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The petiole is lobed- (chronic); parenterally: 1 to 2 ml sc acute: 3 times daily; winged proven 250mcg fluticasone. The cauline leaves are smaller generic fluticasone 250 mcg without a prescription, petiolate or sessile chronic: once a day; eye drops 1 to 3 times daily; liquid with 2 clasping lobes at the base cheap fluticasone 100mcg without prescription. The plant has a strong, hard dilutions D2 to D6: 20 to 60 drops; D12 to D30: 15 to 45 root up to 6 cm thick. Not to be Confused With: Because of the similarity in name, Hansel R, Keller K, Rimpler H, Schneider G (Hrsg. The (Drogen), Springer Verlag Berlin, Heidelberg, New York, 1992- plant is also confused with Inula racemosa. Volatile oil (1 to 6%): chief components dehydrocostus Roth L, Daunderer M, Kormann K, Giftpflanzen, Pflanzengifte, - lactone (35%) and costunolid (15%), including as well 4. Lignans: including olivil-4"-0-beta-D-glucoside Teuscher E, Lindequist U, Biogene Gifte - Biologie, Chemie, Pharmakologie, 2. Various drug extracts exhibit antimicrobial and fungi- static efficacy, and have an influence over liver metabolism Flower and Fruit: Single axillary, radial flowers are and liver sugar levels. A broncho- fused, divided into 5 and surrounded by 3 large, deeply spasmolytic effect has also been described. The stamens are numerous, and over a 3-month period led to a statistically significant the filaments are fused into a tube. The ovary is superior, and reduction of angina pectoris attacks among patients with the carpels are fused. These are covered in Indian Medicine: The root has been used in India since single-celled hair up to 46 mm long. Chinese Medicine: Internal uses include gastric complaints, Habitat: The plant is indigenous to the U. Commonwealth of Independent States, India, Pakistan and Externally, it has been used for poorly healing wounds and Egypt. Cotton seed oil No health hazards are known in conjunction with the proper is the refined, fatty oil from the seeds. It is using solvents or pressing followed by refinement with a conceivable that the plant could cause allergic reactions due yield of approximately 19%. Gossypium semen is derived to its sesquiterpene lactone content, but no cases of this have from the industrial extraction of cottonseed oil. Steroids: sterols, particularly beta-sitosterol, as well as campesterol, stigmasterol, delta7-stigmasterol, 24-methyl cycloartenol Costus specious Tocopherols (vitamin E): including 0. After feeding sheep and cattle a total of 2 to 3 kg of The oil contains large amounts of unsaturated fatty acids and Cotton seed press cakes over a period of 3 to 4 weeks, is chiefly used as a dietetic. Eye damage (Cotton seed ^ Fatty oil (20 to 30%): chief fatty acids include linoleic acid blindness) was also noted. Hagers Monosaccharides/oligosaccharides (7%): saccharose, raffi- Handbuch der Pharmazeutischen Praxis, 5. Bde 4-6 nose, stachyose, glucose, fructose (Drogen), Springer Verlag Berlin, Heidelberg, New York, 1992- 1994. Unproven Uses: Folk medicine indications for Gossypii oleum have included hypercholesteremia and vitamin E Flower and Fruit: The flowers are in apical, sparsely deficiency. The seeds are reniform, approximately 7 mm headache, coughs, dysentery, constipation, gonorrhea, chron- long, 5 mm wide and villous. Reference is also made to use as an abortifacient and Leaves, Stem and Root: Cochlospermum gossypium grows aphrodisiac. Efficacy for these indications has not yet been as a tree, rising up to 10 m high. Animal experiments over a period of several weeks involving the Habitat: The tree is indigenous to India, Southeast Asia, administration of cyclopropene-fatty acids led to elevated Kenya and Mauritius. The drug is derived from the hair of the Water-soluble polysaccharides: partially-acetylated, acidic pods. Indian Medicine: Uses include coughs, diarrhea, dysentery, Carminative, hypotensive, hypoglycemic and cholesterol- pharyngitis and venereal disease. Blaschek W, Hansel R, Keller K, Reichling J, Rimpler G, Indian Medicine: Uses in Indian medicine include gonor- Schneider G (Eds), Hagers Handbuch der Pharmazeutischen rhea, sterility and general debility. The intake of the hairs for the purpose of fighting Mucuna pruriens intestinal worms should be avoided. The seeds are made up of conical, sharply acuminate Hegnauer R, Chemotaxonomie der Pflanzen, Bde 1-11, cells less than 1 mm in diameter and barbed at the apex. Habitat: The plant is indigenous to tropical regions, especial- Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, ly India and the West Indies. Kormann K, Giftpflanzen, Pflanzengifte, Heaven, Fairy Caps, Petty Mulleins, Buckles, Crewel. Flavonoids (3%): including rutin, kaempferol-3-O-rutino- side, isorhamnetin-3-O-glucoside; isorhamnetin rhamnosyl Teuscher E, Biogene Arzneimittel, 5. The flowers are turned to one methyl ester-O-xyloglucoside) changing over during dehy- side and grow in clusters (up to 25) from the center of the dration into the characteristic-smelling 5-methoxy-methyl leaf rosette. The corolla is odorless, usually sulfur Triterpene saponins (5 to 10%): chief components primulic yellow and has a tube with 5 triangular, orange spots. They are 3 to 6 • Cough/Bronchitis cm long during the flowering season, but grow larger later. Unproven Uses: Cowslip flower is used internally for catarrh The upper side of the leaf is glabrous. In folk medicine it is used for Habitat: The plant is indigenous to all of Central Europe as insomnia, anxiety states, as a cardiac tonic for feelings of far as the Southern European mountains. Unproven Uses: Cowslip root is used internally for catarrh of Storage: Should be protected from light and moisture. Externally it is used for headaches and and strained (1 teaspoon corresponds to approximately 3. The epigeal organs of the Primula species possess a Liquid extract: the Primula extract is dissolved in a mixture very high potential for sensitization due to the primine of ethanol (30 parts), glycerol 85% (20 parts) and water (20 content. The flowers are radial with the structures arranged in Madaus G, Lehrbuch der Biologischen Arzneimittel. The ovary is formed from 5 carpels, which are fused to the sides of the Steinegger E, Hansel R, Pharmakognosie, 5. Leaves, Stem and Root: The herbaceous perennial grows Teuscher E, Biogene Arzneimittel, 5. The stem is upright, green, Biiechi S, Antivirale Saponine, pharmakologische und klinische pubescent and dichotomously branched. Habitat: The plant is found throughout Europe, but also in Calis I, Yuruker A, Riiegger H. Sticher O, North America from Newfoundland to Manitoba and as far Triterpene saponins from Primula veris ssp.

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It lowers systemic vascular resistance while maintaining renal order fluticasone 250 mcg on line, coronary purchase fluticasone 250mcg without prescription, and cerebral blood flow quality fluticasone 250 mcg. Intravenous boluses of labetalol require 2 to 5 minutes to begin lowering the blood pressure. Esmolol is effec- tive in blunting the reflex tachycardia induced by nitroprusside. The main adverse effect is abrupt reduction in blood pres- sure and reflex tachycardia, which can be harmful in patients with coronary heart disease. It decreases preload and also increases coronary blood flow to the subendocar- dium. Nitroglycerin can be administered as a paste, sublingual spray, dissolvable tablet, or an infusion. It has a rapid onset and is considered the drug of choice in hypertensive emergencies in patients with cardiac ischemia, left ventricular dys- function, and pulmonary edema. It is not recommended in patients with severe aortic stenosis, left ventricular outflow obstruction, or inferior wall myocardial infarction because of the chance of precipitating cardiovascular collapse. Fenoldopam: It is a selective peripheral dopamine type 1 (D1) agonist that has recently been added to the list of medications used in the treatment of hypertensive emergencies. It has the advantage of increasing renal blood flow and improving creatinine clearance. As a result, fenoldopam may be the drug of choice in treating hypertensive emergen- cies in the setting of impaired renal function. Hydralazine: It lowers blood pressure by a direct vasodilatory effect on arteriolar smooth muscle. It is the preferred treatment by obstetricians in treating preeclampsia/eclampsia for decades, but has fallen out of favor for treatment of hypertension in other conditions. Another downside of hydralazine is that while the half life is 3 to 6 hours, the total duration of effect is up to 36 hours and can be unpredictable. Enalaprilat lowers systemic vascular resistance, pulmonary capil- lary pressure, and heart rate while increasing coronary vasodilation. More aggressive lowering of the blood pressure can lead to hypoperfusion and ischemia as discussed above. Acute cerebral infarction or hemorrhage: There is continued controversy as to when and how much elevated blood pressure should be lowered in patients with ischemic stroke. In fact, a recent multicenter, randomized control trial in Europe failed to demonstrate any benefit of lowering blood pressure in acute stroke and showed a trend towards harm. For patients who are candidates for thrombolytic therapy, blood pressure should be lowered to less than 185/110 mm Hg and main- tained to less than 180/105 mm Hg for the next 24 hours. Otherwise, for patients who are not thrombolytic candidates, cautious lowering of pressure greater than 220/120 mm Hg is generally accepted, being careful to avoid lowering it too much or too rapidly as to induce drops in cerebral perfusion and cause greater ischemia. Acute myocardial infarction: The goal in lowering the blood pressure in these cases is to decrease cardiac work by decreasing afterload and increasing coronary perfusion pressure. Aortic dissection: It is critical to lower blood pressure rapidly in this condition to limit progression of the dissection. Acute aortic dissection represents the only hypertensive emergency where rapid, aggressive blood pressure reduction is indicated. The goal is to maintain arterial pressure as low as possible without compromising end-organ per- fusion. If this does not adequately lower blood pressure it should be used in combination with sodium nitroprusside. Preeclampsia/eclampsia: The most commonly used agent in the past was hydral- azine. However, obstetricians are using labetalol more frequently because it has similar efficacy and fewer side effects. In addition, magnesium sulfate is generally administered for seizure prophylaxis, though it has not been shown to lower blood pressure in hypertensive pregnant patients. Observe the blood pressure and recheck in 1 hour, and supportive mea- sures for the headache and vomiting. She has been out of her medications for 2 weeks and cannot get an appointment with her private physician until next week. Give her a prescription for her medications, instruct her to take them immediately, and have her follow-up in 48 hours. Counsel the patient on the dangers of her noncompliance, admit to the hospital, and begin the patient on intravenous labetalol. After complete evaluation it is determined that he sustained a fractured right tibia. The patient has a history of hypertension for which he is on pharmacologic treatment. She has no symptoms related to her elevated blood pressure and no signs of end-organ damage. The patient should restart her medications and have her blood pressure reassessed in 48 hours. Although this man has a history of hypertension, he is in excruciating pain, which could be causing his elevated blood pressure. The appropriate treatment is to control the pain, have the leg set back into place, and monitor his blood pressure. One of the most common reasons for hypertensive emergency is patient noncompliance with antihypertensive medication. It is critical to cautiously lower blood pressure to avoid inducing a hypoperfusion state that leads to cerebral ischemia. Patients with hypertensive emergency should be admitted to a monitored setting, preferably an intensive care unit. Cardiovascular alterations in severe pregnancy induced hypertension: acute effects of intravenous magnesium sulfate. Hypertensive emergency and severe hypertension: what to treat, who to treat, and how to treat. Emergencies in the second and third trimesters: hypertensive disorders and antepar- tum hemorrhage. The pain is described as constant, exacerbated by move- ments, and associated with subjective fevers and chills. The abdomen is mildly distended and tender in both right and left lower quadrants. Involuntary guarding and localized rebound tenderness are noted in the right lower quadrant. The pelvic examination reveals no cervical discharge; cervical motion tenderness and right adnexal tenderness are present. Her examination indicates the presence of fever and lower abdominal tenderness (right > left). If these suggest pelvic source of pathology, then strong consideration should be given to perform exploratory laparoscopy or laparotomy. Learn the relationships between symptoms, findings, and pathophysiology of the various types of disease processes capable of producing acute abdominal pain. Learn to develop reasonable diagnostic and treatment strategies based on clinical diagnosis, resource availability, and patient characteristics.

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Diabetes Management in General Practice Guidelines for Type 2 Diabetes 2011/12 Australia 3 cheap fluticasone 250mcg with visa. Complications Le diabète de type 2 multiplie par un facteur 2 à 3 la morbidité et la mortalité cardiovasculaire generic fluticasone 100mcg without prescription. Il est aussi défini par la présence de symptomes de diabète (polyuropolydipsie) avec une glycémie supérieure ou égale à 2 g/l order 250 mcg fluticasone amex. Une HbA1c supérieure ou égale à 6,5 % à deux intervalles différents à n’importe quel moment de la journée peut aussi définir le diabète. Le diagnostic et la prise en charge du diabète de type 2 doivent être le plus précoce possible. Pied diabétique • Les plaies du pied, chez le patient diabétique, ont une origine à la fois neuropathique (perte de sensibilité, déformations et limitation de mobilité articulaire) et ischémique. Le monofilament doit pour cela être appliqué 3 fois, perpendiculairement et avec suffisamment de force pour le courber, sur 3 sites plantaires : pulpe du gros orteil, et en regard de la tête des 1er et 5e métatarsiens. Le statut vaccinal antitétanique doit être systématiquement vérifié, avec si nécessaire une revaccination. Diabète et chirurgie • Le chirurgien et l’anesthésiste doivent prendre en compte l’existence éventuelle d’une insuffisance coronarienne, d’une hypertension artérielle, d’une dysautonomie (risque d’hypotension), d’une insuffisance rénale, d’une gastroparésie (risque de stase gastrique et d’inhalation à l’induction anesthésique). En raison du risque accru d’insuffisance rénale et d’acidose lactique chez les patients sous metformine, ce médicament doit être interrompu 48 h avant l’intervention et réintroduit 48 h après la reprise de l’alimentation. Ainsi certains traitements prolongés (par exemple antiagrégants après pose de stent coronaire) peuvent compliquer la prise en charge chirurgicale. Le recours à l’insuline pourrait être utile pour le maintien du bon contrôle glycémique. Diabète et grossesse (recours au diabétologue) • Grossesse chez une femme diabétique : la patiente diabétique doit être informée des risques que le diabète représente pour le développement embryofoetal, ainsi que des difficultés de gestion de la période obstétricale chez une femme présentant un diabète. Une éventuelle grossesse doit ainsi être prévue, et les modalités de suivi en milieu spécialisé envisagées, avant la conception. Conseils aux patients • La participation active, prolongée, régulière et persévérante du patient diabétique à sa prise en charge est indispensable. Physiopathologie Les lipides ayant une importance sur le plan clinique sont les triglycérides en tant que fournisseurs d’énergie et le cholestérol comme constituant des membranes cellulaires. Le cholestérol a une double origine : Exogène (300-700mg/jour) en provenance de l’alimentation (graisse animales essentiellement), et endogène (700- 1250mg/jour) par biosynthèse essentiellement hépatique. La dyslipidémie peut être due à un dysfonctionnement du système de régulation qui permet à cette synthèse de diminuer lorsque les apports alimentaires augmentent. Epidémiologie Les dyslipidémies sont des affections extrêmement fréquentes puisqu’elles affectent près de 4% de population occidentale de plus de 30 ans. Traitement non médicamenteux : • Mesure générale : Traitement de la cause d’une dyslipidémie secondaire et élimination des facteurs de risque associés. Traitement médicamenteux (voir la liste des médicaments citée) : • Dans les hypercholestérolémies pures ou mixtes, les statines sont le traitement de première intention. La cible thérapeutique est déterminée selon des facteurs de risque cardiovasculaire. Hyperlipidémies secondaires Certaines hyperlipidémies peuvent être secondaire à une pathologie (hypothyroïdie, syndrome néphrotique, insuffisance rénale, cholestase, etc. Elles ne doivent pas donner lieu à des prescriptions d’hypolipémiants sans traitement de la maladie causale ou arrêt du traitement responsable. Au-delà de 80 ans, les interventions médicamenteuses doivent être limitée à la prévention secondaire. En prévention primaire, ne prolonger un traitement médicamenteux que si le patient a plusieurs facteurs de risques, si son espérance de vie n’est pas réduite par une autre pathologie, si l’on a prise en charge les autres facteurs de risque réversibles et si les prescriptions n’entraînent ni effets indésirables, ni interactions médicamenteuses. Chez l’enfant présentant une hypercholestérolémie pure, on prescrira : un régime, de la cholestyramine, en évitant las autres médicaments. Sa prise en charge n’est donc pas isolée, mais s’inscrit dans une prise en charge globale de tous les facteurs de risque susceptibles d’être corrigés par des règles hygiéno-diététiques et/ou par un traitement médicamenteux. Polycopié Nationale du Collège des enseignants d’ Endocrinologie, diabète et Maladeies métaboliques 2007. Collection Med-Line : Cardiologies et Pathologies Vasculaires, Pierre Vladimir Ennezat, Medline Editions 2007. L’adhérence sur le long terme à ce type de recommandations est soumise à de nombreux aléas comme pour les mesures diététique. Adults may have goiters that are diffuse or nodular, and the goiters may be associated with normal, decreased, or increased thyroid hormone production. There is often a family history of goiter, suggesting that genetic factors may also play a role. The following observations support this sequence of events: - Thyroid volume is larger in older patients. Epidemiology Simple goiter is present in about 5% in general population and 10% for multi- nodular goiter. In patients with infection, the thyroid abnormalities are predominantly unilateral, whereas most patients with sub-acute thyroiditis have bilateral thyroid enlargement and pain. The rare anaplastic thyroid cancers or primary lymphomas of the thyroid often present with a rapidly enlarging neck mass that may cause obstructive symptoms, such as dyspnea, wheezing, and cough. Goiter may also be an incidental finding during a radiologic procedure performed for other purposes (eg, neck ultrasound). Once goiter is detected, the diagnostic evaluation is aimed at: - identifying the underlying cause, the presence of obstructive symptoms, the presence of suspicious sonographic features in nodules within the goiter, and - assessing thyroid function. It is important to rule out malignancy through history, clinical examination, ultrasound, and fine needle aspiration biopsy of large or suspicious nodules. In the absence of autoimmune thyroid disease, thyroiditis, and thyroid malignancy, benign multinodular goiter is the most likely diagnosis. In patients with goiter, a history of iodine intake (including country of origin), medication history, family history of benign or malignant thyroid disease, and history of head and neck irradiation or radioiodine exposure from should be obtained. A thyroid ultrasound should be obtained to assess sonographic features, the presence of nodularity, and the presence of lymphadenopathy. In patients with overt or subclinical hyperthyroidism and goiter, multinodular goiter with autonomy or Graves’ disease is the most likely diagnosis. Thyroid ultrasound — Thyroid ultrasound should be obtained in all patients with nontoxic goiter unrelated to Hashimoto’s thyroiditis or iodine deficiency. In the latter two circumstances, ultrasound should be reserved for patients with thyroid asymmetry or palpable nodules. Thyroid ultrasound in patients with Hashimoto’s thyroiditis should be interpreted with caution due to the diffuse heterogeneity and the presence of pseudonodules related to ongoing inflammation. Ultrasound may identify distinctive, nonpalpable thyroid nodules within a nodular or diffuse goiter. Nodules with indeterminate or suspicious ultrasound features should be considered for biopsy because the prevalence of cancer in an individual nodule in a goiter is independent of the number of sonographically identified nodules.

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Lesion volume was obtained from of polyneuropathy occurring after vasculitis due to viral infection purchase 250 mcg fluticasone fast delivery. A)) to determine the effect of computer-based The Relationship between Motivation and Functional work on postural balance fluticasone 250 mcg free shipping. Static balance control was measured by equilibrium score and dynamic balance control was measured by Outcome in an Inpatient Rehabilitation Setting rhythmic weight shift test fluticasone 250mcg with mastercard. Results: Data were collected 1 1 1 related to patient`s lesion volume (mean volume=14 cm3 or 4. The p value for Introduction:Apathy is a disturbance of motivation, emotion or in- the regression coeffcient of lesion volume was 0. Conclusion: There are no signifcant relation- athy has been reported to interfere with efforts at rehabilitation and ship in lesion volume and postural control ability in the chronic complicate further both assessment and treatment. Other factors may account for variance in postural to assess whether, and to what extent, lack of motivation relates to control ability after stroke. Twenty two had orthopedic problems and Traumatic Spinal Cord Injury Patients 8 had right- hemispheric stroke. The apathetic patients tended to the effect of electrical stimulation in extensor spasticity of lower be older (mean age 82. Apathy had a statistically signifcant im- Design: Hospital-based randomized study. Intervention: Study group discharge did not differ signifcantly in the patients with or without (n=18) received electrical stimulation and standard physiotherapy apathy. Conclusion: Results showed stimulation in study group were 60 Hz with 5 second on and 2 that apathy appeared to have a signifcant negative impact on over- second off, intensity ranging from 1 to 10 mA with suboptimal mo- all functional outcome. It does seem to interfere in improving or tor contraction with treatment duration of 20 minutes per session, worsening the patients’ clinical condition. After 6 weeks of treatment, there was a signifcant reduction in spasticity in study group. Conclusion: There was statistically signifcant to look at the prevalence of Vitamin D defciency (≤30 nmol/L improvement in outcome measures in study group. Methods: Serum 25–hy- 1 to 4) of lower limbs following traumatic spinal cord injury. Conclusion: The study found that the preva- posterior lateral spinal artery, arising from the left T11 intercostal lence of Vitamin D defciency in patients admitted between April artery. The decision was made against neurosurgical treatment and and October 2014 was 56. The procedure was fully independent in transfers, feeding, and upper body dress- developed recommends which blood tests to perform and an action ing, and at follow-up, was ambulating with bracing and walker, plan for supplementation, depending on the levels of Serum 25-hy- independent in bowel/bladder management. This non- an extremely rare clinical entity with an annual incidence estimated surgical case is equally important is highlighting the importance about 1 per 5 millions. Moebious syndrome, Leukemia, Viral infections, Syphilis, Basilar skull fractures and Pontine gliomas. The purpose of this paper is to describe a case of a 21-year-old man with idiopathic Simultane- ous Bilateral Facial Nerve Palsy. There was tre (Trauma and Neurological Rehabilitation Unit) no other signifcant past medical history and he was on no regular medications. Osman3 plete lower motor neuron type of facial palsy (House & Brackman 1Royal Liverpool University Hospital Trust and Broadgreen Hos- Grade V). Cranial Computed Tomography Scan was normal and Lumbar Puncture did not revealed alterations. He was diagnosed with probable Idiopathic Simulta- cause muscle weakness, musculoskeletal pain, increased body neous Bilateral Facial Nerve Palsy and started on 60 mg/day of sway and falling events, impaired physical function and reduced prednisone and a rehabilitation program. Conclusion: Simultaneous presentation of New research is looking into the link between Vitamin D and cog- bilateral facial palsy is very uncommon. Their rehabilitation exercise program emphasizes accuracy of facial movement pat- progress is also affected by other diseases and co morbidities which terns and isolated muscle control improving the complete recovery. Keywords: Bilateral facial nerve palsy, idiopathic, rehabilitation Material/Methods: The subjects were 43 patients (27 males/16 fe- clearness of the guides during distant training as 2. The average duration of stay in the rehabilitation as no need for transfer, staying in comfortable home environment, center, was 114 days. Patients were categorized according to the fexible schedule, optimal training due to professional guidance. In case of limited funding short-term intervention may be group F (diabetes mellitus). Additionally in group C (orthopedic diseases-fractures), Robotic-Assisted Rehabilitation of the Upper Limb in patients were evaluated 2 months post-admission. Results: Group E had the worst progress in all categories, especially in toileting Stroke Patients with Unilateral Neglect and Shoulder (72. Finally, the improvement in eat- bilitation program which utilises robotic support using Armeo® ing was impressive in all groups, (only 11. We hope to achieve repetitive training of reach, grasp, and bidities do not actually affect the progress of rehabilitation as well release in an engaging environment that can be adapted to indi- as group C after two-month rehabilitation. Eating is the category vidual capabilities, and to enable stroke survivors whose motor in which patients reach the highest levels of independence, while weakness and visuo-perceptual problems may have excluded them toileting presents the worst progress of all. The pa- Training Tool to Improve Upper Limb Functionality in tients were randomly assigned to experimental (14) and control Stroke Patients (10) groups. Robotic (Armeo in joints) and daily life activities (Barthel Index) at baseline and Spring) training devices are increasingly being used in the rehabil- post-intervention. Results: The results show that experimental itation of upper limb function in subjects with neurological disor- group patients improved signifcantly better than subjects of the ders. Material/Methods: Ten participants (5 males and 5 females) control group according to visuo-perceptual, visuo-motor abili- with ischemic stroke for the frst time between 65-83 years old ties, reduction in subluxation, arm function and activity scales. Oxford scale, Upper Extremity Functional Index are promising with respect to reducing upper limb impairments in (U. Results: Participants started the occupational therapy sessions on average Oxford scale 1+ and a mean score in U. Subse- quently the occupational therapy program patients were started a panying Factors Affect the Functional Independence two months robotic therapy with Armeo Spring. Sgout- months patients were evaluated three times with the Workspace J Rehabil Med Suppl 54 E-Posters 199 program. Relationship between Dysphagia and Biochemical Mark- Conclusion: The results of this study indicate that occupational ers in Patients with Stroke therapy has the leading role of rehabilitation in patients with low or A. Culha2 no upper extremities muscle power but also robotic therapy could 1 Ankara Physical Medicine and Rehabiitation Training and Re- be useful to improve occupational therapy’s achievements. Introduction: Dysphagia is a symptom that defned as diffculty of swallowing foods by mechanical obstruction, reduced muscle strength or impaired muscle coordination. Aim was to determine the relationship Study about 50 Cases between dysphagia and biochemical markers in patients with 1 1 1 1 stroke. Methods: Retrospective study between Junuary tients, there was no statistically difference for age, sex, and time 2010 and December 2013 in the department of physical medicine after stroke and affected side. Total protein, lesions were at the thoracic (15 cases) and cervical level (15 cases). Regarding this, magnesium defciency was the were admitted to our department after a post operative period of 78 most encountered electrolyte defciency.