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II. Dissertation 20 Choose one of the two essay questions and respond with a one-page recto about 200 words ; essay. In France, about 10% of the population uses anti-depressants. Describe the pros and cons of this medication. Do you think it is a good idea that general practitioners have the right to prescribe them? Or Define generic drugs and explain the current debate on their use in France.
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ASSOCIATION OF DEPRESSIVE SYMPTOMS WITH ANGIOGRAPHIC CORONARY ARTERY DISEASE Shalini Chhabra, PGY3, Internal Medicine * ; Sandeep Chhabra, PGY6 Cardiology Fellow, SUNY HSC Brooklyn; Satish Reddy, Assistant Clinical Professor Of Psychiatry. The Brooklyn Hospital Center, Brooklyn, NY PURPOSE: While the incidence of depression after myocardial infarction has been studied, there is paucity of data on the prevalence of depression in patients presenting with angina like symptoms. We studied whether depressive symptoms are associated with presence & extent of coronary artery disease CAD ; or angina as graded by the Canadian Cardiovascular Society Classification System. METHODS: We prospectively enrolled patients who were referred for cardiac catheterization during a one month period. Patients with previously established CAD diagnosis previous MI CABG previous cardiac catheterization previous PCI etc. ; were excluded. Patients were administered the Hamilton Rating Scale for Depression HAM-D ; questionnaire prior to undergoing cardiac catheterization. CAD was defined as an epicardial stenosis 50%. RESULTS: 33 of 45 patients completed the questionnaire and were included in the study, mean age 57 8 years, 48%male. 58% of patients were found to have CAD. There was no significant difference between mean HAM D scores in patients with and without CAD 8.7 -6.5 vs 8.4 -7.4 in patients without CAD. There was no relationship between HAM D scores and the extent of CAD r -.09, p .7 ; . Depression scores were strongly correlated with anginal scores r .7, p .01 ; . CONCLUSION: In a consecutive series of patients referred for cardiac catheterization, depressive symptoms were related to anginal symptoms but not to the presence or extent of angiographic coronary artery disease. CLINICAL IMPLICATIONS: The strong relationship between depressive symptoms and anginal symptoms suggests that depression lowers the threshold for anginal chest pain or that anginal chest pain is another clinical manifestation of depression in a subset of patients. DISCLOSURE: S. Chhabra, None.
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About clinic-pathogenesis virgogamia were widened. For the first time the complex investigation of clinic- psychopathologic, psychological, social, hormonal and of vegetative level of patients with virgogamia was made. The psycho traumatic factors, which are components of neurotic disorders, and proximate reasons of couples disharmony were marked, and this brings to neurotic misbalance; the specification of sexual disorders in patients with virgogamia was investigated, the psychological behavior and psycho vegetative dysfunctions were studied in patients with virgogamia; diagnostic meaning of neurotic disorders were investigated and several clinical syndromes which effects on virgogamia were chosen; the personal-specialties of patients with virgogamia were investigated. The principle of psychotherapy of neurotic disorders were offered and the recommendations of their corrections were made. Conclusions: The research helps us show the diagnostic level of neurotic disorders of psychic in virgogamia. The recommendations on deferential psychotherapy effects on the treatment of virgogamia are stated. The modern investigation and treatment of virgogamia can serve as a prophylactic of nervous and nervous conditions among the population of our republic. PP.406 An Evaluation of Psychosexual Adjustment In Patients With Physical Intersex Condition In Taiwan: A Pilot Study Hsin-Yi Liang Department of Child Psychiatry, Chang Gung Children's Hospital, Tao Yuan, Taiwan Aim: To understand the psychopathology, quality of the life, body image, psychosexual adjustment, and the impact of prior of gender assignment surgery to patients with physical intersex condition in Taiwan. Method: Patients were evaluated with Child Behavior Checklists, the Body Image Questionnaire, Quality of life Questionnaire, and Chinese Health Questionnaire. Psychopathology, gender identity and sexual orientation were assessed by a semi-structured interview, conducted by child psychiatrists. Information about disease characteristics and genital surgery, and the gender preference of the families were obtained from medical records. Result: Among of the 16 patients, eleven of the pseudohermaphroditisms born with ambiguous external genitals received gender-assignment surgery. Two of patients were female pseudohermaphroditisms without prior gender assignment sought medical evaluation due to primary amenorrhea at the ages of 19 and 24 delayed diagnosis ; . Three born 46 XY females with complete female external genitalia were assigned female sex. One bisexually orientated patient suffered from gender dysphoric disorder; another homosexual patient suffered from gender identity disorder. Six patients showed low scores in appearance evaluation and appearance orientation of body image. Conclusion: We noticed that early diagnosis followed by adequate intervention and illness education for parents and patients result in good adjustment and better mental health in later life. From this study, we would suggest earlier psychiatric evaluation and management for these patients. PP.407 Evaluation of Sexual Dysfunction Among Women On Flouxetine Therapy In Tabriz Fatemeh Ranjbar Kouchaksaraei, Solmaz Vojoudi, Gholamreza Norazar Tabriz University of Medical Science, Iran Background and objectives: One of the most common side effects of selective serotonin reuptake inhibitor SSRI ; drugs is.
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CLASS: HIV protease inhibitor PI ; STANDARD DOSE: Rarely used by itself two 400 mg capsules every eight hours with no food or a low-fat snack ; . Almost always boosted with Norvir, both twice daily: 400 mg Crixivan + 400 mg Norvir; 800 mg + 100 mg; or 800 mg + 200 mg all combination doses taken with food, and with plenty of water to avoid kidney sludge or stones ; . Take missed dose as soon as possible, but do not double up on your next dose. Also available in 100 mg, 200 mg and 333 mg capsules. AWP: $548.12 month for 400 mg, 180 capsules MANUFACTURER CONTACT: Merck and Co., crixivan , 1 800 ; 8503430 AIDSINFO: 1 800 ; HIV0440 4480440 ; , aidsinfo.nih.gov POTENTIAL SIDE EFFECTS AND TOXICITY: Potential side effects include: headache, fatigue or weakness, malaise general ill feeling ; , nausea, diarrhea, stomach pains, loss of appetite, yellowing of skin eyes, changed skin color, dry mouth sore throat, taste changes, painful urination, indigestion, joint pain, hives, and liver toxicity. Itchy dry skin, ingrown toe nails and hair loss are unique to Crixivan. Kidney stones, which may lead to more serious problems, can also occur. If pain develops in the middle to lower stomach or the back, or if there is blood in the urine call your healthcare provider immediately. An increase in bilirubin a test of liver function ; has been reported, but it is not associated with liver problems. It may sometimes cause yellowing of the skin or eyes. As seen with other protease inhibitors, there can be increased levels of cholesterol and triglycerides except possibly unboosted Reyataz ; which may be associated with an increased risk of heart disease. But it is important to remember the risk of heart disease is determined by many other factors, such as family history of heart disease, smoking, high blood pressure, diabetes, obesity, etc. HIV therapy should not be delayed due to this risk. Other possible side effects are lipodystrophy body fat changes, including thinning of the face, arms and legs, with or without fat accumulation in the stomach, breasts and sometimes the upper back ; , onset of new cases or worsening of diabetes see your doctor promptly ; and increased bleeding in hemophiliacs. POTENTIAL DRUG INTERACTIONS: Do not take with Tambocor flecainide ; , Rythmol propafenone ; , Cordarone amiodarone ; , Versed midazolam ; , Halcion triazolam ; , Rifadin rifampin ; , Orap pimozide, a psychiatric drug ; , ergot derivatives such as Cafergot, Wigraine and Methergine, D.H.E. 45 ; , garlic supplements, or the herb St. John's wort hypericum perforatum ; . Do not use Zocor simvastatin ; or Mevacor lovastatin lipid-lowering alternatives are Lipitor atorvastatin ; , Lescol, and Pravachol pravastatin ; , but they should be used with caution due to potential for liver toxicity. Not recommended in combination with Reyataz. Reduce Crixivan to 600 mg every eight hours when taken with Rescriptor. Reduce Crixivan to 600 mg every eight hours when taken with Sporanax itraconazole, 200 mg twice-a-day ; or Nizorwl ketoconazole, 200 mg once-a-day ; . The dose of rifabutin Mycobutin ; should be reduced by 50% and increase Crixivan dose to 1, 000 mg every eight hours when taken together. Protease inhibitors increase blood levels of Viagra sidenafi l citrate ; , Cialis tadalafi l ; and Levitra vardenafi l ; . Use with caution. Initially the Viagra dose should be 12.5 mg 1 2 of 25 mg tablet ; and increased as needed and tolerated. It's recommended that people on PIs do not exceed 25 mg of Viagra in a 48-hour period because of potential for serious reaction such as low blood pressure, visual changes, and prolonged erection leading to permanent tissue damage. Use Cialis at reduced doses of 10 mg every 72 hours and Levitra at reduced doses of no more than 2.5 mg every 72 hours, with increased monitoring for adverse events. Effectiveness of birth control pills may be decreased; consider the use of alternative or additional contraception. Additional monitoring may be required when taking Coumadin, immunosuppressants, or calcium channel blockers such as Norvasc, Procardia, and others ; . Tegretol, Dilantin, or phenobarbital may decrease Crixivan, so alternate seizure medications should be used. Crixivan may decrease levels of methadone but withdrawal rarely occurs and methadone doses may need to be increased. Also, increased levels of Desyrel trazodone ; can occur with Crixivan, which may lead to nausea, dizziness, low blood pressure, or loss of consciousness. 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Products and services What legislative and regulatory matters are most important for ASCP to be working on? In the following order, members said these matters were the most imporant: legislating payment for clinical services influencing Medicare drug benefit regulations monitoring and influencing nursing home regulations, including survey issues Please tell us the top two ways you prefer to obtain continuing education. Members surveyed said live meetings and print are the top two ways they prefer to obtain continuing education. In thinking about other professional associations in which you have been a member, how well does ASCP serve you compared to these other membership organizations? Members ranked the following services as the top three: keeping me informed about issues affecting my practice.
Also known as: Citrus Aurantium Amara, Citrus Bergamia, Citrus Bigaradia, Citrus Vulgaris Historical Perspective: Bitter Orange is a plant that belongs to the Rutaceae Family. The peel, flower, leaf, and fruit are used in both traditional Chinese medicine and in modern medicine. Common Uses: As a dietary supplement, bitter orange has been marketed to help relieve stomach upset, stimulate the appetite, assist with mild insomnia, and treat ringworm infections such as athletes foot and jock itch. Bitter orange fruit and peel are also commonly marketed as a weight loss remedy and a nasal decongestant. Topically, bitter orange peel is used for inflammation of the eyelid, skin bruising, and muscle pain. The Food and Drug Administration FDA ; has approved bitter orange in small amounts ; as a flavoring agent. In manufacturing, bitter orange is used in pharmaceuticals, cosmetics, and soaps. Form s ; Used: Bitter orange is available as an oil, fruit, peel, or juice. Potential Side Effects: Bitter orange is safe in the small amounts found in foods. HOWEVER, bitter orange is not safe when used in high doses due to the fact that it contains the stimulant called synephrine. Bitter orange, which contains synephrine and N-methyltyramine, can cause hypertension and cardiovascular toxicity. The adverse side effects of bitter orange can be exacerbated when used in combination with other stimulants such as caffeine, coffee, cola nut, ephedra, guarana, and mate. Frequent contact with bitter orange peel or oil can also cause adverse skin reactions, which include sensitivity to the sun, blisters, pigment spots, and others. The ingestion of large amounts of bitter orange peel in children can cause intestinal colic, convulsions, and even death. Food-Drug-Supplement Interactions: Bitter orange interferes with many drugs. Bitter orange may INCREASE stomach acid, which might interfere with the effectiveness of acid lowering drugs. Some of these medications include: 1 ; Antacid medications calcium carbonate Tums ; , aluminum magnesium hydroxide Maalox ; , and others 2 ; Ulcer medications sucralfate Carafate ; ranitidine Zantac ; , omeprazole Prilosec ; , and others. Bitter orange can also INCREASE THE SIDE EFFECTS of many other medications. Some of these medications include, but are not limited to the following: 1 ; Anti-anxiety medication Alprazolam Xanax ; , and others 2 ; Blood pressure medications felodipine Plendil ; , losartan Cozaar ; , verapamile Calan, Isoptin ; , and others 3 ; Cholesterol medications lovastatin Mevacor ; , simvastatin Zocor ; , and others 4 ; Decongestant medications phenylpropanolamine Dura -Vent, Entex LA ; , pseudoephedrine Sudafed ; , and others 5 ; Depression medications amitriptyline Elavil ; , buspirone Buspar ; , citalopram Celexa ; , sertraline Zoloft ; , phenelzine Nardil ; , and others 6 ; Allergy medication fexofenadine Allegra ; 7 ; Fungal medications itraconazole Sporonox ; , and ketoconazole Nkzoral ; continued on next page.
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Department of Zoology, Faculty of Science, Charles University, Vinicn 7, CZ-128 44, Prague 2 Faculty of Biological Sciences, University of South Bohemia, Branisovsk 31, CZ-370 05, Cesk Budjovice Spiny mice are a proper model for studies concerning sex ratio. They possess several predispositions to maternal manipulation of the sex ratio: 1 ; they regularly live in environments with high spatiotemporal variation in resource availability. 2 ; Adolescent males are driven away by the territorial male while females are tolerated. Local resource competition between the mother and female offspring can be, therefore, reasonably expected. 3 ; Spiny-mice have extended gestation period 36-42 days i.e., nearly twice as long as in laboratory mice ; and large and well-developed newborns. Maternal investment is therefore extremely biased in favour of prenatal period. Thus, maternal manipulation of sex ratio after the parturition is unlikely. Our laboratory colonies of spiny mice were of following origin: A. cahirinus from Abu Simbel in southern Egypt, A. cilicicus from Silifke in southern Turkey, A. sp. from SW Iran and A. dimidiatus from Israel. The animals were kept in family groups consisting of 2 nearrelative females full or non-full sisters ; , 1 non-relative male, and their descendants. The groups were established from founding animals about the age of 3 months maturing age ; and then allowed to breed freely for several months. Manipulation with group structure occurred only in case of male aggression between male founder and his mature male offspring in these cases were young males removed ; . Each litter and its circumstances were thoroughly recorded. Altogether, we collected data concerning 1079 litters 112 of A. sp., 169 of A. cilicicus, 384 of A. cahirinus and 414 of A. dimidiatus ; . We recorded sex of 3126 newborns of which 1518 were males and 1608 were females. Thus, overall sex ratio was close to one to one 48.6% ; . Among studied species, only A. sp. from Iran exhibited significant deviation from balanced ratio 41.7% of males ; , however, this particular population was represented by the smallest sample size. GLMM evaluating the effect of four life history and six social variables has revealed significant effect of the number of adult males, number of juvenile males, litter size and number of juvenile females on sex ratio. While the first two factors contributed positively those latter contributed negatively. In spite of their statistical significance, we emphasize that these effects are very small. Therefore, we conclude that our empirical data do not support maternal manipulation hypothesis.
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This November ACAM will host an extraordinary conference is Palm Springs, California. We invite you to rest, relax and connect in this tranquil environment while earning up to 36 CMEs. This fall we present "Neurorestoration: Integrative Approaches to Brain Health." Our faculty will deliver the latest in evidence-based, cutting-edge CAIM research. There are four preconference workshops to choose from. We have designed the schedule to allow you to attend two one-day seminars that will enrich your practice.
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Fig. 3. Early response of corneal nerves during wound healing. AntiIII tubulin staining for corneal nerves at 0 hour A ; and 24 hours B ; after wounding. There were fewer nerves detectable at 0 hour and most were randomly distributed. At 24 hours after wounding, nerve numbers were increased dramatically. Nerve sprouts run parallel to each other and are oriented perpendicularly toward the wound edge bottom ; . Bars, 50 m.
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