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By N. Kliff. Clarke College.

The average American woman gets only 14 grams of fiber per day— measure your baseline fiber intake by going to http://sparkpeople buy discount minocin 50 mg. Women experience a lot of bloating in pregnancy buy generic minocin 50 mg online, and part of the problem is that we have 10 feet more colon than men discount minocin 50mg otc. Instead of a horseshoe like the guy’s have, our intestines are more like a Six Flag’s roller coaster. Check out Georgetown gastroenterologist Robynne Chutkan’s new book Gutbliss 5 to learn more. Pregnancy tends to be constipating, and you need to slowly increase the fiber by no more than 5 grams per day to avoid discomfort before and during pregnancy. Supplements It took me a full nine years of medical training to feel confident discerning the safe from the unsafe, the known from the unknown, when it comes to advising women about medications and supplements when they are pregnant and nursing, so I encourage you to come armed with research and questions when you visit your own ob/gyn. Even with all of my training as a doctor, board-certified in all things that can go wrong with a woman’s body, I find that many drugs and supplements lack sufficient data to prove safety and efficacy during pregnancy and lactation. Studies show that multivitamin use can reduce chances of ovulatory infertility as well as birth 6 defects. I recommend adding a prenatal vitamin to your daily regimen for at least three months before you want to get pregnant. Some studies have shown a link between low vitamin D and difficulty with conception, so add a vitamin D supplement if your 7 levels are low. A Stanford University School of Medicine study shows that in women with low progesterone, fertility rates are higher among those taking chasteberry. After six months of treatment, 32 percent of the women taking chasteberry became pregnant, compared with 10 percent of 8 the group taking a placebo. Supplementing with chasteberry increased progesterone and fertility, and the American Herbal Products Association recommends chasteberry in pregnancy to prevent miscarriage. I can’t give you a strict rule on whether to continue it during pregnancy —that decision is best left to a woman to discuss with her practitioner—but my standards are high and I advise against it once pregnant. Farmers’ markets are popping up with ever-increasing regularity across the country, and the affordability may surprise you! I also encourage people to try growing their own food—even a windowsill herb garden is a healthy, toxin-free way to supplement your pantry. Phthalates and Bisphenol- A Phthalates—compounds used in plastics—and bisphenol-A are two more chemical compounds to avoid at all costs. The risk of certain chemicals in plastics, particularly to reproductive health, comes from their effect on the hormones. Phthalates are xenoestrogens, and I think of them as a “toxic mimic of estrogen” or “fake estrogen. Most studies on phthalates and their effects on reproduction have been 12 conducted on males. However, recent research into how phthalates and xenoestrogens impact female fertility shows that they disrupt levels of estrogen— the hormone crucial to women’s fertility and reproductive cycles. They have been linked scientifically to endometriosis, infertility, 13 and allergy rate increases. In one study, researchers found that odds of implantation failure in women with the highest level of phthalates was double that of women with the lowest level of phthalates, that fewer eggs were retrieved in women with the highest level of phthalates, that a dose- response occurred, and that as phthalate levels rise, egg production and implantation 14 drop. Here’s what you can do to reduce your exposure to phthalates: • Beware of anything with the word fragrance in the title. Lower your exposure by reducing the use of scented personal care products, including baby products and air fresheners. Pregnancy Exercise Along with maintaining a healthy diet and supplement routine, it is also important to figure out the right exercise plan for each stage of your pregnancy. Exercise helps prevent gestational diabetes and improves mood, energy, muscle tone, and sleep 16 quality. Here are the basics: • If you aren’t very active now, work with your physician to develop a gradual, safe workout plan for the duration of your pregnancy. So do I, but I may change that recommendation based on your prepregnancy level of physical conditioning and your medical condition during pregnancy. Overall, exercise makes you feel better and, in my opinion, helps you create a stronger, healthier baby.

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Chronic adhesive pericarditis consists of adherent pericardium and it usually causes no embarrassment of the heart thus differing from chronic constrictive pericarditis order minocin 50mg with mastercard. Chronic constrictive pericarditis is a result of healing of inflammatory exudate and is characterized by marked fibrous thickening of the pericardium which becomes so rigid that it mechanically interferes with heart action and the Cardiomyopathy minocin 50 mg mastercard, Myocarditis & Atrial Myxoma - Gerald Berry cheap 50 mg minocin free shipping, M. Pick’s disease is a syndrome consisting of chronic constrictive pericarditis with severe venous congestion of the liver that may lead to fibrosis and ascites (note: there is another Pick’s disease in the brain! The subject has not received a great deal of attention in textbooks because the etiology of this disease is not yet clear and also, up until recently, there has not been any good treatment. It is now likely that there would be questions on this subject in the National Boards. This lecture covers not only idiopathic cardiomyopathies, but also specific heart muscle disease (secondary cardiomyopathies) and so covers a great deal of cardiac pathology. Tumors of the heart are very rare and only one or two are important for you to remember, such as myxomas and secondary metastases to the heart. The pathology of the three main types of idiopathic cardiomyopathies and their physiologic effect. Cardiomyopathy is a condition affecting primarily the myocardium unassociated with significant narrowing of the extramural coronary arteries, or systemic hypertension, or anatomic valvular disease, or congenital malformation of the heart and vessels or intrinsic pulmonary parenchymal, or vascular disease. In other words, the diagnosis depends partly on the exclusion of other common types of heart disease. These forms of myocardial disease (cardiomyopathies) are described in diverse journals; moreover, definitions are often sketchy or controversial; the diagnosis is often made by exclusion of the usual causes of cardiac failure; and Cardiomyopathy, Myocarditis & Atrial Myxoma - Gerald Berry, M. It has been recently proposed by the Task Force on Cardiomyopathies, World Health Organization, and the Scientific Council on Cardiomyopathies, International Society and Federation of Cardiology, that nomenclature for these disease entities be made more specific and less ambiguous. According to the new classification, the term cardiomyopathy should be used to describe the group previously known as “primary cardiomyopathy” or “heart muscle disease of unknown cause,” and that “secondary cardiomyopathy” should be replaced by the term “specific heart muscle disease. In this type, the heart is enlarged, the ventricles markedly dilated and the clinical signs are those of systolic pump failure. The morphological changes are nonspecific, but include interstitial fibrosis and long attenuated myofibers. Intracardiac mural thrombi are often seen because of depressed cardiac output and stasis. Once symptoms begin, one-half of the patients are dead within a year and two-thirds within two years. The cause of death is heart failure, embolization, or terminal ventricular arrhythmias. The ultrastructural changes seen are reminiscent of the early stages of myocardial embryogenesis. In this condition, the interventricular septum is thicker than the left ventricular free wall and the ventricular cavities are reduced in size. The septal myocardium shows pathognomonic features of severely disorganized multidirectional myocytes. Gradually the terms “idiopathic subaortic stenosis” and “obstructive” cardiomyopathy are dwindling in usage and importance, reflecting the realization that hypertrophic cardiomyopathy is essentially a disease of heart muscle rather than an outflow tract obstruction. The understanding of the importance of the diastolic dysfunction manifested by impaired relaxation and irregular filling represents an advance in knowledge of this disease. This cardiomyopathy manifests itself during pregnancy or within three months following the puerperium. The myocardial changes are similar to that in patients with idiopathic dilated cardiomyopathy occurring in non-puerperal states. Alcoholic, anthracycline-related, selenium deficiency also cause end stage cardiomyopathies. A disease of unknown etiology characterized by severe focal endocardial fibrosis of one or both ventricles, with underlying subendocardial fibrosis with or without associated Cardiomyopathy, Myocarditis & Atrial Myxoma - Gerald Berry, M.

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Acute administration of clomipramine potentiates morphine analgesia in mice whereas chronic administration attenuates them (52) discount 50mg minocin otc. Metabolism Opioid interaction on drug metabolism that reported are mostly in vitro or in experi- mental studies cheap minocin 50 mg with amex. The use of morphine in patients who are intoxicated with alcohol is especially dangerous and even small doses can be fatal when there is a high concentration in the blood (15) minocin 50 mg with amex. However, age, gender, and other risk factors do not account for the strong age and gender patterns observed among victims of overdose. There is evidence that systemic diseases particularly pulmonary and hepatic disorders may be more prevalent in users who are at greater risk of overdose. There is no effective role for opiate mediation in ethanol intake as well as any ethanol sweet-fluid intake interactions (60). Both ethanol and opioids are metabolized in part by the hepatic mixed enzyme oxidative system. When both drugs are used together, slower disposal rates and possibly higher toxicity may arise. Ethanol may affect some opiate receptors and possibly change the brain tis- sue endogenous opiate peptide levels in some loci. Mixed alcohol and opiate abusers did poorly in standard alcohol abstinence treatment compared to matched alcoholics without opiate abuse histories (61). It has been found that rifampin was found to reduce morphine’s analgesic effects, probably due to the induction of its metabolism (62). Opioids and Opiates 137 fluvoxamine (and fluoxetine to a less extent) may cause an important increase in serum methadone concentrations (64). In patients unable to maintain effective methadone blood level throughout the dosing interval, fluvoxamine can help increase the methadone blood level and alleviate opiate withdrawal symptoms (65). The inhibition of differ- ent clusters of the cytochrome P450 system is involved in these interactions. Quinidine-induced inhibition of codeine O-demethylation is ethnically dependent with the reduction being greater in Caucasians (67). Ciprofloxacin may inhibit cytochrome P450 3A4 up to 65%, thus elevat- ing methadone levels significantly (68). The clearance of intravenous morphine (1 mg) was increased by 75%, oral morphine (10 mg) by 120% in six young women taking an oral contraceptive (70). This implies that the dosage of morphine will need to be virtually doubled to achieve the same degree of analgesia. Urinary morphine concentration will then be greater in patients taking oral contraceptives. In a study, the administration of ammonium chloride and sodium carbonate over 3 d each resulted in a mean methadone elimination half- 138 Moallem, Balali-Mood, and Balali-Mood life of 19. It was shown that haemodynamic changes induced by propofol may have an important influence on the pharmacokinetics of alfentanil (76). In 30 normal subjects, it was found that quinalbarbitone and morphine depressed ventilation when given alone. However, a combination of quinalbarbitone and morphine resulted in a much greater and more prolonged depression. Other respiratory depressant drugs such as narcotics, opiates, and analgesics can also have additive effects (77). In one study, it was found that fen- tanyl and alfentanil pretreatment have also reduced the dose of thiopental required for anesthesia induction (78). Also, the simultaneous administration of morphine and phenothiazines can result in significant hypotension (15). Alprazolam mediated analgesic effects, most probably via a µ opiate mechanism of action (79). For instance, sertaline increases the plasma methadone concentration significantly in depressed patients on methadone (80). Several lines of evidence suggest that benzodiazepines and methadone may have synergistic interactions and that opiate sedation or respiratory depression could be increased.

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These compounds have a high affinity with the enzyme minocin 50mg line, and their inhibitory action is reversible buy discount minocin 50 mg online. These inhibitors differ from acetylcholine in that they are not easily broken down by enzymes 50 mg minocin fast delivery. Enzymes are reactivated much slower than it takes for subsequent hydrolysis of acetylcholine to happen. Physostigmine is made synthetically in various ways [40–42], one of which being from p- ethoxymethylaniline, which is reacted with α-bromopropionyl bromide in the presence of aluminum chloride, giving 1,3-dimethyl-5-ethoxyindolin-2-one (13. Reacting this with chloracetonitrile in the presence of sodium ethoxide gives 1,3-dimethyl-5-ethoxy- 3-cyanomethylindolin-2-one (13. The nitrile group is reduced to an amine group, which is further methoxided, giving 1,3-dimethyl-5-ethoxy-3-(β methylaminoethyl) indolin-2-one (13. The ethoxy-protecting group is removed by hydrogen bromide, giving a compound with a phenol hydroxyl group (13. Cholinomimetics Physostigmine is easily absorbed from the gastrointestinal tract and other mucous mem- branes. Its action on the organism is basically similar to that of acetylcholine, and it is used for the same indica- tions in ophthalmology for constricting the pupil and lowering ocular pressure in glau- coma. The presence of a quaternary nitrogen atom in the molecule leads to other significant differences between physostigmine and neostig- mine, the main difference being that neostigmine, besides cholinesterase inhibition, has a direct stimulatory effect on cholinergic receptors. However, with the exception of these serious differences, the general action of neostigmine is analogous to the action of physostigmine. Like other reversible cholinesterase inhibitors, neostigmine exhibits pow- erful antimuscle relaxant action. This property of neostigmine is used in anesthesiology for overcoming paralysis of skeletal muscle caused by muscle relaxants. Neostigmine is pri- marily used in myasthenia, motor damage after brain trauma, paralysis, for atrophy of the optic nerve, and for treating atony of the bowels and urinary bladder. It is a reversible cholinesterase inhibitor that is longer lasting than the others. It is used to constrict pupils, elevate intraocular pressure in treating glaucoma, and also for alleviating atropine mydriasis. Unlike the rapid hydrolysis of the acetylcholine complex with the enzyme and the some- what slower hydrolysis of the carbamate complexes, organophosphorous enzymes react very slowly with water, which generally leads to irreversible inhibition of the enzyme. Upon using most organophosphoric substances in the organism, new synthesis of enzyme must take place in order to restore cholinesterase activity of the tissue. Despite the fact that such activity is called irreversible, some chemical compounds, such as oximes, can restore the vital functions of the enzyme. However, phosphorylated enzymes also can undergo a process such as deterioration, during which organophosphate loses an alkyl group and makes a stronger, irreversible bond with the enzyme, which makes the enzyme unable to be restored by oximes. Signs and symptoms of severe toxicity caused by introduction of organophosphorous anti- cholinesterase compounds can be easily predicted and explained by the hyperactivity of the parasympathetic nervous system, neuromuscular junctions, autonomic ganglia, and 13. A few organophosphates are useful as medical drugs, and others as insecticides and potential chemical weapons because of their high toxicity. Isoflurophate: Isoflurophate, the di-iso-propyl ester of fluorophosphoric acid (13. According to the possible mechanism described above, isofluorophate causes irreversible inactivation of cholinesterases. It also inactivates acetyl- cholinesterase and ‘nonspecific’ cholinesterases of the plasma. Isofluorophate is used for treating certain types of glau- coma in which short-lasting myotics are unsuitable. Many of them are lipid-soluble compounds that are quickly and completely absorbed in practically every way, including skin as well as respiratory and 192 13. Most organophosphorous compounds undergo biotransformation through hydrolysis of the ester groups and are excreted with urine. Malthion is widely used in the home and garden and is not very toxic to humans because it is easily hydrolyzed.

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