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http://projects.csail.mit.edu/courseware/?term=titanic-film-review-essay titanic film review essay The national cancer institute (nci) has provided a standardized system for evaluating and grading the toxicity from chemotherapy to provide uniform grading of toxicity and evaluation of new agents and new regimens (table 88–5). Combination chemotherapy the underlying principles of using combination therapy are to use (1) agents with different pharmacologic actions, (2) agents with different organ toxicities, (3) agents that are active against the tumor and ideally synergistic when used together, and (4) agents that do not result in significant drug interactions (although these can be studied carefully and the interactions addressed). When two or more agents are used together, the risk of development of resistance may be lessened, but toxicity may be increased. Traditional chemotherapy agents have some similar side effects, usually manifested on the most rapidly proliferating cells of the body. However, there are unique toxicities of various pharmacologic categories of antineoplastic agents. Anthracyclines (eg, doxorubicin) have the potential to cause cardiac toxicity, which is related to the cumulative dose. Microtubule-targeting agents (eg, vincristine) are associated with various forms of 1296  section 16  |  oncologic disorders table 88–4  performance status scales description. Karnofsky scale karnofsky scale (%) zubrod scale (ecog) description.

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http://projects.csail.mit.edu/courseware/?term=value-of-nature-essay value of nature essay Activation of the compensatory mechanisms occurs in an effort to increase co and preserve blood flow to vital organs. However, the increase in preload and afterload in the setting of a failing ventricle leads to elevated filling pressures and further impairment of cardiac function, which manifests as systemic and/or pulmonary congestion. It is important to remember that congestion develops behind the failing ventricle, caused by the inability of that ventricle to eject the blood that it receives from the atria and venous return. As such, signs and symptoms may be classified as left sided or right sided. Symptoms of left-sided hf include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (pnd), whereas symptoms of right-sided hf include fluid retention, gastrointestinal (gi) bloating, and fatigue. Although most patients initially have left ventricular failure (lvf. Pulmonary congestion), the ventricles share a septal wall. Because lvf increases the workload of the right ventricle, both ventricles eventually fail and contribute to the hf syndrome. Because of the complex nature of this syndrome, it has become exceedingly more difficult to attribute a specific sign or symptom as caused by either rvf (systemic congestion) or lvf. Therefore, the numerous signs and symptoms associated with this disorder are collectively attributed to hf rather than to dysfunction of a specific ventricle. General signs and symptoms refer to the clinical presentation and diagnosis of chronic heart failure textbox for a description of signs and symptoms. It is important to note that in chronic severe hf, unintentional weight loss can occur that leads to a syndrome of cardiac 70  section 1  |  cardiovascular disorders cachexia, defined as a nonedematous weight loss more than 6% of the previous normal weight over a period of at least 6 months. Hf prognosis worsens considerably once cardiac cachexia has been diagnosed, regardless of hf severity. This results from several factors including loss of appetite, malabsorption due to gi edema, elevated metabolic rate, and elevated levels of norepinephrine and proinflammatory cytokines. Absorption of fats is especially affected, leading to deficiencies of fat-soluble vitamins. Patients can experience a variety of symptoms related to buildup of fluid. The most recognized finding of systemic venous congestion related to rvf is peripheral edema. It usually occurs in dependent areas of the body, such as the ankles (pedal edema) for ambulatory patients or the sacral region for bedridden patients. Patients may complain of swelling of their feet and ankles, which can extend up to their calves or thighs. Abdominal congestion may cause a bloated feeling, abdominal pain, early satiety, nausea, anorexia, and constipation. Often patients may have difficulty fitting into their shoes or pants due to edema. Weight gain often precedes signs of overt peripheral edema. Therefore, it is crucial for patients to weigh themselves daily even in the absence of symptoms to assess fluid status. A clinically validated measure of venous congestion is assessment of the jugular venous pressure (jvp). This is performed by examining the right internal jugular vein for distention or elevation of the pulsation while reclining at a 45-degree angle. A jvp more than 4 cm above the sternal angle is indicative of elevated right atrial pressure. Jvp may be normal at rest, but if application of pressure to the abdomen can elicit a sustained elevation of jvp, this is defined as hepatojugular reflux (hjr).

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movie evaluation essay 3,30 placental buy viagra spray online transmission and blood transfusions are also sources of malaria. Pathophysiology within minutes after the bite of the anopheles mosquito, the sporozoites invade hepatocytes and begin an asexual phase called schizonts (exoerythrocytic stage or schizogony). The patient may be asymptomatic during this period. After a lapse of between 5 and 15 days (depending on the species), schizonts rupture to release daughter cells (merozoites) into the blood, which then invade erythrocytes. In erythrocytes, the merozoites undergo a number of sequential forms. A ring form, trophozoite, schizont, and merozoite, which then invade new erythrocytes. This asexual phase is about 48 hours for p. Falciparum, p. Vivax, and p. Ovale, and 72 hours for p. Malariae. Subsequently, the merozoites develop into gametocytes and undergo a sexual phase (sporogony) in the anopheles mosquito. In the mosquito, the gametocytes undergo a number of stages.

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http://www.cs.odu.edu/~iat/papers/?autumn=need-help-essay-paper need help essay paper This page intentionally left blank section 15 diseases of infectious origin 69 antimicrobial regimen selection buy viagra spray online catherine m. Oliphant learning objectives upon completion of the chapter, the reader will be able to. 1. Recognize that antimicrobial resistance is an inevitable consequence of antimicrobial therapy. 2. Describe how antimicrobials differ from other drug classes in terms of their effects on individual patients as well as on society as a whole. 3. Identify two guiding principles to consider when treating patients with antimicrobials, and apply these principles in patient care. 4. Differentiate between microbial colonization and infection based on patient history, physical examination, and laboratory and culture results. 5. Evaluate and apply at least six major drug-specific considerations when selecting antimicrobial therapy. 6. Evaluate and apply at least seven major patient-specific considerations when selecting antimicrobial therapy. 7. Select empirical antimicrobial therapy based on spectrum-of-activity considerations that provide a measured response proportional to the severity of illness. Provide a rationale for why a measured response in antimicrobial selection is appropriate.

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