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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Helen Boussios, MD
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Another patient is very erotic gastritis diet из order gasex 100 caps overnight delivery, but demands that he be changed to another "bedroom" because of the immoral dreams which he has been having gastritis acute diet generic 100caps gasex visa. A woman patient suddenly begins to scold and curse gastritis diet лесбиянки generic gasex 100caps with mastercard, stating that no one had the right to say that she was a child-murderess because she had never hurt any child gastritis chronic diet buy gasex 100 caps free shipping, had never had a child gastritis sweating buy cheap gasex 100 caps line, that after all she was not engaged to the ward-physician gastritis blog order 100caps gasex. Here the wish was negatively expressed to us for the first time since she entered the hospital. We see in this negation not only the reality which opposes the wish but also the fear which is produced by this very mixture of wish and reality. If the patient did have a child by the doctor, it would be a great shame and scandal; she would have to do away with it at once since "she is not engaged to him. Analogous to dreams, it is not improbable that only those complexes which are ambivalent give occasion to true delusions. The ambivalence attached to the delusion is based not only on this factor, but also on a special tendency of the delusion-forming complex. The voices insist that she is that girl and the patient, in great anger, tries to prove that she is not. The voices tell him that he could easily marry another woman, a younger woman, in particular, his niece who is only sixteen years old and has made a great impression on him. Legally, of course, he cannot have anything to do with her sexually, but the wish to do so illegally is present. The voices make a compromise between wish and reality; they tell him that he had raped her. When he is transferred to a different shop in the factory, the delusion begins to spread; he hallucinates that his new fellow-workers do not want to work alongside such a vicious rascal. He becomes further enraged and, of course, even more unpleasant to his wife whose existence prevents the fulfillment of his wish. When this above-mentioned paranoid factory worker was in the hospital, the voices soon began to tell him that in six weeks he would be released; at other times they told him he was going to be kept in the hospital forever. In contrast to the later nasty remarks made by his fellowworkers, the voices had previously told him that he was going to be made foreman at the factory. The same patient, at the start of his psychosis, had heard much more simple hypostatizations of his wishes and anxieties. Thus it was whispered to him that the daughter of a certain person wanted to marry him, that he was going to receive a large sum of money before nightfall. At his rifle club, all the members had whispered that he had better be careful not to shoot accidentally the referee. A real lover may also have his bad points; he may, for example, be morally inferior to the unloved husband. A patient developed the delusion that the dolt on whom she had hung her heart was insane. Therefore, he was more to be pitied than blamed since it was quite contrary to all her feelings to assume that, out of revenge, she might desire his becoming mentally ill. Conflicts arise primarily from the usual struggles of our various drives, regardless of whether they be called good or bad. Corresponding to those drives, the patients develop "voices" and impulses to act; the "bad" drives are exposed by the twinges of conscience in those patients who have one. The "good" drives arc endowed with negative feeling tones because of the sacrifices which they demand of us. The voices often bring the patients to the point of despair when they first command that something be done and then make the ugliest reproaches after the command is carried out and the action completed. These voices reproached the patient for his scandalous behavior; they told him that he was utterly incapable of doing anything useful; that he allowed himself to be fed and cared for in Burgholzli. Perhaps, under certain conditions, the whole persecutory delusion may originate in a bad conscience. Some patients, though, claim that others knew about their masturbation by looking at them, and then proceed to develop the idea that they are being stared at because of their onanism. The ambivalence of feelings is often revealed in the contradictory voices: there arc voices which console the patient, take his part; and there are others which complain about him, annoy and torture him. They may even divide themselves as to which of the two cars they appear to speak into: the "good" voices using the right car, and the "bad" ones using the left ear. According to Freud, the anxiety dreams are also wishes which are being thought of negatively only because of the obstacles opposing them. At the moment, at least, I cannot see why a negative affect could not directly produce its corresponding thoughts just as the positive affect does. When a patient, who is very jealous of his brother, fears in his dreams that his brother is going to die, one could just as well interpret this as a wish to which a negative element has been added. Thus, the previously mentioned woman believed not only in the insanity of her husband, but also in that of their son. An unmarried gravid woman was referred to us by the courts for observation and examination. She was in love with the father of her child and was always happy when she received any news of him, or when anyone mentioned him. But as the lover hesitated to visit her in the hospital and, above all, gave indications of being unfaithful to her, she began to cry and sob: she said the child was disappearing from her womb and finally insisted that it was dead. Here, very characteristically, we note the distinct equivalence of the delusional idea of death and the wish that the child should die. The identification of the husband with the child was also revealed in the case of a delirious woman who insisted that her husband had two wives and that she saw him trying to drown himself in such a fashion that it was exceedingly difficult for anyone to rescue him. I remember four other cases of psychotic mothers really wanting to kill the children of their detested husbands. One of the women who had poured gasoline over her baby and was caught in the process of sharpening a knife, gave as reason for the attempted murder: "It is not my child; I wanted to sacrifice the dear child to God. A husband wanted to marry another woman in order to make his present wife and her siblings happy; but he also thought that someone wanted to kill him, that his own children would have to be sacrificed so that his life would be spared because of their innocence. Mobius relates a story of a female stork throwing the almost fully hatched eggs from the nest and filling it with grass after she had been left by her mate. A patient, whose children had actually died of natural causes, expressed her hatred of her husband by the falsification of memory that she herself had murdered her children. In instances they are married but childless; generally they have a lover whom they cannot meet (whether they are married or not), but who is the father of their (imaginary) child. In some cases and, especially, at the onset of the illness, the patient is not conscious of the imaginary pregnancy. Now the thought occurred to her that she could get a divorce and marry her first sweetheart. Then the patient became pregnant (in her imagination only), had labor pains which had been displaced to the upper abdomen in a vague way by the time she came to see us. Finally, a friend suggested that she must have gallstones in which she now firmly believed in spite of 52. A certain lady of my acquaintance clearly regulates the degree of her tenderness toward her husband by the good or bad behavior of her children. She was unable to work, had consulted any number of physicians for these pains which showed every characteristic of the nervous type of pain. In one instance, the delusion of being pregnant was, perhaps, a product of simple fear. A girl was surprised one night by an unknown man who had managed to get into her room. In spite of many medical examinations, as well as the continuance of her menses, she still believed that she was pregnant. Such false conclusions from false premises are something altogether different from tracing the genesis of a delusion to physical disorders. Lomer gives us some figures as to the frequency of the occurrence of sexual ideas and sexual hallucinations, but I think he has under-estimated it by a good deal. Generally, it dominates the foreground of the picture; in many patients, we are able to find only the sexual complexes. Struggle as we will against it, the more experience we obtain, the more "sexual" we become in our interpretations. Concerning the objections which are often made to such interpretations, I must emphasize that in our method of questioning, we have been more than careful not to suggest sexual matters to our patients. Nevertheless, in some men, less commonly in women, we can observe other important complexes which are not related to sexuality any more than other ideas which also have their associations and connections to this vast ideational and emotional complex which we call sexual. In some men, the sexual complex has been pushed into the background by other complexes. The most frequent objection to the sexual interpretation of hysteriform phenomena is that not everyone can be so versed in such matters and develop the kind of feeling-tones which the theory postulates. But schizophrenia, which must have an organic basis, cannot be understood in such exclusive terms. How often do we hear from astonished parents: "Where could my daughter have heard all that Who has not heard of sexual matters, of the really significant problems of procreation The answer is: no one; everyone has heard very much about such things throughout his whole life. I will not mention the newspapers and literature; or servants; or what everyone hears on the streets; or, for that matter, the sparrows, pidgeons and dogs in the city, and domestic animals in the country. But history and, above all, religion, as it is so assiduously crammed into our children, teems with things which can only be grasped if one has some understanding of the most intimate facts of sexuality. And Protestant children are even given the Bible which speaks of such matters as candidly as Freud. And if all the nicely brought-up children did not have an adequate knowledge of sexual matters, it would soon enough be clear to them that they did not understand many things and that they would have to ask questions. However, children know what they must not ask about, or what they can only ask of their servants and comrades, proving how much they already know. We saw the same process in the patient who gave approximate answers; he responded to the question: "How much is three plus two The children also know quite early-long before starting to school-what, on the whole, they must not do for sexual reasons. A nineteen-year-old girl of a highly educated and extremely religious family became catatonic. In this instance, whatever was at all humanly possible to do had been done to keep her "pure. One can be fairly cercain that she never read anything that had not been approved by her parents. From the beginning of her school years which had been brief, her education had been completely in the hands of her mother. Another girl, who had also been protected as much as possible, refused to eat eggs because she feared to destroy the "little ovaries"; while eating, she bore children from out of her mouth. Now, I do not want to assert that all women, who insist that prior to marriage they knew nothing of these things, are liars and hypocrites. On the contrary, I am well aware of the process by which these things are isolated and blocked off; and I trust no girl in whom this blocking does not become complete when someone asks her about sexual matters, the very knowledge of which is believed to constitute a degradation of her person. One can call this type of not-knowing a partial emotional stupor and compare the phenomenon with the generalized stupor which, for instance, army recruits show: when they are asked questions in a certain way, they do not seem to know even the simplest things. In the schizophrenic, sexuality expresses itself, first of all in the sexual character of most deliria which are particularly prominent at the onset of the illness. Thus, we have a girl who became ill soon after she had found her ideal man in a certain policeman. She does not present us with a well thought through performance: the execution of her ideas appears rather artificial and caricatured; the temporal sequence is not too well maintained; she often goes back on some of her notions, repeats requests with which her lover already complied.
Benommenheit as such has the tendency to linger diet while having gastritis buy cheap gasex 100caps, and can even persist for decades in the way we have described it above gastritis icd 9 order gasex 100 caps line, or in more attenuated forms gastritis diet школьные gasex 100 caps generic. The underlying cause of this condition may be a uniform impairment of all the psychic processes gastritis diet нщгегиу buy cheap gasex 100caps line. In other instances gastritis diet 1000 gasex 100 caps otc, particularly in chronic cases gastritis diet что purchase gasex 100 caps without prescription, it is difficult to differentiate this condition from severe, long persisting cases of perplexity. It is possible, however, that there are also other disturbances which lead to the same picture. Confusion, Incoherence Most disturbances of association, if sufficiently pronounced, lead to confusion. Thus we observed a catatonic woman painter who was perfectly capable of executing many difficult tasks, but once she was simply incapable of drawing a chair in perspective. The converse is indeed more frequent; that is, it is the common, ordinary, and simple. They are quite restless and constantly busy doing something, but their activities lack purpose and are not carried through to the end, even such simple actions as leaving a room. We see merely fragments of their behavior, as we do of their thinking, even though certain emotionally charged ideas, such as fear of misfortune or the joy of some dreamed happiness may to some extent become intelligible in terms of their total behavior. Physical symptoms, such as a coated tongue or a coarse tremor, are often present in these cases. One such patient felt much better the day after being examined and seemed better able to manipulate her fund of information. She knew she had been in a room with a number of gentlemen; that there had been a sofa in the room; that one of the men sat on the same sofa with her. She could later identify who it had been and partly describe the doctors who were present at the time, but she was entirely unaware of the fact that one of those doctors was her own ward surgeon. This sort of fragmentation differs strikingly from the usual catatonic excitement in which, even during the wildest outbreaks, the patient is able within a few minutes to identify the names of a whole room of patients, attendants, doctors, etc. All forms of confusional states may combine with melancholic, manic, and particularly catatonic symptoms, but they need not do so. Fits of Anerer We also have to mention the fits of anger, cursing and vilification which are released usually by some external event or experience. At that moment, it is absolutely useless to attempt to correct any misunderstandings. The picture is frequently complicated by the emergence of hallucinations and delusions of which there may have been no indications during the quiet periods. These episodes may last anywhere from a few minutes to several weeks and show characteristic patterns for each individual patient. The patients celebrate special days on which something happened that had some connection with their complexes. On these particular days they become agitated, irritable, hallucinating, stuporous, etc. The patients themselves are ignorant of the reasons for their moodiness before one has analyzed the situation with them. Days on which the patient lost or won a husband or sweetheart, the marriage anniversary of a sister, or even days on which the patient may have celebrated certain sinful "orgies" in the past can give occasion for these outbursts of excitement. These episodes may disappear with the passing of the special day or persist for longer periods once they have been provoked. Stupor Acute stupors occupy a very prominent and important place in the descriptions of mental disturbances of many a psychiatric authority. A summary of the anomalies which may appear as stuporous manifestations has already been given earlier in the volume. Deliria How many of the hallucinatory conditions of schizophrenia should be designated by the term delirium is purely an arbitrary matter in view of the fact that it is not a clearly defined term. However, it should be remembered in this connection that states resembling the fever deliria also occur in the terminal stages of fatal catatonic states. Fugue States Intercurrent episodes of `agitation and excitement can also assume the form of fugues. Some patients may have been quite dependable in many respects, led a life devoid of desires and interests, yet suddenly they may run off, often getting quite far away. It may be no more than a sudden feeling of discontent appearing with or without occasion. From this situation it is only a small step to the hallucinatory excitement in which the patients suddenly receive the command to clear out of the hospital. Some may give the impression of being normal, although in the hospital they may have been rather asocial or bizarre. The subsequent explanations and memories are, of course, variable: they differ for each patient in accordance with the various causal factors involved. As far as their drinking is concerned, they do have a certain degree of insight into their difficulties. If they are not too severely ill, they will even make fine resolutions not to drink anymore. But from time to time, they are subject to tense, anxious moods which drive them to obtain alcohol, by any and all means, until after a few days of heavy drinking, they are found lying somewhere completely exhausted. Nonetheless, we do have the practical need of characterizing the various clinical pictures that present themselves to us in this disease by terms corresponding, at least, to rather broad and crude subdivisions. We prefer to adhere to the already quite current labels used by Kraepclin, in view of the fact that nothing better has as yet been established to take their place. The symptom combinations are endless, but since many syndromes repeat themselves so frequently and in so similar a manner, one can select a few of these forms as examples. However, a more definite symptoms, in the sense that from the presence of one absence or presence of others, is not as yet possible 22 The Paranoid Group3 the majority of cases, which were called "paranoia" by the older authorities, comprise the first part of this group. The patients do not feel as they used to anymore; at times, everything seems different than it was before. Then come "suspicions," notions that they are destined or dedicated to this or that. Someone "calls out" after him that he has done nasty things with small children, that he masturbates, that he steals. Always more and more people give him to understand, by all kinds of signs and allusions, etc. The patient changes his dwellings, his jobs, but everywhere there is whispering about him. There is a conspiracy; they take a great deal of trouble to persecute and hound him. One day he hears how they are talking about him; then they actually speak to him, call him nasty names, curse, reproach, scorn him. He clouts somebody on the ear or shoots, or creates a disturbance, especially at night. He does not dare to leave his quarters and lives there in peculiar disorder, filth, and hunger. After some time, he becomes more sociable; he begins to do a certain amount of work. Ultimately he can be released, quiet, but without any essential improvement in his delusional ideas. He again begins to change jobs, or he is dismissed from his work because he cannot get along, makes too many mistakes, 3. It is impossible to keep using the cumbersome expression "paranoid form of schizophrenia. For a long time, he continues to be very unpleasant and difficult; he curses, shouts, is aggressive. He may wander about the hospital; or under favorable circumstances, he may even maintain himself outside the hospital by working, but generally he lives from day to dav, indifferent and idle. Things do not alwavs follow this pattern; generally the course is far more irregular. The delusions may appear suddenly like a bolt of lightning in a clear sky-fixed and complete while the patient is still fully competent at his work. They may disturb and excite him for several days only to fade away and reappear again later. Often the real paranoid state begins very acutely after a more or less lengthy period of marked "prodromes" which in themselves need not have any paranoid character at all. In the persecuted, there is often a period of hallucinatory excitement lasting several hours or even several days, frequently combined with marked confusion and disorientation. Such revelations are found in the case histories of most delusional schizophrenics. The hallucinatory confusional states are about as frequent as the melancholic depressions. Thus a patient had assumed a certain position against a wall with outspread legs which he maintained for several years, verbigerated, and was negativistic (more or less independently of his delusions). She carried her complaints to the courts, always of the opinion that she had and could prove all her allegations. She was judged to be mentally ill by a board of experts; she filed a complaint against the expert testimony, etc. From time to time, she managed to spend a year outside the hospital although never without difficulty. Such patients refer many a thing to themselves which even a normal person might regard as referring to himself, but we would not pay much attention to it. They do manage to get along in occupations which do not require contact with other people. Conversely, we see patients who have no real delusional ideas; there may be only hallucinations which in many cases are almost completely limited to the auditory sphere. At first, the patients react only by an altered behavior; and the persons of their environment are quite in the dark, often for years, about the real inner processes of the patient.
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The researchers then measured radiation patterns in the laboratory using both individual feathers and arrays of feathers spaced varying distances apart gastritis diet mayo generic gasex 100caps visa, and proved that bird feathers make fine receiving aerials for microwaves gastritis diet of augsburg order gasex 100 caps. In the 1990s and early 2000s gastritis upper back pain cheap gasex 100caps otc, when cell phone towers proliferated gastritis symptoms bupa cheap gasex 100caps mastercard, raising the ambient levels of microwave radiation tens to hundreds of times higher everywhere in the world diet while having gastritis buy gasex 100 caps without prescription, when white storks had trouble reproducing near antennas gastritis diet natural discount gasex 100caps visa, and when house sparrows made it onto the endangered species list in the United Kingdom, membership in pigeon-racing clubs plummeted and pigeon fanciers were forced to pay renewed attention to a problem they had laid aside in the 1950s. The secretary of the New Ross and District Pigeon Club in Ireland, Jim Power, blamed the new problem of lost birds, which had begun in about 1995, on "satellite television and the mobile telecommunications network. And sometimes just standing out in the rain," read the first paragraph of an article in the Washington Post. Out of 1,800 birds competing in a race from New Market, Virginia to Allentown, Pennsylvania, about 1,500 vanished. In a race from western Pennsylvania to suburban Philadelphia, 700 out of 900 pigeons failed to return. In a 350-mile race from Pittsburgh to Brooklyn, 1,000 out of 1,200 birds never showed up. Many members of the British Royal Pigeon Racing Association changed the route their birds flew so as to avoid cell towers and lose fewer pigeons. And as old-time pigeon racers gradually left the sport in discouragement, they were replaced by young enthusiasts who do not remember what it was like when almost all released pigeons would fly directly back to their roosts. The kinds of extraordinary losses Larry Lucero of New Mexico complained about in 1997-an 80 percent loss of birds in eight weeks of racing-are no longer considered unusual. Sankaralingam, the president of the Chennai Homer Pigeons Association in India, reminisces. But the devices will track birds by satellites and cell phone towers-the very things that are now responsible for far more pigeon losses than solar flares. Worse, the devices, being radio transmitters themselves, will expose the birds at point blank range to far more radiation than distant cell towers. Microchipping pigeons to keep track of them is not yet standard practice in this sport. These are passive devices containing no batteries and rely on external sources of energy to activate them. But sudden deaths of exotic birds immediately after being microchipped are not unusual. Attaching a radio tracking device to a wild animal is like giving the animal a cell phone to wear. Satellite tracking systems, such as are used to track dolphins and whales, require the animal to wear a much stronger transmitter, radiating from 250 milliwatts up to 2 watts of power-equivalent to giving the animal a satellite phone to wear. These are also used to track turtles, sharks, polar bears, musk oxen, camels, wolves, elephants, and other animals that roam or swim very long distances. They are also used on long-migrating or elusive birds, such as albatrosses, bald eagles, penguins, and swans. Even butterflies, and fish in lakes and rivers are being outfitted with transmitters. If a creature exists today that is large enough to fashion antennas for, you may be assured that resourceful wildlife biologists have devised ways to affix them onto members of its species, be it by means of collars, harnesses, or surgical implants. In one study of moose, calves with plain ear tags and calves without any ear tags had equal mortality rates-about 10 percent-while 68 percent of calves with ear tags that contained transmitters died. This had the researchers scratching their heads because they could find no difference between the plain tags and the ones that killed the calves except the presence of radio waves. The researchers concluded that likely none of the radio tagged female voles gave birth to any female offspring. In 1998, the first Siberian snow tiger ever to go through her pregnancy and give birth while wearing a radio collar delivered a litter of four, of which two died from genetic abnor- malities. But of those studies that asked the question, the majority found one or more detrimental effects of these devices on their bearers. Even in captivity, when the migratory season is upon them, songbirds will face the direction in which they have an urge to fly. Therefore, scientists at the University of Oldenburg in Germany were shocked to find, beginning in 2004, that the migratory songbirds they had been studying were no longer able to orient themselves toward the north in spring and toward the southwest in autumn. Suspecting that electromagnetic pollution might be responsible, they surrounded the aviaries in which they kept European robins with grounded aluminum sheeting beginning in the winter of 2006-2007. Only when the aluminum sheeting was grounded did the birds orient normally in springtime. In a rural area outside Oldenburg, the robins were still able to orient themselves without the aluminum screening. But the scientists issued a warning: "If anthropogenic electromagnetic fields prevent migratory songbirds from using their magnetic compass, their chances of surviving the migratory journey might be significantly reduced, in particular during periods of overcast weather when sun and star compass information is unavailable. Like the debris of recently wrecked craft, this catastrophe should provide the ship of humanity with urgent cause to shift direction. Their deformed legs, extra legs, missing eyes, misplaced eyes, and other genetic mistakes were frightening school children out on field trips. The boreal toad, which used to be so abundant near Boulder, Colorado that drivers would squish large numbers on mountain roads, had dwindled to about five percent of its former population. In the Monteverde Cloud Forest Preserve of Costa Rica, the famous and highly protected golden toad, named for its brightly colored skin, had gone extinct. The gastric-brooding frog of Australia, I read, named for its habit of incubating its young in its stomach, "broods no longer. I was only speculating, at that time, that the discovery of grossly deformed frogs in the midwest was related to the increasingly frequent reports from farmers in the midwest of cows and horses born with webbed necks and legs on backwards after cell towers were built on or next to their farms. During a two-month period he took care of two almost identical tanks of tadpoles of the common frog that he set out on the fifth floor terrace of an apartment in Valladolid. One hundred forty meters (450 feet) away, on the roof of an eight-story building, stood four cellular phone base stations, which were irradiating the neighborhood. The only difference between the two tanks of tadpoles was that a layer of thin fabric was draped over one. The fabric, woven with metallic fibers, admitted air and light but kept out radio waves. The results were a shocking confirmation of what was occurring out in the rest of the world: in a period of two months, the mortality rate was 90 percent in the exposed tank, and only 4 percent in the shielded tank. Almost all of the exposed tadpoles-exposed only to what the residents of the apartment building were also exposed to-swam in an uncoordinated fashion, showed little interest in food, and died after six weeks. Balmori titled his 2010 article, "Mobile Phone Mast Effects on Common Frog (Rana temporaria) Tadpoles: the City Turned Into a Laboratory. They exposed developing frog embryos and tadpoles to an ordinary personal computer. The resulting frogs had severe malformations that included anencephaly (absence of a brain), absence of a heart, absence of limbs, tail necrosis, and other deformities that were "incompatible with survival. In fact, as Alexander Chan discovered in 2004, it is so easy to demonstrate the effects of computers and cell phones on diminutive creatures that even a sophomore in high school can do it for a science fair project. Then fifteen years old and a student at Benjamin Cardozo High School in Queens, New York, Chan exposed fruit fly larvae daily to a loudspeaker, a computer monitor, and a cell phone and observed their development. Like Chan-and unlike most other scientists doing research on electromagnetic radiation-he and his colleagues in the Department of Cell Biology and Biophysics decided to expose their flies not to specialized equipment, but to an ordinary cell phone in use. Exposing adult flies to the antenna of a working cell phone for just six minutes a day for five consecutive days reduced the number of eggs they laid by 50 to 60 percent. Even flies that were exposed for only one minute a day for five days produced 36 percent fewer offspring than their unexposed cousins. Regardless of whether just male flies, just female flies, or both were exposed, the number of offspring was greatly reduced. Their experiments cried out for an explanation, because such rapid sterilization was an effect scientists were used to seeing from X-rays, not from an ordinary cell phone. Using this technique they proved that the brief exposure to a cell phone was causing the death and degeneration of 50 to 60 percent of both eggs and their supporting cells at all stages of development. In other words, the greatest damage is not always done by the greatest levels of radiation. Exposure time varied from 6 minutes, just once, up to thirty minutes a day for nine days. Every experiment, regardless of exposure time, produced cell death in the developing eggs and at least a ten percent reduction in the number of offspring. She brought thousands of ants into her laboratory at the Free University of Brussels, placed an older model flip phone under their colonies where they could neither see nor smell it, and simply watched them walk. The little creatures darted back and forth with increased vigor, as if trying to escape an enemy they could not see. The rate at which they changed directions-their angular speed- increased by 80 percent. Immediately all the ants left their nest, taking their eggs, larvae, and nymphs with them. After the experimentation, when the mobile phone has been removed, the ants returned to their initial nest, transporting back their brood into the nest. But "after a few seconds of exposure, the ants clearly presented signs of bad health and, consequently, a disturbed behavior. For this reason the biological changes due to microwave radiation may be far more dangerous as they may not be restricted only to changes in reproductive capacity. Beekeepers the world over are still poisoning their bees against parasites that are not killing them, instead of paying attention to the influence that is. He observed the strange behavior after telecommunications antennas appeared in a field near his hives. In the winter, despite snow and below zero temperatures, the bees would fly out and freeze to death next to the hive. Colonies that exhibited this behavior collapsed, even though they were strong, healthy colonies with active queens before the winter. They were provided with adequate additional food and the fall pollen supply had been more than sufficient. The majority of Bienenvater readers who filled out his form corroborated what he had written: their bees had become suddenly aggressive when the antennas appeared, and had begun to swarm; their healthy colonies had vanished for no other reason. By 1906, the island, then host to the greatest density of radio transmissions in the world, was almost empty of bees. Thousands, unable to fly, were found crawling and dying on the ground outside their hives. During the next few decades "Isle of Wight disease" was reported throughout Great Britain and in Italy, France, Switzerland, Germany, Brazil, Australia, Canada, South Africa, and the United States. However, this theory was soon disproven by John Anderson and John Rennie in Scotland; swarms of bees that were "crawling" with Isle of Wight disease were free of Nosema, while healthy stocks were found teeming with the parasite. His article in the Transactions of the Royal Society of Edinburgh had such wide influence that the tracheal mite is today regarded as one of the two major parasitic infections of bees that are responsible for colony collapse disorder. It supposedly kills bees by sucking their blood and clogging their breathing tubes. In fact, this is so widely accepted that it is standard practice for commercial beekeepers to treat all their bees with miticides to kill both tracheal mites and a second kind of mite, the Varroa mite. However, in the late 1950s the tracheal mite theory was disproven, too, by the eminent British bee pathologist, Leslie Bailey. Not only did he show that mite-infested bees did not die at greater rates than non-infested bees, but he deliberately infected healthy bees with the parasite and proved that it did not cause disease. The only effect of infestations, wrote Bailey in 1991, is to "shorten very slightly the life of bees, but usually causing no obvious sickness in spite of the abnormal appearance of infested tracheae. The problem of Isle of Wight disease smoldered for decades, not often making the news. But the number of managed honey bee colonies in the United States has been quietly declining since the 1940s. Beekeepers would open their hives in autumn or winter to find ample supplies of stored pollen and honey but no bees. Where some dead or living bees remained, they were not malnourished and had no mites or other parasites, bacteria, viruses, or poisons. Attempts to transmit the condition by introducing bees from "diseased" hives into healthy ones failed. When a survey was conducted by the United States Department of Agriculture in 1975, the problem turned up in 33 states, with beekeepers often volunteering that it had been prevalent in their colonies for ten or fifteen years, and that it was getting worse with each passing year. The smoldering, half-forgotten problem about disappearing bees was erupting in flames. During the previous winter, beekeepers had lost 45 percent of their hives in Kentucky, 60 percent in Michigan, 80 percent in Maine. Officially there was no panic: colony losses were "only" 20 percent in Sweden and 29 percent in Germany. When he opened up his hives that winter, 50 out of 70 colonies were devoid of life. Fellow beekeepers in Austria, Germany, Belgium, Denmark, and Finland were reporting similar huge losses, although many could find no Varroa mites, and no sign of foulbrood, sacbrood, chalkbrood, Nosema, or other bee diseases. Finally, during the winter of 2006-2007, what was once known as Isle of Wight disease became a worldwide panzootic, frightening farmers and the public everywhere, and was given yet another name: colony collapse disorder. And the culprit, according to a study conducted by a joint team of American and Belgian researchers, does not seem to be tracheal mites, Varroa mites, Nosema, or any other particular infectious disease vector. Tracheal mites were actually more than three times as prevalent in the healthy colonies as in the decimated colonies. Even the supposedly devastating Varroa mite was not more prevalent in collapsed or collapsing colonies. The picture of this disease that has beekeepers so thoroughly baffled resembles nothing so much as the scene of an apparent mass murder where there is not even any real evidence of a crime. A million colonies a year in the United States disappear overnight without leaving a trace. The queen bee and mother of the hive is simply abandoned by the workers and left to starve and die. What has scientists even more stumped is that the dead colonies tend to be left alone even by the parasites that normally infest dead honey bee colonies.
If therapeutic drug monitoring is not possible or kidney dysfunction is not present severe gastritis diet plan discount gasex 100caps amex, frequent complete blood counts with differential gastritis diet ayurveda buy gasex 100caps overnight delivery. Patients treated with flucytosine also should be monitored for hepatotoxicity and gastrointestinal toxicities gastritis diet закон purchase 100caps gasex otc. Common side effects of higher dose fluconazole therapy can include dry skin (17% of patients) and alopecia (16% of patients) gastritis symptoms burning cheap gasex 100caps mastercard. However gastritis symptoms shortness of breath discount gasex 100caps overnight delivery, if treatment failure or relapse occurs gastritis diet using frozen cheap gasex 100 caps mastercard, Cryptococcus isolates should undergo antifungal susceptibility testing. Patients who do not respond to induction with fluconazole monotherapy should be switched to amphotericin B, with or without flucytosine. Those initially treated with an amphotericin B formulation should remain on this agent until clinical response occurs. The newer triazoles-posaconazole, voriconazole, and isavuconazole-have activity against Cryptococcus spp. Most clinical failures are not due to antifungal drug resistance, but rather result from inadequate induction therapy, nonadherence, drug interactions that decrease the serum concentrations of fluconazole. Failure to administer secondary prophylaxis for an entire year is the most common reason for subsequent relapse of cryptococcal disease. Special Considerations During Pregnancy the diagnosis of cryptococcal infections in individuals who are pregnant is similar to that in individuals who are not pregnant. Neonates born to women on chronic amphotericin B at delivery should be evaluated for renal dysfunction and hypokalemia. In animal studies, flucytosine is teratogenic; experience in humans is limited to case reports and small series. Congenital malformations similar to those observed in animals exposed to the drug-including craniofacial and limb abnormalities-have been reported in infants born to mothers who received fluconazole at doses of 400 mg per day through or beyond the first trimester of pregnancy. A nationwide cohort study in Denmark also found that exposure to oral fluconazole during pregnancy was associated with an increased risk of spontaneous abortion compared with unexposed pregnancies or those with topical azole exposure only. Use of fluconazole in the first trimester should be considered only if the benefits clearly outweigh the risks. For pregnant women, amphotericin B should be continued throughout the first trimester. After induction therapy, weekly amphotericin B has been used for consolidation therapy for women who are pregnant throughout the first trimester. With life-threatening cryptococcal disease, fetal demise is common even without fluconazole exposure. Voriconazole (at doses lower than recommended human doses), posaconazole, and isavuconazole are teratogenic and embryotoxic in animals; no adequately controlled studies have assessed their teratogenicity and embryotoxicity in humans. Alternatively, if flucytosine levels cannot be measured, at least twice weekly complete blood counts may be used to monitor for cytopenias. All the triazole antifungals have the potential to interact with certain antiretroviral agents and other anti-infective agents. Table 5 lists these interactions and recommends dosage adjustments where feasible. Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. Multisite validation of cryptococcal antigen lateral flow assay and quantification by laser thermal contrast. Symptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysis. Inadequacy of high-dose fluconazole monotherapy among cerebrospinal fluid cryptococcal antigen (CrAg)-positive human immunodeficiency virus-infected persons in an Ethiopian CrAg screening program. Cryptococcal Meningitis Diagnostics and Screening in the Era of Point-of-Care Laboratory Testing. Multicenter Evaluation of BioFire FilmArray Meningitis/ Encephalitis Panel for Detection of Bacteria, Viruses, and Yeast in Cerebrospinal Fluid Specimens. Pitfalls Associated With the Use of Molecular Diagnostic Panels in the Diagnosis of Cryptococcal Meningitis. A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. Short-course High-dose Liposomal Amphotericin B for Human Immunodeficiency Virus-associated Cryptococcal Meningitis: A Phase 2 Randomized Controlled Trial. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. Successful use of amphotericin B lipid complex in the treatment of cryptococcosis. Dromer F, Bernede-Bauduin C, Guillemot D, Lortholary O, French Cryptococcosis Study G. One-year Mortality Outcomes From the Advancing Cryptococcal Meningitis Treatment for Africa Trial of Cryptococcal Meningitis Treatment in Malawi. Point-of-care diagnosis and prognostication of cryptococcal meningitis with the cryptococcal antigen lateral flow assay on cerebrospinal fluid. Cerebrospinal fluid culture positivity and clinical outcomes after amphotericin-based induction therapy for cryptococcal meningitis. Voriconazole treatment for less-common, emerging, or refractory fungal infections. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome. Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania. The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Management of elevated intracranial pressure in patients with Cryptococcal meningitis. A randomized, double-blind, placebo-controlled trial of acetazolamide for the treatment of elevated intracranial pressure in cryptococcal meningitis. Standardized electrolyte supplementation and fluid management improves survival during amphotericin therapy for cryptococcal meningitis in resource-limited settings. Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome. Cryptococcal lymphadenitis and immune reconstitution inflammatory syndrome: current considerations. Trends in antifungal drug susceptibility of Cryptococcus neoformans isolates in the United States: 1992 to 1994 and 1996 to 1998. Minimum Inhibitory Concentration Distribution of Fluconazole against Cryptococcus Species and the Fluconazole Exposure Prediction Model. Cryptococcosis in Australasia and the treatment of cryptococcal and other fungal infections with liposomal amphotericin B. The safety of oral fluconazole during the first trimester of pregnancy: a systematic review and meta-analysis. Pregnancy outcome after in utero exposure to itraconazole: a prospective cohort study. Cryptosporidium can also infect other gastrointestinal and extraintestinal sites, especially in individuals whose immune systems are suppressed. Viable oocysts in feces can be transmitted directly through contact with humans or animals infected with Cryptosporidium, particularly those with diarrhea. Cryptosporidium oocysts can contaminate recreational water sources, such as swimming pools and lakes, and public water supplies and may persist despite standard chlorination. Person-to-person transmission of Cryptosporidium is common, especially among sexually active men who have sex with men. Clinical Manifestations Patients with cryptosporidiosis most commonly have acute or subacute onset of watery diarrhea, which may be accompanied by nausea, vomiting, and lower abdominal cramping. Fever is present in approximately one-third of patients, and malabsorption is common. Antigen-detection by enzyme-linked immunosorbent assay or immunochromatographic tests also is useful; depending on the specific test, sensitivities reportedly range from 66% to 100%. A single stool specimen is usually adequate to diagnosis cryptosporidiosis in individuals with profuse diarrheal illness, whereas repeat stool sampling is recommended for those with milder disease. Modes of transmission include direct contact with people, including diapered children, and animals infected with Cryptosporidium; swallowing contaminated water during recreational activities; drinking contaminated water; and eating contaminated food. Paying attention to hygiene and avoiding direct contact with stool are important when visiting farms or petting zoos or other premises where animals are housed or exhibited. Waterborne infection also can result from swallowing water during recreational activities. Outbreaks of cryptosporidiosis have been linked to drinking water from municipal water supplies. This includes avoiding directly working with people with diarrhea; with farm animals such as cattle and sheep; and with domestic pets that are very young or have diarrhea. If exposure is unavoidable, gloves should be worn, and good hand hygiene observed. Rifabutin and possibly clarithromycin taken for Mycobacterium avium complex prophylaxis have been found to protect against cryptosporidiosis. Rehydration and repletion of electrolyte losses by either the oral or intravenous route are important. Patients with biliary tract involvement may require endoscopic retrograde choledocoduodenoscopy for diagnosis. Nitazoxanide is approved by the Food and Drug Administration for treatment of cryptosporidiosis in children and adults. Paromomycin is a non-absorbable aminoglycoside indicated for the treatment of intestinal amebiasis but not specifically approved for cryptosporidiosis. Paromomycin in high doses is effective for the treatment of cryptosporidiosis in animal models. A meta-analysis of 11 published studies of paromomycin in humans reported a response rate of 67%; however, there were few cures, relapses were common, and long-term success rates were only 33%. The clinical response rather than results of stool tests should be used to guide the response to therapy. Nitazoxanide is not teratogenic in animals but no data on use in human pregnancy are available. Limited information is available about the teratogenic potential of paromomycin, but oral administration is associated with minimal systemic absorption, which may minimize potential risk. However, one study identified an increased risk of congenital malformations, and specifically hypospadias, among 683 women with exposure to loperamide early in pregnancy. A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium. The evolution of respiratory cryptosporidiosis: evidence for transmission by inhalation. Expectoration of cryptosporidium parasites in sputum of Human Immunodeficiency Virus-positive and -negative adults. Community laboratory testing for cryptosporidium: multicenter study retesting public health surveillance stool samples positive for cryptosporidium by rapid cartridge assay with direct fluorescent antibody testing. High early mortality in patients with chronic acquired immunodeficiency syndrome diarrhea initiating antiretroviral therapy in Haiti: a case-control study. Multicenter trial of octreotide in patients with refractory acquired immunodeficiency syndrome-associated diarrhea. Effect of nitazoxanide in diarrhea and enteritis caused by Cryptosporidium species. Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial. Nitazoxanide in the treatment of acquired immune deficiency syndrome-related cryptosporidiosis: results of the United States compassionate use program in 365 patients. Paromomycin: no more effective than placebo for treatment of cryptosporidiosis in patients with advanced human immunodeficiency virus infection. Effect of antiretroviral protease inhibitors alone, and in combination with paromomycin, on the excystation, invasion and in vitro development of Cryptosporidium parvum. Indinavir reduces Cryptosporidium parvum infection in both in vitro and in vivo models. Pulmonary cryptosporidiosis and immune reconstitution inflammatory syndrome: a case report and review. Immune reconstitution inflammatory syndrome following cryptosporidial cholangitis. On the basis of limited data, the maturation process is completed in approximately 1 to 2 days but might occur more rapidly in some settings. Clinical Manifestations the most common manifestation is watery, non-bloody diarrhea, which may be associated with abdominal pain, cramping, anorexia, nausea, vomiting, and low-grade fever. The diarrhea can be profuse and prolonged, particularly in immunocompromised patients, resulting in severe dehydration, electrolyte abnormalities such as hypokalemia, weight loss, and malabsorption. It is the only agent whose use is supported by substantial published data and clinical experience. Single-agent therapy with pyrimethamine has been used, with anecdotal success for treatment and prevention of isosporiasis. For patients with documented sulfa intolerance or in whom treatment fails, use of a potential alternative agent (typically pyrimethamine) should be considered. Chemoprophylaxis probably can be safely discontinued in patients without evidence of active I. Although pyrimethamine has been associated with birth defects in animals, limited human data have not suggested an increased risk of defects. Epidemiology of isosporiasis among persons with acquired immunodeficiency syndrome in Los Angeles County.
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