By E. Murat. Transylvania University.
Eg how do you feel about yourself generic 30 mg priligy with visa, have you blamed yourself for things buy 60mg priligy, do you feel guilty? Key difference between grief and depression is whether they themselves feel worthless or not Also review risk factors: Prior history of major depressive episode or suicide attempt 30mg priligy mastercard. Previous episode 50% lifetime risk of recurrence Family history of mood disorder or suicide attempts. Its usually multifactorial regardless of cause may well need a multi-factorial approach to management Subgroups Subgroup Essential Features Implications Psychotic Depression Hallucinations and/or delusions More likely to become bipolar than non-psychotic types (esp under 25s). May be misdiagnosed as schizophrenia Melancholic Depression Loss of pleasure and lower mood Indicative of more severe (typically in morning), marked depression. Maybe misdiagnosed as agitation, significant weight dementia if cognitive impairment changes and inappropriate guilt or psychomotor retardation are prominent Atypical Depression Various: overeating, oversleeping, Common in younger people. May weight gain, mood still reactive to be misdiagnosed as a personality events, anxiety symptoms, disorder. Summer episodes may also occur Epidemiology and Aetiology Lifetime risk of depression in women is 20% Female: Male is 2:1, but in younger cohorts an in male depression is bringing the ratio down to 1. This is not an artefact of help-seeking behaviour Rate is increasing Variety of theories: Biological (eg neurotransmitter dysfunction) Freud: unresolved early childhood events resurrected by similar events in later life Bent (? Can be used to monitor progression of treatment and relapse Assess duration: (> 6 months, > 24 months) Refer to specialist services when: There is serious risk of suicide (or harm to others, especially younger children) th th 428 4 and 5 Year Notes The child is under the age of 13 years There are psychotic symptoms or bipolar disorder (depressed phase) The diagnosis is unclear and needs further evaluation Melancholic features are so severe that they are unable to look after themselves and have inadequate community support There are complex problems (eg poor relationship, another psychiatric disorder) Considering enhancing antidepressants with mood stabilisers (eg lithium) Failure to respond to recommended treatment within 12 weeks Treatment of Major Depressive Disorder Fundamental to treatment is: Establishing positive therapeutic relationship Developing shared understanding of problems Safety: suicide risks common (lifetime risk 25 50%). Some retrograde loss may be permanent Response is proportional to length and quality of seizure. These factors compounded by indices of socio-economic adversity, which are risk factors for these outcomes and for depression. If used in isolation without a mood stabiliser, may precipitate a manic phase as the depression lifts Can be very stressful on relationships for family members Lithium Indication: In bipolar, but also recurrent unipolar. Not good for acute mania takes 2 4 weeks, full response may take 6 months Pharmacokinetics: Variable absorption. Care if suicidal (overdose risk), mania, and variety of medical conditions th th 432 4 and 5 Year Notes Pharmacokinetics: Very low Vd dialysing for overdose ineffective Long T once a day dose possible, but may split dose to reduce the dose dependent anti Ach effects st Well absorbed. In correct dose is as effective as imipramine and significantly better than placebo. Typically 2 or 3 person auditory hallucinations Delusions: fixed false beliefs out of cultural context Thought disorder: loss of syntax, non-linear. Different to confusion or incoherence Bizarre and/or disorganised behaviour: eg aggressive, disinhibited, violent (often in self- defence if paranoid - rare but possible). Dont try to pull the wool over their eyes Alogia: poverty of speech or speech content Affective flattening: including reduced intensity of emotional response Anhedonia: dont care about their lack of interest, cf depression where they want to enjoy themselves but cant Asociality - uninterested in the company of others, unresponsiveness, withdrawal Prodrome = gradual change prior to first episode of frank psychosis. Important given stage of life (adolescence) and the potential problems for subsequent social and occupational development etc Treatment programme involving health professionals, family members, support agencies, and cultural/community context Brains ability to process and interpret information is affected think carefully about how information conveyed is received. Usually months or years after treatment Fairly common: 15 30% Slow, repetitive involuntary movements of mouth/face, and maybe limbs and trunk. Effective for negative side effects and also affective symptoms (depression, anxiety). Course 6 8 years ( may die of something else first) If < 65 then Alzheimers disease, if > 65 then Senile dementia, Alzheimers type Clinical diagnosis. Contain abnormal form of the protein tau th th 440 4 and 5 Year Notes Senile plaques: extracellular intracortical spherical clusters of dilated axons and dendrites surrounding a spherical deposit of amyloid fibrils (amyloid beta peptide). There are lots in Alzheimers Amyloid angiopathy Granulovacuolar degeneration: clear intraneuronal cytoplasmic vacuoles Pathogenesis: ? Accumulation of amyloid beta protein, with failure to exocytose the protein Apoe4 allele is a marker for Alzheimers but is not yet recognised as a screening or diagnostic tool Vascular: 20%. M > F Caused by discrete infarcts (ie multi-infarct dementia) but also small vessel disease (eg cerebral arteriolar sclerosis from chronic hypertension) Presentation: Often impaired attention and frontal features, emotional lability Multiple subcortical white matter injury Binswanger disease (damage to association fibres) Defuse Lewy Body Dementia: 20%: Often associated Parkinsonian features (rigidity, tremor and bradykinesia) less tremour but trunkal rigidity Can have fluctuating attention and visual hallucinations (so like delirium) Very sensitive to anti-psychotics. A small dose can profound tranquilliser effect Picks Disease: Much less common, but similarities with Alzheimers. Differences are early onset of personality, behavioural changes and language impairment. Microscopically, surviving neurons show ballooning degeneration (Picks cells) and Picks bodies (filamentous intracytoplasmic inclusions). Prion causes conformational change from a -helix to a -pleated sheet chain reaction neuronal death Can be transferred via pituitary extracts, dural grafts, etc 15% of cases familial No macroscopic changes. Progressive decline following single trauma suggests another problem (eg hydrocephalus or major depressive episode) Psychological Medicine 441 Management Fatigue and stress result from: Poor concentration, impaired executive function and memory due to injury Sleep requirements increase, but patients try and do the same amount as before No knowledge about what to expect (both patients and families) Fatigue + stress frustration, anxiety and depression. So reduce factors leading to fatigue and stress Management focuses on: Education Proper assessment of cognitive deficits by a psychologist (eg cognitive testing = neuropsychological testing) Support from informed family, friends and employers Regular breaks/sleeps. Take things in small bites and structure day around these Teach relaxation methods Compensating for cognitive losses: structured day (ability to plan), lists, diaries Continual reassurance Medication: Use for depression if symptoms do not resolve with counselling and support. Maori and Pacific Islanders may be more sensitive so lower dose initially Lorazepam (short acting benzo) 0. If find something on tests this validates and reinforces the worry Processes contributing to symptoms and motivation for symptom production is unconscious. Require evidence of substance use and are not related to pre- existing problems Abuse vs. Verification of sample source is important minimise the risk of substitution (eg giving you someone elses urine sample). Requires long term follow-up and behaviour modification (as with diabetes and hypertension) Often unsympathetic response because addiction is perceived as self-afflicted: but there are numerous involuntary components in the addictive process. Success rates are comparable with other chronic diseases Treatment is cost-effective Issues In Treatment Compliance with treatment. Seen in over of long term alcoholics at post-mortem Ventricular dilation, widening of the cerebral and cerebellar sulci No specific cortical changes have been described. No hypnotic, anxiolytic or antidepressant effects For non-drug treatment, see Treatment of Substance Abuse, page 448 Alcohol Withdrawal Most common drug withdrawal state. Can be life threatening (unlike opioid withdrawal) Detoxification is only the first step in treatment Aetiology of alcohol withdrawal syndrome poorly understood Features of withdrawal: A spectrum. Alcohol metabolised at 20 mg/dl/hour (4 mmol/L/hour) can predict when it will reach zero Previous withdrawal severity good indicator of likely current severity. Likely to occur early in withdrawal, especially if history of seizures with previous withdrawal th th 452 4 and 5 Year Notes Other Disorders Eating Disorders History Questions Do you worry about how much you weigh? Anorexia Nervosa Low weight not due to other illness Persistent refusal to maintain weight (cf depression dont want to eat). The new mental disorder on the block Epidemiology: 1 3 % of population are pathological gamblers. There are no longer stereotypical groups young and women also now affected Maori 3 times more likely, Pacific Islanders 6 times more likely (heavy socio-economic confounding) 2/3 of presenting problem gamblers are under 30.
Journal of Clinical Endocrinology & Metabolism Giuberti A cheap 60mg priligy visa, Picozzi S C generic priligy 90 mg visa, Mazza L et al generic 90 mg priligy overnight delivery. Control of penile erection by the melanocortinergic cancer randomly assigned to hormonal medication or system: Experimental evidences and therapeutic perspectives. Visually sildenafil for the treatment of erectile dysfunction in spinal cord stimulated erection in castrated men. Eur J Med Res Quality of Life Aspects of Treatment, Care & Rehabilitation 2002;7(10):435-446. Revisiting erectile dysfunction in cardiovascular levels in psychogenic impotence. Delayed diagnosis of psychological erectile dysfunction because of the presence of Hatzimouratidis K, Hatzichristou D. Fluoxetine and premature ejaculation: a double-blind, crossover, placebo- Hellstrom W J G, Kendirci M. Int J Impot Res 2006;18(3):287 Hellstrom Wayne J G, Egan Robert A, McGee Hall T 295. Comparative results of goal oriented therapy for Hemodynamic effects of sildenafil in men with severe erectile dysfunction. Treatment once daily: effect on sexual function in patients with lower program for erectile dysfunction in patients with urinary tract symptoms suggestive of benign prostatic cardiovascular diseases. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with Jackson G. Effects of levodopa on confidence in treating erectile dysfunction in the nocturnal penile tumescence: a preliminary study. Phosphodiesterase 5 inhibition: Effects on Howes O D, Wheeler M J, Pilowsky L S et al. Int J Clin Pract and gonadal hormones in patients taking antipsychotic treatment 2001;55(3):183-188. The metabolic syndrome and erectile dysfunction: multiple vascular risk factors and Howes Oliver D, Smith Shubulade, Aitchison Kathy J E. Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non- James J S. Correlation between voiding and erectile function in patients with symptomatic benign Jani A B. Adenosine: a new arteries in papaverine-induced erection with color Doppler agent in the diagnosis of impotence. A placebo-controlled, double-blind trial of Ginkgo biloba for antidepressant-induced Kim N N, Dhir V, Azadzoi K M et al. Risk factors for an early increase in dose of vasoactive agents for Kaufman J M, Hatzichristou D G, Mulhall J P et al. Urol Int and chronic renal failure: a study of the hemodynamic 2000;65(4):204-207. Curr of vardena fi l dose from 10 mg to 20 mg improved Opin Investig Drugs 2001;2(4):545-549. The aetiology, system, doxazosin standard and placebo in patients pathogenesis and management of priapism. Efficacy of calcium channel blocker induced smooth muscle relaxation extended-release doxazosin and doxazosin standard in using a model of isolated corpus cavernosum. Br J Urol patients with concomitant benign prostatic hyperplasia 1993;150(1):249-252. Journal of the pharmacodynamic and interaction study with intravenous European Academy of Dermatology & Venereology nitroglycerine in healthy male subjects. Erectile dysfunction in the levels and adverse events in patients treated with Africa/Middle East Region: Epidemiology and experience with risperidone. Venlafaxine extended release for the treatment of patients with premature ejaculation: a pilot, Kloner R A, Brindis R G, Cheitlin M D et al. J Am Prevalence of sexual disorders in those young males Coll Cardiol 2003;42(10):1855-1860. Br J Erectile vascular dysfunction and analysis of the risk Urol 2004;172(5:Pt 1):t-40. Effectiveness of oral L- arginine in first-line treatment of erectile dysfunction in a Labbate Lawrence A. A Randomized Open- Label Study of the Impact of Quetiapine Versus Risperidone on Labbate Lawrence A, Croft Harry A, Oleshansky Sexual Functioning. Antidepressant-Related Erectile Dysfunction: Management via Avoidance, Switching Knoll L D, Benson R C, Bilhartz D L et al. Hillside J Clin Psychiatry pentoxifylline in the management of vasculogenic impotence. Adult-onset Sexual dysfunction induced by serotonin reuptake idiopathic hypogonadotropic hypogonadism presented with antidepressants. Current treatment options for benign in saliva in a population-based survey of lifestyle, medical prostatic hyperplasia and their impact on sexual conditions, marriage, sex life and hormone status in aging men: function. Sexual dysfunctions and dysfunction after kidney transplantation: our 22 years blood hormonal profile in men with focal epilepsy. Journal of Molecular & Cellular Cardiology life in men with erectile dysfunction: Results from the 2004;36(2):165-173. Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type Laumann Edward O, West Suzanne, Glasser Dale et impotence? Oral medications in the relationship between sex hormones and erectile dysfunction? Acta Endocrinol experience with testosterone replacement and vacuum (Copenh) 1993;128(4):301-307. The role of androgen deprivation therapy combined in males following rectal excision for benign and with prostate brachytherapy. Intracavernous prostaglandin E1 discontinuing intracavernous injection therapy with in erectile dysfunction. The role of the medical andrologist in the assisted dysfunction in men with diabetes. Clinical Sexual dysfunction in hypertensive patients treated Pharmacology & Therapeutics 2004;76(4):365-370. Can Pharm J dysfunction and premature ejaculation: An evaluation 2005;274(7334):109 of men presenting with erectile difficulty at a sex therapy clinic. The prospective and randomized control study of Viagra combined with Li J Y, Li X Y, Li M et al. Minimally invasive prosthetic surgery in the treatment of erectile therapies in the treatment of erectile dysfunction in dysfunction. A retrospective study of 45 impotent anticoagulated cases: a study of satisfaction and safety.
A Canadian national sur- ventions discount 90mg priligy free shipping, which include physical activity discount priligy 30 mg amex, healthy nutrition and veillance study demonstrated a minimum incidence of type 2 dia- mental health supports have been shown to result in a modest betes in children and adolescents <18 years of age of 1 purchase line priligy. The most effective interventions were those observed with the highest minimum incidence seen in Manitoba delivered by a specialized interdisciplinary team that included group of 12. In adolescents with obesity insulin resistance, the screening ecacy of A1C improved to 99% and evidence of severe insulin resistance, pharmacological therapy sensitivity and 96% specicity (38). The use of A1C as a screening test for pediatric of a supervised clinical trial (1719). The long-term effectiveness of bariatric be done in those in whom there is a discrepancy between the A1C surgery remains unknown. Testing for diabetes autoantibodies should be consid- in children at high risk for type 2 diabetes in order to prevent an ered in all children and adolescents with a clinical diagnosis of type 2 acute, life-threatening presentation and to decrease the develop- diabetes because of evidence that up to 10% to 20% of these chil- ment of chronic complications. In addition, the absence of islet autoan- related short- and long-term complications (21). Fasting insulin levels are not helpful at diagnosis, as levels include a history of type 2 diabetes in a rst- or second-degree rela- may be low due to glucose toxicity (46). Neuropsychiatric disorders and the use Management of neuropsychiatric medications are more common in children with obesity and type 2 diabetes compared to the general pediatric Children with type 2 diabetes should receive care in conjunc- population (34). In children of Aboriginal, Cauca- for most children with type 2 diabetes should be 7. Thus, consideration should be given the rst 6 months of diagnosis may reduce the risk of treatment for screening at a younger age in those at high risk (2). A glycated hemoglo- A recent quality improvement initiative using anonymized data bin (A1C) 6. Type 2 diabetes remission rates were reported ciated with a signicantly attenuated 5-year increase in A1C among to range from 68% to 100% following vertical sleeve gastrectomy and adolescents with type 2 diabetes (53). Thus, it is reasonable to rec- from 79% to 94% following Roux-en-Y gastric bypass (61). While these ommend (in the absence of direct evidence for this population ) remission rates are high, the potential benet must be balanced that children with type 2 diabetes strive to achieve the same activ- against potential risks of intra-, peri- and post-operative compli- ity level recommended for children in general (i. Titra- tion increments may be reduced to 250 mg if there are gastroin- The recommendations for inuenza and pneumococcal testinal side effects. The study population Complications included youth 10 to 17 years of age with a mean diabetes dura- tion of 7. Serious adverse events thought to be related to study at onset of type 2 diabetes (7173). Given atrics often requires more aggressive uid resuscitation with delayed the concerns raised around the long-term safety of rosiglitazone insulin administration at a lower dose and careful replacement of since the start of this trial, it is premature to recommend its routine potassium, phosphate and magnesium (74). Peripheral nerve liraglutide was well tolerated in youth with type 2 diabetes, with abnormalities were detected in 1 in 5 youth with type 2 diabetes safety, tolerability and pharmacokinetic proles similar to pro- in 1 study, with more than half having autonomic neuropathy after les in adults (60). In the absence of longitudinal data on the signicance nopathy within 2 to 8 years of diagnosis, but none had macular of these changes, it would be premature to recommend routine edema, advanced nonproliferative retinopathy or proliferative reti- echocardiography. These ndings suggest that screening at diagnosis and yearly and death (11%), as early as in their 40s (80). Therefore, screening for these com- inactivity) must be promoted in this vulnerable population. Comorbid Conditions Furthermore, Aboriginal youth in Canada are at increased risk of renal diseases that are not associated with diabetes (78). Thus, screening for dyslipidemia at diagnosis and yearly thereafter is recommended (Table 1). In chil- Children with type 2 diabetes may already display cardiac struc- dren with familial dyslipidemia and a positive family history of early ture abnormalities. Children with obesity should receive intensive healthy behaviour inter- race/ethnicity were not. Notably, males had 87% higher risk of ventions that incorporate family-oriented counselling and behaviour therapy to reduce the risk of diabetes [Grade D, Level 4 (9)]. Screening for type 2 diabetes should be considered every 2 years using a sion and/or microalbuminuria, 38. This would and adolescents with any of the following conditions: suggest that management of hypertension in these youth may be a. Risk challenging and referral to a pediatric nephrologist should be con- factors include: sidered. First-degree relative with type 2 diabetes and/or exposure to obesity and 73% have clinical evidence of insulin resistance as mani- hyperglycemia in utero [Grade D, Level 4 (2)] fested by acanthosis nigricans (2), surveillance should occur for iv. Use of atypical antipsychotic medications [Grade C, Level 3 (3133)] children and youth at diagnosis of type 2 diabetes (2). A small study among youth with type 2 diabetes suggests that the prevalence may 6. Regular physical activity, consisting of 60 minutes of moderate-to- be even higher in this population than in obese youth without dia- vigorous physical activity daily, should be recommended to all children with type 2 diabetes [Grade B, Level 2 (93)]. There were no differences in the prevalence of and no/minimal symptoms), metformin should be initiated in conjunc- depressive symptoms across ethnic groups. Depression scores were tion with healthy behaviour interventions [Grade D, Consensus]. If targets are still more episodes of binge eating in the past month), with 24% being not achieved on a combination of metformin and basal insulin, then pran- dial insulin should be initiated [Grade D, Consensus]. Children with type 2 diabetes should be screened for neuropathy at diag- and percentage overweight compared with subclinical binge eaters nosis [Grade D, Consensus] and annually thereafter [Grade D, Consensus]. Children with type 2 diabetes should be screened at diagnosis for reti- concerns (90). They also had more depressive symptoms and lower nopathy [Grade D, Consensus] and yearly thereafter [Grade B, Level 2 (76)]. There were no noted differences in the prevalence of binge eating across age, sex, race or glycemic control (90). Children with type 2 diabetes should be screened for chronic kidney sive symptoms appear to be associated with poor adherence to dia- disease at diagnosis [Grade B, Level 2 (77)] and yearly thereafter [Grade betes treatment (91,92). Children with type 2 diabetes should have a fasting lipid prole mea- Level 3 (10,11)] to prevent type 2 diabetes. Children with type 2 diabetes should be screened for hypertension begin- lines for children and youth: An integration of physical activity, sedentary ning at diagnosis of diabetes and at every diabetes-related clinical encoun- behaviour, and sleep. Inuence of adiposity, physical activ- ity, tness, and screen time on insulin dynamics over 2 years in children. Dietary sugars and body weight: Systematic review and meta-analyses of randomised controlled trials and cohort studies. Association between sugar- diabetes-related clinical encounter thereafter (at least biannually) sweetened and articially sweetened soft drinks and type 2 diabetes: [Grade B, Level 2 (89,90)]. Sugar and articially sweetened beverage consumption and adiposity changes: National longitudinal study. Acute and chronic complications of type 2 diabe- Denition, Classication and Diagnosis of Diabetes, Prediabetes tes mellitus in children and adolescents. Type 2 diabetes mellitus in children: Pre- natal and early infancy risk factors among native canadians. Obesity and type 2 diabetes mellitus Author Disclosures in a birth cohort of First Nation children born to mothers with pediatric-onset type 2 diabetes.
This involves all stakeholders concerned with the use of antimicrobials in both food animals and humans order cheap priligy online. Recommendations Some measures at the level of veterinary purchase priligy line, phytosanitary and human medicine have to be taken to contain the growing public health problem of antibiotic resistance 90mg priligy with mastercard. International cooperation in efforts to combat anti-microbial resistance in international forums has to be reinforced. Also, phasing out all uses other than direct use as therapeutic agents has to be pursued. Principles on the prudent use of antibiotics should be developed and awareness of the problem of antimicrobial resistance should be raised through informing the public. In a parallel way, there should be a tightening of controls covering the licensing of antibiotics so that the development of antimicrobial resistance in animals given antibiotics can be monitored, evidence of cross-resistance to other antibiotics detected and consideration given to appropriate action to minimize risks. Establishing appropriate surveillance systems is a necessity and, for this purpose, standardized and harmonized procedures need to be established to evaluate micro- organisms resistance to a specific antibiotic. In animal food husbandry, it is important to reduce the need for antibiotics and the consequent transference of resistance through applying good husbandry practices and reinforcing immunization programmes and hygienic conditions. In the light of a body of evidence, particularly the Scandinavian countries experience, reduced consumption of antibiotics in animal husbandry has contributed to slowing down the development of resistance. This very interesting approach deserves careful observation and should be considered a remarkable approach to combat the resistance threat. In aquaculture, responsible conduct in the prudent use of antibiotics should be to reduce their use to therapeutic purposes alone; prophylactic use must be replaced by good husbandry practices, including adequate hygiene conditions and vaccination programmes. Among producers, the priority should be education programmes that emphasize proper drug use, e. It should be noted that, for fish products, the use of dip solutions or ice with antibiotics for the purpose of extending product shelf life is forbidden. Research projects should be encouraged that aim at better understanding of the mechanisms of emergence and spread of resistance within a species, and from animal to man and the environment. Addressing the Problem of Bacterial Resistance to Antimicrobial Agents and the Need for Surveillance. Origins and consequences of antimicrobial-resistant nontyphoidal Salmonella: implications for the use of fluoroquinolones in food animals. Emergence of Newport 9+, A Highly Resistant Strain of Salmonella Newport in the United States. Penaeidins, antimicrobial peptides of shrimp: a comparison with other effects of innate immunity. In vitro studies of the fate of sulfadimethoxine and ormethoprim in the aquatic environment. Report of the Thirty Second Session of the Codex Committee on Food Hygiene, Washington D. Codex Guidelines for the Establishment of a Regulatory Programme for Control of Veterinary Drug Residues in Foods. Establishment of a national surveillance program for antimicrobial resistance in Salmonella. Careful antibiotic use to prevent resistance from the division of bacterial and mycotic diseases. Proposal for a Council Recommendation on the prudent use of antimicrobial agents in human medicine. Communication from the Commission on a Community Strategy against Antimicrobial Resistance. Aminoglycoside resistance genes aph(2)-Ib and aac(6)-Im detected together in strains of both Escherichia coli and Enterococcus faecium. Detection of antibiotic residues in milk and animal tissues: Fermentation failure due to residues. Effect of oxytetracycline-medicated feed on antibiotic resistance of Gram-negative bacteria in catfish ponds. Molecular characterization of gentamicin- resistant Enterococci in the United States: Evidence of spread from animals to humans through food. Note for guidance on the risk analysis approach for residues of veterinary medicinal products in food of animal origin. Update of the Position Paper on Availability of Veterinary Medicines agreed on 21 June 2000. Available studies for evaluating the effects of antimicrobial drugs on human gut flora. Letter to the National Center for Infectious Diseases with Comment on the Interaction Task Forces Public Health Action Plan to Combat Antimicrobial Resistance. Byrne welcomes Parliament vote on safer rules for feed additives - prohibition of antibiotics as growth promoters confirmed. Effect of the use of antimicrobials in food producing animals on pathogen load: Systematic review of the published literature. Links between quinolones use in food animals, observed increases in quinolone-resistant food-borne pathogens and human treatment problems. Standardization of the bioencapsulation of enrofloxacin and oxytetracycline in Artemia franciscana Kellog, 1906. By tricking the immune system, doctors think they can beat a deadly microbe and its own game. Mobile gene cassette and integrons: moving antibiotic resistance genes in Gram-negative bacteria. Health Protection Branch Laboratory, Centre for Disease Control, Bureau of Infectious Diseases. Statement on Antimicrobial Resistance: Solutions to a Growing Public Health Threat. Petition to rescind approvals of the subtherapeutic uses in livestock of antibiotics used in or related to those used in human medicine. Fluoroquinolone resistance in Campylobacter from chickens and human health impact: a quantitative risk assessment using data from FoodNet and other sources. Conjugated linoleic acids: physiological effects in animal and man with special regard to body composition. Detection of the high-level aminoglycoside resistance gene aph(2)-Ib in Enterococcus faecium. Evaluation of two commercial screening tests for the detection of chloramphenicol residues in shrimp and honey (Board A-28). Drug resistance and broad geographical distribution of identical R plasmids of Pasteurella piscicida isolated from cultured yellowtail in Japan. Sequence analysis of the florfenicol resistance gene encoded in the transferable R-plasmid of a fish pathogen, Pasteurella piscicida. Detection of R-plasmid encoded with resistance to florfenicol in Pasteurella piscicida. Identification of pathogenic bacteria in biofilms of recirculating aquaculture systems.