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Men were eligible as cases if they had been aged 30 years or more at the time of diagnosis propranolol 80 mg without a prescription cardiovascular outcomes trial, their lymphoma had been diagnosed between March 1981 and October 1983 in Iowa and between October 1980 and September 1982 in Minnesota and they were resident in the state discount 40 mg propranolol mastercard cardiovascular x ray tech salary, excluding propranolol 80 mg for sale cardiovascular system diabetes, for Minnesota generic 80 mg propranolol with mastercard capillaries are best described as, the cities of Minneapolis, St Paul, Duluth and Rochester. Of the 780 iden- tified patients, 694 (89%) were interviewed, and 622 of the cases were confirmed to be non-Hodgkin lymphoma after the review. The 1245 controls were frequency matched to cases by age, residence and vital status. Living subjects were selected by random-digit dialling (age < 65 years) and from Medicare rosters (age ≥ 65); death certificate files were used to select deceased controls. Proxy interviews were conducted for deceased or incompetent men (184 cases and 425 controls). A detailed history of farming and pesticide use was obtained by an interviewer from all subjects who had worked on a farm for at least 6 months since the age of 18 by means of a questionnaire to the participating subjects or proxy responders. Odds ratios were estimated by unconditional multiple logistic regression, allowing for the matching variables plus other potential risk factors. The reference category was men who had never worked or lived on a farm as adults (266 cases and 547 controls). Eight patients and 19 controls had ever handled toxaphene as an animal insecticide (odds ratio, 0. When the analysis was limited to those who had handled it prior before 1965, the odds ratio for use on crops was 2. In a study of leukaemia parallel to that of non-Hodgkin lymphoma conducted in Iowa and Minnesota (Cantor et al. A group of 10 mice of each sex served as matched controls and received normal diet for 90–91 weeks; 50 male and 50 female pooled controls from other experiments were used to provide further control data. Survival was not significantly affected by toxaphene: by 52 weeks, 49/50 males at the low dose and 46/50 at the high dose and 46/50 females at both doses were still alive. The incidences of hepatocellular carcinoma in males were 0/10 matched controls, 4/48 (8%) pooled controls, 34/49 (69%) at the low dose and 45/46 (98%) at the high dose (p < 0. In females, the incidences were 0/9 matched controls, 0/48 pooled controls, 5/49 (10%) at the low dose and 34/49 (69%) at the high dose (p < 0. The liver tumours in this study were re-evaluated by a pathology working group, which reclassified most of the hepatocellular carcinomas as adenomas and the adenomas as hepatocellular foci. This analysis indicated no statistically signifi- cant increase in the incidence of carcinomas at any dose, but the incidences of adenomas and total tumours remained statistically significantly increased in both male and female mice at the high dose. The revised incidences of carcinomas in males were 3/48 pooled controls, 8/50 at the low dose and 5/47 at the high dose, and those in females were 0/50 pooled controls, 0/49 at the low dose and 3/47 at the high dose. The revised incidences of adenomas in males were 5/48 pooled controls, 30/50 at the low dose and 42/47 at the high dose, and those in females were 1/50 pooled controls, 11/49 at the low dose and 37/47 at the high dose (Goodman et al. A study conducted by Litton Bionetics in 1978, but not published by that organization, was later reviewed by Goodman et al. Groups of 55 male and 55 female B6C3F1 mice [age unspecified] were fed a diet containing 0, 7, 20 or 50 mg/kg toxaphene [purity unspecified] for 18 months, followed by untreated diet for a further 6 months. No significant difference in the incidence of liver adenomas or carcinomas was observed between the treated and untreated groups when evaluated separately, although a signifi- cant difference was observed in the total number of liver tumours in males at the high dose and controls (18/51 versus 10/53; p < 0. The dose regimen for high-dose males was 2560 mg/kg of diet for 2 weeks, 1280 mg/kg of diet for 53 weeks and 640 mg/kg of diet for a further 25 weeks; that for high-dose females was 1280 mg/kg of diet for 55 weeks followed by 640 mg/kg of diet for 25 weeks; that for low-dose males was 1280 mg/kg of diet for 2 weeks, 640 mg/kg of diet for 53 weeks and 320 mg/kg of diet for 25 weeks; and that for low- dose females was 640 mg/kg of diet for 55 weeks, followed by 320 mg/kg diet for 25 weeks. Matched control groups of 10 untreated rats of each sex were given toxaphene-free diet for 108–109 weeks; 55 untreated males and 55 untreated females from other bioassays served as pooled controls. Survival was not significantly affected, as 90–92% of rats were alive at week 52 of the study, even at the high dose. The incidences of thyroid follicular-cell tumours (adenomas and carcinomas) were 7/41 (17%) and 9/35 (26%) in male rats at the low and high doses, respectively, in compa- rison with 1/7 (14%) matched controls and 2/44 (5%) pooled controls. In females, the incidences were 1/43 (2%) at the low dose and 7/42 (17%) at the high dose in compa- rison with 0/6 (0%) matched controls and 1/46 (2%) pooled controls. In male rats, the incidence of thyroid tumours (adenomas and carcinomas) was dose-related (p = 0. In female rats, the incidence of thyroid follicular- cell adenomas was dose-related in comparison with either matched (p = 0. Follicular-cell carcinomas were found in two males at the high dose, while all the remaining thyroid tumours were follicular-cell adenomas. Hyper- plasia of thyroid follicular cells was observed only in treated males (low-dose, 3/41; high-dose, 3/35) and females (low-dose, 5/43; high-dose, 3/42). In female rats, pituitary tumours (mainly chromophobe adenomas) occurred in 15/41 at the low dose and 23/39 at the high dose, the incidence being statistically significantly increased in comparison with either the matched (3/8; p = 0. In male rats, the incidence of hepatocellular adenomas at the low dose (6/44) was higher than that in pooled controls (1/52; p = 0. Hamster: A study conducted by Litton Bionetics in 1978, but not published by that organization, was later reviewed by Goodman et al. Treatment- related effects were observed only in males and included decreased body weight and the presence of megahepatocytes in the liver at the high dose. Toxaphene administered for 12 weeks had no effect on the induction of forestomach tumours by benzo[a]pyrene although at 200 mg/kg of diet there appeared to be a slight but significant decrease in the number of forestomach tumours per mouse (4. Toxaphene fed at 100 mg/kg of diet for 12 weeks resulted in a small but significant reduction in the incidence (25% versus 8. At 200 mg/kg of diet for 20 weeks, toxaphene markedly decreased the incidence of lung tumours (100% versus 67%) and the mean number of lung tumours (7.

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Positive associations were reported between hexachlorobenzene concentrations in breast milk (> 146 μg/kg of fat) and the risk for otitis media during the first year of life among Inuit infants in Canada (Dewailly et al buy propranolol 40mg free shipping heart disease obesity. The serum concentrations of hexachlorobenzene were measured in persons with porphyria cutanea tarda and in two control groups 40 years after the original exposure buy propranolol 40mg visa capillaries around nose. The authors also found no relationship between current hexachlorobenzene and circulating hormone concentrations 80mg propranolol capillaries exchange vessels, but they did find a relationship between the rate of spontaneous abortion and the serum hexa- chlorobenzene concentration discount 40mg propranolol overnight delivery cardiovascular system responsibilities. Expo- sure to hexachlorobenzene affected the female gonad histopathologically and endocri- nologically. Hexachlorobenzene induced follicular degeneration and increased atresia in rodents and primates (Sims et al. The highest dose of hexa- chlorobenzene used (10 mg/kg bw per day orally for 90 days) specifically reduced the numbers of primordial follicles in cynomolgus monkeys (Macaca fascicularis) (Jarrell et al. The effects of hexachlorobenzene on ovarian morphology and steroidogenesis can be induced at a dose as low as 0. Decreased uterine estrogen receptor concentrations were also observed in these rats, but no change was found in uterine weight. No studies were found on the effects of hexachlorobenzene on the male reproductive system. Exposure in utero and during lactation caused neonatal mortality in rats fed diets containing 60–140 mg/kg hexa- chlorobenzene (Kitchin et al. The latter effects were observed in the pups of dams treated with 10 or 50 mg/kg bw per day on days 6–16 of gestation (Andrews & Courtney, 1986). These malformations were strikingly similar to the terata associated with exposure to dioxins in utero, as noted by these authors, which raises the issue of the possible presence of traces of dioxins in technical-grade hexachlorobenzene. Both doses diminished delayed-type hypersensitivity responses in offspring tested at 40 days of age; the higher dose impaired mixed lymphocyte response to allo- genic spleen cells; and, in adulthood, small changes in the relative proportion of T and B cells in the spleen were observed. Two studies were conducted to determine the effects of exposure to hexachloro- benzene during development on neurobehavioural end-points. Female Sprague- Dawley rats were exposed before gestation to hexachlorobenzene by gavage at a dose of 2. In assessments of behaviour during the first 20 days after birth, hexachlorobenzene- exposed pups responded more quickly to negative geotaxis tests and in olfactory discrimination tests. The complexity of these effects makes it difficult to propose hypo- theses about the mechanism of action, but the results demonstrate that hexachloro- benzene can affect neurobehavioural function in developing rats (Goldey & Taylor, 1992). No changes were found in open-field activity at postnatal day 21; however, in tests of operant learning begun at postnatal day 150, treated animals showed decreased response rates (Lilienthal et al. In adult female rats fed hexachlorobenzene at a concentration that induced porphyria, the activity of microsomal glucuronyltransferase was increased (Graef et al. Both crude and purified hexachlorobenzene were found to increase the activity of liver enzymes in male and female Sprague-Dawley rats 4 days after an intraperitoneal injec- tion of 150 mg/kg bw. The enzyme activities induced included benzphetamine N-de- alkylation, ethoxyresorufin deethylation and ethoxycoumarin O-dealkylation (Franklin et al. The effect of a single dose of 200 mg/kg bw hexachlorobenzene was compared in male Syrian hamsters and male Fischer 344/N rats. In rats, the two enzyme activities were induced approximately 12- and fivefold, res- pectively (Smith et al. During that time, one-third of the rats died, and the urinary porphyrin concentration increased to 100 times the control level. It was further noted that, whereas the animals that died began wasting 5 days after cessation of intake of hexachlorobenzene, when relatively minor disturbances in porphyrins were found, the survivors developed major porphyrin disturbances without wasting; the deaths were therefore not correlated with porphyria (Rozman et al. Microsomal cytochrome P450 was induced to a greater extent in male than in female Fischer rats, while cytochrome b5 was induced only in males. Aminopyrine-N-de- methylase activity doubled in animals of each sex after treatment, while that of Ah hydroxylase was 16 times the control value in females and 1. After hexachlorobenzene treatment, the phospholipid content of microsomal membranes in liver was increased, while the cholesterol content was unchanged. Ana- lysis of the phospholipid pattern showed that hexachlorobenzene interfered with the bio- synthesis of phospholipids containing choline. Hexachlorobenzene showed more pronounced features of a phenobarbital type inducer in males than in females (Cantoni et al. Taken together, these results indicate that hexachlorobenzene is a weak agonist for the Ah receptor and suggest that some of its effects are mediated by its interaction with this gene-regu- latory protein (Hahn et al. After 42 days, the mice were injected a second time with 75 mg/kg bw hexachlorobenzene and killed 20 days later. In wild-type mice, the hepatic uroporphyrin concentration ranged from 70 to 310 nmol/g of liver, whereas in null mice it was < 1 nmol/g of liver. This study also showed that hexachlorobenzene did not increase hepatic microsomal uroporphy- rinogen oxidation in Cyp1a2(-/-) mice (Sinclair et al. Female B6-Ahb mice (Ah receptor, approximately 30–70 fmol/mg of cytosolic protein) and B6-Ahd mice (Ah receptor, undetectable) were pretreated with iron at 500 mg/kg bw (given as iron dextran) and then fed a diet containing 0 or 200 mg/kg hexachlorobenzene for up to 17 weeks. Urinary excretion of porphyrins was increased after 7 weeks of hexachlorobenzene treatment in B6-Ahb mice, and by 15 weeks was over 200 times greater than that of mice given only iron. In B6-Ahd mice, porphyrin excretion did not begin to increase until after 13 weeks, and after 15 weeks was only six times greater than that of controls. Similar differences were seen in the hepatic porphyrin concentrations at 15 weeks: B6-Ahb, 1110 ± 393; B6-Ahd, 17.

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Therapeutic use: Liver diseases cheap propranolol 80mg visa arteries that supply blood to cardiac muscle, dystrophic damages of myocardium buy cheap propranolol 80 mg line blood vessels and blood circulation, ischemic heart diseases order 80mg propranolol otc coronary heart disease symptoms, atherosclerosis buy discount propranolol 40 mg cardiovascular vein, alcoholism. Acidum ascorbinicum (C) Pharmacocinetics: Acidum ascorbinicum is absorbed in intestines distributed in all tissues and organs. In organism under influence the substances with P-vitamine activity (vitaminum P, catechines, gallic acids) transforms into dehydroascorbinic acid which has vitamin properties. Alcohol and smoking accelerate transformation of acidum ascorbinicum into nonactive metabolite. Pharmacodynamics: Acidum ascorbinicum activates synthesis of collagen and procollagen, providing of bones grows and formation of cartilages and dentine. Acidum ascorbinicum transforms acidum folicum into acidum tetrahydrofolicum which promotes proteins and nucleinic acids synthesis. Acidum ascorbinicum improves function of sympathetic nervous system, activates catecholamines 318 synthesis. Acidum ascorbinicum activates nonspecific protective function of organism (increasis interferone synthesis, antibodies formation, intensifies fagocytosis, migration and hemotaxis of leucocytes. Acidum ascorbinicum intensifies desintixycate of xenobiotics and synthesis in liver. Acidum ascorbinicum inhibits peroxides and cancerogenic substances formation, it increases organism stability to oxygen deficiency, so it is antioxydant. Mechanism of action: Acidum ascorbinicum is donator and acceptor of hydrogen groups, its role is related to its ability to act as an oxidation-reduction system. Therapeutic use: Hypovitaminosis, infections diseases, hemorrhagic diatheses, bleeding, intoxication, atherosclerosis, heart, hepatic, renal impairment, radiation, sickness, diseases of respiratory ways, for stimulation of protective powers of organism. Rutinum (vitaminum P) Pharmacokinetics: Rutinum is absorbed fully, distributed in all tissues and organs, and is more excreted with urine. Pharmacodynamics: Rutinum promotes capillary permeability and increases stability of organism to oxygen deficiency. Mechanism of action: Rutinum has antioxydant action, prevents acidum ascorbinicum, catecholamines oxydation, lengthens its action, and decreases gialuronidase activity, promotes transformation of acidum ascorbinicum into acidum dehydroascorbinicum and its accomodation. Therapeutic use: Hypovitaminosis, leukemia, bleeding, hemorrhagic diathesis, 319 capillary toxicosis, prominent disease. Quercetinum is also a drug of vitaminum P, it has more cardioprotective activity, decreases ulcerogenic effects of nonsteroid antyinflammatory drugs, is used in capillary fragility also. There are complex drugs which consist of acidum ascorbinicum and Rutinum – Galascorbinum and ascorutinum. Fat – soluble vitamins Retinoli acetas (A) Pharmacokinetics: Retinolum is absorbed quickly in intestines. In the presence of bile acids it emulgates, forms micells which contain bile acids, cholesterine, fatty acids. It may be transformed and existed in three forms: retinolum, retinalum, acidum retinoicum which are excreting predominantly excreted with urine. Pharmacodynamics: Retinolum stimulates regenerative processes, prevents damages of epithelium cells, normalizes structure of epithelium cells. Retinolum improves trophy of myocardium, skeletal muscles, liver, and nervous system. Mechanism of action: Retinolum stimulates oxydative reduction processes in cells, intensifies their proliferation and differentiation. Retinolum regulates metabolism of phospholipides synthesis of nucleonic acids, proteins, enzymes. Therapeutic use: Hypo- and avitaminosis, skin diseases, cornea and retina diseases, burns, frostbites, rachitis, infectious, liver diseases, bronchopulmonary diseases, gastric, intestines diseases, in complex therapy of rachitis, in stomatology. Beta-carotenes are prodrugs of retinolum, have antiratiative immunomodulatory action. Ergocalciferolum (D2) and Cholecalciferolum (D3) are biological active formes of vitamin D. Pharmacokinetics: As other fat-soluble vitamins Ergocalciferolum is absorbed by means of bile acids, transports into lymph caniculas, and to the liver. In plasma of blood it transports in connective status by means of calciferol connective protein transcalciferrine. It is excreted with bile, and then it is absorbed again and excreted with urine and feces. Pharmacodynamics: Ergocalciferolum in form of calcitriolum promotes synthesis of proteins (phosphatase and other) which intensifies absorption of calcium in intestines and kidney and synthesis of proteins which connect calcium in bones and tissue. It increases calcium and phosphorus concentration in blood and regulates bone mineralization, it stimulates immune system and regeneration. Mechanism of action: Ergocalciferolum regulates calcium and phosphorus metabolism, its absorption and mobilization from bone. Therapeutic use: Hypovitaminosis, rachitis prophylaxis and treatment, bone fractures, skin diseases, osteoporosis, osteomalacia. Treatment of D hypervitaminosis: administration of antioxydants (vitamin E, C, A), drugs which intensifies biotransformation of vitamin D (phenobarbitalum) and remove acidosis (natrii hydrocarbonas), drugs which contain Kalium and magnesium, glucocorticoides and drugs which prevent demineralization of bones 321 (calcitrinum) oleum jecoris Aselli has properties of vitamins A and D. Tocopheroli acetas (E) Pharmacokinetics: Tocopheroli acetas is absorbed mainly in proximal part of ileum by means of bile acids. It transports to lymph and blood and then to all tissues of organism, includes into lipoprotein, membranes of mitochondrias and microsomes. Tocopheroli acetas activates erythropoiesis and improves rheological properties of blood.

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The common organisms causing resistant infections of the urinary tract as reported in 34 of the reviewed articles were Pseudomonas in 7 studies (28 propranolol 80 mg with mastercard cardiovascular quizlet nursing. Other uncommon organisms reported to cause resistantinfections were Citrobacter and Salmonella species generic propranolol 40 mg visa arteries sclerosis. Nitrofurantoin showed the lowest resistance levels among the frst line drugs with resistance rates as low as 6 generic propranolol 40mg fast delivery cardiovascular system medical terminology worksheet answers. However ciprofoxacin and gentamicin had the lowest rates of resistance compared to the other drugs even though appreciable resistance was demonstrated 80mg propranolol with amex cardiovascular and respiratory system. Sepsis means systemic responses to disseminated microorganism throughout the body with accompanying organ dysfunction. Eighteen articles were selected for qualitative synthesis for this review according to the aforementioned criteria. However, there was less resistance to amikacin than to 64 Antimicrobial Use and Resistance in Nigeria gentamicin in studies in which both antimicrobials were tested107, 108. Resistance to the quinolones was also variable with resistance to ciprofoxacin ranging between 0% in Osun State and 73. Most of the studies did not mention the methicillin sensitivity of the Staphylococcus species. In addition, some other unnamed gram negative bacilli were 100% resistant to ampicillin and chloramphenicol. The above fndings are in contrast to those of another study which was conducted in Edo State in which the gram negative bacilli were all Federal Ministries of Agriculture, Environment and Health; September 2017 65 Situation Analysis and Recommendations highly resistant to the antimicrobials tested. Typhimurium were resistant to ampicillin but were all sensitive to amoxicillin/ clavulanate, gentamicin, amikacin, ceftazidime and cefotaxime. However, it must be administered with caution because of complications like diarrhoea, nausea, vomiting, abdominal discomfort, headache. The lowest resistance rates for pathogens causing meningitis were seen with ceftriaxone. This is in keeping with most studies that show that resistance to ceftriaxone is rare. It is for this reason that third generation cephalosporins such as ceftriaxone are still recommended asthe choice drug for meningtitis treatment. Resistant rates for antimicrobials commonly used to treat pneumonia such as ceftriaxone; erythromycin, penicillin G, and augmentin, were found to be 18. Septrin resistance rate was the highest, and this differs from what has been found in other countries. Antibacterial agents such as ceftriaxone and chloramphenicol will remain useful in the treatment of meningitis in Nigeria for the foreseeable future. The fnding 68 Antimicrobial Use and Resistance in Nigeria of a high number penicillin-resistant S. Apart from supportive measures, treatment of meningitis is by the use of co-amoxiclavulanate, benzyl-penicillin or cefuroxime. They are infections acquired in hospital or health care service units, that appear 48 hours or more after hospital admission, and occupational infections among staff. Two of the reviewed articles focused on clinical specimens sent to the microbiology laboratory for routine analysis130-132 with clinical isolates coming from in-patients admitted during time of study that met the criteria. Wound swabs and wound biopsies were specimens taken for microbiological investigation. Surgical site infections have been seen following Caesarean Sections138 or orthopaedic manoeuvres130, 138, 141 and organisms most isolated include: S. Common organisms isolated from health care-associated urinary tract infection include: Klebsiella spp, Pseudomonas spp, E. Surveillance on ventilator-associated pneumonia was rarely done among the reviewed articles. Other health care-associated infections studied in this systematic review included: gastroenteritis, skin and soft tissue infection (e. Often, antimicrobial residues (either the parent coumpound or its metabolite) are excreted into the environment by animals after exposure to antimicrobials either for growth or therapeutic reasons. Drugs are the most frequently detected chemical residues in food of animal origin, and majority of these are antimicrobials commonly used in veterinary practice in Nigeria. Drug residues in foods of animal origin threaten human health by being acutely or cumulatively allergenic, organotoxic, mutagenic, teratogenic or carcinogenic. For these reasons and more African livestock is denied entry into the European and American livestock markets. The indiscriminate use of antimicrobials for the prevention and treatment of bacterial infection in animals is a common practice as in other developing countries. Medicated feedstuffs are basically mixtures animal feed and veterinary medicinal products. Medicated feedstuffs are usually authorised for the animal species which the feed is administrated to and contains high antimicrobial concentrations depending on its intended aim and the physiological-health State of the animals. Human error, improper production, handling and storage practices can lead to the Federal Ministries of Agriculture, Environment and Health; September 2017 73 Situation Analysis and Recommendations unintentional contamination of antimicrobial negative feeds with antimicrobials. For example during the production of medicated feedstuff, a little proportion may be left in production line or storage tanks leading to the cross-contamination of next batches of antimicrobial negative feed. Therefore, a therapeutic failure might be observed with associated economic losses for the producer as well as the farmer. However, only a few cases of hypersensitivity have been reported as a result of exposure to residues in meat. Anaphylactic reactions to penicillin in pork and beef have been described and in one case, anaphylaxis was possibly caused by streptomycin residues. Angioneurotic edema and tightness in the chest may also be caused by penicillin residues in meat.