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By Mohammed F. Shamji Queen's University Preceptor: None ABSTRACT Objectives: Assessing the demographic of adolescent organ donation decisions and examining associations between risk-taking and donation decisions. The goal is to determine optimal setting for transplantation medicine education. Hypotheses: Responsible risk-taking, such as contraceptive use, should associate with socially conscious attitudes about organ donation. Rebellious risk-taking, such as illegal drug use, implies less social obligation with neglect of such choices. Decisions, motivated by information, should parallel historical adult cohort increases. Methods: A confidential, self-administered questionnaire polled 300 students and young adults. Risky behaviours included illegal drug use, cigarette smoking, alcohol use, sexual activity, bike helmet and seatbelt use, and in-hospital violent injury treatment. Understanding of brain death legislation in Canada was assessed. Outcomes were consideration about donating organs, decision making, willingness to donate, and communication of decision to family. Results: Positive association was found with risk-taking behaviour and thoughts and decisions about organ donation, particularly with responsible activity. Illegal risk-taking is negatively associated with such consideration. Adolescent participation in the donor pool has significantly increased over the last decade with a disproportionately higher increase in communicating such wishes to family members. Interpretation: Responsible risk-takers accept consequences of their activity and choose socially conscious behaviour. Illegal behaviour manifests rebelliousness and commitment to beliefs of invincibility. The positive evolution of the adolescent donation demographic presumably results from education about donation process and transplant success. Education is paramount at this unstable period, and information directed donor pool enlargement must involve a setting isolated from other teachings that may elicit attitudes of rebellion. Introduction "If I consent [to organ donation], I have tacitly accepted that my body is an assemblage of replaceable parts, that my `self' is anatomically reducible to neural activity, and that when brain activity ceases, `I' no longer exist." Baer, 1997.
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3.2.3. Precision, accuracy and robustness Intra-assay and inter-assay precision was determined by testing six replicates during method validation ; and 10 replicates during routine analysis ; of blank plasma samples spiked with the control samples of the respective alkaloids. Precision expressed as %CV ; and accuracy expressed as R.E. ; results obtained in the method validation phase are shown in Table 2. In the routine phase, precision values %CV ; between assays for quality controls were below 12.4 for harmine, 11.1 for harmaline, 9.1 for THH, 3.5 for harmol and 5.9 for harmalol; and accuracy values %R.E. ; between 10 assays were below 6.9 for harmine, 9.0 for harmaline, 5.0 for THH, 10.4 for harmol and 5.4 for harmalol. 3.2.4. Estimation of limits of detection and quantification The LOQ was established as the lowest concentration values in the calibration curve with acceptable precision and accuracy, i.e. 0.5 ng ml for harmine, 0.3 ng ml for harmaline, 1.0 ng ml for THH, and 0.3 ng ml for harmol and harmalol. The limit of detection was 0.1 ng ml for harmine, harmaline, harmol and harmalol, and 0.3 ng ml for THH. 3.2.5. Stability study Freeze and thaw stability was assessed with two analyte concentrations for each alkaloid one high and one low ; in spiked plasma samples stored at 280 8C. The samples were subjected to three freeze and thaw cycles in three consecutive days. Concentrations determined in each cycle were within the method's accuracy , 10% ; except for harmaline, which showed a 16% variation in the third cycle. To test the stability of samples in the autosampler, three, for instance, is zanaflex a narcotic.
Second Line Tension Headache Abortive Medications 1. Butalbital compounds: Effective but habit forming. Fiorinal, Esgic, Esgic Plus, Fioricet, and Phrenilin are the primary butalbital compounds. Generic butalbital preparations do not work as well as brand names. Sedation or euphoria is common. Strict limits need to be set for daily and monthly use. If used daily, one or two is the usual limit. These should not be used daily unless preventive medications, and milder abortives, have failed. See "Butalbital Fiorinal ; Compounds" for ingredients of butalbital compounds. 2. Opioids: Codeine, hydrocodone, and propoxyphene are a last resort, and should be limited per month, and generally should not be used on a daily basis. These need to be discontinued if patients use them to alleviate stress, depression, fatigue or anxiety. Vicoprofen generic available ; combines 200 mg. ibuprofen with 7.5 mg. hydrocodone, and is generally more effective than Vicodin. Rebound and addiction are always a primary concern. 3. Sedatives: Most are benzodiazepines, such as diazepam Valium ; and clonazepam Klonopin ; . Sedation is common. Because they are habit forming, these need to be monitored with a monthly limit. They are a last resort, not a first choice. Addiction is always the major drawback. Also helpful for insomnia and anxiety. 4. Triptans: While triptans are generally utilized for migraine and cluster headaches, the triptans can be useful for tension headaches as well, particularly the more severe tension headaches. There are some patients who only do well with a triptan with any of their headaches. In migraine patients, triptans often work for their "lesser" headaches. We usually limit to 2 or days per week. 5. Muscle Relaxants: These are occasionally useful on a "prn" basis; the nonaddicting ones are preferred. These include orphenadrine Norflex ; , tizanidine Zanafled ; , cyclobenzaprine Flexeril ; , and Skelaxin. These may be combined with caffeine or nsaids. Sedation may be a problem. Zanaflex, 1 4, 1 or the 4 mg. tablets, is particularly useful. Skelaxin is mild but nonsedating. Norgesic Forte combines aspirin, caffeine, and orphenadrine; the usual dose is 1 2 every 4 hours prn, 2 in a day at most. Generic is available for all of these, except Skelaxin and adalat.
Yposis, and the prevention of relapses of this common disorder, is a subject of much debate among clinicians and researchers. In allergyrelated nasal polyposis, medical treatment is, in most cases, not sufficient, and surgical treatment for nasal polyposis is only partially successful.1-3 Better knowledge on the cause and pathogenesis of nasal polyposis is mandatory in the treatment of nasal polyps. The efficacy of systemic corticosteroids is well-known, 4 but these drugs are of limited use for pathologic conditions of the sinus, because of their serious adverse effects and their contraindications in such diseases as heart disease, hypertension, diabetes mellitus, obesity, and cataracts. The use of topical corticosteroids is considered by some to be the best treatment for the prevention of recurrence of nasal polyposis.5, 6 Systemic adverse ef.
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Post-traumatic stress disorder PTSD ; may arise as a delayed and or protracted response to a stressful situation of an exceptionally threatening or catastrophic nature that would be likely to cause pervasive distress in almost anyone, for example armed combat. PTSD is characterised by repeated reliving of the trauma in the form of intrusive memories, daytime imagery or dreams, occurring against a persistent background of a sense of numbness and emotional blunting. Detachment from others, anhedonia and avoidance of activities and situations reminiscent of the trauma are typical features. There may be evidence of autonomic hyperarousal with hypervigilance, an enhanced startle reaction and insomnia. Comorbidity is not uncommon, varying from anxiety and depression to excessive use of alcohol or drugs. Diagnostically, the disorder should usually arise within six months of the trauma. Lifetime prevalence figures are approximately 5% for males and 10% for females. Studies indicate that persons with untreated PTSD experience symptoms for a mean duration of five years.
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