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Comment Imipenem, a beta-lactam agent, is the first carbapenem antibiotic used in clinical practice. It is filtered at the glomerulus and hydrolyzed in the brush border. Imipenem is given as a one to one combination with cilastatin, an inhibitor of the brush border dehidropepridase, to prevent enzymatic degradation that would compromise efficacy in the urinary tract. The combination I C has broad-spectrum antibacterial properties. It is effective against Gram-positive species including enterococci and Gram-negative species including pseudomonas [1]. Adverse events of I C have been predominantly related to the gastrointestinal system nausea and vomiting ; or to the skin rash ; but neurological complications, including convulsion, extrapyramidal symptoms and seizures have also been reported [2]. The frequency of these complications is generally low and is dose-dependent. The principal risk factors for developing neurological complication are central nervous system abnormalities, excessive dosage, and renal impairment [3]. In patients with normal renal function a dose of 500 mg every 6 h to doubled in seriously infected patients has been recommended [4]. If the glomerular filtration rate GFR ; ranges between 10 and 30 ml min 1.73 m3 the daily dose should be reduced by 50% [5]. In patients with GFR 10 ml min 1.73 m3 or in dialysed patients the dose should be reduced to 500 mg every 12 h. With such a dosage no neurological side effect was reported in previous experiences [6 ]. Since haemodialysis results in the removal of 4070% of imipenem and variable amount of cilastatin depending on the type of dialysis and the filter employed, it was also suggested that a supplemental dose may be administered at the end of the dialysis session [5]. There are no data on peritoneal dialysis. Some textbooks suggest an average dose of 500 mg every 12 h [7, 8]. Reviewing our own experience, we found six patients treated with I C who developed neurological complications Table 1 ; . Excluding the patient no. 3 who had a previous cerebral ischaemia, none of the others had additional risk factor. All of our patients recovered completely from neurological complications but three patients died a few days later because of the basic infection. In our patients the time interval between I C administration and seizures ranged between a few hours and a few days. Therefore it is difficult to assess a time-related event. In all the patients the antibiotic dosage was appropriately adjusted according to the residual renal function. On the other hand, some uraemic patients developed neurological complications after 12 doses of I C and provera.
Medication for bph, finasteride, known commercially as proscar, has gained international media attention in recent weeks following the early release of some complex results from a major clinical trial in the united states[1].
References: 1. McConnell JD, Bruskewitz R, Walsh P, et al, for the PROSCAR Long-Term Efficacy and Safety Study PLESS ; Group. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med. 1998; 338: 557563. Data available on request from Professional Services, WP1-27, Merck & Co., Inc., West Point, PA 19486. Please specify information package DA-PRO19 3 ; . 3. Data available on request from Professional Services, WP1-27, Merck & Co., Inc., West Point, PA 19486. Please specify information package DA-PRO13 2 and rabeprazole.
Have no one to share the holiday . Some families have been met by unfortunate circumstances prohibiting them from buying the luxury of a grand turkey dinner with all the trimmings. And still others are homebound or are too frail to cook a big feast. But there are also those whose idea of a perfect Thanksgiving has nothing to do with their own family . It means getting up before the crows come home to put the finishing touches on dozens of turkeys and hundreds of pies. For these people, it is about celebrating all they have to be thankful for by serving their community and by giving others a brighter, happier holiday . "I feel that cooking is my ministry, " ried about the money It's not a fund. raiser. There are little baskets near the door as you exit the event and people can drop in a donation if they want. We usually break even, but that isn't the point. We are happy to do this." The whole community comes together for the event. Members of the Lions Club usually seat guests, Girl Scouts cut and serve the pies, the Boy Scouts do the dishes and other volunteers from throughout the town help cook the food and deliver it served up on nice china to tables. "We use real china to make the event more homey and special, " Printz said. "And if someone comes and has a family member who is sick at home, we'll let them take a dinner home.
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A broad, holistic approach is required to address all the obstacles to improving global health, of which access to medicines is but one. The number of industry projects documented in this book which involve capacity building aspects, such as creation of medical infrastructure and provision health care training, bears testimony to this, as does the number of R&D projects. For, as we have seen with HIV AIDS, Malaria and Tuberculosis, there is no guarantee that the treatments which are effective today will remain so for very much longer. New ones will be required sooner or later if progress is to be maintained.
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