Toprol XL

Soo Yeon Kim, M.D.


https://www.hopkinsmedicine.org/profiles/results/directory/profile/10004837/soo-kim

Sesame oil attenuates Cisplatin-induced hepatic and renal injuries by inhibiting nitric oxide-associated lipid peroxidation in mice 04 heart attack m4a buy toprol xl line. Free radical reactions and antioxidant activities of sesamol: pulse radiolytic and biochemical studies heart attack what to do cheap toprol xl. Sesamin is one of the major precursors of mammalian lignans in sesame seed (Sesamum indicum) as observed in vitro and in rats heart attack is recognized by a severe pain buy discount toprol xl 100 mg on line. Protection against deoxycorticosterone acetate-salt-induced hypertension and cardiovascular hypertrophy blood pressure medication starting with c toprol xl 100mg for sale. Effects of sesamin on altered vascular reactivity in aortic rings of deoxycorticosterone acetate-salt-induced hypertensive rat blood pressure medication list buy discount toprol xl on line. Protection against development and maintenance of hypertension in stroke-prone spontaneously hypertensive rats blood pressure 6050 buy toprol xl 100mg otc. Serum enterolactone and risk of breast cancer: a case-control study in eastern Finland. Functional and nutritional properties of modified proteins of sesame (Sesamum indicum L. Coconut oil and sesame oil affect lymphatic absorption of cholesterol and fatty acids in rats. Yokota T, Matsuzaki Y, Koyama M, Hitomi T, Kawanaka M, Enoki-Konishi M, Okuyama Y, Takayasu J, Nishino H, Nishikawa A, Osawa T, Sakai T. Sesamin, a lignan of sesame, down-regulates cyclin D1 protein expression in human tumor cells. Risk of cardiovascular diseaserelated and all-cause death according to serum concentrations of enterolactone: Kuopio Ischaemic Heart Disease Risk Factor Study. Sesame ingestion affects sex hormones, antioxidant status and blood lipids in postmenopausal women. Comparative effects of flaxseed and sesame seed on vitamin E and cholesterol levels in rats. Traditional Preparation: A tea is prepared of the dried (or sometimes fresh) leaves by infusion or decoction. Traditional Uses: Albahaca is considered a sweet herb with cooling and refreshing properties. For spiritual healing, it is used in baths of sweet herbs for good luck, especially during the New Year. The aerial parts of this plant, particularly the leaves, are used for culinary purposes as a seasoning agent. Availability: In New York City, albahaca is often sold fresh in botanicas, either in a refrigerated case or on the counter, tied into small bundles with a rubber band and kept in a container with their roots or stems covered in a small amount of water to keep them fresh. The leaves are egg-shaped in outline, pointed at the tip, with leaf edges that can be smooth or irregularly toothed. One defining characteristic is its strong scent and flavor (Bailey Hortorium Staff 1976). Distribution: this plant most likely originated in India and the Middle-East, and it is now cultivated worldwide as a culinary herb (Bailey Hortorium Staff 1976). As a culinary herb, it is generally considered safe for regular consumption in moderate amounts as a condiment. Animal Toxicity Studies: Estragole and safrole, constituents of the essential oil, have shown mutagenic and carcinogenic effects in vitro and in animal experiments (see contraindications below; Gruenwald et al. The aqueous extract of the dry leaf produced bradycardia in rats and cats at a dosage of 10-20 mg/kg (Ojewole, Adekile & Odebii 1982). Contraindications: Use of this plant is contraindicated in children under 5 years of age and during pregnancy and lactation (Germosen-Robineau 2007). Major chemical constituents include the following: essential oil chief constituents: linalool (54. Other constituents present in a significant quantity (>1000 ppm) include: acetic acid, aspartic acid, beta sitosterol, caffeic acid, caryophyllene, chavicol, citral, citronellol, essential oil, estragole, eugenol, eugenol methyl ether, geranial, geraniol, methyl chavicol, methyl cinnamate, methyl eugenol, mucilage, oleanolic acid, p-methoxycinnamialdehyde, phytosterols, rosmarinic acid, thymol and ursolic acid (Duke & Beckstrom-Sternberg 1998). These uses are recommended only if strict hygiene measures are observed and proper diagnosis and care is provided by a qualified health practitioner (Germosen-Robineau 2007). Administration and dosage, based on traditional use, is as follows: for stomachache and vomiting: an infusion (2 spoonfuls of the fresh leaf steeped in 2 cups of boiling water) taken as 1 cup 3 times daily; and for earache: crushed leaf applied locally (GermosenRobineau 2007). Evaluation of the gastric antiulcerogenic effects of Solanum nigrum, Brassica oleracea and Ocimum basilicum in rats. Antiulcerogenic effects of Ocimum basilicum extracts, volatile oils and flavonoid glycosides in albino rats. Antiviral activities of extracts and selected pure constituents of Ocimum basilicum. Chemomodulatory efficacy of basil leaf (Ocimum basilicum) on drug metabolizing and antioxidant enzymes and on carcinogen-induced skin and forestomach papillomagenesis. Determination of antioxidant and radical scavenging activity of Basil (Ocimum basilicum L. Screening for antimicrobial activity of some essential oils by the agar overlay technique. Effective treatment of experimental acute otitis media by application of volatile fluids into the ear canal. Relaxant effects of terpenoid on tracheal and ileal smooth muscles of the guinea pig. Comparative evaluation of anti-inflammatory potential of fixed oil of different species of Ocimum and its possible mechanism of action. Industrially it is extracted by steam distillation of the roots, branches or wood chips. The solid, crystallized essential oil is sold in commerce as flattened cubes or tablets, called tabletas in Spanish. Traditional Preparation: this remedy is primarily used externally by applying tablets of the crystallized oil to the affected area. In some cases, a very small amount of the essential oil is dissolved in water and taken internally. In cases of indigestion, gastrointestinal pain and gas, a very small amount of the essential oil is dissolved in water and taken internally to dispel gas that has accumulated in the stomach or intestines. To treat upper or lower respiratory tract infections, asthma, bronchitis, difficulty breathing or conditions of phlegm in the lungs, the essential oil is applied topically as an ointment to the chest area and is said to open up the lungs, loosen phlegm and make it easier to breathe. A salve or pomade of the essential oil is also used for treating backache, muscle pain and arthritic conditions, applied topically to the affected area. For spiritual and physical health, the essential oil is added to a glass of water and set in the corner of a room or living space to release its fragrant vapor which is said to keep away insects and infectious agents, to cleanse the air of contamination and to absorb negative energy. Availability: Alcanfor is sometimes sold at botanicas or pharmacies as semi-translucent white tablets or cubes of the crystallized oil and may be pre-packaged in clear plastic or unwrapped in bins. Distribution: Native to East Asia (Vietnam, southern China and Japan), it is cultivated in tropical and subtropical areas and is an invasive species in non-native areas in that region (Bailey Hortorium Staff 1976). The lethal dose of camphor taken internally for adults is approximately 20 g, although signs of toxicity have been observed after taking as little as 2 g. Symptoms of overdose include the following: intoxicated states, delirium, spasms and irregular respiration or difficulties with breathing (Gruenwald et al. Camphor is listed as a medication that can be fatal to a toddler (10 kg body weight; < 2 yrs) if one standard dose unit (1 tablet or teaspoon) is ingested (Koren 1993). Contraindications: Alcanfor should not be used internally during pregnancy due to emmenagogue, uterine stimulant and feticidal effects of isolated camphor. Externally, this plant should not be used on broken skin or open wounds due to rubefacient effects of the essential oil constituents. Caution is advised in individuals with gastrointestinal infection due to the potential irritating effects of camphor bark preparations on the digestive tract (Brinker 1998). Due to the highly toxic nature of the essential oil, internal use is not recommended. Pediatrics Warning: Oils or salve preparations containing camphor as a main ingredient should not be administered to infants because of their potential for skin irritation, especially when applied to the nasal area or near mucous membranes (Gruenwald et al. Small children and infants (under 2 years of age) should not be administered camphor near the nose or via inhalation because absorption of small amounts can potentially lead to seizures and nervous system over stimulation (Brinker 1998). Major chemical constituents include the essential oil: D(+)-camphor ((1R,4R)-1,7,7-trimethylbicyclo[2. Indications and Usage: Camphor is approved by the German Commission E for the following health conditions: arrhythmia, cough/bronchitis, hypotension, nervous heart disorders and rheumatism (Blumenthal et al. This remedy can be taken as a liquid (camphor spirit), administered by inhalation or used as a topical application such as an oil, salve or liniment. It is typically sold as a commercial pharmaceutical preparation in the form of a cream, salve or gel. Concentrations of camphor in preparations should not be more than 25% for adults and 5% for children, and it is recommended that ointments and liniments contain 10-20% camphor but no more than 25% (Gruenwald et al. Clinical Data: Cinnamonum camphora Activity/Effect Preparation Design & Model Results Reference Antiplatelet & 2. The effects of camphor, eucalyptus and menthol vapour on nasal resistance to airflow and nasal sensation. In vitro anti-inflammatory and anti-oxidative effects of Cinnamomum camphora extracts. A preliminary study of the effect of essential oils on skeletal and smooth muscle in vitro. Traditional Uses: the leaf is used for treating vaginal infections, genitourinary inflammation and excess vaginal discharge, prepared as a decoction with cornsilk (barba de maiz) and taken orally. This plant functions by removing the heat (quita el calor) caused by inflammation and cleansing the body internally. The flower is also used to treat vaginal infections and excess vaginal discharge (flujo vaginal), prepared as a decoction and administered as a vaginal wash or douche. A remedy for infections in general (especially those that are considered pre-cancerous) is prepared by boiling the leaves of algodon morado with cinchona (quina) and black nightshade (hierba mora), taken orally. Availability: the dried herb is sometimes sold at botanicas specializing in Caribbean medicinal plants. Leaves have 3-7 pointed lobes arranged so that they resemble a maple leaf or star in general shape with smooth leaf edges (5-20 cm fi 9-20 cm). Flowers grow singly or in small branching clusters with large yellow petals (to 8 cm long) that have a dark red spot at the base. Distribution: Native to South America, this plant is widely cultivated for the production of cotton fiber, grows in the Caribbean and can be found in open, dry areas (Acevedo-Rodriguez 1996). More research needs to be done to determine the mechanism and potential toxicity of this constituent (Aitken 1983, Qian & Wang 1984, Ye et al. In mammalian cell cultures (including human lymph and hamster ovary cells), gossypol was shown to be cytotoxic. Animal Toxicity Studies: In adult male rats, an aqueous extract of cotton seed administered intraperitoneally (0. Gossypol isolated from the plant has shown strong antifertility effects as a male contraceptive agent due to its antispermatogenic effects (reducing sperm count and motility). It has reportedly been used in clinical trials with thousands of human volunteers in China during the 1970s. The chief constituents (>1000 ppm) of the essential oil of the plant include: 1-trans-alphabergamotene, alpha-humulene, cadinene, caryophyllene, copaene and guaiene. Primary compounds in the 93 seed include: gossypol, inositol, linoleic acid, myristic acid, oleic acid, palmitic acid and stearic cid. The root contains salicylic acid, and the stem is high in tannins (Duke & Beckstrom-Sternberg 2007). Indications and Usage: Insufficient information is available to determine standard indications and usage. Clinical Data: Gossypium barbadense Activity/Effect Preparation Design & Model Results Reference Antifertility Gossypol (20 mg Clinical trial: 172 Reduced sperm count & Liu 1981 daily for 60 day healthy male caused immotility; adverse loading period; volunteers (under age effects reported: decreased 1/3 original dose 50, married with at libido, decreased appetite & for maintenance least 1 child) fatigue; induced period) hypokalemia (probably renal); discontinuing treatment for 3 mo reversed these adverse effects Laboratory and Preclinical Data: Gossypium barbadense Activity/Effect Preparation Design & Model Results Reference Hypotensive Decoction of In vivo: rats Confirmed dose-dependent Hasrat, Pieters & leaves hypotensive & bloodVlietinck 2004 pressure-lowering effects Antifertility Gossypol In vitro: sperm cells Active; reduced sperm Poso et al. Note: In the Dominican Republic, the common name tuna de espana typically refers to Nopalea cochenillifera (L. Additionally, the common name tuna can be used for any species of the genus Opuntia (Liogier 2000). Although not reported as a medicinal use, the fruits are also consumed as food in Latin American culinary traditions. Traditional Preparation: this remedy can be prepared by eating or liquefying the cladophyll (cactus pad), taken orally. Traditional Uses: this plant is used to treat diabetes, high blood pressure, liver disorders and heart problems, taken as a drink prepared by liquefying the fresh cactus pads in a blender. For kidney disorders, the cactus pads of alquitira are combined with fresh coconut milk and liquefied in a blender to prepare a drink. For skin conditions, the cactus pads are used in a manner similar to that of Aloe vera; the mucilaginous gel inside the leaf is applied externally for cuts, burns and abrasions to facilitate wound-healing. Availability: Fresh cactus pads can be purchased from select botanicas, grocery stores and food markets, particularly in Latino/Caribbean neighborhoods; fresh fruits can be purchased in season from some fruit stands and grocery stores in New York City. Cactus pads (called cladodes or cladophylls because they are stems with a leaf-like appearance) are fleshy, spatula-shaped and succulent with a waxy coating and are covered with sharp, yellow, spine-like hairs called glochids.

purchase toprol xl 100mg without prescription

Associated Symptoms Weight loss 5 htp and hypertension order toprol xl 25mg otc, fatigue hypertension causes and treatment order toprol xl 25mg overnight delivery, and fever are common especially in Site chronic cases hypertension young adults order genuine toprol xl on line. If dissection occurs heart attack kit order toprol xl 50mg with visa, sudden and on chest X-ray if there is an effusion pulse pressure measurement cheap toprol xl 25mg line, as well as changes severe pain occurs blood pressure monitor best toprol xl 25mg, maximal at onset. Usual Course the course varies depending on the etiology and may range from being acute to chronic. Page 140 Signs and Laboratory Findings Site A discrepancy may develop between pulses or blood Diaphragmatic pain is deep and difficult to localize. A new aortic regurgitant Noxious stimulation may affect phrenic nerve sensory murmur may develop. A neurological impairment may fibers C3, C4, and C5 and therefore is often felt at the develop. Chest X-ray may show widening of the supeshoulder tips and along the upper border of the trapezius rior mediastinum. Aortography may demonstrate a false muscle, or it may affect the intercostal nerves T6, T7, lumen. T8, and T9 with radiation of pain into the anterior chest, the upper abdomen, and the corresponding region of the Usual Course back. If there is a large aortic aneurysm, there can be chronic dull, central chest aching. If dissection occurs, an acute System medical and surgical emergency has developed. The system is musculoskeletal, cardiac, pulmonary, or intestinal depending upon the disease. Acute Main Features complications include acute aortic valvular incompethe pain is deep, dull, poorly localized, and non-specific tence, occlusion of major vessels, hypotension, and if it involves only the central chest and upper abdomen death. Social and Physical Disability the main problems with aortic aneurysms are life and Associated Symptoms death considerations. Hiccoughs may aneurysm consists only of adventitia and/or perivascular be present. Cystic medial Frequently there are no physical findings, but if there necrosis is a major cause of dissection. Arteriosclerosis are, the most classic would be elevation of a hemidiais a major cause. Usual Course Differential Diagnosis There is usually a specific therapy once the etiology is Angina, pulmonary diseases, and thoracic disk disease. Chronic aneurysm If the pain assumes a thoracic spinal pattern (although of Social and Physical Disability visceral origin), code according to X-7. These relate partly to the underlying disease process and partly to the vagueness of understanding of the cause of pain. Definition Etiology Pain from the diaphragm related to irritation of the diaAlthough a wide range of causes can cause disease afphragmatic nerves by a disease process above the diafecting the diaphragm, the most important are infections phragm, in the diaphragm (rare), or below the diaphragm. Page 141 Summary of Essential Features and Diagnostic Complications Criteria Esophageal obstruction, erosion into a bronchus, Abdominal pain in epigastrium with radiation to central bronchoesophageal stricture, erosion into aorta with chest, posterior midthorax and shoulder tip(s), with evicatastrophic hemorrhage. Social and Physical Disability If the tumor is inoperable and the patient cannot eat, a Differential Diagnosis plastic tube can be passed through the tumor or a feeding Involves a wide range of cardiac, pulmonary, muscujejunostomy performed. X2 Infection: chest or pulmonary source Smoking-chronic disorders of esophagus. X2 Infection: gastrointestinal source Summary of Essential Features and Diagnostic 453. Pain due to malignant disease of the esophagus resulting Code from malignant transformation of either the squamous 353. Definition Chronic pain at the costal margin which may mimic visMain Features ceral pain. This is a relatively uncommon tumor in the Western World but has localized areas of high incidence, espeSite cially in Iraq and Iran among the Kurds. Pain is not usuEighth, ninth, or tenth rib cartilages, one or more rib ally a prominent feature. The condition may be bilatusually dysphagia without pain, which usually occurs eral. At that point dysphagia and retrosternal pain may become Main Features continuous and radiate through the back. Quality: a Associated Symptoms constant dull ache or a sharp stabbing pain which may Dysphagia is the major symptom; others include regurgiitself be followed by a dull ache. Signs and Laboratory Findings Aggravating Factors Evidence of weight loss and cervical lymphadenopathy, Movement, especially lateral flexion and rotation of the particularly deep to the sternomastoid. Rising from a sitting position in an armchair is show a dilated esophagus; barium swallow, a narrowing often a particularly painful stimulus. Signs Usual Course Manipulation of the affected rib and its costal cartilage Unless the tumor is removed, the patient will become will exactly reproduce the presenting pain. Page 142 Usual Course mastectomy or removal of a lump, affecting the anterior Some cases may resolve spontaneously, but most pathorax, axilla, and/or medial upper arm. Site Relief Anterior thorax, axilla, medial upper arm; usually one Restriction of movement may give relief. Pain Quality: often burning, intensified by touch Physical activities are often restricted by pain or fear of or clothing. Associated Symptoms Pathology the patient may be unable to tolerate a prosthesis, clothNo specific histological changes identified. Signs Increased response to touch; hyperesthesia and allodynia Summary of Essential Features and Diagnostic Crito skin stroking or skin traction. Reduction in appreciateria tion of pinprick, cold, and touch related to the incision A fairly common condition which should be considered and upper arm. May also respond to block with local anesthetic may produce confirmatory ointments based on capsaicin. Complications Treatment Can be compounded by emotional stress, recurrence of Reassure patient-this may be sufficient for some patients disease. Social and Physical Disability Impairment of social, occupational, and sexual activities. X6 Summary of Essential Findings and Diagnostic Criteria References Pain commencing postoperatively, usually immediately, Copeland, G. Allodynia over widespread areas of the chest or arm, or both; sensory loss over anterior chest or arm, or both. Differential Diagnosis Postmastectomy Pain Syndrome: Herpes zoster, local infection, radiation necrosis in ribs, recurrent neoplasm. X9 Chronic pain commencing immediately or soon after Page 143 Late Postmastectomy Pain or may be present in the skin with pigmentation and signs of radiation arthritis. Objective evidence of recurthan three years after the initial treatment for cancer of rent disease. Differential Diagnosis Site Herpes zoster; pleurisy related to infection; and second Spine, thorax at site of cancer, arms. Shooting or jabbing pain occurs with brachial plexus lesion, usually spontaneously, sometimes with paresthesias. Pain that recurs or persists along a thoracotomy scar at Associated Symptoms least two months following the surgical procedure. Main Features Pain following thoracotomy is characterized by an achUsual Course ing sensation in the distribution of the incision. It usually With skeletal secondaries and brachial plexus damage, resolves in the two months following the surgery. However, that persists beyond this time or recurs may have a burnwith radiation damage to the brachial plexus, the course ing dysesthetic component. There may also be a is more protracted, with onset more than five years after pleuritic component to the pain. Complications Associated Symptoms Patients with skeletal, visceral, and brachial plexus damIf the thoracotomy was done for tumor resection and age have a short survival of less than one year. Radiation there was evidence of pleural or chest wall involvement damage is a progressive disorder with disability and long at the time of surgery, it is likely that the pain is due to survival. Social and Physical Disability Signs and Laboratory Findings Moderate impairment of social and occupational activThere is usually tenderness, sensory loss, and absence of ity, with depression related to chronic illness. Auscultation of the Pathology chest may reveal decreased breath sounds due to underLocal skin, subcutaneous, skeletal, or visceral metastatic lying lung consolidation or a malignant pleural effusion. Page 144 Usual Course most frequently associated with sharp, spontaneous If the pain is due to traumatic neuromata, it usually depains radiating to the chest, axilla, or neck. The pain clines in months to years and can be relieved by antidemay be mild, moderate, or intense. If the pain is due to tumor recurrence, some relief may be obAssociated Symptoms tained by an intercostal nerve block or radiation therapy. The patients usually do not tolerate contact with clothing or the water of the shower. Immobility of the upper extremity because of exacerbation of the pain may result in a frozen shoulder. AggresSigns and Laboratory Findings sive physiotherapy is necessary to prevent this While the area is anesthetic or hypoesthetic, most pacomplication. For benign disease, the pathology is that of neuroma Most patients will continue to demonstrate slow healing formation. If there is an underlying malignancy, there is at the site of the median sternotomy. An active bone tumor infiltration of the intercostal neurovascular bunscan may be found up to 4 years after surgery due to dle. Summary of Essential Features and Diagnostic Criteria Usual Course Persistent or recurrent pain in the distribution of the thoWithout treatment the pain may decrease in intensity racotomy scar in patients with lung cancer is commonly during the first year post surgery, may remain the same, associated with tumor recurrence. Thoracic sympathetic ganthe diagnostic procedure of choice to demonstrate this glia blocks may significantly reduce pain, allodynia, and recurrence. Differential Diagnosis Complications Epidural disease and tumor in the perivertebral region Pain can be compounded by emotional stress and suspican also produce intercostal pain if there is recurrent cion of recurrence of heart disease. Social and Physical Disability Code Depending on the degree of discomfort, impairment 303. Patients System may benefit from reassurance that this pain does not Peripheral nervous system. Main Features Differential Diagnosis Burning pain across a well-circumscribed area defined Ischemic heart pain, costochondritis, hyperesthesia from by the sternum medially, the intercostal junction at T2 or the scar. T3 superiorly, the intercostal junction at T5 or T6 inferiorly, and approximately the nipple line laterally. Site Most frequent in precordium; may be associated with Either symmetrical, more often in the posterior thoracic tachycardia and fear or conviction of heart disease being region, or precordial. Main Features Tension pain is rare in the posterior thoracic region Code compared with tension headache (perhaps one-tenth or 31 X. Precordial pain is more common, often associated with tachycardia or a fear of heart disease. Often follows intra-abdominal Pain related to the protrusion of an abdominal organ surgery, especially with perforated viscus. Site Associated Symptoms Pain can be related either to the organ herniating or the Fever, malaise, weight loss, hiccoughs. There may be tenderness to Main Features percussion or to palpation of the upper abdomen. White Burning epigastric pain (or retrosternal pain, or both), blood cell count and erythrocyte sedimentation rate may often following eating or lying recumbent. The patient may also complain of chest pain similar to angina, right upper quadrant abdominal pain similar to Usual Course that in cholelithiasis, epigastric pain like that in peptic Treatment with antibiotics with or without surgery usuulcer disease, abdominal bloating and air swallowing. Radiographic Complications techniques will show evidence of abdominal viscera in Prolonged fever and weight loss. Social and Physical Disability Usual Course May lead to usual effects both of chronic sepsis and Pain typically is intermittent and aggravated by certain chronic pain. Etiology Traumatic and congenital or degenerative weaknesses in Signs and Laboratory Findings the diaphragm are of key etiologic significance, although Patients usually point out their pain with one finger. Gastroscopy, barium swallow, cine-esophagoscopy or esophageal manometry may show evidence of increased Summary of Essential Features and Diagnostic Crior asynchronous esophageal motility. The cardiac symptoms, with radiographic or endoscopic evidence of sphincter may remain closed until a large amount of extra-abdominal organs. In patients with prolonged achalasia the esophagus may Differential Diagnosis contain foreign material, which is undigested food. EsoAngina, cholelithiasis, acid-pepsin disease without herphageal manometry will show disordered motility with a nias, and pancreatitis, etc. X6 Abdominal pain cial pressure devices in the esophagus for 24 to 48 hours may pick up very high pressure contractions, which may be related to the pain. It may vary from very occasional to cyclic or be continuous throughout Definition the day. Most paAttacks of severe pain, usually retrosternal and midline, tients with motility disorders run a benign course with due to a diffuse disorder of the esophageal musculature occasional attacks of pain. Occasionally the symptoms with severe attacks of spasm and/or failure of relaxation progress to the point where the patient has to undergo of the cardiac sphincter. In contrast, patients with achalasia usually progress to the point where they require definitive Site treatment.

discount toprol xl online visa

Medical costs of a live donor used in egg retrieval after the donor has been released by the reproductive endocrinologist blood pressure pills kidney failure buy toprol xl uk. Assisted hatching: A micromanipulation technique in which a hole is artificially created in the outer shell of an embryo to assist with the potential implantation of that embryo heart attack by one direction buy generic toprol xl pills. Carrier: A health service corporation blood pressure medication gynecomastia buy toprol xl 50mg with mastercard, hospital service corporation blood pressure charts readings by age order 100 mg toprol xl free shipping, medical service corporation arteria lingual generic toprol xl 100 mg on-line, insurance company or a health maintenance organization blood pressure chart female buy generic toprol xl line. Completed egg retrieval: All office visits, procedures and laboratory and radiological tests performed in preparation for oocyte retrieval; the attempted or successful retrieval of the oocyte(s); and, if the retrieval is successful, culture and fertilization of the oocyte(s). Cryopreservation: the freezing of embryos in liquid nitrogen until such time as required for a frozen embryo transfer, and includes the freezing of female gametes (ova) and male gametes (sperm). Embryo: A fertilized egg that has: (a) begun cell division; and (b) completed the pre-embryonic stage. Gamete intrafallopian tube transfer: the direct transfer of a sperm/egg mixture into the fallopian tube by laparoscopy, where fertilization takes place inside the fallopian tube. The term does not apply to a person who has been voluntarily sterilized, regardless of whether the person has attempted to reverse the sterilization. It can involve the extraction of sperm and fluid from epididymal tubules inside the epididymis or the provision of testicular tissue from which viable sperm may be extracted. Ovulation induction: the use of drugs (oral or injected) to stimulate the ovaries to develop follicles and eggs. Zygote intrafallopian tube transfer: A procedure whereby an egg is fertilized in vitro, and the zygote is transferred to the fallopian tube at the pronuclear stage before cell division takes place. Hearing Aids and Related Services this Program covers expenses Incurred for or in connection with the purchase of a hearing aid or hearing aids that have been prescribed or recommended by a Practitioner for a Child Dependent who is 15 years of age or younger. For a Child Dependent who is 15 years of age or younger and for whom a Practitioner has recommended a hearing aid, such expenses include, but are not limited to , charges Incurred for the following: fi the purchase of the hearing aid; fi hearing tests; fi fittings; fi modifications; and fi repairs (but not battery replacement). Home Health Care this Program covers Home Health Care services furnished by Home Health Agency. Each Visit by a home health aide, Nurse, or other Provider whose services are authorized under the home health care plan can last up to 4 hours. Maternity/Obstetrical Care Pursuant to both federal and state law, covered medical care related to pregnancy; childbirth; abortion; or miscarriage, includes: (a) the Hospital delivery; and (b) a Hospital Inpatient stay for at least 48 hours after a vaginal delivery or 96 hours after a cesarean section. For the purposes of this provision and as required by federal law, a Hospital Inpatient stay is deemed to start: (a) at the time of delivery; or (b) in the case of multiple births, at the time of the last delivery; or (c) if the delivery occurs out of the Hospital, at the time the mother or newborn is admitted to the Hospital. Services and supplies provided by a Hospital to a newborn child during the initial Hospital stay of the mother and child are covered as part of the obstetrical care benefits. Medical Emergency and Medical Screening Examinations this Policy provides coverage for Medical Emergencies, including diagnostic X-ray and lab and Urgent Care for medical conditions and mental or nervous disorders, on a 24-hour, 7-day-a-week basis. This Policy provides coverage for eligible services and supplies provided by an In-Network Provider as stated in this Policy for the treatment of a Medical Emergency, whether or not the services or supplies were arranged for or provided by an In-Network Provider. See the Schedule of Covered Services and Supplies for additional limitations and benefit levels. Mental or Nervous Disorders (including Group Therapy) and Substance Abuse the Program covers treatment for Mental or Nervous Disorders and Substance Abuse. A Covered Person may receive covered treatment as an Inpatient in a Hospital or a Substance Abuse Center. This section does not apply to nutritional counseling related to "Diabetes Benefits". Orally Administered Anti-Cancer Drug this Policy covers expenses Incurred for Orally Administered Anti-Cancer Drugs. Benefits for Covered Charges for these Orally Administered Anti-Cancer Drugs are not subject to any Deductible, Copayment or Coinsurance. For the purpose of this subsection, "Orally Administered Anti-Cancer Drugs" are Prescription Drugs that: (a) are used to slow or kill the growth of cancerous cells; and (b) are administered orally. But, the term does not include: fabric and elastic supports; corsets; arch supports; trusses; elastic hose; canes; crutches; cervical collars; or dental appliances or other similar devices carried in stock and sold by drug stores, department stores, corset shops or surgical supply facilities. Pre-Admission Testing Charges this Program covers Pre-Admission diagnostic X-ray and lab tests needed for a planned Hospital Admission or Surgery. For all Covered Persons 35 years of age or older, a glaucoma eye test every five years. For all Covered Persons 40 years of age or older, a yearly stool exam for presence of blood. For all Covered Persons 45 years of age or older, a left-sided colon exam of 35 to 60 centimeters every five years. For all Covered Persons 20 years of age and older, a yearly consultation with a Provider to discuss lifestyle behaviors that promote health and well-being, including but not limited to: smoking control; nutrition and diet recommendations; exercise plans; lower back protection; weight control; immunization practices; breast self-exam; testicular self-exam; and seat belt usage in motor vehicles. Well Child Immunizations and Lead Poisoning Screening and Treatment this Program covers Well Child immunizations and lead poisoning screening. Colorectal Cancer Screening this Program covers colorectal cancer screening rendered at regular intervals for: (a) Covered Persons age 50 or over; and (b) Covered Persons of any age who are deemed to be at high risk for this type of cancer. Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the Covered Person; 3. With respect to female Covered Persons, such additional preventive care and screenings, not described in part 1, above, as are provided for in comprehensive guidelines supported by the Health Resources and Services Administration. Skilled Nursing Facility Charges this Program covers bed and board (including diets, drugs, medicines and dressings and general nursing service) in a Skilled Nursing Facility. Specialist Services this Program covers services rendered by a Network Provider who provides services within his/her specialty to Covered Persons. This includes coverage for speech-language pathology services rendered by a physician or a licensed speech-pathologist. As part of the coverage for Surgery, if a Covered Person is receiving benefits for a mastectomy, the Policy will also cover the following, as determined after consultation between the attending physician and the Covered Person: fi Reconstruction of the breast on which the mastectomy was performed. This Program also provides benefits for the treatment of cancer by dose-intensive Chemotherapy/ autologous bone marrow transplants and peripheral blood stem cell transplants. When organs/tissues are harvested from a cadaver, this Program will also cover those charges for Surgical, storage and transportation services that: (a) are directly related to donation of the organs/ tissues; and (b) are billed for by the Hospital where the transplant is performed. Urgent Care this Program provides benefits for Covered Services and Supplies furnished for Urgent Care of a Covered Person. The Program will not cover other travel or communication expenses of patients, Practitioners, Nurses or family members. This Program does not pay for blood that has been donated or replaced on behalf of the Covered Person. This Program also covers expenses Incurred in connection with the purchase of blood products and blood infusion equipment required for home treatment of routine bleeding episodes associated with hemophilia. The home treatment program must be under the supervision of a State approved hemophilia treatment center. Benefits for self-management education and education relating to diet shall be limited to Visits that are Medically Necessary and Appropriate upon: 1. Physical Rehabilitation this Program covers Inpatient treatment in a Physical Rehabilitation Center. The care must be furnished while: (i) intensive skilled nursing care is required in the treatment of an acute Illness or during the acute period after an Accidental Injury; and (ii) the patient is not in a Facility that provides nursing care. This Program covers only the initial fitting and purchase of artificial limbs and eyes, and other prosthetic devices. Specialized Non-Standard Infant Formulas this Program covers specialized non-standard infant formulas, if these conditions are met: a. The infant has not responded to trials of standard non-cow milk-based formulas, including soybean and goat milk. Wigs Benefit this Program covers the cost of wigs, if needed due to a specific diagnosis of Chemotherapy induced Alopecia. This coverage is subject to the limitations shown in the Schedule of Covered Services and Supplies. We must receive the notice and request at least five business days (or as soon as reasonably possible) before the Admission is scheduled to occur. Definitions "Alternate Treatment": Those services and supplies that meet both of these tests: a. Benefits for charges Incurred for them would not otherwise be covered under this Program. We will evaluate the appropriateness of the level of patient care given to a Covered Person as well as the setting in which it is received. Benefits payable under the Alternate Treatment/Individual Case Management Plan will be counted toward any Benefit Period and/or Per Lifetime maximum that applies to the Covered Person. Anesthesia and consultation services when they are given in connection with Non-Covered Charges. Blood or blood plasma or other blood derivatives or components that are replaced by a Covered Person. This includes the following connected with Cosmetic Services: procedures: treatments; drugs; biological products; and complications of cosmetic Surgery. Custodial Care or domiciliary care, including respite care except as otherwise stated in this Booklet. For the purposes of this Program, orthognathic Surgery will always be deemed a dental treatment. Experimental or Investigational treatments; procedures; hospitalizations; drugs; biological products; or medical devices, except as otherwise stated in this Booklet. Food products (including enterally administered food products, except when used as the sole source of nutrition). Maintenance therapy for: fi Physical Therapy; fi Manipulative Therapy; fi Occupational Therapy; and fi Speech Therapy. Milieu Therapy: Inpatient services and supplies which are primarily for milieu therapy even though covered treatment may also be provided. Non-medical equipment which may be used chiefly for personal hygiene or for the comfort or convenience of a Covered Person rather than for a medical purpose. This includes: air conditioners; dehumidifiers; purifiers; saunas; hot tubs; televisions; telephones; first aid kits; exercise equipment; heating pads; and similar supplies which are useful to a person in the absence of Illness or Injury. Room and board charges for any period of time during which the Covered Person was not physically present in the room. Routine Foot Care, except as may be Medically Necessary and Appropriate for the treatment of certain Illnesses or Injuries. This includes treatment for: corns; calluses; flat feet; fallen arches; weak feet; chronic foot strain; symptomatic complaints of the feet, except as otherwise stated in this Booklet. Services required by the Employer as a condition of employment; services rendered through a medical department, clinic, or other similar service provided or maintained by the Employer. Services or supplies: eligible for payment under either federal or state programs (except Medicare and Medicaid when, by law, this Program is primary). Smoking cessation aids of all kinds and the services of stop smoking providers, except as otherwise stated in this Booklet. Surgery, sex hormones, and related medical and psychiatric services to change sex; services and supplies arising from complications of sex transformation and treatment for gender identity disorders. Transportation; travel, except as otherwise provided in this Booklet for ambulance service. Throughout the rest of this provision, these defined terms appear with their initial letter capitalized. Allowable Expense: the charge for any health care service, supply or other item of expense for which the Covered Person is liable when the health care service, supply or other item of expense is covered at least in part under any of the Plans involved, except where a statute requires another definition, or as otherwise stated below. Self-funded arrangements of group or group-type coverage, including insurance continued pursuant to a Federal or State continuation law; c. Medicare or other governmental benefits, except when, pursuant to law, the benefits must be treated as in excess of those of any private insurance plan or non-governmental plan. Group or group-type coverage where the cost of coverage is paid solely by the Covered Person except when coverage is being continued pursuant to a Federal or State continuation law; d. If a Covered Person is covered by more than one Secondary Plan, the order of benefit determination rules of this Coordination of Benefits and Services provision shall be used to determine the order in which the benefits payable under the multiple Secondary Plans are paid in relation to each other. The benefits of each Secondary Plan may take into consideration the benefits of the Primary Plan or Plans and the benefits of any other Plan which, under this Coordination of Benefits and Services provision, has its benefits determined before those of that Secondary Plan. If a Plan has no coordination of benefits provision, or if the order of benefit determination rules differ from those set forth in these provisions, it is the Primary Plan. The benefits of the Plan that covers the Covered Person as an Employee, Member, subscriber or Retiree, or as the Dependent of such person, shall be determined before those of the Plan that covers the Covered Person under a right of continuation pursuant to Federal or State law. If the other Plan does not contain this rule, and as a result the Plans do not agree on the order of benefit determination, this portion of this provision shall be ignored. Birthday, as used above, refers only to month and day in a Calendar Year, not the year in which the parent was born. If a Child is covered as a Dependent under Plans through both parents, and the parents are separated or divorced, the following rules apply: a. The benefits of the Plan of the spouse of the parent with custody shall be determined second. Until the entity providing coverage under the Plan has knowledge of the terms of the court decree regarding health care expenses, this portion of this provision shall be ignored. If the above order of benefits does not establish which Plan is the Primary Plan, the benefits of the Plan that covers the Employee, Member or subscriber for a longer period of time shall be determined before the benefits of the Plan(s) that covered the person for a shorter period of time. In this section, a Plan that bases benefits on a Reasonable and Customary Charge is called a "Reasonable and Customary Charge Plan. This means that although a Provider, called an InNetwork Provider, bills a charge, the Covered Person may be held liable only for an amount up to the negotiated fee. The Covered Person is liable only for the applicable Deductible, Coinsurance and/or Copayment. Primary Plan is Capitation Plan and Secondary Plan is Fee Schedule Plan or Reasonable & Customary Plan If the Covered Person receives services or supplies from a Provider who is in the network of both the Primary Plan and the Secondary Plan, the Secondary Plan shall pay the lesser of: a. The amount of any Deductible, Coinsurance and/or Copayment required by the Primary Plan; or b.

order 100mg toprol xl amex

Neonates: A prophylactic transfusion trigger of <20 blood pressure chart dr oz best toprol xl 50mg,000/mm3for stable neonates at term blood pressure medication usa toprol xl 50 mg visa, or <30 blood pressure values discount toprol xl 25 mg mastercard,000/mm3for stable premature neonates blood pressure medication nausea generic 25mg toprol xl with visa, is justifed blood pressure chart related to age buy toprol xl 25mg line. Patient-specifc clinical data may increase the threshold at which prophylactic transfusion is desirable prehypertension uptodate purchase toprol xl uk. Prophylactic platelets may also be given at higher counts when availability of compatible platelet products is reduced. Higher-than-usual doses of platelets result in longer intervals between transfusions which may be of value in the outpatient setting. Chemotherapy for Solid Tumors: the usual prophylactic transfusion trigger is fi10,000/ mm3. The greater risk of bleeding from bladder neoplasms / necrotic tumors and the serious impact of even minor bleeding in patients with limited physiologic reserve may warrant a transfusion trigger of fi20,000/mm3. Transfusion Refractoriness: a) Post-transfusion platelet counts obtained 10-60 minutes after infusion should be obtained whenever possible. The 10-60 minute post infusion count measures transfusion recovery which is most sensitive to immune platelet destruction. The American Society of Clinical Oncology recommends that additional products be given if post transfusion counts are unacceptable. Alloimmunization should be confrmed by demonstration of antibodies to platelets. Transfusion may be considered before elective splenectomy with platelet counts fi10,000/mm3. If maternal platelets are used, they should be washed or volume-reduced and irradiated. Aplastic Anemia: Transfuse stable patients prophylactically at counts fi5,000/mm3 and patients with fever or minor hemorrhage at counts 6,000-10,000/mm3. Description of Components: Plasma consists of the noncellular portion of blood that is separated and frozen after donation. By convention, 1 U of a coagulation factor is defined as that activity present in each milliliter of a standard pool of plasma units. Frozen Plasma must be thawed, usually in a water bath, and infused immediately or stored at 1-6oC for up to 24 hours. When used to correct multiple coagulation factor deficiencies, plasma transfusion should be guided by coagulation testing. When such testing is not readily available, clinical evidence of bleeding may be used to direct transfusion decisions. Plasma should be administered in doses calculated to achieve a minimum of 30% of plasma factor concentration. This is usually achieved with the administration of 10-20 mL/kg, though more may be required depending upon the clinical situation. When used to correct isolated coagulation factor deficiencies for which no concentrated preparation is available. The volume and/or frequency of exchange may be tapered as disease activity declines. Indications and Contra-indications: Frozen Plasma is indicated for use in patients with the following conditions: 1. Active bleeding due to defciency of multiple coagulation factors, or risk of bleeding due to defciency of multiple coagulation factors. Bleeding or prophylaxis of bleeding for a known single coagulation factor defciency for which no concentrate is available. However, the response may be unpredictable and complete normalization of the hemostatic defect does not occur. Frozen Plasma is indicated for patients on warfarin only if there is serious bleeding or urgent reversal of warfarin efect is necessary. Other patients can be treated simply with withdrawal of warfarin and administration of vitamin K. Factor Defciency: Prophylactic correction of a known factor defciency for which specifc concentrates are unavailable is guided by recommended perioperative hemostatic levels for each type of procedure. Massive Transfusion and Cardiopulmonary Bypass: Frozen Plasma may be used to treat excessive microvascular bleeding, as determined on visual assessment of the operative feld jointly by the anesthesiologist and surgeon when the coagulation screening test results are abnormal or not available in a timely fashion. However, microvascular bleeding may be a result of hypofbrinogenemia or residual heparin efect. Acute Disseminated Intravascular Coagulation: Addressing the underlying cause is the foundation of treatment, and the patient is supported with transfusion of Frozen Plasma in combination with Platelets and Cryoprecipitate. If there is no bleeding, blood products are not indicated prophylactically, regardless of the results of laboratory tests. Thrombotic Thrombocytopenic Purpura: If plasma exchange is not immediately available, simple transfusion of plasma can be a useful alternative until exchange can be started. Selection and Preparation: Cryoprecipitate is considered to be an acellular blood component. Frozen cryoprecipitate is thawed in a protective plastic overwrap in a waterbath at 30-37oC up to 15 minutes. Thawed cryoprecipitate should be kept at room temperature and transfused as soon as possible after thawing or within 6 hours if it is a closed single unit or has been pooled prior to freezing. It should be transfused within 4 hours if it is 38 an open system or units have been pooled after thawing. The frequency of dosing depends on the half-life and recovery of the coagulation factor that is being replaced (check factor levels). A typical dose for the treatment of hypofbrinogenemia is one cryoprecipitate unit per 7 10 kg of body weight. One unit of cryoprecipitate per 10 kg of body weight raises plasma fbrinogen concentration by ~ 50 mg/dL in the absence of continued consumption or massive bleeding (assuming minimum fbrinogen content per bag of cryo). Do not transfuse cryoprecipitate unless laboratory studies confrm defciency of a specifc clotting protein for which this component is indicated. Cryoprecipitate should not be used in the critical care setting as a source of fbronectin to improve reticuloendothelial system function. Massive Transfusion: Transfuse for bleeding in massively transfused patients when the fbrinogen level is documented to be <100 mg/dL. The treatment of patients with an isolated fbrinogen defciency should be reserved for episodes of clinical bleeding, or when there is a signifcant risk of bleeding complications due to an invasive procedure or pregnancy. Congenital afbrinogenemia / Congenital and acquired dysfbrinogenemia: Transfuse for bleeding or risk of bleeding associated with a fbrinogen level <100 mg/dL by a quantitative or functional assay. Cryoprecipitate can be given in doses of one bag per 10-20 kg of body weight every 3 to 4 weeks. Others may charge a Quality Assurance Committee or a Blood and Tissue Committee with this task. For the most part, the accrediting and regulatory agencies do not specify how this peer review function is accomplished, as long as it is being performed. The responsible committee should address through review or audit the following aspects of blood utilization (list may not be all inclusive): 01. Clinical alternatives to blood transfusion (perioperative salvage) 44 Membership and Structure: this multidisciplinary committee should include representatives from the Medical Staf (surgery, anesthesia, medicine, hematology, pediatrics), Nursing, Hospital Administration, the Transfusion Service and other interested parties as applicable. If guests are invited, they may be excused during discussions with potential liability issues. The Medical Director of the Transfusion Service is a vital member of the committee who may or may not serve as chairperson. The chairperson should, however, be a physician knowledgeable in transfusion medicine. The committee should establish guidelines for administration of each of the blood components transfused in the institution, using current medical literature as a resource. The transfusion guidelines should be approved by the Medical Staf prior to implementation. Transfusion guidelines are intended to remind ordering physicians of the transfusion practices for which there is general support and clinical trial evidence. Guidelines cannot be expected to cover every instance in which a transfusion is indicated. In every case, however, the rationale for transfusion should be clearly documented in the medical record. Process: the review of transfusions can be done prospectively by transfusion service personnel (before blood is issued) or retrospectively by the Transfusion Committee (after blood is issued) for certain high cost blood products, prospective review may be appropriate to prevent unnecessary transfusions. Similarly, prospective review of potentially inappropriate orders, for example, an order for platelet transfusion to a patient with thrombotic thrombocytopenic purpura or an order for four units of red blood cells for a child, may also require review prior to blood issue. For most transfusions and blood products, 45 however, involving large numbers of transfusions and patients, retrospective reviews are adequate and most commonly used. Applicable lab or clinical results before and after transfusion Trained hospital quality assurance or compliance staf can do chart or electronic record reviews, using the approved transfusion guidelines developed by the committee. When there are questions about the indications and results of a transfusion, the clinical records should be peer reviewed or reviewed at the transfusion committee meeting. If the letter is ignored or if repeated unjustifed transfusion practices are noted, a department chair or credentialing committee may need to be involved in the review process. Monitors: Blood usage should be monitored by whichever parameters are most useful for the institution: by physician, by clinical department, by diagnosis (Diagnosis-Related Groups), or by surgical procedures In addition, the Transfusion Committee must ensure that blood is administered correctly. The wastage of all blood components, both allogeneic and autologous, should be monitored. The committee must also ensure that a mechanism exists for reporting and evaluation of suspected transfusiontransmitted diseases. Reports: the Transfusion Committee or its equivalent, should document activities by minutes and generate reports of its work for submission to other entities of the hospital. The intent of this reporting is to provide other peer review committees with the results of reviews of transfusion related patient care. These minutes can be protected from inappropriate legal discovery as a critical component of an institutions quality monitoring program. Summary: Hospitals are required to review blood transfusion practices and adverse outcomes. Accrediting and regulatory agencies do not specify how this peer review function is accomplished, as long as it is being performed. It is simply a matter of having appropriate policies and procedures in place, reviewing and revising them as necessary, and monitoring that they are followed. General the following side efects and hazards pertain to transfusion of Whole Blood or any component prepared from blood collected from individual donors. Hemolytic transfusion reaction, the destruction of transfused red cells, is discussed in detail in the section on red-cell-containing components. Febrile nonhemolytic reaction is typically manifested by a temperature elevation of fi 1 C or 2 F occurring during or shortly after a transfusion and in the absence of any other pyrexic stimulus. This may refect the action of antibodies against white cells or the action of cytokines, either present in the transfused component or generated by the recipient in response to transfused elements. Febrile reactions may accompany about 1% of transfusions; and they occur more frequently in patients previously alloimmunized by transfusion or pregnancy. No routinely available preor posttransfusion tests are helpful in predicting or preventing these reactions. Patients who experience repeated, severe febrile reactions may beneft from receiving leukocytereduced components. If these reactions are due to cytokines in the component, prestorage leukocyte reduction may be benefcial. Allergic reactions usually occur as urticaria, but may also include wheezing or angioedematous reactions. No laboratory procedures are available to predict or prevent these reactions, which usually respond to antihistamines or, in severe cases, corticosteroids or epinephrine. Anaphylactoid reactions, characterized by autonomic dysregulation, severe dyspnea, pulmonary and/or laryngeal edema, and bronchospasm and/or laryngospasm, are a rare but dangerous complication requiring immediate treatment with corticosteroids and epinephrine. The majority of these reactions have been reported in IgA-defcient patients who have IgA antibodies of the IgE class. Such patients may not have been previously transfused and may develop symptoms after infusion of very small amounts of IgA containing plasma, in any blood component. Delayed hemolytic reaction is described in detail in the section on red-cell-containing components. Alloimmunization to antigens of red cells, white cells, platelets, or plasma proteins may occur unpredictably after transfusion. Primary immunization does not become apparent until days or weeks after the immunizing event, and does not usually cause symptoms or physiologic changes. If components that express the relevant antigen are subsequently transfused, there may be accelerated removal of cellular elements from the circulation and/or systemic symptoms. Clinically signifcant antibodies to red cell antigens will ordinarily be detected by pretransfusion testing. Alloimmunization to antigens of white cells, platelets, or plasma proteins can only be detected by specialized testing. While the immune specifcity may be to a plateletspecifc antigen the patient lacks, autologous and allogeneic platelets are destroyed. Transmission of infectious disease may occur because this product is made from human blood. For other infectious agents, there are no 50 routinely available tests to predict or prevent disease transmission.

Purchase toprol xl 100mg without prescription. Benicar Drug for High Blood Pressure: Side Effects Dosage & Uses.

References