. When we are feeling consumed by change, it is The fellow meets with the other fellows in the department critical to force ourselves to shift perspectives. Physical activity, and discovers that everyone is dealing with the news in a mindful practices, healthy distraction, time with loved ones and similar fashion. They openly discuss their concerns about good friends, and engagement in hobbies and activities take on job security, workplace culture, and the way in which more importance. These activities remove us from the stress information was either withheld or presented late in the of change and also help us put our worries in perspective. More importantly, they talk about the posi- tive possibilities that the announced changes might bring. The fellow begins to spend more time at the gym, as One of the fellows notes that enhanced academic activity working out helps clear their head and brings them new might facilitate the development of new resources for insights. The fellow also begins to spend more time with their hockey team and enjoys the break that this activity gives from the work-related worries. It can be helpful to consider where we would like to be at the end of that phase and to do what we can to progress toward that goal. If we allow ourselves to keep moving forward, and allow ourselves to be fexible and to let some things go, we are likely to end up in a better place than the one we left behind. Case resolution The fellow meets with the new chair and shares their personal career goals and aspirations. Together, they real- ize that a new opportunity in quality management exists that would allow the fellow to contribute to the academic mission of the department while focusing primarily on clinical practice. Several years later, the fellow is deeply satisfed with their clinical practice and overall position Strategy 4: Be fexible and anticipate the unexpected. When a hurricane hits landfall, the most vulnerable objects are those that are rigid. Without fexibility, structures cannot cope with stress and tend to snap or bend hopelessly out of Key references shape. In practical terms, this means ensuring that we take time to carefully refect on aspects of change, thinking Flach F. New of various ways we can and ought to react to circumstances, York: Hatherleigh Press. Cambridge: Harvard Business to project genuine thoughtfulness and consideration, and School Press. The fellow moves from a perspective of frank hostility toward the new chair to a stance that is at least open to considering how the fellow might ft within the depart- ment s new vision. Initially, efforts Eight per cent of physicians will struggle with substance abuse in physician health focused largely on helping to recognize, and dependence at some point during their career. Caring for colleagues The chapters in this section will outline a number of unique It is essential that physicians have access to clinical services issues of importance to meeting the needs of Canada s physi- that appreciate the unique aspects of care associated with phy- cians, as follows: sician health. This chapter is designed to help inform providers on issues that require particular attention, such as establishing Physical health rapport, boundaries, confdentiality and privacy. This chapter will emphasize the importance for physicians of having a primary care provider, outline unique issues faced by Mandatory reporting physicians as patients and as health care providers for other Perhaps the most confusing and uncomfortable area of concern physicians, and suggest practical strategies that can directly to physicians as patients, and to physicians providing care to promote physicians physical health. This chapter outlines some of the key principles involved in mandatory reporting, Mental health offers practical tips and strategies to inform the decision to It is alarming to consider that the rate of suicide among report (or not), and suggest further resources that physicians medical professionals and trainees is much higher than among may consult. Fortunately, physicians and medical students are increasingly recognizing the importance of mental Physician health programs health, and physician health programs are reporting a rise in Canada has a national network of physician health programs the number of requests received for help in this area. This sec- that allows every medical student, resident and practising tion will outline the most common mental health issues among physician access to services and programs focused on their physicians, summarize the challenges physicians face when unique health needs. This chapter summarizes the history of they consider or seek care, and emphasize how intervention these programs, outlines other national efforts in physician and treatment are highly successful. Interactive and practical, well as several of the unique sources of stress in the medical it includes sections on relationships, depression and workplace. This section section of the guide and offers practical methods to will address these themes and outline other resources that enhance the health care workplace. Many other sections cian health, information on upcoming conferences of the Physician Health Guide will be of value in your search and workshops, and additional learning resources on for information and practical ways to move forward with your physician health. Yizchak Dresner examined population outline preventive care guidelines, quality indicators for physicians as compared to non physicians. Screening colonoscopy rates were higher Case and fecal occult blood testing rates lower among physicians. A fourth-year resident has planned a dream vacation with For complex reasons, it appears that the care physician patients their spouse to Africa. This is not always to resident keeps putting off getting vaccinations and has their advantage. Frustrated, the resident turns to a fellow in providers infectious disease and asks for help, as the resident feels All patients self-diagnose, including physician patients. Like other pa- tients, a physician patient may fail to recognize the seriousness Introduction of a symptom or to recognize non-specifc symptoms. And, Physicians receive care that is different from that obtained by like others, physician patients may avoid seeking care because other people because they are physician patients. To expect a treating physician to provide Physician patients also have a tendency to edit out information generic medical care and ignore occupational issues specifc to that does not ft with their original self-diagnosis. It is not known how think you know, what you would like to know, and what you physicians apply their knowledge and experience to decisions need to know in order to manage your health care. Although physicians have had extensive training, they may lack information on prevention, screening, diagnosis and treatments in certain areas. Preparing for a primary care visit: Tips for the physician patient The underuse of family physicians and preventive health Book an appointment and advise the staff of services by physicians themselves is notable and concerning. Physician patients, even those with health problems or concerns, likely have far fewer routine visits than the average patient; thus, a periodic health examination is of great importance to this group. Do doctors look after their health as well as play in sustaining the health of fellow health professionals, their patients? Health problems and the use of health services Case resolution among physicians: A review article with particular emphasis on The fellow gently and respectfully refuses to treat the Norwegian studies. The fellow suggests that the resident see a family physician, as it has been three years since the last primary care visit.

Gastric cancer is reportedly higher in patients having had a previous gastric surgery generic 25 mg pamelor visa. Four cases were localized type found at gastric antrum and two cases were generalized type with linitis plastica appearance of the stomach 25 mg pamelor sale. One case showed hyperrugosity of gastric rugae folds with relative normal gastric volume and peristalsis 25mg pamelor free shipping. So elderly patients presented with hyperrugosity we must have high index of suspicions for primary gastric carcinoma. Chloroquine 300 mg base was administered orally to 16 adult diarrhoeal patients from the Infectious Disease Hospital, Yangon and 12 healthy non-diarrhoeal volunteers. The drug serum levels at various time intervala up to 96 hours were analysed fluorometrically and the pharmacokinetic profile studied. Acute diarrhea was found to decrease the rate, but did not alter the extent of absorption of chloroquine. Sine the overall bioavailability of chloroquine remaina unchanged, it was concluded that if ther is no vomiting, dosage adjustment is not necessary in acute diarrhea. Computation was made of prevalence and intensity (worm burden) of Ascaris infection, and other parameters for estimation of basic reproductive rate (R0) of the parasite and of the proportion of target age group to be treated 3-monthly (g) by employing the mathematical model for targeted chemotherapy. The 3 treatment regimens were almost equally effective in reducing prevalence and intensity in both the targeted and non-targetted age groups. Ascaris transmission in each of the 3 communities was interrupted, as indicated by the values of mean worm burden per person. The findings are compared with those of other similar studies and the reasons for the impact are discussed. The possible impact in similar endemic areas of applying the mathematical model predictions for age-targetted chemotherapy in controlling ascariasis is also discussed. Also, there is a lack of information on the comparative prevalence of malnutrition and intestinal parasitosis among school-enrolled and non-enrolled school-age children in Myanmar. We, therefore, undertook a cross-sectional survey comprising 3325 school children from 13 primary schools and 164 non-enrolled school-age children from neighbouring quarters. Height and weight of the children were measured and a total of 944 stool samples, including 148 non-enrolled children, were examined for the presence of intestinal parasites. Expressing the nutritional status as standard deviation scores for weight- for-height, the prevalence of wasting among 5-10 years non-enrolled school-age children was 151 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar 19. In addition, non-enrolled school-age children had higher infection rates than school children regarding Ascaris lumbricoides (66. The policy implication on this study is that health and nutritional status of non- enrolled school-age children needs to be promoted and this should be partly solved by the provision of regular and periodic mass chemotherapy against major intestinal parasitoses influencing nutritional status. Morbidity of patients with and without peritoneal drain was compared regarding the postoperative fever, duration of nasogastric suction, duration of stay in bed, wound sepsis and hospital stay. Some of the findings were as follows; most of the drain (26 out of 27) could not fulfill their function well, the commonest complications of the peritoneal were (a) sepsis at the drain site (77. Duration of the postoperative fever, nasogastric suction and be stay were more prolonged in patients with peritoneal drain than those without peritoneal drain. Modern management of peptic ulcer includes eradication of associated Helicobactor pylori infection with the use of expensive drugs such as colloidal bismuth citrate and a combination of antibiotics. Regimens such as proton-pump inhibitors and newer antibiotics such as clarithromycin are also used but unfortunately these medicines are also expensive and may not be affordable for a developing country like Myanmar. Plantigo major Linn (Ahkyaw-baung-tahtaung) is readily available and affordable plant compound with reputed healing activities and with documented anti-ulcerogenic properties. In the initial 7 days, they also received Amoxicillin (1000mg twice a day) and Tinidazole (500)mg twice a day. Histological examination of gastric biopsies for gastric severity and biopsy urease 14 testing and C breast test for the presence of H. P major is a potential candidate to be used as a medication in the management of peptic ulcer disease in Myanmar. In 11 patients 1% Thrombar was used as a 152 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar sclerosant and in the remaining 10 patients who are unable to afford it, 100% Alcohol was used as a sclerosant. With 1% Thrombar, obliteration of the varices was achieved in 6 patients, persistence of the varices was noted in 2 patients even after 5 sessions of sclerotherapy, in whom the shunt operation had been advised; 3 patients died during the follow up period due to recurrent bleeding. With 100% Alcohol, obliteration of the varices was obtained in 4 patients, 3 patients had some improvement and 1 patient died during the follow up period. The incidence of oesophageal ulceration and other side effects after the procedure were the same in both series. It is evident that 100% Alcohol is as effective as 1% Thrombar in the sclerosis of the oesophageal varices. Ulcer healing was achieved in 24 out of patients (95%) in Denol group and 29 out 30 patients (96. Helicobacter eradication was achieved in 17 out of 25 patients (68%) in Denol group and 8 out of 30 patients (26. Denol is superior in eradication of Helicobacter pylori infection, however, one week treatment of antibiotics is not sufficient to obtain satisfactory eradication rate for Helicobacter pylori infection. The specific study regarding bowel habit included retrospective and prospective studies done on 300 children aged 1 to 5 years. In the retrospective study investigated by asking the questionnaires to the mothers, each child passed 2 soft stools per day with an average of one tea cup for each motion. In the prospective study, in which each motion of every child was observed for one week, the amount of stool passed per motion ranged from 54. On average, they passed stools once daily for 5 days, and twice daily for at least one day. The small intestinal transit time, done on 74 children by breath hydrogen test, was 90. The whole gut transit time done on 30 children by colorimetric method using Norit capsules were 1009. The amount of daily stool output in our children was very much larger than that of children from the United Kingdom. The whole gut transit time of our 153 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar children was similar to those in Bangladesh. The study involved 1206 children aged 2-12 years in 21 villages in Myanmar [Burma] starting in August 1984. The intervention and non- intervention villages were comparable regarding almost all the important baseline variables, including prevalences of Ascaris infection (80. A significant increment of th th height gain was found, starting after the 6 month, and of weight gain after the 24 month, of the study among the treated 2-10 years old children when compared with the non-treated ones. Lesser increments in height-for-age and weight-for-age were also observed after successive treatments among the treated children with initially higher mean worm burdens. The findings are discussed in the context of causal relationship between ascariasis and malnutrition in children. The controls, consists of 6 children from the same locality as patients, were apparently healthy and in the same age group. Serum chloride tends to increase in the patients and the increase was more pronounced in the group suffering from both malnutrition and diarrhea. Serum aldosterone levels were raised in all the three groups of patients namely malnutrition, diarrhea. Rural area of Shwepyithar Township, Yangon Division and rural area of Tharbaung Township, Ayeyarawaddy Division were chosen for diarrhoea case management trained area (case) and non trained area (control) respectively. From each trained and non trained areas 100 mothers of under five children, 6 basic health staff and 4 voluntary health workers were included in the study. Regarding the result of basic health staff there was no difference between training and non training areas, both area showing reasonably good results. Most of the intestinal types were well and moderately differentiated, and most of the diffuse types were poorly differentiated. Peritoneal aspiration cytology was performed in 41 patients who were provisionally diagnosed as acute appendicitis. Patients with positive results underwent emergency surgery, 34 had histologically proven acute appendicitis and two patients were of other cause (tubo-ovarian abscess and Meckel s diverticulitis). It is concluded, therefore, that peritoneal aspiration cytology is a useful diagnostic test in management of patients with suspected acute appendicitis. Hence, the detection of Urease activity in gastric biopsies is used for assessment of the presence of Helicobacter pylori in chronic gastritis. With an aim to establish a sensitive and locally available test kit, microtiter biopsy urease broth testkit is developed. All cases presented with features consistent with findings reported by other s from developing countries.

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