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Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training purchase 50 mg female viagra overnight delivery menstrual yeast infection. Intense tai chi exercise training and fall occurrences in older buy female viagra 50 mg menopause center of mn, transitionally frail adults: a randomized, controlled trial. Balance and strength training in older adults: intervention gains and Tai Chi maintenance. The effects of Tai Chi on bone mineral density in postmenopausal women: a systematic review. A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Other related systems that are less well known in the west but may be just as popular in some areas of south and south-east Asia include unani, siddha and jamu. Both systems fundamentally aim to promote health and enhance the quality of life, with therapeutic strategies for treatment of specific diseases or symptoms in holistic fashion. Almost half of the botanical sources used as medicines have similarities; moreover, both systems have similar philosophies geared towards enabling classification of individuals, materials and diseases. According to this system an individual’s basic constitution to a large extent determines predisposition and prognosis to diseases as well as therapy and life-style regime. Disease is considered to be an imbalance and its treatment involves diverse procedures to restore optimum function and balance. Practitioners use nutrition, yoga, exercise, complex herbal medicines and surgical techniques reactively as therapies and proactively for the preservation of health. Ayurveda in its first recorded form (literature known as vedas) is specifically called atharveda. Indian medicine spread across the eastern world to Tibet, central Asia, Indo-China, Indonesia and Japan, filling the same role in Asia as Greek medicine did in the west. The surgical principles of ayurveda were explained by Sushruta, considered to be the father of surgery in his partic- ular samhita, a text known as the Sushruta Samhita. He described a number of techniques and instruments familiar to modern-day surgery: pre- and postoperative care, asepsis, suturing and sterilisation. He also described 141 types of surgical instruments and a number of surgical procedures, including the treatment of cataracts, haemorrhoids and bone problems, as well as techniques involved in cosmetic surgery such as rhinoplasty. Charak’s text described the significance of the vata, pitta and kapha doshas, elements that form the basis of tridosha physiology (see below), the seven tissues (dhatus) and the three excretions (malas), as well as giving information on the treatment of disease and the preparationofdrugs. Otherimportantcompendiawerewrittenduringthefirst and second centuries by Sushruta (also spelt Susruta) and Vagbhata, who together with Charak are considered to be the great three fathers of ayurveda. The main beliefs are as follows: • There is a close relationship between humans and the universe. The general ayurvedic approach involves: • determining the constitution of the patient and identifying the cause of the illness • applying therapeutic measures to balance any disharmonies. The body is thought of as being composed of the following basic concepts: • The five basic elements of life (pancha mahabhutas). Health is believed to comprise a balanced state of the doshas (made from five basic elements and senses), the dhatus, the malas and a gastric fire (agni), together with the clarity and balance of the mind, senses and spirit. The five basic elements of life (pancha mahabhutas) Ayurveda considers that the universe is made up of combinations of the five elements (pancha mahabhutas).

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Proteolysis stimulates further coagulation and fibrinolysis discount female viagra 50 mg amex breast cancer knee high socks, causing disseminated generation of thrombin and plasmin cheap 100mg female viagra mastercard women's health clinic london ontario king street. Excessive fibrin production and deposition consume clotting factors (hence ‘consumptive coagulopathy’) and cause inappropriate clotting. Consumption of clotting factors leaves insufficient supply for homeostasis so that patients bleed readily (typically from invasive cannulae and trauma, such as endotracheal suction). As coagulopathy progresses, patients bleed from multiple sites, clotting at bleeding sites taking progressively longer. Skin symptoms are easily visible; subdermal haemorrhages cause purpura, the skin may appear cyanotic, mottled or cool, and in latter stages gangrene may develop. Bleeding may occur from traumatic endotracheal suction, further complicating respiratory function. The gastrointestinal tract is especially susceptible to haemorrhage, and so gastric drainage/aspirate and stools should be assessed for blood (including occult and melaena). Intensive care nursing 308 If patients are not being fed enterally, stomach decompression (free nasogastric drainage) reduces stomach stretch and acid accumulation, thus helping to prevent haemorrhage. Early beliefs that heparin would release clotting factors from microthrombi for normal homeostasis proved unfounded. Since hypovolaemia is a common complication, fluid replacement with whole blood and plasma substitutes is likely (see Chapter 33). Symptoms typically include purpura, neurological deficits, multifocal neuropsychiatrie disturbances and renal failure. Heparin stimulates heparin-dependent anti-platelet antibodies, causing intravascular platelet aggregation, thrombocytopenia and arterial and venous stenosis (Cavanagh & Colvin 1997). Many nursing interventions may provoke haemorrhage: ■ endotracheal suction ■ turning ■ cuff blood pressure measurement ■ rectal temperature ■ enemas ■ rectal/vaginal examinations ■ plasters and tape ■ shaving ■ mouthcare Some interventions may be necessary, although alternative approaches should be considered. For example, wet shaves are likely to cause bleeding; electric shavers may be safely used (staff may need to ask families to bring electric razors in, as electric shavers are usually unavailable in hospitals for infection control reasons). Invasive cannulae and procedures should be minimised to reduce risks of haemorrhage. The sight of blood can cause many people great distress, often out of all proportion to the amount of volume lost. The loss of 5 ml of blood is physiologically unimportant, but Intensive care nursing 310 can cause a large enough stain on bedding to create distress, and possible fainting. Visitors should be warned about the possible sight of blood, escorted to the bedside, and observed until staff are satisfied about their safety. Relatives experiencing stress may transmit their fears to patients; apart from humanitarian reasons for reducing stress, it may increases fibrinolytic activity (Thelan et al. Early treatments with anticoagulants have been largely superseded by more conservative (temporary) approaches of replacing clotting factors and treating symptoms to buy time while the underlying pathology is treated. Nursing care should focus on avoiding complications of trauma, while minimising anxiety to both patients and relatives. Of journal articles, Kesteven & Saunders (1993) and Rutherford (1996) give useful overviews. Kelly’s haematological investigations included: Kelly’s results Normal Prothrombin time 22 sec 1–15 sec Partial thromboplastin time 60secs 39–48 sec Thrombin time 15 sec 10–13 sec Fibrinogen levels 0. With reference to physiology, explain why Kelly developed coagulation disorder from hyperthermia and hypermetabolic state. Outline the rationale for this treatment and the nursing approaches which can maximise their therapeutic benefits (e. Reflect on how such a discussion should be managed, appraise the feasibility of organ donation (e. When patients with pre-existing chronic renal failure are admitted, renal management usually continues previous care (e.

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The recent approval of bupropion as a smok- ing cessation agent is a good example of a chance observation while the drug was being used for its 4 discount 100 mg female viagra womens health 21 day. This has led to realization of the influence of nico- tine on depression buy generic female viagra 50 mg on-line menstrual cramps during pregnancy, and investigational drugs of a Pharmacognosy is the science of identifying poten- new class, based on this alkaloid molecule, are now tial drugs that are naturally formed within plants or being designed. It is not yet an abundant source of mole- a drug that was originally designed for one ther- cules, although The Pacific Yew did recently yield apeutic action and wound up becoming a blockbus- paclitaxel for ovarian cancer. This chapter began with a survey of the modern Combinatorial chemistry methods of drug discovery. Pharmaceutical physi- cians should be aware of some of the techniques The breakthroughs in technology that have allo- employed and the rapid rate at which genetic infor- wed sequencing of genes ‘on a chip’ and high- mation is becoming available. It should be noted throughput screening of compounds in microtiter that this modern revolution has not quite comple- plate format have also caused a revolution in tely swept away the occasional new drug found by chemical synthesis, known as combinatorial serendipity or astute clinical observation. The measurement of molecular drug development candidates from many com- diversity: a three dimensional approach. It is a triumph of modern pharmaceutics that most of us do not give a thought to the difference Product storage and stability (or lack thereof) between a white powder and a tablet, and think can bias clinical trials results, and dictate shelf- that ‘a drug is a drug is a drug’. Nevertheless, it is important to understand some elements of this For all these reasons, and more, marketing and science because of the following: clinical input on suitable formulations should be included in the earliest considerations of project Packaged white powders are probably not mar- feasibility, and it behooves the clinical researcher ketable, and overcoming Gallenical problems is to be able to provide such input in an informed a sine qua non for product success. Equally, we should understand the con- straints, difficulties and regulatory ramifications A suitable formulation permits the conduct of that all of our colleagues experience, including clinical trials. For example, the vinegar-like odor of racemate); old aspirin tablets is due to acetic acid, which is a degradant due to hydrolysis of acetylsalicylate, manufacturing impurities; which is an ester. Lastly, differential efficacy exists among dif- Impurities ferently colored placebos, and this should therefore also be expected for active formulations. An impurity is defined as a compound which is the Impurities and degradants may possess their by-product of the manufacturing process used for own toxicological properties. Early in develop- the active compound that has not been removed ment, the structures of these impurities and degra- prior to formulation. Thus, in order to preclude any new toxicology problems developing later during clinical development, it is Excipients common practice to use the less pure bulk drug for toxicology studies. This is commonly accom- An excipient is defined as a material that is delib- plished by using drug removed from the production erately incorporated into the formulation to aid process before the last step, for example before the some physicochemical process, for example for a last recrystallization. This usually guarantees that a tablet, integrity, dissolution, bioavailability or lower purity, that is mixture with greater molecular taste; excipients are typically chosen from among diversity than the drug of interest, will be tested many compounds without pharmacological prop- toxicologically than that to which patients will erties (e. There are specialized examples of excipients, testing by ‘herbal medicine’ manufacturers is com- for example propellants are excipients that assist in pletely illogical in this context. For example, the the delivery of inhaled drugs to the respiratory Butterbur (or Bog Rhubarb; Petasites hybridus) tract. For intravenous infusions or ophthalmic pro- contains well-characterized carcinogens. Butter- ducts, the excipients are usually pH buffers or bur extract tablets are sold as chronic oral therapies 5. Similarly, oral melatonin has an lipophilicity, usually measured as the octanol/ absolute bioavailability of about 15% maximum water distribution coefficient when the aqueous and was eventually withdrawn in the United King- phase is buffered at pH 7. Powder density is the dom and Japan after safety concerns arose ratio of weight and volume occupied by a powder; (DeMuro et al. The types and amounts of some powder particles pack together more effi- degradants and impurities in these products are ciently; the familiar comparison between table unknown. For example, hydrocortisone is given species by a particular route of administra- available for at least seven routes of administration, tion. Hygroscopicity is a measure of the capability as tablets, several creams and ointments, intraocu- of a drug to absorb water from the atmosphere; lar solutions, suppositories, intrarectal foams, such drugs gain weight with time, are often less injections and eardrops.

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Foods to avoid: • Fast food and processed foods contain hydrogenated (trans fats) and saturated fats cheap female viagra 100mg without a prescription menstrual queening, which generate free radicals female viagra 100mg with amex menopause weight gain on abdomen. While this won’t prevent cataracts, early detection gives you a chance to take steps to slow or prevent their development. Avoid smoky environments and people who smoke, as second-hand exposure can be just as damaging. Vitamin C: A major antioxidant in the lens; essential for healthy vision and to protect the eye against free radicals. Low blood C levels of vitamin E have been linked to increased risk of cataracts and some research shows protective benefits with supplements. Consistent and long-term use of antioxidants, along with lifestyle changes, are your best defence. In one study, people who took multivitamins or supplements containing vitamins C or E for more than 10 years had a 60 percent lower risk of devel- oping cataracts (Archives of Ophthalmology, 2000: 118;1556–1563). Complementary Supplements B-complex: Vitamins B2 and B3 protect glutathione in the eye, and some evidence shows protective benefits with supplements. Boost antioxidant and carotenoid intake by eating lots of berries, carrots, peppers, kale, collard greens, spinach, and broccoli. When a person with celiac disease eats gluten-containing food, the immune sys- tem reacts by producing antibodies, which attack the villi in the small intestine, reducing their ability to absorb nutrients. Over time, the reduced absorption of nutri- C ents leads to malnutrition and vitamin, mineral, and essential fatty acid deficiencies. This can damage the health of every organ and body system and increase the risk of many diseases, such as osteoporosis and depression. The cause of celiac is not known; however, three factors are typically present in those who develop the disease: genetic predisposition, a diet containing gluten, and a triggering event. Possible triggers include: introduction of grains into a baby’s diet, puberty, pregnancy, menopause, stress, viral or bacterial infection, and trauma (ac- cident, surgery). There is no cure for celiac disease, but the condition can be managed by following a gluten-free diet for life. Those who do not adhere to a gluten-free diet are at greater risk of developing os- teoporosis; cancer of the intestines, mouth, esophagus, or bowel; and neurological diseases (seizures and nerve damage). Once gluten is removed from the diet, the villi start to heal and intestinal inflammation subsides. Complete healing and regrowth of the villi may take several months in younger people and as long as two to three years in older people. For severe cases that don’t respond to dietary changes, medications such as prednisone are temporarily used to suppress the immune response. Vitamin, mineral, and essential fatty acid supplements are recommended to correct deficiencies and restore health. Dietary Recommendations Read labels carefully; look for products labelled gluten-free. When eating out, ask to speak directly to the chef as service staff may not be familiar with gluten and the many possible hidden sources. Cross-contamination can occur if gluten-free foods are prepared in unwashed bowls previously containing gluten, or cooked in the same pots or deep-fryer. Foods to include: • Lean meats, fish and poultry, fruits, vegetables, corn, potato, rice, quinoa, and soy. Healthy fats (fish, nuts, and seeds) are very important to help restore essential fatty acids, which are depleted in those with celiac disease. Foods to avoid: • Foods containing wheat, barley, rye, bulgur, Kamut, spelt, and triticale, such as breads, pasta, cereals, baked goods, crackers, and pies.

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