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Outcome of acute renal failure in the elderly: a different approach Sir, In the December issue of Nephrology, Dialysis Transplantation, Klouche et al. show their experience concerning prognosis of acute renal failure ARF ; in a group of 68 elderly patients in an intensive care unit ICU ; [lj. There is some controversy about the role of age in the prognosis of ARF [2], and the survival rate of elderly patients comparing to younger ones. We have studied a group of 59 patients older than 65 years with ARF in a hospital setting during a period of 15 months January 1992 to March 1993 ; . From these patients, 19 32% ; were treated in an ICU. We considered ARF when serum creatinine increased over 2 mg dl or doubled previous values in patients with chronic renal failure CRF ; and basal serum creatinine 3 mg dl. The main characteristics of this group and their relationship to prognosis are shown in Table 1. Oliguria, sepsis, shock, and requirement of replacement therapies are well-known prognostic factors that were confirmed in our series [1-4]. We could not find any statistically.

OPERS PRESCRIPTION MEDICATION COVERAGE FACTS In 2005, OPERS spent approximately $366 million on prescription medications. This amount accounts for approximately 40 percent of our $1 billion in health care expenditures. On average, OPERS retirees each receive 28 prescriptions per year. 54 percent of all these prescriptions are generic medications. On average, each OPERS retiree takes between five and six medications for chronic conditions and flutamide, for example, olmesartan. Khandekar R 2003 ; Data from the community survey conducted in year 1996-97, Dr Rajiv Khandekar, Eye Health Care, Ministrey of Health, Oman. [Data provided for this project] PAKISTAN National Task Force on Trachoma July 2002 ; Report on Trachoma Rapid Assessment In Pakistan. Prepared by The National Task Force on trachoma, Ministry of Health, Pakistan, revised report ; July 2002. Pakistan [Data provided for this Project] Qureshi M.B, 2003 ; . Data from Trachoma Rapid Assessment in Pakistan, Conducted by the National Task Force on Trachoma, Ministry of Health, Pakistan [Data provided for this Project] SENEGAL Saal, M., Schemann, J., Saar, B., Faye, M., Momo, G., Mariotti, S.P. & Negrel, A.D. 2003 ; . Trachoma in Senegal: Findings of a national survey. Med Trop, 63, 53-59. SUDAN Abusin, S. ; Prevalence and causes of blindness in the Sudan, A review of published and unpublished data. Masters Thesis. Academy of Medical Sciences and Technology, Khartoum Binawi. K. 2004 ; Trachoma prevalence surveys in Halfa Province and Malakal Province, 1999; and Renk Province in 2001 2. Conducted by the Sudan Trachoma Control Programme, assisted by The Carter Centre. [Data provided for this project] Binawi. K. 2004 ; Trachoma prevalence surveys in Upper Nile Zone and Bahr Al Jabal State, Sudan 2001. Conducted by the Sudan Trachoma Control Programme, assisted by The Carter Center. [Data provided for this project] Mahmoud, E.A., Sheikh, A.H., Domeika, M.A. & Mardh, P.A. 1994 ; . Prevalence of trachoma among displaced persons in the Sudan: a clinical and sero-epidemiological study. Eye, 8, 130-3. Ngondi, J., A. Onsarigo, et al. 2005 ; . The epidemiology of trachoma in Eastern Equatoria and Upper Nile States, southern Sudan. Bull World Health Organ 83 12 ; : 904-912. TANZANIA Congdon, N., West, S., Vitale, S., Katala, S. & Mmbaga, B.B. 1993 ; . Exposure to children and risk of active trachoma in Tanzanian women. J Epidemiol, 137, 366-72. Paxton, A. 2001 ; . Rapid assessment of trachoma prevalence--Singida, Tanzania. A study to compare assessment methods. Ophthalmic Epidemiol, 8, 87-96. Turner, V.M., West, S.K., Munoz, B., Katala, S.J., Taylor, H.R., Halsey, N. & Mmbaga, B.B. 1993 ; . Risk factors for trichiasis in women in Kongwa, Tanzania: a case- control study. Int J Epidemiol, 22, 341-7. Wedner, S.H., Ross, D.A., Balira, R., Kaji, L. & Foster, A. 2000 ; . Prevalence of eye diseases in primary school children in a rural area of Tanzania. Br J Ophthalmol, 84, 1291-7. Massae, P.A., Safari, S., Solomon, A.W., and Courtright, P. Prevalence of trachoma in the sixty-four villages of Rombo District, Kilimanjaro Region, Tanzania. [Unpublished report] 2002. Tanzanian National Trachoma Control Programme 2003 ; Preliminary report of baseline trachoma survey 2003. Trachoma Prevalence in Program Districts and Tunduru 2000 - 2002. Conducted by the Tanzania National Trachoma Control Program. [Data provided for this project] TOGO Balo, P. 2001 ; . Lot Quality Assurance Sampling LQAS ; for trachoma assessment in Tchaoudjo District, Togo. Masters Thesis. Institue of Opthalmology, University College London VIETNAM Vietnam Trachoma Survey: Survey of 13 districts of 8 Provinces as part of SAFE trachoma control project phase I, 2000 -2001 Conducted by the ITI-Supported Vietnam National Trachoma Control Program [Data provided for this project]. 1.5. A European Journal of Tropical Medicine & International Hygiene 8 ; 1.5.1. Cairncross, S. Handwashing with soap a new way to prevent ARIs? Pp. 677-684 and raloxifene. 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Primary Prevention Aspirin appears to be protective as primary prevention against coronary heart disease for men, but less so for women.10, 11 The benefit of aspirin for the prevention of a cerebrovascular event stroke ; appears to be comparable for both aging men and women.10, 11 Overall, the American Heart Association AHA ; does not recommend the routine use of aspirin as primary prevention in low risk women.12 However, it may be appropriate in certain situations to use low dose aspirin 75-162 mg ; in women over the age of 65.10 The USPSTF recommendation for the primary prevention of cardiovascular events states that "the optimum dose of aspirin for chemoprevention is not known. Primary and secondary prevention trials have demonstrated benefits of a variety of regimens including 75 mg per day, 100 mg per day, and 325 mg every other day. Doses of about 75 mg daily appear as effective as higher doses; whether doses below 75 mg daily are effective is not established. Enteric-coated or buffered preparations do not clearly reduce adverse gastrointestinal effects of aspirin. Uncontrolled hypertension and concomitant use of other nonsteroidal anti-inflammatory agents or anticoagulants increase risk for serious bleeding."11 Because of the potential for dose-dependent GI complications, USPSTF encourages practitioners to use the lowest dose recommended for a specific indication see Table 1 ; .6, 11 In short, the decision to use aspirin for primary prevention must include a discussion with the. 2 the influence on human osteoblasts in vitro of non-steroidal anti-inflammatory drugs which act on different cyclooxygenase enzymes and etoposide and microzide, for example, high blood pressure.
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Liver detox with Turmeric 600 mg 3 times a day or eat curry powder cooked ; 40 gm a day. Milk thistle Super Thistle X ; is also an herb that aids in liver detoxification. Supplements: a. Multivitamin with minerals, one twice a day. DaVinci Spectra or Phytopharmica ; Not needed if you are already taking Thymate. b. Vitamin C with flavinoid 500 mg 4 times a day. c. Flax seed oil capsules or hemp seed oil; one tablespoon 100 pounds of weight a day. d. Inositol 500 mg two 3 times a day. Helps the body to eliminate silicate ; Natural Source; Beans, lentils, nuts, oats, rice, wheat germ, cantaloupe, citrus except lemon ; , whole grain. e. Thymic factors 3 twice a day to 6 twice a day, depending on severity of immune autoimmune problems. Thymate has thymic factors, vitamins, minerals and herbs or see i. ; below. f. Ginkgo biloba 40 mg 3 times a day. Avoid two weeks prior to surgery. g. Bromelain 300 mg 3 times a day or eat 1 3 pineapple a day. Note: Phytopharmica makes a supplement called CurcuMax that contains Curcuma Root Extract & Bromelain, which are natural anti-inflammatory agents ; . Boswellia serrata, an Ayurvedic herb is also an antiinflammatory. h. Immunocal one packet 10gm ; twice a day is recommended to rebuild intracellular stores of glutathione. Colostrum or BioPure protein Metagenics ; may be substituted. i. Transfer Factor Plus contains transfer factor, thymic factors, and glyconutrients IP6, Cordyceps, Maitake, and Shitake mushrooms, Beta Glucans, and Aloe ; . Transfer Factor Plus is a combination of many immune supplements also listed separately on the protocol. j. MSM 1 4 teaspoon per 30 lbs body weight dissolved in liquid orally once per day. Capsules are available. For patients with joint problems, Joint Connection, which contains.

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