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Table 3 summarizes the values of the statistical parameters, detection limits, and EU-MRL for sulphonamides. The effect of sulphonamide concentrations upon the relative absorbance of Delvotest "SP" is shown in Figure 3, where the logistic curves constructed on the basis of the "0" and "1" coefficient in Table 3 are also represented. It may be observed that sulfametoxypyridazine requires greater increments in concentration than the other sulphonamides assayed in order to achieve 100% absorbance. The logistical parameters of the other antimicrobial agents aminoglycosides, macrolides, tetracyclines, chloramphenicol, and trimethoprim ; are shown in Table 4. It may be seen that the "1" coefficient values are lower than those obtained for beta-lactam antibiotics Table 2 ; . This demonstrates the low sensitivity of Bacillus stearothermophilus in detecting residues of these antimicrobial agents compared with the beta-lactam antibiotics. The Delvotest "SP" method detection limits found in the literature consulted were determined by means of visual readings in cow milk; thus, the results with said values for each of the antimicrobial groups studied are discussed below. Beta-Lactam Antibiotics The detection limit of amoxycillin 3 g kg, Table 2 ; was lower than the 6 g kg determined by HonkanenBuzalski and Reybroeck 1995 ; and Suhren and Reichmuth 1998 ; . In the case of ampicillin, the level detected in this work 2 g kg, Table 2 ; was similar to the 3 g kg calculated by Luitz et al. 1996 ; , while the 18 g kg cloxacillin Table 2 ; was lower than the 30 g kg.
It is very important to keep track of how well the drugs are working, what side effects you are having, and report all details to your health care provider.
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Diabetes Care 2004; 27 suppl 1 ; : S36S46; S55S57. 2Refer to Weight Loss Algorithm. 3Refer to Lipid Algorithm. 4Refer to Hypertension Algorithm. See web site : tdh ate.tx diabetes healthcare standards ; for latest version.
Antiarrhythmic drugs are used to terminate or prevent AF and controlling the ventricular response to acute or chronic AF. Table 2 shows the proarrhythmic responses of agents used for treating AF. Proarrhythmic risk during drug conversion of sinus rhythm In one of the first reports, Sokolow and Edgar [4] used quinidine to obtain sinus rhythm. In one of the 10 patients managed, a new episode of ventricular tachycardia occurred. Subsequently, there have been other reports of quinidine arrhythmogeTable 1. Types of proarrhythmia produced by drugs for AF and
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Cap. Ampiciolin 250 mg ; one capsule 6th hourly for 5-7 days AND Cap. Cloxacillin 250 mg ; one capsule 6th hourly for 5-7 days. Gut and urinary tract E.coli.
S. Valdezate, M. Arroyo, R. Gonzalez, R. Ramiro, S. Herrera-Leon, M.A. Usera, J.A. Lopez Portoles, A. Echeita Madrid, E ; Objectives: To study the clonal relationship and the antimicrobial resistance showed by strains of different serotypes of Salmonella spp. isolated from food for human consumption during a one-year period. Methods: Antimicrobial susceptibility to 23 antibiotics was determined by disk diffusion in 380 Salmonella spp. isolates submitted to LNRSSE from all Spanish regions with the following distribution by serotypes: Enteritidis n 176 ; , Typhimurium n 60 ; and other serotypes n 144 ; . Molecular epidemiology of Enteritidis and Typhimurium serotypes was investigated using PFGE and computerized numerical analysis of the data. Phage typing was also performed. Results: Analysis was carried out with strains without epidemiological link. Analyzed Enteritidis strains n 96 ; were mainly from eggs and derived 27% ; and from poultry and derived 24% ; , detecting 16 phage types PT ; with predominance of PT1 39% ; . They were identified 9 pulsetypes, with a similarity genetic range of 8196%, emerging a frequent clone 74% ; . Analyzed Typhimurium strains n 53 ; were from sausage and cold meat 21% ; , pig and derived 15% ; , and from poultry and derived 15% ; , detecting 12 DTs, with predominance of DT104 28% ; and U302 19% ; . They were identified 13 pulsetypes, with a similarity genetic range of 64 86%, emerging a frequent clone 34% ; . Antimicrobial resistance rates NCCLS, M100-S13 ; for the strains of Enteritidis, Typhimurium, and other 49 different serotypes n 115 ; were, respectively: ampicillin 8, 62 and 14% ; , spectinomycin 99, 87 and 100% ; , streptomycin 1, 53 and 59% ; , gentamicin 1, 4 and 0% ; , tobramycin 1, 4 and 0% ; , amikacin 1, 0 and 0% ; , netilmicin 1, 4 and 0% ; , nalidixic acid 41, 22 and 14% ; , tetracycline 16, 72 and 31% ; , sulphonamide 7, 62 and 21% ; , trimethoprim-sulphamethoxazole 7, 19 and 14% ; and cloramphenicol 0, 51 and 9% ; . All the strains were susceptible to the other tested betalactams and fluorquinolones. Conclusion: High clonality of food strains of Enteritidis serotype, showing higher discrimination index ID ; the phage typing 0.81 ; than PFGE 0.44 ; with a high nalidixic acid resistance 42% ; . High efficiency of PFGE in the serotype Typhimurium, with similar ID in both techniques 0.86 ; , noteworthy resistances higher than 50% for ampicillin, streptomycin, tetracycline, sulphonamide and cloramphenicol. Strains of other serotypes showed minor resistance rates and
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CORRELATION OF SEROLOGIC IBD MARKERS WITH WCE FINDINGS IN SMALL INTESTINAL CROHN'S DISEASE M.T. Takami, L.R. Fisher Internal Medicine Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, USA Wireless Capsule Endoscopy WCE ; is the most sensitive way to diagnose mucosal abnormalities in the small bowel SB ; . Studies have reported WCE findings consistent with Crohn's disease CD ; in SB when a diagnosis DX ; of Inflammatory Bowel Disease IBD ; in symptomatic patients PTS ; eludes a traditional work up. These studies have not correlated WCE findings with other objective evidence of IBD such as serologic markers or histology, yet PTS have received treatment TX ; for CD based on WCE findings alone. Difficult clinical decisions follow the initiation of such TX, regarding maintenance TX, immunosuppressive or immunologic TX, and follow up. Prometheus IBD First StepTM Generation II IBDFSII ; is a commercial diagnostic panel ANCA, ASCA IgA, ASCA IgG, OmpC IgA ; meant to rule out IBD in symptomatic PTS. The + predictive value has been reported as high as 90%, but the - predictive value of IBDFSII is low, due to low sensitivity. Thus while neither test is optimal for the DX of SB CD, it may be possible to identify a subset of PTS with specific symptoms, WCE findings, and + IBD serology in whom the DX of SB would be more meaningful. We performed a pilot study to test if WCE findings of SB inflammation correlate with serologic markers for CD. We reviewed charts of 145 pts who had WCE 1 02 04 -10 27 04. PTS with a DX of NSAID use were excluded. WCE was administered by standard protocol. Lesions considered inflammatory were ulcers, erosions, aphthi, strictures, denuded villi, mucosal breaks or fissures. 22 PTS had IBDFSII drawn. 18 of these had markers detected, 14 confirmed by Elisa assay D C ; . the 14 PTS, 10 had inflammation in SB by WCE and 4 had normal or non specific findings on WCE, indicating 71% correlation with WCE for + serologies. - or unconfirmed serologies ND, D NC ; favored + findings on WCE, consistent with the low - predictive value of IBDFSII previously published. Conclusion: + IBD serologies show 71% correlation with WCE findings of SB inflammation in symptomatic PTS. Future studies will focus on whether combining WCE findings with IBD serologies strengthens the + predictive value of either test alone for DX of SB.
100 isolates, 58 58.0% ; were ESBL positive. The antimicrobial resistance was significantly P 0.05 ; higher in ESBL producers than in non-ESBL producers. All the isolates were sensitive to imipenam and meropenam except one ; . ESBL producing Klebsiella spp. were almost always resistant to ampicillin, ticarcillin and piperacillin. Monobactem and cephalosporin resistance was also higher in ESBL producing Klebsiella spp. Aminoglycosides i.e., amikacin and gentamycin accounted for 58.6 and 70.6 per cent resistance among ESBL producers. Piperacillin tazobactem showed less resistance as compared to ticarcillin clavulanic acid and amoxycillin clavulanic acid Table and atarax.
Objective: To find out the pattern of drug prescribing to adults with acute exacerbation of chronic bronchitis AECB ; in outpatient departments in Russia. Methods: Case histories of outpatients with AECB attending the consulting rooms in 1998 in seven regions of Russia were randomly selected for retrospective assessment. Drugs were classified according to ATC-codes. The specially designed computer program was used for data analysis. Results: 783 case histories of patients aged from 16 to 92 389 males, 394 females, average age 51.613.7 ; were included in the study. The most often prescribed group of drugs was antimicrobials for systemic use J01 ; - 83.9%, followed by cough and cold preparations R05 ; 75.5%, anti-asthmatics R03 ; 48.7%, antihistamines for systemic use R06 ; - 23.0% and vitamins A11 ; 9.8%. The most common antimicrobials for initial therapy were co-trimoxazole 26.7% ; , ciprofloxacin 15.2% ; and ampicillin 10.9% ; . Among anti-asthmatics the short-acting theophylline was the most frequently prescribed drug 18.5% ; . Anticholinergics and selective beta2adrenoceptor agonists were used in 7.4% and 6.8% patients, consecutively. Conclusions: Systemic antimicrobials were prescribed to almost all patients with AECB although controversial reports on their effectiveness have been published. Short-acting theophylline remained the most popular bronchodilator despite of its well-known numerous adverse reactions!
223. 224. 225. Syp. Albendazole Suspension 10 ml Syp. Amoxcillin Suspension 60 ml Syp. Ampciillin Suspension 40 ml Syp. Ampicilllin + Cloxacillin Syp. Aristozyme Liquid 200 ml Syp. Avil 100 ml Syp. Avil Expetorant 100 ml Syp. Benadril Exil Cough Syp. Cephadroxil Syp. Cephelaxin Suspension 40 ml Syp. Cetrizin Syp. Cotrimoxazole Suspension 60 ml Syp. Cremaffin Suspension Syp. Cyproheptidin 100 ml Syp. Diazepam 30 ml Syp. Diethyl Carbamazin Citrate 100 ml Syp. Dilosin Expectorent 150 ml Syp. Diloxanide Furoate + Metronidazone Syp. Disodium Hydrogen Citrate 100 ml Citralka ; Syp. Erithromycin Suspension 60 ml Syp. Etophyllate 100 ml Syp. Ferrous Sulphate + Folic Acid 100 ml Syp. Fesovit 100 ml Syp. Furazolidon Suspension 60 ml Syp. Gelusil MPS 170 ml 210 ml 450 ml Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle Bottle 4420 14100 9100 and
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9.2 The State Government shall launch an Industrial and Allied Infrastructure Development Fund IAIDF ; with an initial corpus of Rs.100 crore to support industrial infrastructure and associated social infrastructure projects. The Fund shall encourage private investment in infrastructure development by providing supplementary viability gap funding, wherever needed, on the lines of Central Government viability gap funding scheme. IDCO shall also be eligible to avail itself of financial support from the IAIDF for creation of such infrastructure. The Fund shall also support pre-project development activities by designated agencies. The State Government shall separately issue detailed guidelines for operation of the IAIDF. 9.3 The State Government shall announce a comprehensive Land Policy to address all issues concerning identification, procurement and allotment of land for industrial and allied purposes, including creation of associated social infrastructure. IDCO along with Revenue Department shall vigorously implement the Land Bank Scheme, which was announced in the IPR-2001 to ensure orderly industrial growth. IDCO in association with DLNAs shall identify suitable tracts of and
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In suspected cases of osteomyelitis, why are holes drilled into the bone? To relieve the pain, to debride the wound, and to obtain a sample for laboratory analysis. How long does it take for the laboratory to be fairly confident that Staphylococcus aureus is present? Given the aetiology of the condition, about ten minutes - a Gram stain will show Grampositive cocci in the pus. How long does it take for the laboratory to be certain that Staphylococcus aureus is present? Up to 48 hours, if the slide test for clumping factor is negative, and a DNase test and tube coagulase must be carried out. If Staphylococcus aureus resists penicillin, why is it also resistant to ampicillin and amoxycillin, but sensitive to flucloxacillin? Flucloxacillin is an anti-staphylococcal penicillin that can resist the action of staphylococcal penicillinase. The other penicillins listed are sensitive to staphylococcal penicillinase. How would you have managed this case had the patient been allergic to penicillins? Because of the patient's allergy to penicillins, an alternative antimicrobial regime must be sought. Due to the poor penetration of many antibiotics into bone, the choice of therapy in such cases is not easy. Clindamycin as a single agent is a reasonable choice, reserving vancomycin as a first-line agent for the treatment of resistant staphylococcal infections.
Uterine fundus not felt on abdominal palpation Slight or intense pain Inverted uterus Start an IV infusion two if possible ; using a large-bore cannula or needle. Rapidly infuse normal saline or Ringer's lactate at the rate of 1 L minutes. Give at least 2 L of fluid in the first hour. Give a single dose of prophylactic antibiotics: ampicillin 2 g IV PLUS metronidazole 500 mg IV; OR Give cefazolin 1 g IV PLUS metronidazole 500 mg IV and
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The accounting policies applied by the Group in these condensed consolidated interim financial statements are the same as those applied by the Group in its consolidated financial statements as at and for the year ended 31 December 2006, except for the adoption of the Standard and Interpretations, noted below. Adoption of this Standard and Interpretations did not have any effect on the financial position of the Group. IFRS 7 Financial Instruments Disclosures, and the Complementary Amendment to IAS 1, Presentation of Financial Statements Capital Disclosures effective for annual periods beginning on or after 1 January 2007 ; . IFRS 7 introduces new disclosures relating to financial instruments. This standard does not have any impact on the classification and valuation of the Group's financial instruments. IFRIC 8 - Scope of IFRS 2 The Group adopted IFRIC 8 as of January 2007, which requires consideration of transactions involving the issuance of equity instruments where the identifiable consideration received is less than the fair value of the equity instruments issued to establish whether or not they fall within the scope of IFRS 2. IFRIC 9 Reassessment of Embedded Derivatives The Group adopted IFRIC 9 as of January 2007, which states that the date to assess the existence of an embedded derivative is the date that an entity first becomes party to the contract, with reassessment only if there is a change to the contract that significantly modifies the cash flows. As none of the Group's entities have changed the terms of their contracts, IFRIC 9 is not relevant to the Group's operations. IFRIC 10 Interim Financial Reporting and Impairment The Group adopted IFRIC 10 as of January 2007, which requires that an entity is prohibited to reverse an impairment loss recognised in a previous interim period in respect of goodwill or an investment in either an equity instrument or a financial asset carried at cost. IFRIC 11 Group and Treasury Share Transactions The Group has elected to adopt IFRIC 11 as of January 2007. This interpretation clarifies the treatment to be applied in certain special cases of employee benefits involving different entities of a group. The adoption of this Interpretation did not have any effect on the financial position or performance of the Group and
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Hypothesis. However, the observation that a sequence of 20 nucleotides of the extreme of the amplified fragment showed homology with several known cloning vectors and ampicilllin resistance plasmids may at least indicate some relationship with plasmid origin. 3.2.3. Detection limit of ajpicillin resistance gene transfer and limitations of the methods used The level of detection of the methods used can be calculated from the enrichment factor and the dilution.
229. EFFECT OF ISOPROTURON, A WEEDCIDE, ON FOWL BLOOD PRESSURE. KUMAR V., MAITY N.K. AND RANA R.D. Department of Veterinary Pharmacology, CCS Haryana Agricultural University, Hisar-125 004. India Healthy female white leghorn hen weighing between 1.2 to 1.8 kg were used to study the effect of isoproturon on blood pressure. The birds were anaesthetized with phenobarbitone sodium given intramuscularly at the dose rate of 165 mg kg, body weight. The femoral artery was cannulated and connected to Condon's mercury manometer with the help of polythene tubing. Normal responses of blood pressure to graded doses of isoproturon suspension 100 g, 300 g, 1 mg, 3 mg, 10 mg, 30 mg, and 100 mg kg, body weight ; in gum acacia were studied. No response was produced upto doses 3.0 mg kg, body weight, but fall in blood pressure was produced at doses 10, 30 and 100 mg kg, body weight. Gum acacia had no effect on blood pressure. Effect of isoproturon on responses of blood pressure in presence of various antagonists, viz ., chlorpheniramine 5.0 mg kg ; , atropine 10 mg kg ; , cimetidine 15.0 mg kg ; , phentolamine 5.0 mg kg ; and propranolol 0.5 mg kg ; were studied. Isoproturon raised the blood pressure in presence of chlorpheniramine and in presence of atropine, which was blocked by phentolamine. Isoproturon 10 mg kg ; induced rise in blood pressure in presence of chlorpheniramine could not be blocked by cimetidine. Isoproturon induced fall in blood pressure could not be blocked by propranolol. These responses of blood pressure seem to be mediated through histaminergic and or cholinergic receptors, and alpha-adrenergic receptors. 230. SERUM DISPOSITION OF LONG ACTING AMPICILLIN IN COWS AND BUFFALOES SOMKUMAR A. P., DESHPANDE D. A. AND RANADE V. V. Department of Pharmacology and Toxicology, Bombay Veterinary College, Parel, Mumbai - 400 012. India and
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Review: In a few areas of the UK support services for physically disabled young people have been organised on a multi-disciplinary basis rather than the usual uncoordinated expectation that the disabled will fit into the health system. This qualitative study was to find out whether this approach was worthwhile. The results are striking. The team approach increased the likelihood that disabled young people would participate in.
3. Endoscopic Procedures: Endoscopic procedures are those where a gastroscope, a long flexible tube of light fibres, optical fibres and other channels, is passed through the mouth, down the oesophagus and into the stomach. These procedures have not yet established a role in the treatment of obesity but there is plenty of effort seeking an effective method and
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3. Are all FDA approved generic drug products, including those which are not listed on the formulary, available to HealthChoice enrollees? No 4. Is FDA MedWatch form required for authorization of a Brand Medically Necessary BMN ; request? 4.0 THERAPEUTIC INTERCHANGE Yes.
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Compound Tetracycline Chloramphenicol Florfenicol Ampidillin Amoxicillin a clavulanic acid Cephalothin Ceftiofur Sulfonamide Trimethoprim Apramycin Gentamicin Neomycin Spectinomycin Streptomycin Ciprofloxacin Nalidixic acid Colistin % Resistant [95% Confidence interval] 20 0 0 [6.8-40.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [0.0-13.7] [21.1-61.3] [21.1-61.3] [0.0-13.7] 100 60.0 32.0 Distribution % ; of MICs 0.03 0.06 0.12.
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There are many prescribed methods of emergency postcoital contraception. The most commonly prescribed method consists of 2 doses of combined estrogen and progestin contraceptive pills taken within 72 hours of unprotected intercourse followed by 2 pills 12 hours later.64 For this method of ECPs, the dose depends on the oral contraceptive agent used Table 3 ; . The US Food and Drug Administration has indicated that the use of ECPs is safe and effective. Nausea is a likely side effect that may be relieved by the use of antiemetics. Pediatricians should inform adolescents that ECP is available in cases of emergency but should not be considered a substitute for ongoing contraception. The ECP has an efficacy of approximately 75% in, for instance, ampicillin dosage.
4.1. Emergence of resistance in coliforms II, III, IV ; An increase in ampicillin resistance multi-resistance ; was detected in all treatment groups but the resistance rate was significantly higher in the Amp Pla group than in the and
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GUIDANCE TO SURVEYORS LONG TERM CARE FACILITIES TAG NUMBER F496 Cont. REGULATION ii ; The individual can prove that he or she has recently successfully completed a training and competency evaluation program or competency evaluation program approved by the State and has not yet been included in the registry. Facilities must follow up to ensure that such an individual actually becomes registered. 6 ; Multi-State registry verification. Before allowing an individual to serve as a nurse aide, a facility must seek information from every State registry established under sections 1819 e ; 2 ; A ; 1919 e ; 2 ; A ; the Act the facility believes will include information on the individual. 7 ; Required retraining. If, since an individual's most recent completion of a training and competency evaluation program, there has been a continuous period of 24 consecutive months during none of which the individual provided nursing or nursing-related services for monetary compensation, the individual must complete a new training and competency evaluation program or a new competency evaluation program. Guidelines: 483.75 e ; 7 ; If individual does not wish to be retrained, the individual must establish that he or she performed nursing or nursing-related services for monetary compensation for at least one documented day i.e., 8 consecutive hours ; during the previous 24 months. The State is required to remove the individual's name from the registry if the services are not provided for monetary compensation during the 24-month period. Thus, in the absence of any evidence to the contrary, you can assume that the retraining requirement does not apply to an individual whose name appears on the registry. GUIDANCE TO SURVEYORS.
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All the 34 medicines on the core and supplementary list are on the essential medicines list 2003 edition ; . SN 1. Medicine Name Aciclovir Amitriptyline Amoxicillin 250mg Amoxicillin 500mg Ampiillin Cloxacillin 500mg Artesunate Atenolol Beclomethasone Captopril Carbamazepine Ceftriaxone Cimetidine Ciprofloxacin Clotrimazole Co-trimoxazole Diazepam Diclofenac sodium Dihydroartemisin Fluconazole 50mg Fluoxetine Fluphenazine decanoate Glibenclamide Hydrochlorothiazide Indinavir Ketoprofen Metformin Nevirapine Nifedipine Retard Omeprazole Phenytoin Pyrimethamine with sulfadoxine Ranitidine Salbutamol Zidovudine Essential medicines list all levels ; Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes.
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Table 3. Quantitative Results of Macrophages and Activated Myofibroblast Infiltration in the Infarct Zone as Well as Transforming Growth Factor- 1 in the Noninfarcted Regions of Left Ventricle Septum ; and RV in Rats After AMI.
Antibiotics are in consistent enough concentrations for resistance to evolve. "There's a lot of interesting things that they found, but what do they mean scientifically?" asks Tom Burkgren, Executive Director of the American Association of Swine Veterinarians. At the 1999 meeting of the American Society for Microbiology, research was presented that shows the extent to which antibiotic resistant bacteria is present in the environment. One researcher sampled waterborne bacteria from more than a dozen rivers in the U.S., including the Mississippi, Missouri, Ohio and Colorado. He tested the microbes' resistance to ampicillin, a synthetic penicillin. At each of the 21 sites examined, ampicillin failed to kill between 5 and 50 percent of the bacteria. Yet another study presented at the conference showed geese living yearround in Chicago's suburbs had bacteria in their feces that was resistant to streptomycin, erythromycin, vancomycin, tetracycline and penicillin-type drugs.
Ampicillin sulbactam Aztreonam Cefazolin Cefoxitin Ceftriaxone Fluconazole PO Metronidazole IV Piperacillin tazobactam Valacyclovir 3 grams IV q6h 1 gram IV q8h 1 gram IV q8h 2 grams IV q6h 1 gram IV q24h 100 mg PO q24h 500 mg IV q8h 3.375 grams IV q6h or 4.5 grams IV q8h 1 g PO q8h.
Infrastructure investments: Crisis services Childrens' school-based services Bed tracking system Evidence-based practices grants Address workforce shortages increase rates by 23.7% for psychiatrists and other critical mental health professionals Specialty populations grants Outcomes measurement County maintenance of effort Increase in county share for RTC placements.
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For the last five or six years, Government Medical College and Hospital Jammu has been receiving many patients of an unknown illness. The cases start as trickle in ending June, a trickle which soon turns into a deluge by ending August when about five or six patients are received everyday in the emergency wing. What is so dramatic is that all these are coming from Noushehra and adjoining areas of a district Rajouri in Jammu Province. By the time these patients come to Jammu, they have already received antimalarias and antibiotics like ampicillin, penicillin and ceftriaxone but without any effect at all. The cases have responded to doxycycyline and we have reasons to believe that these patients are suffering from endemic typhus. Recently, a 20-year old female was brought to the hospital with a history of fever of about a week's duration. The fever was high-grade and continuous. On the third day of illness, she started with facial puffiness and ankle swelling. The very next day, there was abdominal pain and metrorrhagia. By now, the patient had cough and was breathless even at rest. She was drowsy and had subconjuctival haemorrhage at the time of hospitalization. She also had tachycardia, tachypnoea, bilateral pedal oedema and facial puffiness. Jugular venous pressure was normal. She had bilateral crepitations. Haemoglobin of 8-g% with TLC of 5000 cubic mm; renal and liver function tests were normal; xray chest revealed pulmonary oedema; echocardiography.
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