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Phenazopyridine

By W. Spike. Hartwick College.

Each drug was tested on 15 patients separately for a period of 21 days during which the benefits and the side effects were monitored clinically and by laboratory methods cheap phenazopyridine 200mg mastercard. The consumption of aminophylline tablets were significantly reduced in patients treated with Khway-thay-pan-ywet (69 phenazopyridine 200mg with amex. A study has been undertaken on the 4 species of the genus Annona which grown in Yangon District discount 200mg phenazopyridine amex, Pyay District and Kalaw Townships (Southern Shan State). The comparative morphological studies on both the vegetative and reproductive parts and the anatomical studies on the leaves, stems and fruits have been made. The morphological and anatomical characters of the four species studied, namely Annona cherimolia Mill. It is annual of perennial herbs, growing wild in various part of Myanmar, particularly in hilly regions of Shan, Kachin, Chin, Kayah States, Mandalay and Sagaing Divisions. They were very similar to the botanical name of both Indian and European medicinal plant of Swertia chirayita Roxb. Due to the differents in vernacular name and similarity in the common features and the medicinal value. The morphology of these 10 plants specimens from various parts was carefully studied. Comparative study on effect of Myanmar traditional medicine paste and wax-bath physiotherapy in treatment of osteoarthritis knee in female patients. Female osteoarthritis cases are common clinical problem in Department of Physical Medicine and Rehabilitation, treated by several conservative methods with varying degree of effectiveness. Topical therapy has the obvious advantages of being simple to apply, non-invasive and self-administer by the patient. Among topical medicine, Myanmar traditional medicine paste (Ahtoo-lane-hsay) is a commonly used traditional medicine for arthritis in Myanmar Traditional Medicine Hospital since 1976. Although it is said to be effective in osteoarthritis, there has been no scientific study as yet. To determine the effectiveness of Myanmar Traditional Medicine Paste in treatment of osteoarthritis knee; in female patients. A prospective hospital based randomized controlled clinical study was carried out in (110) female osteoarthritis patients who attended the Physical Medicine and Rehabilitation Department, No. Pain, range of movement, muscle power, stiffness and knee functional capacity and quality of life were assessed by appropriate scoring methods in both groups initially and then periodically reassessed up to 3 months. Cinoared to the baseline, both groups showed significant improvement in all measurements, more obvious in first 4 weeks. Myanmar Traditional Medicine paste (Ahtoo-lane-hsay) has significant anti-inflammatory and analgesic effect in osteoarthritis knee cases. It can be recommended as an effective, safe, and easy to administer inexpensive alternative therapy for osteoarthritis knee effects of long term analgesic therapy. Comparative study on quantitative determination of eugenol in the essential oil of Piper betle Linn. The physical properties such as moisture, total nitrogen content, total alcohol soluble matter, total water soluble matter and microchemical tests on alcohol and water soluble matters were determined. The yield percent were determined depending on the method and quality of betel leaf. The physicochemical characteristics were determined by standard methods of analysis for vegetable oil and fats. The elemental contents of betel leaf were determined by atomic absorption spectroscopy. The betel leaf decoction was prepared according to the procedures usually used by traditional practitioners. The type of sugars, the amount of free reducing sugars and the amount of minerals of the betel leaf decoction were determined. The comparison between the betel leaf decoction and the oral rehydration salt solution was also determined. The present study was to investigate the anti-inflammatory and anti-plaque properties of Ixora coccinea Linn. The present study was performed on sixty young subjects with chronic gingivitis at the Institute of Nursing, Yangon. All subjects were randomly divided into two equal groups with equal sex distribution. Clinical examination and recording of the scores was obtained weekly up to one month. Mean scores of gingival inflammation, bleeding on probing and plaque accumulation were significantly reduced in both groups. Cultural beliefs and traditional medicine utilization in Myanmar: A model assessment.

Korsakoff’s psychosis probably represents irreversible brain damage secondary to the combined toxic- ity of alcohol and metabolic derangement resulting from thiamine deficiency purchase phenazopyridine 200 mg mastercard. Randomised controlled trial of general practitio- ner intervention in patients with excessive alcohol consumption buy generic phenazopyridine 200 mg on-line. Cocaine abuse in methadone maintenance patients is associated with low serum methadone concentrations buy phenazopyridine 200mg visa. Guidance for the Use of Buprenorphine for the Treatment of Opioid Dependence in Primary Care. Cocaine-induced ventricular arrhythmias and rapid atrial fibrillation temporarily related to naloxone administration. Flunitrazepam intoxication in a child successfully treated with the benzodiazepine antagonist flumazenil. Diagnostic utility of flumazenil in coma with suspected poisoning: a double blind randomised controlled study. Volatile substance abuse: a review of possible long-term neurological, intellectual and psychiatric sequelae. Mescaline, lysergic acid diethylamide and psilocybin: comparison of clinical syndromes, effects on color perception and bio- chemical measures. An association between the regular use of 3,4, methylenedioxy-methamphetamine (ecstasy) and excessive wear of the teeth. Acute systemic effects of cocaine in man—a controlled study by intranasal and intravenous routes. Use and abuse of khat (Catha edulis): a review of the distribution, pharmacology, side effects, and a description of psycho- sis attributed to khat chewing. The effects of superphysiologic doses of testosterone on muscle size and strength in normal men. Three cases of nalbuphine hydro- chloride dependence associated with anabolic steroid use. Pharmacokinetics of gamma-hydroxybu- tyric acid in alcohol dependent patients after single and repeated oral doses. Presented at the 49th Annual Meeting of the American Acad- emy of Forensic Sciences, New York, 1997 107. Multistate outbreak of poisonings associated with the illicit use of gammahydroxybutyrate. Saturday night blue—a case of near fatal poisoning from the abuse of amyl nitrite. Biochemistry and physiology of alcohol: applications to forensic science and toxicology. Food-induced lowering of blood-ethanol profiles and increased rate of elimination immediately after a meal. Lack of observable intoxication in humans with high plasma alcohol concentrations. Alcohol and the law: the legal framework of scientific evidence and expert testimony. Eye signs in suspected drinking drivers: clinical examination and relation to blood alcohol. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. Drunken detain- ees in police custody: is brief intervention by the forensic medical examiner fea- sible? The validity of self-reported alcohol consumption and alcohol prob- lems: a literature review. Assessment and management of individuals under the influence of alcohol in police custody. This chapter aims to pro- vide a broad basis for the understanding of the disease processes and the mecha- nisms that may lead to death and also to provide some understanding of the current thinking behind deaths associated with restraint. The worldwide variations in these definitions have caused, and continue to cause, considerable confusion in any discussion of this subject. For the purposes of this chapter, “in custody” relates to any individual who is either under arrest or otherwise under police control and, although similar deaths may occur in prison, in psychiatric wards, or in other situations where people are detained against their will, the deaths specifically associated with police detention form the basis for this chapter. It is important to distinguish between the different types of custodial deaths because deaths that are related to direct police actions (acts of commission) seem to cause the greatest concern to the family, public, and press. It is also important to remember that police involvement in the detention of individuals From: Clinical Forensic Medicine: A Physician’s Guide, 2nd Edition Edited by: M. These acts are considerably harder to define and perhaps sometimes result from the police being placed in, or assuming, a role of caring (e. Police involvement with an individual can also include those who are being pursued by the police either on foot or by vehicle, those who have been stopped and are being questioned outside the environment of a police station, and those who have become unwell through natural causes while in contact with or in the custody of the police. The definitions of “death in custody” are therefore wide, and attempts at simple definitions are fraught with difficulty.

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Many factors may determine the type of transport used and the position of the individual in that vehicle generic phenazopyridine 200mg on-line. Detention in the police station will be followed by an interview period inter- spersed with periods of time incarcerated buy phenazopyridine 200mg amex, usually alone order phenazopyridine 200mg visa, within a cell. After the interview, the individual may be released directly, charged and then released, or he or she may be detained to appear before a court. It is at this point that custody moves from the police to other authorities, usually to the prison service. When considering the types of death that can occur during each of these phases, six main groups can be identified based on the reported causes of death. It is clear that different factors may lead directly to or play a major part in the death of an individual while in custody and that different factors will play their part at different phases in the period of custody (see Table 1). Acute alcohol intoxication or the deleterious effects of drugs are, in most cases, likely to have a decreasing effect because they are metabolized or excreted from the individual’s body. Therefore, they are most likely to cause death in the postarrest and early detention phases, and it is important to 332 Shepherd note that their effects will be least visible to those with the “duty of care” while the individual is out of sight, detained within a cell, particularly if he or she is alone within that cell. Similarly, the effects of trauma, whether accidentally or deliberately inflicted, are most likely to become apparent in the early phases of detention, and it would only be on rare occasions that the effects of such trauma would result in fatalities at a later stage, although this has occurred on several occasions, particularly with head injuries (7). Conversely, death resulting from self-inflicted injuries is unlikely to occur in the prearrest and arrest phases of detention but it can and does occur when the individual is placed in a cell and is not under immediate and constant supervision. On the other hand, deaths from natural causes can occur at almost any time during the arrest and detention period. It is possible that the stress (whether emotional, physical, or both) associated with the initial phases of arrest and with the subsequent, more emotionally stressful phases during detention are likely to precipitate the death of the susceptible individuals through the effects of sympathetic stimulation and adrenalin release. Deaths from natural causes should be reduced by the medical examination and supervision of detainees from the time of initial detention and throughout the period of deten- tion (see Chapter 8). However, it is quite clear that the deaths described in many reports are not “pure” (i. Individu- als with heart disease may also be under the influence of alcohol; individuals under the influence of alcohol or drugs may also have suffered trauma, either accidental or deliberate, before or during their detention. In determining the cause of death, it can therefore be extremely difficult to weigh each of the factors that could be identified during the period of detention. There is great need for early assessment and accurate diagnosis of natural disease (physical or psychiatric),alcohol or drug intoxication, and for the identification, docu- mentation, and treatment of all types of trauma. The removal of an individual’s freedom places on the police a duty of care to that individual, and it is only by the active assessment of each and every person entering police custody and the continuing care of that individual that the number of deaths in custody can be reduced. Natural Causes Apart from a few unusual cases, deaths resulting from natural causes while in police custody fall into the groups of disease processes that are com- monly associated with sudden natural death in the community. Cardiovascular Disease The most common cause of death in the community, and of sudden death particularly, is cardiac disease, and within this group, those deaths recorded as resulting from ischemic heart disease or coronary atheroma are the most com- mon. The exact definitions and criteria for the pathological diagnosis of sig- nificant ischemic heart disease (8) are not within the scope of this chapter. Although there is a clear increase in the incidence of this cause of death with age (9), it is important to remember that a small percentage of people in the younger age groups, most commonly those with hypercholesterolemia and hyperlipidemia, may also have significant coronary artery disease, and because the younger age groups are more likely to be arrested by the police, these few individuals may assume great significance. The significance of coronary atheroma is that individuals with this dis- ease are particularly prone to the development of dysrhythmias during periods of stress when their decreased ability to perfuse areas of the myocardium may result in the development of ectopic electrical foci. Deaths may be preceded by the development of classical cardiac chest pain, or it may present with sudden collapse and death without warning. Individuals suffering from significant myocardial hypertrophy resulting from chronic hypertension are also at greater risk during periods of stress. Once again, it is the older age groups that are most commonly affected by essential hypertension, which may also render these individuals susceptible to focal lack of myocardial perfusion during periods of tachycardia. In addition to these two disease processes, there are also rarer diseases or syndromes that may cause sudden death, which are possibly more significant in the context of “deaths in custody” because some of them tend to affect younger age groups in particular. Current research is now focusing on a genetic basis for many other sud- den cardiac deaths in the younger age groups. The examination for these specific gene markers in any sudden death in police custody must now be considered in the absence of other causes of death. Other cardiovascular causes of sudden death, for the most part, are also age related. The rupture of atheromatous aortic aneurysms is a disease almost entirely confined to late-middle and old age, whereas the rarer forms of aorti- tis and collagen diseases of the aorta (11), which may also result in rupture, are more commonly seen in the younger age groups. It is most unusual for deep venous thrombosis of the leg veins to be present in a young active male; however, the association between some types of the combined oral contraceptive pill and the development of thromboses has been known for some time (12) and may render a small sub- group of the female population at greater risk of pulmonary emboli than the general population. Central Nervous System The stress associated with arrest and detention in custody may also have significant effects on the cerebrovascular system and may, in suscep- tible individuals, precipitate intracerebral hemorrhage by the rupture of con- genital or acquired aneurysms or vascular malformations.

Information cannot be determined accurately by conventional angiographic approaches purchase 200mg phenazopyridine with visa. The critical factor in whether a patient needs coronary artery bypass surgery or angioplasty is how well the left ventricular pump is working buy cheap phenazopyridine 200 mg online, not the degree of blockage or the number of arteries affected buy phenazopyridine 200mg with amex. The left ventricle (chamber) of the heart is responsible for pumping oxygenated blood through the aorta (the large artery emanating from the heart) to the rest of the body. Bypass surgery is helpful only when the ejection fraction, the amount of blood pumped by the left ventricle, is less than 40% of capacity. The results from large studies with these procedures, including the use of stents that release drugs to prevent blockage (drug-eluting stents), show the same lack of benefit as bypass operations. Complications arising from coronary bypass operations are common, as this surgery represents one of the most technically difficult procedures in modern medicine. Considering the cost of the procedure, the lack of long-term survival benefit, and the high level of complications, it appears that electing to have this surgery is unwise for the majority of patients. This is particularly true in light of the availability of effective natural alternatives to coronary bypass surgery. Numerous studies have shown that dietary and lifestyle changes can significantly reduce the risk of heart attack and other causes of death due to atherosclerosis (see the chapter “Heart and Cardiovascular Health”). Simple dietary changes—decreasing the amount of saturated fat and cholesterol in the diet; increasing the consumption of dietary fiber, complex carbohydrates, fish oils, and magnesium; eliminating alcohol consumption and cigarette smoking; and reducing high blood pressure—would greatly reduce the number of coronary bypass operations performed in westernized countries. In addition, clinical studies have shown that several nutritional supplements and botanical medicines improve heart function in even the most severe angina cases. Although this therapy is controversial, considerable clinical research has proved its efficacy. When an Angiogram Is Unavoidable When an angiogram or angioplasty is deemed necessary, the goal is then to prevent the damaging effects produced by this procedure. This can be accomplished with a high-potency multiple vitamin and mineral formula, along with additional vitamin C (minimum 500 mg three times per day) and CoQ10 (300 mg per day two weeks prior to surgery and for three months afterward). Vitamin C supplementation is rarely employed in hospitals, despite the fact that it may provide significant benefits; low vitamin C status is quite common in hospitalized patients. In a study analyzing the vitamin C status of patients undergoing coronary artery bypass, the plasma concentration of vitamin C was shown to plummet by 70% in the 24 hours after coronary artery bypass surgery; this level persisted in most patients for up to two weeks after surgery. Given the importance of vitamin C, this serious depletion may deteriorate defense mechanisms against free radicals, infection, and wound repair in these patients. Supplementation appears to be essential in patients recovering from heart surgery, or any surgery, for that matter. Return of blood flow (reperfusion) after coronary artery bypass surgery results in oxidative damage to the vascular endothelium and myocardium and thus greatly increases the risk of subsequent coronary artery disease. Coenzyme Q10 is recommended in an attempt to prevent such oxidative damage after bypass surgery or angioplasty. In one study, 40 patients undergoing elective surgery either served in the control group or received 150 mg CoQ10 each day for seven days before the surgery. The treatment group also showed a statistically significant lower incidence of ventricular arrhythmias during the recovery period. These results clearly demonstrate that pretreatment with CoQ10 can play a protective role during routine bypass surgery by reducing oxidative damage. Therapeutic Considerations Nutritional Supplements From a natural perspective, there are two primary therapeutic goals in the treatment of angina: improving energy metabolism within the heart and improving blood supply to the heart. These goals are interrelated, as an increased blood flow means improved energy metabolism and vice versa. It converts free fatty acids to energy in much the same way as an automobile uses gasoline. Defects in the utilization of fats by the heart greatly increase the risk of atherosclerosis, heart attack, and angina pain. Specifically, impaired utilization of fatty acids by the heart results in accumulation of high concentrations of fatty acids within the heart muscle. This makes the heart extremely susceptible to cellular damage, which ultimately leads to a heart attack. Carnitine, pantethine, and coenzyme Q10 are essential compounds in normal fat and energy metabolism and are of extreme benefit to sufferers of angina. These nutrients prevent the accumulation of fatty acids within the heart muscle by improving the conversion of fatty acids and other compounds into energy. Antioxidants Using antioxidant supplementation is important for patients with angina. In an analysis of normal controls and patients with either stable or unstable angina, the plasma level of antioxidants has been shown to be a more sensitive predictor of unstable angina than the severity of atherosclerosis. Oral nitroglycerin is widely used in the conventional treatment of angina, but its continuous use can result in the development of tolerance (loss of effectiveness). Experimental findings indicate that tolerance is associated with increased vascular production of superoxide, a free radical form of oxygen.

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