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Yet the author not merely mentions that men have these same disorders but (with the exception of two cases isoptin 120 mg on line, where the ther- apy is not differentiated) s/he provides full details of the differing treatments needed for men buy discount isoptin 240 mg on line. Moreover, there are two remedies exclusively for men: ¶ on swelling of the penis and lesions of the prepuce and ¶ on swollen tes- ticles. The inclusion of this material probably reflects more than the mere cate- gorical affinity of gynecological and andrological diseases. In his mid-twelfth- century compendium of medical practices, the Salernitan physician Johannes Platearius credited ‘‘Salernitan women’’ with a remedy for pustules of the penis very similar to that described in ¶. I will have more to say about the Salerni- tan women momentarily; here it should simply be noted that Platearius’s cita- tion suggests that it was not considered problematic for female practitioners to treat both men’s and women’s reproductive complaints. Copho is credited with the statement that sneezing can aid obstructed birth by rupturing the ‘‘cotyledons’’ (¶). He is also mentioned as the ‘‘author’’ of a special powder used for treatment of impetigo (a skin condition). Both place greatest stress on maintaining (or attempting to maintain) regular menstruation;171 both are concerned to remedy displacements and lesions of the uterus; both offer sug- gestions for aiding difficult childbirth. In this respect, it is quite understand- able that the two texts should have been brought together at the end of the twelfth century and ultimately ascribed to a single author (see below). While Conditions of Women is thor- oughly bookish, having little material beyond what the author has found in other tracts (which he readily admits in his prologue), Treatments for Women ranges more broadly, covering well over twice as many gynecological disease entities as its counterpart, not to mention its considerable material on cos- Introduction  metics and other topics. Despite their differences, both texts are equally rep- resentative of twelfth-century Salernitan medicine, though of two clearly dif- ferent varieties. While Conditions of Women embraces the new Arabic medicine and reflects the more learned, literate direction that Salernitan medical writing began to take in the early and middle decades of the twelfth century, Treat- ments of Women reflects an alternate, practical and probably largely oral tra- dition. It advocates a medicine that depends upon access to the international trade routes that brought into the Mediterranean basin spices and other ex- pensive substances like cloves and frankincense,172 and in its references to the treatments or theories of certain Salernitan masters it shows itself aware of a larger realm of medical discourse and practice. Yet on many other levels it is sui generis, independent of the growing theoretical and pharmaceutical sophisti- cation embraced by contemporary authors. There were, these texts suggest, at least two distinct subcultures of medicine in twelfth-century Salerno. The third of the three Trotula texts, On Women’s Cosmetics, reflects a point of intersection between them. Women’s Cosmetics Women’s Cosmetics does not participate in any theoretical system of explana- tion. Though often very detailed in its therapeutic prescriptions, listing down to the finest detail how to prepare this or that mixture, how to test when it is ready, and how to apply it, the text’s sole organizing principle is to arrange the recommended cosmetics in head-to-toe order. Then there are recipes forcare of the hair: for making it long and dark, thick and lovely, or soft and fine. For care of the face there are recipes for removing unwanted hair, whitening the skin, removing blemishes and abscesses, and exfoliating the skin, plus general facial creams. For the lips, there is a special unguent of honey to soften them, plus colorants to dye the lips and gums. For care of the teeth and prevention of bad breath, there are five different recipes. The final chapter is on hygiene of the genitalia: ‘‘There are some women who because of the magnitude of their instrument [i. The author gives detailed instructions on how to apply the water just  Introduction prior to intercourse, together with a powder that the woman is to rub on her chest, breasts, and genitalia. She is also to wash her partner’s genitals with a cloth sprinkled with the same sweet-smelling powder. It also employs a variety of mineral substances: orpiment (a compound of arsenic), quicklime, quicksilver, sulfur, natron, and white lead. White or rosy skin (or both together),177 black or blonde hair seem equally prized. As the figure of the bathing woman in a late-twelfth-century copy of a Salernitan pharmaceutical text shows (fig. One therapy the author even claims to have witnessed himself: ‘‘I saw a certain Saracen woman in Sicily curing infinite numbers of people [of mouth odor] with this medicine alone. What we have here in Women’s Cosmetics, it seems, is confirmation of Ibn Jubayr’s observation of Christian women’s adoption of Muslim cosmetic practices in Sicily. It was, in fact, precisely the Women’s Cosmetics author’s recognition of this demand for knowledge of cosmetics that (by his own account) induced him, a male physi- cian, to strengthen his account ‘‘with the rules of women whom I found to be practical in practicing the art of cosmetics. The portable cauldron is reminiscent of equip- ment in the bathhouse of the Salernitan monastery of Santa Sofia, while the covered box and bag no doubt hold unguents orcosmetics. Two Anglo- Norman writers of the twelfth century, Orderic Vitalis and Marie de France, each tell different stories of a Norman (or, in Marie’s case, possibly English) traveler journeying to Salerno and finding there a woman very learned in medi- cine. The necrology of the cathedral of Salerno lists a woman healer (medica) named Berdefolia,who died in . The motherof Pla- tearius (one of several members of a veritable medical dynasty of that name) is said to have cured a certain noblewoman of uterine suffocation. Moreover, sev- eral male medical writers of the twelfth century who either taught or studied at Salerno refer frequently to the medical practices of the mulieres Salernitane,the ‘‘Salernitan women.

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Some experts on lifestyle even discuss their own lifestyle in the pages of national newspapers generic isoptin 240 mg free shipping. Cancer statistics became available around the beginning of this century and the impression was gained that cancer was on the increase buy 120mg isoptin fast delivery. The causes were sought in lifestyle, particu- larly in drinking, smoking and meat consumption. Professor Richard Doll, in his early book on cancer prevention, published in 1967, was quite specific about what the causes of cancer were (though at that time he still did not use the term cause): Exposure of the skin to sunlight, the chewing of various mixtures of tobacco, betel, and lime, the smoking of tobacco, the consumption of alcohol, sexual intercourse, and lack of physical cleanliness are all, in one way or 33 another, related to the development of cancer. Surprisingly he did not mention diet, which since then, according to various experts, may be responsible for up to 80 per cent of all cancers, that is, all those not caused by smoking. As all cancers are caused by avoid- able activities, it is only a small step from saying that whoever gets cancer is himself or herself to blame. It is because of their unhealthy behaviour, that is, their misbehaviour, that they die. Athletics dont make anybody either long-lived or useful (George Santayana) This comment is appropriate from a philospher who died at the age of 99. In the past, sport used to be seen as a playful diversion, a purposeless activity, a pleasurable pastime of homo ludens. Doctors only became interested in physical exercise late in history, and then more often than not, were apprehensive about the dangers of exercise. Thus, in 1895, Professor Ger- main See, of Paris, after careful study concluded that children under 12 years of age should not ride bicycles, though after this age, moderate cycling could be recommended as a treat- ment for neurasthenia. Professor of mental and nervous dis- eases, G H Hammond, worried about abnormally developed thighs in habitual cyclists. Another worry was the effect of cycling on the pelvic organs, especially in women. In the New York Medical Record of 1895, Dr Theresa Bannan was of the opinion that The saddle is physically and morally injurious to women [as] the sensitive tissues are subjected to a pressure, the evil results of which cannot yet be estimated. Moreover, the impingement and vibration of the saddle can act as a 37 sexual excitant. Dr H Macnaughton-Jones saw several cases of women in whom cycling induced irregularity of the heart action, anae- mia and menstrual disturbances. The latest addition to this litany of woes appeared a few years ago in the Journal of the Royal Colleges of Physicians of London, describing six cases of malignant melanoma (five in women) in patients who used to cycle in 42 shorts when young. Even gentler forms of exercise, such as piano playing, did not escape medical censure. In the 1890s, piano playing was thought responsible for nervous hyperexcitability in girls. Out of 6,000 young girls examined in the Indian province of Goa, no fewer than 12 per cent were suffering from affections attribi|ted to piano playing. The Editor of the Provincial Medical Journal commented that such risks might not be worth running, considering that piano playing in young girls 43 rarely passed the mark of mediocrity. A Dr Hill studied the subject extensively and concluded that skating brought out latent predisposition to disease. Moralists, however, taught that physical fitness was a patri- otic duty and a duty to the race. Mass simultaneous gymnastic displays of tens of thousands of human ants were annual events in many communist countries to celebrate health, beauty and the victory of the working class over their oppressors. Physical fitness was important since it conferred military advantage, so the proponents claimed, while the country was in the throes of economic depression, malnutrition, and unemployment. The story of jogging is instructive, as it encapsulates much of the interplay between health concerns, morality, and poli- tics. Muriel Gillick showed that the roots of interest in physical fitness were initially military, with the National Committee on Physical Fitness established in 1943 within the Office of Defence, with the intention of improving the fitness of draf- 46 tees. But in the 1960s America needed more than fit draf- tees, they needed a spiritual renewal, a patriotic sense of strength, achievable by healthy diet and jogging, a new faith in a healthy future. The Complete Book of Running, by James Fixx, published in 1977 became a national best- seller, selling over a million copies. Fixx, having jogged for some 20 years, a 74 Lifestylism steady 10 miles a day, dropped dead on the jogging track in 1984 at the age of 52. In the same year, a Californian pathol- ogist and marathon runner, Thomas J Bessler, came up with the theory that marathon running provided complete immun- ity against atherosclerosis and coronary heart disease. This belief was rapidly adopted by the medical profession, and between 1973 and 1978, even patients after myocardial infarc- tion were encouraged to train for the marathon. Then reports started appearing in medical journals of marathon runners who died in their shoes, presumably of heart attacks. Cardiologists from Groote Schuur Hospital in Cape Town promptly provided the required evi- dence: five marathon runners who had died of coronary heart 48 disease at ages of 44, 41, 38, 36, and 27. The commonest cause of death among joggers and marathon runners is 49 coronary heart disease.

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Contra-indications buy generic isoptin 40mg, adverse effects order isoptin 240mg without prescription, precautions – Do not administer to patients with severe respiratory impairment or decompensated hepatic impairment. The child may develop withdrawal symptoms, respiratory depression and drowsiness when the mother receives morphine at the end of the 3rd trimester and during breast-feeding. In these situations, administer with caution, for a short period, at the lowest effective dose, and monitor the child. Nevertheless, vitamin supplementation helps to prevent some deficiencies in people at risk (e. Contra-indications, adverse effects, precautions – Do not administer to patients with severe hepatic impairment, history of severe intolerance to nevirapine that led to permanent discontinuation of treatment. In these cases, stop taking nevirapine immediately and permanently; • gastrointestinal disturbances, headache, myalgia. If the enzyme level reaches 5 times the normal level, stop nevirapine immediately. In the event of restarting treatment after having stopped for more than 7 days, recommence initial 14-day phase. When half a tablet is required, use a cutter to cut the tablet into two equal parts. Dosage and duration – Child and adult: 300 to 500 mg/day in 2 divided doses, with a diet rich in protein, until the patient is fully cured Contra-indications, adverse effects, precautions – Pregnancy and breast-feeding: avoid, except if clearly needed (safety is not established) Remarks – Nicotinamide is also called niacinamide. Never administer sublingually (risk of foetal death from placental hypoperfusion). They should not be used for the treatment of oropharyngeal candidiasis as this requires topical treatment. The treatment should be discontinued gradually (10 mg/day for one week then, 10 mg on alternate days for one week). Contra-indications, adverse effects, precautions – Administer with caution and monitor use in patients with epilepsy, diabetes, history of gastrointestinal bleeding or bipolar disorders. For information: – Child: initial dose of 3 to 4 mg/kg once daily or in 2 divided doses, increase to 8 mg/kg/day if necessary – Adult: initial dose of 2 mg/kg once daily at bedtime (up to 100 mg maximum), then, increase gradually if necessary, to the maximum dose of 6 mg/kg/day in 2 to 3 divided doses. Duration – According to clinical response Contra-indications, adverse effects, precautions – Do not administer in respiratory depression. Dosage – Child: 3 to 8 mg/kg/day in 2 to 3 divided doses – Adult: 2 to 6 mg/kg/day in 2 to 3 divided doses; do not exceed 500 to 600 mg/day Duration – According to clinical response Contra-indications, adverse effects, precautions – Do not administer in case of hypersensitivity to phenytoin. Combination with other drugs must be closely monitored (diazepam, phenobarbital, digoxin, corticosteroids, etc. Treatment of 1 to 2 days is typically sufficient when the patient is fully able to drink oral rehydration solution and can eat. Contra-indications, adverse effects, precautions – Reduce dosage in elderly patients and patients with renal impairment (risk of hyperkalaemia). Duration – According to clinical response and duration of diuretic treatment Contra-indications, adverse effects, precautions – Administer with caution and reduce dosage in elderly patients and in patients with renal impairment (risk of hyperkalaemia). If immediate treatment not considered essential for fluke infections, it should be delayed until after delivery. If treatment lasts over 10 days, a high initial dose should be reduced as quickly as possible to the lowest effective maintenance dose. If the treatment lasts more than 3 weeks: do not stop abruptly, reduce the daily dose gradually. Contra-indications, adverse effects, precautions – Do not administer to patients with active peptic ulcer (except if ulcer under treatment); infections not controlled by a specific treatment; acute viral infection (e. Remarks – 5 mg of prednisolone has the same anti-inflammatory activity as 5 mg of prednisone, 0. Dosage – Child from 2 to 5 years: 10 mg/day in 2 divided doses or 5 to 15 mg once daily at bedtime – Child from 5 to 10 years: 10 to 25 mg/day in 2 divided doses or once daily at bedtime – Child over 10 years and adult: 25 to 75 mg/day in 3 divided doses or once daily at bedtime Duration – According to clinical response; single dose or for a few days Contra-indications, adverse effects, precautions – Do not administer to patients with prostate disorders or closed-angle glaucoma and to children less than 2 years. Remarks – Storage: below 25°C PyRanTel Therapeutic action – Anthelminthic Indications – Ascariasis – Enterobiasis – Ancylostomiasis – Trichinellosis Presentation – 250 mg pyrantel embonate chewable tablet – Oral suspension, 50 mg pyrantel embonate per ml Dosage and duration – Ascariasis Child and adult: 10 mg/kg as a single dose – Enterobiasis Child and adult: 10 mg/kg as a single dose followed by a second dose after 2 to 4 weeks – Ancylostomiasis Child and adult: 10 mg/kg as a single dose; in severe infection, 10 mg/kg once daily for 4 days – Trichinellosis Child and adult: 10 mg/kg once daily for 5 days Contra-indications, adverse effects, precautions – May cause: gastrointestinal disturbances, headache, dizziness, drowsiness, skin rash. Dosage – Prevention of isoniazid neuropathy Child under 5 kg: 5 mg once daily Child over 5 kg and adult: 10 mg once daily – Treatment of isoniazid neuropathy Child: 50 mg once daily Adult: 150 mg/day in 3 divided doses Duration – Prevention: as long as treatment with isoniazid continues. Remarks – The combination of sulfadoxine/pyrimethmine is used for the treatment of uncomplicated falciparum malaria. With the exception of quinine bisulfate, the dosage is the same for all quinine salts (sulfate, hydrochloride, dihydrochloride): Child and adult < 50 kg: 30 mg/kg/day in 3 divided doses at 8-hour intervals for 7 days Adult ≥ 50 kg: 1800 mg/day in 3 divided doses at 8-hour intervals for 7 days age Weight 300 mg tablet 5 months to < 2 years 7 to < 12 kg ¼ tab x 3 2 to < 8 years 12 to < 25 kg ½ tab x 3 8 to < 11 years 25 to < 35 kg 1 tab x 3 11 to < 14 years 35 to < 50 kg 1½ tab x 3 ≥ 14 years ≥ 50 kg 2 tab x 3 Contra-indications, adverse effects, precautions – May cause: headache, skin rash; visual, auditory and gastrointestinal disturbances. During treatment, closely monitor the rate of administration in order to avoid overhydration. Increase in respiratory and pulse rates and appearance or increase of oedema are signs of over rapid rehydration. Risk of maternal and neonatal bleeding disorders when the mother receives rifampicin in late pregnancy: administer phytomenadione (vitamin K) to the mother and the newborn to reduce the risk. Duration – Acute psychosis: minimum 3 months; chronic psychosis: minimum one year.

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Good farming practices can help reduce stress and thus the negative impact of disease 240mg isoptin amex. Sources of stress include exposure to extreme temperatures and salinity buy isoptin 120mg with visa, starvation, handling and infection with other parasites. Actions should be directed firstly at prevention of the disease as subsequent control can be very difficult. A number of simple measures can minimise or prevent the spread of oyster diseases. These include: Reduction in stocking densities and/or restocking and lowering of water temperatures may suppress clinical manifestation of the disease although no eradication procedures have worked successfully to date. Early harvesting at 15-18 months of production and subtidal culture may also minimise the effects of disease on oyster production and profitability. Prevention of introduction or transfer of oysters from waters where causal agents are known to be enzootic into historically uninfected waters. The use of increased salinities which appear to suppress clinical manifestation of the disease caused by Marteilia spp. Wild oyster beds should be monitored for signs of disease as, if infected, Wildlife they may transmit disease to other beds both wild and farmed. Humans Humans must ensure that all biosecurity measures are followed to reduce the chance of spreading the infectious agents to previously uninfected sites. Direct impacts on wildlife are not clear, although indirect long-term effects may include threats to the environment and aquatic biodiversity through, for example, declining biomass and irreversible ecological disruption. Effect on Aquaculture High losses (up to 80-90% with bonamiosis) to oyster farmers through and Fisheries mortalities, and reduced growth/productivity. However, oysters could potentially pose a health concern for humans in cases where they contain high levels of Vibrio spp. Economic importance Oyster disease has the potential to financially decimate those who run oyster farming operations. Subsequently, oyster diseases can negatively affect the community and industries depending on the oyster trade. Risk assessment of Vibrio vulnificus in raw oysters: interpretative summary and technical report. Photos Oysters infected with Bonamia ostreae, illustrating classic symptoms of Bonamia ostreae infection, e. Although often characterised by high morbidity and mortality rates, pathogenicity can vary significantly, with clinical disease ranging from mild to severe. The outcome of infection may often be complicated by the involvement of pre-existing secondary pathogens. Species affected Small ruminants, predominantly sheep and goats, although many other species have been reported to be infected and develop clinical disease. The role of wildlife species in the transmission of the virus remains unclear although zoological collections in Saudi Arabia and various wildlife species across Africa have been shown to be susceptible (e. Arabian oryx Oryx leucoryx, Dorcas gazelle Gazella dorcas, Laristan sheep Ovis orientalis laristanica, gemsbok Oryx gazella, Nubian ibex Capra nubiana, Thomson’s gazelle Eudorcas thomsonii, grey duiker Sylvicapra grimmia, kobs Kobus kob and Bulbal hartebeest Alcelaphus buselaphus). Camels are also susceptible to infection and can display signs of clinical disease. However, the virus is known to be excreted in eye and nasal discharge as well as, to a lesser extent, in urine and faecal matter. Transmission via infected bedding, water, feed troughs and other inanimate objects (fomites) is possible but is thought to occur at a very low level. The variability in virulence between different isolates of the virus is currently poorly understood. However, animals can excrete and therefore spread the virus in the absence of clinical disease, often allowing the spread of virus to naïve populations when groups of animals are moved. Clinical disease is often preceded by a 4-5 day incubation period where animals must be considered to be contagious. Factors affecting the outcome of infection include breed, age, immunological competence, general health, and the presence of secondary infections. Subsequent and additional measures: quarantine affected area and restrict movement of animals avoid introduction of healthy animals collect samples (where appropriate and as directed) dispose of carcases (burning or burying as directed) disinfect in-contact fomites; most common disinfectants can be used. Diagnosis A tentative diagnosis can be made based on the clinical signs described above. The virus may survive for short periods in carcases and in refrigerated meat, and may survive for several months in salted or frozen meat. Livestock Livestock stakeholders are advised to monitor susceptible animals closely and frequently for any signs of disease or developing illness. Where possible, any newly acquired small ruminants should be quarantined for a minimum of 21 days and monitored, before being released.

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