Immune Checkpoint Inhibitors Immune checkpoint inhibitors are a class of immunotherapy that activate tumor-killing immune cells. Precision Medicine the advent of precision medicine will enable patients to have their tumors profiled for mutations that render them sensitive to certain therapies. Patients who participate in clinical trials become citizen scientists, providing an invaluable service both to treatment science and fellow patients. Clinical trials bring life extending and curative new treatments to cancer patients. At what time during disease progression and treatment do we insert a drug into the regimen? Treatments that are approved will further improve outcomes for patients and join the 8 lifeextending drugs that have been approved for men with advanced metastatic prostate cancer: 3 Jevtana (cabazitaxel) 3 Keytruda (pembrolizumab) 3 Provenge (sipuleucel-T) 3 Taxotere (docetaxel) 3 Xgeva (denusomab) 3 Xofigo (radium-223 dichloride) 3 Xtandi (enzalutamide) 3 Zytiga (abiraterone) For more prostate cancer clinical trial information, visit the Prostate Cancer Clinical Trials Consortium at If you are considering a clinical trial, speak to your doctor about the potential benefits of participating in a trial so you can make an informed decision that is best for you. Remember: A common misconception about clinical trials is that the "placebo" group gets no treatment at all; in fact, they still receive the minimum standard of care. Phase 1: Test a new agent on healthy volunteer test subjects for overall safety and to find the appropriate dose that can be safely given with acceptable side effects. Phase 3: Compare promising treatments from Phase 2 against standard treatments to determine if the test treatment works better and has fewer or more manageable side effects. Phase 3 trials are typically large (hundreds of patients), randomized (each patient is randomly assigned to the standard treatment or the test treatment), and sometimes blinded (the patient and/or doctors are not told which treatment the patient is getting as a way to control for the "placebo effect"). Revisiting Family Risk If a family history of prostate cancer or genetic predisposition exists, it is all the more important that your family understand the full picture of risk related to prostate cancer. Age: the risk of prostate cancer increases with age, and average age at diagnosis of prostate cancer in the United States is 69 years. Race: African Americans are more likely to develop prostate cancer and have more than twice the risk of dying from it. Conversely, Asian men who live in Asia have the lowest risk; but when they migrate to the west, their risk increases. Family history: A man with a father or brother who developed prostate cancer has a twofold-increased risk for developing it. This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected 3 or more family members. You should discuss with your doctor if you have a family history of not only prostate cancer, but also breast cancer, ovarian cancer, colon cancer, or pancreatic cancer. Where you live: the risk of developing prostate cancer for men who live in rural China is 2%, and is 17% for men in the United States. Similar results were found in Sweden, which is also a high-risk country for prostate cancer: immigrants to Sweden had a lower risk compared with native-born Swedes but, interestingly, the difference diminished the longer they were in Sweden. As mentioned, prostate cancer is over 8 times more common in Western culture than in Asia; moreover, when Asian men migrate to western countries the risk of prostate cancer increases over time. Researchers are now looking at prevention strategies which may shed light on this mystery. Because we now know so much about the relationship between genetics and risk, it is our hope that readers will immediately consider these issues in consultation with their extended family. The question of screening is a personal and complex one, which may be further complicated by family history. Benefits include early detection, offering a better chance to cure the disease if your cancer warrants treatment. The problem with screening is that, because most prostate cancers grow very slowly, the side effects of diagnosis (a prostate biopsy) and treatment of low-risk prostate cancers would likely outweigh any benefit that might be gained. Very few men will die of these less-aggressive forms of prostate cancer in the first decade after diagnosis. When to Start-and Stop-Screening Age 40 is a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate, breast, or ovarian cancer at a young age). For men age 70 years and older, they continued to recommend against screening for prostate cancer, with the rationale that potential benefits do not outweigh the harms. For otherwise healthy men at high risk (positive family history or African American men), starting at age 40 to 45 years is reasonable.
A great many physicians may indeed have been motivated to the profession we have chosen in some magical effort to control death. The inevitability of our own mortality disturbs us all to a greater or lesser extent, in spite of our best efforts to contain and control it with black humor, denial or active combat, but we cannot evade it and will not be excused from dealing with it. And the thought occurred to me that maybe the pornography of violence and death that we are constantly exposed to in our media, in movies and in video games is (subconsciously? He writes: Heart in Hand 176 Suppose, then, that after the greatest, most passionate vividness and tender glory, oblivion is all we have to expect, the big blank of death. One option is to train yourself gradually into oblivion so that no great change has taken place when you have died. This is what the Beat writer Jack Kerouac did and many other people have done as well. In his essay, "After the Deluge," shortly before his death, he wrote: A lifelong struggle to avoid disaster. Politics, gambling, hard work, drinking, patriotism, protest, pooh-poohings, all therapeutic shifts against the black void. Why am I made to feel that I am free, while yet I am constrained within my character as in a prison? He never really found deliverance in his agonized effort to find sense in human life. He was distracted by ardent activity; he was helped by his sense of humor to cast off the burden; a vivid concern about intellectual question strengthened him and helped to still a nearly unquenchable thirst for knowledge and comprehension. Do we have only two paths to choose from, as Woody Allen, with black humor puts it: "Despair and utter hopelessness" or "Total Extinction"? Total Extinction it could be, but, if so, there are several things that we can do along the way to ward off and hold at bay the despair and hopelessness of this outcome. Confronting Death 177 One thing to do is to live day-to-day in the eternal present. Like George Crosby, we should strive to live in a way that embraces a compassionate approach to life. The loving care with which he handles those vines seems to inject a kind of kinetic energy into the body of this nearly 102 year-oldman, almost like it comes from another world. It comes from the innermost nature of our world, from the ultimate underlying reality of life. I am convinced, not only as an observer of the human condition but also as a physician, that following this approach to life is the best and most secure way one has of living, in good health, to an old age. Another way we can cope with the potential oblivion of death is to engage in "a vivid concern about intellectual questions" and to have "an unquenchable thirst for knowledge and comprehension. Intellectual pleasures are one kind of pleasure seeking that does not produce boredom. Instead of boredom, seeking intellectual pleasures and insights produces the opposite effect. There is simply not enough time to read all the books you want to read and to gather all the information you find that you want to gather. The only thing one can do is to live a long life, like George Taylor, who in his nineties continues to be a voracious reader with well-honed critical faculties and a sharp wit. We may not like what we find out about the realities of life, but at least there is some solace in knowing. There is some comfort to be found in knowing that we are not being fooled or duped about what the true realities of life really are. The veneer of civilized behavior in human beings may be thinner than we thought, or would like it to be, but there are many fascinating and comforting aspects to the realities of life. We can take a kind of deep-seated consolation in knowing how bacteria work altruistically to support each other as a global community. It is interesting to know and understand how we evolved from them, and to appreciate the very close biological connection we have with all living things. And finally, we reflective animals have acquired the wonderful capacity to be able to appreciate art.
Diseases
On the right, urine flow is affected because the enlarged prostate is pressing on the bladder and urethra. Your symptoms may change over time, so be sure to tell your doctor about any new changes. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear. The doctor passes an instrument through the urethra and trims away extra prostate tissue. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery. This can be an option for men who should not have major surgery because they have other medical problems. The doctor passes a laser fiber through the urethra into the prostate, using a cystoscope, and then delivers several bursts of laser energy. General anesthesia or a spinal block is used, and a catheter remains for 3 to 7 days after the surgery. Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure. For a list of questions to ask, see the "Checklist of Questions for Your Doctor" on page 28. Cell changes may begin 10, 20, or even 30 years before a tumor gets big enough to cause symptoms. By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. So bone pain, especially in the back, can be a symptom of advanced prostate cancer. African-American men have the highest risk of prostate cancer-the disease tends to start at younger ages and grows faster than in men of other races. After African-American men, 20 prostate cancer is most common among white men, followed by Hispanic and Native American men. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer. Studies have shown that 5-alpha reductase inhibitors finasteride and dutasteride can lower the risk of developing prostate cancer, but whether they can decrease the risk of dying of prostate cancer is still unclear. A screening test may help find cancer at an early stage, when it is less likely to have spread and may be easier to treat. Doctors do not yet know whether prostate cancer screening lowers the risk of dying from prostate cancer. Therefore, large research studies, with thousands of men, are now going on to study prostate cancer screening. Although some people feel it is best to treat any cancer that is found, including cancers found through screening, prostate cancer treatment can cause serious and sometimes permanent side effects. Some doctors are concerned that many men whose cancer is detected by screening are being treated- and experiencing side effects-unnecessarily. Talk with your doctor about your risk of prostate cancer and your need for screening tests. They can help you find the best care, answer your questions, and address your concerns. Talking openly with your doctors can help you learn more about your prostate changes and the tests to expect. It is a good idea to get a copy of your pathology report from your doctor and carry it with you as you talk with your health care providers. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine.
Pharmaceutical chemistry is focused on quality aspects of medicines and aims to assure fitness for the purpose of medicinal products. The facility has been established to offer researchers with small molecule synthesis and drug metabolism expertise. The main goal of the core will be to help facilitate and stimulate fundamental and collaborative research at the university; a chemical synthesis core geared t o p rovide c ompounds t o he lp r esearches v alidate pr oof-of-principle t arget discovery studies and/or assist in pre-clinical evaluation. Wempe, PhD a) How is the quality of your measurements evaluated quality control? University of Colorado Cancer Center Metabolomics Core Contact: Natalie Serkova, PhD, Director Associate Professor, Dept. Natalie Serkova Metabolomics, one of the "omic" sciences in systems biology, is the global assessment and validation of endogenous small-molecule biochemicals (metabolites) within a biologic system. We performed expanded quantitative metabolic analysis: · · · · on cells cell extracts human and animal tissues and biopsy extracts body fluids (including blood, plasma, urine, cerebral and prostatic fluids etc). Our Services · · · · · · · · · Project design and consultation: recommendations and advice on end points to be monitored, budget, suggestions for data analysis. We do it already for the past 3 years: Cancer Center provides us with our cost study every fiscal year. This Core provides an array of assays over a broad range of species (rat, mouse, human, sheep) and tissue types (fat, muscle, liver), for multiple investigators studying the clinical consequences of nutrition-related disorders. For example, many investigators who did not previously assess insulin action in their own studies have taken advantage of this core laboratory to obtain these measures using the insulin signaling assays. Thus, the Metabolic Core of the Nutrition Center achieves an overall cost-savings and provides more important investigator time in their own laboratories for their own experiments. TaqMan probes available from the Core range from genes involved in gluconeogenesis and lipogenesis to neuropeptides and transcription factors, as well as reference genes for normalization of gene expression. The Core measures activity and phosphorylation state (tyrosine and/or serine) where appropriate. The Metabolic Core lab is also a resource for providing expertise and technology for analysis of genetically defined mouse and rat models relevant to nutrition research. We provide experimental support and technical advice regarding measurement of insulin sensitivity in vivo (insulin clamps) and end organ-based metabolism. Facilities: the Metabolic Core Laboratory is located in the Center for Human Nutrition within basic science Division of Adult Endocrinology in Dr. The lab is adjacent to a satellite animal facility set up for performing chronic animal surgeries, energy balance, and hormone infusion studies in mice. This section of the lab includes a general work area, surgery set-up, lamps, Harvard infusion pumps and metabolic chamber. The extent of support provided by core staff will depend largely on the type of extramural support available for the project, with priority given to those projects for which funds for personnel expenses are limited (pilot/exploratory studies, career development awards, etc). Detailed plans for prioritizing samples are based on the source of funding and the type of award, as follows: 1. Members of the research base with non-federal funding for nutrition/obesity projects. Members of the research base with non-federal funding for non nutrition/obesity projects. The mechanisms for monitoring budgetary overlap of current funded projects and the Metabolic Core lab are handled by Dr. This Core continues to provide services at no cost to new investigators without grant funds and at subsidized rates for pilot awardees in order to help them compete at the national level for independent funding. Consultation /Research training: Quality control is part and parcel of the services provided by this core. Core personnel are actively involved with investigators in providing assistance with the selection of assessment methods and the design of experimental protocols to insure the samples we receive are of high quality. Investigators receive assistance in determining the most appropriate assay for a specific research study.
Administration of insulin or glibenclamide (a sulfonylurea) produced abnormally low glucose levels. Intravenous administration of X129 at time points wherein the drug-induced glucose levels were falling below normal levels rapidly stabilized blood glucose levels thereby preventing hypoglycemia. In normal minipigs, intramuscular administration normalized the hypoglycemia induced by Vetsulin (an intermediate acting pig insulin) with the effect lasting for several hours, thereby confirming the activity in mammals. When tested in a nocturnal hypoglycemia model in minipigs, subcutaneous administration of X129 successfully prevented blood glucose drop through the eight-hour duration of the study. We believe X129 could potentially offer clinicians a therapy that has rapid onset, improved efficacy and optimal duration of therapy to treat patients with acute severe hypoglycemia where currently available therapies are inadequate. In December 2010, we entered into a collaboration agreement with Les Laboratories Servier ("Servier") to jointly develop and commercialize gevokizumab in multiple indications. Under the terms of that collaboration agreement, Servier had worldwide rights to gevokizumab for cardiovascular disease and diabetes indications (cardiometabolic field) and rights outside the United States and Japan to all other indications. The termination of the collaboration agreement became effective on March 25, 2016. This increases the probability of technical and business success in finding rare and unique functional antibodies directed to targets of interest. The technology uses a unique method developed by us, based on analysis of the conserved structure-function relationships among antibodies. The method defines which residues in a non-human variable region are candidates to be modified. This unique arrangement facilitates flexible manufacturing and eliminates change-over downtime. This translates into significantly reduced capital expenditures, production costs, and maintenance costs while offering meaningful time advantages over conventional manufacturing facilities. The flexible manufacturing system can be applied to fields as diverse as pharmaceuticals, biologics, and electronics. Financial and Legal Arrangements of Product Collaborations, Licensing and Other Arrangements Licensing and Collaboration Agreements Historically, we have licensed with or provided research and development collaboration services to world-class organizations, including Novartis, Novo Nordisk and Takeda in pursuit of new antibody products, and we expect that we will continue to capitalize on partnered product arrangements as opportunities arise. Novartis is solely responsible for the development and commercialization of the antibodies and products containing the antibodies arising from this program. We also are eligible to receive royalties on sales of licensed products, which are tiered based on sales levels and range from a midsingle digit percentage rate to up to a low double-digit percentage rate. These royalties are tiered based on sales levels and now range from a mid-single digit percentage rate to up to a low double-digit percentage rate. Our right to milestone payments expires at such time as no collaboration product or former collaboration product is being developed or commercialized anywhere in the world and no royalty payments on these products are due. Our right to royalty payments expires on the later of the expiration of any licensed patent covering each product or 10 years from the launch of each product. The note agreement is secured by our interest in the collaboration and was due and payable in full on June 21, 2015. At December 31, 2016, the outsta nding principal balance under this note agreement totaled $14. Under the terms of the arrangement as restructured in November 2008, we will not make any additional borrowings on the Novartis note. Novo Nordisk has an option to add these additional rights to its license upon payment of an option fee. Based on the achievement of prespecified criteria, we are eligible to receive up to $290. We are also eligible to receive royalties on sales of licensed products, which are tiered up to a high-single-digit percentage rate based on sales levels. The agreement contains customary termination rights relating to material breach by either party. Servier Gevokizumab In December 2010, we entered into a license and collaboration agreement (the "Collaboration Agreement") with Servier to jointly develop and commercialize gevokizumab in multiple indications. We retained development and commercialization rights in the United States and Japan for all indications other than cardiovascular disease and diabetes. In December 2010, we also entered into a loan agreement with Servier (the "Servier Loan Agreement") that provided for an advance of up to 15. Interest is calculated at a floating rate based on a Euro Inter-Bank Offered Rate and is subject to a cap.
Surgery is a consideration for resectable sources of abnormal activity (more common in partial seizures). Repetitive or unremitting seizures without any period of regained consciousness 2. Caused by withdrawal of anticonvulsants, alcohol withdrawal, trauma, preexisting seizure disorder, metabolic abnormalities 3. Idiopathic dopamine depletion, loss of dopaminergic striated neurons in the substantia nigra, and Lewy body (eosinophilic cytoplasmic inclusions in neurons) formation leading to abnormal cholinergic input to cortex Neurologic DisorDers 187 2. Deep brain electrical stimulation has emerged as a viable option in disease not responsive to medication alone. Characteristic signs include movement and mental dysfunction starting in middle age. H/P 5 progressive, rapid irregular involuntary movement of extremities (chorea); dementia. Treatment 5 dopamine antagonists may improve chorea; genetic screening can be used in asymptomatic family members with proper counseling 7. Progressive demyelinating disease of brain and spinal cord with possible autoimmune etiology 2. Symptoms may progress slowly with several remissions and become worse during stressful events. Late symptoms and signs include worsening vision, poor movement control, difficulty speaking. Treatment 5 corticosteroids, methotrexate, and avoidance of stress may help decrease length of exacerbations; interferon-b and glatiramer acetate decrease frequency of exacerbations; supportive care for worsening neurologic dysfunction 8. It occurs because of antibodies to presynaptic Ca21 channels and is treated with immunosuppressive agents and plasmapheresis. H/P 5 periodic weakness and muscle fatigue that worsens throughout day; ptosis, diplopia. Autoimmune demyelinating disorder of peripheral nerves associated with recent viral infection, surgery, or vaccination (rare) 2. H/P 5 sudden onset of unilateral facial muscle weakness/paralysis (asymmetrical smile, drooling, ptosis, inability to close the eye, inability to raise eyebrow) 3. Treatment 5 supportive care (artificial tears, patch the eye at night to prevent injury); high-dose glucocorticoids. The facial nerve nucleus receives bilateral projections from the cortex to control the upper face, so a unilateral cortical stroke will not cause paralysis of the upper face. Abnormal involuntary movement associated with specific neurologic diseases or other causes 2. Brain tumors that are not caused by distant metastases; more common in young and middle-aged adults 2. H/P 5 headache, vomiting, lethargy; focal neurologic abnormalities, change in mental status, possible seizures; blown pupil seen if herniation occurs 5. Tumors that have metastasized to brain from distant site; lung, renal cell carcinoma, melanoma, breast, and colorectal cancer are most common primary tumors 2. H/P 5 symptoms similar to presentation for primary tumors; headache, vomiting, lethargy; focal neurologic abnormalities, change in mental status, seizures 3. Treatment 5 treat original tumor; surgical resection for single metastasis, palliative radiation 6. Neurofibromatosis type 2 is a rare autosomal dominant disorder linked to chromosome 22, characterized by the development of bilateral acoustic neuromas. Initial signs are freckling, cafй-au-lait spots, Lisch nodules, neurofibromas, and bone abnormalities evident in first few years of life. Severe functional limitations are seen in movement and gait, caused by nonunion of bone fragments. Treatment 5 therapy directed at maintaining function and treating complications 8. Hypoventilation during sleep secondary to pulmonary obstruction or decreased neurologic respiratory drive (see Chapter 2, Pulmonary Disorders) 3. Benzodiazepines increase stage N2 sleep, decrease stage N3, and do not reproduce normal sleep architecture.
Madagascar Vanilla (Vanilla). Fildena.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96239
Raol is responsible for the management of the daily operations of the core facility, and training and supervision of the technicians. Timberly Roane, Department of Biology - Mission Statement the Shared Analytical Services Laboratory provides basic and analytical chemistry related resources, including advanced analytical instrumentation. Additionally, the continuing effort to more efficiently use University resources has created a demand for sharing resources. At the same time, the Laboratory allows faculty the freedom from duplicating instrumentation and other resources that are used only peripherally. Restarting the instrument may take several days before it would be ready for analytical use. The Hitachi uses a very small aliquot of the sample (20 microliters for most analysis) and has detection limits in the low parts-per-billion range. Sample prep is time consuming, the instruments must be reconfigured, and either result in poor detection limits. To address these shortcomings, Leeman Labs created their dedicated mercury analyzer. The mercury analyzer combines an aliquot of the sample with tin chloride to convert all of the mercury containing species in the sample and liberates ground state gaseous mercury. Depending on how the instrument is configured, the detection limits for the mercury analyzer can be in the low parts-per-trillion range. The instrument can either display all of the produce ions, or one ion can be selected for further fragmentation. The multiple fragmentations can be used to isolate one compound out of a complex mixture. Most frequently this involves the determination of anions such as fluoride, chloride, nitrate, nitrite, sulfate, and sulfite, or cations such as ammonium, sodium calcium, and potassium. The system adds a series of reagents to a portion of the sample to create a color change in the sample. The intensity of the color is an indication of the concentration of the species in the sample. A series of analyte-specific modules are installed in the instrument for each analysis. Some of the possible analytes include nitrogen species, some of the industrial important metals, and a range of water-quality related ions. Without the presence of a mass spectrometer, the identification of the eluting species is determined by the time it takes the species to come off of the column. Because of this lack of verification, a careful method development cycle is important for any analysis. All are expected to become operational as time and money for repairs are available. With this capability, it is possible to perform experiments like carbon 14 dating. The Mattson is designed to be fitted with an external long path gas cell for the determination of atmospheric species. These revisions are required to adhere to new policies instituted by several federal granting agencies. Our revised pricing schedule will be published to this page once the new policies have been finalized. Until that time the current schedule is in use and any pricing questions should be directed to the Laboratory Manager. The price schedule for analytical services or use of the Laboratory is based on the affiliation of the customer to the University and to the College of Liberal Arts and Sciences. These costs are calculated from the analyst cost, instrument depreciation, and the cost of the materials and supplies consumed to perform the analysis. It is possible to decrease the cost of the analysis by using either a student working for the Laboratory, or an acceptable qualified and trained student of the faculty member. Costs associated with particular instrumentation can be found under the instrumentation section. In some cases, the costs of a short study to investigate the feasibility of a procedure, with an eye towards submitting a grant proposal using the method, may be underwritten by the Laboratory. Because of issues regarding tax-payer funded competition with private laboratories, we are required to charge a minimum of 95% of the cost for a comparable analysis performed by a private laboratory.
Do not employ a less than 1 m filter, expose to bright light or mix with any other drug. Add 12 ml of water for injection to obtain a solution containing 4 mg/ml and shake vigorously until the powder is completely dispersed. Take 20 mg (5 ml) from the vial using the 5 m filter provided, dilute to 10 ml with 5% glucose to give a solution containing 2 mg/ml, and infuse the prescribed amount over 3060 minutes. Remove the required volume of the suspension and dilute to a concentration of 2 mg/ml using 5% glucose. Compatibility: Do not let any of these product come into contact with any fluid other than 5% glucose. If using a pre-existing cannula, this must be flushed with 5% glucose before and after the infusion. Pharmacokinetics, outcome of treatment, and toxic effects of amphotericin B and 5-fluorocytosine in neonates. Antifungal therapy in children with invasive fungal infection: a systematic review. Treatment of candidaemia in premature infants: comparison of three amphotericin B preparations. Liposomal amphotericin B: a review of its use in empirical therapy in febrile neutropenia and in the treatment of invasive fungal infections. Candida infection in very low birth-weight infants: outcome and nephrotoxicity of treatment with liposomal amphotericin B (AmBisome). Ampicillin is a semi-synthetic broad-spectrum aminopenicillin that crosses the placenta. A little appears in human milk, but it can safely be given to a lactating mother since the baby is known to receive less than 1% of the weight-related maternal dose. Maculo-papular drug rashes are not a sign of serious drug sensitivity and are relatively rare in the neonatal period. The drug is actively excreted in the urine and, partly as a result of this, the plasma half-life falls from about 6 to 2 hours during the first 10 days of life. Ampicillin was, for many years, the most widely used antibiotic for treating infection with Listeria, -lactamase-negative Haemophilus, enterococci, Shigella and non-penicillinase-forming Proteus species. It is also effective against streptococci, pneumococci and many coliform organisms. Ampicillin has frequently been used prophylactically to reduce the risk of infection after abdominal surgery (including caesarean delivery). Care in spontaneous preterm labour Similar prophylaxis does not delay delivery, or improve outcome, when labour threatens to start prematurely before the membranes rupture, but high-dose penicillin during delivery can reduce the risk of early-onset neonatal group B streptococcal infection. One recent study has suggested that a combination of these two strategies would result in 80% of all the babies currently dying of any bacterial infection of intrapartum origin. It means giving antibiotics to between 40 and 60 women during labour to provide optimum treatment for one baby with bacterial sepsis of intrapartum origin. Many policies treat even more patients than this, and it seems possible that this could increase the risk of late-onset infection. In other situations, a dose of 50 mg/kg is more than adequate, given (when the patient is well enough) by mouth. Timing: Give every 12 hours in the first week of life, every 8 hours in babies 13 weeks old and every 6 hours in babies 4 or more weeks old. Sustain treatment for 1014 days in proven septicaemia, for 3 weeks in babies with meningitis and for 4 weeks in osteitis. Oral medication can sometimes be used to complete treatment even though absorption is limited. No sugar-free oral suspension is currently available (a sugar-free oral suspension of amoxicillin is available and is a suitable alternative). Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Antibiotic treatment in preterm and premature rupture of membranes and neonatal morbidity: a meta-analysis. Association of intrapartum antibiotic exposure and late-onset serious bacterial infections in infants.
Physical examination on the affected side discloses the presence of decreased chest motion, absent tactile fremitus, percussion dullness, and decreased or absent breathes sounds. Diagnosis and laboratory findings · · the diagnosis of pleural effusion can be suspected from a properly done physical examination. It demonstrates the presence of pleural fluid as homogenous opacity with a meniscus-sign and obliteration of the costophrenic angle. Large pleural effusions may result in complete opacification of the hemithorax and mediastinal shift to the opposite side. The best way to identify and localize a loculated pleural effusion is with ultrasonography. Some of the causes include pulmonary infarction and pleural carcinomatosis o · · Translucent or opaque, thick fluid as purulent. Microscopic examination of the fluid is important including Gram stain and culture (if possible). Exudative effusions have at least one of the following characteristics, whereas transudates have none of these: o o o Pleural fluid protein/ serum protein > 0. Treatment: · · Therapeutic thoracenthesis should be done in massive effusion to relieve respiratory distress. Definitive treatment of pleural effusion requires identifying the underlying condition and administration of specific therapy. Parapneumonic effusions and other bacterial infections in the pleural space should be treated with long course of antibiotics. Neoplasms of the lung Learning Objective: At the end of this unit the student will be able to 1. Refer patients with lung neoplasms to hospitals for further investigations and treatment · · Metastatic tumors are more common than primary tumors of the lungs; the commonest primary sites being the breasts, stomach, prostate, and ovary. Majority (90 95%) of primary lung tumors are malignant epithelial tumors collectively called bronchogenic tumors carcinomas. The disease is common between the age ranges 65 75 years, and affects men more than women, with M: F ratio of 2:1. Etiology: A number of factors have been found to be associated with lung cancer and include · Cigarette smoking - cigarettes contain at least 55 carcinogens and the risk of lung cancer increases to 20 fold for people who smoke more than 40 cigarettes/d. All lung neoplasms are very aggressive, invasive and widely metastasizing commonly to liver, adrenals brain and bones; they also produce bioactive hormones and other products. Others present with symptoms referable to metastasis before local pulmonary symptoms. About 10 - 15% of lung tumors are detected by chance (a coin shaped lesion on chest x-ray). Manifestations could be related to local obstruction, local tumor invasion, distant metastasis or ectopic hormone secretions by tumor cells (paraneoplastic syndromes). When tumors are endobronchial cough, hemoptysis, stridor, wheezes, dyspnea, and nonresolving pneumonia may predominate. Pericardial or pleural effusions, and bronchial obstruction leading to atelectasis, pneumonia, and lung abscess Paraneoplastic syndromes: · Occur in 10 15% of bronchogenic carcinoma and the manifestations are related to ectopic hormone secretions by tumor cells. Diagnosis Screening · · · Is mandatory for men over 45 years, and those smoking more than 40 cigarettes/day Screened tumors were resectable in 62% of cases, and nonscreened tumors were resectable only in 20%. Other investigations commonly used to make the diagnosis and staging of lung tumors, most of which are available in specialized hospitals · · · · · Management 1. Non-small cell carcinoma · Surgical excision is curative for patient with ipsilateral lymph node involvement but without local/distant spread or contralateral lymph node involvement. Intrathoracic disease - radiotherapy is palliative Pancoast syndrome radiotherapy/chemotherapy Extrathoracic disease analgesics, radiotherapy, dexamethasone, obliteration of the pleural cavity 2. Bronchial adenomas, carcinoids need surgical resection Prevention Cessation of smoking References: 1) Kasper L. This is reflected in the high burden as well as the estimated escalation of those burdens over the next two decades.
Claude Bernard, Leзons sur les Phйnomиnes de la Vie Communs aux Animaux et aux Vйgйtaux (Lectures on the phenomena of communal life in animals and plants), J. Auguste Comte, the Catechism of Positive Religion (translated by Richard Congreve), John Chapman, London, 1858 (first published in French as Catйchisme positiviste ou Sommaire exposition de la religion universelle, Paris, 1852 the Positivist Catechism or Summary Exposition of the Universal Religion), pp. Alexis Carrel, "Le Rфle Futur de la Mйdecine" (The future role of medicine), in Mйdecine Officielle et Mйdecines Hйrйtiques (Official Medicine and Heretical Medicines), Plon, Paris, 1945, pp. Bruno Salazard, Christophe Desouches, Guy Magalon, "Auguste and Louis Lumiиre, inventors at the service of the suffering," European Journal of Plastic Surgery, 28(7), 441-447, 2006. Auguste Lumiиre, Sйnilitй et Rajeunissement (Aging and Rejuvenation), Librairie J. Auguste Lumiиre, La Renaissance de la Mйdecine Humorale, Deuxie edition (The Renaissance of Humoral Medicine), Imprimerie Lйon Sйzanne, Lyon, 1937. Auguste Lumiиre, Les Horizons de la Mйdecine (The horizons of medicine), Albin Michel, Paris, 1937, pp. Baati T, Bourasset F, Gharbi N, Njim L, Abderrabba M, Kerkeni A, Szwarc H, Moussa F, "The prolongation of the lifespan of rats by repeated oral administration of [60] fullerene," Biomaterials, 33(19), 4936-4946, 2012. Jean Poucel, "La Mйdecine Naturiste" (The Naturist Medicine), in Mйdecine Officielle et Mйdecines Hйrйtiques (Official Medicine and Heretical Medicines), Plon, Paris, 1945, pp. George Weisz, "A moment of synthesis: medical holism in France between the wars," in Christopher Lawrence, George Weisz (Eds. Eugene Steinach and John Loebel, Sex and Life; Forty Years of Biological and Medical Experiments, Faber, London, 1940. Eine Kritische Darstellung der Endokrinen "Verjьngungsmethoden", Ihrer Theoretischen Grundlagen und der Bisher Erzielten Erfolge, Verlag von Curt Kabitzsch, Leipzig, 1931 (Aging and Rejuvenation. A Critical Presentation of Endocrine "Rejuvenation Methods," Their Theoretical Foundations and Up-to-Date Successes). Concepts of Rejuvenation from the late 19th century until the Third Reich), Bцhlau Verlag, Kцln, 2004. Julius Hermann Greeff, "Hundertjahrige" (Centenarians), Archiv fur Rassen- und Gesellschafts-Biologie (Archive for Racial and Social Biology), 27 (3), 241-270, 1933. Karl Fahrenkamp, Kreislauffьrsorge und gesundheitsfьhrung (Care of the circulation system and healthy life-style), Hippokrates-Verlag, Stuttgart, 1941. Johannes Steudel, "Zur Geschichte der Lehre von den Greisenkrankheiten" (On the history of the study of the diseases of old age), Sudhoffs Archiv fьr Geschichte der Medizin und der Naturwissenschaften, 35, 127, 1942. Auflage, Mьnchen, 1937 (Fundamental health improvement: Full power, Success, Rejuvenation, 7th edition, first published in 1925). A popular scientific presentation), Deutscher Alpenverlag, Innsbruck, 1941 (published posthumously). Renй Rйmond, Les Droites en France (The right-wingers in France), Aubier, Paris, 1982, pp. Alexander Bogdanov, Tektologia: Vseobshaya Organizatsionnaya Nauka (1913-1928), "4. Kolichestvennaya i strukturnaya ustoychivost" (Tectology: the universal science of organization (19131928), Ch. Marios Kyriazis, "Third phase science: defining a novel model of research into human ageing," Frontiers in Bioscience, 22, 982-990, 2017. Ilia Stambler, A History of Life-Extensionism in the Twentieth Century, Longevity History, 2014, Ch. The evolution of rejuvenation methods: From organotherapy to replacement medicine. David Blokh and Ilia Stambler, "The application of information theory for the research of aging and aging-related diseases," Progress in Neurobiology, 157, 158-173, 2017, dx. Life-extensionism as a Pursuit of Constancy When speaking of the extension of life, or radical extension of life, the question that should immediately arise what is it exactly that we desire to extend or preserve during life extension? What is that thing that we would wish to preserve in continuity or even in perpetuity? I would argue that the goal of life extension has been associated with a striving for stability and equilibrium, desiring to stabilize and thus perpetuate the current state of the body or personality, and the present social system. Therefore, the impression that life-extensionism represents a form of utopianism, a fringe or revolutionary movement, or an advocacy of a radical change of human nature should be rejected or accepted only with profound reservations.
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