This document describes the 17-year medical case history of a female patient diagnosed with multiple sclerosis at age 22. She experienced her first attack in July 1997 and was treated with intravenous methylprednisolone. She had relapses in October 2000, August 2001, September 2002, April 2003, and July 2003. Her disease progressed to being aggressive after September 2002. She was treated with various medications, including Avonex, azathioprine, steroids, and cyclophosphamide pulse therapy, and has been stable on Rebif injections since November 2004 with no further relapses.
MRI characteristics in Relapsing- Remitting versus Secondary- Progressive MS by Till Sprenger, Department of Neurology and Division of Neuroradiology University Hospital Basel, Switzerland
MRI characteristics in Relapsing- Remitting versus Secondary- Progressive MS by Till Sprenger, Department of Neurology and Division of Neuroradiology University Hospital Basel, Switzerland
GB Syndrome is an inflammatory disease, incidence is rising sharply in Pakistan, it needs epidemiological investigation and extensive search for reason of this endemic status.
Austin Anesthesiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Anesthesia & Anesthesiology. The renowned editorial team ensures a balanced, expert assessment of the articles published with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in all areas of anesthesiology.
Austin Anesthesiology accepts original research articles, review articles and short communication covering all aspects of Anesthesia for review and possible publication.
Austin Anesthesiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Muscular Dystrophy & Myasthenia Gravis - PPT
By Prof. Dr. R. R. Deshpande
• This PPT is based on the – Syllabus of CCIM ( 2014) for4th BAMS – Kayachikitsa subject – Paper 2 Part A Point No 5 .
• Contents of PPT are – Causes ,Symptoms & Treatment of Muscular Dystrophy & Myasthenia Gravis
• Visit – www.ayurvedicfriend.com
• Phone – 922 68 10 630
ANAESTHESIA MANAGEMENT IN PATIENTS OF NEUROMUSCULAR DISORDERS.pptxSumit Tyagi
Comprehensive ppt covering myasthenia graves in details along with other neuromuscular disorders.
brief and complete solution for presentation needs of DNB/MD students in anaesthesia department.full coverage of myasthenia graves with light on all other neuromuscular disease.illustrative diagram of NMJ.Tabular list of drugs exacerbating myasthenia graves and increasing the duration of action of the muscular relaxants
GB Syndrome is an inflammatory disease, incidence is rising sharply in Pakistan, it needs epidemiological investigation and extensive search for reason of this endemic status.
Austin Anesthesiology is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of Anesthesia & Anesthesiology. The renowned editorial team ensures a balanced, expert assessment of the articles published with an aim to provide a forum for physicians, researchers and other healthcare professionals to find most recent advances in all areas of anesthesiology.
Austin Anesthesiology accepts original research articles, review articles and short communication covering all aspects of Anesthesia for review and possible publication.
Austin Anesthesiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Muscular Dystrophy & Myasthenia Gravis - PPT
By Prof. Dr. R. R. Deshpande
• This PPT is based on the – Syllabus of CCIM ( 2014) for4th BAMS – Kayachikitsa subject – Paper 2 Part A Point No 5 .
• Contents of PPT are – Causes ,Symptoms & Treatment of Muscular Dystrophy & Myasthenia Gravis
• Visit – www.ayurvedicfriend.com
• Phone – 922 68 10 630
ANAESTHESIA MANAGEMENT IN PATIENTS OF NEUROMUSCULAR DISORDERS.pptxSumit Tyagi
Comprehensive ppt covering myasthenia graves in details along with other neuromuscular disorders.
brief and complete solution for presentation needs of DNB/MD students in anaesthesia department.full coverage of myasthenia graves with light on all other neuromuscular disease.illustrative diagram of NMJ.Tabular list of drugs exacerbating myasthenia graves and increasing the duration of action of the muscular relaxants
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
A case of multiple sclerosis final! website (2)
1. A CASE OF MULTIPLE SCLEROSIS :
Follow Up Since 1997
Dr. L. K. Malhotra
MBBS, MD, DM (Neurology)
Consultant Neurologist
New Delhi, India
2. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
BACKGROUND
• Tertiary neurocentre : 0-2 new patients of
MS/ yr
• Majority patients have no insurance cover
• Patient can consult any neurologist
throughout India anytime
3. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• 22 yrs Female SM
• On 22/7/97 H/O Acute onset ataxia
without headache, vomiting, fever, tinnitus,
deafness
• No past H/O fever, immunization, rash,
visual loss. H/O myocarditis in childhood.
No DOE
• O/E : Fundus normal, Gait ataxia, brisk
jerks, extensor plantars
4. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• Investigations : Haemogram, Blood sugar,
liver, renal function tests, Rheumatoid
factor, ANF, DsantiDNA Ab, Se B12 levels,
ECG, X - ray chest ---- normal
• HIV and VDRL ---- negative
• CSF : cytology : 20 cells L, Proteins : 80
mg, sugar : 40mg, oligoclonal bands
----negative
• VEP : 112 ms ----- bilateral
8. A CASE OF MULTIPLE SCLEROSIS : 17 YEARS
FOLLOW-UP
• Treatment : I.V. -- M.P. 5 g followed by
oral steroids for 2 weeks
• Clinical and radiological improvement
seen
14. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• Oct 2000 : worsening of ataxia
• MRI brain : Fresh brain stem and supra
tentorial lesions
• Treatment : I.V. M.P. 5 g
• Partial Improvement
15. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• Nov 2000 : started on Avonex
16. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• Aug 2001 : Worsening of ataxia, Tremulousness
on standing, limb ataxia
• MRI brain : fresh lesion in medulla
• Treatment : I.V. M.P. 3 g, Azathioprine added.
• Partial improvement
20. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• April 2003 : worsening of symptoms. Oral
steroids for 3 weeks minimal improvement
• July 2003 : worsening of symptoms. Oral
steroids started. No improvement.
• MRI Brain : fresh parasaggital lesion
• MRI cervical and dorsal spine : sub acute
to chronic plaque seen.
• I.V. M.P. 3 g, no improvement
25. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• Aug 2003 : dysarthric, gaze evoked
nystagmus, limb and gait ataxia, ankle
clonus, brisk jerks, extensor plantars
• Needed support to walk.
• RRMS SPMS
26. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
SUMMARY
• 22 yrs Female
• 7 / 1997 : First attack --- I.V. M.P.
• 10/2000 : Second attack --- I.V. M.P.
• 11/2000 : Avonex started
• Relapses : Aug 2001, Sep 2002, Apr 2003,
Jul 2003 Progressive course
• Aggressive Disease since Sep 2002
27. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
Treatment options :
• Mitoxantrone
• Cyclophosphamide
• I.V. MethylPrednisolone monthly
• I.V. Immunoglobulins
• G.A.
• Injection Rebif
28. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
Pulse therapy
• I.V. cyclophosphamide with I.V. high dose steroids
• Cyclophosphamide 1000 mg/m2 /course
(approx. 1500-2000 mg for average person)
• I.V. Methylprednisolone 750 mg BD or
Dexamethasone 150 mg BD
• Monitor blood counts, urine, X-ray chest, ECG
• Anti – emetics before cyclophosphamide
• Hydration I.V. / oral
29. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
PULSE THERAPY
1. 27 Oct 2003 --------- 6 weeks
2. 08 Dec 2003 --------- 6 weeks
3. 13 Jan 2004 --------- 6 weeks
4. 03 Mar 2004 --------- 2 months
5. 05 May 2004 --------- 2 months
6. 06 Jul 2004 --------- 4 months
7. 13 Nov 2004
30. A CASE OF MULTIPLE SCLEROSIS : Follow Up
Since 1997
• No urinary / menstrual problem. Mild
alopecia.
• Injection Rebif 22 microgm thrice a week
since Nov 2004 till now.
• And no relapse since then.
