Are only accurate if there is concordance of several criteriae, as is the case with our study. Mortality is encouragingly low in both the short term and the long term for those treated in the prehospital phase and the difference is significantly lower than in the hospital group. Although the hospital treated group appears to have a high mortality when compared to the large studies of thrombolysis, this may be explained by the fact that patients in our study were included irrespective of age, the presence of cardiogenic shock or pulmonary oedema. A more valid comparative group might be that of MacLennan et al, 10 who used intravenous streptokinase in a group of 50 patients in a tertiary cardiac centre with similar hospital mortality rates. Recently, other studies11-14 with pre-hospital thrombolysis have shown the feasibility of this treatment and the time gains that can be achieved. Morrison and colleagues published a meta-analysis12 of six trials of pre-hospital thrombolysis carried out by paramedics, general practitioners or mobile intensive care units in Europe or the UK. The "call-toneedle time" was reduced by 33 to 130 minutes and short-term hospital mortality was reduced by 17%. Because of delays in admission to hospital, less than 30% of patients with chest pain are suitable for thrombolysis. Methods of improving the percentage of patients who might benefit from this treatment have been suggested: a ; reducing the delay in the admission of patients with chest pain, primarily by encouraging such patients to contact the emergency services directly, thus bypassing the general practitioner, b ; initiation of treatment in the pre-hospital phase by ambulance crews, general practitioners, or mobile coronary care units and c ; reducing in-hospital delays such as time spent in A&E departments awaiting bedspace. Although significant reductions in delay to admission have been achieved in some areas, notably Brighton, general practitioners in general are reluctant to relinquish their role in the management of acute myocardial infarction and they would contend that they are ideally placed to institute thrombolytic therapy at home. However, Rawles15 in a survey of GPs in the Aberdeen area has highlighted the problems that may occur should this approach be used - only 18% of GPs carried an ECG machine on call and only 30% carried a defibrillator. The vast majority stated that they were reluctant to use any drugs other than opiates or atropine in the treatment of patients with chest pain.
Information or at least have a logo of a hospital or health authority to lend credibility to the source. For patients today, the principle of choice and autonomy is of increasing importance. Materials should indicate treatment options and the risks and benefits of each treatment. An honest approach should be adopted where there are gaps in research and areas of uncertainty, e.g. the treatment of early prostate cancer.16 READABILITY AND DESIGN Before I discuss these very important aspects of producing patient information materials, it is necessary to consider the patient's state of mind. Symptoms that affect concentration like anxiety, fatigue and sedation caused by medication or the patient's diagnosis itself play a huge part in their ability to take on board information. Often educational materials produced for cancer patients are written at reading levels too difficult for many to understand.17-19 The Irish results of the International Adult Literacy Survey IALS ; 20 in 1997 certainly made for sobering reading. It found that 25% of the Irish population could not fully understand the directions on a popular headache medication packet. By IALS standards, 53% of Irish adults, for instance, generic for hyzaar.
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Examination of the emergence of obesity from birth to adulthood in the OLETF rat model A. Weller, M. Schroeder, O. Zagoory-Sharon, S. BI and T.H. Moran Psychology Department and Gonda Brain Research Center, Bar Ilan University; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA. OLETF rats do not express functional cholecystokinin type 1 receptors and represent a well-recognized model of obesity that has been lately used to study the neurobiology of obesity. Adult OLETF males are hyperphagic, obese and eventually become diabetic. To examine the early origins of obesity in this model, we measured body-weight, intake from lactation and during independent ingestion, fat-pad distribution, leptin levels, and central NPY POMC mRNA expression in OLETF and LETO control ; males from postnatal day 1 until young adulthood day 65. Compared to controls, OLETF rats 1 ; were significantly heavier beginning at birth, 2 ; ate more in independent ingestion tests, 3 ; spent more time nursing, showing increased initiative to start nursing episodes and increased weight gain after nursing, 4 ; gained weight more dramatically from the third postnatal week, accumulating significantly more retroperitoneal and inguinal white adipose tissues from the post weaning period and on and more epididymal white fat only in adulthood, 5 ; displayed increased leptin levels from weaning. 6 ; analysis of the mRNA of NPY orexigenic peptide ; and POMC anorexigenic peptide ; in hypothalamic brain sections showed that POMC was up-regulated in the arcuate nucleus from day 23 and on and NPY was up-regulated as early as PND 15 and 23 in the dorsal motor nucleus of OLETF pups, while arcuate NPY levels were not different from controls. The results suggest that OLETF rats present phenotypical pre-obese characteristics. The elevated NPY gene expression in the dorsal motor hypothalamus during the early period of development may play an etiological role in the hyperphagia and obesity of OLETF rats.
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Hepatic and Renal Impairment HYZAAR is not recommended for patients with hepatic impairment or severe renal impairment creatinine clearance 30mL min ; see Dosage and Administration ; . Losartan Renal Function Impairment As a consequence of inhibiting the renin-angiotensin system, changes in renal function including renal failure have been reported in susceptible individuals; these changes in renal function may be reversible upon discontinuation of therapy. Other medicines that affect the renin-angiotensin system may increase blood urea and serum creatinine in patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney. Similar effects have been reported with losartan. Hydrochlorothiazide Hypotension and electrolyte fluid imbalance As with all antihypertensive therapy, symptomatic hypotension may occur in some patients. Patients should be observed for clinical signs of fluid or electrolyte imbalance, e.g. volume depletion, hyponatraemia, hypochloraemic alkalosis, hypomagnesemia or hypokalaemia which may occur during intercurrent diarrhoea or vomiting. Periodic determination of serum electrolytes should be performed at appropriate intervals in such patients. Metabolic and endocrine effects Thiazide therapy may impair glucose tolerance. Dosage adjustment of antidiabetic agents, including insulin, may be required see Medicine Interactions ; . Thiazides may decrease urinary calcium excretion and may cause intermittent and slight.
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Heywood R, Palmer AK, Foll CV et al. Pathological changes in fetal rhesus monkey induced by oral chenodeoxycholic acid. Lancet 1973; 2: 1021. Hierl T, Ziegler R, Kasperk C. Pregnancy in persistent acromegaly. Clin Endocrinol Oxf ; 2000; 53: 262-263. Higby K, Xenakis EMJ, Pauerstein CJ. Do tocolytic agents Stopp preterm labor? A critical and comprehensive review of efficacy and safety. J Obstet Gynecol 1993; 168: 12471259. Hiilesmaa VK, Teramo K, Granstrom ML, Bardy AH. Fetal head growth retardation associated with maternal antiepileptic drugs. Lancet 1981; 2: 165-167. Hill LM, Malkasiam GD jr. The use of quinidine sulfate throughout pregnancy. Obstet Gynecol 1979; 54: 366-368. Hill RM, Desmond MM, Kay IJ. Extrapyramidal dysunction in a infant of a schizophrenic mother. J Pediatr 1966; 69: 589-595. Hill RM, Horning EC. Antiepileptic drugs and fetal well-being. In Boreus L, ed. Fetal Pharmacology. New York, Raven Press 1973. Hill RM, Tennyson LM. Drug-induced malformations in humans. In: Drug Use in Pregnancy. L Stern ed. Adis Health Science Press, Balgowlah, Australia, 1984. Hill RM, Verinaud WM, Rettig CM, et al. Relationship between antiepileptic drug exposure of the infant and developmental potential. In: Janz D et al. eds. Epilepsy, pregnancy and the child. New York: Raven Press, 1982: 409-417. Hill RM, Verniaud WM, Horning MG, et al. Infants exposed in utero to antiepileptic drugs. A prospective study. J Dis Child 1974; 127: 645-653. Hill RM. Ovarian pregnancy; a case report and short review of the literature. Northwest Med 1958; 57: 747-748 and isosorbide.
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SMITH, K.3, HAMSHERE, M.L.3, COLEMAN, S.3, GUY, C.3, O'DONOVAN, M.C.3, OWEN, M.J.3, BUCKLAND, P.R.3 `Characterisation, mutation detection, and association analysis of alternative promoters and 5'UTRs of the human dopamine D3 receptor gene in schizophrenia'. Molecular Psychiatry, 7 5 ; , 493-502, 2002. ARCUS, V.L.2, LANGLEY, R.5, PROFT, T., FRASER, J.D., BAKER, E.N.2 `The three dimensional structure of a superantigen-like protein, SET3, from a pathogenicity island of the Staphylococcus aureus genome'. Journal of Biological Chemistry, 277 35 ; , 32274-32281, 2002. BELL, P. J. L.3, SUNNA, A.3, GIBBS, M. D.3, CURACH, N.C.3, NEVALAINEN, H.3, BERGQUIST, P.L. `Prospecting for novel lipase genes using PCR'. Microbiology, 148, 2283-2291, 2002. BERGQUIST, P.L., TE'O, V.S.J.3, GIBBS, M.D.3, CZIFERSZKY, A.C.E.3, DE FARIA, F.P.3, AZEVEDO, M.O.3, NEVALAINEN, K.M.H.3 `Production of recombinant bleaching enzymes from thermophilic microorganisms in fungal hosts'. Applied Biochemistry and Biotechnology, 98, 165-176, 2002. BERGQUIST, P.L., TE'O, V.S.J.3, GIBBS, M.D.3, CZIFERSZKY, A.C.E.3, DE FARIA, F.P.3, AZEVEDO, M.O.3, NEVALAINEN, K.M.H.3 `Production of enzymes from thermophilic microorganisms in fungal hosts.' Extremophiles, 6, 177-184, 2002. BERGQUIST, P.L., TE'O, V.S.J.3, GIBBS, M.D.3, CZIFERSZKY, A.C.E.3, DE FARIA, F.P.3, AVEZADO, M.O.3, NEVALAINEN, K.M.H.3 `Expression of thermophilic xylanases in fungal hosts'. Progress in Biotechnology, 21, 239-246, 2002. BRIGGS, S.3, UPTON, A.3, BILKEY, M.3, TAYLOR, S.3, ROBERTS, S.3, HOLLAND, D.J. `Vancomycin-resistant enterococci colonization of hospitalized patients in Auckland'. New Zealand Medical Journal, 115, U145, 2002. BRUMBY, A.M.3, ZRALY, C.B.3, HORSFIELD, J.A., SECOMBE, J.3, SAINT, R.3, DINGWALL, A.K.3, RICHARDSON, H.3 `Drosophila cyclin E interacts with components of the Brahma complex'. The EMBO Journal, 21, 1-13, 2002. BURTON, C.L. , CHHABRA, S.R. , SWIFT, S., BALDWIN, T.J. , WITHERS, H.3, HILL, S.J.3, WILLIAMS, P.3 `The growth response of Escherichia coli to neurotransmitters and related catecholamine drugs requires a functional enterobactin biosynthesis and uptake system'. Infection and Immunity, 70, 5913-5923, 2002. CAO, L.3, DURING, M., XIAO, W.3 `Replication competent helper functions for recombinant AAV vector generation'. Gene Therapy, 9 18 ; , 1199-1206, 2002. CHEN, J.J.2, DEADY, L.W.2, KAYE A.J.2, FINLAY, G.J., BAGULEY B.C.2, DENNY, W.A.2 `Synthesis and cytotoxic activity of N- 2-diethylamino ; ethylcarboxamide and other derivatives of 10H-quindoline'. Bioorganic and Medicinal Chemistry, 10, 2381-2386, 2002. COUBAN, S.3, SIMPSON, D.R.3, BARNETT, M.J.3 and lanoxin.
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By CE using a-CD as the chiral selector. A detection limit as low as 1 mg l was achieved. The chiral purity control of S- or R-camphorsulphonic acid commercially available ; was performed by Tanaka et al. [154] using CEMS. The authors found the presence 0f 2 and 0.9% of S- and R-form, in the samples declared to contain R- and S-enantiomer, respectively. Table 3 reports a list of the main application of chiral CE analysis to real samples.
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