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Z. Fedor, M.S., Ph.D.

Professor, Michigan State University College of Human Medicine

Treatment of trichomonas in pregnancy and adverse outcomes of pregnancy: a subanalysis of a randomized trial in Rakai, Uganda. Treatment of trichomoniasis in pregnancy and preterm birth: an observational study. Neonatal respiratory tract involvement by Trichomonas vaginalis: a case report and review of the literature. Reduced fluconazole susceptibility of Candida albicans isolates in women with recurrent vulvovaginal candidiasis: effects of long-term fluconazole therapy. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. Clinical, laparoscopic and microbiological findings in acute salpingitis: report on a United Kingdom cohort. Cost-effectiveness of alternative outpatient pelvic inflammatory disease treatment strategies. Randomized comparison of ampicillin-sulbactam to cefoxitin and doxycycline or clindamycin and gentamicin in the treatment of pelvic inflammatory disease or endometritis. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Effect of human immunodeficiency virus-1 infection on treatment outcome of acute salpingitis. Retention of intrauterine devices in women who acquire pelvic inflammatory disease: a systematic review. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Prevalence of anogenital warts among participants in private health plans in the United States, 20032010: potential impact of human papillomavirus vaccination. Possible mechanisms in the induction of vitiligolike hypopigmentation by topical imiquimod. Local and systemic adverse effects to topical imiquimod due to systemic immune stimulation. Delayed recognition of podophyllum toxicity in a patient receiving epidural morphine. Effect of specimen order on Chlamydia trachomatis and Neisseria gonorrhoeae test performance and adequacy of Papanicolaou smear. Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature. European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology. Confusion regarding cervical cancer screening and chlamydia screening among sexually active young women. Updates on human papillomavirus and genital warts and counseling messages from the 2010 Sexually Transmitted Diseases Treatment Guidelines. Pap smear versus speculum examination: can we teach providers to educate patients? The psychosocial burden of human papillomavirus related disease and screening interventions. Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis. Transmission of hepatitis B to chimpanzees by hepatitis B surface antigen-positive saliva and semen. A mathematical model to estimate global hepatitis B disease burden and vaccination impact. Observational study of vaccine efficacy 24 years after the start of hepatitis B vaccination in two Gambian villages: no need for a booster dose. The evaluation of children in the primary care setting when sexual abuse is suspected.

The herbal medicines side of things was, however, not something that we were particularly familiar with, and we were greatly relieved to be approached by Elizabeth Williamson, with a very similar idea to our own, but with a wealth of knowledge on herbal medicines with which to guide us. Liz is widely published in the field of herbal medicines, and is a member of a number of bodies that consider many aspects of herbal medicine use, such as the British Pharmacopoeia Commission. Herbal medicines are, more than ever, receiving attention, both from the public and healthcare professionals alike, with many countries now undertaking registration schemes for traditional medicines. However, healthcare professionals still freely admit their lack of knowledge in this area, and surveys suggest that patients often rely on friends and family for advice about herbal medicines. Our aim, as ever, has therefore been to critically evaluate the published literature and present it in a familiar, easy-tohandle format, so that the busy healthcare professional can quickly access the information and apply it to their clinical situation. Are the drugs and substances in question known to interact or is the interaction only theoretical and speculative? Is it best to avoid these two substances altogether or can the interaction be accommodated in some way? A pharmacopoeia section is also included for those herbal medicines, dietary supplements and nutraceuticals that have entries in the latest editions (at time of press) of the British Pharmacopoeia, the European Pharmacopoeia and the United States Pharmacopoeia. An indication of the constituents that the herbal medicine may be standardised for is also provided where necessary, but note that this does not necessarily mean that all marketed products are standardised in this way. Terminology has been carefully considered and international terms have been added where it was thought helpful to do so. This and the inclusion of the synonyms and pharmacopoeia sections will, we hope, cater for the needs of healthcare professionals around the world. As always, the Editorial team have had assistance from many other people in developing this publication, and the Editors gratefully acknowledge the assistance and guidance that they have provided. Particular thanks are also due to the editor of Martindale, Sean Sweetman, who has acted as our mentor on a number of other projects, and continues to provide invaluable support. Thanks are also due to Tamsin Cousins, who has handled the various aspects of producing this publication in print. Ivan Stockley remains an important part of all products bearing his name, and we are most grateful for the feedback that he provided on this new project. Before using this publication it is advisable to read this short explanatory section so that you know how the drug interaction data have been set out here, and why, as well as the basic philosophy that has been followed in presenting it. Clinical evidence, detailing the interaction and citing the clinical evidence currently available. Due to the nature of interactions with herbal medicines much of the data currently available comes from animal and in vitro studies. It has been deliberately kept separate from the clinical data, because this type of data is a better guide to predicting outcomes in practice. As with all Stockley products, providing guidance on how to manage an interaction is our key aim. Some of the monographs have been compressed into fewer subsections instead of the more usual five, simply where information is limited or where there is little need to be more expansive. Reading the Importance and management section will explain which members of the groups are most likely to represent a problem. Action: this describes whether or not any action needs to be taken to accommodate the interaction. Severity: this describes the likely effect of an unmanaged interaction on the patient. These ratings are combined to produce one of five symbols: For interactions that have a life-threatening outcome, or where concurrent use is considered to be best avoided. For interactions where concurrent use may result in a significant hazard to the patient and so dosage adjustment or close monitoring is needed. The monographs this publication includes over 150 herbal medicines, nutraceuticals or dietary supplements. For each of these products there is an introductory section, which includes the following sections where appropriate. The synonyms, constituents and uses have largely been compiled with reference to a number of standard sources. We have therefore adopted one name for each herbal medicine that is used consistently throughout the monograph, and indeed across the publication. However, we are aware that we will not always have selected the most appropriate name for some countries and have therefore included a synonyms field to aid users who know the plant by different names.

Plantaginis ovatae testa (Blond Psyllium). Meldonium.

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Immunodeficiency associated with other congenital conditions: Down syndrome Shwachman syndrome Secondary Immunodeficiency: Malnutrition. Metabolic problems such as diabetes mellitus, uremia, vitamin and mineral deficiency. Only the more common primary immune deficiency syndromes will be emphasized in this chapter. All infants develops physiologic hypogammaglobulinemia at approximately 5-6 months of age. However the intrinsic defects of B cells, diminished T helper cells and dysregulation of cytokines have been described. A patient with borderline immunoglobulin levels needs an evaluation of specific antibody responses with immunizations. Some patients may have abnormal T cell function studies such as absent delayed hypersensitivity or depressed responses of mitogen stimulation. There are associated abnormalities including neutropenia, hemolytic anemia and aplastic anemia. Pneumocystis carinii infection has an important impact on morbidity and mortality during the first years of life, whereas liver disease mainly contributes to late mortality. Selective IgA deficiency is the most common primary immunodeficiency disorder with the prevalence between 1 in 400 to 1 in 800. The physiologic lag in serum IgA may delay the diagnosis until after the age of 2. Aggressive treatment with broad spectrum antibiotics is recommended for recurrent sinopulmonary infections to avoid permanent pulmonary complications. Some selective IgA deficiency patients may develop antibody to IgA, in which case, there is a risk of anaphylaxis with blood product transfusions. Selective IgG subclass deficiencies are generally defined as a serum IgG subclass concentration that is at least 2 standard deviations below the normal for age. The subclass deficiency has been reported in patients with recurrent infections, despite normal total IgG serum or with an associated deficiency of IgA and IgM deficiency. The diagnosis and its implication have long been problematic since there are insufficient normative data for very young children and major technical problems of measurement of IgG subclass. Additionally, normal healthy children with low IgG2 subclass levels and normal responses to polysaccharide antigens as well as completely asymptomatic individuals with lacking IgG1, IgG2, IgG4 have been reported. A low value of IgG2 in a child may be a temporary finding which normalizes in adulthood. IgG3 levels may be low with an active infection because it has the shortest half life and the greatest susceptibility to proteolytic degradation. Immunoglobulin and antibody production are severely impaired even when mature B cells are present. The majority of the patients present by age 3 months with unusually severe and frequent common infections such as bacterial otitis media and pneumonia or opportunistic infections including Pneumocystis carinii, and cryptosporidiosis. A positive response to these intradermal antigens indicates intact T cell function. Patients who are well nourished, uninfected and younger than 6 months prior to transplantation have the best outcomes. Complement deficiency: Complement proteins are a key component of the innate immune system due to their function of direct lysis of their targets and being an opsonin. Most of the complement deficiency diseases are inherited in an autosomal recessive mode except C1 inhibitor deficiency (autosomal dominant) and properdin deficiency (X-linked). There is no specific treatment for complement deficiency, except a purified C1 inhibitor preparation for hereditary angioedema due to C1 inhibitor deficiency. This protein is involved in the reorganization of the actin cytoskeleton in the cells. The initial manifestations often present at birth and consist of petechiae, bruises, bleeding from circumcision or bloody stools. The diagnosis can be made based on the manifestations and immunologic findings including low IgM, high IgA and IgE, poor antibody responses to polysaccharide antigens, moderately reduced number of T cells and variable depression of in vitro T cell function studies. Immunologic studies reveal combine immunodeficiency consisting of selective IgA and IgG2 deficiency, cutaneous anergy and depression of in vitro T cell function study.

Morphological and biometrical features of Trypanosoma evansi isolates from an outbreak in mainland Spain. This handout includes information gathered by rabbit lovers and rabbit doctors to help your rabbit have a happy, healthy, long life. Thus it is not safe for rabbits to be left unsupervised with a dog or cat, or allowed outdoors in an unsecured enclosure. As cute as those little fluffy baby bunnies are in the pet store, they are at a high risk for getting sick. Baby bunnies in pet stores are exposed to a lot of germs at an age when they are most susceptible to illness. If you obtain a baby bunny from a breeder, there may be less exposure to germs, but the young bunny will still be at an age wherein it has a higher risk of getting sick due to stress. Baby bunnies are very cute, but young adult bunnies are still extremely adorable, they will easily bond with you, and will run and play for many more years to come. The bunny will be under a great deal of stress with changing homes, so allow the bunny to get used to its new surroundings with as little stress as possible in order to avoid illness. Making your bunny a house rabbit will help to create a special bond between you and your bunny. Rabbits make terrific house pets, and can be kept in a similar manner as we would keep an indoor cat. While there are many cages available at pet stores, they are truly too small to house an average sized bunny. Since cages are so limiting, a better purchase would be a pen, called a dog exercise pen or x-pen. Pens give your bunny a lot more room when he has to be caged, and easily allows bunny to come out to play. This allows the rabbit to feel secure in its new home, because it knows where to run to be safe and it can approach you and meet you as it would a friend. One rabbit, living alone in an outdoor hutch, will feel like he is in jail, in solitary confinement. In addition to the mental and emotional hardships, outdoor rabbits are exposed to extremes of heat and cold, which may kill them. If your rabbit must live outdoors, give it a bunny friend (see Bonding section) and provide them with shade, a wooden hide box filled with hay for protection from the elements, ice-free water in the winter, a frozen 2-liter bottle of water to help them stay cool in the summer, and fresh food. Make sure your rabbit has a very large cage, and take it out of the cage frequently for exercise and attention If you get a cage with a wire bottom, give the bunny something to stand on like a piece of wood, grass matt, carpet, or a towel or synthetic fleece. If your rabbit chews excessively on the towel or carpet, remove it to avoid an obstruction in the digestive tract. Make wires inaccessible (place wires behind furniture, attach wires to the wall out of bunny reach, or cover wires with plastic tubing from the hardware store). Since bunnies are so social, keep them in an area in which you spend most of your time. Be aware that an extremely busy and noisy area may be too stressful for some rabbits. When rabbits share our homes, their personality will blossom and you will enjoy a rewarding relationship with an adorable critter that is smarter than you think! You can put urine-soaked litter and poops in the litter boxes, but the best thing to entice bunnies to hang out in their litter boxes is to place hay in the litter box. Place about an inch of rabbit safe litter in the box and cover with a generous handful of hay. Changing litter often and providing a clean living area encourages bunnies to use their litter boxes. Plain green pellets are higher in fiber o If pellets have a pungent odor that does not smell like hay, they may be rancid and should be discarded. The two easy things you can do to keep your rabbit healthy: give your bunny a loving and low- stress environment, and feed it lots of grass hay. If the environment changes in the digestive tract, (for example, more acidic) the good bacteria die and bad bacteria proliferate and cause illness and death.