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Health care providers recommend that all babies born to HIV positive mothers be tested for HIV. However, states differ in the ways they approach HIV testing for babies. some states require that babies receive a mandatory HIV test if the status of their mother is unknown some states require that health care providers test babies for HIV unless a mother refuses some states are only required to offer an HIV test to pregnant women not their babies ; , which they can either accept or refuse!

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Welcome to our office's Chiropractic newsletter. We'd like to entertain you, inform you and even inspire you a little ; . Please let us know if you have any question regarding any of the articles in this newsletter. we have obviously opted for a new newsletter format for 2005. Let's make the New Year a healthy one! Dr. Craig Tarini & Dr. Laura Bertram. Prescription drugs: economic implications for patients, payers and providers. Pharmacoeconomics, 19, 109 119. Pharmacoeconomics, 19 and ventolin. Members with our Three-Tier Drug Rider pay different co-payments or coinsurance for drugs based on whether they are: Generic Preferred Brand-name that is, on our Preferred Brand-name Drug list ; Non-preferred Brand-name not on our Preferred Brand-name Drug list ; RESTAT, our prescription drug manager, changes the Preferred Brand-name list in two circumstances: The list changes four times a year to reflect drugs entering or leaving the marketplace. Members receive notification through their Vigor newsletter. In most cases, we give 30 days notice of these changes. RESTAT automatically deletes drugs from the Preferred Brand-name list without notice throughout the year when generic forms become available. We will not be able to provide notice of these changes, as they can happen at any time. When members switch to the new generic form of the drug, their co-payments or coinsurance will be significantly lower. The following medications have been added to our Preferred Brand-name Drug List: CLIMARA LEVSIN-SL CONCERTA LEVSINEX FULVICIN P G NULEV FULVICIN U F ORTHO TRI-CYCLEN INTAL INHALER ORTHO TRI-CYCLEN LO LEVBID SANDIMMUNE The following medications have been deleted from our Preferred Brand-name Drug List: ACULAR DIOVAN HCT ACULAR PF VIOKASE DIOVAN The following medications are deleted because they are now available as generics: BUSPAR MICRONOR CORDARONE NITRODISC COUMADIN NITRO-DUR DAYPRO PRILOSEC DECONAMINE SR ROCALTROL EURAX CREAM LIQUID EULEXIN SARAFEM FLORINEF THEO-DUR HALDOL VASOCIDIN IMURAN WESTCORT KLOTRIX ZESTORETIC LOESTRIN FE ZESTRIL MEDROLS ZIAC. Before taking vioxx, tell your doctor if you are taking any of the following drugs: aspirin or an aspirin-like medication such as salsalate disalcid ; , choline salicylate-magnesium salicylate trilisate, tricosal, others ; , and magnesium salicylate doan's, bayer select backache formula, others an over-the-counter cough, cold, allergy, or pain medicine that contains aspirin, ibuprofen, naproxen, or ketoprofen; a diuretic water pill ; such as furosemide lasix ; , hydrochlorothiazide hydrodiuril, others ; , chlorothiazide diuril, others ; , chlorthalidone hygroton, thalitone ; , and others; an angiotensin-converting-enzyme inhibitor ace inhibitor ; such as benazepril lotensin ; , captopril capoten ; , enalapril vasotec ; , lisinopril prinivil, zestril ; , moexipril univasc ; , quinapril accupril ; , and others; a steroid medicine such as prednisone deltasone and others ; , methylprednisolone medrol and others ; , prednisolone prelone, pediapred, and others ; , and others; an anticoagulant blood thinner ; such as warfarin coumadin methotrexate rheumatrex, folex theophylline theo-dur, theobid, and others lithium eskalith, lithobid, others or rifampin rimactane, rifadin, rifater and cimetidine.

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L O N Common Brand Names Inhaled Corticosteroids QVAR Azmacort Aerobid, Aerobid-M Flovent, Flovent Diskus Pulmicort Turbuhaler and Respules Combination Products Advair Fluticasonesalmeterol Mast Cell Stabilizers Intal Tilade Long-Acting Beta2-Agonist Serevent Diskus Foradil Oral Corticosteroids Prednisone, Deltasone, Orasone, etc. PediaPred, Prelone, Orapred Decadron, etc. Cortef prednisolone dexamethasone hydrocortisone prednisone Effectively reduces swelling, inflammation and mucous production. These products are used with beta2-agonists and or ipratropium to treat a severe asthma attack. Long-term use can lead to numerous side effects Leukotriene Inhibitors Accolate Singular Zyflo Theophylline Slo-Bid, Uniphyl, Theo-Dur, etc. theophylline Relax the smooth muscle of the lungs and pulmonary blood vessels Yes zafirlukast montelukast zileutin Reduce inflammation in the lungs caused by asthma No No No Yes, in most strengths Yes Yes, in most strengths Yes, in most strengths salmeterol fometerol Relaxes the muscle of the lungs so that more oxygen can reach the blood No No cromolyn sodium nedocromil Reduces the inflammation that is caused by asthma Yes, except inhaler No Contains an inhaled corticosteroid and long acting beta2-agonist No beclomethasone triamcinolone flunisolide fluticasone budesonide Decreases the swelling, inflammation and mucous production in the airways associated with asthma; most effective products at preventing hospitalization No No No Generic Name How Do They Work? Generic Available? and eldepryl. Asthma Introduction Although the exact causes of asthma are unknown, several factors, including exercise, may induce an asthma attack. The majority of patients with asthma and patients with allergies will have exercise-induced bronchospasm EIB ; . EIB usually occurs during or minutes after vigorous activity, reaches it's peak 5-10 minutes after stopping the activity, and usually resolves in another 20-30 minutes. Asthma Medications Depending on the severity of asthma, medications can be taken on an as-needed basis prn ; or regularly to prevent or decrease breathing difficulty. Most of the medications fall into two major groups: quick relief medications and long-term control medications. Quick relief medications are used to treat asthma symptoms or an asthma episode. The most common quick relief medications are the short-acting beta-agonists that relieve asthma symptoms by relaxing the smooth muscles around the airways. Common beta-agonists include Proventil and Ventolin albuterol ; , Maxair pirbuterol ; , and Alupent metaproterenol ; . Atrovent ipatroprium ; , an anticholinergic, is a quick relief medication that opens the airways by blocking reflexes through nerves that control the smooth muscle around the airways. Steroid pills and syrups, such as Deltasone prednisone ; , Medrol methylprednisolone ; , and Prelone or Pediapred prednisolone ; are very effective at reducing swelling and mucus production in the airways; however, these medications take 48-72 hours to take effect. Long-term control medications are used daily to maintain control of asthma and prevent asthma symptoms. Intal cromolyn sodium ; and Tilade nedocromil ; are long-term control medications which help prevent swelling in the airways. Inhaled steroids are also long-term control medications. In addition to preventing swelling, they also reduce swelling inside the airways and may decrease mucus production. Common inhaled steroids include Vanceril, Vanceril DS, Beclovent, and Beclovent DS beclomethasone ; , Azmacort triamcinolone ; , Aerobid flunisolide ; , Flovent fluticasone ; and Pulmicort budesonide ; . Leukotriene modifiers are new long-term control medications. They may reduce swelling inside the airways and relax smooth muscles around the airways. Common leukotriene modifiers include Accolate zafirlukast ; , Zyflo zileuton ; and Singulair muntelukast ; . Another long-term control medication, Theophylline, relaxes the smooth muscle around the airways. Common theophyllines in oral form include Theo-Dur, Slo-Bid, Uniphyl and UniDur. Serevent salmeterol ; , in inhaler form, is also a long-term control medication. As a long-acting betaantagonist, it opens the airways in the lungs by relaxing smooth muscle around the airways. Inhaled Medications Inhaled medications are delivered directly to the airways, which is useful for lung disease. Aerosol devices for inhaled medications may include the metered-dose inhaler MDI ; , MDI with spacer, breath activated MDI, dry powder inhaler or nebulizer. The most commonly used inhaled medications are delivered by the MDI, with or without the spacer. There are few side-effects because the medicine goes right to the lungs and not to other parts of the body. It is critical that the patient use the prescribed MDI correctly to get the full dosage and benefit from the medication. Unless the inhaler is used in the right manner much of the medicine may end up on the patient's tongue, the back of their throat, or in the air. Use of a spacer or holding chamber helps significantly with this problem and their use is strongly recommended. A spacer is a device that attaches to a MDI and holds the medication in its chamber long enough for the patient to inhale it in one or two slow deep breaths. This eliminates the possibility of inadequate medicine delivery from poor patient technique. Using the MDI The UGA sports medicine staff may assist a student-athlete in the use of a prescribed MDI as follows: Remove the cap from MDI and hold the inhaler upright Shake the inhaler Tilt patient head back slightly and have patient breathe out Open mouth with inhaler 1-2 inches away or mouth to spacer mouthpiece if spacer available ; Press down on the inhaler to release the medication as patient starts to breathe in slowly Patient breathes in slowly for 3-5 seconds Patient holds breath for 10 seconds to allow the medication to reach deeply into the lungs Repeat puffs as prescribed; waiting 1 minute between puffs may permit the 2nd puff to go deeper into the lungs If possible, ausculate breath sounds and measure peak expiratory flow rate PEFR ; prior to and after MDI administration.

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DOP-PCR ; or primer extension preamplification PEP ; . However, these PCR-based methods generate non-specific amplification artifacts and give incomplete coverage of loci. The use of QIAGEN's REPLI-g technology for forensic identity testing, utilizing a novel method for whole genome amplification WGA ; termed multiple displacement amplification MDA ; is described. This technique is capable of accurate in vitro DNA replication of whole genomes, without sequence bias, yielding DNA suitable for direct use in STR typing. Normalized yields from a variety of samples: Various samples can be used in a REPLI-g MDA reaction, including purified genomic DNA and fresh or dried blood. Typical DNA yields from a REPLI-g Mini Kit in vitro DNA replication reaction are approximately 10 g per 50 l reaction. A uniform concentration of amplified DNA is usually achieved regardless of the quantity of template DNA Figure 2 ; . Obtaining uniform DNA yields from varying template concentrations is particularly important for STR typing applications, enabling subsequent analysis without the need to measure or adjust DNA concentration. The average product length is typically greater than 10 kb, with a range between 2 kb and 100 kb Figure 3 ; . Whole Genome Amplification WGA ; of human mitochondrial DNA: A single mitochondrion contains several copies of mtDNA and each cell in the human body contains hundreds to thousands of mitochondria. This effectively means that there are hundreds to thousands of mtDNA copies in a human cell compared to just 2 copies of nuclear DNA located in that same cell. Thus, forensic scientists make use of enhanced sensitivity by characterization of mtDNA in situations where nuclear DNA is significantly degraded, or present in very small quantities. In situations where a reference sample cannot be obtained e.g., from a long deceased or missing individual ; , a mtDNA reference sample can be obtained from any maternal relation. The newly developed REPLI-mt Kit contains DNA polymerase, buffers, and reagents for whole genome amplification from small samples of human mitochondria genome using multiple displacement amplification MDA ; . The technology allows uniform amplification of the whole mitochondrial genome with minimal nuclear DNA contamination. Typical DNA yields are approximately 5 g per 50 l reaction. Method: The REPLI-g MDA method is an isothermal genome amplification utilizing a uniquely processive DNA polymerase capable of replicating 100 kb without dissociating from the genomic DNA template Figure 1 ; . The DNA polymerase has a 3 5 exonuclease proofreading activity to maintain high fidelity during replication and is used in the presence of exonuclease-resistant primers to achieve high yields of DNA product. In addition, the REPLI-g amplification enzyme is significantly more tolerant against inhibition than Taq DNA polymerase. Two novel technologies have been developed for the amplification of highly compromised material and for specific amplification and enrichment of human mitochondrial DNA. Genomic DNA becomes damaged on exposure to the environment, as is often the case with crime scene samples. mtDNA analysis is applied in forensic science to enhance sensitivity in situations where nuclear DNA is significantly degraded or where insufficient quantity is available. The application of these new WGA techniques will further enhance the usefulness of WGA to forensic sciences. Minimum sequence bias: PCR-based methods e.g., DOP-PCR and PEP ; generate nonspecific amplification artifacts, give incomplete coverage of loci, and generate DNA fragments significantly less than 1 kb long that will lead to reduced amplification success and poor results when using large STR amplicons. In contrast, REPLI-g provides highly uniform amplification across the entire genome, with no sequence bias. Amplification of fragmented or damaged DNA Biological samples exposed to the environment often yield compromised DNA. The degree of DNA damage depends on a number of factors, including environmental conditions such as UV irradiation, pH, and the method of sample processing prior to DNA isolation e.g and feldene.

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Lukast Accolate ; , zileuton Zyflo theophylline Theo-Dur, Slo-Bid, Uni-Dur, theophylline ethylenediamino [Aminophylline] anticholinergic: ipratropium Atrovent 2agonists: salmeterol Serevent ; . 3 ; Antibiotics to control infection. c. Oxygen therapy with increased humidity as ordered. d. Frequent monitoring for respiratory distress. e. Rest periods and gradual increase in activity. 2. Goal: facilitate expectoration. a. High humidity. b. Increase fluid intake. c. Monitor for dehydration. d. Respiratory therapy: IPPB. 3. Goal: health teaching to prevent further attacks: a. Identify and avoid all asthma triggers. b. Teach importance of peak flow meter readings. c. Medications--when to use, how to use, side effects, withdrawals. d. Methods to facilitate expectoration--increase humidity, postural drainage when appropriate, percussion techniques. e. Breathing techniques to increase expiratory phase. f. Stress-management techniques. g. Importance of recognizing early signs of asthma attack and beginning treatment immediately. h. Steps to take during an attack. F. Evaluation outcome criteria: 1. No complications. 2. Has fewer attacks. 3. Takes prescribed medications, avoids infections. 4. Adjusts lifestyle. 5. Pulmonary function tests return to normal. VIII. Bronchitis: acute or chronic inflammation of bronchus resulting as a complication from colds and flu. Acute bronchitis is caused by an extension of upper-respiratory infection, such as a cold, and can be given to others. It can also result from an irritation from physical or chemical agents. Chronic bronchitis is characterized by hypersecretion of mucus and chronic cough for 3 months per year for 2 consecutive years. A. Pathophysiology: bronchial walls are infiltrated with lymphocytes and macrophages; lumen becomes obstructed due to decreased ciliary action and repeated bronchospasms. Hyperventilation of alveolar sacs occurs. Long-term condition results in respiratory acidosis, recurrent pneumonitis, emphysema, or cor pulmonale. B. Risk factors: 1. Smoking.

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Centrations using a two-compartment model indicated that -fluoro VPA, like VPA, may be asymmetrically transported across the blood-brain-barrier. This property of -fluoro VPA was also reflected in its low brain-to-serum concentration ratio of 0.09 at the peak brain drug concentration 0.16 for VPA ; . The primary -oxidation metabolite of VPA was not found in the serum and urine of mice treated with -fluoro VPA. Although the glucuronide was a major metabolite of VPA 28.5% of the dose ; , -fluoro VPA was observed to conjugate extensively with L-glutamine 33.3% of the dose ; . -Fluoro VPA appeared to persist in the general circulation, which, in turn, may contribute to the apparent slow elimination of the drug from the brain. The fluorinated compound was demonstrated to have anticonvulsant activity in the 1, 5-pentamethylenetetrazole seizure test and to be capable of increasing brain synaptic -aminobutyric acid, the ED50 being 1.70 mmol kg. These results suggest that -fluoro VPA has potential as a new anticonvulsant drug and frusemide.

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Device, an increased incidence of initial adverse events including substantial thigh pain probably resulting from overexpansion of the artery ; , and cost factors, Saxon and colleagues34 concluded that the improvements in long-term patency and clinical outcome warranted further evaluation. In a European single-center prospective study, 52 patients underwent placement of PTFE-covered endoprostheses for treatment of medium or long-segment 3 cm ; femoropopliteal occlusions and stenoses.36 Primary patency rates among these patients were 78% after 12 months and 74% after 24 months, with no significant differences noted in primary patency rates among patients grouped according to lesion length. Procedure-related complications, including 4 distal embolizations, were observed in 12 23% ; of 52 patients, but none resulted in clinical sequelae; 3 patients reported pain at the endograft site and had elevated body temperatures, but their symptoms responded to anti-inflammatory medication and resolved within 48 hours. In our own experience, the large delivery profile and obstruction of side branch access have been drawbacks, and edge restenosis was not prevented, for example, theodur 300 mg.

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