Outcomes after Transplantation of Cord Blood or Bone Marrow from Unrelated Donors in Adults with LeukemiaMary J. Laughlin, M.D., Mary Eapen, M.B., B.S., Pablo Rubinstein, M.D., John E. Wagner, M.D., Mei-Jei Zhang, Ph.D., Richard E. Champlin, M.D., Cladd Stevens, M.D., Juliet N. Barker, M.D., Robert P. Gale, M.D., Ph.D., Hillard M. Lazarus, M.D., David I. Marks, M.D., Ph.D., Jon J. van Rood, M.
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Test.arboris.bePharma in the Plumbing
The planet may still be paying for the cold you had last choking on industrial sludge, traces of drugs seemed a winter. If it was a bad one, you probably took medicine. small matter. It would take until the 1990s for that view Maybe you rinsed the little dosing cup in the sink every to change. That was when pharmaceutical estrogens, time you used it. Maybe you finished the bottle and threw principally from birth control pills, began showing up in it in the trash. What you surely did several times a day the water too, leading to male fish with androgynous sex was go to the bathroom — perhaps more than usual if organs. Scarily, it did not take much estrogen to affect billionths of a gram, per liter of lake water. passed straight through you. What all this means is that while you were taking your The planet is also paying for your dad's hypertension, your aunt's high cholesterol pharmaceutical soup our drinking water had and your colleague's throat infection, all of become. Even a partial list of the drugs chemical residue then leaked into sewers antidepressants, anticonvulsants, tranquil- lizers, antibacterials, antipsychotics, ACE inhibitors, nitroglycerin, steroids, ibuprofen prescription pharmaceuticals in use in the U.S. and thousands more over-the-counter But the mere fact that so many drugs have off. "Between cosmetics, pharmaceuticals have become so refined that even the most and other sources," says John Spatz, commissioner of inconsequential levels of contaminants cannot elude Chicago's department of water management, "there are detection. "Some of these concentrations are thousands 80,000 potential combinations of chemicals." It's of parts smaller than what could be of pharmaceutical impossible to keep our drinking supply safe from a gusher concern," says Robert Renner, director of the Water like that. Wastewater from homes gets treated at sewage Research Foundation, a nonprofit group that evaluates plants, but it's never possible to remove every trace of water safety. "We're aware that they're there only drugs. What's more, sewage pipes break, septic tanks because we're measuring at parts per billion." overflow, and in some parts of the U.S. "straight-piping" — which sends untreated sewage flowing directly into surface water — is still practiced. One way or another, the So just how worrisome are pharmaceuticals when they're so thoroughly diluted? A study described in a recent AMWA report estimated that at the highest levels ever detected for the antianxiety medication meprobamate, a Pharmaceutical pollutants are worrisome for reasons person would have to drink 1.24 million gal. (4.7 million beyond their mere numbers. They're also specifically L) in a day to ingest even a safe therapeutic dose. Not all designed to be reactive with human tissue. If they drugs are present at such vanishingly small levels. Some weren't, they'd be useless. In March, Lisa Jackson, are much higher, though for now they too are far below administrator of the Environmental Protection Agency the danger threshold. More troubling, nearly all research (EPA), announced that Washington is formulating new conducted so far looks only at short-term exposure — one rules to regulate all contaminants in water, including day's consumption of one chemical. What it doesn't take drugs. The measures will include better enforcement of into consideration is what happens over the course of existing regulations, closer coordination with states and years or decades, particularly when multiple drugs development of new water-treatment techniques. "We are identifying contaminants at a much faster pace than we are addressing them," she warned in an address to the The EPA acknowledges that studies on that topic must still Association of Metropolitan Water Agencies (AMWA) in be done but stresses that there is no reason to panic. "We are concerned but not alarmed by the very low levels of pharmaceuticals that have been detected in water," says Peter S. Silva, assistant administrator of the EPA's Office In the 1970s, scientists began detecting pharmaceutical of Water. Adds another agency official: "We need more residue in waterways, but in an era when rivers were Pharma in the Plumbing – TIME ON LINE – April 1, 2010 Proper disposal of pharmaceuticals helps, and some communities have set up take-back centers for leftover Whatever danger does exist, it's hard to know what to do meds in police stations and other public facilities. All about it. Bottled water may help a little, but it's no those drugs are disposed of in nonpolluting ways and thus guarantee of safety, the EPA warns, since merely labeling are kept out of landfills. But this addresses only about a product "ultra-filtered" or "spring-water" is no proof of its cleanliness. Some risk is mitigated naturally, pharmaceuticals passing through the body and into the depending on where you live. Despite serving about 3 sewage system — a nonnegotiable pollution source if ever million people, the Chicago water system is comparatively clean. "We take our water from Lake Michigan, which is For now the answer might hinge on better technology, pretty pristine," says Spatz. "And our wastewater flows with the EPA and other groups working to develop new away." Colorado and other points west are a different cleaning techniques, improve others and lower the cost of matter, since many towns dot the Colorado River, and ones that work well but are still too expensive. It's well and good if our drugs keep us healthy — but not if they make the water supply sick in the process. Pharma in the Plumbing – TIME ON LINE – April 1, 2010
VALIDACIÓN DE UNA HERRAMIENTA CLÍNICA SIMPLE PARA LA EVALUACIÓN DE LA GRAVEDAD EN NIÑOS CON SÍNDROME BRONQUIAL OBSTRUCTIVO VALIDATION OF A CLINICAL TOOL TO PREDICT SEVERITY IN CHILDREN WITH WHEEZING Seudónimo: ODOS Introducción: La infección respiratoria baja aguda suele manifestarse por Sindrome Bronquial Obstructivo (SBO), pudiéndose acompañar de diversos grados de