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Each of the twenty amino acids is produced by a unique three letter combination of the four bases (A what is your cholesterol ratio supposed to be order 160mg fenofibrate visa, T cholesterol test no fasting order fenofibrate 160 mg with visa, C what cholesterol medication is safest purchase fenofibrate 160mg online, and G). The Exons and Introns of a Gene Notes: Copyrighted by the National Health Museum Available online at. Only a small percentage of the entire human genome (approximately 10 percent), however, actually regulates the synthesis of proteins. The nucleotide sequences of a gene that code for protein production are known as exons. Regions of the gene that are not implicated in the formation of proteins are known as introns. Interestingly, the average gene contains nearly 3,000 base pairs, but only about 1,200 actually code for protein production. Genes do not, however, manufacture proteins; they only provide the instructions necessary for the creation of a protein. The process by which genes ultimately create proteins has become known as the "central dogma" of molecular biology. The central dogma of biology is made up of two steps-transcription and translation-that are ultimately responsible for converting the genetic code. Ridley (2003) presents evidence showing one gene may actually code for more than one protein because of complex splicing schemes that are not wholly understood. Until recently most researchers thought splicing was a relatively simple occurrence (as described above). However, during the past thirty years or so, some researchers 4 3 13 this document is a research report submitted to the U. Once created, the protein migrates away from the ribosome and performs its specialized function for the cell. Each person has their own unique genetic code, and this unique genetic code brings about observable human differences, such as have contended that "there was more to splicing than merely cutting out the nonsense. In some genes, there are several alternative versions of each exon, lying nose to tail, and only one is chosen; the others are left out. Depending on which one is chosen, slightly different proteins can be produced from the same gene. Only in recent years, however, has the full significance of this discovery become apparent. It seems to occur in approximately half of all human genes; it can even involve the splicing in of exons from other genes; and in some cases it produces not just one or two variants from the same gene but hundreds or even thousands" (Ridley, 2003:141-142). Genes are also responsible for coordinating the activities and functions of the human body. Genes, however, do not actually perform all of these duties-that job is accomplished by proteins. Proteins, which are manufactured through a process known as the "central dogma" of biology, are the workhorses of the human body. They give the body its structural characteristics and its form, they provide the body with energy, and they execute almost every other function necessary to sustain life. Different genes code for the production of different proteins, and these different proteins may give rise to heterogeneity in human characteristics. Thus, it is critically important to understand how and why genes vary from person-to-person. Genetic Variation Genes are organized on threadlike configurations called chromosomes. The human body contains twenty-three pairs of chromosomes, with one set inherited maternally and the other set inherited paternally. One pair of chromosomes-referred to as the sex chromosomes- determines whether a person is a male or a female. In general, females have two X chromosomes (one X inherited from both parents), whereas males have an X chromosome and a Y chromosome (the X is always inherited maternally and the Y paternally). The remaining twenty-two pairs of non-sex chromosomes are referred to as autosomes. The nucleus of almost every cell in the human body contains the two sex-determining chromosomes and the forty-four autosomes. Every person has two copies of each gene, one copy located on one of the twenty-three maternal chromosomes and one copy located on one of the twenty-three paternal chromosomes. The two copies make up the entire structure of the gene and each copy of the gene is what geneticists call an allele. There can be any number of different alleles for each gene, with each one representing a variant found in the human population. Eye color, for example, has many different variants, including an allele for brown eyes, an allele for blue eyes, an allele for hazel eyes, and an allele for green eyes. For the vast majority of all genes, only one known allele exists-that is, the entire human population has the same allelic combinations for these genes. This single allele makes up both copies of the gene and obviously these genes can not vary across the population. But for a small fraction of all genes, there are at least two alternative alleles that can be inherited. When there is more than one allele available in the population for a gene, the gene is called a genetic polymorphism, or polymorphism for short. More specifically, "a gene is said to be polymorphic (poly = many, morphic = forms) when the rarer allele has a frequency of 1 percent or higher, and the more common allele has a frequency of 99 percent or lower" (Rowe, 2002:94). Just because two alleles may be available for a particular gene does not necessarily mean that the gene will be formed from two different alleles. As will be outlined below, a polymorphic gene can be comprised of two similar alleles or two different alleles. Suppose there are two different alleles for a hypothetical "height gene": a "tall" allele (T) and a "short" allele (S). Suppose further that an individual receives a T 17 this document is a research report submitted to the U. In this example, the "height gene" would be comprised of identical alleles: two T alleles. Polymorphic genes that are formed from the same alleles are referred to as homozygous genes. In this case, the height gene is homozygous because it is created by two T alleles. Instead, heterozygous genes are created when two different alleles are possessed by one person. The formation of heterozygous genes can be demonstrated by using the previous example of height.
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The episodes themselves tend to cholesterol definition science purchase 160mg fenofibrate visa persist for anywhere from weeks up to cholesterol lowering foods and recipes order fenofibrate us 6 months does cholesterol medication remove plaque arteries cheap 160 mg fenofibrate free shipping, after which there is generally a remission. Repeat episodes can occur; however, it is not clear whether this is the case for all, or even most, patients, nor is it clear how long the intervals are between episodes. Clinical features the clinical features have been most clearly described in two case series from the Mayo Clinic (Castillo et al. Although most patients are in their forties, the age of onset varies widely, from childhood to the eighth decade; the onset itself is typically subacute, over days or perhaps weeks. The overwhelming majority of patients have a delirium, which in most cases is accompanied by any or all of tremor, myoclonus, ataxia, or seizures; seizures may be grand mal, complex partial or, rarely, simple partial, and grand mal status epilepticus may occur in a small minority. Strokelike episodes are common and are typically characterized by aphasia (Bohnen et al. These stroke-like episodes are of brief duration, lasting in the order of hours or a day or more, and typically undergo a full remission. An elevated total protein is most common; in a small minority there may be a mild lymphocytic pleocytosis. Rarely, there may be oligoclonal bands or the 14-3-3 protein (Hernandez Echebarria et al. Thyroid indices are generally normal; if abnormal Etiology Neuropathologically there is widespread perivascular lymphocytic inflammation, microglial activation, and gliosis (Castillo et al. Although the mechanism underlying this inflammatory change has not been positively identified, an autoimmune process is strongly suggested both by the association with anti-thyroid antibodies and by the good response to steroids. In all likelihood, however, the anti-thyroid antibodies are not pathogenic but merely represent part of a wider autoimmune response, with other antibodies directed at the brain; in this regard serum anti-neuronal antibodies have been demonstrated (Oide et al. Differential diagnosis Various other causes of delirium, as discussed in Section 5. In pursuing this differential, it must also be kept in mind that anti-thyroid antibodies may be found in about 3 percent of children and adolescents (Kabelitz et al. Treatment Although there are no blind treatment studies, most patients are given 1000 mg/day of intravenous methylprednisolone for 57 days, followed by 60100 mg/day of oral prednisone in a tapering dose over the following weeks (Castillo et al. In most cases the response is prompt, within days, and most patients do well with tapering. In some cases, however, prolonged treatment with steroids is required, and it appears also that some patients are resistant to steroids and require treatment with immunosuppressants (azathioprine, methotrexate, or cyclophosphamide), plasma exchange, or intravenous immunoglobulins. Although intuitively it makes sense to monitor levels of anti-thyroid antibodies to gauge treatment response, in practice this is not useful, as in some cases levels may actually rise despite a good clinical response. In addition to chorea, these patients also display other neuropsychiatric features, most notably obsessions and compulsions. The onset itself is typically characterized by symptoms reminiscent of attention deficit/hyperactivity disorder, such as restlessness, fidgetiness, irritability, and emotional lability; choreiform movements, if present, are mild and evanescent (Diefendorf 1912; Gerstley et al. When the chorea does settle in, it is usually generalized but most prominent in the limbs and face; alternatively, one may occasionally see hemichorea (Abt and Levinson 1916; Nausieda et al. Although they tend to peak in severity along with the worsening of the chorea and to remit before the chorea does, in fact they generally make their appearance before the chorea sets in (Swedo et al. Psychosis, with hallucinations and delusions, may occur in a small minority (Hammes 1922) and may symptomatically resemble the psychosis seen in schizophrenia (Leys 1946; Putzel 1879). Although there may be some very mild residual chorea, especially evident when the patient is under stress (Lessof 1958; Swedo et al. The mortality rate is less than 1 percent (Abt and Levinson 1916; Bussiere and Rhea 1926; Lessof and Bywaters 1956). There is also suggestive evidence that some cases of obsessivecompulsive disorder (Swedo 1994; Swedo et al. Autopsies of patients who died from unrelated causes long after recovering from the chorea have revealed evidence of old endarteritis (Benda 1949) and patchy gliosis and neuronal loss (Lange et al. It appears that these vasculitic and encephalitic changes occur secondary to an autoimmune assault on the central nervous system, which is triggered by the preceding group A beta-hemolytic streptococcal pharyngitis. Treatment with steroids makes sense in that it targets the underlying mechanism of the disease and could conceivably, if effective, prevent the occurrence of some of the sequelae noted above, such as obsessivecompulsive disorder. In the double-blind study that demonstrated the effectiveness of prednisone, patients were given 2 mg/kg/day for 4 weeks, after which the dose was gradually tapered (Paz et al. In contrast to steroids, valproic acid, carbamazepine, and haloperidol all represent purely symptomatic treatments. One open study found valproic acid to be superior to carbamazepine, which in turn was superior to haloperidol (Pena et al. Valproic acid and carbamazepine are given in customary doses; haloperidol has been given in doses ranging from 1 to 4 mg/day (Axley 1981; Shenker et al. A reasonable strategy would be to initiate treatment with prednisone and observe the patient. In cases in which there is a response but it is slow and the chorea is of such severity as to threaten the patient, consideration may then be given to adding a symptomatic treatment, beginning with valproic acid. In cases in which there is no response to prednisone, symptomatic treatment may also, of course, be considered, but some authors would recommend further etiologic treatment, with consideration given to a course of intravenous methylprednisolone (Cardoso et al. Patients should also be treated with injections of penicillin G benzathine, using a dose of 1. For children or adolescents, such treatment should probably continue for 5 years or until the age of 21 years, whichever comes later. For adults, the decision must be individualized, with special attention given to those at risk of contracting further streptococcal pharyngitides, such as teachers or pediatricians. Clinical features the onset of the chorea is usually during the first half of pregnancy, and symptoms resolve either toward the end of the third trimester or during the puerperium. Chorea gravidarum has also been noted in association with the anti-phospholipid syndrome (Cervera et al. There has been one autopsy case, which revealed neuronal loss and gliosis within the caudate nucleus (Ichikawa et al. If symptomatic treatment is required, consideration may be given to an antipsychotic, such as haloperidol (Patterson 1979) or risperidone; however, in most cases it is prudent to simply let the disease run its course. Role of antiribosomal P protein antibodies in the diagnosis of lupus isolated to the central nervous system. Paraneoplastic temporal lobe epilepsy with testicular neoplasm and atypical amnesia. Limbic encephalitis and small cell lung cancer: clinical and immunological features. Autoantibodies in paraneoplastic syndromes associated with small-cell lung cancer. Obsessive-compulsive and related symptoms in children and adolescents with and without chorea: a prospective 6-month study. Memory lost, memory regained: neuropsychological findings and neuroimaging in two cases of paraneoplastic limbic encephalitis with radically different outcomes.
- Pat the area dry or allow to air-dry.
- Physical illness. This is due to an inactive lifestyle and side effects of medication.
- Spinal tap (lumbar puncture)
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- Drink plenty of fluids while exercising and increase your potassium intake. Orange juice and bananas are great sources of potassium.
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Several travelers cholesterol absorption inhibitor purchase 160mg fenofibrate with visa, missionaries and diplomatic from Britain and 52 Community Health Nursing France were also in Ethiopia during this period cholesterol medication for diabetics discount fenofibrate 160mg with mastercard. Even though these foreigners came for different missions cholesterol levels us cheap fenofibrate 160mg with visa, they were expected to know and practice modern medicine by the local inhabitants. Religious missionaries Diplomatic Travelers Traders Invaders and Warriors the interesting fact about these foreign introducers was that most of them were not a medical people by themselves. Some may have been exposed to the practice with friends or relatives while they were in their country. Some of them were forced to prescribe the drugs and 53 Community Health Nursing instructions after they have reached in Ethiopia and were obliged to do so. The first Russian operated hospital was established at the time as a result of the Adowa battle, few Ethiopian were also in the country at that time. At the first time the first medical team consists of 3 doctors 4 nurses and several health orderlies arrived and treated wounded soldiers in Harrar. After completing the task the team arrived at Addis Ababa and 54 Community Health Nursing established a hospital in the tent with 50 beds. Again in that year there were several Christian missionaries operating in the country, and in addition to their religious and sometimes educational activities, they often provided health services. Thomas Capable coasted money, erected a building in the Gulele area, west of Addis Ababa, and established a hospital with 70 beds. And after the liberation it was converted first into "Medical Research Institute" in 1942, then "Institute Pasture" in 1950 and finally in 1964 in to the "Central Laboratory and Research Institute" as it is called today. In speaking of the history of medicine in Ethiopia one must mention the first Ethiopian medical doctor. As a child of three years he was found on the battlefield after the battle of Magdala in 1868 by the British Indian forces that took the child to Indian and later to Britain, sponsored by two officers, Colonel Charles Chamberlain and Colonel Martin, and he was then named Charles Martin. Martin arrived in Addis Ababa where he pitched a tent in the center of the city and operated a clinic, treating patient free of 55 Community Health Nursing charge. During that time he learned who are parents were and found his grandmother who told him his name was Workneh. Hakim (Doctor) Workneh, as he was popularly known, served not only as physician but also as a diplomat. Melaku Beyan who early in the 20th century obtained his medical degree from Howard University in the United States. He was chief medical officer of the Ethiopian Army during the Italian occupation of Ethiopia. She was married and lived with her husband in Lekempte where she died of childbirth at the age of 23 years. Sister Mahret Paulos is probably the second Ethiopian nurse graduate in Jerusalem in 1942. Sister Sambatu Gabru graduated from Beirut in 1949 is the third Ethiopian trained nurse. A new chapter in the development of health services was opened when the Ethiopian Red Cross Society established the first school of nursing at the Haile Selassie I Hospital (Bethesda Hospital). It was in March 1953 that the first eight 56 Community Health Nursing nurses graduated. The patron was Emperor Haile Selassie and its chairman was Belata Geta Hiruy W/Selassie. In 1952 the Gondar public health collage and training center was established to train three categories of health personnel called the three man team (Health Officers, Community Nurses and Sanitarians), who were intended to serve in health centers, a new type of health institution. One health center was supposed to serve 50,000 people with the help of satellite health stations. The first organized training of health personnel can be traced back to 1945 when a six month course was offered to hospital orderlies, who were then upgraded to the status of "dressers. A Medical School was established in 1962 and graduated nearly 140 medical doctors in 20 years of its existence, because of which the past regime considered it as a prestigious project for the elite. One might say that the actual concrete development of health services started after the 1974 revolution. There had been several attempts and successes to mobilize the masses of 57 Community Health Nursing Ethiopia to participate actively in the development of health services even to the remote areas of the country. The Italians under the guise of the consulate mission built a hospital which late they presented as a "token of friendship" to Ethiopians. This hospital organized in the early treat as 1930 as a clinic, then changed to hospital which was named Ras-Desta hospital. It is a General hospital at that time with a small department for mental cases, today it is a mental hospital with 300 beds. This plan tried to establish a strategy for the basic health services with the following objectives. In this plan period there was nothing especial except strengthening the 2nd 5 yr plan. Schistosomiasis Maldistribution of available resources appeared in exaggerated form Health expectations were not improving. These were some of the disturbing situation that enhanced the consideration of an appropriate approach to at least move a 65 Community Health Nursing little more a head. Universally Accessible - Collective expression of political will in the spirit of social equity. Because of the inequitable distribution of the available resources, the services are not 67 Community Health Nursing reachable (approachable) by all who need them. If was wrongly conceived that health for communities can achieved through the efforts of health workers alone. Communities can achieve better health status through their own efforts and the health workers role is to help them identify their problems and to point out methods for dealing with the problems. Cost that the community or country can afford - Health services are expensive because of professional costs and the cost of equipment and capital expenses. Knowing when and for what purpose to turn to others for support and co-operations. Equitable distribution of services, resources and facilities for the entire population. Education, income supplementation, clean water, improved housing and sanitation, construction of roads and water ways, enhanced role of women have substantial impacts on health. Key health related sectors · public education and information agriculture, commerce, industry water, sanitation and housing related to human behavior and human development. Public Education and Information · Teach local health problems in schools Use locally produced learning materials Organize refresher courses for teachers Provide sanitary facilities and water in schools Organize programme competitions. Agriculture, Food and Nutrition - Promotion of household food security, local food crop production, fishing and animal husbandry - Training of farmers in new methods Promotion of agricultural extension Promotion of agricultural extension Organize marketing for agricultural products Food hygiene measures Local weaning foods Management deficiencies and prevention of specific - Organize conservation/ Storage of foodstuffs Production technologies of simple efficient agricultural - Education/Management of pesticide use. Public works, water, sanitation and housing · Clean drinking water Protect and maintain existing supplies Provides new water supplies, digging wells, etc. Water use and conservation (in the house and education of public) 72 Community Health Nursing · Check water quality Environmental sanitation Drainage of surface rain water Ensure adequate disposal of human excreta Ensure adequate disposal of domestic waste Ensure public education Implement, legislative measures. While the community must be willing to learn, the health system is responsible for explaining and 73 Community Health Nursing advising and providing clear information about the favorable and adverse consequences of the interventions being proposed as well as their relative costs. Important rules to follow in community involvement: · Do not tell them, but inform them Do not force them, but persuade them Do not make them listeners, but decision makers Involve them in the: · In the assessment of the situation Definition of the problems Setting of priorities Planning, implementation, monitoring and evaluation and management programs.
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In addition to cholesterol disease definition purchase generic fenofibrate canada the main effects of the independent variables cholesterol granuloma order fenofibrate 160 mg otc, they also included an interaction term 42 this document is a research report submitted to cholesterol levels zocor cheap fenofibrate 160 mg without prescription the U. Data for their study came from the publicly available version of the Add Health sample (N=6,504). However, there was also a significant effect for their proxy GxE measure: the interaction term for pubertal development X delinquent peers exerted a statistically significant effect on delinquency (=. Lastly, Button and her colleagues (2005) examined whether family dysfunction interacted with genes in the creation of antisocial conduct. They measured conduct problems by using five items extracted from the Strengths and Difficulties Questionnaire. Family dysfunction was indexed by using twelve questions from the General Functioning subscale of the McMasters Family Assessment Device. These questions tapped two dimensions of the home life: family pathology and family health. The results of their statistical analysis supported "both a heritable component to conduct problem and a small but significant association between family dysfunction and childhood and adolescent conduct problems" (Button et al. In general, the results generated from studies indirectly testing for GxEs have revealed the importance of examining the interactive effects of genetic and environmental factors in the development of antisocial behaviors. While useful, these studies have been unable to identify the precise genes that may be implicated in GxEs. To test for a GxE, they employed the Dunedin Longitudinal Study, a prospective study of 1,037 children born in New Zealand between April of 1972 and March of 1973. Thus far, data have been collected from the participants when they were ages 3, 5, 7, 9, 11, 13, 15, 18, 21, and 26. Remarkably, 96 percent of the original sample was contacted and re-interviewed in the latest wave of data collection. Four different dependent variables indexing antisocial behaviors were used in their analysis. Dunedin participants were assessed for conduct disorder at ages 11, 13, 15, and 18. A "lifetime diagnosis" dichotomous measure was created by summing across all of the assessment waves and placing those participants who had been categorized as conduct disordered at any of the waves into one group and placing those participants who had never been classified as conduct disordered into another group. The third dependent variable used in the analysis was a disposition towards violence scale. Questions such as, when I get angry, I am ready to hit someone, were included in the scale (alpha=. For this scale, male study members nominated one person who knew them very well. These nominated individuals were then contacted and asked a series of questions pertaining to antisocial personality symptoms exhibited by the Dunedin participants. The responses to these items were then summed together to form an additive scale of antisocial personality symptoms (alpha=. The interrelationships among these four different scales were then analyzed and results demonstrated moderate inter-scale correlations. Additional model-fitting techniques revealed that a common factor accounted for the four antisocial behavior measures. As a result a composite index was created by summing together scores for these four scales. Physical maltreatment was measured by using behavioral observations, parental reports, and retrospective reports reported on by Dunedin participants. At the age 3 assessment, independent observers watched the mother and the child interact. Observers who indicated that the mother engaged in two or more of these negative actions were characterized as rejecting their child. Second, at the age 7 and age 9 interviews, parents were presented with a checklist of disciplinary behaviors, including items that tapped physical punishment. Parents who were in the top ten percent of on this scale were coded as unusually harsh disciplinarians. Those children who had more than two primary caregivers were classified as having suffered disruptive caregiver changes. Fourth, at the age 26 assessment, study members completed a retrospective questionnaire asking about incidents of physical abuse occurring before the age of 11. Finally, during the age 26 interviews, Dunedin participants were asked about unwanted sexual abuse. Based on this information, study members were grouped as either having been sexually abused or not having been sexually abused. A cumulative physical maltreatment scale was created by adding the number of maltreatment experiences together. Their sample consisted of 514 white males who were participants in the Virginia Study for Adolescent Behavioral Development. The child, their mother, and their father were presented with a series of symptoms that indexed antisocial behavior. If any of the respondents responded affirmatively to these items, then the child was rated as having this symptom. This scale indexed three different dimensions of the family environment: parental neglect, exposure to parental violence, and inconsistent parental discipline. The results of their multivariate equations revealed that the childhood adversity measure exerted a significant main effect on conduct problems. To provide a 6 Detailed information about the items used, or the number of symptoms needed in order to be considered conduct disordered, were not provided. Three different scales tapping antisocial behaviors were included as dependent variables in the analysis. The conduct problems scale included items indexing frequency of fighting, violence, and delinquency. The conduct problems scale were calculated for each of the three waves of data and averaged together. Second, a binary measure of violent offending was also used as an outcome measure (details about the scale were not presented). They also created a composite antisocial index by including a scaled version of the conduct problems scale and items related to violent convictions. Study members were presented with a list of items that indexed abuse and neglect. Responses to these items were then added together to form a global measure of childhood maltreatment. The results revealed that the childhood maltreatment scale had a statistically significant effect on the conduct problems scale (b=. Although there was an insignificant trend in the predicted direction, the results of the study conducted by Haberstick et al.
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In December 2005 cholesterol lowering diet plans free fenofibrate 160mg online, freelancer Hayatullah Khan cholesterol hdl levels safe fenofibrate 160 mg, who for years had been under threat from government officials and militant groups in North Waziristan cholesterol ratio units fenofibrate 160mg discount, took photographs of the remnants of an American-made Hellfire missile that had hit a house inside Pakistan, apparently targeting senior Al-Qaeda figure Hamza Rabia. At the time, the military-backed government of President Pervez Musharraf was denying that the United States was violating Pakistani territory with military operations inside its borders. Like Shahzad six years later, Khan was abducted and died a violent 142 Asia: Analysis death after discrediting the military. He was grabbed by gunmen on December 5, 2005, the day after his pictures were published worldwide. Musharraf ordered an investigation, in this case by High Court Justice Mohammed Reza Khan. While those journalists remaining in the Federally Administered Tribal Areas have become a major source for news on fatalities from U. Many local journalists have left the profession or report on only the most benign topics. Fearing for their safety, most have asked that their individual cases go unpublicized. Waqar Kiani, 32, who in the past had been a local correspondent for the British newspaper e Guardian, survived two assaults before resolving to leave Pakistan. In 2008, he was abducted in Islamabad by suspected 143 Attacks on the Press in 2011 intelligence agents, blindfolded, beaten, and burned with cigarettes. His ordeal ended 15 hours later when he was dumped 120 miles (180 kilometers) outside the city. Traumatized, Kiani continued to freelance, telling only his closest friends and colleagues of the ordeal. But after Islamabad Senior Superintendent of Police Tahir Alam said preliminary investigations showed that police were not involved in the attack, the investigations stopped. Kiani lowered his profile as a journalist and with the help of e Guardian, he left the country for a few months, waiting for the threat to fade. Temporarily separated from his family, he was seeking asylum in a European country in late year. He fled Pakistan because of military action in his native Baluchistan province, where secessionist groups battle each other and the Pakistani military, and where his exposure of military abuses would, he believed, make him a target. Sometimes it is impossible to narrow down who may be responsible because of the sheer number of potential culprits. On May 10, about 700 miles (1,100 kilometers) due north of Karachi, in the Federally Administered Tribal Areas along the border with Afghanistan, Nasrullah Khan Afridi was killed when his car exploded in a crowded market in Peshawar. No one knows whom to blame for the targeted killing of this prominent regional reporter who worked for Pakistan Television and the Urdu-language Mashreq. Exile is lled with hardship, says one journalist, but no story is worth dying for. Although he later returned to work, he faced ongoing threats that forced him to switch beats. But after four witnesses to the killing were shot and killed, as well as the brother of the police officer leading the investigation, the case went fallow. So far his government has taken no action, in some cases because it apparently chooses not to, in others because it has no control over the actors. But the milieu in which Zardari rules and journalists operate is reeling out of control. A May report from the Center for Strategic International Studies identified 2,113 terrorist attacks, 369 clashes between the security services and militants, 260 operational attacks by the security forces, 135 U. With violence at a high level, special investigations proving fruitless, and an ineffective, impotent government unable or unwilling to protect them, Pakistani journalists have come to realize they must act on their own. Haroon, who is chief executive of Dawn Media Group along with heading the All Pakistan Newspapers Society, led a conversation about the creation of a press organization to monitor and compile data on anti-press attacks. Haroon wants to create a hub of experts and gather knowledge about the assaults, kidnappings, and murders of journalists over the years. Zaffar Abbas, the editor of Dawn, suggested that a similar model would work for members of the journalist community when threatened or in immediate danger. Amin Yousuf, the Pakistan Federal Union of Journalists secretary-general at the Karachi Press Club, said the union would be interested in working with such a group. Large and small, they are owned by strong-willed, successful businesspeople with For now, solutions will have to be found by people in the profession. For now, whatever solutions exist will have to be found by people in the profession. Among their many challenges will be confronting a government unable and unwilling to stand up for a free press. Criticism that began on social media sites facilitated some unusually aggressive press coverage. Indeed, the expansion of public debate may create an illusion of increased political participation. Soon, there were unsigned calls for political demonstrations, dubbed "the Jasmine revolution," on Chinese-language websites. Foreign journalists looking to cover protests in Beijing and elsewhere found a few dozen dissenters outnumbered by security agents. A Bloomberg journalist who was punched and kicked by men in plainclothes required hospital treatment. Regulations forbidding foreign journalists to report without permission near protests appeared on a city website. One tall Western journalist was told to leave a protest for "obstructing traffic," e Atlantic reported. Meanwhile, the government began a pre-emptive crackdown on known government critics. Dozens of online writers, lawyers, and activists were 150 Asia: Analysis detained, harassed, or disappeared. Security agents detained at least two individuals, Liang Haiyi in northern Heilongjiang province and Hua Chunhui in eastern Jiangsu, for reposting details about the rallies on social networks. Other reprisals were handed down for comments on unrelated, though sensitive, issues, including political reform and media control. At least four professional journalists in the comparatively freewheeling media environment of southern Guangdong province were "side-shuffled" or given "leave," euphemisms for dismissal, which colleagues used to avoid further injunctions. Security officials placed Ran, a prominent Sichuan-based online commentator, in custody on February 20, and indicted him in March on charges of inciting subversion of state power. Authorities either lacked evidence to prosecute, or considered the threat of re-arrest an adequate deterrent. Other detentions concluding in residential surveillance, also translated as house arrest or soft detention, included those of writer Yang Hengjun and lawyer and blogger Xu Zhiyong.
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Each test animal shall be weighed and the individual weights recorded immediately prior to cholesterol medication recommendations buy fenofibrate uk injection and on the last day of the test cholesterol reduced eggs order online fenofibrate. Any animal response including any which is not specific for or expected from the product and which may indicate a difference in its quality shall be recorded on the day such response is observed cholesterol medication and weight loss generic fenofibrate 160mg visa. The test product shall be administered as follows: (1) Liquid product or freeze-dried product which has been reconstituted as directed on the label. The route of administration, test dose, and diluent shall be as approved in accordance with § 610. Modification of any particular test method or manufacturing process or the conditions under which it is conducted as required in this part or in the additional standards for specific biological products in parts 620 through 680 of this chapter shall be permitted only under the following conditions: (a) the applicant presents evidence, in the form of a license application, or a supplement to the application submitted in accordance with § 601. Tests for potency shall consist of either in vitro or in vivo tests, or both, which have been specifically designed for each product so as to indicate its potency in a manner adequate to satisfy the interpretation of potency given by the definition in § 600. A general safety test for the detection of extraneous toxic contaminants shall be performed on biological products intended for administration to humans. The general safety test is required in addition to other specific tests prescribed in the additional standards for individual products in this subchapter, except that, the test need not be performed on those products listed in paragraph (g) of this section. The route of administration, test dose, and diluent shall be as in accordance with § 610. Administer the test product as approved on at least two mice and at least two guinea pigs. A safety test is satisfactory if all animals meet all of the following requirements: (1) They survive the test period. If a filling fails to meet the requirements of paragraph (d) of this section in the initial test, a repeat test may be conducted on the species which failed the initial test, as prescribed in paragraph (c) of this section. The filling is satisfactory only if each retest animal meets the requirements prescribed in paragraph (d) of this section. If a filling fails to meet the requirements of the first repeat test, a second repeat test may be conducted on the species which failed the test: Provided, That 50 percent of the total number of animals in that species has survived the initial and first repeat tests. The second repeat test shall be conducted as prescribed in paragraph (c) of this section, except that the number of animals shall be twice that used in the first repeat test. The filling is satisfactory only if each second repeat test animal meets the requirements prescribed in paragraph (d) of this section. The manufacturer must submit information as part of a biologics license application submission or supplement to an approved biologics license application establishing that because of the mode of administration, the method of preparation, or the special nature of the product a test of general safety is unnecessary to assure the safety, purity, and potency of the product or cannot be performed. The requirements for general safety for inactivated influenza vaccine shall not be considered to be satisfied unless each lot of influenza vaccine is assayed for endotoxin in comparison to a reference preparation provided by the Food and Drug Administration, and such lot is found to contain no more endotoxin than the reference preparation. Except as provided in paragraphs (f) and (g) of this section, the sterility of each lot of each product shall be demonstrated by the performance of the tests prescribed in paragraphs (a) and (b) of this section for both bulk and final container material. Bulk material shall be tested separately from final container material and material from each final container shall be tested in individual test vessels as follows: (1) Using Fluid Thioglycollate Medium-(i) Bulk and final container material. The volume of product, as required by paragraph (d) of this section (hereinafter referred to also as the ``inoculum'), from samples of both bulk and final container material, shall be inoculated into test vessels of Fluid Thioglycollate Medium. The inoculum and medium shall be mixed thoroughly and incubated at a temperature of 30 to 35 °C for a test period of no less than 14 days and examined visually for evidence of growth on the third, fourth, or fifth day, and on the seventh or eighth day, and on the last day of the test period. If the inoculum renders the medium turbid so that the absence of growth cannot be determined reliably by visual examination, portions of this turbid medium in amounts of no less than 1. The material in the additional vessels shall be incubated at a temperature of 30 to 35 °C for no less than 14 days. Notwithstanding such transfer of material, examination of the original vessels shall be continued as prescribed above. The additional test vessels shall be examined visually for evidence of growth on the third, fourth, or fifth day of incubation, and on the seventh or eighth day, and on the last day of the incubation period. If growth appears, repeat tests may be performed as prescribed in paragraph (b) of this section and interpreted as specified in paragraph (c) of this section. I (4112 Edition) (a)(1)(i) of this section, final container material containing a mercurial preservative shall be tested using Fluid Thioglycollate Medium following the procedures prescribed in such subparagraph, except that the incubation shall be at a temperature of 20 to 25 °C. Except for products containing a mercurial preservative, a test shall be made on final container material, following the procedures prescribed in paragraph (a)(1)(i) of this section, except that the medium shall be Soybean-Casein Digest Medium and the incubation shall be at a temperature of 20 to 25 °C. If growth appears in any of the test media during testing of either bulk or final container material, the test may be repeated to rule out faulty test procedures as follows: (1) Repeat bulk test. The volume of inoculum to be used for the repeat bulk test shall be as prescribed in paragraph (d)(1) of this section. The repeat test shall be performed using the procedure prescribed in paragraph (a)(1)(i) of this section. The number of test samples and the volumes of product used for the first repeat test shall be as prescribed in paragraph (d)(2) of this section. For products that do not contain a mercurial preservative, the repeat test shall be performed, using both Fluid Thioglycollate Medium and SoybeanCasein Digest Medium, following the procedures prescribed in paragraphs (a)(1)(i) and (a)(2), respectively, of this section. If the product contains a mercurial preservative, the repeat test shall be performed using Fluid Thioglycollate Medium and the procedures prescribed in paragraphs (a)(1) (i) and (ii) of this section. If growth appears in any of the first repeat final container tests, all tests of the first repeat final container test shall be repeated, provided there was no evidence of growth in any test of the bulk material. The test samples used for the second repeat final container test shall be twice the number used for the first repeat final container test. The results of all tests performed on a lot shall be considered in determining whether or not the lot meets the requirements for sterility, except that tests may be excluded when demonstrated by adequate controls to be invalid. The lot meets the test requirements if no growth appears in the tests prescribed in paragraph (a) of this section. If repeat tests are performed, the lot meets the test requirements if no growth appears in the tests prescribed in paragraph (b)(2) or (3) of this section, whichever is applicable. Each sample for the bulk sterility test shall be representative of the bulk material and the volume tested shall be no less than 10 ml. The sample used for each test medium or each incubation temperature of a test medium for the final container and first repeat final container test shall be no less than 20 final containers from each filling of each lot, selected to represent all stages of filling from the bulk vessel. If more than 2 filling machines, each with either single or multiple filling stations, are used for filling one lot, no less than 10 filled containers shall be tested from each filling machine for each test medium or each incubation temperature condition, but no more than 100 containers of each lot need be tested. The items tested shall be representative of each filling assembly and shall be selected to represent all stages of the filling operation. A lot of culture medium is that quantity of uniform material identified as having been thoroughly mixed in a single vessel, dispensed into a group of vessels of the same composition and design, sterilized in a single autoclave run, and identified in a manner to distinguish one lot from another. Each lot of culture medium shall be tested for its growth-promoting qualities unless it meets the exception for dehydrated culture medium described in this subpart. The growthpromoting quality test shall be performed on the smallest sized vessel used in an autoclave run. When using a single batch of dehydrated culture medium, a manufacturer need not perform growth-promoting tests on each lot of prepared liquid medium, provided that a validation program exists for autoclaves used to sterilize the culture medium, and the manufacturer has received approval for this practice from the Director, Center for Biologics Evaluation and Research or the Director, Center for Drug Evaluation and Research. Two or more strains of microorganisms that are exacting in their nutritive and aerobic/anaerobic requirements shall be used to test the growth-promoting qualities of each lot of test medium. Manufacturers shall choose the strains of microorganisms from the chart in this paragraph. Periodic tests shall be performed to verify the integrity of the test organisms in accordance with § 610. The results of these periodic tests shall be recorded and retained in accordance with § 600.
Fructus Jujubae (Jujube). Fenofibrate.
- Are there safety concerns?
- Dosing considerations for Jujube.
- How does Jujube work?
- What is Jujube?
- Liver disease, muscular conditions, ulcers, dry skin, wounds, diarrhea, fatigue, and other conditions.
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I (4112 Edition) ten request for a hearing within 15 days of receipt of the notice cholesterol chart of meat generic fenofibrate 160mg on-line, the applicant waives the opportunity for a hearing cholesterol medication bad breath cheap 160 mg fenofibrate mastercard. Hearings held under this section will be conducted in accordance with the provisions of part 15 of this chapter cholesterol hdl ratio normal value buy cheap fenofibrate 160 mg on-line, with the following modifications: (1) An advisory committee duly constituted under part 14 of this chapter will be present at the hearing. Before requesting an order from a court for a stay of action pending review, an applicant must first submit a petition for a stay of action under § 10. Biological products approved under this program are subject to the postmarketing recordkeeping and safety reporting applicable to all approved biological products. The availability for public disclosure of any record in the biological product file shall be handled in accordance with the provisions of this section. The Food and Drug Administration will maintain a list available for public disclosure of biological products for which a license application has been approved. Persons wishing to request this information shall submit a request under the Freedom of Information Act. This information may include the purpose of the study, the type of study, the patient population addressed by the study and the indication(s) and dosage(s) that are to be studied. If the schedule has been previously revised, provide both the original schedule and the most recent, previously submitted revision. The study is proceeding according to or ahead of the original schedule described under paragraph (b)(7) of this section. The study is behind the original schedule described under paragraph (b)(7) of this section. Postmarketing studies within the meaning of this section are those that concern: (1) Clinical safety; (2) Clinical efficacy; (3) Clinical pharmacology; and (4) Nonclinical toxicology. Provide a revised schedule, as well as the reason(s) for the revision, if the schedule under paragraph (b)(7) of this section has changed since the previous report. Submit two copies of the annual progress report of postmarketing studies to the Center for Biologics Evaluation and Research or Center for Drug Evaluation and Research (see mailing addresses in § 600. In assessing the sufficiency of animal data, the agency may take into account other data, including human data, available to the agency. This subpart applies to certain biological products that have been studied for their safety and efficacy in ameliorating or preventing serious or lifethreatening conditions caused by exposure to lethal or permanently disabling toxic biological, chemical, radiological, or nuclear substances. When such studies are feasible, the applicant must conduct such studies with due diligence. Applicants must include as part of their application a plan or approach to postmarketing study commitments in the event such studies become ethical and feasible. For biological products or specific indications approved under this subpart, applicants must prepare, as part of their proposed labeling, labeling to be provided to patient recipients. The patient labeling must be available with the product to be provided to patients prior to administration or dispensing of the biological product for the use approved under this subpart, if possible. The Director of the Center for Biologics Evaluation and Research or the Director of the Center for Drug Evaluation and Research will give the applicant notice of an opportunity for a hearing on the proposal to withdraw the approval of an application approved under this subpart. The committee will be asked to review the issues involved and to provide advice and recommendations to the Commissioner of Food and Drugs. No other person attending the hearing may question a person making a presentation. The presiding officer may, as a matter of discretion, permit questions to be submitted to the presiding officer for response by a person making a presentation. I (4112 Edition) agency for consideration during the preapproval review period copies of all promotional materials, including promotional labeling as well as advertisements, intended for dissemination or publication within 120 days following marketing approval. After 120 days following marketing approval, unless otherwise informed by the agency, the applicant must submit promotional materials at least 30 days prior to the intended time of initial dissemination of the labeling or initial publication of the advertisement. Biological products approved under this subpart are subject to the postmarketing recordkeeping and safety reporting applicable to all approved biological products. For biological products being considered for approval under this subpart, unless otherwise informed by the agency, applicants must submit to the Subpart B-Organization and Personnel 606. As used in this part: (a) Blood means whole blood collected from a single donor and processed either for transfusion or further manufacturing. All personnel shall have capabilities commensurate with their assigned functions, a thorough understanding of the procedures or control operations they perform, the necessary training or experience, and adequate information concerning the application of pertinent provisions of this part to their respective functions. I (4112 Edition) (6) the quarantine storage, handling and disposition of products and reagents not suitable for use. Drains shall be of adequate size and, where connected directly to a sewer, shall be equipped with traps to prevent back-siphonage. Facilities shall be maintained in a clean and orderly manner, and shall be of suitable size, construction and location to facilitate adequate cleaning, maintenance and proper operations. The facilities shall: (a) Provide adequate space for the following when applicable: (1) Private and accurate examinations of individuals to determine their suitability as blood donors. The equipment shall be observed, standardized and calibrated on a regularly scheduled basis as prescribed in the Standard Operating Procedures Manual and shall perform in the manner for which it was designed so as to assure compliance with the official requirements prescribed in this chapter for blood and blood products. Standardize with container of known mass or volume before initial use, and after repairs or adjustments. The effectiveness of the sterilization procedure shall be no less than that achieved by an attained temperature of 121. All supplies and reagents used in the collection, processing, compatibility testing, storage and distribution of blood and blood components shall be stored in a safe, sanitary and orderly manner. All final containers and closures for blood and blood components not intended for transfusion shall be clean and free of surface solids and other contaminants. Such examination shall include inspection for breakage of seals, when indicated, and abnormal discoloration. Where any defect is observed, the container shall not be used, or, if detected after filling, shall be properly discarded. I (4112 Edition) measure accurately the quantity of blood removed from the donor. Such procedures shall be available to the personnel for use in the areas where the procedures are performed. The written standard operating procedures shall include, but are not limited to, descriptions of the following, when applicable: (1) Criteria used to determine donor suitability, including acceptable medical history criteria. The review or portions of the review may be performed at appropriate periods during or after blood collecting, processing, compatibility testing and storing. A thorough investigation, including the conclusions and followup, of any unexplained discrepancy or the failure of a lot or unit to meet any of its specifications shall be made and recorded. I (4112 Edition) (3) the donor, pool, or lot number relating the unit to the donor. The Rh group shall be designated as follows: (i) If the test using Anti-D Blood Grouping Reagent is positive, the product shall be labeled: ``Rh positive. All blood establishments that manufacture, process, repack, or relabel blood or blood components intended for transfusion and regulated under the Federal Food, Drug, and Cosmetic Act or the Public Health Service Act.
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This is typically determined during the non-directive portion of the interview cholesterol zelftest order fenofibrate 160mg overnight delivery, when it becomes clear whether or not patients recognize that they are ill xylitol cholesterol purchase line fenofibrate, and in a hospital for treatment cholesterol medication that starts with c buy discount fenofibrate 160mg on-line, etc. This is a particularly important clinical finding given that the differential diagnosis between delirium and dementia rests, in large part, on its presence or absence. Traditionally, three aspects of memory are tested: immediate, short-term, and long-term memory. Here, the patient is given a list of random digits, slowly, one second at a time, and then immediately asked to recall them forwards, from first to last. One starts with a list of three digits, and if the patient recalls these correctly, moves to a list four digits long, proceeding to ever longer lists until the patient either errs in recall or reaches seven digits; normal individuals can recall lists of five to seven digits in length. If this is done correctly one proceeds to longer lists, again until errors are made or the patient performs within the normal range of spans of three to five digits. Short-term recall is tested by telling the patient that you will give a list of three words and that you would like him or her to memorize them because in a few minutes you will ask that they be recalled. Orientation to person may be determined by asking patients for their full names; such orientation is only very rarely lost. Orientation to place is checked by asking patients to identify where they are, including the name of the city and of the building. In cases where patients hesitate to answer, perhaps because they are unsure, it is important to encourage them to take a guess. Should they misidentify the building, inquire further as to what kind of building it is. Orientation to time is determined by asking patients the date, including the day of the week, the month, day of the month, and year. This is often assessed informally during the non-directive portion of the interview as one ascertains whether the patient recalls what happened in the days leading up to admission, during recent holidays, or recalls where he or she worked/went to school. Recall of public events may be checked by asking about recent newsworthy events or, in a somewhat more quantitative way, by asking the patient to recall the names of the last four prime ministers or presidents. Deficits in immediate recall are typically accompanied by confusion and generally indicate a delirium. In addition to delirium, deficits in short- and long-term memory may also be seen in dementia and amnesia. In some cases, either during testing for long-term memory or during the interview, one may find evidence of confabulation (Section 4. Judgment or insight may be lost in delirium, dementia, or a personality change such as frontal lobe syndrome. I plead guilty on both accounts, but urge the reader to try this approach and then to reshape it in light of future experience and wide reading. Although, in most cases, the examination may be conducted in the order suggested here, flexibility must be maintained, especially with fatigued, agitated, or uncooperative patients. Bear in mind that even with a completely uncooperative patient, much may be gathered by a simple observation of eye and facial movements, speech, movement of the extremities, gait, etc. For most findings, further detail on, and a consideration of, the differential diagnosis of the finding may be found in the appropriate chapter, as noted below. Concrete responses may be seen in delirium or dementia and typically indicate frontal lobe dysfunction. Fewer than one-half of normal individuals are able to do this perfectly, most making two or three errors (Smith 1962). In cases in which patients are unable to do serial sevens at all, it is appropriate to ask them to attempt simpler mathematical tasks, such as adding four plus five, or subtracting eight from 12. General appearance In some cases, the overall appearance of the patient may immediately suggest a possible diagnosis. Facial appearance, including facial dysmorphisms, may also be diagnostically suggestive (Wiedemann et al. Handedness Inquire as to handedness and observe as patients handle implements such as a pen; if there is doubt, ask which hand the patient uses to throw a ball or which foot is used to kick with. Their diameter should be measured and their reactions to light and to accommodation should be noted. The pupillary reaction to light is tested first by shining a penlight into one eye and observing the reaction, not only of that pupil but also in terms of the consensual reaction in the opposite pupil. A preserved reaction to accommodation in the face of an absent or sluggish reaction to light is known as an Argyll Robertson pupil and is very suggestive of neurosyphilis. Visual acuity may be informally tested by asking the patient to read text from a newspaper or, more formally, by use of a Snellen chart. If the patient has glasses or contact lenses, vision should be tested both with and without them. Importantly, in cases where the patient fails to respond to an object in one hemi-field, one must consider not only the possibility of an hemianopia, but also the possibility of left visual neglect (see Neglect, p. The depth of the optic cup should be noted, as should the presence or absence of venous pulsations. Eye movements should be full and conjugate in all directions of gaze, and without nystagmus. The oculomotor nerve also innervates the upper eyelid; thus, the presence or absence of ptosis should be noted. If eye movements are full then the lesion responsible for the voluntary vertical gaze palsy is supranuclear, as may be seen in disorders such as progressive supranuclear palsy. In a pinch one may use a substance readily the trigeminal nerve has both motor and sensory components. Sensory testing, to both light touch and pin-prick, is checked in all three divisions, namely the ophthalmic, maxillary, and mandibular. In cases of unilateral voluntary facial paresis note must be made of which divisions of the facial nerve are involved: the upper (controlling forehead wrinkling), the lower (controlling elevation of the side of the mouth), or both. At times facial weakness may be quite subtle, manifesting perhaps only with a slight flattening of the nasolabial fold on one side. This may be accomplished by telling a joke, or, if the physician is in less than a humorous mood, by simply observing the patient for any spontaneous smiling. Voluntary and involuntary facial movements are quite distinct neuroanatomically and thus both should be tested for (Hopf et al. Voluntary facial palsy affecting only the lower division indicates a lesion of the pre-central gyrus or corticobulbar fibers, whereas emotional facial palsy (Section 4. Once this has been accomplished, the patient is asked to protrude the tongue as far as possible, noting especially whether it protrudes past the lips and also whether it deviates to one side or the other. Sensory testing Elementary sensory testing involves light touch, pin-prick, and vibration. Vibratory sensation is tested by touching a vibrating tuning fork to a bony structure (such as a finger joint, the lateral malleolus, or the great toe) and asking the patient whether he or she can tell if it is vibrating; if so, the tuning fork is held in place and the patient is asked to say when the vibration ceases, with the physician taking note, in a rough sort of way, of how much the tuning fork is still vibrating at that point. If there are any abnormalities in elementary sensation it is critical to determine whether or not they are bilateral. In general, it is sufficient to test sensation at both hands and both feet, reserving more detailed testing for cases in which the history suggests a more focal sensory loss. Graphesthesia and two-point discrimination tests also constitute part of the sensory examination but these should only be used if elementary sensation is intact. Agraphesthesia is said to be present when patients, with their eyes closed, are unable to identify letters or numerals traced on their palms by a pencil or dull pin.
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Antiradical activity of hydrolyzed and non-hydrolyzed extracts from Helichrysi inflorescentia and its phenolic contents cholesterol lowering weekly diet plan discount fenofibrate 160 mg on-line. Isolation and identification of the antibacterial compounds from Helichrysum stoechas what is cholesterol in shrimp cheap fenofibrate 160 mg fast delivery. Pharmacology of galenic preparations and flavonoids isolated from Helichrysum arenarium cholesterol test nyc buy cheap fenofibrate 160 mg line. Selected vernacular names Abm, argasse, argousier, argoussier, astelpaju, bautphut, buckthorn, ctin, ctin alb, chharma, ch-liu, chuk, chuma, dhurchuk, duindoorn, echter sanddorn, espino armarillo, espino falso, ghв, gorra, griset, haftdorn, kaham, kalabisa, kвm, kando, milech, miles, neichak, oblebiha krushinovidnaja, olivella spinosa, pangi, sallow thorn, sanddorn, sarla, scheitbeziлn, sea berry, sea buckthorn, seedorn, sendjed-e-talkh, shallow thorn, shawk el qassвr, sirma, sirna, smiltsrksis, starbu, stechdorn, stranddorn, sыl rыmi, suts, olivella, olivello spinoso, rakytnik esetlбkovэ, rakytnik resetliakovitэ, ramnoida hiopogeo, tarru, tarwa, tasru, tirku, tsakanda, tsarap, tsarmand, tsarmaniechak, tserkar, tswak, tyrni, vetrice spinosa, weidendorn, willow thorn, yabani igde a, zhongguoshaji (4, 618). Geographical distribution Indigenous to Europe and some northern regions of Asia, it is widely distributed throughout the temperate regions of Asian countries. In the Newly Independent States, it is grown in the Caucasus and the Ural Federal District, in southern Siberia, and also in Altai and the Sayan Mountains. Stems, many stout branches, round greyish-green crown, brown or black rough bark, thorny grey twigs. Leaves, alternate, almost sessile, linear to lanceolate, enrolled margins, dark green on the upper surface, silver-grey on the lower surface, main central vein prominent, 28 cm long, up to 8 mm wide. Flowers, unisexual; male flowers in catkin-like spikes, 2-sepalled calyx, brown-spotted ovate sepals, 4 stamens and no corolla; female flowers in short racemes of 25 flowers at the axils of the small branches, one pistil; calyx is a tight tube clasping the ovary with erect, inward-inclined tips, brown and reed-like on the outside. Fruits, oval drupes, 311 mm long, 35(9) mm in diameter, turn yellow to orange when mature and persist through winter. Seeds, ovate-oblong, 37 mm long, 35 mm in diameter, dark brown to black, shiny (4, 8, 9, 20, 22, 2732). Plant material of interest: ripe fresh berries General appearance the fruit is an oval, ovoid or subglobose drupe, with or without peduncle. The fruit contains an embryo encased in a seed coat that is surrounded by a thin seed sac or pericarp, all of which is enclosed in the hypanthium (fleshy portion of the fruit). The colour varies from yellow or bright orange to reddish orange or brownish orange. The seed is oblong, smooth, shiny, with a longitudinal furrow, colour ranges from light or dark brown to nearly black. Harvesting by removing the pedicel from the fruit, rips the epidermis, exposes fruit flesh and results in loss of juice from the fruit (4, 9, 3335). Organoleptic properties Odour: light and pleasant; taste: acid, pineapple-like (9, 33, 34, 36). Microscopic characteristics the hypanthium, a false fruit, consists of epicarp and mesocarp. The epicarp has polygonal or polygonal-oval cells with straight irregularly thickened walls and it is confluent with the exterior of the peduncle. The epider188 Fructus Hippophaлs recens mis has corymb-like trichomes characteristic for the Elaeagnaceae. The corymb-like trichomes have a continuous multicellular disc with ray-serrate edge and a multicellular stalk. The trichome stalk consists of 68 radial cells, which surround one or a few (24) smaller cells; there are numerous solitary stalks after detaching of the broken corymb-like disc. It represents a mixture of entire cells, cytoplasm, oil droplets, chromoplasts and chaotic vascular bundles. There are hairs in the calyx opening, in the seed cavity and on the tail of the seed sac. The peduncle has an epidermis with corymb-like trichomes and external thick-walled cells, cortical parenchyma with sclerenchymatic cells and some primary vascular bundles arranged in circles. The achene, the true fruit, usually known as the "seed", consists of tegument, perisperm and endosperm. The tegument is formed by thickwalled palisade cells, perpendicularly arranged on 23 layers of compressed parenchyma. General identity tests Macroscopic and microscopic examinations, chemical analysis and thinlayer chromatography tests for the characteristic constituents, isorhamnetin and quercetin (39). Foreign organic matter Not more than 1% fragments of stems and other parts of plant. Chemical, sulfated ash, and water-soluble 190 Fructus Hippophaлs recens extractive tests are to be established in accordance with national requirements. Chemical assays Contains not less than 10 mg% of total carotenoids expressed as -carotene (1, 2). Major chemical constituents Vitamins and related compounds are the major biologically active constituents. Other significant constituents are flavonoids (especially kaempferol, isorhamnetin, rutin and catechin, as well as quercetin tri- and tetra-glycosides). The fatty oil (in seeds commonly about 10% and up to 1516%), consists of triglycerides rich in the two fatty acids, linoleic and -linolenic acid; other glycerides include 1,3-decapryloyl-2-linoleyglycerol; other major fatty acids are oleic, palmitic, stearic and vaccenic acids). Minerals present include selenium, zinc, calcium, iron, manganese, potassium, sodium, phosphorus, boron and copper, among others (4, 8, 22, 23, 25, 34, 4653). Uses described in pharmacopoeias and well established documents the fruits of Hippophaл rhamnoides are used to relieve cough with profuse expectoration, to promote digestion in people with prolonged gastrointestinal transit with abdominal pain, and for treatment of amenorrhoea (39). Fruit decoctions are used externally as a wash to treat traumatic swelling and cutaneous eruptions (21). Uses described in traditional medicine In the Islamic Republic of Iran, ethanol extracts of Hippophaл fruits are used internally as an astringent and anthelminthic. Hippophaл fruits have been used extensively in India and Tibet for the treatment of circulatory disorders, ischaemic heart disease and hepatic injury (55, 56). Pharmacology Experimental pharmacology Antioxidant, radioprotective and immunomodulatory activities the effects of an extract from fresh H. Alterations in erythrocyte malondialdehyde levels, activity of some erythrocyte antioxidant enzymes, and plasma levels of vitamins E and A were determined. It was observed that nicotine-induced increase of malondialdehyde levels was prevented by the extract and by vitamin E. Nicotine-induced decrease in superoxide dismutase activity was prevented by the extract, but not by vitamin E. Antioxidant activity was assessed using 2-deoxyribose degradation and 2,2-bipiridyl assays in mice. Both the in vitro and ex vivo samples were exposed to gamma ra192 Fructus Hippophaлs recens diation of 1. At a concentration of 1000 µg/ml, 67% scavenging of hydroxyl radicals was observed. In ex vivo experiments, the extract prevented strand-breaks in a dose-dependent manner with a maximum effective concentration of 100 µg/ml. Postirradiation treatment with high concentrations of the extract (150 µg/ml or more) resulted in dense compaction of chromatin (58, 59). In another study, an extract of the fresh fruits was investigated for radioprotective effects in mitochondria isolated from mouse liver. Superoxide anions, reduced and oxidized succinate-cytochrome C oxidoreductase, lipid peroxidation and protein oxidation were used to measure extract-mediated radioprotection. This study suggests that preirradiation treatment of mice with the extract protects the functional integrity of the mitochondria from radiation-induced oxidative stress (60).
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Community example "Dor Yeshorim" as a response to cholesterol levels different units cheap fenofibrate 160mg otc the specific cultural needs of the Ashkenazi Jewish population A range of specific genetic diseases occur at higher prevalence in the Ashkenazi Jewish population cholesterol norms discount fenofibrate 160 mg fast delivery. One example is Tay Sachs disease cholesterol levels 21 year old male order fenofibrate online from canada, a degenerative neurological disorder that follows an autosomal recessive inheritance pattern. One in 25 Ashkenazi Jews are carriers for the disease, and screening for the mutation is well established. The strict Orthodox Jewish community has specific social and cultural requirements for a successful genetic screening programme because they do not endorse prenatal diagnosis or abortion. In this community, marriage often arises as a result of an arranged introduction undertaken by parents, with the support of a professional matchmaker (70). In response to demand for carrier screening, a private international organization called Dor Yeshorim was established in the United States in the late 1980s to provide pre-introduction screening of teenagers for Tay Sachs disease (150). One major concern raised in relation to the screening programme was the potential stigma that detected carriers, particularly women, could suffer and how this might affect their chances of being introduced to potential partners. The programme developed an innovative solution to minimize stigmatization and discrimination of identified carriers: test results remain confidential, even to the individual and their family (84). Each blood sample is given a code number and the results are stored in an international database only under the code, which is given to individuals and their parents. Prior to an introduction, the codes of both potential partners will be given to the professional matchmakers who will submit them to Dor Yeshorim for analysis. The matchmaker, and subsequently the families, will receive one of two responses: compatible or incompatible. If the result is incompatible, the introduction will not occur but neither family will know for which of the 10 diseases their child is a carrier. Keeping the test results confidential does not tackle and may, in fact, perpetuate, the underlying stigma associated with genetic disease. Furthermore, the strict rules regarding confidentiality run contrary to the principle of autonomy because patients are not allowed access to the results even if they request them. This limitation can be very frustrating for individuals who wish to know their carrier status. Some have argued for the availability of publicly funded alternatives to the Dor Yeshorim model to increase choice among the Ashkenazi Jewish population (144). By contrast, the student screening programme for genetic blood diseases in the Kingdom of Bahrain (see Case study 5) represents a different response to the potential discrimination of carriers in marriage. It relies on a system of comprehensive community education to address stigmatization and discrimination, rather than strict confidentiality of test results. This approach has been very important in addressing the initial public resistance to the screening programme because of concerns that girls found to be carriers would not be able to find husbands. The programme includes an education campaign targeted at teachers, parents and children, which emphasizes that (a) all people carry some defective genes; (b) if a carrier married a non-carrier they would be able to avoid the heightened risk of giving birth to an affected child; (c) that although carriers were advised to marry non-carriers instead, they were not prevented from marrying other carriers. By relying on a comprehensive education programme to reduce stigma and discrimination of carriers, public understanding about genetic disease-how it is passed on and how it can be treated or prevented-is likely to increase. Some research suggests that the potential for discrimination may be lower in communities that favour consanguineous marriage, such as the Kingdom of Bahrain, because of the highly cohesive and mutually supportive nature of family and community structures. A study of South Indian families at risk of familial adenomatous polyposis concluded that this tight knit, supportive social structure might result in less stigmatization of affected and carrier individuals (214:5960). Countries that have ratified international human rights treaties have taken on an obligation to give effect to the rights contained within these documents through their national legal systems. Several international human rights documents address the issue of genetic discrimination. The Council of Europe also addresses genetic information in the Convention on Human Rights and Biomedicine; however, it uses the more general wording "[a]ny form of discrimination against a person on grounds of his or her genetic heritage is prohibited (57, Art. A number of developing countries have introduced legislative measures to discourage or prohibit discrimination and stigmatization, some of which focus on discrimination specifically related to medical conditions or genetic disease. In Georgia, for example, discrimination on the grounds of genetic heritage is prohibited (see section 4. Under the law of Peru, individuals have the right not to be discriminated against for suffering a disease or disorder (82, r15). The Fijian Constitution prohibits discrimination on the basis of disability, which could include genetic disease (54, §38). Similarly, the Constitution of Ghana guarantees freedom from discrimination (55, §17). By contrast, a person who without authorization enters a hospital record room or computer databank violates rights of privacy rather than rights of confidentiality (24). As an example, the previous section discussed the potential for discrimination against women in countries that favour arranged marriage, and the stigmatization suffered by thalassaemia patients in Sri Lanka is discussed in Case study 3. Privacy and confidentiality standards are a vital tool for protecting individuals from possible discrimination and stigmatization on the basis of a genetic disorder. Both the right to privacy and the right to confidentiality can be derived from the principle of autonomy. Autonomy, broadly understood, is the capacity of self-determination: based on the idea of a region of sovereignty for the self and the right to protect it by restricting access (see also Autonomy 4. Privacy, fully conceived, can include all things that fall within this personal space- bodily integrity, mental space, personal relationships, and personal information. Privacy is often defined, more narrowly, as relating exclusively to information about a person. For the purposes of the following discussion, we are interested in this narrower definition, though in the context of genetic testing, privacy and confidentiality rights can extend to the right not to disclose information to third parties and the right not to undergo testing. In Australia, Canada, New Zealand, the United Kingdom, the United States, and many European countries confidentiality is currently considered to be paramount, and full consent must be received before any information is disclosed to third parties (175; 110; 107; 106; 109). However, because genetic information may affect an entire family, rather than only the individual, the information revealed by genetic testing may be relevant to the health of people beyond the patient themselves. In many cultures, especially in highly endogamous or consanguineous communities, and where arranged marriage is the norm, a genetic disease may influence, not only the marriage prospects of the affected individual, but potentially all members of the extended family. Under such circumstances, it may be necessary to balance respect for patient confidentiality against the needs and considerations of other family members for whom information about genetic risk could influence decision-making about their own health or reproduction. Other countries, for instance Peru (82, r15) and Argentina (138, r2(f)) have passed more generic privacy and confidentiality laws that do not focus on genetic information specifically, but which may cover it. As an example, Peruvian law states that all users of health services shall have the right to respect for his or her person, dignity and privacy and to demand confidentiality of his or her medical information (82, r15). The implementation of the privacy legislation and regulations discussed above is commendable; however, it should be acknowledged that there is the potential for discrepancies between law, policy and practice. Enforcement can often depend on a number of factors relating to the status of the individual whose rights have been breached (including socioeconomic, ethnic or other status). In settings where female carriers are stigmatized and where there are social repercussions for the reputation of the family, any further publicity of test results is likely to serve as a significant disincentive to people bringing cases to court or even reporting a breach of confidentiality or privacy. Women may be especially disadvantaged in this respect as they may be unable to access mechanisms for remedying discrimination on the basis of gender. For example, in some countries women may lack legal standing to bring complaints or face bias within the legal system. They may also be unable to access mechanisms to report and remedy discrimination due to restrictions on their access to public spaces or illiteracy (239). Also addressed are issues of authorized disclosure, and unauthorized disclosure to third parties for public interest reasons (236, Art.