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Its action must then be checked by an antidote generic dilantin 100 mg free shipping, or when no antidote to it is known discount 100mg dilantin otc, another antipsoric medicine more accurately answering its symptoms must be given in its place; in this these false symptoms may continue a few more days buy cheap dilantin 100mg on line, or they may return, but they will soon come to a final end and be replaced by a better help. Least of all, need we to be concerned when the usual customary symptoms are aggravated and show most prominently on the first days, and again on some of the following days, but gradually less and less. This so-called homoeopathic aggravation is a sign of an incipient cure (of the symptoms thus aggravated at present), which may be expected with certainty. This will be decided in the first sixteen, eighteen or twenty days of the action of the medicine which has been given in too large a dose, and it must then be checked, either by prescribing its antidote, or, if this is not as yet known, by giving another antipsoric medicine fitting as well as possible, and indeed in a very moderate dose, and if this does not suffice to extinguish this injurious medicinal disease, another still should be given as homoeopathically suitable as possible. The physician can, indeed, make no worse mistake than first, to consider as too small the doses which I (forced by experience) have reduced after manifold trials and which are indicated with every antipsoric remedy and secondly, the wrong choice of a remedy, and thirdly, the hastiness which does not allow each dose to act its full time. Still ignorant of the strength of its medicinal power, I gave sepia in too large a dose. This trouble was still more manifest when I gave lycopodium and silicea, potentized to the one-billionth degree, giving four to six pellets, though only as large as poppy seeds. It can hardly be given too small, if only everything ill the diet and the remaining mode of life of the patient which would obstruct or counteract the action of the medicine is avoided. The medicine will still produce all the good effects which can at all be expected from a medicine, if only the antipsoric was homoeopathically, correctly, selected according to the carefully investigated symptoms of the disease, and if the patient does not disturb its effects by his violation of the rules. If ever it should happen that the choice has not been correctly made, the great advantage remains, that the incorrectly selected medicine in this smallest dose may in the manner indicated above be counteracted more easily, whereupon the cure may be continued without delay with a more suitable antipsoric. As to the second chief error in the cure of chronic diseases (the unhomoeopathic choice of the medicine) the homoeopathic beginner (many, I am sorry to say, remain such beginners their life long) sins chiefly through inexactness, lack of earnestness and through love of ease. With the great conscientiousness which should be shown in the restoration of a human life endangered by sickness more than in anything else, the Homoeopath, if he would act in a manner worthy of his calling, should investigate first the whole state of the patient, the internal cause as far as it is remembered, and the cause of the continuance of the ailments his mode of life, his quality as to mind, soul and body, together with all his symptoms (see directions in Organon), and then he should carefully find out in the work on Chronic Diseases as well as in the work on Materia Medica Pura a remedy covering in similarity, as far as possible, all the moments, or at least the most striking and peculiar ones, with its own peculiar symptoms; and for this purpose he should not be satisfied with any of the existing repertories, - a carelessness only too frequent; for these books are only intended to give light hints as to one or another remedy that might be selected, but they can never dispense him from making the research at the first fountain heads. He who does not take the trouble of treading this path in all critical and complicated diseases, and, indeed, with all patience and intelligence, but contents himself with the vague hints of the repertories in the choice of a remedy, and who thus quickly dispatches one patient after the other, does not deserve the honorable title of a genuine Homoeopath, but is rather to be called a bungler, who on that account has continually to change his remedies until the patient loses patience; and as his ailments have of course only been aggravated he must leave this aggravator of diseases, whereby the art itself suffers discredit instead of the unworthy disciple of art. They should only serve as a confirmation of a choice made according to the pure actions of the medicines; but never to determine the selection of a remedy which can cure only when used according to the exact similitude of its homoeopathic symptoms. There are, we are sorry to say, even authors who advise following this empiric pathway of error! The third leading mistake which the homoeopathic physician cannot too carefully nor too steadfastly avoid while treating chronic diseases, is in hastily and thoughtlessly - when a properly moderate dose of a well selected antipsoric medicine has been serviceable for several days, - giving some other medicine in the mistaken supposition that so small a dose could not possibly operate and be of use more than eight or ten days. This notion is sought to be supported by the statement that on some day or other, while allowed to continue its action, the morbid symptoms which were to be eradicated, had shown themselves somewhat from time to time. But if once a medicine, because it was selected in a correct homoeopathic manner, is acting well and usefully, which is seen by the eighth or tenth day, then an hour or even half a day may come when a moderate homoeopathic aggravation again takes place. The good results will not fail to appear but may, in very tedious ailments, not show themselves in their best light before the twenty-fourth or thirtieth day. The dose will then probably have exhausted its favorable action about the fortieth or fiftieth day, and before that time it would be injudicious, and an obstruction to the progress of the cure, to give any other medicine. Let it not be thought, however, that we should scarcely wait for the time assigned as the probable duration of action to elapse, before giving another antipsoric medicine: that we should hasten to change to a new medicine in order to finish the cure more quickly. Experience contradicts this notion entirely, and teaches on the contrary, that a cure cannot be accomplished more quickly and surely than by allowing the suitable antipsoric to continue its actions so long as the improvement continues, even if this should be several, yea, many* days beyond the assigned, supposed time of its duration, so as to delay as long as practicable the giving of a new medicine. Only when the old symptoms, which had been eradicated or very much diminished by the last and the preceding medicines commence to rise again for a few days, or to be again perceptibly aggravated, then the time has most surely come when a dose of the medicine most homoeopathically fitting should be given. Experience and careful observation alone can decide; and it always has decided in my manifold, exact observations, so as to leave no doubt remaining. Now if we consider the great changes which must be effected by the medicine in the many, variously composite and incredibly delicate parts of our living organism, before a chronic miasm so deeply inrooted and, as it were, parasitically interwoven with the economy of our life as psora is, can be eradicated and health be thus restored: then it may well be seen how natural it is, that during the long- continued action of a dose of antipsoric medicine selected homoeopathically, assaults may be made by it at various periods on the organism, as it were in undulating fluctuations during this long-continued disease. Experience shows that when for several days there has been an improvement, half hours or whole hours or several hours will again appear when the case seems to become worse; but these periods, so long as only the original ailments are renewed and no new, severe symptoms present themselves, only show a continuing improvement, being homoeopathic aggravations which do not hinder but advance the cure, as they are only renewed beneficent assaults on the disease, though they are wont to appear at times sixteen, twenty or twenty-four days after taking a dose of antipsoric medicine. But vice versa also those medicines which in the healthy body show a long period of action act only a short time and quickly in acute diseases which speedily run their course (e. The physician must, therefore, in chronic diseases, allow all antipsoric remedies to act thirty, forty or even fifty and more days by themselves, so long as they continue to improve the diseased state perceptibly to the acute observer, even though gradually; for so long the good effects continue with the indicated doses and these must not be disturbed and checked by any new remedy. These great, pure truths will be questioned yet for years even by most of the homoeopathic physicians, and will not, therefore, be practiced, on account of the theoretical reflection and the reigning thought: ÒIt requires quite an effort to believe that so little a thing, so prodigiously small a dose of medicine, could effect the least thing in the human body, especially in coping with such enormously great, tedious diseases; but that the physician must cease to reason, if he should believe that these prodigiously small doses can act not only two or three days, but even twenty, thirty and forty days and longer yet, and cause, even to the last day of their operation, important, beneficent effects otherwise unattainable. Experience alone declares it, and I believe more in experience than in my own intelligence. But who will arrogate to himself the power of weighing the invisible forces that have hitherto been concealed in the inner bosom of nature, when they are brought out of the crude state of apparently dead matter through a new, hitherto undiscovered agency, such as is potentizing by long continued trituration and succussion. But he who will not allow himself to be convinced of this and who will not, therefore, imitate what I now teach after many yearsÕ trial and experience (and what does the physician risk, if he imitates it exactly? It seemed to me my duty to publish the great truths to the world that needs them, untroubled as to whether people can compel themselves to follow them exactly or not. If it is not done with exactness, let no one boast to have imitated me, nor expect a good result. Do we refuse to imitate any operation until the wonderful forces of nature on which the result is based are clearly brought before our eyes and made comprehensible even to a child? Would it not be silly to refuse to strike sparks from the stone and flint, because we cannot comprehend how so much combined caloric can be in these bodies, or how this can be drawn out by rubbing or striking, so that the particles of steel which are rubbed off by the stroke of the hard stone are melted, and, as glowing little balls, cause the tinder to catch fire? And yet we strike fire with it, without understanding or comprehending this miracle of the inexhaustible caloric hidden in the cold steel, or the possibility of calling it out with a frictional stroke. Again, it would be just as silly as if we should refuse to learn to write, because we cannot comprehend how one man can communicate his thought to another through pen, ink, and paper - and yet we communicate our thoughts to a friend in a letter without either being able or desirous of comprehending this psychico-physical miracle! Why, then, should we hesitate to conquer and heal the bitterest foes of the life of our fellowman, the Chronic diseases, in the stated way, which, punctually followed, is the best possible method, because we do not see how these cures are effected? Another antipsoric remedy which may be ever so useful, but is prescribed too early and before the cessation of the action of the present remedy, or a new dose of the same remedy which is still usefully acting, can in no case replace the good effect which has been lost through the interruption of the complete action of the preceding remedy, which was acting usefully, and which can hardly be again replaced. It is a fundamental rule in the treatment of chronic diseases: To let the action of the remedy, selected in a mode homoeopathically appropriate to the case of disease which has been carefully investigated as to its symptoms, come to an undisturbed conclusion, so long as it visibly advances the care and the while improvement still perceptibly progresses. This method forbids any new prescription, any interruption by another medicine and forbids as well the immediate repetition of the same remedy. Nor can there be anything more desirable for the physician than to see the improvement of the patient proceed to its completion unhindered and perceptibly. There are not a few cases, where the practiced careful Homoeopath sees a single dose of his remedy, selected so as to be perfectly homoeopathic, even in a very severe chronic disease, continue uninterruptedly to diminish the ailment for several weeks, yea, months, up to recovery; a thing which could not have been expected better in any other way, and could not have been effected by treating with several doses or with several medicines. To make the possibility of this process in some way intelligible, we may assume, what is not very unlikely, that an antipsoric remedy selected most accurately according to homoeopathic principles, even in the smallest dose of a high or the highest potency can manifest so long- continued a curative force, and at last cure, probably, only by means of a certain infection with a very similar medicinal disease which overpowers the original disease, by the process of nature itself, according to which (Organon, ¤ 5, Fifth Edition,) two diseases which are different, indeed, in their kind but very similar in their manifestations and effects, as also in the ailments and symptoms caused by it, when they meet together in the organism, the stronger disease (which is always the one caused by the medicine, ¤33, ibid. In this case every new medicine and also a new dose of the same medicine, would interrupt the work of improvement and cause new ailments, an interference which often cannot be repaired for a long time. Yet when a sudden great and striking improvement of a tedious great ailment follows immediately on the first dose of a medicine, there justly arises much suspicion that the remedy has only acted palliatively, and therefore must never be given again, even after the intervention of several others remedies. Nevertheless there are cases which make an exception to the rule, but which not every beginner should risk finding out. We may declare it once, that the practice of late, which has even been recommended in public journals of giving the patient several doses of the same medicine to take with him, so that he may take them himself at certain intervals, without considering whether this repetition may affect him injuriously, seems to show a negligent empiricism, and to be unworthy of a homoeopathic physician, who should not allow a new dose of a medicine to be taken or given without convincing himself in every case beforehand as to its usefulness. This is rare in chronic diseases, but in acute diseases and in chronic diseases that rise into an acute state it is frequently the case. It is only then, as a practiced observer may recognize - when the peculiar symptoms of the disease to be treated, after fourteen, ten, seven, and even fewer days, visibly cease to diminish, so that the improvement manifestly has come to a stop, without any disturbance of the mind and without the appearance of any new troublesome symptoms, so that the former medicine would still be perfectly homoeopathically suitable, only then, if say, is it useful, and probably necessary to give a dose of the same medicine of a similarly small amount, but most safely in a different degree of dynamic potency. To adduce an example: a freshly arisen eruption of itch belongs to those diseases which might soonest permit the repetition of the dose (sulphur), and which does permit it the more frequently, the sooner after the infection the itch is received for treatment, as it then approaches the nature of an acute disorder, and demands its remedies in more frequent doses than when it has been standing on the skin for some time. But this repetition should be permitted only when the preceding dose has largely exhausted its action (after six, eight or ten days), and the dose should be just as small as the preceding one, and be given in a different potency. Nevertheless it is in such a case often serviceable, in answer to a slight change of symptoms, to interpose between the doses of pure sulphur, a small dose of Hepar sulphuris calcareum. This also should be given in various potencies, if several doses should be needed from time to time. Often also, according to circumstances, a dose of Nux voinica (x) or one of mercury (x)** may be used between. A dose of medicine may also have been suddenly counteracted and annihilated by a grave error in the regimen of the patient, when perhaps a dose of the former serviceable medicine might again be given with the modification mentioned above. Thereby the remedy seeing to take a deeper hold on the organism and hasten the restoration in patients who are vigorous and not too sensitive. Indeed it is hardly ever needed in chronic diseases, as we have a goodly supply of antipsoric remedies at our disposal, so that as soon as one well selected remedy has completed its action, and a change of symptoms, i.

Waterborne Diseases ©6/1/2018 52 (866) 557-1746 Protozoan Diseases Protozoan pathogens are larger than bacteria and viruses but still microscopic buy dilantin 100mg line. Some parasites enter the environment in a dormant form purchase 100 mg dilantin, with a protective cell wall buy dilantin 100 mg lowest price, called a “cyst. Effective filtration treatment is therefore critical to removing these organisms from water sources. It has also been referred to as “backpacker’s disease” and “beaver fever” because of the many cases reported among hikers and others who consume untreated surface water. Symptoms include chronic diarrhea, abdominal cramps, bloating, frequent loose and pale greasy stools, fatigue and weight loss. Waterborne outbreaks in the United States occur most often in communities receiving their drinking water from streams or rivers without adequate disinfection or a filtration system. The organism, Giardia lamblia, has been responsible for more community-wide outbreaks of disease in the U. Cryptosporidiosis Cryptosporidiosis is an example of a protozoan disease that is common worldwide, but was only recently recognized as causing human disease. Cryptosporidium organisms have been identified in human fecal specimens from more than 50 countries on six continents. The mode of transmission is fecal-oral, either by person-to-person or animal-to-person. All of these diseases, with the exception of hepatitis A, have one symptom in common: diarrhea. They also have the same mode of transmission, fecal-oral, whether through person-to-person or animal-to-person contact, and the same routes of transmission, being either foodborne or waterborne. Although most pathogens cause mild, self-limiting disease, on occasion, they can cause serious, even life threatening illness. By understanding the nature of waterborne diseases, the importance of properly constructed, operated and maintained public water systems becomes obvious. While water treatment cannot achieve sterile water (no microorganisms), the goal of treatment must clearly be to produce drinking water that is as pathogen-free as possible at all times. For those who operate water systems with inadequate source protection or treatment facilities, the potential risk of a waterborne disease outbreak is real. For those operating systems that currently provide adequate source protection and treatment, operating and maintaining the system at a high level on a continuing basis is critical to prevent disease. Waterborne Diseases ©6/1/2018 53 (866) 557-1746 Summary of Common Waterborne Diseases Name Causative organism Source of organism Disease Viral gastroenteritis Rotavirus mostly in young children; Human feces; Diarrhea or vomiting. Norwalk-like viruses Human feces; also, shellfish; lives in polluted waters; Diarrhea and vomiting. Human feces; Symptoms vary with type caused; gastroenteritis Typhoid Salmonella typhi (bacterium) Human feces, urine Inflamed intestine, enlarged spleen, high temperature— sometimes fatal. Cholera Vibrio cholerae (bacterium) Human feces; also, shellfish; lives in many coastal waters; Vomiting, severe diarrhea, rapid dehydration, mineral loss —high mortality. Hepatitis A virus Human feces; shellfish grown in polluted waters; Yellowed skin, enlarged liver, fever, vomiting, weight loss, abdominal pain — low mortality, lasts up to four months. Amebiasis Entamoeba histolytica Human feces; Mild diarrhea, dysentery, (protozoan) extra intestinal infection. Giardiasis Giardia lamblia (protozoan) Animal or human feces; Diarrhea, cramps, nausea, and general weakness — lasts one week to months. Cryptosporidiosis Cryptosporidium parvum (protozoan) Animal or human feces Diarrhea, stomach pain — lasts days to weeks. The Best Method to kill most of these Bugs Disinfection is usually synonymous with chlorination. That is because chlorine addition is by far the most common form of disinfection used today. Disinfection is the process of killing microorganisms in water that might cause disease (pathogens). Disinfection, however, should not be confused with sterilization, which is the destruction of all microorganisms. Cryptosporidium parvum and Giardia lamblia will require proper water treatment techniques. An illustrated guide to the species used as biological indicators in freshwater biology. Pollution related structural and functional changes in aquatic communities with emphasis on freshwater algae and protozoa. Soil protozoa: fundamental problems, ecological significance, adaptations in ciliates and testaceans, bioindicators, and guide to the literature. Respiratory energy losses related to cell weight and temperature in ciliated protozoa. Temperature responses and tolerances in ciliates from Antarctica, temperate and tropical habitats. The annual cycle of heterotrophic planktonic ciliates in the waters surrounding the Isles of Shoals, Gulf of Maine: an assessment of their trophic role. Field evaluation of predictions of environmental effects from multispecies microcosm toxicity test. Waterborne Diseases ©6/1/2018 55 (866) 557-1746 Waterborne Diseases ©6/1/2018 56 (866) 557-1746 Chapter 1 Review Example Question, fill-in-the blank with one correct answer. The German scientist __________________, a student of Jacob Henle, and the British surgeon Joseph Lister developed techniques for growing cultures of single organisms that allowed the assignment of specific bacteria to specific diseases. The first experimental transmission of a viral infection was accomplished in about 1880 by the German scientist __________________, when he demonstrated that extracts from infected tobacco leaves could transfer tobacco mosaic disease to a new plant, causing spots on the leaves. Because __________________ was unable to isolate a bacterium or fungus from the tobacco leaf extracts, he considered the idea that tobacco mosaic disease might be caused by a soluble agent, but he concluded incorrectly that a new type of bacteria was likely to be the cause. The Russian scientist __________________ extended Mayer’s observation and reported in 1892 that the tobacco mosaic agent was small enough to pass through a porcelain filter known to block the passage of bacteria. In 1917 the French-Canadian scientist __________________ discovered that viruses of bacteria, which he named bacteriophage, could make holes in a culture of bacteria. In 1935 the American biochemist __________________ crystallized tobacco mosaic virus to demonstrate that viruses had regular shapes, and in 1939 tobacco mosaic virus was first visualized using the electron microscope. Frosch (both trained by __________________) described foot-and-mouth disease virus as the first filterable agent of animals. In 1900, the American bacteriologist __________________ and colleagues recognized yellow fever virus as the first human filterable agent. For several decades viruses were referred to as filterable agents, and gradually the term virus (Latin for “__________________” or “poison”) was employed strictly for this new class of infectious agents. Through the 1940s and 1950s many critical discoveries were made about viruses through the study of __________________ because of the ease with which the bacteria they infect could be grown in the laboratory. Louis Pasteur along with __________________ developed the germ theory of disease which states that "a specific disease is caused by a specific type of microorganism. In 1876, __________________ established an experimental procedure to prove the germ theory of disease. Bacteria are prokaryotes (Kingdom Monera), which means that they have a large nucleus. Most bacteria lack or have very few internal membranes, which means that they don’t have some kinds of organelles (like mitochondria or chloroplasts). Most bacteria are benign (benign = good, friendly, kind) or beneficial, and only a few are “bad guys” or pathogens. All bacteria relatives can do photosynthesis—because they have chloroplasts, because chlorophyll and other needed chemicals are built into their cell membranes. These organisms are called Cyanobacteria (cyano = blue, dark blue) or bluegreen algae, although they’re not really algae (real algae are in Kingdom Protista). Like us, some kinds of bacteria need and do best in O , while others are poisoned/killed by it. All other life forms are Eukaryotes (you-carry-oats), creatures whose cells have nuclei. The mitochondria (mite-oh-con-dree-uh) that make energy for your body cells is one example of such an organelle. There are less than 200 hundred of species of bacteria, but all of them are basically one of five different shapes. Some bacterial cells exist as individuals while others cluster together to form pairs, chains, squares or other __________________. Bacterial cell walls are made mostly of a chemical called peptidoglycan (made of polypeptides bonded to modified sugars), but the amount and location of the peptidoglycan are different in the two possible types of cell walls, depending on the species of bacterium. All antibiotics, like penicillin, prohibit the formation of the chemical cross linkages needed to make peptidoglycan.

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Extraordinary points are those with regular names and regular locations purchase dilantin 100mg on-line, but are not among the above- mentioned 14 channels buy 100 mg dilantin visa. Ashi points have no specific names and definite locations order dilantin 100mg visa, and the tender spots and other sensitive spots are the places for needling and moxibustion. The clinical practice has gained solid evidence to prove the therapeutic properties of the acupoints. Interestingly, needling certain points may bring forth biphasic beneficial regulation on a variety of functional abnormalities of the body. In fact, ancient medical classics suggest that doctors should treat diseases according to the principles of acupuncture treatment. Regulating the Yin and Yang Regulation of Yin and Yang is a fundamental principle in clinical acupuncture. The mechanism of acupuncture treatment lies in regulating the Yin and Yang, which brings the body back to the physiological state of “Yin and Yang in equilibrium” and cures the patient. By employing different manipulations of acupuncture or moxibustion and the autoregulation mechanism, strengthening of the body resistance and elimination of the pathogenic factors can be achieved in clinical treatment. Therefore, for a patient with excessive-heat syndrome, superficial puncture to cause bleeding is often used for eliminating excessive heat, while for a patient with asthenic-cold syndrome, the reinforcing method, such as retaining the needle for a long period or applying moxibustion for restoring Qi and dispelling cold, is often employed. However, for a patient with intermingled insufficiency and excess syndrome, reinforcing and reducing methods are used simultaneously. Distinguishing the primary from the secondary The conceptions of the primary fundamental and secondary incidental are relative to each other, involving different meanings. For instance, the genuine Qi is the primary, and the pathogenic factor is the secondary; the etiology is the primary, and the manifestation is the secondary; and the original disease is the primary, while the consequent disease is the secondary. This concept represents the two opposite aspects of one entity during the course of a disease. The incidental is generally the phenomenon and the secondary aspect of a disease, while the fundamental cause is normally the nature and the primary aspect of a disease. Under general circumstances, the principle is to treat the incidental first when it is acute or emergent, and subsequently treat the fundamental later, when the course becomes insidious or gradual. However, if the incidental and the fundamental are both emergent, then they must be treated at the same time. In acupuncture treatment, a disease should be assessed according to different conditions, such as the primary, secondary, root cause, symptoms, acute, and chronic, so as to determine the principle of the treatment (Lu et al. Apart from Shanghai, doctors in other cities of China, such as Xi’an, Wuhan, and Nanjing, carried out operations such as tooth extraction, detachment of retina, thyroidectomy, and appendectomy using acupuncture anesthesia in the same or the subsequent year. In 1960, the First Tuberculosis Central Hospital in 5 Acupuncture Therapy of Neurological Diseases: A Neurobiological View Shanghai succeeded in applying acupuncture anesthesia to pneumonectomy. Subsequently, many other major and difficult operations (such as surgery on the anterior cranial fossa, total laryngectomy, cardiac surgery, cholecystectomy, subtotal gastrectomy, pan-hysterectomy, cesarean section) were also carried out using acupuncture anesthesia between 1960s and 1970s, which showed satisfactory results (Zhang 1989). However, during that period, acupuncture failed to produce sufficient analgesia during operation, although it had prominent analgesic effect and could be used in many surgical operations. It was found that the shortcoming of acupuncture anesthesia could be overcome by combining acupuncture with certain drugs (Xu et al. Acupuncture combined with selected drugs to fulfill the requirement of anesthesia is termed as acupuncture-balanced anesthesia, which is a type of balanced anesthesia (Cao 1997). Although the Chinese medicine, as a part of the Chinese culture, came to the United States in 1836, acupuncture was not officially recognized until 1972, when President Richard M. In June 1971, James Reston, the Director of the Washington Bureau of The New York Times, who was a gifted reporter and writer, was sent by the Times to China, prior to the official visit by Nixon. His appendectomy was performed under conventional chemical anesthetics, while his post-surgical complications were treated by acupuncture. Twenty minutes after acupuncture treatment, he felt a noticeable relaxation of the pressure and distension within an hour, and no recurrence thereafter. On July 26, 1971, Reston published his famous essay titled, Now, About My Operation in Peking, in the Times, in which he reported his personal experience about acupuncture in China (Reston 1971). In addition, Schwartz reported, “Acupuncture: The Needle Pain-Killer comes to America” and “Nothing in the American discovery of China has excited the popular imagination more than acupuncture anesthesia” (Schwartz 1972; Li and Singer 2006). The discovery of a relationship between acupuncture analgesia and neurochemicals, particularly endorphins, was exciting indeed, and began to provide a scientific basis for understanding its mechanism”. One of the advantages of acupuncture is that the occurrence of adverse side effects is extremely low. Findings from basic research have begun to elucidate the mechanisms of action of acupuncture (National Institutes of Health 1997). In brief, acupuncture research is one of the rare fields that has influenced the western science and technology. As a top Chinese medical institution in China, Shanghai First Medical College (later Shanghai Medical University; now Shanghai Medical College of Fudan University) made significant contributions to the mechanistic exploration of acupuncture. As all the research papers before 1972, were published in Chinese internal publications, a brief introduction to the major contributions made by our institution is presented in the following section. This was the first direct evidence that all the meridians where the points were lying could be traced to certain peripheral nerves. They also found that (1) the nerve supply of acupoints and the related viscera could be traced to the same spinal segment or around that segment; and (2) each pairs of “Yin” and “Yang” or “Outer” and “Inner” meridians could be located at the same spinal segment, communicating with different side branches, overlapping or anastomosing (Zhou et al. A large-scale study was carried out with our medical students and teachers (totally 624 people/times) at the beginning of 1965. The changes in the pain threshold and pain-tolerance threshold were measured from 41 classical points of the body surface before and during acupuncture. The results showed that the manual twisting of the needling point separately could elevate the pain and pain-tolerance threshold in most of the subjects. Simultaneous stimulation of the bilateral points was observed to induce better effect than that of unilateral needling. The study of the time course showed that 20 min, instead of 60 min, is sufficient for the induction. Effect of sham acupuncture on normal subjects In 1976, the Institute of Physiology, Shanghai Academy of Sciences, collaborated with us and performed another set of experiments on young volunteers (aged 20 26 years; medical students and teachers). In the sham acupuncture, the conditions were similar to those of true acupuncture, except that after the subject had the needling-feeling, 8 1 History of Modern Acupuncture Research in China the needle was drawn out swiftly without the subject being aware of the needle being pulled out, while the mechanical manipulator was kept running with its rhythmic noise within the subject’s hearing range and its rhythmic wave displayed on the screen (Jiang et al. The results showed that the sensory discrimination between faint pain and pain or between touch and faint pain was significantly decreased when subjected to acupuncture (Study 2). At the same time, the verbal report criteria of both faint pain and pain were also markedly elevated. In contrast, these changes were not found in the same subjects during rest (Study 1) or when exposed to sham acupuncture (Study 3). These data indicate that the analgesic effect of acupuncture does have its physiological basis, but not necessarily the psychological basis. Furthermore, the changes in blood pressure, pulse rate, and respiratory movements were to lesser extent than those under general anesthesia. Further studies indicated that acupuncture could elevate the pain threshold, warmth threshold, and pain- tolerance threshold; however, only the pain-tolerance threshold correlated well Figure 1. These observations suggest that acupuncture is able to inhibit the functional activity of the sympathetic nervous system (Cao et al. The patients were divided into 3 groups according to their responses to acupuncture. In Group A (far left), the skin temperature showed a constant rise during acupuncture stimulations in 20 cases, and all these patients responded very well to acupuncture during operations. In Group B (to the right of Group A), the skin temperature dropped at the early period of acupuncture, then went up after 20 min of acupuncture in 13 cases, and these patients also experienced a good acupuncture-analgesic effect. In Group C (to the right of Group B), the skin temperature constantly decreased after acupuncture in 14 patients (29. As acupoints are closely linked to the nerves, it is necessary to determine the kinds of nerve fibers that are activated by acupuncture. It was found that in patients with complete brachial plexus and 11 Acupuncture Therapy of Neurological Diseases: A Neurobiological View spinal transectional lesions, the needling sensation was absent at all points in the affected regions (Fig. The impulses of needling sensation were observed to ascend mainly through the ventro-lateral funiculi, which conduct pain and temperature sensation upward to the brain. Central neuromodulatory mechanism of acupuncture analgesia Based on the experimental studies, Chang (1973) indicated that the analgesic effect is essentially the result of interaction between the afferent impulses from 13 Acupuncture Therapy of Neurological Diseases: A Neurobiological View the region of pain and those from the point of acupuncture. In addition, it was also found that the Ach content in the perfusate of the lateral ventricles increased simultaneously with the elevation of pain threshold when the rabbits were needled, exhibiting a significant association between them. In clinical observations, it was found that the caudate stimulation through chronic implanted electrodes resulted in alleviation of intractable pain in patients, caused by late malignancies. There was a linear correlation between the percentage increase of ȕ-endorphin-like immunoreactive substances and the pain threshold or pain-tolerance threshold of the patients.

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The new strand of avian fu is one of the few avian infuenza viruses to have crossed the species barrier to infect humans cheap 100mg dilantin amex, and is the most deadly of those that have crossed the barrier buy dilantin 100 mg low cost. In the recent outbreaks in Asia order dilantin 100mg on-line, Europe, and Africa, more than half of those infected with avian fu have died. Those who have contracted the virus have handled birds or surfaces contaminated with secretions or excretions from infected birds. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. August 2007 Student Manual 5- 5 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. What would happen to other areas in the nation if a pandemic outbreak were to happen? August 2007 Student Manual 5- 7 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. Inter-Agency Cooperation: Establish relationships with community public health department and other emergency management groups. Defne functional roles and responsibilities of internal and external agencies, organizations, departments and individuals and establish lines of authority. Communications Plan: Establish systems and procedures (how, how often, when, what and to whom the information will be disseminated) and articulate resource requirements. Set up authorities, triggers, and procedures for activating and terminating response plan. Develop and plan for scenarios likely to result in an increase or decrease in demand for your services during a pandemic (e. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. Ensure fre department has a written infection control policy statement defning the department’s mission in limiting the exposure of members to infectious diseases during the performance of their assigned duties and while in the fre station living environment. Ensure fre department has an experienced individual within the department designated as the infection control offcer. Ensure training and education is a component of the infection control program and includes proper selection and use of personal protective equipment, standard operating procedures for safe work practices in infection control, proper methods of disposal of contaminated articles and medical waste, cleaning and decontamination, exposure management and medical follow-up. Ensure fre department implements and enforces hand and skin washing practices and decontamination procedures. Establish ft-testing and skill training on all respirator types used to prevent exposures. Inventory Checklist Community: Develop an understanding of the local community dynamics, available resources and how they may shift during a pandemic – size and distribution of population, number and location of health facilities, quarantine sites, transportation issues, large spaces that could be transformed into healthcare or shelter facility, etc. August 2007 Student Manual 5-2 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. Impact on Staff Determine impact on staff – absenteeism due to illness or attending to ill family member or afraid to come into work and develop Contingency Plan for such an event. Evaluate staff access to, and availability of, healthcare services during a pandemic. Establish policies for restricting travel and preventing infuenza spread at the worksite. Disseminate information frequently to all staff to prevent misinformation or fears based on rumors. Establish a dedicated staff member who is responsible for disseminating information. Staff must also be able to easily provide feedback to designated staff member on what they are facing, including those issues experienced in the feld. August 2007 Student Manual 5-2 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. The safety/infection control and prevention offcers will be the frst line of defense for policies your department makes for the pandemic. Here are some examples of what the safety/infection control and prevention offcers will ensure. August 2007 Student Manual 5-25 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. Infuenza is spread from person to person by contact with respiratory secretions from an infected person. When an infected person coughs or sneezes, large droplets carrying the virus land on the surfaces of the upper respiratory tracts of persons who are within three feet of the infected person. The virus can also spread by direct or indirect contact with respiratory secretions – touching contaminated surfaces and then touching the eyes, nose, or mouth. Respiratory Protection During the class discussion, use the space below to take notes on respiratory protection. Surgical mask N-95 P-100 August 2007 Student Manual 5-27 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. If you taste or smell the agent, you will test another disposable mask size (or type). August 2007 Student Manual 5-2 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. Immediately after activities involving contact with a patient’s body fuids, gloves should be removed and discarded and hands should be cleaned. Do not rub eyes after using eyewear, or after handling patients or equipment until you have thoroughly washed your hands. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. You are dispatched as part of Ladder Company to West Point Drive where a -year-old male complains of shortness of breath. As you talk to him, he reveals that he works as a consultant to a company that produces down comforters and has spent a great deal of time in factories that house ducks. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. If the turnout gear is visibly contaminated by bodily fuid, it should be placed in a biohazard bag at the scene and washed, following prescribed laundry procedures. August 2007 Student Manual 5- 5 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. The vaccine could be used in the event the current H5N avian virus were to develop the capability to effciently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an infuenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 infuenza virus contained in the vaccine. H5N1 infuenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The vaccine has been purchased by the federal government for inclusion within the National Stockpile for distribution by public health offcials if needed. The vaccine was generally well tolerated, with the most common side effects reported as pain at the injection site, headache, general ill feeling, and muscle pain. The study showed that 5 percent of individuals who received the 0 microgram, two-dose regimen developed antibodies at a level that is expected to reduce the risk of getting infuenza. Although the level of antibodies seen in the remaining individuals did not reach that level, current scientifc information on other infuenza vaccines suggests that less than optimal antibody levels may still have the potential to help reduce disease severity and infuenza-related hospitalizations and deaths. National Institutes of Health and other government agencies and manufacturers are working to develop a next generation of infuenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nation’s ability to protect those at increased risk of exposure. August 2007 Student Manual 5- 7 International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally. In this unit, you learned: • Basic facts about avian and pandemic infuenza • How a pandemic could affect the fre house, the department, your family, the wider community and the nation • How to prepare the department for a pandemic • How to keep yourself safe • How to care for and transport patients who may be infected with avian or pandemic fu • How to decontaminate equipment • Why vaccinations are important Based on what you learned in this course, what proactive steps can you take before a pandemic occurs? Work individually to describe how you will prepare for an outbreak of pandemic fu. August 2007 Student Manual 5- International Association Infectious Diseases of Fire Fighers Unit 5 – Avian & Pandemic Infuenza Page left blank intentionally.

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If no reaction develops purchase dilantin 100mg with visa, the vaccination should be Child over 1 year dilantin 100 mg lowest price, full repeated after 3 months dilantin 100mg on line. Follow manufacturers instructions on dosage Pentavalent vaccine Intramuscularly in the upper outer part of the thigh. A definite severe reaction to a preceding vaccine dose is a contraindication to further doses. The intramuscular route should not be used in patients with bleeding disorders such as haemophilia or thrombocytopaenia. Side−effects and adverse reactions to vaccinations Range from mild to severe for various vaccines. Major reactions are persistent crying, high pitched cry, excessive somnolescence, convulsions, encephalopathy and coma. Bacterial Infections Bacterial infections are a leading cause of morbid_ity and mortality. The following section summarizes the drugs of choice for common bacterial infections. The charts which follow provide comparison of the treatment cost for common antibacterial drugs. Penicillin Refers to narrow spectrum penicillin such as benzylpenicillin, procaine penicillin and phenoxymethylpenicillin. Benzylpenicillin is used in moderate to severe infections where high blood levels are required and because of its short half−life is given 4−6 hrly. Procaine penicillin is given by intramuscular route and is used in uncomplicated pneumonia and in treatment of gonorrhoea. Chloramphenicol Oral absorption is excellent and peak plasma levels are reached at the same time whether given intravenously or orally. Malaria Malaria parasites are usually transmitted by the bite of an infected female anopheles mosquito. Plasmodium falciparum is the commonest in Kenya and is associated with significant morbidity and mortality. Where cerebral malaria is suspected appropriate 128 therapy must be instituted promptly. Administer paracetamol concurrently to reduce fever • Avoid concurrent use of sulfa−based antibiotics e. Fluid intake should be calculated according to weight (minimum 10mls/Kg) and hydration status. Monitoring Response: Is as for children with special attention to the complications. Then into the syringe, draw up 600 mg (2 ml) from an ampoule of quinine and shake. Refer patient if the following conditions are present or persist: • Patient is in renal failure − oliguria and rising blood urea. All non−immune visitors to malarious areas; (a) long term residence >4 weeks (b) short term residence <4 weeks 2. Proguanil • Group 1a and 1b proguanil daily beginning one week before arrival and continuing for 4 weeks after leaving malarious area. Measles is never subclinical, however the severity of the disease is related to the infective dose of virus. All children 9 months of age or older who are not immunised against measles and are brought to a health facility for any reason should be immunised and given Vitamin A supplements before leaving that facility. Management Most children can be treated at home • Treatment with antibiotics is not recommended • Give an antibiotic only if pneumonia [see 21. Consider Staphylococcal pneumonia if the child has had prior antibiotic treatment for pneumonia • Give two doses of oral Vit. Give antibiotic eye ointment for conjunctivitis only if there is purulent eye discharge. Supervised feeding: expressed breastmilk feeds, and occasionally nasogastric tube feeding will be needed • Assessment: Nutritional follow up is very necessary. Increasing the frequency of feeding (an extra meal per day over the usual feeding) after measles illness is very important to help the child regain lost weight adequately • For the hospitalised child, give supportive care. Admit If the following are present; 134 • A haemorrhagic rash • Stridor (from infection of the larynx and trachea; laryngotracheitis) • Pneumonia, dehydration, or severe undernutrition • Great difficulty in drinking or eating. Prevention • Immunisation Measles immunisations is given to babies who are 9 months or above irrespective of whether they have suffered from measles/measles like illness. Complications These must be looked for in all patients: • Serious signs Persistent fever with darkening of the rash (“black measles”) and subsequent desquamation. Also important are frequent harmful cultural practices that impose fasting upon a child with measles. Advice to mothers/Caretakers • Ensure all her children are fully immunised • Child should attend under 5 years children clinic on discharge. Most commonly due to invasion by bacteria (Pyogenic meningitis), and less so due to viruses (Aseptic meningitis), tubercle bacilli (Tuberculous meningitis) or fungi (Fungal meningitis). The commonest bacterial organisms are streptococcus pneumoniae (Pneumococcus), Haemophilus influenzae and Neisseria meningitidis (Meningococcus), but almost any other bacteria may be involved depending on circumstances of the invasion and the age of the child. Predisposing factors in children are low immunity, prematurity, septicaemia: infections in the nose, sinuses, ears, throat and lungs; penetrating injuries of the skull and spinal column and congenital malformations of the brain and spine. In children the following features occur; refusal to feed, bulging anterior fontanelle, irritability, cyanosis, focal or generalised fits, high pitched cry, opisthotonos. Refer If • There is no improvement after 3−4 days of full treatment • There is persistent fever and/or bulging fontanelle and/or persistent fits • Patient develops a widespread skin rash, or easy bleeding before or during treatment • The mother reports that the child cannot see, hear or cries all the time or his head is enlarging • After full treatment, he is brought back with fits with or without fever. Flaccid paralysis is due to neuronal injury and the ensuing muscular atrophy due to denervation and atrophy of tissue. During early phase; analgesics, limb support to prevent deformities, nutrition and physiotherapy after acute phase. For purposes of polio eradication, notify the local Medical Officer of Health of any Acute Flaccid Paralysis 12. Adult flukes are white worm−like creatures which inhabit parts of the venous system of man. Eggs hatch in fresh water liberating cercariae that multiply in snails (intermediate host) and produce thousands of cercariae. These penetrate human skin within a few minutes after exposure and transform into schistosomiasis which develop into sexually active adult worms in the intestinal veins or venous plexus of genitourinary tract depending on the species. Mansoni − widespread particularly in Machakos, rice schemes and parts of Nyanza and even Nairobi. Clinical Features Acute dermatitis and fever after exposure is a rare presentation. Salmonella infection in patients with schistosomiasis is difficult to eradicate until schistosomiasis has been treated. Mansoni: − stool for ova, use concentration or Kato technique − rectal snip − barium swallow and endoscopy to demonstrate oesophageal varices − abdominal U/S • S. Haematobium − hatching test − X−ray lower abdomen may show calcified bladder (sandy patches) − intravenous urogram when obstructive uropathy is suspected. Prevention • Avoid contact with contaminated water • Mass chemoprophylaxis in school age in endemic areas • Environmental hygiene − use of toilets • Eradication of intermediate hosts (snails). Tetanus occurs in several clinical forms including generalised, neonatal and localised disease. Clinical Features Trismus, (lock jaw), opisthotonos (rigid arching of back muscles), dysphagia, laryngospasm. Guideline for dosage administration Time (Hours) 0 3 6 9 12 15 18 21 24 Diazepam + + + + + Chlorpromazine + + + + Phenobarbitone + + • Frequency of drug administration should be titrated against clinical condition. Optimum level of sedation is achieved when patient remains sleepy but can be aroused to follow commands. Prevention • Neonatal tetanus: − pregnant mothers − tetanus toxoid 2 doses at least 4 weeks apart as early as possible in pregnancy. One booster dose at every subsequent pregnancy • People with open wounds − 2 doses of tetanus toxoid at least 4 weeks apart.

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