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Fatal cases are characterized by the presence of great numbers of parasites in the small intestine together with ascites and pleural transudate depression yahoo answers buy 20mg citalopram with amex. Diagnosis is based on clinical ndings plus the identi cation of eggs or larval or adult parasites in the stool mood disorders young adults 20mg citalopram fast delivery. Occurrence—Intestinal capillariasis is endemic in the Philippines and in Thailand; cases have been reported from Egypt anxiety girl cartoon citalopram 40 mg mastercard, Japan depression symptoms during menstrual cycle order citalopram discount, the Republic of Korea and Taiwan (China). Isolated cases have also been reported from Colombia, India, Indonesia, and the Islamic Republic of Iran. Mode of transmission—A history of ingestion of raw or inade quately cooked small sh eaten whole is usually obtained from patients. Experimentally, infective larvae develop in the intestines of freshwater sh that ingest eggs; monkeys, Mongolian gerbils and some birds fed these sh become infected, the parasite maturing within their intestines. Susceptibility—Susceptibility appears to be general in those geo graphic areas in which the parasite is prevalent. Preventive measures: 1) Avoid eating uncooked sh or other aquatic animal life in known endemic areas. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Case report by most practi cable means, Class 3 (see Reporting). Epidemic measures: Prompt investigation of cases and con tacts; treatment of cases as indicated. Identi cation—An uncommon and occasionally fatal disease in humans due to the presence of adult Capillaria hepatica in the liver. The picture is that of an acute or subacute hepatitis with marked eosinophilia resembling that of visceral larva migrans; the organism can disseminate to the lungs and other viscera. Diagnosis is made by demonstrating eggs or the parasite in a liver biopsy or at necropsy. Occurrence—Since identi cation as a human disease in 1924, about 30 cases have been reported from Africa, North and South America, Asia, Europe and the Paci c area. Reservoir—Primarily rats (as many as 86% infected in some reports) and other rodents, but also a large variety of domestic and wild mammals. Mode of transmission—The adult worms produce fertilized eggs that remain in the liver until the death of the host animal. When infected liver is eaten, the eggs are freed by digestion, reach the soil in the feces and develop to the infective stage in 2–4 weeks. When ingested by a suitable host, embryonated eggs hatch in the intestine; larvae migrate through the wall of the gut and are transported via the portal system to the liver, where they mature and produce eggs. Spurious infection in humans may be detected when eggs are found in stools after consumption of infected liver, raw or cooked; since these eggs are not embryonated, infection cannot be established. Susceptibility—Susceptibility is universal; malnourished children appear more often infected. Preventive measures: 1) Avoid ingestion of dirt, directly (pica) or in contaminated food or water or on hands. In the soil, larvae develop in the eggs and remain infective for a year or longer. Infection is acquired mainly by children, through ingestion of infective eggs in soil or in soil-contaminated food or water. Human cases have been recorded from the Islamic Republic of Iran, Morocco and the former Soviet Union; animal infection has been reported in North and South America, Europe, Asia and Australia. Identi cation—A subacute, usually self-limited bacterial disease characterized by malaise, granulomatous lymphadenitis and variable pat terns of fever. Often preceded by a cat scratch, lick or bite that produces a red papular lesion with involvement of a regional lymph node, usually within 2 weeks; may progress to suppuration. Parinaud oculoglandular syndrome (granulomatous conjunctivitis with pretragal adenopathy) can occur after direct or indirect conjunctival inoculation; neurological com plications such as encephalopathy and optic neuritis can also occur. Prolonged high fever may be accompanied by osteolytic lesions and/or hepatic and splenic granulomata. Cat-scratch disease can be clinically confused with other diseases that cause regional lymphadenopathies. Diagnosis is based on a consistent clinical picture combined with serological evidence of antibody to Bartonella. Histopathological examination of affected lymph nodes may show consistent characteristics but is not diagnostic. Pus obtained from lymph nodes is usually bacteriologically sterile by conventional techniques. Infectious agent—Bartonella (formerly Rochalimaea) henselae has been implicated epidemiologically, bacteriologically and serologically as the causal agent of most cat-scratch disease. A pia felis, a previously described candidate organism, plays a minor role if any. Occurrence—Worldwide, but uncommon; equally affects men and women, cat-scratch disease is more common in children and young adults. Dog scratch or bite, monkey bite or contact with rabbits, chickens or horses has been reported prior to the syndrome, but cat involvement was not excluded in all cases. Incubation period—Variable, usually 3 14 days from inoculation to primary lesion and 5–50 days from inoculation to lymphadenopathy. Needle aspiration of suppurative lymph adenitis may be required for relief of pain, but incisional biopsy of lymph nodes should be avoided. Meyer Director of Publications Terence Mulligan Production Manager Printed and bound in the United States of America Cover Design: Michele Pryor Typesetting: Cadmus Set in: Garamond Printing and Binding: United Book Press, Inc. Identi cation—An acute bacterial infection localized in the genital area and characterized clinically by single or multiple painful, necrotizing ulcers at site of infection, frequently accompanied by painful swelling and suppuration of regional lymph nodes. Minimally symptomatic lesions may occur on the vaginal wall or cervix; asymptomatic infections may occur in women. Diagnosis is by isolation of the organism from lesion exudate on a selective medium incorporating vancomycin into chocolate, rabbit or horse blood agar enriched with fetal calf serum. Gram stains of lesion exudates may suggest the diagnosis if numerous Gram-negative coccoba cilli are seen “streaming” between leukocytes. Most prevalent in tropical and subtropical regions, where incidence may be higher than that of syphilis and approach that of gonorrhoea in men. The disease is much less common in temperate zones and may occur in small outbreaks. Mode of transmission—Direct sexual contact with discharges from open lesions and pus from buboes. Beyond the neonatal period, sexual abuse must be considered when chancroid is found in children. Period of communicability—Until healed and as long as infec tious agent persists in the original lesion or discharging regional lymph nodes—up to several weeks or months without antibiotherapy. Susceptibility—Susceptibility is general; the uncircumcised are at higher risk than the circumcised. Fluctuant inguinal nodes must be aspirated through intact skin to prevent spontaneous rup ture. Epidemic measures: Persistent occurrence or increased inci dence is an indication for stricter application of measures outlined in 9A and 9B above. When compliance with treatment is a problem, consideration should be given to a single dose of ceftriaxone or azithromycin. Empirical therapy to high-risk groups with or without lesions, including sex workers, to clinic patients reporting contact with sex workers, and to clinic patients with genital ulcers and negative dark elds may be required to control an outbreak. Interventions providing peri odic presumptive treatment covering sex workers and their clients have an impact on chancroid and provide valuable information for strategies to eliminate the disease in areas of high prevalence. Identi cation—Chickenpox (varicella) is an acute, generalized viral disease with sudden onset of slight fever, mild constitutional symp toms and a skin eruption that is maculopapular for a few hours, vesicular for 3 4 days and leaves a granular scab. The vesicles are unilocular and collapse on puncture, in contrast to the multilocular, noncollapsing vesicles of smallpox. Lesions commonly occur in successive crops, with several stages of maturity present at the same time; they tend to be more abundant on covered than on exposed parts of the body. Lesions may appear on the scalp, high in the axilla, on mucous membranes of the mouth and upper respiratory tract and on the conjunctivae; they tend to occur in areas of irritation, such as sunburn or diaper rash. Occasionally, especially in adults, the fever and constitutional manifestations may be severe.

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Doses varied among studies of the same supplement depression symptoms questions generic citalopram 40 mg overnight delivery, and often proprietary blends of components were studied depression symptoms wikihow purchase citalopram with amex. This information is provided to postnatal depression definition nhs buy 40 mg citalopram mastercard support informed dialogue between the healthcare provider and patient economic depression history definition cheap citalopram 10mg on-line, particularly for those patients who may be unduly influenced by marketing or anecdotal information on claims of dietary supplement effectiveness. Healthcare providers should encourage patients to disclose and discuss their supplement use with the medical team and providers should document supplement use in the medical record. This may help to avoid a negative drug supplement interaction and potentially lessen adverse events associated with dietary supplement use. Additionally, there is information on the site to guide healthcare providers in reporting any adverse events associated with a dietary supplement. However, three of these four studies allowed the use of rescue medications during the study period. Additionally, there was a lack of consistency in defining “clinically meaningful” across the studies, particularly for pain. Similar results were found for pain management as there was no difference in efficacy between glucosamine and polyherbal supplementation. Clinical Practice Guideline for the Non-Surgical Management of Osteoarthritis Page 44 of 126 Much of the research on nutritional supplements were funded by industry. The studies found statistically significant improvements however the high risk of potential funding bias resulted in lower certainty of the evidence. Whether acupuncture is applicable to these various clinical complaints adds another dimension to its possible utility. Acupuncture is performed via a variety of formats including adding temperature and electric stimulation in addition to the needling itself. A number of studies have been published on the effects of needle acupuncture against sham needling. There remains concern about the appropriateness of a needling sham and how blinding could be adequately controlled. Unfortunately, there is a paucity of research available to make evidence based statements on efficacy. A difference is seen when looking at results for motion, mobility, pain control and function. In patients with hip and/or knee osteoarthritis, there is insufficient evidence to recommend for or against referral for short term trial of needle acupuncture or chiropractic therapy for relief of pain and improved function. When all acupuncture versus sham controlled trials were combined, patients experienced statistically significant, but clinically irrelevant, short term improvement in pain and function over sham treated patients. However, there was much heterogeneity among the individual studies’ effect sizes and some studies identified no difference in efficacy. When sham controlled trials were limited to those with adequate patient blinding, the heterogeneity and the effect sizes decreased. Overall, these acupuncture trials lacked a level of certainty over a clinically important improvement over the sham comparator. There clearly is a need for further well controlled prospective studies to clarify the value and efficacy of this intervention. Chiropractic care is not always specified for the involved joint, but may be directed solely to the axial skeleton, rather than involving the appendicular skeleton. A difference is also seen when looking at results for motion, mobility, pain control and function. While the review identified no harm results, there was not overwhelming evidence for efficacy in improving function and controlling pain. In light of these findings, it is important that healthcare providers consider the cost versus relative research proven benefit when discussing this alternative. Clinical Practice Guideline for the Non-Surgical Management of Osteoarthritis Page 46 of 126 Module F. At that time the primary care provider should engage in frank discussions with the patient regarding further treatment options that encompass realistic treatment goals and the patient’s values. One of the possible interventions is surgical intervention such as a total knee or hip arthroplasty. If the patient is agreeable, then consultation with an orthopedic surgeon is appropriate. Prior to surgical consultation, radiologic imaging may be needed to expedite the orthopedic surgery consultation. For patients with osteoarthritis of the hip and/or knee, who experience joint symptoms (such as pain, stiffness, and reduced function) with substantial impact on their quality of life (individualized based upon patient assessment), and who have not benefited from the core non-surgical therapies, clinicians may offer referral for joint replacement surgery. In patients with osteoarthritis of the hip and/or knee considered for surgical consultations, clinicians should obtain weight-bearing plain radiographs within 6 months prior to the referral to surgical consultation. In candidates for joint replacement of the hip and/or knee, joint injections should not be given into the involved joint if surgery is anticipated within three months. Risk factors may be modifiable; therefore, identifying them prior to surgery may lead to beneficial lifestyle modifications that could reduce the risk of a poor surgical outcome prior to the patient undergoing surgery. Joint replacement can effectively alleviate pain and restore function; however, it is associated with risk and does not prolong life. The potential benefits of joint replacement must be weighed against the risk of surgical mortality and morbidity and the discomfort and inconvenience associated with recovery. Therefore, appropriate due diligence by the primary care provider should be employed to engage the patient in shared decision making about the benefits of intensifying lifestyle modification (weight loss, smoking cessation, controlling diabetes and hypertension) and consider adjusting medication for depression, as needed, to improve postoperative outcomes and to minimize postsurgical complications. Clinical Practice Guideline for the Non-Surgical Management of Osteoarthritis Page 47 of 126 Moreover, the indirect research body of evidence does not recommend precluding a referral for surgery. Indeed, it must be noted, not all patients with the previously mentioned modifiable risk factors will necessarily have a poor postoperative outcome. Clinicians often do not discuss joint replacement surgery with elderly patients who might benefit. The review of the evidence revealed studies that indirectly addressed the role of radiographic imaging. Again, there were no studies that compared any advanced imaging to plain radiographs. Intra-articular injections are often used as a bridge to surgery or as an attempt to improve patient function and thus delay the need for a total joint arthroplasty. Fluoroscopy or ultrasound guided intra-articular hip corticosteroid injections have also become increasing utilized in the past decade. Despite the widespread use of intra-articular corticosteroids for the hip and knee in osteoarthritis, no randomized controlled trials or non-randomized prospective controlled studies have addressed their efficacy in the delaying of surgical interventions to these joints. Creation of a high quality study addressing this question is difficult as the decision to proceed to a major surgical intervention involves incorporation of many patient-dependent variables, making standardization complex. The efficacy of an intra-articular injection may or may not be the deciding factor to proceed to surgery for any individual patient. The other two studies [146,147] were retrospective case series found to be of fair quality. The majority of the patients in the three studies were candidates for knee replacement who had been unsuccessfully treated with conservative forms of therapy. Clinical Practice Guideline for the Non-Surgical Management of Osteoarthritis Page 49 of 126 Appendix A: Guideline Development Process Introduction the methodology used in the development of the clinical practice guideline for non-surgical management of osteoarthritis (Version 1. Conducting the evidence review, including providing direction on inclusion and exclusion criteria b. The specialties areas included are dietetics, family practice, internal medicine, nursing, orthopedics, primary care, pharmacy and rheumatology. It includes the condition(s), populations or sub Patients, Population P populations, disease severity or stage, comorbidities, and other patient characteristics or or Problem demographics. Intervention or Refers to the specific treatments or approaches used with the patient or population. It includes I Exposure doses, frequency, methods of administering treatments, etc. Describes the interventions or care that is being compared with the intervention(s) of interest C Comparison described above. It includes alternatives such as placebo, drugs, surgery, lifestyle changes, standard of care, etc. Outcomes can include short, intermediate, and long-term O Outcome outcomes, or specific results such as quality of life, complications, mortality, morbidity, etc. Describes the duration of time that is of interest for the particular patient outcome, benefit, or (T) Timing, if applicable harm to occur (or not occur). Setting can be a location (such as primary, specialty, or (S) Setting, of applicable inpatient care).

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Me oquine (25 mg/kg daily in 2 doses 12 hours apart) is effective for treatment of chloroquine-resistant P depression fallout cost of citalopram. Currently bipolar depression medication and weight loss purchase citalopram overnight delivery, the best treatment for cases from these areas is me oquine (25 mg/kg) combined with artesunate or artemether (4mg/kg/day) for 3 days mood disorder meds purchase citalopram with mastercard, or artemether lumefantrine (as artemether 1 mood disorder 29690 generic citalopram 40 mg mastercard. Quinine, halofantrine and artemether-lume fantrine are possible alternatives; consult package in serts. Many, particularly Af ricans and Americans of African origin, can tolerate hemolysis, but if it occurs during treatment, primaquine should be discontinued. Malaria epidemics must be controlled through rapid and vigorous action and effective treatment of all cases; in advanced epidemics where a large part of the popu lation is infected, mass treatment may be considered. Usually, indoor residual spraying is preferred because of its rapid effect; this may be followed by the use of insecticide treated bednets and anti-larval measures. Disaster implications: Disasters may lead to malaria epidem ics as a result of population movements, ecological changes, breakdown of health services and other factors. In recent years in complex emergencies in Africa, malaria has presented with an epidemic pattern, taking an extraordinarily high toll among children and often adults. The drug resistance situation often turns out to be worse than had been assumed from national data. Control measures include early effective treatment and vector control (insecticide-treated nets, indoor residual spray ing or other). In densely populated refugee camps, space spraying may be effective in the emergency phase; environmen tal measures may be relevant later. In areas of intense transmis sion in Africa, intermittent preventive treatment in pregnancy should be initiated. Health education, as in any context, is required to support these interventions and promote better malaria control. International measures: 1) Important international measures include the following: a) Disinsectization of aircraft before boarding passengers or in transit, using a residual spray application of an effective insecticide; b) Disinsectization of aircraft, ships and other vehicles on arrival if the health authority at the place of arrival has reason to suspect importation of malaria vectors; c) Enforcing and maintaining rigid anti-mosquito sanitation within the mosquito ight range of all ports and air ports. Among the agents implicated in the pathogenesis of various human malignancies, either directly or indirectly, are parasites, viruses and the bacterium Helicobacter pylori. The infectious agent is neither necessary nor suf cient cause for all cases of agent-related malignancy; other causes are involved; cofactors, both external (environmental) and internal (genetic and physiological at immunological and molecular levels), play important roles in each of these malignancies, which usually represent the late outcome of the infection. A common feature of most virus-related cancers is the persistence of the virus following infection early in life or the presence of immuno suppression: this leads to integration and development of cancer, usually in a single cell clone (monoclonal tumour). The rst 3 occur worldwide and produce many more inapparent than apparent infections; most result in a latent virus state that is subject to reactivation. Monoclonality of the tumour cells and integration of the virus into the tumour cell indicate a causal association. Evidence from serol ogy, virology and epidemiology strongly implicates them in the causation of speci c malignancies. Many patients go through stages of chronic hepatitis and cirrhosis before development of the tumour. Rates are intermediate on the Indian subcontinent and relatively low in North America and western Europe. The tumours may be monoclonal, polyclonal or mixed; not all are Burkitt-type, but all are acute lymphoblastic sarcomas. Variant translocations t(2;8) and (8;22) involve the c-myc gene and the immunoglobulin kappa and lambda chain loci, located respectively on chromosomes 2 and 22. The subsequent activation of the c-myc gene plays an important role in malignant transformation. Recent studies suggest that the chromosomal breakpoint locations in African cases differ from those in American cases, suggesting a molecular hetero geneity in Burkitt lymphoma in general. Burkitt lymphoma is a highly aggressive tumour but can nevertheless be cured in 90% of cases with intensive multiple chemotherapy. Incidence is particularly high (about 10-fold when compared with the general population) among groups from China (Taiwan and southern China), even in those who have moved elsewhere. Its appearance may precede the clinical appearance of nasopharyngeal carcinoma by several years and its reappearance after treatment heralds recurrence. The tumour occurs worldwide but is highest in southern China, southeastern Asia, northern and eastern Africa and the Arctic. Repeated respiratory infections or chemical irritants, such as nitrosamines in dried foods, may play a role. The histology shows the presence of a highly speci c but nonpathognomonic cell, the Reed Sternberg cell, also seen in cases of infectious mononucleosis. The disease is more common in industrialized countries, but age-adjusted incidence is relatively low. It is more common in higher socioeconomic settings, in smaller families, and in Caucasians compared with Americans of African origin. The disease commonly occurs in the presence of other forms of immunode ciency, such as that in posttransplant patients, those given immunosuppressive drugs and per sons with inherited forms of immunode ciency. The classical form occurs in older males of mainly Mediterranean or eastern European Jewish back grounds. An endemic form occurs in all age groups in parts of equatorial Africa; neither has a known precipitating environmental factor nor is associated with immune de ciency. Despite differences in clinical manifestations and serostatus, it is appropriate to consider all forms of Kaposi sarcoma as one entity given the identical immunohistochemical features of the characteristic spindle cell of the tumour. Discovered in 1994, it is a new human Gammaherpesvirus related to an oncogenic herpesvirus of monkeys, Herpesvirus saimiri. Evidence of viral infection is found in virtually all cases and several lines of evidence point to a key etiologic role in this disease. Serological analyses also suggest that infection occurs primarily in sexually active people, particularly men who have sex with men. There is no known cure for Kaposi sarcoma, but partial and complete remissions have been noted. Infection early in life, primarily through breastmilk, leads to tumour development in the adult, peaking at about age 50. Cervical cancer risk is associated with lower socioeco nomic status, early start of sexual activity, multiple sexual partners and smoking. For the moment, the best prevention tool against cervical cancer is organized screening programs based on cytological smears (Papanicolaou smears). Identi cation—An acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough and small spots with white or bluish white centers on an erythematous base on the buccal mucosa (Koplik spots). A characteristic red blotchy rash appears on the third to seventh day; the rash begins on the face, then becomes generalized, lasts 4–7 days, and sometimes ends in brawny desquamation. Complications may result from viral replication or bacterial superinfec tion, and include otitis media, pneumonia, laryngotracheobronchitis (croup), diarrhea and encephalitis. The case-fatality rates in developing countries are estimated to be 3%–5%, but are commonly 10%–30% in some localities. Measles is a more severe disease in the very young and in malnourished children, in whom it may be associated with hemorrhagic rash, protein-losing enteropathy, otitis media, oral sores, dehydration, diarrhea, blindness and severe skin infections. Children with clinical or subclinical vitamin A de ciency are at particularly high risk. In children whose nutrition status is borderline, measles often precipitates acute kwashiorkor and exacerbates vitamin A de ciency that may lead to blindness. The detection of measles-speci c IgM antibodies, present 3–4 days after rash onset, or a signi cant rise in antibody concentrations between acute and convalescent sera con rms the diagnosis. Infectious agent—Measles virus, a member of the genus Morbilli virus of the family Paramyxoviridae. Occurrence—Prior to widespread immunization, measles was com mon in childhood, so that more than 90% of people had been infected by age 20; few went through life without becoming infected. In the prevac cine era, there was an estimated 100 million cases and 6 million measles deaths a year. Measles, endemic in large metropolitan communities, attained epidemic proportions about every second or third year. In smaller communities and areas, outbreaks tended to be more widely spaced and somewhat more severe. In temperate climates, measles occurs primarily in the late winter and early spring. With effective childhood immunization programs, measles cases in many industrialized countries have dropped by 99% and generally occur in young unimmunized children or older children, adolescents or young adults who received only one dose of vaccine. In 1994, the countries of the western hemisphere established a regional target of elimination of indigenous measles transmission by the end of the year 2000 through a comprehensive measles immunization strategy, including the provision of measles vaccine to at least 95% of children aged 12–15 months through routine immunization services, with another opportunity for measles immunization to all children and careful measles surveillance.

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Place each on a any electronics shop) 2 copper pipes depression test game buy citalopram 20mg with mastercard, ” diameter depression retreat buy on line citalopram, 4” long non-conductive surface anxiety or heart problem cheap 20mg citalopram fast delivery, (from a hardware store) like a plastic bag mood disorder medicine generic 20 mg citalopram mastercard. Connect the positive battery terminal to one handhold and the negative terminal to the other handhold using alligator clip leads. When you get tired pick up the left handhold with your left hand and tap with your right hand. Connect positive termi nals of the batteries to each other, and the negatives also. Everything liv ing on you or in you, not just to perch, but to take its food from you is a parasite. But in some way the big worms need to be distinguished from the medium-sized amoebae, the even smaller bacteria and the smallest of all—viruses. Roundworms are round like earthworms even though they may be as thin as hairs (threadworms, filaria) or micro scopically small (like Trichinella). They have a way to attach themselves sometimes with the head (scolex) like tapeworms, sometimes with a special sucker like flukes. Worms Flatworms Roundworms Tapeworms Flukes Threadworms Pinworms Hookworms Worm parasites go through stages of development that can look very, very different from the adult. The favorite organ for Dirofilaria (dog heartworm) is the heart (even human heart). My tests show Dirofilaria can live in other organs, too, if they are sufficiently polluted with solvents, metals and other toxins. If you are a meat eater, you could eat such a cyst if it happens to be lodged in the meat you are eating! The little larva is swallowed and tries to attach itself to your intestine with its head. They come out of their metacercarial cyst as a small adult and quickly attach themselves to the intestine with a sucker. Four common flukes are: human intestinal fluke, human liver fluke, sheep liver fluke, pancreatic fluke of cattle. Has cilia, can swim vigorously and must find intermediate snail host in one to two hours or may be too exhausted to in vade. Those are "mother" redia, and each one bears "daughter" redia for up to 8 months, all still inside the snail, and living on the fluids in the lymphatic spaces. If the snail is feeding on a plant, cercaria can latch onto plant with sucker mouth and start to encyst (form a "cocoon") within minutes. But as you eat the plant it is stuck to, the least pressure will break it, leaving the cyst in the mouth. The "almost unbreakable" inner cyst wall protects it from chewing, and the keratin-like coat prevents digestion by stomach juices. However when it reaches the duodenum, contact with intestinal juices dissolves away the cyst-wall and frees it. It then fastens itself to the intestinal lining and begins to develop into an adult. Note that the adult is the only stage that “normally” lives in the human (and then only in the intestine). Fasciolopsis depends on a snail, called a secondary host, for part of its life cycle. If propyl alcohol is the solvent, the intestinal fluke is invited to use another organ as a secondary host—this organ will become cancerous. If xylene (or toluene) are the solvents, I typically see any of four flukes using the brain as a secondary host. I call the diseases caused by fluke stages in inappropriate locations Fluke Disease; it is discussed in more detail later (page 249). Pollutants can invade your body via the air you breath, the foods and beverages you eat, and the products you put on your skin. The one who did not assumes the cream is not harmful to themthat they are like a bank vault, impreg nable to that product. A better assumption is that the face cream is somewhat toxic, as evidenced by the rash that can develop, and they escaped the rash only because they had a stronger im mune system. The immune system is like money, paid out of the bank vault, for every toxic invasion. Most other solvents dissolve fats and are life threatening, because fats form the membrane wall around each of our cells, especially our nerve cells. Metal Pollution Biochemists know that a mineral in raw element form always inhibits the enzyme using that mineral. Inorganic copper, like you would get from a copper bottomed kettle or copper plumbing, is 3 carcinogenic. We put metal jewelry on our skin, eat bread baked in metal pans, and drink water from metal plumbing. Mercury amalgam fillings, despite the assurances of the American Dental Association, are not safe. And sometimes the mercury is polluted with thallium, even more toxic than mercury! Gold and silver seem to have fewer harmful effects, but no one should have any pure metal in or on their body. Other prevalent toxic metals include lead and cadmium from soldered and galvanized plumbing, nickel and chromium from dentalware and cosmetics, and aluminum from food and drink cans, and cooking pots. From Carcinogenicity and Metal Ions, volume 10, page 61, of a series called Metal Ions in Biological Systems, edited by Helmut Sigel, 1980. One small moldy fruit or vegetable can pol lute a huge batch of juice, jam or other product. Although molds are alive, and can be killed by zapping, mycotoxins are not, and must be detoxified by your liver. But because mycotoxins are so extremely poisonous, a tiny amount can incapacitate a part of the liver for days! For that reason I am always cautioning people to eat only perfect citrus fruit, and never drink commercial fruit juice. Of the thousands of oranges that go into the batch of orange juice you drink, one is sure to be moldy, and that is all it takes to give your liver a setback. It also helps get rid of aflatoxin before it is consumed, right in the food container. So keep a plastic shaker of vitamin C powder handy and use it like salt on all your food. Physical Toxins Breathing in dust is quite bad for you so your body rejects it by sneezing, coughing, spitting up and out. But because it is sharp it gets caught in your tissue, then works its way deeper and deeper. We are unaware that it fills our homes when fiberglass insulation is left imperfectly sealed off. Any hole made through the ceiling or wall, even if covered with cloth, lets swarms of broken glass bits into the house air. Of course, fiberglass should never be used in home construction, draperies, or around water heaters. The best advice is to have it all removed while you are away and then vacuum and dust. Chronic exposure from a single small hole in the ceiling does a lot of harm, leading to cyst formation. And that cyst is a perfect place for parasites and bacteria to settle and multiply. Asbestos is another tiny bit, sharp as glass, that moves through your body like a swordfish, impaling your cells until it, too, gets routed into a cyst. We have been led to believe that we no longer have asbestos in our homes because we have outlawed the fireproofing mate rials it was used in. While that may be true, the source I find most often is all too prevalent: the clothes dryer belt. As it gets hot the belt releases a blast of asbestos particles that are forced through the seams of your dryer, and also openings in your exhaust hose, by the high pressure formed inside. By the time your air conditioner or refrigerator needs recharging, you have been exposed for a long time. Our diligent scientists have studied the mechanism of arsenic poisoning in great detail. Then why are we allowed to put it on our lawns to be carried into our carpets via shoes

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