/library/oar/handle/123456789/32763 Tue, 23 Dec 2025 12:28:37 GMT 2025-12-23T12:28:37Z /library/oar/handle/123456789/107187 Title: The use of antidepressant drugs in geriatric patients Abstract: An understanding of the mechanisms of drug clearance in humans and of the effects of age on the clearance should help remind clinicians that adjustments in the therapeutic strategy may be needed for the elderly depressed patient. The significance of age notwithstanding, it is only one factor that can influence the clearance of drugs. The clinician can use a knowledge of pharmacokinetics as an adjunct to the art of clinical monitoring and titration. The growing elderly population receives an increasing proportion of prescriptions dispensed each year. There are a number of problems associated with drug therapy in the elderly. The first part of this dissertation deals with some of the pharmacological factors which may change with increasing age, including absorption, transportation, tissue localization, receptor sites, homeostasis, excretion and metabolism, and which in turn may alter the action of a drug. Suggestions are made regarding the treatment of elderly patients. A short account reviews the Amine Hypothesis; which in its simplest form suggests that depression results from a functional deficiency of noradrenaline and/or 5-hydroxy tryptamine at the brain receptor sites; hypomania is due to an excess. The evidence accrues from postmortem studies on brains from depressives, urinary and CSF studies of monoamine metabolites of drugs such as reserpine and amphetamine with known actions on cerebral amines. The majority of elderly depressed patients will not be treated unless this treatment is given by the general medical physician. In many cases, this treatment can be lifesaving. If symptoms are sought using the “SIG E CAPS” method and if the treatment guidelines given here are followed, the general medical physician can easily diagnosed and treat depression in the elderly in most cases. Controversy exists as to whether antidepressant drugs can be selected for a given patient on the basis of their relative abilities to inhibit norepinephrine or serotonine uptake mechanisms. The 20% of the patients who do not respond to treatment can be referred to psychiatrists specializing in geriatric therapy. An understanding of the pharmacologic profiles of the most important classes of antidepressants may help avert adverse reactions and side effects. Perhaps this part of the review may alert the primary-care physician to the major potential drug-related problems that can occur when treating the geriatric patient for adverse illness. The exquisite sensitivity of the elderly patient to anticholinergic activity, cardiotoxicity, and orthostasis can complicate drug management. In spite of the significant risk which all of these drugs may pose, they are nevertheless efficacious therapeutic agents. If used prudently, they can restore a normal level of functioning in the majority of elderly depressed patients, conferring the reward of a safe and successful treatment on both patient and physician. The last part of the dissertation deals with a survey which was carried out locally. The results obtained (in Malta) compared well with previous investigations carried out in Japan by Dr. Kazuo Hasegawa in 1974. On the contrary, figures were in clear contrast with other similar survey results obtained from an American community. Basically, the higher prevalence of depressive illnesses found in Western countries and the very low numbers found in Japan (and Malta), appear to be closely related to socio-cultural differences particularly in family structure. This chapter also carries some information regarding the methodology for the conduction of the survey done in Malta and an account of the difficulties encountered in doing so. Description: B.PHARM. Fri, 01 Jan 1988 00:00:00 GMT /library/oar/handle/123456789/107187 1988-01-01T00:00:00Z /library/oar/handle/123456789/107183 Title: Pharmacotherapy of congestive heart failure in the elderly Abstract: This thesis was carried out in order to determine the modern line of treatment of congestive heart failure (CHF) and to identify specific problems associated with drug treatment for CHF in the elderly. A survey was carried out at St. Luke’s Hospital and Ħas-Serħ Hospital. The treatment chart of 118 patients over sixty years currently in CHF was investigated. From the survey it resulted that diuretics are still the first line of treatment for CHF, whereas digoxin remains the drug of choice in CHF when there is supraventricular tachycardia. The incidence of CHF in the elderly increases with age. In fact, eighty per cent of patients with CHF are older than sixty years of age, the greatest prevalence in both males and females occurring in the seventh decade of life. Within this age group, CHF may result from several factors such as coronary artery disease, hypertension, valvular disease or intrinsic myocardiopathies. Heart failure in the elderly is not fundamentally different from heart failure in any other age. However, it is more common and almost certainly more often misdiagnosed or missed. Description: B.PHARM. Fri, 01 Jan 1988 00:00:00 GMT /library/oar/handle/123456789/107183 1988-01-01T00:00:00Z /library/oar/handle/123456789/90243 Title: Monoclonal antibodies in forensic serology Abstract: Since 1975, when monoclonal antibodies were first reported to be produced by in vitro cultures, by Kohler and Milstein, many cell lines were developed to produce antibodies with predefined specificities against various antigenic determinants. This led to a logarithmic increase in use of such constant nature reagents. Because of their obvious advantages in use over older, conventional, polyclonal antibodies, monoclonal reagents were introduced to use in forensic matters, and are now being constantly used to replace polyclonal antibodies and perform new reactions unknown with polyclonal reagents in forensic serology studies. The role of these new reagents is studied with reference to blood group serology, including the ABO, Rhesus, MNSs, and Lewis systems. A comparative review is given with details of methods employed, involving use of both polyclonal and monoclonal reagents. Besides, the possibilities of the application of monoclonal antibodies in typing Gm and Km serum immunoglobulins are considered. The recently introduced HLA system typing is also reviewed with regard to it's genetics and it's applications in forensic cases. Monoclonal antibodies may prnvi.de an answer to the various problems related to specificity and cross-reactions that are frequently encountered in such a system. The possibilities of the applications of monoclonal reagents is briefly reviewed. Furthermore, a discussion regarding the possible use of monoclonal antibodies in isoenzyme typing follows, and includes a brief account of the methods that might be proposed. Description: B.PHARM.(HONS) Thu, 01 Jan 1987 00:00:00 GMT /library/oar/handle/123456789/90243 1987-01-01T00:00:00Z /library/oar/handle/123456789/32765 Title: Twenty surgical case histories Abstract: This book contains a selection from the cases that I interviewed during my clerkship period as a senior medical student. The case studies have been varied as much as possible to include work from most of the departments that I was attached to. In particular I am pleased to present case numbers 15 and 17 which were operated on by foreign consultants namely: Mr. Mundy M.R.C. P, F .R.C.S. and Mr. Edgar F.R.C.S. respectively. Description: M.PHIL. Thu, 01 Jan 1987 00:00:00 GMT /library/oar/handle/123456789/32765 1987-01-01T00:00:00Z