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Query: UMLS:C0027497 (nausea)
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The aim of this study was to determine whether total copper or soluble copper concentration is associated with gastrointestinal signs and symptoms. Forty-five healthy adult women (18-55 years of age), living in Santiago, Chile, ingested tap water with 5 mg/L of copper containing different ratios of soluble copper (copper sulfate) and insoluble copper (copper oxide) over a 9-week period. Three randomized sequences of the different copper ratios (0:5, 1:4, 2:3, 3:2, and 5:0 mg/L) were followed. Subjects recorded their water consumption and gastrointestinal symptoms daily on a special form. Mean water consumption was similar among groups. Serum copper levels, ceruloplasmin, and activities of liver enzymes were within normal limits. No differences were detected between the means of biochemical parameters at the beginning and at the end of the study. Twenty subjects presented gastrointestinal disturbances at least once during the study, 9 suffered diarrhea (with or without abdominal pain and vomiting), and the other 11 subjects reported abdominal pain, nausea, or vomiting. No differences were found in incidence of abdominal pain, nausea, vomiting, and diarrhea regardless of the ratio of copper sulfate to copper oxide. In conclusion, both copper sulfate (a soluble compound) and copper oxide (an insoluble compound) have comparable effects on the induction of gastrointestinal manifestations, implying that similar levels of ionic copper were present in the stomach.
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PMID:Gastrointestinal effects associated with soluble and insoluble copper in drinking water. 1167 25

In 1977-78, 120 women aged 15-35 at the CEMP Centre in Milan, Italy, were assigned randomly (60 each) to 5 tablets EE (1 mg) daily for 5 days; or insertion of Cu-T. All women were followed up for at least 40 days from last menstrual period. 88% were nulliparous; 90% were under age 25. With ovulation estimated as 14 days before the mean length of the 6 previous cycles, 40% had had unprotected coitus within 2 days of ovulation; 30% had coitus 3-4 days before or 3-5 days after ovulation. None of the 120 women became pregnant. Of the 60 women taking EE, 80% experienced side effects; 51% nausea, 18% vomiting; 30% breast pain; 25% headache, and 22% bleeding. The side effects from the Cu-T were 38%: 8% vagal reflex during insertion; 11% serious uterine cramps within 4 days of insertion; 33% bleeding; and 1 expelled 5 days after insertion. Both postcoital ethinylestradiol and the Copper-T 200 were effective in preventing pregnancy.
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PMID:Postcoital estrogen or IUD? 1217 44

Acute liver failure and haemolytic syndrome appeared quite suddenly as the first manifestations of Wilson disease (WD) in five of our patients previously regarded as healthy persons (although an interview showed that 2-4 weeks prior to the illness the patients complained of several non-specific symptoms, such as abdominal pain, headaches, fever, weakness or behavioural changes). All the patients were young women (17-23 years), none of them had any history of liver disease. They were admitted with icterus, nausea, vomiting and symptoms of increasing haemolysis. The diagnosis of WD was given as disturbed copper metabolism. After a short period of observation ascites and anasarca occurred, haemorrhagic diathesis and other symptoms of liver failure increased. Levels of clotting factors decreased rapidly. Despite treatment with D-penicillamine, plasmapheresis, and symptomatic drugs, three of the women died in irreversible liver coma, due to the unavailability of liver transplantation. The fourth woman was carried to the Transplantation Centre, due to aggravation of the symptoms of liver failure, where liver transplantation was performed. Histopathologically micronodular cirrhosis was shown in all these cases. The fifth patient survived having undergone the above treatment without liver transplantation. The main differences between the patient who survived and those who died or underwent transplantation were relatively higher activity of alkaline phosphatase (26 U/l vs. 10-20 U/l), slightly higher levels of clotting factors and prothrombin time, which never fall below 68% of the control (versus 14-44% in other patients). Only in the surviving patient was the Kayser-Fleischer ring present. In four of our patients we found family members who were carriers of WD.
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PMID:Acute haemolytic syndrome and liver failure as the first manifestations of Wilson's disease. 1221 29

The experience of the Utrecht State University with postcoital estrogens in high and low combined doses and with postcoital placement of IUDs since 1964 with over 4000 patients is summarized. The high dose postcoital estrogen treatment consists of 5 mg ethinyl estradiol for 5 days, either orally, or in case of vomiting not controlled by an antiemetic, estradiol benzoate 30 mg by injection. Side effects recorded in 3016 women were nausea in 54%, vomiting in 24%, tender breasts in 23%, menorrhagia in 11%, altered cycle length in 24%. Complications were 1 case of non-fatal pulmonary edema and 1 case of an 8 kg weight gain during treatment. There were 3 pregnancies. The overall failure rate in the whole series was 0.15%, with 10% ectopic pregnancies. There were no thromboembolisms or teratogenic effects. The combined estrogen treatment consisted of 50 mc ethinyl estradiol with 250 mc levonorgestrel (Neogynon oral contraceptive), 2 pills followed by 2 pills 12 hours later. A double-blind randomized trial resulted in no significant differences in pregnancy rates or side effects between the high and low dose regimens. The alternate treatment, if the woman presents more than 72 hours after intercourse, or if estrogens are contraindicated, is postcoital insertion of an IUD. The Dept. of Obstetrics and Gynecology does not place an IUD in a woman with infection nor in case of rape unless there is time for a complete work-up. Nulliparas are informed of the increased risk of pelvic inflammatory disease. Recently, the Multiload-copper 250 and later ML 375 were used exclusively, to achieve better blastocidal effect and lower expulsion rates. The ethical debate over use of postcoital methods centers around the morality of "procuring a miscarriage," but this argument is not relevant since these methods will not terminate a pregnancy once implantation has occurred. In the Netherlands, 25% of all abortion clients become pregnant during their 1st intercourse. In 1982, 35,000 postcoital contraceptives were administered, (roughly 16% of all pregnancies), compared to 15,000 abortions (7% of pregnancies; a total of 23% of pregnancies terminated). Compare these figures with 29% unwanted pregnancies all terminated by abortion in Sweden in that year. The postcoital methods are cheap, effective, and invaluable in emergency cases of rape, incest, intoxication, failure of barrier contraceptives, or unwanted pregnancy in women fearful or opposed to abortion.
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PMID:Post coital contraception. 1226 14

Since "sexarche" -- the age of 1st coitus -- is occurring at very young ages and 60% of these 1st sexual exposures are unprotected, an effective method of postcoital contraception is necessary, if abortion is to be avoided. In the Netherlands, where the incidence of induced abortions (18,000/180,000 live births) and the incidence of adolescent pregnancy (14/100) are both the lowest in the world, 4 methods of postcoital contraception are used. Within 72 hours of intercourse high-dose or combined estrogens may be used to interfere with endometrial hyperplasia. 1 method involves the administration of 5 mg of ethinyl estradiol daily for 5 days. The other method involves the administration of 50ug of ethinyl estradiol combined with 250 ug of levonorgestrel. 2 tablets are given immediately and 2 more 12 hours later. Side effects -- nausea, vomiting, sore breasts, and menstrual irregularities -- are the same with both regimens, as was the failure rate, .15%. If the woman requests intervention more than 72 hours but less than 7 days after intercourse, insertion of the Multiload Cu 250 or the ML 375 IUD prevents pregnancy through blastocidal effects of copper salts. However, nulliparas, sexually active women, and rape victims are at high risk for pelvic inflammatory disease. The newest postcoital contraceptive is mifepristone (RU-486), which binds competitively to endometrial progesterone receptors and can prevent pregnancy irrespective of the time lapse following intercourse. 3 tables of 200 mg, taken on day 27 of the cycle will induce menstruation within 3 days, with a failure rate of 1.6%. Because of their interference with early gestation, postcoital use of antiprogesterones is called "contragestion." Since they interfere with gestation before implantation is completed, antiprogesterones are classed as contraceptives rather than abortifacients. Postcoital contraceptives should not be used as an ongoing contraceptive regimen except by women who have intercourse very infrequently.
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PMID:Post-coital contraception. 1228 24

If used correctly, only 2 out of every 100 women using a diaphragm would conceive over a year; however, because of forgetfulness the figure increases to 19 out of every 100. With good care they can last up to 12 years. The contraceptive sponge works because of the sperm-killing ingredients in the spermicide and because it blocks the cervix. The condom may also provide some protection against a variety of sexually transmitted diseases (STDs), such as herpes and gonorrhea. Missing one day of a low-dose oral contraceptive formulation (35 mcg) will have no consequences since the pill works by keeping hormone levels in the body elevated over time. With IUDs the only potential pitfall is forgetting to check for the tail every week of the first month and once a month thereafter to be sure the IUD is still in place. Some physicians suggest using a second form of contraception for the first three months after an IUD is inserted, since the odds are slightly higher it will be dislodged during this time. The manufacturers of Cu-7's and Cu-T's, as well as most physicians, recommend replacement of this device every three years. Experts are in agreement, however, that copper-containing IUDs carry a slightly lower risk of infection than Progestasert and the Lippes Loop. For postcoital contraception douching or using a spermicide within 10 minutes may help a bit. Although an IUD insertion can prevent pregnancy 90-95% of the time if it is done within five days of unprotected intercourse, because of the infection risk, this is not recommended unless a woman is planning on leaving the device in place as a contraceptive. The morning-after pill also works by preventing implantation of the fertilized egg. Taking two within 24 hours and two more 12 hours later prevents pregnancy 90-95% of the time, possibly with mild nausea or headache.
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PMID:Birth-control trip-ups. How to avoid just-this-once risks. 1232 Feb 44

This article answers some questions about use of emergency contraceptive pills (ECP) in the US. It is acceptable to prescribe ECPs over the telephone. ECPs should not be given to women with severe migraine headaches with neurologic impairment. ECPs are acceptable for women who are smokers and over 35 years old, diabetics with vascular disease, women with a history of severe migraine, and women with a benign or malignant liver tumor. Women who seek ECPs over 72 hours after unprotected sexual intercourse could have ECPs, insertion of a Copper T380 IUD, or Ru-486, when available in the US. Lo-Ovral4+4 is the preferred ECP. Ovral2+2 is less often available and tends to cost more. An ECP prescription might indicate Phenergan (25 mg), 4 tablets, taken between 6 and 7 PM, and repeated in 12 hours. Another ECP prescription might indicate Lo-Ovral (21-pill pack), 4 tablets taken one half hour after anti-nausea medication, and repeated in 12 hours. If nausea is severe from the first or second dose of Lo-Ovral, an extra tablet of Phenergan may be taken. For continued contraception, the patient should be prescribed a low-dose pill and not a 50 mcg pill. The most common transition from ECP combined pills to regular oral contraception is to prescribe 4 tablets followed by 4 tablets 12 hours later, and to start a new package of pills the Sunday after menstruation begins. Nonlapsed pill taking involves taking the 4 tablets, followed by 4 tablets in 12 hours, and 1 tablet taken daily for the next 13 days (with backup contraception the first 7 days), and a lapse for 7 days. Nothing needs to be done for vomiting. Women are not likely to abuse this option. It should be widely known and appreciated that mistakes do happen, emergency contraception does work, and women should be aware of ECPs. 98% of women bleed by 21 days after ECP use. There appears to be no increased risk of birth defects among pill users who become pregnant.
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PMID:10 common questions on emergency contraception. 1234 14

Early effects of acute copper exposure consist mainly of nausea and altered gastric permeability. To assess copper effects on gastric response 30 apparently healthy volunteers underwent two controlled trials receiving a solution with (10 mg Cu/l) and without (<0.01 mg Cu/l) copper sulfate after overnight fasting, in random order. Ultrasonography was chosen to follow indirectly the gastric emptying pattern for 120 min. Measurements were expressed as z scores [z=(mean-Xi)/S.D.]. Results showed that nobody presented symptoms after drinking water without added copper while 9 subjects presented nausea after receiving the 10 mg Cu/l solution. The group receiving drinking water with 10 mg Cu/l presented greater antral areas during the first 60 min of observation. Individual and mean fitted curves for antral area, calculated and compared using the linear mixed-effects model fit by REML, showed a group effect of copper on antral area over time (L. Ratio=23.98, P<0.0001); the effect was due to delay in decreasing antral area in the copper treated group during the first hour after ingestion. No differences were found by gender or nausea. Results show a copper effect on gastric response suggesting that acute exposure to copper in water modify the first phase of gastric emptying.
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PMID:Gastric response to acute copper exposure. 1260 65

In a double blind, 3x3 factorial (volumexdose) study, 70 adult females (18-60 years of age) at four different international sites (total pooled n=269) were given 100, 150, or 200ml of bottled drinking water with 0.4, 0.8, or 1.2mg of copper (Cu) as the sulfate salt once each week. Two additional doses (0 and 1.6mg Cu) were added at the 200ml volume to determine a dose-response relationship and corroborate previously reported results. All subjects completed a questionnaire at 0, 0.25, and 1h post-dosing that screened for positive gastrointestinal (GI) effects (nausea, vomiting, abdominal pain, and diarrhea). Nausea was the most prevalent symptom reported and was generally reported within the first 15min (water volume, p<0.032; copper dose, p<0.0001; and water volumexcopper interaction, p<0.97). As volume increased, the effect of Cu-induced nausea decreased; as Cu dose increased, the incidence of nausea increased. At 200ml, a significant increase in reported incidence of nausea at 0.25h occurred at 1.2 mg Cu (6mg Cu/L), indicating a NOAEL of 0.8mg Cu (4mg Cu/L) for adult females. These data confirm a previously determined human acute NOAEL for Cu added to distilled water, and provide additional, controlled human data for determining safe concentrations of Cu in drinking water.
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PMID:Confirmation of an acute no-observed-adverse-effect and low-observed-adverse-effect level for copper in bottled drinking water in a multi-site international study. 1462 88

This survey is part of a more comprehensive study on the health consequences of pesticide exposure. In the county (municipality) of Paty do Alferes, Rio de Janeiro State, Brazil, 55 agricultural workers were interviewed on the use of pesticides, use of personal protective equipment, data on health status, and symptoms related to pesticide exposure, disposal of agrochemical containers, and technical assistance. The most widely used pesticides were insecticides such as abamectin, organophosphate compounds, and pyrethroids, and fungicides such as mancozeb, chlorothalonil, and copper products. As a rule, pesticides are handled carelessly, and 92% of workers involved in the mixing, loading, and spraying of insecticides and fungicides used no protective clothing or equipment whatsoever. Some 62% of workers reported at least one illness associated with mixing or spraying pesticides. The most frequently reported symptoms were headache, nausea, vomiting, dizziness, skin irritation, and blurred vision, and 21% of affected workers required medical care. In more than half (51%) of the cases, workers reported using organophosphate insecticides from toxicological class I when they felt sick.
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PMID:[Pesticide use and poisoning among farmers from the county of Paty do Alferes, Rio de Janeiro, Brazil]. 1502 19


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