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THE ROLE OF SMOKING ON OSTEOPOROSIS IN LIVER TRANSPLANT PATIENTS Wesley Leung * , Angela Cheung, Nigel Girgrah, Les Lilly Toronto General Hospital, University Health Network Introduction: Several studies have shown that patients who undergo liver transplantation are at higher risk for osteoporosis, predisposing a person to an increased risk of fracture. Although the pathogenesis of this association is poorly understood, it is likely to be multifactorial, involving factors such as smoking. Objective: to determine whether smoking was associated with increased bone loss and fractures in liver transplant patients pre and post-transplant. Methods: The influence of smoking on osteoporosis in the liver transplant population was investigated by retrospectively obtaining smoking data from thirty-two patient charts at Toronto General Hospital. Bone mineral density BMD ; and epidemiologic data was collected electronically from the osteoporosis database. Fracture data was also obtained from patient chart review. From the data, the effect of smoking on bone density and fractures pre and post transplant was determined. Results: Liver transplantation was found to be associated with increased prevalence of osteopenia and osteoporosis in lumbar spine LS ; and total hip TH ; . However, smoking was not associated with increased bone loss before or after liver transplant. Finally, smoking was associated with increased prevalence of fractures and increased number of fractures in liver transplant patients. Conclusions: Taken together, our findings suggest that smoking is associated with increased fractures but not bone loss in liver transplant patients. Thus, it may be prudent for past or current smokers that are osteoporotic to be encouraged to cease smoking and be treated more aggressively with anti-resorptive medications and fracture prevention measures, for example, ortho mcneil. Grade 3 or incidentally discovered pulmonary embolus second occurrence, Grade 4 first occurrence In the case of an arterial thromboembolic event e.g. angina, MI ; treatment with bevacizumab must be discontinued Haemorrhage Grade 1 and 2 No dose modification Grade 3 or 4 First occurrence ; Discontinue bevacizumab Hypersensitivity Reaction Hypersensitivity reaction Treat with hydrocortisone, antihistamines and adrenaline if required attributable to bevacizumab See "Guidelines for the Treatment of Allergic Reactions" for more details ; Grade 3 or 4 Discontinue bevacizumab treatment Gastrointestinal perforation Gastrointestinal perforation or Discontinue bevacizumab treatment dehiscence and evista. View pubmed citation view isi citation publication history issue online: 23 jun 2005 home list of issues table of contents article abstract headache: the journal of head and face pain volume 16 issue 6 page 280-283, january 1977 to cite this article: robert e ryan sr b. Remember that at this tool you can solicit information regarding not only about detrol, but also about all the products available on this web site and flomax.

Vaccine supply, transport and storage In Victoria, influenza and pneumococcal vaccines are available to GPs free for people over 65 years, and Aboriginal & Torres Strait Islander people over 50 years. The National Immunisation Program NIP ; provides free influenza vaccine [1]. The Victorian Department of Human Services provides free pneumococcal vaccine [2]. Pneumococcal for restricted use is available via PBS. Attached is an Immunisation Vaccine Order Form that can be filled out and faxed to the Department of Human Services for ordering vaccines. This form is available at dhs.vic.gov.au phd immunisation It is important to maintain a temperature between 2C and 8C when transporting and storing vaccines. Vaccines should be transported in a cold box with a thermometer to prevent breaking of the cold cycle, and stored in refrigerators dedicated to the storage of medications. Regular quality assurance testing of refrigerators e.g. cleanliness, use, and temperature ; is a requirement for accreditation in general practice and residential aged care facilities. Further advice is available from DHS cold chain enquiries on 9637 4144 Patient information and consent When considering immunization for a resident, the GP needs to discuss the implications of vaccination with the resident and or his or her family, and consider the resident's wishes, existing medical care plans, and advance care plan. Patient information sheets are available from the Victorian Department of Human Services. These include `Preimmunization checklist: what to tell your doctor or nurse before immunization', and `Comparison of effects of vaccines and diseases'. Documentation and reminder system Clearly document in the resident's progress notes and or health record: Date and time of vaccination Type and batch number of vaccination Any adverse effects. Table 5.1 Outline of good sexual health examination practice1 Essential elements 1. Allay the patient's fears 2. Privacy 3. Examination bed 4. Good lighting 5. Good preparation 6. General examination Hint Explain what will be done and encourage disclosure of any discomfort Provide a curtain across the window or around the examination bed and close the door Examine the patient supine Small lesions are best seen with a patient examination light Have equipment e.g. slides, swabs and spatulas, disposable plastic or sterilisable specula and proctoscopes ; nearby Note nutritional status. Examine the skin, mouth, lymph nodes, chest, cardiovascular system, abdomen and central nervous system Patient descriptions of signs can be unreliable; perform anoscopy where indicated Wash hands with soap and water before and after examination and flonase and detrol, for example, enablex!

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