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The MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 1985 and January 2001. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. When reliable research was not available, expert opinions from obstetriciangynecologists were used. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force: I Evidence obtained from at least one properly designed randomized controlled trial. II-1 Evidence obtained from well-designed controlled trials without randomization. II-2 Evidence obtained from well-designed cohort or casecontrol analytic studies, preferably from more than one center or research group. II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments could also be regarded as this type of evidence. III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories: Level A--Recommendations are based on good and consistent scientific evidence. Level B--Recommendations are based on limited or inconsistent scientific evidence. Level C--Recommendations are based primarily on consensus and expert opinion.
Radiochemistry of Carbon-11-Hydroxyephedrine. A detailed description of the synthesis of " C-hydroxyephedrine has been published 11 ; . Briefly, "C-hydroxyephedrine was produced by direct N-methylation of metaraminol with "C-methyl iodide in dimethyl formamide dimethyl sulfoxide and purified by reversephase, high-performance liquid chromatography in an isotonic aqueous buffered system. The specific activity was 37, 000 MBq mmole at the end of synthesis; radiochemical and chemical purities were 95%. Data Acquisition. Studies were performed with a Siemens 931-12 Siemens Gammasonics, Des Plaines, IL ; whole-body tomograph. This device allows simultaneous acquisition of 15 cross-sectional images eight direct planes and seven cross planes ; with a spatial resolution of 6-8 mm. A l3N-ammonia scout scan of 5 min was used for positioning the subject correctly in the field of view of the tomograph. Transmission scans were acquired for 20 min using a retractable 68Ge ring source for correction of the emission scans. The imaging protocol consisted of a cardiaca ynamic positron emission tomographic imaging after " C-hy droxyephedrine administration followed by a myocardial blood flow study. Carbon-11 -hydroxyephedrine 740 MBq ; was injected and rimonabant.
ENVIRONMENTAL TOBACCO SMOKE AND HEALTH STATUS IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION Hubert Chen MD * Mark D. Eisner MD Carla M. Teehankee BA Paul D. Blanc MD Teresa De Marco MD UCSF, San Francisco, CA PURPOSE: We sought to quantify environmental tobacco smoke ETS ; exposure among patients treated for pulmonary arterial hypertension PAH ; , and to determine whether ETS exposure is related to health status in these patients. METHODS: We enrolled consecutive patients referred to a tertiary care center for PAH. Criteria for inclusion were elevated mean pulmonary artery pressure MPAP ; 25 mmHg by right heart catheterization and medical stability on PAH therapy for 3 months. ETS exposure was assessed using a validated passive smoke exposure questionnaire, as well as by urine cotinine. Exercise capacity was assessed by six-minute walk 6MW ; distance. Disease-specific qualityof-life was assessed using both the 20-item Airways Questionnaire AQ20 ; and Minnesota Living with Heart Failure Questionnaire MLHFQ ; . RESULTS: We analyzed 91 patients with the following characteristics: mean age 49 13 yrs; 70% female; mean MPAP 50 14 mmHg; WHO class I-II 42% ; , III 51% ; , and IV 7% ; . Forty 44% ; patients reported exposure to ETS. Urine cotinine was positive in 45 57% ; of 79 tested. Self-reported ETS exposure correlated significantly with urine cotinine level r 0.42, p 0.0003 ; . There was no significant correlation between self-reported ETS exposure and either 6MW distance p 0.26 ; or quality-of-life AQ20: p 0.80; MLHFQ: p 0.83 ; . Similarly, there was no significant association between urine cotinine positivity and either 6MW distance p 0.14 ; or quality-of-life AQ20: p 0.77; MLHFQ: p 0.90 ; . CONCLUSION: ETS exposure is common among patients treated for PAH, however, its relationship with exercise capacity and quality-of-life remain uncertain. CLINICAL IMPLICATIONS: Patients on PAH therapy should be encouraged to avoid ETS exposure until stronger evidence regarding its effects are available. DISCLOSURE: Hubert Chen, None.
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British Medical Journal January 31, 2006 : eurekalert pub release s 2006-01 bmj-adl013106 Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: Longitudinal cohort study BMJ Online First Anticholinergic drugs may lead to mild cognitive mental ; impairment in elderly people, finds a study published online by the BMJ today. These drugs are commonly used in elderly patients to treat illnesses such as irritable bowel syndrome, urinary incontinence, and Parkinson's disease, so it is important that doctors are aware of this effect, say the researchers. They interviewed 372 elderly people without dementia about current and past illnesses and drug use. Cognitive performance was assessed and participants were monitored for up to eight years. About 10% of the people in the sample took anticholinergic drugs over an extended period. Drug users showed poorer cognitive performance compared with non-users and 80% met the criteria for mild cognitive impairment compared with 35% of non-users. However, drug users were not at increased risk of developing dementia. Even after taking account of other known risk factors for cognitive impairment, anticholinergic drugs remained the most highly significant predictor of this condition, say the authors.
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1. What advice could you give to a pregnant woman suffering from morning sickness? 2. What product could you recommend to a pregnant woman for constipation? 3. When should cases of pruritus in a pregnant woman be referred? This article relates to the Royal Pharmaceutical Society's core competency of "appropriate advice, referral or selection of treatment" see "Medicines, ethics and practice -- a guide for pharmacists", number 26, July 2002, pp1056 ; . You should consider how it will be of value to your practice.
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What will happen to what the researchers find out? The results are likely to be available in 5 to years time and will be talked about in medical meetings and published in medical journals. The sample of blood for genetic tests will be used to work out why people get thyrotoxicosis but will not be used to clone you and the blood or DNA will not be put back into you. After a few years the blood samples will be destroyed. Did anyone else check the study? This study has been planned and checked by several people to make sure that it is alright. How can I find out more about the study? Your mum, dad or other grown-up you trust may be able to answer your questions. Thankyou for reading this.
Routine examination of sex partners is not necessary for the management of genital warts because the role of reinfection is probably minimal and, in the absence of curative therapy, treatment to reduce transmission is not realistic. However, because self- or partnerexamination has not been evaluated as a diagnostic method for genital warts, sex partners of patients who have genital warts may benefit from examination to assess the presence of genital warts and other sexually transmissible infections. Sex partners also may benefit from counselling about the implications of having a partner who has genital warts. Because treatment of genital warts probably does not eliminate the HPV infection, patients and sex partners should be cautioned that the patient might remain infectious even though the warts are gone. The use of condoms may reduce, but does not eliminate, the risk for transmission to uninfected partners. Female partners of patients who have genital warts should be reminded that cytological screening for cervical cancer is recommended for all sexually active women. However, the benefit of evaluating sex partners of patients with external genital warts has not been carefully studied. Similarly, the specific benefit of evaluating sex partners of women with HPV-related cervical squamous intra-epithelial lesions SILs for external genital warts is not known. Although as many as one-half of male sex partners of women with cervical SILs may have evidence of genital HPV infection, relatively few have external genital warts. It is unclear whether treatment of men with evidence of genital HPV infection influences the natural history of their female sex partner's cervical disease.21, 31 There is little information available currently about the health effects of HPV-related cervical disease on female sex partners of women with HPV infection.32 Women who are sex partners of patients with external genital warts should undergo cytological screening for cervical cancer at intervals recommended by national cervical screening guidelines. The benefit of evaluating male sex partners of men with external genital warts is not known.
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