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Major topics are listed above. Below are numerous short A-C topics: Abortion: Spontaneous Miscarriages are Better Handled Without Surgical Intervention: Woman prefer non-surgical expectant management which is preferred by in Netherlands, but not England. There is a need for surgical evacuation of retained products in 20-50% of cases due to profuse bleeding. If intrauterine sac is great than 10 mm, surgical evacuation is better. The physician must rule out ectopic and molar pregnancies. BMJ 6/2/2001 Ageing: Androgen Oxandrolone Increases Muscle Mass in Low Testosterone Men: Men over age 60 who took the androgen oxandrolone daily for 12 weeks had significantly stronger muscles. 20mg/d. Skeletal muscle mass reportedly declines about 15 percent between the third and eighth decades of life, and as much as 30 percent afterward. fat carried in the trunk and throughout the body decreased. Only those seniors with initially low testosterone levels will benefit the most, Schroeder says although 2/3rds accepted for study. USC. 6/24/02. Ed: I prefer using acetyl-L-carnitine because of the risk of increasing prostate cancer with androgens. Aging: Growth Hormone and Testosterone Better Together in Low Dose: Growth hormone (GH) and testosterone (Te) secretion decrease in aging. In a 6-month DB PC study of 80 healthy men ages 65-80 with GH doses were titrated over 8 weeks to produce IGF-I levels in the upper half of the age-specific reference range, fixed dose Te (5 mg) was given by transdermal patches. Lean body mass increased with GHTe (P = 0.008) and with GH (P = 0.004), compared with placebo. Fat decreased with GHTe only (P = 0.02). Mid-thigh muscle (P = 0.006) and VO2max (P < 0.001) increased only after GHTe. Bodily Pain increased with GH alone (P = 0.003). There were no major adverse effects. The Effects of Growth Hormone and/or Testosterone in Healthy Elderly Men: A Randomized Controlled Trial. Giannoulis MG, et al. King's College London, UK. J Clin Endocrin Metab 2005 Dec 6 Aggression: Multiple Assessments Much More Sensitive: In a study on the experience of adolescent relationship aggression (physical aggression and threatening behavior) of 125 high school students collected by 2 different methods: (a) a 1-time, 2-month retrospective assessment and (b) a cumulative method based on four 2-week retrospective assessments, each spaced 2 weeks apart found 48%) reported experiencing physical aggression using the cumulative method vs. 27% for the single assessment method. The prevalence of threatening behavior was also higher using the cumulative method (49% vs. 25%). Adolescent trauma and anxiety symptoms correlated more strongly with physical aggression data derived from the cumulative method than from the 1-time assessment method. Aggression: Cranial Electrotherapy Stimulation Might Help: Nine aggressive, retarded patients refractory to conventional care at a maximum security hospital were given a 3-month course of cranial electrotherapy stimulation. Aggressive episodes declined 59% from baseline; seclusions were down 72%; restraints were down 58%; and use of prescribed-as-needed sedative medications decreased 53%. No patients discontinued cranial electrotherapy stimulation (CES) because of side effects. Cranial electrotherapy stimulation reduces aggression in a violent retarded population: a preliminary report. Childs A. North Texas State Hospital, Vernon, TX. . J Neuropsychiatry Clin NeuroSci 2005 Fall;17(4):548-51. Allergies: Peanut Oil Creams for Infants Cause Allergies: Products that contain peanut oil often list the ingredient, sometimes described as Arachis oil. Parents often use these products to soothe diaper rash or dry skin in newborns. Following about 14,000 preschool-aged children from birth, forty-nine children were designated as "highly likely" to be allergic to peanuts. Based on interviews from the children's parents, preschool children whose parents had rubbed them with creams that contain peanut oil were almost seven times as likely as kids who had not been exposed to the creams to have an allergy to the nut. Infants who were frequent drinkers of soy milk and soy products were also almost three times as likely to have peanut allergies March 13/03, New England Journal of Medicine. Soybeans and peanuts are both legumes, and children who become sensitive to one can also become sensitive to the other. Creams with trace amounts of peanut oil may spark allergies in infants when the creams are applied to skin that has been broken down, perhaps from a skin condition. Infants who had experienced a rash--particularly one that had oozed and become crusty--were also at higher risk of developing peanut allergies. Amyotropic Lateral Sclerosis: More Common in Athletes, Thin People: Study of 279 with motor neuron disease and 140 with other neurological diseases found thin 2.21 times more likely get motor neuron disease and athletics 1.7 times more likely. Columbia U, Neurology 9/02 Antibiotics: 1st generation fluoroquinolone: nalidixic acid (1962). 2nd generation: Cipro; Third Generation Fluoroquinolone Third Generation Quinolone, Zagam. Sparfloxacin. Gatifloxacin; 1st generation cephalosporins: cephalexin (Keflex), cefadroxil (Duricef), cefazolin (Ancef-IV); 1nd generation: cefprozil (Cefzil), cefuroxime (Ceftin), cefaclor (Ceclor)(causes serum sickness so no longer used); 3rd generation oral: cefixime (Suprax), cefpodoxime (Vantin); http://www.fpnotebook.com Family Practice Notebook.com Aortic Aneurysm Screening No Benefit: Screening for abdominal aortic aneurysm did not reduce mortality among Australian men aged 65-83. Researchers randomized 41,000 men to invitation to ultrasound screening or no intervention. About 7% of respondents had an aortic diameter Arterial Flexibility: Vitamin E Helped: In a very small, 20-healthy adult DB PC 1-month study of 700 IU/day vitamin E, plasma vitamin E levels increased by 123%, which was associated with a 20% increase in carotid artery compliance and a 30-60% increase in baroreflex indices. All these changes regressed 1 month after cessation of vitamin E supplementation. Effect of vitamin E on carotid artery elasticity and baroreflex gain in young, healthy adults. Studinger P, Mersich B, Lenard Z, Somogyi A, Kollai M., Semmelweis University, Budapest, Hungary. Auton Neurosci. 2004 Jun 30;113(1-2):63-70 Ataxia Telangectasia: Telomeres Shorten: AT is a genetic disease that occurs in about 1 in 40,000 births. Beginning in the first few years, patients gradually lose their ability to walk and are unusually prone to frequent infections and various types of cancers. AT is fundamentally caused by a mutation in a gene, Atm, which makes a protein that is involved in sensing and coordinating repair of DNA. Atm also helps maintain telomere length in normal cells. Shortened telomeres destabilize cell and allows cancers to take over and also causes premature aging. Science Daily 1/23/03 Ataxia: Ataxia: Friedreich's: CoQ-10: A 4-year follow-up on 10 Friedreich's Ataxia patients treated with coenzyme Q10 and vitamin E showed a substantial improvement in cardiac and skeletal muscle bioenergetics and heart function. Mitochondrial dysfunction likely plays a role in the pathophysiology of migraine as well as age-related macular degeneration and a therapy including coenzyme Q10 produced significant improvement. Curr Opin Clin Nutr Metab Care 2005 Nov;8(6):641-6. Ataxia with vitamin E deficiency (AVED) is an autosomal recessive disease characterized clinically by neurological symptoms with often striking resemblance to those of Friedreich's ataxia (FA). In 16 patients from seven Moroccan families presenting an autosomal recessive Friedreich-like ataxia with vitamin E deficiency, all were homozygous for 744 del A mutation of alpha-TTP gene. Early vitamin E supplementation may provide considerable improvement of neurological signs and other associated abnormalities. Vitamin E deficiency ataxia with (744 del A) mutation on alpha-TTP gene: genetic and clinical peculiarities in Moroccan patients. Marzouki N, et al. Hospital of Rabat, Morocco. . Eur J Med Genetics 2005 Jan-Mar;48(1):21-8. Ataxia: CoQ-10 and Vitamin E Might Help: Decreased mitochondrial respiratory chain function and increased oxidative stress have been implicated in the pathogenesis of Friedreich ataxia. In an open-labeled pilot trial over 47 months off 77 patients, combined coenzyme Q(10) (400 mg/d) and vitamin E (2100 IU/d) therapy of 10 patients with FRDA over 47 months found a significant improvement in cardiac and skeletal muscle. Echocardiographic data revealed significantly increased fractional shortening at the 35- and 47-month time points. Comparison with cross-sectional data from 77 patients with FRDA indicated the changes in total International Cooperative Ataxia Rating Scale and kinetic scores over the trial period were better than predicted for 7 patients, but the posture and gait and hand dexterity scores progressed as predicted. Antioxidant treatment of patients with Friedreich ataxia: four-year follow-up. Hart PE, et al. Royal Free and University College Medical School, London, England. Arch Neurol 2005 Apr;62(4):621-6. Ataxia: Selenium Might Help: As iron-induced mitochondrial lipid peroxidation is central to the pathology of Friedreich's ataxia, the administration of selenium supplements should normalize the antioxidant activity of myocardial glutathione peroxidase and slow the progression of the life-shortening cardiomyopathy associated with this illness. Med Hypothesis 2002 Feb;58(2):127-32. Ataxia: Citalopram Might Help: Two patients (siblings) with Friedreich's ataxia showed improvement in their clinical symptoms--particularly spasticity and cardiac symptoms--after treatment with the selective serotonin reuptake inhibitor citalopram. Citalopram, a selective serotonin reuptake inhibitor, improves symptoms of Friedreich's ataxia. Rohr A, et al. Pharmacopsychiatry 1999 May;32(3):113-4. Ataxia: L-Carnitine Might Help: In a DB triple crossover of 16 patients of L-carnitine (3 g/d) and creatine (6.75 g/d), after 4 months on L-carnitine phosphocreatine recovery was improved compared to baseline (p<0.03, t-test) but comparison to placebo and creatine effects did not reach significance (p=0.06, F-test). Ataxia rating scale and echocardiographic parameters remained unchanged. Creatine had no effect in FA patients. L-carnitine is a promising substance for the treatment of FA patients, and larger trials are warranted. L-carnitine and creatine in Friedreich's ataxia. A randomized, placebo-controlled crossover trial. Schols L, et al. University of Tubingen, Germany. . J Neural Transm 2005 Jun;112(6):789-96. Ataxia: Thiamine, 5-HTP, Amantidine: It is hypothesized that a drug cocktail, i.e. L-5-hydroxytryptophan, thiamine and amantadine hydrochloride, would be more beneficial. This cocktail proved to be useful in open studies, improving respiratory disorders in FA patients. More powerful inhibitors of N-methyl-D aspartate receptor channels should be tried initially in animal experiments. The treatment of spinocerebellar ataxias: facts and hypotheses. Botez MI, et al. University of Montreal, Quebec, Canada. Med Hypothesis 1998 Nov;51(5):381-4. In a 1-year, DB PC study of idebenone in 29 patients with Friedreich ataxia, there was a significant reductions of interventricular septal thickness and left ventricular mass in the idebenone group vs the placebo group, with no improvement in other heart ultrasound measures or neurologic condition. Idebenone treatment in Friedreich patients: one-year-long randomized placebo-controlled trial. Marlotti C, et al. National Neurological Institute, Milan, Italy. Neurology 2003 May 27;60(10):1676-9. Athlete's Foot: See Tinea Infections. Atrial Fibrillation: Isbesartan Helps Amiodarone and Cardioversion: AF occurs in 10% of those over age 75. It doubles the risk of death and quadruples it for strokes. In a DB PC study of 154 patients who had continuous AF for more than seven days with Group I on amiodarone, and group II amiodarone plus irbesartan, at the three-week point, 62 patients had stable heart rhythms on medication alone and 92 went on to have electrical cardioversion, 83 successfully. During the next two months, 26 patients had a recurrence of AF. Two-month probability of maintaining a stable heartbeat was 85% for irbesartan vs 63% those who did not. Patients treated with irbesartan had a greater probability of remaining free of AF than those treated with amiodarone alone (80 percent vs. 56 percent). One of the most important factors to predict recurrence was the duration of AF before randomization. Spain. Circ 6/25/02 Atrial Fibrillation: Stroke Prevented by ACE Inhibitor: In a DB PC study of 476 patients with atrial fibrillation, the risk of a major stroke decreased 41% in patients who already were on anticoagulants, and 34% in patients who were not. Patients with atrial fibrillation obtain substantial additional benefit from anticoagulant therapy. Dr. John C. Chalmers, et al. George Institute for International Health, Sydney, Australia. Stroke 9/1/05. Auto Safety: Seat Belts Key; Air Bags Little Value: Air bags very minor benefit with 8% life-saving alone or 3% increase over the 65% benefit with seat belts alone. BMJ 5/11/02. Auto Safety: Air Bags No Benefit: A new analysis of existing data indicates that, controlling for other factors, airbags are actually associated with slightly increased probability of death in accidents. NHTSA recorded 238 deaths due to airbags between 1990 and 2002, all occurred at very low speeds. They also cause deaths at high speeds, but these have been attributed to the crash. Previous studies used data from the Fatality Analysis and Reporting System (FARS), a high-quality compilation of information about every highway accident for which a death occurred. The Crashworthiness Data System (CDS), another high-quality dataset, containing random samples of all accidents, was used in the new study. Mary C. Meyer, University of Georgia, Chance 6/05. While the value of airbags seems dubious in the new study, the value of seatbelts is not. The analysis found that proper use of a seatbelt reduces the odds of death by 67% for any given speed category and airbag availability. Airbags, however, cause no statistical difference in car-crash deaths, except for unseatbelted occupants at low speeds, where the odds of death are estimated to be more than four times higher with an airbag than without. Auto Safety: Driver’s Ed No Benefit: BMJ 2002;324:1142-1145. No controlled studies have found benefit and more advanced courses with skip-control and off road recovery have been found to increase, not decrease, crashes! Autoimmune Disease: XLAAD Gene Found: X-linked autoimmunity-allergic disregulation syndrome affects only boys. The X chromosome carries a mutated FOXP3 gene. XLAAD also called IPEX = immune disregulation, polyendocrinopathy, X-linked syndrome. Boys get eczema, thyroid problems, allergies, and type I diabetes. Boys in general twice as likely to get DM I, compatible with an XLAAD influence. J Clin Investig 12/00. Back Pain: B-12 Helps Back Pain: DB PC 60pt 18-65yo rx IM B-12. Large effect. U Palermo, Italy. Vitamin B12 in low back pain: a randomized, double-blind, placebo-controlled study. Mauro GL, Martorana U, Cataldo P, Brancato G, Letizia G. Eur Rev Med Pharmacol Sci 2000 May-Jun;4(3):53-8 Back Pain: Medium-Firm, Not Firm Mattress Best: A DB 90-day study of 313 chronic back pain patients assigned them to a firm spring mattress (2-3 on a 10 point scale) or a medium-firm spring mattress (5-6 on the scale). A change of mattress was associated for most patients with improvement in pain while lying in bed (firm mattress, 77.8% vs. 82.6% for medium-firm mattress; and when rising (80.4% vs. 85.8%). Participants with medium-firm mattresses had significantly better outcomes for pain in bed (OR, 2.36), pain on rising (OR, 1.93), and disability (OR, 2.10) than did patients with firm mattresses. Participants with medium-firm mattresses also reported less daytime low-back pain (P = .059). Lancet. 11/15/2003; 362:1599-1604 Birth Control Pill: Risk of Death the Same: 46,000 women in a Royal College of General Practitioners’ study found that after 25 years of follow-up there was no difference in the overall rate of death among those taking birth control pills although ovarian cancer RR 0.2, cervical cancer RR 2.5, and stroke RR 1.9 were more common. These risks returns to baseline 10 years after BCP. BMJ 1/9/99 Birth Control: Lemon Juice for Birth Control and AIDS Prevention: Research Roger Short notes lemon juice very effective against sperm and AIDS in vitro and used in middle ages as a contraceptive. No human research available. He recommends a small piece of sponge soaked in juice. BBC 10/11/02 Birth Control: Tubal Coil Essure Permanent: Essure procedure is done with local anesthetic in office. No incision. During the procedure, doctors use a thin, telescope-type instrument called a hysteroscope and insert it through the cervix to reach the fallopian tubes. A camera on the end of the scope allows them to see into the uterus. Doctors place a small, soft coil in the fallopian tube, where it expands and fills the tube. Doctors then move to the other side to place another coil in the other tube. The entire procedure takes less than 30 minutes. While the procedure itself is quick, it takes longer for the scar tissue to develop and permanently block the tubes. Women must use another form of contraception for at least three months. They also need to return 12 weeks after the procedure to have a special x-ray to confirm that the tubes are closed. Birth Defects: Solvents Cause Defects: 125 pregnant women exposed to organic solvents at work: factories, labs, graphic design, print shops: phenols, xylene, acetone, trichloroethylene, had 11% miscarriages and 12% of births with majors defects vs. 1% for controls. Inhaled chemicals cross placenta and damage rodent fetuses. JAMA 3/24/99 Birth Defects: Cousin Marriage Only a Little Bad: birth defect, significant mental retardation or serious genetic disease. An unrelated couple has about a 3-4% risk of having a child with such problems. But for close cousins who are married, that risk jumps only 1.7% to 2.8% more. J Genetic Counseling 4/02, U Washington. Blood Testing: Red Cross: Blood is screened for hepatitis B surface antigen by an EIA test and PCR tests for hepatitis C and HIV (AIDS). Body Piercing: Associated with Problems: High school students with body piercings tend also to have smoked, used alcohol, had sex, skipped school and gotten into fights. Timothy Roberts of the University of Rochester found clear links between body piercings -- other than the ears -- and risky behavior. 4,600 teens aged 12-19 taken in a U.S. government survey in 1995 and 1996. Females (with body piercings) were about 2-1/2 times more likely to have had sex, 2-1/2 times more likely to have smoked, 2-1/2 times as likely to have used marijuana in the past month, and almost two times as likely to have skipped school in the last year. Boys with piercings were five times as likely to have skipped school in the past year, and had similarly higher risks for smoking and drinking as girls. Roberts did a study last year that showed a very strong association between tattoos and risky behavior in teens. Washington (Reuters) 5/7/02 Brain: More Neurons in Children: The number of neurons and connections are much higher in childhood than later in life an intense pruning process in adolescence. D2 receptors peak in density at age 4 and decrease dramatically by age 7, then slowly decreased at 1.9% per decade, although in schizophrenia the loss is 6% per decade. Am J Psychiatry 2/99 Philip Seeman, p 168 Bronchitis: Acute: Ciprofloxacin had an 85% success rate with 500 mg twice a day for 10 days in a DB study. Respiration 2002;69(3):217-22. Cipro had a 96% cure rate vs. 82% for cefuroxime generic (Ceftin) 500 mg both twice a day. (Cipro 17 cents vs. cefuroxime $1.50). Clin Inf Dis 1998 Oct;27(4):722-9. Fleroxacin had a 90% cure rate vs. 82% for amoxicillin 500 mg three times a day. Am J Med 1993 Mar 22;94(3A):136S-141S. Cipro 750 mg twice a day had a 98% cure rate and as good as ampicillin 500 mg four times a day with fewer side-effects. Am J Med 1987 Apr 27;82(4A):164-8. Doxycycline had a 97% cure rate at 100 mg per day vs. a long-acting erythromycin with a 96% cure rate. Arzneimittelforschung 1993 Sep;43(9):1014-7. Roxithromycin did as well as doxycyline 200 mg daily with 81% and 80% success rates with fewer side-effects. The doxycycline was given once a day which probably increased its side-effects. Diagn Microbiol Infect Dis 1993 Sep;43(9):1014-7. Doxycycline 200 mg first day then 100 mg daily for six more days did much better than ampicillin 250 mg four times a day (90% vs. 35%). Chemotherapy 1975;21 Suppl 1:68-75. Ed: Doxycycline and ciprofloxacin are my current favorites due to their low cost. Some studies have not found antibiotics to be better than placebo. My routine is to give antibiotics for chest congestion and especially if yellow or green sputum until the chest or sputum clears. Burns: See Honey. Canker Sores: See Individual Cancer Sore page above. Cat or Dog Bite Treat with 2nd or 3rd Generation Cephalosporin: A retrospective German study of emergency room patients found a much higher rate of infection and need for further care for hand and arm bites not treated prophylactically. Treatment of bites to the hand and wrist--is the primary antibiotic prophylaxis necessary? othe M, Rudy T, Stankovic P. Handchir Mikrochir Plast Chir. 2002 Jan;34(1):22-9; Another report says Pasteurella multicida is most common pathogen and many cases in the literature. Cat and Dog Bites: Meta-Analysis Says Antibiotics for Human bites Very Helpful but Cat and Dog Not Proven: Antibiotic prophylaxis for mammalian bites. Medeiros I, Saconato H. Cochrane Database Syst Rev. 2001;(2):CD001738; Does not preliminary evidence for treating hand and arm bites from cats and dogs. Conn's Current Therapy (2001) says give augmentin 250-500 tid or penicillin with a cephalosporin or dicloxacillin and that doxycycline can be substitute for penicillin. Ed: Honey is a very effective topical antibiotic and accelerate wound healing better than anything else. That is what I would use unless suturing is necessary. Of course, this can also be used in combination with an antibiotic medication. Cataracts: See Cataracts. Celiac Sprue: Peptidase May Help: Stanford U found gliadin, 37-amino acid peptide, a toxic and difficult to digest breakdown product of gluten, is cause of gluten enteropathy, a disease in 1 of 200 Americans usually diagnosed in childhood. A peptidase active against proline worked well in vitro and in rats. Science 9/27/02. Child Abuse: Vitamin K Deficiency Can Mimic: Supplemental vitamin K is required for normal hemostasis in infancy. Infants born outside the hospital may not receive prophylactic vitamin K. They may suffer from bleeding into various tissues and are likely to present to the emergency department. This report describes an infant born at home who presented with intracranial bleeding and signs and symptoms consistent with child abuse. Further investigations confirmed the diagnosis of Vitamin K deficiency. Vitamin K deficiency mimicking child abuse. Brousseau TJ, et al. University of Florida Jacksonville, Florida. J Emerg Med 2005 Oct;29(3):283-8. Children: Stay at Home Moms Better: Children of mothers who go to work full time before the youngsters are 9 months old have poorer mental and verbal development at age 3 than those with stay-at-home mothers. Children of married couples were more affected than those of single mothers. Children of attentive, sensitive mothers were not as strongly affected. Columbia University. 7/02 Child Development, Brooks-Gunn. Chiropractic as Good as Physical Therapy and Education: DC Cherkin, NEJM 98;339:1021, El Skargran, Pain 98;77:201 Chiropractic: Spinal Manipulation as Good as Amitriptyline and Better than Ice Pack & Massage for Non-migrane Headaches: H Vernon, Complement Ther Med 99:7:142 Chiropractic: No Benefit Asthma, Dysmenorrhea, Enuresis: Review of DB PC studies with sham interventions. E. Ernst, J Pain Symptom Manage ’01;22:879 Chronic Fatigue Syndrome: See Chronic Fatigue Syndrome. Clostridium Difficile: Most common diarrhea after anti-biotics, especially clindamycin, and fluoroquinolones, not tetracyclines. Treat with metronidazole 500 three times a day. If no better after 7 days, give vancomycin 125-500 four times a day. Relapses in 20-25%. Medical Letter 11/6/06. Don't forget the yogurt, although the Medical Letter claims proof of benefit inadequate. Colon: Bleeding Colon Diverticulosis Emergencies Best Rx by Colonoscopy: 121 cases with colonoscopy Rx better than surgery. Surgery should be reserved for patients in whom definite or presumptive diverticular hemorrhage has been diagnosed by urgent colonoscopy after vigorous purging of the colon and for whom medical and colonoscopic treatment has failed or resulted in complications. NEJM 1/13/00 Conjunctivitis: Allergic Conjunctivitis Meds: Olopatadine (Patanol)—a mast cell stabilizer and H-1-receptor antagonist, probably best since lower cost ($18/2wk) and BID. Cromolyn sodium a mast-cell stabilizer generic for $18 but QID. Acular (Ketorolac NSAID) most expensive and less effective. Zaditor (Ketotifen) like Patanol but cheaper (15) tho BID-TID. Emadine (emedastine) & Livostin (levocabastine) H-1-receptor antag at $28 and $22 QID. Alocril (nedocromil sodium) BID but $30, a mast cell stabilizer. Alomide (lodoxamide) & Alamast (pemirolast) both mast cell stabilizers for $19 but QID. (Med Letter 5/1/2000). OTC antihistamine-decongestants short duration and can cause rebound vasodilation. Conjunctivitis (Bacterial) Helped by Povidone: A Philippines study of topical povidone-iodine 1.25% found it effective against bacterial conjunctivitis in 459 children, according to a randomized controlled study vs. neomycin-polymyxin-B-gramicidin. Povidone was as effective against conjunctivitis caused by bacteria or Chlamydia trachomatis, but ineffective against conjunctivitis that, by clinical criteria of exclusion, appeared to be caused by viruses. Annual meeting of the American Academy of Ophthalmology (AAO) 11/17/03. While there were no overall differences, Pov-I appeared to be more effective than the antibiotic against Chlamydia after one week of treatment (P = .057). It is evident that you applied it by virtue of the fact the eye turns brown. It's very inexpensive. Constipation Helped by Yogurt-Life Lactobacillus: In a German DB PC study of 70 patients with chronic constipation, two ounces a day of a beverage containing L. casei found that 89% of patients on the beverage had a positive effect on their constipation vs. 56% on placebo. Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Koebnick C, Wagner I, Leitzmann P, Stern U, Zunft HJ. Can J Gastroenterol. 2003 Nov;17(11):655-9. Ed: Regular plain yogurt should work just as well. Consumer Tips: At Death: To avoid credit cards taken out on the name of the deceased, don't include exact birthdate in the obituary or exact address. Mail copies of the death certificate to all 3 creit bureaus, contact your state dept of motor vehicles to cancel any driver's license, and run a credit report a couple weeks following the death at www.annualcreditreport.com . COPD Worsened After Withdrawing Inhaled Steroid on Beta2 Agonist Alone: The effects of 1 year withdrawal of the ICS fluticasone propionate (FP) after a 3 month run-in treatment period with FP combined with the LABA salmeterol (S) (500 microg FP + 50 microg S twice daily in 373 COPD patients randomised found that the withdrawal of FP in COPD patients using SFC resulted in acute and persistent deterioration in lung function and dyspnoea and in an increase in mild exacerbations and percentage of disturbed nights. Withdrawal of fluticasone propionate from combined salmeterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomised controlled trial. Wouters EF, et al. University Hospital Maastricht, The Netherlands. Thorax. 2005 Jun;60(6):480-7. Cranial Electrotherapy Stimulation: Click Here. Crohn’s Disease: See Crohn's Disease. Thomas E. Radecki, M.D., J.D.
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30 mm and 0.5% a diameter