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And multiple-drug therapy may pose additional considerations for the use of COX2 specific inhibitors. Two COX-2-specific inhibitors, celecoxib Celebrex ; and rofecoxib Vioxx ; , have been approved for use in patients with osteoarthritis.22, 23 Two recently published long-term studies have shown differences between COX2 specific inhibitors and nonselective NSAIDs with respect to major gastrointestinal clinical outcomes.24, 25 Another advantage of rofecoxib and celecoxib is that neither drug has a clinically significant effect on platelet aggregation or bleeding time. At doses recommended for the treatment of osteoarthritis, these drugs appear to be better tolerated than comparative nonselective NSAIDs, and therefore, both have become widely used in the treatment of osteoarthritis. As with nonselective NSAIDs, COX-2 specific inhibitors can cause renal toxicity. In addition, celecoxib is contraindicated in patients with allergic reactions to a sulfonamide. Alternatively, nonselective NSAIDs can be combined with misoprostol Arthrotec, Cytotec ; or omeprazole Prilosec ; . In either case, although there may be a decrease in serious adverse upper gastrointestinal events with these combinations of therapy, platelet aggregation would still be inhibited. Opioid analgesics can be used for severe pain associated with osteoarthritis unresponsive to acetaminophen, tramadol, or nonsteroidal anti-inflammatory drugs. Glucosamine and chondroitin sulfate have been used in the treatment of osteoarthritis for more than 40 years. Products are found in both health food stores and pharmacies. They have been purported to decrease the pain of osteoarthritis. A meta-analysis of 15 different studies was recently published.26 Only controlled studies of at least 4 weeks' duration were analyzed. Fifteen such studies were included, and all but one was classified as positive. The studies demonstrated moderate effects for glucosamine and large effects for chondroitin. The authors concluded that the quality of the studies was poor, and therefore, the methodologic problems could have exaggerated the estimates of benefits. The National Institutes of Health is currently supporting a multicenter, randomized, double-blind, placebo-controlled study of patients taking glucosamine alone, chondroitin sulfate alone, glucosamine and chondroitin sulfate together, or placebo. Results are not expected for another 3 years!

M Diaz, B Skipper, and D Braude, Albuquerque, NM. University of New Mexico School of Medicine WSMRF ; Abstract 286, for example, omeprazole liquid. Pathophysiology and Medical Therapy Jan Rakinic, M.D. Colorectal Surgery. To clear up your infection completely, continue taking this medicine for the full course of treatment even if you begin to feel better in a few days, for instance, omeprazole prilosec otc. Complex investigations were undertaken to study the population longevity phenomenon in different regional-ethnic settings, involving 8, 000 people Abkhasians in Abkhasia, Azerbaijanians and Russians in Azerbaijan, Ukrainians in Ukraine ; . Longevity is conditioned by genetic factors, being established as a result of a long-term adaptation of people to naturalecological conditions. They show their action, due to a traditional system of marital rules, either among ethnic majority Abkhasians ; or among its separate part - endogamic settlements Azerbaijanians ; . The regional longevity of Abkhasians and Azerbaijanians is conditioned by psychological factors: personality features of long-lived and the existence of an ethnic-traditional system of anti-stress settings, a respectful "gerontophilic" attitude to older persons and their prestigious status in social life. References: M. Bergener, S.I. Finkel 1990 ; : Clinical and Scientific Psychogeriatrics. Volume 1. The Holistic Approaches, New York: Springer Publishing Company N.B. Mankovsky, A. Ya. Mints, S.M. Kuznetsova, R.P. Belonog 1985 ; : The LongLived. The Neurophysiological Aspects, Institute of Gerontology, Kiev. T h e Your surgeon will likely give you instructions to follow. Those instructions will probably include some of the following. Bathing You'll probably want to take advantage of the fact that you are allowed to bathe on the day of your surgery, because you won't be able to shower for a few days after your procedure. So, feel free to bathe the day of, but remember that you cannot use any products, such as oils, lotions, make up--not even deodorant. Again, make sure you wash your surgical areas with antimicrobial soap to cleanse your body and prepare it for your procedure. Remove Nail Polish You'll also need to remove nail polish from at least one of your fingernails on each hand so that your medical team can monitor the color of your nails and ensure that your blood is well oxygenated during surgery. A probe that measures the amount of oxygen in blood also will be placed on your finger before surgery. N o F Remember, no food or liquids today. If your surgeon makes an exception and allows you to continue to take your current medication on the day of your procedure, take the tiniest sip of water possible with it. And when you are brushing your teeth, remember not to swallow any water while rinsing your mouth and ondansetron.

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Zanamivir Relenza ; - this treatment for influenza, along with oseltamivir Tamiflu ; and amantadine Lysovir Symmetrel ; is currently being reviewed by NICE. Meanwhile the APC recommend that the original appraisal for Zanamivir no 15 ; is followed which states that the treatment should only be used when influenza is circulating locally as advised by the public health department. Practices will also be advised by public health in specific circumstances such as an outbreak in a care home or similar institution. Insulin Glargine Lantus ; - NICE have now reported on this no 53 ; and recommended it as a treatment option for people with type 1 diabetes and limited use in those with type 2 diabetes. The APC have agreed a protocol with the local diabetic specialists which has been sent to all practices and is also available on the PCT website, from the pharmaceutical team and from the diabetic nurse specialists. The specialists will be recommending Glargine for type 1 diabetics on basal-bolus insulin regimens who suffer troublesome hypoglycaemia in spite of education about snacks, monitoring and injections sites and a trial of rapid acting insulin analogue. Patients with type 2 diabetes who require twice daily injections administered by carers or health professionals will also be considered. Esomeprazole Nexium ; - The APC has agreed a protocol with the gastroenterologists at the Acute Trust for limited use of this drug. This is due to esomeprazole being licensed for use in reflux disease at a highly potent dose. Indications for the use of Esomeprazole by Acute Trust specialists: Grade IV ulcerative ; oesophagitis Grade IV Ulcerative ; oesophagitis with bleeding Grade V oesophagitis with stricture formation Healing therapy for gastro duodenal ulceration associated with GI blood loss and visible vessel or clot. Glitazones - The diabetic consultants would like to use pioglitazone and rosiglitazone early in therapy for type 2 diabetics. Unpublished studies, use in other countries and theoretical advantages suggest that early use of glitazones could reduce the risk of CHD and the progression of the disease. The APC had reservations about endorsing this use of glitazones since it is contrary to current NICE guidance no. 21 ; . NICE is also reviewing the evidence for the glitazones and will produce new guidance this year. The discussion will continue at the next APC meeting when further information will be available. Meanwhile prescribers are reminded that NICE advise that glitazones are only used when patients have had a trial of oral combination therapy with metformin and a sulphonylurea, unless there are contraindications or tolerability problems. Cerazette Contraceptive - This is a new progesterone-only pill which is more effective than existing progesterone only pills and has a wider safety margin with late missed pills. It was approved for limited use by the Sexual Health Directorate in selected women. The annual cost is 36 compared to 8 for Micronor , 11 for Microgynon 30 and 29 for Marvelon. A11 receptor antagonists - Valsartan has now been added to losartan, irbesartan and candesartan which are already in the County formulary. They all four appear to have similar efficacy but have slightly different licensing and each one is the preferred choice by specific consultants. County Guidelines The following have been sent to practices and are available on the PCT website: Cox 11 Selective Inhibitors NSAIDS ; Prescribing nicotine replacement therapy in pregnancy Guidelines for prescribing to aid smoking cessation Revised guidelines for identification and treatment of depression Guidelines for the identification and treatment of anxiety!

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Recent reports claimed that a visit to the hairdresser could be a risk factor for stroke. Known as `Beauty Parlour Syndrome', it is alleged that when extending your neck backwards to have your hair washed, there is a small risk of having a stroke and has been identified as a factor in several recent strokes. Beauty Parlour Syndrome was first reported in the early 1990s. An American neurologist identified five patients who suffered a stroke due to prolonged deformation of their necks. However, further research was slow to develop until 1997 when a report in The Lancet detailed how a 42-year old woman had a stroke after the dissection of her right internal carotid artery during a hair wash. Her head had been extended backwards for about five minutes and afterwards she felt numb and experienced slurred speech. On this occasion doctors recommended that hairdressers should use a cushion so that the head is not overextended. Most medical experts do stress, however, that strokes caused by manoeuvering the neck into an awkward position, though possible, are extremely rare. Peter Humphrey, a consultant neurologist at The Walton Centre for Neurology and Neurosurgery in Liverpool explains: "It is not due to pressure on the artery cutting off the blood supply to the brain, but is much more likely to be caused by a small tear in the lining of the vertebral arteries which run from the back of the neck up into the base of the brain. Clots could form on the rough, irregular torn area, break off and be swept upstream into the brain to cause a stroke." For a person to experience a stroke in this case they would have. Robert Merrett of the University of Alberta has been named Vice President Development and will lead the fund-raising campaign. The goal is to place the Federation on a secure financial footing and to promote support for the humanities and social sciences. For further information, contact Dr Merrett at For Canadian universities, these are important days. Federal--and some provincial-initiatives are beginning at last to address the needs of our cash-starved institutions. In the 2001 Federal budget the government took two decisions with long-term impact when it comes to research and education in Canada. In funding the indirect costs of research, it has taken an historic step forward, a step which will help to ease the difficult situation in Canadian universities. But, at the same time, the long term impact of the government's funding decision for the Social Sciences and Humanities Research Council of Canada is cause for serious concern. While the $9.5M increase to SSHRC's budget was welcome news, the Federation had looked to this budget to create balance in the government's funding of research. By increasing NSERC and SSHRC budgets by exactly 7% each, the Federal Budget actually increases the disparity between Granting Councils leaving SSHRC with only an 11.5% share of the total money provided to Granting Councils in Canada. We will continue our efforts on your behalf to make the case to government of the need to strike a balance when it comes to funding SSHRC. In this context, we must do everything to ensure that the voice of our disciplines is strong and clear and that it be heard. This is a moment for the Federation to give critical attention to its communications strategy, both internal so that we consolidate our collective strength ; and external so that we have impact in decision-making ; . This year, the Executive and the Staff of the Federation are putting into place a Strategic Plan aimed at achieving the following goals: - strengthening member associations; - raising the profile of the Federation on university campuses; - developing the effectiveness of our partnership with SSHRC; and - reinforcing the Government Lobby and increasing awareness of the humanities and social sciences in interested communities. All of these goals support the overall mandate of the Federation. They are designed to give clear purpose and strength to our collective voice. I would be grateful to have any comments or input on these issues c o jawright hssfc ; . Other Federation activities over the coming year include: - Congress 2002 at University of Toronto. - Continued monitoring of the impact of the Canada Research Chairs and other funding initiatives on humanities and social sciences. - Continued participation in Tri-Council Policy on the Ethical Conduct for Research Involving Humans. At our AGM, Mr. Tim Flaherty, Director, Ethics Division of Health Canada, presented his views on the governance of the ethics of research on humans. One of the suggestions was the formation of a national body to ensure the accreditation of research ethics boards and the education of board members and researchers. Mr Flaherty will undertake a formal public consultation process in the new year and hopes to have a report completed by March 2002 and oxytetracycline.

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