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Mu Mu Sein Myint; May Aye Than; Khine Khine Lwin; Aye Than; Khin Tar Yar Myint; Mar Mar Myint; Phyu phyu Win; Hla Phyo Lin; Khin May Nyo purchase 10 ml astelin with amex. The aim of this study is to determine phytochemical constituents cheap 10 ml astelin overnight delivery, acute toxicity and hypoglycemic effect of aqueous and 95% ethanol extract of whole plant of Phyllanthus niruri Linn. Phytochemical results showed that crude powder, aqueous extract and 95% ethanol extract contained alkaloids, flavonoids, tannins, saponins, steroids, amino acids and polyphenols. Acute toxicity study of crude powder, aqueous extract and 95% ethanol extracts were evaluated in mice. Both crude powder and 95% ethanol extracts showed no evidence of toxicity up to the maximum feasible dose level of 3gm/kg body weight. In contrast, the maximum feasible dose level of aqueous extract was 6g/kg body weight. It was found that 95% ethanol extracts significantly lowered the body glucose levels at 2hr (p<0. Aqueous extract also lowered the body glucose levels at 1hr, 2hr,3hr and 4hr (P<0. Hypoglycemic effect of standard drug glibenclamide (4gm/kg body weight) was also studied to compare with that of the plant extracts. Than Lwin; Khin Chit; Ti Ti; Thaw Zin; Phyu Phyu Win; Mar Mar Myint; Tin Nu Swe; Paing Soe. Results were not optimistic since 2 of the patients expired within 5 months, one showed no improvement, and gradual deterioration in chest X-ray. All patients showed significant improvement between 3 months to one year of treatment. The last patient revealed fall and rise phenomenon in bacillary load on direct smear examination. They may even find place as alternative to extremely expensive drugs like macrolides and beta-lactam antibiotics. On human subjects the fresh leaves showed no purgative action unless heat-treated by boiling otherwise. It caused purgation in 1-2 hours, with maximum effect within 3-6 hours and no effect after 12 hours following the injection. Preparations of various tincture forms to withstand storage were tested and it was observed that there was no marked difference in potency between that from the fresh leaves and that from the partially dried leaves. Administered together with meal it was found to be significantly more effective (p<0. May Aye Than; Mu Mu Sein Myint; Aye Than; Myint Thuzar Thant; Thandar Myint; Tin Nu Swe. Majority of Myanmar national people lived in rural areas and have been using traditional medicinal plants for hundred of years. Many people have used some medicinal plants, which claimed to have purgative activity, as crude drugs or as traditional medicine formulations. The study was a controlled, complete cross-over single dose design using magnesium sulphate and phenolphthalein as positive standard. Pway-mezali fresh leaves 4g which was just heated for few seconds for softening, magnesium sulphate 1 teaspoonful, and phenolphthalein 0. Pway-mezali fresh leaves showed no significant different efficacy on frequency, volume and onset when compared to phenolphthalein. It was also found that the onset time of action of Pway-mezali and phenolpthalein is prolonging than magnesium sulphate due to the different mechanism of action. Role of Say-tha-gya plant, Stevia rebaudiana cultivated in Shan State, Myanmar: Either as dietary sugar substitute or hypoglycemic agent for diabetics. Nwe Nwe Yee; Group from Central Committee for Drug Abuse Control; Htun Naing Oo; Mu Mu Sein Myint; Moh Moh Htet Kyaw; Khin Tar Yar Myint; Yin Yin Aye; Zaw Naing Win. A composite plant Stevia rebaudiana (Bertono) Bertoni, Say-tha-gya (Sweet herb) has been cultivated in Shan State, Myanmar as “Stevia-Poppy Substitution Project” since September, 2002. Aqueous extract of that plant clutivated in Myanmar, 3g/kg was tested on normal and adrenalin induced hyperglycemic rabbits for its effect on blood glucose levels. Acute toxicity test was performed on mice at different doses: 1g/kg, 2g/kg, 3g/kg and 4g/kg. After oral administration, blood glucose levels did not rise in normal rabbits after 1, 2, 3, 4 and 24hr (p<0. Chemical constituents were analyzed qualitatively and thin layer chromatogram and ultraviolet spectrum of the extract were taken. Cultivation of this plant may highly benefit our nation as a natural source of non-sugar sweetener. The role of traditional medicine in the treatment of multidrug-resistant pulmonary tuberculosis, Myanmar. Plants showing satisfactory efficacy were further subjected to phyto- chemical characterization and acute and sub-acute toxicity testing before having approval from the National Ethical Committee, Department of Medical Research (Lower Myanmar).

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In Myanmar also purchase 10 ml astelin otc, many of the traditional remedies are accepted and used by a large segment of the population cheap 10 ml astelin with mastercard. Generally people believe that herbal medicine are effective and have no toxic effect. Kyaung-yo-they or Kyaung- hsay-pin is one of the well known Myanmar medicinal plants used for bronchodilating and mucolytic activities. This plant was reported to contain an exciting compound known as cyanogenic glycoside stated in some literatures. In order to prove the presence of dangerous cyanogenic glycoside in Kyaung-hsay-pin, a highly sensitive color reaction test for cyanogenic glycoside was carried out on the various fresh and dried parts of the plant specimens. It was clearly detected that higher content of cyanogenic glycoside contained in fresh specimen but a little amount in dried parts. Expressed juice of leaves was also tested for its acute toxicity administering orally to mice and rats. May Aye Than; Khine Khine Lwin; Ohnmar Than; Phyu Phyu Win; Nu Nu Win; Aye Aye Mon, Mi; Mar Mar Myint; Ei Ei Soe. As defined in The Food Drugs and Cosmetic Acts, the term adulteration involves the content of a product, such as the addition of substances that make it inferior, impure or not genuine and a product that has unprescribed colouring substance or the colouring substance in excess of the prescribed limits. Adulterated foods were dangerous because it may be toxic, can affect health and it could deprive nutrients essential for proper growth and development. Therefore it was needed to detect by using chemical and pharmacognostical standard tests. Nine brands of chilli and turmeric powders, three brands of blacks pepper and cumin powders samples were collected from various markets in Yangon. They were coded and studied for pharmacognostical characteristic of powdered spices microscopically, to find out whether they were pure or genuine. Some chemical tests for sand, soil, and dirt, heavy metal like lead and arsenic as well as for specific colourants (eg. Lead chromate, charcoal, metanil yellow, rhodamine-d and other dye) were also done. It was found that two out of nine chilli powders were contaminated with sand and dirt which can cause stomach problem. One out of three black pepper powders was contaminated with other part of plants materials. Three out of nine turmeric powders were contained corn and rice starch and two out of three turmeric powder showed non permitted colourant like metanil yellow which is highly carcinogenic and can cause hepatocellular carcinoma and Central Nervous System toxicity after chronic ingestion. These results can provide necessary data for public awareness for their harmful effects. Determination of colchicine content in tuber and seed of Gloriosa superba family: Liliaceae and effect of temperature on tuber. Belonging to the good weather and geograghical background, Myanmar possesses a wide variety of plants and some of them are used as medicine. In addition, Myanmar traditional medicine always plays a major part in health of Myanmar people especially in rural areas. Therefore, quality, safety and efficacy of herbal medicines are very important and they depend mainly on their raw materials, medicinal plants. Nowadays, the utilization of herbs as medicine has been promoted with increasing population. To supply the increasing demand of medicines produced by herbs, local production findings from medicinal plants should be adequate. Which is widely distributed in Myanmar, is useful not only in medicine but also in agriculture. This local plant, Si-mi-tauk (qDrD;awmuf), which belongs to the family Liliaceae, was identified botanically to verify for true Gloriosa superba Linn. For the authenticity of plant, its habit, macroscopic and microscopic examination was carried out thoroughly. For standardization, preliminary screening on physicochemical and phytochemical aspects was conducted according to international standard procedures. By referring to the standard substance, colchicine, chromatographic and spectroscopic methods were also applied to marker compounds in it. Moreover, content of active principle of same plant may vary with the different geographical sources, method of cultivation, collection, drying, transportation, storage and production. Colchicine, one of the poisonous substances, is a distinct component in this plant and their content is not the same in different regions. Myanmar Traditional Medicine is experienced based and it should be promoted to scientific based to keep abreast with international level. To verify that, tubers were roasted, then extracted and analyzed their content of colchicine. For safety aspect, acute toxicity test on powder of tuber roasted at different temperature were carried out on albino mice. The dead animals suffered from diarrhoea and they were dead after twelve hours of administration.

Of the various psychological theories of depression buy astelin 10 ml cheap, the one that may have the most merit is the learned helplessness model order 10 ml astelin otc, developed by Martin Seligman, Ph. His animal model provided a valuable clue to human depression, as well as serving as the research model to test antidepressant drugs. They got exactly the same shocks as the first group but could not turn off the shock. The shock would cease only when the “yoked” dog in the first group would press its nose to the panel. Thus the second group of dogs had no control over the degree of shock they received. Once the dogs went through this first part of the experiment, they were placed in a “shuttle box,” a box separated in the middle by a small barrier that the dogs could jump over. The dogs would be electrically shocked but could escape the shock by simply jumping over the barrier to the other side. Seligman hypothesized that the first and third groups would quickly figure this out but that the second group of dogs would have learned to be helpless in that they would believe nothing they could do mattered. Seligman thought that the dogs in the second group would simply lie down and accept the shock. As predicted, the first and third groups of dogs learned within seconds that they could avoid the shock by jumping over the barrier, while the dogs in the second group would simply lie down and not even make an effort to jump over the barrier, though they could see the other side of the shuttle box. Seligman and his colleagues went on to show that many humans react in a fashion identical to that of animals in these experiments. The adoption of Seligman’s model was revolutionary in psychopharmacology, as it became an effective experiment to test antidepressant drugs. Basically, when animals that had learned to be helpless were given antidepressants, they would unlearn helplessness and start exerting control over their environment. Researchers discovered that when animals learned to be helpless, this resulted in alteration of brain monoamine content. Researchers also discovered that when animals with learned helplessness were taught how to gain control over their environment, their brain chemistry also normalized. The alteration in brain monoamine content in the animals with learned helplessness mirrors the altered monoamine content in human depression. Although most physicians look quickly to drugs to alter brain chemistry, helping patients to gain greater control over their lives actually produces even greater biochemical changes. One of the most powerful techniques to produce the necessary biochemical changes in the brains of depressed individuals is to teach them to be more optimistic. Outside the laboratory setting, Seligman discovered that the determining factor in how a person would react to uncontrollable events, either “bad” or “good,” was his or her explanatory style—the way in which the person explained events. However, individuals who were pessimistic were extremely likely to become depressed when something went wrong in their lives. Seligman and other researchers also found a direct correlation between an individual’s level of optimism and the likeliness of developing not only clinical depression but other illnesses as well. Optimists rarely got depressed, but pessimists were extremely likely to battle depression and other psychological disturbances. Serotonin has been referred to as the brain’s own mood- elevating and tranquilizing drug. Because the manufacture of serotonin in the brain is dependent upon how much tryptophan is delivered to the brain, in experimental studies researchers can feed human volunteers or animals diets lacking tryptophan and note the effects of such a diet. The results from these sorts of studies have contributed greatly in our understanding on just how vital proper levels of serotonin are to a positive human experience. For example, low levels of serotonin are linked to depression, with the lowest levels being observed in people who have committed or attempted suicide. Most of the commonly used antidepressant drugs work primarily by increasing the effects of serotonin. Once serotonin is manufactured in the brain it is stored in nerve cells waiting for release. Upon release, the serotonin carries a chemical message by binding to receptor sites on the neighboring nerve cell. Almost as soon as the serotonin is released enzymes are at work that will either break down the serotonin or work to uptake the serotonin back into the brain cells. It is at this point that various drugs typically work to either inhibit the reuptake of serotonin or prevent its breakdown. Because serotonin reuptake is inhibited, there is more serotonin hanging around, capable of binding to receptor sites. The effectiveness of antidepressant drugs has been the subject of several reviews. The results indicate that they have not been shown to work any better than a placebo in cases of mild to moderate depression, the most common reason for prescription medication, and claims that antidepressants are more effective in more severe conditions have little evidence to support them. As one group of researcher concluded, “Given doubt about their benefits and concern about their risks, current recommendations for prescribing antidepressants should be reconsidered. While antidepressant drugs are only marginally successful at best in alleviating depression, they do produce many side effects. Approximately 20% of patients experience nausea, 20% headaches, 15% anxiety and nervousness, 14% insomnia, 12% drowsiness, 12% diarrhea, 9.

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Symons infusion exceeds metabolism astelin 10 ml lowest price, then citrate overload cheap astelin 10 ml mastercard, techniques, coupled with careful coordination between sometimes known as citrate lock, can occur. This will nephrology and critical care services, will help to result in systemic total hypercalcemia due to ongoing improve these outcomes further. Correction requires a decrease in citrate delivery, an increase in citrate removal, or both. Citrate infusion Take-Home Pearls can be held for approximately 30 min and then resumed at a slower rate, or increased solute clearance can be › Dialysis utilizes the physical properties of convection and achieved by augmenting replacement fluid rates and diffusion to transfer molecules from the blood. Some › Intermittent hemodialysis requires a level of cardiovas- retrospective studies may be limited by provider bias; cular stability for the rapid fluid and electrolyte shifts. Others suggest that the need for vasopressors or the › Successful therapy requires coordination between critical underlying disease process is the better predictor of care and dialysis teams. American Journal fluid overload (<10%) has improved patient outcome of Kidney Diseases 49(5):650–655 [11, 14, 15]. Kidney International 70:963–968 better overall outcomes than previously reported; this 3. Pediatric Nephrology 17:150–154 multisystem organ dysfunction can bridge the patient 7. American Journal of Kidney Diseases 35(6):1111–1116 bolic imbalance, permitting the delivery of necessary 8. Clinical versus unfractionated heparin as anticoagulant during con- Nephrology 9(1):15–18 tinuous venovenous hemodialysis with filtration. Pediatric Nephrology 19:1394–1399 of acute renal failure in newborns by continuous arterio- 15. Kidney International 29:908–915 children receiving continuous venovenous hemofiltration. Pediatric Nephrology 20:1328–1333 ment therapy for acute renal failure in children: European 18. Pediatric Nephrology 19:199–207 (1998) Anticoagulation with prostaglandin E1 and unfrac- 32. Clinical Journal of the Wochenschr 55:1121–1122 American Society of Nephrology 2:732–738 20. Critical Care Clinics 19:563–575 children with acute renal failure: Survey results. Kluwer Academic, Dordrecth Nutrition for the Critically Ill 9 Pediatric Patient with Renal Dysfunction N. Inadequate nutritional sup- port will result in poor protein retention and excessive 9. Case Vignette › Water-soluble vitamins will be removed with dialysis and should be supplemented accordingly to avoid deficits. To optimize had decreased intake of solid nutrition for approxi- digestibility, similar proportions of fat, protein, and mately 5 days and decreased liquid intake for 3 days. Her extremities are ble for white blood count of 25,000 cells µL−1 with warm, though her peripheral pulses are weak. A chest a left shift, hematocrit of 31%, and platelet count of radiograph reveals left lobar pneumonia with asso- 660,000 cells µL−1. Volume resuscitation is not sufficient, of total energy requirements should consider resting however, and she requires dopamine and epinephrine energy expenditure, energy needed for physical activity, continuous infusions to maintain hemodynamic and diet- induced thermogenesis. She initially passes a small amount of urine, not associated with critical illness, energy expenditure but then becomes anuric. Plans to initiate continuous has been shown to be comparable to its expenditure venovenous hemodialysis are made. Given her hemo- as measured by indirect calorimetry in healthy sub- dynamic instability, she is not provided with enteral jects [59]. Adult patients with sepsis or severe trauma nutrition but total parenteral nutrition is initiated. This hypermetabolic response apparent in adults acquired malnutrition has been identified as a contrib- has not been a consistent finding in critically ill pedi- uting factor resulting in the poor outcome of severe atric patients [16, 25]. There is consensus failure itself does not appear to increase overall energy that nutritional support improves anthropometric out- requirements. A study of critically ill adults compared comes as assessed by body weight and mid-arm mus- the energy expenditure of those who required dialy- cle mass. However, controversy persists as to whether sis for severe renal dysfunction to those who required nutritional support improves clinical outcomes, such only supportive measures for normal or moderately as length of stay and mortality [33, 34]. The average measured hyper- ous illness, the aim of nutritional support is to blunt metabolism was 28% for those who required dialysis the negative nitrogen balance, though this trend can- and 42% for those who did not. Knowledge of a child’s total energy expenditure is As significant renal dysfunction results in impairment essential to optimize nutritional support. Basal meta- of nitrogenous waste excretion and altered regulation bolic rate is the largest component of total energy of water, electrolyte, and acid–base homeostasis, the expenditure, though energy is also utilized for growth, provision of optimal nutrition may be challenged. Determining The following chapter will outline principles for the the energy requirement of a critically ill patient may be nutritional management of critically ill children with challenging as potential stress factors such as fever and disturbances in renal function.

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