Human serum albumin nanoparticles for efﬁcient delivery of Cu quality 150 mg zyban, Zn superoxide dismutase gene discount zyban 150 mg on line. Gold Nanoparticles and Surfaces: Nanodevices for Diagnostics and Therapeutics Hariharasudhan D cheap 150mg zyban with amex. Chirra generic zyban 150 mg mastercard, Dipti Biswal, and Zach Hilt Department of Chemical and Materials Engineering, University of Kentucky, Lexington, Kentucky, U. The use of gold as a key component in biodiagnostic and therapeutic ﬁelds has emerged pri- marily over a period of three decades, though it has been used for centuries for artistic purposes. Gold is known to be the main ingredient for the preparation of an ancient Roman elixir of life. An example of a historical use of gold was in the coloring of glass during the 17th century to produce intense shades of yellow, red, or brown depending on the concentration of gold. In 1842, colloidal gold was used in chrysotype, a photographic process to record images on paper. During the 19th century, the pure form of gold called activated gold, due to its inert behavior to harsh environments, was prominently employed for catalysis (1). With the advent of numerous tools, techniques, and concepts related to nanotechnology, in combi- nation with the inherent property of gold to form functionalized bioconjugates via simple chemistry, gold has found importance in various biodiagnostic and thera- peutic applications (2–6). Herein, we detail the progress made in the functionaliza- tion of gold surfaces, both planar and particulates, at the nanoscale for diagnostic and therapeutic applications. Although gold can be directly used for biomedical applications, unique applications of this inert metal require functionalization with other biomolecules or biocompati- ble polymeric systems. The presence of an appropriate stabilizing agent prevents particle agglomera- tion by binding to the particle surface to impart high stability and also rich linking chemistry if it acts as a functional group for bioconjugation (8–10). The functionalization of gold surfaces can be achieved by using either “graft- ing to” or “grafting from” methods (Fig. Initially, grafted polymer layers over these active sites, however, hinder the further attach- ment of polymer chains because of limited availability of more active sites, thus limiting ﬁlm thickness and brush density. In the “grafting from” approach, a reac- tive unit on the surface initiates the polymerization, and consequently the polymer chains grow from the surface. Most “grafting from” polymerization reactions uti- lize controlled radical polymerization mechanisms. Since monomers diffuse more easily to reactive sites than macromolecules, this approach generally leads to higher grafting densities. A variety of functionalization techniques over gold surface are described in the following text. The thiol gold chemistry is used as the key mechanism for graft- ing small biomolecules and short-chain, end-functionalized polymeric stabilizers to gold. Murray and his colleagues extended Schiffrin’s method to diversify the functionality of monolayer-protected clusters to mixed monolayer-protected clus- ters by using a place-exchange reaction between the thiols (13). Table 1 provides a list of “grafting to” surface-modiﬁed particles, as synthesized by various researchers for biorelated diagnostic and therapeutic applications. For further information, the reader is directed to the respective references given in the table for the attach- ment/reaction chemistry. This is due to the effect of steric hindrance on the nonuniform attachment of polymer chains to the gold surface. This one monomer at a time attachment to the surface of interest leads to a much denser and more uniform polymer-coated surface when compared to that obtained by “grafting to” techniques. While a wide combination of polymeric networks can be obtained via “grafting from” techniques, the same is not viable by using “grafting to” techniques. Surface modiﬁcation with polymer brushes had been widely used to tailor various surface properties of gold (14,15). A general mechanism of how controlled radical polymeriza- tion renders a uniform, polymer-coated surface is shown in Figure 2. Although bioconjugation with modiﬁed thiols is the most common method for addressing bioapplied gold surfaces, polymerization via “grafting from” techniques affords controlled polymer grafting density and com- position. By encompassing biomolecules, which lead to a change in the environmental conditions, these materials on gold surface can be effectively used as biosensors. Living Ionic Polymerization The use of multiple functionalities on material surfaces enables multiplex usage for various biomedical applications. The Advincula group reported the surface-initiated living anionic polymerization of styrene and diene homopolymers as well as diblock copolymer brushes on gold surfaces (20,21). Other groups have also reported work related to anionic polymerization on gold surfaces (22). Using these polymerization techniques, dense polymer brushes were prepared in a “one- pot multistep” reaction. The halogen atom undergoes reversible switching between the oxidation states of the transition metal complexes, thereby reducing the initial radical concentration Gold Nanoparticles and Surfaces 97 and also suppressing the bimolecular termination step. It has been used to amplify patterned monolayers of assembled initiators formed using various lithography techniques into polymeric brushes (30–33). Hydrogels are hydrophilic, insoluble poly- meric networks that have the property of swelling to a high degree when placed in an aqueous or biological medium. By tailoring the various functional groups along the polymer backbone, hydrogels can be designed to be sensitive when subjected to changes in the ambient conditions such as temperature, pH, electric ﬁeld, or ionic strength. To utilize the environmentally responsive intelligent hydrogel sys- tems over material surfaces for a wide range of applications in the ﬁeld of biomedi- cal engineering, Chirra et al. Nanoparticles, in particular, have been developed for accu- rate, sensitive, and selective biosensing devices due to their unique size-related, ease-of-functionalization, and unique physical properties (electrical, optical, electro- chemical, and magnetic) (39). The immediate follow-up work done by researchers by using the colorimetric system worked on the principle of color change observed when a polymeric network of nanoparticles was formed speciﬁc to the length of the oligonucleotide that aggregated to the biomolecule of interest (5,42). A real-time bioafﬁnity monitoring system based on an angular-ratiometric approach to plasmon resonance light scattering was recently developed by Aslan and colleagues (52). In this strategy, the target molecule induces a conformational change of the detector–ﬂuorophore chain, from arch to stretched form and vice versa, thereby either restoring or quenching the ﬂuorophore for optical detection (Fig. A summary of the recent approaches in the construction of electrochemical biosensors utilizing 100 Chirra et al. When these capture probes are hybridized to matching targets, the binding of the labeled proteins is hindered and is indicated by the decrease in the Au redox sig- nal. This, in turn, establishes a unique Au oxidation wave that can be detected using the electrode (Fig. These devices have an added advantage of low background currents, depending on the type of electrode used (55). This was successfully applied as a biosensor for the amperometric detection of glucose at 0. A similar matrix was used by Tang and colleagues for the detection of carcinoma antigen 125 as represented in various tumors (64). The advantage of this technique is that by controlling the electrochemical parameters of polymer grown on the electrode surface, it is pos- sible to control the various polymer characteristics, such as ﬁlm thickness, perme- ation, and charge transport. Chitosan, a natural polymer exhibiting excellent ﬁlm-forming and adhe- sion ability, together with susceptibility to chemical modiﬁcation, has led to the immobilization of various enzymes over conductive electrodes. The release of these ther- apeutic agents can be triggered by cellular chemical [e.
It includes: the presence of the social mission of the enterprise discount zyban 150 mg with amex, social development strategy discount zyban 150 mg on-line, the use of social partnership programs purchase 150mg zyban visa, the use of methods to solve social problems of staff and customers discount zyban 150 mg overnight delivery, achieving high indicators of social relations in society. Company constantly develops and implements innovative marketing and promotional social-focused strategies that reinforce its positive image, which affects customer loyalty to the brand and increases brand perception. As part of the charity project company assisted hospitals in all regions of Ukraine. Every month two antenatal clinics in two different 217 regions receive necessary equipment for the treatment and diagnosis. The community appreciates the value and importance of the project in terms of development of Ukrainian health system. The main competitive advantages of the company are coordinated business behavior, rich network of business contacts and relationship management skills, adaptation to change the unfavorable external environment, strategic flexibility, the use of programs of social partnership, innovation activity in solving social problems. Note that it is formed by the social partnership system allows the company to combine resources to create social programs that it cannot develop on their own. Human resources of cosmetic company is recruiting and retaining the necessary personnel corporation, his professional training and development, evaluation of each of the employees in terms of the implementation of the social objectives of the company, it gives the opportunity to adjust its behavior, and provides rewards for staff for his efforts. In their laboratory, scientists are creating new recipes and improve existing ones. Each year the company receives patents for ten or more cosmetic products, which are then used in production. The company has modern pharmaceutical equipment and cosmetic raw materials from leading manufacturers from France, Germany, Austria and other countries. Thus, the social management of modern perfumery and cosmetic companies - a system of social control that ensures the efficiency of the production of social production by addressing social problems in society and can effectively influence social processes in the country. We investigated the main aspects of the social management of modern enterprises perfume and cosmetic industry and found that the management model according to the system of social management provides a clear mission statement, goals and objectives for socially-directed enterprise perfumes and cosmetics, which affects the process of strategic planning, organization, motivation and evaluation practice. The pharmaceutical sector of health care isn‘t only one of the most significant, as it develops and manufactures medicines for maintenance and recovery of health, but also one of the most problem in economy, as it isn‘t able to ensure the availability of pharmaceutical care to all persons in need. A degree of participation of pharmaceutical companies in the work on increase in the availability of medicines and medical support is reflected by the rating indicator «The Access to Medicine Index» (than the bigger efforts a company applies to increase the availability of drugs and medicines in 106 low- and middle-income countries, the rating is the higher). A level of corporate social responsibility is reflected by a rating indicator «RepTrak® 100». It is the «gold standard» for measurement of reputation of the international companies, including pharmaceutical. The study of the major international rating indicators in the pharmaceutical industry and the identification of leaders among the pharmaceutical companies Materials and methods. During carrying out the research the data of Access to Medicine Index [http://www. The pharmaceutical branch in a rating «RepTrak® 100» in 2015 was presented by 10 international pharmaceutical companies, the leaders were «Johnson & Johnson», «Eli Lily», «Abbott Laboratories», «Novo Nordisk», «Bayer», «Bristol- Myers Squibb», «Roche», «Sanofi», «Merck Sharp & Dohme» и «AstraZeneca» (Table 2). Unfortunately, the companies «GlaxoSmithKline» and «Pfizer» in 2015 were not included into the top 100 of world leaders in the corporate social responsibility. Deregulation constantly brings changes with direct or potential impact on community pharmacies. For their understanding and positive use in provision an affordable and good quality pharmaceutical care, it is important to continuously monitor and analyse their development, particularly in relation to demographic and geographic characteristics. The number of community pharmacies, population to pharmacy ratio and area to pharmacy ratio are important parameters that are sensitive to changes with strong regulatory potential. Data on the number of public pharmacies, population, land area during the years 1998-2014, were drawn from a database of the Statistical Office of the Slovak Republic. Mann-Kendall test, Fisher test and Pettitt tests were carried out under the R statistical software. Gradually, increased the number of community pharmacies, concurrently the number of residents and the surface area per community pharmacy statistically significant decreased in all regions of Slovakia (p <0. Deregulation increased the number of community pharmacies and enhanced access to community pharmacies. Despite the fact, the public pharmacies were mostly established in major cities, we have recorded improvement of accessibility also in rural areas. It is therefore very important to correctly and promptly appoint a treatment every needy patient. The clinical protocol of diagnosis and treatment of psoriasis have more than 60 names of drugs. Study Objectives: To conduct a comparative analysis of the use of medicines in the diagnosis and treatment of psoriasis in a hospital. Results: The clinical protocol of diagnosis and treatment of psoriasis approved minutes of the meeting of the Expert Commission for the Development of Health number 18 by the Ministry of Health and Social Development of the Republic of Kazakhstan from September 19, 2013. This document specifies the treatment of two types of drugs for the treatment of psoriasis, the first - essential medicines (compulsory, 100% probability), the second is additional drugs (probability less than 100%). In the list of essential medicines, there are two pharmacological groups of drugs. There are immunosuppressive agents, including anti-cytokine agents (these include methotrexate, cyclosporine, inflisimab, ustekinumab) and preparations for the topical treatment (derivatives of vitamin D3, glucocorticosteroid ointments). And more than 10 pharmacological groups such as antihistamines, sedatives, sorbents, vitamins,immunomodulators, desensitizing drugs, steroids, drugs improving peripheral circulation in the supplementary list of protocol treatment of psoriasis. In general name of 46 drugs, among them 22 solid formulation, the liquid 21, 3 soft form. Conclusions: We have reviewed the use of medicines in the treatment of psoriasis in a hospital for the clinical protocols of diagnosis and treatment of this disease. Good Distribution Practice is a quality assurance system standards, guarantees the quality of medicines, supported at all stages of the supply chain from the enterprise of the manufacturer to the pharmacy. To implement this goal were defined tasks: • an analysis of the literature data and legal documents on the general concept of wholesale distribution executives. Analysis of the literature and regulatory documents showed that the structure of the new leadership of the Good Distribution Practice consists of 10 main points: quality control; personnel; facilities and equipment; documentation; operations; claims, refunds, suspected of drug counterfeiting, and their reviews; autsoring; transport; self-inspection; special provisions for intermediaries. In our further research, we will use most of them during questioning Ukrainian distributors. In the first phase of our research we analyze patterns of species distribution of the Software was held in the world. It happens: • Standard - The manufacturer-distributor of Pharmacy-Patient; • Directly to the pharmacy; • Custom distribution; • Hospital. In the next stage of our research we analyzed the patterns of interaction of the manufacturer and the buyer. The analysis showed that there are two basic supply chain: Producer-distributor of Pharmacy and Pharmacy Manufacturer. In our view, part of the patient, more promising since the second a continuous information flow and cash flow. What ultimately reduce the cost of medicines to consumers, and therefore - the availability and improve the information to pharmacies and patients about the drugs. The analysis showed that 36% of the countries the number is 223 less than 100 distributors, 24% from 500 to 1000. Analysis of the dynamics of indicators of distribution of the Software showed that in Ukraine since 1999.
While the serum institutes were set up to produce serum for local needs (generally supplying a signifcant but local region) they also developed a diagnostic capacity buy zyban 150 mg fast delivery, often in the same building zyban 150 mg low price. The creation of a microbiology laboratory for diagnosis tempted many into research purchase zyban 150mg on line. The fnal step taken by Nancy cheap 150 mg zyban with mastercard, and possibly other serum producers as well, was to organize courses in microbiology based on the model of the Pasteur Institute, where many of the staff had themselves received their initial training. Thus, the indirect result of Paris’s initial inability to supply the provinces was not only the de-localization of serum production with regional centers (usually with only two or three horses) supplying local demand funded by the municipality or public donations, but also the introduction of veritable regional Pasteur institutes. The irony of this situation was that these regional centers found themselves in the same situation as the Pasteur Institute, needing to wait three months to have immunized horses ready to produce the serum. Thus, although he started the immunization process in November 1894, Arloing was only able to supply the Lyon hospitals with locally produced serum in February 1895, by which time a generous supply was available from Paris. This scenario was repeated all over France, with the result that the Pasteur 12 ‘Rapport de M. It is interesting to note, however, that this competition was not at all on the German model of different for- proft private enterprises. Although they were sometimes private charitable foundations, these provincial producers were never for-proft companies, and often had the appearance of an extra department attached to a city’s medical school. I now want to return to the point I was elaborating above and relate it to the developments in Lyon. In the second half of 1895, the serum commission could no longer enforce the monopoly of the Pasteur Institute as by now there was a range of regional producers that were already well established. Furthermore, these regional producers were academically respectable enterprises usually supported by local notables and more or less closely associated with the medical faculty. The moment in which a Parisian monopoly would have been possible – stretching from September to October 1895 – had now passed. The pastorians were obliged to accept the existence of the provincial producers, which were often run by medical doctors trained in serum production at the Institute itself, and were usually intimately – if not directly – linked to medical faculties around the country. Nevertheless, the producers outside Paris approved by the serum commission were, it seems, limited to ‘friends’ of the Pasteur Institute. It is in this context that we can pose the question about the non-approval of German serum, along with the absence of any private producers. Unfortunately, although we can raise this question, we are not in a position to give any conclusive response. In the absence of the archives of the serum commission, we cannot know who was applying for permission to produce or supply diphtheria serum, and, more importantly, who was being refused, and why. Judging by the outcome, however, it is reasonable to conclude that the pastorians instrumentalized the serum commission to keep a tight control on the producers, limiting them to a network of more or less intimate associates of the Institute. A subsidiary question that presents itself, therefore, is whether the Ministry of the Interior intended to give so much power to the pastorians via the commission, or whether this indirect regulatory control of the Pasteur Institute was an accident that depended on the particular circumstances in which the commission was constituted. After all, just as in the case of the regional producers, the only place to learn about microbiology in France at the end of the nineteenth century was the Pasteur Institute, in particular the course offered by Roux and later Martin. In practical terms, the Pasteur Institute already exercised a monopoly over the expertise in this feld in France, a situation exacerbated by the reluctance of medical faculties to take an active interest in it. This meant that the majority of medical doctors who specialized to some degree in microbiological research had been trained at the Institute and so were favourably disposed to it and may well have enjoyed privileged relationships of exchange and support. This was the case with Grancher or Nocard – two members of the serum commission – for example, who maintained intimate links with the Pasteur Institute throughout their lives. Thus, had the Ministry wished to keep the Institute from exercising infuence over the commission, it would have been extremely diffcult to recruit appropriately qualifed members. To continue the analysis from the perspective of ‘satisfcing’, therefore, I would argue that from a technical or more precisely ‘technocratic’ point of view, the government had no choice but to entrust the oversight of serum production to the Pasteur Institute. First, I would suggest that the regulation of April 1895 does not represent an absolute minimum that can be directly opposed to the much heavier and more intrusive German solution. One can easily imagine a hands-off approach dispensing with government approval, and simply applying a regime of post-hoc policing of dangerous substances (including ineffective serum in this case). Nevertheless, French regulation does appear to have been a kind of necessary minimum in light of certain exigencies I have pointed out in the text, in particular the high mortality associated with the disease and its prominent public image as the scourge of honest families. Furthermore, the idea of forming a commission to provide the government with an expert opinion on which to base its opinion was quite standard. It was typical of a long history of French management of public health that the members of the commission should be drawn from the country’s elite medical professional body – the Academy of Medicine. The French (but not exclusively French) technocratic refex turned towards (and continues to privilege) expert committees and commissions to inform government policy, with the chosen scientists purveying independent, objective advise that can reliably underwrite government action. Indeed, the Serum Commission and the French Government ‘colluded’ in legitimating and rubber-stamping the system that was in place when the law of April 1895 was introduced. This was a system dominated by the Pasteur Institute in Paris, but accepting limited regional production intended to supply local, essentially public (hospital) demand. As long as there were no ‘accidents’ or major scandals, this was a satisfactory solution for all those concerned. While it might have been an unsatisfactory solution for interested parties excluded from the market, it appears that no such protests made themselves heard on the French political scene. It is from this perspective that one might consider the legislation sub-optimal, that is to say from the perspective of the French government’s global national interests, including both its economic interests and its interests in terms of national public health. Nevertheless, on the positive side, the diphtheria serum was covered by government regulation, and without any major scandals resulting from the legislation. One specifcally concerning the French legislation, and the other considering the comparative situations in France and Germany: a) In France, then, the legislation was limited to granting offcial approval to producers (and in principle products as well), and left the issue of quality control in the hands of the approved producers. What was decisive, and typical of a certain French technocratic approach to public health issues, was the nomination of a ‘professional’ advisory body to advise the government on who could legally produce the serum. I have suggested that the approval system put in place served to legitimate and perpetuate the network of production and distribution that was already in place, and turned around the Pasteur Institute. If we accept this analysis, we can ask whether this solution was put into effect at the cost of excluding other potentially competent producers and the technical and economic advantages they may have brought with them. In trying to analyse this issue, however, we run up against the problem of sources, as for the moment we 103 Jonathan Smon do not know what efforts were made to introduce new elements into this network. Thus, the question remains open as to whether the French legislation provided a satisfactory system, or whether the system just appeared to be satisfactory. At the other extreme, I have no ideal optimal (whether in terms of market economics or public health) model of legislation to offer as a benchmark against which to measure this French approach. Why did they need an ‘independent’ institute to check the quality of all the serum that was produced? Was it because of the tuberculine scandal associated with Robert Koch and the failure of the state to assume its responsibilities in this case? We can also consider an explanation in terms of different cultures of legislation and administration? Of course, looking in more detail at the economics of production may also provide some clues about the national interest of ‘satisfcing’ in regulating a proftable drug marketplace versus introducing stronger strictures that give the state more leverage in encouraging competition or shoring up ‘cartels’ that are seen to be functioning in everyone’s interest. Whatever the answers to these questions, it seems improbable that the differences between France and Germany can be reduced to ‘rational’ economic calculations. Marks Cured yesterday of my disease I died last night of my physician Matthew Prior (1664-1721)1 A popular statin used to lower cholesterol is associated with an unusual breakdown of muscle tissue.
Repeated measurements of plasma potassium are necessary to determine whether further infusions are required and to avoid the development of hyperkalaemia which is especially likely to occur in renal impairment 150mg zyban for sale. Inital potassium replacement therapy should not involve glucose infusions because glucose may cause a further decrease in the plasma-potassium concentraton zyban 150mg amex. Glucose* Indicatons Fluid replacement without signifcant electrolyte defcit; treatment of hypoglycaemia; varicose veins order zyban 150mg without prescription. Contraindicatons Anuria; thiamine defciency; trauma; intracranial haemorrhage; haemodiluton; acute ischaemic shock; hypophosphatemia; sepsis purchase zyban 150 mg without prescription. Precautons Diabetes mellitus (may require additonal insulin); mannitol fuid balance. Adverse Efects Glucose injectons, especially if hypertonic, may have a low pH and cause venous irritaton and thrombophlebits; fuid and electrolyte disturbances; oedema or water intoxicaton (on prolonged administraton or rapid infusion of large volumes of isotonic solutons); hyperglycaemia (on prolonged administraton of hypertonic solutons); anaphylactoid reacton. Glucose + Sodium Chloride* Indicatons Fluid and extracellular volume depleton with excess diuresis; gastroenterits. Dose Intravenous infusion Adult and Child- Fluid replacement: determined on the basis of clinical and wherever possible, electrolyte monitoring. Precautons Restrict intake in impaired renal functon; cardiac failure, hypertension, peripheral and pulmonary oedema; toxaemia of pregnancy. Precautons If serum osmalarity >320 -mannitol of litle use may be harmful, given along with mannitol if no response in 3-6 hours, monitor serum sodium levels. Adverse Efects Hyperchloremic metabolic acidosis; acute renal failure; subarachnoid hemorrhage; central pontne myelinosis; coagulopathies disorder; pulmonary edema; congestve heart failure due to overload; hypokalemia; hemolysis; phlebits; rebound cerebral edema. Potassium Chloride* Pregnancy Category-C Indicatons Electrolyte imbalance; hypokalaemia. Dose Slow Intravenous infusion Adult and Child- Electrolyte imbalance; depending on the defcit or the daily maintenance requirements. Contraindicatons Plasma-potassium concentratons above 5mmol/litre; chronic renal failure; systemic acidosis; acute dehydraton; adrenal insufciency. Precautons For intravenous infusion the concentraton of soluton should not usually exceed 3. Adverse Efects Cardiac toxicity on rapid infusion; nausea, vomitng, fatulence, diarrhoea. Sodium Bicarbonate* Pregnancy Category-C Indicatons Metabolic acidosis; cardiopulmonary resuscitaton; hyperkalaemia; muscle spasm. Dose Slow intravenous infusion Adult and Child-Metabolic acidosis: a strong soluton (up to 8. Contraindicatons Metabolic or respiratory alkalosis, hypocalcaemia, hypochlorhydria; hypoventlaton; hypoosmolarity. Precautons Restrict intake in impaired renal functon, cardiac failure, hypertension, peripheral and pulmonary oedema, toxaemia of pregnancy (Appendix 7c); monitor electrolytes and acid- base status; stomach disorder; allergies. Adverse Efects Excessive administraton may cause hypokalaemia and metabolic alkalosis, especially in renal impairment; large doses may give rise to sodium accumulaton and oedema seizures; lactc acidosis; pulmonary oedema; hyperventlaton. Sodium Chloride Indicatons Electrolyte and fuid replacement; hyponatremia; diabetc ketoacidosis; leg cramps; poisoning. Dose Intravenous infusion Adult and Child- Fluid and electrolyte replacement: determined on the basis of clinical and wherever possible, electrolyte monitoring. Contraindicatons Hypertension; liver cirrhosis; ischaemic heart disease; nephrotc syndrome; congestve heart failure. Adverse Efects Administraton of large doses may give rise to sodium accumulaton and oedema; vomitng; intraocular coagulopathy. Sodium Lactate Indicatons Perioperatve fuid and electrolyte replacement; hypovolaemic shock; metabolic acidosis; peritoneal dialysis. Dose Intravenous infusion Adult and Child-Fluid and electrolyte replacement or hypovolaemic shock: determined on the basis of clinical and wherever possible, electrolyte monitoring. Contraindicatons Metabolic or respiratory alkalosis; hypocal- caemia or hypochlorhydria; hypernatremia. Precautons Restrict intake in impaired renal functon; cardiac failure, hypertension; peripheral and pulmonary oedema; toxaemia of pregnancy; cortcosteroid therapy; shock; hypoxemia. Adverse Efects Excessive administraton may cause metabolic alkalosis; administraton of large doses may give rise to oedema; tssue necrosis; hypernatremia; hypervolemia; reacton at injecton site. Water for Injecton* Indicatons In preparatons intended for parenteral administraton and in other sterile preparatons. Precautons Preparaton should not be greater than 10%, intravenous preparatons should be administered slowly to prevent haemolysis. Adverse Efects Haemolysis, haemoglobinuria; renal failure; hyperosmolar coma; much frequent and severe rebound efect; hyperglycemia. Vitamins, Minerals and Antanaemic Drugs Vitamins: Vitamins are used for the preventon and treatment of specifc defciency states or when the diet is known to be inadequate. It has ofen been suggested but never convinc- ingly proved, that subclinical vitamin defciencies cause much chronic ill-health and liability to infectons. This has led to enormous consumpton of vitamin preparatons, which have no more than placebo value. Most vitamins are compara- tvely non-toxic but prolonged administraton of high doses of retnol (vitamin A), ergocalciferol (vitamin D2) and pyridoxine (vitamin B6) may have severe adverse efects. Retnol (vitamin A) is a fat-soluble substance stored in body organs, principally the liver. Periodic high-dose supplementa- ton is intended to protect against vitamin A defciency which is associated with ocular defects partcularly xerophthalmia (including night blindness which may progress to severe eye lesions and blindness), and an increased susceptbility to infectons, partcularly measles and diarrhoea. Universal vitamin A distributon involves the periodic administraton of supplemental doses to all preschool-age children with priority given to age groups, 6 months to 3 years, or regions at greatest risk. All mothers in high-risk regions should also receive a high dose of vitamin A within 8 weeks of delivery. Since vitamin A is associated with a teratogenic efect it should be given in smaller doses (no more than 10,000 units/day) to women of child-bearing age. Doses of vitamin A should be admin- istered orally immediately upon diagnosis of xerophthalmia and thereafer patents with acute corneal lesions should be referred to a hospital on an emergency basis. In women of child-bearing age there is a need to balance the possible teratogenic efects of vitamin A should they be pregnant with the serious consequences of xerophthalmia. Where there are severe signs of xerophthalmia high dose treatment as for patents over 1 year should be given. When less severe symp- toms are present (for example night blindness) a much lower dose is recommended. Vitamin A therapy should also be given during epidemics of measles to reduce complicatons. Vitamin B is composed of widely difering substances which are, for convenience, classed as ‘vitamin B complex’. Chronic dry ‘beri-beri’ is characterized by peripheral neurop- athy, muscle wastng and weakness, and paralysis; wet ‘beri- beri’ is characterized by cardiac failure and oedema. Thiamine is given by intravenous injecton in doses of up to 300 mg daily (parenteral preparatons may contain several B group vitamins) as inital treatment in severe defciency states. Ribofavin (vitamin B2) defciency may result from reduced dietary intake or reduced absorpton due to liver disease, alcoholism, chronic infecton or probenecid therapy. Pyridoxine (vitamin B6) defciency is rare as the vitamin is widely distributed in foods, but defciency may occur during isoniazid therapy and is characterized by peripheral neurits.