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His killing had the apparently desired chilling effect: Many journalists in Pakistan openly admit they were intimidated acne natural treatment order zupar 400mg/325mg with amex. Reporters covering security matters said they had received the sorts of threats and abuse that Shahzad had been receiving medicine zalim lotion discount 400mg/325mg zupar overnight delivery. Others started talking of threats from other sources treatment brown recluse spider bite discount zupar, including ground-level political groups in restive areas such as Karachi treatment plant buy 400mg/325mg zupar fast delivery, Baluchistan, and the Federally Administered Tribal Areas. For some, intimidation is part of the cost of doing business, and they have learned when to dial back a story to avoid more serious consequences. In December 2005, freelancer Hayatullah Khan, who for years had been under threat from government officials and militant groups in North Waziristan, took photographs of the remnants of an American-made Hellfire missile that had hit a house inside Pakistan, apparently targeting senior Al-Qaeda figure Hamza Rabia. At the time, the military-backed government of President Pervez Musharraf was denying that the United States was violating Pakistani territory with military operations inside its borders. Like Shahzad six years later, Khan was abducted and died a violent 142 Asia: Analysis death after discrediting the military. He was grabbed by gunmen on December 5, 2005, the day after his pictures were published worldwide. Musharraf ordered an investigation, in this case by High Court Justice Mohammed Reza Khan. While those journalists remaining in the Federally Administered Tribal Areas have become a major source for news on fatalities from U. Many local journalists have left the profession or report on only the most benign topics. Fearing for their safety, most have asked that their individual cases go unpublicized. Waqar Kiani, 32, who in the past had been a local correspondent for the British newspaper e Guardian, survived two assaults before resolving to leave Pakistan. In 2008, he was abducted in Islamabad by suspected 143 Attacks on the Press in 2011 intelligence agents, blindfolded, beaten, and burned with cigarettes. His ordeal ended 15 hours later when he was dumped 120 miles (180 kilometers) outside the city. Traumatized, Kiani continued to freelance, telling only his closest friends and colleagues of the ordeal. But after Islamabad Senior Superintendent of Police Tahir Alam said preliminary investigations showed that police were not involved in the attack, the investigations stopped. Kiani lowered his profile as a journalist and with the help of e Guardian, he left the country for a few months, waiting for the threat to fade. Temporarily separated from his family, he was seeking asylum in a European country in late year. He fled Pakistan because of military action in his native Baluchistan province, where secessionist groups battle each other and the Pakistani military, and where his exposure of military abuses would, he believed, make him a target. Sometimes it is impossible to narrow down who may be responsible because of the sheer number of potential culprits. On May 10, about 700 miles (1,100 kilometers) due north of Karachi, in the Federally Administered Tribal Areas along the border with Afghanistan, Nasrullah Khan Afridi was killed when his car exploded in a crowded market in Peshawar. No one knows whom to blame for the targeted killing of this prominent regional reporter who worked for Pakistan Television and the Urdu-language Mashreq. Exile is lled with hardship, says one journalist, but no story is worth dying for. Although he later returned to work, he faced ongoing threats that forced him to switch beats. But after four witnesses to the killing were shot and killed, as well as the brother of the police officer leading the investigation, the case went fallow. So far his government has taken no action, in some cases because it apparently chooses not to , in others because it has no control over the actors. But the milieu in which Zardari rules and journalists operate is reeling out of control. A May report from the Center for Strategic International Studies identified 2,113 terrorist attacks, 369 clashes between the security services and militants, 260 operational attacks by the security forces, 135 U. With violence at a high level, special investigations proving fruitless, and an ineffective, impotent government unable or unwilling to protect them, Pakistani journalists have come to realize they must act on their own. Haroon, who is chief executive of Dawn Media Group along with heading the All Pakistan Newspapers Society, led a conversation about the creation of a press organization to monitor and compile data on anti-press attacks.
Once the stock is established medications equivalent to asmanex inhaler order zupar 400/325 mg with visa, the guppy fish can be brought to the local level to establish local stocks treatment kidney disease order 400/325 mg zupar visa. Young hatchlings medicine xifaxan cheap zupar 400/325 mg with mastercard, however medicine universities cheap zupar 400/325 mg with amex, will not survive the stressful trip and 14 Managing Regional Public Goods for Health: Community-Based Dengue Vector Control should not be transported. For longer trips, the fish should be transported in closed containers holding chlorine-free water, such as large sealable plastic bags or containers with lids. The first project was a community-based field trial in 20062007 to test the use of guppy fish (Poecilia reticulata) in domestic water containers in Trapeang Kong commune, Kampong Speu (Chang et al. About 1,000 households in 14 villages took part in the intervention; 260 other households in the same commune received routine vector control services and served as the comparison group. A stock of guppies was established at the Centre for Parasitology, Entomology and Malaria Control in Phnom Penh. About 10%20% of the guppy fish needed to be replaced monthly, so the breeding and distribution system was a key factor in the success of the program. One year later, 25% of the intervention households were visited and entomological indices were compared with those found in the comparison group. Of the water storage containers in the intervention households that were appropriate for the fish, 57% contained guppy fish, and the intervention community had 79% less Aedes infestation than the households without fish. There was a highly significant difference between the intervention and comparison areas in the number of water jars and tanks found with Aedes larvae or pupae: only 10% of these containers in the intervention area were positive, compared with 50% among households without fish. The significant reduction in mosquito larvae and pupae in the water jars and tanks in the intervention households not only resulted in fewer adult mosquitoes produced from those water jars and tanks, but also reduced by 51% the number of smaller water containers without fish that were found to be with larvae and pupae. A second project using guppy fish took place in 20082009 in Bati district, Bakeo province, Cambodia. Information, education, and communication materials, such as leaflets, posters, songs, and audio spots (broadcast from motorbicycle trailers), were produced to support the outreach activities of the volunteers and health center staff. Focus groups were used to gather information from mothers and 5th- and 6th-grade schoolchildren about their perceptions and knowledge of dengue, dengue prevention and control, dengue education efforts, and use of guppy fish in water jars and tanks to prevent dengue. A very important finding from the qualitative evaluation was that health staff at the national and health center levels fully supported the community-based effort and felt that face-to-face dengue health education by the volunteers and use of posters and banners had been effective. In the case of dengue prevention and control, why residents follow some control measures but not others must be understood. Years of experience and research have proven that knowledge does not automatically result in behavior change. Communities with low levels of knowledge of the disease may readily accept vector control recommendations. This behavior was not feasible because of the size of the jars and because people would not throw precious water away. Placing larvivorous fish in the large water jars was found to be a sustainable way of eliminating mosquito larvae. The project developed a mobilization and communication strategy for implementing the guppy fish intervention in the two countries. Effective Health Communication and Community Mobilization Health communication is the planned and systematic use of communication strategies to inform, influence, and motivate individual and community decisions that improve health and quality of life. Often people cannot change their behavior unless the setting in which they live or work also changes. It may be necessary to pass new laws or enforce existing ones, examine how houses and schools are designed and built to reduce mosquito breeding, look at national and municipal processes of installing water and sanitation systems, or improve vector control services. At the household level, an enabling environment would be one where the recommended vector control strategies are feasible, as in the guppy fish research project. As an alternative to cleaning the large water jars weekly, communities were encouraged to keep two or three guppy fish in each large jar to render it inhospitable to mosquito larvae or pupae. The desired behavior involved keeping guppy fish in large water jars; the existing behaviors entailed doing away with small water containers no longer used by the household and taking anyone with a fever for more than 24 hours to a clinic or hospital. For dengue prevention and control, this evaluation goes beyond the use of entomological indices as the indices simply measure mosquito, not human, behavior. However, countries have used qualitative indicators to measure whether the behavior was being implemented, and in some cases at what frequency.
Treatment with propranolol or bromocriptine usually prevents further attacks; alternatives include gabapentin and morphine medicine nobel prize cheap zupar 400mg/325mg on-line. A full or partial frontal lobe syndrome is typical symptoms anxiety order zupar in india, with disinhibition being the most common symptom; affective changes and perseveration may also occur treatment with cold medical term purchase zupar canada. Pharmacologic treatment of the frontal lobe syndrome may include treatment with carbamazepine or an antipsychotic medicine journal discount zupar 400mg/325mg with visa, such as quetiapine. Depression Depression appears during the first 2 years in up to onehalf of patients, and may either remit spontaneously or persist (Jorge et al. Importantly, in considering a diagnosis of depression, in this population one must keep in mind that transient displays of depressed mood or affect, as may be seen in emotionalism or emotional incontinence, simply do not qualify. Furthermore, both apathy and abulia must be kept in mind as other possibilities: in both cases, the requisite depressed mood is not present. Methylphenidate may also be considered, and in one double-blind study was similar to sertraline (Lee et al. Typically, patients find themselves uncharacteristically prone to sadness and tearfulness. Importantly, although patients, especially males, may complain of their lack of emotional restraint, they do not complain that the sadness is unmotivated or out of place. Citalopram is effective here, sometimes in as little as 2 or 3 days (Muller et al. Patients with abulia, if supervised, may complete tasks at a normal rate, whereas patients with apathy do not. Patients with depression may also complete tasks slowly; however, here, in contrast with apathy, there is a depressed mood. When severe, consideration may be given to treatment with methylphenidate or amphetamines; however, these agents should be given cautiously, if at all, in cases where they might be abused. Mania Mania may occur in the year following injury, but is relatively uncommon (Nizamie et al. The episodes themselves tend to be relatively short, lasting on average 2 months (Jorge et al. In evaluating a patient suspected of having post-traumatic mania, it is important to differentiate manic exuberance from the disinhibition that is seen in the frontal lobe syndrome: the main differential point here is that whereas mood is heightened in mania, it is not in the frontal lobe syndrome. Furthermore, before attributing mania to head injury, a careful history is required to exclude a premorbid bipolar disorder. Treatment should generally include a mood stabilizer, such as divalproex or carbamazepine; lithium may also be considered, however, as noted earlier, patients with head injury may be especially prone to develop side-effects to this agent. Sleep disturbances Sleep disturbances occur in the majority of patients and may include hypersomnia, excessive daytime sleepiness or insomnia (Baumann et al. Hypersomnia may be directly related to the head injury but consideration must also be given to the use of any sedating medications. Excessive daytime sleepiness may be likewise be directly related to the head injury or may be due to sleep apnea, which in turn may be either central or obstructive (Castriotta and Lai 2001; Masel et al. Given that these latter disorders have specific treatments, it is reasonable to request polysomnography in any brain injury patient who complains p 07. In cases of excessive daytime sleepiness occurring directly secondary to head injury, a case may be made for a trial of either methylphenidate or modafinil. Insomnia may occur secondary to pain, or as part of depression, or exist independently (Beetar et al. Psychosis Psychosis, that is to say a condition characterized by delusions and/or hallucinations in the absence of delirium or dementia, is reported, albeit rarely, as a long-term sequela to traumatic brain injury (Fujii and Ahmed 2002; Sachdev et al. In the reported cases, latencies of 15 or more years are reported between the head injury and the gradual onset of the psychosis, and a family history of schizophrenia was found to be a significant risk factor (Sachdev et al. Given these findings, the argument may be made that the psychosis represents merely the coincidental occurrence of schizophrenia in a patient with a history of traumatic brain injury. Treatment involves use of an antipsychotic, preferably one of the better-tolerated second-generation agents, such as risperidone or quetiapine. Post-traumatic seizures Post-traumatic seizures may be defined as occurring early, during the first 7 days post-injury, or late, occurring at any time thereafter. Early seizures are reported in anywhere from 2 to 15 percent of cases, and are most likely to occur within the first 24 hours. Late seizures are seen in from 5 to 10 percent of cases, and in those destined to have a late seizure, the first one usually occurs within the first year post-injury (Mazzini et al. Several features increase the risk of occurrence of a late seizure, including the following: having an early seizure; the presence of contusions or intracerebral hemorrhages; intracranial operations; and dural penetration with bone or metal fragments (Englander et al.
However medications you can take while nursing cheap zupar 400/325 mg on line, a decoction or 80% ethanol extract of the dried roots had no effect (30) symptoms 8 days after iui discount zupar online mastercard. Treatment of scalded mice with suppressed immune functions with an aqueous extract of the whole plant (dose and route not specified) stimulated the immune response (32) medications with weight loss side effects zupar 400mg/325mg on-line. Nitric oxide synthesis inhibition induced by cadmium in mouse peritoneal macrophages stimulated with recombinant interferon- and lipopolysaccharide was counteracted by treatment of the cells with an aqueous extract of the whole plant medicine woman discount zupar online amex, 100 µg/ml. Treatment of primary cultures of rat astrocytes with an aqueous extract of the whole plant, 100. The treatment also decreased the production of interleukin-1 in astrocytes stimulated with lipopolysaccharide and substance P. Treatment of mouse peritoneal macrophages with an aqueous extract of the whole plant, 100 µg/ml, after treatment of the cells with recombinant interferon-, resulted in increased nitric oxide synthesis owing to an increase in the concentration of inducible nitric oxide synthase. In rats, the maximum tolerated dose of a 50% ethanol extract of the whole plant administered by the 378 Radix cum Herba Taraxaci intraperitoneal route was 500. No visible signs of toxicity were observed in rabbits after intragastric administration of the powdered whole plant at doses of 36 g/kg bw per day for up to 7 days (36). Adverse reactions Allergic reactions including anaphylaxis and pseudoallergic contact dermatitis have been reported (3740). Cross-reactivity has been reported in individuals with an allergy to the pollen of other members of the Asteraceae (41). Contraindications Radix cum Herba Taraxaci is contraindicated in obstruction of the biliary or intestinal tract, and acute gallbladder inflammation. In case of gallbladder disease, Radix cum Herba Taraxacum should only be used under the supervision of a health-care professional (2). Warnings May cause stomach hyperacidity, as with all drugs containing amaroids (2). Precautions Drug interactions A decrease in the maximum plasma concentration of ciprofloxacin was observed in rats treated with concomitant oral administration of 2. Carcinogenesis, mutagenesis, impairment of fertility No effects on fertility were observed in female rabbits or rats after intragastric administration of 1. Pregnancy: teratogenic effects No teratogenic or embryotoxic effects were observed in the offspring of rabbits or rats after intragastric administration of 1. Other precautions No information available on general precautions or on precautions concerning drug and laboratory test interactions; non-teratogenic effects in pregnancy; nursing mothers; or paediatric use. Posology (Unless otherwise indicated) Average daily dose: 34 g of cut or powdered whole plant three times; decoction, boil 34 g of whole plant in 150 ml of water; infusion, steep 1 tablespoonful of whole plant in 150 ml of water; 0. Scientific names of plants in English, French, German, Arabic and Persian languages. Inhibitory effect of edible plant extracts on 12-O-tetradecanoylphorbol-13-acetate-induced ear oedema in mice. The effects of various methanol and aqueous extracts of crude drugs on antiulcer activity. Effects of Portulaca oleracae (kulfa) and Taraxacum officinale (dhudhal) in normoglycaemic and alloxan-treated hyperglycaemic rabbits. Taraxacum officinale restores inhibition of nitric oxide production by cadmium in mouse peritoneal macrophages. Hypoglycemic activities of some indigenous medicinal plants traditionally used as antidiabetic drugs. Daisy, dandelion and thistle contact allergy in the photosensitivity dermatitis and actinic reticuloid syndrome. Allergic contact and photoallergic contact dermatitis to plant and pesticide allergens. Analysis of cross-reactivity between sunflower pollen and other pollens of the Compositae family. Description An aromatic perennial sub-shrub, 2030 cm in height, with ascending, quadrangular, greyish brown to purplish brown lignified and twisted stems bearing oblong-lanceolate to ovate-lanceolate greyish green leaves that are pubescent on the lower surface. The flowers have a pubescent calyx and a bilobate, pinkish or whitish, corolla and are borne in verticillasters.
Medical · Clotting disorders symptoms zoloft withdrawal buy 400/325 mg zupar, including use of warfarin or contraindications heparin medications 2015 generic zupar 400mg/325mg with mastercard. Some restrictions may be in place symptoms just before giving birth zupar 400mg/325mg low price, such as 12month waiting periods for travel from malaria endemic areas and Iraq (because of leishmaniasis) symptoms nasal polyps purchase genuine zupar on-line. The different blood groups are classified according to the antigens found on the surface of the red blood cells. People spontaneously develop antibodies (also called agglutinins) against antigens they lack. If the recipient receives a transfusion that is not correctly matched, the antibodies in the blood will attack the antigens in the transfused blood. There are about 50 Rh antigens, but the D antigen is most important because it can cause a systemic immune response in Rh (negative) individuals. People who are Rh- rarely have anti-D antibodies because they are not produced by contact with the environment. However, people can produce these antibodies in response to a sensitizing event, such as a pregnancy or transfusion with Rh + blood. If transfused with Rh+ blood, the Rh person could experience a transfusion reaction, but this rarely occurs because of blood typing. Rh typing Of bigger concern is the possibility of mother-fetus incompatibility, which occurs when the mother is Rh- and the father Rh+. During a second pregnancy, these antibodies pass to the baby, resulting in the fetal red blood cells agglutinating or bursting. Blood types are not distributed evenly among humans, and percentages vary according to country of origin. For example, B type blood worldwide accounts for about 16% of people but only 10% in the United States. At one time, type O was considered the "universal donor," but as researchers have learned more about the makeup of blood, using type O for other types of blood is no longer advised although it is sometimes done in emergency situations. Because of rare blood types, blood is usually labeled with the race of the donor so subsequent testing in which racial matching is required is easier. Blood donations are routinely tested for a number of different infective agents, including viruses, bacteria, and parasites. Most recently, blood banks began to test for Chagas disease because incidence is increasing in the United States. Testing for infective agents Blood that is infected or cannot be used is destroyed. Instead, whole blood is fractionated into components, such as red blood cells, white blood cells, platelets, and plasma. Plasma is further fractionated into a number of blood components, including albumin, gamma globulins, and clotting factors. There are a number of reasons for the movement away from whole blood and toward components: · Whole blood is more likely to carry disease. For example, one unit of whole blood can be divided into a unit or packed cells, a unit of platelets, and a unit of fresh frozen plasma. When blood is separated, the erythrocytes or red blood cells (about 40-50% of total volume) settle on the bottom, the leukocytes and platelets settle above the red blood cells in a band called the buffy coat, and the plasma (about 55% of total volume) settles at the top. Blood and blood components Whole blood Storage: Varies depending on intended use/separation. Washed blood cells must be used within 24 hours from the start of the washing procedure. Storage: Used as soon as possible but can be stored up to 24 hours at 20-24C without agitation. Uses: Stimulate graft-versus-disease-effect for treatment of leukemia after ablative and nonablative stem cell transplantation with apheresis of lymphoctyes from original stem cell donor to prevent treatment failure. Considerations: Lymphocytes may be collected and stored at the time of the original stem cell donation. Albumin (5%, Storage: Room temperature 20-25C with 25%) excursions to 15-30C permitted. Volume Blood is usually ordered in units, but the volume varies depending on the type of component. Packed red blood cells are typically about 350 mL and include approximately 150-210 mL of red blood cells, 100 mL of Optisol (a crystalloid solution that extends shelf life) and 30 mL plasma. Fresh frozen plasma is about 225 mL and contains plasma proteins, all coagulation factors, and complement.
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