SPECIAL ARTICLE Evidence-based guideline: Antiepileptic drugselection for people with HIV/AIDSReport of the Quality Standards Subcommittee of the American Academy ofNeurology and the Ad Hoc Task Force of the Commission on TherapeuticStrategies of the International League Against Epilepsy ABSTRACT Objective: To develop guidelines for selection of antiepileptic drugs (AEDs) among p
Bardzo tanie apteki z dostawą w całej Polsce kupic levitra i ogromny wybór pigułek.
Microsoft word - clomid informationThe Centre For Women’s Reproductive Care
MB ChB, BSc(Med), FCOG (SA), MMed (O&G), FRANZCOG Obstetrician & Gynaecologist WHEN YOUR DOCTOR PRESCRIBES CLOMID
You have been advised to take Clomid (Clomiphene by thickening mucus in the cervix and impairing citrate) also sold as Serophene. This is a mild sperm penetration. Recent studies suggest a fertility drug, similar in structure to the natural pregnancy screen rate of 63% within a year. hormone oestrogen. It does not stimulate ovulation (egg release) directly but induces a series Multiple Pregnancy
of events that promotes release of Follicle Stimulating Hormone (FSH) from the pituitary The usual rate of multiple pregnancy in this gland located at the base of the brain. FSH, community is around 1:80 or 1.25% of all together with its close relative, Luteinising pregnancies. The chance of a multiple pregnancy Hormone (LH), stimulates the ovaries to prepare with Clomid may be 5 or 6-fold higher than this. and then release one or more eggs from the ovary. However, this means a twin rate of only 6-8%, The response can be monitored with blood tests while triplets and higher order multiples are rare. Side Effects
When to Take Clomid
It is not possible to guarantee that any drug is Clomid is usually started within day 3 – day 7 of a 100% free of side effects and 100% safe in both cycle and where day 1 is the first day after last the short and long term. As for many things we period. It is therefore commonly referred to as a undertake in life, it is a matter of weighing the “kick start” for ovulation, which then occurs up to possible benefits i.e. pregnancy and a baby, one or even two weeks after the last tablet, is against the known and unknown risks. The taken. The usual dose is one tablet (50 mg) daily following symptoms may occur while taking but individual requirements differ and it is usual to monitor at least one or two cycles carefully to ensure that the desired outcome is achieved. The Hot flushes (about 10%), sore breasts, tiredness, cycle is monitored by an ultrasound scan at about feeling bloated or light headed, headaches, nausea, loss of appetite, muscle aches and pains, mood swings with anxiety and depression. Blurred How Successful is Clomid?
or double vision (1-3%). Painful ovulation is not Whether given to induce ovulation for women who are not producing a monthly egg or to enhance Clomid has been used for more than 40 years and fertility in others requiring assisted conception the there is a large body of information about its chance of pregnancy in any one month that Clomid effects in both animals and man. There is no is used is no more than 15-20%. Several cycles of evidence that Clomid causes any long term treatment are therefore usually required. The hormonal effects in women, for example, those exact reasons why some women who appear to relating to weight, hair growth, acne, mood ovulate but do not conceive with Clomid are changes, mental illness or premature exhaustion of unclear. For some there may be other factors which are impairing fertility, for example problems Pregnancy Outcome after Clomid
with sperm or the tubal transport of eggs and embryos. For others the eggs may not actually be About 15% (or one in six) pregnancies conceived released from the ovary despite many of the other naturally miscarry and the rate after ovulation signs of ovulation. It can also be shown that induction may be slightly higher. Some of these Clomid has some anti fertility effects, for example occur in older women who have other medical problems with a high risk of miscarriage. some women this rapid growth of a follicle or Pregnancy is also diagnosed earlier after assisted follicles is painful. Sometimes these follicles conception than natural conception and this alone continue to grow after ovulation and a larger cyst may contribute to an apparently higher rate of may form. Ovarian cysts caused by Clomid resolve There is some evidence that, if Clomid is given Fertility Drugs and Cancer
after a conception has occurred, then it can cause miscarriage. It is for this reason it is recommended It has been argued that the use of Clomid may that Clomid should not be taken until pregnancy is increase a woman's risk of ovarian cancer. This is first excluded by testing and/or a full and normal based on two observations. Firstly, women who take the contraceptive pill and thereby suppress ovulation over a long period of time have a lower Ectopic pregnancy is the implantation of a incidence of ovarian cancer. Secondly, ovarian pregnancy outside the uterus and usually in the cancer has been shown to occur more frequently in fallopian tubes. Whereas after spontaneous women who have used ovulation-inducing drugs. conception 1-2% of pregnancies are ectopic, this However, it is worth noting that about one woman rate is slightly higher after ovulation induction. in 100 will develop an ovarian cancer in a lifetime and women with fertility problems have a higher There is no convincing evidence that the rate of risk of ovarian cancer then others. It is uncertain birth deformities is higher than normal when how much this contributes to the apparently Clomid has been used to assist the conception. increased risk of ovarian cancer in women who One or two babies in every hundred born (1-2%) have used Clomid. It is recommended that the use have a significant birth defect. You may discuss of Clomid should proceed only with medical with the doctor the tests which are available to detect abnormalities of the baby during the early months of the pregnancy but keeping in mind that There have also been claims that the high the only "treatment" that can be offered in most oestrogen levels that are generated in women during ovarian stimulation may trigger breast cancer since it is known that some breast cancers Ovarian Hyper stimulation and Cysts
are stimulated to grow by oestrogen. Women who breast-feed for long periods of time have a lower A very rare but significant complication of Clomid risk of breast cancer and it is known that breast- relates to the stimulation of multiple follicles (cysts) feeding suppresses the ovarian production of in the ovaries which, in turn, causes the ovaries to oestrogen. However, it is not certain that enlarge to several times their normal size. This oestrogen actually causes a breast cancer and, results in lower abdominal discomfort, a bloated because breast cancer is very common (about one feeling and sometimes distension of the abdomen woman in every 12 will develop this cancer in a or discomfort during intercourse. There is lifetime), it is not surprising that some women who sometimes vomiting with a risk of dehydration. received Clomid have subsequently developed breast cancer. It is of interest and possible relevance that a drug that is closely related to Eggs within the ovary develop and are released Clomid and called Tamoxifene is used to treat and from follicles that are fluid filled cysts. They reach a size of almost 1 inch (2 cm) in the few days before release of the egg(s) i.e. ovulation. For
Student-written practice questions: Midterm 1 1. You are running an experiment in which you want to study the metabolism of E. coli . You know that you have a pure culture because you’ve done a nice series of isolation streaks, and you’re excited to inoculate a new broth culture so you can perform your assays the next day. You perform a series of standard assays including OF medium and mo