Mark Corson

By W. Silvio. The Rockefeller University.

The primary goal of the program is to reduce the mortality of these severe disorders cheap 2 mg imodium. This high-tech equipment not only allows easier generic 2mg imodium with amex, earlier cheap 2 mg imodium with visa, and more precise diagnosis of various tumorous diseases, but it also helps in the early recognition of several neurological and cardiovascular disorders. Markusovszky Kollégium Phone +36-52-411-717/55376 Fax +36-52-255-028 Internet www. Tünde Fekete English Program Officer Tamás Bagi (3rd-4th year Medicine, 1-5th year Pharmacy) Ms. Allergology Full Professor, Head of Division of Human Surgery and István Juhász M. Haematology and Oncology Associate Professor, Head of Division of General Gábor Mogyorósy M. Health Psychology Associate Professor, Head of Division of Humanities Attila Bánfalvi M. The requirements in these premedical science subjects are rigorous, thus it is recommended that students who need a period of preparation prior to beginning the General Medicine, Dentistry or Pharmacy Program join the Basic Medicine Course. Students successfully completing the course are directly admitted to their chosen program. Students are encouraged to ask questions related to the topic of the lectures discussed, and participate in solving problems related to the topic of the seminar. Some professors will ask for students to volunteer information, but some professors call on students randomly. It is, thus, a good idea to come to class prepared so as not to be embarrassed in front of the class. The usage of electronic devices, textbooks and any form of interaction between students during the tests are strictly forbidden. Violation of these above mentioned regulations results in an immediate and unconditional dismissal from the program. Attending lectures is strongly recommended, attendance of seminars is compulsory and recorded. Self Control Tests, End of Semester Exams, and Final Exams will be assessed as follows. Year, Semester: Basic Medicine Course, 1 semesterst Number of teaching hours: Lecture: 60 Seminar: 30 st 1 week: Lecture: The chemistry of life 1. Fungi: recyclers, pathogens, parasites 2 Differential gene expression in development 1. Year, Semester: Basic Medicine Course, 2nd semester Number of teaching hours: Lecture: 45 Seminar: 60 st 1 week: Lecture: Tissues, Organs and Organ Systems 1. Year, Semester: Basic Medicine Course 1 , semesterst Number of teaching hours: Lecture: 60 Seminar: 30 st 1 week: Lecture: 1-2. The content of each Self Control Test is indicative and subject to change with prior notice. Year, Semester: Basic Medicine Course, 2nd semester Number of teaching hours: Lecture: 60 Seminar: 30 1st week: Lecture: 1-2. The camera, the simple magnifier, the compound microscope, the telescope and the eye. Year, Semester: Basic Medicine Course, 1 semesterst Number of teaching hours: Lecture: 60 Seminar: 30 1st week: Lecture: Introduction to general chemistry. Year, Semester: Basic Medicine Course, 2nd, semester Number of teaching hours: Lecture: 60 Seminar: 30 st 1 week: Lecture: The halogens. Discussion of inorganic chemistry th 4 week: Lecture: Covalent bonding in organic compounds. Academic advisor: László Répás, Department of Foreign Languages Recommended books: Marschalkó, Gabriella: Hungarolingua Basic Level 1. The requirements of these condensed premedical science subjects are very rigorous, thus preparation prior to the beginning the General Medicine, Dentistry or Pharmacy Program is recommended. Students successfully completing the course are directly admitted to their chosen program. Students are encouraged to ask questions related to the topic of the lectures discussed, and participate in solving problems related to the topic of the seminar. Some professors will ask for students to volunteer information, but some professors call on students randomly. It is, thus, a good idea to come to class prepared so as not to be embarrassed in front of the class. The usage of electronic devices, textbooks and any form of interaction between students during the tests are strictly forbidden. Violation of these above mentioned regulations results in an immediate and unconditional dismissal from the program. Attending lectures is strongly recommended, attendance of seminars is compulsory and recorded. Self Control Tests, End of Semester Exams, and Final Exams will be assessed as follows. The camera, the simple magnifier, the compound microscope, the telescope and the eye. Carboxylic acid derivatives: esters, fats, lactones, amides, lactams, thiol esters anhydrides, acyl chlorides. A credit is a relative index of cumulative work invested in a compulsory, a required elective or a freely chosen subject listed in the curriculum. The credit value of a course is based upon the number of lectures, seminars and practical classes of the given subject that should be attended or participated in (so called "contact hours"), and upon the amount of work required for studying and preparing for the examination(s). Together with the credit(s) assigned to a particular subject (quantitative index), students are given grades (qualitative index) on passing an exam/course/class.

In this chapter imodium 2mg amex, the author attempts to establish prin- ciples of general applicability; however cheap 2 mg imodium with visa, it is written from the perspective of the law applicable in England and Wales and should be read with that in mind cheap imodium 2mg visa. Recently in the United Kingdom and elsewhere, many statutes relevant to medical practice have been enacted. Ignorance of the law is no defense, and today’s doctors are at risk of prosecution for breaches of the law as no previous generation has been. Yet the teaching at undergraduate level of forensic (or legal) medicine is now patchy and variable, so today’s doctors are seldom well informed about laws that govern their daily practices. It is hoped that this chapter will help redress that position, but only a brief out- line of some relevant law can be offered here. Although enactments in Europe, such as the Human Rights Act of 1998, have afforded better protection of the rights and liberties of citizens, the forensic physician has a real part to play in acting honorably by ensuring that the rights of the detainee are upheld in accordance with medical professional codes of ethics. A forensic physician who believes that the rights of the detainee are being ignored or abused may have a duty to report the concern to an authoritative person or body. First, they are independent medical assessors of victims and/or alleged perpetrators of crimes and, as such, no conventional therapeutic relationship exists. It is most important that this be made clear to the victims or detainees by the doc- tor, so that properly informed consent is secured for the proposed examina- tion. Second, a therapeutic relationship may arise when advice or treatment or other therapeutic intervention is offered, but the nature of the therapeutic rela- tionship will be constrained by the circumstances and by the forensic physician’s duty to pass information to police officers who will be respon- sible for observing the detainee or victim. Great care is necessary concerning issues of consent and confidentiality in such circumstances. Most of the ethical principles will be familiar to doctors who practice in countries that derive their laws from the Anglo-American common law system, but the detail of local rules and regulations will vary from nation to nation and state to state. This reflects the autonomy of each individual and the right of self-determination. Lest reiteration may diminish the impact of this principle, it is valuable to recognise the force of the lan- guage used when the right of self determination was most recently consid- ered in the House of Lords (1). It is well established English law that it is unlawful, so as to constitute both a tort (a civil wrong) and the crime of battery, to administer medical treat- ment to an adult who is conscious and of sound mind without his consent. Such a person is completely at liberty to decline to undergo treatment even if the result of his doing so will be that he will die (2). The principle of self-determination requires that respect must be given to the wishes of the patient, so that if an adult patient of sound mind refuses, however unreasonably, to consent to treatment or to care by which his life would or might be prolonged, the doctors responsible for his care must give effect to his wishes, even though they do not consider it to be in his best interests to do so…To this extent, the principle of the sanctity of human life must yield to the principle of self-determination …and, for present purposes perhaps more important, the doctor’s duty to act in the best interests of his patient must likewise be qualified (3). Any treatment given by a doctor to a patient which involves any interference with the physical integrity of the patient is unlawful unless done with the consent of the patient: it constitutes the crime of battery and the tort of tres- pass to the person (4). A doctor has no right to proceed in the face of objection, even if it is plain to all, including the patient, that adverse consequences and even death will or may ensue (5). The author can do no better than to open a discussion of the topic of consent by quoting the powerful and unambiguous language of the law lords in a leading case. The underlying reason for this position: …is that English law goes to great lengths to protect a person of full age and capacity from interference with his personal liberty. We have too often seen freedom disappear in other countries not only by coups d’etat but by gradual erosion; and often it is the first step that counts. The foregoing applies to all adults who are mentally competent; when a patient lacks the capacity to make decisions about whether to consent to treat- ment (e. Requisites for Consent To intervene without consent may give rise to criminal proceedings (for alleged trespass to the person) and may also give rise to tortious liability (a civil claim for damages). To protect against such proceedings, the medical practitioner should ensure that the patient is capable of giving consent, has been sufficiently well informed to understand and therefore to give a true con- sent, and has then expressly and voluntarily consented to the proposed inves- tigation, procedure, or treatment. Capacity If there is serious doubt about the patient’s capacity to give consent, it should be assessed as a matter of priority. The patient’s general practitioner or other responsible doctor may be sufficiently qualified to make the assessment, but in serious or complex cases involving difficult issues about the future health and well-being, or even the life of the patient, the issue of capacity to consent should be assessed by an independent psychiatrist (in England, ideally, but not necessarily, one approved under section 12 of the Mental Health Act of 1983) (9). If after assessment serious doubts still remain about the patient’s competence (e. Understanding Risks and Warnings A signature on a form is not, of itself, a valid consent. For a valid, true, or real consent in law, the patient must be sufficiently well informed to under- stand that to which he or she is asked to give consent. To defend a doctor against a civil claim alleging lack of consent based on a failure to warn adequately, it is necessary to have more than a signature on a standard consent form. Increasingly, in medical negligence actions, it Fundamental Principals 41 is alleged that risks were not explained nor warnings given about possible adverse outcomes. Therefore, it is essential for the doctor or any other healthcare professional to spend adequate time explaining the nature and purpose of the intended investigation, procedure, or treatment in terms that the patient can understand. The patient’s direct questions must be answered frankly and truthfully, as was made clear in the Sidaway case (11), and thus the discussions should be undertaken by those with adequate knowledge and experience to deal with them; ideally, the clinician who is to perform the operation or procedure. Increasingly, worldwide the courts will decide what the doctor should warn a patient about—applying objective tests, such as what a “prudent patient” would wish to know before agreeing. For example, in the leading Australian case (12), the court imposed a duty to warn about risks of remote (1 in 14,000) but serious complications of elective eye surgery, even though professional opinion in Australia at the time gave evidence that they would not have warned of so remote a risk. In the United States and Canada, the law about the duty to warn of risks and adverse outcomes has long been much more stringent. In the leading case (13), the District of Columbia appeals court imposed an objective “prudent patient” test and enunciated the following four principles: 1. Every human being of adult years and sound mind has a right to determine what shall happen to his or her body. Consent is the informed exercise of choice and that entails an opportunity to evaluate knowledgeably the options available and their attendant risks. In the leading Canadian case (14), broad agreement was expressed with the propositions expressed in the American case. The prac- titioner is not required to make an assessment based on the information to be given to an abstract “prudent patient;” rather, the actual patient being con- sulted must be assessed to determine what that patient should be told.

The wound should be debrided buy discount imodium 2mg line, the lower beak should be trimmed in a ramp-like flushed with saline imodium 2mg visa, dried 2 mg imodium free shipping, and then filled with a fashion to encourage the upper beak to slide over to dental acrylic. Differences in the indented, it should be elevated to the level of the rest height of the occlusal surfaces of the mandibular of the beak with a bent needle before applying the beak should be corrected, and digital pressure should acrylic patch. The acrylic patch will eventually be applied to the beak two to four times daily to loosen as granulation tissue fills the wound. Correction of severe beak deformities in older of the Mandible of Macaw Beaks birds is seldom complete, but substantial improve- An elongated, shovel-like deformity of the mandible ment can be made. If noted before the beak Mandibular prognathism (underbite), in which the calcifies, it can be corrected by trimming beak tissue upper beak tucks within the lower, is seen primarily from the lateral walls and manually reshaping the in cockatoos (Figure 30. It has been suggested that the parent bird may hook the maxilla during feeding and Traumatic Subluxation of the Premaxilla-frontal Joint help extend it, an event that may not occur during hand-feeding. If the beak is still soft, physical therapy usually be displaced dorsally, and fractures of the may correct the condition. It is can be used at each feeding to apply traction and extremely painful, and the bird should be anesthe- extend the maxillary beak rostrally. The cartilagi- tized while the beak is placed back in a normal nous extensions should be clipped if they are con- position (see Chapter 42). If the beak is calcified, physical therapy ported to heal well, although some may need to be hand fed for a few days. A few stress bars in an otherwise normal bird are of only temporary cosmetic concern. Large numbers of stress bars may indicate malnutrition, stunting or a disease problem. Determining the cause of stress bars is often difficult because they represent a problem that occurred when the feather was developing. The problem had been pre- Occluded Ear Openings sent since hatching, and the aviculturist had been incorrectly told that this was normal and would resolve with age. If corrected from Occlusions of the external openings of the ears are hatching, this problem can be resolved by gently pulling the upper most often seen in macaws, (especially Military Ma- beak forward and placing it over the lower beak for about ten caws). If allowed to progress, as in this cockatoo, repair requires surgical intervention (see Chapter 42). This material should be removed by curettage and flushing, cultured for bacteria and fungus, and the ear treated with appropriate topical and systemic antibiotics. Eyelid Malformation Malformation of the eyelids resulting in a narrow aperture is occasionally seen in cockatiels. The bird was being fed a homemade diet with a baby cereal base that was nutritionally reported cases, the aperture closed following treat- deficient. If the canal fails to open, it should be explored with blunt forceps and an opening surgically created if necessary. If a small hole is found, it can often be enlarged by stretching it with the tips of a pair of hemostats. Loxahatchee, Avicultu- Jean Delacour/Intl Foundation for hepatic biliary cyst in a congo African of Cage and Aviary Birds 2nd ed. J Am Vet rum biochemical reference intervals an African grey parrot and an um- Avian Vet 1990, 12-24. J Zoo Wildlife Med rum biochemical reference intervals rots: Methodology and expected 1986, pp 333-340. Clubb K, Clubb S: Management of Breeding and Research Center, 1992, Medicine 1:11-21, 1992. The diet of every avian patient should be carefully evaluated, even if the bird appears clinically to be well nourished. Marginal nutritional inadequacies frequently occur (see Chapter 8), and correcting the 31 diet will improve a bird’s general health and its ability to resist infectious diseases. Gastrointestinal malabsorption, hepatitis or renal disease can in- crease nutrient requirements so that diets that are sufficient in healthy birds may be insufficient for unhealthy birds. Interestingly, free-ranging gra- nivorous birds that are offered both organic (no pes- ticides) and pesticide-treated grains will preferen- tially consume the organic foods. Birds with signs of malnutrition have often devel- oped strong preferences for unbalanced diets. Most seed diets, for example, contain excessive levels of fat and may be deficient in vitamins A, D3, E, B12 and K1, plus riboflavin, pantothenic acid, niacin, biotin, choline, iodine, iron, copper, manganese, selenium, Patricia Macwhirter sodium, calcium, zinc and some amino acids (eg, lysine and methionine). Gradually decreasing the quantity of old food items and increasing the quantity of new foods in the mixture will allow for a smooth transition in the diet. Converting birds housed in large groups to a new diet is often easier than converting individual birds. Ketosis was seen in some Obesity is the most common and the most severe cockatoos that refused to eat during the transition to malnutrition-related problem recognized in avian formulated diets. Obesity occurs if the energy loss, diarrhea, weakness, lethargy and possible vomi- content of the diet is excessive for the energy de- tion. Ketonuria can be demonstrated by a reagent strip mands created by normal metabolic functions and examination of the urine. In some cases, obesity will be trose, supportive alimentation and placing the bird secondary to the over-consumption of food in a bird back on its regular diet. Associated with Malnutrition Because companion birds frequently have limited opportunities for exercise, the energy content of their diet needs to be monitored closely. In species prone to obesity, it is important to avoid offering foods that Avian veterinarians encounter a different type of have high caloric densities and to avoid excessive malnutrition today than was described five to ten quantities of attractive, palatable food. Nutrient deficiencies were historically twice the caloric density of either carbohydrates or common, but with the use of formulated diets in proteins, and foods containing high levels of fats combination with vitamin and mineral supplementa- (such as peanuts or sunflower seeds) should be lim- tion, many malnutrition problems noted today are a ited. Fresh fruit and vegetables have lower calorie densities than dried foods or seeds and should make up a sizable portion of a low-energy diet. Decreasing caloric intake can also be achieved by restricting feeding times (eg, ten minutes in the morning and evening) rather that offering food ad lib.