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When the weather is inclement, cover the necessary areas with a clean, weather-resistant material, such as plastic. When the vehicle arrives at its destination, sign the evidence log to verify that the vehicle was checked into the storage facility, then check that all seals on the vehicle are intact. When seals are broken, note when the break occurred and reapply evidence tape to secure the vehicle. Electronic and Digital Evidence9 Computers and other electronic devices are often found at crime scenes and may contain evidence of criminal wrongdoing. Other devices Procedure: Loose media Electronic media, in this context, are objects on which digital data can be stored. Equipment Needed Anti-static bags, bubble-wrap and other packing materials; clean paper bags, boxes, or envelopes; evidence tape; flashlight; waterproof pen; labels; personal protective equipment. Electronic evidence is fragile and sometimes includes time sensitive data of investigative value that is stored on or transmitted by electronic devices. Electronic media is small, can be easily hidden, and is sometimes camouflaged to appear as a non-electronic object. Cell Phones Identify whether a warrant is needed or there is an exception to the warrant requirement. When the media is inside of a computer or other electronic component, do not remove it without the assistance of an electronic evidence collection expert. Documentation When the media is readily accessible, document it as it was found before collecting it. Photograph the media as found using standard crime scene photographic techniques (overall, mid-range and close up). Photograph all connections (network cables, power cables, and peripheral cables) to the device as you found them. Sketch a diagram of the placement of the media in the area and relative to devices, equipment, and objects. Include your initials and identification number, the date and time, evidence number, location and evidence description. This number should correspond to the numbered placard photographed and diagramed next to the evidence. Do not use destructive techniques, such as applying fingerprinting chemicals, while collecting the electronic evidence. Use plastic bubble-wrap or foam pads as packing material when original packing materials are not available. Write your initials, identification number, and the time and date across the evidence tape seal. Store electronic media in a secure area in a controlled climate away from magnetic sources, dust, and other contaminants. Electronic media can be damaged when stored in areas where temperatures and humidity vary significantly. Procedure: Networked Computers the seizure of networked computers presents unique challenges. Always consult with a qualified computer forensic analyst or network administrator before shutting down and seizing a networked system. Due to the size and complexity of modern computer networks, seizure is frequently not possible. When dealing with networked devices the amount of time it takes to secure the network and data is critical. By design many of these devices can be accessed from offsite and critical evidence can be remotely destroyed, copied, or encrypted. Contact an electronic evidence collection expert as soon as discovering computer equipment and related components. Depending on the investigation, proprietary software such as database or financial software may

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Return airway 713 An employer must ensure that underground oil transformers rated at more than 1000 kilovoltamperes, garages, bulk oil storage areas and fuel stations are ventilated by air that flows directly to the return airway. Doors 714(1) An employer must ensure that airlock doors (a) remain open no longer than is necessary for workers or vehicles to pass through, (b) are designed to be self-closing, and (c) operate in such a way that if one door of the airlock system is open, the other door remains closed. Stoppings 715 An employer must ensure that (a) ventilation stoppings between intake and return airways prevent air leaks, (b) the space between the faces of ventilation stoppings and roadways is kept free of obstructions, and (c) ventilation stoppings are constructed at crosscuts on each side of the conveyor system up to the last crosscut before the tail end of the last conveyor in order to minimize the potential contamination of those airways. Fans 719(1) An employer must ensure that (a) all main fans in a mine have an automatic ventilating pressure recording device that is always operating and monitored daily, (b) a mine has a standby main fan, and (c) a mine has an emergency power supply capable of running the main fan if the principle source of power fails. Surface fans 721(1) An employer must ensure that the main surface ventilating fans (a) are offset by not less than 5 metres from the nearest side of the mine opening, and (b) have non-combustible air ducts and housing. Booster fans 722 An employer must ensure that a booster fan (a) does not restrict the free passage of air delivered by a main fan if the booster fans stops, (b) stops if a main fan stops, and (c) is continuously monitored by a system that alarms at a permanently attended monitoring station if the fan stops or its performance falls below an established efficiency level. Brattice, vent tubes 724(1) If brattice or vent tubes are used to ventilate the working face, an employer must ensure that the brattice or vent tubes are kept advanced as close as possible to the working face. Operating procedures for booster and auxiliary fans 725(1) An employer must ensure that (a) if a booster fan or auxiliary fan stops, workers in an area that is affected by the stopping move to a place that is adequately ventilated, and (b) a competent worker tests the affected area to ensure it is adequately ventilated before other workers enter the area. Ventilation monitoring 727(1) An employer must appoint a competent worker who must measure the barometric pressure outside the mine and the velocity and quantity of air in all airways and old workings of the mine that are accessible to workers. Cross cuts 728(1) Repealed 728(2) An employer must ensure that all cross-cuts except the one nearest to the working face are securely stopped off. Gas and Dust Control Gas inspections 730(1) An underground coal mine manager must ensure that a mine official (a) always carries an approved gas testing device for methane, carbon monoxide and oxygen when underground, and (b) within four hours of each shift commencing work, inspects, with the device referred to in (a), that part of the mine being worked, or intended to be worked, and all related roadways. Flammable gas levels 731(1) An underground coal mine manager must ensure that workers are withdrawn from a work area if the amount of flammable gas in the general body of the air exceeds 40 percent of the lower explosive limit. Diesel vehicle roads 732(1) If workers operate a diesel vehicle in an underground coal mine, the underground coal mine manager must ensure that a worker measures the air flow and the percentage of flammable gas present in the general body of air at all points that the underground coal mine manager or the Director specify. Degassing procedures 733(1) An employer must ensure that procedures for degassing headings are prepared and certified by a professional engineer. Gas removal 734 An employer must ensure that workers remove standing gas in a mine under the direct supervision of a mine official. Unused areas 735(1) An employer must ensure that parts of a mine that are not being worked are, so far as is reasonably practicable, kept free of dangerous gases. Approval of devices for testing and measuring 737 An employer must ensure that combustible gas detectors and other devices used for testing and measuring air quality, velocity, and volume in a mine are approved for use in coal mines by one of the following: (a) the United States Mines Safety and Health Administration, or its predecessors or successors in administration; (b) the Ministry of Power of the Government of Great Britain, or its predecessors or successors in administration; or (c) the Department of Natural Resources, Canada, or its predecessors or successors in administration. Roof bolting 741(1) An employer must ensure that a worker operating a roof bolter (a) is competent to use a combustible gas detector, (b) carries a combustible gas detector, and (c) takes flammable gas readings at roof level. Incombustible dust 743(1) this section does not apply to the part of a roadway within 10 metres of the working face while coal cutting is in progress. Welding, cutting and soldering 746(1) An employer must ensure that a worker does not weld, cut or solder using an arc or flame. Competent supervisor 751(1) An employer must appoint a supervisor to supervise an exploration, drilling, servicing, snubbing, testing or production operation. Breathing equipment 752(1) If a worker is undertaking emergency response activities at a well site and the worker may be exposed to a harmful substance in excess of its occupational exposure limit, an employer must ensure that sufficient self-contained breathing apparatus units that comply with section 251 are provided, based on the hazard assessment required by Part 2 and the emergency response plan required by Part 7. Drilling rig, service rig, and snubbing unit inspections 758(1) An employer must ensure that the drilling rig, service rig or snubbing unit is inspected by a competent worker (a) before it is placed into service, and (b) every seventh day on which it is used for as long as it is in service. Exits from enclosures 761(1) An employer must ensure that a drilling rig, service rig or snubbing unit floor enclosure has exits to ground level that (a) are located on at least two sides of the drilling or service rig floor, (b) open away from the drill hole, and (c) have no obstacles that would hinder or prevent a worker who is leaving in an emergency. Emergency escape route 762(1) If a primary exit from the principal working platform above the drill floor may be blocked or otherwise compromised, an employer must ensure there is an emergency means of escape from the principal working platform that (a) is visually inspected by a competent worker at least once a week, and (b) is kept free of obstructions. Trailer pipe rack 765(1) An employer must ensure that a trailer that is used as a pipe rack (a) has guardrails and toe boards along the full length of both sides of the trailer, (b) has a stairway at the end farthest from the drilling or service rig floor, and (c) is constructed so that the lower end of the pipe does not roll off the trailer when the pipe is hoisted into the derrick. Brakes 767(1) An employer must ensure that a mechanism used to hold the drawworks brakes of a drilling or service rig in the ?on? position is designed so that the brakes cannot be accidentally disengaged. Travelling blocks 769(1) An employer must ensure that each hook of a travelling block has a safety latch, mousing, shackle or equivalent positive locking device. Catheads 771(1) An employer must ensure that workers do not use a rope-operated friction cathead on a drilling or service rig.

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In order to pre the survey also provided pivotal information on vent the onset of thyroid storm in such cases, providing the sequelae of thyroid storm. It revealed that thyroid information to the general population about life-threat storm frequently causes neurological sequelae and that ening thyroid storm may be important. In this regard, the clinical course Thyroid storm can be caused by several medical of neurological complications should be carefully fol triggers such as radioiodine therapy, thyroidectomy, lowed. The mechanisms underlying this neurological and nonthyroid surgery in patients with uncontrolled involvement have not been fully elucidated. A laboratory investigation to dine therapy, but no patients who developed thyroid elucidate these mechanisms is warranted. Therefore, it is impor tant to carefully monitor general patient condition and 10. Prevention of thyroid storm and roles thyroid hormone levels prior to and after radioiodine of defnitive treatment therapy. Patients who cannot tolerate these treatments Quality of evidence: low or respond poorly to them require preparation for sur 2. Defnitive treatment of Graves? disease, either gery using all available means to normalize thyroid by radioiodine treatment or thyroidectomy, should hormone levels preoperatively, as mentioned above. The authors ence even after repeated education should be treated advocated early thyroidectomy to treat thyroid storm, by radioiodine treatment or thyroidectomy. In thyro particularly in chronically ill older patients with con toxic patients with potential triggering conditions for current cardio-pulmonary and renal failure who fail to thyroid storm, these triggering factors should be simul respond to the standard intensive multifaceted therapy taneously treated. If the patient has a history of treatment for vascular system, and gastrointestinal tract present, it is Graves? disease, family history of thyroid disease, and important to consider the possibility of thyroid storm. Strength of recommendation: high Appropriate sampling of blood, urine, and sputum is Quality of evidence: low essential in patients with high fever. Guidelines of thyroid storm management 1049 nance imaging or brain computed tomography without underlying disease is required. Sedation may be intravenous contrast is required in patients with distur required when neurological symptoms are attributed bances of consciousness. The presence of the cardiohemodynamic condition of a patient with factors that can precipitate thyroid storm should be thyroid storm is unstable (Fig. Future directions for clinical trials in We obtained a detailed clinical database of 356 thy the management of thyroid storm roid storm cases between 2004 and 2008 after a nation wide large-scale survey. Multiple Quality of evidence: low regression analysis demonstrated that independent risk 2. Therefore, in Strength of recommendation: strong order to improve the prognosis of patients with thyroid Quality of evidence: low storm, clinical trials are needed to determine the effec tiveness of treatments for these comorbidities. This condi records documenting various actual treatment prac tion is characterized by multiple organ failure, decom tices in each patient with thyroid storm. Therefore, although it is rare, ple, plasma exchange should theoretically be an effec thyroid storm requires prompt diagnosis and multidis tive treatment for eliminating excess thyroid hormone ciplinary intensive medical care. Therefore, the establishment of appropriate diagnostic and therapeutic guidelines has been eagerly awaited? Detailed clinical data from tions associated with the cardiovascular and nervous 356 patients with thyroid storm were obtained by this system. On the other hand, large clinical trials that process, which revealed that the incidence of thyroid have been designed but not yet been performed actu storm was estimated as 150 cases/year (0. However, there have been diffculties in sary for mild disturbances in consciousness in thyroid making a generalized treatment plan because of the storm? Is rehabilitation in early thyroid storm effective rarity of thyroid storm, its acute clinical course, and for preventing the neurological complications associ the need for prompt decision-making. Therefore, a randomized controlled the relationship between thyroid function and coag intervention trial to determine the optimal therapy has ulation disorder has been previously described [130, not yet been performed. The rapid clinical degradation; contraindication to other half-life of thyroid hormones is as long as 6. In thyroid storm pitals who participated in the nationwide surveys for case reports published in Japan between 1983 and their valuable and kind cooperation. Endocrinol Metab Clin North (2005) Type 2 iodothyronine deiodinase is the major Am 22: 263-277.

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If expertise is not available within the primary clinical team, the patient should be offered genetic counseling and referred to the clinical genetics service (4, D). Initial assessment should focus in identifying the small proportion of patients with localised disease and good performance / status, that may bene? The surgical intent should be gross tumour resection and not merely an attempt at debulking. Patients should be informed about and given the opportunity to consider participation in ongoing randomized clinical trials in cases where there is genuine clinical equipoise or lack of level 1 evidence (4, D). Audit of various aspects of the service should be an ongoing process at network and national level. In spite of advances in diagnostic methods, surgical techniques and clinical care, there are differences in survival of patients with 1. Thyroid cancer is the most common malignant endo ndatory national peer review, equity of access to specialist care, crine tumour, but represents only about 1% of all malignancies. It is hoped that the third edition of the national papillary thyroid cancers found when surgery is performed for guidelines for thyroid cancer, and their implementation through thyroid diseases other than cancer. Aim of the guidelines 3,9 of thyroid cancers of all sizes has been increasing over time. This document changing iodine status and exposure to radiation,10 but in most is not intended as guidelines for management of thyroid nod cases the cause is unknown. Therefore, evidence is based on dent, the incidence of thyroid cancer rose several hundred times large retrospective studies and the level of evidence is ascribed in children in the region. In cases of populations or individuals being contaminated with 131I the thyroid can be protected by administering potassium the three main aims of the guidelines are: iodide. Screening of patients with thyroid cancer; At present there is no screening programme to detect thyroid. Testing for these genes is not routinely 14 do with incidental thyroid nodules on imaging? New England Journal in cases where there is genuine clinical equipoise or lack of of Medicine, 325, 599?605. Nine per cent of 4,5 mary tumour patients with a diagnosis of thyroid cancer die of their disease. This enables a more accurate prognosis to be ment of Cancer methodology given and the appropriate treatment decisions to be made. Age at the time of diagnosis is one of the most consistent sively for registration and predicts mortality (Table 2. The male gender has been reported as an independent risk factor in some but not all studies. However, of patients with a good prognosis to invasive therapies associ if the confounding effects of age and extent of tumour at ated with long-term side effects, which may impact on quality of diagnosis are removed, survival rates are comparable. Advances in molecular medicine and the development of 7,25 40 the degree of cellular differentiation and vascular invasion. However, for ?Widely invasive? and ?vascular invasion? are features of follicular the foreseeable future, conventional clinical and histopathologi 26 cal parameters remain the principal tools on which management cancers associated with a poorer prognosis. Poorly differentiated and oncocytic follicular (Hurthle-cell)? carcinomas decisions have to be based. The risk of recurrence and mortality correlates clinical management but also for design and analysis of clinical with the size of the primary tumour. Annual Tg assessment can be carried Key recommendation out without stimulation and follow up intervals can be extended (Chapter 13). Generally the greater the number of risk factors the stronger is the case in favour of the intervention 2. Both clinicians and patients can feel uncomfortable Examples of uncertainty in decision making where Persona dealing with uncertainty. However, if handled appropriately, lised Decision Making may be applied are shown in Table 2.

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Key commentary: Management of the patient with palpitations depends on the clinical situation taken as a whole, including iron loading status and cardiac function. Clinical examination A thorough medical history and physical examination are required for a basic cardiological assessment, which should also include: 12-lead electrocardiogram and a detailed echocardiogram, undertaken according to published guidelines. Key commentary: the regular assessment of cardiac status helps physicians to recognise the early stages of heart disease and allows prompt intervention. First degree heart block and conduction disturbance in the forms of bundle branch block may be seen but higher degrees of conduction disturbance are rare. This is particularly the case for changes suggesting an increase in right heart forces. There are now many types of recorders suited to the detection of intermittent cardiac arrhythmia. Adequacy of treatment of cardiac disease can also be gauged by exercise test performance. A large number of parameters can be obtained from the cardiac ultrasound investigation but even the simplest measurements of chamber size can provide immediate and valuable data on cardiac status and clinical progress, as long as they are obtained by a skilled practitioner following a standardised protocol. Examples of echocardiography in thalasaemia patients this is not an exhaustive list, but includes most of the parameters, which characterize cardiac function in thalassaemic patients. A recent publication has illustrated the value of simple echocardiographic follow up in patients with thalassaemia (Maggio 2013). Iron cardiomyopathy presents first with increased end-systolic volumes and borderline ejection fractions; progression to dilated cardiomyopathy is a late and ominous finding. A combination of conventional and tissue Doppler should be used to evaluate diastolic function. A simple database for each patient can easily be developed for each patient to aid longitudinal follow up. Newer echo methods may also increase the sensitivity of the echo in detecting pre-clinical disease (Vogel 2003). Examination by echocardiography of the ventricular response to exercise may also be useful, highlighting individuals with sub-clinical disease in whom the ejection fraction fails to rise, or even falls, in response to exertion or simulated exercise using intravenous (i. The cardiac T2* parameter has been validated as an accurate reflection of cardiac iron content and its usefulness in clinical management cannot be over-emphasized (Modell 2008, Wood 2009). It is now a matter of basic clinical standards that cardiac T2* should be undertaken in every transfused thalassaemia patient from as early an age as practicable, 10 years in most centres, but as early as 7 years in some cases, if there exists a suspicion of a high iron burden. Key commentary: the value of the T2* parameter is that it identifies those individuals at risk of developing cardiac complications, before they become evident by changes in function detected by simpler non-invasive methods, such as echocardiography. Monitoring the effectiveness of chelation in individual patients has proven to be critical in benefiting patient motivation in adhering to demanding treatment programmes and thus to outcomes. Studies are recommended at 24, 12, and 6 month intervals for low, standard, and high risk patients. As a result of chronic anaemia, norms for cardiac volumes and ejection fraction are different for thalassaemia patients and must be taken into account when evaluating results (Westwood 2007). Management of cardiovascular complications the therapeutic strategy to diminish the risk of heart complications in patients with thalassaemia involves a number of general measures including the maintenance of a pre transfusion Hb of at least 10 g/dl, along with particular cardiovascular interventions. Impaired myocardial function may require specific cardiac treatment, but it also calls attention to the immediate need for much stricter adherence to chelation protocol or the initiation of a more intensive chelation programme, in order to prevent an inexorable progression to severe cardiac dysfunction. Cardiac dysfunction generally lags cardiac iron deposition by several years (Carpenter 2011). Unfortunately, cardiac iron clearance is an extremely slow process, often requiring 3 or more years to clear severe cardiac iron deposition (Anderson 2004). Combined therapy with deferiprone 75-100 mg/kg and deferoxamine 40-50 mg/kg/day represent the best option to clear cardiac iron and stabilize ventricular function (Porter 2013). Deferoxamine should be given continuously, either subcutaneously or through a percutaneous intravenous catheter, until the ventricular function normalizes (Anderson, 2004, Davis 2000, Tanner 2008). An important practical point is that intra-venous lines pose a considerable risk of thrombosis and iatrogenic pulmonary hypertension, through chronic pulmonary thromboembolism and should mandate formal anticoagulation, particularly in chronically implanted lines. Patients with cardiac T2* values below 6 ms are at high risk for symptomatic heart failure (Kirk 2009) and should be treated with intensive chelation, even if cardiac function remains normal.

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In the normal living subject, the internal anal sphincter is tonically contracted so that the anal canal is closed. The internal sphincter is supplied by autonomic nerve fibers and is not consid ered to be under voluntary control (3). Thus, although it appears to contract 104 Rogers and Newton during a digital assessment of voluntary anal contraction, it is presumed to result from its compression by the surrounding external sphincter fibers (177). External Anal Sphincter this sphincter encircles the internal sphincter but extends below it, end ing subcutaneously. The lower edges of the external and internal sphincters can be distinguished on digital palpation. Although this sphincter is tonically contracted in the resting state, this contraction can be overcome with firm pressure (177). If the patient is asked to contract the anus during a digital assessment, the external sphincter can be felt to ensure contraction and clos ing of the anus tightly. However, because the muscle fibers are predominantly the slow-twitch type, a maximum contraction of the external sphincter can only be maintained for approx 1 minute(178). Fecal continence is maintained by several factors, the relative impor tance of which has not been fully elucidated. Currently, the most important factor is the angulation between the rectum and the anal canal, which is main tained at a mean of 92? by continuous contraction of the puborectalis muscles, located above the external sphincter. Both sphincters have supportive roles in maintaining fecal continence (175), and their disruption can result in inconti nence (see Subheading 10. Forensic Evidence the presence of semen in the anus or rectum of a male complainant can be corroborative evidence of alleged anal intercourse in conjunction with the presented history and possible physical findings. The same is only true for a female complainant if no semen is detected in the vagina, because semen has been found on rectal and anal swabs taken from women who described vaginal intercourse only. It is postulated that the presence of semen in these cases results from vaginal drainage (49,179). Swabs should also be taken if a condom or lubricant was used during the sexual assault and if anilingus is alleged (see Subheading 7. Just as when sampling the skin elsewhere, if the perianal skin is moist, the stain should be retrieved on dry swabs. If there is no visible staining or the stain is dry, the double-swab technique should be used (28). The forensic practitioner should use as many swabs as are necessary to remove any visible stain (repeating moistened swab followed by dry swab). Although not specifically defined for forensic pur Sexual Assualt Examination 105 poses, the perianal area should be considered as an area with a radius of 3 cm from the anus. Even though traditionally these swabs have been labeled ?external anal swab,? they should be labeled as ?perianal swab? to clearly indicate the site of sam pling. The anal canal is then sampled by passing a wet swab and then a dry swab, sequentially, up to 3 cm through the anus. The proctoscope (anoscope) is then passed 2?3 cm into the anal canal, and the lower rectum is sampled using a dry swab. As the proctoscope is withdrawn, the anal canal can be sampled, again with a dry swab. As discussed previously, when examining female complainants of anal intercourse alone, swabs should also be obtained from the vagina. If doctors decide for clinical reasons to use a lubri cant, they should apply the lubricant (from a single-use sachet or tube) sparingly, taking care not to contaminate the swabs, and must note its use on the forms returned to the forensic scientist. In the process of sampling the rectum/anal canal, the proctoscope may accumulate body fluids and trace evidence. Therefore, the used proctoscope should be retained, packaged separately, and stored in accordance with local policy. If the proctoscope is visibly wet on removal, swabbing may be con ducted to retrieve visible material. If storage space is restricted, then the instrument should be swabbed and the swabs retained instead.

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Summary of Clinical Studies in Men Clinical studies were conducted in men aged 18 to 41 with mild to moderate degrees of androgenetic alopecia. In general, the difference between treatment groups continued to increase throughout the 5 years of the studies. Breast changes including breast enlargement, tenderness and neoplasm have been reported [see Adverse Reactions (6. Biotechnology Unit,* Biology Department,** and Artificial Insemination Department,*** Animal Reproduction Research Institute, Giza, Egypt. Semen parameter, samples of 37 animals (Cattle n=21 and buffalo n=16), were used in the study. The study demonstrate all the measured biochemical parameters and hormonal profile of cattle and buffalo were significantly different (P<0. Regarding to buffalo population, different genotypes has significant difference in term of fresh motility, frozen motility at 1h and viability index. We suggest to be used in artificial insemination programs as marker assisted selection for anti-heat stress and good reproductive bulls. Radioimmunoassay of triiodothyronine (T3): in winter and summer with daily mean temperature Part of each semen sample are analysed for T3 16? Fresh semen samples determination according to methods of Todini (2007) were evaluated just after collection for motility, and was stored in aliquost at -20? After incubation at 56 C Milovanov (1962) it is equal to half of the post-thaw for 1 h, the mixture was boiled for 20 minutes. After motility in addition to the summation of recorded vortexing the material was centrifuged at 10. Only by promoter (base positions 749-1288) was successfully combining the traditional Sanger technology with the amplified for bull (Fig. The association analysis with the fresh semen quality traits showed bovine 4 Gafer et al. The table also clarify significant percentage of spermatozoa with normal acrosome interaction (P<0. Concerning to Irrespective to genotype there was significant the frozen-thawed semen characteristics there was no difference (P<0. Concerning to buffalo bulls there the interaction between genotype and season there were significant difference (P<0. Such significant with intact cell membrane correlates positively with correlations were not found in case of bulls. Observably T allele was of higher membrane integrity, normal acrosome and viability frequency in both cattle and buffalo population. The spermatozoa during cooling and after freezing (Lloyd highest cholesterol concentration reported in winter et al. The mean sperm motility were associated with a decrease in value was the highest during winter. The higher levels of concentration of fructose obtained is in agreement cholesterol and triglycerides during winter may be due with the reports of Dhami et al. In fructose gives useful indication of the fertilizing addition to this, Cholesterol is secreted to seminal ability of bulls. Low value of seminal fructose in plasma by the prostate gland and it protects sperm summer might be due to a decrease in glucose cells against environmental shock (Sofikitis and utilization in order to preserve energy during their Miyagawa 1991). High ambient the increase of T3 level during winter season depicted temperature has negative impact on biochemical and in current study may be due to increase in oxygen hormonal parameter consequently semen quality. High ambient population to evaluate genotype by environment temperature was found to decrease T3 activity (Table interactions. Evaluation of different methods of dna extraction level was correlated with the increase in rectal from semen of buffalo (bubalus bubalis) bulls. Oxidative stress and male reproductive circulating thyroid and progesterone hormones in health. Effects of seminal plasma on the in drink ing water under winter and hot summer survival and fertility of spermatozoa kept in vitro.


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There was essentially no change in heart rate in valsartan-treated patients in controlled trials. Pediatric Hypertension the antihypertensive effects of Diovan were evaluated in two randomized, double-blind clinical studies. In a clinical study involving 261 hypertensive pediatric patients 6 to 16 years of age, patients who weighed < 35 kg received 10, 40 or 80 mg of valsartan daily (low, medium and high doses), and patients who weighed? Renal and urinary disorders, and essential hypertension with or without obesity were the most common underlying causes of hypertension in children enrolled in this study. At the end of 2 weeks, valsartan reduced both systolic and diastolic blood pressure in a dose-dependent manner. Overall, the three dose levels of valsartan (low, medium and high) significantly reduced systolic blood pressure by -8, -10, -12 mm Hg from the baseline, respectively. Patients were re-randomized to either continue receiving the same dose of valsartan or were switched to placebo. In patients who continued to receive the medium and high doses of valsartan, systolic blood pressure at trough was -4 and -7 mm Hg lower than patients who received the placebo treatment. In patients receiving the low dose of valsartan, systolic blood pressure at trough was similar to that of patients who received the placebo treatment. Overall, the dose-dependent antihypertensive effect of valsartan was consistent across all the demographic subgroups. In a clinical study involving 90 hypertensive pediatric patients 1 to 5 years of age with a similar study design, there was some evidence of effectiveness, but safety findings for which a relationship to treatment could not be excluded mitigate against recommending use in this age group [see Adverse Reactions (6. Other background therapy included diuretics (86%), digoxin (67%), and beta-blockers (36%). At the end of the trial, patients in the valsartan group had a blood pressure that was 4 mmHg systolic and 2 mmHg diastolic lower than the placebo group. There were two primary end points, both assessed as time to first event: all-cause mortality and heart failure morbidity, the latter defined as all-cause mortality, sudden death with resuscitation, hospitalization for heart failure, and the need for intravenous inotropic or vasodilatory drugs for at least 4 hours. The number of black patients was small and does not permit a meaningful assessment in this subset of patients. In the combination group, the dose of valsartan was titrated from 20 mg twice daily to the highest tolerated dose up to a maximum of 80 mg twice daily; the dose of captopril was the same as for monotherapy. The population studied was 69% male, 94% Caucasian, and 53% were 65 years of age or older. The data were assessed to see whether the effectiveness of valsartan could be demonstrated by showing in a non inferiority analysis that it preserved a fraction of the effect of captopril, a drug with a demonstrated survival effect in this setting. Valsartan would be considered effective if it preserved a meaningful fraction of that effect and unequivocally preserved some of that effect. Pregnancy: Advise female patients of childbearing age about the consequences of exposure to Diovan during pregnancy. Ask patients to report pregnancies to their healthcare provider as soon as possible [see Warnings and Precautions (5. Lactation: Advise women not to breastfeed during treatment with Diovan [see Use in Specific Populations (8. Symptomatic Hypotension: Advise patients that lightheadedness can occur, especially during the first days of therapy, and that it should be reported to their healthcare provider. Tell patients that if syncope occurs to discontinue Diovan until the physician has been consulted. Caution all patients that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to an excessive fall in blood pressure, with the same consequences of lightheadedness and possible syncope [see Warnings and Precautions (5. Hyperkalemia: Advise patients not to use salt substitutes without consulting their healthcare provider [see Drug Interactions (7. This leaflet does not take the place of talking with your doctor about your medical condition or treatment. Talk to your doctor about other ways to lower your blood pressure if you plan to become pregnant. Blood pressure is the force in your blood vessels when your heart beats and when your heart rests.