• ARTICLE_TITLE


    By F. Zuben. Western International University. 2018.

    Decreased serum total choles- terol concentration is associated with high intake of soy products in Japanese men and women cheap 20 mg cialis soft fast delivery. Low-fat diets do not lower plasma choles- terol levels in healthy men compared to high-fat diets with similar fatty acid composition at constant caloric intake cialis soft 20 mg amex. The effect of dietary docosahexaenoic acid on plasma lipoproteins and tissue fatty acid com- position in humans. The effect of dietary docosahexaenoic acid on platelet function, platelet fatty acid composi- tion, and blood coagulation in humans. Problems with the report of the Expert Panel on blood cholesterol levels in children and adolescents. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Nutritional quality of a high carbohydrate diet as consumed by children: The Bogalusa Heart Study. Niinikoski H, Viikari J, Rönnemaa T, Lapinleimu H, Jokinen E, Salo P, Seppänen R, Leino A, Tuominen J, Välimäki I, Simell O. Prospective randomized trial of low-saturated-fat, low-cholesterol diet during the first 3 years of life. Niinikoski H, Lapinleimu H, Viikari J, Rönnemaa T, Jokinen E, Seppänen R, Terho P, Tuominen J, Välimäki I, Simell O. Growth until 3 years of age in a prospective, randomized trial of a diet with reduced saturated fat and choles- terol. Niinikoski H, Viikari J, Rönnemaa T, Helenius H, Jokinen E, Lapinleimu H, Routi T, Lagström H, Seppänen R, Välimäki I, Simell O. Men who consume vegetable oils rich in monounsaturated fat: Their patterns and risk of prostate cancer (New Zealand). Energy intake and physical activity in relation to indexes of body fat: The National Heart, Lung, and Blood Institute Growth and Health Study. Effects of inherent respon- siveness to diet and day-to-day diet variation on plasma lipoprotein concentra- tions. Calcium and magnesium absorption from the colon and rectum are increased in rats fed fructooligosaccharides. Fish consumption and coronary heart disease mortality in Finland, Italy, and the Netherlands. Dietary conjugated linoleic acids increase lean tissue and decrease fat deposition in growing pigs. The antioxidant/anticancer potential of phenolic compounds isolated from olive oil. A high-monounsaturated-fat/low-carbohydrate diet improves periph- eral insulin sensitivity in non-insulin-dependent diabetic patients. Evidence that the trans-10,cis-12 isomer of conjugated linoleic acid induces body composition changes in mice. Rela- tionship of dietary saturated fatty acids and body habitus to serum insulin concentrations: The Normative Aging Study. Lipoprotein con- centrations in normolipidemic males consuming oleic acid-rich diets from two different sources: Olive oil and oleic acid-rich sunflower oil. Circulating levels of endothelial function are modulated by dietary monounsaturated fat. A Mediterranean and a high-carbohydrate diet improves glucose metabolism in healthy young persons. Impact of adopting lower-fat food choices on nutrient intake of American children. Role of life-style and dietary habits in risk of cancer among Seventh-Day Adventists. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men. Dietary manipulation and energy compensation: Does the intermittent use of low-fat items in the diet reduce total energy intake in free-feeding lean men? Effect of dietary manipulation on substrate flux and energy balance in obese women taking the appetite suppressant dexfenfluramine. Dietary supplementation of omega-3 polyunsaturated fatty acids improves insulin sensitivity in non-insulin-dependent diabetes.

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    Hypotension re- r Septicaemia is used to describe organisms multiplying sults from widespread induction of nitric oxide causing in blood causing symptoms order 20mg cialis soft mastercard. The systemic inflammatory response syndrome is de- r Septic shock refers to the presence of severe sepsis with fined as follows: r Temperature over 38˚C or less than 36˚C cialis soft 20 mg overnight delivery. Specific causes include Organ hypoperfusion may manifest as altered mental r direct introduction of bacteria into the blood stream state, lactic acidosis or oliguria. Full blood count, glucose, urea and r meningococcaemiafromarespiratorysourcemayalso electrolytes, liver function tests, arterial blood gases and result in sepsis with or without associated meningitis coagulation screen should be sent and repeated regularly (Neisseria meningitidis), until the patient is stable. Airway patency and oxygenation must be maintained and may require Pathophysiology theuseofanoropharyngealairwayorendotrachealin- The normal mechanisms involved in overcoming in- tubation. Blood pressure support involves aggressive fection become detrimental when the infection is fluid replacement via wide bore canulae with care- generalised. Septicaemia from the urinary tract should adrenaline, noradrenaline, dopamine or dobutamine be treated with a cephalosporin and gentamicin. Pseudomonas infection is suspected piperacillin or r Identification and management of underlying causes ciprofloxacin are effective. Septicaemia originating in skin and soft tis- sue infections requires flucloxacillin and benzylpeni- Prognosis cillin. Cardiovascular system 2 Clinical, 23 Cardiac failure, 61 Hypertension and vascular Ischaemic heart disease, 32 Disorders of pericardium, diseases, 73 Rheumatic fever and valve myocardium and Congenital heart disease, 84 disease, 40 endocardium, 65 Cardiovascular oncology, 88 Cardiac arrhythmias, 48 r The pain of chronic stable angina is brought on by Clinical exercise or emotion, and it is usually relieved within 2–3minutesbyrestandrelaxation. Chest pain can arise from the cardiovascular system, the r Angina that occurs at rest or is provoked more easily respiratory system, the oesophagus or the musculoskele- than usual for the patient is due to acute coronary syn- tal system. In acute coronary syndrome it is not possible to dif- Enquire about chest pain ask about the site, nature ferentiate angina from myocardial infarction without (constricting, sharp, burning, tearing), radiation, pre- further investigations. Features suggestive of myocardial infarction r Site rather than angina include pain, which lasts longer r Onset than 30 minutes, associated symptoms due to the re- r Character lease of catecholamines including sweating, dizziness, r Radiation nausea and vomiting. Some patients describe a feeling r Alleviating factors of impending doom (angor animi). It is a ret- r Exacerbating factors rosternal or epigastric pain that radiates to the neck, r Symptoms associated with the pain back or upper abdomen. The pain is usually altered in Ischaemic heart pain is classically a central aching chest severity in relation to posture, typically exacerbated by pain, often described as a tightness or heaviness, con- deep inspiration or lying flat and relieved by leaning for- stricting or crushing in nature, radiating into the arms wards. The pain of pericarditis may last days or even 2–3 (particularly the left) and jaw. Its onset is abrupt and of greatest intensity at the and may hang their legs over the side of the bed or go time of onset. Chest pain associated with tenderness is suggestive of r Cheyne–Stokes respiration is alternate cyclical hy- musculoskeletal pain. Oesophageal pain is a ret- failure, in some normal individuals (often elderly), in rosternal sensation often related to eating and may be patients with cerebrovascular disease and patients re- associated with dysphagia. It is thought that this pattern retrosternal burning pain, often exacerbated by bending of breathing results from depression of the respiratory forwards. Equally,painarisingfromstructures r Patients with severe acute left ventricular failure often in the chest may present as abdominal pain, e. Dyspnoea However, the major causes of frank haemoptysis are from the respiratory system. In general dyspnoea arises from either the respiratory or cardio- vascular system and it is often difficult to distinguish Palpitations between them. The patient may notice it on strenuous ‘a missed beat’, or their heart beating irregularly. In severe failure, patients are breath- rate and rhythm (ask the patient to tap out the beat with less at rest. Associated symptoms may include breath- pnoea an underlying cause should be sought, such as lessness, dizziness, syncope and/or chest pain. This symptom normally arises when a patient’s exer- r Palpitations lasting just a few seconds are often due cise tolerance is already reduced. The patient becomes aware of the mechanisms are responsible for this phenomenon: a pause that occurs in the normal rhythm after a prema- redistribution of fluid through gravity in the lungs ture beat and may sense the following stronger beat.

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    Dressler’s syndrome is an immune- Pulmonary hypertension 20 mg cialis soft for sale, right ventricular failure and mediated pericarditis occurring between 1 month and the chest disease together produce the clinical picture generic 20mg cialis soft with mastercard. Pathophysiology During acute pericarditis the pericardium is inflamed Management and covered in fibrin causing a loss of smoothness and r Heart failure should be treated and the underlying an audible friction rub on auscultation. Sharp substernal pain with radiation to the neck and r Long-termoxygentherapyhasbeenshowntoimprove shouldersandsometimestheback. Characteristicallythe prognosis in hypoxic chronic obstructive airways dis- pain is relieved by sitting forward and made worse by ly- ease but must be maintained for >18 hours per day. A pericardial 66 Chapter 2: Cardiovascular system friction rub is pathognomonic but may be transient, best Aetiology heard at the left sternal edge accentuated by leaning for- Haemopericardium, tuberculous pericarditis and acute ward and held expiration. Complications Pericarditis is often complicated by pericardial effusion Pathophysiology and occasionally tamponade. Where there is an associ- Chronicinflammation,orhealingafteracutepericarditis atedmyocarditis,featuresofheartfailuremaybepresent. This surrounds and constricts the ventricles Macroscopy/microscopy such that the heart cannot fill properly, hence causing a An acute inflammatory reaction with both pericardial reductionincardiac output. Auscultation reveals soft S1 and S2 echocardiogram, viral titres and blood cultures. Investigations r Chest X-ray is frequently normal but may show a rel- Management atively small heart. There may be a shell of calcified Analgesia and anti-inflammatory treatment with aspirin pericardium particularly on the lateral film. However, it may be normal even in the pres- Most cases of acute pericarditis, particularly of viral ori- ence of the disease. Constrictive pericarditis Definition Management Acondition in which reduced elasticity of the peri- Medical intervention is of little value except for digoxin cardium results in poor cardiac output. The treatment of choice is Chapter 2: Disorders of pericardium, myocardium and endocardium 67 surgical removal of a substantial proportion of the peri- ment, but follow-up observation is mandatory to iden- cardium (pericardectomy). In cases of recurrent Prognosis effusion, surgical treatment with a pericardial window The majority of patients respond well to surgery. Cardiac tamponade Definition Pericardial effusion Pericardial/cardiac tamponade is an acute condition in which fluid in the pericardial sac causes impaired ven- Definition tricular filling. It Almostanycauseofacutepericarditisinducestheforma- may occur with other causes of pericarditis and effusion tion of an exudate. A pericardial transudate may occur and also as a post-traumatic complication following car- as a result of cardiac failure. Pathophysiology Fluid accumulating within the closed pericardium may reduce ventricular filling and hence cause compromise Pathophysiology of the cardiac output (cardiac tamponade). Once the space between the pericardium and the heart becomes full of fluid the ventricles are prevented Clinical features from filling properly during diastole thus reducing the Heart sounds are soft and apex beat is difficult to pal- cardiac output. If the effusion accumulates quickly, features of low cardiac output failure usually appear. Slow accumula- tion of fluid is often well tolerated until very large due to Clinical features distension of the pericardial sac. The pulse is of low volume and reduced on inspi- r Chest X-ray often shows an enlarged globular heart, ration (pulsus paradoxus). Oliguria or anuria develops which may have very clear borders (because cardiac rapidly and eventually there is hypotension and shock. If the tamponade is haemodynamically compromising the Management diagnosis may have to be clinical, but ideally an echocar- This is determined by the size and haemodynamic ef- diogram is done immediately on suspicion. The relief following pericardiocentesis is often Management temporary, so a fine catheter should be inserted for con- Bed rest and eradication of the acute infection, i. Prognosis Disorders of the myocardium Depending on the aetiology the prognosis is usually good,althoughachroniccardiomyopathymayoccasion- Myocarditis ally result. Definition An acute or chronic inflammatory disorder of the my- Cardiomyopathies ocardium. These are diseases of the heart muscle, which may be primary (intrinsic to myocardium) or secondary (due Aetiology to an external or systemic cause). Myocarditis is often a feature of a systemic infection but r Primary cardiomyopathies include dilated cardiomy- occasionally septicaemia may lead to focal suppurative opathy, hypertrophic cardiomyopathy and restrictive lesions. Protozoa: Trypanosoma cruzi (Chagas’ disease), Toxo- r Secondary cardiomyopathies occur when ventricular plasma gondii. Dilated cardiomyopathy Clinical features Myocarditis is an acute illness characterised by fever and Definition cardiac failure.

    At this point in time purchase 20 mg cialis soft visa, we need to stop examining and picking apart therapies that have hundreds buy 20 mg cialis soft amex, and in some cases, thousands of years of practical experience behind them. We already know that traditional natural therapies like herbal medicines, urine therapy and homeopathy work, and many are still widely used in other civilized countries. Chinese hospitals and doctors even today largely depend on their traditional natural herbal medicine and acupuncture; England has homeopathic hospitals; Germans rely heavily on their herbal medicines which are even available in their drugstores. In France, too, pharmacies carry and doctors prescribe natural homeopathic and herbal medicines in addition to synthetic drugs. There are a wonderful variety of alternatives to invasive and synthetic medicine that have been proven to be safe and effective over centuries of use and observations, we just have to relearn the art of using them and cure ourselves of our dependency on drugs and surgery. The challenge of achieving and maintaining good health is in creating a balanced lifestyle and in finding the combination of natural treatments and remedies that are right for you individually. Even though there have been amazing scientific discoveries about the medical use of urine, medical researchers, for the most part, do not tell the public about their discoveries. So the urologists, for instance, who discovered that urine can prevent and heal urinary tract infections might publish their findings for other urologists, but a doctor in general practice would probably not come in contact with these studies on the importance of urine in bladder or kidney infections. The public and most practicing doctors today consider urine to be nothing more than a body waste. But many medical researchers know that in reality, urine is an enormously comprehensive and powerful medical substance. The research studies and articles selected for this chapter are each nurnbered and presented in chronological order to present a broad overview of how consistently and intensively urine has been researched during the twentieth century. More About Urea As an added note, many of these research studies were done using the urine extract, urea, which is the primary organic solid of urine. The body eliminates excess nitrogen which is produced during protein metabolism in the form of urea. Urea is also used by the body to help in the mechanism which determines how concentrated the urine is, or in other words, how much water is excreted from the blood. Urea was discovered centuries ago, in 1773, when it was 69 first separated from urine; later, in 1828, natural urea was synthesized or chemically "copied" in the laboratory. The discovery of urea was one of the most important events of modem chemistry and biochemistry because it was the first organic compound to be separated in a relatively pure state. For this reason, chemists have been fascinated for years by urea and its amazing and diverse applications in the fields of science and medicine: "More scientific papers have probably been published on urea than on any other organic compound. People who have heard of the term "uremia", or uremic poisoning, often assume that urea itself is toxic and is therefore excreted in the urine. Excess urea becomes toxic to the body only when the filtering mechanisms of the kidneys are damaged or impaired, and the urea level of the blood is not properly regulated But in this case, excessive amounts of other benign substances like wáter and sodium become toxic also if the kidney is unable to regulate them in the blood. However, as wonderful as urea has proven to be in medicine, I want to stress that it cannot and should not be used to replace or supersede natural urine as a healing agent. As the research in this chapter proves, whole urine contains hundreds of known and unknown medically important elements that clearly and definitively are not found in urea alone. These elements in whole urine are not found in either natural or synthetic urea alone. For instance, if you have an allergic reaction to wheat, your body produces a complex of antibodies to deal with the allergy and those antibodies are found in your urine. Medical studies have demonstrated that when you reintroduce these urine antibodies into your system by ingesting or injecting your own urine, that the allergy can be corrected. You could be exposed to polio, for example or tuberculosis and not even realize it until acute symptoms appear – but, as medical research has proven, your urine can contain antibodies to those diseases even if acute symptoms are not appearing. So regular use of urine therapy can most definitely provide extremely comprehensive therapeutic treatment that goes far beyond urea or other medicines. This is not to say that other therapies are not useful and effective, they are, of course, but urine therapy, correctly applied, should be the foundation for our health regimens and medical treatments and should definitely be used routinely in illness and preventive health care. Doctors tried frantically but unsuccessfully to diagnose her condition but she deteriorated and died several days later. This is a good example of why urine and urea therapy should be incorporated into all types of medicine. In the first place, urea itself has been scientifically proven to dissolve or destroy the rabies virus, so it could most definitely have aided this little girl. And the real tragedy is that there is absolutely no downside risk here – absolutely none!. As hundreds of people have experienced, and as research has shown, urine is undoubtedly an amazing natural medicine that can give you health benefits beyond any other natural or chemical substance in existence.

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