Bentyl

Mandisa-Maia Jones-Haywood, MD

• Assistant Professor
• Anesthesiology
• Wake Forest University School of Medicine
• Winston Salem, North Carolina

What causes an asthma episode in one person gastritis diet ���� order bentyl 20 mg free shipping, however gastritis chronic cure buy bentyl cheap, may not bother another person who has asthma the gastritis diet buy bentyl with mastercard. The frst step in managing your asthma is identifying your asthma triggers and fnding ways to avoid them as much as possible gastritis diet menu buy cheapest bentyl and bentyl. Allergens people gastritis diet ����������� purchase bentyl cheap online, the allergic reaction to specifc allergens is an Your immune system is designed to protect your body asthma episode gastritis diet 50 order cheap bentyl on-line. Asthma and allergies often go hand-in-hand, but When one of these intruders, or antigens, enters the having one of these conditions does not necessarily body, the immune system kicks in by releasing special mean you have or will develop the other. For example, maybe you have allergy symptoms only at certain times of the year or when you If you have a bacterial or viral infection, these may visit a home where a cat or dog lives. Maybe you have cause your body temperature to rise or your nose to run year-round symptoms, indicating that you might be as a way of ridding the antigen from the body. Tese antigens are called allergens, and grew up on a maple-lined street may be well into the immune systems overreaction is called an allergy. Cats, though perhaps or become watery the most frequent culprits, arent the only sources of animal allergens. A food allergen, such as Allergens may be found in animal dander (similar eggs or peanuts, may cause a person with that specifc to dandruf), saliva or urine. On the other hand, an about the safest pets for people prone to animal airborne allergen, such as animal dander, pollen, mold allergies. In addition to pets, household pests such or dust, may cause a runny nose or itchy eyes. Tree pollens are most abundant during the Reducing allergens in your home spring, grasses in the spring and summer, and weed Here are a few things you can do pollens, such as ragweed, in late summer and fall. Dust mites (microscopic } Encase the mattress and pillows in allergen-free insects found in household dust) and fungi covers to help reduce dust and dust mites in the (mold and mildew) can cause year-round allergy bedding; some mattress encasings are made symptoms. Dust mites and fungi especially like to with microfber fabric to prevent excess heat breed in damp places and humid environments, and moisture such as the bathroom, basement and kitchen. He or she may recommend your home) that you see an allergist (a doctor specializing in } Dust and vacuum regularly allergies) for allergy testing. During an allergy test, } Dont use feather pillows or genuine very small amounts of allergens are placed on (a down comforters scratch test) or injected under your skin. If your skin reacts with redness or a raised, itchy bump } Take a quick shower before bed to rinse of any where the allergen was placed, you are allergic to pollens or mold spores on your body and prevent that allergen. If they are, the frst and most humidity; if you have central air conditioning, keep important step for controlling both your allergies and windows closed to help prevent pollens and mold your asthma is to fnd ways to avoid those things to spores from entering the house; air conditioning which you are allergic. Your health care } Avoid hanging clothes to dry outside, where they can provider can give you more information on how to be exposed to pollens and mold minimize your exposure to specifc allergens. You may fnd some suggestions very practical and others nearly } Take precautions in your basement, which impossible given your personal circumstances. If coughing can also be a symptom of an asthma your asthma is triggered by allergies, taking your episode, you dont want to mask the asthma by using allergy medications as directed can help prevent a strong cough suppressant. In some a nagging cough, you may use an over-the-counter cases, immunotherapy or allergy shots are used to cough medicine containing dextromethorphan, but be desensitize the immune system to certain allergens. Drinking lots of clear liquids (water and Infections juices) is the best medicine for loosening mucus in the Bacterial and viral infections are another common airways so it is easier to cough up and clear away. Viral infections, such as colds and fu, tend to trigger asthma episodes more frequently If colds or fu tend to trigger your asthma, your health than bacterial infections, such as strep throat or sinus care provider can recommend asthma medications to infections. Tough these types of infections mostly begin taking early during the viral infection to help afect the upper airways in the nose, throat and sinuses, prevent an asthma episode. Call your health care the lower airways may also become irritated if you provider for advice if cold symptoms: have asthma. You should also call for advice if your asthma fares up with the cold or if you are coughing up colored mucus Avoiding trigger infections from your chest. For colds in children, call for advice if } Keep healthy with nourishing foods, lots of fuids, fever persists and cold symptoms are very bothersome regular exercise and plenty of sleep after three days. Using a temperature, barometric pressure, or humidity decongestant, however, may help relieve stufness and } Air pollution congestions that can irritate your asthma. Youll also cross-country skiing, which involve continuous notice that some are easier to avoid than others. During those As with allergens, you can use an asthma diary to kinds of activities, air is breathed in through the mouth. In those with exercise-induced asthma, the colder, drier air acts as an Tobacco smoke is a particular concern, especially in irritant to the lower airways, causing them to spasm. Studies have shown that very young children who live in homes Not all sports or exercise involve this kind of where someone smokes are more likely to develop continuous, sustained movement. Football, baseball and asthma and to have asthma episodes that require tennis are examples of sports involving shorter sprints. School-age children also have Brisk walking can provide aerobic exercise without more school absences if parents or other members of the need to breathe through the mouth. In addition, smokers themselves often recommended as one of the best aerobic activities are known to develop more frequent upper-respiratory for people who have asthma. If you choose to jog or participate in activities that can Cold air may irritate the lungs of some people with trigger your asthma, ask your health care provider to asthma. Short of packing up and moving to Arizona, recommend pretreatment medications to avoid asthma those with asthma can prepare for fuctuations in the episodes, then allow yourself an adequate warm-up period. In very cold or windy weather, wear a scarf or face mask over your mouth to Pay attention to your bodys reactions to exercise. Be sure to have appropriate medications Outdoor air pollution is an irritant you cant totally available in case you have an asthma episode. Read labels carefully, or ask your pharmacist before taking any non-prescription medication, especially pain relievers and cold remedies. Choose products containing acetaminophen (Tylenol) for treating fever or pain, such as headaches. In reality, however, the emotions themselves are standing, such as waiting in line, or just not the direct trigger; rather, the asthma episodes occur before an anticipated stressful event. Draw in a deep breath through your nose, emotions are involved, asthma is still a physical disease. Exhale slowly through your mouth, Stress management techniques and tell all your muscles to relax. Repeat this Practicing stress management techniques can be an two or three times to become more com efective way of reducing asthma episodes triggered pletely relaxed. In addition to promoting relaxation, these techniques e quieting response technique takes from are useful during asthma episodes to help you get more 30 to 60 seconds. You will be able to use these techniques best during asthma } Technique 2: Deep breathing episodes or times of emotional upset if you practice them regularly during non-stressful times. The more you your nose (count 1-and-2-and-3-and, practice these relaxation techniques, the more they can to eight). Daily practice, especially at frst, will help make these relaxation techniques become second nature for you. Resume slow, rhythmic breathing for a few When this happens, it will be even easier for you to use minutes. If you are breathing as you should from your diaphragm, your Parents can coach their children through these exercises chest should barely move, but your abdomen and encourage them to use them if they feel an asthma will expand and contract. A written asthma management plan can also ofer reassurance and confdence for people with asthma. Just knowing that you can efectively treat the episode and continue to breathe can help prevent an episode from worsening because of fear. Once you know what triggers your asthma, you can begin to fnd ways to avoid triggers. Monitoring your asthma The goal for those with asthma should be to live like everyone else, without asthma getting in the way of lifes wonderful possibilities. A good asthma management plan should be able to reduce the severity and frequency of asthma symptoms, as well as prevent unscheduled visits to the doctor or hospital. You will Just as fngerprints are different from person know your plan is working if it helps you achieve to person, so is asthma; your symptoms the following asthma-management goals: and treatment plan may be different from someone elses } Reduce the severity and frequency of asthma symptoms Asthma episodes range from mild to severe } Alleviate nighttime awakenings and can last from a few minutes to a few days } Allow for fuller activity } Prevent unscheduled visits to the doctor or hospital When your asthma is well controlled, you can live a healthy and active life Most asthma management plans include the following elements: } Watching for early warning signs by monitoring symptoms or using a peak fow meter to measure Using a peak fow meter lung function A peak fow meter is a good tool for assessing and } An asthma diary to record peak fow readings, monitoring asthma. This inexpensive, hand-held device asthma episodes and circumstances surrounding measures the maximum or peak speed at which air asthma episodes can be exhaled from the lungs. During an asthma } Appropriate medications for preventing and episode, the peak fow is slowed because the airways are controlling asthma episodes constricted and partially blocked. The when to take medications and help you identify your peak fow meter can detect this drop so that you can asthma triggers and ways to avoid them. By reading start taking appropriate medications before wheezing this guide, youre already of to a good start. But not everyone who has self-care techniques, including when and how to use asthma needs to use a peak fow meter. Early detection of an asthma episode can also make it easier to identify your asthma triggers. For example, a weather change or a visit to a home with a pet on Saturday afternoon may be the trigger behind an asthma episode but if you dont notice any asthma symptoms until Sunday, it may be more difcult to 10 Oxford draw the connection between the cat or the weather change and your asthma. A routine peak fow Steps for using the peak fow meter measurement taken on Saturday, however, may make it easier to identify the real trigger. Hold the peak fow meter, being careful not to block either the mouthpiece or the air exit. Your doctor can help you determine the (The device measures the maximum best testing times for you. Write down the number indicated by the in the green zone mean you are doing fne, while pointer. Repeat steps 1 through 7 two more times well controlled and you should take medications as (unless the test has provoked a coughing prescribed in your asthma action plan. Record the highest of the three numbers and you should call your health care provider or seek achieved. Height and age are factors, and the best possible peak fow readings vary somewhat between men and women and among diferent ethnic groups. Your health care provider will help you determine your personal best peak fow and then use this number to establish the three zones of your asthma action plan. Green (all clear) represents 80-100 percent of your personal best reading; yellow (caution) indicates 50-80 percent of your personal best; and red (danger) shows below 50 percent of your personal best. Once these zones are established, your doctor can recommend an asthma action plan specially tailored to your needs. However, until your or asthma diary, that shows peak fow meter readings, child is old enough to accurately keep an asthma diary medications taken, asthma symptoms and and follow an asthma action plan unassisted, you will possible triggers. Your doctor may also use the information recorded in Increased amounts of mucus production in the airways your asthma diary along with peak fow readings taken may produce coughing and wheezing in a sleeping in the ofce to determine whether your medications are child. When asthma is properly The information you record in your asthma diary is managed, however, there should be no nighttime important for developing an asthma action plan that asthma symptoms. An asthma diary can also Talk with your childs teacher or daycare provider about help you identify possible asthma triggers you may not asthma. Make sure the day care provider, teacher and the school Keep your asthma diary in a safe, accessible place, and health ofce have copies of your childs asthma action take it along on each visit to your health care provider. Also be sure your child has a separate supply of medications that is kept in a readily accessible place at A sample asthma diary is shown on page 40. In the same way, ways to treat asthma must be targeted to each persons Asthma cannot be cured, but it can be needs. The most common is mild Most people with asthma need to be seen by intermittent asthma. Ten it keeps control Some over-the-counter drugs can cause bad with the minimum efective dose. Check with your doctor or pharmacist before taking Learning about your medications will help you to use other drugs. Work with your health care provider to tailor The best way to control an asthma episode is to prevent a program to your needs. Many types of medications are used for long-term How asthma medications work control. They do help mild intermittent asthma can manage well with a control asthma with regular use. They increase breathing montelukast (Singulair) are oral drugs that block test results. They can be used alone or with inhaled It can take fve to seven days before they begin to work.

Key Clinical Points Within the United States in 2018 gastritis beer purchase generic bentyl online, about 13 distal gastritis definition purchase bentyl without a prescription,240 new cases of cervical cancer are projected resulting in approximately 4 diabetic gastritis diet cheap bentyl online mastercard,170 deaths gastritis diet 2014 cheap 20mg bentyl mastercard. The prognosis of an individual with cervical cancer is markedly affected by the extent of disease at the time of diagnosis gastritis diet questions bentyl 20mg for sale. Brachytherapy (internal radiation) Brachytherapy is an important component of the radiation therapy regimen in the curative treatment of cervical cancer gastritis symptoms treatment diet order bentyl us. Dose recommendations are available in the literature of the American Brachytherapy Society. It is recognized that disease presentations and anatomic deformity may result in less than optimal dosimetry using conventional radiation applicators, and that supplementary interstitial brachytherapy may be required on an individual basis to achieve optimal therapeutic effect. Surgical findings of clinical relevance include the size of the primary tumor, depth of stromal invasion, and presence of lymphovascular invasion. Positive pelvic and /or para-aortic nodes, surgical margins, and involvement of the parametrium are also important. When indicated, postoperative radiation therapy is typically delivered using up to 30 fractions. An intracavitary boost may be clinically appropriate in the setting of positive surgical findings. Management of the para-aortic nodesthe treatment of para-aortic nodal regions may be indicated in the following clinical situations: A. Positive para-aortic lymph nodes on surgical staging if lymph nodes are less than 2 cm and are below L3 B. Positive para-aortic lymph nodes on surgical staging and all macroscopic para aortic nodes are removed C. Pathologic confirmation is recommended if technically feasible When treatment of the para-aortic nodes is indicated, treatment may be concurrent or sequential. For concurrent treatment, up to 6 gantry angles are approved, and a conedown (additional phase) may be appropriate. For sequential treatment, up to 6 gantry angles, 1 conedown, and up to 28 additional fractions may be appropriate. Devices for the immobilization of the cervix are considered experimental at this time. Palliative therapy In the non-curative setting and where symptoms are present, palliative external photon radiation therapy may be medically necessary. Chemotherapy Randomized trials have shown an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy, while one trial examining this regimen demonstrated no benefit. Although the positive trials vary in terms of the stage of disease, and incorporate varying radiation treatment regimens with chemotherapy schedules of cisplatin alone or combined with fluorouracil; the trials demonstrate significant survival benefit for this combined approach. Based on these results strong consideration should be given to the incorporation of concurrent chemotherapy with radiation therapy in women who require radiation therapy for the treatment of cervical cancer. Cervix moves significantly more than previously thought during radiation for cancer. Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive treatment of cervix cancer. Pelvic radiotherapy for cancer of the cervix: is what you plan actually what you deliver Cervical carcinoma: postoperative radiotherapy: fifteen-year experience in a Norwegian health region. Combined intensity-modulated radiation therapy and brachytherapy in the treatment of cervical cancer. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. Preliminary outcome and toxicity report of extended-field, intensity modulated radiation therapy for gynecologic malignancies. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Effect of intensity-modulated pelvic radiotherapy on second cancer risk in the postoperative treatment of endometrial and cervical cancer. Postoperative brachytherapy (alone) is considered medically necessary for any of the following: A. Pelvic external beam photon radiation therapy (alone) is considered medically necessary for either of the following: A. Postoperative pelvic external beam photon radiation therapy and brachytherapy are considered medically necessary for any of the following: A. Para-aortic lymph node radiation treatment with pelvic external beam radiation therapy with or without brachytherapy is considered medically necessary for either of the following: A. Tumor directed radiation therapy is considered medically necessary for any of the following: A. Electronic/kilovoltage brachytherapy is considered medically necessary when utilizing a vaginal cylinder. Endometriod (tumors resembling the lining of the uterus; adenocarcinomas) are the most prevalent subtype. The treatment options for treatment of cancer of the endometrium are defined by stage of disease, grade of the cancer, completeness of surgical staging and the presence of adverse risk factors. Adverse risk factors include advancing age, lymphovascular extension, tumor size, lower uterine involvement classified as cervical glandular involvement (newly classified as Stage I). For cases that are not completely surgically staged, radiologic imaging plays an important role in selecting a treatment strategy. Should treatment rather than observation be decided upon for these same groups, radiation techniques are stratified in the preceding guideline statements. With more advanced clinical state and/or radiological presentations, more extended external beam photon radiation fields with or without brachytherapy may be medically necessary. In advanced disease, the increased utilization of adjuvant chemotherapy has called into question the magnitude of the added benefit of adjuvant radiation therapy. We are awaiting the results of some recent trials that may help to answer some of these questions. Patients younger than age 60 who received external beam treatment did not have a survival benefit but did suffer an increase risk of secondary cancers with subsequent increased mortality. For all other stages in an individual with positive radiologic imaging, surgical restaging or pathologic confirmation of more advanced disease is recommended (image directed biopsy). An individual then enters the fully surgically staged treatment recommendations with her newly assigned stage. Pelvic external beam photon radiation therapy (alone) is considered medically necessary for an individual who is medically inoperable. An individual who is medically inoperable would receive definitive radiation therapy alone. An individual with advanced cancer who cannot have surgery because the cancer is too extensive would receive palliative external beam photon radiation therapy. Palliation/Recurrence: Either brachytherapy or external beam photon pelvic radiation alone or combined treatment may be considered based on the clinical presentation. In the non-curative setting and where symptoms are present, palliative external beam radiation therapy may be appropriate. Additional information is available from the American Brachytherapy Society Survey (Small et al. Brachytherapy should be initiated as soon as the vaginal cuff has healed or no later than 12 weeks following surgery a. Following the performance of a hysterectomy, brachytherapy using a vaginal cylinder is generally limited to the upper vagina with the dose prescribed at the vaginal surface or to a depth of 0. External beam photon radiation therapy doses to the pelvis and tumor volume for microscopic disease A. When treatment of the para-aortic nodes is indicated, treatment may be concurrent or sequential. For concurrent treatment, up to 6 gantry angles are approved, and a conedown (additional phase) may be appropriate C. For sequential treatment, up to six (6) gantry angles, one conedown, and up to 28 additional fractions may be appropriate D. There is solid evidence that the risk of severe small bowel injury after conventional radiotherapy for postoperative patients with gynecologic cancer is 5 to 15% (Corn et al. The use of chemotherapy and radiation treatment in the management of endometrial cancer either concurrently or sequentially remains for the most part the object of clinical study and investigation B. Combined modality treatment may be considered in an individual with high risk of recurrence, recurrent, or metastatic disease C. If imaging results are negative, they should be treated according to their assigned stage. If positive or suspicious, however, an attempt should be made to either restage surgically or document the presence of metastatic disease. Individuals who have been surgically restaged should be treated according to their appropriate new Stage and findings. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histiopathologic study of 540 patients. Impact of improved irradiation technique, age, and lymph node sampling on the severe complication rate of surgically staged endometrial cancer patients: a multivariate analysis. A prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation. Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the endometrium. Long-term outcomes after pelvic radiation for early stage endometrial early-stage endometrial cancer. Randomized trial of radiation therapy with or without chemotherapy for endometrial cancer. Postoperative pelvic intensity-modulated radiotherapy in high risk endometrial cancer Gynecol Oncol. American Brachytherapy Society survey regarding practice patterns of postoperative irradiation for endometrial cancer: current status of vaginal brachytherapy. Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer. Among the treatments investigated to improve upon these results is the use of preoperative chemoradiotherapy. Two hundred and thirty-six (236) patients with T1-4, N0-1 squamous cell carcinoma or adenocarcinoma were randomized to 50. It is noted because of the concern that the stomach could not safely tolerate 64. As such, the standard-dose arm was associated with a non significant improvement in median survival (18. On the other hand, the high-dose arm was associated with a non-significant reduction in local-regional persistence or failure (50% vs. As a result of these findings, the authors conclude, the standard radiation dose is 50. The authors state, these results lend further weight to our previous conclusion that radiotherapy to 50. For example, in the treatment of esophageal carcinoma, several studies have confirmed an association between cardiac dose and toxicity. Symptomatic toxicity was not observed if the whole heart V20, V30 and V40 was kept below 70%, 65% or 60%, respectively. Using a fitted multivariate inverse probability weighted-adjusted Cox model, Lin et al. Effect of concurrent radiation therapy and chemotherapy on pulmonary function in patients with esophageal cancer: dose-volume histogram analysis. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. Comparison of heart and coronary artery doses associated with intensity modulated radiotherapy versus three-dimensional conformal radiotherapy for distal esophageal cancer. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose-volume histogram parameters. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Women at increased risk for cardiac toxicity following chemoradiation therapy for esophageal carcinoma. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Grade 3 late toxicity was experienced by 3 patients who developed small bowel obstruction. Grade 2 late toxicity was experienced by 3 patients: 1 with gastritis, 1 with esophagitis, and 1 with an ulcer. The conclusion of this paper was although locoregional control is good with adjuvant chemoradiotherapy, overall outcomes for gastric cancer remain poor. Limited advantages of intensity-modulated radiotherapy over 3D conformal radiation therapy in the adjuvant management of gastric cancer. Intensity-modulated radiation therapy with concurrent chemotherapy as preoperative treatment for localized gastric adenocarcinoma. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. Treatment of high-risk gastric cancer postoperatively using intensity-modulated radiotherapy; a single-institution experience.

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Derivatization at R1 and R2 and less energetically favorable epimers make up the more than 20 members of this class treating gastritis diet buy discount bentyl 20mg. Even within endemic regions gastritis in english buy 20 mg bentyl fast delivery, however gastritis keeping me up at night buy bentyl canada, it is highly variable and spotty in distribution gastritis diet 6 weeks cheap 20mg bentyl free shipping. Difficulties in predicting toxic areas and detecting toxicity in sh has always been a major impediment to the implementation of control measures chronic gastritis meal plan purchase discount bentyl online. In severe cases gastritis or gallbladder order 20mg bentyl amex, symptoms can de velop in as little as 30 minutes; in milder cases onset can be delayed 24 hours or more. The early symptoms are typically gastrointestinal, including nausea, vomiting, diarrhea, and abdominal pain. These neurological symptoms occur in nearly all cases and are often accom panied by a wide range of other signs and symptoms (34). Fatigue, muscle and joint pain, and mood disorders such as anxiety or depression occur in 50% or more of cases (33). Severe cases may also manifest cardiac symptoms such as bradycardia and hypotension. There are also regional differences in symptomatology, probably resulting from regional differences in toxins (33). Although the gastro intestinal symptoms resolve early, neurological symptoms often persist for weeks or even months. Late in the course of recovery, symptoms may become episodic, recurring during periods of stress or after consumption of certain foods or alcohol. Like brevetoxins, ciguatoxins bind to neurotoxin receptor site 5 on the voltage-dependent so dium channel and cause a hyperpolarizing shift in the voltage dependence of channel activation (33). While not benecial in all cases, patients diagnosed early may respond to intravenous mannitol treatment (35,36). During the recovery period, avoiding the consumption of sh and alcohol are recommended. Ciguatoxins in sh are best detected with analytical methods such as liquid chromatography coupled to mass spectrometry. However, such analytical techniques are not useful for analyzing large numbers of samples. Because levels in sh tissues are typically in the parts-per-billion range or below, most techniques lack the required sensitivity. Development of immunological assays has been hindered by the lack of puried toxins with which to vaccinate animals for specic antibody production. Synthesis of the backbone structures is extremely difficult, but progress is being made for some of the Pacic forms (37,38). At present, the most useful in vitro assay available is still the competitive receptor-binding assay with rat brain membranes (18,31). This assay takes advantage of the fact that ciguatoxins and brevetoxins bind to a common receptor site and therefore radiolabeled brevetoxin can be used as the probe. It is sufficiently sensitive to detect ciguatoxins at levels that are believed to cause human intoxication but not to provide the desired safety margin for regulatory testing. Improved assays for these toxins are desperately needed in many parts of the world. At present, there is no regulatory guidance level for ciguatoxins and the commercial sh harvests are not monitored. Some local jurisdictions have implemented bans on the sale of certain toxic species. For consumers this means being aware of the local situation with regard to prevalence and implicated species. It is prudent to avoid eating locally implicated species in particular and large coral reef-dwelling predators in general. Although screening individual high-risk sh is not yet fully feasible for either the seafood industry or the individual consumer, research continues for new assay technologies to achieve this goal. Diarrhetic Shellsh Poisoning Diarrhetic shellsh poisoning occurs after consumption of shellsh containing okadaic acid or its derivatives. Okadaic acid was named for the black sponge Halichondria okadai, from which it was rst isolated. However, it was later determined that the origin of the toxin was actually dinoagellates of the genera Prorocentrum and Dinophysis. It occurs seasonally and is a major problem to the shellsh industry in Europe and Japan, but has also been documented in South America, South Africa, New Zealand, Australia, Thailand, Mexico, Scandinavia, and Canada (2,39). Treatment is symptomatic, including maintenance of uid and electro lyte balances, and no deaths have been reported. Diarrhea is thought to be a result of hyperphosphorylation of proteins control ling sodium secretion by intestinal cells (39), causing impaired water balance and uid loss. Whether these effects are important in human intoxications is not fully understood. Again, it is not known whether this activity poses a signicant public health threat to the seafood consumer. One study, although only tentative in its conclusions, has suggested an association be tween long-term regular shellsh consumption and digestive cancers in France (43). Other techniques, such as an in vitro phosphatase inhibition assay, immunoassays, and a variety of in vitro bioassays have been proposed and are currently in various stages of valida tion (17). Recreational harvesters, as always, should closely moni tor the local restrictions on harvesting and remember that there will probably be no visible indicators of shellsh toxicity. In this event, over 100 people became ill after eating contaminated mussels, and 3 people died. Domoic acid was not an unknown compound; it had been isolated from red macroalgae in 1958 (47) and was the active ingredient in an algal extract used as an antihelmitic in shing villages in rural Japan. Consequently, it was quite surprising to discover link between domoic acid and an outbreak of human seafood intoxication. Even more surprising was the identication of the diatom Nitzschia Copyright 2003 by Marcel Dekker, Inc. Since that time, several other species of Pseudo-nitzschia around the world have been demonstrated to produce domoic acid (48). In 1991 a die-off of numerous cormorants and pelicans occurred in Monterey Bay, California. These birds had been feeding on anchovies containing high levels of domoic acid in their guts after lter-feeding during a bloom of P. This bloom later moved up the coast and caused the toxication of razor clams and Dungeness crabs in Washing ton and Oregon. Several cases of human intoxication are thought to have resulted from the ingestion of these razor clams, although a denite connection was not made (49). In 1998, over 400 California sea lions died and numerous others displayed signs of neurological impairment in the Monterey Bay area during another bloom of P. Again, high levels of domoic acid were detected in anchovies and in the feces of the sea lions (50). Domoic acid has since been found to be seasonally widespread along the Pacic coast of the United States (51) as well as the Gulf of Mexico. Around the world, domoic acid has been reported in such diverse locales as New Zealand, Mexico, Denmark, Spain, Portugal, Scotland, Japan, and Korea. Occasionally, levels in shellsh become sufficient to stimulate bans on harvesting. Fortunately, since the initial 1987 Canadian outbreak and the suspected cases in Washington in 1991, no further human cases have been reported. The nonsensitizing nature of these currents causes a protracted inux of cations into the neurons through the receptor channels, stimulating a variety of intracellular biochemical events that lead to cell death in susceptible cells (52). Symptoms of intoxication occur within hours of ingestion and include vomiting, diarrhea, or abdominal cramps within 24 hours and potentially confusion, disorientation, memory loss, and, in serious cases, seizures, coma, and death. The memory loss involves primarily short-term memory, and in the Canadian outbreak was more prevalent in elderly patients (53). Even so, the European Community is in the process of reducing their regulatory limit to 4. However, both immunological methods and a very simple and inexpensive thin-layer chromatographic method have been reported to work very well (17). As with other recognized shellsh intoxications, avoiding toxic shellsh is paramount. Effective monitoring programs are in place and commercial products are typically safe. Azaspiracid Poisoning In November 1995, at least eight people in the Netherlands became ill after consuming cultured mussels harvested in Killary Harbor, Ireland. After further investigation, a new class of cyclic polyether shellsh toxins, known as the azaspiracids. After the initial outbreak in the Netherlands, further outbreaks in 1997 and 1998 occurred in Ireland, France, and Italy, all of which traced back to mussels harvested in Ireland. However, the cyclic polyether nature of the molecules and their seasonal occurrence suggests a dinoagellate origin (54). Unlike okadaic acid, however, azaspiracid also caused dilation of the stomach, hepa titis and fatty accumulation in the liver, and decreased lymphocyte counts in the thymus and spleen (56). While the effects of okadaic acid were transient, the deleterious effects of azaspiracids lasted for many days. These results were later conrmed in chronic exposure studies, which revealed that the stomach and intestinal damage took several months to heal (57). Even more importantly, this latter study revealed a tumorigenic property of the azaspiracids. Methylated and acylated derivatives have also been isolated and associated with azaspiracid poisoning. To date, only azaspiracids from mussels cultured in Ireland have caused human intoxication. Levels below the current regulatory limits have recently been demonstrated in mussels from northeastern England and southwestern Norway (58). Once the causative organism is identied, a wider distribution of these toxins in shellsh will likely come to light. Many regions may detect low levels of azaspiracids in shellsh, well below those required for acute intoxication. However, the tumorigenic properties identied by (56) will no doubt make this a sensitive issue. Much more research is urgently needed to better delineate appropriate safety levels for these compounds. Because these toxins occur naturally in fresh and otherwise wholesome foods, possess no visual or olfactory clues to their presence, and are impervious to typical cooking tempera tures, they can be a difficult problem for both the industry and the consumer. To combat this problem most nations have employed vigorous monitoring programs to ensure the quality and wholesomeness of their seafood. However, occasional outbreaks of poisoning occur, primarily from recreationally harvested seafood. For the recreational shellsh harvester, the best defense against biotoxins is to keep abreast of information from the state monitoring labs and apply the same standards as the industry. Consumers are best served by consuming only commercially harvested shellsh or that harvested personally or by a known source. In the event of outbreak of seafood poisoning from any source, victims should seek medical care immediately. Urine and serum samples should be collected and frozen, and any remaining implicated seafood frozen and retained for investigators. Food and Drug Administra tions Center for Food Safety and Applied Nutrition for further instructions. These steps can aid in timely diagnosis and treatment of victims as well as supply important information on human pharmacokinetics and elimination of toxins. And, as was the case in Canada in 1987 and Ireland in 1995, new types of marine biotoxins are often discovered in this manner. A procedure for isolation and purication of the poison from toxic clams and mussels. Paralytic shellsh toxins in bivalve molluscs: occurrence, transfer kinetics, and biotransformation. Paralytic shellsh toxins: their origin, characteristics, and methods of detection: a review. Hypertension and identication of toxin in human urine and serum following a cluster of mussel-associated para lytic shellsh poisoning outbreaks. Liquid chromatographic determination of paralytic shellsh poisons in shell sh after prechromatographic oxidation. In: Proceedings of the Workshop Conference on Seafood Intoxications: Pan American Implications of Natural Toxins in Seafood. Development and preliminary validation of a microtiter plate-based receptor binding assay for paralytic shellsh poisoning toxins. Characterization of saxitoxin binding to saxiphilin, a relative of the transferrin family that displays pH-dependent ligand binding.

The canons of imperialism form predetermined settings in which acceptable decisions (and conversely unacceptable ones) for consumers are often prescribed gastritis what not to eat purchase bentyl pills in toronto. Nonetheless gastritis symptoms deutsch 20 mg bentyl for sale, it is in the best interest of capitalist participants to reduce consumer 68 agency as doing so further promotes the acceptance of the spectacle as real gastritis que comer purchase bentyl 20 mg. In this way gastritis diet �������� discount bentyl 20mg on line, the effective forms of manipulation achieved in part through capitalist media allow for the homogenizing effects of culture to be understood as a normalized feature of society gastritis from coffee order bentyl 20 mg line. As Debord relates gastritis xanax purchase bentyl online from canada, social life is no longer about living, but acquiring:the first phase of the domination of the economy over social life brought into the definition of all human realization the obvious degradation of being into having. The present phase of total occupation of social life by the accumulated results of the economy leads to a generalized sliding of having into appearing, from which all actual having must draw its immediate prestige and its ultimate function. At the same time all individual reality has become social reality directly dependent on social power and shaped by it. Commodities are symbolized through mass media as meaningful not only for the purposes of procurement, but also for their representation of affluence and superiority. For example, some of the most currently coveted shoes worldwide are made by the French designer Christian Louboutin and are priced in order to maximize profit while limiting access to the affluent. However, the cost of the shoes (though not necessarily corresponding with their value) is an insufficient marker of elite status as it is not publicly viewable. In order to demarcate those who have the shoes from those who cannot afford them, they have copyrighted red soles that are subtly visible. One of the perils of the culture industry lies in its subtle infiltration into multiple aspects of life, which then preys on curbed consumer consciousness. Additionally, non-elites particularly possess limited agency to actively participate in the formation of culture in terms of enquiry, resistance, and instrumentality. One way in which identities are exploited by Western imperialists is through the targeting of groups through mainstream media for particular 69 commodities that reflect specific values relating to whiteness. The attributes of whiteness, (such as power, wealth, and the aesthetic quality of beauty) are often represented (and/or perceived to be by Westerners and non-westerners alike) in many Western commodities. As such, the symbolic value of Western goods is, in part, a material site of whiteness. Furthermore, the consumption of these products furthered through capitalism, also embodies the nature of whiteness. Moreover, hierarchal representation of images imputed onto objects increases the distance between humans, allowing for racialized fabricated truths to persevere. These so-called truths then operate as validations of constructed racial performativity as the distinction between the haves and the have nots is clearly delegated by those in power. It is through this designation that relations of force among whites and nonwhites become critically involved in the proliferation of the concepts of superior and inferior, respectively. Skin color becomes a site of demarcation that highlights assigned values and meanings assembled through history and perpetuated by popular culture. To elucidate this point, I refer to the growing prominence of skin bleaching products in Asia that depict not only how commodities are used for racializing purposes by privileging whiteness, but also their operational role in progressing existing indoctrinated beliefs. Capitalism and the neoliberalization of the Indian economy at the end of the twentieth century has led to a great influx of skin bleaching products on the market that seek to exploit darker womens situation (Karan, 2008). Capitalism has changed the lives of Indians as discussed by Mathur and Parameswaran: the globalization of the economy marked a transition from a primarily agrarian society to a more industrialized, market-driven economy, resulting in a drastic alternation in Indians attitudes toward consumption (Mathur & Parameswaran, 2004, p. Skin bleaching products gain importance via the spectacle that employs images and representations to convey what consumers want as well as require in order to improve status. According to Jenkins et al, the Frankfurt Schooldescribed popular culture as a mechanism of modern capitalisms repressive ideology (Jenkins, et al. Equating authoritarian control with capitalist media, Horkheimer and Adorno argue that mainstream ideologies weaken resistance (Jenkins, et al. Standardization delineates the doctrines of capitalism with an objective of mass-producing goods to be delivered to apathetic consumers (Jenkins, et al. Adorno and Horkheimer state:the conspicuous unity of macrocosm and microcosm confronts human beings with a model of their culture: the false identity of universal and particular. All mass culture under monopoly is identical, and the contours of its skeleton, the conceptual armature fabricated by monopoly, are beginning to stand out. Those in charge no longer take much trouble to conceal the structure, the power of which increases the more bluntly its existence is admitted. It is not my intent to collapse the complex aspects of culture into a simple economic explanation, yet in framing the hegemonic systems informing social life, a Marxist model effectively expounds the cycle of production and consumption fundamental to Western industries operations as well as encompassing simulations and identity performance. The message and content of skin bleaching products offer an escape through emulation of whiteness from the oppressiveness generated by colonial ideologies and imperialism. Societal divisions are further propagated and normalized through pigmentocratic ideals appropriated from hegemonic systems transmitted by the West. Paradoxically, nonwhite consumers of skin bleaching products continue to promote the racializing of colonization and Western imperialism, specifically in which lighter skin is more valued and desired. Although consumers of skin lightening cosmetics may recognize the meaning whiteness holds (materially and ideologically), the consideration for how and why this came to be is often overlooked in favor of accessing its privileges through racial performativity. Approaching whiter skin serves not only as an aesthetic ideal, but also as representative of dominance wielded through the synonymous forces of power and wealth. The lingering ideologies of colonialism and imperialism are predominantly embedded in the minds of nonwhites and further cultivated through socioeconomic dynamics such as globalization and capitalism, subsequently allowing for commodities to influence social life. Debord summarizes this notion in the following thesis:the spectacle obliterates the boundaries between self and world by crushing the self besieged by the presence-absence of the world and it obliterates the boundaries between true and false by driving all lived truth below the real presence of fraud ensured by the organization of appearance. One who passively accepts his alien daily fate is thus pushed toward a madness that reacts in an illusory way to this fate by resorting to magical techniques. The acceptance and consumption of commodities are at the heart of this pseudo-response to a communication without response. The need to imitate which is felt by the consumer is precisely the infantile need conditioned by all the aspects of his fundamental dispossession. In the terms applied by Gabel to completely different pathological level, the abnormal need for representation here compensates for a tortuous feeling of being on the margin of existence (Debord, 1983, p. Debords theory can be applied fittingly to images demarcating race, such as those disseminated through media including advertisements for skin bleaching agents. Through these appearances, 72 truths become lost, distorted and submerged under fraud, in this case the belief (guised as reality) that whiteness is inherently more valuable. In my parallel comparison of Debords theory and whiteness, magical techniques could denote the ways in which marginalized people driven by anxiety stemming from inequalities resort to skin bleaching to magically transform their lived experience to one of advantage. In such cases, emulation is regarded as the primary (and perhaps sole) method of attaining privileges associated with whiteness and subsequently any efforts to resist the dominant discourse will undoubtedly lead to marginalization. However, the argument that nonwhite individuals who prefer light skin are asserting their own form of agency can also be made. Through the repositioning of the boundaries of whiteness, the dichotomized categories of white and nonwhite can be altered. These forces reveal how domination can emerge through seemingly logical systems of knowledge valuation. If discourse is a crucial manifestation of constructed epistemologies, then it could also serve as a preferred site of resistance. Emancipation from the pervasive implications of mass deception calls for a critical analysis and deconstruction of knowledge derived through historical events (such as colonization) and assumptions shaped by context, experience, intellectual predispositions, political economies, and so forth. Here again I locate my theoretical framework within 13 Lyric from Bob Marleys Redemption Song. And instead of according them unqualified, spontaneous value, we must accept, in the name of methodological rigour, that, in the first instance, they concern only a population of dispersed events (Foucault, 1972, p. To unpack Foucaults ideas, we must first begin by acknowledging the limitations of discourse (as well as the ways in which discourse limits) and endeavor to uncover a will to truth. The accumulation of ideas normalizing our understanding of the world must be detached or distanced (to the furthest extent possible) from knowledge production in order to identify those contributions that lack relevance to actual events and realities, are injudiciously included and/or are dependent on illogical historical sequences. Suppositions based on continuity of events and ideologies become further removed from true genealogy as particular knowledge gains more meaning while other knowledge is dismissed. In order to dismantle reigning methodologies, we as consumers, scholars, and recipients of mass communication must conduct an inquiry that examines how and why certain designs prevail over others. This ultimately requires an examination of the history of the present (Foucault, 1972, p. We must recognize that truth claims have a past that must be investigated in order to uncover the nonlinearity and complexities of discursive formations 74 (Foucault, 1972, p. By doing so, we are better able to recognize that truth claims materialize through specific settings, perspectives, memory, and circumstances, which in turn can indicate patterns of human behavior entrenched in power relations. Conclusion Historical knowledge can be manipulated as a simulation, which interprets and represents events and narratives as absolute truths, which hold far more power than claims. Culture and society are often organized through the dichotomies of expression and repression of power stemming from interpretation of events that are then arranged hierarchically. The projected causal relationship between color, class and power is not logical or natural, rather a performative construction manifested as a means for dividing and vertically organizing races. Popular cultural forms, as products of capitalist agents and representations involved in promoting consumption, participate and reproduce pigmentocratic notions as an investment in a hegemonic system that is beneficial to their purpose. Due to this phenomenon, nonwhites increasingly attempt to access the socioeconomic privileges associated with whiteness by appearing more Western. This practice is how pigmentocracy is ethically justified through sequences and images that have been laden with subjugating racialized values. The normalization of such values must be interrupted in order to challenge the foundational standpoints from which knowledge is constructed. Disconnecting statements, representations, images and identities from historical discourse will be more conducive for dissenting and ostracized views to emerge and partake in our understanding of humanity. The symbolic supremacy seemingly inherent in whiter bodies demarcates and perpetuates divisions in class, modernity, and value, allowing for the normalization of pigmentocracy 75 through recognizable contexts. Using racial paradigms, historical discourse has established standards to which nonwhite masses must adhere in order to be validated. Assimilation to Western standards is depicted as the means for eschewing marginalization. Commanding imperial doctrines informed by discourse dictate the necessary dissociation of Indians from Indianness. According to Jenkins et al, Horkheimer and Adorno argue that mass media in a capitalist democracy manipulates the masses by lulling them into the pleasures of conformity, consumption and consumer ideology (Jenkins, et. The result is cultural displacement through the emulation of colonial and imperial structures. Through their business practices (regardless of intentionality), western corporations that promote skin-bleaching are serving as conduits of oppression. In this way, capital and power reproduce, reinforce, and reify the nonwhite body as the Other of dominant discourse. The politics of culture are manipulated through capitalist spheres of power and the relationship of (false) dependency that is constructed between those in power and those attempting to access that power through emulation, much in the same way as shadows depend on their subjects. In this way, skin-bleaching companies sell the belief that whiteness is fundamentally superior, with reliance on socioeconomic and aesthetics implications rooted in discourse as validation of these claims. Intraracial and interracial inequalities serve as a profitable resource for not only Western cosmetic industries, but also as a method for preserving racialized hierarchies and the privileges that accompany dominant groups. In short, cultural economies rather than military and government regimes become the site of mental colonization and imperialism. More specifically, I examine foreign presences in India, including theories of Aryan domination as well as British and Portuguese colonization, and the ensuing effects on caste, religion, class, and color. That is, at times caste and color reinforce one another; while at other times they undermine each other. For example, possibly the most substantial percentage of Asias Blacks [darker groups] can be identified among Indias 160 million Untouchables or Dalits. Yet, dark skin color is not always a marker of Dalits and/or lower castes in the same way that whiteness is not always indicative of upper castes. There are instances in which some Untouchables have lighter skin and claim to be descendants of Aryans (Ayyar & Khandare, 2013, p. In some contexts, light skin can at times afford Dalits with prospects to assert racial equality and can also allow access to previously denied opportunities. Nonetheless, the burden of proof for advocating egalitarianism falls on Dalits, including those with light skin. The chief aspects of Indian society as they relate to pigmentocracy including the intricacies of the caste system, marriage, Hinduism, Christianity, and occupations are discussed in this chapter in greater detail with an emphasis on their intersection with skin color. I further posit that Dalits, who comprise the lowest strata of the caste system and society, face oppression due to religious and racial ideologies and are consequently reduced to the lowest division of Indian society. I also draw parallels between Dalit lived experiences and that of African Americans in their shared subjugation and efforts to challenge it. My purpose for doing so is to further illustrate that intraracial prejudices often take similar form to those of interracial 78 prejudices, including institutional discrimination (occupations, education, etc. In discussing racism in India, it is not my intent to portray India as timeless and non modern. On the contrary, I argue that pigmentocracy is in part an indication of Indias attempts to embrace modernity and nationalism by assimilating to Western and global values. This is partially achieved through the ideological distancing of lighter upper castes from darker upper castes, lighter lower castes from darker lower castes, and lighter Dalits from darker Dalits. In addition, some members of the upper castes and classes often stereotype lower castes and Untouchables as dark regardless of skin color in order to promulgate further distinctions between castes. The reverse can also be true in which lower castes/classes stereotype upper castes/classes as whiter. I argue that the legacy of pigmentocracy in India is predominantly attributable to the perpetuation of whiteness ideals as part of a greater, western-informed racial project. Racial projects establish what race means historically through image, representations, and explanations about racial categories or groups (Hunter, 2005, p.