By G. Tarok. Virginia Commonwealth University.
This acceptance of biological reality does not mean that we need new laws that ofﬁcially deﬁne in statutory terms the category of cosmeceuticals order 10mg atarax with amex anxiety blog. Cosmeceutical is a pragmatic term that enables us to state without pretense the beneﬁts of a product discount atarax 25 mg otc anxiety symptoms legs. A strict, legal interpretation of the 1938 law would necessitate the con- version of ‘‘active’’ cosmetics to drugs. This would be a disaster of the highest magnitude that would immediately stiﬂe innovation and creativity. Cosmetics, on the other hand, do not require premarketing clearance and can be rapidly commercialized provided that the claims are not grossly mis- leading. The trouble comes when some cosmetic manufacturers make frank drug claims for their products. Competitors who are prudent and conscientious may be at a disadvantage if they make less aggressive claims, an issue highlighted by the ‘‘antiaging’’ claims made for certain α-hydroxy acids. Cosmeceuticals enable cosmetic scientists to communicate with each other regarding the standards that must be met to justify performance claims, without resorting to hype. Obvi- ously globalization as an integrated free-trade network cannot work if each block classiﬁes and regulates skin care products differently. Unfortunately, no interna- tional consensus currently exists, inevitably sparking disputes and trade practices that may place some producers at a grave disadvantage. The product information that must be made available to ofﬁcials encompasses the following: qualitative and quantitative composition of the product: speciﬁcations of raw materials; methods of manufacture; safety assessments; and proof of effec- tiveness. In the United States, manufacturers are not required to demonstrate either safety or efﬁcacy prior to marketing, as is the case for drugs. Japanese authorities have created their own laws in response to the problem that many skin care products are neither pure drugs nor pure cosmetics in the traditional sense, but mixtures of the two. They allow cosmetics to include pharmacologically ac- tive ingredients, provided that the medicinal effects are mild and the products have been demonstrated to be safe. The legal wording leaves a lot of room for ambiguities and ad hoc interpretations that some perceive as a trade restraint. Even a cursory look at these regulatory disparities shows the detrimental effects of not establishing uniform, international standards. The following exam- ples illustrate the quandaries which now exist, a situation which is bound to get nasty without an international consensus. In the United States, the following agents are regulated as drugs while in Europe (according to the European commission on cosmetics) they are sold as cosmetics. Sunscreens This classiﬁcation is detrimental to industry in the United States, especially in the case of sunscreens, which are more advanced and more effective in Europe because there is greater choice of ingredients. For example, retinol (vitamin A) can be sold as a cosmetic, but its oxidation product, retinoic acid, is regulated as a drug. On the other hand, minoxidil, a drug that purports to grow hair and improve attractiveness, satisﬁes the basic deﬁnition of a cosmetic and is available without a prescription. Sometimes, there are too many statutory exceptions and loopholes that are downright dangerous. For example, theophyllin is a powerful drug with a narrow therapeutic index, and is used in the treatment of asthma; blood levels should be monitored frequently. Yet, this same agent can be sold as an unregulated cosmetic when incorporated in topical formulations for the treatment of cellulite. I recommend that all interested parties read the scholarly treatise prepared by Vermier and Gilchrest, respectively (6). They argue that cosmeceuticals al- ready exist and are in fact desirable as intermediates between cosmetics and drugs and that they should continue to be regarded as cosmetics. They move toward the European position and recommend that it is in the interest of manufacturers to prove the efﬁcacy of active cosmetics. Recent papers strongly express the feelings and beliefs of major players in this ﬁeld. Is it an attempt to convince the consumer that their skin care product is really a topical medicine without a proper license, or is it a genuine category that attempts to provide a mild product that has been more stringently tested than a normal skin care product?
Folic acid deficiency was associated with adverse pregnancy outcome in one study (Dansky et al atarax 25mg online anxiety symptoms in children checklist. The untoward effects of hypervitaminosis B12 are not well studied discount atarax 25mg fast delivery anxiety symptoms gi, especially during preg- nancy. For this reason, folate intake among women who are of childbearing age should regulate their intake to 0. Iron Iron is an essential dietary metal and its requirements during pregnancy increase as gesta- tion age advances. Preterm delivery was doubled and the incidence of delivering a low- birth weight baby was tripled among the iron deficiency anemic women. Iron supplementation (60–100 mg daily) is needed because the normal diet cannot supply the required amounts. It is also rec- ommended that the iron supplement be given alone and not as a component of prenatal vitamins because of lower absorption from multivitamin preparations (Cunningham et al. A prudent practice for high-risk patients is to provide only a 1-week supply at a time, which limits access to toxic doses of iron. Iron supplement megadoses are among the more commonly used medications in suicide ges- tures, which is discussed in Chapter 14, Drug overdoses during pregnancy. Congenital anomalies were not increased in frequency among 66 infants born to women who received parental iron supplementation during the first trimester. No com- plications or malformations were found among more than 1800 infants whose mothers received iron supplementation at any time during pregnancy (Heinonen et al. Similarly, the frequency of congenital anomalies or complications was no different than the general population among 1336 infants born to either women who received iron supplements when they were anemic or women who routinely received the supplement during the second and third trimester of pregnancy (Hemminki and Rimpela, 1991). Therefore, it may be prudent to limit prescriptions to a 1-week course per refill in gravi- das with a history of suicide gestures, although no abnormalities were observed in a group of 19 children whose mothers had ingested overdoses of iron during the last two trimesters of pregnancy (McElhatton et al. Rats born to moth- ers given up to 100 times the usual therapeutic dose of iron during embryogenesis showed frequency of congenital anomalies no different from controls (Flodh et al. Central nervous system anomalies were increased in fre- quency above control levels among mice and rabbits whose mothers were given compa- rably large doses of iron during embryogenesis (Flodh et al. Calcium Calcium is an essential nutrient required for normal physiological function and fetal growth. The frequency of congenital anomalies was not increased among more than 1000 infants born to women who received calcium supplements during the first trimester, or among more than 3500 infants whose mothers took supplements after the first trimester (Heinonen et al. A slight, but significant excess of nonspecific central nervous system abnormalities was reported. The heterogeneity of the defects suggests that the association may be a chance occurrence of multiple comparisons. Fetal death and growth retardation occurred more frequently in the offspring of pregnant rats given about 1600 mg/kg. Nutritional summary In conclusion, iron supplements during pregnancy are definitely necessary. The gravid vegetarian or one who is follow- ing a ‘fad’ diet is a special concern and a nutritional assessment should be undertaken to assure adequate intake. Prenatal vitamins should probably be given, although there is no consensus on whether they are necessary. Following Hippocrates to above all do ‘no harm,’ prenatal vitamins should be given. Nausea, with or without vomiting is the most common gastrointestinal disorder of early pregnancy. Pyrosis or ‘heartburn’ is a very common symptom in pregnancy and is related to increased gastroesophageal reflux secondary to decreased muscular tone in the lower esophagus. Gastrointestinal disorders that may be associated with pregnancy, but occur with about the same frequency in nongravid women, include peptic ulcer disease, inflammatory bowel disease, and gallbladder disease – cholelithiasis and cholecystitis (Cunningham, 1994). Medications to treat gastrointestinal disorders, including antacids, anticholinergics, antiemetics, antiflatulents, and laxatives, are discussed in this section. Corticosteroids, which may be useful in the therapy of inflammatory bowel dis- ease, are discussed in Chapter 4. Antacids Antacids are classified based on their content: aluminum, calcium, magnesium, magal- drate, sodium bicarbonate, and combinations of any of these. Antacids are the most common over-the-counter and prescribed gastrointestinal medications used by pregnant 224 Nutritional and dietary supplementation during pregnancy women.
Mack Smith discount atarax 25mg fast delivery anxiety symptoms zoloft, Published by The Viking Press "The History of Sugar" by Noel Deere purchase 25 mg atarax mastercard anxiety symptoms 10 year old, Chapman ∓ Hall, Ltd. The fate and fortune of Venice were founded on sugar and the trade in silks and spices. The civic archives of Narbonne tell us that in 1153 a toll on sugar was introduced, called the lende: eight deniers per quintal if the goods arrived by sea, 14 deniers if they arrived by land. Marseilles instituted the lesde in 1228, and the Count of Provence added sugar to his toll tariff 25 years later. It should be remembered that alcohol and alembic are words of Arabic origin, although the Koran forbade alcohol and all fermented drinks. The alembic was a still, and was already known to the author of the first part of the Roman de la Rose, Guillaume de Lorris, around 1236. Hammond, 1993, Alan Sutton Publishing Limited, Phoenix Mill, Far Thrupp, Stroud, Gloucestershire, England: "Sugar and spices played an important part in food in the Middle Ages.... Prices remained very similar to this until well into the sixteenth century, although the actual figure depended on the degree of refinement. Very large amounts of sugar were used by the royal household before the end of the thirteenth century (6,258 lb in 1288), and from then on increasing amounts were imported. One ship alone, which entered Bristol from Lisbon in 1480, carried nearly 10 tons. Considerable amounts of treacle, as well as violet and rose sugar, were brought in too. The sugars were more expensive than regular sugar and were partly used as medicine. Sack seems to have been dry Spanish wine, given this name to differentiate it from the sweeter wines from elsewhere, although the name was later extended to wines from many other places-sherry sack, Madeira sack and Canary sack (this latter was sometimes known as sweet sack) - all of which were imported. For the purposes of their trade they bought Arras, Bergen (Mons), Elron (in Bretagne) and Normandy canvas for packing wool. Mercola | February 28 2011 | Modifications by Desire’Dubounet in Lila The latest Public Service Announcement warning New Yorkers about the dangers of excessive soda consumption shows exactly how much sugar you might be inadvertently drinking. Glucose and fructose are both simple sugars, but scientists have long suspected there are differences in the way your body processes them. Scientist have known the simple differences but the lack of the scientific understanding of quantum physics with the sugar lobby groups hiding and twisting the truth is not readily available. In a new study, researchers scanned the brains of nine subjects after they got an infusion of equal volumes of glucose, fructose or saline. The brain scans were looking at activity in the hypothalamus, a part of the brain which plays a key role in setting appetite levels and controlling production of metabolic hormones. Fructose had the opposite effect, causing activity in the same areas to drop and stay low for 20 minutes after the infusion. This delay process stabilizes the blood sugar and prevents it from surging up and down. It is the surge up and down from dextrose sugar (the high glycemic reaction) that makes the disease causing nature of dextrose. People everywhere are finally waking up to the indisputable fact that all simple sugars are not the same when it comes to the physical end results they create. The latest Public Service Announcement warning New Yorkers about the dangers of excessive soda consumption is a powerful illustration of this increasing level of awareness. It is important to understand that fruits are not implicated nor is natural fruit sugar. Nine healthy, normal-weight subjects received either glucose, fructose, or saline (as the control). Their brains were then scanned to evaluate activity around the hypothalamus, which is a key player in appetite control and production of metabolic hormones. Interestingly, the researchers discovered that the "cortical control areas" surrounding the hypothalamus responded very differently to each substance: Glucose significantly raised the level of neural activity for about 20 minutes Thru hyperglycemic reactions followed by a one hour hypoglycemic low. The Chicago Tribune reported that: "At this point, said [lead researcher] Purnell in a phone interview, it means nothing more than that the two substances did prompt different responses in the brain--that the brain did not respond to them identically. Within some of the "cortical control areas" where differences were seen, lie some important neural real estate, including regions where notions of reward and addiction are processed. As scientists have a closer look in future studies, they should be able to zero in on which specific areas are affected differently by the two forms of sugar. So, time will tell what these latest findings really mean, but we already know that fructose has a detrimental impact on two hormones involved with satiety and hunger, namely leptin and ghrelin, and that this influence sets in motion a vicious cycle of hunger, increased food intake, and increased fat storage.
Loosening of the nails has been attributed to the drug in a case report discount atarax 10 mg visa anxiety 1-10 rating scale, but that is unusual best atarax 10 mg anxiety questionnaire for adults. Somewhat less surprising is a case report of jaundice, less surprising because many drugs add a burden to the liver. The drug routinely makes people sleepy, and users are cautioned against operating dangerous machinery. Nonetheless, a laboratory simulation of driving showed no effect on operating a motor vehicle. One authority contends that the substance should not impair driving performance but acknowledges that trouble arises if a driver does not use the drug as medically directed or uses alcohol simultaneously. Other unwanted effects occur less often: peevishness, headache, stomach irritation, dry mouth, rashes, double vision, and unclear speech. Therapeutic advantage sometimes comes from the drowsiness factor, with patients instructed to take the drug at bedtime to help reduce insomnia, a technique that then also allows them to obtain the long-lasting antianxiety effect during daytime hours the next day. In one study people reported more restful sleep, and measurements after they awoke showed little drug impact on performance tests (illustrating the difference a few hours can make on how well someone performs after taking a substance). If usage continues for a long time and suddenly stops, a withdrawal syndrome can occur. Withdrawal symptoms can include trouble with sleeping and memory, jitteriness and crankiness, sore muscles, and loose bowels. Those discomforts are similar to what happens in alcohol or barbi- turate withdrawal. Researchers suspect the problem may be worsened if a person has taken some other benzodiazepine class drug off and on. The with- drawal problem may be avoided by gradual discontinuation of clorazepate dipotassium. A canine test demonstrated that abrupt clorazepate dipotassium with- drawal can cause fatal seizures. The kinds of well-documented dependence mentioned above involve relatively brief withdrawal. Reportedly human with- drawal symptoms may continue for months, which is an unusual persistence of dependence. Long-term signs of withdrawal, however, are described as reappearance of anxiety, sometimes accompanied by psychosis and convul- sions. Such long-term “withdrawal symptoms” sound much like conditions for which the drug is prescribed, raising a question of whether the victim is experiencing long-term dependence or simply reemergence of conditions for- merly controlled by the now-absent drug. A group of recreational drug abusers was tested to determine their likings, 90 Clorazepate and the group declared clorazepate dipotassium to be less attractive than di- azepam or lorazepam. Members in a group of recreational drug abusers re- ported that alcohol boosted clorazepate dipotassium’s effect and that the com- bination made their mood bleaker, but when subjects in another study took that combination they felt happier than alcohol normally made them. Another experiment found that the combination impaired memory, although still an- other study found that clorazepate alone did not affect memory. In testing how long the desmethyldiazepam metabolite lasts from a clorazepate dipo- tassium dose, conﬂicting results have come from experiments comparing cig- arette smokers to nonsmokers. Animal studies have failed to ﬁnd evidence of any cancer-causing potential in clorazepate dipotassium. Experiments with pregnant rats and rabbits revealed no im- pairment of fertility and failed to produce any birth defects attributable to clorazepate dipotassium. One rat study also found no behavioral conse- quences from prenatal exposure to the drug, but another rat study discovered that offspring walked more slowly than normal and also had some learning difﬁculty. A case report associates it with fatal lung collapse in a newborn whose mother had used the drug during pregnancy, and another case report associates the drug with fatal birth defects. Breast-feeding mothers are warned to avoid the drug because its metabolite nordiazepam (which is also a metabolite of diazepam) passes into the milk and into the infant. The metab- olite desmethyldiazepam also passes into milk, as does clorazepate dipotas- sium itself. The coca bush is native to the Andes, where it has been harvested since ancient Inca days. Use in that era has been conﬁrmed through analysis of hair from ancient corpses and from examination of artwork. At ﬁrst only upper-class Incas and select individuals were permitted to use coca, but usage spread to Inca society as a whole after the Spanish conquest. In modern times the plant has been cultivated in India and Sri Lanka as well as Formosa, Indonesia, and Malaysia.