cryptosporidium treatment metronidazole. metronidazole. Childrenespecially infantsare predisposed to dehydration and require more diligence in determining hydration status. nausea. Please enable it to take advantage of the complete set of features! 5 0 obj Bookshelf . Nitazoxanide: a new thiazolide antiparasitic agent. If you are treating a vaginal infection, your sexual partner may also need to take metronidazole so you don't become reinfected. Tell your doctor if you have symptoms such as itching or discharge during or after treatment with this medicine. Healthcare professionals might consider re-testing stool at least 1 week after the last dose of nitazoxanide only if symptoms do not resolve. When metronidazole is given as follow up treatment for persistent symptoms of chlamydia, usually in addition to other antibiotics such erythromycin, it is there to provide treatment for other possible bacterial causes that may cause similar symptoms to chlamydia. There has been one reported death associated with this reaction. Albendazole and nitazoxanide are effective against giardiasis but require multiple doses. See permissionsforcopyrightquestions and/or permission requests. When a person consumes alcohol, the body breaks it down in two steps. vomiting. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. In some animals, particularly ruminants but also wild mammals, Giardia infection commonly occurs without overt or apparent clinical signs. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 4. Therefore, parents should talk to their healthcare providers about fluid replacement therapy options for infants. There is a need for a highly effective treatment for cryptosporidiosis in immunodeficient patients, but the quest for such a drug has proven to be elusive. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use metronidazole only for the indication prescribed. Cryptosporidiosis is the second most common cause of diarrhea in children (after rotavirus). If you cant keep anything down or your diarrhea is severe (more than 10 watery stools a day), contact your healthcare provider. Some drugs can affect your blood levels of other drugs you use, which may increase side effects or make the medicines less effective. Application of Proteomics to the Study of the Therapeutics and Pathogenicity of. To help diagnose giardia infection (giardiasis), your doctor is likely to test a sample of your stool. Stool cultures are the diagnostic standard for bacterial foodborne illness; however, culture results are positive in less than 40% of cases. All 3 are primarily spread via ingestion of cysts in contaminated water (AKA fecal-oral transmission) and all 3 present with diarrhea. Foodborne illnesses are becoming a greater challenge because of new and emerging microorganisms and toxins, the growth of antibiotic resistance, increasing food contamination caused by new environments and methods of food production, and an increase in multistate outbreaks.1 There are more than 250 identified pathogens that cause foodborne illness. Visitation, mask requirements and COVID-19 information. . 16 . Metronidazole and tinidazole are also active against amoebae which may have migrated to the liver. Cryptosporidium enteritis is an infection of the small intestine that causes diarrhea. This site needs JavaScript to work properly. Unable to load your collection due to an error, Unable to load your delegates due to an error. The .gov means its official. If you have a weakened (compromised) immune system, you can have symptoms for months or years. Leder K, et al. Most people with healthy immune systems will get better without treatment for cryptosporidiosis. Compared with leukocyte examinations, lactoferrin measurements are more sensitive but more expensive, have a higher false-positive rate, and require a fresh-cup sample examined by an experienced microscopist.5, Use of antidiarrheal medications, including antimotility agents, anticholinergics, and adsorbents, is not recommended in children, especially those younger than two years, and is discouraged if infection with Shiga toxinproducing E. coli is suspected.68 Symptomatic treatment with loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) is effective and may be considered in adults with uncomplicated acute or traveler's diarrhea.911 Although loperamide is more effective than bismuth subsalicylate, it is not recommended for patients with hematochezia and systemic symptoms because it may increase the risk of invasive disease.10. Activity is based on recent site visitor activity relative to other medications in the list. The schedule may depend on the exact dosage form or strength of the medication. Cryptosporidiosis is a highly prevalent gastrointestinal parasitic disease caused by protozoan species of the genus Cryptosporidium that infect a wide range of animals, including people, throughout the world. Physicians should avoid attributing cases of foodborne illness to specific food sources without definitive testing and reporting. If treatment is necessary, discuss the best available treatment option with your doctor. Tell any doctor who treats you that you are using this medicine. Metronidazole is the most commonly used antibiotic for giardia infection. Centers for Disease Control and Prevention. 2022 Dec;46(4):1133-1146. doi: 10.1007/s12639-022-01513-2. This limitation of treatment . Metronidazole (10-15 mg/kg PO Q 12 H for 7 days) Tritrichomonas blagburni Pentatrichomonas hominis: Ingestion of trophozoites (fecal-contaminated material) . What happens if you drink alcohol with metronidazole? Signs and symptoms of Cryptosporidium infection. Cloacal swabs were collected every 2 months for 6 months to measure C. serpentis shedding by probe . A limited number of infectious agents account for most of these illnesses, raising the hope that advances in the treatment and prevention of these infections can have global health impact. eCollection 2022 Nov. Aziz AFE, Roshidi N, Othman N, Mohd Hanafiah K, Arifin N. Diagnostics (Basel). The only drug that has FDA approval for treatment of Cryptosporidium is nitazoxanide [ 2 ]. The injection is given as an infusion into a vein. government site. You usually get it from contaminated water in public pools or other recreational swimming areas. The gastrointestinal protozoa include Cryptosporidium, Giardia Lamblia & Entamoeba Histolytica. Cryptosporidiosis spreads easily. Doumbo O, Rossignol JF, Pichard E, Traore HA, Dembele TM, Diakite M, Traore F, Diallo DA. People with severe immune suppression, particularly those with advanced HIV infection . It is possible that the reaction could just be a side effect of metronidazole or potentially only occur in a small sub-group of susceptible people, because the reaction does not appear to occur in everybody. You also may be given instructions about how to bring in a sample of your stool. Dont drink untreated water or unpasteurized milk. Many people who do have problems often get better on their own in a few weeks. In recent years, nitazoxanide has been licensed in the United States for the treatment of cryptosporidiosis in non-immunodeficient children and adults, becoming the first drug approved for treating this disease. Nitazoxanide in the treatment of cryptosporidial diarrhea and other intestinal parasitic infections associated with acquired immunodeficiency syndrome in tropical Africa. The best way to take care of yourself at home with cryptosporidiosis is to make sure youre staying hydrated and that your symptoms dont worsen. There is a lack of accepted safety for use under medical supervision. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Version: 15.01. INTRODUCTION. Not all uses of metronidazole are approved for treating children and teenagers. Metronidazole oral is taken by mouth. Copyright 1996-2023 Cerner Multum, Inc. While not effective against Cryptosporidium, nitroimidazoles such as metronidazole or tinidazole are effective treatments for giardiasis and can be administered as a single dose. Abuse may lead to severe psychological or physical dependence. Giardiasis is an intestinal infection with the protozoan parasite Giardia spp. skin tissue infection due to Peptostreptococcus bacteria. 1999 Dec;18(12):885-9. doi: 10.1007/s100960050424. Empiric treatment should focus on symptom management, rehydration if the patient is clinically dehydrated, and antibiotic therapy. This will help reduce the risk of reinfection. Eat small bites of food if youre able to. Continue reading. cryptosporidium treatment . But usually infection with cryptosporidium causes a gastroenteritis-type illness. What should I do if my symptoms get worse or change? Anti-diarrheal medicine may help slow down diarrhea, but a healthcare provider should be consulted before such medicine is taken. . Diagnosis and management of a foodborne illness are based on the history and physical examination. is a leading cause of diarrheal disease morbidity and mortality .Recent estimates suggest Cryptosporidium spp. Most cases of acute infectious diarrhea are viral, and improper use of empiric antibiotics is associated with increased morbidity caused by adverse effects and Clostridium difficile colitis. Oral yeast infections (oral thrush or oral candidiasis) have also been reported with metronidazole oral treatment. Drinking alcohol while taking metronidazole is not recommended because the combination of metronidazole and alcohol can cause a reaction (often referred to as a disulfiram-like reaction) in some people. Yes 1, 2. It is most commonly seen in children aged between 1 and 5 years. Outbreaks can be declared by local, county, state, or national agencies; reporting outbreaks to the CDC is left to the discretion of the agency. Cryptosporidiosis is a diarrhoeal disease caused by the parasite, Cryptosporidium, which infects the intestine. Shake the oral suspension (liquid). 1. It is critical that this recommendation is followed to prevent the spread of this chlorine-resistant parasite through public swimming pools and other aquatics venues. Editorial Note: Cryptosporidium is a protozoan parasite; it is a well recognized . Alcohol-based hand sanitizers and chlorine in pools dont kill Cryptosporidium. Am J Trop Med Hyg. The site is secure. Discussion. Continue reading, If you are taking oral metronidazole or using metronidazole gel for an infection that is linked with sexual activity, such as trichomoniasis, pelvic inflammatory disease, or bacterial vaginosis you should not have sex for 7 days after single-dose therapy (or until you have completed the 7-day treatment regimen) and your symptoms have resolved. Repurposing of drugs developed for other indications and development of inhibitors for novel targets offer hope for improved therapies, but none have advanced to clinical studies. AHFS DI Monograph, Prescribing Information, Drug class: Metronidazole treatment caused a significant decrease in OPG count from 6th day post treatment and onward (P less than 0.05). #YEtB%W:|)Zchp0=e98;*N TOt5{4O]x:QC3T,# mVUxvqICz]4h-WF3sDV#GJ2rmE&-,jY]^jo:4%d b. Currently, nitazoxanide is the only proven anti-parasitic treatment for Cryptosporidium infections. FOIA Rapid loss of fluids from diarrhea may be especially life threatening to babies. The parasite can cause a gastrointestinal illness called cryptosporidiosis (crip-toe-spor-id-ee--sis). Treatment Metronidazole is the drug of choice. Gharpure R, Perez A, Miller AD, Wikswo ME, Silver R, Hlavsa MC. Keep using this medicine even if your symptoms quickly improve. 2022 Nov 3:1-11. doi: 10.1007/s11259-022-10025-6. Cryptosporidium enteritis is an infection of the small intestine characterized by diarrhea, which is caused by the parasite cryptosporidium. Other tests that can be considered include serum chemistry (including albumin levels), C-reactive protein levels, complete blood count, blood cultures, urinalysis, abdominal radiography, anoscopy, and endoscopy, if warranted by the severity and pattern of symptoms.5 In severe cases of infectious diarrhea, toxic megacolon should be considered, which can be identified on plain abdominal radiography.4 Severe inflammatory changes can also be seen on computed tomography. doi: 10.1128/AAC.01505-17. Copyright 2023 American Academy of Family Physicians. Follow all directions on your prescription label and read all medication guides or instruction sheets. Go to the nearest ER if you cant keep any food or liquid down, have more than 10 episodes of watery diarrhea in a day or have symptoms of severe dehydration, including: Cryptosporidiosis spreads easily and can be hard to completely avoid. Clostridium perfringens is a bacterial infection of the intestines with which most cats develop long-term clinical symptoms of diarrhea and clinical signs associated with . Clin Infect Dis. Consumer information on food safety is available from the CDC at http://www.cdc.gov/foodsafety/facts.html or from the U.S. Food and Drug Administration at http://www.fda.gov/Food/FoodborneIllnessContaminants/FoodborneIllnessesNeedToKnow/default.htm or http://www.foodsafety.gov, or by calling (888) SAFEFOOD ([888] 7233366). Nitazoxanidehas been FDA-approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems and is available by prescription. official website and that any information you provide is encrypted Giardia duodenalis (C&D) trophozoites measure 9 to 21 long, 5 to 15 wide, and 2 to 4 thick. Fox LM, Saravolatz LD. Expert Rev Anti Infect Ther. Take all of your medication as prescribed, even if you feel better before youve finished it. Continue reading. Weller PF. Jumani RS, Bessoff K, Love MS, Miller P, Stebbins EE, Teixeira JE, Campbell MA, Meyers MJ, Zambriski JA, Nunez V, Woods AK, McNamara CW, Huston CD. Albendazole . Dont swim in public pools or have sex for two weeks after having diarrhea. Disclaimer. Cleveland Clinic is a non-profit academic medical center. Paromomycin used against Cryptosporidiosis under experimental conditions showed better results than albendazole and metronidazole. FOIA The drug has multiple schedules. Nitazoxanide has been approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems. The .gov means its official. Symptoms of cryptosporidiosis. Policy. Advertising on our site helps support our mission. . Investigation of the prophylactic and therapeutic effectiveness of oral thyme extract in rats experimentally infected with cryptosporidium parvum. Accessed Nov. 3, 2020. This medicine will not treat a viral infection such as the common cold or flu. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Epub 2014 Feb 24. Drink unfiltered or untreated water (often while traveling, hiking or camping). What should I eat or drink? ACS Infect Dis. Epub 2022 Dec 26. Can metronidazole cause a yeast infection? In June 2004, nitazoxanide was also licensed for older children and adults. This content is owned by the AAFP. Cryptosporidium infections usually arent serious for someone with a healthy immune system. Do not take two doses at one time. An official website of the United States government. A positive stool culture is more likely when analysis indicates an inflammatory process. The gut microbiome composition changed significantly, and . Cryptosporidiosis Drug Discovery: Opportunities and Challenges. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Molecular epidemiology of Cryptosporidium species in Kpong and its environs, Ghana. When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: Metronidazole (Flagyl). Although there are several species of Cryptosporidium, Cryptosporidium hominis causes the most infections in humans in Australia. . If you have this condition, stop taking this medicine and contact your doctor if you have signs of liver failure--nausea, stomach pain (upper right side), dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). This site complies with the HONcode standard for trustworthy health information: verify here. Its very easy for cryptosporidiosis to spread from infected people or animals. Follow standard ChAMP guidelines where appropriate. An official website of the United States government. Several studies that have investigated the reaction of metronidazole with alcohol have found evidence of the existence of this interaction to be absent or weak. Diarrhea can be managed by drinking plenty of fluids to prevent dehydration. Incidence of Cryptosporidium spp. Foodborne illnesses should be reported to local and state health agencies; reporting requirements vary among states. Foodborne illness can have various presentations, ranging from clinically mild illness that requires only outpatient care to severe illness that requires hospitalization. As Cryptosporidium and Giardia (oo)cysts are robust and resistant to environmental conditions, including disinfectants such as chlorine used in water treatment systems, numerous waterborne and foodborne outbreaks of human cryptosporidiosis and giardiasis have been reported, with Cryptosporidium and Giardia responsible for > 95% of outbreaks . However, it is not effective in severely immunocompromised patients and there is limited data in infants. Accessed Nov. 3, 2020. This content does not have an English version. Before your appointment, you may want to write a list of answers to the following questions: During the physical exam, your doctor may ask you to lie down so that he or she can gently press on various parts of your abdomen to check for tender areas. When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: There are no consistently recommended medications for giardia infection in pregnancy because of the potential for harmful drug effects to the fetus. ?H[r>3\?NSnGd{K9SNG9F0L[!^q-]) q2 i v6go5ou[=w( 2lJg0(>-!isbWaOynq$5y RJKdJj }kyOOxk_SvMnTL:f Y09[_>(DWTo17y|R_k9t.:9\e A@or}wp$a5L)21tO-\ye;P`yflu"#HU3!hhXnv5-$O5m-[. In most outpatients who have self-limiting gastroenteritis, a stool culture does not affect management.4 Bacteria are the most common cause of nonself-limiting foodborne illness; however, stool cultures are positive in less than 40% of cases.4,5 Newer techniques such as polymerase chain reaction testing have become readily available and provide more rapid, reliable determination of specific pathogens. Do not use metronidazole to treat any condition that has not been checked by your doctor. 2017 Aug;64(4):837-850. doi: 10.1016/j.pcl.2017.03.014. Metronidazole is active against anaerobic bacteria and some protozoa (e.g. fever. DOC for entamoeba histolytica, giardias, trichomoniasis kills trophozoites but not cysts treatment usually followed by luminal drug to eliminate asymptomatic infection mechanism involves ETC Tinidazole is an alternative with less toxicity. Generic name: metronidazole (oral/injection) It spreads easily in kids because they dont yet have good hand washing habits or understand how germs spread. MeSH The dormant (inactive) form of Cryptosporidium , called an oocyst . A single dose of ondansetron (Zofran) is recommended in children with clinically significant gastroenteritis-related vomiting. Get emergency medical help if you have signs of an allergic reaction to metronidazole (hives, itching, warmth or tingling; fever, joint pain; dry mouth, dry vagina; stuffy nose, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). Can you have sex while taking metronidazole? Drinking lots of fluid like broth, water, sports drinks or oral rehydration solutions can help replace the fluid youve lost and prevent life-threatening electrolyte problems. It was thought that metronidazole blocked the enzyme aldehyde dehydrogenase as well, although this now seems to be incorrect. Although these recommendations have been shown to reduce the risk of foodborne illness in the United States, the risk increases with travel. You may be contagious up to two weeks after your symptoms stop, so make sure you continue to take precautions even after you feel better. 16th ed. Antimicrob Agents Chemother. nitazoxanide (if no HIV) paromomycin (decreases diarrhea) . What symptoms should prompt me to call you or go to the ER? The main symptoms are watery diarrhoea with tummy (abdominal) cramps. Cryptosporidium can also infect other gastrointestinal and extraintestinal sites, especially in individuals whose immune systems are suppressed. Metronidazole pregnancy and breastfeeding warnings, Detailed Metronidazole dosage information. Would you like email updates of new search results? Cryptosporidiosis Outbreaks United States, 20092017. If someone else touches a surface youve contaminated or gets water in their mouth that youve swum in, they can get sick too. In patients with clinically significant vomiting, antiemetics can alleviate symptoms and reduce the need for hospitalization and intravenous fluid administration. An awareness of the likely aetiological agents and . Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. infect the microvillar border of cells lining the small intestine and other organs. If youre prescribed antiprotozoal medication for cryptosporidiosis, it can take five days or more to start feeling better. (Cryptosporidium, . Cryptosporidium felis: Ingestion of oocysts (fecal-contaminated material) . sharing sensitive information, make sure youre on a federal Metronidazole (25 mg/kg) administered orally, twice a day, for 5 to 7 days was successful in clearing Giardia infections in adult laboratory-reared cats. All reports of outbreaks are entered into the CDC's Foodborne Disease Outbreak Surveillance System, after which the data are analyzed to monitor and identify the root cause of the outbreak. Cryptosporidiosis is caused by various species of the protozoan parasite Cryptosporidium, which infects the small bowel mucosa, and, if symptomatic, the infection typically causes diarrhea. Cryptosporidium parvum: Oro-fecal: Diarrhea: Ooocysts in stool: Paromycin (investigational) Isospora belli: Oro-fecal: Giardiasis-like . Avoid getting water in your mouth if you swim in lakes, rivers or public pools. O'|Xqj'i1|/PqQ08 GIp@p%`H4W}SMlw?yp:1N-[u* az=";`;I1 )=N35]0 Cryptosporidium; Cryptosporidium hominis; Cryptosporidium parvum; cryptosporidiosis; nitazoxanide; paromomycin. Cleveland Clinic is a non-profit academic medical center. For many years the primary treatment for Giardia in dogs and cats has involved metronidazole. This medicine can affect the results of certain medical tests. Humatin. Tell your doctor about all your current medicines. This can result in an . PMC While taking metronidazole and for 3 days after your last dose: Do not drink alcohol or consume foods, medicines, or other products that contain alcohol or propylene glycol. It contains 4 sporozoites and a residium. It causes watery diarrhea that can be severe. A Novel Piperazine-Based Drug Lead for Cryptosporidiosis from the Medicines for Malaria Venture Open-Access Malaria Box. All Rights Reserved. Parasitologic cure rate was a key consideration in developing prevention recommendations that ask people to refrain from swimming for 2 weeks after resolution of symptoms. June 29, 2022; seattle seahawks schedule 2023; psalms in spanish for funeral . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The site is secure. It may be reasonable to obtain blood cultures in patients with fever and diarrhea (with or without blood), because up to 1% of cases of nontyphoidal Salmonella infections are associated with bacteremia.4,5 Sigmoidoscopy or colonoscopy may be useful in hospitalized patients with bloody diarrhea to obtain tissue and histology, which could aid in the diagnosis. All rights reserved. Metronidazole is the drug of choice for treating giardiasis - but note cautions with pregnancy and breast-feeding. Federal government websites often end in .gov or .mil. Diarreia causada por Cryptosporidium parvum em pacientes peditricos com 1 a 11 anos de idade Em dois estudos duplo-cegos controlados, em pacientes peditricos com diarreia causada por Cryptosporidium parvum, um curso de trs dias de tratamento com nitazoxanida suspenso oral (100 mg, duas vezes ao dia em crianas de 12 a 47 meses; Bessoff K, Spangenberg T, Foderaro JE, Jumani RS, Ward GE, Huston CD. Clipboard, Search History, and several other advanced features are temporarily unavailable. For oral dosage forms (capsules or tablets): For amebiasis infections: Adults500 or 750 milligrams (mg) 3 times a day for 5 to 10 days. Experts estimate that nearly 15-20 percent of all feline diarrhea cases are Clostridium perfringens related. Metronidazole has caused cancer in animal studies. 2005 40(8):1173-80. Seizures and other nervous system abnormalities have been reported in patients treated with metronidazole. Once an outbreak has occurred, prevention strategies should focus on educating the public through the news media and correcting the underlying cause, such as through food product recalls. in ducks was 39.9 % (365 out of 915 ducks). Author disclosure: No relevant financial affiliations. Identification of potent anti-Cryptosporidium new drug leads by screening traditional Chinese medicines. Infected poop in diapers also helps spread crypto among young kids and their parents. dosage, interactions, side effects, Brand name: Levinson W, et al. Vancomycin is a glycopeptide antibiotic that is used for the treatment of C. diff diarrhea and staphylococcal enterocolitis. you took disulfiram (Antabuse) within the past 14 days. The telltale symptoms of Crypto include: frequent and watery diarrhea. (2013) reported that Paromomycin to be the more valuable than metronidazole for the treatment of Cryptosporidium infection in cattle based on the clinical trials. 1997 Jun;56(6):637-9. doi: 10.4269/ajtmh.1997.56.637. Anti-Cryptosporidium activity of albendazole, metronidazole, and paromomycin in experimentally infected cattle. This limitation of treatment options presents a major public health challenge given the important burden of disease. Microorganisms. Site of Infection and Pathogenesis. They help us to know which pages are the most and least popular and see how visitors move around the site. 2014 May;58(5):2731-9. doi: 10.1128/AAC.02641-13. The most important treatment is drinking plenty of fluids to keep hydrated. Drug classes: Amebicides, Miscellaneous antibiotics. 2022 Nov 15;10(11):2260. doi: 10.3390/microorganisms10112260. Foodborne illness is a worldwide problem, and U.S. outbreaks often garner media attention and result in food recalls. Treatment options include: Ponazuril (20-50 mg/kg PO Q 24 H for 1-3 days*), a direct . You can get cryptosporidiosis from: There are lots of different ways to get cryptosporidiosis, but the main cause of infection is usually from drinking contaminated water or getting water in your mouth at a lake, pool or other public swimming area. Available for Android and iOS devices. Diarrhea, severe in immune compromised Use Kinyoun acid fast stain Rx. But it may take a couple of days before you start to feel better or notice an improvement in your symptoms. This can result in an overgrowth of the candida yeast. Metronidazole is the drug of choice for acute invasive amoebic dysentery since it is very effective against vegetative forms of Entamoeba histolytica in ulcers. Yes, cryptosporidiosis is contagious it can spread from person to person, although indirectly. New potentially promising drug targets in Cryptosporidium and Giardia have been identified, but there appears to be little activity toward clinical development of new drugs. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. . Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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