CH is one of the most severe pain syndromes

in humans female patients decribe each attack

as being worse than childbirth. The conditions is
still underdiagnosed and suboptimally managed
in primary care. The importance of an effective
preventive regimen cannot be overstated. The
primary goal of preventive therapy is to suppress
headache attacks and maintain remission over the
expeted duration of the cluster period. To achieve
this goal, an individual therapy regimen has to be
developed with the patient.
 There are, however, no data to indicate
what the optimum dose of verapamil for the
treatment of CH might be. In fact,
practitioners as well as neurologists have been
left alone to find a scheme fot each individual
patient, and even headache specialists have
varying ideas and regimens. The stakes are
high, however, as Ch is excruciating and
patients need fast relief. Most patients will
respond to doses between 240 mg and 480 mg
daily, but some need exceedingly high doses.
Consequently, many clinicians will increase
their patients dosage fairly impetuously.
 Againts this background, Cohen et al
reported two remarkable figures: 41 % of
all patients on verapamil never underwent
ECG examination; and of those who did,
27 % showed significant ECG changes.
Most clinicians will agree that all patients
receiving high-dose verapamil are at risk of
developing heart block and therefore, need
careful ECG monitoring, but it is also
important to note that some patients might
develop delayedonsert arrhythmias on a
stable dosage. As a consequence, ECG
monitoring should be continued long term.
1. Severe : very serious, extreme, very
great pain.
This is a school for children with severe
learning difficulties.
2. Regimen : any set of rules about food
and exercise that someone follows,
especially in order to improve their
health.
After his heart attack the doctor put
him on a strict regimen
3. Overstated : to describe/explain something
in a way that makes it seem more
important or serious than it really is.
The impact of the new legislation has been
greetly overstated
4. Cornerstone : a stone in a corner of a
building, especially one with the date when
the building was made or other writing on
it.
In most countries the family unit is still the
corner stone of society
5. Apparent: able to be seen or understood
Her unhappiness was apparent to everyone
6. Excruciating: extremly painfull
His confession when it came, was excruciating
7. Exceendingly : to a very greet degree
He was clever, handsome, and
exceendingly.
8. Incremental : in a series of amounts
Most research proceeds by small
incremental advances
9. Intervene: to intentionally become involved
in a difficult situation in order to improve
it or prevent it from getting worse
The central bank intevened in the currency
markets today to try to stabilize the
exchange rate
10.Unfeasible : not able to be done or
achieved
Dodi have a unfeasible solution to the
problem
 A number of studies have documented the high
prevalens of vitamin D deficiency in community-
dwelling men and women through out North
America and Europe. As 25-hydroxy-vitamin D
levels drop below 50 nmol/l (20ng/ml), intestinal
calcium absorption falls, parathyroid hormone
levels rise, and osteoclastic bone resorption
increases. These effects result in a net loss of bone
mass, structural weakening, and an increased risk
of fractures.
 Given the indisputable importance of optimal
calcium and vitamin D levels to skeletal health, it is
quite remarkable that we continue to debate whether
supplementation with calcium and vitamin D reduces
fractures. In 1992, Chapuy et al. Convincingly
demonstrated that treatment of elderly women in
nursing homes (mean age 84 years) with 1.200 mg
calcium and 800 IU vitamin D3 daily for 3 years
markedly reduced hip and nonvertebral fractures.
When other studies did not confirm this observation,
however, physicians and the publics were left with
confusicon and doubt. For example, a 2006 analysis
from the womans health initiative, which involved
36.000 postmenopausal woman, cocluded that taking
1.000 mg calcium and 400 IU vitamin D daily not only
failed to reduce hip fractures but also increased the risk
of kidney stones. The fact that woman who complied
with the regimen had 20 % fewer hip fractures was lost
in the post-publication media haze.
Fortunately, the elegant meta-analysis by Tang et al.
brings some much-needed clarity to the field. This
study is largest meta-analysis on the topic published to
date and the result are unequivocal. Calcium with or
without vitamin D supplementation reduce the rate of
bone loss and decreases fractures consistenly and
significantly among individuals aged 50 years or older.
The effectiveness of therapy is greatest among the
subgroups who need it most : namely, those who are
older than 70 years, institutionalised, on low-calcium
diets (<700 mg daily), vitamin-D-deficient (<25 nmol/l),
or who have a low BMI. The supplements were equally
effective among men and women; however, the largest
treatment effects were seen in trials where compliance
rates were 80% or more. In other words, the
supplements really do need to be taken in order to be
effective.
1. Fragility : weakness and lack of health or
strength.
Tolerant of human fragility in whatever
form, she almost never judged people.
2. Whereas : compared with the fact that.
He must about sixty, whereas his wife
looks about thirty.
3. Regimen : any set of rules about food
and exercises that someone follows.
After his heart attact the doctor put him
on a strict regimen.
4. Indisputable : true and impossible to
doubt.
One fact is indisputable this must never
be allowed to happen again.
5. Convincing : able to make you believe
that something is true or right.
I didnt find the ending of the film very
convincing.
6. Institutionalised : mainly disapproving.
We need to avoid long stay patients in
the hospital becoming instituyionalised.
7. Equally : use to show that two things are
the same in value, size, meaning.
She divided her chocolate equally
between us.
8. Compliance : formal when people obey
on order, rule or request.
It is the job of the inspectors to enforce
complience, with the regulations
9. Elderly : Polite word for old
The city is building new housing for the
elderly.
10. Intestinal : bravery and determination.
The fact that he is still trying for the
campionship is a tribute to his intestinal
fortitude.