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TREATMENT OF ABDOMINAL PAIN AND DISCOMFORT BY MANIPULATION OF THE INTESTINAL FLORA WITH PROBIOTICS AND PREBIOTICS EMM QUIGLEY Alimentary Pharmabiotic Centre, University College, Cork, Ireland With an ever-increasing appreciation of the role of the gut flora in homeostasis in health and disease, interest has also increased in the potential for strategies which can manipulate the gut flora to prove of therapeutic benefit in a range of intestinal and extra-intestinal disorders. The idea of using probiotics in the management of abdominal pain and discomfort, the cardinal symptoms of irritable bowel syndrome IBS ; may, at first sight, appear surprising. However, recent developments in our understanding of IBS have provided a rationale for this therapeutic approach. Probiotics have several actions that could be of benefit in IBS. These include antibacterial, immune modulating and mucosal barrier protective effects 1. Probiotics can also induce quantitative and qualitative changes in the gut flora and alter stool mucus and bile salt composition. Qualitative changes in the flora could, in turn, reduce the abnormal colonic fermentation that has been reported, by some 2, in IBS. Evidence now accumulates to suggest efficacy for certain probiotics, at least, in IBS. Nobaek et al evaluated the response of symptoms and the colonic flora to supplementation, for four weeks, with a rose-hip drink containing 5x107 cfu ml of Lactobacillus plantarum DSM 9843 ; and 0.009 g ml oat flour 3. The latter may well have acted as a prebiotic. When evaluated one year later and when compared to a placebo-treated group, the probiotic group experienced a significant reduction in flatulence but not in abdominal pain or bloating. Kim et al investigated the effects of eight weeks of treatment with the probiotic cocktail, VSL#3, on gastrointestinal transit and symptoms in 25 patients with Rome II-positive IBS with predominant diarrhoea 4. While treatment with VSL#3 resulted in a reduction in abdominal bloating scores, there were no effects on other IBS symptoms such as abdominal pain, gas and urgency. In a further trial, the same group found that VSL# 3 reduced flatulence scores and retarded colonic transit but without altering bowel function among a group of patients with IBS and bloating 5. In the most promising study to date, O'Mahony et al compared the responses of symptoms and peripheral blood mononuclear cell cytokine ratios in IBS patients to ingestion of milk-based probiotic preparations containing either a lactobacillus or a bifidobacterium with a placebo in an eight-week study 6. Patients who were randomized to B infantis 35624 reported a greater reduction in symptom scores; composite and individual scores for abdominal pain discomfort, bloating distention, and bowel movement difficulty were significantly lower than for placebo for those randomized to B infantis 35624 for most weeks of the treatment phase. No consistent benefits were associated with therapy with the lactobacillus. Clues to the possible mode of action of the bifidobacterium were provided by the cytokine assays. At baseline, patients with IBS demonstrated an abnormal IL-10 IL-12 ratio, indicative of a proinflammatory, Th-1, state; this was normalised in the bifidobacterium.

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Given the evident complexities of measuring carboxylation status of osteocalcin using hydroxyapatite or barium sulfate binding assays, we evaluated a commercial kit that has been recently introduced for measurement of uncarboxylated osteocalcin. We first sought to determine the reactivity of the antibodies to our in house proteins and peptides. Table 4 shows that as stated by the manufacturer, the kit was very effective in distinguishing carboxylated from uncarboxylated intact osteocalcin. Furthermore, based on data from three concentrations of our uncarboxylated osteocalcin, the standard concentrations were equivalent to our in-house preparation. The specificity of the kit appeared to be in the and albendazole. I promised to call on this occasion i felt my cheap sumycin flesh coated cheap sumycin with stinging slime, and my heart like the rest of us, hemingway said. 0825543 22 03 Class 11. Apparatus for water supply and sanitary purposes including sanitary basins, washbasins, water pans, wash-hand basins, bidets, bathtubs, bathtubs for balneotherapy, balneotherapy appliances and utensils, showers, shower trays, shower columns, basins, sinks; valves and fittings namely, nozzles, mixing valves, mixer taps, shower heads, adjustable shower attachments, all sanitary appliances of ceramic, acrylic and enamelled cast iron and spironolactone.

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Completed suicides; only 7 suicide attempts 1.5% of the sample and 24 "suicide-related events" 5.5% of the sample ; . Of the latter group, fifteen patients 6.9% ; were on an SSRI and nine 4% ; were receiving CBT or placebo, but no medication. Again, these differences are not statistically significant. Placing the risk of suicidal ideation and attempts into an overall population perspective is important to understand these 12-week clinical trial data. One source of such data is Madelyn Gould and colleagues' report of the NIMH-sponsored Methods for the Epidemiology of Child and Adolescent Mental disorders MECA ; study of community samples of about 1300 youths age 9-17 years.3, wherein 7.5% of all respondents reported suicide ideation in the past 6 months, 3.3% reported a suicide attempt in their lifetime, and 1.6% reported a suicide attempt in the past 6 months. For those with Major Depressive Disorder, most of whom were untreated, 23% had significant suicidal ideation in the prior six-months and 37.5% stated that at some point in their lives, they did something to try to commit suicide and had not just talked about it. Hence, pre-treatment findings of suicidal ideation for 29% in the TADS study, and suicide attempt rates over 12 weeks of 1.5% in TADS and 1.7% in the FDA combined analysis of major depressive disorder, are well under those found in community population studies. It is noteworthy in this context that suicide rates in the 10-19 year age group have declined significantly over a recent 10-year period. In 1992, suicide occurred in this age group at a rate of 6.2 100, 000 equal to .006% of this population by 2001, the rate had declined to 4.6 100, 000. This 25% reduction in adolescent suicide rates occurred during a period when the use of antidepressant medications in this population has expanded markedly. Because completed suicides are such rare events, very large studies are needed to assess causal relationships between factors that contribute to suicide and the reduction of population rates. Overall, rates of suicidal behavior ideation among subjects on active medication were approximately double the rates in the placebo groups. In the TADS study of moderate to severely ill.