Mark Corson

Waterborne Diseases ©6/1/2018 522 (866) 557-1746 Chloride is also a useful and reliable chemical indicator of river / groundwater fecal contamination cheap 20 mg cialis super active amex erectile dysfunction icd 9 code, as chloride is a non-reactive solute and ubiquitous to sewage & potable water order 20 mg cialis super active with mastercard erectile dysfunction green tea. Many water regulating companies around the world utilize chloride to check the contamination levels of the rivers and potable water sources purchase cialis super active 20mg visa erectile dysfunction treatment san francisco. A chlorite (compound) is a compound that contains this group,2 with chlorine in oxidation state +3. Chlorine can assume oxidation states of -1, +1, +3, +5, or +7 within the corresponding anions Cl-, ClO-, ClO -, ClO -, or ClO -, known commonly and respectively as chloride,2 3 4 hypochlorite, chlorite, chlorate, and perchlorate. An additional oxidation state of +4 is seen in the neutral compound chlorine dioxide ClO , which has a similar structure to chlorite2 ClO - (oxidation state +3) and the cation chloryl (ClO +) (oxidation state +5). As one of several oxides of chlorine, it is a potent and useful oxidizing agent used in water treatment and in bleaching. The molecule ClO2 has an odd number of valence electrons and it is therefore a paramagnetic radical. Its electronic structure has long baffled chemists because none of the possible Lewis structures are very satisfactory. Chemist Linus Pauling further developed this idea and arrived at two resonance structures involving a double bond on one side and a single bond plus three-electron bond on the other. In molecular orbital theory this idea is commonplace if the third electron is placed in an anti-bonding orbital. Chlorine dioxide is a highly endothermic compound that can decompose extremely violently when separated from diluting substances. As a result, preparation methods that involve producing solutions of it without going through a gas phase stage are often preferred. In the laboratory, ClO is prepared by oxidation of sodium chlorite:2 2 NaClO + Cl - 2 ClO + 2 NaCl2 2 2 Over 95% of the chlorine dioxide produced in the world today is made from sodium chlorate and is used for pulp bleaching. It is produced with high efficiency by reducing sodium chlorate in a strong acid solution with a suitable reducing agent such as methanol, hydrogen peroxide, hydrochloric acid or sulfur dioxide. Modern technologies are based on methanol or hydrogen peroxide, as these chemistries allows the best economy and do not co-produce elemental chlorine. Two advantages by not using the chloride-based processes are that there is no formation of elemental chlorine, and that sodium sulfate, a valuable chemical for the pulp mill, is a side-product. A much smaller, but important, market for chlorine dioxide is for use as a disinfectant. Since 1999 a growing proportion of the chlorine dioxide made globally for water treatment and other small-scale applications has been made using the chlorate, hydrogen peroxide and sulfuric acid method, which can produce a chlorine-free product at high efficiency. Alternatively, hydrogen peroxide may efficiently be used also in small scale applications. Haloacetic Acids Haloacetic acids are carboxylic acids in which a halogen atom takes the place of a hydrogen atom in acetic acid. The inductive effect caused by the2 2 electronegative halogens often result in the higher acidity of these compounds by stabilizing the negative charge of the conjugate base. Exposure to such disinfection by-products in drinking water has been associated with a number of health outcomes by epidemiological studies, although the putative agent in such studies has not been identified. Hypochlorites Hypochlorites are calcium or sodium salts of hypochlorous acid and are supplied either dry or in liquid form (as, for instance, in commercial bleach). The same residuals are obtained as with gas chlorine, but the effect on the pH of the treated water is different. Hypochlorite compounds contain an excess of alkali and tend to raise the pH of the water. Calcium hypochlorite tablets are the predominant form in use in the United States for swimming pools. Pound-for-pound of available chlorine, hypochlorite compounds have oxidizing powers equal to gas chlorine and can be employed for the same purposes in water treatment. Gas chlorination requires a larger initial investment for feed equipment than what is needed for hypochlorite compounds. Calcium hypochlorite materials used in the water industry are chemically different from those materials variously marketed for many years as bleaching powder, chloride of lime, or chlorinated lime. Materials now in common use are high-test calcium hypochlorites containing about 70 percent available chlorine and marketed under several trade names. High-test calcium hypochlorites are white corrosive solids that give off a strong chlorine odor. Granular powdered or tablet forms are commercially available and all are readily soluble in water. Sodium hypochlorite is sold only as a liquid and is normally referred to as liquid bleach. It is generally available in concentrations of 5 to 15 percent available chlorine. These solutions are clear, light yellow, strongly alkaline, and corrosive in addition to having a strong chlorine smell. Waterborne Diseases ©6/1/2018 525 (866) 557-1746 High-test hypochlorites, though highly active, are relatively stable throughout production, packaging, distribution, and storage. All sodium- hypochlorite solutions are unstable to some degree and deteriorate more rapidly than the dry compounds. Because light and heat accelerate decomposition, containers should be stored in a dry, cool, and dark area.

The severity of symptoms can vary from person to person order cialis super active 20 mg fast delivery impotence treatment vacuum devices, even among those in the same family cialis super active 20mg on line impotence and smoking. This disease is most common in Iraqi Jews cheap 20mg cialis super active with amex impotence organic origin definition, in whom 1 in 10,000 newborns are afected by the disease. Only a few cases of the disease have been seen outside the Iraqi Jewish population. The mutation for which Counsyl screens has been found exclusively in Iraqi Jews and is responsible for all the known cases of Costef optic atrophy syndrome in that population. There is no cure for Costef optic atrophy syndrome; treatments can only address symptoms as they arise. Often the medical team includes a neurologist, orthopedic surgeon, ophthalmologist, geneticist, and physical therapist. People with the Costef optic atrophy syndrome have been known to live into their 30s; life expectancy beyond that is unknown. The Counsyl Family Prep Screen - Disease Reference Book Page 73 of 287 Cystic Fibrosis Available Methodologies: targeted genotyping and sequencing. Variants Genotyped (100): G85E, R117H, R334W, R347P, A455E, G542*, G551D, R553*, R560T, R1162*, W1282*, N1303K, c. Detection Population Rate* 78% African American 97% Ashkenazi Jewish 55% Eastern Asia 91% Finland 91% French Canadian or Cajun 83% Hispanic 55% Middle East 54% Native American 91% Northwestern Europe 54% Oceania 54% South Asia 55% Southeast Asia 91% Southern Europe * Detection rates shown are for genotyping. This abnormal mucus results in the clogging The Counsyl Family Prep Screen - Disease Reference Book Page 74 of 287 and obstructing of various systems in the body. Infertility, particularly in men, and delayed puberty are also common among people with cystic fbrosis. The severity of symptoms varies from person to person, even among individuals with the same mutations. However, in general, individuals with two classic mutations are more likely to have a severe form of the disease including problems with the pancreas, while individuals with one classic and one non-classic or individuals with two non- classic mutations are more likely to have a milder form of the condition and may avoid problems with the pancreas. Ethnic Group Carrier Rate Afected Rate French Canadian 1 in 16 1 in 900 Caucasian 1 in 28 1 in 3,000 Ashkenazi Jewish 1 in 28 1 in 3,000 Hispanic 1 in 46 1 in 8,300 African American 1 in 66 1 in 17,000 The Counsyl Family Prep Screen - Disease Reference Book Page 75 of 287 Ethnic Group Carrier Rate Afected Rate Asian 1 in 87 1 in 30,000 How is Cystic Fibrosis treated? This treatment, known as "postural drainage and chest percussion" must be performed by someone other than the afected person, and is typically done at least once daily. Physicians will also monitor the digestive system to ensure that the person is getting proper nutrition. The Counsyl Family Prep Screen - Disease Reference Book Page 76 of 287 Cystinosis Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American 67% Ashkenazi Jewish <10% Eastern Asia 67% Finland 75% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American 67% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia 67% Southern Europe * Detection rates shown are for genotyping. Cystinosis is an inherited disease that causes the amino acid cysteine to accumulate within body cells and form crystals which can damage the body’s organs, particularly the kidneys and eyes. Without treatment, children with the condition will experience kidney failure around the age of 10. It causes poor growth and renal tubular Fanconi syndrome, a kidney disorder in which the organ eliminates certain essential nutrients and minerals. The loss of these nutrients inhibits normal body growth and may result in soft, bowed bones. Cysteine crystals also accumulate in the eyes, causing photophobia, an extreme sensitivity to light. Other symptoms may include muscle wasting, difculty swallowing, diabetes, an underactive thyroid gland, and nervous system problems. Less severe forms of the disease cause symptoms to begin later in life and may not afect the kidneys. The Counsyl Family Prep Screen - Disease Reference Book Page 77 of 287 How common is Cystinosis? Taken orally in capsules (brand name: Cystagon), it reduces the accumulation of cysteine crystals in the body. The drug has been shown to delay or prevent kidney failure and improve growth rates in children. Supplements of several vitamins and minerals are also recommended for most people with the disease. Human growth hormone treatments have been shown to help people with cystinosis reach normal height. Cysteine crystals will not build up in the newly transplanted kidney, although they may still afect other organs of the body. Cystagon has extended the lifespan of people with cystinosis, but exact lifespan is not known. The Counsyl Family Prep Screen - Disease Reference Book Page 78 of 287 D-Bifunctional Protein Defciency Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* 35% African American 35% Ashkenazi Jewish 35% Eastern Asia 35% Finland 35% French Canadian or Cajun 35% Hispanic 35% Middle East 35% Native American 35% Northwestern Europe 35% Oceania 35% South Asia 35% Southeast Asia 35% Southern Europe * Detection rates shown are for genotyping. D-bifunctional protein defciency, also known as peroxisomal bifunctional enzyme defciency, is an inherited disease causing severe biochemical abnormalities that are usually fatal within the frst two years of life. Infants with peroxisomal bifunctional enzyme defciency are foppy at birth with poor muscle tone. Most experience seizures shortly after birth and almost all develop seizures within the frst few months of life. The majority show visual and hearing impairment and have severe mental and physical retardation. Infants with D-bifunctional protein defciency also tend to share characteristic facial features. Few infants with D-bifunctional protein defciency reach any developmental milestones or develop motor skills. D-bifunctional protein defciency is the most severe among a group of diseases known as peroxisomal fatty acid oxidation disorders.

Combinations of diet cheap 20mg cialis super active free shipping erectile dysfunction natural remedies at walmart, vitamins best cialis super active 20mg erectile dysfunction cream 16, and supplements have been tried without much success discount cialis super active 20mg without a prescription erectile dysfunction caused by guilt. While the number of known cases does not allow for a well-established prognosis, it is thought that most people with E3 will die during childhood. The Counsyl Family Prep Screen - Disease Reference Book Page 176 of 287 Long Chain 3-Hydroxyacyl-CoA Dehydrogenase Defciency Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American 87% Ashkenazi Jewish <10% Eastern Asia >99% Finland 87% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American 87% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia 87% Southern Europe * Detection rates shown are for genotyping. This process, called fatty acid oxidation, normally breaks down fatty acids stepwise until they can be turned into usable energy. They are at high risk for life-threatening heart and breathing problems, comas, and seizures, as well as sudden unexplained infant death. Repeated episodes, if not properly treated, can cause brain damage, learning disabilities, or mental disability. Periods of fasting, illness, or strenuous exercise can instigate or exacerbate these episodes. The disease can also cause damage to the retina of the eye, causing progressive visual impairment over many years. Based on a carrier rate estimation of 1 in 150, 1 in 90,000 people would be afected by the disease. A physician or nutritionist will devise a course of treatment that normally involves frequent meals, often around the clock. There may need to be an additional feeding schedule for times when the person is sick. The diet is often low in fats and high in carbohydrates, which are easier for an afected person to break down. A physician may also prescribe medium chain triglyceride oil, L-carnitine, and/or other supplements for additional energy. What is the prognosis for a person with Long Chain 3-Hydroxyacyl-CoA Dehydrogenase Defciency? With careful monitoring of diet, people with the disease can live long, near- normal lives. Despite careful treatment, they may experience periodic problems in body chemistry that can result in brain damage, learning disabilities, or The Counsyl Family Prep Screen - Disease Reference Book Page 178 of 287 mental disability as well as problems with the muscles, heart, liver, and/or vision. The Counsyl Family Prep Screen - Disease Reference Book Page 179 of 287 Maple Syrup Urine Disease Type 1B Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American 99% Ashkenazi Jewish <10% Eastern Asia <10% Finland <10% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American <10% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia <10% Southern Europe * Detection rates shown are for genotyping. Maple syrup urine disease can be classifed into four general types: classic, intermediate, intermittent, and thiamine-responsive. Within 12 to 24 hours, or upon frst consumption of protein, the infant’s urine will take on a maple syrup smell. If untreated, life-threatening coma or respiratory failure could occur within 7 to 10 days and most will die within several months. People with the disease are particularly prone to crisis during illness, infection, fasting, or after surgery. Symptoms often appear during illness, fasting, or periods of high protein consumption. This form of the disease is rare, but in times of crisis its risks and symptoms are similar to the classic form. Many people with this form of the disease can tolerate some protein in their diet. The ability to treat the disease with thiamine, however, makes it easier to control than the other forms, whose treatment hinges largely on diet. It is most common among the Old Order Mennonite population, where about 1 in 385 infants is afected by the disease. Among Mennonites of eastern Pennsylvania, the frequency has been reported as high as 1 in 176 infants. This often means severe restrictions on meat, fsh, eggs, dairy foods, wholegrain four, beans, and nuts. These dietary restrictions should begin immediately upon diagnosis and must continue for the person’s entire life. It is particularly critical to recognize the disease as soon as symptoms appear in The Counsyl Family Prep Screen - Disease Reference Book Page 182 of 287 order to avoid brain damage and mental disability. Despite careful treatment, some people with the disease will experience periodic fare-ups, particularly during times of illness. These may create learning problems or mental disability and can be life-threatening. The Counsyl Family Prep Screen - Disease Reference Book Page 183 of 287 Medium Chain Acyl-CoA Dehydrogenase Defciency Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American 78% Ashkenazi Jewish <10% Eastern Asia 78% Finland 78% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American 78% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia 78% Southern Europe * Detection rates shown are for genotyping. As a result, partially metabolized fatty acids can accumulate in body tissues, causing damage to the brain, liver, and other organs. Rarely, these The Counsyl Family Prep Screen - Disease Reference Book Page 184 of 287 symptoms do not appear until adulthood. Often the episodes of metabolic crisis can be triggered by long periods without eating or by illness. The disease is rare among Hispanics, African Americans, Asians, and Native Americans in the United States. Consuming cornstarch can provide a sustained release of energy and allow for longer gaps between meals. Certain types of fat should be avoided while high amounts of carbohydrates can be benefcial.

Mode of transmission—Direct contact with discharges from re- spiratory mucous membranes of infected persons by the airborne route cialis super active 20 mg with amex erectile dysfunction ring, probably via droplets cheap cialis super active 20mg with mastercard erectile dysfunction treatment vitamins. In vaccinated populations 20 mg cialis super active mastercard impotence emedicine, bacteria are frequently brought home by an older sibling and sometimes by a parent. Period of communicability—Highly communicable in the early catarrhal stage and at the beginning of the paroxysmal cough stage (first 2 weeks). Thereafter, communicability gradually decreases and becomes negligible in about 3 weeks, despite persisting spasmodic cough with whoop. When treated with erythromycin, clarithromycin or azithromycin, patients are no longer contagious after 5 days of treatment. Incidence is highest in children under 5 years except where infant vaccination programs have been very effective and a shift has occurred toward adolescents. One attack usually confers prolonged immunity, although subsequent attacks (some of which may be attributable to B. Cases in previously immunized adolescents and adults in countries with long-standing and successful immunization programs occur because of waning immunity and are a source of infection for non immunized young children. Preventive measures: 1) Immunization is the most rational approach to pertussis control; and whole-cell vaccine against pertussis (wP) has been effective in preventing pertussis for more than 40 years. Educate the public, particularly parents of infants, about the dangers of whooping cough and the advantages of initiating immunization on time (between 6 weeks and 3 months depending on the country) and adhering to the immuniza- tion schedule. This continues to be important because of the wide negative publicity given to adverse reactions. In terms of severe adverse effects aP and wP vaccines appear to have the same high level of safety; reactions (local and transient systemic) are less commonly associated with aP vaccines. Similar high efficacy levels (more than 80%) occur with the best aP and wP vaccines although the level of efficacy may vary within each group. Protection is greater against severe disease and begins to wane after about 5 years. Although the use of aP vaccines is less commonly associ- ated with local and systemic reactions such as fever, price considerations affect their use and wP vaccines are the vaccines of choice for most developing countries. In countries where immunization programs have considerably reduced pertussis incidence, a booster dose approximately one year after the primary series is warranted. Vaccines containing wP are not recom- mended after the seventh birthday since local reactions may be increased in older children and adults. Formulations of acellular pertussis vaccine for use in adolescents and adults have been licensed and are available in several countries. Minor adverse reactions such as local redness and swelling, fever and agitation often occur after immunization with wP vaccine (1 in 2–10). Prolonged crying and febrile seizures are less common ( 1 in 100); hypotonic-hyporesponsive epi- sodes are rare ( 1 in 2000). The only true contraindication to immunization with aP or wP is an anaphylactic reaction to a previous dose or to any constituent of the vaccine. In young infants with suspected evolving and progressive neurological disease, immunization may be delayed for some months to permit diagnosis in order to avoid possible confusion about the cause of symptoms. Clarithromycin and azithromy- cin are expensive but better tolerated alternatives. Suspected cases should be removed from the presence of young children and infants, especially nonimmunized infants, until the patients have received at least 5 days of a minimum 7-day course of antibiotics. Suspected cases who do not receive antibiotics should be isolated for 3 weeks after onset of paroxysmal cough or till the end of cough, whichever comes first. Passive immu- nization has not been demonstrated to be effective and there is no product currently commercially available. The initiation of active immunization following recent exposure is not effective against infection but should be undertaken to protect the child against further exposure in case it has not been infected. A 7-day course of erythromycin, clarithromycin or azithromy- cin for household and other close contacts, regardless of immunization status and age, is recommended for house- holds where there is a child under 1. Prophylactic antibio- therapy in the early incubation period may prevent disease, but difficulties of early diagnosis, costs involved and con- cerns related to the occurrence of drug resistance all limit prophylactic treatment to selected individual conditions: - children under 1 year and pregnant women in the last 3 weeks of pregnancy (because of the risk of transmission to the newborn); - stopping infection among household members, particularly if there are children aged under 1 and pregnant women in the last 3 weeks of pregnancy. Epidemic measures: A search for unrecognized and unre- ported cases may be indicated to protect preschool children from exposure and to ensure adequate preventive measures for exposed children under 7. Accelerated immunization, with the first dose at 4–6 weeks of age and the second and third doses at 4-week intervals, may be indicated; immunizations should be completed for those whose schedule is incomplete. Disaster implications: Pertussis is a potential problem if introduced into crowded refugee camps with many non-immu- nized children. International measures: Ensure completion of primary immu- nization of infants and young children before they travel to other countries; review need for a booster dose. A scaling painless papule with satellite lymphadenopathy ap- pears 1–8 weeks after infection, usually on the hands, legs or dorsum of the feet. Within 3–12 months a maculopapular, erythematous secondary rash appears and may evolve into tertiary splotches of altered (dyschro- mic) skin pigmentation of variable size. These treponema-containing macules pass through stages of blue to violet to brown pigmentation, finally becoming treponema-free depigmented (achromic) scars. Lesions coexist at different stages of evolution and are most common on the face and extremities. Serological tests for syphilis usually become reactive before or during the secondary rash and thereafter behave as in venereal syphilis. Occurrence—Found only among isolated rural populations living under crowded unhygienic conditions in the American tropics. Mode of transmission—Presumably person-to-person through di- rect and prolonged contact with initial and early dyschromic skin lesions.