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By: R. Zuben, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

Clinical Director, Michigan State University College of Human Medicine

Comparisons with animals or everyday objects took the place of careful observation virus symptoms purchase on line minocycline. The internal economy of a woman virus clothing best buy for minocycline, for instance antibiotic resistance executive order buy generic minocycline 50 mg online, was imag­ ined as a tube, in which the womb wandered from its normal position, to which it might be attracted back by sweet, or repelled by foul, substances introduced into the vulva or the nose. It offers advice on gynae­ porates both modern diagnosis and forecasting the likely cology, head wounds, epilepsy, and a whole range of dis­ outcome of a case as seen in both Babylonian and Egyptian eases. Hippocratic prognosis also acted as an insurance: collections of case notes; some depend on close observation, provided the doctor distinguished between what he could others are highly speculative. A typical piece of advice in the and could not do, no blame was attached to subsequent fail­ Epidemics tract was ure or refusal to treat. Two fluids above all were singled out for special concern Declare the past, diagnose the present, foretell the bile and phlegm the ostensible cause of summer dis­ future: practise these things. The art thought of the body as a constant battleground between the involves three things disease, the diseased, and the two, in which the mind was also affected phlegm causes doctor. The diseases epilepsy, bile frenzy and in which environment, seasonal must join with the doctor in combating the disease. Other authors Although the historical Hippo­ described blood in similar terms, crates was famous as a physician and the tract On the Nature of and teacher, no single tract can Man added a fourth humour, yet be securely identified as his, black bile or melancholy, a mys­ and many of the traditional terious substance as deadly in its details of his life are later inven­ pure state as blood was usually tions. Hippocratic medicine, as shown this system of the four humours, in the Corpus, is characterized by later regarded as that of Hippo­ three things: close observation of crates himself, was easily exten­ symptoms, an openness to ideas ded to cover the four elements, from all sides, and a willingness earth, air, fire, and water; the to explain the causes of disease. It health and disease as some form offered a rationale for under­ of balance or imbalance. Some­ standing man, in sickness and in times this is a balance of ele­ health, against the wider cosmos, ments (the ultimate building and, at the same time, for explain­ blocks of the body and the whole ing the individuality of illness. The body was from the top right, are the sanguine, the phlegmatic, environment to explain physical viewed as inherently unstable, the choleric, and the melancholic. The artist shows (and even political) differences liable to disease, hard to diag­ both the ages and the mental states that are domi­ between Greeks, North Africans, nose, and often impossible to cure. The Rise of Medicine 59 the Hippocratic Oath I swear by Apollo the healer, by Aesculapius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise to the best of my ability and judgement. A medieval Greek manuscript of the I will not cut, even for the stone, but I will leave such Hippocratic Oath. If, therefore, I observe this Oath and do not violate it, Whatever I see or here, professionally or privately, may I prosper both in my life and in my profession, earn­ which ought not to be divulged, I will keep secret and tell ing good repute among all men for all time. The philosopher-scientist Aristotle and his followers embarked on a massive pro­ gramme of zoological and biological investigation, and his contemporary Diodes of Carystos is credited with the first book on dissection (but of animals). The breakthrough into human anatomy came outside Greece, in the newly founded city of Alexandria at the mouth of the Nile in Egypt. The conquests of Alexander the Great (reigned 336-323 bc) had brought Greek civilization out of the Aegean basin (and Sicily) to cover the whole of the Middle East, from Libya to the Pun­ jab. Although his empire fragmented at his death, his sucessors maintained their Greek (Hellenistic) culture. Chief among them was Ptolemy, who ruled in Egypt from 323 to 282 bc and who created in Alexandria a major culture centre with a famous library and ‘Hall of the Muses’. The Cam bridge Illustrated H istory of M edicine Here, perhaps freed from some of the constraints on mutilating a corpse known in Greece, two Greek physician-scientists almost simultaneously around 280 bc began to investigate the internal body. Herophilus examined carefully the layout and organs of the body, giving names to the duodenum, and other anatomical structures. He dissected the eye, and, following his master Praxagoras of Cos, studied the pulse as a guide to illness. Erasistratus dissected the brain, trying to establish how movement and sensa­ tion were produced, and, using analogies from Alexandrian science, described the body and its processes in mechanical terms. He had little time for humours, and thought that the arteries contained only air, pneuma, a form of refined air produced in the heart. He explained the presence of blood in the arteries as resulting from seepage or from attraction following the escape of pneuma and the temporary creation of a vac­ uum. He rejected equally strongly the view of Plato and Aristotle that everything was created for a purpose (teleology), favouring a mechanical development.

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Each health care facility should establish a process Students and trainees must be identifed to antimicrobial use guidelines buy cheap minocycline 50 mg on-line the to bacterial cell structure buy minocycline online ensure that designated personnel have been patient antibiotic resistance week order 50mg minocycline fast delivery. Mechanisms should be in place to Appropriate staffng numbers and skill mix should ensure appropriate training and supervision of be in place to ensure that safe practices can be inexperienced staff and trainees. Table 1 is a suggested list chemotherapy should have access to appropriate of essential knowledge. Suggested list of knowledge and skills applicable to health care professionals involved in the prescribing, dispensing and administration of cancer chemotherapy and targeted therapy. This list is not defnitive the principles involved in treating patients with cancer the basic principles of chemotherapy and targeted therapy including mechanism of action, dosage methods, scheduling and administration Chemotherapy protocols commonly used within scope of clinical practice Adverse effects and toxicities associated with chemotherapy and targeted therapy including, early identifcation, ongoing monitoring, principles of prevention and management Principles of safe handling of chemotherapy and targeted therapy Chemotherapy and targeted therapy medication preparation, storage and transportation Information and support needs of patients and their families including psychological support for persons receiving treatment for cancer Ethical and legal issues associated with the use of chemotherapy and targeted therapy as a treatment modality for cancer Local policy and procedures as they relate to cancer treatment Guidelines for the Safe Prescribing, Supply and Administration of Cancer Chemotherapy and Information technology systems. The use of electronic systems are used to obtain information, electronic programs to facilitate the prescribing, procedures should be in place for storage and dispensing and administration of cancer therapy access of information. Access to original templates should be linked to avoid possible duplication of therapy. Policy and Procedures dosage calculations and body Surface area (bSa) Procedures and polices should be in place to provide direction and clear instruction on the majority of chemotherapy doses are working practices to staff involved in providing individualised for each patient and most commonly chemotherapy. The Mosteller should be approved by an appropriate authoritative calculation method is the simplest and most widely committee. Printed material should be adjuvant setting the actual body weight should be clearly annotated with the date of printing. Information should be easily accessible adjustments are made if the patient’s weight and up to date. The primary patient medical varies by greater then 10% during treatment, there record/chart and all documentation applicable to is no evidence that this should be undertaken. Dose adjustment should should be made available to all staff in a timely, easy be made according to the presence or absence to read manner i. Where of toxicity, as well as changes in other factors that Guidelines for the Safe Prescribing, Supply and Administration of Cancer Chemotherapy may affect drug elimination such as renal and Clearly referenced. It must be ensured that the weight basis and in these circumstances the weight content is maintained regularly. The Treatment given as part of a clinical trial may use of pre-documented protocols has been shown utilise drugs, doses and scheduling outside those to reduce errors in prescribing. Whilst guidance for should come from an evidence-based, published clinical trials is beyond scope of this document source wherever possible and there should be the principles described in this document to a process of initial review by a multi disciplinary reduce medication errors apply. Clinical trial team before a protocol is implemented in clinical protocols should clearly outline the treatment practice. The use of an abstract or journal paper protocol however the format may differ according as a direct source for writing a chemotherapy order to the originating investigator and local ethics should be discouraged unless an exceptional case requirements. Misinterpretations of articles and errors that information is presented in a clear manner in in original papers have led to fatal outcomes. Fatal errors have occurred where protocol at a local level should be considered trial protocols have been misinterpreted by staff. Protocols should be reviewed on a limited to those familiar with the trial protocol. Protocol templates stored electronically should be in read-only format to avoid unapproved alterations on the original. Access to the original protocol document should be restricted to authorised persons. Suggested content of the chemotherapy protocol Name of the protocol Care should be taken to distinguish protocols with similar names. Usual number of cycles to be given for a course of treatment and total length of the course Other treatment modalities that may accompany the protocol. References sources that support the use of the protocol in clinical practice Where the protocol details vary from the detail in the original reference then the reasons should be stated clearly on the protocol. All chemotherapy and targeted therapy relevant to the protocol including those to be administered by the oral route and other routes Generic names (not trade names) must be used as the primary drug name. Names must not be abbreviated to the chemical or trial names however it may be useful to include names the drug may also be known by as a reference source. Dose limits for individual and cumulative doses per dose, cycle and lifetime Drug vehicle and volume (where appropriate). Rate and duration of administration this should specify whether an infusion is intermittent or continuous. Infusions that run over several days should clearly state the daily dose and total dose.

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For persons over 70 antibiotic resistance gene in plasmid buy minocycline 50 mg free shipping, no benefit from oxaliplatin added to treatment for uti back pain buy 50mg minocycline free shipping adjuvant treatment has been found infection you get from hospital discount minocycline 50 mg mastercard. However, there is a case for the addition of oxaliplatin in the elderly where there are metastases. Neoadjuvant and adjuvant therapy for rectal cancer the decisions about neoadjuvant chemotherapy are not easily summarised as it is intimately linked with radiotherapy, for which chemotherapy is used as a sensitizer, at least in part. Outcomes can be very grave, and precise location and staging are required to determine treatment. Fluorouracil by infusion or capecitabine by mouth are the drugs most commonly used. The Guidelines state that there is not strong evidence of success of adjuvant therapy with fluorouracil or capecitabine for rectal cancer, and the use of other agents is not warranted on present evidence. Management of non-resectable locally recurrent and metastatic disease Clearly the presentation of recurrences present challenges that are unique to each patient, and treatments are therefore tailored. Chemotherapy is but one small part, and regimens when administered systemically are similar (fluorouracil and folinic acid) as well as other drugs via innovative treatment routes. The main drugs mentioned in this section of the Guidelines have already been discussed in this paper. Clearly, decisions as to which to use when will mostly be on a case-by-case basis as the adverse effects and likely benefit will need to be balanced for each individual. There is also a range of other emerging biomarkers whose significance is still being researched. A little of what is there will be repeated here to aid understanding, but generally it will be assumed the reader has read Appendix 2. Each type of cell culture is engineered to produce an antibody of a certain type/structure that has a specific effect on the tumour cells, which is not achievable by the body’s immune response alone. Panitumumab (Vectibix) the pathway of action of Panitumumab is very similar to that of cetuximab and its use is also similar, as are its approved indications. This reduces the growth of blood vessels to tumours, thus inhibiting tumour growth. The kinase inhibitors are mostly small molecules, not large like proteins, but can be large. Regorafenib Regorafenib (Stivarga) is a tyrosine kinase inhibitor interferes with a number of these enzymes involved in cancer. Tyrosine kinases transfer phosphate to other proteins in the cell to switch them on or off. Other drugs Tegafur/Gimeracil/Oteracil the combination therapy Tegafur/Gimeracil/Oteracil (aka S-1) is mentioned in the Guidelines but is not discussed here. If it becomes more frequently used a section on them can be prepared but the biochemistry/pharmacology is complex and so is omitted to keep the focus on more mainstream treatments at this stage. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Adenine and guanine are purines and cytosine and thymine are pyrimidines, as is uracil. Hence the reference to the class of fluoropyrimidine drugs, all of which have the pyrimidine structure in there somewhere, with fluorine and other entities hooked on to that basic structure. The similarity of thymine, uracil and fluorouracil is readily seen when they are side by side. Fluorouracil has a fluorine atom added to the uracil molecule in the position where thymine had a methyl group. A greater understanding of the biology of cancer at the cellular and subcellular level has identified cellular markers that indicate when certain drugs may or may not work – resulting in so called tailored therapy. Colorectal cancer is frequently associated with mutations affecting proteins on a complex pathway that controls cell growth and survival. An attempt to outline the key features of the pathway simply is given below, as a precursor to trying to understand the targeted therapies better. The first step in activation is the binding of a ‘ligand’ – a protein that binds to a receptor on the surface of a cell. Things occasionally go wrong with the proteins or the genes involved in these processes.

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They will alter course to antibiotic resistance washington post generic minocycline 50mg without a prescription take brief advantage of the shade from a stand of trees treatment for dogs eating cane toads buy minocycline 50mg without a prescription. But where the shadow is depends on the time of day virus and fever 50 mg minocycline visa, because the Sun is moving across the sky. Later in the afternoon, as the Sun is setting toward the west, shadows are cast to the east. Not only are hunter-gatherers expert in the tracks of other animals; they also know human tracks very well. Laurens van der Post recounts, [M]any miles from home and separated from the rest, Nxou and I, on the track of a wounded buck, suddenly found another set of prints and spoor joining our own. Does every tracker in the course of his training sit on his haunches for hours, following the slow degradation 296 the Wind Makes Dust of an eland hoofprint? The local variations wind speed, soil moisture are updated as needed in each generation, or seasonally, or day-by-day. Every time we try to judge the age of a crater on the Moon or Mercury or Triton by its degree of erosion, we do not perform the calculation from scratch. We dust off a certain scientific paper and read the tried-and-true numbers that have been set down perhaps as much as a generation earlier. They try to understand the principles and the mathematics, they observe its utility, they note how Nature follows these rules, and they take these sciences to heart, making them their own. Yet someone had to figure out all these tracking protocols for the first time, perhaps some palaeolithic genius, or more likely a succession of geniuses in widely separated times and places. Kung tracking protocols of magical methods examining the stars the night before or the entrails of an animal, or casting dice, or interpreting dreams, or conjuring demons, or any of the myriad other spurious claims to knowledge that humans have intermittently entertained. You need a precise answer that magic and divina tion simply do not provide, or at least not often enough to stave off starvation. Instead hunter-gatherers who are not very superstitious in their everyday life, except during trance dances around the fire and under the influence of mild euphoriants are practical, workaday, motivated, social, and often very cheerful. You can even see it in chimpanzees when tracking on patrol of the frontiers of their territory, or when preparing a reed to insert into the termite mound to extract a modest but much needed source of protein. The other principal food-garnering activity of pre-agrarian societies is foraging. Botanists and anthropologists have repeatedly found that all over the world hunter-gatherer peoples have distinguished the various plant species with the precision of western taxonomists. This vestige of colonialism and racism is belied by the everyday activities of people living with no fixed abode and almost no possessions, the few remaining hunter-gatherers the custodians of our deep past. What Ionia and ancient Greece provided is not so much inven tions or technology or engineering, but the idea of systematic inquiry, the notion that laws of Nature, rather than capricious gods, govern the world. Each such explanation identified with a different pre Socratic philosopher was deeply flawed in its details. But the 298 the Wind Makes Dust mode of explanation, an alternative to divine intervention, was productive and new. When, through indifference, inatten tion, incompetence, or fear of scepticism, we discourage children from science, we are disenfranchising them, taking from them the tools needed to manage their future. Although there are many ways of making stone tools, what is remarkable is that in a given site for enormous periods of time the tools were made in the same way which means that there must have been educa tional institutions hundreds of thousands of years ago, even if it was mainly an apprenticeship system. When the training is unchanged for immense periods of time, traditions are passed on intact to the next generation. Teachers despair at how educational standards have deteriorated, and how lackadaisi cal students have become. In a world in transition, students and teachers both need to teach themselves one essential skill learning how to learn. There are many better responses than making the child feel that asking deep questions constitutes a social blunder. The best of 20 fifth-grade classrooms in Minneapolis was outpaced by every one of 20 classrooms in Sendai, Japan, and 19 out of 20 in Taipei, Taiwan. Such dismal trends for average students in the United States are occasionally offset by the performance of outstanding students.