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Held responsible for its failure to do so due to fire, war, civil commotion, strikes, failure of transportation, any act of God, or other cause beyond its control. In the event of any delay in delivery caused by the Buyer, Tracewell Systems, Inc. will store and handle all items ordered at the Buyer's risk and will invoice the Buyer for the unpaid portion of the contract price, on or after the date on which the equipment is ready for delivery. This amount will become due and payable in full within thirty 30 ; days from invoice date. A monthly storage and extra handling charge of one percent 1% ; per month or any fraction thereof of the contract price covering the stored equipment shall be billable as a separate item. 9. SHIPPING. Unless otherwise provided in the contract, Tracewell Systems, Inc. will select the method of transportation and routing for equipment sold F.O.B. place of origin and shipment may be made freight collect. Inspection and Acceptance of the products shall be Buyer's responsibility. Buyer is deemed to have accepted the products unless written notice of rejection is received within thirty 30 ; days after delivery of the products. Buyer waives any right to revoke acceptance thereafter. Buyer shall report any discrepancy in shipment quantity or damage within thirty 30 ; days after delivery. No return of product shall be accepted by Tracewell Systems, Inc. without a Return Material Authorization RMA ; Number, which may be issued by Tracewell Systems, Inc. in its sole discretion. Returned Material must be in original manufacture's shipping carton s ; complete with all packing materials. If Buyer cannot comply with packaging guidelines, Tracewell Systems, Inc. will not accept the repair costs. RMAs issued in this situation, must be accompanied by a customer PO to be used for the repair costs. All products for return shall be returned freight prepaid in the manner specified in the RMA. If returned products are claimed to be defective, a complete description of the nature of the defect must be included with the returned products. Products not eligible for return shall be returned to Buyer, freight collect. Shipments have been carefully packed and checked. No materials may be returned without written authorization from Tracewell Systems, Inc., Customer Service Department. All product and paperwork must display RMA Number given by the Customer Service Department. All claims must be made within thirty 30 ; days upon shipment. 10. CHANGES. Buyer may make changes in the specifications for equipment, work or shipping covered by the contract only with the express written consent of Tracewell Systems, Inc. In such event, the contract price and delivery dates shall be equitably adjusted. Tracewell Systems, Inc., shall be entitled to payment for reasonable costs and expenses incurred by it for work and materials rendered unnecessary as a result of such changes and for work and materials required to effect said changes, plus Tracewell Systems, Inc. usual profit thereon. 11. CANCELLATION. Equipment or work that remains to be furnished under the contract may be canceled by the Buyer only with the express written consent of Tracewell Systems, Inc. In the event of such cancellation, Tracewell Systems, Inc. is entitled to payment for the cost and expenses, with normal overhead, incurred by it in connection with the equipment or work so cancelled, plus an amount determined by applying Tracewell Systems, Inc. usual rate of profit for similar items to such costs and expenses, or fifteen percent 15% ; of the contract price, whichever is greater. 12. PRODUCT WARRANTY. Tracewell Systems, Inc., to Buyer, warrants new systems manufactured by Tracewell Systems, Inc., against defects in workmanship and materials for a period of one year from the date of manufacture subject to the limitations hereinafter set forth. All non-system products shall be warranted for a period of thirty days. Should any defects be found and reported during that period, Tracewell Systems, Inc., at its option, will repair or replace such defective equipment provided that Buyer ship the product containing the defect to Tracewell Systems, Inc., transportation charges prepaid with notice of the defect and representation that the equipment has been properly installed, maintained, and operated within the limits of rated and normal usage. The repaired or replacement equipment will be shipped F.O.B. the Tracewell Systems, Inc. plant. The terms of this product warranty do not extend to any product or part thereof which, under normal usage, has an expected useful life of less than one year. This warranty shall not apply to apply equipment where the installation, calibration, or servicing of such equipment is improper, or where equipment is operated above rated load capacity, or subject to accident, alteration, or abuse. TRACEWELL SYSTEMS, INC. LIABILITY UNDER THIS Tracewell Systems Inc. Page 2 of 3 Standard Terms and Conditions of Sale Print Date: 06 24 03 Time: 2: 05 095-7000-000-CS Rev. 02 6 03.
Management Non-drug treatment All patients with stage II-IV and severely ill patients with stage I must be hospitalised for parenteral antibiotic therapy. Patients are nursed in a semi-Fowlers position, with frequent monitoring of general abdominal and pelvic signs. IUDs, if present, should be removed if there is no rapid clinical response. Adequate fluid replacement, analgesics and antipyretics should be provided. Patients should be tested for syphilis and other STD. Comments Definition PID includes salpingitis with or without ophoritis and, as precise clinical localisation is often difficult, denotes the spectrum of conditions resulting from infection of the female genital tract. Sequelae are recurrent infections if inadequately treated, infertility, increased probability of ectopic pregnancy, chronic pain dyspareunia, dysmenorrhoea, and low back pain ; . Early death may occur in the septicaemic stage, late death may follow a ruptured ectopic pregnancy Chronic PID may follow if the abnormalities persist with hydro pyosalpinx, adhesions to bowel and to the uterus. Manifestations are chronic lower abdominal pain and dyspareunia, secondary dysmenorrhoea, chronic lower backache, menorrhagia, secondary infertility, post-coital bleeding, offensive vaginal discharge The surgical procedure of choice depends on the age, parity, desire for pregnancy and the general condition of the patient, as well as on the skill of the surgeon and the facilities of the hospital ultrasound ; . Also effective against chlamydia infection and glimepiride.
DISCUSSION We have selected FIV mutants resistant to two -L-oxathiolane nucleosides, ; -FTC and 3TC the absolute configuration of these compounds is 2R, 5S ; , and these mutants carry a unique Met183Thr mutation in the YMDD motif of RT. Previous studies of HIV-1 have shown that Met-to-Val and Metto-Ile mutations in the YMDD motif position 184 in HIV-1 ; confer resistance to these oxathiolane nucleosides 5, 17, 49, ; . Here we have identified a drug resistance mutation in FIV which is localized to the same codon within the highly conserved YMDD motif as that associated with 3TC resistance in HIV-1 but which leads to a novel amino acid substitution. It is interesting to note that during 3TC monotherapy of HIV-1-infected patients, drug-resistant variants appear which initially carry the Met184Ile mutation. As therapy continues, these mutants are subsequently replaced by variants carrying the Met184Val substitution. In addition, it has recently been reported that the Met184Thr mutation has been observed in 3TC-resistant HIV-1 isolates selected in vitro, although both the replication capacity and the RT activity of this variant were markedly reduced 25 ; . The 10- to 15-fold resistance to ; -FTC and 6- to 8-fold resistance to 3TC exhibited by these FIV mutants differs from the 100-fold or greater resistance seen previously in oxathiolane nucleoside-resistant HIV-1 mutants obtained both from clinical isolates 51 ; and from in vitro selections with either ; -FTC 49 ; or 3TC 17, 49, ; . In addition, these FIV mutants display slight cross-resistance threefold ; to ddC but wild-type sensitivity to ddI. This again is in contrast to oxathiolane nucleoside-resistant HIV-1 mutants, which possess either low-level resistance to both ddC and ddI 17, 55 ; or no resistance to either 2 , 3 -dideoxy compound 49 ; . These phenotypic differences may result from basic differences between the two lentiviruses, or alternatively they may be due to differences in selection protocols, cell culture systems, or phenotypic assays used to determine the drug sensitivities of mutant isolates. Further selections with 3TC are being performed to determine if FIV mutants can be obtained which display a higher level of 3TC resistance than reported here. Reverse transcriptase purified from our ; -FTC-resistant mutant was resistant to ddCTP, ; -FTCTP, and 3TCTP. The mutant enzyme had Ki values and Ki Km ratios for ; -FTCTP and 3TCTP which were about three- and twofold higher, respectively, than those of the wild-type FIV RT. Additionally, the mutant enzyme displayed a higher level of resistance to ddCTP, with Ki values and Ki Km ratios 13- and 8-fold higher, respectively, than those of the wild-type enzyme. A comparison of these data to data on the ability of the corresponding nucleosides to inhibit FIV replication demonstrates that the degree of resistance to these three inhibitors at the enzyme level did not correlate with the level of viral resistance to ; -FTC, 3TC, and ddC. Previous studies of HIV-1 have shown similar discrepancies between inhibition at the phenotypic level and inhibition of the enzyme. An HIV-1 variant resistant to ; -FTC showed an EC50 300 times greater than the EC50 of the wild-type parent at the phenotypic level. However, the 50% inhibitory concentration for the inhibition of RT by ; -FTCTP for this mutant was only 25-fold higher than that for the parent strain 49 ; . We have previously described AZT-resistant mutants of FIV which revert very rapidly within one round of infection ; when passaged in the absence of AZT 46 ; . In contrast, both of the oxathiolane nucleoside-resistant FIV mutants described here remained significantly resistant to 3TC following three rounds of infection in the absence of drug. However, the decrease in.
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PROPONENTS: Chair: Lenora Fernandez, MD, FPCCP Interim chair: Tito Atienza MD, FPCCP Co-chair: Norberto Francisco, MD, FPCCP Members: Jubert Benedicto, MD Celeste Mae Campomanes, FPCCP Annette David-Rubio, MD Virginia Delos Reyes, MD Elmer Garcia, FPCCP Renato Heradura, FPCCP Luisito Idolor MD, FPCCP Isaias Lanzona, FPCCP Julius Ligo, FPCCP Perla Manlapaz, FPCCP Buenaventura Medina, Jr. MD Cesar Mendoza MD, FPCCP Jenny Mendoza MD Advisers: Rodolfo Carungin, MD, FPCCP Teresita de Guia MD, FPCCP Camilo Roa, Jr. MD, FPCCP Daniel Tan MD, FPCCP Charles Yu MD, FPCCP Family Medicine Practitioner Advisers: Erle Castillo MD, FPAFP Leilani Nicodemus MD, FPAFP Jennifer Ann Mendoza-Wi, FPCCP Rodolfo Pagcatipunan, MD Rolando Perez, FPCCP Percival Punzal, FPCCP Tomas Realiza, FPCCP Rhoderick Ian Reyes, MD Joel Santiaguel, MD Ma. Bella Siasoco, FPCCP Bobbin Sy, FPCCP Sullian Sy-Naval, FPCCP Marietta Tanchoco-Tan, FPCCP Dennis T eo, FPCCP Romulo Uy, FPCCP and panadol.
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