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Acute reactions to trauma and psychotherapy: a multidisciplinary and international perspective cheap 40 mg levitra super active mastercard. Sample Citation and Introduction to Citing Individual Volumes With a Separate Title but Without Separate Authors/Editors The general format for a reference to a volume of a book with a separate title but without separate authors/editors buy cheapest levitra super active, including pagination: Examples of Citations to Individual Volumes With a Separate Title but Without Separate Authors/ Editors Many medical texts are published in more than one volume because the number of pages is too large to be contained in one physical volume discount levitra super active 20 mg with visa. If a book is published in multiple volumes, and if each volume has a separate title, the volumes may be cited individually: Use the title page and the verso (back) of the title page of the individual volume as the source for authoritative information. Continue to Citation Rules with Examples for Individual Volumes With a Separate Title but Without Separate Authors/Editors. Continue to Examples of Citations to Individual Volumes With a Separate Title but Without Separate Authors/Editors. Citation Rules with Examples for One Volume of a Book Without Separate Authors/Editors Components/elements are listed in the order they should appear in a reference. Ano Box 60 Numbers labeled other than volume Most books in multivolume sets are identified by volume numbers, such as vol. When other names are used: Abbreviate them and end the abbreviated words with a period Section = Sect. Volumes of books without separate authors/editors following an edition statement 3. Volumes of books without separate authors/editors following an edition statement and secondary authors 4. Volumes of books without separate authors/editors with numbers labeled other than volume 6. Volumes of non-English books without separate authors/editors Location (Pagination) of Volume (optional) General Rules for Pagination of Volume Place pagination after the date of publication Provide the total number of pages on which the text of the volume appears Do not count pages for such items as introductory material, appendixes, and indexes unless they are included in the pagination of the text Follow the number by a space and "p. Specific Rules for Pagination of Volume Roman numerals for page numbers Volumes continuously paginated Box 63 Roman numerals for page numbers If all of the pages (not just the introductory pages) of a volume have roman numerals instead of the usual arabic numbers: Convert the roman numeral on the last page of the text to an arabic number Follow the number by "p. Volumes of books without separate authors/editors continuously paginated Examples of Citations to Volumes of Books with a Separate Title for the Volume but Without Separate Authors/Editors 1. Pocket atlas of sectional anatomy: computer tomography and magnetic resonance imaging. Volumes of books without separate authors/editors following a content type Merbach W, Muller-Uri C. Volumes of books without separate authors/editors with numbers labeled other than volume Merbach W, Muller-Uri C. Volumes of non-English books without separate authors/editors Lagunas Rodriguez Z. Cytokine reference: a compendium of cytokines and other mediators of host defense. Sample Citation and Introduction to Citing Individual Volumes With a Separate Title and Separate Authors/Editors The general format for a reference to a volume with a separate title and separate authors/editors: Books 153 Examples of Citations to Individual Volumes With a Separate Title and Separate Authors/Editors If each volume of a book in a multivolume set has its own author(s) or its own editor(s) distinct from the authors/editors of the set of volumes, the individual volume may be cited. 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Continue to Examples of Citations to Individual Volumes With a Separate Title and Separate Authors/Editors. Citation Rules with Examples for Individual Volumes With a Separate Title and Separate Authors/Editors Components/elements are listed in the order they should appear in a reference. Standard volume with a separate title and separate authors/editors for each volume 2. Box 78 Names for cities and countries not in English Use the English form for names of cities and countries if possible. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Espana becomes Spain Examples for Author Affiliation 5. Books 165 Box 83 No title can be found Occasionally a publication does not appear to have any title; the book or other short document simply begins with the text. In this circumstance: Construct a title from the first few words of the text Use enough words to make the constructed title meaningful Place the constructed title in square brackets Example: Alizai S, Zia A. 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There is a need to make dementia a public the role of caregivers are also working and cannot spend health priority and create a network of home care advisers as much time caring for the elderly order genuine levitra super active. Dementia is considered to provide supportive and educational interventions for the as a normal part of ageing and is not perceived as requiring family caregivers through the primary health-care system medical care buy genuine levitra super active on line. According to United Nations es- are poor levitra super active 20mg overnight delivery, so that many elderly people who retire do not re- timates, it is likely that the gure of 0. Recently the Federal Government has the whole population) people over 60 years of age in 2000 introduced a contributory pension scheme, but in the past will have more than trebled by 2040 (1. No effective alternatives have is being piloted only among certain Federal civil servants. Assessing the extent of dementia among this huge, Specialist health services are in short supply. In 2005 varied and shifting population is not easy, but what little there were only about 77 psychiatrists and three occupa- research has been done suggests prevalence rates for de- tional therapists in the country. Specialist social workers are few and Nigerians is only just beginning: for example in the past work under severe limitations. There are no specialist ser- three years, old-age mental health clinics have been es- vices for the elderly (geriatric or psychogeriatric services, tablished at two universities. There is no formal training meals on wheels, respite care or drop-in centres) and few for geriatric medicine and psychiatry. The term is also applied to a large group of 63 Research conditions characterized by common symptoms 64 Education and training called epileptic seizures, which may occur in the 65 Partnerships within and beyond the health system context of a brain insult that can be systemic, toxic 67 Conclusions and recommendations or metabolic. These events (called provoked or acute symptomatic seizures) are presumed to be an acute manifestation of the insult and may not recur when the underlying cause has been removed or the acute phase has elapsed. Epilepsy has been dened as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiological, cognitive, psychological and social consequences of this condition. The denition of epilepsy requires the occurrence of at least one epileptic seizure (1). An epileptic seizure is dened as a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain (1). These denitions recognize that a diagnosis of epilepsy implies the existence of a persistent epileptogenic abnormality that is present whether seizures occur or not, as well as that there may be consequences of this persistent abnormality other than the occurrence of seizures that can cause continuous disability between seizure occurrence (interictally). Because it is often dif- cult to identify denitively an enduring predisposition to generate epileptic seizures, a common operational denition of epilepsy is the occurrence of two or more non-provoked epileptic seizures more than 24 hours apart. Differential diagnosis of transient events that could represent epileptic seizures involves rst determining that the events are epileptic, then distinguishing between provoked epileptic seizures and a chronic epileptic condition. Febrile seizures in infants and young children and withdrawal seizures in alcoholics are common examples of provoked seizures that do not require a diagnosis of epilepsy. If seizures are recurrent, it is next necessary to search for an underlying treatable cause. If such a cause cannot be found, or if it is treated and seizures persist, then treatment of seizures is guided by diagnosis of the specic seizure type(s), and syndrome if present (see Box 3. Etiology and risk factors Epileptic conditions are multifactorial disorders, and it is useful to discuss three important factors. Anyone with a functioning brain is capable of having a seizure; however, seizures occur more easily in some people than in others. The ease with which a seizure can be provoked, or an epileptic condition can be induced, is referred to as a threshold. Individual differences in threshold are largely attributable to genetic variations but could also be acquired, such as certain types of perinatal injuries, which can alter threshold. Threshold is a dy- namic phenomenon; it varies throughout the day, it also changes in relation to hormonal inuences neurological disorders: a public health approach 57 during the menstrual cycle in women. Stimulant drugs lower seizure threshold and sedative drugs increase it; however, withdrawal from sedative drugs can lower threshold and provoke seizures. Epilepsies attributable to identiable brain defects are referred to as symptomatic epilepsies. Treatment for symptomatic epilepsy is most effective if it is directed at the underlying cause. The most common symptomatic epilepsy is temporal lobe epilepsy, usually associated with a characteristic lesion called hippocampal sclerosis. Hippocampal sclerosis appears to be caused by cerebral injury within the rst few years of life in individuals with a genetic predisposi- tion to this condition. Some forms of epilepsy are unassociated with identiable structural lesions or diseases and are usually unassociated with other neurological or mental decits. These are genetically transmitted, generally easily treated with medications without sequelae, and referred to as idiopathic epilepsies. The third important factor is the precipitating condition, which determines when seizures occur. Common precipitating factors include fever for children with febrile seizures, alcohol and sedative drug withdrawal, sleep deprivation, stimulant drugs and in some patients stress. Identication of precipitating factors is helpful if they can be avoided, but in most patients specic precipitating factors are not apparent, and may not exist at all. Patients with a high seizure threshold can experience severe epileptogenic brain injuries and precipitating factors but never have seizures, while those with low seizure thresholds can develop epilepsy with minimal insults and, in many, from precipitating factors alone (provoked seizures). Prognosis depends on the seizure type, the underlying cause, and the syndrome when this can be determined. Approximately one in 10 individuals will experience at least one epileptic seizure in their lifetime, but only one third of these will go on to have epilepsy. There are a number of idiopathic epilepsy syndromes characterized by onset at a certain age, and specic seizure types. Clonic and tonic seizures A Local B Absences 1 Neocortical C Myoclonic seizure types 2 Limbic D Epileptic spasms B With ipsilateral propagation E Atonic seizures C With contralateral spread D Secondarily generalized Source: adapted from (2). Slowly, the genetic basis of these idiopathic epilepsies is being revealed, and there appears to be considerable diversity in that single-gene mutations can give rise to more than one syndrome, while single syndromes can be caused by more than one gene mutation. The prognosis of symptomatic epilepsies depends on the nature of the underlying cause. Epilepsies attributable to diffuse brain damage, such as West syndrome and Lennox Gastaut syndrome, are characterized by severely disabling medically refractory generalized seizures, mental retardation and often other neurological decits. Epilepsies resulting from smaller lesions may be associated with focal seizures that are more easily treated with drugs and can remit spontaneously as well. When pharmacoresistant focal seizures are due to localized structural abnormalities in one hemisphere, such as hippocampal sclerosis in temporal lobe epilepsy, they can often be successfully treated by localized resective surgery. Some patients with more diffuse underlying structural lesions that are limited to one hemisphere can also be treated surgically with hemispherectomy or hemispherotomy. Whereas 80 90% of patients with idiopathic epilepsies can expect to become seizure free, and many will undergo spontaneous remission, the gure is much lower for patients with symptomatic epilepsy, and perhaps only 5 10% of patients with temporal lobe epilepsy and hippocampal scle- rosis will have seizures that can be controlled by pharmacotherapy. Of these patients, however, 60 80% can become free of disabling seizures with surgery. Advances in neurodiagnostics, particularly neuroimaging, are greatly facilitating our ability to determine the underlying causes of seizures in patients with symptomatic epilepsies and to design more effective treatments, including surgical interventions. The overall incidence of epilepsy in Europe and North America ranges from 24 and 53 per 100 000 per year, respectively (4 6). The incidence in children is eventually higher and even more variable, ranging from 25 to 840 per 100 000 per year, most of the differ- ences being explained by the differing populations at risk and by the study design (3).
Desquamation of bronchial epithelium can be identified on histologic examination ( 109) or when a patient coughs up clumps of desquamated epithelial cells (creola bodies) levitra super active 20mg online. Bronchial mucus contains eosinophils purchase levitra super active 20mg visa, which may be observed in expectorated sputum order 20mg levitra super active free shipping. Charcot-Leyden crystals (lysophospholipase) are derived from eosinophils and appear as dipyramidal hexagons or needles in sputum. Viscid mucus plugs, when expectorated, can form a cast of the bronchi and are called Curschmann spirals. Clinically, mucus hypersecretion is reduced or eliminated after treatment of acute asthma or inadequately controlled chronic asthma with systemic and then inhaled corticosteroids. Mucus from patients with asthma has tightly bound glycoprotein and lipid, compared with mucus from patients with chronic bronchitis ( 110). Macrophages have been shown to produce a mucus secretagogue as well as generate mediators and cytokines ( 98,111). Because plasma cell staining for IgE was not increased in number, it has been thought that IgE is not produced locally. However, because the lung is recognized as an immunologic organ, further work may that show IgE is produced in the lung. The mechanism of bronchial hyperresponsiveness in asthma is unknown but is perhaps the central abnormality physiologically. However, bronchial hyperresponsiveness is not specific for asthma because it occurs in other patients without asthma ( Table 22. Nevertheless, hyperresponsiveness consists of bronchoconstriction, hypersecretion, and hyperemia (mucosa edema). The bronchial responsiveness detected after challenge with histamine or methacholine measures bronchial sensitivity or ease of bronchoconstriction ( 106). As stated, an additional finding in some patients with asthma is excessive bronchoconstriction, which can be attributable to associated increases in residual volume and possibly more rapid clinical deterioration ( 106). Often, on opening the thorax of a patient who has died from status asthmaticus, the lungs are hyperinflated and do not collapse ( Fig. In some cases, complicating factors, such as atelectasis or acute pneumonia, are identified. Upon histologic examination, there is a patchy loss of bronchial epithelium with desquamation and denudation of mucosal epithelium. Other histologic findings include hyperplasia of bronchial mucus glands, bronchial mucosal edema, smooth muscle hypertrophy, and basement membrane thickening (Fig. Occasionally, bronchial epithelium is denuded, but histologic studies do not identify eosinophils. Similarly, although many autopsy examinations reveal the classic pattern of mucus plugging ( Fig. Eosinophils have been identified in such cases in airways or in basement membranes, but a gross mechanical explanation, analogous to mucus suffocation, is not present. A third morphologic pattern of patients dying from asthma is that of mild to moderate mucus plugging (107). Some patients dying from asthma have evidence of myocardial contraction band necrosis, which is different from myocardial necrosis associated with infarction. Contraction bands are present in necrotic myocardial smooth muscle cell bands in asthma and curiously the cells are thought to die in tetanic contraction whereas in cases of fatal myocardial infarction, cells die in relaxation. Pleural pressure becomes more negative, so that as inspiration occurs, the patient is able to apply sufficient radial traction on the airways to maintain their potency. Air can get in more easily than it can be expired, which results in progressively breathing at higher and higher lung volumes. The residual volume increases several-fold, and functional residual capacity expands as well. The lung hyperinflation is not distributed evenly, and some areas of the lung have a high or low ventilation-perfusion ratio ( / ). Overall, the hypoxemia that results from status asthmatics occurs from reduced /, not from shunting of blood. The lung hyperinflation also results in dynamic autopeep as the patient attempts to maintain airway caliber by applying some endogenous positive airway pressure. There is no evidence of chest wall (inspiratory muscle) weakness in patients with asthma. Nevertheless, some patients who have received prolonged courses of daily or twice-daily prednisone or who have been mechanically ventilated with muscle relaxants and corticosteroids can be those who have respiratory muscle fatigue. After successful treatment of an attack of status asthmaticus, the increases in lung volume may remain present for 6 weeks. Small airways may remain obstructed for weeks or months; in some patients, they do not become normal again. At the same time, it can be expected that the patient has no sensation of dyspnea within 1 week of treatment of status asthmaticus despite increases in residual volume and reduced small airways caliber. This divergence between symptom recognition in asthma and physiologic measurements has been demonstrated in ambulatory patients who did not have status asthmaticus (114). The reduction in trapped gas in the lung can result in symptom reduction even without improvement in expiratory flow rates. In summary, asthma pathophysiology includes poor or impaired symptom perception in some patients. There may be poor sensitivity or discrimination (recognizing improvement or worsening status) (115). Even this list is oversimplified because asthma must be considered a very complex condition in terms of airway caliber and tone. Selected neuropeptides and their proposed actions in asthma Mediator release caused by mast cell activation results in acute and late bronchial smooth muscle contraction, cellular infiltration, and mucus production. The neurotransmitter for postganglionic parasympathetic nerves is acetylcholine, which causes smooth muscle contraction. However, there appears to be little if any significant smooth muscle relaxation through stimulation of postganglionic sympathetic nerves. Circulating endogenous epinephrine apparently does not serve to produce relaxation of smooth muscles. Sensory nerves in the respiratory epithelium are stimulated and lead to release of a host of neuropeptides that may be potent bronchoconstrictors or bronchodilators. Respiratory epithelium itself may contain bronchi-relaxing factors that may become unavailable when epithelium is denuded. Although much attention has been directed at understanding the contribution of IgE and mast cell activation in asthma, triggering or actual regulation of some of the inflammation of asthma may occur because of other cells in lungs of patients. These cells, as well as mast cells in the bronchial mucosa or lumen, can be activated in the absence of classic IgE-mediated asthma. Bronchial biopsy specimens from patients with asthma demonstrate mucosal mast cells in various stages of activation in patients with and without symptoms (117,118). Mast cell hyperreleasibility may occur in asthma, in that bronchoalveolar mast cells recovered during lavage contain and release greater quantities of histamine when stimulated by allergen or anti-IgE in vitro (119,120). The latter can be demonstrated by their reduced density upon centrifugation that occurs during acute episodes of asthma. In vitro, for example, peripheral blood mononuclear cells from patients with asthma are stimulated with allergen, and the supernatant is obtained.
Despite what had been learned purchase 20mg levitra super active with visa, another epidemic occurred in New Zealand 10 years later ( 118) effective levitra super active 40mg. Epidemiologic studies found that the risk for asthma death was increased in those patients who had been treated with the potent but less b 2-selective agent fenoterol ( 119 order levitra super active without prescription,120 and 121). Subsequent studies have attempted to address whether this is a specific effect of fenoterol or a class effect of rapid-acting b agonists. The Saskatchewan studies suggest a general class effect ( 122,123), although their methods have been contested (124,125 and 126). Other studies have demonstrated increased risk for death in asthmatic children receiving fenoterol ( 127). The Serevent National Surveillance Project enrolled more than 25,000 adults but had insufficient power to establish relative risk because of the low number of deaths from asthma ( 128). Another large-scale study, which tracked prescription events, lacked a control group, and no causal association could be established between salmeterol and asthma death ( 129). A much smaller, case-control study of salmeterol and near-fatal asthma suggested that salmeterol confers no increased risk ( 130). Refinements in their chemical structure have led to improvements in efficacy, safety, and tolerance. Rapid-acting agents are indicated for the treatment of mild, intermittent asthma and for initial management of acute asthma symptoms in patients with persistent asthma. Long-acting b agonists should not be used as monotherapy for asthma, and current guidelines emphasize their position as adjunctive therapy in combination with inhaled corticosteroids. Levalbuterol, the enantiomer of racemic albuterol, may offer some benefit, but additional studies are needed to confirm and establish its position in the pharmacologic management of asthma. Formoterol: pharmacology, molecular basis of agonism, and mechanism of long duration of a highly potent and selective beta2-adrenoceptor agonist bronchodilator. Inhibition of IgE-dependent histamine release from human dispersed lung mast cells by antiallergic drugs and salbutamol. Beta adrenergic modulation of formyl-methionone-leucine-phenylalanine stimulate secretion of eosinophil peroxidase and leukotriene C4. Beta-adrenergic regulation of the eosinophil respiratory burst as detected by lucigenin-dependent luminescence. Effect of regular inhaled albuterol on allergen-induced late responses and sputum eosinophils in asthmatic subjects. Time course and duration of bronchodilatation with formoteroal dry powder in patients with stable asthma. Inhaled dry-powder formoterol and salmeterol in asthmatic patients: onset of action, duration of effect and potency. Salmeterol versus formoterol in patients with moderately severe asthma: onset and duration of action. Prolonged protection against methacholine-induced bronchoconstriction by the inhaled b 2-agonist formoterol. The effect of inhaled salmeterol on methacholine responsiveness in subjects with asthma up to 12 hours. Effect of a single dose of inhaled salmeterol on baseline airway caliber and methacholine-induced airway obstruction in asthmatic children. A single-dose comparison of inhaled albuterol and two formulations of salmeterol on airway reactivity in asthmatic subjects. Salmeterol provides prolonged protection against exercise-induced bronchoconstriction in a majority of subjects with mild, stable asthma. Formoterol, a new inhaled b 2-adrenergic agonist, has a longer blocking effect than albuterol on hyperventilation-induced bronchoconstriction. Salmeterol protects against hyperventilation-induced bronchoconstriction over 12 hours. Effect of inhaled salmeterol on sulfur dioxide induced bronchoconstriction in asthmatic subjects. Sustained protection against distilled water provocation by a single dose of salmeterol in patients with asthma. The effect of salmeterol on the early and late phase reaction to bronchial allergen and postchallenge variation in bronchial reactivity, blood eosinophils, serum eosinophil cationic protein and serum eosinophil protein X. Late asthmatic reaction decreased after pretreatment with salbutamol and formoterol, a new long-acting b 2-agonist. Salmeterol: a potent and long-acting inhibitor of inflammatory mediator release from human lung. Effect of eight weeks treatment with salmeterol on bronchoalveolar lavage inflammatory indices in asthmatics. The effect of salmeterol on nocturnal symptoms, airway function, and inflammation in asthma. The long-acting b 2-agonist salmeterol xinafoate: effects on airway inflammation in asthma. Partial inhibition of the early and late asthmatic response by a single dose of salmeterol. Effect of salmeterol compared with beclomethasone on allergen-induced asthmatic and inflammatory responses. Anti-inflammatory effects of salmeterol compared with beclomethasone in eosinophilic mild exacerbations of asthma: a randomized, placebo controlled trial. A comparative study in atopic subjects with asthma of the effects of salmeterol and salbutamol on allergen-induced bronchoconstriction, increase in airway reactivity, and increase in urinary leukotriene E 4 excretion. Effect of a single dose of salmeterol on the increase in airway eosinophils induced by allergen challenge in asthmatic subjects. The influence of inhaled salmeterol on bronchial inflammation: a bronchoalveolar lavage study in patients with bronchial asthma. Comparison of the effects of salmeterol and salbutamol on clinical activity and eosinophil cationic protein serum levels during the pollen season in atopic asthmatics. The effects of regular inhaled formoterol, budesonide, and placebo on mucosal inflammation and clinical indices in mild asthma. An antiinflammatory effect of salmeterol, a long-acting b 2 agonist, assessed in airway biopsies and bronchoalveolar lavage in asthma. Effects of enantiomers of beta 2-agonists on Ach release and smooth muscle contraction in the trachea. S-albuterol exacerbates calcium responses to carbachol in airway smooth muscle cells. Effect of enantiomeric forms of albuterol on stimulated secretion of granular protein from human eosinophils. Pharmacokinetics and pharmacodynamics of cumulative single doses of inhaled salbutamol enantiomers in asthmatic subjects. The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients. Effect of single doses of S-albuterol, R-albuterol, racemic albuterol, and placebo on the airway response to methacholine. Tolerance to the bronchoprotective effect of b 2-agonists: comparison of the enantiomer of albuterol with racemic albuterol and placebo. Is the routine use of inhaled b-adrenergic agonists appropriate in asthma treatment?