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Getting active while monitoring nocturnal animals was the theme for our Night Stalk event held on 24 September 2004 in the Chittering Shire. The Night Stalk is an initiative of the Perth Zoo held during August and September with the purpose of local communities documenting the spotting of native and feral animals at night. We linked the message of "Find 30" to the Night Stalk initiative to create enjoyable exercise. For more information I can be contacted by phone on 9622 4328 or via e-mail at Josephine.Sinnamon health.wa.gov.au.
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Author year ; Baigent et al., 200226 Antithrombotic Trialists' Collaboration ; Objective To determine the effects of antiplatelet therapy among patients at high risk of occlusive vascular events. Inclusion exclusion criteria Study designs RCTs that used a randomisation method that precluded prior knowledge of the next treatment to be allocated and that were `unconfounded' i.e. contained two randomised groups that differed only with respect to the antiplatelet comparison of interest ; were included. Trials that used an alternation or odd even date method of randomisation were excluded. Trials of oral antiplatelet regimens were included if they had assessed more than one day of treatment, but trials of parenteral antiplatelet regimens of any duration were included. Participants Participants at high risk 3% per year ; of vascular events because of evidence of pre-existing disease previous occlusive event or predisposing condition ; . Trials among patients with dementia or occluded retinal veins were excluded. Intervention Trials that compared an antiplatelet regimen with a control or one antiplatelet regime with another were included. An antiplatelet drug was defined as one whose primary effect on the vascular system is to inhibit platelet adhesion, platelet aggregation or both. Outcomes measure The primary outcome measure was `serious vascular event' i.e. non-fatal MI, non-fatal stroke or death from a vascular cause and also including any death from an unknown cause ; . An event was considered non-fatal only if the patient survived to the end of the scheduled follow-up period or died of a definitely non-vascular cause. Deaths were divided into those with a vascular cause defined as cardiac, CV, venous thromboembolic, haemorrhagic, other vascular or unknown cause ; and non-vascular. Strokes were subdivided into intracranical haemorrhages including intracerebral, subdural, subarachnoid and extradural haemorrhages ; and strokes of ischaemic or unknown aetiology; TIAs were not included. Major extracranial bleeds were defined as those occurring outside the cranial cavity that were considered by the trialist to be serious in general this meant that the patient required admission to hospital or blood transfusion ; . If during the trial a patient experienced more than one type of non-fatal outcome, both events were recorded but the patient contributed only once to the composite outcome of serious vascular events. If during the trial a patient experienced more than one non-fatal event of the same type or more than one pathological type of stroke, only the first was recorded. Results Number of included studies 289 RCTs overall total n 78, 956 197 RCTs compared antiplatelet therapy versus control, 195 with data on vascular events ; and 90 compared different antiplatelet regimens, 9 with data on vascular events ; . Participant baseline characteristics Previous stroke TIA n 18, 270 Acute stroke n 40, 821 stable angina n 2920 atrial fibrillation n 2770 PAD n 9214 diabetes n 4961 ; . Serious vascular events 195 trials of antiplatelet treatment versus control; n 135, 640 ; : 7705 10.7% ; serious vascular events were recorded among 71, 912 patients allocated antiplatelet therapy versus an adjusted total of 9502 13.2% ; among 72, 139 allocated control p 0.0001 ; . Division of the trials into five subcategories of patients, indicated evidence of differences in the proportional reductions in serious vascular events among them 2 for heterogeneity between categories 2.14; df 4; p 0.0003 ; . A smaller effect was observed in patients treated during acute stroke 2 for heterogeneity between acute stroke and other categories 18.0; df 1; p 0.00002 ; . The overall net benefit was highly significant both among patients with acute stroke p 0.0009 ; and separately among patients in each of the other categories p 0.0001 ; . Non-fatal MI 2774 non-fatal MIs in 150 trials and 48, 428 deaths attributed to CHD ; : overall, antiplatelet treatment produced a 34% 3% ; proportional reduction in non-fatal MI p 0.001 ; and a 26% 2% ; reduction in non-fatal MI or death from CHD p 0.001 ; . continued.
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13. Tunbridge WMG, Brewis M, French J, et al. Natural history of autoimmune thyroiditis. Br Med J Clin Res Ed ; 1981; 282: 258-262. Jayme JJ, Ladenson PW. Subclinical thyroid dysfunction in the elderly. Trends Endocrinol Metab 1994; 5: 79-86. Rosenthal MJ, Hunt WC, Garry PJ, Goodwin JS. Thyroid failure in the elderly. Microsomal antibodies as discriminant for therapy. JAMA 1987; 258: 209-213. Sawin CT, Castelli WP, Hershman JM, et al. The aging thyroid. Thyroid deficiency in the Framingham Study. Arch Intern Med 1985; 145: 1386-1388. Hak AE, Pols HA, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med 2000; 132: 270-278. Lazarus JH, Burr ML, McGregor AM, et al. The prevalence and progression of autoimmune thyroid disease in the elderly. Acta Endocrinol Copenh ; 1984; 106: 199-202. Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism: Prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab 2002; 87: 3221-3226. Diez JJ, Iglesias P. Spontaneous subclinical hypothyroidism in patients older than 55 years: An analysis of natural course and risk factors for the development of overt thyroid failure. J Clin Endocrinol Metab 2004; 89: 4890-4897. Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002; 137: 904-914. Arem R, Patsch W. Lipoprotein and apolipoprotein levels in subclinical hypothyroidism. Effect of levothyroxine therapy. Arch Intern Med 1990; 150: 2097-2100. Caron P, Calazel C, Parra HJ, et al. Decreased HDL cholesterol in subclinical hypothyroidism: The effect of L-thyroxine therapy. Clin Endocrinol Oxf ; 1990; 33: 519-523. Monzani F, Caraccio N, Kozakowa M, et al. Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: A double-blind, placebo-controlled study. J Clin Endocrinol Metab 2004; 89: 2099-2106. Bindels AJ, Westendorp RG, Frolich M, et al. The prevalence of subclinical hypothyroidism at different total plasma cholesterol levels in middle aged men and women: A need for case finding? Clin Endocrinol Oxf ; 1999; 50: 217-220. Imaizumi M, Akahoshi M, Ichimaru S, et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 2004; 89: 3365-3370. Mya MM, Aronow WS. Subclinical hypothyroidism is associated with coronary artery disease in older persons. J Gerontol A Biol Sci Med Sci 2002; 57: M658-M659. 28. Muller B, Tsakiris DA, Roth CB, et al. Haemostatic profile in hypothyroidism as potential risk factor for vascular or thrombotic disease. Eur J Clin Invest 2001; 31: 131-137. Mya MM, Aronow WS. Increased prevalence of peripheral artery disease in older men and women with subclinical hypothyroidism. J Gerontol A Biol Sci Med Sci 2003; 58: 68-69. Monzani F, Di Bello V, Caraccio N, et al. Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: A double blind, placebo-controlled study. J Clin Endocrinol Metab 2001; 86: 1110-1115. Danese MD, Ladenson PW, Meinert CL, Powe NR. Clinical review 115: Effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: A quantitative review of the literature. J Clin Endocrinol Metab 2000; 85; 2993-3001. Caraccio N, Ferrannini E, Monzani F. Lipoprotein profile in subclinical hypothyroidism: Response to levothyroxine replacement, a randomized placebo-controlled study. J Clin Endocrinol Metab 2002; 87: 1533-1538. Cooper DS, Halpern R, Wood LC, et al. L-Thyroxine therapy in subclinical hypothyroidism. A double-blind, placebo-controlled trial. Ann Intern Med 1984; 101: 18-24 and lercanidipine.
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He is clearly a great protagonist of the use of albumin and cited its wellknown value in anaphylaxis, certain volume replacement situations, paediatric heart surgery, severe lung leak, and plasmapharesis, but reminded us that these were all areas where it was known to work but there are no studies to prove it! In addressing the future progress of ICM, he stressed the importance of large clinical trials, which may involve commercializing research. He ended by saying that the 5 tasks of a wise Doctor were to be a clinician, a researcher, a manager, a teacher, and to accept the snakes and ladders of medical practice. His excellent talk was enthusiastically received and I say this is an entirely complimentary manner ; , for me, it raised more questions than it answered, making us question what we do, questions why we do it, and question what should make us change our practice.
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Challenges. 53 F. Supp. 2d 454 at 463 emphasis added. ; . Biovail's argument that its patent lawsuit alleging infringement, specifically relating to IMPAX 150 mg tablets See Complaint 12 ; , should stay approval of IMPAX 300 mg tablets is untenable, for at least two reasons. First, it requires analysis of the merits of complicated patent cases that FDA does not have either the resources or expertise to assess, and that it is not required to possess under the law. See Watson Pharmaceuticals, 194 F. Supp.2d at 445 "the legislation clearly reflects that Congress recognized that the FDA had a very limited ministerial role in patent fights between patentees and generic marketers" ; See also 54 Fed. Reg. 28, 872, 28, July 10, 1989 59 Fed. Reg. at 50, 342-43, 50, October 3, 1994 ; . The statute should not be read to require such action by FDA and FDA's contrary interpretation is a permissible reading of the statute. See Watson Pharmaceuticals, 194 F. Supp.2d at 445 noting that FDA "has no expertise much less any statutory franchise to determine matters of substantive patent law" ; . Moreover, in the present case, to accept Biovail's argument would require not only that FDA delve into these complicated patent cases, but that when it does so that it interpret a complaint that makes allegations about a specific product in this instance 150 mg tablets ; to include some indeterminate scope of other drug products, including at least a 300 mg tablet strength that Biovail was fully aware of when it filed its complaint but which was conspicuously absent from the otherwise specific allegations of its complaint regarding the 150 mg strength. In addition to being illogical, this argument would also undercut the competition the Hatch Waxman amendments sought to foster, whereas FDA's interpretation of the statute, making.
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Kalantari S Gilan University of Medical Sciences, Iran Sub clinical hypothyroidism SCH ; is defined as a normal serum FT4 and a high serum thyrotropin TSH ; concentration. Up to 30% of patients with SCH may have vague, non-specific symptoms of hypothyroidism, but attempts to identify the patients on the basis of clinical finding have not been successful, so the diagnosis can only be made with laboratory testing. The causes of SCH are the same as those of overt hypothyroidism. Most patients have Hashimoto's thyroiditis. The worldwide prevalence of SCH ranges from 1-10%. A substantial proportion of patients with SCH develop overt hypothyroidism. Serum TSH concentration and positive antithyroid antibodies ATA ; are significant predictors of progression to clinical hypothyroidism. Some patients with SCH have some symptoms of hypothyroidism, some studies show significant improvement in hypothyroid symptom scores and psychometric test. Others found no improvement in symptoms with levothyroxine therapy. In the largest crosssectional study to date, subjects with serum TSH between 5.1 and 10 mU L had significantly higher total cholesterol CH ; levels than those who were euthyroid. In contrast many studies have found no difference in serum total CH between SCH patients and normal subjects. There is no consensus in regard to low density lipoprotein LDL ; and high density lipoprotein HDL ; as well. In some studies patients with SCH had high serum LDL and low HDL concentrations, but the values were normal in other studies. Although in meta-analysis of 13 studies of SCH patients, T4 therapy resulted in significant reductions in serum total CH and serum LDL, with no change of mean serum HDL and triglyceride TG ; , but still the evidence that therapy will reduce total and LDL cholesterol in these patients is in conclusive. Some studies indicate that SCH is associated with an increased risk of cardiovascular disease, coronary heart disease and possibly all-cause mortality, but there is insufficient evidences to support this association and as well benefits of T4 therapy of patients with SCH. There is a consensus that SCH in pregnancy is a risk factor for poor developmental outcomes in the offspring and should be screened and treated in women who wish to become pregnant. There is also agreement that patients with SCH and TSH levels greater than 10 mU L, or goiter should be treated. Population-based screening for SCH is not.
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Differentiated thyroid cancer has in most cases a very favourable prognosis. There are three standard therapeutic modalities which have been used for many years: thyroidectomy, followed by radioiodine treatment courses to ablate remnant thyroid tissue and, if necessary, irradiate any metastases, and finally levothyroxine is given life-long to suppress the production of thyroidstimulating hormone TSH ; . About one-third of metastasized or recurrent thyroid carcinomas dedifferentiate over time, and this will eventually make them inaccessible to radioiodine therapy. For instance, a reduced expression of the thyroidal sodium iodide symporter NIS ; may lead to a decreased iodine uptake and make radioiodine treatment ineffective 1 ; . Loss of TSH receptor expression will take the growth-regulating effect of TSH away and will make levothyroxine treatment for growth suppression ineffective. For these reasons, there is a clinical need for new treatment options for those patients in.
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P , 0: 0001. Similarly, fever clearance was faster in the CQ + AS compared with the CQ group: i ; by day 1, 10.3% 20 ; vs. 36.7% 72 196 ; still with fever, P , 0.001; and ii ; by day 2, 2.6% 5 ; vs. 23.2% 44 190 ; , P , 0.001. Paracetamol use was similar in the 2 groups of children details not shown ; . Few children had gametocytes at recruitment Table 1 ; . Among children without gametocytes at recruitment, gametocyte carriage was significantly lower in the CQ + AS group at day 7 CQ alone, 26.6% 34 128 CQ + AS, 5.5% 10 181 P , 0.0001 ; and day 14 CQ alone, 10.8% 7 65 CQ + AS, 2.2% 4 178 P , 0.01 ; . After day 14 the difference was not statistically significant although the percentage of gametocyte carriers was still higher in the CQ group. At enrolment the mean PCV was 31.2% in children treated with CQ alone and 32.2% in those who received CQ + AS. By day 7, the mean PCV was 30.5% in the CQ group and 32.5% in the CQ + AS group P 0.03 ; and the mean difference between days 0 and 7 was 0.16 and 1.25, respectively P 0.02 ; . However, the PCV at day 14 and at day 28 was not significantly different between the 2 study groups data not shown ; . Discussion Our study shows that the combination of CQ + was safe and well tolerated; there was no documented serious drug-related toxicity. Combination CQ + AS.
The association of mild thyroid failure and cardiovascular dysfunction is increasingly clear. Both systolic and diastolic abnormalities are not only observed in the mildly hypothyroid state but are reversible when subjects ingest thyroxine and are rendered euthyroid.10, 11 More recently, investigators have demonstrated that abnormalities in the subclinical hypothyroid state were reversible with the application of levothyroxine LT4.
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For each patient, the starting dose, the frequency of dose titration, and the optimal full replacement dose must be carefully determined. These parameters will be influenced by patient age for older patients, start lower and titrate more slowly ; , weight 1.5-1.6 mcg kg lean body weight ; , cardiovascular status positive history of coronary artery disease warrants initiation at a very low dose and very slow titration ; , general health, concomitant medications, and the severity and duration of hypothyroidism.8 Therapy with levothyroxine products requires individualized patient dosing, using careful titration, clinical evaluation, and laboratory monitoring.8 Individualized titration should be based on both clinical.
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