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No animal studies have been conducted with the combined products in Metaglip 100mg kamagra soft with mastercard. The following data are based on findings in studies performed with the individual products buy kamagra soft master card. A 20-month study in rats and an 18-month study in mice at doses up to 75 times the maximum human dose revealed no evidence of drug-related carcinogenicity order discount kamagra soft. Bacterial and in vivo mutagenicity tests were uniformly negative. Studies in rats of both sexes at doses up to 75 times the human dose showed no effects on fertility. Long-term carcinogenicity studies were performed with metformin alone in rats (dosing duration of 104 weeks) and mice (dosing duration of 91 weeks) at doses up to and including 900 mg/kg/day and 1500 mg/kg/day, respectively. These doses are both approximately 4 times the maximum recommended human daily (MRHD) dose of 2000 mg of the metformin component of Metaglip based on body surface area comparisons. No evidence of carcinogenicity with metformin alone was found in either male or female mice. Similarly, there was no tumorigenic potential observed with metformin alone in male rats. There was, however, an increased incidence of benign stromal uterine polyps in female rats treated with 900 mg/kg/day of metformin alone. There was no evidence of a mutagenic potential of metformin alone in the following in vitro tests: Ames test (S. Results in the in vivo mouse micronucleus test were also negative. Fertility of male or female rats was unaffected by metformin alone when administered at doses as high as 600 mg/kg/day, which is approximately 3 times the MRHD dose of the metformin component of Metaglip based on body surface area comparisons. Teratogenic Effects: Pregnancy Category CRecent information strongly suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities. Most experts recommend that insulin be used during pregnancy to maintain blood glucose as close to normal as possible. Because animal reproduction studies are not always predictive of human response, Metaglip should not be used during pregnancy unless clearly needed. No animal studies have been conducted with the combined products in Metaglip. The following data are based on findings in studies performed with the individual products. Glipizide was found to be mildly fetotoxic in rat reproductive studies at all dose levels (5-50 mg/kg). This fetotoxicity has been similarly noted with other sulfonylureas, such as tolbutamide and tolazamide. The effect is perinatal and believed to be directly related to the pharmacologic (hypoglycemic) action of glipizide. In studies in rats and rabbits, no teratogenic effects were found. Metformin alone was not teratogenic in rats or rabbits at doses up to 600 mg/kg/day. This represents an exposure of about 2 and 6 times the MRHD dose of 2000 mg of the metformin component of Metaglip based on body surface area comparisons for rats and rabbits, respectively. Determination of fetal concentrations demonstrated a partial placental barrier to metformin. Nonteratogenic EffectsProlonged severe hypoglycemia (4-10 days) has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. It is not recommended that Metaglip be used during pregnancy. However, if it is used, Metaglip should be discontinued at least 1 month before the expected delivery date. Studies in lactating rats show that metformin is excreted into milk and reaches levels comparable to those in plasma. Similar studies have not been conducted in nursing mothers. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made whether to discontinue nursing or to discontinue Metaglip, taking into account the importance of the drug to the mother. If Metaglip is discontinued, and if diet alone is inadequate for controlling blood glucose, insulin therapy should be considered. Safety and effectiveness of Metaglip in pediatric patients have not been established. Of the 87 patients who received Metaglip in the second-line therapy trial, 17 (19. No overall differences in effectiveness or safety were observed between these patients and younger patients in either the initial therapy trial or the second-line therapy trial, and other reported clinical experience has not identified differences in response between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Metformin hydrochloride is known to be substantially excreted by the kidney and because the risk of serious adverse reactions to the drug is greater in patients with impaired renal function, Metaglip should only be used in patients with normal renal function (see CONTRAINDICATIONS, WARNINGS, and CLINICAL PHARMACOLOGY: Pharmacokinetics). Because aging is associated with reduced renal function, Metaglip should be used with caution as age increases. Care should be taken in dose selection and should be based on careful and regular monitoring of renal function. Generally, elderly patients should not be titrated to the maximum dose of Metaglip (see also WARNINGS and DOSAGE AND ADMINISTRATION ). In a double-blind 24-week clinical trial involving Metaglip as initial therapy, a total of 172 patients received Metaglip 2. The most common clinical adverse events in these treatment groups are listed in Table 4. Table 4: Clinical Adverse Events >5% in any Treatment Group, by Primary Term, in Initial Therapy StudyUpper respiratory infectionIn a double-blind 18-week clinical trial involving Metaglip as second-line therapy, a total of 87 patients received Metaglip, 84 received glipizide, and 75 received metformin. The most common clinical adverse events in this clinical trial are listed in Table 5. Table 5: Clinical Adverse Events >5% in any Treatment Group, by Primary Term, in Second-Line Therapy StudyThe dose of glipizide was fixed at 30 mg daily; doses of metformin and Metaglip were titrated. In a controlled initial therapy trial of Metaglip 2. In a controlled second-line therapy trial of Metaglip 5 mg/500 mg, the numbers of patients with hypoglycemia documented by symptoms and a fingerstick blood glucose measurement ?-T50 mg/dL were 0 (0%) for glipizide, 1 (1. Gastrointestinal symptoms of diarrhea, nausea/vomiting, and abdominal pain were comparable among Metaglip, glipizide and metformin in the second-line therapy trial. Overdosage of sulfonylureas, including glipizide, can produce hypoglycemia. Mild hypoglycemic symptoms, without loss of consciousness or neurological findings, should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns.
Protection against sexually transmitted diseases The best way to protect yourself against contracting an STD while having sex is to properly use a latex condom purchase 100 mg kamagra soft visa. No other type of condom provides as much protection order 100mg kamagra soft otc. There is not much research data to show how effective plastic and animal-tissue condoms are for protection against sexually transmitted infections order genuine kamagra soft. Some viruses, such as hepatitis B and HIV, may be small enough to pass through the pores of animal tissue. Latex condoms have been shown to provide protection against pelvic inflammatory disease (PID), gonorrhea, chlamydia, syphilis, human immunodeficiency virus, vaginitis caused by infections like trichomoniasis, and vaginitis caused by changes in the pH balance of the vagina that can be triggered by semen chancroid. Conclusion The condom is a good option for preventing pregnancy and sexually transmitted diseases. Although it is the most proven and effective barrier, the condom may not prevent all cases of pregnancy, nor all cases of HIV, and people should be extremely careful even during protected intercourse. That said, government-sponsored studies have shown that using a condom is 10,000 times safer than not using one in protecting against HIV. My recommendation to a couple using condoms is to use a latex condom in addition to other protection such as a diaphragm, cervical cap, contraceptive cream, foam, jelly, or even the birth control pill. This combination of contraception will provide you and your partner excellent protection from an unwanted pregnancy and/or sexually transmitted disease. Note, however, that spermicides containing nonoxynol-9 have been shown to be ineffective in preventing HIV transmission and may even increase the risk of infection. A recent WHO report advises against the use of condoms with nonoxynol-9, especially for women at high risk of HIV infection. HIV testing determines whether or not you are infected with the Human Immunodeficiency Virus (HIV). HIV testing tells you if you are infected with the Human Immunodeficiency Virus (HIV) which causes AIDS. Antibodies are proteins produced by the immune system to fight a specific germ. Other "HIV" tests are used when people already know that they are infected with HIV. These help measure how quickly the virus is multiplying (a viral load test) or the health of your immune system (a T-cell test). For more information, see Fact Sheet 124 (T-cell Tests), and Fact Sheet 125 (Viral Load Tests). Immune system monitoring and early treatment can greatly improve your long term health. Knowing you are positive may help you change behaviors that would put yourself and others at risk. Women and their partners considering pregnancy can take advantage of treatments that potentially prevent transmission of HIV to the baby. If you test negative, you may feel less anxious after testing. From an infected mother to her child, during pregnancy, birth, or breast feeding. Testing is recommended if:You think you may have been exposed to the HIV. You are sexually active (3 or more sexual partners in the last 12 months)You received a blood transfusion between 1977 and 1985, or a sexual partner received a transfusion and later tested positive for HIV. You are a male who has had sex with another male at any time since 1977. Any of your male sexual partners has had sex with another male since 1977. You have used street drugs by injection since 1977, especially when sharing needles and/or other equipment. You are a health care worker with direct exposure to blood on the job. There are now treatments that can greatly reduce the risk that a pregnant woman who has HIV will give the virus to her baby. You are a woman who wants to make sure you are not infected with HIV before getting pregnant. Even if you have no risk factors for HIV infection, you may still want to get tested to ease your own mind. This also encourages everyone to be more responsible about HIV transmission. An HIV test will not detect the presence of the HIV virus immediately after exposure. Statistics show that 96% (perhaps higher) of all infected individuals will test positive within 2 to 12 weeks. Think about this: if you got a negative HIV test at six weeks, would you believe it? But to be certain, you will need to be tested again for HIV at six months. Many people continue to engage in some degree of risky behavior, and choose to be tested for HIV periodically (every six months, every year, or every other year. There are clear benefits to early medical attention for infection with the HIV virus. There is little agreement on how early this must be. But if you wait longer than two years, treatment of the disease may be less effective. If you are beyond the six month window period from a possible HIV transmission event and were reported HIV negative by an accurate HIV test (and you are not subsequently put at risk for HIV), you can consider yourself HIV negative. However if it eases your anxiety, you may wish to take the test again periodically. Anonymous testing means that absolutely no one has access to your test results since your name is never recorded at the test site. Confidential testing sometimes means identifying yourself in some manner to the test site, with their assurance that this information will remain private. Anonymous test sites are highly recommended because:The quality of the education and counseling that is provided is very good. The testing is reliable and automatically includes confirming tests. It protects you from risks of discrimination or adverse impact, especially in applications for insurance. Sometimes even taking an HIV test, regardless of the result, might cause an insurance application to be refused.
Depression symptoms can be thought of as mild or moderate if they mildly or moderately affect everyday functioning purchase 100mg kamagra soft with mastercard. Possible mild symptoms of depression include: Sadness or feeling "empty" or easy to tearLoss of interest in pleasurable activities buy cheapest kamagra soft and kamagra soft, hobbiesIrritability or frustrationHopelessness order genuine kamagra soft online, pessimismSlowed thinking and movementsTiredness, loss of energyAny of the above mild symptoms of depression can occur as severe symptoms depending on the individual. When the depression symptoms become severe, they can be crippling and affect everything from personal care to work and home life. Some of the severe symptoms of depression include:Inability to make decisionsObsessive thoughts of death or suicide, suicide plans or suicide attemptPersistent, unexplained physical pain such as headaches, digestive problems, or joint and muscle painInability to feel pleasureDifficulty in thinking and memoryRead more about the symptoms of depression in specific groups:In spite of depression being a mental illness that will affect more than 10% of the population at some point in their lives, the main causes of depression are yet to be pinpointed. Physical and psychological factors appear to cause depression in adults, teens and children. Genetics are also believed to be involved, as depression often runs in families. However, the specific genes that cause depression have not yet been found. It is likely factors combine in many ways to create the actual cause of depression in any given person. There are several biological factors believed to contribute to depression but their exact mechanisms are unclear. In spite of years of research, we only understand that biological differences exist in people with depression, and not how the differences cause depression, specifically. These biological causes of depression are thought to be present in teens and children as well. The biological factors that contribute to depression include: Physical changes to the brain ??? it is known that some part of a depressed brain show less activity than normal when stimulated; some parts of the brain even reduce in volume. Neurotransmitters ??? these chemical messengers in the brain have been implicated in the cause of depression since the 1970s. A central nervous system disruption in serotonin, norepinephrine and dopamine are thought to be a direct cause of depression. Hormones ??? hormone changes may trigger depression. Hormone changes are seen in thyroid problems, menopause and in other conditions. While no single life event is thought to cause depression, stressful events can trigger, or worsen, depression. Some research has shown those with a specific genetic abnormality are at greater risk of depression during stressful life events. Other environmental factors contributing to depression include:One of the causes of teen depression is thought to be a learned feeling of helplessness. Causes of depression in women and men include all of the above, but there are certain risks more common to each gender. An environmental cause of depression in men is more likely to be job-related while an environmental cause of depression in women is more likely to involve their social relationships. Other causes of depression that appear to be gender-related include:Menopause ??? the changes in hormones are thought to be a cause of depression in women. Low testosterone levels ??? men with lower testosterone levels later in life have a greater chance of developing depression. Effective depression treatments are available today and help many people dealing with this serious mental health condition. Depression is a common, treatable mental illness that affects millions of people in the United States every year. Researchers estimate more than 12 million women and 6 million men are affected by depression in any given year. Depression treatment options include: medical, self-help psychotherapeutic and alternative techniques. No one depression treatment is right for everyone, but with treatment, most people experience a significant reduction in depression symptoms. Antidepressants are the most common medication used in depression treatment and are indicated particularly in the treatment of severe depression. One type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), is typically the first-line treatment for moderate-to-severe depression. SSRIs alter a chemical messenger (serotonin) in the brain. SSRIs are generally prescribed first as they are proven effective and carry fewer risks of side effects than other medications for the treatment of depression. Other types of antidepressants include: Tricyclic antidepressants ??? older antidepressants, typically only used if other types have failedTherapy is often the first choice of depression treatment in mild to moderate cases of depression. Several types of therapy have been proven effective in the treatment of depression. They include:Cognitive behavioral therapy (CBT) ??? short-term therapy designed to address faulty and illogical thought patterns contributing to depressionInterpersonal therapy ??? short-term therapy designed to address maladaptive patterns in situations and relationshipsPsychodynamic therapy ??? long-term therapy designed to alleviate deeper issues underlying depressionEye movement desensitization and reprocessing (EMDR) ??? therapy designed to work through traumatic memoriesSelf-help depression treatment can be found in books and online. Depression or other mental health support groups can also offer self-paced treatment for depression. Neurostimulation depression treatments involve the modulation and stimulation of parts of the brain. Neurostimulation is typically accomplished through the use of an electrical current but can also use a strong magnetic field. Neurostimulation treatments for depression include: Electroconvulsive therapy (ECT) ??? an electrical current is applied to the brain while the patient is sedated Vagus nerve stimulation (VNS) ??? an implanted generator sends an electrical current to the vagus nerve of the patient at set intervalsAlternative treatments for depression include herbs, supplements and mind-body techniques. Alternative depression treatments are often used in conjunction with more traditional treatments like medication and therapy. Alternative treatments for depression include:This ADD quiz / ADHD quiz is for parents of children who might have attention deficit disorder (see ADD Definition ). If you suspect your child may have this mental health condition, please answer the ADHD quiz questions and share the results of this ADD child quiz with your pediatrician. And the behaviors, or what you might consider ADHD symptoms, should have been taking place for at least 6 months. If the time period is less than 6 months, your child may have another mental health problem such as depression or anxiety. Runs or climbs excessively in situations where it is clearly inappropriate4. Has difficulty waiting his/her turn for games or group situations6. Leaves classroom or situation in which staying seated is expected8. Easily frustrated in situations that require sustained effort10. Only attends to a task if he/she is very interestedTotal the scores for all ADD quiz questions.