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III. METHODS Qualitative and quantitative methods were used to collect data about the delivery of ECPs at eight health care clinics in Philadelphia. The clinics were chosen because 1 ; managers and key staff expressed willingness to participate in the study; 2 ; they were located in different geographical areas and serve a diverse population; 3 ; they provided variation with respect to clinic type; and 4 ; they were at different stages of implementing ECP servicesranging from the planning stage to full implementation of ECP provision "prophylactically" and emergency services. By selecting a broad range of types of clinics, the intention was to document the variety of challenges that providers might expect to encounter as they integrate ECPs into their service offerings. A. Characteristics of Provider Agencies The eight family planning clinics in this study are Title X clinics. Each has a contract with the Family Planning Council. Three of the clinics are community health centers, two are Planned Parenthood affiliates PP ; , and three are hospital-based ambulatory care clinics, of which two serve teens exclusively. The Planned Parenthood affiliates are located in the suburbs of Philadelphia. All others are located in or near low income, inner city, minority neighborhoods in Philadelphia--with the exception of one communitybased clinic, which is in a smaller city outside of Philadelphia that has suffered substantial economic deterioration over the past 15 years. All three community health centers offer a full range of health care services to community adults and children, including reproductive health care. The PP affiliates offer reproductive health care, but not onsite abortion services. Among the hospital-based clinics, reproductive health care services are offered to adults at one clinic and to teens under the age of 19 years at the other two. The two Planned Parenthood affiliates and one of the teen clinics had, prior to the FPC policy, already been providing ECPs upon request to clients for 10 to 15 years. The PP affiliates followed the guidelines and protocols for dispensing ECPs that are provided by the Planned Parenthood Federation of America, similar to the FPC requirements and protocol. One of the hospital-based clinics had dispensed ECPs upon request for several years. Prior to the FPC's requirement, one hospital-based teen clinic and the community health clinics rarely dispensed ECPs. B. Characteristics of Clients All clinics serve clients between 12 and 48 years of age. The two Planned Parenthood affiliates serve suburban and rural women, mostly White and middle class, although they also had some low income women as clients. Clients attending all three community health clinics resided in low income and physically deteriorated neighborhoods and are predominantly African Americans 55%, 80% and 90% respectively ; . Between 10-25% of their clients are Latinos. One community health clinic additionally reported a small population of Vietnamese clients. Another clinic located in a peri-urban area outside of Philadelphia has some Asian and White clients. The client population at the three hospital-based clinics were similar to the community health clinics in being predominantly low income African-American, with.
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Operations The overall operations organization on which the feasibility study has been based is shown in Figure 1-5. The OG will be responsible for operation of the mine and plant as well as legal matters, government relations, public relations, finance, marketing and human resources during the project construction and operational phases. During operations, most senior staff positions will be located in offices at the process plant site near Toamasina, with a smaller complement at the mine site near Moramanga. An office will be maintained in Antananarivo to assist with central government and public relations. Key senior expatriate staff will be relocated to Madagascar with their families, to live in either rented or purchased accommodation in Moramanga or Toamasina. Although training of Madagascar residents to fill as many positions as possible will be a priority, it will not be possible to hire sufficient local staff and or workers with the necessary skills to supervise, operate and maintain the facilities in the early years. In the interim, the project will hire personnel from outside Madagascar who will be contracted on a fly-in, fly-out basis and housed in camps near the plant. Appropriate expatriates may be hired either from developed countries, or from developing countries such as India, Indonesia and the Philippines. The project's human resources strategy will be aimed to attract and retain a quality workforce through competitive compensation and benefits practices and opportunities for growth and development. The human resources plan will be designed to maximize the use of the local population and will include a proactive training program to upgrade worker and contractor skills to suitable levels.
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Effect of acute extrinsic denervation of the stomach on the haemodynamic responses to acid challenge of the gastric mucosa study 3 ; . Acute extrinsic denervation of the stomach was achieved by bilateral subdiaphragmatic vagotomy and removal of the coeliac-superior mesenteric ganglion complex 2 h before acid challenge of the gastric mucosa. This operation had no influence on HR but lowered MAP and enhanced the baseline vascular conductance in the left gastric artery GVC ; whereas the vascular conductance in the femoral artery FVC ; was not diminished to a significant extent Table 3 ; . The ability of gastric acid challenge to increase GVC was strongly inhibited by extrinsic denervation of the stomach as shown by a 77 % reduction of the acid-evoked increment of GVC Fig. 3 ; and a significant depression of the maximal GVC.
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Anticonvulsants gabapentin or lamotrigine, as noted below. In the current series, if one were to utilize the cut-off of hypometabolism, one could have theoretically increased the response rate from 25% to 36% with the calcium channel blocker nimodipine. Interestingly, one area of the brain the left insula showed the best and most linear prediction of clinical response. Hypofunction in this one area correlated with the degree of nimodipine response, and hypermetabolism in the left insula correlated with a better response to carbamazepine. Again, it must be emphasized that even if these data were replicated in a series of subsequent studies by other laboratories, they still would not provide the kind of definitive prediction of treatment response that is available with use of antibiotics, for example, if the appropriate microorganism is cultured and specific antibiotic sensitivity assessed. Nonetheless, even some assistance with increasing the odds of treatment response would be clinically useful, particularly in relationship to the growing list of potential antidepressant and mood stabilizing compounds where there is little clinical or neurobiological empirical basis for assessing the best order of sequential clinical trials in individual patients for the highest likelihood of response. It should also be noted that PET scans are not currently available except in the context of a few controlled trials. PET and Other Anticonvulsants, Lamotrigine Lamictal ; and Gabapentin Neurontin ; Even more preliminary are the emerging data of Tim Kimbrell et al. in our group with other potential PET predictors, using baseline O15 blood flow in relationship to gabapentin and lamotrigine response. In the studies headed by Mark Frye and associates, we have found promising evidence of an initial clinical response in a six-week, randomized, double-blind clinical trial comparing gabapentin, lamotrigine, and placebo. Fiftythree percent of our first 22 treatment-refractory patients showed much or marked improvement on lamotrigine monotherapy, 39% on gabapentin, and, as expected, only 8% on placebo. When responders to these two agents were compared with and lithobid.
This model of pmtct service delivery should be adopted, particularly for progress to occur in poorly resourced lower-level health facilities in the rural areas of high hiv-burdened countries.
TABLE IFeeding Status of Infants 0 to 12 months ; Age in months ; 0-1 n 16 ; 2-3 n 19 ; 4-6 n 27 ; 0-6 n 62 ; 7-8 n 17 ; 9-10 n 16 ; 11-12 n 15 ; 6-12 n 48 ; Ever breast fed 16 100 ; 19 100 ; 27 100 ; 62 100 ; 17 100 ; 16 100 ; 15 100 ; 48 100 ; Exclusively Partial breast breast fed feeding artificial feeding 13 81.25 ; 13 68.42 ; 17 62.96 ; 43 69.35 ; 11 64.71 ; 5 31.25 ; 2 13.33 ; 18 37.50 ; 3 18.75 ; 6 31.58 ; 10 37.04 ; 19 30.65 ; 6 35.29 ; 11 68.75 ; 13 86.67 ; 30 62.50 ; Semisolids started complementary feeding ; 0 1 5.26 ; 4 14.81 ; 5 8.06 ; 4 23.53 ; 9 56.25 ; 15 100 ; 28 58.33 and lithium.
Hyoscyamine . 9 I ibuprofen . 1, 3 IMITREX. 3 indomethacin . 1, 3 INFERGEN . 11 INTAL . 13 INVEGA . 5 INVIRASE. 5 ipratropium bromide . 13 isoniazid . 4 isosorbide dinitrate . 7 isosorbide mononitrate . 7 itraconazole . 3 J JANUMET. 6 JANUVIA . 6 K KEPPRA . 2 KETEK . 1 ketoconazole . 3 ketoconazole cream . 3 ketoconazole shampoo . 3 ketotifen fumarate opthalmic . 12 L lactulose . 9 LAMICTAL. 2 LAMISIL . 3 leucovorin calcium . 4 LEUKERAN . 4 leuprolide acetate . 10 LEVAQUIN. 1 levobunolol . 12 levothyroxine . 10 levoxyl . 10 lidocaine. 8 lidocaine viscous. 1 LIDODERM . 1 LIPITOR . 7 lisinopril . 7 lithium . 5, 6 LORABID . 1 LOTRONEX . 9 lovastatin . 7 LOVENOX . 6 LUMIGAN . 12 LYSODREN . 10.
Then lamictal was added; seroquel was removed and that combo works great for him and loxitane.
Global pharmaceutical turnover in the fourth quarter of 2003 declined two per cent, reflecting a US turnover decline of six per cent to 2, 188 million; whereas in Europe turnover grew two per cent to 1, 363 million, and in International turnover grew four per cent to 964 million. Turnover in the US declined due to generic competition toPaxilwhich began in September 2003. Pharmaceutical turnover by therapeutic area GlaxoSmithKline's ability to continue to deliver pharmaceutical turnover growth, despite generic competition to several of its products, is primarily due to an exceptionally broad product portfolio of fast-growing, high-value products. These include the Respiratory productSeretide Advair 2.2 billion ; up 39 per cent, the diabetes treatmentAvandia Avandamet 0.9 billion ; up 24 per cent, Wellbutrinfor depression 0.9 billion ; up 18 per cent, the emesis treatmentZofran 0.8 billion ; up 16 per cent, Lamictalfor epilepsy 0.6 billion ; up 31 per cent, Trizivirfor HIV 0.4 billion ; up 22 per cent, Valtrexfor herpes 0.5 billion ; up 23 per cent, Coregfor heart disease 0.4 billion ; up 28 per cent and the pediatric vaccineInfanrix Pediarix 0.3 billion ; up 32 per cent. Central nervous system CNS ; CNS sales grew four per cent to 4, 455 million. Sales in the US and Europe grew three per cent. International sales grew 15 per cent. Sales ofSeroxat Paxil, GlaxoSmithKline's leading product for depression and anxiety disorders, declined four per cent to 1, 877 million. US sales declined nine per cent to 1, 179 million following the launch of a generic paroxetine in September 2003. By January 2004, GlaxoSmithKline's innovative new productPaxil CRincreased its share of totalPaxilprescriptions branded and generic ; since the generic launch from 33 per cent to 37 per cent.Paxil CRsales in 2003 were 387 million. EuropePaxilsales declined eight per cent to 369 million reflecting competition and pricing pressures. International sales grew 25 per cent to 329 million led by continued strong growth in Japan. Sales ofWellbutrin, for depression, grew 18 per cent to 953 million, reflecting increased physician awareness of the product's outstanding efficacy and favourable side-effect profile. A new once-daily formulation, Wellbutrin XL, was launched in September 2003. This formulation accounted for 40 per cent of brandedWellbutrinprescriptions in early February 2004 and seven per cent of sales in 2003. Limited generic competition toWellbutrinbegan in the USA in January 2004 for the 100mg dose. Generic competition across all dose forms ofWellbutrin SRis expected at any time. GlaxoSmithKline's medicine for epilepsy, Lamictal, continued to grow across all regions achieving sales of 556 million, up 31 per cent. In June 2003, the FDA approvedLamictalfor long-term maintenance treatment of bi-polar disorder.
Btw, i'm also on clonipin for anxiety and lamictal for bp and loxapine.
Second line intensity and setting weekly office + e rp homework weekly office + out-of-office therapist assisted e rp intensive cbt 50 hours of daily cbt over 3 weeks ; biweekly e rp partial hospital inpatient hospital group individual + family therapy behavioral family therapy number of sessions 13 20 sessions 7 12 sessions 20 50 sessions 3 6 sessions ocd contents home page guideline 3: selecting a specific medication strategy summary: among the classes of medications, the serotonin reuptake inhibitors sris ; are by far the most effective for ocd and the experts recommend all five sris as first line treatments for ocd.
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He' s got me on 100 mgs of lamictal and 100 mgs of zoloft although he' s getting ready to switch me to wellbutrin.
THIRD QUARTER PERFORMANCE 2002 PHARMACEUTICALS DRIVEN BY SALES GROWTH IN CNS AND RESPIRATORY Pharmaceutical sales increased 6% to 4.2 billion, with US sales growth up 9% to 2.3 billion, representing 54% of the business. The underlying growth rate for the US business is broadly consistent with reported sales growth although some products were affected by wholesaler stocking patterns. Europe sales were up 2% to 1.1 billion, reflecting declines in some older products, as well as significant government reforms in Italy. International markets grew 6% to 836 million, with strong performances in Canada and the Middle East Africa, partially offset by continuing weakness in Mexico. HIGHLIGHTS FOR THE QUARTER STRONG PERFORMANCE IN CNS SALES GREW 21% TO 1.1 BILLION GSK's leading product for depression, Seroxat Paxil, was up 27% in the USA. Paxil CR now represents 24% of Paxil's new prescriptions in the USA and continues to gain acceptance since the product's launch in April. Sales of Wellbutrin, also for depression, increased 53% in the USA helped by wholesaler stocking; underlying growth was estimated at 21%. During the quarter, GSK filed for FDA approval of Wellbutrin XL, the new once daily version. Lamictal, for epilepsy, showed strong sales growth, up 25% worldwide with 41% growth in the USA. In August the company filed an sNDA for Lamictal seeking approval for the first-ever indication for longterm management of depressive episodes in bipolar disorder. RESPIRATORY UP 11% TO 922 MILLION; SERETIDE ADVAIR CONTINUES STRONG GROWTH GSK's leading respiratory product - Seretide Advair - grew 70% worldwide to 392 million, driven by market share gains in the USA and continued growth in Europe and International markets. A recent European study suggested that Seretide is more effective than budesonide and formoterol used concurrently. While both treatments produced clinically meaningful increases in lung function, Seretide patients benefited from significantly greater improvements in night-time symptoms, awakenings and a lower rate of exacerbations. ANTI-VIRALS GREW 11% TO 558 MILLION Global sales of HIV medicines grew 12%, driven by Trizivir, GSK's triple combination therapy. Sales of Valtrex for herpes increased 22% worldwide and 29% in the USA. In September, the FDA approved an sNDA for Valtrex for the one day treatment of cold sores. Additionally, promising data has shown that Valtrex reduces transmission of symptomatic genital herpes and the company expects to file an sNDA for this additional indication in the fourth quarter. ANTI-BACTERIALS DECLINED 15% TO 434 MILLION; AUGMENTIN XR TO BE LAUNCHED IN NOVEMBER US sales of Augmentin declined 40% due to generic competition that began in July. Augmentin ES, the extra strength antibiotic for children with recurrent acute otitis media now represents 15% of total prescriptions of the Augmentin branded and generic ; franchise. This market share has not been impacted by generic competition. In September the FDA granted approval for Augumentin XR to treat adults with acute bacterial sinusitis and community-acquired pneumonia. The product will be launched in November. METABOLIC GI DOWN 23% TO 289 MILLION; AVANDAMET TO BE LAUNCHED IN NOVEMBER Sales of Avandia, for diabetes, were down 26% worldwide. In the USA reported sales of Avandia were down 32%, due to unfavourable wholesaler stocking patterns, which resulted in a very strong Q3 last year. Underlying growth was estimated at 6% in the USA. The company received FDA approval in October for Avandamet the first treatment that both targets insulin resistance and decreases glucose production in one convenient pill. In November GSK expects to re-introduce Lotronex in the USA for use by women with severe diarrhoea-predominant irritable bowel syndrome.
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The incidence of these rashes, which have included sjs, is approximately 8% 1000 ; in pediatric patients age how can i simplify titration with lamictal and lamotrigine.
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Bottlender R, Rudolf D, Strauss A, Moller HJ. Mood-stabilisers reduce the risk of developing antidepressant-induced maniform states in acute treatment of bipolar I depressed patients. J Affect Disord 2001; 63 1-3 ; : 79-83. Goldberg JF, Truman CJ. Antidepressant-induced mania: an overview of current controversies. Bipolar Disord 2003; 5 6 ; : 407-20. Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwin GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. J Psychiatry 2004; 161 9 ; : 1537-47. Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. The expert consensus guideline series: medication treatment of bipolar disorder. Postgraduate Medicine 2000; Special No: 1-104. Bhagwagar Z, Goodwin GM. The role of lithium in the treatment of bipolar depression. Clinical Neuroscience Research 2002; 2: 222-227. Normann C, Hummel B, Scharer LO, Horn, Grunze H, Walden J. Lamotrigine as adjunct to paroxetine in acute depression: A placebo-controlled, doubleblind study. J Clin Psychiatry 2002; 63 4 ; : 337-44. Obrocea GV, Dunn RM, Frye MA, Ketter TA, Luckenbaugh DA, Leverich GS, et al. Clinical predictors of response to lamotrigine and gabapentin monotherapy in refractory affective disorders. Bioll Psychiatry. 2002; 51 3 ; : 253-60. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361 9360 ; : 799-808. Tohen M, Vieta E, Calabrese J, Ketter TA, Sachs G, Bowden C, et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Archives of General Psychiatry. 2003; 60 11 ; : 1079-88. Bauer MS, Calabrese J, Dunner DL, Post R, Whybrow PC, Gyulai L, et al. Multisite data reanalysis of the validity of rapid cycling as a course modifier for bipolar disorder in DSM-IV. J Psychiatry 1994; 151 4 ; : 506-515. Coryell W, Endicott J, Keller MB. Rapidly cycling affective disorder: Demographics, diagnosis, family history, and course. Arch GenPsychiatry 1992; 49 2 ; : 126-131. Koukopoulos A, Sani G, Koukopoulos AE, Minnai GP, Girardi P, Pani L, et al. Duration and stability of the rapid-cycling course: a long-term personal followup of 109 patients. J Affect Disorders 2003; 73 1-2 ; : 75-85. Maj M, Magliano L, Pirozzi R, Marasco C, Guarneri M. Validity of rapid cycling as a course specifier for bipolar disorder. J Psychiatry 1994; 151 7 ; : 1015-9. Kupka RW, Luckenbaugh DA, Post RM, Leverich GS, Nolen WA. Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies. J Clin Psychiatry 2003; 64 12 ; : 1483-94. Post RM, Uhde TW, Roy-Byrne PP, Joffe RT. Correlates of antimanic response to carbamazepine. Psychiatry Res 1987; 21 1 ; : 71-83. Swann AC, Bowden CL, Calabrese JR, Dilsaver SC, Morris DD. Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania. J Psychiatry. 1999; 156 8 ; : 1264-1266. Baldessarini RJ, Tondo L, Floris G, Hennen J. Effects of rapid cycling on response to lithium maintenance treatment in 360 bipolar I and II disorder patients. J Affect Disord 2000; 61 1-2 ; : 13-22. Tondo L, Baldessarini RJ, Floris G. Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders. Br J Psychiatry 2001; 178 Suppl41 ; : s184-s190. Vieta E, Parramon G, Padrell E, Nieto E, Martinez-Aran A, Corbella B, et al. Quetiapine in the treatment of rapid cycling bipolar disorder. Bipolar Disord 2002; 4 5 ; : 335-340. Sanger TM, Tohen M, Vieta E, Dunner DL, Bowden CL, Calabrese JR, et al. Olanzapine in the acute treatment of bipolar I disorder with a history of rapid cycling. J Affect Disord 2003; 73 1-2 ; : 155-61. Calabrese JR, Suppes T, Bowden CL, Sachs GS, Swann AC, McElroy SL, et al. A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapidcycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry 2000; 61 11 ; : 841-50. Bowden CL, Brugger AM, Swann AC, Calabrese JR, Janicak PG, Petty F, et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA 1994; 271 12 ; : 918-924. McElroy SL, Keck PE, Jr., Pope HG, Jr., Hudson JI, Faedda GL, Swann AC. Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. J Psychiatry 1992; 149 12 ; : 1633-44. Perugi G, Akiskal HS, Micheli C, Toni C, Madaro D. Clinical characterization of depressive mixed state in bipolar-I patients: Pisa-San Diego collaboration. J Affect Disord 2001; 67 1-3 ; : 105-14. Calabrese JR, Fatemi SH, Kujawa M, Woyshville MJ. Predictors of response to mood stabilizers. J Clin Psychopharmacol 1996; 16 2 Suppl 1 ; : 24S-31S. Chun BJ, Dunner DL. A review of antidepressant-induced hypomania in major depression: suggestions for DSM-V. Bipolar Disord 2004; 6 1 ; : 32-42. Davis JM, Janicak PG, Hogan DM. Mood stabilizers in the prevention of recurrent affective disorders: a meta-analysis. Acta Psychiatrica Scandinavica 1999; 100 6 ; : 406-417. Burgess S, Geddes J, Hawton K, Townsend E, Jamison K, Goodwin G. Lithium for maintenance treatment of mood disorders Cochrane Review ; . In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.
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Item 1. Business RECENT DEVELOPMENTS Appointment of New CEO On February 26, 2007 Pharmos Corporation the "Company" or "Pharmos" ; announced that Elkan Gamzu, Ph.D., had been appointed by the Board of Directors to become Chief Executive Officer, effective March 31, 2007. He will succeed Haim Aviv, Ph.D., who will be retiring on that date. Dr. Aviv will continue as Chairman of the Board. Dr. Gamzu, a Director of the Company since February 2000, is currently a consultant to the biotechnology and pharmaceutical industries and has held a number of senior executive positions in those industries, including Vice President, Project Management Leadership, of Millennium Pharmaceuticals, CEO of Cambridge Neuroscience and senior positions with Warner-Lambert and Hoffmann-La Roche. Dr. Gamzu has worked in the pharmaceutical industry since 1971. He is a graduate of Hebrew University in Jerusalem, and has M.A. and Ph.D. degrees in experimental and physiological psychology from the University of Pennsylvania. Dr. Gamzu will be based in the Company's corporate headquarters in Iselin, New Jersey. He also will spend a significant amount of his time at the Company's Rehovot, Israel offices, where its research and drug development activities are centered. As part of a brief transition period, Dr. Gamzu started his employment immediately and, after assuming the position of Chief Executive Officer on March 31, 2007, will devote full time to Pharmos. Acquisition of Vela Pharmaceuticals Inc. In March 2006, the Company announced an agreement to acquire Vela Pharmaceuticals, Inc. "Vela" ; , which had a Phase II product candidate, dextofisopam, in development to treat irritable bowel syndrome. The Company intends to dedicate substantial resources to complete clinical development of this product candidate. The Vela acquisition also included additional compounds in preclinical and or clinical development for neuropathic pain, inflammation and sexual dysfunction. The issuance of up to million shares in connection with the acquisition was approved by the Company's shareholders on October 25, 2006 and the acquisition was consummated immediately thereafter.
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| KEY GROWTH DRIVERS CONTINUE TO PERFORM STRONGLY GSK's biggest selling product - Seretide Advair for asthma and COPD - continues to grow very strongly with sales up 22% to 690 million. Advair had an excellent performance in the USA with sales up 25% to 380 million. In March, GSK, in collaboration with the American Lung Association, launched a new campaign which helps patients to assess their level of symptom control using the new Asthma Control TestTM. Sales were strong in Europe + 19% to 251 million ; . European sales are expected to benefit from the CONCEPT trial data published in March 2005. This study showed that patients receiving Seretide had significantly more symptom-free days, and a rate of asthma attacks almost half that of Symbicort with adjustable maintenance dosing. Sales of the Avandia family of diabetes treatments Avandia Avandamet ; rose 25% to 287 million in the quarter. Growth was strong in all regions: USA + 21% to 215 million ; , Europe + 53% to 32 million ; and International markets + 31% to 40 million ; . In the first quarter, Avandia received FDA approval for two new indications: use in triple combination with metformin and a sulfonylurea which makes it the only glitazone with this indication ; and use at its highest dose of 8mg in combination with a sulfonylurea. In the USA, the disruption in supplies of Avandamet from the Cidra manufacturing site has been largely offset by conversion to Avandia. Lamictal, GSK's epilepsy and bipolar disorder treatment, continues to perform very strongly with sales up 30% to 195 million during the quarter. US sales of Lamictal rose 38% to 120 million. Sales of heart disease treatment Coreg rose 50% in the quarter to 135 million, benefiting from growth in three key areas of the heart disease market hypertension, heart failure and post-myocardial infarction. Sales of Valtrex, for herpes, rose 28% to 164 million, driven by a strong performance in the USA + 36% to 112 million ; where the product is the clear market leader for the treatment and prevention of genital herpes. GSK's portfolio of vaccines grew 3% to 248 million, led by a strong performance in Europe where sales grew 10%. International sales declined 4% impacted by the phasing of tender orders which are expected to recur later in the year. In the USA, Boostrix a booster vaccine to prevent diphtheria, tetanus and pertussis ; and Fluarix to prevent flu ; are expected to be launched during the second half of 2005. OTHER PRODUCTS Sales of Flixonase Flonase rose by 12% to 171 million during the quarter, benefiting from a particularly strong allergy season in Japan where sales more than doubled to 27 million. GSK's HIV franchise had a solid quarter with sales up 6% to 363 million US sales up 8% to 178 million ; , helped by good performances from newly launched drugs Epzicom Kivexa and Lexiva, and a favourable comparison with a weak first quarter last year. Other products performing well during the quarter included: Zofran + 8% to 189 million Requip for Parkinson's Disease + 15% to 30 million and Avodart, for the treatment of benign prostatic hyperplasia, sales of which more than doubled to 26 million. The quarter also included the first full quarter contributions from cardiovascular treatments Fraxiparine Arixtra purchased from Sanofi in September 2004 56 million ; . Overall sales of Seroxat Paxil products fell 43% to 163 million as a result of generic competition to Paxil IR -36% to 122 million ; and the disruption to supplies of Paxil CR -57% to 41 million ; . Wellbutrin sales were down 23% to 163 million. Sales of Wellbutrin IR and SR -75% to 32 million ; continue to be affected by generic competition, which began in full in March 2004. However, this impact continues to be partially offset by the strong performance of Wellbutrin XL + 56% to 131 million.
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LIVER ABSCESSES IN A POST-PARTUM FEMALE AS THE INITIAL PRESENTATION OF CROHN'S DISEASE Mubashir Khan, MD Associate ; , J Broxterman, MD Associate ; , H Shen, MD Associate ; , and N Chalasani, MD. Indiana University School of Medicine, Indianapolis, IN. Liver abscesses are rare but serious complication of Crohn's disease. We describe a case of liver abscesses in a female as the initial manifestation of Crohn's disease. The patient is a 34-year old white female who was admitted to our hospital after diagnosis and initial management of liver abscesses. The patient developed unrelenting fevers and right upper quadrant pain approximately six weeks before admission and was treated initially for a urinary tract infection. She delivered her baby four weeks back and was subsequently readmitted for the same complaints. An abdominal CT scan revealed multiple liver abscesses, and she was started on intravenous antibiotics at the outside hospital but came to us for persistent symptoms. On admission, she was febrile, had hepatomegaly which was tender, leukocytosis, as well as high alkaline phosphatase level. A CT scan done at our institution showed `innumerable' lesions consistent with liver abscesses as well as thickening of the terminal ileum suspicious for Crohn's disease. Colonoscopy at the outside hospital had showed terminal ileitis, and biopsy reports were also suggestive of Crohn's disease. An enteroclysis showed severe ileal Crohn's disease with fistulization. The patient underwent resection of part of her ileum and colon as these were suspected to be the source of infection. She was started on broad spectrum antibiotics as well as antifungal therapy to cover for organisms recovered by blood cultures Streptococcus species ; and on staining of aspirated pus yeast like fungus ; . Drainage of the abscesses could not be performed due to the vast number and small size of the lesions. The patient is likely to have a prolonged treatment course given the number of abscesses and the slow initial response to antibiotics. Awareness of liver abscesses as a complication of Crohn's disease is important for early diagnosis and management of this entity. This diagnosis must be pursued in any patient with Crohn's disease presenting with a fever of unknown origin. Moreover, this case highlights the importance of a meticulous search for the cause of the liver abscess when it occurs in an otherwise healthy adult.
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