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Sexual offences and paraphilias – legal criteria according to the Criminal Code of the Republic of Bulgaria entocort 100mcg cheap allergy symptoms 7dpiui. Criminal abortion – legal regulation of willful abortion in the Republic of Bulgaria order entocort 100 mcg with mastercard allergy testing numbers. Forensic Medical Expert Examination of dead body of newborn infant in cases of infanticide entocort 100 mcg without a prescription allergy treatment while pregnant. Acquainting students with the requirements of the department, the proceedings of the seminars, the current control and the final exams. Introduction of the normative base concerning Forensic Medical Expert Examinations in the Republic of Bulgaria. Experts – rights, 325 obligations, responsibility, right of challenge, forensic problems in the work of medical practitioners. Injuries caused by mechanical factors – general description, classification of injuries. Demonstrations of specimens, photographs, and slides of both dead bodies and living people. Demonstrations of specimens, photographs, and slides of both dead bodies and living people. Demonstrations of specimens, photographs, and slides of both dead bodies and living people. Demonstrations of specimens, photographs, and slides of both dead bodies and living people. Types of mechanical asphyxia- hanging, ligature strangulation and manual strangulation – general and type characteristics, manner of death. Other types of mechanical asphyxia - drowning, airway obstruction, postural asphyxia, asphyxia due to exhaustion or displacement of environmental oxygen. Medicolegal autopsy in cases of traumatic injuries, postmortem changes, diagnosis of death. Introduction and preparing a specific Forensic Medical Expert Examination for a particular case. Practical introduction of the methods of chemical examination of biological materials. Basics of legal proceedings in Forensic Medicine in the Republic of Bulgaria (Penal Procedure Code and Code of Civil Practice). Blunt force trauma – definition, types, mechanism of causation, morphological characteristics of the injuries. Abrasions – definition, mechanism of causation, morphological characteristics, medicolegal importance. Bruises – definition, mechanism of causation, morphological characteristics, medicolegal importance. Lacerations - definition, mechanism of causation, morphological characteristics, medicolegal importance. Motor vehicle trauma – definition, classification, major issues concerning Forensic Medical Expert Examinations. Common morphological characteristics in cases of death caused by mechanical asphyxia-postmortem appearances. Airway obstruction, postural asphyxia, asphyxia due to exhaustion or displacement of environmental oxygen. Major issues of Forensic Medical Expert Examination in cases of mechanical asphyxias. Major issues concerning Forensic Medical Expert Examination in cases of electrical injuries and lightning stroke. The impairment of health and death caused by the effect of chemical agents (Forensic Toxicology). Medium bodily injury - legal and medical criteria (article 129 from Criminal Code) 31. Severe bodily injury - legal and medical criteria (article 128 from Criminal Code) 32. Fornication (act for the purpose of arousing or satisfying sexual desire, without copulation - articles 149 and 150 from Criminal Code). Homosexual acts (sexual intercourse or acts of sexual satisfaction with a person of the same sex - article 157 from Criminal Code). Rape (sexual intercourse with a person of the female sex - 329 article 152 from Criminal Code). Short summary for different types of examination- genetic and serological methods. Forensic Medical Expert Examination of dead body in cases of sudden natural death. Early postmortem changes –changes in the skin, changes in the eye, livor mortis, algor mortis and rigor mortis. Application of medical methods for diagnosis and treatment leading to a temporary change in consciousness. Score assessment Participation in seminars, weekly tests, essay preparation and presentation Semester exam: Yes / written and oral examination State Exam Yes Lecturer Full Professor from the Department of Epidemiology Department: Epidemiology and medicine of disastrous events. Methodology and methods of epidemiology of infectious diseases and their application in the study of massive, socially significant diseases. Epidemiologic characteristics, prevention, surveillance and control of infectious diseases. Teoretical and practical training in the field of epidemiology as a essential medical discipline. Knowledge about the mode of transmition and distribution of infectious diseases and the system of measures for prevention and control them. Knowledge of basic epidemiological characteristics of chronic mass non communicable diseases and their prevention and control. Knowledge of basic epidemiologic characteristics of non communicable diseases with massive infectious etiology and their prevention and control. Skills such as physicians to participate in solving practical problems limiting, reducing economic and social losses, elimination and eradication of infectious diseases. Theoretical knowledge about the epidemiologic features characteristic of mass non communicable diseases with such infectious etiology. Technical means and methods - autoclave, desinfection chamber - evaluation effienciency of prevention and control. Practical skills: - To make the epidemiologic history of different infectious diseases. Subject, theory and methods of epidemiology of infectious diseases and epidemiology of mass non-infectious diseases. Definition, the aim, the main tasks of epidemiology of infectious diseases and epidemiology of mass non-infectious diseases.

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These devices are logic or urologic surgery patients or medical being used more frequently buy discount entocort 100 mcg allergy testing on back, especially now that patients who are at bed rest (including all critical many can be safely retrieved after several months buy generic entocort 100 mcg penicillin allergy symptoms joint pain. Interventional catheter extraction if the bleeding risk is extremely high generic entocort 100 mcg free shipping allergy symptoms pictures, mechanical or fragmentation may become viable options for methods of prophylaxis should be used. The vascular changes involve the pulmonary arteriole, and they are characterized by vasoconstriction, vascular remodeling with intimal and medial proliferation, the formation of plexiform lesions, and thrombosis Figure 3. Platelets likely play an impor- patients with an unexplained isolated reduction in tant role as procoagulants by increasing the plate- diffusing capacity). The most common symptoms are liver transplantation, and patients with congenital dyspnea on exertion, fatigue, and syncope, result- systemic to pulmonary shunts. When suggested by his- more advanced disease, the physical examination tory, an overnight polysomnography can be reveals signs of right ventricular dysfunction. Signs Symptoms Left-sided heart catheterization can evaluate for coronary artery disease, as well as measure left Jugular vein distention Dyspnea or exertion Prominent right ventricular heave Fatigue ventricular end-diastolic pressure. This test has been very troversial because of the lack of well-designed useful in monitoring the response to therapy and randomized controlled trials in this population. Unfortunately, calcium- ment is screening of high-risk patients (as previ- channel blockers have no antiproliferative effect, ously discussed) because it is generally believed and thus, only a small subset of patients will ben- that earlier diagnosis and treatment may improve efit from long-term use. General measures Significant adverse effects include systemic hypo- include pneumococcal and influenza vaccinations tension, pulmonary edema, and right ventricular in addition to the avoidance of pregnancy, high- failure. In addition, the reducing endothelial and smooth-muscle cell pro- following supportive treatments are available: liferation target the following three major path- 1. Two studies have shown improved survival with Their overall recommended approach is shown in bosentan therapy compared with historical control Figure 4. Although many of the trials that use these (the sixth line) treatment (lung transplantation or classes of medications were not powered to detect atrial septostomy) should be considered. Responders to patients who are in functional class I receive gen- calcium-channel blockers have a 95% 5-year sur- eral care only, although trials with early use of vival rate. Posttreatment consensus as to which agent to start first, nor is markers of poor prognosis included persistent there any current consensus as to the role of com- increases in right atrial pressure, low cardiac index, bination therapy. Trends in the location affects the sensitivity of a rapid quantitative d- incidence of venous thromboembolism during preg- dimer assay in the diagnosis of pulmonary embolism. Intern Med J 2007; 37:38−48 College of Chest Physicians evidence-based clinical This article, although focusing on the Australian experience practice guidelines. Pulmonary arterial hyperten- ultrasonography in the diagnosis of suspected deep sion: epidemiology, pathobiology, assessment, and venous thrombosis and pulmonary embolism. Ann Intern Med 2008; 162:1964−1973 148:278−283 This review summarizes the current state of knowledge A short, easily understandable description of the discovery regarding pulmonary venoocclusive disease. Chest 2004; 126(suppl):14S−34S unfractionated heparin for treatment of pulmonary A comprehensive evidence-based review and recommenda- embolism: a meta-analysis of randomized, controlled tions on the diagnostic approach to patients with suspected trials. The 2008; 29:3−14 duration of oral anticoagulant therapy after a second An up-to-date review of the diagnostic accuracy and utility, episode of venous thromboembolism. However, there suspected acute pulmonary embolism and negative was a trend toward a greater risk of major hemorrhage when computed tomographic findings: a cohort study. N Engl J Med of cancer cases was 1,372 based on national statistics from 2008; 358:1037−1052 Denmark (ratio of observed/expected number of cancer cases, An updated review of the epidemiology, diagnosis, treat- 1. In so doing, the authors have also performed after withholding anticoagulation from patients with a systematic review of the literature regarding clinical 36 Pulmonary Vascular Diseases (Moores) prediction rules and d-dimer levels and applied these data in This is an extensive review of a pathophysiologic approach to the context of clinical decision making. Major pulmonary embolism: review of risk gratification in part based on right ventricular dysfunc- a pathophysiologic approach to the golden hour of tion. The expected 5-year survival • Review the paraneoplastic syndromes associated with lung for the diagnosis of lung cancer is 16% as compared cancer with 65% for colon cancer, 89% for breast cancer, • Place in perspective the appropriate use of laboratory studies, imaging techniques, and diagnostic approaches and nearly 100% for prostate cancer. The current • Review the results of various treatment modalities for both overall 5-year survival rate of 16% is only slightly small cell and non-small cell lung cancers better than the 8% survival rate of the early 1960s. Before reviewing the subject at hand, it must Lung cancer is currently the leading cause of be said that much of the effort evidenced in this cancer deaths in both men and women in the review might not be necessary but for the real United States. Lung cancer causes more deaths than the the efforts of clinicians and clinical researchers, but next four most common cancers combined (colon, the “biggest bang for the buck” comes in the form 49,962; breast, 40,930; pancreas, 34,290; and pros- of lung cancer prevention. Fortunately, the death rate from lung ondary, or tertiary, the prevention of cigarette cancer in men in the United States began to smoking has the biggest potential to improve the decrease in 1991, which is reflective of a decrease dismal statistics associated with this cancer. The antici- Etiology of Lung Cancer pated decrease has lagged behind the decrease in men, likely to the result of smoking prevalence Tobacco causes 80 to 90% of all lung cancers. The risk of lung cancer increases, in cigar association or a role for supplemental beta-carotene and pipe smokers, depending on inhalation prac- in the prevention of lung cancer. The effect of pipe and cigar use on the risk of same studies provide striking evidence of an exces- lung cancer is generally similar to that of light sive lung cancer incidence in smokers (an adverse cigarette smoking. This finding stresses the importance of chewing tobacco and snuff) are carcinogenic for establishing the efficacy of chemoprevention the upper aerodigestive tract but not for the agents in carefully conducted clinical trials. Genetic Lesions and the Molecular Pathogenesis Passive Smoking of Lung Cancer It is estimated that up to 25% of lung cancer in It is becoming apparent through candidate nonsmokers comes from passive exposure to ciga- gene and genome-wide approaches that clinically rette smoke, which translates into an estimate that evident lung cancers have accumulated numerous passive smoking causes approximately 1. These alterations from mainstream smoke inhaled by the active include the classical genetic abnormalities of tumor smoker and may be even more carcinogenic. It has been conjectured that air pollution increased our understanding of the multiple events may promote the action of other carcinogens but that lead to the development of lung cancer. As risk factors for field cancerization theory suggests that multiple lung cancer, most, if not all, of these environmental genetic abnormalities occur throughout the respira- factors either require or are markedly augmented tory epithelium as a result of long-term carcinogen by concomitant exposure to cigarette smoke. Mutations may occur during adult life as a result of cigarette smoking, but it is also possible Dietary Factors that some of them may be acquired during embry- onic development of the bronchial epithelium. The constituents of green and yel- A predisposition to early age of onset of lung low vegetables, such as beta-carotene and selenium, cancer may be inherited in a Mendelian codominant appear to have potential as protective agents against fashion. Both bupropion, an antidepressant that inhibits the Inheriting genes predisposing to malignancy usu- reuptake of dopamine and norepinephrine, and ally results in a high rate of secondary tumors varenicline, a partial nicotine agonist at a subtype (lung, head and neck, esophagus, and other of the nicotinic acetylcholine receptor, have been organs). In the There may be an increased risk of neuropsychiatric United States, 10 to 15% of lung cancer occurs symptoms, including agitation, depressed mood, in never smokers (5 to 10% in men and 15 to 25% suicidal ideation, and worsening of preexisting in women). Pharmacotherapy tobacco smoke, cooking fumes, indoor air quality, doubles the cessation success rate at 6 months genetic factors, occupational exposures, hormonal when compared with placebo. Small- Psychological and behavioral techniques, such cell carcinoma is generally regarded as a disorder as delivering a strong personalized message, for which surgery is not indicated. Histologically, they use of telephone “Quit-lines” (telephone therapy are characterized by scant cytoplasm, fine chroma- is now accessible in every state at 1-800-Quit now), tin, and nuclear molding. Conversely, the use cells and stains positive for synaptophysin, of hypnosis or acupuncture has not proven to be chromogranin A, and neuron-specific enolase. Non-small cell lung resistant to radiation therapy and chemotherapy carcinomas are believed to arise from lung epithe- and are therefore best treated by surgery. Fortunately, Adenocarcinomas are the least closely associ- atypical carcinoid tumors of the lung are more ated with cigarette smoking and most commonly responsive to chemotherapy and radiation therapy.

Impaired insight in cocaine addiction: Laboratory evidence and effects on cocaine-seeking behaviour discount entocort 100mcg without prescription allergy forecast maryland. Dual diagnosis patients in substance abuse treatment: Relationship of general coping and substance-specific coping to 1-year outcomes discount 100mcg entocort free shipping allergy forecast in fresno ca. Motivational interviewing versus feedback only in emergency care for young adult problem drinking order 100 mcg entocort amex allergy mask. Naltrexone and cue exposure with coping and communication skills training for alcoholics: Treatment process and 1-year outcomes. The Fagerstrom Test for Nicotine Dependence and the Diagnostic Interview Schedule. Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction. Primary care-based intervention to reduce at-risk drinking in older adults: A randomized controlled trial. Cigarette smoking, low birth weight, and preterm births in low- income African American women. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Impact of distinct chemical structures for the development of a methamphetamine vaccine. Effectiveness of intensive case management for substance-dependent women receiving temporary assistance for needy families. Examining mechanisms of action in 12-step treatment: The role of 12-step cognitions. Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. Smoking cessation for persons with mental illness: A toolkit for mental health providers. An experimental comparison of three types of case management for homeless mentally ill persons. Comorbid disruptive behavior disorder symptoms and their relationship to adolescent alcohol use disorders. The role of self-image in the relationship between family functioning and substance use among Hispanic adolescents. Brief interventions for alcohol problems: A meta-analytic review of controlled investigations in treatment-seeking and non- treatment-seeking populations. Pharmacogenetics: A tool for identifying genetic factors in drug dependence and response to treatment. A double-blind, placebo-controlled pilot study of carbamazepine for the treatment of alcohol dependence. Effects of progression to cigarette smoking on depressed mood in adolescents: Evidence from the National Longitudinal Study of Adolescent Health. Binge drinking in the preconception period and the risk of unintended pregnancy: Implications for women and their children. State policy report #34: Health center reimbursement for behavioral health services in Medicaid. Identification and description of multiple alcohol and other drug treatment systems: Final report. Quarterly report potency monitoring project: Report 104: December 16, 2008 thru March 15, 2009. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. An improved diagnostic instrument for substance abuse patients: The Addiction Severity Index. Integrating behavioral therapies with medication in the treatment of drug dependence. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Imaging studies expand understanding of how methamphetamine affects the human brain. S Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Preventing drug abuse among children and adolescents: Chapter 1: Risk factors and protective factors. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse. Developmental neural mechanisms of cognitive control: Implications for drug abuse interventions. Research report series: Heroin abuse and addiction: What are the treatments for heroin addiction? National voluntary consensus standards for the treatment of substance use conditions: Evidence- based treatment practices. Cost- effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department. Bupropion reduces methamphetamine-induced subjective effects and cue-induced craving. Using qualitative research to inform survey development on nicotine dependence among adolescents. Brief alcohol intervention to prevent drinking during pregnancy: An overview of research findings. Retail tobacco outlet density and youth cigarette smoking: A propensity-modeling approach. Cigarette smoking, cardiovascular disease, and stroke: A statement for healthcare professionals from the American Heart Association. Provider training for patient-centered alcohol counseling in a primary care setting. Methods of detoxification and their role in treating patients with opioid dependence. Three methods of opioid detoxification in a primary care setting: A randomized trial. Integrating addiction medicine into graduate medical education in primary care: The time has come.

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The following enzymes are of most relevance to psychiatry : 678 P450 enzymes became very important after erythromycin inhibited enzymatic breakdown of the antihistamine astemizole generic entocort 100mcg fast delivery allergy testing gippsland, accumulation of the latter leading to arrhythmias cheap entocort 100mcg visa allergy testing numbers. Adverse effects may therefore arise despite having drug levels in the ‘therapeutic range’ buy entocort 100 mcg cheap allergy forecast pa. Such variations in enzymes may lead to inactive forms or failure to activate prodrugs (e. Pharmacodynamics: the mechanism of action of drugs, or what drugs do to the body, e. Pharmacogenetics: Also called pharmacogenomics, this discipline examines the influence of genetic variation on the success or failure of a drug treatment. Some workers failed to find any association between serotonin receptor genes and treatment respone. Another genomewide association study (Uher ea, 2010) found single-nucleotide polymorphisms in two intergenic regions containing copy number variants on chromosomes 1 and 10 that seem to be important in clinical response to escitalopram and nortriptyline. Following this, different genetic sequence polymorphisms are numbered in sequence: *2, *3. Psychotropics are highly ionized due to gastric acidity and so their movement across lipid cell membranes is blocked; they are therefore mostly absorbed via the small intestine. Some drugs are excreted with bile and reabsorbed in the distal small intestine (entero-hepatic circulation). Anticholinergic drugs may delay absorption of other drugs with the result that co-administered medication reaches higher concentrations in plasma. This matters little when 682 drugs are administered over a prolonged period since a drug’s steady state is mainly dependent on metabolism (rather than absorption). Competition for binding sites are particularly important when the patient is taking warfarin or digoxin. Most psychotropic drugs are highly protein bound and can 684 displace warfarin or digoxin with potential complications. Factors affecting distribution include the percentage of drug bound to plasma proteins and the tissues, solubility in lipid and water, size of the molecule, and pH partition. The use of the word ‘apparent’ here is because some drugs may have huge distribution values (e. Apart from obvious allergy or overdose, the practitioner is generally in a position to consider tolerability (and to a lesser extent efficacy) when steady state is reached. Depending on the receptor, phosphorylation of certain amino acid residues by a kinase may increase or decrease receptor function. When taking samples for plasma levels one should note how long it was since the last dose since apparent non-compliance (e. Up-regulation: ‘hypersensitivity’ of receptors; often follows prolonged receptor blockade; possibly involves increased receptor synthesis. Volume of distribution: ratio between amount of drug in body and plasma concentration. Apparent volume of distribution or Vd = extent to which the drug equilibrates outside the blood compartment: small and large volumes indicate that the drug is mainly retained within the blood compartment or that a significant part is in the tissues respectively. Most psychoactive agents are very soluble in lipid and big volumes of distribution. Of course, lipid solubility is needed if the drug is to pass the blood-brain barrier. In this regard, it is important to note that there are no openings (fenestrations) between the endothelial cells of capillaries in the brain. Ach can be hydroylsed by acetylcholinesterase or released into the synapse to act on its receptors. Most of the brain’s cholinergic receptors are muscarinic, and there are at 685 least 5 subtypes, M1-M5. The α7-nicotinic receptor gene may be involved in the auditory sensory gating defect reported in schizophrenics. M1 receptors have a high affinity for the anti-muscarinic agent pirenzepine, while M2 receptors have a low affinity for this agent. The balance between Ach and other transmitters in the striatum, such as dopamine, appears to be critical in both Parkinson’s and Huntington’s diseases in which anticholinergic drugs respectively improve and worsen the movement disorder. Meynert’s nucleus projects throughout the cortex and to the hippocampus and amygdala, whereas the latter two centres project to the cingulate gyrus and the hippocampus. Another agent which has become available is galantamine (Reminyl), a component of snowdrops and daffodils, which is both a cholinesterase inhibitor and nicotine agonist, the latter action leading to Ach release. Rivastigmine (Exolon) inhibits acetylcholinesterase only, but itself reverses this action over some hours, so-called pseudoreversibility. Botulinum toxin inhibits, and Black Widow spider venom facilitates, the release of Ach from the presynaptic neurone. Nicotine acts agonistically, and d- tubocurarine, succinylcholine, decamethonium, hexamethonium, fuxamethonium and gallamine act 692 antagonistically at cholinergic nicotinic receptors, while muscarinic receptors have their own agonists 693 and antagonists. Drugs like succinylcholine and decamethonium do not compete with Ach for the receptor site, instead causing prolonged depolarisation of the receptor rendering it insensitive to Ach. Low dose Ach is excitatory at nicotinic receptors in low doses, whereas in high doses it causes blockade by depolarisation; it is inhibitory at muscarinic receptors. Similarly, low doses of nicotine produce stimulation in the periphery, whilst high doses block nicotinic receptors with paralysis of the neuromuscular junction. The effects of Ach on the peripheral autonomic system are muscarinic, whilst those on autonomic ganglia and the neuromuscular junction are nicotinic. Cholinergic drugs or poisons, such as physostigmine and organophosphate fertilisers, can acutely cause a depressed, listless, fatigued, irritable state, with later seizures, myoclonus, and delirium. Anticholinesterases such as physostigmine inhibit acetylcholinesterase, with accumulation of Ach at cholinergic synapses. Yohimbine, central α-2 adrenergic antagonist, increases locus coeruleus firing and hence noradrenaline release, causing anxiety in humans; the α-2 agonist clonidine reduces locus coeruleus firing, and has a modest anxiolytic effect. All 5 receptor subtypes are found postsynaptically, while D2 and D3 are also found presynaptically. D2 antagonism from the strongest to the weakest can be illustrated as follows: haloperidol > risperidone > perphenazine > chlorpromazine > clozapine. The benzamides sulpiride and remoxipride are specific D2 antagonists, while another benzamide, amisulpride (Solian) is highly selective for D2 and D3 receptors. Clozapine has relatively strong affinities for α-1 (postsynaptic) and α-2 receptors. D3 receptors are expressed in the limbic system and have a possible role in schizophrenia. D3 and D4 receptors are subtypes of D2, and D5, which is found in the hippocampus, is a subtype of D1.

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