By I. Fabio. Virginia Military Institute.

The blood circulates throughout your body carrying these food molecules and other nutrients discount 3.03mg drospirenone amex took birth control pill 6 hours early, along with critical immune defense and regulating elements such as red and white blood cells buy drospirenone 3.03 mg free shipping birth control for women with blood clots, antibodies generic drospirenone 3.03mg mastercard birth control pills 1 hour late, plasma, microscopic proteins, hormones, enzymes, etc. The blood continually distributes its load of life-sustaining elements throughout the body, nourishing every cell and protecting the body from disease. As it flows through the body, this nutrient-filled blood passes through the liver where toxins are removed and later excreted from the body in the form of solid waste. When the blood enters the kidneys it is filtered through an immensely complex and intricate system of minute tubules called nephron through which the blood is literally "squeezed" at high pressure. This filtering process removes excess amounts of water, salts and other elements in the blood that your body does not need at the time. Many of the constituents of this filtered watery solution, or urine, are then reabsorbed by the nephron and delivered back into the bloodstream. The remainder of the urine passes out of the kidneys into the bladder and is then excreted from the body. The kidneys do not filter out important elements in the blood because those elements in themselves are toxic or poisonous or bad for the body, but simply because the body did not need that particular concentration of that element at the time it was excreted. As medical research has revealed: "One of the most important functions of the kidney is to excrete material and substances for which the body has no immediate need. But both elements could be lethal if there were too much water or sodium in your blood. These nutritional elements are extremely valuable substances to the body, certainly not toxic, and yet the kidney excretes these elements into the urine - why? Actually, it is this regulating 21 process of the kidneys and the excretion of urine that allows us to eat and drink more than our bodies need at any one time. Scientists have discovered that urine, because it is actually extracted from our blood, contains small amounts of almost all of the life-sustaining nutrients, proteins, hormones, antibodies and immunizing agents that our blood contains: "Urine can be regarded as one of the most complex of all body fluids. Urine is known to contain minute amounts of proteins made by the body, including medically important ones such as growth hormone and insulin. This summer, Enzymes of America plans to market its first major urine product called urokinase, an enzyme that dissolves blood clots and is used to treat victims of heart attacks. The company has contracts to supply the urine enzyme to Sandoz, Merrell Dow and other major pharmaceutical companies. When the president of Porta-John began consulting with scientists about a urine filtration system, one told him he was sitting on a gold mine. From 26 collection centers the urine is sent to Rome, where Ares-Serono technicians then isolate the ovulation-enhancing hormone. Obviously, most of us are operating under a gross misconception when we wrinkle our nose at the thought of using urine in medicine. Like any other substance in the body, too much urea can be harmful, but urea in and of itself is enormously valuable and indispensable to body functioning. Not only does urea provide invaluable nitrogen to the body, but research has shown that urea actually aids in the synthesis of protein, or in other words, it helps our bodies use protein more efficiently. Urea has also been proven to be an extraordinary antibacterial and anti-viral agent, and is one of the best natural diuretics ever discovered. These are a few more examples of commercial medical applications of urine and urea in use today: Ureaphil: diuretic made from urea 24 Urofollitropin: urine-extract fertility drug PureaSkin: urea cream for skin problems Amino-Cerv: urea cream used for cervical treatments Premarin: urine-extract estrogen supplement Panafil: urea/papain ointment for skin ulcers, burns and infected wounds Urea was discovered and isolated as long ago as 1773 and is currently marketed in a variety of different drug forms. Medical researchers have also proven that urea is one of the best and only medically proven effective skin moisturizers in the world. In many years of laboratory studies researchers discovered that, unlike just about all other types of oil-based moisturizers that simply sit on the top layers of the skin and do nothing to improve water retention within skin cells (which gives skin its elasticity and wrinkle-free appearance), urea actually increases the water-binding capacity of the skin by opening skin layers for hydrogen bonding, which then attracts moisture to dry skin cells. So as surprising as it seems, urine and urea do have an amazing and voluminous history in both traditional and modem medicine. Herman, Clinical Professor of Urology at Albert Einstein College of Medicine in New York City, points out the general misconceptions regarding urine and its medical use: "Autouropathy (urine therapy) did flourish in many parts of the world and it continues to flourish today. If the blood should not be considered ‘unclean’, then the urine also should not be so considered. Actually, the listed constituents of human urine can be carefully checked and no items not found in human diet are found in it. Percentages differ, of course, but urinary constituents are valuable to human metabolism… " Look up urea in a medical dictionary. Uric acid, another ingredient of urine, is normally thought of as an undesirable waste product of the body that causes gout. But even uric acid has recently been found to have tremendous health-promoting and medical implications. Medical researchers at the University of California at Berkeley reported in 1982 that they have discovered that: Uric acid could be a defense against cancer and aging. It also destroys body-damaging chemicals called free radicals that are present in food, water and air and are considered to be a cause of cáncer and breakdowns in immune function. Uric acid could be one of the things that enable human beings to live so much longer than other mammals. Medical scientists study urine with tremendous intensity because, unlike the public, they know that it contains innumerable vital body nutrients and thousands of natural elements that control and regulate every function of the body The research book on urine published in 1975, Urinalysis in Clinical Laboratory Practice, stated that: "The magnitude of the attention which urine receives is attested to by a recent study which dealt with only the low-molecular weight constituents of human urine. This publication revealed that more than 1,000 technical and scientific papers, related only to low molecular weight substances in urine, appeared in the medical and scientific literatura in one (1) single year. It is now recognized that the urine contains thousands of compounds, and as new, more sensitive analytical tools evolve, it is quite certain that new constituents of urine will be recognized. As the research studies presented in Chapter Four illustrate, natural _ urine and simple urea have been used consistently and extensively by medical researchers and scientists over the entire course of the twentieth century and have been proven to be profoundly effective and comprehensive therapeutic medicines that even in their natural or basic forms can produce outstanding and amazing healing results. Many people might consider a synthetic or chemically altered form of urine, such as urokinase, the blood clot dissolver, as preferable to using it as a natural medicine. Just as nature produces no two people who are exactly the same, there are also no two urine samples in the world that contain exactly the same components. Your own urine contains elements that are specific to your body alone which are medicinally valuable ingredients tailormade to your own health disorders. Because your urine contains hundreds of elements that are manufactured by your body to deal with your personal, specific health conditions. Modem research and clinical studies have proven that the thousands of critical body chemicals and nutrients that end up in your individual urine reflect your individual body functions, and when reutilized, act as natural vaccines, antibacterial, antiviral, anti-cancer agents, hormone balancers, allergy relievers, etc. Another reason that many doctors have emphasized the use of the natural form of urine is that it does not produce side effects, whereas synthetic drugs and therapies all produce side effects, many of which are extremely dangerous. As an example, the urine-extract drug called urokinase, which is used to dissolve dangerous blood clots, can cause serious abnormal bleeding as a side effect; but natural urine itself (which contains measurable amounts of urokinase) has been used medicinally even in extremely large quantities without causing side effects. Urine therapy not only has dozens of successful research trials supporting it, but also thousands of success stories from people all over the world. As many people today have discovered, conventional medicine held no answers for either their chronic or acute illnesses and health disorders – but urine therapy did. Learning More About One of the Biggest Secrets in Medical History I realize that by now many of you are saying to yourselves, "All this information on the medical use of urine sounds fascinating, but can I really use this therapy at home?

Pa- Asymptomatic patients may have a normal life ex- tients may complain of fatigue and pruritus generic drospirenone 3.03 mg otc birth control for women 70s clothes, followed pectancy drospirenone 3.03 mg line birth control pills yaz. Any sign of liver disease atomegaly buy cheap drospirenone 3.03mg online birth control pills free, high bilirubin, low albumin and cirrhosis may be present, such as clubbing, hepatomegaly, spider correlate with shortened survival (5–7 years in severe naevi, xanthomata. Definition Macroscopy/microscopy A disease of unknown aetiology in which chronic in- Throughout the disease, copper accumulates due to the flammation of the bile ducts leads to stricture formation chronic cholestasis. There is also a strong association with inflam- Complications matory bowel disease, which is present in 60–75%, but r Oesophagealvarices,osteoporosis,osteomalacia,pan- may be asymptomatic. Chronic inflammation of the intra- and extra-hepatic r Associated with many other disorders, such as bile ducts leads to fibrosis and short strictures form Sjogren’s,¨ hypothyroidism, systemic lupus erythe- which obstruct the passage of bile. Patients usually present with progressive jaundice and Raised alkaline phosphatase suggests damage to bile pruritus or ascending cholangitis. Liver biopsy is diagnostic demonstrating concen- tric, (onion-skin) fibrosis around medium-sized bile Investigations ducts, including those in portal tracts. Corticosteroids, azathiporine and methotrexate have been tried, but have no proven benefit. Liver transplantation is used in advanced Supportive,patientsmustnotsmoke,end-stageliverfail- cases. Prognosis Slowly progresses to chronic liver disease with risk of ful- Hereditary haemochromatosis minant hepatic failure, cholangiocarcinoma and hepa- tocellular carcinoma. Aetiology The gene for α1 antitrypsin (Pi, for Protease Inhibitor) Sex is found on chromosome 14. Z is the most abnormal allele, it encodes Aetiology for a defective protein which cannot be excreted from Hereditary haemochromatosis is inherited in an autoso- hepatocytes. The commonest α antitrypsin is an extracellular inhibitor of neutrophil mutation is a cysteine-to-tyrosine substitution at amino 1 elastase. Cigarette smoke C282Y mutation, 75–99% of homozygotes are clinically probably contributes to this by inhibiting any function- disease free. Iron Chapter 5: Disorders of the liver 211 accumulates in the tissues as haemosiderin particularly Wilson’s disease within the liver, pancreas, pituitary, heart and skin. Clinical features Pigmentationoftheskin(duetoincreasedmelanin),dia- Age betes and hepatomegaly is the classical description of the May present at any age. Arthritis due to calcium pyrophosphate deposi- tion may occur, usually affecting the knees and meta- Sex carpophalangeal joints. Other presenting features in- M = F clude pituitary dysfunction, cardiac enlargement and/or Aetiology failure. In Wilson’s disease the mutation is thought to affect the excretion of copper from hepatic lysosomes into the bile. Excess copper in the hepatocytes causes lipid to collect Complications in the cytoplasm. There is increasing inflammation and There is a high risk of hepatocellular carcinoma if cir- fibrosis and untreated, it progresses to cirrhosis. Clinical features Investigations Heterozygous individuals are asymptomatic and usually Diagnosed on liver biopsy. Kayser–Fleischer rings (green/brown rings around the edge of the cornea) are a late diagnostic sign, but are Management variably present. Regular venesection reduces the iron load and the risk Microscopy of cirrhosis and hepatocellular carcinoma. Other man- Excess copper can be seen in the liver using special stain- ifestations are treated symptomatically, e. Itis∼2–20 × normal, but this also occurs in chronic diabetes, testosterone for gonadal failure. Investigations Reduced serum copper and ceruloplasmin levels (not Prognosis specific and 25% of patients will have normal levels). The earlier the diagnosis and treatment, the better the Urinary copper is high and increases markedly following prognosis. If diagnosed Poor prognostic factors are co-existent biliary tract dis- and treated sufficiently early, there is some improvement ease, old age and multiple abscesses. Amoebic liver abscess Pyogenic liver abscess Definition Definition Infection of the liver by Entamoeba histolytica. The development of liver abscesses is thought to follow Aetiology/pathophysiology bacterial infection elsewhere in the body. The infection water is food borne and is most common Aetiology/pathophysiology in parts of the world with poor sanitation, e. Infectionmay reach the liver by the portal of trophozoites in the intestine, which are thought to vein from a focus of infection drained by the portal vein, invade through the mucosa gaining entry to the portal e. Infection may also result from a generalised septicaemia or direct spread from the biliary tree. Clinical features Symptoms include right upper quadrant pain, anorexia, Symptoms and signs range from mild to severe, often nausea, weight loss and night sweats. Tender hepatic en- the symptoms are less marked in elderly patients, with largement without jaundice is usual. Macroscopy/microscopy Maybesingle or multiple lesions ranging from a few Investigations millimetres to several centimetres in size. Investigations Guided aspiration and stool ova, cyst and parasite exam- Ultrasound scan is useful for screening, and pus may be ination may demonstrate the organism. Blood cultures, Management liver function tests and inflammatory markers should Treated with metronidazole. Hydatid disease Management Repeated ultrasound guided aspirations may be re- Definition quired. Extensive, difficult to approach abscesses are A tapeworm infection of the liver common in sheep rear- drained by open surgery, with soft pliable drains. Chapter 5: Disorders of the liver 213 Aetiology/pathophysiology r Hepatic adenomas are oestrogen dependent tumours In man hydatid disease is caused by one of two tape- generally only seen in women. They are strongly asso- worms Echinococcus granulosus and Echinococcus mul- ciated with the oral contraceptive pill. Clinical features The disease may be symptomless but chronic right up- Primary hepatocellular carcinoma perquadrant pain with enlargement of the liver is the common presentation. The cyst may rupture into the Definition biliary tree or peritoneal cavity and may cause an acute Also called hepatoma, this is a tumour of the liver anaphylactic reaction. Investigations Incidence/prevalence Eosinophilia is common and serological tests are avail- Relatively uncommon in the Western world (2–3%), but able. Small, calcified cysts may be seen on plain abdom- by far the most common primary tumour of the liver inal X-ray. Percutaneous ultrasound guided fine nee- Sex dle aspiration with injection of scolicidal agents and re- M > F (3–4:1) aspiration may be used.

This includes medical care while trekking in third world countries cheap drospirenone 3.03mg line birth control pills 833, deep-water ocean sailing purchase drospirenone 3.03mg free shipping birth control pills quitting, isolated tramping and trekking order drospirenone 3.03 mg otc birth control quick start method, and following a large natural disaster or other catastrophe. It’s good, relatively complete, and used by many a medical student as a learning manual. An anatomy atlas such as Grays or Grants are also excellent references for any would-be austere surgeons. Of course you could also download the free Android, Win, or iPhone apps available from medscape or Epocrates. A good nursing or paramedic drug reference will also give you a significant reference to drugs, effects, and dosages. Remember that the United States name may not be recognized in other countries… eg lidocaine, lignocaine. Amazon $25 (1993) Vital for basic emergency surgical procedures and a stepping stone into more advanced stuff. Check with Amazon or Powell’s The Disaster Medicine Textbooks Ciottone, Gregory R. The Borden Institute I haven’t read this one completely yet, but the Borden Institute produces a whole lot of good works. Thomas, “Hunter’s Tropical Medicine & Emerging Infectious Diseases 8th Edition,” 2000 W. This sailing classic covers emergency medical care at sea, examining common accidents and ailments which can occur when medical care is unavailable and not likely to be immediate in forthcoming. Diagrams and photos accompany step by step treatment options, while the revised edition includes drugs, dosages, and the latest methods. Not particularly oriented towards austere medical care, but certainly has some aspects. Given its price, I would suggest only those who already have a good basic knowledge of wilderness medicine or need for outdoor medicine consider buying it. Although ‘some’ of the treatment mentioned in this book are ‘dated,’ it is still quite in line with appropriate practice. Mayeaux (Author) $120 from Amazon Featuring over 1,300 full-color illustrations, this atlas is a comprehensive, hands-on guide to more than 100 medical procedures most commonly performed in an office setting. The book presents step-by-step instructions and illustrations for each procedure and discusses strategies for avoiding common pitfalls. It does not cover dislocations and some emergency procedures such as tube thoracostomy very well. It is a historical text for the Austere Medical practitioner that deserves to be mentioned in any list of books on the subject. If going to Haiti… know the signs, symptoms, treatment, and prophylaxis for Malaria and Cholera. The cover photo shows a bioreactor at Roche’s Penzberg facility and conveys at least a rough of idea of the sophisticated technical know-how and years of experience required to manufacture biopharma- ceuticals. Modern biotechnology plays a crucial role both in the elucidation of the molecular causes of disease and in the development of new diagnostic methods and better target- ed drugs. These developments have led to the birth of a new economic sec- tor, the biotech industry, associated mostly with small start-up companies. For their part, the more established healthcare com- panies have also been employing these modern techniques, known collectively as biotechnology, successfully for many years. By studying the molecular foundations of diseases they have developed more specific ways of combating diseases than ever before. This new knowledge permits novel approaches to treatment, with new classes of drug – biopharmaceuticals – at- tacking previously unknown targets. Increasing attention is also being paid to differences between individual patients, with the result that in the case of many diseases the goal of knowing in advance whether and how a particular treatment will work in a given patient is now within reach. When a disease, rather than being diagnosed on the ba- sis of more or less vague signs and symptoms, can be detected on the basis of molecular information, the possibility of suc- cessful treatment depends largely on what diagnostic techniques are available. To the healthcare industry this represents a major development in that diagnosis and treatment are growing ever closer together, with clear benefits for companies that possess competence in both these areas. To patients, progress in medical biotechnology means one thing above all: more specific, safer and more successful treatment of their illnesses. For example,more than 40% of the sales of Roche’s ten best-sell- ing pharmaceutical products are currently accounted for by bio- pharmaceuticals, and this figure is rising. This booklet is intended to show what has already been achieved via close cooperation between basic biological research, applied science and biotechnologically based pharmaceutical and diag- nostic development. Just as in the past the development of beer, bread and cheese were major breakthroughs, another revolution is now about to overtake medicine: compounds produced using biotechnological methods are opening up entirely new possibilities in medical diagnostics and therapy, and in so doing are bringing about a major restructuring of markets. From knowledge to science: the history of biotechnology Babylonian biotechnologists were a highly regarded lot. Their products were in demand among kings and slaves and were ex- ported as far as Egypt. They are even mentioned in the Epic of Gilgamesh, the world’s oldest literary work – the Babylonian brewers, with their 20 different types of beer. Their knowledge was based on a biological technology that was already thousands of years old – fermentation Terms by yeast. Biopharmaceuticals drugs manufactured using biotech- Though it may sound nological methods. The only thing that is relatively new about the biotechnology industry is its name. Stone Age, Iron Age, The term ‘biotechnology’ was first used in a 1919 Age of Biochemistry publication by Karl Ereky, a Hungarian engineer and economist. He foresaw an age of biochemis- try that would be comparable to the Stone Age and the Iron Age in terms of its historical significance. For him, science was part of an all-embracing economic theory: in combination with po- litical measures such as land reform, the new techniques would provide adequate food for the rapidly growing world population – an approach that is just as relevant today as it was in the pe- riod after the First World War. Until well into the second half of the 20th century biologists worked in essentially the same way as their Babylo- Beer for Babylon 9 1665 C. Two years later Antoni van Leeuwenhoek becomes the first person to see bacterial cells. Thanks to newly developed methods, however, the biotechnol- ogy of the 20th century was able to produce a far greater range of such natural products and at far higher levels of purity and quality. This was due to a series of discoveries that permit- ted the increasingly rapid development of new scientific tech- niques: T In the first half of the 19th century scientists discovered the basic chemical properties of proteins and isolated the first enzymes. Over the following decades the role of these sub- stances as biological catalysts was elucidated and exploited for research and development. T The development of ever more sophisticated microscopes rendered the form and contents of cells visible and showed the importance of cells as the smallest units of life on Earth. Louis Pasteur postulated the existence of microorganisms and believed them to be responsible for most of the fermen- tation processes that had been known for thousands of years. T From 1859 Charles Darwin’s theory of evolution revolution- ised biology and set in train a social movement that led ul- timately to a new perception of mankind. For the first time the common features of and differences between the Earth’s organisms could be explained in biological terms. As a result, biology changed from a descriptive to a more experimental scientific discipline.

Multivariate-adjusted relative risk/hazard risk/odds ratio estimates were used in this table whenever possible trusted 3.03mg drospirenone birth control pills 2016. Short-term energy balance: Relationship with protein order 3.03 mg drospirenone with amex birth control pills definition, carbohydrate purchase drospirenone 3.03mg overnight delivery birth control pills uti, and fat balances. Studies in human lactation: Milk composition and daily secretion rates of macronutrients in the first year of lactation. The safety and efficacy of a controlled low-energy (‘very-low-calorie’) diet in the treatment of non-insulin-dependent diabetes and obesity. Energy and macronutrient content of human milk during early lactation from mothers giving birth prematurely and at term. Metabolic and endocrine responses to cold air in women differing in aerobic capacity. Metabolic rates during recovery from protein–calorie malnutrition: The need for a new concept of specific dynamic action. Glucose metabolism during fasting through human pregnancy: Comparison of tracer method with respiratory calorimetry. Obesity as an adaptation to a high-fat diet: Evidence from a cross-sectional study. Impact of the v/v 55 polymorphism of the uncoupling protein 2 gene on 24-h energy expenditure and substrate oxidation. Interrelation of age, obesity, cigarette smoking, and blood pressure in hypertensive patients. A meta-analysis of the factors affecting exercise- induced changes in body mass, fat mass and fat-free mass in males and females. Psychological measures of eating behavior and the accuracy of 3 common dietary assessment methods in healthy postmenopausal women. A Metabolic Study with Special Refer- ence to the Efficiency of the Human Body as a Machine. The Gaseous Metabolism of Infants, with Special Reference to its Relation of Pulse-Rate and Muscular Activity. Using biochemical markers to assess the validity of prospective dietary assessment methods and the effect of energy adjustment. Comparison of dietary assessment methods in nutritional epi- demiology: Weighed records v. Variations and deter- minants of energy expenditure as measured by whole-body indirect calorimetry during puberty and adolescence. Total energy expenditure and spontaneous activity in relation to training in obese boys. Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake. Human energy expenditure in affluent societies: An analysis of 574 doubly-labelled water measurements. Thermogenic response to temperature, exercise and food stimuli in lean and obese women, studied by 24 h direct calorimetry. Thermogenic response to an oral glucose load in man: Comparison between young and elderly subjects. Daily energy expendi- ture and physical activity assessed by an activity diary in 374 randomly selected 15-year-old adolescents. The effects of body weight on serum cholesterol, serum triglycerides, serum urate and systolic blood pressure. Dietary methods research in the Third National Health and Nutrition Examination Survey: Underreporting of energy intake. Muscle accounts for glucose disposal but not lactate appearance during exercise after acclimatization to 4,300 m. Effect of moderate cold exposure on 24-h energy expenditure: Similar response in postobese and nonobese women. Energy expenditure variations in soldiers performing military activities under cold and hot climate conditions. Energy expen- diture and deposition of breast-fed and formula-fed infants during early in- fancy. Adjustments in energy expenditure and substrate utilization during late pregnancy and lacta- tion. Energy requirements derived from total energy expenditure and energy depo- sition during the first 2 y of life. Energy requirements of lactating women derived from doubly labeled water and milk energy output. Obesity as a risk factor for osteoarthritis of the hand and wrist: A prospective study. Influence of body composition and resting metabolic rate on variation in total energy expendi- ture: A meta-analysis. Total daily energy expenditure in free-living older Afri- can-Americans and Caucasians. Obesity, fat distri- bution, and weight gain as risk factors for clinical diabetes in men. The relationship between body mass and breast cancer among women enrolled in the Cancer and Steroid Hormone Study. The association of obesity with osteo- arthritis of the hand and knee in women: A twin study. Tracking of blood lipids and blood pressures in school age children: the Muscatine study. Establishing a standard defini- tion for child overweight and obesity worldwide: International survey. Human Energy Metabolism: Physical Activity and Energy Expenditure Measurements in Epidemiological Research Based upon Direct and Indirect Calorimetry. Multivariate correlates of adult blood pressures in nine North American populations: The Lipid Research Clinics Prevalence Study. Influence of mild cold on 24 h energy expenditure, resting metabolism and diet-induced thermogenesis. Breast- Feeding, Nutrition, Infection and Infant Growth in Developed and Emerging Countries. Energy utilization and growth in breast-fed and formula-fed infants measured prospectively during the first year of life. Moderate alcohol intake and spontaneous eating patterns of humans: Evidence of unregulated supplementation. Energy balances of healthy Dutch women before and during pregnancy: Limited scope for metabolic adaptations in pregnancy. Physical activity and body composition in 10 year old French children: linkages with nutritional intake?