2011년 11월 1일 화요일

No responsibility for da Vinci error

U.S Court of Appeals dismiss charges that a software failure of the da Vinci might have caused post-operation complications of a patient in Philadelphia.
"A federal appeals court clears Intuitive Surgical Inc. in a case involving a malfunction of one of its da Vinci surgical robots during a prostatectomy.
A federal appeals court cleared Intuitive Surgical Inc. (NSDQ:ISRG) of any liability in a lawsuit alleging that one of its malfunctioning da Vinci surgical robots caused a Pennsylvania man's erectile viagra cialis online pharmacy pharmacy.
Roland Mracek sued Intuitive after undergoing a prostatectomy at Bryn Mawr hospital in June 2005. During the surgery, the da Vinci robot went on the fritz and displayed error messages; after his surgical team and an Intuitive rep couldn't make the robot work, surgeons performed a traditional laparoscopic prostatectomy, according to court documents. A week later Mracek suffered an episode of gross hematuria (visible blood in the urine) and later developed severe groin pain and erectile dysfunction.
The U.S Court of Appeals for the Third Circuit's three-judge panel upheld the U.S. District Court for Eastern Pennsylvania's March 2009 decision that Mracek failed to prove that the robot's malfunction caused his injury. (Read more)"

More about da Vinci failures.

Source: Mass Device
Illustration is from a previous case: Koliakos (2008)

2011년 10월 29일 토요일

Tablets dosage form|standards for different types of tablets dosage form advantages and disadvantage|Quality control limits for all types of tablets

|standards for different types of online pharmacy dosage form advantages and disadvantage|Quality control limits for all types of tablets

Tablets dosage form what is tablet standards for different types of tablets dosage formQuality control limits for all types of tablets dosage form
TABLETS
Tablet dosage forms is a dosage form in solid form ,each tablet consists of a unit dose of one or more active ingredients medicament . Tablets dosage form is intended for oral administration. where as some tablets are swallowed whole or after being chewed, some are dissolved dispersed in water before taken internaly, and some are retained in the mouth where the active ingredient is liberated
eg. Glyceryl trinitrate Sublingual tablets which is given in emergency for angina pectoris .
Drugs which are intended for administration by other routes, for example, in the form of implants and pessaries, may also be presented in the form of tablets these formulations may require special formulations, method of manufacture or form of presentation appropriate to the particular use they may not comply with all the requirements of official monograph of tablets.
Tablets are manufactured by method of compression of uniform volumes of powders or granules by compressing under high pressures and using punches and dies punches and dies requires special treatments to bare the pressure . The granules to be compressed contains of one or more medicaments, with or without excipients , substances such as diluents, binders, disintegrating agents, lubricants, glidants and substances capable of modifying the behaviour of the medicaments in the digestive tract. Such substances must be innocuous and therapeutically inert in the quantities present.
Because of their composition, method of manufacture and intended use, tablets present a variety of characteristics and consequently there are several categories of tablets.
Unless otherwise stated in the individual monograph of respective pharmacopoea , tablets are uncoated. Where coating is permitted the monograph states "The tablets may be coated". Where the monograph directs coating the statement reads "The tablets are coated". Unless otherwise directed, tablets may be coated in one of different ways.
General characteristics of Tablets dosage form : Tablets are usually solid, circular cylinders, the end surfaces of which are flat or convex and the edges of which may be bevelled. Tablets dosage form may exist in other shapes like triangular, rectangular, etc also. Tablets dosage form may have lines or break-marks and may bear a symbol or other markings. Tablets dosage form are sufficiently hard to withstand handling without crumbling or breaking.
Uncoated Tablets dosage form: Uncoated tablets may be single layer tablets resulting from a single compression of granules or multi-layer tablets consisting of parallel layers obtained by successive compression of granules of different compositions colour. No treatment is applied to such Tablets dosage form after compression. Any added substances are not specifically intended to modify the release of their active ingredient(s) in the digestive fluids.
The addition of colouring or flavouring agents to uncoated tablets other than multi-layer tablets is not official unless permitted in the individual monograph. Uncoated Tablets dosage form have the general characteristics of tablets. When a broken section of an uncoated tablet is examined under a lens, either a relatively uniform texture (single-layer tablets) or a stratified structure (multi-layer tablets) is seen; there are no signs of coating.
Coated Tablets dosage form: Coated tablets are tablets covered with one or more layers of mixtures of various substances such as resins, gums, inactive and insoluble fillers, sugars, plasticisers, polyhydric alcohols, waxes,. Coating may also contain medicaments. In compression-coated tablets, the coating is applied by compressing around the tablets granules prepared from tablet excipients such as lactose, calcium phosphate, etc. Substances used as coatings are usually applied as a solution or suspension in conditions in which evaporation of the vehicle takes palce. When the coating is thin, the tablets are described as film-coated.
Coated Tablets dosage form may contain flavouring and or one or more colouring agents permitted under the Drugs and Cosmetics Rules,
Coated tablets have a smooth, usually polished and often coloured, surface; a broken section examined under a lens shows a core surrounded by one or more continuous layers of a different texture.
Enteric-coated Tablets dosage form: Enteric-coated tablets (Gastric-resistant tablets) are tablets covered with one or more layers of coatings intended to resist the gastric fluid but to release their active ingredients in the intestinal fluid. For this purpose substances such as cellulose acetate phthalate and anionic copolymers of methacrylic acid and its ethers are used for providing tablets with a gastric-resistant coating or for covering either granules or particles with gastric-resistant coating.
Enteric-coated tablets have the characteristics of Coated Tablets dosage form.
eg-Diclofenac sodim tablets
Diclofenac sodium is a acidic drug and is better absorbed through lower inestine so it has to be formulaed as enteric coated tablets.
Dispersible Tablets dosage form: Dispersible tablets are uncoated tablets that produce a uniform dispersion in water and may contain permitted colouring matter and flavouring agents.
However addition of saccharin or its salts is not permitted in the preparation meant for paediatric use
Modified-release Tablets dosage form: Modified-release tablets (Sustained-release tablets) are coated or uncoated tablets containing auxiliary substances or prepared by procedures that, separately or together, are designed to modify the rate or the place at which the active ingredient is released.
Soluble Tablets dosage form: Soluble tablets are uncoated tablets that dissolve in water. The solution produced may be slightly opalescent due to added substances used in the manufacture of the tablets.
Effervescent Tablets dosage form: Effervescent tablets are uncoated tablets generally containing acidic substances and either carbonates or bicarbonates which react rapidly in the presence of water to release carbon dioxide. They are intended to be dissolved or dispersed in water before administration.
Tablets dosage form for Use in the Mouth: Tablets for use in the mouth are usually uncoated tablets formulated to be chewed or to effect a slow release and local action of the active ingredient (lozenges) or the release and absorption of the active ingredient under the tongue (sublingual tablets). Chewable tablets and lozenges may contain flavouring agents
eg.Drugs which are requred to give effect in mouth , lozenges for mouth ulcers ,deodarant

WHAT ARE THE BASIC STANDARD REQUIREMENTS OF TABLET DOSAGE FORM

Uniformity of container contents for tablets dosage form:
Tablets comply with the test for contents of packaged dosage forms, content of active ingredients: Determine the amount of active ingredient(s) by the method described in the Assay and calculate the amount of active ingredient(s) per tablet. The result lies within the range for the content of active ingredient(s) stated in the monograph. This range is based on the requirement that 20 tablets, or such other number as may be indicated in the monograph, are used in the Assay. Where 20 tablets cannot be obtained, a smaller number, which must not be less than 5, may be used, but to allow for sampling errors the tolerances are widened in accordance standards in pharmacopoea . The requirements of standards in pharmacopoea apply when the stated limits are between 90 and 110%. For limits other than 90 to 110%, proportionately smaller or larger allowances should be made.
Uniformity of weight of tablets: This test is not applicable to coated tablets other than film-coated tablets and to tablets that are required to comply with the test for uniformity of content for all active ingredients.
Weigh 20 tablets selected at random and calculate the average weight. Not more than two of the individual weights deviate from the average weight by more than the percentage shown in Table 2 and none deviates by more than twice that percentage.
weight variation limits
Average weight of tablet =Percentage deviation
80 mg or less =10 %
More than 80 mg but less then 250 mg= 7.5 %
250 mg or more =5 %

Uniformity of content of tablets : This test is applicable to tablets that contain less than 10 mg or less than 10% w/w of active ingredient. For tablets containing more than one active ingredient carry out the test for each active ingredient that corresponds to the aforementioned conditions.
The test for Uniformity of content should be carried out only after the content of active ingredient(s) in a pooled sample of the tablets has been shown to be within accepted limits of the stated content.
The test for Uniformity of content is not applicable to tablets containing multivitamins and trace elements.
Determine the content of active ingredient(s) in each of 10 tablets taken at random using the method given in the monograph or by any other suitable analytical method. The tablets comply with the test if not more than one of the individual values thus obtained is outside the limits 85 to 115% of the average value and none is outside the limits 75 to 125% of the average value. If two or three of the individual values are outside the limits 85 to 115% of the average value and none is outside the limits 75 to 125%, repeat the determination using another 20 tablets. The tablets comply with the test if in the total sample of 30 tablets not more than three of the individual values are outside the limits 85 to 115% and none is outside the limits 75 to 125% of the average value.
Disintegration test for Tablets dosage form: This test is not applicable to modified-release tablets and tablets for use in the mouth. For those tablets for which the dissolution test for tablets and capsules, is included in the individual monograph, the test for Disintegration is not required.
Uncoated Tablets: Comply with the disintegration test for tablets and capsules,. Unless otherwise directed in the individual monograph, use water as the medium and add a disc to each tube. Operate the apparatus for 15 minutes unless otherwise directed.
Coated Tablets: Comply with the disintegration test for tablets and capsules,. Unless otherwise directed in the individual monograph, use water as the medium and add a disc to each tube. Operate the apparatus for 30 minutes for film-coated tablets and for 60 minutes for other coated tablets unless otherwise directed in the individual monograph. For coated tablets other than film-coated tablets, if any of the tablets have not disintegrated, repeat the test on a further 6 tablets, replacing the water in the vessel with 0.1M hydrochloric acid. The tablets comply with the test if all 6 tablets have disintegrated in the acid medium.
Enteric-coated Tablets: Comply with the disintegration test for tablets and capsules,. If the tablet has a soluble external coating, immerse the basket in water at room temperature for 5 minutes. Suspend the assembly in the beaker containing 0.1M hydrochloric acid and operate without the discs for 120 minutes, unless otherwise stated in the individual monograph. Remove the assembly from the liquid. No tablet shows signs of cracks that would allow the escape of the contents of disintegration, apart from fragments of coating. Replace the liquid in the beaker with mixed phosphate buffer pH 6.8, add a disc to each tube and operate the apparatus for a further 60 minutes. Remove the assembly from the liquid. The tablets pass the test if all six have disintegrated.
Dispersible and Soluble Tablets: Disintegrate within 3 minutes when examined by the disintegration test for tablets and capsules, using water at 24o to 26o, unless otherwise stated in the individual monograph.
Effervescent Tablets: Place one tablet in a 250-ml beaker containing water at 20o to 30o; numerous gas bubbles are evolved. When the evolution of gas around the tablet or its fragments has ceased the tablet shall have disintegrated, being either dissolved or dispersed in the water so that no agglomerates of particles remain. Repeat the operation on a further 5 tablets. The tablets comply with the test if each of the 6 tablets disintegrates in the manner prescribed within 5 minutes, unless otherwise stated in the individual monograph.
Uniformity of dispersion of tablets : This test is applicable only to Dispersible Tablets.Place 2 tablets in 100 ml of water and stir gently until completely dispersed. A smooth dispersion is obtained which passes through a sieve screen with a nominal mesh aperture of 710 m m (sieve number 22).
tablets dosage form advantages and disadvantages
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2011년 5월 3일 화요일

TESTIMONIALS ABOUT "VITALITY"

REAL PEOPLE, REAL RESULTS...
Testimonials of people using ageLOC VITALITY.


"I am a professor of medicine currently lecturing. Here is what I have experienced.

DAY 1 - My first day on vitality was Thurs..... nothing happened.... thinking I'll give it a few days for the benefit of the doubt.... prob BS tho! (skeptical science brain)

DAY 2 (fri) again nothing..... what a hoax... biggest mass market placebo known to mankind..... def Bull S%$# !!

DAY 3 (y'day) Holllleeeeeeeeeee s%$#. Who turned on the genes???? What the frig happened over night? I wake up this morning and feel like running a marathon.. in all my 28 years in medicine and science I've never known or experienced anything like this...!!!" t
Dr. Andy Stuart, BPhEd, BEd, BSc, MSc,PhD
Auckland, New Zealand
********************

"I wanted to share one more thing about this morning that I thought was incredible. I just got race results for a 5k that I ran this morning. (3.2 miles). The last 5k I ran was about 29 minutes race time. That's about average, I ran hard. 9 - 11 minute miles are my thing, I'm not a big runner.

This morning I finished 16th overall, my time was 23:47, I ran 7:40 miles! Let me say that again...I ran 7 minute miles!?!? That's unbelievable for me! When I was in my young 20's I wasn't this fast.

My brother trains for Triathlons and he asked me if I've been doing speed training drills...
I said, NO! I'm not even training, I walk and use an elliptical machine. I added Vitality to my supplements.

The only thing I can attribute to this is Vitality. The only reason I even ran this particular race was out of respect for Fallen Officers and Ashley's entire family are officers from SWAT to Forensics so it was a family event. We ALL dropped one in our drawers today!"

Jason Tropf
Tampa, Florida USA
********************

"Gidday Jeff, I know your probably getting plenty of these e-mails. But just in case, I wanted to share what's been happening for us.

First I noticed with Clare, was how calm she was at airport when flying back from Sydney Monday night.. And that was day 2.. Flying with a 6 month old baby is never easy..
Then as this week has progressed for me it is 4 big things.. Sleep, Energy, food and coffee intake.
I am sleeping like a baby and wake full of energy. Normally I am still asleep when Clare goes to work 7am. Not this week, up and enjoying the early mornings.
Next is coffee. I normally have 4-5 cups a day. Today I had one with breakfast and that's it. Brilliant.
Lastly no cravings for snacks. Just 3 meals a day and all is good.

And Clare is noticing lots as well. But I will let her share in her own time. And loving sharing this with family and friends. My mum (66) and sister today started on Vitality."

Marty Baker, New Zealand Fire Service
Auckland, New Zealand
********************

"I was diagnosed with MS over 20 years ago and have experienced various challenges on the left side of my body, eyesight issues, bowel and bladder control issues. Previously, the most successful treatment I have received is live cell treatment in Germany which is also an anti-aging treatment.

A few months ago I was struggling and felt I needed to repeat the live cell treatment but did not go to Germany. I have been taking Vitality for 4 weeks and am experiencing the same positive benefits of the live cell treatment!

I have not had the pain and burning I was experiencing on my left side since the 2nd week of taking Vitality. I have also experienced a sense of calm in previously uncomfortable situations (claustrophobia) and an overall emotionally balanced feeling while sleeping better than I have in years!"

Liz Young
Clearwater, FL
********************

"I have been on Vitality for 3 weeks. The first thing I noticed was that my stamina increased and my vision became very sharp and clear. I have MS, multiple sclerosis, and fatigue can be a very big problem. I have more energy than I have ever had and am able to workout longer and harder with my trainers. They are very impressed with my strength and endurance. The most significant result is in my right leg and right hand. I have not been able to hold with or use my right hand in 7 years and now I am using it more and am actually able to hold objects! My walking has also improved. Overall, I am feeling great."

Becky B.
Toronto, Canada
********************

"In the fall of 2007, I was stricken with Rheumatoid Arthritis, an autoimmune disease that attacks your joints. Joints become inflamed and swollen, leaving you helpless and in extreme pain.

I was prescribed Methotrexate and Prednisone. I was up to 7 Methotrexate (it is prescribed to treat some Cancers), each week and 15 mg of Prednisone (is a steroid), per day along with a couple other temporary drugs. Due to the severe side effects, I have to have blood tests done every 6 weeks to check for damage to other organs. My liver soon became a problem on a regular basis. I tried repeatedly to wean myself off the Prednisone and sometimes got down to only 2 mg per day, but the throbbing pain in my joints and stiffness to walk when I first awaken or had been sitting for a long time would return, so I would go back to 5 mg per day to keep the pain away.

So, just before you introduced me to Vitality, I had taken it upon myself to stop the Methotrexate. I seemed to have no adverse reactions from going without. However, knowing how dangerous long term use of the Prednisone was, it does wonders for the pain and did not see myself ever being able to do without it.

I took my normal dose of Prednisone on Friday, October 8th. I received my order of Vitality on that day also and took my first dose (6 first thing in the mornings) on Saturday, October 9th. I felt so energized I actually forgot to take any meds and didn't even eat until that evening. I realized the next day, I had forgotten to take my Prednisone, but I would usually start experiencing the pain within 24 hours of not taking it. So, I felt so fabulous, I thought I would do an experiment and see how long I could go without the Prednisone.

You've probably guessed my now; I have been 10 days without it!!!! Will it last? I don't know yet, but in the last 3 years, I have NEVER been able to go more than 24 hours without it. I did one day do some heavy work and that evening, my wrists were aching, but I took a couple of Ibuprophen before I went to bed and was fine the next morning. This is a medical miracle for me as I never imagined myself ever being able to avoid the pain without it. And with the energy I have now, I can move around a lot more and feel like doing more things. This has resulted in losing 4 lbs, which I desperately need to loose a lot more weight for health reasons.

And setting all that aside, I started the first 5 days, saying how "Good" I feel, but have changed it to how "Young" I feel. I feel like I did before I got RA, before I gained all this weight. Like I have never been sick! Thank you Nu Skin for bringing such a wonderful product to the table and Thank you Martha for sending me that email. I sincerely hope this will be everlasting and become an alternative to the millions of other people with RA."
Respectfully,

Carla Morrison
Arizona
********************

"I would like to share with you my personal experience after using Vitality for 7 days. I'm very happy to report that many other male trial participants have also experienced similar results.

I am 67 years old and have had prostate cancer so many physical areas of my life have been significantly affected over the years. About one year ago, against my doctors advice, I started taking order cialis daily and in the beginning the results were excellent. With my doctor's concern about the long term health risks related to this product, I stopped taking it about five months ago. When I was asked to be a trial participant for Vitality I was excited to try it. I was pleasantly surprised that the third day on Vitality I was experiencing results that at least matched what I had experienced with cialis. The good news is that this is not a prescription drug, has no known health risks and is very affordable.

My doctor tells me that neither Viagra or Cialis work for everyone and different people have different results, so I don't know if Vitality will be this effective for everyone, but for me and others it has given very positive and exciting results!"

Norm Dell
Arizona, USA
********************

"This is now day 8 for me on our new ageLoc Vitality product. I started a day after Norm because our label clearly states to consult your physician if pregnant, lactating or taking a prescription. I fit into the latter category. I have been on 3 prescriptions for 1 ½ years after being diagnosed with heart problems. I called my physician and left a message. I called my pharmacist. He requested the ingredient list so he could research it.

The label ingredients include:
Cordyceps Cs-4 Mushroom Mycelia (cordyceps sinersis (Berk) Sacc.)
Pomegranate (Hunica granatum)
Fruit Extracts, Pharmanex Asian Ginseng Rb 1 (Panax ginseng) Root Extract

My pharmacist called back and said he could see no conflict between the product and my prescriptions. My heart physician called back the next day and expressed no concern and gave me the go ahead.

For anyone on a prescription drug you will realize that over time you often feel your cognitive thinking becoming slower and a bit foggy. It's like looking through a dirty window. On my 3rd day I felt not only more energy but my thinking was clearer, as if I were looking through a squeaky clean window. I have not experienced the usual 4:00 p.m. drowsiness and feel more alert when I get up in the morning. Also, I am more alert in the evening when I used to feel a lull around 8:00pm. The energy I'm feeling is hard to explain because it is not a burst of jittery energy. It is a slow steady refreshing vibrancy."
To your vitality,

Joyce Dell
Arizona, USA
********************

"I am a longtime sufferer of psoriasis and have this on my face, arms, legs and butt. I have tried all of the traditional things prescribed by doctors - vitamin D creams and cortisone creams, tar bath oils and light treatment but nothing has been long-lasting. As soon as you stop, it all comes back. Of course the doctors will tell you that it is genetic and has periods of remission and flare up, once you have it you have it for life.

Witness now what I have found out:

1. Psoriasis is a patch of skin that is aging approx 35 times faster than the surrounding skin, so based on this I started using the Ageloc transformation system on my face. For me, I found this works better and faster than my cortisone cream. I don't get those huge flakes coming off which you get after using cortisone, my face is not raw afterwards and I can go in the sun (Mexican holidays) without fear of becoming a tomato. If I let my patches get bad, it can sting a bit putting on the Ageloc but this is temporary. The effect is lasting so I don't need to use it every day but find it works best if I do. I spoke with my dermatologist about this and he is not opposed as long as it does the trick.

2. I have been using LifePak since 1997, along with various other Pharmanex supplements such as the Marine Omega, Estera, Cortitrol, etc. trying to find my smoking gun (dietary deficiency? Lack of GLA? etc.). Enter Vitality...now a very strange thing happened, part of my experiment was to cease using my cortisone cream on my body - body not liking me here! Started taking Vitality and my body started acting like I was using my cortisone cream, huge flakes coming off my legs and arms. Now, after just two weeks, my body looks like I am using the cortisone cream but without the rawness (thinning of the skin) that goes with that.

Sure, I get all the other benefits of the Vitality product such as biking to work but not arriving winded, actually took 10 minutes off my ride by the end of the first week on Vitality. I also sleep much better - before I was a bit of an insomniac waking up 3-4 times a night.

I'll keep you posted on how this goes but I am very hopeful given this preliminary 2 week result."

Lori
Ottawa, Ontario
Canada

Erectile dysfunction linked to aspirin and other NSAIDs

See also: cheap cialis | 


The Chicago Tribune reports:
Daily use of aspirin and other nonsteroidal anti-inflammatory drugs, commonly known as NSAIDs, is associated with a 22% increase in the risk of erectile purchase cialis, Kaiser researchers found in a study of more than 80,000 men in Southern California.