By P. Irmak. Florida Gulf Coast University. 2018.


Reference has already been made to the promising results obtained using bioadhesive hyaluronane ester microspheres for vaginal drug delivery purchase arimidex 1 mg without a prescription womens health 4 garcinia. Other bioadhesive polymers under investigation include: Polycarbophil Polycarbophil purchase arimidex 1 mg fast delivery womens health skinny pill, a poly(acrylic acid) lightly cross-linked with divinyl glycol, can remain on vaginal tissue for extended periods and has demonstrated many potential clinical applications: 296 Dry vagina: the bioadhesive gel can hydrate vaginal tissue for 3–4 days after a single application. Tissue hydration is caused by an increased blood flow, thus increasing transudation of vaginal fluid though the intercellular channels of the vaginal epithelium. Clinical assessment of local tissue pH in postmenopausal women shows a reduction in pH from about 7 to 4 and maintenance of this acidic pH for about 3–4 days. This acidic pH is an unfavorable environment for pathogens, thereby protecting against bacterial vaginosis. Spermicide-antiviral: the polymer appears to be an effective delivery system for the spermicidal/antiviral agent nonoxynol-9. By its ability to adhere to vaginal tissue while retaining nonoxynol-9 in its gel structure, it is an excellent extended effect spermicide. In contrast, the bioadhesive gel containing nonoxynol-9 attaches to lymphocytes and maintains sufficient contact time to allow the nonoxynol-9 surfactant to disrupt the cell wall, thus eliminating the lymphocyte and killing the virus within. Progesterone delivery: as described above, estrogen replacement therapy increases the risk of endometrial cancer when used alone. This risk can be eliminated by treatment with a progestational agent for up to 14 days a month. The vaginal delivery of a polycarbophil gel loaded with progesterone has been shown to allow the extended vaginal delivery of the drug for 2–3 days from a single dose and protect the endometrium against cancer. Low serum levels of progesterone were detected after vaginal delivery, which corresponds to fewer side-effects. A commercial progesterone-loaded polycarbophil gel preparation for intravaginal delivery, Crinone, has recently been launched. Smart hydrogel Smart hydrogel preparations, comprising poly(acrylic acid) and a poloxamer (see Section 16. The temperature- dependent gelling of the system helps to prevent leak-back and provides sustained release properties. Smart hydrogel preparations containing estradiol have shown similar bioavailability to a commercial vaginal cream and suppository, even though the gel contained only 20% of the relative estradiol dose. However, the low and erratic bioavailability of biopharmaceuticals via this route necessitates the use of absorption enhancers. Until safe, non-toxic absorption enhancers can be found, the route is of limited potential. A further major limitation of this route is the lack of reproducibility resulting from cyclic changes in the reproductive system. Finally, no matter what degree of optimization can be achieved via this route, it can only ever benefit approximately 50% of the population! Mucosal penetration enhancers for facilitation of peptide and protein drug absorption. Give examples of the classes of the pharmaceutical agents which are presently marketed as topical formulations for vaginal administration. Which other epithelial membrane has a structure most similar to that of the vaginal epithelium? During which phase of the menstrual cycle is the vaginal epithelia thickest and the epithelial tight junctions most cohesive, thereby reducing the absorption of hydrophilic compounds via the paracellular route? Which of the following do not leak through the intercellular channels of vaginal epithelium at the late luteal phase and early follicular phase? What factor controls the pH in the vaginal lumen at between pH 4 and pH 5, preventing the proliferation of pathogenic bacteria? Describe the types of absorption enhancers under development for use in vaginal route. Describe the possible reasons for enhanced vaginal vaccination using microparticulate systems. Research has recently been directed towards the development of alternatives to the parenteral route, such as the transdermal, nasal and other routes thus far discussed in this book, for the systemic delivery of such drugs. However, unlike the other routes described in this text, ophthalmic drug delivery is used only for the treatment of local conditions of the eye and cannot be used as a portal of drug entry to the systemic circulation. Nevertheless, this route warrants study within the general context of drug delivery and 299 targeting, as the local delivery of drugs to their site of action represents a form of drug targeting, reducing the dose needed to produce a pharmacological effect and also minimizing side-effects.

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For bilateral renal artery emboli or emboli to a solitary kidney purchase 1 mg arimidex amex menopause neuropathy, streptokinase catheter embolectomy or surgical treatment may be necessary order arimidex 1 mg fast delivery diagnosis women's health issues. Nonurologic Causes Other problems that cause flank pain that should be considered by the clinician include intraabdominal pathology that secondarily results in flank pain. Since the kidneys are related anatomically to the colon, pancreas, spleen, ovaries, and psoas muscle, pathology involving these organs can produce flank pain. Usually, the abdom- inal symptoms are the primary complaint of the patient in these situations. Musculoskeletal causes of flank pain are not uncommon and also need to be considered. Most patients with a musculoskeletal cause of flank pain present with pain of long-standing duration (12 weeks or more). In contrast to flank pain secondary to a urologic cause, muscu- loskeletal pain tends to be localized more medially, below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). Barone Psychological If the evaluation of a patient with flank pain is normal and the patient continues to complain of pain and seeks narcotic medication for relief of symptoms, consider drug-seeking behavior or Munchausen syn- drome. These patients are well aware of the clinical presentation of stone disease and have been known to put a drop of blood from a pricked finger in the urine to simulate microscopic hematuria. Such patients may have an “allergy” to all nonnarcotic analgesics and some- times indicate the narcotic that works best for them. Such patients also have brought in small stones that they recently have “passed” in the urine. Patients with drug-seeking behavior or Munchausen syndrome should not be given narcotics; however, psychiatric evalua- tion is recommended. History and Physical Examination History The history is the most important component of the evaluation of the patient with flank pain. Long-standing, dull pain is more typical of an infectious, malignant, or congenital problem. Acute, severe pain is characteristic of renal colic and most commonly results from an acute obstruction of the urinary tract due to a calculus, as seen in the case presented. It is not uncommon for patients with renal colic to complain of prior stone episodes, since calculi tend to reoccur in up to 60% of patients. These symptoms are due to irritation of the peri- toneum and distention of the renal capsule. Nausea and vomiting, therefore, can occur with most causes of flank pain; however, it is most severe when the flank pain is acute and severe, such as from a renal calculi. Associated urinary frequency and urgency are common with many causes of flank pain and are due to pain that is referred to the bladder area. The presence of gross hematuria is an important sign that can occur during an episode of flank pain and can be due to a renal calculi, infection, or tumor. Gross hematuria mandates a com- plete urologic evaluation to rule out a malignancy of the urinary tract, such as a renal carcinoma, bladder carcinoma, or ureteral tumor. A history of fever, in association with flank pain, is an ominous sign that usually indicates infection (Table 38. The source of the fever typ- ically is infected urine that remains undrained behind the source of obstruction, such as a calculi, stricture, or tumor. If no obstruction is present, yet the patient complains of flank pain in the presence of fever, 38. In this situation, the renal tissue itself is infected, without obstruction of the urinary tract collect- ing system. The presence of comorbid conditions must be considered when evaluating a patient with flank pain. Most healthy individuals with flank pain and no fever can be managed safely as outpatients. Prob- lems that might predispose an individual to developing urosepsis include diabetes, immunosuppression, and pregnancy. Tobacco use should be determined, since there is an increased risk for developing a transitional cell carcinoma in smokers. Transitional cell epithelium can be found in the bladder, ureter, and renal collecting system.

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In spite of lots of research at “sleep labs” sleep problems are not understood buy arimidex 1 mg mastercard xanthelasma menopause, except for sleep apnea buy arimidex 1mg low price webmd women's health issues. Sleep Apnea Since breathing is regulated by acid levels in the blood and this is influenced by air quality, air toxins should be searched for first. Do your own checking since gas companies give wrong answers four out of five times. Drug reactions, even in a nursing baby, where only the mother is using a medicine could be the problem. Allergy to food, chemicals has been suggested, as well as a simple lack of vitamin C (implicating mold and medicine which consume vi- tamin C in the detoxification process). Kill all invaders with a zapper and try to understand the basis of low immunity in the throat. Keeping metal in the mouth constantly, is a cause of low throat immunity since it must drain past the throat. Chester Fannon, 5Oish, was quite overweight and wore a mask at night with an air blower to assist his breathing. He was toxic with arsenic (roach killer), bismuth (cologne), tin (toothpaste), and thallium (polluted dentalware). His diet was completely changed, to things he rarely ate (bananas, milk, soup, oatmeal) and off things he ate daily (hamburgers, fries, tea, pancakes with genuine maple syrup). Maybe it was the molds in the maple syrup, maybe it was the oxalic acid in the tea, or something else he could not detoxify in these foods. He was certainly happy not to live the rest of his life with an artificial voice box. Insomnia Another sleep disturbance is waking in the night and not being able to go back to sleep for hours. Ornithine, an ammonia reducer, induces a wonderful sleep in sleep- deprived persons. It is also observed that after killing parasites, which produce ammonia, sleep is much improved. We produce urea which is ex- creted by the kidneys along with water and then called urine. When we are parasitized, our metabolism is burdened with am- monia, though, made by the parasites. The brain lacks an essential enzyme, ornithine carbamyl-transferase, for this bit of biochemistry. In fact, a person can be awakened from a coma by being made to smell ammonia “smelling salts. Arginine, another amino acid, also reacts with ammonia, but does not put you to sleep. Arginine results in alertness and therefore should be used in the morning, when needed. Both are perfectly safe, since they are natural to your body, and a food constituent. Sometimes it takes five days to “catch up” on everything that needs to be done for the brain and get you sleeping. Meanwhile, of course, you are planning to kill your parasites and be done with insomnia in the most effective way of all. We are all so different in our metabolism details, we respond differently to herbs. Herbs, a tradition that precedes civilization, need to be forever off limits for intervention by government agencies. Tryptophane, another amino acid, is about twice as power- ful as ornithine, but was taken off the market a few years ago. Some persons taking it daily were seen to become quite ill and some deaths ensued. Since tryptophane had been used in prior years without noticing toxicity, something unusual should have been suspected. Persons with illness due to taking tryptophane developed an extremely high eosinophil count in their blood test—an index of parasitism, too.

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He directed that half a drachm be administered three times a day until it purged freely arimidex 1mg on line menopause for men, and then that it be given in doses of five drops three times a day until the disease was subdued discount 1 mg arimidex amex breast cancer 4th stage survival rate. Even in doses much smaller than this, it will be found to exert a curative influence upon chronic nephritis and cystitis. In cathartic doses Elaterium has been a prominent remedy in the treatment of dropsy, and even in very small doses it will sometimes cure this disease, and I have alternated it with Apocynum. We wish to determine its influence upon the urinary apparatus, and the intestinal canal. For this purpose a tincture of the fresh leaves may be prepared with dilute alcohol. For general use the infusion is the preferable form for administration; but we have a tincture prepared with dilute alcohol, employing pressure. The Epilobium exerts a specific influence upon the intestinal mucous membrane, relieving irritation, and promoting normal function. Thus, it is employed in acute diarrhœa and dysentery, and in colic, with advantage. It is especially valuable, however, in chronic diarrhœa and dysentery; sometimes effecting cures where all other means had failed. Thus, I employed it extensively in the treatment of the chronic diarrhœa during the recent war, and with a success not to be obtained from other remedies. I do not pretend to account for its action, but its curative influence is well established. It influences mucous tissue, especially of the bowels and lungs, and this will be the direction of the investigation. The fresh Ergot may be used in powder, infusion, or a tincture may be prepared in the usual way, with alcohol of 76 per cent. To strengthen the pains in labor, I should prefer this remedy in infusion, but for medicinal use I prefer the tincture. In tedious labors, when the os is dilated, and the soft parts dilatable, and the pains grow weaker, the patient showing evidences of exhaustion, Ergot may be given in the usual doses. In passive hemorrhage with a feeble circulation of blood, tincture of Ergot may be given in doses of five to ten drops, until the flow of blood is arrested. In dizziness, partial loss of consciousness, unsteadiness in the legs, with dull eyes and dilated or immobile pupil, Ergot becomes a prominent remedy. For passive hemorrhage it is one of the most valuable remedies we have, and may be relied upon in hemorrhage from any organ or part. For this purpose the dose will be from five to ten drops on sugar, as often as may seem necessary. It may be employed in diabetes and albuminuria with advantage; also, in chronic inflammation of the kidneys, bladder and urethra. The Yerba Santa is a stimulant to the respiratory mucous membranes, and for this purpose it may be employed in pharyngitis, laryngitis, and bronchitis. The Eryngium exerts a specific influence upon the bladder and urethra, relieving irritation. Given in large quantity in the ordeal it produces giddiness, and inability to coordinate the voluntary muscles, and it may produce emesis by which it is ejected from the stomach. If it produces emesis the patient may live, if not he dies from paralysis of the respiratory apparatus and heart. It is inhaled from the cupped napkin, as we administer chloroform, care being used to admit a sufficient amount of air. In doses of two to ten drops on sugar it is a stimulant to the brain and spinal cord, and will relieve nervous headache, palpitation and irregular action of the heart, imperfect respiration, etc. It exerts a gently stimulant influence upon the nerve centers, improves the circulation and respiratory function, and opposes the influence of malaria in the blood. It is a feeble antiperiodic but will sometimes arrest an ague; when an ague is broken, it is a very good remedy to perfect a cure. It is also a fair means of prophylaxis, though not so good as the small doses of quinine.

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