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buride easy to divide in half with slight pressure if necessary is available in tablet sizes of 15 mg, 3 mg, and 6 mg Glyburide has few adverse effects other than its potential for causing hypoglycemia, which at times can be prolonged Flushing has rarely been reported after ethanol ingestion It does not cause water retention, as chlorpropamide does, but rather slightly enhances free water clearance Glyburide is absolutely contraindicated in the presence of hepatic impairment and should not be used in patients with renal insufficiency, in elderly patients, or in those who would be put at serious risk from an episode of hypoglycemia Glipizide is available in 5-mg and 10-mg tablets For maximum effect in reducing postprandial hyperglycemia, this agent should be ingested 30 minutes before meals, since rapid absorption is delayed when the drug is taken with food The recommended starting dose is 5 mg/d, with up to 15 mg/d given as a single daily dose before breakfast When higher daily doses are required, they should be divided and given before meals The maximum dose recommended by the manufacturer is 40 mg/d, although doses above 10 15 mg probably provide little additional benefit in poor responders and may even be less effective than smaller doses At least 90% of glipizide is metabolized in the liver to inactive products, and 10% is excreted unchanged in the urine Glipizide therapy is therefore contraindicated in patients with hepatic or renal impairment, who would be at high risk for hypoglycemia; but because of its lower potency and shorter duration of action, it is preferable to glyburide in elderly patients Glipizide has also been marketed as Glucotrol-XL in 5-mg and 10-mg tablets It provides extended release during transit through the gastrointestinal tract with greater effectiveness in lowering prebreakfast hyperglycemia than the shorter-duration immediate-release standard glipizide tablets However, this formulation appears to have sacrificed its lower propensity for severe hypoglycemia compared with longer-acting glyburide without showing any demonstrable therapeutic advantages over glyburide Gliclazide (not available in the United States) is another intermediate duration sulfonylurea with a duration of action of about 12 hours It is available as 80 mg tablets The recommended starting dose is 40 80 mg/d with a maximum dose of 320 mg Doses of 160 mg and above are given as divided doses before breakfast and dinner The drug is metabolized by the liver; the metabolites and conjugates have no hypoglycemic effect An extended release preparation is available Glimepiride is given once daily as monotherapy or in combination with insulin to lower blood glucose in diabetes patients who cannot control their glucose level through diet and exercise Glimepiride achieves blood glucose lowering with the lowest dose of any sulfonylurea compound, and this tends to increase its cost-effectiveness A single daily dose of 1 mg/d has been shown to be effective, and the maximal recommended dose is 8 mg It has a long duration of action with a pharmacodynamic half-life of 5 hours, allowing once-daily administration, which improves compliance It is completely metabolized by the liver to relatively inactive metabolic products b Meglitinide analogs Repaglinide is structurally similar to glyburide but lacks the sulfonic acid-urea moiety It acts by binding to the sulfonylurea receptor and closing the ATP-.

The incidence of colon adenocarcinoma is higher in blacks than in whites It is unclear whether this is due to genetic or socioeconomic factors (eg, diet or reduced access to screening)

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Adenocarcinomas grow slowly and may be present for several years before symptoms appear However, some asymptomatic tumors may be detected by the presence of fecal occult blood (see Colorectal Cancer Screening, below) Symptoms depend on the location of the carcinoma Chronic blood loss from right-sided colonic cancers may cause iron deficiency anemia, manifested by fatigue and weakness Obstruction, however, is uncommon because of the large diameter of the right colon and the liquid consistency of the fecal material Lesions of the left colon often involve the bowel circumferentially Because the left colon has a smaller diameter and the fecal matter is solid, obstructive symptoms may develop with colicky abdominal pain and a change in bowel habits Constipation may alternate with periods of increased frequency and loose stools The stool may be streaked with blood, though marked bleeding is unusual With rectal cancers, patients note tenesmus, urgency, and recurrent hematochezia Weight loss is uncommon Physical examination is usually normal except in advanced disease A mass may be palpable in the abdomen The liver should be examined for hepatomegaly, suggesting metastatic spread For cancers of the distal rectum, digital examination is necessary to determine whether there is extension into the anal sphincter or fixation, suggesting extension to the pelvic floor

The risk of adenocarcinoma of the colon begins to rise 7 10 years after disease onset in patients with ulcerative colitis and Crohn s colitis The cumulative risk approaches 5 10% after 20 years and 20% after 30 years Chronic treatment with 5ASA agents and folate is associated with a lower risk of cancer in patients with ulcerative colitis

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In this section we will cover elements that affect master data as well as introduce master data in tables

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