By L. Joey. Strayer University.

Aminoglycoside- because it is not removed by efflux and can bind to modifying enzymes discount 60caps ayurslim with amex herbals guide, usually encoded on plasmids discount ayurslim 60caps free shipping vedantika herbals, trans- altered ribosomes. The modified antibiotic is less active because of diminished binding to its ribosomal target. Modifying Although the topical compound mupirocin was intro- enzymes that can inactivate any of the available aminogly- duced into clinical use relatively recently; resistance is cosides have been found in both gram-positive and gram- already becoming widespread in some areas. Mutations that confer resis- prim and the sulfonamides in both gram-positive and tance to multiple unrelated antimicrobial agents occur gram-negative bacteria is the acquisition of plasmid- in the genes encoding outer-membrane porins and encoded genes that produce a new, drug-insensitive target— efflux proteins of gram-negative bacteria. These muta- specifically, an insensitive dihydrofolate reductase for tions decrease bacterial intracellular and periplasmic trimethoprim and an altered dihydropteroate synthetase accumulation of β-lactams, quinolones, tetracyclines, for sulfonamides. Some gram-negative bacteria develop concentrations in serum and tissue versus time and reflects mutations that both decrease outer-membrane porin the processes of absorption, distribution, metabolism, and permeability and cause active drug efflux from the cyto- excretion. Mutations that result in active quinolone efflux trough serum concentrations and mathematically derived are also found in gram-positive bacteria. Most patients with infection are treated with oral antibac- terial agents in the outpatient setting. The tiple antibacterial agents is becoming increasingly com- percentage of an orally administered antibacterial agent mon. The construction of multiresistant strains by linezolid, and most fluoroquinolones]. These differences acquisition of multiple genes occurs by sequential steps in bioavailability are not clinically important as long as of gene transfer and environmental selection in areas of drug concentrations at the site of infection are sufficient high-level antimicrobial use. However, therapeutic efficacy may be compromised when absorption is the eye, the prostate, or infected cardiac vegetations, high 443 reduced as a result of physiologic or pathologic condi- parenteral doses or local administration for prolonged tions (e. In addition, even though shunting of blood away from the gastrointestinal tract in an antibacterial agent may penetrate to the site of infec- patients with hypotension), drug interactions (e. For example, because the tively mild infections in whom absorption is not activity of aminoglycosides is reduced at acidic pH, the thought to be compromised by the preceding condi- acidic environment in many infected tissues may be partly tions. In addition, the oral route can often be used in responsible for the relatively poor efficacy of aminoglyco- more severely ill patients after they have responded to side monotherapy. Most bacteria that cause human infections are located Intramuscular Administration extracellularly. Similar to other drugs, antibacterial agents are disposed of by hepatic elimination (metabolism or biliary elimi- Intravenous Administration nation), renal excretion of the unchanged or metabo- lized form, or a combination of the two processes. For many mode of excretion of an antibacterial agent is in adjust- patients in whom long-term antimicrobial therapy is ing the dosage when elimination capability is impaired required and oral therapy is not feasible, outpatient par- (Table 42-3). For drugs whose elimination is primarily return home from the hospital earlier or to avoid hospi- hepatic, no simple marker is useful for dosage adjust- talization entirely. Concentrations of most antibacterial agents in interstitial The choice of an antibacterial compound for a particu- fluid are similar to free-drug concentrations in serum. These conditions favor appropriate, material containing the infecting organism(s) rapidly growing aerobic or facultative organisms and assess should be obtained before the start of treatment so that bacteriostasis only. Specialized testing is required for the presumptive identification can be made by microscopic assessment of bactericidal antimicrobial activity; for the examination of stained specimens and the organism can detection of resistance among such fastidious organisms as be grown for definitive identification and susceptibility obligate anaerobes, Haemophilus spp. Awareness of local susceptibility patterns is useful and for the determination of resistance phenotypes with when the patient is treated empirically. After the organ- variable expression, such as resistance to methicillin or ism has been identified and its susceptibility to antibac- oxacillin among staphylococci. Antimicrobial susceptibil- terial agents have been determined, the regimen with ity testing is important when susceptibility is unpre- the narrowest effective spectrum should be chosen. The dictable, most often as a result of increasing acquired resis- choice of antibacterial agent is guided by the tance among bacteria infecting hospitalized patients. Susceptibility testing is designed to estimate the point, the species is considered to be within the spec- susceptibility of a bacterial isolate to an antibacterial drug trum of the antibiotic. Three pharmacodynamic codynamic relationships are in the early stages of investi- parameters quantify these relationships: the ratio of the gation; their elucidation should eventually result in more area under the plasma concentration vs. The host’s antibacterial rapid rate of bacterial death, or time dependent (β-lactams), immune function is of importance, particularly as it relates such that the reduction in bacterial density is propor- to opsonophagocytic function. Likewise, Dosing strategies attempt to maximize these ratios by the patients who have deficient humoral immunity (e. Table 42-5 extreme susceptibility of most infectious organisms to summarizes drug safety in pregnancy.

The line of demarcation between viable and nonviable tissue becomes clear in 1 to 2 months after the initial cold injury discount ayurslim 60 caps with visa herbs cooking, but surgery may be delayed until 2 to 3 months ayurslim 60 caps sale herbals on deck review. Atrial fibrillation is the most common dysrhythmia in hypothermia and is characteristically seen at a core temperature of 30°C. Prolongation of any interval, bradycardia, asystole, atrial fibrillation/flutter, and ventricular tachy- cardia may also be seen. Below a core temperature of 25°C (77°F), they are most commonly found in the precordial leads (especially V3 and V4) and their size increases. Hemorrhagic blisters are a poor prognostic indicator due to their associa- tion with deep tissue injury. These blisters should not be debrided or drained because it leads to tissue desiccation and worsening of the injury. Clear blis- ters, on the other hand, should be drained because the fluid contains throm- boxane, which is thought to be destructive to healthy tissue. Field rewarming is rarely warranted because of the potential for incomplete or interrupted rewarming. Standard hospital thermometers only read as low as 34°C (93°F), so a specialized low-temperature thermometer is required to obtain an accu- rate core body temperature. A severely hypothermic patient can present with rigidity, asystolic, and with fixed pupils; however, he or she should not be pronounced deceased until the core body temperature has been warmed to at least 35°C (95°F). Hypoglycemia, sepsis, and hypothyroidism are conditions that may mimic or coexist with hypothermia. Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical centre. Early complications include non- cardiogenic pulmonary edema, hypoxic encephalopathy, respiratory and meta- bolic acidosis, dysrhythmias, and renal impairment. Coagulopathy, electrolyte abnormalities, and hemodilution or hemoconcentration are rare but possible sequela. Pneumonia and acute respiratory distress syndrome can occur later in the patient’s hospital course. Victims of submersion injury often require aggressive respiratory support, which may range from administra- tion of supplemental oxygen to intubation. If cervical spine injury is suspected (as in this patient who dove off a platform), cervical spine stabilization should be maintained until spinal trauma is ruled out. Initial diagnostics may include a complete blood count, blood glucose, electrolytes, creatinine, arterial blood gas, and chest x-ray. These precipitants may include alcohol or drug intoxication, seizures, hypoglycemia, car- diac arrest, attempted suicide or homicide, and child abuse or neglect. In addition, if the submersion is associated with a history of trauma (eg, diving into water, motor vehicle collision), cervical spine and head injuries are considerations. In children 1 to 14 years old, it is the second leading cause of death (behind motor vehicle collisions). The incidence of submersion injuries peaks in toddlers and young children, adolescents and young adults, and in the elderly. Between 15 to 19 years of age, black boys have drowning rates 12 to 15 times higher than those of white boys. Alcohol use and other medical conditions have also been associated with an increased risk of submersion injuries. Among teenagers and adults, alcohol use may be a contributing factor in 30% to 50% of drownings. Seizures, autism, and other devel- opmental and behavioral disorders also increase the risk of drowning. Submersion injuries can occur in natural bodies of water (freshwater and saltwa- ter) as well as in domestic settings (such as bathtubs and swimming pools). However, if the infant is less than 6 months old or has an atypical presentation, healthcare providers should maintain a high suspicion for abuse. Efforts to decrease the incidence of submersion injuries and drowning deaths have focused on educating the public and increasing awareness of preventive measures. Water safety education for children, teenagers, and parents that encourages wearing flotation devices and never swimming alone should be rein- forced in the school, community, and physician’s office. As hypoxia and air hun- ger develop, they eventually involuntarily swallow and aspirate water.

It is nently in developed countries cheap 60caps ayurslim yogi herbals delhi, examines acute stroke units that implemented on our de novo Neurorehabilitation Census Board include rehabilitation or early supported discharge models best ayurslim 60 caps herbs los gatos. The system concomitantly targets medi- Conclusions: There is a tremendous opportunity to examine the cal, rehabilitation, case management, social services, and care availability, provision and effectiveness of post-acute stroke reha- coordination barriers to expedite hospital discharge. There is a need for the development of a Leprosy fscal benefts from delays to care, length of stay, and avoidable Rehabilitation Score. Throughout the inception of the specialty service Introduction: “Protective Edge” operation took place from July 8 to August 26 2014. During this period 67 soldiers and 5 civilth th - alone, benefts ranged from $19,662,984 to $22,026,840 at its low- est approximation. Hospital wide impact with this model reached ians were killed, and 1,620 soldiers were injured. The orthopedic rehabilitation ward at pensations of hospital-adjusted expenses), translating to 61. Fiscal trends were maintained when considered by service, will be admitted at our ward. During routine times the ward treats ownership, and annual percent growth in healthcare expenditures. The ward and tracking, an impact ranging up to 59 to 116 million in a non- discharged civilian patients and admitted wounded soldiers at a proft hopital setting. Material and Methods: During “Protective Edge” op- eration 53 wounded soldiers were admitted at the orthopedic reha- bilitation ward at Sheba Medical Center. Results: 53 wounded soldiers with a range of orthopedic injuries were admitted at the orthopedic reha- Leprosy Elimination in Cameroon bilitation ward at Sheba Medical Center. We adjusted to keep continuity of psychological treat- restoration of treated patients to normal activity, so that they may ment by following the patients from the acute wards to the reha- be able to resume their place in the home and community. Objectives: This study sions: The implications of “Protective Edge” operation forced the was carried out to assess the role of rehabilitation as an epide- orthopedic rehabilitation ward at Sheba Medical Center to adapt miological determinant for leprosy elimination in an endemic re- to a changing reality concerning the patients admitted. Methods: Focus group discussions, in-depth interviews and a has changed dramatically rapidly. Mapping and understanding the structured questionnaire were used to investigate leprosy rehabili- processes that took place during this unique period of time may tation among lepers, their contacts and a control group comprised have a major contribution to determining future treatment plans of patients attending hospital for reasons other than leprosy. In- for medical rehabilitation systems, as well as for the treatment formed consent was sought and gained from all study participants teams composing those medical systems. The proportion of the study sample with correct Developing a Cancer Rehabilitation Continuum of Care... A statistically signifcant relationship be- Connecting Acute and Post Acute Cancer Rehabilitaton tween knowledge of leprosy rehabilitation and the study subjects *C. Among Around the world individuals are surviving from cancer but with- leprosy contacts, 78 (73. The commonest rehabilitation trade stated by the an active team member throughout the trajectory of cancer care. Utilizing the Dietz model of care focusing on preven- epidemiological determinant of leprosy show that there was a sta- tive, restorative, supportive and palliative care these programs may tistically signifcant relationship within and between the various be delivered in a variety of settings, including hospitals, healthcare categories of lepers, contacts and controls (p = 0. Can- Rehabilitation has improved the quality of life of lepers in the lep- cer rehabilitation is an integral component of quality cancer care. Participants will learn from the frst two accredited cancer clude temperament, energy and drive, memory, emotions, pain and rehabilitation program medical directors how they have developed repair function of the skin. Learn from those doing the actual development tant concept not previously considered in trauma rehabilitation and implementation of quality rehabilitation cancer care services, and 26 environmental categories were identifed. This will enable comparison between individuals, regions Experiences of Providing Prosthetic and Orthotic Ser- and international trauma systems to identify important rehabilita- vices in Sierra Leone − the Local Staff’s Perspective tion gaps and needs amongst trauma populations. Sierra Leone is among the ten least developed countries in the world and half of the population live under the absolute pov- Short- and Long-Term Improvement in Mental and erty line with an income less than $1. Aim: The aim of Physical Functioning after Rehabilitation among Indi- this qualitative study was to explore the experiences of prosthetic viduals with Disabilities and orthotic service delivery in Sierra Leone from the local staff’s 1 2 3 4 perspective. Røe1 working at allthe rehabilitation centres providing prosthetic and orthoticservices in Sierra Leone were interviewed.

Frankincense Oil: One of the earliest documented essential oils buy 60 caps ayurslim overnight delivery herbals wholesale, evidence of its use goes back 5000 years to ancient Egypt purchase ayurslim 60 caps with mastercard herbals for anxiety. Studies from Johns Hopkins and Hebrew Universities state that Frankincense relieves anxiety and depression in mice (how, exactly, was this determined? Direct application of the oil may have antibacterial and antifungal properties, and is thought to be helpful for wound healing. Blue Tansy Oil: Helpful as a companion plant for organic pest control, Blue Tansy is sometimes planted along with potatoes and other vegetables. Oregano Oil: An antiseptic, oregano oil has been used in the past as an antibacterial agent. It should be noted that Oregano oil is derived from a different species of the plant than the Oregano used in cooking. One of the minority of essential oils that are safe to ingest, it is thought to be helpful in calming stomach upset, and may help relieve sore throats. Its antibacterial action leads some to use the oil in topical applications on skin infections when diluted with a carrier oil. Oregano Oil may reduce the body’s ability to absorb iron, so consider an iron supplement if you use this regularly. Thyme Oil: Reported to have significant antimicrobial action, diluted Thyme oil is used to cure skin infections, and may be helpful for ringworm and athlete’s foot. As inhalation therapy, it may loosen congestion from upper respiratory infections. This is a combination of clove, lemon, cinnamon bark, eucalyptus and rosemary essential oils. Touted to treat a broad variety of ailments, studies at Weber State University indicate a good success rate in killing airborne viruses and bacteria. Of course, the more elements in the mixture, the higher chance for adverse reactions, such as phototoxicity. Most of the essential oils listed are unsafe to use in pregnancy, and may even cause miscarriage. Also, allergic reactions to essential oils, especially on the skin, are not uncommon; use the allergy test I described earlier before starting regular topical applications. Even though essential oils are natural substances, they may interact with medicines that you may regularly take or have adverse effects on chronic illness such as liver disease, epilepsy or high blood pressure. Thorough research is required to determine whether a particular essential oil is safe for you. Anyone interested in maintaining their family’s well- being should regard them as just another weapon in the medical arsenal. Learn about them with an open mind, but maintain a healthy skepticism about “cure-all” claims. Planting your own medicinal garden is a prudent way to provide alternatives to modern medicine. Until pharmaceuticals were produced in factories, communities and homesteads had to grow their own “medicine”. This common practice was a natural part of the landscape and provided needed remedies for many medical issues. Oftentimes, a community would have a person that served as an herbalist and supervised the cultivation and processing for proper administration. Growing your own medicinal garden is both rewarding and beneficial; in times of trouble, you will likely have limited access to pharmaceuticals. The learning curve when gardening can be steep, so don’t delay planting those medicinal seeds until the situation is critical. Although some herbs grow well in shade, most plants need at least 6-8 hours of full sun for proper growth and development. Potting is appropriate for medicinal plants that will need to be transported inside during a cold winter. Water should be provided on a regular basis to allow the soil to stay moist, but not muddy or waterlogged. A small amount of natural mulch is perfect for maintaining an even moisture level in very dry conditions. Bronner’s lavender, tea tree or peppermint castile soap and, optional, a few drops of tea tree essential oil to 4-8 cups of water makes a great disease and natural pest control. However, with certain plants, you may be able to grow warmer climate plants by protecting them from the cold with greenhouses or using row covers.

A watery infusion revealed a significant There are 4 sepals that are often colored and 8 stamens order 60 caps ayurslim otc herbals products. A linear capsule-like order 60caps ayurslim free shipping herbals summit 2015, quadrangular, 4-valved and opens with 4 suspension of the fresh drug in ethanol stunts the growth of bending valves. Tincture and the may be covered in tiny warts with a white, often short- liquid extract showed anti-microbial effect against Candida stemmed, tuft of hair. There are 5 paper, shows a weak effect against Bacillus subtilis, Esche- stamens and 1 superior ovary. The fruit is a cherry-sized, richia coli, Mycobacterium smegmatis, Shigella flexneri, globular, scarlet berry, enclosed in the swollen, orange-red Shigella sonnei and Staphylococcus aureus. The drug was helpful in treating benign prostate angular with opposite, long-petioled, entire-margined leaves. Native Americans use the drug Production: Winter Cherry fruits are the ripe fruits of for rectal bleeding; the Chinese use it for menstrual Physalis alkekengi. Unproven Uses: Winter Cherry is used as a diuretic in Hansel R, Keller K, Rimpler H, Schneider G (Hrsg. The ripe fruit is edible, but unripe fruit can cause poisoning Hiemann A, Mayr K, Sci Pharm 53:39. Medicinal Parts: The medicinal parts are the ripe fruit and Kawai M, Matsuura T, (1970) Tetrahedron 26:1743. Biogene Gifte - Biologie, Chemie, Sesquiterpenes: including drimenol, drimenin, confertifoline, Pharmakologie. Medicinal Parts: The medicinal part is the dried bark of the trunk and larger branches. The sepals are membranous, broadly ovate to Handbuch der Pharmazeutischen Praxis, 5. The 4 to 14 petals are also membranous, oblong to (Drogen): Springer Verlag Berlin. There are 9 to 18 Hegnauer R, Chemotaxonomie der Pflanzen, Bde 1-11, ovules on a short seed stalk. The fruit is berry-like, black to Birkhauser Verlag Basel, Boston, Berlin 1962-1997. The leaf blade is coriaceous, oblong- ovate to elliptical, with a somewhat re volute margin. The bark is collected from the dried trunk or flowers grow from the base of the leaves. They are fleshy, globular, bilocular, and contain Not to be Confused With: The drug is often confused with numerous whitish, ovoid, flattened seeds. Cortex Canellae albae and with the bark of Cinnamodendron Leaves, Stem and Root: Gaultheria procumbens is a bushy corticosum. The active ingredient, methyl salicylate, is produced synthetically at a lower cost. Methyl Characteristics: Wintergreen has an aromatic odor; the taste salicylate is a constituent of liniments and bath additives. Monotropitoside (Gaultherin): changing into methyl salicy- late when the plant is dried Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, Nachdruck, Georg Olms Verlag Hildesheim 1979. Daunderer M, Kormann K, Giftpflanzen, Pflanzengifte, Volatile oil: chief component methyl salicylate (96-98%), in 4. Health risks or side effects following the proper administra- tion of designated therapeutic dosages are not recorded. The Flower and Fruit: The androgynous and unisexual flowers drug and its volatile oil can, however, trigger contact grow in light to golden yellow, short-stemmed clusters on allergies. The 4 sepals are ovate or triangular, Signs of poisoning such as severe stomach and kidney curved outward, yellow-brown to brown on the inside. Fatal poison- petals are bright yellow, long, narrow-linear, rolled to a ings can occur through oral and percutaneous administration spiral in the bud and crushed like tissue paper when open. Poison- Fertilization takes place during the spring that follows 5 to 7 ings with fatal results have been observed following the oral months after pollination. The fruit capsule is woody, ovate, intake of as little as 4 to 6 g of the volatile oil. The tannins and tannin elements have an astringent, anti- inflammatory and locally hemostatic effect.

No signifcant correlations between received identical assessment at baseline cheap ayurslim 60 caps without a prescription herbs used in cooking, 4 weeks and 8 weeks in pulmonary functions parameters and functional data were ob- the home setting generic ayurslim 60caps fast delivery jenith herbals. In this study the type of hemiparesis demonstrated high of language lateralization reorganization in chronic Broca’s apha- infuence in the rehabilitation success of the patients. Methods: Conclusion: The physical therapy should start as soon as possible, Five patients with chronic Broca’s aphasia were recruited for a and the presented algorithm of rehabilitation should be taken into ten-day intensively Word Association Navigation Training. All subjects were evaluated using area were signifcantly higher than Wernicke’s area, left supra- standard nerve conduction study; median sensory and motor con- marginal gyrus, and left premotor area respectively before train- duction. After training, these differences between right brain motor latency comparison test. Results: Total of 1,705 hands were areas and left brain areas were not observed (p>0. Keywords: Broca’s aphasia; magnetoencepha- absent median sensory and motor response, 42 hands (75. Cerebrovascular accident is a pathology more frequented among population age group 45-60 ance Inequality during Gait in Hemiplegia? Methods: Data was extracted upon review of patient records Background: Most chronic stroke patients walk awkwardly be- of the Physiatric Clinic, University Clinical Center of Prishtina, cause of deviation of body weight balance on intact side, causing who have undergone rehabilitation from January 2009 until De- frequent fall and decreased gait endurance. During this study down mentioned methods of lem, we aimed to assess the change of standing balance during physical therapy are implemented: electrotherapy, kinesiotherapy, progression of gait training stage and determine the appropriate seating and standing balancing, respiratory exercises, massage, er- timing to start balance training in subacute hemiplegia. Results: als and Methods: Consecutive subacute hemiplegic stroke patients Multi-morbidity is more frequent among patients above 60 years who were prescribed for gait training in neurology or rehabilita- age. The 3 stages; 1) tilt table training, 2) parallel bar (p-bar) standing train- most frequent risk factor that can cause hemiparesis is hyperten- ing, and 3) p-bar or cane gait possible for more than 10 steps. Important correlation symmetry of weight bearing during quiet standing was evaluated is acquired from the number of risk factors in the success of reha- using a pair of force-sensor embedded shoe. There were signif- py, consisting of memory and mental calculus exercises, attention cant difference between stage 1 and 3 (p=0. The patients who were ini- used the following assessment tools: The Clock Drawing Test, The tially in stage 3 (n=7, group B) showed 35. The psychological Conclusion: This was the frst study to evaluate the longitudinal evaluation has been performed before the frst session and after change of weight distribution with regards to gait training stage. Results: The ex- Despite partial neurologic recovery of lower extremities, hemi- ecution times improved from one session to another, the patients plegic patients demonstrated a tendency to bear more weight on became more self confdent and more operative. The scores of the intact side with gait stage progression, especially when they the cognitive evaluation tests and of the quality of life improved started gait training in p-bar. Early facilitation of the hemiplegic considerably, as well as the physical functioning scores and the lower limb during stroke rehabilitation is necessary. Conclusion: A well designed cog- nitive therapy intervention reduces the time costs of a rehabilita- tion program and improves the patient´s quality of life. Score nique is an electrotherapy system designed for different neuro- for fatigue with Parkinson Fatigue Scale scale was by 61% or pa- muscular conditions. Specifcally, Vitalstim is a dual-channel tient was with bad quality of live 75-100%. The purpose of this study Severity Scale was by 82% or their quality of live was 65-85%. Conclu- an analysis of the literature aimed at aiding with the decision of sion: The assessment of fatigue by patient with Parkinson, can be whether or not to acquire the instrument for our hospital. Methods: basis information of potential of him in future, to plan program Basic information is provided about the physiological background for rehabilitation and how much we can expect of him. The literature reviewed in this manu- fatigue assessment, Parkinson, rehabilitation. The literature about Cognitive Optimization – Interim Results of a Pilot Study this condition varies greatly regarding all kinds of dysphagia and *A. Therefore, neurological rehabilitation must munities, especially around the commercially available Vitalstim involve, besides the interventions for improving the physical func- stimulator, is objectively explained. References: 1) Margareta tioning of the person, a specifc, individually tailored cognitive Bulow, Renee´ Speyer, Laura Baijens, Virginie Woisard, Olle optimization intervention. Dysphagia (2008) and to ensure an effcient entrainment and use of the preserved 23: 302-309. Suiter, PhD, conditions (stroke and traumatic brain injury), presenting a mild Steven B. Ruark, PhD: Effects of Neu- cognitive impairment, expressed by memory and mental calculus romuscular Electrical Stimulation on Submental Muscle Activity.

There are two cir- cumstances in which a relatively small prolongation of pregnancy is likely to confer mea- surable benefits in terms of morbidity and mortality: • When it occurs at a gestational age in which every day or week gained confers a subs- tantial benefit (for instance between 25 and 27 weeks) order ayurslim 60 caps on-line herbals hills. Tocolysis to inhibit preterm labour should not be undertaken: • If the mother’s condition warrants delivery as soon as possible buy 60 caps ayurslim otc herbals vs pharmaceuticals. All betamimetic agents are chemically and pharmacologically related to the catecholamines, and all act by binding to b-receptors that are present on cell membranes in the uterus and in many organs throughout the body. Stimulation of b-recep- tors is responsible for actions such as an increase in heart rate and stroke volume, relaxation of intestinal smooth muscle and lipolysis. Also, b-stimulation mediates glyco- genolysis and relaxation of smooth muscle in the arterioles, the bronchi and the uterus. Ritodrine and terbutaline are the most common drugs used for prevention of preterm delivery. Intravenously, in continuous perfusion, starting with 50 mg/min, and increasing 50 mg/min every 15 minutes until uter- ine contractions stop. Maximum dose recommended is 360 mg/min or when mother heart rate exceeds 120 bytes per minute. As betamimemetic drugs are powerful agents with adverse effects that are related to the dose administered, this would seem to be unde- sirable. It has, therefore, been proposed to lower the infusion rate as soon as uterine in- hibition is achieved to a level that is sufficient to maintain uterine inhibition. Oral admi- nistration (10 mg every 4-6 hours, maximum 120 mg/day) has not proved efficacy in maintenance management and only should be administrated if contractions do not let the mother rest. Terbutaline can be administrated orally (2,5 mg/4-6 h), subcutaneously (0,25 mg/20 min) or intravenously. It has been known for some time that continuous administration of betamimetic agents results in a loss of efficacy. This is attributed to down-regulation of the b-receptors and desensitisation of the adenylate cyclase activity. It may be possible to overcome this prob- lem by alternative regimens of drug administration, such as intermittent or pulsatile ad- ministration but the evidence that this is clinically useful is far from conclusive. Heart frequency, breath frequency, blood pressure and liquid balance (income and expen- diture) must be controlled. It is advisable to measure of serum glucose every 12 hours or every 2 hours if patient is diabetic. Contraindications: a) hyperthyroidism, b) cardiac dis- ease, and c) poorly controlled diabetes mellitus6. Start dose is 6,75 mg in bolus intravenously, it is followed by doses of 300 mg/min du- ring 3 hours and finally 100 mg/min during 45 hours. Although its efficacy is waiting to be demonstrated, at the moment it seems similar to ritodrine. Several such agents have become available over the years, but only one, nifedipine, has been applied to the treat- ment of preterm labour. Nifedipine is the calcium channel blocker most used to prevent preterm labour although there is not enough evidence to use it for this indication. Start dose is 30 mg, following 20 mg/4 h during 24 h, and then maintenance with 10 mg/8 h. Suppression of endogenous prostaglandin synthesis is therefore a logical approach to inhibition of preterm labour. There have been numerous inhibitors that have been used to treat preterm labour, but the most widely used has been Indomethacin. It is an effective drug for delaying deli- very at least 48 h in pregnant women less than 32 weeks. Starting dose is 100 mg rectal or 50 mg oral, following 25-50 mg/4-6 h orally during maximum 48 h. It can’t be used in gas- trointestinal ulcer, coagulation diseases, asthma and allergy to aspirin. It cannot be used in pregnancies over 32 weeks, and during not more than 48-72 h, because the risk to cause oligohydramnios (which is reversible stopping the administration) and foetal ductus arterio- sus closure. The occurrence of ductal constriction has been related to gestational age (the younger the foetus the lower the risk), so that this effect is less marked at the gestational ages in which the infant is more likely to benefit from prolongation of pregnancy. However, there is actually little solid information on the mechanism by which magnesium sulphate administration may affect uterine contraction in preterm labour.