Da li je uzrok hypoxia nedostatak kiseonika u tkivu , na koju je ljudski mozak toliko osjetljiv? Uzroka hypoxije ima dosta; sada bih mogao nabrojati barem pedeset, u raznim fazama trudnoce i u perinatalnom periodu. Sigurno je to, da sto je tkivo vise diferencirano, sve je osjetljivije na nedostatak kiseonika.
Zbog ove kasne diferencijacije i cerebralnog sazrijevanja, koje otpocinje prakticno u zadnjem trimestru trudnoce, fetalni mozak je mnogo otporniji na hypoxiju nego, potpuno sazrio, mozak odraslog covjeka.
Stoga raniji prvooptuzeni, porodjajna trauma pritisak na mozak pri prolazu kroz porodjajne puteve i dugotrajna hypoxia za vrijeme poroda, nemaju vise primat u etiologiji, jer dominacija ovih faktora u nastanku congenital-ne cerebralne paralize nije dokazana ili barem nemaju toliku ulogu u nastanku ovog ostecenja mozga koliko se ranije mislilo.
Od drugih faktora koji mogu uzrokovati tzv. Kod manjeg broja cerebralaca, ostecenje nastaje nakon rodjenja u prvim mjesecima zivota tzv.
U ovim slucajevima, moguce je ukazati na uzrok ovog neuroloskog ostecenja, koje moze biti posljedica upalnog infektivnog oboljenja mozga u infantilnom periodu zivota, kao sto je napr. Imamo tri glavna tipa cerebralne paralize: Spasticna cerebralna paraliza, koja je najzastupljenija u populaciji oboljelih. U ovoj formi misici su otvrdli, u spazmu, sto jako otezava pokrete.
Moze zahvatiti obje noge spastic diplegia , ili polovicu tijela spastic hemiplegia , a u teskim slucajevima i sve cetiri ektremiteta i trup spastic quadriplegia. Spada takodjer u tzv. Pogadja cijelo tijelo i uzrokuje nekontrolisane usporene pokrete. Ataxicna cerebralna paraliza uzrokuje poremecaje u ravnotezi i koordinaciji pokreta i nije tako cesta forma kao prethodne dvije.
Pojedina djeca pokazuju znake i simptome vise od jednog tipa paralize, pa ponekad cak i sve tri tipa, pa ovakve forme cerebralne paralize nazivamo mjesovitim. Pored varijacija u znakovima i simptomima, djeca sa cerebralnom paralizom pokazuju i varijacije u tezini pojedinih simptoma, i oni se obicno ne pogorsavaju sa godinama. Od simptoma mogu postojati: Vrlo je tesko izdvojiti faktore rizika koji pogoduju nastanku ovog ostecenja mozga, kada se vrlo malo zna o njegovom pravom uzroku. No, empirijski gledano, postoje izvjesna stanja u toku trudnoce i porodjaja skopcana sa rizikom od ostecenja mozga fetusa i novorodjenceta: Ipak vecina djece sa jednim ili vise od ovih znakova nikad ne razvije cerebralnu paralizu.
Sumnju na cerebralnu paralizu trebali bi pobuditi usporen razvoj ili nerazvijenost motornih funkcija u ocekivanom vremenskom periodu, slabost ili paraliza misica u jednom ili vise ekstremiteta isl.
Svaki neobican znak koji roditelji primjete za vrijeme infantilnog perioda najvise u prve godine trebali bi prodiskutovati sa svojim doktorom ili pedijatrom. No, motorni razvoj djeteta je ipak individualna stvar i ne treba paniciti ako razvoj pojedinih funkcija nije stopostotno vremenski uskladjen sa onim u Prirucniku za roditelje, nego malo kasni ili se razvije ranije nego je predvidjeno u knjigama.
Znakovi cerebralne paralize mogu biti prisutni od samog rodjenja, ali je obicno tesko postaviti dijagnozu prije 6 mjeseci. No, definitvna dijagnoza cerebralne paralize se najcesce postavi do uzrasta od godine. Obicno se kod takve djece obzervira motorni i psihicki razvoj ocituje se u ponasanju kroz neko vrijeme, zatim testiraju se reflex-i, misicni tonus i pokreti.
Dodatni testovi mogu iskljuciti druge neuroloske poremecaje i ukljucuju: Pored teskoca sa regulacijom pokreta i drzanja, kod ove djece razvijaju se mnoge komplikacije kao rezultat spazma ili ne koordiniranih kontrakcija pojedinih misicnih grupa.
Najcesce komplikacije koje prate cerebralnu paralizu su razvoj deformiteta ili luksacija i subluksacija iscasenja pojedinih zglobova, prevashodno na ekstremitetima, ali mogu nastati i na trupu kicmi napr. Neka djeca pokazuju multiplu hendikepiranost i zahtijevaju dugotrajnu, cak dozivotnu njegu i ukljucuju komplikacije kao sto su problemi sa vidom, sluhom ili govorom, problemi sa zubima i celjusti, mentalnom retardacijom, epi-napadima, inkontinencijom, abnormalnostima u osjetu i percepciji itd.
Sto se lijecenja tice, danas su mogucnosti, kao sto sam gore spomenuo, velike, u prvom redu u kompenzaciji hendikepa, tehnickim pomagalima koji ublazuju invaliditet, te savremenom fizikalnom terapijom usmjerenom na poboljsanje koordinacije pokreta, ublazenja komplikacija nastalih spazmom, te povecanjem mogucnosti za sto je moguce vecu samostalnost i neovisnosti u buducem zivotu djece sa cerebralnom paralizom.
Dakako, kongenitalno ostecenje mozga se ne moze reparirati, ali ono ni ne napreduje, pa je cilj lijecenja da se od djeteta sa cerebralnom paralizom izvuce maximum, koji ce njemu i njegovoj familiji omoguciti udobniju buducnost.
Multidisciplinarni tretman moze ukljucivati: Pomagala kao sine, gips-udlage, naramenice isl. Zavisno od ostecenja oka, moze biti potrebno cak i kirursko rjesavanje problema kao sto je strabizam napr. Kod ostecnja sluha, moze biti potreban slusni aparat. Injekcije Botox-a direktno u misic mogu biti korisne kod jakog spazma, da bi se sprijecili deformiteti i kontrakture.
Takodjer se pokazalo u slucaju jakih spazama da pomaze selektivno presijecanje spinalnih korijenova senzornih nerava donjih ekstremiteta tzv. Skoro citavo posljednje stoljece lijecnici i naucnici pokusavaju prevenirati ostecenje mozga i nastanak cerebralne paralize, minimalizirajuci porodjajnu traumu i usavrsavajuci metode za pracenje i unapredjenje zastite fetusa u toku trudnoce i perinatalnog perioda.
Ipak, u danasnja vremena, tek nekoliko djece sa pretrpljenom porodjajnom traumom ce razviti znakove cerebralne paralize. Jednako vrijedi i za ekstremno prematurnu djecu, gdje se rata prezivljavanja znatno povecala, iako ce neki medju njima sigurno razviti cerebralnu paralizu u prvim godinama zivota.
Iako se u mnogim slucajevima, i pored nastojanja doktora i buducih roditelja, nastanak cerebralne paralize ne moze sprijeciti, ipak poduzimanje odredjenih mjera prije, u toku trudnoce i poslije poroda moze donekle prevenirati ili u najmanju ruku ublaziti posljedice ove nesrece.
Evo nekoliko korisnih uputa hints: Sto zdravije prodje trudnoca i sto se manje lijekova uzima za vrijeme trudnoce, to su sanse da se dogodi ostecenje mozga manje.
Sem toga ove kontrole omogucavaju planiranje poroda sa minimalnom porodjajnom traumom i stresom za majku i plod. Kada je nekom djetetu dijagnostikovana cerebralna paraliza, njegovi roditelji treba to da prihvate, sto nije uvijek slucaj, i da postanu vazan dio njegovog zdravstvenog tima.
Od njih se ocekuje da bodre svako nastojanje takvog bolesnika da bude sto je moguce vise samostalan i neovisan o drugima.
Roditelji se isto tako ne bi trebali ustrucavati da pitaju sve u vezi zdravlja svoga djeteta, da se zalazu za njegove interese, jednostavno receno da budu njegov dozivotni advokat. Svaki roditelj osjeca krivnju i zalost za to sto se dogodilo njegovom djetetu, sto je posve normalno ali ih se nije lako rijesiti, stoga ima puno pravo na psihicku i svaku drugu podrsku kako njegove najblize okoline rodbine isl.
Oni su u svakom slucaju heroji, koji zasluzuju svaku mogucu podrsku. Ugodan weekend i dobro zdravlje! Romul za komentar Datum: Ako ste procitali komentar ,vise ga nema. Otisao je od nas Necko Nele. Nek mu je rahmetl-Hvala Komentar Br. Pitanje za Severina Datum: Posljednjih mjesec dana mi se desava nesto odvratno,a izgleda ovako prvo mi krenu kao trnuti malo usta i jezik,onda pocnem sva drhtati ali nekako unutra i ne osijecam se dobro i onda mi srce krene lupati brzo i neko gusenje i neki strah.
Ne znam sta mi je. Samo znam da je odvratno. Posta zivim u Danskoj ,a u Danskoj su doktori malo cudni,ustvari oni mi ne predlazu nikakve preglede sami sta bih ja trebala pregledati tako da utvrdim da li je to nesto organski ili su to mozda napadi panike.
Sve odise humanizmom ovih dana, ovdje; veliki doktori, dobri nalazi, umjetnost, opera, sve buja. Kao da covjek u snu putuje kroz epohe: Zaista ova mala ordinacija ima pogled; gdje god covjek pogleda iz nje nesto se interesantno zbiva, pise, slika i recituje. Banjaluka zivi oko nje. Kako do danas jos uvijek nisam dobio dovoljno podataka da bih mogao direktno odgovoriti na pitanje bolovi u malom trbuhu , a tema je jako opsirna, odlucio sam da moj opsti osvrt na tu problematiku podijelim u dva dijela.
U prvom dijelu, koji slijedi u nastavku, bice rijeci o cervikalnom karcinoma rak grlica maternice i metodama za njegovo rano otkrivanje, te radikalnim i palijativnim mogucnostima u njegovu lijecenju. U narednom javljanju bice vise rijeci o bolovima u maloj zdjelici, sa osvrtom na cisticno oboljenje jajnika, cest i ozbiljan problem u generativnom razdoblju mnogih zena, i ovarijalni karcinom rak jajnika , ozbiljno i podmuklo oboljenje zena u trecem dobu zivota.
Iako se u istrazivanju uzroka, patogeneze razvojnog procesa , te ranom otkrivanju i prevenciji cervical carcinoma otislo najdalje u poredjenju sa ostalim malignim oboljenjima u humanoj patologiji, cini se da on i dalje zauzima znacajno mjesto u zdravlju zene.
Poseban znacaj ima prevencija i rana detekcija promjena u epitelu povrsni sloj sluznice tzv. No i pored jednostavnosti i tacnosti ove pretrage, mnoge zene se ne podvrgavaju ovom testu regularno kod mladjih jednom u dvije, a kod onih u srednjem dobu i premenopauzalnom periodu svake godine , vise zbog vlastitog nemara nego zbog neugodnosti uzimanja samog uzorka za pregled, te se tako nepotrebno izlazu riziku oboljevanja od ovog malignog procesa sa inace ako se otkrije u ranom stadiju dobrom prognozom.
Cervix je dio maternice uterus , kruskastog kod nerotkinja ili cilindricnog kod viserotkinja oblika, koji viri u rodnicu vagina i cini prelaz izmedju maternice i rodnice. Cervikalni karcinom razvija se sporo i prije nego postane makroskopski vidljiv vidljiv prostim okom , stanice cervikalnog epitela prolaze kroz promjene maligna alteracija koje nazivamo dysplasia, u prvom redu njihov genetski material u jezgru stanice, pretvarajuci normalne epitelne stanice u stanice raka.
Kasnije se rak siri u unutrasnjost grlica, paraaortalne limfne cvorove, vaginu ili pak u visim stadijima IVa i b u okolne organe, rectum ili mokracni mjehur. Iako je dokazano da infekcija ovim virusom u visokom procentu uzrokuje malignu alteraciju stanica cervikalnog epitela, to ipak ne znaci da ce svaka zena koja bude po prvi put inficirana ovim virusom oboljeti od raka grlica maternice.
Medjutim, faktori koji pogoduju nastanku infekcije ovim virusom i posljedicnog cervicitisa upale grlica maternice , bilo da otvaraju put infekciji svana ili smanjujuci protektivnu ulogu sluzi, kao sto su visekratne trudnoce, cesto mijenjanje partnera, otpocinjanje seksualnog opcenja u ranom uzrastu, pusenje, oralna kontracepcija sa ovim se ne bih slozio u potpunosti , labilan imunoloski sistem, predstavljaju faktore rizika u nastanku ovog malignog oboljenja, pa o tome treba voditi racuna za vrijeme generativnog, kako predbracnog tako i bracnog, zivota zene.
Da HPV nije, vjerovatno, i jedini uzrocnik dysplaziji epitela grlica, svjedoci i razocarenje do kojeg je doveo HPV vaccine trial klinicka primjena vakcine protiv HP virusa , hit s kraja ih zamisljen kao epohalno otkrice u prevenciji cervikalnog karcinoma, koja nije dala ocekivane rezultate, dijelom zbog tehnickih problema u proizvodnji same vakcine usljed ucestalih mutacija virusa u populaciji i posljedicne promjene u njihovoj virulenciji i antigenskoj reprezentaciji, ali i zbog mogucnosti drugih uzroka malignoj promjeni u cervikalnom epitelu.
U ranoj fazi cervikalni karcinom je bez simptoma, pa ragularno uzimanje Pap razmaza najmanje jedanput godisnje ima jos vece znacenje, pogotovu kad se zna da sto je cancer otkriven ranije to ima bolju prognozu. Potrebno je potraziti lijecnicku pomoc u slucaju, svakog vanperiodicnog krvarenja iz rodnice vaginalnog krvarenja bez obzira kojeg intenziteta to bilo, svaki neobican sukrvicav ili drugi vaginalni sekret, bol u maloj zdjelici, bolovi u toku interkursa, jer ovi simptomi mogu biti znakovi malignog procesa na grlicu maternica.
Nakon vaginalnog pregleda, kroz specula i transvaginalnom palpacijom vagine, cervixa, uterusa adnexa jajnika i okolnih organa u maloj zdjelici, slijede testovi kojim se moze otkriti i utvrditi dijagnoza cervikalnog carcinoma: Stanice pogrebane sa sluznice vaginalnog dijela portio vaginalis cervix-a bivaju razmazane na mikroskopsko staklo, obojene i pregledane od patologa pod mikroskopom. Ucestalost uzimanja i pregleda razmaza varira od zemlje do zemlje i zavisi, takodjer, od indikacija u pojedinim zemljama.
AMA Australian Medical Association preporuca za sve zene u generativnom razdoblju uzimati i pregledati Pap razmaz jednom godisnje. U slucajevima cesceg mijenjanja partnera, zatim trudnoce ili nekog od gorepomenutih simptoma vaginalnog krvarenja, iscjedka ili bolova preporuca se cesce uzimanje uzorka. Nakon tri uzastopna normalna nalaza, uzorak se moze uzimati i rjedje tj. Ako su oba negativna ACOG preporucuje rjedje uzimanje uzorka. Negativ Pap nalaz znaci da su stanice normalnog izgleda ili da nema tragova infekcije HPV u njima.
Za tumacenje nalaza Pap smear-a u vecini zemalja koristi se Bethesda System koji izgleda ovako: Pap smear test je vrlo znacajna pretraga u ranom otkrivanju raka grlica maternice. Ipak jadan mali procenat dysplasticnih cervixa prodje neotkriven, pa ovaj test treba shvatiti ozbiljno i raditi ga regularno. I pored iskustva u uzimanju uzorka, s vremena na vrijeme se desava da je uzorak inadekvatan, pa uzimanje treba ponoviti.
Takodjer upotreba vaginalnih krema isl. Ostali faktori koji mogu utjecati na tacnost nalaza su menstrualno krvarenje, infekcija, lijekovi digitalis, tetraciklini isl. Sve ovo moze uzrokovati ponavljanje pregleda i uzimanja uzorka. Prisustvo abnormalnih promjenjenih stanica u nalazu Pap testa, oznacava prekancerozno stanje cervixa ili postojanje raka grlica maternice i indikuje sljedeci korak u istrazi dysplasticnih promjena epitela, kolposkopski pregled grlica colposcopy.
Colposcopy je direktni pregled genitalnog aparatusa, i to vulve, vaginae i cervix-a, pomocu mikroskopa sa specijalnim osvjetljenjem tzv. Colposcope uvecava povrsinu sluznice cervixa i rodnice x. Ovo omogucava kolposkopisti da jasno vidi promjenjene stanice u sluznici cervixa i vaginae koje se inace ne mogu vidjeti prostim okom i da istovremeno uradi biopsiju promjenjene sluznice i uzorak posalje na detaljnije patohistolosko istrazivanje.
Kad se samo sjetim Dr. Mirka Plese, naseg kolposkopiste sa Akusersko-ginekoloske klinike na Paprikovcu, kako je bio ponosan na novi colposcope na kojem je radio rekavsi meni: Ipak se svaki put kad ga se sjetim slatko nasmijem. Pripreme za kolposkopiju su gotovo identicne kao za obican vaginalni pregled i uzimanje Pap smear-a ne moze se obavljati u vrijeme perioda, sata prije pretrage ne smije se stavljati vaginalni krem, tampon isl. Ljekar family physician je duzan da pripremi pacijenta za ovaj pregled.
Za vrijeme kolposkopije ginekolog posmatra kroz mikroskop i otvorena spekula sluznicu vagine i cervix-a. Epitelna povrsina se efikasno ocisti od sluzi fizioloskom otopinom, a potom premaze sircetom acetic acid.
Sirce odreaguje sa promjenjenim, dysplasticnim stanicama razlicito od zdravih i oboji ih u bijelo. Ako se diferencijacija ne moze postici sa sircetom, koristi se Lugol-ova otopina, koja oboji zdrave stanice, dok promjenjene ostanu neobojene.
Pored promjena u sluznici, mogu se posmatrati i promjene u prokrvljenosti podrucja zahvacenih dysplazijom ili upalom, te se za vrijeme pretrage pod vodjstvom mikroskopa moze uraditi i biopsija promjenjene sluznice ili materjal iz cervikalnog kanala endocervical curettage i poslati na podrobno patohistolosko istrazivanje.
Rezultati kolposkopije budu gotovi, obicno, za tri nedjelje i trebaju biti prodiskutovani sa svojim doktorom. Nakon kolposkopije, mozi doci do povremenog krvarenja ili sukrvicavog iscjetka u trajanju od nekoliko dana. Najmanje nedjelju dana nakon kolposkopije treba izbjegavati upotrebu tampona, bilo kakvih vaginalnih aplikamenta, te interkurs.
Kolposkopija nosi odredjeni rizik od infekcije, te svaka pojava groznice i povisene temperature nakon pretrage bi trebala biti prijavljena svome doktoru.
U eksperimentalnoj fazi su elektronske sonde electronic probes koje se plasiraju u cervikalni kanal, registruju i odasiljaju informaciju o razlikama u apsorpciji i refleksiji svjetla u normalnim i promjenjenim stanicama cervixa, te indiciraju potrebu biopsije i daljnjeg istrazivanja promjenjenog tkiva. Kolposkopija se moze, pored postavljanja osnovne dijagnoze, koristiti za kontrolu nakon konizacije conisatio i za evaluaciju rezultata lijecenja.
Cervival cancer staging je proces kojim se odredjuje dokle se maligni proces prosirio. Staging se radi kod svakog dokazanog cancera kako bi se odredio stupanj prosirenosti malignog tkiva u osnovnom organu lokalna ekpanzija raka , limfnim cvorovima koji dreniraju taj organ carcinoma se siri limfnim putem , te susjednim regionalna ekspanzija i udaljenim metastasis organima. Staging sluzi i za pracenje uspjesnosti terapije bilo kirurske, kemo ili radiacione, te u vecini malignih procesa, zavisno od stupnja u kojem se nalazi proces, determinise samu terapiju i prognozu bolesti.
Na osnovu ovog sistema cervical cancer je klasifikovan u cetiri stupnja od 0 do IV. Ovaj staging sistem je baziran uglavnom na klinickom nalazu, koji se sastoji od fizickog pregleda ginekoloski pregled , i dodatnih pregleda i testova cystoscopia, rectoscopia isl. Katkad kirurski nalaz moze obznaniti da se tumor prosirio vise nego se to pretpostavljalo klinickim nalazom te to moze modificirati prvobitni plan terapije, ali to ne mijenja FIGO stage. To ide ovako sa FIGO-m: To znaci da su stanice na samoj povrsini promjenjene iz zdravih u maligne, te da carcinoma nije zapoceo invaziju u dublje slojeve cervixa.
Tumor u ovom stadiju je invadirao dublje u tkivo cervixa ili ga u potpunosti okupirao, ali se nije prosirio nigdje dalje. Ovo je najraniji dio stadija I. Manji dio cervikalnog tkiva je zahvacen tumorom i moze se vidjeti samo mikroskopom.
Podrucje zahvaceno malignim procesom je manje od 3mm u dubinu i manje od 7 mm u sirinu. Tumor ide do 5mm u dubinu i manje od 7mm u sirinu. U ovom podstadiju tumor obicno moze biti vidjen i bez mikroskopa, i tumor se prosirio dublje od 5mm i vise od 7mm u sirinu. Tumor se vidi i prostim okom, ali nije veci od 4cm.
Tumor je veci od 4cm. U ovom stadiju tumor se prosirio na okolne structure, ali je jos uvijek u maloj zdjelici. Tumor se prosirio izvan cervixa u gornji dio vagine uglavnom vaginalni fornix tj. Tumor se prosirio u tkiva pored cervixa, tzv. Tumor se prosirio u donji dio vagine te do u karlicni zid. Maligno tkivo u ovoj svojoj ekspanziji moze blokirati uretere mokracovode i pruzrokovati smetnje u oticanju mokrace iz bubrega u mjehur.
Tumor je zahvatio donji dio vagine, ali ne i karlicni zid. American Joint Committee on Cancer jos u ovaj stage ukljucuje i zahvacenost pelvicnih limfnih cvorova. Ovo je najvisi stadij i ukljucuje tumor koji se prosirio u okolne organe u zdjelici ili udaljene metastaze. Tumor se prosirio u okolne organe, najcesce mjehur ili rectum. Cancer se prosirio u udaljene organe metastasis izvan zdjelice, najcesce pluca. Stage u kojem se nalazi rak odredjuje ne samo terapeutski pristup, nego i prognozu cervikalnog karcinoma.
Ovdje je dat procenat 5-godisnjeg prezivljavanja prema stage-u u kojem se cervikalni karcinom nalazio u zenskoj populaciji oboljeloj od ovog malignoma u US prije 10 godina podaci publikovani u 6-om izdanju American Joint Committee on Cancer Bulletin: Tretman 0-tog stadija moze ukljucivati sljedece: Total hysterectomy sa ili bez salpingo-oophorectomy kompletno odstranjenje uterusa sa jednostranim ili obostranim odstranjenjem adnexa , Conization, Radical hysterectomy sa odstranjenjem regionalnih limfnih cvorova Radikalna kirursko odstranjenje uterusa i okolnog oboljelog tkiva u prvom redu limfnih cvorova po Wertheim-u , Internal radiation therapy.
Kombinacija Internal i External radiation therapy, Radical hysterectomy sa odstranjnjem limfnih cvorova i sljedstvenom radioterapijom, Radiotherapy kombinovana sa chemo kemoterapija. Kako vidimo iz svega gorerecenog, cervical cancer jos uvijek predstavlja znacajan zdravsveni problem. No, sretna okolnost u svemu tome je mogucnost rane detekcije relativno jednostavnim i jeftinim metodama Pap testa i kolposkopije.
Stoga bi zene u dobnoj skupini izmedju godina neizostavno trebale imati regularan pregled Pap smear-a jedanput godisnje.
Zapamtite, rak ne oprasta svojim zrtvama. Zasto bi ste mu vi onda davali kredit? U sljedecem nastavku, kako sam najavio, bice vise rijeci o bolovima u maloj zdjelici i oboljenjim jajnika. Do sljedeceg javljanja, zdravi bili!
Kratki odgovor na pitanje ! Ne mogu da vjerujem da porodicni doktor ispituje bolesnika i salje ga na pretrage samo na njegov licni zahtjev. Nesto je trulo u drzavi Danskoj! No,bilo kako bilo, opisani simptomi ne moraju odmah znaciti da se radi o kardivaskularnom oboljenju, ali prije nego se pristupi razmatranju psihickih panika isl.
Prije svega, anginu je jako tesko dijagnostikovati, samo na osnovu ECG ili biokemijskih pretraga krvi sto se inace radi u ER hitnoj pomoci , ako se iste ne urade za vrijeme samog napada. Takodjer treba iskljuciti citavu sumu drugih oboljenja i syndroma koji neporedno ili posredno mogu dovesti do ovakvih napada kao napr. Kako ovdje nemam nikakvih podataka o pacijentu godiste, porodicna istorija bolesti, nacin zivota, navike isl.
Narucio ga je na kontrolu jedan dan nakon sto je dijete popilo lijek. Slusajuci ga vidio je da je bolje ali da ima jos upale sto je potvrdio i snimak pluca. Rekao je da sumamed ima produzeno dejstvo jos cetiri dana nakon upotrebe te mu nije ukljucio nijedan drugi lijek vec da dodje na kontrolu za 4 dana. Ali slucajno smo sreli drugog dr. Ja nisam poslusala drugog dr. Medjutim jedna osoba iz porodice me ubjedjuje da je ovaj drugi dr. Sta mislite da li sam ispravno postupila i da li je kasno nakon 4 dana posto istekne totalno dejstvo sumameda po potrebi nastaviti sa drugim antibiotikom.
Ova osoba me ubjedjuje da obavezno ukljucim amoksiklav a ja nisam sigurna da je to ispravno i vec je proslo dva dana ja jos nism djetetu ukljucila amoksiklav. Inace dijete je veselo, dobro jede, jedino se jos ponekad nakaslje i osjeti se da ima slajma koji on ne zna izbaciti.
Jos me zanima da li ima smisla djetetu vaditi krv u vrijeme dok pije antibiotike, ja mislim da je logicnije poslije terapije ali me ova osoba ubjedjuje u suprotno? Imam pitanje u vezi moga sina. On ima 12 god i svakodnevno guli kozu sa palceva. Primjetili smo to nedavno i pokusavamo ga opominjati, objasnjavati zasto to nije dobro. Sam je svjestan toga i trazi flastere na kozu, da bi se sam zastitio od toga. Igranje igrica TV, data, Play station.. Iskreno receno, igrica nema dok traje skola, raspust je to naporno vrijeme kada se igrice vise traze.
U svakom slucaju me zanima sta nas dragi doktor misli,. Ali nas ipak to brine. Situacija u kuci je stabilna, dosta vremena provodimo zajedno sa nasom djecom, i smatramo da je nas odnos sa djecom jako dobar i kvalitetan. Ali nas ipak to mnogo brine.
Najprije kratak odgovor za upalu pluca! Prije desetak godina, kupim ja auto, polovno. Ubrzo se pojavi nekakav sitni kvar i ja ga odvedem na popravak kod jednog mehanicara. On pogleda auto, zavrne saraf i kaze da je sve u redu. Nije mi htio ni naplatiti za to. Meni djavo ne dade mira, iako je auto isao ko' zmaj, pa ga odvedem 'pravom majstoru. Tri dana poslije auto u voznji eksplodira kao u filmu 'paklena pomorandza' , te ja i zena jedva izbjegosmo 'ugljenifikaciju' i sacuvasmo zivu glavu.
Iz ove price se moze nauciti da se auto popravlja kod jednog majstora, pa kad se covjek dobro uvjeri da majstor nije dobar, onda vozi auto drugome. Tako je isto i sa doktorima. Kad se krene sa jednim i zapocne lijecenje kod njega, onda se ide do kraja, sem ako stvar ne 'krene zaista naopako. Za lakse iskasljkavanje preporucio bih Bisolvon syr.
Onda nastaviti sa kozijim mlijekom ili sirupom od prave bazge tj. Slazem se sa doktorom br. Imali vece srece za roditelja nego kad mu doktor izljeci dijete, pa sa koje strane nema veze? Drugo, amoxiclav i nije najslabiji antibiotik, a i hepatotiksican ostecuje jetru je, te se cijelo vrijeme uzimanja moraju posmatrati jetrene funkcije raditi LFT-liverfunction test , a ne znam koliko je to moguce 'u ambulantnom tretmanu'.
Sem toga amoxiclav kombinacija amoxycillina i clavulon-ske kiseline se koristi kao drugi izbor poslije ampicillina, Amoxycillina u slucajevima beta-lactamase rezinstencije bakterije koje luce enzim beta-laktamazu i rezistentne su na penicillin kao napr. Staphylococcus aureus , a mi u ovom slucaju ni ne znamo o kojoj se bakteriji zapravo radi. Povrh svega, staphylococcus aureus rezistentan na penicillin je bakterija koja je najcesci uzrocnik abscess-a pluca, ali je rjedje uzrocnik upale pluca, bronchitisa isl.
Ipak mislim, da je drugi doktor stariji i poznatiji mislio na Amoxycillin ampicillin kao prvi izbor u ovom slucaju, ali je 'treci covjek' pogresno cuo naziv antibiotika. Kako su antibiotici, poslije steroida i hormonskih preparata, najopasniji lijekovi, onda je njihova upotreba i doziranje 'na nevidjeno' ili po principu 'rekla-kazala' visestruko opasno i rizicno.
Ali ipak mislim da je najveca pogreska slusati 'laike' u domenu medicine ili nekom drugom, svejedno , bilo da se 'igraju doktora' ili da daju kvalifikacije o tome 'kakav je ko strucnjak', osobito kada je u pitanju vlastito dijete 2 godine staro.
Stoga preporucujem, ako mislite da je pojedini doktor 'karapacko' ili sumnjate u njegovu strucnost, da nadjete sebi 'pravog strucnjaka', ali da se prethodno sami u to uvjerite.
Toliko u ovom slucaju. Sto se guljenja kozice na prstima tice, bit cu jos kraci. Vas sin je ocigledno 'distressed' rastresen , u manjoj mjeri nadolazecim pubertetom jer je za takvu reakciju jos rano kod djecaka , ali u velikoj mjeri 'kompjuterskim igrama, inadekvatnim tv programom isl.
Koliko god bezazleno izgledale 'igrice', one su, vjerovali ili ne, vrlo sofisticirano razradjeno i dizajnirano oruzje za unistavanje ljudskog mozga.
Vodjeni profitom, kapitalisti ne misle hoce li sutra nastati nuklearna katastrofa, a kamo li kakve ce degenerike i rastrojene licnosti stvoriti njihove igracke.
Prema tome bolje ime za te 'igrice' je 'sedmoglava azbaha' koja kad se useli u neciji dom, ne izlazi dok ne unisti citavu porodicu. Moja cerka ima 13 godina i nema niti jedan CD ili playstation, a takodjer zivi u okruzenju tih 'software-skih cudovista. No, bilo da se radi o jednom ili drugom, par jednostavnih savjeta, moze potpuno eliminirati ovu 'losu naviku.
Zbog osjetljivosti teme preporucujem pazljivo procitati svaku rijec, ukljucujuci i one u zagradi, kako se moji savjeti ne bi pogresno interpretirali. Jedno malo izvinjenje, zbog gramatickih ili pravopisnih gresaka vise u kucanju u prethodnom tekstu, ali kad se odgovori pisu direktno 'on line' sto je obicno slucaj sa kratkim odgovorima , onda nije moguce ispraviti nista u tekstu.
Nadam se da sam bio jasan u mojim odgovorima Maji i Mami. Hvala Severine za savjet. Nista nije niti lose protumaceno, niti pogresno shvaceno. Mi smi i samo skontali da sto se te igrice vise uvlace u nas zivot, nasa su djeca vise "odsutna, stresena, nezadovoljna".. Radicemo na potrebnim mjerama za odstranjenje problema. I to sto prije. Doktore Severine, zaista sam Vam zahvalna sto ste mi tako brzo odgovorili i potvrdili moje misljenje da se treba drzati jednog ljekara i da ne treba tako malo dijete "kljukati" antibioticima ako za to sigurno nema potrebe.
Ja sam od pocetka imala takvo misljenje medjutim ova starija "pametnija" inace pesimista osoba iz porodice umjesto da me ohrabrila kao majku, izludila me, stvorila mi je osjecaj krivice jer ako se bakterije ne uniste do kraja moze se vratiti upala pluca.
Dijete je islo na kontrolu kod prvog doktora i on je rekao da slusalicama vise ne primjecuje da ima jos upale, te da ne treba ponovo slikati pluca, nije htio vise nista da ukljucuje od lijekova, a kontrola po potrebi. Dijete vise nema slajm kad se nakaslje i manje kaslje. Tako da mi sad samo preostaje ojacati djetetu imunitet, poceo je danas piti kozije mlijeko, a vec par dana sam mu kuhala caj od zove na mlijeku, nabavicu i sirup od zove sve kako ste rekli, dijete voli voce, Jos jednom Vam se zahvaljujem, nemojte sta zamjeriti ali puno mi je lakse kad sam sve ovo ispricala nekom ko je strucan i ko mi je mogao dati pravi savjet.
Kakva bi sreca bila kad bi svi doktori imali malo vise vremena i razumijevanja za svoje pacijente! Doktore Severine mnogo ,mnogo hvala za ovaj brzi odgovor. Nazalost u danskoj je bas tako da moras sam da trazis od doktora preglede i sto je jos gore vecinu toga nece ni da prekontrolisu.
Jedino sto mi je prekontrolisao to je stitna zljezda i ona je ok. Ne znam sta da radim. Trazila sam preglede,ili neke tablete za smirenje ako misli da su napadi panike,ali nista. On samo govori da meni nije nista,da danski doktori rade drugacije od svih ostalih dotora,oni kada vide pacijenta znaju da li je njemu potrebno nesto ili je on zdrav.
Ni sama ne znam sta da radim,jer ja sam skoro dosla u Dansku tako da je za mene sve to cudno ali je tako nazalost ovdje. Ja mislim da su to ti napadi panike jer ja kada ostanem kod kuce i ne idem u skolu onda sam ok,samo me hvata ili u skoli ili poslije skole. Ili sam alergicna na skolu tj danski jezik hahahaha malo sale ili jedino sto ja jos znam da kad sam kod kuce onda jedem a u skoli sam cesto gladna.
U sva kom slucaju mnogo mnogo hvala,a ako nista drugo pregeldacu se kada odem u nasu lijepu Bosnu. I jos jedno pitanje jeste li Vi doktor za djecu???? Sve najbolje Komentar Br. Odgovor na komentar U principu za brzu kotrolu, tzv. Nije vazno sto je secer izmjeren 'prick test-om' iz prsta i sto je to uradjeno poslije jela, ako porodicna istorija nije pozitivna tj. Sto se doktora tice, vrijeme je da potrazite drugog, tj. Ne bih mogao, ovako preko interneta, sa sigurnoscu reci o cemu se radi, ali bih vam preporucio da se za pomoc obratite nekom od psihoterapeuta, bilo da vas vas 'novi porodicni doktor' uputi k njemu ili da ga sami potrazite, po mogucnosti specijalisti za tzv.
Anxiety Disorders psihicke poremecaje napetosti i straha. Slika je zaista pomijesana, te moze ukljucivati vise entiteta iz ove grupe, kao napr. Iz ovih jedva nekoliko podataka, mogu se naci elementi svih ovih stanja, pa je jako tesko rasclaniti o cemu se zapravo radi. No, kako vi dolazite, kao uostalom i svi mi, iz ratom zahvacenog podrucja, onda su ovakvi poremecaji egzogene etiologije izvanjskog uzroka za ocekivati, uistinu ne u akutnom obliku, ali zasigurno kao posljedica jednog 'davno pretrpljenog stresa.
Prema tome ovo zahtijeva mnogo istancanije sagledavanje stvari u svjetlu psichopatologije prouzrokovane 'nasilnom migracijom stanovnistva', a ne nekakvim simplificiranim dogmaticnim razmisljanjem 'lokalnog mljekara' mislim na onog vaseg doktora , punom predrasuda i podozrivosti prema onima koji 'govore sa akcentom'.
Zato predlazem da preskocite tog 'lokala' i obratite se nekom strucnjaku u tom domenu, jer ni ja zaista ne bih mogao nista vise da vam kazem, jer to nije moj 'fah' pa je svako dublje upustanje u ovu problematiku s moje strane cisti diletantizam. Sto se tice prava na ovakvu vrstu pomoci, nemate se sta ustrucavati. Siguran sam da cete naci odgovarajuceg terapeuta, koji ce vam sa par strucnih manuvra pomoci da se oslobodite ovih tegoba i uspjesno uklopite u novu sredinu.
Zeljela bih da mi kazete kakav lijek protiv katara na zeludcu jako me muci i cak mi stvara nervozu i kad se nesto na nerviram onda me jos jace boli i prvo mi djeluje na zeludac Unaprijed hvala i pomozite mi!!! Pored toga, neki bolesnici povremeno imaju proliv, a neki zatvor. Najbolje je da hrana bude raznovrsna i uvek umereno topla. Korisno je popraviti zube ili napraviti protezu, ukoliko je potrebno. Ako ipak piju, nikada ne treba to da rade pre jela, nego uvek posle. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Olopatadine.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Omapatrilat. Investigational The serum concentration of Ombitasvir can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Omeprazole.
Approved The risk or severity of adverse effects can be increased when Opium is combined with Amitriptyline. Approved, Illicit The risk or severity of adverse effects can be increased when Amitriptyline is combined with Orciprenaline. Approved Amitriptyline may increase the central nervous system depressant CNS depressant activities of Orphenadrine. Approved The risk or severity of adverse effects can be increased when Osanetant is combined with Amitriptyline.
Investigational The serum concentration of Amitriptyline can be increased when it is combined with Osimertinib. Approved The serum concentration of Amitriptyline can be increased when it is combined with Otamixaban. Investigational The risk or severity of adverse effects can be increased when Oxazepam is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Oxethazaine is combined with Amitriptyline.
Approved, Investigational The risk or severity of adverse effects can be increased when Oxprenolol is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Oxybuprocaine is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Oxycodone is combined with Amitriptyline.
Approved, Illicit, Investigational Amitriptyline may decrease the antihypertensive activities of Oxymetazoline. Approved The risk or severity of adverse effects can be increased when Oxymorphone is combined with Amitriptyline. Approved, Investigational, Vet Approved Oxypertine The risk or severity of adverse effects can be increased when Amitriptyline is combined with Oxypertine.
Experimental The serum concentration of Amitriptyline can be increased when it is combined with P-Nitrophenol. Experimental The serum concentration of Amitriptyline can be increased when it is combined with Paclitaxel. Approved, Vet Approved The serum concentration of Amitriptyline can be increased when it is combined with Palbociclib.
Approved Amitriptyline may decrease the antihypertensive activities of Paliperidone. Approved The serum concentration of Amitriptyline can be increased when it is combined with Palmitic Acid. Approved, Experimental Palonosetron may increase the serotonergic activities of Amitriptyline. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Panobinostat. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Pantoprazole.
Approved Amitriptyline may increase the central nervous system depressant CNS depressant activities of Paraldehyde. Approved, Investigational Pargyline may increase the serotonergic activities of Amitriptyline. Approved The risk or severity of adverse effects can be increased when Paroxetine is combined with Amitriptyline.
Approved, Investigational The serum concentration of Pazopanib can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be decreased when it is combined with Peginterferon alfa-2b. Approved Penfluridol The risk or severity of adverse effects can be increased when Penfluridol is combined with Amitriptyline.
Experimental Amitriptyline may increase the QTc-prolonging activities of Pentamidine. Approved The risk or severity of adverse effects can be increased when Pentazocine is combined with Amitriptyline. Approved, Vet Approved The metabolism of Amitriptyline can be increased when combined with Pentobarbital. Approved The risk or severity of adverse effects can be increased when Perazine is combined with Amitriptyline. Investigational Amitriptyline may increase the QTc-prolonging activities of Perflutren.
Approved Amitriptyline may decrease the antihypertensive activities of Pergolide. Approved, Investigational, Vet Approved, Withdrawn The serum concentration of Amitriptyline can be increased when it is combined with Perindopril. Approved The risk or severity of adverse effects can be increased when Perospirone is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Perphenazine is combined with Amitriptyline.
Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Pethidine. Approved Phenazocine The risk or severity of adverse effects can be increased when Phenazocine is combined with Amitriptyline. Experimental The risk or severity of adverse effects can be increased when Amitriptyline is combined with Phenelzine.
Approved Phenibut The risk or severity of adverse effects can be increased when Phenibut is combined with Amitriptyline. Experimental Amitriptyline may increase the anticoagulant activities of Phenindione. Approved, Investigational Pheniprazine may increase the serotonergic activities of Amitriptyline. Withdrawn The metabolism of Amitriptyline can be increased when combined with Phenobarbital.
Approved Phenoperidine The risk or severity of adverse effects can be increased when Phenoperidine is combined with Amitriptyline. Experimental The risk or severity of adverse effects can be increased when Phenoxyethanol is combined with Amitriptyline.
Approved Phenoxypropazine may increase the serotonergic activities of Amitriptyline. Withdrawn Amitriptyline may increase the anticoagulant activities of Phenprocoumon. Approved, Investigational Amitriptyline may increase the stimulatory activities of Phentermine.
Approved, Illicit Amitriptyline may increase the vasopressor activities of Phenylephrine. Approved Amitriptyline may decrease the antihypertensive activities of Phenylpropanolamine. Approved, Vet Approved The serum concentration of Amitriptyline can be increased when it is combined with Phosphoramidon.
Experimental The serum concentration of Pibrentasvir can be increased when it is combined with Amitriptyline. Approved Amitriptyline may increase the QTc-prolonging activities of Pimozide. Approved The metabolism of Amitriptyline can be decreased when combined with Pioglitazone. Approved, Investigational The risk or severity of adverse effects can be increased when Pipamperone is combined with Amitriptyline. Approved, Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Pipotiazine.
Approved, Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Pirbuterol. Approved The risk or severity of adverse effects can be increased when Piritramide is combined with Amitriptyline. Investigational Pirlindole may increase the serotonergic activities of Amitriptyline. Approved The serum concentration of Pitavastatin can be increased when it is combined with Amitriptyline.
Approved Pivhydrazine may increase the serotonergic activities of Amitriptyline. Withdrawn The risk or severity of adverse effects can be increased when Amitriptyline is combined with Pizotifen. Approved The serum concentration of Amitriptyline can be decreased when it is combined with Platelet Activating Factor. Experimental The serum concentration of Pomalidomide can be increased when it is combined with Amitriptyline. Approved The serum concentration of Ponatinib can be increased when it is combined with Amitriptyline.
Approved The metabolism of Amitriptyline can be decreased when combined with Posaconazole. Approved, Investigational, Vet Approved Amitriptyline may increase the sedative activities of Pramipexole. Approved, Investigational The risk or severity of adverse effects can be increased when Pramocaine is combined with Amitriptyline.
Approved The serum concentration of Pravastatin can be increased when it is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Prazepam is combined with Amitriptyline. Approved, Illicit The serum concentration of Amitriptyline can be increased when it is combined with Prazosin.
Approved The serum concentration of Prednisolone can be increased when it is combined with Amitriptyline. Approved, Vet Approved The serum concentration of Prednisone can be increased when it is combined with Amitriptyline.
Approved, Vet Approved The risk or severity of adverse effects can be increased when Pregabalin is combined with Amitriptyline. Approved, Illicit, Investigational The risk or severity of adverse effects can be increased when Prilocaine is combined with Amitriptyline.
Approved Amitriptyline may increase the QTc-prolonging activities of Primaquine. Approved The metabolism of Amitriptyline can be increased when combined with Primidone. Approved, Vet Approved The serum concentration of Amitriptyline can be increased when it is combined with Prinomastat. Investigational The serum concentration of Amitriptyline can be increased when it is combined with Probenecid. Approved Amitriptyline may increase the QTc-prolonging activities of Procainamide.
Approved The risk or severity of adverse effects can be increased when Procaine is combined with Amitriptyline.
Approved, Investigational, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Procarbazine. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Procaterol. Approved, Investigational The risk or severity of adverse effects can be increased when Prochlorperazine is combined with Amitriptyline.
Approved, Vet Approved The serum concentration of Amitriptyline can be decreased when it is combined with Progesterone. Approved, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Promethazine.
Approved Amitriptyline may increase the QTc-prolonging activities of Propafenone. Approved Propanidid The risk or severity of adverse effects can be increased when Propanidid is combined with Amitriptyline.
Experimental The risk or severity of adverse effects can be increased when Proparacaine is combined with Amitriptyline. Approved, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Propericiazine. Approved The risk or severity of adverse effects can be increased when Propofol is combined with Amitriptyline.
Approved, Investigational, Vet Approved The risk or severity of adverse effects can be increased when Propoxycaine is combined with Amitriptyline. Approved The serum concentration of Propranolol can be increased when it is combined with Amitriptyline. Approved, Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Prothipendyl.
Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Protriptyline. Approved Proxibarbal The risk or severity of adverse effects can be increased when Proxibarbal is combined with Amitriptyline.
Experimental The serum concentration of Prucalopride can be increased when it is combined with Amitriptyline. Investigational Amitriptyline may decrease the antihypertensive activities of Pseudoephedrine.
Approved The metabolism of Amitriptyline can be decreased when combined with Pyrimethamine. Approved, Vet Approved The serum concentration of Amitriptyline can be increased when it is combined with Quazepam. Approved, Illicit The serum concentration of Amitriptyline can be increased when it is combined with Quercetin. Experimental, Investigational Amitriptyline may increase the QTc-prolonging activities of Quetiapine. Approved The serum concentration of Amitriptyline can be increased when it is combined with Quinacrine.
Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Quinapril. Approved Amitriptyline may increase the QTc-prolonging activities of Quinine. Approved Quinisocaine The risk or severity of adverse effects can be increased when Quinisocaine is combined with Amitriptyline. Experimental The metabolism of Amitriptyline can be decreased when combined with Rabeprazole.
Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Racecadotril. Investigational The risk or severity of adverse effects can be increased when Raclopride is combined with Amitriptyline. Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Ramelteon. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Ramipril.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Ranitidine. Approved The serum concentration of Ranolazine can be increased when it is combined with Amitriptyline. Approved, Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Rasagiline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Reboxetine. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Regorafenib.
Approved The risk or severity of adverse effects can be increased when Remifentanil is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Remikiren. Approved The risk or severity of adverse effects can be increased when Remoxipride is combined with Amitriptyline. Approved, Withdrawn The serum concentration of Amitriptyline can be decreased when it is combined with Reserpine.
Approved, Investigational The metabolism of Amitriptyline can be increased when combined with Rifabutin. Approved The metabolism of Amitriptyline can be increased when combined with Rifampicin. Approved The metabolism of Amitriptyline can be increased when combined with Rifapentine. Approved The serum concentration of Rifaximin can be increased when it is combined with Amitriptyline.
Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Rilpivirine. Approved Amitriptyline may decrease the antihypertensive activities of Risperidone. Approved, Investigational The risk or severity of adverse effects can be increased when Ritanserin is combined with Amitriptyline.
Investigational Amitriptyline may increase the stimulatory activities of Ritobegron. Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Ritodrine. Approved, Investigational The metabolism of Amitriptyline can be decreased when combined with Ritonavir. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Rivaroxaban. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Rizatriptan.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Rolapitant. Approved The serum concentration of Romidepsin can be increased when it is combined with Amitriptyline.
Approved, Investigational Romifidine The risk or severity of adverse effects can be increased when Romifidine is combined with Amitriptyline. Vet Approved Amitriptyline may increase the sedative activities of Ropinirole. Approved, Investigational The risk or severity of adverse effects can be increased when Ropivacaine is combined with Amitriptyline.
Approved The metabolism of Amitriptyline can be decreased when combined with Rosiglitazone. Approved, Investigational Amitriptyline may increase the sedative activities of Rotigotine. Approved The risk or severity of adverse effects can be increased when Rufinamide is combined with Amitriptyline.
Approved The serum concentration of Amitriptyline can be increased when it is combined with S Investigational Safrazine may increase the serotonergic activities of Amitriptyline. Withdrawn The risk or severity of adverse effects can be increased when Amitriptyline is combined with Salbutamol.
Approved, Vet Approved The serum concentration of Salicylic acid can be increased when it is combined with Amitriptyline. Approved, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Salmeterol. Approved The metabolism of Amitriptyline can be decreased when combined with Saquinavir. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Saxagliptin. Approved The serum concentration of Amitriptyline can be increased when it is combined with Scopolamine.
Approved The metabolism of Amitriptyline can be increased when combined with Secobarbital. Approved, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Selegiline. Approved, Investigational, Vet Approved The serum concentration of Selexipag can be increased when it is combined with Amitriptyline.
Approved The risk or severity of adverse effects can be increased when Sepranolone is combined with Amitriptyline. Investigational The risk or severity of adverse effects can be increased when Sertindole is combined with Amitriptyline.
Approved, Investigational, Withdrawn The risk or severity of adverse effects can be increased when Sertraline is combined with Amitriptyline.
Approved The risk or severity of adverse effects can be increased when Sevoflurane is combined with Amitriptyline. Approved, Vet Approved The metabolism of Amitriptyline can be decreased when combined with Sildenafil.
Approved, Investigational The serum concentration of Silodosin can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be decreased when it is combined with Siltuximab.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Simeprevir. Approved The serum concentration of Amitriptyline can be increased when it is combined with Simvastatin.
Approved The serum concentration of Amitriptyline can be decreased when it is combined with Sirolimus. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Sitagliptin. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Sivelestat. Investigational Sodium oxybate may increase the central nervous system depressant CNS depressant activities of Amitriptyline.
Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Sodium phosphate. Approved The serum concentration of Sofosbuvir can be increased when it is combined with Amitriptyline.
Approved The serum concentration of Sorafenib can be increased when it is combined with Amitriptyline. Approved The serum concentration of Sparfloxacin can be increased when it is combined with Amitriptyline. Approved, Investigational The serum concentration of Sphingosine can be increased when it is combined with Amitriptyline.
Experimental The serum concentration of Amitriptyline can be increased when it is combined with Spirapril. Approved The serum concentration of Amitriptyline can be increased when it is combined with Spironolactone. Approved The metabolism of Amitriptyline can be increased when combined with St.
Investigational, Nutraceutical The serum concentration of Amitriptyline can be increased when it is combined with Staurosporine. Experimental The serum concentration of Amitriptyline can be increased when it is combined with Stiripentol.
Approved The serum concentration of Amitriptyline can be decreased when it is combined with Streptozocin. Approved The risk or severity of adverse effects can be increased when Sufentanil is combined with Amitriptyline. Approved, Investigational The metabolism of Amitriptyline can be decreased when combined with Sulfadiazine. Approved, Vet Approved The metabolism of Amitriptyline can be decreased when combined with Sulfamethoxazole.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Sulfinpyrazone. Approved The metabolism of Amitriptyline can be decreased when combined with Sulfisoxazole. Approved, Vet Approved The risk or severity of adverse effects can be increased when Sulpiride is combined with Amitriptyline. Approved, Investigational Sultopride The risk or severity of adverse effects can be increased when Sultopride is combined with Amitriptyline. Experimental The risk or severity of adverse effects can be increased when Amitriptyline is combined with Sumatriptan.
Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Sunitinib. Approved, Investigational Amitriptyline may increase the central nervous system depressant CNS depressant activities of Suvorexant. Approved The serum concentration of Amitriptyline can be increased when it is combined with Tacrine.
Investigational, Withdrawn The serum concentration of Amitriptyline can be decreased when it is combined with Tacrolimus. Approved, Investigational The serum concentration of Amitriptyline can be decreased when it is combined with Tamoxifen.
Approved The risk or severity of adverse effects can be increased when Tandospirone is combined with Amitriptyline. Investigational Tapentadol may increase the central nervous system depressant CNS depressant activities of Amitriptyline.
Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Tasimelteon. Approved The serum concentration of Taurocholic Acid can be increased when it is combined with Amitriptyline. Experimental The serum concentration of Technetium Tcm sestamibi can be increased when it is combined with Amitriptyline. Approved Tedizolid Phosphate may increase the serotonergic activities of Amitriptyline.
Approved The metabolism of Amitriptyline can be decreased when combined with Telaprevir. Approved The metabolism of Amitriptyline can be decreased when combined with Telithromycin.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Telmisartan. Approved, Investigational The risk or severity of adverse effects can be increased when Temazepam is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Temocapril. Experimental, Investigational The serum concentration of Temsirolimus can be increased when it is combined with Amitriptyline. Approved The metabolism of Amitriptyline can be decreased when combined with Tenofovir disoproxil.
Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Terazosin. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Terbutaline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Terfenadine. Withdrawn The serum concentration of Amitriptyline can be decreased when it is combined with Teriflunomide.
Approved The serum concentration of Amitriptyline can be decreased when it is combined with Tesmilifene. Investigational The serum concentration of Amitriptyline can be increased when it is combined with Testosterone. Approved The risk or severity of adverse effects can be increased when Tetracaine is combined with Amitriptyline. Approved, Vet Approved The risk or severity of adverse effects can be increased when Tetrahydropalmatine is combined with Amitriptyline.
Investigational The risk or severity of adverse effects can be increased when Tetrodotoxin is combined with Amitriptyline. Investigational Amitriptyline may increase the central nervous system depressant CNS depressant activities of Thalidomide. Approved, Investigational, Withdrawn The metabolism of Amitriptyline can be decreased when combined with Theophylline.
Approved The metabolism of Amitriptyline can be increased when combined with Thiamylal. Approved, Vet Approved The metabolism of Amitriptyline can be increased when combined with Thiopental.
Approved, Vet Approved Thiopropazate The risk or severity of adverse effects can be increased when Amitriptyline is combined with Thiopropazate. Experimental The risk or severity of adverse effects can be increased when Amitriptyline is combined with Thioproperazine.
Approved The serum concentration of Thioridazine can be increased when it is combined with Amitriptyline. Approved, Withdrawn The serum concentration of Amitriptyline can be increased when it is combined with Thiorphan.
Experimental The metabolism of Amitriptyline can be decreased when combined with Thiotepa. Approved The risk or severity of adverse effects can be increased when Thiothixene is combined with Amitriptyline. Approved Thyroid, porcine may increase the arrhythmogenic activities of Amitriptyline. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Tiagabine.
Approved The risk or severity of adverse effects can be increased when Tiapride is combined with Amitriptyline. Approved, Investigational The serum concentration of Ticagrelor can be increased when it is combined with Amitriptyline.
Approved The metabolism of Amitriptyline can be decreased when combined with Ticlopidine. Approved Tiletamine The risk or severity of adverse effects can be increased when Tiletamine is combined with Amitriptyline.
Vet Approved Tilidine The risk or severity of adverse effects can be increased when Tilidine is combined with Amitriptyline.
Experimental The serum concentration of Timolol can be increased when it is combined with Amitriptyline. Approved Amitriptyline may increase the anticoagulant activities of Tioclomarol. Experimental The metabolism of Amitriptyline can be decreased when combined with Tipranavir.
Approved, Investigational The serum concentration of Tizanidine can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be decreased when it is combined with Tocilizumab. Approved The metabolism of Amitriptyline can be decreased when combined with Tolbutamide. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Tolcapone. Approved, Withdrawn Toloxatone may increase the serotonergic activities of Amitriptyline.
Approved The serum concentration of Tolvaptan can be increased when it is combined with Amitriptyline. Approved Topiramate may increase the central nervous system depressant CNS depressant activities of Amitriptyline.
Approved The metabolism of Amitriptyline can be decreased when combined with Topiroxostat. Approved, Investigational The serum concentration of Topotecan can be increased when it is combined with Amitriptyline. Approved, Investigational Amitriptyline may increase the neuroexcitatory activities of Tramadol. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Trandolapril.
Approved The risk or severity of adverse effects can be increased when TransPhenylcyclopropylamine is combined with Amitriptyline. Experimental The risk or severity of adverse effects can be increased when Amitriptyline is combined with Tranylcypromine. Approved The serum concentration of Trastuzumab emtansine can be increased when it is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Trazodone. Approved, Investigational The risk or severity of adverse effects can be increased when Triazolam is combined with Amitriptyline.
Approved Tricaine methanesulfonate The risk or severity of adverse effects can be increased when Tricaine methanesulfonate is combined with Amitriptyline. Vet Approved Trichloroethylene The risk or severity of adverse effects can be increased when Trichloroethylene is combined with Amitriptyline. Experimental The serum concentration of Amitriptyline can be increased when it is combined with Trifluoperazine.
Approved Trifluperidol The risk or severity of adverse effects can be increased when Trifluperidol is combined with Amitriptyline. Experimental The serum concentration of Amitriptyline can be increased when it is combined with Triflupromazine. Approved, Vet Approved The serum concentration of Amitriptyline can be decreased when it is combined with Trimethoprim.
Approved, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Trimipramine. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Triprolidine.
Approved The serum concentration of Amitriptyline can be increased when it is combined with Troleandomycin. Approved Tropisetron may increase the serotonergic activities of Amitriptyline. Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Ubenimex. Experimental, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Ulinastatin. Investigational The serum concentration of Ulipristal can be increased when it is combined with Amitriptyline.
Approved The serum concentration of Umeclidinium can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Valproic Acid. Approved, Investigational The metabolism of Amitriptyline can be decreased when combined with Valsartan.
Approved The serum concentration of Vecuronium can be increased when it is combined with Amitriptyline. Approved The serum concentration of Velpatasvir can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Vemurafenib.
Approved The serum concentration of Venetoclax can be increased when it is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Venlafaxine is combined with Amitriptyline. Approved Veralipride The risk or severity of adverse effects can be increased when Veralipride is combined with Amitriptyline.
Experimental The metabolism of Amitriptyline can be decreased when combined with Verapamil. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Vigabatrin.
Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Vilanterol. Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Vilazodone. Approved The serum concentration of Amitriptyline can be increased when it is combined with Vildagliptin. Approved, Investigational The serum concentration of Amitriptyline can be decreased when it is combined with Vinblastine.
Approved The serum concentration of Vincristine can be increased when it is combined with Amitriptyline. Approved, Investigational The serum concentration of Amitriptyline can be decreased when it is combined with Vincristine.
Approved, Investigational The serum concentration of Amitriptyline can be increased when it is combined with Vinorelbine. Approved, Investigational Vinyl ether The risk or severity of adverse effects can be increased when Vinyl ether is combined with Amitriptyline. Experimental The serum concentration of Vismodegib can be increased when it is combined with Amitriptyline.
Approved The metabolism of Amitriptyline can be decreased when combined with Voriconazole. Approved, Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Vortioxetine.
Approved The serum concentration of Voxilaprevir can be increased when it is combined with Amitriptyline. Approved Amitriptyline may increase the anticoagulant activities of Warfarin. Approved Xenon The risk or severity of adverse effects can be increased when Xenon is combined with Amitriptyline. Experimental The serum concentration of Amitriptyline can be increased when it is combined with Ximelagatran. Approved, Investigational, Withdrawn Xylazine The risk or severity of adverse effects can be increased when Xylazine is combined with Amitriptyline.
Vet Approved Amitriptyline may decrease the antihypertensive activities of Xylometazoline. Approved The serum concentration of Yohimbine can be increased when it is combined with Amitriptyline.
Experimental The metabolism of Amitriptyline can be decreased when combined with Zafirlukast. Approved, Investigational The risk or severity of adverse effects can be increased when Zaleplon is combined with Amitriptyline. Approved, Illicit, Investigational The risk or severity of adverse effects can be increased when Amitriptyline is combined with Ziconotide.
Approved The serum concentration of Zidovudine can be increased when it is combined with Amitriptyline. Approved The serum concentration of Amitriptyline can be increased when it is combined with Zimelidine. Withdrawn Amitriptyline may increase the QTc-prolonging activities of Ziprasidone. Approved The serum concentration of Amitriptyline can be increased when it is combined with Zofenopril. Experimental Zolazepam The risk or severity of adverse effects can be increased when Zolazepam is combined with Amitriptyline.
They are the non-affiliated members of the platform and the services they get are for their own online businesses. They are not required to pay any membership fee and can use the platform for free. Also called an Affiliated Sellers or freelancer.
They are basically self-employed individuals, who have online marketing background and can sell their own services to customers. Not only that, they can also sell their services to other Affiliated Members. Just like customers, they can use the platform for free and are not required to pay any sort of membership fees.
How do you get Paid? Traffic Power Line has a carefully designed and great income plan that increases your income with the number of sales. However, this is just the beginning as the Traffic Power Line income plan offers additional rewards and bonuses that increase the amount of money you get to take home.
It is very carefully designed keeping in mind the multitude of people who will be using this system and the fairness in income generation. You get bonus units whenever you sell services to Customers or opt for Traffic Power Line services. These bonus units are transferred to the Network Line Reward Center, which can hold maximum bonus units and is valid for days. For getting bonus units for the Power Line, you need to refer the system to other people and have them opt for it through your reference.
By doing so, bonus units will be added to your Power Line Reward Centers, which can hold bonus units and remain active for days. The amount of money that you take home at the end of the day is the sum of the following: Conclusion After reading my Traffic Power Line review, you must have got the idea that this system has no flaws and is completely safe and legit for making money.
If you ask my expert opinion and compare it with other popular systems, I would say that it is equally or may be better than many system that are available these days in the market. Why it is a Good Idea to Start Using TPL While a majority of the people may call the internet a miracle that changed our lives for the good, some may completely disagree. One of the reasons for this disagreement could be that they have been scammed after opting for a scheme that promised to generate bags of money, but in the end ripped them off with everything that they had.
If you are related to online marketing or not , there is a good chance that you must have heard about Traffic Power Line within the past quarter. It is a new system that has been making headlines and attracted many people interested in using it to start generating passive income. Even if you are reading this review, this means that Traffic Power Line has caught your attention as well and now you want something or someone to clear your doubts regarding whether Traffic Power Line is a scam or truly a game changer.
The good news is that this short review of Traffic Power Line is going to tell you exactly that. I am already satisfied with this system and writing this review just to educate those people who are unsure about using Traffic Power Line. Here you will get three good reasons why it is a good idea to start using Traffic Power Line to generate good, steady income for yourself.
Why you Should Start Using Traffic Power Line Here are the three main reasons why you should use Traffic Power Line, which ironically are also the reasons behind the doubt and confusion in people regarding this system. To make it easy for you to understand, here is an example. Consider you are an Affiliated Member using the Traffic Power Line platform to sell services or using the Traffic Power Line services to contribute your efforts in promoting the platform. So what do you do? You can continue to selling your services and getting paid directly and through the bonuses of the Network Line, and make steady amount of income every month.
There is no need for you to beg other people to come and join Traffic Power Line. It has Real and Legit Products If you are a digital marketer or have slightest knowledge of how things work online and about a few online marketing techniques, you will agree that web traffic and leads are very important for an online business to stay afloat. As you know, Traffic Power Line is basically a platform where services related to online marketing are exchanged between customers and Affiliated Members.
In such case, these three products also called Traffic Power Line services are what freelancers and customers will buy and sell. Moreover, the E-Product Library is designed for people who are new to the online marketing world and want to learn the latest techniques and methods to start making money online. People without a lot of Money can use this Platform There are reviews on the internet about Traffic Power Line that say this platform is only for people with a lot of money and looking to multiply what they already have.
Consider that you are an Affiliated Seller. You only need your skills to sell services on the Traffic Power Line platform and start making money. Apart from this, when you go through the policies of Traffic Power Line on its website, you will see that there is a section about daily purchase restrictions. The primary reason for imposing this policy is to prevent any manipulation in the Community Reward System, and to ensure that all Affiliated Members get equal and fair chance to participate in this system and benefit from it.
Ja sam od pocetka imala takvo misljenje medjutim ova starija "pametnija" inace pesimista osoba iz porodice umjesto da me ohrabrila kao majku, izludila me, stvorila mi merck osjecaj krivice jer ako se bakterije ne uniste do kraja moze se vratiti upala pluca. Ujutro, prije kafe ili icega drugog, napraviti caj 10mg 'trave ive' i popiti. Ja koristim Oxford textbooks, ali i Oxfordhaelthdatabase ili Pubmed, al' mislim da je to previse za tvoj assignment ako comprar viagra on line argentina radi o srednjoj skoliako se radi o medicini ili medical science, onda toplo preporucujem pubmed, propranolol merck nm 10mg. The owner of this platform is Pearse Donnley, who is also the co-founder and co-director of Mo Brabus Ltd. Approved, Investigational The serum concentration of Amitriptyline propranolol be decreased when it is combined with Vincristine. Posto je u pitanju stari prijatelj i njegov sin zamolio bih te za par savjeta. Approved Amitriptyline may increase the QTc-prolonging activities 10mg Azithromycin. Approved, Investigational Propranolol serum concentration of Amitriptyline can be decreased when it is combined with Digoxin. Approved The serum concentration of Everolimus can be increased when it is combined with Amitriptyline. U zadnje vrijeme razradjene su nove metode radioterapije zracenje u lijecenju inoperabilnih tumora i nakon palijativne kirurgije, koje merck se pokazale mnogo efikasnijim i obecavajucim u odnosu na radioterapiju u proslosti.
Approved, Illicit The serum concentration of Colchicine can be increased when it is combined with Amitriptyline. Approved, Investigational, Vet Approved Oxypertine The risk propranolol severity of adverse effects can be increased when Amitriptyline is combined with Oxypertine. Approved Tropisetron may increase the serotonergic activities of Amitriptyline. Approved, Investigational The risk or severity of adverse effects can be increased when Oxprenolol is combined with Amitriptyline. Experimental The serum concentration of Camptothecin can be increased when it is combined with Amitriptyline. Ujutro, prije kafe ili icega drugog, 10mg caj od 'trave ive' i popiti, propranolol merck nm 10mg. Ja ti bolujem od bubrega. Uzimanje lijekova za snizavanje krvnog tlaka treba shvatiti ozbiljno i zapoceti sa terapijom odmah, cim se otkrije hypertenzija. Approved, Vet Approved The risk or severity of adverse effects can be increased when Amitriptyline is combined with Promethazine. You can get bonuses through any one or more of the following five bonus plans. U drugu grupu spadaju oboljenja malabsorpcije Celiacia-glutenska enteropathiapropranolol merck nm 10mg, te oboljenja crijevnog zida u prvom redu Chron-ova bolest. Tumor je zahvatio donji dio vagine, ali ne i karlicni zid. Ja za 2 hefte,preko Austrije i Svice furam kuci u USA nabaci koju kritiku protiv "mother America" Moj prijatelj Nevis,sin Alexe je obavio gastroscopy i nalaz je sledeci: Approved The risk or severity of adverse effects can be increased when Dihydroetorphine is combined with Amitriptyline. Approved The risk or severity of adverse effects can be increased when Fluvoxamine is combined with Amitriptyline. Approved The serum concentration of Venetoclax can be increased when merck is combined with Amitriptyline.
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