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By Z. Marcus. Kendall College. 2018.

X-rays are usually described by their maximum energy chloramphenicol 250mg on line bacteria yeast and fungi slides, which is determined by the voltage between the electrodes purchase chloramphenicol 500mg free shipping vyrus 987 c3 2v. The amount or frac- tion of the electron energy that is transformed into x-rays from the anode surface is only about a percent of the electron energy. This implies that most of the energy is dissipated as heat, and consequently the anode must be cooled. The probability for transferring the elec- tron energy into radiation is proportional to Z E. The result is a spec- trum – in the fgure called “initial spectrum” In order to use the radiation it must get out of the X-ray tube. The spectrum changes like that illustrated above – from the “initial spectrum” into the “fnal spectrum”. For example, if low energy x-rays are needed, a beryllium window is used since this window has much lower density than a glass window. The spectrum also contains characteristic x-rays from dislodging of K- and L-shell electrons from the target. This will not be further discussed when the x-rays are used for diagnostic purposes, but is important for x-ray crystallography. We are not going to describe all the technological developments with regard to the control of the exposure time – and equipment for the different types of examinations. Thus, in the case of mammography the maximum energy is low (below 30 kV) whereas in skeletal and abdominal examinations the energy is larger, between 60 to 85 kV. Another aspect is that the radiation dose in an examination should be kept as low as possible. Several developments – using intensifying screens have reduced the exposure (see below). Absorption and scattering in the body The x-ray picture is based on the radiation that penetrates the body and hit the detector (flm). The details in the picture are due to those photons that are absorbed or scattered in the body. Since both the absorption and the scattering depend upon the electrons in the object (body) we can say that; “the x-ray picture is a shadow-picture of the electron density in the body. Since x-ray diagnostic uses low energy radiation only the ”photoelectric effect” and the “Compton scattering” contribute to the absorption. The photoelectric effect occur with bound electrons, whereas the Compton process occur with free or loosly bound electrons. Both processes vary with the radiation energy and the atomic number of the absorber. Photoelectric effect – variation with photon energy For the energy region in question – and for atoms like those found in tissue the photoelectric cross- section varies with E–3. Photoelectric effect – variation with atomic number The variation with the atomic number is quite complicated. For an energy above the absorption edge, the cross-section per atom varies as Z4 (i. It can be noted that the K-shell energy for all atoms in the body (C, N, O, P, and Ca) is below 4 keV. Compton effect – variation with photon energy For the energy range used for diagnostic purposes the Compton effect is rather constant – and de- creases slightly with the energy. Compton effect – variation with atomic number The Compton process increases with the electron density of the absorber. This implies that the absorption in bones (with an effective atomic number of about 13) is much larger than that for tissue (with effec- tive atomic number of about 7. For energies below about 30 keV the absorption is mainly by the photoelectric effect. In this energy region it is possible to see the small variations in electron density in normal and pathological tissue like that found in a breast. It can be noted that due to the strong dependence of the photoelectric effect with the atomic number we fnd the key to the use of contrast compounds. Thus, compounds containing iodine (Z = 53) or barium (Z = 56) will absorb the low energy x-rays very effciently.

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You may experiment with illegal drugs because of curiosity 250 mg chloramphenicol with mastercard antibiotics kidney disease, because your friends are doing it or to escape boredom or worries generic chloramphenicol 250mg mastercard infection under armpit. This may be because of emotional, psychological or social problems you are experiencing. Some drugs can make you addicted or dependent, where you lose control over your drug use and feel you cannot function without the drug. Some people use more than one drug at the same time – this is known as ‘polydrug use’. Mixing drugs can be dangerous because the effects and side-effects are added together. This includes mixing illegal drugs with legal drugs such as alcohol or medication. For example, taking alcohol with cocaine increases your risk of irregular heart rhythms, heart attacks and even death. Myth “All drugs are addictive” Fact Some drugs can create addiction or dependence much quicker than others. There is no evidence that people get ‘hooked’ after one or two uses, or that everyone who tries a drug will become addicted. Myth “Only drug addicts have a problem” Fact Addiction or dependency is not the only problem drugs can cause. Some people have problems the first time they use a drug, or problems may develop as you use them more often. Drug use can affect your physical and mental health, your family life, relationships and your work or study. Using illegal drugs can also get you into trouble with the law or cause money problems. Myth “All illegal drugs are equally harmful” Fact Different drugs can harm you in different ways. Some drugs, such as heroin, are regarded as more dangerous because they have a higher risk of addiction and overdose, or because they are injected. Myth “My teenager is moody and losing interest in school – they must be on drugs” Fact Parents often ask how they can tell if their child is using drugs. Many of the possible signs, such as mood swings or loss of interest in hobbies or study, are also normal behaviour for teenagers. Find out the details of their drug taking – what they have taken, for how long and why. You can help your child develop a sensible attitude towards drugs, by showing a sensible attitude to your own use of drugs – particularly legal drugs such as alcohol and medication. Myth “Young people are tempted to try drugs by pushers” Fact Most young people are introduced to illegal drugs by a friend or someone they know. In many cases drugs are ‘pulled’ rather than ‘pushed’ – the person asks for it themselves, often out of curiosity. You may feel uncomfortable talking about drugs because you don’t know enough about the subject. If someone you know is taking drugs or you think they are taking drugs: • Listen to them – it is important to understand and respect how they feel; • Keep the lines of communication open; and • Look for more information before you do anything. A number of voluntary agencies also provide education, counselling and treatment throughout the country. To get information on your local services: Freephone: Drugs helpline 1800 459 459 (Monday – Friday, 9am to 5pm) Web: www. They are known as ‘controlled drugs’ and are listed in different groups called schedules. The schedules group drugs according to how useful they are and what is needed to control their use. They have the same general effects as depressants but they cause addiction in a different way. Depressants and sedatives are sometimes called ‘downers’ and stimulant drugs are sometimes called ‘uppers’.

But some changes were not calculated emendments but accidental errors that crept into the texts generic 500mg chloramphenicol with mastercard antibiotic 3142. The loss of the negative in the opening sentence of ¶ in Treatments for Women 250mg chloramphenicol fast delivery antibiotic treatment for pink eye, for example, had the result of encouraging treatment of old women suffer- ing from a sanious flux, whereas the original text had said it was pointless to treat them because they were already incapable of bearing children. Many errors or corruptions, of course, would not have been obvious to readers without multiple copies of the texts at hand. Yet the failure of later scribes or readers to correct some of the more glaring errors must give us pause when imagining how actively the standardized ensemble in particular might  Introduction have been used in any kind of clinical setting. Not a single reader of the extant standardized ensemble manuscripts seems to have noticed, for example, the obvious logical inconsistency within a recipe in Women’s Cosmetics for redden- ing the skin and lips, where an accidental misreading changed a prescription to use a violet dye into one for a green dye (¶). And one wonders how even the most dedicated occultist could have made sense of the garbled magical passages in ¶¶ and . It is likely, however, that the standardized ensemble became the preferred version of the Trotula texts, not because it was scrutinized in de- tail for every possible remedy for women’s conditions (there are, after all, over three hundred different prescribed therapies), but because it could serve a more general function as a basic referencework on fertility—a subject on which there was increasing concern from the thirteenth century on. L D The standardized ensemble is today found in twenty-nine manuscripts from all parts of Latinate Europe. In the fifteenth century, even though other forms of the texts were still being tran- scribed in many parts of Europe, the standardized ensemble seems to have been rarely copied in Italy, England, or even in France, where the text had earlier achieved its greatest popularity. Most of the extant fifteenth-century manu- scripts come from central and eastern Europe. The standardized ensemble seems always to have been closely associated with university circles and in this context manuscripts preserved their utilityas reference texts for years after their initial composition. At his death (sometime between  and ), the theo- logian Gérard of Utrecht left his copy to the College of the Sorbonne in Paris, where it was to remain until the modern period. Caillau then gave the manuscript to his patron the duke in exchange for another book. A final indication of the standardized ensemble’s utility was its translation in the fifteenth century into the vernacular, once into Dutch, once, perhaps twice into French, and twice into German. Copy after copy reproduced the text with hardly any variation, in stark contrast to earlier versions, which copyists often felt free to abridge or emend as they liked. One scribe re- interpreted the title as ‘‘The Good TreatiseWhich Is Entitled ‘The Old Woman on the Sufferings [of Women]. Kraut’s major editorial innova- tion was to reorganize all the material from the ensemble into one smoothly ordered summa, rearranging the ensemble’s disparate parts into sixty-one chap- ters. Gone, too, of course, were any remaining hints that the Trotula was a concretion of a variety of sources from a variety of differ- ent authors. While in general Kraut seems to have been concerned to preserve most of the material he found in the standardized ensemble, humanist that he was he could not refrain entirely from tidying up the text. He suppressed the two references to magical practices to aid birth in Conditions of Women (¶¶ and ), he clarified that the contraceptives were to be used only if out of fear of death the woman did not dare conceive,221 and he apologized for the in- clusion of mechanisms to ‘‘restore’’ virginity, saying that he would not have included them were they not necessary to aid in conception. Kraut was apparently motivated by the desire to make both the femininity and the originalityof ‘‘Trotula’’ more apparent. Whereas neither the original Condi- tions of Women nor the standardized ensemble had offered any direct hint of the author’s gender, Kraut, presuming the whole of his newly unified text to be the work of a single feminine author, altered the preface to stress her gender. He also omitted the names of Hippocrates and Galen and even the author’s clear admission that the work was a compilation of excerpts from other writings. Kraut’s artificial text with his artificially unified and gendered author proved to be authoritative; all subsequent Renaissance editors reprinted this humanist fabrication rather than returning to the medieval manuscripts. Kraut’s edition thus occluded the medieval history of the texts from view, with the result that most of the modern controversy about the authoress ‘‘Trotula’’ has produced little more than idle speculation. The Trotula texts, whoever their authors may have been, were very real and very influential throughout Europe for nearly half a millennium. What- ever their relationship to Trota or the other women of Salerno, the Trotula were one of the pillars on which later medieval culture was built, being present in the libraries of physicians and surgeons, monks and philosophers, theolo- gians and princes from Italy to Ireland, from Spain to Poland. When Latin- ate physicians or surgeons (such as the anonymous surgeon who owned the Laon manuscript used in the edition here) wanted a handbook on women’s medicine, they used the Trotula. When medieval translators looked for gyne- cological material to render into the vernacular, it was to the Trotula texts that they most frequently turned.

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Key: a Ref: Meningitis (Page 1224) Davidson’s Principles and Practice of Medicine buy chloramphenicol 500mg with visa antibiotic used to treat uti. The most common risk factor for chronic obstructive pulmonary disease is: a) Air pollution effective 250mg chloramphenicol antibiotic 5 year plan. Key: e Ref: Chronic Obstructive, Pulmonary Disease (Page 678) Davidson’s Principles and Practice of Medicine. Key: a Ref: Cushing’s Syndrome (Page 779) Davidson’s Principles and Practice of Medicine. In a young boy with hypertension, examination of cardiovascular system reveals radio-femoral delay. The most likely cause of hypertension in this patient is: a) Coarctation of aorta. Key: a Ref: Coarctation of the Aorta (Page 637) Davidson’s Principles and Practice of Medicine. The gait of a patient with cog-wheel rigidity and pill rolling tremors is likely to be: a) Drunken. Key: e Ref: Parkinsonism (Page 1218) Davidson’s Principles and Practice of Medicine. An old patient presented in emergency ward with history of weakness of right side of body of rapid onset. The most helpful first line investigation for management of this patient is: a) Cerebral angiography. Key: c Ref: Cerebrovascular Disease (Page 1200) Davidson’s Principles and Practice of Medicine. In a patient of thalessemia peripheral blood film for red cell morphology shows: a) Hypochromic microcytic cells. Key: a Ref: Thalessemia (Page 1038) Davidson’s Principles and Practice of Medicine. Key: b Ref: Pyogenic Liver Abcess (Page 986) Davidson’s Principles and Practice of Medicine. Key: d Ref: Cerebrovascular Disease (Fig: 26:34, Page 1209) Davidson’s Principles and Practice of Medicine. A forty year old man gives history of high grade fever for last one week associated with cough productive of rusty sputum. The anti diabetic agent of choice for a fifty year old obese lady with mild hyperglycemia is: a) Chlorpropamide. Key: d Ref: Oral Anti-Diabetic Drugs (Page 831) Davidson’s Principles and Practice of Medicine. Which of the following characteristic suggests a benign structure of esophagus: a) Anaemia. Key: c Ref: Benign Esophageal Structure (Page 880), Carcinoma of Esophagus (Page 882) Davidson’s Principles and Practice of Medicine. A thirty five year old man presents with history of low grade fever and cough for last three months. Which of the following feature on chest X-ray suggests this diagnosis: a) Cavitation. Key: a Ref: Pulmonary tuberculosis (Page 695) Davidson’s Principles and Practice of Medicine. In a patient with history of shortness of breath, which of the following sign indicates left heart failure: a) Ascites. Key: b Ref: Heart Failure (Page 545) Davidson’s Principles and Practice of Medicine. A fifty year old man is admitted in emergency ward with acute myocardial infarction. Key: d Ref: Myocardial Infarction (Page 595) Davidson’s Principles and Practice of Medicine.

Activities: Children with draining sores should not participate in activities where skin-to-skin contact is likely to occur until their sores are healed purchase chloramphenicol 250mg without prescription infection x girl. Childcare/school personnel should notify parents/guardians when possible skin infections are detected cheap chloramphenicol 500 mg amex can antibiotics for uti cause yeast infection. Wash hands thoroughly with soap and warm running water after touching body secretions or skin drainage of an infected or colonized person. They should take care to keep their skin clean and dry and do first aid care when an injury (cut, scrape, etc. If you think your child Symptoms has a Staph Infection: Your child may have infected areas that are red and warm  Tell your childcare with or without pus. Examples are boils, impetigo, wound provider or call the infections, and infections of hair follicles. This means that the bacteria may be there but it Childcare and School: does not cause infection or harm. Yes, if draining sores If your child is infected, the time it will take for symptoms to cannot be completely start will vary by type of infection. Contagious Period Activities: As long as the infection or colonization is present. A child Avoid activities where who has draining infections has more bacteria and is more skin-to-skin contact is contagious than a child who is only colonized. Put used bandages in a plastic bag, close the plastic bag, and put it in the trash. Wash clothes, bed sheets, and blankets in hot water with detergent and dry in a hot dryer. The rash appears most often on the neck, chest, elbow, and groin, and in the inner thigh and folds of the armpit. These illnesses are usually not serious; however, rare problems such as rheumatic fever (which can damage heart valves) or kidney disease may develop if children do not receive proper antibiotic treatment. Children without symptoms, regardless of a positive throat culture, do not need to be excluded from childcare or school. Persons who have strep bacteria in their throats and do not have any symptoms (carriers) appear to be at little risk of spreading infection to those who live, go to childcare or school, or work around them. Check with your local environmental health department to see if people with skin lesions need to be excluded from food handling. Strep may be identified in the throat either by using a rapid strep test, which can provide results the same day, or by throat culture. Treatment may be dependent on how severe the infection is and will help prevent more serious illness such as rheumatic fever. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. If you think your child Symptoms has Strep Throat: Strep throat - Your child may have a fever that starts suddenly, red sore throat, and swollen glands. The rash is most often on the neck, Childcare and School: chest, elbow, and groin and in the inner thigh and folds of the armpit. Children who test Spread positive for strep but do not show symptoms do - By coughing or sneezing. They are unlikely to Contagious Period spread the infection to Until 24 hours after antibiotic treatment begins. Tularemia is also spread by infected meat and blood of animals such as rabbits and cat bites. Follow tick precautions: Wear light colored clothing, wear insect repellants, and do tick check of the full body every night after being in tick infested areas. The Centers for Disease Control and Prevention recommends that confirmation testing be done in addition to the screening test to ensure more accurate results. Wear long pants, tuck pants into socks, wear a long sleeved shirt tucked into pants, and wear light-colored clothing so ticks are easier to see. Always grasp the tick by the head or mouth parts and gently but steadily pull straight back.

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Reduc- tions in physical activity have been reported in early lactation (4 to 5 weeks postpartum) in the Netherlands (van Raaij et al buy chloramphenicol 500 mg amex antibiotic resistance mechanisms of clinically important bacteria. Physical activity increased in the lactating Dutch women from 5 to 27 weeks post- partum (van Raaij et al cheap 250mg chloramphenicol amex ear infection 9 year old. While a decrease in moderate and discretionary activities appears to occur in most lactating women in the early postpartum period, activity patterns beyond this period are highly variable. These sources of error may be attributed to isotope exchange and sequestration that occurs during the de novo synthesis of milk fat and lactose, and to increased water flux into milk (Butte et al. Milk energy output is computed from milk pro- duction and the energy density of human milk. Beyond 6 months post- partum, typical milk production rates are variable and depend on weaning practices. The energy density of human milk has been measured by bomb calorimetry or proximate macronutrient analysis of representative 24-hour pooled milk samples. The changes in weight and therefore energy mobilization from tissues occur in some, but not all, lactating women (Butte and Hopkinson, 1998; Butte et al. In general, during the first 6 months postpartum, well-nourished lactating women experience a mild, gradual weight loss, averaging –0. Changes in adipose tissue volume in 15 Swedish women were measured by magnetic resonance imaging (Sohlstrom and Forsum, 1995). In the first 6 months postpartum, the subcutaneous region accounted for the entire reduction in adipose tissue volume, which decreased from 23. Mobilization of tissue reserves is a general, but not obligatory, feature of lactation. In the 10 lactating British women, the total energy requirements (and net energy requirements, since there was no fat mobilization) were 2,646, 2,702, and 2,667 kcal/d (11. In 23 lactating Swedish women, the total energy requirement at 2 months postpartum was 3,034 kcal/d (12. In nine lactating American women, the total energy requirement was 2,413 kcal/d (10. The women in the above studies were fully breastfeeding their infants, who were less than 6 months of age. In these studies, mean milk energy outputs during full lactation were similar (483 to 538 kcal/d or 2. During the first 6 months of lactation, milk production rates are increased (Butte et al. Customary milk pro- duction rates beyond 6 months postpartum typically vary and depend on weaning practices (Butte et al. Because adap- tations in basal metabolism and physical activity are not evident in well- nourished women, energy requirements of lactating women are met par- tially by mobilization of tissue stores, but primarily from the diet. In the first 6 months postpartum, well-nourished lactating women experience an average weight loss of 0. The coefficients and standard error derived for only overweight and obese men and women are provided in Appendix Table I-10. For the combined data sets, the standard deviations of the residuals ranged from 182 to 321. Persons who do not wish to lose weight should receive advice and monitoring aimed at weight maintenance and risk reduction. This could be due to a reduction in energy expenditure per kg body weight or to a decrease in physical activity. These values can be used to estimate the anticipated reduction in metabolizable energy intake necessary to achieve a given level of weight loss, if weight loss is achieved solely by a reduction in energy intake and there is no change in energy expenditure for physical activity. For example, a weight loss of 1 to 2 lb/wk (65 to 130 g/d) is equivalent to a body energy loss of 468 to 936 kcal/d, because the energy content of weight loss aver- ages 7. Therefore, to maintain a rate of weight loss of 1 to 2 lb/wk, the reduction in energy intake would need to be 844 (468 + 376) to 1,478 kcal/d (936 + 542) after 10 weeks of weight loss. The impact on energy expenditure of weight loss regimens involving lesser or greater reductions in energy intake need to be assessed before rates of weight reduction can be more precisely predicted. However, it must be appreciated that reduction in resting rates of energy expenditure per kilo- gram of body weight have a small impact on the prediction of energy deficits imposed by food restriction, and the greatest cause of deviation from projected rates of weight loss lies in the degree of compliance.