Professor Jean-Louis Vanherweghem
Challenging patriarchal masculinities and promoting more transformative masculinities can seem as if it is a huge task symptoms endometriosis order exelon 6 mg line, beyond the ability of any one individual or any one organisation treatment of tuberculosis discount 6mg exelon overnight delivery. In a sense this is true symptoms 32 weeks pregnant order exelon 1.5 mg, because challenging patriarchal masculinities is about social change medications qt prolongation buy exelon in united states online. But social change also depends on people taking action in their own lives to make that change a reality, to be the change they want to see in the world. Before moving on to the next section, take a look at the table below and identify some actions that you think a man could take at each of the levels to help challenge patriarchal masculinities and promote more transformative masculinities. Then compare your answers to those that we have identifed, which have been adapted from the One Man Can Toolkit developed by Sonke Gender Justice in South Africa. Within Have the courage to look inward and ask himself: What kind of man do I want to be How much do I care about values of equality, dignity and respect for all people, irrespective of gender identity What kind of relationships do I want that will refect these values with my intimate partner, my children, my friends If a man suspects that a brother, friend, colleague, classmate or teammate is being abusive to women, what can he do Remind him of the damage his violence is doing to his partner, his children and to his relationship. Encourage him to seek professional help and follow up with him frequently to make sure the violence stops. With his intimate Talk to his partner openly and honestly and listen carefully to what they partner have to say. Open communication helps people to know what they want from each other, especially when it comes to sharing the tasks of taking care of the family as well as supporting each other. Gender-equitable men can be powerful role models for boys and other men in their community. Boys are watching how men relate to women to fgure out how they should relate to girls and women. So it is important for men to teach boys early, and teach them often, that there is no place for violence in a relationship. With his friends Stand up for his principles and resist the pressure from friends to act in ways that disrespect women or those people whose gender identity and/or sexual orientation do not conform to dominant social norms. If friends act in ways that devalue women or contribute to violence, it is important that men challenge them to think about what theyre saying or doing and not let them use cultural justifcations to excuse violent or abusive behaviour. One thing that men can do with their male friends is to promote the idea that a society with greater gender equality and less rigid roles for men will beneft men too. If it is hard for a man on his own to challenge patriarchal masculinities, it is important for men to support each other in doing so. Self-Learning Booklet: Understanding Masculinities and Violence Against Women and GirlsSelf-Learning Booklet: Understanding Masculinities and Violence Against Women and Girls 6161 With his work Get involved in efforts to make the workplace a safe and dignifed environment colleagues for everyone who works there, irrespective of gender identity. Workplaces continue to be places where women are often discriminated against, harassed and feel disrespected and unsafe. Men can play an important role in allying with women in efforts to create safe and dignifed workplaces, both in terms of working to change policies as well as challenging men to change their behaviour. In most societies, women still earn less than men for doing the same work and have fewer economic rights. A powerful way for men to be allies to women in struggles for greater gender equality is to support their very practical struggles for equal pay and rights. More and more men are getting directly involved community with local organisations that work to end violence against women and girls. It is important that men fnd out what is going on in their community, and lend their energies and skills to such efforts. This includes supporting efforts to work directly with boys and men on transformative masculinities. It can also include: writing newspaper articles or press releases; joining marches for gender equality; participating in protests saying no to violence against women; and helping to raise money for womens shelters and activist organisations demanding womens rights. Existing laws related to domestic and sexual working for social violence make it very clear in most societies that governments have an justice obligation to ensure safety for all and to arrest, prosecute and convict perpetrators of domestic and sexual violence. In most countries, the police and the criminal justice system are repeatedly failing victims of violence. It is essential that men get involved in taking action to demand that the government meet its obligations to safety and security. They can also help by accompanying survivors to court, helping them to access their human rights, and when necessary, putting pressure on the police and the courts. Before moving on to the next section, look the table below to learn more about key lessons that have been learned from such work. Be the change we want to see in the worldPrograms working on transformative masculinities are learning the importance of engaging men and boys in expressing their visions of what they want their personal relationships, family lives and community situation to be like, and then refecting on and committing to the changes they need to make in their own behaviours in order to make a contribution, however small, to turning this vision into reality. Get and give support One valuable lesson being learned is the importance of fostering supportive relationships and peer groups for boys and men who are trying to embrace and promote transformative masculinities. We need to work with others to make changes in our lives we cannot do it alone, especially when we are dealing with deeply entrenched ideas about and practices of masculinities and femininities. But in most societies, ideas about masculinity make it hard for men to ask for help or express their feelings, or support other men in dealing with such feelings. At the same time, men who are advocating for transformative masculinities can face a backlash from other men, and even some women, who want to preserve patriarchal masculinities. Being able to both seek and give support is an important part of men being able to deal with this backlash, challenge patriarchal masculinities and promote transformative masculinities. Strengthen our power to Programming with boys and men on transformative masculinities is also learning the importance of not simply providing men with information about masculinities and the benefts for all of more transformative masculinities. A critical focus of this work must also be on equipping men and boys with the skills and support they need to make change, both in their own personal lives and in the life of their community. Build our power with Challenging patriarchal masculinities can sometimes seem as if it is an overwhelming task. Hence the emphases on getting and giving support and the practical skills that men need to make changes in their lives. This is also why programming with boys and men on transformative masculinities has emphasized the need to work closely with organisations working on rights and empowerment for girls and women, in order to strengthen the collective power to make change. Self-Learning Booklet: Understanding Masculinities and Violence Against Women and GirlsSelf-Learning Booklet: Understanding Masculinities and Violence Against Women and Girls 6363 Be an ally In order to build such power with collaborations with women and girls, boys and men need to recognise the importance of girls and womens leadership in efforts to end the violence against them and secure full gender equality. Given that patriarchal masculinities rely on the belief in mens natural authority and leadership, it is essential that transformative masculinities work with boys and men seeks to strengthen the leadership of girls and women by focusing on the ways in which boys and men can be allies to women and girls, taking their lead on the actions that must be taken. Be accountable A key lesson being learned is the importance of challenging and supporting boys and men to be more accountable for the ways in which they continue to act on their male privilege. Because patriarchal ideas about masculinities and femininities are so deeply engrained in many societies, much of this privilege is barely noticed, especially by men themselves it is simply the way things are. Bringing mens attention to the ways that they are privileged by masculinity and the ways that they act on this privilege, and then helping them to change their behaviour so that they no longer reinforce male privilege, is a key part of strengthening work for gender equality by helping men be more accountable. The bigger picture what the international community is doing the international community has long been concerned with efforts to work with boys and men on challenging patriarchal masculinities. Transforming masculinities in practice On the ground, work with boys and men on transformative masculinities continues to be done across a range of sectors and sectors. This refects our understanding that for efforts to end violence against women and girls to be truly effective, they must involve multiple sectors that relate to the political, economic and social factors fuelling such violence and maintaining gender inequalities. Look below at the different sectors in which work is being done with men to promote more transformative masculinities. In the global South, male contraceptive methods account for 7 percent of use compared to 93 percent for female methods. In addition to availability, accessibility, and information regarding methods, cultural constructions of masculinity that emphasize fertility and male sexual pleasure and risk-taking signifcantly shape mens perceptions about and use of contraception methods, both female and male. While sexual and reproductive health, contraception, and related matters are still widely considered to be a womans concern, womens actual access to and use of services is still, in many ways, shaped by mens decision-making. At the individual and household levels, this is true where men control fnancial resources and womens mobility. At the societal level, in many settings, male politicians, cultural, and religious leaders with conservative agendas control girls and womens access to sexual and reproductive health services more broadly. Patriarchal masculinities also put mens own health at risk, as well as the health of their sexual partners. When masculinity is associated with sexual risk-taking and control over women, men may not use condoms, have more partners, and engage in more transactional sex.
In other words medicine dosage chart 1.5mg exelon for sale, stretch causes a temporary deformation of an axon that gradually returns to the original orientation and morphology even though internal damage might have been sustained (Smith et al medicine ketorolac order discount exelon on-line. Axons contain numerous microscopic elements including microtubules and neurofilaments (see medications via endotracheal tube order exelon 1.5 mg with amex. Microtubules are thick cytoskeletal fibers and con sist of long polar polymers constructed of protofilaments packed in a long tubular array treatment associates buy exelon 3mg visa. They are oriented longitudinally in relation to the axon and are associated with fast axonal transport (Schwartz 1991). Neurofilaments are essentially the bones of the axon and are the most abundant intracellular structural element in axons (Schwartz 1991). This initiates metabolic dysfunction and when acceleration/deceleration forces are sufficiently high, a progressive series of intracellular events will occur that result in damage to the cytoskeleton and microtubules (Christman et al. Various characteristics of neurons themselves appear to make them more sus ceptible to injury. Where axons change direction, enter target nuclei, or where they decussate, they can be more easily damaged (Adams et al. Injured axons are observed more often where a change in tissue density occurs, such as at the gray/white matter interface near cerebral cortex (Gentry et al. In summary, a single acceleration/deceleration event might result in (1) no apparent change in structure or function, (2) functional or metabolic change, (3) eventual structural change in the axon, or (4) frank separation of the axon into proximal and distal segments. Neuroimaging On neuroimaging, macroscopic abnormalities can be seen within the brain tissue or outside the brain, in what is often referred to as the extra-axial space. Within the brain, injuries include hemorrhagic contusions, non-hemorrhagic contusions, hem orrhagic or non-hemorrhagic shearing injuries, herniations, and cerebral edema. However, many of these patients experience ventricular dilation and reduced brain volume. This occurs gradually, following diffuse brain injury, as the result of neuronal loss. It can be illustrated more elegantly and precisely, however, using quantitative imaging methods. This can be readily identified, using quantitative imaging methods, in the corpus callosum (Adams et al. Those regions of the corpus callosum found to be most vulnerable are the genu and splenium (Huisman et al. Neurological and Neuropsychiatric Problems Moderate and severe traumatic brain injuries can result in temporary, prolonged, or permanent neurological or neuropsychiatric problems. Motor Impairments and Movement Disorders Motor impairments, such as paresis (weakness) or plegia (paralysis), sometimes occur following severe traumatic brain injury. Some patients experience spasticity (increased muscle tone and exaggerated reflexes), ataxia (loss of muscle coordination), or both. Post-traumatic movement disorders manifest by either slowness or poverty of move ment (hypokinesia) or by excessive involuntary movements (hyperkinesia). The two most common classifications of movement disorders are tremors and dystonias (see Krauss and Jankovic 2007 for a review). Tremor types include (1) resting (or rest tremor; seen when the body part is at rest), (2) postural (seen when holding a body part out, such as outstretched arms), and (3) kinetic (also referred to as an intention tremor; seen when moving a body part, such as during the finger-to-nose test). Dystonia is characterized by sustained muscle contractions that cause twisting or repetitive movements, and/or abnormal postures or positions. Moreover, dizziness is a common complaint in patients with traumatic brain injuries of all severities. It is a mistake to assume uncritically that difficulties with imbalance or dizziness are due to traumatically induced brain damage. This is because imbalance and dizziness can be related to multiple potential causes. For example, balance is related to the vestibular system, visual system, and the somatosensory and proprioceptive systems. Multiple ana tomical structures, peripheral pathways, and central interconnections are involved. Of course, direct damage to the brainstem or cerebellum can be a central cause for balance problems. Visual Impairments Visual impairments and ocular abnormalities can arise from orbital fractures; cornea, lens, or retinal injuries; cranial neuropathies; brain stem damage; or damage to subcortical or cortical regions involved with the visual system (see Kapoor and Ciuffreda 2005; Padula et al. Lange Cranial Nerve Impairments the cranial nerves provide motor and sensory innervation to the head and neck and can, of course, be damaged as a result of traumatic injuries to the head or brain. Damage to a cranial nerve can cause problems with olfaction, vision, hearing, balance, eye movements, facial sensation, facial movement, swallowing, tongue movements, and neck strength. Headaches Temporary or chronic headaches can occur following injuries to the neck, head, or both. Post-traumatic headaches are defined as new headaches that emerge within the first week post-injury. The most common types of headaches following injuries to the neck or head are: (1) muculoskeletal headaches (typically a cap-like discomfort), (2) cervicogenic headaches (typically unilateral sub-occipital head pain with secondary oculo-frontotemporal discomfort), (3) neuritic and neuralgic head pain. Headaches can also be associated with depression and psychological distress (Breslau et al. Sexual Dysfunction Changes in sexuality and sexual functioning are commonly reported by patients or spouses. Human sexuality is influenced by physical, cognitive, emotional, and social factors. Thus, traumatic injuries to the brain can lead to changes in sexuality and functioning through multiple mechanisms. Fatigue can interfere with cognitive functioning and a persons day-to-day activities. Fatigue and sleep disturbances can be related to traumatic brain damage, co-occurring depression, or both. However, chronic depression and late onset depression have been reported 3 years post-injury (14 and 10%, respectively, Hibbard et al. Compared to depression, the emergence of post-injury anxiety disorders is less common, though still problematic. Warden and colleagues followed 47 active-duty service members, who sustained moderate trau matic brain injuries, and who had neurogenic amnesia for the event. It is hypothesized that some injured people can experience some degree of fear conditioning even while in a state of post-traumatic amnesia or confusion. Moreover, they can reconstruct their traumatic experiences over time, with a combination of accurate and possibly inaccurate information, and this might intermingle with the original fear conditioning to perpetuate anxiety symptoms. Risk factors may include: (1) injuries to the left hemisphere, particularly the temporal and parietal lobes, (2) increased severity of brain injury, (3) closed head injury, as opposed to a penetrating head injury, (4) vulnerability and/or predisposition to psychosis. For example, dam age to the frontal lobes can result in impulsivity, emotional liability, socially inap propriate behaviors, apathy, decreased spontaneity, lack of interest, or emotional blunting. Damage to the temporal lobes can result in episodic hyper-irritability, aggressive outbursts, or dysphoric mood states (Lucas 1998). However, personality changes can also manifest as a consequence of individuals reactions to their injury as they experience cognitive and behavioral deficits and major changes in their lifestyle. Depression, anxiety, irritability, restlessness, low frustration tolerance, and apathy are common in this regard (OShanick and OShanick 2005). Personality changes typically manifest as a consequence of a complex interaction between the direct consequences of the brain injury and secondary reactions to impairment or loss (Lezak et al. Lack of awareness tends to be function specific, in which some deficits may be accurately assessed by the patient. In general, patients tend to underestimate the severity of their cognitive and behavioral impairments when compared to ratings of family members. In addition, although many patients tend to exhibit some awareness of cognitive and speech deficits, they are less likely to report changes in personality and behavior. Lack of awareness has been described using the following neurologic and psychodynamic terminology: (1) Agnosia: Impaired recognition of previously meaningful stimuli that cannot be attributed to primary sensory defects, attentional disturbances, or a naming disorder; (2) Anosognosia: A lack of knowledge, or unawareness of cognitive, linguistic, sensory, and motor deficits following neuro logical assault; (3) Anosodiaphoria: Lack of concern for serious neurological impairments, without denying their existence; (4) Denial of Insight: A psychological explanation to account for symptoms of anosognosia. Patients with anosognosia are thought to be motivated to block distressing symptoms from awareness by using a defense mechanism (denial); and (5) Lack of Insight: A multidimensional construct that describes a spectrum of concepts, ranging from a psychological defense mechanism to lack of cognitive skills that permit understanding of deficits (Flashman et al. We believe that in most cases involving severe traumatic brain injury, the underlying cause of the lack of awareness is neurological not psychological. Lange Functional and Neuropsychological Outcome All aspects of recovery and outcome are affected by injury severity. Order discount exelon line. What Your Lip Color Says About Your Health.
With this considerable overlap symptoms uterine fibroids generic 4.5mg exelon amex, one might expect in any randomly chosen male and female pair that the woman would run a good chance of being taller than the man medicine daughter lyrics exelon 6mg online. In actuality treatment quadricep strain cheap exelon online, among heterosexual couples medications made from plants cheap exelon 4.5 mg free shipping, one only occasionally sees such a combination, because height is a significant factor in peoples choice of a heterosexual mate. Not only do people mate so as to keep him taller than her, they also see him as taller than her even when this is not the case. Biernat, Manis, and Nelson 1991 (cited in Valian 1998) presented college students with photos of people and asked them to guess the peoples height. Each photo had a reference item like a doorway or a desk, making it possible to compare the heights of people across photos. Although photos of a male of a given height were matched by photos of a female of the same height (and vice versa), the judges saw the males as taller than they actually were and the females as shorter than they actually were. While we recognize that biology imposes certain physiological constraints on the average male and female, we treat the elaboration and magnification of these differences and the erasure of differences among males and among females as entirely social. This does not mean that individuals are helpless pawns shaped by external social forces: the social emerges as individuals develop their own perspectives, react to others, and interpret others reactions to them. Nor does it mean that someones gender identity (or sexual orientation) can just be freely chosen. They may have certain understandings of the implications for gender of biological and medical science. All we ask of our readers is that they open-mindedly consider the evidence and arguments we advance. Our own thinking about gender has developed and changed over many years of thinking about these issues, and it will undoubtedly continue to change as we continue to explore gender issues in our research and in our lives. As we understand that perspective, the basic capabilities, rights, and responsibilities of women and men are far less different than is commonly thought. At the same time, that perspective also suggests that the social treatment of women and men, and thus their experiences and their own and others expectations for them, is far more different than is usually assumed. In this book we offer evidence that these differences in what happens to women and to men derive in considerable measure from peoples mutually developed beliefs about sexual difference, their interpretations of its significance, and their reliance on those beliefs and interpretations to justify the unequal treatment of women and men. And the ritual announcement at birth that it is in fact one or the other instantly transforms an it into 6 a he or a she (Butler 1993), standardly assigning it to a lifetime as a male or as a female. This attribution is further made public and lasting through the linguistic event of naming. In some times and places, the state or religious institutions disallow sex-ambiguous given names. Finland, for example, has lists of legitimate female and legitimate male names that must be consulted before the babys name becomes official. For example, Evelyn was available as a male name in Britain long after it had become an exclusively female name in America, and Whitney, once exclusively a surname or a male first name in America, is now bestowed on baby girls. But these changes do nothing to mitigate the fact that English names are gendered. Either way, the sex of the child is frequently as great a preoccupation as its health. These early linguistic acts set up a baby for life, launching a gradual process of learning to be a boy or a girl, a man or a woman, and to see all others as boys or girls, men or women as well. In the beginning, adults will do the childs gender work, treating it as a boy or as a girl, and interpreting its every move as that of a boy or of a girl. Then over the years, the child will learn to take over its part of the process, doing its own gender work and learning to support the gender work of others. At birth, many hospital nurseries provide pink caps for girls and blue caps for boys, or in other ways provide some visual sign of the sex that has been assigned to the baby. While this may seem quite natural to members of the society, in fact this color coding points out no difference that has any bearing on the medical treatment of the infants. You are unlikely to buy overalls with vehicles printed on them for a girl, and even more reluctant to buy a frilly dress with puffed sleeves or pink flowered overalls for a boy. And if youre buying clothing for a baby whose sex you do not know, sales people are likely to counsel you to stick with something thats plain yellow or green or white. Colors are so integral to our way of thinking about gender that gender attributions have bled into our view of the colors, so that people tend to believe that pink is a more delicate color than blue (and not just any blue, but baby blue). This is a prime example of the naturalization of what is in fact an arbitrary sign. In America in the late nineteenth and early twentieth centuries, Anne Fausto-Sterling (2000) reports, blue was favored for girls and bright pink for boys. If gender flowed naturally from sex, one might expect the world to sit back and simply allow the baby to become male or female. But in fact, sex determination sets the stage for a lifelong process of gendering, as the child becomes, and learns how to be, male or female. Names and clothing are just a small part of the symbolic resources used to support a consistent ongoing gender attribution even when children are clothed. That we can speak of a child growing up as a girl or as a boy suggests that initial sex attribution is far more than just a simple observation of a physical characteristic. Being a girl or being a boy is not a stable state but an ongoing accomplishment, something that is actively done both by the individual so categorized and by those who interact with it in the various communities to which it belongs. The newborn initially depends on others to do its gender, and they come through in many different ways, not just as individuals but as part of socially structured communities that link individuals to social institutions and cultural ideologies. Indeed, we do not know how to interact with another human being (or often members of other species), or how to judge them and talk about them, unless we can attribute a gender to them. Gender is so deeply engrained in our social practice, in our understanding of ourselves and of others, that we almost cannot put one foot in front of the other without taking gender into consideration. People even, it seems, apply gender stereotypes to computer-generated speech depending on whether they perceive the computers voice as male or female (Nass et al 1997). From infancy, male and female children are interpreted differently, and interacted with differently. Experimental evidence suggests that adults perceptions of babies are affected by their beliefs about the babies sex. Condry and Condry (1976) found that adults watching a film of a crying infant were more likely to hear the cry as angry if they believed the infant was a boy, and as plaintive or fearful if they believed the infant was a girl. In a similar experiment, adults judged a 24-hour-old baby as bigger if they believed it to be a boy, and finer-featured if they believed it to be a girl (Rubin, Provenzano and Luria 1974). Such judgments then enter into the way people interact with infants and small children. People handle infants more gently when they believe them to be female, more playfully when they believe them to be male. Parents use more diminutives (kitty, doggie) when speaking to girls than to boys (Gleason et al. Perhaps, one might suggest, the boys need more prohibitions because they tend to misbehave more than the girls. But Bellinger and Gleason found this pattern to be independent of the actual nature of the childrens activity, suggesting that the adults and their beliefs about sex difference are far more important here than the childrens behavior. Apparently, male and female infants cry the same amount (Maccoby and Jacklin 1974), but as they mature, boys cry less and less.
These are excreted in an inactive form into bile and to a lesser extent into urine (<1% is in urine in an unchanged form) medicine 8 discogs purchase exelon 6 mg. Although the M-5 part of the metabolism is by cytochrome P450 3A4 (of which micafungin is a weak inhibitor) medicine ball abs buy exelon 1.5mg, this is fairly minor medications and side effects discount 4.5 mg exelon mastercard, and few drug interactions are described medicine allergies exelon 3 mg for sale. Clearance in the newborn and premature infants is faster than in older children and adults, and it is believe that age-dependent serum protein binding of micafungin might be responsible for its higher clearance. Side effects include disturbances of liver enzymes, hypokalaemia, hyperbiliru binaemia and hypertension; however, all are rare even at doses up to 15 mg/kg. Drug interactions Micafungin increases plasma concentration of amphotericin, itraconazole and nifedipine. Treatment is continued for at least 7 days after the neutrophil count reaches the desirable range. Supply and administration Micafungin comes as a powder ready for reconstitution in 50 mg vials that cost 196 each. For accurate low-dose administration, further dilute the resultant solution to a concentration of 0. The pharmacokinetics and pharmacodynamics of micafungin in experimental hematogenous Candida meningoencephalitis: implications for echinocandin therapy in neonates. Higher clearance of micafungin in neonates compared with adults: role of age-dependent micafungin serum binding. There is good controlled trial evidence that miconazole is better than nystatin at eliminating oral thrush. Pharmacology Miconazole is an artificial imidazole agent first developed in 1969 which is active against a wide range of pathogenic yeasts and dermatophytes, as well as a range of Gram-positive bacteria (staphylococci and streptococci). These properties make it particularly useful in the treatment of oral and vaginal thrush, candida nappy rash, intertrigo, paronychia, ringworm and athletes foot. It works by interfering with ergosterol synthesis, damaging fungal cell wall permeability. It is moderately well absorbed when given by mouth (unlike nystatin) and then inactivated by the liver before excretion in the urine, but much of any oral dose is excreted unchanged in the stool. It was, for some years, given by intravenous injection or by mouth in the treatment of a range of systemic fungal infections but is now only used topically to treat infection of the skin, gut or mucous membranes. Miconazole seems to eliminate vaginal candidiasis in pregnancy better than nystatin, and while it is systemically absorbed in very small amounts after vaginal applica tion, there is no evidence that topical use by the mother during pregnancy or lactation poses any hazard to the baby at least when used properly. Candida dermatitis Candida can be found in the vagina of a quarter of pregnant women, and a fifth of their babies become colonised at birth, and more over the next month. Candida proliferates in moist skin, but overt infection is seldom seen except in babies with excessive intestinal colonisation. It is not surprising, therefore, that overt skin damage (dermatitis) usually starts in the perianal region, especially if the skin is already damaged. Prior prolonged and broad-spectrum antibiotic use makes overt infection more likely. Use of gentian violet Gentian violet (also known as crystal violet), a triarylmethane antiseptic dye, is an old-fashioned treatment for Candida infection of the skin that is also active against a range of Gram-positive organisms including staphylococci. While it is effective despite its alarming colour, it is no longer used in the United Kingdom (especially on broken skin or mucous membranes) because of theoretical concern about carcinogenicity in mice. Drug interactions the combination of oral miconazole and cisapride (now withdrawn) carried a high risk of arrhythmia. Oral miconazole can affect the anticoagulant effect of warfarin and increase the serum concentrations of carbamazepine and phenytoin. Candida (Monilia) dermatitis: Use miconazole nitrate as a cream twice a day for at least 10 days, even if the rash improves quickly. It may be advisable to treat the gastrointestinal tract as well as the skin if there is evidence of stubborn infection (and nystatin may be better at eradicating Candida from the lower bowel). A 15 g tube of sugar-free oral gel (24mg/ml) costs 3 and is also available in the United Kingdom without prescription. The manufacturer does not recommend use in babies less than 4 months old because excessive Continued on p. The cream and a dusting powder are also available over the counter without prescription. Avoid the use of alcoholic solutions and solutions that are more concentrated than this, especially when treating the mouth and tongue. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Prophylactic miconazole oral gel for the prevention of neonatal fungal rectal colonization and systemic infection. Pharmacology Midazolam hydrochloride is a short-acting benzodiazepine with hypnotic, anxiolytic, muscle relaxant and anticonvulsant activity. Bioavailability is about 35% when given as a syrup and 50% when absorbed through the nasal or buccal mucosa. Additionally, the main metabolite, 1-hydroxymethyl midazolam, which is also pharmacologically active, is eliminated through the kidney; thus, while the half-life is only 2 hours in adults, it is 12 hours in the neonate. The manufacturer does not recommend use as a sedative in any child <6 months old, and the Cochrane overview found inadequate evi dence to support neonatal use. Maternal use during the third trimester of pregnancy or during labour may cause neonatal withdrawal or the infant to be hypotonic. However, the drugs rapid clearance means that very little appears in breast milk. Midazolam pharmacokinetics during therapeutic hypothermia have not been established, but as the drug is metabolised extensively by hepatic cytochromes P450 3A4 and 3A5, the half-life is likely to be extended further in cooled infants. Treatment Short-term sedation: A 500micrograms/kg dose by mouth is often used to premedicate chil dren prior to anaesthesia. Continuous sedation: Some units give 60micrograms/kg/hour to sedate the ventilated baby, but this strategy is now increasingly questioned. The rate of infusion must be halved after 24 hours in babies of <32 weeks postmenstrual age to prevent drug accumulation. However, 300 micrograms/kg of the buccal preparation given into the nose or under the tongue will usually achieve this just as quickly (and this can be done outside hospital). Antidote All benzodiazepines cause hypotonia, hypotension and coma in excess, but these effects can be reversed by flumazenil, a competitive antagonist with a relatively short (50minute) half-life. Withdrawal symptoms in critically ill children after long term administration of sedatives and or analgesics: a first evaluation. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Comparison of continuous drip of midazolam or lidocaine in the treatment of intractable neonatal seizures. Therapeutic options include dietary interventions (smaller, more fre quent feeds), positioning (elevating the head of the cot), drugs and, in extreme cases, surgery. Thickened formulae are increasingly being used to treat infants with reflux, driven in large part by the baby food industry. There is no good evidence, as yet, that this approach is of any value in reducing the apnoeic episodes attributed to reflux in the preterm baby. In some babies, it is important to exclude and treat cows milk protein allergy as the cause of the reflux (see web commentary). Milk thickeners A number of thickeners, designed to be added to the milk at the point of use, are available; rice cereal (more popular in North America), carob bean gum, carob seed flour, starches and sodium carboxymethylcellulose are often used. Care must also be taken to ensure that any products used are designed for use in babies and not older children. Carob seed flour is a galactomannan refined from the seeds of the carob (or locust) bean tree, Ceratonia siliqua. |
