topeesp.gif (5672 bytes)

[ Index ]

EPI-PCVC Mailing List

Messages

Go to #: 83
Go to #: 82
Go to #: 81
Go to #: 80

#80 De: Eduardo Bianco  <biamau@adinet.com.uy>
Enviado: Viernes 04 de Enero de 2000 20:57
Asunto: Tabaquismo/Smoking
Sponsored by: Pfizer
Creo que el intercambio de ideas entre los interesados en el tema Tabaquismo, seguramente nos va a enriquecer a todos, porque aprenderemos y podemos confrontar , e incluso reveer, nuestras posiciones o creencias sobre el tema.
En esta nota, me interesaría intercambiar opiniones, y porqué no , discrepar con los Dres. Carlos Fullone y Daniel Flichtentrei.
El Dr. Fullone dice que no es cuestión de conocimiento, y en eso discrepo.
Para cambiar una conducta, lo primero que hay que hacer es educar, "darle conocimientos " al individuo , para que analizándo la situación desde nuevas perspectivas, valore la posibilidad del cambio. Sobre lo que sí , seguramente, estaremos de acuerdo, que el conocimiento que se debe aportar no debe basarse sólo en "generar susto y temor a enfermar". Cuando me refiero a educación en este tema, hablo de darle información para que el fumador cuestione las verdaderas razones por las que fuma, y sobre todo que porqué le cuesta tanto dejar. Que critique su conducta, razone, y termine llegando a la conclusión de que no fuma por "placer, manejo de los nervios , o compañía" como cree ( o quiere creer), sino que eso es la fachada de una conducta adictiva poderosa, de una "tremenda , sutil y mortal trampa" .
Con respecto a lo dicho por el Dr. Flichtentrei: Estoy totalmente de acuerdo en que no debe sorprender la "brecha entre el conocimiento y el comportamiento", porque lo vemos todos los días, no solo en tabaquismo, sino también en Hipertensión arterial, dislipemias, obesidad, y en todas las enfermedades crónicas en general, en donde a pesar de la información científica disponible sólo el 15% , como máximo, de los individuos que sufren estas patologías están "debidamente tratados y compensados". Éste es uno de los grandes desafíos que debemos aceptar los médicos en este siglo: aprender a modificar la conducta de nuestros pacientes. Pero ello pasa siempre, por comenzar por la nuestra. Cuando el colega se refiere a "premios o recompensas", creo que se refiere a la Campaña del Deje y Gane. Yo estoy de acuerdo con él , que no es la estrategia que más me seduce. Pero no dejo de reconocer que la misma ha tenido un gran impacto poblacional, y creciente.
Es verdad que seguramente, tiene su mayor efectividad, probablemente, en individuos con grados de adicción leve a moderados. Pero su gran valor está en ir sensibilizando a la población sobre la necesidad de dejar de fumar. Es nuestra obligación, tener la suficiente creatividad, para generar otras alternativas , que complementen a las ya existentes. No todas las personas son iguales, ni tienen el mismo nivel de desarrollo sicoespiritual, y para muchas, la motivación de "un premio", puede ser "el empujón" que les faltaba para intentar modificar la conducta. Con respecto a que no encuentra razonable que el "medico sea modelo"deseable de vida sana, discrepo. Todos somos modelos, queramos o no , en algún momento de nuestras vidas, dado que la mayoría de nuestras conductas se adquieren por aprendizaje, en donde suele existir un "modelo"  que ejecuta la conducta a imitar: así lo fueron nuestros padres, nuestros maestros o profesores, nuestros ídolos, etc. , y lo somos nosotros de nuestros hijos.
Por lo tanto, el médico, "que es un individuo especializado en salud" de los grupos humanos, si él mismo no "practica lo que recomienda a los demás", ¿quién le va a creer? .
Sí estoy de acuerdo , en que los médicos , muchas veces, "tenemos una visión amputada de la realidad". Y si tendemos a simplificar problemas complejos, en función de poder enfrentarlos. Que muchas veces , si no hemos logrado la respuesta en estudios "controlados, doble ciego, randomizados", actuamos como si no hubiera una respuesta para dicho problema, e incluso "dejamos de lado", algunas aproximaciones al problema, porque aún no tienen la suficiente evidencia científica. Y también, muchas veces nos olvidamos de los factores psicosocioculturales e "hipertrofiamos la biología". Aún a la Medicina le falta mucho camino por recorres... pero lo estamos recorriendo!
Es verdad, combatir sólo al tabaquismo, no arregla todos los problemas de la humanidad. Pero por tener muchos problemas, no vamos a quedarnos sólo en quejarnos, por alguno hay que empezar a trabajar. Bueno, algunos de nosotros empezamos a trabajar en el problema del tabaquismo, otros en el manejo del estrés, a otros les corresponderá estudiar e intentar modificar las múltiples conductas inadecuadas que tenemos los seres humanos.
Para terminar, debo reconocer que me fascina poder intercambiar ideas con Uds. Seguramente del intercambio de ideas , obtendré unas cuántas que me harán crecer como ser humano, y porque no, hasta me harán cambiar de opinión en algún aspecto.
Saludos a todos.

I think that exchange of ideas between those interested in the subject of smoking, will surely enrich us all, because we will learn, and we can compare, and even review our positions or beliefs on the topic.
In this note, I would be interested in exchanging opinions, and  why not, to disagree with Drs. Carlos Fullone and Daniel Flichtentrei.
Dr. Fullone said that it is not a question of knowledge, and I disagree with that.
In order to change a behavior, the first thing to do is to educate, "provide knowledge" to the individual, so that by analyzing the situation from new points of view, s/he assesses the possibility of change. We would agree for sure, in that the knowledge that must be provided should not be based only in "generating fright or fear of becoming ill". When I say education in this subject, I mean providing information so that the smoker would question the true reasons for his/her smoking, and most of all why it is so difficult to quit. The individual should review his/her behavior, reason, and conclude that s/he is not smoking for "pleasure, control of nerves, or company" as s/he believes (or wants to believe), but that this is the facade of a powerful addictive behavior, of a "tremendous, subtle, and mortal trap".
In regard to what Dr. Flichtentrei said: I totally agree in that we should be not surprised by the "gap between knowledge and behavior", because we see this everyday, not only in smoking, but also in Blood Hypertension, dyslipidemias, obesity, and in all chronic diseases in general, in which in spite of the scientific information available, only a 15% at the most, of individuals that suffer these pathologies are "properly treated and compensated". This is one of the great challenges that we, physicians of this century must accept: to learn to modify our patients' behavior. But this always begins by changing our own behavior.
When the colleague mentioned "prizes or rewards", I think he means the Quit and Win campaign. I agree with him in that this strategy is not one that seduces me the most. But I do reckon that it has a great impact on population, and it is growing. It is true that surely, it has its greatest effectiveness, probably, in individuals with mild to moderated degrees of addiction. But its great value lays in that it increasingly raises awareness in population about the need of quitting smoking. It is our obligation, to have enough creativity to generate other alternatives, that  supplement those already existing. Not all individuals are equal, and do not have the same level of psycho-spiritual development, and for many the motivation of "a prize" may be the "prod" they needed to try to modify their behavior.
About not finding reasonable that the "doctor is a model" of healthy life, I disagree.
We are all models, whether we want it or not, in some moment of our lives, given that most of our behaviors are acquired by learning, in which usually there is a "model" that executes the behavior to imitate: our parents were like this, so were our teachers, or professors, our idols, etc., and we are for our children, too. Therefore, the doctor "that is an individual specialized in health" of human groups, if he himself does not "practice what he advises to others", who is going to believe him?
Yes, I agree that doctors, many times, "have an amputated vision of reality". And we do tend to simplify complex problems, so that we could face them. Many times, if we did not get an answer in "controlled, double blind, randomized" studies, we act as if there was no answer for this problem, and even "leave aside" some approaches to the problem, because we still not have enough scientific evidence. And also, many times we forget the psycho-socio-cultural factors and we "produce a hypertrophy on biology". Medicine has still a long way to go... but we are walking it!
It is true, the fight against smoking only, does not solve all the problems of humanity. But because we have too many problems, we should not just complain, we have to begin somewhere. Well, some of us have begun to work on the problem of smoking, others in management of stress, others will have to study or to try to modify the multiple wrong behaviors we, human beings, have.
To finish, I have to reckon that I am fascinated with the possibility of exchanging ideas with you. Surely from this exchange of ideas, I will obtain some that will make me grow up as a human being, and why not, maybe you will make me change my mind in some aspect.
Greetings for everyone,
Dr. Eduardo Bianco

Top

#81 De: Eduardo Bianco <biamau@adinet.com.uy>
Enviado: Viernes  04 de Enero de 2000 21:05
Asunto: Tabaquismo en los médicos/Smoking in physicians
Sponsored by: Agilent Technologies
Con gran alegría recibo la discusión que se ha generado en torno a como encarar el Tabaquismo de los médicos.
En nuestro país (Uruguay), es también un problema "serio" que requiere una "intervención urgente".
Los Profesionales de la Salud, como agentes de salud, tenemos en este tema una gran responsibilidad: 1) somos "tutores" de la salud de nuestra población, 2) somos los técnicos que deberían asesorar a los Políticos y Administradores en temas de Salud, 3) somos "modelo" (se  quiera o no) de hábitos de conducta saludables de nuestra población, y 4) nos corresponde "por las generales de la ley", acutar como guías, educadores o instructores dde aquellas personas que sufren de "adicción al consumo" de tabaco, a fin de ayudarles a superarla. Además en nuestra profesión, nos hemos comprometido a trabajar para :"tratar la enfermedad en aquellos que la padecen, y prevenirla , de ser posible".
Por lo tanto, si el tabaquismo ha sido definido como una Drogadicción, y revista en el C.I.E. de la OMS como una "enfermedad crónica", los médicos que no asuman la responsabilidad de "tratar el Tabaquismo" de sus pacientes, en un futuro , podrían estar incurriendo en "omisión de asistencia".
El tema puntual que nos ocupa es "cómo modificar la conducta" de nuestros colegas fumadores. Para ello hay que tener presente los siguientes hechos: a) La gran mayoría de los médicos fumadores, se convierten primero en "adictos a la nicotina" y luego se reciben de médico. b) Si se cumple lo que ocurre en la población general, y no tenemos razones para sostener lo contrario, por lo menos el 70 % tiene intenciones de dejar de fumar. c) La adicción al consumo de tabaco es una conducta compleja, que no tiene "una solución simple", y para muchos puede ser muy
difícil lograr superar si no reciben ayuda adecuada. A mi juicio, ante este grupo de colegas se debería tomar una actitud "empatica pero firme".
Empática: No es cuestión de "tirar piedras" y prohibir todo. Hacer eso sería desconocer que los médicos fumadores son personas que sufren de "una enfermedad cerebral" caracterizada por una "obsesión mental" por consumir tabaco, a pesar de que racionalmente saben que no deberían consumir. Por lo tanto hay que ofrecer:1) Educación: porque la mayoría de los médicos fumadores no sabe "realmente" lo que es fumar , ni porqué les cuesta tanto dejar. Creen que es una " libre elección de un placer" y no tienen conciencia de cómo los tiene atrapado su dependencia. Es necesario realizar cursos de formación sobre la adicción al consumo de tabaco y su tratamiento. Quizás a través de este medio fabuloso que es la internet, y de la organización que ha logrado el PCVC, en un futuro se podría lograr un curso de formación sobre dicho tema. 2) Exhortar a las intituciones de asistencia médica, que desarrollen programas de apoyo a la cesación del tabaquismo para sus propios médicos fumadores, y que los impulsen a participar.
Firme: Dejar bien claro que "no es adecuado que un médico fume". Los médicos que fuman hacen perder credibilidad al mensaje que debe dar la Medicina sdobre el consumo de tabaco.
Por lo tanto propongo: 1) Comenzar a "sugerir" a nuestros colegas que "se traten de su enfermedad", y terminar de ser cómplices de la creencia de los fumadores de que fumar es "simplemente un mal hábito". 2) Reflotar el concepto de "Hospital libre de Humo", que no se suele respetar por parte de los médicos. Nadie les prohíbe fumar en sus casas o en la calle, pero en un centro de asistencia médica, es inadmisible que un médico fume. Si existen empresas en donde funcionarios administrativos pasan horas sin fumar , porque no les está permitido, ¿porqué a los médicos fumadores se les debe conceder el privilegio de fumar en los hospitales o sanatorios?. Un problema es que muchas veces, los que tienen que hacer cumplir los reglamentos, también fuman. 3) Todo evento científico o cultural donde participen médicos, solicitar expresamente que no se fume durante el mismo. 
El aspecto que más le puede llegar a un colega fumador, no es "el riesgo de morirse por fumar", sino el estigma social que genera el ser visto, por la población y los colegas,como un "enfermo o adicto". Deben perder el "soporte social" de su adicción y entender que no fuman por "placer, nervios o compañía" sino por adicción.
Para concluír, deseo manifestar que es necesario instrumentar estructuras supranacionales de prestigio que presionen sobre las Asociaciones Médicas Nacionales de Latinoamérica, a fin de que pongan en funcionamientos los conceptos vertidos. Sería interesante saber la opinión de la Dra. Beatriz Champagne, Directora Ejecutiva de la Fundación Interamericana del Corazón, sobre la posibilida de que dicha Institución, a través de su Comisión de Tabaquismo, pueda ayudar a organizar dicha estructura supranacional,  para presionar ante Asociaciones Médicas y Gobiernos.

With great joy, I received the discussion that has been generated about how to face smoking in doctors. In our country (Uruguay), this is a "serious" problem as well, that requires "urgent intervention". Professionals of Health, just as health agents, have a great responsibility in this matter: 1) we are "tutors" of our population's health, 2) we are the technicians that should assess Politicians and Administrators in Health topics, 3) we are "models" (whether we want to or not) of healthy habits of behavior for our population, and 4) it is our duty "by general law" to act as guides, educators, or instructors of those individuals that suffer "addiction to consumption" of tobacco, to help them overcome this.
Besides, in our profession, we have committed to work to: "treat the disease in those who suffer it, and to prevent it, if possible".
Therefore, if smoking has been defined as a Drug Addiction, and in the journal in the International Code of Diseases of the WHO as a "chronic disease", doctors who do not assume the responsibility for "treating Smoking" in their patients, in a future may be falling into "omission of assistance".
The concrete subject we are dealing with is "how to modify behavior" in our colleagues that smoke. For this we have to bear in mind the following facts: a) Most of the doctors that smoke, become "addicted to nicotine" first, and then become doctors. b) If what happens in the population in general is the same with them, and we do not have reasons to maintain the contrary, at least a 70% has intentions of quitting smoking. c) Addiction to tobacco consumption is a complex behavior that has no "simple solution", and that for many may be very hard to
overcome if they do not receive the proper help.
The way I see it, before this group of colleagues we should have an "empathic but firm" attitude.
Empathic: this is not a question of "throwing stones" and forbidding everything. To act thus would be to ignore that doctors that smoke are people who suffer from a "brain disease" characterized by a "mental obsession" with consumption of tobacco, in spite of their rationally knowing that they should not consume. Therefore we have to offer: 1) Education: because most of doctors that smoke do not "really" know what is smoking, or why it is so difficult for them to quit. They think that it is a "free choice of a pleasure" and they are not aware of how they are trapped by their dependency. It is necessary to carry out courses of education about addiction to consumption of tobacco, and its treatment. Maybe, through this great means of communication, the Internet, and the organization achieved by the FVCC, in a future it would be possible to carry out a course of education on this matter. 2) To urge institutions of medical care, to develop programs of support for quitting smoking for their own physicians that smoke, and to encourage them to take part in them.
Firm: to make it very clear that "it is not proper for a doctor to smoke". Physicians that smoke, make the message that Medicine should give about consumption of tobacco, to lose credibility.
Therefore I suggest: 1) To begin "suggesting" to our colleagues to "treat their disease", and to finish being accomplices of smokers' belief that smoking is "just a bad habit" 2) To bring back the concept of "Hospitals free of Smoke", that is not usually respected by physicians. No one forbids them to smoke in their homes, or in the street, but in a center of medical care, it is unacceptable for a doctor to smoke. If there are companies in which administrative employees spend hours without smoking, because they are not allowed to, why doctors who smoke must be conceded the privilege of smoking in hospitals or clinics? There is a problem: many times those who should make rules be obeyed, also smoke.
3) All scientific or cultural events, in which physicians take part, should request specifically not to smoke during them.
The aspect that may move more deeply a colleague who smokes, is not "the risk of dying due to smoking", but the social stigma brought about by being seen by population and colleagues, as an "ill or addicted individual". They must lose "social support" for their addiction, and understand that they do not smoke due to "pleasure, nerves, or company", but because of addiction.
To finish, I would like to express that it is necessary to implement prestigious supranational structures that would put pressure on National Medical Associations from Latin-America, so that they may execute the concepts exposed.
It would be interesting to know Dr. Beatriz Champagne's opinion, who is Executive Director of the Interamerican Heart Foundation, about the possibility that the mentioned Institution, through its Committee on Smoking, may help to organize such supranational structure to pressure Medical Associations and Governments.
Dr. Eduardo Bianco

Top

#82 De: JBM <mariajavier@teleline.es>
Enviado: Viernes 18 de Febrero de 2000 13:04
Asunto: Clamydia/Chlamydiae
Sponsored by: Pfizer
Busco toda la informacion posible acerca de la posible interrelacion entre la chlamydia pneumoniae y los accidentes cardiovasculares y su posible prevencion con el uso de antibioticos(macrolidos); agradeceria me proporcionasen informacion (me vale todo,direcciones internet, articulos publicados sobre el tema...) o bibliografia reciente.
Muchas gracias por el interes y un saludo.

I am seeking all the information possible about the possible interrelation between the chlamyidia pneumoniae, and the cardiovascular accidents, and its possible prevention with use of antibiotics (macrolides); I would be grateful if you could provide me with information (anything would do, internet addresses, articles published about the topic...) or recent bibliography.
Thank you very much for your interest, and greetings.

Top

#83 De:  Jose Bermejo <jbgarcia@jet.es>
Enviado: Viernes 18 de Febrero de 2000
Asunto: Clamydia/Clamydiae
A la lista epi-pcvc:
Adjunto bibliografia actualizada sobre la relacion entre clamydia y enfermedad coronaria. El estudio Wizard (azitromicina como prevencion secundaria) acaba de concluir y pronto tendremos los resultados.
1. Patel P, Mendall MA, Carrington D, Strachan E, Molineaux N, Levy J, Blaqueston C et al. Association of Helicobacter pylori and Chlamydia
pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ 1995; 311:711-714.
2. Thomas M, Wong Y, Thomas D, Ajaz M, Tsang V, Gallagher PJ, Ward ME. Relation between direct detection of clamydia pneumoniae DNA
in human coronary arteries at postmorten examination and histological severity (Stary grading) of associated atherosclerotic plaque. Circulation 1999; 99: 2733-6
3. Maass M, Bartels C, Engel PM, Mamat U, Sievers HH. Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in
coronary artery disease. J Am J Cardiol 1998; 15: 827-32
4. Rasmussen SJ, Eckmann L, Quayle AJ, Shen L, Zhang YX, Anderson DJ et al. Secretion of proinflammatory cytokines by epithelial cells in response to Chlamydia infection suggests a central role for epithelial cells in chlamydial pathogenesis. J Clin Invest 1997, 99:77-87.
5. Frier RH, Schwobe EP, Woods ML, Rodgers GM. Chamydia species infect human vascular endothelial cells and induce procoagulant
activity J Investg Med 1997; 45: 168-174
6. Gurfinkel E, Bozovich G, A, Beck A, Testa E, Livellara B, Mautner B.  Treatment with the antibiotic roxithromycin in patients with acute non-Q-wavw coronary syndromes. The final report of the ROXIS study. Eur Heart J 1999: 20: 121-7
7. Gupta S, Lesthan EW, Carrington D, Mendal MA, Kaski JC, Camm AJ. Elevated chlamydia pneumoniae antibodies, cardiovascular events
and azithromycin in male survivors of myocardial infarction. Circulation 1997; 96: 404-407
8. Altman R, Rouvier J, Scazziota A, Absi RS, Gonzalez C. Lack of assotiation between prior infection with Chamydia pneumoniae and acute or chronic artery disease. Clin Cardiol 1999:22: 85-90
9. Danesh J, Wong Y, Ward M, Muir J. Chronic infection with Helicobacter pylori, Chlamydia pneumoniae or cytomegalovirus: population based study of coronary heart disease. Heart 1999; 81: 245-7
10. Cellesi C, Sansoni A, Casini S, Migliorini I, Zacchini F, Gasparini R et al. Chamydia pneumoniae antibodies and angiographically demonstrated coronary artery disease in a sample population from Italy. Atherosclerosis 1999; 145:81-5
11. Anderson JL, Muhlestein JB, Carlquist J, Allen A, Trehan S Nielson C et al. Randomized secondary prevention trial of azithomycin in  patients with coronary artery disease and serological evidence for Chlamydia pneumoniae infection: The Azitromycin in coronary artery disease: Eliminationof myocardial infection with Chamydia (ACADEMIC) study. Circulation 1999; 99: 1549-7
12. Dahlen GH, Boman J, Birgander LS, Lindblom B. Lp(a) lipoprotein, IgG, IgA and IgM antibodies to Chlamydia pneumoniae and HLA
class II genotype in early coronary artery disease. Atherosclerosis 1995, 114:165-174

To the epi-pcvc list:
I include updated bibliography about relation between clamydiae and coronary disease. The Wizard study (azithromycine as secondary prevention) has just ended, and soon we will have the results.
1. Patel P, Mendall MA, Carrington D, Strachan E, Molineaux N, Levy J, Blaqueston C et al. Association of Helicobacter pylori and Chlamydia
pneumoniae infections with coronary heart disease and cardiovascular risk factors. BMJ 1995; 311:711-714.
2. Thomas M, Wong Y, Thomas D, Ajaz M, Tsang V, Gallagher PJ, Ward ME.  Relation between direct detection of clamydia pneumoniae DNA
in human coronary arteries at postmorten examination and histological severity (Stary grading) of associated atherosclerotic plaque. Circulation 1999; 99: 2733-6 3. Maass M, Bartels C, Engel PM, Mamat U, Sievers HH. Endovascular presence of viable Chlamydia   pneumoniae is a common phenomenon in coronary artery disease. J Am J Cardiol 1998; 15: 827-32
4. Rasmussen SJ, Eckmann L, Quayle AJ, Shen L, Zhang YX, Anderson DJ et al. Secretion of proinflammatory cytokines by epithelial cells in response to Chlamydia infection suggests a central role for epithelial cells in chlamydial pathogenesis. J Clin Invest 1997, 99:77-87.
5. Frier RH, Schwobe EP, Woods ML, Rodgers GM. Chamydia species infect human vascular endothelial cells and induce procoagulant activity J Investg Med 1997; 45: 168-174
6. Gurfinkel E, Bozovich G, A, Beck A, Testa E, Livellara B, Mautner B. Treatment with the antibiotic roxithromycin in patients with acute non-Q-wavw coronary syndromes. The final report of the ROXIS study. Eur Heart J 1999: 20: 121-7
7. Gupta S, Lesthan EW, Carrington D, Mendal MA, Kaski JC, Camm AJ. Elevated chlamydia pneumoniae antibodies, cardiovascular events and azithromycin in male survivors of myocardial infarction. Circulation 1997; 96: 404-407
8. Altman R, Rouvier J, Scazziota A, Absi RS, Gonzalez C. Lack of assotiation between prior infection with Chamydia pneumoniae and acute or chronic artery disease. Clin Cardiol 1999:22: 85-90
9. Danesh J, Wong Y, Ward M, Muir J. Chronic infection with Helicobacter pylori, Chlamydia pneumoniae or cytomegalovirus: population based study of coronary heart disease. Heart 1999; 81: 245-7
10. Cellesi C, Sansoni A, Casini S, Migliorini I, Zacchini F, Gasparini R et al. Chamydia pneumoniae antibodies and angiographically demonstrated coronary artery disease in a sample population from Italy. Atherosclerosis 1999; 145:81-5
11. Anderson JL, Muhlestein JB, Carlquist J, Allen A, Trehan S Nielson C et al. Randomized secondary prevention trial of azithomycin in patients with coronary artery disease and serological evidence for Chlamydia pneumoniae infection: The Azitromycin in coronary artery disease: Eliminationof myocardial infection with Chamydia (ACADEMIC) study. Circulation 1999; 99: 1549-7
12. Dahlen GH, Boman J, Birgander LS, Lindblom B. Lp(a) lipoprotein, IgG, IgA and IgM antibodies to Chlamydia pneumoniae and HLA class II genotype in early coronary artery disease. Atherosclerosis 1995, 114:165-174

Top


© CETIFAC
Bioengineering
UNER

Update
Feb/24/2000