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Regulation EC ; No 726 2004 of the European Parliament and of the Council of 31 March 2004 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a European Medicines Agency. Directive 2004 27 EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001 83 EC on the Community code relating to medicinal products for human use. Directive 2004 28 EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001 82 EC on the Community code relating to veterinary medicinal products. Directive 2004 24 EC of the European Parliament and of the Council of 31 March 2004 amending, as regards traditional herbal medicinal products, Directive 2001 83 EC on the Community code relating to medicinal products for human use. Directive 2004 23 EC on setting standards of quality and safety.
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The guidelines were developed following the recommendations outlined by Marshall 4 ; . The following categories were used to grade the statements in the guidelines according to the guidelines of the Agency for Health Care Policy and Research ; : Ia Evidence obtained from the meta-analysis of randomized, controlled trials. Ib Evidence obtained through one or more randomized, controlled trials. IIa Evidence obtained through a well-designed, controlled study without randomization. IIb Evidence obtained through another type of welldesigned, experimental study eg, from multiple time series or from dramatic results in uncontrolled experiments ; . III Evidence obtained through a well-designed, nonexperimental study eg, descriptive studies which include comparative, correlation and case studies ; . IV Evidence obtained from opinions of respected authorities, and based on clinical experience, descriptive studies, or reports of expert committees!
Primary References Hatcher RA et al. Contraceptive Technology. 18th Revised Edition. Ardent Media, Inc., New York, 2004 Hatcher RA, Zieman M et al. A Pocket Guide to Managing Contraception. Bridging the Gap Foundation, Tiger, GA, 2004 Medical Eligibility Criteria For Contraceptive Use. 3rd Ed., Reproductive Health and Research, World Health Organization, Geneva, Switzerland, 2004 and
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Miller and Krangel, 1992a ; . Other CC chemokines, I-309, and RANTES, were purified and cloned as products of activated T cells Chang et al., 1989; Schall et al., 1988; Miller et al., 1989; Miller and Krangel, 1992b ; . Subtractive hybridization was used to identify genes uniquely expressed in T cells, and this led to the discovery of RANTES cDNA, encoding a polypeptide of 91 amino acids a 8-kDa secreted protein ; . RANTES gene is expressed in IL-2-dependent T cell lines. In peripheral blood mononuclear cells, low but detectable levels of RANTES transcripts can be measured in unstimulated cells, and an increase in mRNA levels is observed 5 to 7 days after antigen treatment or phytohemagglutinin stimulation Schall et al., 1988 ; . HC-14 now called MCP-2 ; , which was discovered in IFN stimulated monocytes, has also been isolated from osteosarcoma cell cultures Van Damme et al., 1992 these cultures also yielded MCP-3, which has been cloned and expressed Opdenakker et al., 1993; Minty et al., 1993 ; . MCP-4 was also identified in a large-scale sequencing and expression program for the discovery of new chemokines Berkhout et al., 1997; Uguccioni et al., 1996; Makwana et al., 1997 ; . Eotaxin is an unusually selective chemokine that was discovered as an attractant for eosinophils in the bronchoalveolar lavage fluid obtained from an experimental model of allergen exposure of sensitized guinea pigs Jose et al., 1994 ; and was subsequently shown to be present in humans Ponath et al., 1996b ; . A functionally similar chemokine, eotaxin-2, was recently described Forssmann et al., 1997 ; . Stimulated T cell chemotactic protein-1 is another newly identified CC chemokine; it is a chemoattractant for Th2 cells Chang et al., 1997 ; . In general, monocytes and tissue macrophages are rich sources of CC chemokines, usually associated with de novo synthesis. MCP-1 and MCP-2 are major stimulated products of monocytes. Lymphocytes are sources of some CC chemokines, particularly RANTES Schall et al., 1988, 1992; Miller et al., 1989 ; , I-309 Miller et al., 1989, 1990 ; , MIP-1 Schall et al., 1992; Miller et al., 1989; Zipfel et al., 1989 ; , and MIP-1 Zipfel et al., 1989; Ziegler et al., 1991 ; . Neutrophils can produce MIP-1 Kasama et al., 1993 ; . Eosinophils of patients with hypereosinophilic syndrome express mRNA for MIP-1 Costa et al., 1993 ; . Epithelial cells stimulated with IL-1 or TNF- produce RANTES Berkman et al., 1995c ; and eotaxin Lilly et al., 1997 ; but not MIP-1 . MCP-1, RANTES, and eotaxin immunoreactivity has been reported in human airway epithelium Berkman et al., 1995c; Sousa et al., 1994 ; . Cultured human airway epithelial cells and cell lines express RANTES and MCP-4 in response to stimulation with proinflammatory cytokines Berkman et al., 1995c; Kwon et al., 1995; Stellato et al., 1995, 1997 ; . RANTES and eotaxin are also produced by cultured human airway smooth muscle cells John et al., 1997 ; . MCP-1 and RANTES are produced by human eosinophils Ying et al., 1996; Izumi et al., 1997.
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ACKNOWLEDGMENTS We thank J. Richard Pink of the World Health Organization for facilitating the antiparasite screening in vitro in the laboratory of Louis Maes of Tibotec, Mechelen, Belgium; Bruce McConnell, Kevan Shokat, David Julius, and James McKerrow for helpful discussions; Wasim Siddiqui for providing malaria parasite reagents; Kay Lynn Peter and Ann Murai for secretarial assistance; and Mimi Zeiger for helpful suggestions about the manuscript. Funding for this study was provided by the UNDP World Bank WHO Special Program for Research and Training in Tropical Diseases TDR and
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Reporting Period July 1, 2002 January 31, 2003 Formula Grant Overview The Delaware Water Gap Science Institute received $15, 998 in formula funds for the grant award period February 1, 2002 through January 31, 2003. The funds were used to support one research project. Accomplishments for the reporting period are described below. Formula Grant Coordinator James E. Skinner, Ph.D. President Principal Investigator Delaware Water Gap Science Institute 399 Autumn Drive Bangor, PA 18013-5543 570 ; 897-0284 Research Project 1: Project Title and Purpose Software Development of PD2i Algorithm for Clinical Use - The purpose of this grant is to develop user-friendly software for the nonlinear PD2i algorithm. This new software will then enable the large-scale multi-centered studies that will be required for this technology to have a medical impact on victims of Sudden Cardiac Death 500, 000 deaths annually ; and patient-costs for "cardiac watch to rule out myocardial infarction" $88-billion in annual hospital costs ; . Duration of the Project 2 1 2002 Project Overview A large unmet need exists in medical markets for a product to assist the Emergency Department physician in the rapid triage of high-risk cardiac patients. A new cuttingedge device is proposed to reduce physician error as well as hospital costs. The aim is to develop user-friendly analytic software to be used on conventional digital ECG's to predict risk of arrhythmic death. The proposal is supported by results from two independent prospective studies, which show that the analysis of heart rate variability.
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Actifed tablets pseudoephedrine 60mg triprolidine 2.5mg ; Tiazac Effexor XR Total daily dose give QD ; Estradiol transdermal patch Climada ; : applied once weekly same dose 24 hrs ; Hyoscyamine extended-release Levbid ; Take total daily dose 2 BID dose ; Niacin SR 250mg BID Take total daily dose 2 BID dose ; Nifedipine Procardia, Adalat ; : 10mg TID 20mg TID 30mg TID XL 30mg QD XL 60mg QD XL 90mg QD Albuterol Ventolin, Proventil ; - same dose Clotrimazole 1% cream Lotrimin ; Oxybutynin Ditropan ; : 2.5mg TID 5mg TID Oxybutynin ER Ditropan XL ; : 5mg QD 10mg QD Tramadol 50mg + Acetaminophen 325mg same frequency ; Tramadol 50mg + Acetaminophen 650mg same frequency and
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Note: For a description of references and other information, refer to the explanation of Committee tables and the accompanying notes at the end of this table. Footnotes: * Partially confirmed by bank information sources 10-14 ; * Fully confirmed by bank information sources 10-14 ; 1. Side agreement with Government of Iraq. 2. Ministry correspondence documents. 3. Company correspondence documents. 4. Other documents. 5. Ministry financial data. 6. Projected ASSF levied based on Government of Iraq policy documents. 7. Projected ASSF paid based on Government of Iraq policy documents. Represents contracts where inland transportation fee was required but no specific information was available 8. Projected Inland Transportation fees based on Government of Iraq policy documents. 9. Amount based on information provided by company and ministry documents. 10. Housing Bank for Trade and Finance Jordan ; , Central Bank of Iraq accounts Jan. 1, 2001 to Dec. 31, 2003 ; . 11. Jordan National Bank Jordan ; , Alia Company for Transport and General Trade accounts Mar. 1, 2000 to Dec. 31, 2003 ; . 12. Al-Rafidain Bank Jordan ; , Central Bank of Iraq accounts Jan. 1, 2000 to May 15, 2003 ; . 13. Fransabank SAL Lebanon ; , Central Bank of Iraq accounts Nov. 12, 2002 to Dec. 19, 2002 ; . 14. Jordan National Bank Jordan ; , Arrow Trans Shipping Company accounts May 1, 2001 to Dec. 31, 2001 ; . Page 225 of 381.
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The Registrant entered into a strategic alliance with Teva Pharmaceutical Industries, Ltd. in July 2000, whereby the Registrant, through its Spanish subsidiaries, will receive licenses for more than 75 of Teva's products for registration and marketing in Spain. The products will be comprised of both branded and generic forms. An investment in additional sales representatives will be required, along with an increase in regulatory activities, both of which may create a short-term reduction in the Registrant's earnings. The Registrant, through its subsidiary, Laboratorios Davur, has also submitted registrations to the Spanish Ministry of Health for generic versions of various products, in response to growing interest in generic products in Spain. The price of a generic product is typically lower than the price for the comparable branded product; consequently, the Registrant believes that resulting gross margins may be lower on sales of such products. The Registrant's decision to enter the generic market was based on its objectives to remain competitive and to grow sales and market share. Selling, general and administrative expenses increased by $278, 000 or 3%, to $10, 260, 000 for the year ended December 31, 2000 compared to $9, 982, 000 for the prior year. Selling, general and administrative expenses increased from 49% of 1999 net sales to 55% of 2000 net sales as a result of the Registrant's 8% decrease in net sales and its efforts to control general and administrative expenses. A significant portion 63% or $6, 494, 000 during 2000 ; of these expenses are selling and marketing expenses, which are necessary for the Registrant to maintain and grow sales and market share in Spain. Selling and marketing expenses increased by $328, 000, or 5% over the same period of the prior year, and as a percent of net sales, increased from 30% in the year ended December 31, 1999 to 35% in the year ended December 31, 2000. Selling and marketing expenses, as reported in U.S. dollars, were approximately $1, 012, 000 lower than would have been reported as a result of the 16% decline in the value of the Spanish Peseta and related Euro in relation to the U.S. dollar during the period. General and administrative expenses decreased slightly from $3, 816, 000 in the year ended December 31, 1999 to $3, 766, 000 in the fiscal year ended December 31, 2000. However, as a percentage of net sales, such expenses increased slightly from 19% of fiscal year 1999 net sales to 20% of fiscal year 2000 net sales. General and administrative expenses, as reported in U.S. dollars, were approximately $274, 000 lower than would have been reported as a result of the 16% decline in the value of the Spanish Peseta and related Euro in relation to the U.S. dollar during the period. To the extent practical, the Registrant intends to continue its efforts to control general and administrative expenses in its effort to reach and maintain profitability. The Registrant reported research and development expenses of $1, 102, 000 for the year ended December 31, 2000 compared to $685, 000 for the prior year. Amounts charged to research and development totaled $1, 263, 000 for the year ended December 31, 2000 and were offset by $161, 000 as a result of a negotiated reduction in an amount previously accrued for research and development expenses. The increase in the Registrant's costs for research and development is primarily the result of costs associated with a Phase I Clinical Study treatment of nail fungal infections ; that is underway at the University of Alabama at Birmingham, pre-clinical programs underway in collaboration with the University of New Hampshire and Dartmouth College and with product formulation and testing efforts being performed in the laboratory in the Registrant's U.S. headquarters, located in New Hampshire. This laboratory is being used by the Registrant to develop potential product applications using its permeation enhancement technology. The limited expenditures in research and development reflect the Registrant's continued de-emphasis of basic research and redirection of its resources to developmental expenses necessary for expansion of its portfolio of marketed products. The Registrant intends to continue to carefully manage its research and development expenditures in order to ensure that its development programs are efficient and cost effective. Depreciation and amortization expenses totaled $580, 000 for the fiscal year ended December 31, 2000, compared to $559, 000 for the prior year. The increase was primarily due to higher depreciation charges with respect to renovations and improvements at the Registrant's manufacturing facility and its U.S. laboratory and higher amortization charges with respect to recently acquired drug licenses and technologies, partially offset by the effect of fluctuations in foreign currency exchange rates. Interest income totaled $347, 000 for the year ended December 31, 2000 compared to $244, 000 for the prior year primarily as a result of higher short-term interest bearing investment balances and higher interest rates earned on the investment balances during the year ended December 31, 2000 than in 1999. Interest expense totaled $439, 000 for the year ended December 31, 2000 compared to $1, 168, 000 for the prior year. The Registrant incurred first quarter 2000 interest expense related to its 12% Senior Subordinated Debentures of approximately $233, 000, which was eliminated beginning in the second quarter of 2000, as a result of the conversion of all Debentures into shares of Common Stock. Consequently, interest expense with respect to the Debentures will not recur in the future and should result in substantially lower interest expense on a prospective basis. Interest expense incurred during the nine months ended December 31, 2000 resulted primarily from the outstanding balances on lines.
Tradename ENJUVIA ESTROGEL clomiphene citrate covaryx covaryx hs eemt eemt hs essian essian h.s. esterified estrogens methyltestosterone ds esterified estrogens methyltestosterone hs estradiol estropipate methyltestosterone esterified estrogen methyltestosterone esterified estrogens ortho-est serophene ANGELIQ CENESTIN CLIMARA PRO COMBIPATCH ELESTRIN ESTRACE ESTRASORB ESTRING EVISTA FEMRING FEMTRACE GYNODIOL MENEST MENOSTAR PREMARIN T1 Generic lowest copay ; T2 Preferred Brand middle copay ; T3 Nonpreferred Brand higher copay ; T4 Specialty T5 Lifestyle 100% copay ; T6 Y, Medical Benefit * Indicates Multiple Dosage Forms Dosage Form TABS GEL TABS TABS TABS TABS TABS TABS TABS TABS TABS * TABS TABS TABS TABS TABS TABS TABS PTWK PTTW GEL CREAM EMUL RING TABS RING TABS TABS TABS PTWK TABS T1 T1 T1 per 90 days ; QL 1 per 90 days ; QL 1 per 90 days ; QL 12 per 90 days ; QL 24 per 90 days ; PA Tier Comment Not Covered Not Covered.
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Of those recruited, 32 of 33 subjects completed the 12-week treatment period according to the clinical protocol. One subject, for unknown reasons, did not attend for the first clinical control and the results of the remaining 32 subjects were analysed. None had to leave the study for adverse events or serious sideeffects. Eighty-one per cent n 26 ; belonged to skin type III, 13% n 4 ; to skin type II and 6% n 2 ; to skin type I. Side-effects were reported by the test subjects and mainly occurred during the first 4 weeks of treatment Table 1 ; . The most common side-effects reported were burning and warmth in the skin. This occurred immediately upon application of the cream and lasted a few minutes. These symptoms eventually, for example, climra estrogen.
Non-Oral Contraceptives -- Patch for Fertility Control FC Patch ; . The innovative FC Patch offers Schering AG the essential entrance into the sub-segment of patches within the fertility control market. This monophasic combined transdermal patch has a daily release rate of 18 g ethinylestradiol and 50 g gestoden. It will be renewed once per week, i. e. three patches for 21 days ; and one week off. The transdermal route of hormone administration will result in improved tolerability. Due to the excellent cosmetic appearance small transparent matrix patch ; and the convenience and user-friendliness "no missed pills", once-a-week application ; high compliance is anticipated. The product is in clinical study phase III. Menopause Management -- Climodien 1 2. Climodien 1 2 is the low dose variation of Climodien, which is already on the market. It contains 1 mg estradiol valerate combined with 2 mg dienogest in a continuous combined regimen for the treatment of climacteric symptoms in the postmenopause. This lower dose preparation provides the prescribers with the option to titrate estrogen doses according to the women's individual needs without changing the gestagen component. Similar to Climodien, Climodien 1 2 provides excellent relief of menopausal symptoms and induces amenorrhoe reliably. -- Climsra ProTM. As an alternative to oral continuous combined therapy, a combination patch with estradiol and levonorgestrel is being developed. This patch will only need to be renewed once a week and is intended for use in osteoporosis prevention and the treatment of climacteric complaints. The product has been submitted for registration in the United States and is planned to be submitted for registration in Europe in 2003. Although we received a not approvable letter from the United States Food and Drug Administration FDA ; for Climarra ProTM in 2002, we are currently undertaking all the necessary measures to ensure that approval will be granted. -- ClimarelleTM. ClimarelleTM is an ultra-low dose patch with an estradiol delivery rate of 12.5 g day. The size of the patch is only 3.25 cm2 and the product has an excellent cosmetic appearance. The patch is indicated for osteoporosis prevention, particularly for women in the late postmenopausal stage of the climacteric. No endometrial stimulation is expected and no progestogens will need to be given. ClimarelleTM is expected to be submitted for registration in 2003. -- Endometrial protection under estrogen therapy. We are developing an intrauterine system IUS ; for women in the climacteric. The technology of the IUS has been used successfully for contraception for some years with the product Mirena and also to protect the endometrium of women in the perimenopause who are receiving estrogen replacement therapy. Women in the postmenopause no longer require contraception. For these women, a smaller version of the IUS is being developed as the uterus shrinks considerably after menopause. The smaller IUS also releases levonorgestrel. If a woman in the postmenopause is on estrogen replacement therapy, this IUS prevents excessive growth of the uterine lining. Since this IUS is a local application, it also avoids the possible side effects of a gestagen. The project is currently in clinical phase III. Gynecological Therapy -- Endometrion. Endometrion is a product specifically targeted for convenient oral treatment of endometriosis. Each tablet contains 2 mg dienogest, a progestogen with no estrogenic activity and a track record of excellent tolerance and acceptability. This new preparation is expected to be as effective as GnRH-agonists but with a lower incidence of progestogenic and estrogen deficiency-related side effects. Treatment is recommended for 24 weeks, but long-term use will be possible. Cost-effectiveness of long-term treatment is an additional benefit. Endometrion has been submitted for registration in Europe in 2002.
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Prosecutions under the EEA have been relatively rare. As of 2003, only 37 cases have been successfully prosecuted under the act. One of the primary problems is the reluctance of companies to file criminal charges. Most companies fear the risk of publicly disclosing valuable trade secret information through court documents. In an espionage case involving Bristol-Meyers Squibb and their secret formulas for the cancer-fighting drug, Taxol, federal judges ruled that prosecutors had to release the confidential documents to the defendants' lawyers in order to protect due process rights. The defendants' were Yuen Foong Paper Co., a Taiwanese company that had two employees. They approached an FBI agent, posing as a Bristol-Meyers technology information broker, and allegedly offered him $200, 000 plus a percentage of their sales for access to Taxol technology. BristolMeyers appealed the ruling in an effort to protect the secrets from those accused of attempting to steal them. In this way, the EEA presents problems for both victims and the accused. Many companies have turned to private consulting or intelligence agencies to help prevent future incidents of economic espionage.
Overview of the menopause Pathophysiology and etiology Menopausal staging definitions Premature and surgical menopause Factors affecting menopause onset Menopausal symptoms Post-menopausal risks associated with estrogen loss Osteoporosis Cardiovascular disease Cancer Alzheimer's disease Incidence and prevalence of menopause Hormone replacement therapy Variations in hormone replacement preparations Types of estrogen Types of progestogen Dosing regimens Dosage levels Delivery methods Alternative medicines Prevalence of hormone replacement therapy use Women's Health Initiative Background and objectives Hormone replacement trial Estrogen progestin study Increased risk of breast cancer Increased risk of cardiovascular disease and thromboembolic events Reduced risk of osteoporotic fractures and colorectal cancer Time trends Overall results Limitations of the WHI trial Fallout from the Women's Health Initiative FDA relabels HRT with black-box warnings US Preventive Services Task Force extends warning to all cHRT American College of Obstetricians and Gynecologists advises shortterm, low dose use Reluctance to fund similar trials Assessment of WHI findings Calm after the storm? Million Women Study focus of concern shifts towards the UK Market analysis: leading and new product sales to 2008 Wyeth Premarin family conjugated estrogens ; Novartis Schering AG Climarx and Clijara Pro estradiol ; Avaden estradiol gestodene ; Solvay Estratest esterified estrogens methyltestosterone ; 43 Figure 1.1: Figure 1.2: Figure 1.3: Figure 1.4: Figure 1.5: Figure 1.6: Figure 1.7: Figure 1.8: Figure 1.9: Figure 2.10: Figure 2.11: Figure 3.12: Figure 3.13: Figure 4.14: Figure 4.15: Figure 5.16: The aging female population provides expanding opportunities in the women's health market 21 More women than men search for health information 23 Women's personal health information needs 24 Women visit physicians more frequently than men 25 As the primary carers of others, women seek health information for about others more often than men 26 Women search more actively than men for non-personal health information 27 Women's health continuum the basis of complementary women's health franchises 28 Pfizer's online women's health resources 30 Virtual women's health network 34 Epidemiology of menopause, 2002 51 Estrogen and combination hormone replacement therapy use in major national markets 58 Prevalence of osteopenia and osteoporosis in the post-menopausal population across the seven major markets, 2002 105 Clinical and environmental unmet needs in the diagnosis and treatment of osteoporosis 126 Use of hormonal contraceptives among the eligible population 160 Global forecasts of leading companies' oral contraceptives to 2008 163 Prevalence of female sexual dysfunction within the general population, 2002 196.
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