USAF Serial Number Search Results. Serial Number Criteria: Description Criteria: F- 4. Data last updated: Tue Mar 1. Como fazer para converter arquivos de v? Para converter seus v Download the latest from Windows, Windows Apps, Office, Xbox, Skype, Windows 10, Lumia phone, Edge & Internet Explorer, Dev Tools & more. Lockheed F- 4- 1- LO Lightning. MSN 2. 22- 5. 31. Lockheed F- 4- 1- LO Lightning. MSN 2. 22- 5. 33. Port engine caught fire. Lockheed F- 5. A- 2- LO Lightning. MSN 2. 22- 5. 37. Lockheed F- 4- 1- LO Lightning. MSN 2. 22- 5. 37. Starboard undercarriage collapsed. AirBedz, seen on ABC's 'SHARK TANK', fits mid & full sized trucks in long & short bed layouts. The patented design comes with Heavy Duty Cloth Material for superior puncture resistance with cutouts on each side that allow the. Pour ceux qui adorent Msn 8.5 (et pas Msn 9), depuis jeudi 5 novembre 2009, la mise . 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Peterson survived crash but later died of. Lockheed F- 4- 1- LO Lightning. MSN 2. 22- 5. 43. Condemned. Apr 2. SOC Apr 9, 1. 94. Lockheed F- 4. A- 1- LO Lightning. MSN 2. 22- 5. 58. French ADO Mar 9, 1. French ADO Mar 9, 1. Consolidated B- 2. D- CO Liberator. 1. Martin B- 2. 6B- 2 Marauder. BG, 4. 44th BS, . The plane. was flying in formation from Marrakech, French Morocco to St Eval, Cornwall, England, when. Portuguese coast and given. Lisbon. The aircraft continued flying and tried to reach its destination. Galician coast, five. Corrubedo (Coru. 4. Douglas- Long Beach B- 1. F- 4. 0- DL Fortress. BG, *Pasadena Nina*) shot down by Obfw Adolf Glunz in Fw 1. A- 6 of. JG 2. 6/5 at Kootwijkerbroek, Netherlands om mission to Munseter. Oct 1. 0, 1. 94. 3. MACR 9. 58. 3. 27. Denver Apr 7, 1. 94. Presque Isle May 2. Assigned to 9. 4th BG, 3. BS, at Earls Colne. May 1. 2, 1. 94. 3, to Rougham Jun 1. Douglas- Long Beach B- 1. F- 4. 5- DL Fortress. BG, 4. 13th BS, . Both planes crashed with no survivors. Egon Mayer in FW- 1. A- 6 of JG 2/Stab at Les Essarts- le- Roi, France. Jul 1. 4, 1. 94. 3 on mission to Villacoublay, France. Egon Mayer in FW- 1. A- 6 of JG 2/Stab at. Saint- Germain- des- Angles, France Jul 1. Boeing B- 1. 7F- 4. BO Fortress. 5. 15. Kearney AAF Feb 2. Burbank Apr 9, 1. BG, 5. 26th BS) crashed into a mountain near Elko, NV. Jan 2, 1. 94. 3. Karl Fey. Bf 1. 10. G- 2. 0 of ZG 1/1 W of Flensburg, Germany Oct 9, 1. Hans- Georg Guthenke in Fw 1. A- 4 of JG 1. 1/3 at. Bourtange, Netherlands Jun 2. Boeing B- 1. 7F- 4. BO Fortress. 5. 25. NE of Brixham, England during attempted. Jan 1. 2, 1. 94. 3 while on ferry flight. Douglas C- 4. 7- DL. MSN 6. 22. 3/6. 25. MSN 7. 36. 5/7. 38. Contract No AC2. 00. MSN 9. 00. 0/9. 01. Contract No AC2. 06. MSN 6. 22. 3) to USAAF Jan 0. To RAF Feb 1. 1, 1. Dakota I FD7. 69. Reported FD7. 68 by Douglas). SOC Feb 1. 0, 1. 95. To Israel Defence Force. Nov 1. 2, 1. 95. 0 as 4. X- FAI, El Al Feb 2. X- ATA, Arkia Apr 0. X- AEO Israeli Aircraft Industries Sep 0. The airplane was. To RAF Middle East Jul 2. Dakota I FD7. 76 - . RAF India Aug 2. 6, 1. Sold to Indian Government Jan 3. To RAF Middle East Mar 3. Dakota I FD7. 78 - A Flt Det. SOC Mar 2. 7, 1. 94. Kasfareet 1. 94. 7. To RAF Middle East Mar 3. Dakota I FD7. 79 - 2. Sqdn, India. To Indian Govmnt Feb 2. Trfrd. to USAAF, 1. AF, India Oct 2. 6, 1. RAF Middle East May 0. Dakota I FD7. 83 - . Sqdn - 3. 1 Sqdn, India Nov 0. To RAF India Apr 3. Dakota I FD7. 88 - 3. Sqdn - Returned to USAAF Mauripur Nov 2. Reported as C- 1. See MSN 5. 66. 6). To civil. registry as NC8. National Skyway Freight Corp 1. NC1. 42. 78 and. N1. Various owners/operators). Lsd to Rep of Congo Jan 1. Q- AED. To civil registry as. NC5. 29. 25 with Sinclair Refining Co (1. N4. 56. R With Colebrook Inc, Bryn Mawr, PA Jun 1. Bryn Mawr, PA - Errol B Resnick, Orlando, FL. Dec 1. 2. 1. 94. 5, b/u Feb 2. Crashed after bomb. Milluni, Bolivia Dec 0. To civil. registry as N5. V, to Mexican AF as AP- 0. Secretaria de Haciende Y Credito Publico. XC- ABF (Dec 0. 7, 1. Back to Mexican AF, to Government of Mexico as XC- BCE. To Baja Air (Banco de Mexico as XA- CUC (1. To Aerolineas California. Pacifico SA (ACAPSA). With 6. 1st TCG, 1. TCS. as damaged by crashing C- 4. A 4. 2- 9. 20. 67 at Sciacca, Italy. Condemned salvage no combat Aug 1. N8. 1P (Piedmont Air 1. N8. 1B (Leased to Cryderman Air Services, Pontiac, MI. To civilian registry as N5. TWA . Apr 1. 98. 0 to May 1. Port au Prince as PP- CED. Nov 1. 98. 3). Sold to Rutaca as YV- 2. C, last noted Ciudad Bolivar Feb 2. To civil registry as NC7. Pan American Airways). XA- GIB (Mexicana - Aeronaves del Sur, ntu). Jun 0. 7, 1. 94. 9, delivered Dec 2. F- 8, code . To civil registry as. PP- BRA (Linhas Aereas Brasileiras Nov 0. PP- AND (Various owners/operators). G- AVNF (Handley Page Ltd May 1. JY- ADE (Alia- Jordanian Jul 0. Del to. UTA, Paris- Le Bourget Apt for spares Aug 2. Lockheed/Vega B- 1. F- 4. 0- VE Fortress. MSN 6. 25. 0/6. 32. Lockheed/Vega B- 1. F- 4. 5- VE Fortress. MSN 6. 32. 6/6. 40. Sold on civil marketto Hancock College of Aeronautics. N7. 94. 2A 1. 94. Heavy Transport. Squadron, Rockcliffe, for mail flights to Europe and North Africa. Ford B- 2. 4H- 5- FO Liberator. BG, 7. 14th BS) lost Jan 5, 1. Germany. MACR 3. 20. BG) lost Apr 2. 5, 1. MACR 3. 54. 7. 7. BG, 7. 22nd BS) crashed at San Pancranzio Jan 3. Schulmayer in Bf 1. F- 2 of JGr Ost/4 2 mi S of Lesparre- Medoc. France Dec 3. 1, 1. Boeing B- 1. 7F- 9. BO Fortress. 3. 02. F- 9 photo- recon aircraft. MACR 1. 88. 9. 3. BG, 5. 51st BS, 'El Lobo/Raunchey Wolf') shot down by Obfw. KIA, 6 POW, 3 evaded. MACR 1. 55. 8. 3 KIA, 7 POW. Gerd Wiegland in. Fw 1. 90. A- 6 of JG 2. Haaksberghen, Netherlands during mission to. Munster Oct 1. 0, 1. Erich. Burkert in Bf 1. G- 6 of JG 2. 6/7 on mission to Regensburg Aug 1. SOC at Searcy Field, Stillwater, OK. POW. 3. 03. 01 (4. BG, 7. 10th BS) lost Jun 1. MACR 5. 90. 1. 3. BG, . MACR 9. 03. BG, 3. 34th BS, . Erich Becker in. Bf 1. F- 4 of NJG 6/2 at Neiderwetz, Germany Aug 1. POW. Plane was also in a midair collision with 4. France. Aug 1. 5, 1. Boeing B- 1. 7F- 1. BO Fortress. MSN 5. Horst Schlick in. Bf 1. 09. G- 6 of JG 7. W of Naples, Italy. Sep 4, 1. 94. 3. To 8. BS(P) at Oulton early 1. Mandrel sets. Hans Ehlers. Fw 1. 90. A- 6 of JG 1/3 at Orvelte, Netherlands Dec 1. Germany. 4. 2- 4. Consolidated B- 2. D- 5. 3- CO Liberator. RFC at Walnut Ridge Dec 2. BG, 3. 19th BS) destroyed at Fenton, Northern Territory Jun 3. Nov 1. 1, 1. 94. 4- Jan 2. BG) lost Aug 1. 7, 1. New Guinea. Aborted before getting to the target and made an emergency landing. Mediterranean island of Cyprus. It was abandoned by the 4. Deversoir, Egypt in October. The aircraft was damaged at RAF. Rackheath following a landing rollout accident Oct 2. It was subsequently. Rackheath. 4. 2- 6. Fairchild UC- 8. 8. Civilian F- 4. 5 NC1. MSN 4. 01. 3) commandeered by USAAF. Fairchild UC- 8. 8. Civilian F- 4. 5 NC1. MSN 4. 00. 4) commandeered by USAAF. Douglas C- 5. 4D- 1. DC Skymaster. MSN 1. MSN 1. 08. 45) to MASDC Aug 1. Bought by Air America/CAT on November 1. Leased to China Air of Taipei in June 1. Sold to Air Distribution Inc., Honolulu, HI. Nov. 1. 3, 1. 97. N4. 03. AD. 2. 5, 1. Air Asia, withdrawn from use and stored September 1. Douglas C- 4. 7A- 2. DK Skytrain. MSNs beginning with 1. Weisbrod Museum, Pueblo, CO also carrying. N6. 46. 05. Sep 1, 1. Dum Dum Airport, Calcutta, India. To G- AKIJ BEA Sep 1. African Airways Corp Jan 3, 1. Then to. 4. W- ABG and finally ET- AHR, crashing at Kombolcha, Ethiopia Oct 7, 1. OY- AIB. then SE- BSI (Named Ravn Viking), next to France Oct 1. F- BGXD for. Aigle- Azur. To instrictional airframe 5. M. Struck by C- 5. Northolt, UK Nov 1. To instructional airframe 4. M. One of the propellers would not unfeather, lost height and bellylanded. SE of Wymeswold, UK Apr 1. Returned to UK as G- ASDX registered Nov 1. NTU when it was. realised that it had previously been G- AJRY. To VR- RCO, to 9. M- ALO, to 9. V- BAN, to XU- DAG. Crashed May 2. 9, 1. Hjeninsfjordur, Iceland in poor weather. Bird, Jan 2, 1. 97. JLR Transport. Feb 1. Hermina De La Cruz. Crashed after takeoff. Manila Nichols Air base Oct 2. In 1. 97. 1 to Indiana Department. Civil Defense as N1. ND. Registered. G- AJPF Apr 1. On November 0. 7,1. KLM as PH- TCW, on December. F- BCYY as assigned to Aigle- Azur Extreme- Orient. Next. transferred to the Armee de l'Air (France) as #9. F- RAJB, next. F- SCJA, then transferred first to Air Burundi, then the military of Burundi. U- BAC. Currently stored by private operator in Burundi. Sold Dec 1, 1. 94. PH- NCR, then to N. Frits Diepen Vliegtuigen Apr 1. PH- TFA. Relegated to ground. M. Was believed to have been destroyed. Hanoi, but in 1. 95. F- BEHC. of Air France. To EC- ARZ with Spantax and w/o Dec 7, 1. Tenerife, Canary Islands. Reregistered as ET- AAT and w/o Nov 3. Butler Air. delivered to Australia April 1. Australian National Airlines. VH- IND, named 'Menana', next to Aviation Sales in Auckland, NZ. ZK- BYE. Imported into Laos with the help of Air America, believed to be. C- 4. 7s delivered to General Vang Pao's Xieng Khouang Air. Transport as XW- PFX. Next to Lao Air Charter now registered as XW- TDJ. On. December 2. 3, 1. Luang Prabang, Laos. Passengers 4 fatal of 1. The wreck was abandoned, but noted. To SAAF as 6. 83. Jul 1. 94. 4. To civil registry as ZS- MRS. To SAAF as 6. 83. Jul 1. 94. 4. To civil registry as ZS- CAI Aug 1. Was VT- CGO of Indian Airlines. Corp from 1. 95. 3 to 1. To civil registry as VT- CYX, operated by Deccan Airwayas and Indian Airlines. To Polish AF Jul 1. No. To civil. registry with LOT as SP- LCH. To Iran Air as EP- AEI Feb 1. W/o near Ahwaz, Iran Feb 2. Sold to Indian government Oct 3. To civil registry VT- CHI. Flew into cliffs in. Salalah, Aden Jul 3. May 2. 3, 1. 96. 7 at Iligan. W/o Ar 2, 1. 96. 4 when DBR at Calcutta. By 1. 95. 5 was VH- AVK of. Mac. Robertson Miller Aviation Co, Ltd. Guinea Airways taken over January 1. Ansett- ANA. aircraft reverted to VH- ANW. Retired Oct 4, 1. South Australia; to Southern Air Maintenance at Parafield Nov 7, 1. Restoration completed 1. VH- MMF. of Mac. Robertson Miller Airlines; was intended for display in a. Perth, Australia. W/o Mar 1. 3, 1. 95. Kingsway Camp in training. Now stored. Port- Au- Prince. France to. Chalgrove in Oxfordshire. Noted 1. 99. 7. undergoing restoration at Yugoslav Aeronautical Museum, Belgrade. MSN 1. 37. 14) to VT- ATY of Tata Airlines Dec 1. Air India Nov 1. 94. Indian AF Dec 1. 94. Galabert Airport, Panama City, Panama. Transportes Aeros REAL. MSN 1. 37. 77) to RFC Nov 5, 1. Republic P- 4. 7D- 4. RA Thunderbolt. 9.
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Re: Brad Gillingham Deadlift Video. Welcome! This forum is for USAPLTM and IPF members. USAPL and IPF issues. Non- members are. Please follow these few guidelines: Use an email address. Brad Gillingham Bench and squat routine. He is a great bencher and an average squatter. He is a great DLer and i could not find his DL routine. I think he DLs monday after the front squats. Interesting to see his approach. Max Calculator: Brad Gillingham Templates: Jackal's Gym Store Rehband Knee Supports. Program List Featured Products. Re: Brad Gillingham Deadlift Video. Posted By: John Hanson Date: Thursday, 22 December 2005, at 3:50 p.m. In Response To: Brad Gillingham Deadlift Video (Jason Burnell) I agree 100%. I did Brad's Russian Front Squat program. Brad Gillingham Squat and Dead Lift Program - Download as Excel Spreadsheet (.xls), PDF File (.pdf), Text File (.txt) or read online. Brad Gillingham Interview. Brad has been the US SHW representative at the last couple IPF Men’s Worlds. Squat 821 Bench 584 Deadlift 825 USAPL American Record 319 Class (Ed. I did Brad's Russian Front Squat program because I have a nagging rib injury that makes it difficult to back squat. Monday I did an easy triple in the front squat which was 1. RM at the start of the program and that was AFTER back squatting. It's a great no nonesense, high volume training routine. The Brad Gillingham automated bench press program calculator created by Adam. Gillingham 16 week Squat Program; Gillingham 16 week Deadlift Program; Meets. Automated Gillingham Bench Press calculator created by. The Evolution of My Deadlift Training by Brad Gillingham. The world's premier site for Kettlebells, Strength, Conditioning, Flexibility, and. Brad Gillingham Squat and Deadlift Program. Front-squat, deadlift program? Discussion in 'Old StrongFirst Forum. Strong posterior chain means a strong squat and deadlift. If I had listened to my Father’s. Read More: July 19, 2016: NSCA New Orleans . 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The purpose of this review is to revise and update on the evolving immunization schedule at national and at global level. Good vaccination practices begin shortly after birth. The WHO estimated that immunization currently averts an estimated 2 to 3 million deaths every year apart from societal burden & medical costs. The expanded program in immunization. Immunization Schedule; Infant; Infant, Newborn. Universal Immunization Program (UIP) o Evolution o Vaccine Preventable Diseases (VPDs). 1978: Expanded Programme of immunization (EPI). Expanded Program on Immunization (Philippines) The Expanded Program on Immunization (EPI) in the Philippines began in July 1979. And, in 1986, made a response to. EXPANDED PROGRAMME ON IMMUNIZATION. EXPANDED PROGRAMME ON IMMUNIZATION PowerPoint PPT Presentation. Expanded Program of Immunization Dr. Expanded Program on Immunization. One significant milestone is that the budget allocation for the immunization program has continued to increase year by year. Expanded Program of Immunisation - EPI. Support for routine immunisation; Accelerated control of vaccine preventable disease.For each birth cohort vaccinated in the United States, approximately 2. This was based on recent evidences for licensed vaccines that are incorporated in our clinical practices in India (Table 1). DTw. P2, IPV2, Hib. PCV2, Rota. 1If RV1 is chosen, the first dose should be given at 1. Only 2 doses of RV1 are recommended at present. DTw. P3, IPV3, Hib. PCV3, Rota. 2(2nd dose Rotarix . The 2nd. dose must follow in 2nd year of life. Conjugated Typhoid vaccine Currently, two typhoid conjugate vaccines. Typbar- TCV and Peda. Typh available in Indian market. Should follow a. booster at 2 years of age. Hep. A1 One of the 2 doses of inactivated now or a- single dose for live attenuated H2- strain Hep. A vaccine now recommended. MMR2, varicella. 1 , PCVb. The risk of breakthrough varicella is lower if given 1. DTw. P b. 1 or DTa. P b. 1IPV b. 1 , Hib b. DTw. P or DTa. P booster (4th dose) may be administered. Considering a higher reactogenicity of DTw. P, consider. DTa. P for the boosters. Hep. A2, Typhoidb. Slide sets on immunization issues and vaccine-preventable diseases: Immunization Action Coalition: Adolescent Immunization: Where We Are Now and How We Can Do Better. Also suggesting only single dose for live attenuated H2- strain Hep. A vaccine. 4 - 6 yrs DTw. P b. 2 or DTa. P b. OPV3 Varicella. 2 and Typhoid b. Tdap or Td, HPV series to begin Tdap is preferred to Td ,followed by every 1. HPV : 2 or 3 doses > 9 yrs. The immunization schedules are intermittently revised and updated; these programs are supported by the Global Alliance for Vaccines and Immunization (GAVI) at the global level. The schedules are approved by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AFP), and the American College of Obstetricians and Gynecologists (ACOG). This method will ensure that readers have the most current recommendations on the clinical and immunogenicity effects of individual vaccines. Further the WHO and GAVI support the Combination Vaccines (Combo. However, the multiplicity of competing vaccine products, with various overlapping antigen menu and subtle immunologic differences, may be confusing to the busy practitioner. Combining vaccines that target children immunization may expand immunization opportunities and effectiveness. However, offering new choices may not necessarily translate into simpler solutions at the practical level. Practice Essentials, Overview, Periodic Abstinence. Implants. The US Food and Drug Administration (FDA) approved the contraceptive use of levonorgestrel implants (Norplant) in 1. This method consists of 6 silicone rubber rods, each measuring 3. The implant releases approximately 8. L within the first 2. The rate of release decreases to an average of 3. Release of the progestational agent by diffusion provides effective contraception for 5 years. Contraceptive protection begins within 2. The rods are inserted subcutaneously, usually in the woman's upper arm, where they are visible under the skin and can be easily palpated. Overall, pregnancy rates increase from 0. Advantages. The longevity of its effectiveness is an advantage. Combination patch contraceptive. Release of the progestational agent by diffusion provides effective contraception for 5 years. Contraceptive protection begins within 24 hours of.Buy Evra Transdermal Contraceptive Patch at Chemist Direct. It is a weekly birth control for the woman on the go and to purchase this item, you must have valid prescription. Cost-effectiveness and contraceptive effectiveness of the transdermal contraceptive patch. Sonnenberg FA(1), Burkman RT, Speroff L, Westhoff C, Hagerty CG. What Is the Birth Control Patch? The birth control patch is a thin, beige. How Much Does the Patch Cost? The effectiveness of the contraceptive shot, pills, patch and ring, and barrier and fertility awareness-based methods, depends on correct and consistent use—so these methods have lower effectiveness with typical use. The contraceptive patch is applied once a week. World Contraception Day/Your Life content does not necessarily reflect the viewpoints of the members of WCD partner coalition. Contraception Methods. Its effectiveness is not related to its use in regards to coitus. Exogenous estrogen is absent. Prompt return to the previous state of fertility occurs upon removal. No adverse effect on breast milk production occurs. Disadvantages. A minor surgical procedure is necessary for incision. Difficulty in removal is a disadvantage. Menstrual irregularities are common along with other adverse effects, including headaches, mood changes, hirsutism, galactorrhea, and acne. Absolute contraindications include active thrombophlebitis or thromboembolic disease, undiagnosed genital bleeding, acute liver disease, benign or malignant liver tumors, known or suspected breast cancer, and a history of idiopathic intracranial hypertension. Relative contraindications include heavy cigarette smoking, a history of ectopic pregnancy, diabetes mellitus, hypercholesterolemia, severe acne, hypertension, and a history of cardiovascular disease, severe vascular or migraine headaches, and severe depression. Appropriate candidates are women who are postpartum or breastfeeding, women who have difficulty with contraceptive compliance, women in whom pregnancy is contraindicated due to a medical condition, and patients with contraindications to the use of estrogen. Wyeth- Ayerst Laboratories (Philadelphia, Pa), the maker of the Norplant System, advised health practitioners to inform patients who had the product inserted since October 2. Laboratory testing showed the product from certain lots may not release enough of the hormone levonorgestrel to deliver effective ongoing contraception. In July 2. 00. 2, Wyeth Pharmaceuticals then announced that patients who had received the Norplant System and who were using backup contraception may safely stop using backup methods for contraception. Due to its recall and controversy over use, Wyeth also had announced that it did not plan to resume distribution or marketing of the Norplant System in 2. The Norplant system had been controversial due to its adverse effects and the company's failure to communicate the risks of adverse effects to the patients. Women alleged that Norplant makers failed to properly and adequately warn them about the severity of adverse effects they may experience, including nausea, headaches, irregular menstrual bleeding, ovarian cysts, weight gain, removal problems, and depression. Another FDA- approved implant is the 2- rod levonorgestrel system, termed Norplant II or Jadelle. Each rod is 4. 4 cm long and contains a cured homogenous mixture of the drug and a polydimethylsiloxane elastomer covered by silicone tubing. Norplant II is approved for 3 years of use but has been shown to be effective for as long as 5 years. After reviewing additional data in 2. FDA changed their requirements so as to allow Jadelle to be used for up to 5 years, if it was sold in the United States. The implant has also been approved in Europe for 5 years' use. Studies have shown Norplant II to have release rates, pregnancy rates, and adverse effect profiles similar to Norplant. At this time, Norplant II is not currently being marketed in the United States. Jadelle is currently available in both developed and developing nations around the world. Implanon is a single- rod implant that is 4 cm long and 2 mm in diameter. It consists of 6. Etonogestrel is a biologically active metabolite of desogestrel. Desogestrel is significantly more potent than levonorgestrel; a serum concentration of 0. L can inhibit ovulation in most women. Serum concentrations are adequate for contraception coverage for approximately 3 years. In more than 1. 0 different studies using 4. Effectiveness in women who are overweight has not been defined. Women who weighed more than 1. Compared with the Norplant system, Implanon is associated with a higher frequency of amenorrhea and oligomenorrhea, a decrease in the prevalence of frequent and prolonged bleeding, and a decrease in the frequency of adverse effects such as weight gain, headache, and acne. When the rod is removed, the return to fertility is rapid, with the return of ovulation within 3 weeks. Implanon was approved for use in the United Kingdom in 1. United States. Knowledge of the long- term effects and overall safety data are limited at this point. However, Implanon is not associated with loss of bone mineral density (BMD). In one study that compared the BMD of patients using Implanon with those using intrauterine devices (IUDs), no decrease was noted in the BMD of either group over a 2- year period. Pharmacologically active levels are achieved within 2. L are maintained for 3 months. During the fifth or sixth month after injection, the levels decrease to 0. L, and they become undetectable by 7- 9 months after injection. DMPA acts by the inhibition of ovulation with the suppression of follicle- stimulating hormone (FSH) and LH levels and eliminates the LH surge. This results in a relative hypoestrogenic state. Single doses of 1. The contraceptive regimen consists of 1 dose every 3 months. Efficacy. DMPA is an extremely effective contraceptive option. Neither varying weight nor use of concurrent medications has been noted to alter efficacy. Within the first year of use, the failure rate is 0. Advantages. DMPA does not produce the serious adverse effects of estrogen, such as thromboembolism. Diminished anemia occurs. Dysmenorrhea is decreased. The risks of endometrial and ovarian cancer are decreased. It contains no estrogen, thus making it suitable for women who cannot or will not take estrogen products. It also is safe for breastfeeding mothers. Disadvantages. Disruption of the menstrual cycle to eventual amenorrhea occurs in 5. Persistent irregular bleeding can be treated by administering the subsequent dose earlier or by prescribing temporary low- dose estrogen therapy. Because DMPA persists in the body for several months in women who have used it on a long- term basis, it can delay the return to fertility. Approximately 7. 0% of former users desiring pregnancy conceive within 1. Similar to the delay in fertility after discontinuation of DMPA, other adverse effects, such as weight gain, depression, and menstrual irregularities, may continue for as long as 1 year after the last injection. A study by Bonny and colleagues found that adolescent girls, who gained more than 5% of their baseline weight after 6 months of DMPA use, are at an increased risk for excessive future weight gain. They concluded that weight gain after 6 months can be used to identify those at risk for further weight gain. Counseling can then be instituted for these patients. The warning urged women not to use Depo- Provera on a long- term basis unless all other methods were inadequate. Most users of DMPA are teens at a crucial age for the building of bone density; about 1. American females aged 1. Depo- Provera, compared with 3% of women in the United States overall. Studies have contradicted the FDA warning. Women who stopped using DMPA experienced an average bone gain of 1. Spine density increased 2. Furthermore, teens regained their bone density faster than older women using Depo- Provera. A subcutaneous version of the drug is now available (depo- sub. Q provera 1. 04) that delivers a lower dose of medroxyprogesterone acetate (MPA) than does the intramuscular formulation (1. The subcutaneous route opens the possibility for home self- injections, and the lower dose could decrease suppression of pituitary function and ovarian estradiol production. Further study is needed. Subcutaneous DMPA, like its intramuscular counterpart, is associated with changes in bone mineral density and also carries a . Studies demonstrate lower decreases in bone mineral density as compared with the intramuscular route and the same reversible effect. Less than 1% of users of oral contraceptives use them as their sole method of contraception. Candidates for use include women who are breastfeeding and women with contraindications to estrogen use. Two formulations are available, both of which have lower doses of progestin than combined oral contraceptives. One formulation contains 7. The other has 3. 50 mcg of norethindrone. Prevention of conception involves a combination of mechanisms similar to, but not as efficacious as, combination oral contraceptives. Mechanisms of action include (1) suppression of ovulation (not uniformly in all cycles); (2) a variable dampening effect on the midcycle peaks of LH and FSH; (3) an increase in cervical mucus viscosity by a reduction in its volume and an alteration of its structure; (4) a reduction in the number and size of endometrial glands, leading to an atrophic endometrium not suitable for ovum implantation; and (5) a reduction in cilia motility in the fallopian tube, thus slowing the rate of ovum transport. Efficacy. Serum progestin levels peak approximately 2 hours after administration. Within 2. 4 hours, rapid distribution and elimination returns the level to baseline. Greater efficacy is achieved with consistent administration. Failure rates with typical use are estimated to be 7% in the first year of use. However, any variation can increase the failure rate. Advantages. Due to the lack of estrogen, evidence of serious complications to which estrogen can contribute (ie, thromboembolism) is minimal. |
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January 2017
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