By G. Carlos. Weber State University. 2018.

The method to analyze the data was done through absolute and rela- Introduction: The rehabilitation with prostheses of individuals tive values and statistical nonparametric tests with equality of two who have undergone bilateral lower limb amputation with pros- proportions buy 800mg nootropil fast delivery symptoms diarrhea, qui square nootropil 800mg sale medications mexico, confdence interval for mean of 95% e theses is a challenging, unique and controversial process. There wasn’t association between the use of pros- of Disabled Children) between December of 1999 and December thesis and anxiety and depression. Forty six (46) records were excluded because they were pression were few prevalent among lower limb amputees patients either incomplete or because patients were still in rehabilitation. Psychosocial adjustment to lower-limb amputa- knee, 36 below the knee and 15 above and below the knee. When analyzed separately, G2 had associa- Introduction: The presence of persistent pain, of the stump, phan- tion with the number of amputation stump complications and G3 tom pain or in the contralateral lower limb may negatively inter- had association with age at the time to ft with prostheses. Younger individuals and individuals J Rehabil Med Suppl 54 E-Posters 325 with fewer complications in amputation stumps presented a lower aggression, irritability and decreased mobility. Genetic testing showed an extra X chromosome in a and Ultraviolet-C on the Stage I Pressure Ulcer male karyotype associated with a clinical features of Klinefelter syndrome. Treatment should be considered, however it is major burden of sickness and reduced quality of life for patients important to capture and interpret full clinical picture. Objective: To assess the effect of the Using the International Spinal Cord Injury Datasets to regiment of ultrasound combined with ultraviolet-C on the stage Ipressure ulcer. All patients received the treatment of ultrasound and violet at the Pelletier Cameron same time. The dosage level of ultraviolet was E1 or E2, according to the condition of the pressure ulcer. The improvement of any items in the above- created based on these datasets to be administered by clinicians mentioned criterions was regarded as effectiveness. Dataset questions were cure time was 4 days, the shortest cure time was only 1 day and adapted for questionnaire format; the measured was tested and the average cure time was 2. The effective percent- cognitive interviewing conducted to ensure appropriateness. The most in another report, and its cure time is also shorter than ultraviolet frequent method of bladder management was intermittent cath- alone (4. The use of oral laxatives, rectal suppositories and digital the early pressure ulcer quickly and effectively. For Clinical Vignette – Neuroendocrine Disorders Post Ac- bowel, hemorrhoids were reported by 38. Background: Causes of neuroendocrine abnormalities may and based on patient’s characteristics. The patient 3 was found to have multiple injuries including closed head injury, L. On examination it was noted concept is highly subjective varying for same person over the life that he looks younger than his stated age and has no facial hair. Using qualitative inter- tibular rehabilitation for unilateral peripheral vestibular dysfunc- views, data were collected on the impact of neurogenic bowel and tion. Conceptualizations of “physical independence” emerged Investigating the Difference between Rectangular and as a salient theme across participants. Newly lation Waveforms Using Knee Extension Torque injured participants characterized loss of independence as a nega- *G. Conclusions: Notions of “independence” appear to change rameters such as waveform, frequency and pulse width. Material and Methods: Thirty able-bodied A Profle of Acquired Brain Injury Survivors Attending individuals (15 males and 15 females) participated in our study. All by the exponentially climbing electrical stimulation was found to individuals completed a full oculomotor, gait and balance assess- be signifcant. Primary pathologies our future research, we wish to investigate the effect of exponen- were traumatic brain injury (49%), stroke (32%), neuro-oncology tially climbing electrical stimulation in the treatment of patients. Of the remain- Effects of Therapeutic Ultrasound in Knee Osteartrithis ing 28 individuals, vestibular diagnoses were as follows: multiple vestibular pathologies (25%), central vestibular disorder (18%), I. Three individuals were linked in with local services and referred Osteoarthrosis is a degenerative articular pathology characterized back with advice to the treating therapist. Aim of the study: A randomized study, to determine the satisfaction with regards to accessibility, location, explanation effectiveness of ultrasound therapy in knee ostearthritis.

Production: Potentilla herb consists of the fresh or dried leaf and flowers of Potentilla anserina harvested shortly before or Kombal R nootropil 800 mg overnight delivery treatment by lanshin, Glasl H nootropil 800mg otc symptoms 6 days before period, Flavan-3-ols and flavonoids from Potentilla during flowering, as well as its preparations. Hydroxycoumarins: umbelliferone, scopoletin Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, Nachdruck, Georg Olms Verlag Hildesheim 1979. On isolated rat uterus a paralyzing effect was proven which Steinegger E, Hansel R, Pharmakognosie, 5. Potentilla erecta Unproven Uses: In folk medicine, Potentilla is used external- ly as a wash for poorly healing wounds. There have been complaints of stomach irritation Potentilla reptans associated with Potentilla. Flower and Fruit: The flowers are purple-blue, globular and Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, long pedicled composite blooms, with a 2 to 3 rowed Nachdruck, Georg Olms Verlag Hildesheim 1979. Primula veris Leaves, Stem and Root: The plant grows from 15 to 80 cm See Cowslip high. Later it becomes woody and dies off except for the upper part, which accounts for its appearance. The stem is erect, sparsely Prunella vulgaris branched, pubescent and has few leaves. The cholesterol with the herb have been seen in many studies bracts are about 3 mm, suborbicular to ovate and sometimes (Davidson, 1998; MacMahon, 1998; Rodriguez-Moran, shortly pubescent. Glucose Control: Postprandial glucose and fasting plasma Leaves, Stem and Root: The plant is an annual almost glucose significantly improved in type 2 diabetic patients stemless, softly pubescent plant. The plant may have one or taking psyllium (Anderson, 1999; Rodriguez-Moran, 1998). The leaves are entire-mar- Inhibition of Gallstones: Psyllium hydrocolloid exerts bile gined or slightly denticulate and sparsely to densely villous- acid sequestrant properties determined by a rise in the cholic/ lanate. Psyllium Habitat: The plant grows in India, Afghanistan, Iran, Israel, also protects against cholesterol - gallstone formation by northern Africa, Spain and the Canary Islands. The protective cultivated in India and neighboring countries, Arizona and effect is associated with a selective decrease in biliary southern Brazil. Production: Psyllium consists of the ripe seeds or epidermis Irritable Bowel Syndrome/Ulcerative Colitis: Stool frequen- of Plantago ovata (synonym: Plantago isphagula). Mucilages (20-30%): chiefly arabinoxylans and Laxative Effects: Psyllium decreases the passage time of the glacturonosidorhamnoses bowel content by increasing the volume of the stool, thus Fatty oil exerting a laxative effect. Psyllium was superior to Iridoids: aucubin docusate sodium in subjects with chronic idiopathic consti- Proteic Substances pation (McRorie, 1998). Hypercholesterolemia/Hyperglycemia Antidiarrheal: When used for diarrhea, psyllium absorbs A randomized, double-blind, placebo-controlled study was water to increase the bowel content viscosity and delay conducted to determine the lipid and glucose lowering gastric emptying (Washington, 1998). Prior to the treatment period, all patients fissures and hemorrhoids; following anal/rectal surgery; and participated in a 6-week period of diet counseling. Externally, increased in the Psyllium treatment group compared to the Psyllium is used for gout, rheumatism, furuncles and as an placebo group, suggesting Psyllium as a useful adjunct to analgesic. Indian Medicine: Psyllium is used for gastritis, chronic Hypercholesterolemia/Hyperglycemia diarrhea, constipation, dysentery, dry cough, gout, gonor- rhea, nephropathy, dysuria, duodenal ulcers and The safety and effectiveness of Psyllium husk fiber as an hemorrhoids. The Psyllium group had significant threatening obstruction of the bowel (ileus), or difficulties in improvements in glucose and lipid values compared with the regulating diabetes mellitus. All day and postprandial glucose concen- of the esophagus or of the intestine,, particularly with older trations were 11. Patients with exocrine pancreatic insufficiency the Psyllium treatment group than in the placebo group should avoid use of Psyllium due to inhibitory actions on (Anderson, 1999). Ulcerative Colitis Allergic Reactions/Anaphylaxis: Allergic reactions ranging from sneezing to chest congestion and wheezing were The objective of an open label, parallel-group, randomized reported in three nurses after Psyllium use (Ford, 1992). One clinical trial was to assess the efficacy and safety of Plantago patient reported anaphylaxis after Psyllium ingestion, and ovata seeds compared to mesalamine in maintaining remis- had experienced recurrent rhinitis and asthma related to sion in ulcerative colitis patients. Occupational allergic mesalamine (500 mg three times daily), or Plantago ovata rhinitis reaction was confirmed by elevation of antipsyllium seeds plus mesalamine at the same doses. After 12 months, IgE after exposure to a Psyllium-based powdered laxative treatment failure rate was 40% in the Plantago ovata seed (Schwartz, 1989). The probability of Flatulence Symptoms: Psyllium did not cause greater gas- continued remission was similar between all treatment eous symptoms compared to placebo reported in one study groups (Mantel-Cox test, p = 0.

Jahrestagung der side trusted 800mg nootropil symptoms qt prolongation, quercetin-3-O-glucoside buy discount nootropil 800 mg online treatment 4th metatarsal stress fracture, quercetin-7-O-glucoside Gesellschaft fur Arzneipflanzenforschung in Saarbriicken. Madaus GrL^hrbuchjder Biologischen Arzneimittel, Bde 1-3, The efficacy of this drug has not been proven. Preparation: To prepare a tea or infusion, pour 250 ml of Flower and Fruit: The small lemon-yellow flowers are in cold water over 2 heaping teaspoonfuls of die drug, bring to dense terminal panicles. The simmering point, simmer for 2 minutes and then allow to corolla is 2 to 3 mm wide, usually golden yellow, and smells draw. Flower and Fruit: The plant has inflorescences of small, insignificant, yellow-green, many-flowered cymes. The peri- Homeopathic Uses: Alchemilla vulgaris is used for Ieucor- anth is 4-leaved. The flower has 4 stamens, 1 ovary and an rhea and for chronic diarrhea resulting from liver disease. No health hazards or side effects are known in conjunction with the proper administration of designated therapeutic Leaves, Stem and Root: Alchemilla vulgaris is a hardy, half- dosages. Schimmer O, Lindenbaum M, Tannins with antimutagenic Production: The balsam of Larix decidua is obtained by properties in the herb of Alchemilla species and Potentilla drilling into the trunks. Volatile oil (14-15%): chief components: (-)-alpha-pinene Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, (70%), Delta3-carene (10%) (-)-beta-pinene (6. Stuttgart, Jena, New Resins: including among others oleoresin acids (50-65%): York. Its use for catarrhal infections of the upper respiratory tract also seems Laminaria hyperborea plausible. The covering scales turn dark red when No health hazards or side effects are known in conjunction in bloom. The foliage is Mode of Administration: Available in form of ointments, light green with delicate needles, arranged singly in spiral gels, emulsions and oils. There is usually only 1 glabrous ovary, Preparation: Larkspur is found only in teas, often as an but numerous stamens. J Nat Prod, 60:472-4, Larkspur is an annual and has a thin stem that is sparsely 1997 May. The presence of alkaloids has sometimes been described in Further information in: the literature but they cannot always be found. Sesquiterpene lactones: dehydrocostuslactone, costunolid, furthermore eremanthin, laurenbiolide Teuscher E. J Nat Prod, components of the volatile oil and a large percentage of 59:360-6, 1996 Apr. The drug possesses a medium potential for Flower and Fruit: The flowers are in axillary bushy umbels sensitization. Mode of Administration: The mixture of essential and fatty Leaves, Stem and Root: Laurel is an evergreen shrub or up to oils, extracted through pressing, was formerly used in the 10 m high tree with smooth, olive green to black bark. The treatment of furuncles; today Laurel is used externally in dark-green bay leaves are lanceolate and alternate, about 10 veterinary medicine, as an udder ointment. Hausen B, Allergiepflanzen, Pflanzenallergene, ecomed Habitat: Laurel is indigenous to Mediterranean countries. Hegnauer R, Chemotaxonomie der Pflanzen, Bde 1-11, Production: Bay leaves are the leaves of Laurus nobilis. Daunderer M, Kormann K, Giftpflanzen, Pflanzengifte, The drug has anti-inflammatory, digestive, stimulation of 4. No health hazards or side effects are known in conjunction with the proper administration of designated therapeutic dosages. Flower and Fruit: The yellow flower heads are 1 cm wide, almost semi-globular, long-pedicled, homogamous and with- out lingual florets. The corolla tube is compressed and Ledum latifolium somewhat winged, with a one-sided appendage. There are 4 compact Lemna minor rows of small leaves that are narrow, linear, 2 to 3 cm wide, fleshy, obtuse, paired-pinate, gray-tomentose, and occasion- See Duckweed ally green. The rind is somewhat rough to Mode of Administration: Lemon is used internally in the almost smooth. Inhibition of bacterial mutagenisis by Citrus and soon become rounded and glabrous with stout axillary flavonoids.

Psychiatric disorders in youth with perinatally acquired human immunodefciency virus infection cheap nootropil 800 mg on line treatment management company. Parenting among adolescents and young adults with Human Immunodefciency Virus Infection in the United States: challenges cheap nootropil 800mg otc medicine on airplane, unmet needs, and opportunities. The rate of perinatal transmission was 8 times higher among women who seroconverted during pregnancy (12. Women can continue to express and store breast milk while awaiting confrmation of infection status. Acquiring human immunodefciency virus during pregnancy and mother-to-child transmission in New York: 2002-2006. Missed opportunities for preventing perinatal transmission of Human Immunodefciency Virus, Florida, 2007–2014. This intrapartum use of the drug is recommended because of the unique characteristics of zidovudine and its proven record in reducing perinatal transmission, even in the presence of maternal resistance to the drug (see Antiretroviral Drug Resistance and Resistance Testing in Pregnancy). When cesarean delivery is planned, oral medications can be continued preoperatively with sips of water. Medications requiring food ingestion for absorption can be taken with liquid dietary supplements, contingent on consultation with the attending anesthesiologist in the preoperative period. No further testing is required for specimens that are nonreactive on the initial immunoassay. Statutes and regulations regarding expedited testing vary from state to state (see http://nccc. The infant should receive enhanced prophylaxis as outlined in the section on Infant Prophylaxis. In general, zidovudine and other nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and the integrase inhibitor raltegravir cross the placenta well, whereas protease inhibitors do not (see Table 9). The combination infant regimens resulted in a 50% reduction in transmission compared with zidovudine alone. Is peripartum zidovudine absolutely necessary for patients with a viral load less than 1,000 copies/ml? Systemic pharmacokinetics and cellular pharmacology of zidovudine in human immunodefciency virus type 1-infected women and newborn infants. Pharmacokinetics of oral zidovudine administered during labour: a preliminary study. Early experience of dolutegravir pharmacokinetics in pregnancy: high maternal levels and signifcant foetal exposure with twice-daily dosing. Pharmacokinetics and placental transfer of elvitegravir and dolutegravir, and other antiretrovirals during pregnancy. This recommendation is based on fndings from a multicenter, randomized clinical trial1 and from a large individual patient data meta-analysis. In a report from a comprehensive national surveillance system in the United Kingdom and Ireland, 3 (0. Risk of Maternal Complications Administration of perioperative antimicrobial prophylaxis is recommended for all women to decrease maternal infectious morbidity associated with cesarean delivery. In addition, caution should be exercised in proceeding with a cesarean delivery in circumstances where there is no clear evidence of beneft, especially in younger women who are likely to have additional pregnancies and perhaps multiple cesarean deliveries. These risks should be considered and discussed with the woman before proceeding with a cesarean delivery. Only a viral load of >10,000 copies/mL was an independent risk factor for perinatal transmission. Among term deliveries, median duration of rupture of membranes was 3 hours 30 minutes; 71 (3. Because the delivery plan in the setting of labor must be made quickly, telephone consultation with a 24-hour, 7-day-a-week hotline (e. When the decision is made to deliver, route of delivery should be according to obstetrical indications.

The improvements in computer speed and capacity increased the number of lead compounds available for further research best 800mg nootropil medications lisinopril. But not only the number of feasible drug candidates increased buy 800mg nootropil fast delivery symptoms to diagnosis, but also the costs and time devoted in various drug discovery processes was reduced, improving the effectiveness of the drug development. It was based on the determination of mathematical equations expressing the biological activities as a function of molecular parameters. It consists of several steps which hopefully lead to the design of new compounds with the desired activity profile. Ideally, each of these activities should cover the range of possible values for that activity. The next step is to compute descriptors that contain sufficient relevant information about the biological phenomenon. However, it is difficult to predict in advance which descriptor variables will be valuable. A correlation coefficient gives a quantitative measure of how well each descriptor describes the activity. Next step, a data analysis is needed to calculate the best mathematical expression linking together the descriptors and biological activities, in which information relating the essential features of the chemical and biological data structure is obtained. In the final step, validation and predictions for non-tested compounds will take place. An interpretation of results should be done for the proposal and design of new compounds with the desired activity outline. Later, in 1893, Richet showed that the cytotoxicities of a dissimilar set of uncomplicated organic compounds were inversely related to their corresponding water solubility. After that, Meyer and Overton independently recommended that the narcotic action of a group of organic molecules correlated with their olive oil/water partition coefficients. The extensive work of Albert, and Bell and Roblin established the importance of ionization of bases and weak acids in bacteriostatic activity. In the physical organic border, great progress was being made in the clarification of substituent effects on organic reactions, led by the influential job of Hammett. Their fragment and additive group contribution idea added two things: the use of calculated properties to correlate with biological activities and the detection that multiple properties may influence the biological activity. Besides the Hansch approach, other methodologies were also developed to deal with structure- activity questions. The Free-Wilson approach (Free and Wilson, 1964) addresses structure-activity studies in a congeneric series in which the contribution of each structural feature was a parameter of interest. These parameters, also called indicator variables, codify the presence or absence of particular structural feature. It has been estimated that thousands of molecular descriptors are now existing (Devillers and Balaban 1999; Karelson, 2000; Todeschini et. The various descriptors in use can be largely categorized as being constitutional, topological, electrostatic, geometrical, or quantum chemical. For example, the number of heteroatoms, the number of rings, the number of double bonds, etc. Topological descriptors are numbers that give information about the bonding collection in a molecule. They are derived from graph representation of chemical structures; they attempt to encode the size, shape, or branching in the compound by handling of graph-theoretical aspects of the structures (Silipo and Vittoria, 1990). Some examples are Randic indices, Kier and Hall indices, Weiner index (sum of the chemical bonds existing between all pairs of heavy atoms in the molecule), the connectivity index and others. Electrostatic descriptors are single values that give information about the molecular charge division. Another deeply used descriptor is the octanol–water partition coefficient, which is designated by a specific prediction scheme such as ClogP or MlogP. Geometrical descriptors are single values that describe the molecule’s size and shape as well as the degree of complementarity of a ligand and the receptor.

Continuation of treatment for elevation of myoglobin would be helpful in distinguishing ≤12 months confers additional benefit in patients treated new myocardial necrosis nootropil 800mg lowest price 68w medications. Troponin-I and troponin-T are conservatively and among those who underwent percuta- more specific markers of myocardial necrosis but have long neous coronary intervention order 800 mg nootropil free shipping treatment wax. Therefore, they are patients and may not be beneficial for patients treated not as useful for detecting new or recurrent injury. The diagnosis of brain death should be confirmed ficial for patients likely to receive percutaneous interven- with the following clinical findings: unresponsiveness to tion. Because decreased blood pressure, sustained ventricular tachycardia, the spinal cord is intact, spinal reflexes may be present. It has been described in patients with brain death but is not a component of the diagnosis. Dopamine has been proven an transtentorial herniation occurs when the medial thalamus ineffective agent to prevent contrast nephropathy. A locked-in state is usually caused by infarction incidence of contrast nephropathy. Although several or hemorrhage of the ventral pons; other causes include small clinical studies have suggested a clinical benefit to Guillain-Barré syndrome and certain neuromuscular the use of N-acetylcysteine, a meta-analysis has been blocking agents. Catatonia is a semi-awake state seen most inconclusive, and the medication should be adminis- frequently as a manifestation of psychotic disorders such as tered well in advance of the procedure. Third-nerve palsies arise from an uncal bonate begun within 1 h of the procedure has shown a transtentorial herniation where the anterior medial tem- significant benefit in a single-center, randomized, con- poral gyrus herniates into the anterior portion of the ten- trolled trial. Because of the time limitations and based torial opening anterior to the adjacent midbrain. Coma on the evidence, only sodium bicarbonate would be may occur because of compression of the midbrain. Further decreases in containing fluid is allowed to dwell in the peritoneum to mean arterial pressure may worsen the patient’s clinical remove toxic materials and volume. Patients with prior abdominal surg- through intrarenal vasoconstriction and through gener- eries often have difficulty with peritoneal dialysis ation of oxygen radicals, causing acute tubular necrosis. This patient may need a saline is an effective measure to prevent contrast lower dialysate potassium concentration. Of the other measures mentioned here, ing is an adjustment of the dialysate sodium that may only sodium bicarbonate or N-acetylcysteine could be lessen the incidence of hypotension at the end of a dial- recommended for clinical use to reduce the risk of ysis session. However, in states of mild to moderate nonionic contrast if required hypoperfusion (as in prerenal azotemia) or in the presence 177–221 (2. In response to a reduction in perfusion pres- to patients undergoing dialysis sures, stretch receptors in afferent arterioles trigger a cas- within 24 h cade of events that lead to afferent arteriolar dilatation and efferent arteriolar vasoconstriction, thereby preserving a The risk is greatest in patients with increasing creatinine levels. These mechanisms are partly mediated by the vasodilators prostaglandin E2 and prosta- secretion from the posterior pituitary. Plasma osmolality normally is regulated within 1–2% of normal (280–290 mosmol/kg). The risk of contrast nephropathy may be osmolality is a key historic piece of data. If the patient is reduced by initiating newer iso-osmolar agents and mini- excreting the minimum amount of maximally concen- mizing the dose of contrast. When the reduction in renal trated urine, gastrointestinal (osmotic diarrhea), insensible blood flow is severe or prolonged, tubular injury devel- (skin or respiratory loss), or remote renal losses (diabetes ops, causing acute renal failure. This patient is excreting a large volume depletion, diabetes, congestive heart failure, mul- amount of dilute urine. He is not excreting >750 mosm tiple myeloma, or chronic renal failure have an increased in his urine daily, which would suggest diuretic use. The urine sediment is bland Either central or nephrogenic diabetes insipidus must be in mild cases, but with acute tubular necrosis, muddy the cause. Therapy is directed at limiting imaging should be obtained to rule out destruction of the further drug absorption by administering activated char- neurohypophysis. Hyper- ysis is reserved for severe cases, especially those involving glycemia and hyperlipidemia can cause hyponatremia, but fulminant renal failure. Diabetes insipidus is a hyperna- are caused by the presence of calcium oxalate in the tremic disorder caused by excess water loss. Calcium oxalate crystals are classically seen in eth- ylene glycol ingestion, which also causes a high anion 96.

Two types of patients can be identified: those – Other maternal factors associated with a specific pathology order nootropil 800mg mastercard treatment 4 ringworm, and tho- with increased fetal risk are thy- se with no known pathology buy discount nootropil 800mg line medications known to cause seizures, but with roid disease (transplacental trans- a risk of adverse fetal outcome. In high-risk pregnancies, the following methods are often used to assess fetal health: — Biophysical profile. A better method is for women to count 10 movements and to record how long it took for these movements to occur (the «count to 10» chart). The autors of the largest randomized study suggested that the failure to reduce the death rate was mainly caused by false reassurances or innappropia- te interpretation of subsequent studies, including fetal heart rate monitoring (cardiotoco- graphy and nonstress testing)6. Formal measurement of symphysis-fundal height (the dis- tance in centimetres from the top of the uterus to the pubic bone) is not more effective and did not improve the perinatal outcomes measured in the one controlled trial found during systematic review7. In theory, fetal arrhythmia, such as congenital heart block or tachyarrhythmia, could be identified, although detection of such rare conditions would require routine and regular documentation of fetal heart rate. Three or fewer body/limb movements in a 30-min movements Continuous active movement episodes 5 single observation period. Fetal tone/posture Demonstration of active extension with rapid re- Low-velocity movement only. Incomplete flexion, turn to flexion of fetal limbs and brisk reposition- flaccid extremity positions, abnormal fetal posture. In normal fetuses, moderate hydramnios (amniotic fluid largest pocket depth, 8 to 12 cm), anatomic issues, idiopathic hydramnios, and fetal macrosomia due to maternal diabetes are the most common explanations, and fetal testing will likely reflect fetal neu- rologic status accurately. For pockets greater than 12 cm in depth in singleton pregnan- cies, neurologic issues, and structural defects associated with aneuploidy, are much more likely, in wich case biophysical profile scoring may be invalid. Thus, one variable may lead to suspicion about the validity of testing and call for additional evaluation. Amniotic fluid pockets are identified in real time, and clear fluid is proven because the fetus readily moves through it. There is evidence that routine application of continuous color imaging may lead to the false impression of oligohydramnios. The presence of rhythmic fetal diaphragm contractions and/ or hiccups lasting more than 30 seconds constitutes a normal score. Fetal «gasping» is a rare phenomenon, probably related to serious acidosis in the near-term fetus. This must be verified by observations of the fetal face and neck, which show the facial equivalent of gasping, not the vigorous diaphrag- matic movement of the hiperglycemic fetus of a diabetic mother. Because the amplitude of fetal breathing depends on gestational age, maternal glucose, exposure to increased oxygen concentrations, and many medications, careful evaluation of all parameters is necessary before intervention is precipitated. One of the interpretative pitfalls of biophysical profile scoring is that at least some movements must be necessary to evaluate tone. Although the evaluation of tone is indeed subjective, there must be at least some movements to assess it. The original de- scription of movement called for large amplitude movements of the fetal body and/or limbs: since ultrasound was primitive at that time it was sometimes difficult to tell if the fetus was moving at all. More detailed instructions on the application of biophysical profile scoring are available elsewhere8,9. The correlation between abnormal scores and high risk of poor outcome has been demonstrated in large population studies and produces a characteristi- cally shaped outcome curve. Before acting, however, one must consider the differential diagnosis of this abnormal behavior. Because so many factors may influence biophysical profile scoring (table 3), prolonged testing, retesting after a brief interval, or adding ancil- lary tests are important steps before the action illustrated in the systematic response for equivocal scores. Thus, confirmatory tests are ap- plied if diagnosis is uncertain but not as a complicated formula of responses in the bio- physical profile scoring system. If score is 6/10, then 10/10, in two rage) continous 30-min periods, manages as 10/10. For persisten 6/10, deliver the mature fetus, repeat within 24 hr in the immature fetus, then deliver if less than 6/10. For scores of 0, 2, or 4, intervention should commence virtually immediately, provided the fetus is viable. Agent Fetal Effect Drugs Sedatives/sedative side effects Diminished activity of all varieties; abolition of none. Beyond 30 weeks, the normal baseline is between 120 and 160 beats/min, the base- line variability is more than 5 beats/min, and there is a 20 to 30 minute cycle of sleep activity.