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All patients showed significant improvement between 3 months to one year of treatment generic kamagra 100 mg amex erectile dysfunction doctors huntsville al. The last patient revealed fall and rise phenomenon in bacillary load on direct smear examination kamagra 100mg fast delivery erectile dysfunction radiation treatment. They may even find place as alternative to extremely expensive drugs like macrolides and beta-lactam antibiotics order kamagra 100mg free shipping erectile dysfunction at the age of 25. On human subjects the fresh leaves showed no purgative action unless heat-treated by boiling otherwise. It caused purgation in 1-2 hours, with maximum effect within 3-6 hours and no effect after 12 hours following the injection. Preparations of various tincture forms to withstand storage were tested and it was observed that there was no marked difference in potency between that from the fresh leaves and that from the partially dried leaves. Administered together with meal it was found to be significantly more effective (p<0. May Aye Than; Mu Mu Sein Myint; Aye Than; Myint Thuzar Thant; Thandar Myint; Tin Nu Swe. Majority of Myanmar national people lived in rural areas and have been using traditional medicinal plants for hundred of years. Many people have used some medicinal plants, which claimed to have purgative activity, as crude drugs or as traditional medicine formulations. The study was a controlled, complete cross-over single dose design using magnesium sulphate and phenolphthalein as positive standard. Pway-mezali fresh leaves 4g which was just heated for few seconds for softening, magnesium sulphate 1 teaspoonful, and phenolphthalein 0. Pway-mezali fresh leaves showed no significant different efficacy on frequency, volume and onset when compared to phenolphthalein. It was also found that the onset time of action of Pway-mezali and phenolpthalein is prolonging than magnesium sulphate due to the different mechanism of action. Role of Say-tha-gya plant, Stevia rebaudiana cultivated in Shan State, Myanmar: Either as dietary sugar substitute or hypoglycemic agent for diabetics. Nwe Nwe Yee; Group from Central Committee for Drug Abuse Control; Htun Naing Oo; Mu Mu Sein Myint; Moh Moh Htet Kyaw; Khin Tar Yar Myint; Yin Yin Aye; Zaw Naing Win. A composite plant Stevia rebaudiana (Bertono) Bertoni, Say-tha-gya (Sweet herb) has been cultivated in Shan State, Myanmar as “Stevia-Poppy Substitution Project” since September, 2002. Aqueous extract of that plant clutivated in Myanmar, 3g/kg was tested on normal and adrenalin induced hyperglycemic rabbits for its effect on blood glucose levels. Acute toxicity test was performed on mice at different doses: 1g/kg, 2g/kg, 3g/kg and 4g/kg. After oral administration, blood glucose levels did not rise in normal rabbits after 1, 2, 3, 4 and 24hr (p<0. Chemical constituents were analyzed qualitatively and thin layer chromatogram and ultraviolet spectrum of the extract were taken. Cultivation of this plant may highly benefit our nation as a natural source of non-sugar sweetener. The role of traditional medicine in the treatment of multidrug-resistant pulmonary tuberculosis, Myanmar. Plants showing satisfactory efficacy were further subjected to phyto- chemical characterization and acute and sub-acute toxicity testing before having approval from the National Ethical Committee, Department of Medical Research (Lower Myanmar). Acute and sub-acute toxicity tests in mice and rats showed no significant abnormalities in biochemical, haematological and histopathological changes in both the control and the test groups. A dose-finding study was conducted, starting from the minimal dose used by traditional practitioners, and slowly increasing it to its maximum tolerable level. All plant extracts were found to be well tolerated and all patients showed significant improvement after three to 12 months of treatment. Amoebiasis is an invasive disease of the caecum and large intestine, and affects mainly the low socio-economic groups living under crowded, poor hygienic conditions. Because of low cost, safety and easy availability, herbal remedies, like Kywe-kyaung-min- say (Euphobia harta Linn. The study tested the effect of crude 50% ethanolic extract of Euphobia hirta on the Caecum amoebiasis induced in mice by E. The ethanolic extract, in serial dilutions of 3, 6 and 9g/kg of Euphobia hirta, were administered daily for 3 consecutive days, to 3 groups of mice infected with E. On the fourth day, the mice were sacrificed and the reduction in caecal wall ulceration was compared with a negative control group of non-infected mice and a positive control group of infected mice receiveing metronidazole (78mg/day). Marked antiamoebic activity of Euphobia hirta was seen as reduction of ceacal wall ulceration in mice treated by the extract and metronidazole when compared to the control animals. The remaining 2 doses of 3 and 6g/kg extract still showed 20- 25% effectiveness in treated mice. Screening, isolation and charaterization of natural antioxidants from Myanmar medicinal plants: Thea sinensis Linn. Chromatographic separation of chloroform extract yielded three curcuminoids, namely curcumin (6%), demethoxycurcumin (0. Thus, from the observation, it is found out that, “catechin” have strong potential to be used as “natural anti-aging substances” for men, and in food industry, they may be employed as “natural antioxidant additives” in place of “synthetic antioxidant additives” 355. Screening of diuretic activity of medicinal plant extracts on in vivo animal model. Mu Mu Sein Myint; Aye Than; Aye Aye Thein; Win Win Maw; Kyi Kyi Myint; San San Myint. Eight Myanmar medicinal plants which are reputed for use in the treatment of urinary ailments and which had never been tested before were selected. Out of eight plants tested five plants were found to have diuretic activity in albino rats. Screening of five Myanmar medicinal plants for hypoglycemic activity on rabbit model. May Aye Than; Mu Mu Sein Myint; Aye Than; Mar Lar Than; Kyi Kyi Myint; San San Myint; Thazin Myint; Win Win Maw; Wai Lwin Oo. The aim of this study was to reveal scientific proof on hypoglycemic properties of reputed Myanmar medicinal plants, usually claimed to be effective for diabetes mellitus in Myanmar traditional medicine system. A complete cross-over experimental study of hypoglycemic activity was tested on glucose-loaded hyperglycemic rabbit model. The blood glucose levels were determined at 0, 2, 3, 4 hours after administration of extracts and powder of plants. Among the plants tested, only Pe-natha-seet was observed that the blood glucose level of glucose loaded control group were 238. It was found that the Pe-natha-seet powder only significantly lowered the blood glucose levels at 2hr (p <0. Ye Htut; Kyin Hla Aye; San San Htwe; Myint Lwin; Myint Oo; Win Myint; Tin Ko Ko Oo; Khin Myo Aye; Ni Ni.

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Adjunct to bile-acid treatment for gall-stone dissolution: low-dose chenodeoxycholic acid combined with a terpene preparation purchase kamagra 50mg without a prescription erectile dysfunction medication covered by insurance. Pilot study of combination treatment for gall stones with medium dose chenodeoxycholic acid and a terpene preparation order 50mg kamagra amex erectile dysfunction 47 years old. Changes in the content and composition of collagen in the glaucomatous eye—basis for a new hypothesis for the genesis of chronic open-angle glaucoma purchase kamagra online pills impotence medication. Regional differences in the structure of the lamina cribrosa and their relation to glaucomatous optic nerve damage. Further contributions on the value of osmotic substances as means to reduce intra-ocular pressure. Clinical evaluation of glycerin-sodium ascorbate solution in lowering intraocular pressure. Effects of Mirtogenol on ocular blood flow and intraocular hypertension in asymptomatic subjects. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. The effect of oral magnesium therapy on visual field and ocular blood flow in normotensive glaucoma. The effects of mild, moderate, and severe exercise on intraocular pressure in glaucoma patients. Effect of bicycle ergometer test on intraocular pressure in elderly athletes and controls. Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Inhibitory action of quercetin on xanthine oxidase and xanthine dehydrogenase activity. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia, 1991–1992. Department of Orthopaedics, Kovai Medical Center and Hospitals, Coimbatore, India, 1995. Glutathione, glutathione S-transferase and reactive oxygen species of human scalp sebaceous glands in male pattern baldness. Effect of oral intake of choline-stabilized orthosilicic acid on hair tensile strength and morphology in women with fine hair. Specific immunotherapy for allergic rhinitis to grass and tree pollens in daily medical practice—symptom load with sublingual immunotherapy compared to subcutaneous immunotherapy. Daily quercetin supplementation dose-dependently increases plasma quercetin concentrations in healthy humans. The variable plasma quercetin response to 12-week quercetin supplementation in humans. Effect of enzymatically modified isoquercitrin, a flavonoid, on symptoms of Japanese cedar pollinosis: a randomized double-blind placebo-controlled trial. Preventative effect of a flavonoid, enzymatically modified isoquercitrin on ocular symptoms of Japanese cedar pollinosis. Clinical effects of apple polyphenols on persistent allergic rhinitis: a randomized double-blind placebo-controlled parallel arm study. Journal of Investigative Allergology and Clinical Immunology 2006; 16(5): 283–289. The effectiveness of physiotherapy and manipulation in patients with tension- type headache: a systematic review. A school-based, nurse-administered relaxation training for children with chronic tension-type headache. Relaxation treatment of adolescent headache sufferers: results from a school-based replication series. Magnesium as a preventive treatment for paediatric episodic tension-type headache: results at 1-year follow-up. Magnesium as a treatment for paediatric tension-type headache: a clinical replication series. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. Use of intravenous magnesium to treat acute onset atrial fibrillation: a meta-analysis. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. Acute attack of hemorrhoids: efficacy of Cyclo 3 Fort based on results in 124 cases reported by specialists. A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine. The method of determining proper doses of vitamin C for the treatment of disease by titrating to bowel tolerance. Observations on the dose of administration of ascorbic acid when employed beyond the range of a vitamin in human pathology. Treatment of hepatitis with infusions of ascorbic acid: comparison with other therapies. Virucidal activity of vitamin C: vitamin C for prevention and treatment of viral diseases. In Proceedings of the First Intersectional Congress of the International Association of the Microbiological Society, vol. Selenium, glutathione and glutathione peroxidases in blood of patients with chronic liver diseases. Acquired tolerance of hepatocellular carcinoma cells to selenium deficiency: a selective survival mechanism? Oxidative stress in chronic hepatitis C: not just a feature of late stage disease. Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Combination of alpha lipoic acid (thioctic acid), silymarin, and selenium: three case histories. Vitamin D: an innate antiviral agent suppressing hepatitis C virus in human hepatocytes. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C. Effects of glycyrrhizin on biochemical tests in patients with chronic hepatitis—double blind trial. Pharmacokinetics of silybin in bile following administration of silipide and silymarin in cholecystectomy patients. Pharmacokinetic studies on IdB 1016, a silybin-phosphatidylcholine complex, in healthy human subjects. Randomized open study of the dose-effect relationship of a short course of IdB 1016 in patients with viral or alcoholic hepatitis.

Cigarette burns buy kamagra 100 mg mastercard erectile dysfunction 47 years old, usually seen as discrete circular areas of reddish-yellow kamagra 100mg on line erectile dysfunction treatment bangalore, parchmented skin 50 mg kamagra otc erectile dysfunction treatment definition, are also quite common. Patterned injuries resulting from being struck with the butt of a gun or tramline bruising owing to blows with a truncheon or baseball bat may be seen; in Northern Ireland, shooting through the lower limbs (“knee-capping”) is a favored method of punishment by para- military organizations. Systematic torture by security personnel, usually during interrogation of suspects, ranges from the subtle use of threats and intimidation to physical violence. Hooding, prolonged standing, and the use of high-pitched sound have all been used, as have attempts to disorientate prisoners by offering food at erratic times, frequent waking up after short intervals of sleep, and burning a light in the cell 24 hours a day. Physical abuse includes beating of the soles of the feet, so-called falanga, which, although extremely painful and debilitating, does not usually cause any significant bruising. Repeated dipping of the victim’s head under water, known as submarining, may prove fatal if prolonged, as can the induction of partial asphyxia by enveloping the head in a plastic bag. Electric torture is well documented and carries the risk of local electric shocks and fatal electrocution. Telefono, as it is known in Latin America, con- sists of repeated slapping of the sides of the head by the open palms, resulting in tympanic membrane rupture. Doctors who have access to prisoners in custody have a heavy responsi- bility to ensure that they are properly treated during detention and interroga- tion. In all cases of suspected or alleged ill-treatment of prisoners, it is essential that the doctor carry out a methodical and detailed “head-to-toe” examina- tion. All injuries and marks must be accurately recorded and photographed, and the appropriate authorities must be informed immediately. Increasingly, forensic physicians are involved in assessments of refugees and asylum seek- ers to establish whether accounts of torture (both physical and psychologi- cal) are true. This role is likely to expand in the future, and the principles of independent assessment, documentation, and interpretation are, as with other 150 Payne-James et al. Introduction The term bite mark has been described as “a mark caused by the teeth alone, or teeth in combination with other mouth parts” (10). Recog- nition, recording, analysis, and interpretation of these injuries are the most intriguing challenges in forensic dentistry. Biting can establish that there has been contact between two people—the teeth being used for offense or defense. When individual tooth characteristics and traits are present in the dentition of the biter and are recorded in the biting injury, the forensic significance of the bite mark is greatly increased. Early involvement of the forensically trained dentist, with experience in biting injuries, is essential to ensure that all dental evidence from both the victim and any potential suspect(s) is appropriately collected, preserved, and evaluated. There may be insufficient evidence to enable comparisons to be made with the biting edges of the teeth of any par- ticular person, but, if the injury can be identified as a human bite mark, it may still be significant to the investigation. It is important that the forensic dentist discusses with investigators the evidential value of the bite mark to enable resources to be wisely used. Clearly, conclusions and opinions expressed by the forensic dentist often lead him or her into the role of the expert witness subject to rigorous examination in court. The forensic physician will mostly be involved with biting injuries to human skin and any secondary consequences, including infection and disease transmission, but should be aware that bites in foodstuffs and other materials may be present at a crime scene and be easily overlooked. It is essential that a human bite can be distinguished from an animal bite, thus exonerating (or incriminating) the dog or cat next door. The following sections will consider issues surrounding bites to human skin caused by another human. Early rec- ognition of a patterned injury (suspected of being caused by biting) by medi- cal personnel, social services, and other investigating agencies is extremely important; the injury may be the only physical evidence and must not be lost. Ideally, the forensic dentist should be contacted sooner rather than later when a possible biting injury is discovered to ensure that all evidence is collected appropriately. All too often the dentist is brought in at a later date, when there has been incorrect recording of the bite mark and the injury is partly healed and distorted or fully healed and no longer visible. Reliance may then have to be placed on ultraviolet photography to demonstrate the “lost” injury (11). Injury Assessment 151 Bites can be found on the victim or the assailant (living, deceased, child, or adult). It is well known that biting is often a feature in nonaccidental injury to children (see Chapter 5). If a bite mark is found on an anatomical site that is accessible to the victim, it becomes necessary to exclude him or her from the investigation. If the answer to the first question is “don’t know,” “possibly,” or “yes,” then request the assistance of the forensic dentist. Ensure that swabs are taken from the injured site (with controls) and photographs should be taken. Make sure that you know which forensic dentists are available in your area; this will prevent delays and frustration. You will need to know whether your local forensic dentist has experience and training in bite mark-analysis or whether he or she focuses mainly on identifications. The forensic dentist will examine the suspected biting injury and con- sider the following: • Whether the injury is oval or round. However, note that a mark from only one arch does not mean that it is not a biting injury. Characteristics, such as tooth size, shape, displacement, rotations, wear facets, etc. Differential Diagnosis It is important to remember that other injuries can mimic bite marks. The following have all been queried as biting injuries: • Dermatological conditions. In a single bite mark, one or any combination of several or all of these components may be present, and they may be discrete or superimposed. However, the complex situation may become even more complicated when there are multiple bite marks at a single location where they may overlap as a result of the biter trying to get a better “grip;” all this leads to interpretation difficulties. In attempting to get answers to these questions, a clearer picture of the incident may develop. Anatomical Distribution of Bitten Sites It can be seen from the anatomical distribution of the bite marks studied by the author (see Fig. This graph does not distinguish between male and female, child or adult, or whether there were multiple bites to one person, but serves purely to illustrate that it is essential for medical personnel to thoroughly examine the body for biting injuries and carefully document the findings. Record the anatomical location and nature of the injury and its size, shape, and color. In many cases, there are multiple bite marks on the body, some that the victim may not be aware of or recall. Mul- tiple bite marks on the body, produced by the same perpetrator, may vary Fig. Anatomical distribution of last 110 bite marks studied by the author (Hinchliffe). In short, do not jump to the conclusion that there are multiple biters or vice-versa. Nor should it be assumed that a small biting injury has been caused by a child; it may be an incomplete adult bite. If the marks on the skin can be identified as being made by the smaller deciduous (baby) teeth, it would suggest the mark has been inflicted by a young child.

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Lieb adds buy kamagra no prescription erectile dysfunction 17, "Tests have been made of the effect of personality disturbances on convalescence: one hospital showed that the average duration of hospitalization was increased by forty per cent from this cause cheap 100mg kamagra otc erectile dysfunction and injections. Is our Success Mechanism a sort of built-in youth serum which we can use for more life purchase cheapest kamagra and kamagra sudden onset erectile dysfunction causes, more energy? Placebos, or "sugar pills" (capsules containing inert ingredients) have long been a medical mystery. Yet, when placebos are given to a control group in order to test the effectiveness bf a new drug, the group receiving the phony pills nearly always shows some improvement, and quite often as much as the group receiving the medicine. In 1946 the New York Journal of Medicine carried an account of a round-table discussion of placebos by mem- bers of the Department of Pharmacology and Medicine of Cornell University Medical College. Group 2 received sugar pills, and only 13 per cent suffered from seasickness, while 30 per cent of Group 3, which received nothing, got sick. Many doctors now believe that a similar type of "sug- gestive treatment" is the best form of therapy for warts. The warts are painted with methalene blue, red ink, or any other color, and a colored light is used to "treat" them. The Journal of the American Medical Association has said, "The facts of the suggestive therapy of warts seem to make a strong case in favor of the reality of such a process. They believe they are receiving legitimate medi- cine which will "bring about a cure. We may do something very similar, but in reverse, when we unconsciously "expect to get old" at a certain age. It is a matter of common observation that some people between the ages of 40 and 50 begin to both look and act "old," while others continue to act and look "young. At least two ways suggest themselves as to how we may think ourselves into old age. In expecting to grow "old" at a given age we may unconsciously set up a negative goal image for our creative mechanism to accomplish. Or, in expecting "old age" and fearing its onset, we may unwit- tingly do those very things necessary to bring it about. Cutting out practically all vigorous physical activity, we tend to lose some of the flexibility of our joints. Lack of exercise causes our capillaries to constrict and virtually disappear, and the supply of life-giving blood through our tissues is drastically curtailed. Vigorous exercise is necessary to dilate the capillaries which feed all body tis- sues and remove waste products. For some unknown reason bio- logically new and "young" cells form inside this tube. Selye suggests that this may be the mechanism of aging, and that if so, "old age" can be postponed by slowing down the rate of waste production, or by help- ing the system to get rid of waste. In the human body the capillaries are the channels through which waste is removed. It has definitely been established that lack of exercise and inactivity literally "dries up" the capillaries. Activity Means Life When we decide to curtail mental and social activities, we stultify ourselves. If you could induce him to sit in a rock- ing chair all day, give up all his dreams for the future, give up all interest in new ideas, and regard himself as "washed up," "worthless," unimportant and non-produc- tive, I am sure that you could experimentally create an old man. John Schindler, in his famous book, How to Live 365 Days a Year (Prentice-Hall, Inc. I believe that life itself is adaptive; that life is not just an end in itself, but a means to an end. Life is one of the "means" we are privileged to use in various ways to achieve important goals. We can see this principle operat- ing in all forms of life, from the amoeba to man. The polar bear, for example, needs a thick fur coat in order to survive in a cold environment. The life force acts as a "means" to these ends, and provides the polar bear with his white fur coat. These adaptations of life to deal with problems in the environment are almost in- finite, and there is no point in continuing to enumerate them. If life adapts itself in so many varied forms to act as a means toward an end, is it not reasonable to assume that if we place ourselves in the sort of goal-situation where more life is needed, that we will receive more life? If we think of man as a goal-striver, we can think of adaptation energy or Life Force as the propelling fuel or energy which drives him forward toward his goal. I believe that we establish this need by looking forward to the future with joy and anticipation, when we expect to enjoy tomorrow, and above all, when we have something important (to us) to do and somewhere to go. As a group, creative workers—research scientists, inven- tors, painters, writers, philosophers not only live longer, but remain productive longer than non-creative workers. Develop an enthusiasm for life, create a need for more life, and you will receive more life. Have you ever wondered why so many actors and actresses manage to look far younger than their years, and present a youthful appearance at age 50 and beyond? Could it not be that these people have a need to look young, that they are interested in maintaining their appearance, and simply do not give up the goal of stay- ing young, as most of us do when we reach the middle years? If the widow feels that her life has come to an end and she has nothing to live for, her attitude gives "outward evidence—in her gradual withering, her graying hair. She may enter into the competi- tion for a new husband, or she may embark on a career in business, or she may do no more than busy herself with an interest for which perhaps she has not had the leisure until now. Futility, pessimism, frus- tration, living in the past, are not only characteristic of "old age"; they contribute to it. Retire from a Job, But Never Retire from Life Many men go down hill rapidly after retirement. They have nothing to look forward to; be- come bored, inactive—and often suffer a loss of self- esteem because they feel left out of things; not important anymore. It is the feeling of uselessness, of being washed up; the dampening of self-esteem, courage and self-confidence, which our present attitudes of society help to encourage. Outmoded and Disproved Medical Concepts Physiologists used to believe that any type of physical activity was harmful to the man over forty. We doctors are to blame as much as anyone for warning patients over 40 to "take it easy" and give up golf and other forms of exercise. Twenty years ago one famous writer even sug- gested that any man over forty should never stand when he could sit, never sit when he could lie down—in order to "conserve" his strength and energy. Or if you have been comparatively inactive for a long while, the suddenness of strenuous exertion may have a powerful stress effect, may be damaging and even fatal. So, if you are not used to strenuous exertion, let me warn you to "take it easy" and "take it gradually.

Severe dyspnea can also be caused by in- creased abdominal pressure (eg order kamagra us erectile dysfunction best treatment, mass discount kamagra master card erectile dysfunction lisinopril, ascites purchase kamagra with a mastercard impotence meaning, hepatomegaly), pneumonia and inhaled foreign bod- ies. Eye lesions, as described in gallinaceous birds, may be caused by hypovitaminosis A. Treatment Treatment of aspergillosis often depends on the loca- tion and extent of the lesion. Resolving advanced cases of aspergillosis is difficult, especially in anatomic areas where surgical removal of affected tissues is not possible. Correction of underlying stress factors is a mandatory component of successful therapy. Surgical debridement of plaques and granu- lomas should be employed when feasible. A severe granu- lomatous sinusitis occurred in an African Grey Par- rot following the accidental use of amphotericin B suspension rather than a solution as a nasal flush. Am- cleansing and disinfection of hatching equipment is photericin B is potentially nephrotoxic. Feed for companion and aviary birds should always be free of fungal growth in order to Flucytosine is also frequently used to treat aspergil- limit exposure to fungal pathogens and mycotoxins losis, especially in combination with amphotericin B (see Chapter 37). The advantage to this drug is that it can mycotin may be effective in reducing aspergillosis in be administered orally; however, bone marrow toxic- susceptible species such as captive penguins and ity has been reported in some cases. Cryptococcosis Some of the azole antifungals have good efficacy Cryptococcus neoformans is an imperfect, sapro- against aspergillosis in mammals and may be admin- phytic yeast that has been reported as a cause of istered orally. Ketoconazole has been used to success- 9,14,43 disease in psittacine birds and pigeons. This transmission and pathogenesis in birds is largely drug preparation has an advantage over other anti- 2,26,42,44,47,53 unknown, but it is isolated frequently from the drop- fungals in having a wide therapeutic index. In gallinaceous birds, cryptococcosis Current information suggests that itraconazole may has been described as a necrotic granulomatous dis- have greater efficacy against Aspergillus spp. An impression smear of any accessible ge- been used in waterfowl, shorebirds, poultry and pen- 15,54 latinous material may reveal the characteristic en- guins without serious side effects. A latex agglutination iting and depression have been reported in an Afri- 38 antibody titer may be elevated in an exposed or can Grey Parrot being treated with itraconazole. Enilconazole also has good efficacy against Central nervous system signs in birds with gelati- Aspergillus sp. Amphotericin B and ketoconazole have been psittacine birds have rarely been documented. Cryptococcosis is a potentially serious of gallinaceous species, and is associated with a zoonosis and may occur when humans inhale dust white crust on the comb and wattles (“fowl favus”) from the dried droppings of pigeons, starlings or (see Color 8). Respiratory signs, encephalitis or meningitis may occur; the outcome is frequently fections is usually made with cytologic evaluation of fatal. Treating cryptococcus cases should be carefully wet mounts or Gram’s-stained smears, culture (ca- considered given the zoonotic potential for this or- nine and feline dermatophyte media for in-hospital ganism. Topical treatment with antifungal creams is recom- mended, with attention to any underlying stress fac- Histoplasmosis tors. Trichophyton gallinae is a zoonotic disease and Histoplasmosis is similar to cryptococcosis in many has been described as a pruritic, scaly lesion of the scalp. Histo- plasma capsulatum is an infectious but not conta- Mucormycosis is a term that includes a variety of gious disease of the reticuloendothelial system. The6 lomas of the gut and ventriculus were found in a organism has been associated with or found in the group of canaries that were being fed sprouted seed; feces of chickens, blackbirds, pigeons and gulls. Surveys of aviary soil are bers of the phycomycetales (zygomycota) can some- needed to determine the incidence of this organism. Granulomatous inflammation involv- Diagnosis of histoplasmosis is based on culture of the ing the liver, myocardium and lung was associated organism (mycelial phase may sometimes be recov- 50 with Trichosporon beigelii. Penicillium griseo- ered on Sabouraud’s agar) and histopathology (peri- fulvum is another rare fungal isolate that caused a odic acid-Schiff, Bauer’s and Gridley stains). Nocardiosis (Nocardia asteroides) involving the lungs and air sacs of two Pesquet Parrots has been reported. It has been docu- Uncommon Fungal Diseases mented in ducks and geese but not in Psittaciformes or Passeriformes. It also occurs in man and the dog, and in most species it can take the form of an erythe- matous nasal polyp. Mycetomas in are of some interest to the avian practitioner because man are eruptions of the extremities that usually of their role in skin and feather abnormalities. Rahway, Merck & Co, 1991, cockatiel nestlings and mucormy- Assoc Avian Vet, 1990, pp 432-459. Vet Med Assoc 181(11):1389-1390, Clinical Avian Medicine and Sur- Today 2(4):202, 1988. Quesenberry K, et al: Roundtable dis- Vet Med Sm Anim Clin 78(2):249- and medicine. Proc Assoc Avian Vet, 1986, zoonoses: Proven and potential dis- in an African grey parrot. Parasitic life cycles may be direct or complex indirect cycles re- quiring various arthropod or animal hosts. Some species of parasites can infect nearly every organ system, although individual genera will inhabit spe- cific organs or tissues. For example, mature tape- 36 worms (Cestoda) and spiny-headed worms (Acantho- cephala) are restricted to the small intestines. Mature flukes (Trematoda) occur in the intestines, liver, kidney, air sacs, oviducts, blood vessels and on the surface of the eyes. Adult roundworms (Nema- toda) parasitize the crop, proventriculus, ventricu- lus, intestines, ceca, body cavities, brain, surface and periorbital tissues of the eyes, heart and subcutane- ous tissues. Sin- gle-celled organisms with discrete nuclei (Protozoa) may be found in the lumen of the intestinal tract, extracellularly in the blood or within cells of many tissues. Long-term symbiotic parasite-host relationships are usually characterized by benign infections compared with parasites that have been recently introduced to a new host. The fact that companion and aviary birds from widely varying geographic regions are combined creates an opportu- nity for exposure of a naive host to parasitic organ- isms that may cause few problems in their natural host. Parasites that are apathogenic in endemic avi- fauna can cause chronic disease or rapid death in unnatural hosts. Diagnostic stages of most avian parasites have infections are most common in birds that are recently not been matched to the adults of the same species imported or that have access to the ground. Some and thus characterization is usually limited to order parasites are host-specific, while others can infect a or superfamily. Free-ranging birds by cooperation among aviculturists, avian veteri- should be restricted from an aviary to prevent them narians and parasitologists. Parasitic prob- lems are best managed by designing facilities that restrict a bird’s access to infectious stages of a para- site and by practicing sound hygiene. Birds main- tained indoors or in suspended welded wire enclo- sures are unlikely to have parasites that have an Diagnosis of Parasites indirect transmission cycle.

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Concentrations of estrogen receptors are higher in fibroid tissue than in the surrounding tissue buy 100mg kamagra otc impotence treatment. In addition to an excess of estrogen production within the body purchase 50mg kamagra with visa impotence young men, a strong case can be made for the role of the most significant environmental factor assaulting female hormonal health—compounds known as xenoestrogens kamagra 100 mg for sale erectile dysfunction unable to ejaculate. These compounds are also known as endocrine or hormone disrupters, environmental estrogens, hormonally active agents, estrogenic substances, estrogenic xenobiotics, and bioactive chemicals. Examples of xenoestrogens include phthalates (used in plastics), pesticides, tobacco smoke by-products, and various solvents. Xenoestrogens enhance or block the effects of estrogen in the body by binding to estrogen receptors. They also promote a shift from healthy estrogen breakdown products to cancer-causing estrogen metabolites. Therapeutic Considerations Reducing the size as well as the symptoms of uterine fibroids with natural medicines is easily accomplished in most cases. Unfortunately, this statement is supported more by the clinical experiences of naturopathic physicians than by scientific evidence, though the approach is scientifically rational—that is, if uterine fibroids are caused by an excess of estrogen produced in the body as well as the effects of xenoestrogens, it makes sense that reducing estrogenic influences should shrink uterine fibroids. Keep in mind that as women pass through menopause there is less estrogen and so there will also be a tendency for the fibroid to shrink on its own. Diet The most important dietary recommendations are to eat a high-fiber diet rich in phytoestrogens (plant estrogens) and to avoid saturated fat, sugar, and caffeine. These simple changes can dramatically reduce circulating estrogen levels and reduce estrogen’s influence on the fibroid. One study looked at what happened when women switched from the standard American diet (40% of calories from fat; only 12 g fiber per day) to a healthier diet (25% of calories from fat; 40 g fiber). That’s a good thing, because when phytoestrogens occupy the receptors, estrogen can’t affect cells. By competing with estrogen, phytoestrogens cause a drop in estrogen effects, and are thus sometimes called antiestrogens. Great sources of phytoestrogens include soy and soy foods, ground flaxseed, and nuts and seeds. These dietary recommendations have extreme significance not only in treating uterine fibroids but also in reducing endometrial cancer. Women with uterine fibroids have a fourfold increase in the risk of endometrial cancer. In a case-control study of a multiethnic population (Japanese, white, Native Hawaiian, Filipino, and Chinese) examining the role of dietary soy, fiber, and related foods and nutrients in the risk of endometrial cancer, 332 women with endometrial cancer were compared with women in the general multiethnic population, and all women were interviewed by means of a dietary questionnaire. Similar reductions in risk were found for greater consumption of other sources of phytoestrogens, such as whole grains, vegetables, fruits, and seaweed. The researchers concluded that plant-based diets low in calories from fat, high in fiber, and rich in legumes (especially soybeans), whole grain foods, vegetables, and fruits reduce the risk of endometrial cancer. These dietary associations may explain at least in part the lower rates of uterine cancer in Asian countries than in the United States. Soy isoflavones appear to be selective in terms of the tissues in which they have an estrogenic effect and the tissues in which their effect is antiestrogenic. Soy phytoestrogens do not appear to have an estrogenic effect on the human uterus and may in fact help shrink uterine fibroids due to an antiestrogenic effect. We recommend moderate but not excessive soy consumption in the range of 45 to 90 mg soy isoflavones per day. See the chapter “Menopause” for more information on the isoflavone content of soy foods. Nutritional Supplements Historically, naturopaths have used lipotropic factors such as inositol and choline to support the healthy detoxification of estrogen. Lipotropic supplements usually are a combination of vitamins and herbs designed to support the liver’s function in removing fat, detoxifying the body’s wastes, detoxifying external harmful substances (pesticides, flame retardants, plastics, etc. These lipotropic products vary in their formulations depending on the manufacturer, but they are all similar and are meant for the same uses. Many now contain anticancer phytonutrients found in vegetables from the brassica family, such as indole-3-carbinol, di-indoylmethane, and sulforaphane. Research has shown that these compounds help to break down cancer-causing forms of estrogens to nontoxic forms, making them especially important for women with uterine fibroids. However, their activity is certainly less than the effects of dietary phytoestrogens such as soy and flax. Newer, nonsurgical techniques such as high-intensity focused ultrasound are also now available. In addition to causing physical discomfort and embarrassment, vaginitis is medically important for several reasons: (1) it may be a symptom of a more serious underlying problem, such as chronic inflammation of the cervix (cervicitis) or a sexually transmitted disease; (2) the infection may travel into the uterus and lead to pelvic inflammatory disease, a serious situation that can result in infertility due to scarring of the fallopian tubes; and (3) chronic vaginal infections are often the underlying cause of recurrent urinary tract infections because they serve as a reservoir of the infectious bacteria. Causes Vaginitis may be sexually transmitted or may arise from a disturbance to the delicate ecology of the healthy vagina. In many instances, vaginal infections involve an overgrowth of common organisms normally found in the vagina of many healthy women. In normal situations these microbes do not cause any problems, but when there is a disturbance in the vaginal environment a normally present microbe can overgrow and produce an infection. Factors influencing the vaginal environment include pH, tissue sugar (glycogen) content, blood sugar (glucose) level, presence of “friendly” organisms (particularly Lactobacillus acidophilus), natural flushing action of vaginal secretions, presence of blood (menstruation), spermicides and lubricants, and presence of antibodies and other compounds in the vaginal secretions. These factors are, in turn, affected by such things as low immune function as a result of nutritional deficiencies, medications (e. In fact, vaginal yeast infections are three times more prevalent in women wearing panty hose than those wearing cotton underwear. Approximately 90% of cases of vulvovaginitis will be associated with one of three organisms, Trichomonas vaginalis, Candida albicans, or Gardnerella vaginalis. The relative frequency of each form varies with the population studied, as well as with sexual activity levels. Less frequent causes of vaginitis include Neisseria gonorrhea, herpesvirus, and Chlamydia trachomatis. The preceding table summarizes the diagnostic differentiation of the most common causes of infectious vaginitis. Candida albicans The relative frequency and the total incidence of vaginal yeast infections (candidal vaginitis) have increased dramatically in the past 40 years. Several factors have contributed to this increased incidence, chief among them being the increased use of antibiotics. The problem with vaginal yeast infections as a result of antibiotic use is well known by virtually every woman. Most cases of recurrent candidal vaginitis are due either to transmission of candida from the gastrointestinal tract or to failure to recognize and treat the presence of one or more predisposing factors. Allergies have also been reported to cause recurrent candidiasis, which resolves when the allergies are treated. Candida vaginitis is often associated with the presence of a thick, curdy, or “cottage cheese” discharge, which may reveal pinpoint bleeding when removed. The presence of such a discharge is strong evidence of a yeast infection, but its absence does not rule out candida.