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19.FAKHERI H, MALEKZADEH R, MERAT, S et al. - Clarithromycin vs. furazolidone in quadruple therapy regimens for the treatment of Helicobacter pylori in a population with a high metronidazole resistance rate. Aliment Pharmacol Ther 2001, 15: 411-6. E - Helicobacter pylori: novel therapies. Can J Gastroenterol 1999; 13: 581-3. SD, LIU WZ, HU PJ et al. - A multicentre study on eradication of Helicobacter pylori using four 1-week triple therapies in China. Aliment Pharmacol Ther 2001; 15: 81-6. SD, LIU WZ, HU PJ et al. High cure rate of Helicobacter pylori infection using tripotassium dicitrato bismuthate, furazolidone and charithoymcin triple therapy for 1 week. Aliment Pharmacol Ther 199; 13: 311-5. NULTY CAM, WIS R Rapid diagnosis of Campilobacter pylori. Lancet 1985; 1: 1443-4. R, SILVA FM, ALEXANDRINO et al. - Validation of 14C-urea breath test for diagnosis of Helicobacter pylori Rev Inst Med Trop S. Paulo 1999; 41: 3-8. A, TOWNSEND WF - Costs of duodenal ulcer therapy with antibiotics. Arch Intern Med 1995; 155: 922-8. LA - Helicobacter pylori and complicated ulcer disease. J Med 1996; 100: 52S-57S DY, LEW GM, KLEIN PD et al. - Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study. Ann Intern Med 1992; 116: 705-8. M, MIWA H, NAGAHARA A et al. - Pooled analysis on the efficacy of the second-line treatment regimens for Helicobacter pylori infection. Scand J Gastroenterol 2001; 36 : 690-700. 29.GISBERT JP, BOIXEDA D, BERMEJO F et al. - Re-treatment after Helicobacter pylori eradication failure. Eur J Gastroenterol Hepatol 1999; 11 : 1049-54. 30.SILVA FM, ZATERKA S, NATAN JE et al. Factors affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor, tinidazole and clarithomycin, in Brazilian patients with peptic ulcer. Rev Hosp Clin Fac Med S. Paulo 2001; 56: 11-16. CE, NIX DE, SCHENTAG JJ - In vitro selection of resistant Helicobacter pylori. Antimicrob Agents Chemother 1990; 34: 1637-41. Received for publication on December 06, 2001. Metronidazole is an antibiotic used to treat different kinds of infections.

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Addition, it becomes a safe yet effective alternative in the treatment of BV during the first trimester of pregnancy since oral metronidazole is contraindicated during this period. 16 This then prevents complications of BV during a woman's pregnancy and results in minimal risk to the fetus as well .The efficacy of a 7 day course of 2% clindamycin phosphate vaginal cream applied once daily has been found to be comparable to that of oral metronidazole.11, 14, 17 This randomized, double -blind study was conducted to determine the efficacy and safety of a three-day course of 2% clindamycin vaginal cream applied once daily compared to the standard regimen of oral metronidazole, 500 mg twice daily for 7 days. Review of various clinical trials using intravaginal clindamycin will be discussed herewith. MATERIALS AND METHODS Fifty one non-pregnant, non-lactating, premenopausal women diagnosed to have BV alone out of the 195 women screened at a gynecologic clinic were enrolled in this prospective study. The clinical diagnosis of BY was based on the presence of at least 3 of the 4 clinical criteria proposed by Amsel and co-workers; 8 namely: 1 ; vaginal secretion pH greater than 4.5, 2 ; a fishy amine odor in vaginal secretion on addition of 10% potassium hydroxide KOH ; , 3 ; presence of clue cells on saline wet mount and or Gram stain of vaginal secretion, with or without 4 ; adherent watery vaginal discharge. The exclusion criteria were: allergy to clindamycin or metronidazole; systemic or vaginal antimicrobial therapy received the previous 2 weeks; presence of other lower genital tract infections; history of antibiotic -associated colitis or frequent diarrhea; anticipation of menstruation during therapy; and unwilling to stop douching during therapy. By random allocation, 25 were given 2% clindamycin phosphate vaginal cream, 5 gm 1 applicator ; administered vaginally at bedtime for 3 days and placebo capsules taken orally twice daily for 7 days n 25 ; and 26 were given metronidazole capsules 500 mg taken orally twice daily for 7 days plus placebo vaginal cream, 5 gm 1 applicator ; administered vaginally at bedtime for 3 days. A written in- formed consent was obtained prior to study participation. Treatment was started as soon as possible or at least less than 14 days from the initial visit. In addition, study participants were instructed to abstain from sexual intercourse during treatment protocol, not to douche, nor take any systemic or intravaginal antibiotics. A speculum examination was done by a physician to inspect and screen for lower genital tract infection. A cervix-brush Rovers B. V. OSS, Holland ; was used to obtain vaginal secretion. The pH of vaginal secretion was determined by using a pH Indikatorpapier, pH range 3.8-5.4 Merck ; . The amine test was considered positive when vaginal secretions emitted a fishy odor with addition of 10% KOH. Clue cells, which are vaginal epithelial cells studded with tiny coccobacilli, were identified from saline wet mount and or Gram stain of vaginal secretion. Women with vaginal candidiasis, trichomoniasis, and gonococcal infection a ssociated with BV were excluded from the study. Direct microscopy on wet mount, Gram stain, and KOH mount was used to identify Trichomonas vaginalis, Neisseria gonorrhea, and Candida, respectively. Endocervical brushings were cultured for N. gonorrhea on Modified Thayer Martin and Candida albicans on plain blood agar plate, which was confirmed by the germ tube test. Evaluation of the efficacy of therapy was based on the clinical outcome at the first follow-up visit between 5 to 9 days post therapy, and at the second follow-up visit, between 28 to 35 days post therapy. Criteria for clinical cure were: 1 ; vaginal fluid pH 4.5, 2 ; no fishy amine odor in vaginal secretions on addition of 10% KOH negative amine test ; , and 3 ; absence of clue cells in vaginal secretions. Patients were considered improved if any of the 2 criteria were present and were regarded as failure when none or only one of the criteria stated above was true. Furthermore, patients were tested for other lower genital tract infections when they had signs and symptoms of vulvovaginitis burning, itching, abnormal vaginal discharge ; , on questioning and or on examination. Side effects were recorded as well, whether systemic or local. When a patient and tamsulosin.

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Even patients with very low levels of LDL cholesterol who suffer a myocardial infarction or other coronary event may benefit from taking a statin drug, according to a new study published in the American Journal of Cardiology. Researchers from the University of Michigan at Ann Arbor reviewed the charts of 155 patients admitted to the hospital with a diagnosis of acute coronary syndrome unstable angina or myocardial infarction ; who had very low LDL levels 80 mg dl or lower ; and were not on statin therapy at the time of admission.

There is little published evidence about reproducibility and reliability in this patient population. Two groups have recently examined specific aspects of geriatric urodynamics which have some bearing on this topic. There is a little older evidence on the reproducibility of some parameters. a ; Filling cystometry One group [427] sought urodynamic changes associated with behavioral and drug treatment of urge incontinence in 105 ambulatory, nondemented, community-dwelling women, of mean age 67 years range 55-91 ; . They especially sought changes which might mediate the positive effects of treatment on the frequency of incontinence. Positive evidence that urodynamic results are related to treatment outcomes would tend to confirm the reliability and relevance of urodynamic measurements and fludrocortisone.
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TREATMENT OF GESTATIONAL DIABETES The ultimate goal of gestational diabetes treatment is to restore normoglycemia in the mother thereby ensuring a euglycemic environment for the fetus. The gold standards for the management of gestational diabetes have been diet and insulin. For the gestational diabetic mother ; , insulin promotes glucose uptake and oxidative metabolism resulting in a lowering of blood sugar, controlling glycosuria and polysuria as well as the disappearance of ketone bodies from the blood and urine [10]. Insulin is the preferred pharmacological treatment in pregnancy because it is unable to cross the placenta due to its large molecular weight 6000 Da ; . However, insulin is not without its shortcomings. Elliott et al. [12, 13] observed anti-insulin antibodies in response to human insulin in women with gestational diabetes. Once bound to these IgG antibodies, insulin can cross the placental barrier and initiate the cascade of events leading to neonatal macrosomia. Moreover, most women who suffer from gestational diabetes were not diabetic prior to pregnancy. Adequate normoglycemia in these women may require several daily injections; pain, discomfort as well as the increased cost and training required to administer these injections make compliance with the therapy a critical issue and ofloxacin.

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Ready, Steady, Cook ! 1 ; Flake the tuna and mix with the mashed potato, parsley and spring onions. Divide into 8 even portions and shape into patties, about 2 cm thick. 2 ; Put the egg and breadcrumbs in separate shallow dishes. Coat each fish cake, first in the egg and then in breadcrumbs. 3 ; Heat 100 ml oil in a frying pan and cook the cakes for 3 to 4 minutes on each side. Serve with a selection of vegetables or salad. The Cost Per Serving: Calories 425 Carbohydrate 24g Fat 25g Saturated Fat 7g Drinking Partner Australian Riesling with its crisp lemon flavours make this an excellent wine and an ideal accompaniment to fish dishes and felodipine.

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Treatment with metronidazole 1, 500 mg day and rectal hydrocortisone 100 mg day colofoam ® , norgine pharma, paris, france ; was introduced in february 1996 when the corticosteroid therapy was tapered to 5 mg day, due to reappearance of crohn's disease intestinal symptoms respiratory symptoms never reappeared since 1995. Although metronidazole-resistant trichomoniasis is thought to be an infrequent occurrence, patients with resistant organisms are left without an alternative treatment and fenofibrate.
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Comparative effectiveness review no prepared by the oregon evidence-based practice center under contract no 290-02-002 ; rockville, md: agency for healthcare quality and research.

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The discriminative stimulus properties of drugs. 3. Periodically, vaginal douching rinsing the vagina with a solution from a clean plastic juice bottle or syringe ; can be used, once or twice a day for 5 days to decrease the amount of bacterial overgrowth. The solutions discussed above bicarbonate, vinegar, or metronidazole ; can be used for douching. Some women may not be familiar with douching, so teaching the process to the ill woman and her caregivers can be helpful. Vaginal douching may cause considerable vaginal bleeding however, so it should be used with caution. 4. If you determine that bacterial overgrowth is likely, broad-spectrum oral antibiotics may be used, such as: Doxycycline Amoxicillin and metronidazole, taken together Note: Fungal vaginitis yeast, candida ; may occur as a side effect of using antibiotics, orally or topically in the vagina. This can be treated with antifungals. Common antifungals are: fluconazole 100 mg by mouth daily for 7 days; ketoconazole 200 mg by mouth once a day for 7 days; and 1 nystatin vaginal pessary daily for 14 days. The dose of doxycycline is 100 mg by mouth two times a day for 5 days. The dose of amoxicillin is 250 mg by mouth three times a day for 5 days. The dose of metronidazole is 400 mg by mouth two times a day for 5 days. Male sexual act, the sperm are combined with ."""`, ~ `"`., : fluids from the seminal vesicles, the " prostate and mucous glands to form Todd is a 40-year-old man who has had mixed spastic " ., semen. athetoid cerebral palsy with total body involvement since birth. He first -., came to the Rehabiliition Technology Services at MetroHealth Medical Center The male sexual act requires `, three separate processes: pein Cleveland seeking assistance to obtain wheelchairseating and an augmentative communication device. nile erection, emission of seminal fluids into the Once he received custom-contoured seating and a Prentke Romich Touch Talker, Todd worked with the RTS staff to develop job skills and identify the types of equipment that would assist ." urethra and ejaculation ' of those fluids from him with writing and dataentry. the body. Erection After working closely together for nearly a year, Todd approached me with an unusual request Could I , zfJ help him and his wife, Ros, conceive a child. Needless to say, this was not my area of expertise; but as Todd `, occurs when im.s t pulses traveling and Ros told their story, we began to formulate a plan Roth Todd and his wife came from large families, and once they were married, they planned tobegin having : : from the sacral to children quickly. After hying to conceive a child for more than three years, they had recentlyntly undergone extensive spinal cord cause ! the arteries of the fertilii testing. The results were discouraging: Todd had a sperm count of 710, 00-far below the normal threshold of 20 million. In addition, none of his sperm showed active motilii. Todd and Ros were advised to accept the fact that penis to dilate. they would never be able to have children. This can be initiated either by a Since I knew of no reason why Todd's CP should be impacting his fertility, I began working with him.and Ros to inspinal reflex arc vestigate other factors that could be related to decreased sperm production. One factor that immediately stood out was Todd's custom-contoured, vinyl-covered foam cushion. Since Todd used his wheelchair all day, we guessed that in response to physical stimulaperhaps his seat cushion retained too much body heat and was destroying his sperm. To test our theory, I fabricated a new wheelchair seat out of cotton batting and terry cloth tion of the sexual o r g reflexocut in the seat to allow optimal air flow in the genital area. Todd found the seat comfortable a sitting on it all day. genie stimulation A few months after our intervention, Todd and Ros returned to the fertility or by cortical control in response to arousing three of us were thrilled to hear that Todd's sperm count had risen to 18 mil stimuli, such as pictures mobility Todd continued to use the new cushion and one month later we re or sexy thoughts psyall: Ros was pregnant. Nine months later, Ros gave birth to a health good news doesn't chogenic stimulation ; . When stop there. Two-year-Jonathan was joined the intensity of sexual stimuli following Todd's use of the specially fabricated cushion. reaches a sufficient level, a second reflex arc in the lower thoracic and Today, Todd uses a foam cushion in his power wheelchair. But he and Ros have hung onto his "fertility cushion"-just upper lumbar areas of the spinal cord is in case. -L.S.M. responsible for emission and closure of the neck of the bladder to prevent retrograde moveand sperm come in contact. ment of semen into the bladder. Filling of the urethra with seminal fluid activates a final sacral reflex arc, causing the Finally, female sexual function can be impacted by neurological disease or trauma. Vaginallubricamuscles at the base of the penis to contract and force the seminal tion is sometimes reduced by antidepressant medications or by emission out of the body as ejaculate. The semen parameters most associated with fertility are the neurological dysfunction, leading to difficult or painful internumber of sperm and the percentage of sperm that are actively course. This can be remedied by using an over-the-counter lubricant such as KY jelly. motile. Most men average 20 million to 150 million sperm with 50 percent to 60 percent motility. Ejaculate containing fewer than Male Infertility 20 million sperm or containing sperm with less than 50 percent The male reproductive system consists of the testes made up of motility is usually unsuccessful in causing pregnancy. about 900 coiled seminiferous tubules ; , the epididymis, the vas Most male infertility is a result of either impaired spermprodeferens and the urethra, which runs through the glans penis. duction or sexual dysfunction impotence ; . Impaired spermproOver a period of about 75 days, the epithelial lining of the semiduction is generally a result of testicular failure. Genetic abnorniferous tubules differentiates into sperm cells. After they are malities, disease, toxins, radiation or elevated temperatures can destroy the epithelium of the seminiferous tubules and prevent formed, the sperm pass through the epidymous to the vas deferTodd's S o y.

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