Midazolam, marketed under the trade name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, severe agitation. It works by inducing sleepiness, decreasing anxiety, causing a loss of ability to create new memories, it is useful for the treatment of seizures. Midazolam can be given by mouth, intravenously, or injection into a muscle, by spraying into the nose, or through the cheek; when given intravenously, it begins working within five minutes. Effects last for between six hours. Side effects can include a decrease in efforts to breathe, low blood pressure, sleepiness. Tolerance to its effects and withdrawal syndrome may occur following long-term use. Paradoxical effects, such as increased activity, can occur in children and older people. There is evidence of risk when used during pregnancy but no evidence of harm with a single dose during breastfeeding, it belongs to the benzodiazepine class of drugs and works by increasing the activity of the GABA neurotransmitter in the brain.
Midazolam was patented in 1974 and came into medical use in 1982. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. Midazolam is available as a generic medication and is not expensive; the wholesale cost in the developing world of a vial is about US$0.35. In many countries, it is a controlled substance. Midazolam is sometimes used for the acute management of seizures. Long-term use for the management of epilepsy is not recommended due to the significant risk of tolerance and the significant side effect of sedation. A benefit of midazolam is that in children it can be given in the cheek or in the nose for acute seizures, including status epilepticus. Midazolam is effective for status epilepticus that has not improved following other treatments or when intravenous access cannot be obtained, has advantages of being water-soluble, having a rapid onset of action and not causing metabolic acidosis from the propylene glycol vehicle, which occurs with other benzodiazepines.
Drawbacks include a high degree of breakthrough seizures—due to the short half-life of midazolam—in over 50% of people treated, as well as treatment failure in 14–18% of people with refractory status epilepticus. Tolerance develops to the anticonvulsant effect, the dose may need to be increased by several times to maintain anticonvulsant therapeutic effects. With prolonged use and tachyphylaxis can occur and the elimination half-life may increase, up to days. There is evidence buccal and intranasal midazolam is easier to administer and more effective than rectally administered diazepam in the emergency control of seizures. Intravenous midazolam is indicated for procedural sedation, for preoperative sedation, for the induction of general anesthesia, for sedation of people who are ventilated in critical care units. Midazolam is superior to diazepam in impairing memory of endoscopy procedures, but propofol has a quicker recovery time and a better memory-impairing effect, it is the most popular benzodiazepine in the intensive care unit because of its short elimination half-life, combined with its water solubility and its suitability for continuous infusion.
However, for long-term sedation, lorazepam is preferred due to its long duration of action, propofol has advantages over midazolam when used in the ICU for sedation, such as shorter weaning time and earlier tracheal extubation. Midazolam is sometimes used in neonatal intensive care units; when used, additional caution is required in newborns. Bolus injections should be avoided due to the increased risk of cardiovascular depression, as well as neurological complications. Midazolam is sometimes used in newborns who are receiving mechanical ventilation, although morphine is preferred, owing to its better safety profile for this indication. Sedation using midazolam can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. Midazolam, in combination with an antipsychotic drug, is indicated for the acute management of schizophrenia when it is associated with aggressive or out-of-control behaviour. In the final stages of end-of-life care, midazolam is used at low doses via subcutaneous injection to help with agitation, restlessness or anxiety in the last hours or days of life.
At higher doses during the last weeks of life, midazolam is considered a first line agent in palliative continuous deep sedation therapy when it is necessary to alleviate intolerable suffering not responsive to other treatments, but the need for this is rare. Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, in alcohol- or other drug-dependent individuals or those with comorbid psychiatric disorders. Additional caution is required in critically ill patients, as accumulation of midazolam and its active metabolites may occur. Kidney or liver impairments may slow down the elimination of midazolam leading to prolonged and enhanced effects. Contraindications include hypersensitivity, acute narrow-angle glaucoma, hypotension, or head injury. Most are relative contraindications. Side effects of midazolam in the elderly are listed above. People experiencing amnesia as a side effect of midazolam are unaware their memory is impaired, unless they had known it as a side effect.
Long-term use of be
The Kuala Langat District is a district of Selangor, Malaysia. It is situated in the southwestern part of Selangor, it covers an area of 858 square kilometres, had a population of 213,876 at the 2010 Census. It is bordered by the districts of Sepang to the east; the Strait of Malacca forms its western border. Among the major towns in Kuala Langat are Banting, Teluk Datok, Morib and an island Carey Island. Kuala Langat District is divided into 7 mukims, which are: Bandar Batu Jugra Kelanang Morib Tanjung 12 Teluk Panglima Garang Kuala Langat is famous for its agricultural produce, industries that recycle scrap metal, home stay programmes for tourists and for its National Space Centre in Kanchong Darat. Local farmers transform scrap metal from cars and other household appliances into large 12 meter transformers. Malaysia Paragliding Flight Park Putrajaya and the Kuala Lumpur International Airport, linked by new highways, have become the catalyst for Kuala Langat’s development. Road networks and infrastructure in the district are good, making it viable for manufacturers to transport their finished goods on freight trucks to Kuala Lumpur, KLIA and Port Klang.
Bandar Saujana Putra, located in the far-north of the district, was established in 2003 by LBS Bina Berhad and is located near Putra Heights, UEP Subang Jaya and Puchong, as well as Cyberjaya and Teluk Panglima Garang. The Telok Panglima Garang Free Trade Zone, industries manufacturing electronic components and car parts have created many job opportunities for locals. Morib is being moulded into an education hub and that plans were afoot to set up a few educational institutions in Jugra. There is the Kuala Langat Community College and Industrial Training Institute. Other institutions being built are a matriculation college, a polytechnic and a Mara skills training institute. List of Kuala Langat district representatives in the Federal Parliament List of Kuala Langat district representatives in the State Legislative Assembly Districts of Malaysia 4. Http://www.mdkl.gov.my/en
The mulard is a hybrid between the different genera of domestic duck: the domestic muscovy and the domestic mallard. American Pekin are most used to breed mulards due to the breed's high meat production. Like many interspecific F1 hybrids, mulards are sterile. While it is possible to produce mulards artificial insemination is used more with greater success; the term mulard or moulard is reserved for offspring where the parental drake is a muscovy and the duck is a pekin. When the drake is a pekin, the offspring are called hinnies; the mulard is commercially produced on farms for foie gras. The white muscovy and Pekin are commercially farmed ducks. Hybrids of the two are calmer, in addition to exhibiting natural hybrid vigor; the incubation period of the hybrid eggs is between the mallard and muscovy, with an average of 32 days. About half of the eggs hatch into mulard ducks. Mulards tend to combine certain traits of the parent breeds. Due to their muscovy heritage, they produce leaner meat than Pekins.
Like muscovy ducks, mulards do not fly and perch. Traditionally, foie gras was produced with geese, but in the 1960s the majority of farmers began to use mulards. Geese are more expensive to maintain than ducks, the more temperamental muscovies did not accept the process of gavage as as Pekins, causing the quality of the foie gras to suffer; this problem was avoided by the introduction of mulards. These hybrids have become common in countries where foie gras is not produced. Today in France, the leading foie gras producer and consumer, the use of hybrid ducks outnumbers the use of geese. In 2007, there were 35 million mulard ducks raised compared with only 800,000 geese. In addition to Europe and the United States, mulards are raised throughout Southeast Asia. List of duck breeds
Benedetta Maria Ernestina d'Este was a noblewoman and princess of the Duchy of Modena and Reggio. She was the daughter of Duke Rinaldo d'Este and Princess Charlotte Felicity, daughter of the Duke of Brunswick and Lüneburg, her parents' marriage had required papal dispensation because of the close interrelationships of the ducal families of Brunswick and Modena. She was given the name Benedetta ‘blessed’ after her maternal grandmother, Benedicta Henrietta of the Palatinate, her cousin James Francis Edward Stuart the Jacobite claimant to the thrones of England and Ireland, paid a visit to Modena in March 1717. He fell in love with Benedetta and asked her to marry him. However, their union was seen as an undesirable entanglement by Rinaldo, who wanted to maintain good relations with George I. Rinaldo first insisted that the betrothal remain secret, definitively refused his consent to it in September 1717, while James was living in Urbino. Benedetta never had no children, she died on 16 September 1777 at Modena at the age of 80.
Bevan, Bryan. King James the Third of England: A Study of Kingship in Exile. London: Robert Hale. Rocca, Emilio Nasalli. I Farnese. Dell'Oglio Editore
The Pittsburgh Keystones were a semi-professional ice hockey club, located in Pittsburgh and was a member of the Western Pennsylvania Hockey League, the first league to hire hockey players from 1900-1904. The team played all of its games at the Duquesne Gardens, was involved in allowing Harry Peel become the first admitted professional hockey player in 1902; the Keystones' history can be traced to the Keystone Bicycle Club, which consisted of students from Western University and Carnegie Tech. Around 1895 the club gave up bicycling, renamed itself the Pittsburgh Keystones and played ice hockey at the newly built Schenley Park Casino, located in the Oakland neighborhood of Pittsburgh, on Saturday afternoons, as an amateur club. On December 30, 1895, the Pittsburgh Press made mention of a “great international hockey and polo tournament” opening game at the Casino; the newspaper reported that a team consisting of ten players from Queen's University played against a group of local players from Western University and Pittsburgh Catholic College of the Holy Ghost and a half hour of exhibition of hockey was played before the ice polo match.
The paper noted. No score or records were kept but the paper did note that the team from Queen's University outplayed the Pittsburghers, who had never played the game before. Since the students from Western University participated in the game, it is possible that several of those players played for the Keystones; the Casino was destroyed in a fire on December 17, 1896 The Yale University hockey team was to have played a series of games against the Keystones, at the Casino, but they were telegraphed and told not to come to Pittsburgh due to the destruction of the arena. Afterwards, the Keystones, every other amateur team in Pittsburgh, began playing all of their games on the new ice rink at the Duquesne Gardens; the Gardens, because of its artificial ice surface, lured many established hockey players to the Pittsburgh-area from Canada. In 1901 the team became members of the Western Pennsylvania Hockey League, with the Pittsburgh Bankers and Pittsburgh Athletic Club. Aside from league play, the teams played exhibition games against some of the best amateur teams from North America.
During the 1901-02 season, Riley Hern, a future member of the Hockey Hall of Fame, began his professional career with the Keystones. In his first season, Hern led the league in victories, with nine in 14 games and was named to the WPHL All-Star Team. However, in the next season, Hern led the league in losses. Joining Hern on the team in 1901 was Arthur Sixsmith who moved to Pittsburgh and turning professional with the Keystones; the Keystones would go on to win the 1901-02 WPHL championship title. In the summer of 1902 Keystones' player Harry Peel, a Keystones player in 1901-02, admitted that he was paid $35 a week to play in the so-called amateur league and so no amateur teams would play against these teams again without being suspended by either Canadian or U. S. officials. According to Peel " make no bones whatever about paying men. If they do not pay them, they give them fake positions." Peel was suspended by the Ontario Hockey Association and his appeal was rejected on December 10, 1903 and again on November 30, 1904.
However, by the 1902-03 season the WPHL, was known as a professional league. The next season, the Portage Lakes Hockey Club of Houghton, Michigan began a professional league which continued to play professional exhibition game against the WPHL's Pittsburgh Bankers; however the exposure given by playing Portage Lakes raised the profiles of some of the Pittsburgh players, who were lured away after the season for the promise of better pay in Michigan. The team soon raided Pittsburgh's teams for top players like Bruce Stuart; this led the Keystones to withdraw from the league on January 17, 1903. Their players were redistributed among the three other WPHL teams. Keystones players inducted into the Hockey Hall of Fame: Riley Hern Trietley, Greg. "Oakland Once the Hockey Center of Pittsburgh". Pitt News. "1895-1896 Pittsburgh's Schenley Park Casino". Pittsburgh Hockey.net. Retrieved April 20, 2012. Fitzsimmons, Ernie. "Pittsburgh can lay claim to at least a portion of the birth of professional hockey". Pittsburgh Hockey.net.
Retrieved April 20, 2012. "Riley Hern — Career statistics". Hockey Hall of Fame. Retrieved 2012-04-20.</ Landucci, Fred. "First'Pros' Start League Play in 1902". Pittsburgh Press. "Before the NHL: Western Pennsylvania Hockey League, International Professional Hockey League". Crashing the Net. Retrieved April 20, 2012
Events from the year 1685 in Sweden Monarch – Charles XI - Jews are formally banned from residing in Sweden. As there are no Jewish minority in Sweden, the ban is in effect a ban against Jewish immigration. - The postal service are now in practice, available in all the nation. - Guds Werk och Hwila by Haquin Spegel - The Sami religion, still practices despite the ongoing Christianization of the Sami people, is outlawed and all evidence of such practice is liable to an arrest, which results in the final forced official conversion of the Sami people to Christianity. 7 January – Jonas Alströmer and agriculture and industry 22 July – Henrik Magnus von Buddenbrock, baron 6 December – George Bogislaus Staël von Holstein and field marshal 24 September - Gustaf Otto Stenbock and military