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FIG. 3. Glucose-lowering effects following administration of 450 mg kg metformin as intraduodenal bolus or intraduodenal infusion or 200 mg kg metformin as constant rate i.v. infusion, variable rate i.v. infusion, or variable rate intraportal infusion. To reveal the metformin-driven glucose-lowering effect, the baseline time course of blood glucose levels following vehicle administration ; was subtracted from the observed blood glucose levels following the drug administration. Data points are the mean observed glucose-lowering effects, and the solid lines are the best fits according to model B. TABLE 2 Mean pharmacokinetic and pharmacodynamic Model B ; parameter estimates!
IGT by OGTT and FPG BMI 24 Intensive diet and lifestyle modification vs. metformin vs. placebo.
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Much in Easter eggs! Our March meeting was a very informative discussion and presentation on primar y vaccinations and defaulters, and the speaker was public health nurse Edel Deane. organising this. Many thanks to Michelle Heneghan from Cow and Gate for Ballina.The topic for discussion was leg ulcers and podiatry issues in diabetes and Roger Towney from Aventis was the sponsor. speaker was Mr Barry, who gave a presentation on breast care. At shortage of DT was also on the agenda, among other issues. Our May meeting was held on the 5th of the month.The guest Our April meeting was on the 14th in The Downhill Hotel and ilosone.
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The displacement of 5-HT binding to receptors in mammalian neuronal preparations by a variety of agents has led to the classification of several major classes of binding sites. 5-HTx binding sites were first identified by their higher affinity for 5-HT than for spiperone, as opposed to 5-HT2 sites which show the opposite affinity Peroutka and Snyder, 1979 ; . In recent years, compounds with greater but incomplete ; selectivity for these two sites have been identified or synthesized. These drugs have permitted the classification of 5-HTi binding sites into four subtypes 1A, IB, 1C and ID ; and have been used to identify a third class of binding sites 5-HT3 ; in the nervous system Peroutka, 1988 ; . Each of these binding sites corresponds to a 5-HT receptor that mediates physiological effects in the peripheral or central nervous systems Bobker and Williams, 1990 ; . The receptors are differentially distributed Peroutka, 1988 ; and many neurones in vertebrates Nicoll, 1988 ; and in invertebrates Gerschenfeld, 1973 ; show multiple responses to 5-HT which depend on the pattern of synaptic inputs. In many neurones, 5-HT receptors are coupled to second messengers; for example, 5-HT 1A receptors that modulate adenylate cyclase Shenker etal. 1985; Markstein et al. 1986; DeVivo and Maayani, 1986 ; and 5-HT2 receptors that activate phosphatidylinositol turnover Brown et al. 1984; Conn & Sanders-Bush, 1985; Kendall and Nahorski, 1985 ; . The combination of multiple responses mediated by a variety of receptors with different regional distributions makes the serotonergic system highly complex. We have been studying the properties of specific synapses formed between identified leech neurones. The mechanosensory P ; cell receives serotonergic innervation in situ and in culture Fuchs et al. 1982 ; . Application of 5-HT by pipette elicits two long-lasting responses in the P cell: activation of an inhibitory Cl~ conductance and of an excitatory cation conductance Henderson, 1983; Drapeau and Sanchez-Armass, 1988 ; . Interestingly, only the Cl~ response is activated upon 5-HT release by the serotonergic Retzius cell Fuchs et al. 1982; Drapeau and Sanchez-Armass, 1988 ; , apparently because of the selective loss of the cationic response at sites of contact between the neurones Drapeau et al. 1989 ; . In this study, we tested the effects of a variety of pharmacological agents in order to characterize the receptors that activate these ionic channels. This was particularly interesting since 5-HT receptors in invertebrate neurones e.g. Walker.
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13. ALPHA PARTICLEEMITTING THYMIDINE ANALOGUES: THERAPEUTIC EXPERIMENTS ON A NEOPLASTIC MENINGITIS ANIMAL MODEL Abraham Boskovitz, Ganesan Vaidyanathan, Gary Archer, Hidenobu Ochiai, Tatsunori Okamura, John Sampson, Darell Bigner, and Michael Zalutsky; Duke University Medical Center, Durham, North Carolina, USA The alpha particleemitting radionuclide astatine-211 211At ; has a high linear energy transfer 97 keV m ; , a short range 73 m ; , and a short, 7.2-hour half-life. It therefore has a significant radiotherapeutic potential for neoplasms with a disseminated pattern, such as neoplastic meningitis. In combination with deoxyuridine UdR ; --a thymidine analogue--as 5-[211At]astato-2, -deoxyuridine AUdR ; , 211At is absorbed by cells in mitotic S-phase and incorporated into DNA, conferring on it a specific preference for dividing tumor cells within the intrathecal space. An exquisite cytotoxic effect of AUdR has been demonstrated in vitro on malignant cell populations. We studied the in vivo endoradiotherapeutic potential of AUdR in an animal neoplastic meningitis model. The model was developed by intrathecal tumor-cell injection in athymic male rats previously operated on for the implantation of an intrathecal catheter. In the first experiment, 28 animals were injected with A431P carcinomatous cells. Animals were randomized in three groups and, 3 days after tumor injection, were treated with a single dose of 37 Ci AUdR, 80 Ci of AUdR, or a saline solution control ; . Animals were neurologically checked daily. A significant increase in median survival from 10 days control ; to 16 days 37 Ci of AUdR ; and 17 days 80 Ci of AUdR ; was observed. Thus, the in vivo and in vitro results indicated that 211Atlabeled thymidine analogues may present a therapeutic benefit for neoplastic meningitis. Results in other animal models different tumor cell line, radioisotope carrier ; have been obtained and will also be discussed.
Table A. Performing and Recording the Peak Expiratory Flow Rate A peak expiratory flow rate PEFR ; is a spirometric pulmonary function test that assesses the acute status and or chronic control of asthma. It assesses large airway function by measuring the maximum rate of air expelled in the first 10 msec of a breath. Various models of peak flow meters are available. The PEFR is more commonly used than other spirometric tests i.e., FEV1 ; because a peak flow meter is relatively small and inexpensive. In order to perform the test, the patient takes a deep breath and blows hard and fast into the peak flow meter. It is considered "effort dependent" in that the cooperation or effort of the patient can greatly influence the results. The degree of effort e.g., good, adequate, poor ; should be assessed subjectively by observing the patient's technique. This is recorded along with the highest value from 3 patient attempts. This patient's PEFR is then compared with a table of predicted volumes based on the patient's height, age, and sex, and may be reported as the absolute value and or either 1 ; the percent of the predicted value or 2 ; the percent of the patient's "personal best" value. The personal best value is the best or highest value recorded for that patient over a 2- to 3-week period when the asthma is well controlled. ; The second option may be more valuable when the patient's personal best is significantly different from the predicted value. Example: A 40-year-old female who is 5 feet, 6 inches tall performs a peak flow 3 times 360, 390, 350 ; . The highest of these 3 values 390 ; is compared with the predicted value 436 ; from a table of population averages. Her results are then reported as a PEFR of 390 which is the best of 3, with good effort ; and 89% predicted 390 436 X 100 and letrozole.
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Initiate assessment and treatment of the patient as indicated by the signs and symptoms. Verify the following: The medication has been prescribed by a physician for the patient, the medication inside the container is the one indicated on the prescription label, and the medication has not passed the expiration date on the prescription label. Determine the last time the patient self-administered the medication and the number of doses taken. If in doubt, contact an ER doctor or patient's personal physician for medical direction, a brief history and assessment. Administer the medication as directed. Document the administration of the medication by recording the drug, dose, method of administration, time of administration and name of physician ordering the assistance with medication. Five minutes after administration of the medication reassess and document the patient's vital signs and any changes in his or her condition.
Free Androgen Index FAI ; The free androgen index increased from 10.0 4.9 before treatment to 11.1 8.8 after 16 weeks, P NS ; in placebo-taking women. There were no changes of free androgen index in the metformin treated group 8.3 3.5 to 7.4 4.2, P NS and levocetirizine.
Nature of complaint SHELF D7 Proctofoam Aerosol Foam, with expiry date 08 1999; Alma Drops, with expiry date 03 2000; Betnovate lotion, with expiry date 10 2003. SHELF D9 Lennon Methyltestosterone-tablets, with expiry date Nov 2001; Zoloft Sertraline-50mg 30 tablets, with expiry date 06 2003. SHELF E2 Exarex Lotion two bottles, with expiry date 11 2002. SHELF E7 Metfofmin 850mg, with expiry date 08 1999; Metfkrmin 500mg, with expiry date 04 2004; Betahistine Dihydrochloride serc 4mg 100 tablets, with expiry date Nov 2002. SHELF F2 SBR Lipocream-4 boxes, with expiry date 07 2002. SHELF F6 Adco-Ibuprofen tablets, with expiry date Aug 2001 Batch no: 5358. you failed to mark or label the following re-packed or pre-packed medicines with the expiry dates and or batch numbers: Prohist 3 bottles 50ml; Ponstan 10x100ml and 5x500ml; Alcophylin 12x50ml; Gryppon 34x50ml; CPL Alliance Ranitidine 300, foil packs of tens ; with no expiry date and no batch numbers. you authorized and or failed to take all necessary or reasonable steps in order to prevent that medicines be supplied, dispensed or sold in contravention of the provisions Section 52 1 ; of Act No. 56 of 1974, as amended.
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Event # 11338 Time: 9: 10 9: Speaker #2 Introduction to Homotoxicology Andrew Bloch DOM, MSPT, ATC Miami Beach, FL aobloch aol Complementary Integrative Perspective European countries use the term, "Biological Medicine" Art and Science! Therapeutic measures geared toward unique life stresses. Healing methods are designed around an individual's ability to regulate, regenerate, adapt and self-heal. Biological Medicine Biological medicine is the same as "complementary integrative medicine". Combines statistical scientific medicine with one or more forms of healthcare that may not be considered "scientific" in statistical terms i.e., alternative Definition of Homeopathy A system of medicine utilizing medications manufactured according to homeopathic principles standards Remedies stimulate the body's own regulation and defense systems HOMEOPATHY similar suffering ALLOPATHY opposite suffering - a term coined by Hahnemann 1890's-1900's Advent of pharmaceutical compounds 1910, the AMA sponsored the Flexner Report, which precipitated homeopathic med school closings Later, antibiotics became the "wonder drug" of the century! Homeopathy now enjoying a resurgence among consumers and practitioners due to its safety and extremely low level of side effects. Samuel Hahnemann, MD - The Father of Classical Homeopathy MD in Germany in 1780's died in 1843 at age 88 ; Medical practices of his time included purging, bleeding, leeches, massive drug combination Frustrated by what he considered barbaric and harmful medical practices, he left his practice and went into medical translation Homeopathy in the USA Homeopathy was introduced in the USA in 1832 with the cholera epidemic. 1800's and early 1900's there were 14, 000 homeopathic MD's, 29 homeopathic medical schools and 100 homeopathic hospitals!! 1840's founding of the AMA in response to the American Institute of Homeopathy in 1844 Principles of Homeopathy The Law of Similars Testing of remedies on healthy individuals called "provers" Prescribing based on the totality of symptoms The use of the minimum dose Potentization of the remedy and lopid.
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There are now four classes of hypoglycemic drugs: sulfonylureas emtformin thiazolidinediones alpha-glucosidase inhibitors and lopressor.
Diet - keeping body weight ideal; measured amounts of carbohydrate, protein, fat. Diet must balance the amount of insulin in the body, whether given as medication or occurring naturally; mild diabetes may be controlled by diet alone. activity - this must balance with food and insulin. increase in activity enhances insulin's effect. insulin or hypoglycemic agent as medication. A. insulin can be given only by injection, so may not legally be administered by medication aide. B. oral hypoglycemic agents. 1 ; action: this is not insulin; exact method of action unknown, but effect is to make more of body's insulin available for use. 2 ; examples: tolbutamide Orinase chlorpropamide Diabinese tolazamide Tolinase glipizide Glucotrol glyburide Diabeta ; , micronase ; , Glynase m3tformin Glucophage ; recommended to give 30 minutes before meals. 3 ; side effects: G.I. disturbance. C. implications for care: 1 ; oral hypoglycemic agents recommended to be given approximately 30 minutes before meals.
Y. MORRISSEY1, C. BOWMAN2, I. CARPENTER1 Centre for Health Service Studies, George Allen Wing, University of Kent, Canterbury, UK 2 BUPA Care Services, Bridge House, Outwood Lane, Horsforth, Leeds, UK Address correspondence to Y. Morrisey. Email: y.c.m.morrissey kent.ac and lotrimin.
Male Wistar rats 250300 g in weight ; were used for preparation of both hepatocytes and liver mitochondria, and for studies in i o. Metformin, phenformin and antibiotics were obtained from Sigma Poole, Dorset, U.K. ; . Cell-culture media were from Gibco-BRL Paisley, U.K. ; . The sources of all other chemicals and biochemicals were as given previously [14, 15].
54. WHICH OF THE BELOW IS NOT TRUE CONCERNING DANGEROUS & CONTROLLED DRUGS? A. CONTROLLED SUBSTANCES ARE LISTED IN THE COMPREHENSIVE DRUG ABUSE PREVENTION & CONTROL ACT OF 1970. B. METHYL ALCOHOL SHOULD ONLY BE ISSUED BY THE PHARMACY IN AN EMERGENCY C. GLACIAL ACETIC , SULFURIC, NITRIC, & OXALIC ACIDS WILL NOT BE ISSUED TO WARDS OR OUTPATIENTS D. METHYL ALCOHOL FOR USE BY MEDICAL ACTIVITIES ; WILL BE ACCOUNTED FOR & ISSUED BY THE SUPPLY DEPARTMENT 55. WHAT SCHEDULE OF CONTROLLED DRUGS HAS A HIGH POTENTIAL FOR ABUSE & ACCEPTED MEDICAL USEFULNESS? A. B. C. III IV and metrogel and metformin, for example, metformin interactions.
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Other radiopharmaceuticals labeled with 99mTc. cation, was experienced in more than half of our pa The desirable biliary imaging characteristics of mTc tients. Infections, either bacterial or viral or both ; were labeled dimethyl IDA spurred interest in the develop found in 27 of patients with liver grafts and led to the ment of other derivatives of N-substituted iminodi demise of 12 of them. It was in these two groups of acetic acids. The properties ofthese various agents have patients that the liver biopsy was used most frequently. been tested extensively in a variety of laboratories The other complications listed in Table 1 are usually throughout the world. It appears at present, that the readily identifiable using the IDA scan. Quantitation of diisopropyl IDA derivative disofenin ; because of its the initial uptake of radioactivity into the graft and somewhat longer substituted side chain allows for in examination of the blood-pool images yields informa creased biliary excretion and visualization of the hepa tion regarding the adequacy of the arterial and portal tobiliary system at somewhat higher serum bilirubin venous supply to the liver. Compromises in arterial or levels approaching 20 mg dl ; than has been possible in portal venous flow were demonstrated in two and with the shorter chain derivatives such as dimethyl IDA three of our patients, respectively. Although vascular or PIPIDA p-isopropyl IDA ; 11"13 ; . occlusion may be secondary to acute rejection as was The rate at which a liver graft accumulates and recently reported 14 ; , our experience indicates that technical problems, such as stenosis at a site of anasto ultimately excretes the various IDA derivatives provides a sensitive indicator of hepatocyte function 6"12 ; . mosis, are much more likely to be the cause ofa vascular Because of this attribute together with its use in assess compromise. ing the integrity of biliary drainage, it is employed In instances of biliary stenosis and or obstruction, the finding on the IDA scan has been quite specific. routinely at our institution to evaluate the liver graft within 48 hr after transplantation. Subsequently, it is The extraction uptake ; of radioactivity of the graft is usually good whereas excretion is delayed. Scintiphotos used for routine follow-up as well as an aid in the obtained a half-hour or more after administration of assessment ofone or more ofthe postoperative compli the tracer show clear evidence ofparenchymal retention cations listed in Table I . As indicated in this table, with gradual filling of dilated biliary radicals. It is in rejection and infection are the two most common com these instances that graphic analyses are particularly plications observed among our liver graft recipients. useful as a reliable means for assessing functional Both may cause a significant reduction in hepatocyte changes occurring in sequential studies. If the integrity function and thus both may markedly depress the up take and clearance of labeled IDA by the liver. This in of biliary outflow is compromised as with a leak at the anastomotic site, the appearance of radioactivity in the turn leads to enhanced renal excretion ofthe radiotracer peritoneal cavity is easily identified. which must be differentiated from that appearing in the The presence of a mass lesion within the liver has abdomen secondary to excretion by way of the biliary been detected from scintiphotos obtained during the system. The presence of radioactivity in the kidneys and mobic.
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Metformin and csii in type 1 diabetes original article: the benefits of metformin therapy during continuous subcutaneous insulin infusion treatment of type 1 diabetic patients.
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76. Vu-Dac N, Schoonjans K, Kosykh V, et al. Fibrates increase human apolipoprotein A-II expression through activation of the peroxisome proliferator-activated receptor. J Clin Invest. 1995; 96: 741-750. Kersten S, Desvergne B, Wahli W. Roles of PPARs in health and disease. Nature. 2000; 405: 421-424. Garg A, Grundy SM. Management of dyslipidemia in NIDDM. Diabetes Care. 1990; 13: 153-169. Garg A. Dyslipoproteinemia and diabetes. Endocrinol Metab Clin North Am. 1998; 27: 613-625, ix-x. 80. Guyton JR, Goldberg AC, Kreisberg RA, Sprecher DL, Superko HR, O'Connor CM. Effectiveness of once-nightly dosing of extended-release niacin alone and in combination for hypercholesterolemia. J Cardiol. 1998; 82: 737-743. Keen H. Therapeutic objectives and their practical achievement in type 2 diabetes. J Diabetes Complications. 2000; 14: 180-184. Zanella MT, Kohlmann O, Jr., Ribeiro AB. Treatment of obesity hypertension and diabetes syndrome. Hypertension. 2001; 38: 705-708. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS 33 ; . UK Prospective Diabetes Study UKPDS ; Group. Lancet. 1998; 352: 837-853. Yki-Jarvinen H. A simple therapeutic combination for type 2 diabetes. Hosp Pract Off Ed ; . 2000; 35: 63-66, Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes UKPDS 34 ; . UK Prospective Diabetes Study UKPDS ; Group. Lancet. 1998; 352: 854-865. Halimi S, Le Berre MA, Grange VV. Efficacy and safety of acarbose add-on therapy in the treatment of overweight patients with Type 2 diabetes inadequately controlled with metformin: a double-blind, placebo-controlled study. Diabetes Res Clin Pract. 2000; 50: 49-56. Stewart CE. New trends in diabetes management. Emerg Med Serv. 2001; 30: 80-88. Malinowski JM, Bolesta S. Rosiglitazone in the treatment of type 2 diabetes mellitus: a critical review. Clin Ther. 2000; 22: 1151-68; discussion 1149-1150.
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