Renagel

Derek Wilson Cain, PhD

• Assistant Professor in Medicine
• Member of the Duke Human Vaccine Institute

https://medicine.duke.edu/faculty/derek-wilson-cain-phd

This causes a painful elbow with tenderness over the medial epicondyle and elbow flexion contracture that may exceed 15 degrees gastritis diet ultimo generic renagel 800mg line. When radiographic evidence of union is noted gastritis diet soy sauce discount 400mg renagel fast delivery, a specific progressive throwing program is started gastritis diet sheet renagel 400mg free shipping. Medial ligament rupture to the ulnar collateral ligament is not common in young athletes and is seen more in adults chronic gastritis raw food order renagel 400 mg without prescription. Patients may have medial tenderness for months to years before the ligament is injured gastritis symptoms hemorrhage generic renagel 800 mg amex, usually in a sudden catastrophic event gastritis diet 13 buy renagel 800mg mastercard. If the injury is detected early, conservative treatment including rest and alternating heat/ice is recommended. It is a self-limiting condition where the capitellum epiphysis essentially assumes a normal appearance as growth progresses. They present with elbow pain and a flexion contracture of greater than or equal to 15 degrees. These patients should be seriously counseled about the dangers of continued throwing and are urged to abstain. Posterior extension and shear injuries are uncommon in young throwers but the incidence increases with age. If there is lack of apophyseal fusion, rest and immobilization can produce good results. Partial avulsion of the olecranon requires surgical reattachment of the olecranon and triceps. They can be seen not just in baseball pitchers but also in quarterbacks, tennis players, volleyball players and javelin throwers. Because the biomechanics of throwing are complex, the physical stresses can cause a group of pathologic entities to include the medial, lateral, and posterior aspects of the elbow. Preventing these types of injuries involves teaching proper throwing mechanics, keeping an accurate pitching count, predetermining a stopping point based on number of pitches thrown, and recognizing early warning signs and stopping once the pain starts. Although many of these injuries have been blamed on throwing curve balls, some studies have shown that a properly thrown curve ball causes no more injuries than the traditional fastball (11,12,13). He was playing in a roller hockey game when a hockey stick was swung high and struck him in the face. Ophthalmology is consulted and further evaluation for the hyphema includes an intraocular pressure measurement, which is found to be normal. The patient and parents are told to limit his activity for the first 72 hours without television or video games. His immunization records are current and the patient is sent home with a narcotic analgesic and follow-up in 3 days. The next season, he is sporting a new pair of safety goggles to every game and practice. Orbital injuries are common injuries in athletes, especially those in high-risk sports with high-speed objects such as sticks, bats, balls, pucks, or aggressive body contact. Males are at higher risk for orbital fractures because of their increased incidence of trauma. The aperture of the bony architecture surrounding the eye does not allow an object with a radius of greater than 5 cm to penetrate the globe (14). The thin orbital floor (maxilla) and the medial wall (ethmoid) are the weakest portions of the orbit. A direct blow to the bony rim may not cause a bony rim fracture, but can be enough to increase intraorbital pressures (as the globe is compressed) resulting in a "blowout fracture" of the weakest point of the orbital wall, which is usually the floor of the orbit. Sphenoid: posterior orbit Related anatomical structures that can be injured during an orbital fracture include the optic nerve, periorbital fat, extraocular muscles, and the inferior orbital nerve. These injuries are multiple and can include corneal abrasion, lens dislocation, iris disruption, choroid tear, scleral tear, ciliary body tear, retinal detachment, hyphema, ocular muscle entrapment, and globe rupture. The patient should be questioned regarding epistaxis or clear fluid from nares or ears, loss of consciousness, visual problems, hearing problems, malocclusion, and facial numbness or tingling. Other specific questions regarding the eye include the presence of diplopia, painful eye motion (entrapment or periorbital edema), photophobia, flashes of light (retinal detachment), or blurred vision (hyphema, vitreous hemorrhage, retinal detachment) (14,16,17). This includes visual acuity, inspection for abrasions, laceration, foreign bodies, changes in pupillary dimension or reactivity to light. Any change in visual acuity, blood in the anterior chamber, or change in the shape of the iris should warrant a consult with an ophthalmologist. They should have their supraorbital ridge and frontal bone palpated for step-off fractures, and their hard palate and teeth palpated for stability. Evaluate the supraorbital, infraorbital, inferior alveolar, and mental nerve distributions for anesthesia. These patients may present with ecchymoses, enophthalmos of the globe (sunken eye), vertical dystopia (a change in vertical position of the pupil in relation to the unaffected side), or numbness in the area on the ipsilateral cheek supplied by the infraorbital nerve. Although a "black eye" was once felt to be a relatively benign injury for which medical attention was often not sought, many instances of periorbital ecchymoses are due to orbit fractures. Radiographically, routine facial views include Waters, Caldwell, and lateral projections (14,15,16). The Waters view is used for identifying inferior orbital rims, nasoethmoidal bones, and maxillary sinuses. The Caldwell projection provides the best view of the lateral rim and ethmoid bone. Lateral views may show air-fluid levels in the posterior maxillary sinus if the patient is lying supine. C-spine films are indicated if the patient complains of neck pain or if a suspected cervical injury cannot be ruled out. A forced duction test can determine if limitation of ocular movements is due to entrapped soft tissues or to edema or contusion of a motor nerve or muscle. This is performed by anesthetizing the affected eye with topical anesthesia, grasping the sclera with a fine toothed forceps at the level of the inferior rectus muscle and moving the eye in a superior/inferior direction. In clinical practice, this test is only rarely performed, since it is more convenient to merely wait to see if diplopia subsides with time. Even patients with signs of entrapment may be discharged home because most entrapment resolves as the swelling goes down. They should; however, return if there is a change in visual acuity, increased pain, or flashing lights. Hyphema occurs more often in males (3:1) and is usually seen in a younger population, less than 30 years old (18). Trauma is the most common cause of hyphema, often seen in baseball or hockey athletes where a blunt compressive force hits the globe causing tears in the ciliary body, iris, and other structures in the anterior segment. Other non-sports related causes of hyphema include microvascular disease such as diabetes causing neovascularization, retinal ischemia, carotid stenosis, or iatrogenic (post-intraocular surgery), sickle cell disease, pupillary microhemangiomas, iritis, or intraocular tumors. Corneal bloodstaining results from blood being forced into corneal endothelial cells. It is an ominous sign and signifies the need for surgical evacuation of the hyphema. This occurs when the clot completely occludes the pupil/lens interface, blocking the flow of aqueous from the posterior to anterior chamber. Historical data important to illicit include the mechanism of injury, type of assaulting object, whether protective eye wear was used, ethnic origin, and past ocular history. Visual acuity, pupillary reaction, extraocular movement, signs of corneal staining, and intraocular pressure are also important aspects of the examination. An exophthalmometer can be used to look for exophthalmos related to ocular trauma. In patients without an increase in intraocular pressure, behavioral modifications begin with limiting activities such as reading, which cause rapid shifts in the globe. Within the first 72 hours, rebleed is most common, therefore, this is the crucial time when children may have to be bedrested. It is especially important to limit activities in infants and children who watch television or play video games. Watching television from a distance greater than 10 feet limits the amount of extraocular movement. In hyperactive children, bilateral patching may be required to minimize activity level. Patching of the affected eye only, is not beneficial because movement of the contralateral eye will cause movement of the affected eye (18). In general, patients should keep activity to a minimum for at least the first 5 days to prevent a rebleed. Cycloplegics and topical steroids, which treat associated iritis may also be used. Cycloplegics are anticholinergic agents that block the response of the iris sphincter muscle and ciliary body to cholinergic stimulation, causing paralysis of accommodation (cycloplegia) and pupillary dilation (mydriasis). Antifibrinolytics such as aminocaproic acid may be used to prevent recurrent hyphemas, but this medication may cause serious adverse effects. Hyphema resulting from a rebleed is usually more extensive than the initial trauma. Rebleeding may present as a total hyphema with blood filling the entire anterior chamber. Patients with a small-sized hyphema can be treated with simple management and have a good prognosis. Promoting public awareness in parents regarding eye safety for their children is important but often difficult, especially in adolescents when image is important. Just as wearing a helmet in football is mandatory, wearing goggles in high-risk sports should become obligatory. Prevention of orbital and ophthalmic injuries includes wearing safety glasses or goggles in those who participate in high-risk sports in which balls, bats, or pucks are used. What types of athletes are subject to Little League elbow besides baseball pitchers Those who do forceful contraction of the quadriceps (jumping sports such as basketball and volleyball). The term "little league elbow" is used to describe a group of pathologic entities in and around the elbow joint in young throwers secondary to overhead throwing. Valgus stress results in lateral compression and medial traction on the elbow leading to the many types of injuries described in the text. A direct blow to the bony rim causing enough of an increase in intraorbital pressures to fracture the thin interior bones (usually the orbital floor). Topical beta blockers, cycloplegics, osmotic diuretics, carbonic anhydrase inhibitors. His past medical history is unremarkable except for asthma during early childhood, which has been well controlled. He is an average student currently in the 9th grade and is the smallest in his class. There is no history of smoking, alcoholism, mental illness, drug abuse or learning problems in the family. Impression: Constitutional Short Stature, Delayed Puberty Clinical Course: Over the next 6 months, pubic hair growth is noted. Puberty refers to the biological changes that lead to reproductive capability while adolescence generally refers to the psychosocial changes that occur. The sequence of events that occur during puberty are generally fairly predictable. The first clinical sign is thelarche (the appearance of breast buds) and adrenarche (the appearance of dark straight pubic hair over the mons veneris, also called the mons pubis). Development of pubic hair starts about 1 year after breast budding and may take place over a 1. Puberty in boys also follows a regular sequence of events, but lacks the clear cut landmarks such as breast development and menarche. In the male, the pubertal growth spurt is a late event starting about two years later than in females. The onset of pubertal changes however, are only about 6 months later than in females (see tables 2 and 3). There is a common misconception that the difference between the onset of puberty in males and females is 2 years. The patient described above is not only short statured but is delayed in his pubertal development. On the basis of the physical findings described, he would fit a presumptive diagnosis of constitutional delay of growth and maturation. Boys with a constitutional delay of growth and maturation, usually have a normal birth weight and length, and progress along their normal growth centile for the first several years of life, following which, they begin to deviate and grow at or below the 3rd percentile throughout childhood. At the time when normal puberty should begin, there is often a marked fall off in growth (pre-adolescent dip) due to a diminished secretion of growth hormone. This transient fall in growth hormone is probably due to failure of sex hormone production and stimulation. Patients with constitutional delay in growth and maturation usually do not reach their "mid parent" or predicted height. Catch up growth is largely dependent upon the delay of bone maturation at the time of diagnosis, indicating that there may be a genetic or familial component to their short stature. The patient presented could have been prescribed a short term course of testosterone or gonadotropins in order to stimulate sexual maturation and growth hormone production. In general, such treatment has been reserved for teenagers with significant behavior or psychological (self image) problems due to their delayed puberty. In most cases, the evaluation of a patient suspected of delayed sexual maturity can be conservative. A thorough family history, physical examination, and assessment of sexual maturity stage will often show signs of early pubertal changes. The difference in age between the initiation of pubertal (sexual) changes in the male and female is how many months There is approximately 6 months difference in the age of onset of sexual maturation in the female vs. Puberty is delayed when there is no sign of pubertal development by age 13 years in girls and 14 years in boys.

Nebido is the frst long-acting testosterone preparation for intramuscular injection chronic gastritis low stomach acid buy cheap renagel 400mg line. Nebido needs to be administered only about 4 times per year for restoration of testosterone levels to the eugonadal range diet of gastritis patient buy renagel 400mg with visa. Unphysiologically high peaks in testosterone levels are largely avoided after the administration of Nebido gastritis diet zantrex buy renagel online now. Reactions at the injection site and other side efects specifc to testosterone occurred only in individual cases gastritis diet in telugu buy 400mg renagel fast delivery. As with any androgen therapy gastritis diet �� generic 400mg renagel with mastercard, the use of Nebido is contraindicated in known cases of carcinoma of the mammary or prostate glands gastritis diet ������� generic 800 mg renagel overnight delivery. The prostate and haematological parameters must be regularly monitored during the treatment. Complete androgen insensitivity syndrome: long-term medical, surgical, and psychosexual outcome. Functional cross-talk between the hypothalamic-pituitary-gonadal and -adrenal axes. Progressive Improvement of T-Scores in Men with Osteoporosis and Subnormal Serum Testosterone Levels upon Treatment with Testosterone over Six Years. Efects of long-acting testosterone undecanoate on bone mineral density in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 36 months controlled study. Androgens and estrogens modulate the immune and infammatory responses in rheumatoid arthritis. Combined testosterone and vardenafl treatment for restoring erectile function in hypogonadal patients who failed to respond to testosterone therapy alone. Organic, relational and psychological factors in erectile dysfunction in men with diabetes mellitus. Reference ranges for testosterone in men generated using liquid chromatography tandem mass spectrometry in a community-based sample of healthy nonobese young men in the Framingham Heart Study and applied to three geographically distinct cohorts. Hypogonadal symptoms are associated with diferent serum testosterone thresholds in middle-aged and elderly men. Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400ng/dL. Pharmacokinetics and tolerability of a bioadhesive buccal testosterone tablet in hypogonadal men. Evaluation of late-onset hypogonadism (andropause) treatment using three diferent formulations of injectable testosterone. Medication adherence and treatment patterns for hypogonadal patients treated with topical testosterone therapy: a retrospective medical claims analysis. Intramuscular injection of testosterone undecanoate for the treatment of male hypogonadism: phase I studies. Repeated intramuscular injections of testosterone undecanoate for substitution therapy in hypogonadal men. Long-term treatment of hypogonadal men with testosterone produces substantial and sustained weight loss. Testosterone therapy in hypogonadal men results in sustained and clinically meaningful weight loss. Efects of fve-year treatment with testosterone undecanoate on metabolic and hormonal parameters in ageing men with metabolic syndrome. Plasma levels of dihydrotestosterone remain in the normal range in men treated with long-acting parenteral testosterone undecanoate. The efcacy and safety of testosterone undecanoate (Nebido ) in testosterone defciency syndrome in Korean: a multicenter prospective study. Treatment of 161 men with symptomatic late onset hypogonadism with long-acting parenteral testosterone undecanoate: efects on body composition, lipids, and psychosexual complaints. Comparison of long-acting testosterone undecanoate formulation versus testosterone enanthate on sexual function and mood in hypogonadal men. Comparison of a new long-acting testosterone undecanoate formulation vs testosterone enanthate for intramuscular androgen therapy in male hypogonadism. A four-year efcacy and safety study of the long-acting parenteral testosterone undecanoate. Timetable of efects of testosterone administration to hypogonadal men on variables of sex and mood. Infuence of testosterone replacement therapy on metabolic disorders in male patients with type 2 diabetes mellitus and androgen defciency. Efect of testosterone treatment on glucose metabolism in men with type 2 diabetes: a randomized controlled trial. Efect of testosterone treatment on constitutional and sexual symptoms in men with type 2 diabetes in a randomized, placebo-controlled clinical trial. Efects of testosterone undecanoate replacement and withdrawal on cardio-metabolic, hormonal and body composition outcomes in severely obese hypogonadal men: a pilot study. An exploratory study of the efects of 12 month administration of the novel long-acting testosterone undecanoate on measures of sexual function and the metabolic syndrome. Improvement of the diabetic foot upon testosterone administration to hypogonadal men with peripheral arterial disease. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. Efcacy and safety of two diferent testosterone undecanoate formulations in hypogonadal men with metabolic syndrome. Efects of testosterone supplementation on markers of the metabolic syndrome and infammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo controlled Moscow study. Concurrent improvement of the metabolic syndrome and lower urinary tract symptoms upon normalisation of plasma testosterone levels in hypogonadal elderly men. Improvement of the metabolic syndrome and of non-alcoholic liver steatosis upon treatment of hypogonadal elderly men with parenteral testosterone undecanoate. Benefcial efects of 2 years of administration of parenteral testosterone undecanoate on the metabolic syndrome and on non-alcoholic liver steatosis and C-reactive protein. A safety study of administration of parenteral testosterone undecanoate to elderly men over minimally 24 months. Efects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic syndrome: results from a 24-month, randomized, double-blind, placebo-controlled study. Hypogonadal obese men with and without diabetes mellitus type 2 lose weight and show improvement in cardiovascular risk factors when treated with testosterone: an observational study. Efects of long-term testosterone therapy on patients with diabesity: results of observational studies of pooled analyses in obese hypogonadal men with type 2 diabetes. Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study. Efects of testosterone treatment on body composition in males with testosterone defciency syndrome. Efects of testosterone treatment on bone mineral density in men with testosterone defciency syndrome. Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone: A randomised controlled trial. Efects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial. Efect of testosterone replacement therapy on bone mineral density in patients with Klinefelter syndrome. Long-term testosterone treatment in elderly men with hypogonadism and erectile dysfunction reduces obesity parameters and improves metabolic syndrome and health-related quality of life. Elderly men over 65 years of age with late-onset hypogonadism beneft as much from testosterone treatment as do younger men. Efects of 5-year treatment with testosterone undecanoate on lower urinary tract symptoms in obese men with hypogonadism and metabolic syndrome. Could Testosterone Replacement Therapy in Hypogonadal Men Ameliorate Anemia, a Cardiovascular Risk Factor Testosterone therapy has positive efects on anthropometric measures, metabolic syndrome components (obesity, lipid profle, Diabetes Mellitus control) and blood indices, liver enzymes, prostate health indicators in elderly hypogonadal men. Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism. Efects of 8-Year Treatment of Long-Acting Testosterone Undecanoate on Metabolic Parameters, Urinary Symptoms, Bone Mineral Density, and Sexual Function in Men With Late-Onset Hypogonadism. Efects of intermission and resumption of long-term testosterone replacement therapy on body weight and metabolic parameters in hypogonadal in middle-aged and elderly men. Efects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity, voiding function and prostate safety parameters. Improvement of sexual function in men with late-onset hypogonadism treated with testosterone only. RigiScan data under long-term testosterone therapy: improving long-term blood circulation of penile arteries, penile length and girth, erectile function, and nocturnal penile tumescence and duration. Efects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome. Testosterone Undecanoate improves Sexual Function in Men with Type 2 diabetes and Severe Hypogonadism: Results from a 30 week randomized placebo controlled study. A prospective, multicenter study on efcacy of long-acting testosterone undecanoate, if desired in combination with vardenafl, in late onset hypogonadal patients with erectile dysfunction. Symptomatic response to testosterone treatment in dieting obese men with low testosterone levels in a randomized, placebo-controlled clinical trial. A dose-response study of testosterone on sexual dysfunction and features of the metabolic syndrome using testosterone gel and parenteral testosterone undecanoate. Efects of testosterone gel followed by parenteral testosterone undecanoate on sexual dysfunction and on features of the metabolic syndrome. Testosterone replacement therapy improves the health-related quality of life of men diagnosed with late-onset hypogonadism. Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study. Testosterone undecanoate improves erectile dysfunction in hypogonadal men with the metabolic syndrome refractory to treatment with phosphodiesterase type 5 inhibitors alone. The efcacy of combination treatment with injectable testosterone undecanoate and daily tadalafl for erectile dysfunction with testosterone defciency syndrome. Testosterone undecanoate restores erectile function in a subset of patients with venous leakage: a series of case reports. Testosterone improves erectile function in hypogonadal patients with venous leakage. A randomized, double-blind, placebo-controlled trial on the efect of long-acting testosterone treatment as assessed by the Aging Male Symptoms scale. Efect of long-acting testosterone undecanoate treatment on quality of life in men with testosterone defciency syndrome: a double blind randomized controlled trial. Efects of two-year testosterone replacement therapy on cognition, emotions and quality of life in young and middle-aged hypogonadal men. Benefcial efects of testosterone administration on symptoms of the lower urinary tract in men with late-onset hypogonadism: a pilot study. Testosterone replacement alone for testosterone defciency syndrome improves moderate lower urinary tract symptoms: one year follow-up. Lower urinary tract symptoms improve with testosterone replacement therapy in men with late-onset hypogonadism: 5-year prospective, observational and longitudinal registry study. Intramuscular testosterone undecanoate: pharmacokinetic aspects of a novel testosterone formulation during long-term treatment of men with hypogonadism. Factors infuencing time course of pain after depot oil intramuscular injection of testosterone undecanoate. Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries. The efect of testosterone treatment on prostate histology and apoptosis in men with late-onset hypogonadism. Retrospective investigation of testosterone undecanoate depot for the long-term treatment of male hypogonadism in clinical practice. Long-acting testosterone injections for treatment of testosterone defciency after brachytherapy for prostate cancer. Complications of injectable testosterone undecanoate in routine clinical practice. Body compositional and cardiometabolic efects of testosterone therapy in obese men with severe obstructive sleep apnoea: a randomised placebo-controlled trial. Efects of testosterone therapy on sleep and breathing in obese men with severe obstructive sleep apnoea: a randomized placebo-controlled trial. The efects of testosterone on ventilatory responses in men with obstructive sleep apnea: a randomised, placebo-controlled trial. Anaphylaxis triggered by benzyl benzoate in a preparation of depot testosterone undecanoate. Long-acting intramuscular testosterone undecanoate for treatment of female to-male transgender individuals. Safety aspects of 36 months of administration of long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals. Efects of intramuscular testosterone undecanoate on body composition and bone mineral density in female-to-male transsexuals. Cross-sex hormone therapy in trans persons is safe and efective at short-time follow-up: results from the European network for the investigation of gender incongruence. Efects of Three Diferent Testosterone Formulations in Female-to-Male Transsexual Persons.

Transxenoestrogenesis names but one form of our shared vulnerability to one another gastritis symptoms pregnancy purchase renagel 400 mg line, our bodies open to the planet gastritis hiatal hernia diet purchase discount renagel online. Eva Hayward teaches in the College of Design gastritis jaundice order cheap renagel line, Architecture gastritis diet nuts purchase renagel now, Art gastritis healing diet generic 400 mg renagel amex, and Planning at the University of Cincinnati hemorrhagic gastritis definition purchase discount renagel on line. By gathering nonnormative sex and gender terms underneath its canopy, the umbrella visually casts an aggregative categorical imaginary that includes all sex/ual and gender-nonconforming identities and expressions. In so doing, the umbrella implies that all formations of sex and gender are not only possible but also taxonomically containable. The aggregating aspect of the transgender umbrella is predicated upon historically shifting understandings of the category transgender. Without this sense of political collectivity, it would not have been possible to visually render transgender as an umbrella instead of as a con tinuum of gender-nonconforming identities and behaviors or as a particular mode of being. Erasures happen when individuals who are placed under the umbrella do not imagine themselves to belong. Erasures also occur through colonizing impulses that include culturally speci c terms like hijra or waria. But given the potential exclusions and erasures produced by an all-encompassing classi catory practice, a caution remains. His work has appeared in the Transgender Studies Reader, the Journal of Medical Humanities, and Discourse. As transgender studies approaches its second iteration, claiming our dis cursive voice is less urgent. To insert the study of whiteness into trans studies means to develop a critical lens of seemingly disparate elements, like beauty, access, visibility, and acceptance within, for instance, the history of transgender peo ple seeking services and gaining access to them (in the mid-twentieth century) and leadership and activism (at the present time). In many instances, constructions of gender are about being white, being perceived to be white, or sometimes they are deeply ingrained in perceptions of beauty as white. Since the study of whiteness coincided very much with the development of transgender studies, the two are intertwined in this given cultural moment (Stryker 1998; Roediger 1999). For instance, in contemporary trans* spaces, the perception of having the choice about being genderless, gender uid, or genderqueer, is often tied to white privilege, especially when some members of communities of color may under stand their trans experience as nonidentity, as expressions of gayness, or as in a space between gay and trans (Valentine 2007). I do not seek to establish an essentialist, oppositional view of trans* that splits people of color and whites but do so in order to illustrate the systemic forms of naming and sustaining trans* as something de ned hierarchically, even if without a conscious intent. While tokenistic efforts to mention trans people of color are often part of the production of whiteness in transgender studies (Vidal Ortiz 2009), the leadership of most contemporary movements involving trans rights, studies, and activism is predominantly white. He coedited the Sexuality of Migration: Border Crossings and Mexican Immigrant Men (2009). The wrong-body conception is criticized from feminist, queer, and trans political/theoretical points of view. And within the Diag nostical and Statistical Manual of Mental Disorders, fourth ed. The theoretical critique regards the assumption of essentialism that underlies the wrong-body conception. Essentialism therefore reinforces the norms of a gender binary, resulting in misrecognition of gender-varied bodies and expressions, risking stigmatization, discrimination, and exclusion. Hence the critique mainly concerns: the master narrative of the wrong body that overshadows gender-variant body experiences as valid; the reference to gender and/or genital essentialism; the rei cation of body and self as static and separable entities; and the reproduction of gender binary norms. This framework ultimately denies rst-person authority to the experience of trans gender identity. Embodiment is understood through an intertwining of subjectivity, materiality, and discursivity. Wrong body as lived body expresses the situatedness of trans body expe rience as wrong, hence relativizing it. This way the gender binary is replaced with gender variance as a frame for understanding gender, offering a more uid understanding of the trans body. Her doctoral thesis concerns the concepts of justice, recognition, and identity in relation to a trans* context. Her research interests are transgender studies and ethics, in particular the ethics and politics of recognition, identity, and visibility. The de nition of x-jendais one that although generally taken for granted remains ambiguous as well as open to individual interpretation. Jendais not a term that one nds on forms requiring personal information; in such cases, seibetsu (often interpreted as referring to biological/physiological sex) is used. The difference in the connotations between the term gender, used in an anglophone context, and jendain Japanese draws attention to the multiple meanings that translation can create and points to the differences in the reception of a term that cultural context fosters. The medicalization of transgender ways of being in Japan as such came about relatively later than in European and North American countries, and this has impacted the path that transgender politics has come to take. As such, it is not necessarily viewed as a local construct but rather as a universal identity. Websites such as Wikipedia do not always provide cultural context; a page about transgender in Japanese, for example, will list x-jendaas a sub-category, without stating the locality of the term (see Wikipedia 2013). X-jendasymbolizes for some the rejection of a system that judges indi viduals based on their sex/gender. The answer is one that has rami cations for personal as well as social conceptions of gender. As such, the abjection of others serves to maintain or reinforce boundaries that are threatened. Drawing on a psychoanalytic reading of subjective identity as a defensive con struction and on the French literary obsession with monsters, psychoanalyst and linguist Julia Kristeva develops the term abjection in Powers of Horror: An Essay on Abjection (1982). Transgendered bodies, then, especially when viewed as physical bodies in transition, defy the borders of systemic order by refusing to adhere to clear de nitions of sex and gender. Like homosexual subjectivities, transgender subjectivities challenge heteronormative understand ings of gender, sex, bodies, embodiment, and (dis)ability. Heteronormative sub jects, then, can come to feel threatened, because in order to maintain their own tenuous subjectivity, they must simultaneously identify with the abject others whom they are also required to reject (ibid. Trans activists have taken up abjection as a con structive political strategy, which can disrupt and confound long-standing sys tems of power that are sustained by the methodical exclusion, repression, and silencing of certain others. Through this declaration, she is reclaiming the word monster in order to relieve it of its power; but more importantly, abjection becomes a tool with which to further challenge and problematize conventions of socially constructed gender categories. Yet, as Halperin argues, by acknowledging and welcoming the abjection that accom panies their subjectivity and subsequently taking advantage of the moments when meaning collapses, marginalized subjects (including transgender individuals and gay men) can question the hegemonic forces that seek their oppression and in the process regain control of the signi cation of their subjectivity. In modern literature, the abject is a prominent feature in the work of writers such as Jean Genet and Marcel Jouhandeau. His book Little Pink Dot: Technology, Sexuality, and the Nation in Singapore is forthcoming. While the word adolescence dates back to the fteenth century in English and can be found to designate a stage of human life through the seventeenth and eigh teenth centuries, adolescence begins to function later in medical discourse and early psychology as a type of person, one who can be shaped and directed away from perceived social ills, such as homosexuality and prostitution, and toward social aims such as marriage and reproduction. Emerging institutions of medicine, psychology, and edu cation deployed childhood and adolescence to construct institutional knowledge and to establish authority and expertise. It becomes the moment of subjective uctuation before the presumed stability of adulthood (Kristeva 1995); and as such, it constructs the narrative inevitability of a normative adulthood. Adolescence constructs and rei es adulthood as the stage of life when selfhood is nal, established, known. And so the idea of adolescence contains transition, movement, and change in which the perceived turbulence of puberty is Downloaded from read. And yet this developmental narrative is one we impose on experience, locating moments of transition, change, and rebellion in adolescence and locating moments of arrival, stability, and confor mity in adulthood. And yet adolescence persists as the ideological container for the trans phenomena that permeate all human experience. The work of transgender theory unravels adolescence along with xed notions of gender identity, sexuality, and selfhood. Hello Cruel World: One-Hundred and One Alternatives to Suicide for Teens, Freaks, and Other Outlaws. Adolescence: Its Psychology and Its Relations to Physiology, Anthropology, Sociology, Sex, Crime, Religion, and Education. Such traces of early transgender history are closely intertwined with the history of sexuality; indeed, as early lesbian and gay archives emerged in the United States in the 1970s, their collections included trans-related materials. Far from a neutral or objective record of the past, a transgender archive is thus a rhetorical institution that is inten tionally adapted to an audience for a particular persuasive purpose. In its radical recontextualization of historical materials, the archive emerges as a discrete object of selection and representation that always involves silences and exclusions. This cycle of inclusion and exclusion, of rep resentation and misrepresentation, is the permanent shadow of any trans archival project, even digital ones; while transgender archives ght historical neglect, silences, and misrepresentations, the selection and discrimination involved in archiving creates a residual silencing of others. Rawson is an assistant professor in the Department of English at the College of the Holy Cross. Schell, he coedited Rhetorica in Motion: Feminist Rhetorical Methods and Methodologies (2010); his scholarship has also appeared in Archivaria, Enculturation, and several edited collections. In relation to transgender phenomena, the asterisk is used primarily in the latter sense, to open up transgender or trans to a greater range of meanings. Proponents of adding the asterisk to trans argue that it signals greater inclusivity of new gender identities and expressions and better represents a broader community of individuals. Trans* is thus meant to include not only identities such as transgender, transsexual, trans man, and trans woman that are pre xed by trans but also identities such as genderqueer, neutrios, intersex, agender, two-spirit, cross-dresser, and gender uid (ibid. We therefore must consider how the asterisk may have a more multifaceted theoretical appli cation. Finally, the asterisk may act as a footnote indicator, implying a complication or suggesting further investigation. As individuals who are frequently rejected by their families and who are especially vulnerable (and often especially visible) members of their communities, trans migrants have few options to access documented status. Routinely depicted as the side door to immigration, asylum allows subjects who are explicitly barred from immigrating, or who are marginalized by the hetero normative family uni cation bias of the 1965 Immigration and Nationality Act, to enter and/or become legally documented in the United States. Of these ve grounds, membership in a particular social group provides the best basis for claims by trans asylum seekers. The requirement highlights the legal strategies necessary for asylum seekers to make themselves legible to asylum adjudicators by practicing a kind of strategic essentialism.

Since acellular vaccines cause fewer side-effects (9 gastritis en ninos order generic renagel,27 gastritis diet vegan discount 800mg renagel mastercard,29) some developed countries gastritis nec purchase renagel 400 mg mastercard. The choice between whole-cell and acellular pertussis vaccines involves trade-offs between safety gastritis symptoms in pregnancy cheap 400 mg renagel with amex, efficacy gastritis quotes purchase renagel no prescription, practicality gastritis symptoms australia discount 400mg renagel overnight delivery, and cost. In addition to fewer mild or moderate reactions, acellular vaccine could interrupt disease transmission by means of its potential use in adolescents and adults. However, the best acellular vaccines may not provide protection equal to that of the best whole-cell vaccines (27). Replacement of whole-cell pertussis vaccines with acellular vaccines might conceivably lead to less effective control at substantially higher costs. Despite the advantages of acellular vaccines, we believe that lower costs and better protection are compelling reasons for use of whole-cell pertussis vaccines to continue in many countries, particularly those with limited resources (40). Scientists and physicians who choose acellular vaccine for their country have a special responsibility to strengthen their surveillance to monitor disease impact, costs, and rare adverse events-information that will guide others in the future. Whereas our study focused on morbidity following anti-vaccine movements against whole-cell vaccines, other reports indicate that pertussis mortality also increased. Pertussis hospitalizations and mortality in the United States, 1985-1988: Evaluation of the completeness of national reporting. In Symposium on Pertussis: Evaluation and Research on Acellular Pertussis Vaccines. Pertussis vaccination: Use of acellular pertussis vaccines among infants and young children. Efficacy of whole-cell pertussis vaccine in preschool children in the United States. Whooping-cough admissions to a paediatric hospital over ten years: the protective value of immunisation. Copenhagen: World Health Organization/Expanded Programme on Immunizations/European Regional Office. Epidemiology of pertussis in a developed country with low vaccination coverage: Italian experience. Vaccination: 100 years of orthodox research shows that vaccines represent a medical assault on the immune system. Persistence of pertussis in an immunized population: Results of the Nova Scotia enhanced pertussis surveillance program. A controlled trial of two acellular vaccines and one whole-cell vaccine against pertussis. Individual versus public priorities in the determination of optimal vaccination policies. The relationship between pertussis vaccine and central nervous system sequelae: continuing assessment. Permanent brain damage and pertussis vaccination: is the end of the saga in sight Sudden infant death and prevalence of whooping cough in the Swedish and Norwegian communities. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pertussis or whooping cough is a highly infectious respiratory disease caused by Bordetella pertussis. In vaccinating countries, infants, adolescents, and adults are relevant patients groups. A total of 707 clinical specimens were received from major hospitals in Malaysia in year 2011. The incidence of pertussis has been less than 1 per 100000 people from 1989 Whooping cough is a major cause of the infant [1]andchild to 2010 [10]. How tussis still remains endemic despite the introduction of vac cination program in 1974 [3]. Hence, they become the reservoir of the disease the incidence of pertussis also increased from 3. Although pertussis is always may also result in many complications such as pneumonia, classifed as infants and children disease, an increasing num apnoea, encephalopathy, death, loss of weight, convulsion, ber of cases in adolescents and adults group were also ob loss of bladder control, and rib fractures [14]. Culture was the gold standard for the diagnosis of pertus According to the vaccination schedule of Malaysia, every sis due to its specifcity; however, it is slow and not sensitive citizen should be given vaccination at 2, 3, and 5 months [15]. Detection by real-time polymerase chain reaction has old and a booster at 18 months old [6]. However, this method of detection requires the use of lular vaccine [6], the whole cell pertussis vaccine is the most expensive instrument. The swab samples were transported in Regan-Lowe medium, Amies, Stuart, or with human hemoglobin gene as described by [20]. For nasopharyngeal and target and internal control bands or target band alone was tracheal aspirates, approximately 0. However, it was considered negative when the inoculated onto the Regan-Lowe charcoal agar plates. Teplates as positive if both screening and confrmatory tests were were inspected afer 72 hours. The lowest predenaturation at 95 C for 5 min, followed by 30 cycles of number of pertussis cases was found in Kuala Lumpur with 2 denaturation at 95 Cfor1min,annealingat57Cfor1min, cases only. Although culture has high specifcity, it can The internal control primers Hg1 and Hg2 were used in be afected by several factors such as specimen transport both screening and confrmatory test to target a region of condition, illness duration, and antibiotic treatment [21, 22]. International Journal of Bacteriology 3 Table 2: Number of positive cases which detected from diferent specimens. However, it was not specifc Tere was no signifcant association between the types of enough as it is also present in B. We believe this number of throat swab samples in this study could also could be due to the inhibitory substances which may be contribute to the low number of positive results. Mattoo and Cherry [29] have suggested treating the spec In our study, infant aged 3 months old was the highest imens with mucolytic agent to remove the inhibitory sub group to be infected by B. The proportion Tere were several factors that could lead to the culture of those in the age group 3 months old (45. Many of the samples were not result was signifcantly higher than that in the age group >3 received on the same day of specimen collection except from months old (26. This could be due to the direct transmission from are geographically near our laboratory. Besides, we found their parents, relatives, or guardians who may be the reservoir that some of the swabs were not transported in the proper for the bacteria. Edwards,Healthburdenofpertussisin adolescents and adults, Pediatric Infectious Disease Journal,vol. Most of the positive samples were from nasopha (whooping cough)-complications, 2013, Guiso, Acknowledgment Nucleic acid amplifcation tests for diagnosis of Bordetella infections, Journal of Clinical Microbiology,vol. Cookson, Diagnosis of community-acquired pertussis [2] Centers for Disease Control and Prevention, Pertussis. Hallander, Microbiological and serological diagnosis of Duration of immunity against pertussis afer natural infection pertussis, Clinical Infectious Diseases,vol. Giuliano,Polymerase chain reaction for the detection of Bordetella pertussis in clinical nasopharyngeal aspirates, Journal of Medical Microbiology,vol. Cherry, Molecular pathogenesis, epidemi ology, and clinical manifestations of respiratory infections due to Bordetella pertussis and other Bordetella subspecies, Clinical Microbiology Reviews, vol. Manual for the Surveillance of Vaccine-Preventable Diseases, in Manual For the Surveillance of VaccIne-Preventable Diseases, 5th edition, 2011. Storsaeter, A controlled trial of a two-component acellular, a fve-component acellular, and a whole-cell pertussis vaccine, The New England Journal of Medicine,vol. Joel,Evaluation of strategies for use of acellular pertussis vaccine in adolescents and adults: a cost-beneft analysis, Clinical Infectious Diseases, vol. The stability data contained in the tables represents information from product monographs or published stability studies that is available in the public domain. The tables have been compiled to provide information on the relative stability of the licensed vaccines that are listed. Approach Information on the presentation, formulation, and stability of licensed vaccines was compiled from information available in the public domain. Vaccines were categorized according to whether they are: a) Vaccines against a single pathogen. Notes to table summarizing stability of commonly used vaccines Vaccines the table is not intended to be exhaustive and it does not include all currently licensed vaccines for each target disease. The vaccines listed have been selected to provide representative information on the stability of vaccines for each target. Formulation Vaccines with aluminum salt-based adjuvants are assumed to be liquid formulations (unless there is information that states otherwise). Damaged by freezing Yes/No is based on published information on whether the vaccine is damaged by freezing. Vaccines with aluminum salt adjuvants are assumed to be damaged by freezing (freeze-sensitive) unless there is available information stating this is not the case. Lyophilized vaccines are assumed not to be damaged by freezing, unless othewise stated. Stability data Any available stability data for each vaccine at the temperatures indicated is shown. The data are for a single exposure at the indicated temperature, unless stated otherwise. Summary of stability data A summary of all the available stability data for each vaccine type is provided where possible. Links Hyperlinks are provided to the summary of product characteristics, product monograph, or package insert for each vaccine. Insufficient data available to make general conclusions regarding heat stability granules Haemophilus influenzae type b (Hib). Exposures to ambient temperatures (for day-weeks) do not affect overall shelf life. Summary Liquid or Relatively short shelf life, possibly increased with lyophilized formulations. Summary Live attenuated Enteric coated Oral No Not known 18 months Insufficient data to make general conclusions regarding the stability of live oral S. Assumed to be freeze sensitive due to presence Hepatitis B and Haemophilus influenzae type b (HepB-HiB) Aluminum. Appropriate education and training is critical to the success of infection prevention and control protocols. All recommendations were current at the time of publication and vetted to the best of our ability. This is a local decision dependent on the systems and policies in the community and the note should be removed once the infectious period has passed. Maintaining a distance of at least six feet may provide1 protection from transmission of many diseases. Responders should be mindful of this and be prepared to reassure patients and to address their distress and fear. The recommendation to maintain a distance of 6 feet or more is used throughout this document to be conservative given the uncertainty. Many communities will also have dedicated infectious disease medical transport services built into their regional transportation plan for planned patient movements. Patients should cover their nose and mouth when coughing or sneezing; use tissues to contain respiratory secretions and, after use, dispose them in the nearest waste receptacle; and perform hand hygiene after having contact with respiratory secretions and contaminated objects or materials. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed. On-scene evaluation is required to adjust precautions according to history and exam. On-scene, additional evaluation is required to determine if higher or lower levels of protection are required. This designation is preliminary and responders may be able to adjust precautions based on further information from the patient/family. If language barriers prevent questions, the dispatcher should advise the crew that they cannot rule out an infectious patient. Implement emerging infectious disease surveillance tool2 whenever a novel or dangerous disease is endemic in specifc areas. Travel history and/or direct exposure to potential case within the number of days of the incubation period for the illness of interest. Modifcations may be necessary for specialized transport units or during specifc epidemics. Examples include routine use of hand hygiene, gloves, and adding eye protection and mask for patients with respiratory symptoms and during airway interventions, or gown for potential splash exposures. Ensure the cuffs are pulled over the sleeves of the gown or coverall and are tight. Avoid other contact with outer surface of coverall during removal, touching only the inside of the coverall. Select gloves and mask and inspect to ensure not torn or ripped and that the correct size is selected. Remove and discard gloves, taking care not to contaminate hands when removing the gloves.

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