Mark Corson

By L. Abbas. Johnson Bible College. 2018.

Several studies have shown that dietary modifications not only are more effective in preventing recurrent heart attack than aspirin but also can reverse the blockage of clogged arteries discount cipro 500 mg without prescription virus-20. In addition to the studies with the Mediterranean diet proven cipro 750 mg infection urinaire homme, three famous studies deserve special mention best 750mg cipro bacteria helicobacter pylori. The control group received regular medical care, while the experimental group members were asked to eat a low-fat vegetarian diet for at least one year. No animal products were allowed except egg whites and 1 cup of nonfat milk or yogurt per day. The diet contained approximately 10% fat, 15% to 20% protein, and 70% to 75% carbohydrates (predominantly complex carbohydrates from whole grains, legumes, and vegetables). The experimental group members were also asked to perform stress reduction techniques such as breathing exercises, stretching exercises, meditation, imagery, and other relaxation techniques for an hour each day and to exercise for at least three hours each week. At the end of the year, the subjects in the experimental group showed significant overall regression of atherosclerosis of the coronary blood vessels. As stated previously, numerous population studies have demonstrated that people who consume a diet rich in omega-3 oils from either fish or vegetable sources have a significantly reduced risk of developing heart disease. A significant challenge for patients is weighing the benefits against the risks when they are referred for angiography, coronary artery bypass surgery, or angioplasty. As is fully discussed in the chapter “Angina,” these procedures are used far more frequently than is justified by objective evaluation of their appropriateness and efficacy. That chapter also gives advice for patient care when angiography, coronary artery bypass surgery, or angioplasty is unavoidable. In one study, angiography performed on 205 consecutive patients showed an 82% accuracy in predicting heart disease, with a false-positive rate of 12% and a false-negative rate of 18%. The earlobe is richly vascularized, and a decrease in blood flow over an extended period of time is believed to result in collapse of the vascular bed. Although the presence of an earlobe crease does not prove heart disease, it strongly suggests it, and examination of the earlobe is an easy screening procedure. The correlation does not hold with Asians, Native Americans, or children with Beckwith’s syndrome. Diet • Follow the dietary guidelines given in the chapter “A Health-Promoting Diet. Increase consumption of fiber-rich plant foods (fruits, vegetables, grains, legumes, nuts, and seeds). Nutritional Supplements • Take a high-potency multivitamin and mineral formula according to the guidelines given in the chapter “Supplementary Measures. Its primary function is to protect the body against infection and the development of cancer. Too often conventional medicine overlooks the importance of susceptibility to infection or disease. Support and enhancement of the immune system are perhaps the most important and vital steps in reducing susceptibility to colds, flu, and cancer. Determining Immune Function The criteria that we use to determine whether the immune system is going to be an area of focus is an answer of yes to any of the following questions: • Do you catch colds or flu easily? Recurrent or chronic infections, even very mild colds, happen only when the immune system is weakened. What makes it difficult for susceptible people to overcome their tendency for infection is a repetitive cycle: a weakened immune system leads to infection, and chronic infection leads to depletion of the immune system, further weakening resistance. Enhancing the immune system by following the guidelines in this chapter may provide the means of breaking the cycle. Components of the Immune System The immune system is composed of the lymphatic vessels and organs (thymus, spleen, tonsils, and lymph nodes), white blood cells (lymphocytes, neutrophils, basophils, eosinophils, monocytes, etc. It is composed of two soft pinkish gray lobes lying like a bib just below the thyroid gland and above the heart. To a very large extent, the health of the thymus determines the health of the immune system. Individuals who get frequent infections or suffer from chronic infections typically have impaired thymus activity. Also, people affected with hay fever, allergies, migraine headaches, or rheumatoid arthritis usually have altered thymus function. The thymus is responsible for many immune system functions, including the production of T lymphocytes, a type of white blood cell responsible for cell-mediated immunity (immune mechanisms not controlled or mediated by antibodies). Cell-mediated immunity is extremely important in the resistance to infection by mold-like bacteria, yeast (including Candida albicans), fungi, parasites, and viruses (including herpes simplex, Epstein-Barr, and viruses that cause hepatitis). If an individual is suffering from an infection from these organisms, it is a good indication that his or her cell-mediated immunity is not functioning up to par. Cell-mediated immunity is also critical in protecting against the development of cancer, autoimmune disorders such as rheumatoid arthritis, and allergies. The thymus gland releases several hormones, such as thymosin, thymopoeitin, and serum thymic factor, which regulate many immune functions. Low levels of these hormones in the blood are associated with depressed immunity and an increased susceptibility to infection. Lymph, Lymphatic Vessels, and Lymph Nodes Approximately one-sixth of the entire body is the space between cells. Collectively this space is referred to as the interstitium and the fluid contained within the space is referred to as the interstitial fluid. These large cells engulf and destroy foreign particles, including bacteria and cellular debris.

These benefits have are several simple principles for the clinician to con- been particularly noted in high-risk patients with renal sider and some obvious questions to ponder: insufficiency [47 500mg cipro free shipping medicine for uti yahoo, 52] discount cipro 250 mg online antibiotic used for staph. Nevertheless buy generic cipro 750 mg line antibiotics and sun, the results of clini- › Is the study that utilizes contrast material really cal studies have shown significant variation as recently needed for the child’s care? Patients conflicting evidence (some experimental trials show- at risk could be observed more closely and timely ing efficacy while others show no statistical advan- intervention be initiated, potentially ameliorating the tage), none of the aforementioned agents can clearly disease course; also, avoidance of additional renal insults be recommended. Without a doubt, more experimental data are required before these agents can be definitively added 20. Certainly continued ing contrast agent could limit renal exposure to its toxic hydration and optimization of the extracellular volume effects. Identify and discontinue any nephrotoxic drugs at a few days regardless of treatment regimen, particu- least 48–72 h prior to contrast administration. Asif A, Epstein M (2004) Prevention of radiocontrast sidered safe with virtually no recognizable or repro- induced nephropathy. N Engl J Med 332:647–655 stage renal disease), the administration of gadolinium 7. A possible mech- Using a dopamine type 1A receptor agonist in high risk anism to explain the etiology is the dissociation of the patients to ameliorate contrast associated nephropathy. Fishbane S (2008) N-Acetylcysteine in the prevention of children recover with no long-term renal sequelae. Grobner T (2006) Gadolinium—a specific trigger for the - High-dose of contrast material (exceeding 5 mL kg−1) development of nephrogenic systemic fibrosis? Pediatr Nephrol 22:2089–2095 - Administration of N-acetylcysteine twice a day admin- 21. Am J Kidney Dis Nephrogenic systemic fibrosis: a review of 6 cases related 24:713–727 to gadolinium injection. Tommaso C (1994) Contrast induced nephrotoxicity in patients systemic fibrosis: suspected etiological role of gadolin- undergoing cardiac catheterization. Margulies K, Schirger J, Burnett J Jr (1992) Radiocontrast Pract 93:29–34 induced nephropathy: current status and future prospects. Rev Cardiovasc Med 4:3–9 nephropathy after coronary angioplasty in chronic renal 39. Kidney Int 41:1408–1415 rial induced renal failure in patients with diabetes, renal 61. They elect to monitor the child closely with neurologic monitoring and attention to any symptoms of 21. The patient was discharged after an Case Vignette uneventful stay of 48 h following admission. In the emergency room, lithium blood Poisonings, intoxications, and medication overdoses are level returns at 5mmol L−1. The emergency room phy- the leading causes for admission of pediatric patients sician reviews available written references and con- to the intensive care unit. In some circumstances, altering of the acid– Alcohols Slurred speech, base status or augmentation of urine output may reduce desinhibition, ataxia, the morbidity and mortality of a toxin. In even rarer cir- hypothermia, confusion, cumstances, extracorporeal removal of the toxin may be memory loss helpful. To achieve excellent outcomes, close abdominal pain, increased communication between the intensivist and nephrologist respiratory effort, hyperthermia, coma is vital, especially in circumstances when initiation of renal replacement therapies is considered. Close collab- Lithium Vomiting, diarrhea, vertigo, confusion, hyperreflexia, oration with a poison control center as well as vigilant coma monitoring are essential components to the management Anticholinergics Fever, tachycardia, dry skin, of any patient with a significant intoxication. This is defined Cyclic antidepressants Tachycardia, drowsiness, as a constellation of signs and symptoms, a syndrome hypotension, insomnia, typical for a specific kind of poisoning. Key to the agitation, cardiac treatment of any pathology is the identification of the arrhythmia syndrome and the offending agent (Table 21. It is important to differentiate the multitude of potential pharmacologic toxins, which can contrib- The toxin can either be eliminated unchanged (as in ute to or be exclusively responsible for renal injury. It has been estimated that toxins contrib- unintended result of treatment for an underlying con- ute to renal failure in up to 20% of patients. As the It is useful from the start to have an accurate picture majority of those agents (including aminoglycosides, of the toxin’s pharmacokinetics. Many toxins in high nonsteroidal anti-inflammatory drugs, contrast material concentrations deviate from their published half-lives [see previous chapter]) are readily appreciated as a and therefore plotting out the concentration of the drug potential source of iatrogenic renal failure they will with serial levels can be useful. We recom- rapid decreases in toxicity over time as the patient mend close consultation with the laboratory to specify quickly returns to nontoxic concentrations. However, what substances are possible based on the history, physical some drugs such as ethanol exhibit zero-order kinetics, and laboratory analysis available at presentation. The velocity of those reactions is independent of the dose of the toxin and a linear decrease in the 21. Elimination of a toxin is primarily through the metabo- Chronic renal failure involves not only decreasing lism of the substance through the liver and elimination toxin clearance of renal-eliminated toxins but also or clearance of the substance through the kidneys. Major clearance systems, Chapter 21 Intoxications 283 C C o o n n c c e e n n t t r r a a t t i i o o n n Time Time Fig. The majority of drug metabolism order kinetic elimination is ethanol intoxication takes place with first-order kinetics (the velocity of the elimina- tion reaction is dependent on the concentration of the toxin) used approach. Theoretically, urine alkalinization such as the hepatic cytochrome P450 system, are should decrease the toxic effects of a myoglobinuria.

Either an increase in cholesterol secretion or a decrease in bile acid or lecithin secretion will result in too much free cholesterol in the bile discount 250 mg cipro with amex antibiotic that starts with c. Once that has occurred buy cipro 750mg otc antibiotics for uti canada, stone formation is initiated by factors such as decreased bile flow discount cipro 500 mg online antibiotics z pack and alcohol, infection, and increased mucin secretion by the gallbladder lining. Obesity Obesity, type 2 diabetes, insulin resistance, and elevated blood triglyceride levels are well-known risk factors for gallstones. Obesity causes increased cholesterol manufacture in the liver with increased secretion of cholesterol in the bile. Therefore obesity is associated with a significantly increased incidence of gallstones. Important to note is that during active weight reduction, changes in body fat and diet can actually promote gallstone problems. Once weight is stabilized, bile acid output returns to normal levels, while the cholesterol output remains low. The net effect is a significant reduction in cholesterol concentration in the bile. Obese patients with a high risk of gallstones should realize that prolonged dietary fat reduction can also promote a condition called biliary stasis, thus contributing to the risk of gallstone formation. Women are thought to be predisposed to gallstones because of either increased cholesterol synthesis or suppression of bile acids by estrogens. Pregnancy, use of oral contraceptives or other causes of elevated estrogen levels, and the chemotherapy drug tamoxifen greatly increase the incidence of gallstones. Genetic and Ethnic Factors The prevalence of gallstones appears to have some genetic aspects. The difference in the prevalence rate between different ethnic and genetic groups reflects the concentration of cholesterol in the bile. The extent to which dietary factors affect this value probably outweighs genetic factors. Gastrointestinal Tract Diseases Malabsorption of bile acids from the small intestine disturbs the natural circulation of excreted bile acids back to the liver, thereby reducing the bile acid pool and the rate of secretion of bile. Diseases associated with this phenomenon include Crohn’s disease and cystic fibrosis. Drugs Tamoxifen treatment in postmenopausal breast cancer patients greatly increases gallstones. One study of 703 women demonstrated that after five years, the incidence of stone formation in the tamoxifen-treated patients was 37. In addition to oral contraceptives and other estrogens, as discussed earlier, drugs that increase the risk of gallstones include ceftriaxone, octreotide, statins, and possibly other lipid-lowering drugs. Age Gallstones have been reported in fetuses and extremely old people and at all ages in between, but the average patient is 40 to 50 years old. Decline in the activity of enzymes that manufacture bile acids with age leads to an increase in biliary cholesterol hypersecretion and thus cholesterol saturation with accelerated formation of gallstones. Pigmented gallstones are more common in Asia, owing to the higher incidence of parasitic infection of the liver and gallbladder by various organisms including the liver fluke Clonorchis sinensis. Bacteria and protozoa can cause stagnation of bile flow or initiate the process of stone formation. In the United States, pigmented stones are usually caused by chronic hemolysis or alcoholic cirrhosis of the liver. Primary treatment, therefore, involves reducing the controllable risk factors discussed earlier. Once gallstones have formed, therapeutic intervention involves avoiding aggravating foods and employing measures that increase the solubility of cholesterol in bile and possibly help dissolve the stones. A number of dietary factors are important in the prevention and treatment of gallstones. Also important are increasing dietary fiber, eliminating food allergies, and reducing the intake of refined carbohydrates and animal protein. Vegetables and fruits have a protective effect against gallbladder cancer, while red meat was found to be associated with increased risk of gallbladder cancer. Other treatment measures involve the use of nutritional lipotropic compounds, herbal choleretics, and other natural compounds in an attempt to increase the solubility of bile. Biliary cholesterol concentration and serum cholesterol levels do not seem to correlate. Silent Gallstones The natural history of silent or asymptomatic gallstones supports the contention that elective gallbladder removal is not warranted. There is a cumulative chance of developing symptoms—10% at 5 years, 15% at 10 years, and 18% at 15 years—but if controllable risk factors are eliminated or reduced, a person should never experience discomfort and require surgery. Diet Dietary Fiber The theory that the main cause of gallstones is the consumption of fiber-depleted, refined foods has considerable research support. Such a diet, high in refined carbohydrates and fat and low in fiber, leads to a reduction in the synthesis of bile acids by the liver and a lower bile acid concentration in the gallbladder. Another way in which fiber may prevent gallstone formation is by reducing the absorption of deoxycholic acid. Dietary fiber has been shown both to decrease the formation of deoxycholic acid and to bind deoxycholic acid and promote its excretion in the feces. A diet high in fiber, especially soluble fiber, which is capable of binding to deoxycholic acid, is extremely important in both the prevention and the reversal of gallstones. Interestingly, diets rich in legumes, which are high in soluble fiber, are associated with an increased risk for gallstones in some populations.

There- fore effective 250 mg cipro infection jobs indeed, it is not possible to reach a conclusion regarding erectile efficiency based on age alone discount 250 mg cipro free shipping virus x trailer. When a defendant reports erectile dysfunction cheap cipro 250 mg with mastercard virus 7 life processes, the expert opin- ion of a urologist should be sought. Penile erection may result from visual stimulation (including fantasy) or tactile stimulation. The penis, scrotum, and rectum are all sensitive to tactile stimulation (153), which may explain why involuntary penile erections can be experienced by a male subjected to nonconsensual anal intercourse. Semen Production Semen is not produced until the male experiences puberty, which usu- ally begins between 9 and 14 years of age (154). The normal volume of a single ejaculate is between 2 and 7 mL, and it will contain approx 50–120 million spermatozoa/mL. There are numerous congenital and acquired causes for impaired spermatogenesis (155), resulting in either decreased numbers (oligozoospermia) or absence of (azoospermia) spermatozoa. Both condi- tions may be permanent or transitory depending on the underlying cause. It is not possible to determine whether spermatozoa are present in the ejaculate without microscopic assessment. However, analy- sis of a defendant’s semen is not a routine part of the forensic assessment. Forensic Evidence After an allegation of fellatio, swabs from the complainant’s penis can be examined for saliva, but, as discussed earlier in Subheading 7. When an allegation of vaginal or anal intercourse is made, penile swabs from the sus- pect can be examined for cells, feces, hairs, fibers, blood, and lubricants. Swabs taken from the meatus and urethra are not suitable for microscopic assess- ment because some male urethral cells can be similar to vaginal cells (7). Therefore, when vaginal intercourse is alleged, two swabs (the first wet, the second dry) should be obtained sequentially from the coronal sulcus, and two additional swabs (the first wet, the second dry) should be taken sequentially from the glans and the shaft together. The swabs must be labeled accord- ingly, and the order in which the samples were obtained must be relayed to the scientist. The same samples are also taken if it is believed that a lubricant or condom has been used during a sexual act or if the assault involved fellatio or anal intercourse. Microscopic and Biochemical Analyses Such analyses of the penile swabs may be undertaken to identify cellular material, blood, or amylase. When the complaint is of anal intercourse, swabs that are discolored by fecal material can be analyzed for urobilinogen and examined microscopically for vegetable matter. Blood and feces have been recovered from penile swabs taken 15 and 18 hours, respectively, after the incident (for saliva, see Subheading 7. Medical Evidence When obtaining the relevant forensic samples, the forensic practitioner should inspect the male genitalia with particular reference to the following points: 1. Pubic hair should be described in terms of its coarseness, distribution (Tanner stages 1–5), and color. A note should be made if the pubic hair appears to have been plucked (including bleeding hair follicles), shaved, cut, or dyed. Acquired abnormalities, such as circumcision, Peyronie’s disease, balanitis xerotica obliterans, vasectomy scars, phimosis, tattoos, and piercing. Foreign bodies may be worn around the base of the penis, sometimes also encir- cling the scrotum, in an attempt to increase and sustain penile tumescence. Such devices may result in local and distal genital trauma (penile tourniquet syndrome) (157). In several case reports, children have had human hairs wrapped around the penis; these hairs may be virtually invisible because of edema or epithelialization (158). Kerry and Chapman (159) have described the deliberate application of such a ligature by parents who were attempting to prevent enuresis. After consensual sexual intercourse, lacerations of the foreskin and frenulum, meatitis, traumatic urethritis, penile edema, traumatic lymphangitis, paraphimosis, and penile “fractures” have all been described (160– 163). Accidental trauma is more common when there is a pre-existing abnormal- ity, such as phimosis (160). Skin injury may be incurred if the genitals are deliberately bitten during fellatio (160). Although the precise incidence of male genital trauma after sexual activity is unknown, anecdotal accounts suggest that it is rare to find any genital injuries when examining suspects of serious sexual assaults (164). In children the genitalia may be accidentally or deliberately injured, and the latter may be associated with sexual abuse (165). Bruises, abrasions, lac- erations, swelling, and burns of the genitalia of prepubescent males have all been described (165,166). Definitions Buggery is a lay term used to refer to penile penetration of the anus (anal intercourse) of a man, a woman, or an animal (also known as bestiality). Consensual Although anal intercourse among heterosexuals is the least common com- ponent of the sexual repertoire, it has been experienced on at least one occa- sion by 13–25% of heterosexual females surveyed (64,80,167), and it was described as a regular means of sexual gratification for 8% of women attend- ing one gynecologist (80). Among 508 men who reported having had a same- gender sexual experience at some stage in their lives, 33. Inter- estingly, in contrast to a common perception, more men had experienced both practices than had been in exclusively receptive or insertive roles (168). Nonconsensual Anal intercourse was reported by 5–16% of females who described hav- ing been sexually assaulted (6,169). Although it may be the only sexual act performed, it is more frequently combined with vaginal and oral penetration (6,169). Fewer data are available regarding sexual assaults on males, although Hillman et al. Legal Implications Under English common law, the term buggery is defined as anal inter- course by a man with another man or a woman and anal or vaginal inter- course by a man or a woman with an animal (bestiality).