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Bicarbonate-containing solu- patients with diabetes insipidus are at greatly increased risk of tions for i bupropion 150mg discount. Diet can be supplemented by foods Desmopressin is also used for nocturnal enuresis in with a high potassium content 150 mg bupropion with amex, such as fruit and vegetables children over seven years old purchase 150 mg bupropion with amex, and intravenously in patients (bananas and tomatoes are rich in potassium ions) generic bupropion 150 mg fast delivery. Intravenous with von Willebrand’s disease before undergoing elective potassium salts are usually given as potassium chloride. The main danger associated with intravenous potassium is hyperkalaemia, which can cause cardiac arrest. Potassium Key points chloride has the dubious distinction of causing the highest fre- Volume depletion quency of fatal adverse reactions. Potassium chloride solution is infused at a maximum rate of 10mmol/hour unless there is • Volume depletion can be caused by loss of blood or severe depletion, when 20mmol/hour can be given with elec- other body fluids (e. Potassium chloride for intravenous crystalloid or blood in the case of haemorrhage. Addison’s disease) or of prediluted fluid); strong potassium solutions (the most dan- water (e. Potassium-retaining diuretics are better tolerated than oral potassium supplements. Hypokalaemia in untreated patients with hyperten- K loss in excess of dietary intake, or by a shift of K sion is suggestive of mineralocorticoid excess (e. Hypokalaemia causes symptoms of fatigue and nocturia (because of loss of increases digoxin toxicity. Oral K Risk factors for more serious hypokalaemia include: preparations are unpalatable and not very effective. They predispose to hyperkalaemia, diuretic and thiazide; especially in patients with impaired renal function or 2. It is a gastric irritant and is given as enteric-coated kalaemia is particularly likely to occur in patients with tablets. Calcium gluconate is a potentially life-saving emergency venously it is used to alkalinize the urine in salicylate overdose treatment in patients with dysrhythmias caused by (see Chapter 54). Sodium bicarbonate, given intravenously, also shifts K absorbed from the gut and metabolized via the tricarboxylic into cells. The main adverse effect when resins are given Use chronically for patients with chronic renal failure is Alkalinization of the urine is used to give symptomatic relief constipation, which can be avoided if the resins are for the dysuria of cystitis and to prevent the formation of uric suspended in a solution of sorbitol. The use of alkaline diuresis to increase urinary excretion of salicylate following overdose is discussed Key points in Chapter 54. Mild hypokalaemia associated with thiazide or loop diuretics is common and seldom harmful per se. Stress incontinence is usually managed without drugs, often • Sodium bicarbonate i. These may be minimized by starting Ammonium chloride given orally results in urinary acidifica- with a low dose and by slow release formulation. Solifenacin is tion and is used in specialized diagnostic tests of renal tubular a newer and more expensive drug. Symptoms of benign prostatic hypertrophy may be improved by a 5α- Answer reductase inhibitor (e. This has led to the development of type V phosphodiesterase inhibitors as Case history oral agents to treat erectile dysfunction. Sildenafil (Viagra™) A 73-year-old man has a long history of hypertension and of was the first of these to be introduced, there are several other osteoarthritis. Three months ago he had a myocardial infarc- longer-acting agents in this class currently. These drugs are tion, since when he has been progressively oedematous and discussed in Chapter 41.
Cloves 150 mg bupropion with mastercard, mace and nutmeg were being traded across Europe by the thirteenth century generic 150 mg bupropion. In nineteenth-century England the popularity of nutmeg as a carminative for flatulence and dyspepsia created a trade in portable nutmeg holders and graters buy discount bupropion 150mg. These were made of silver for the wealthy cheap bupropion 150mg, while rural craftsmen sold little wooden boxes in the form of an acorn and the like for the humble. Now little used in Europe, dragon’s blood, the blood-red resin of various non-European trees, was used in the ancient world for medicinal purposes and its use has spread to folk medical traditions around the world. One of the remedies for relieving the possessed suggested by Florian Canale, an early modern Italian exorcist, involved a distillation including dragon’s blood, ground glass, wax and turpentine. Editions of Aristotle’s Compleat Master-piece, for instance, provided several remedies for ‘spitting of blood’, usually associated with tuberculosis, including one that mixed dragon’s blood with ‘frogspawn water’, ‘plantain water’ and syrup of roses. It became a staple ingredient of chemists and druggists in the nineteenth century, although often purchased by the poor for use in love divination rituals rather than medicine. But, as numerous studies of folk medicine in contemporary urban societies in the Americas, Asia and Africa have shown, this is certainly not the case. Britain was the first industrial urban nation and, although little work has been done on the issue, there is sufficient evidence that folk medicine served an important function in this new way of life. The industrial urban population may not have had the natural environment around them to furnish the herbal ingredients of many traditional remedies, but it did generate the huge expansion of herbalists, chemists and druggists shops, which supplied herbs and substances for folk medical use along with dispensing for licensed doctors. In terms of the survival of an oral tradition, folk medicine remains strongest in Mediterranean and south-eastern European countries. But the trend everywhere is undoubtedly one of considerable decline, with older people now the last repositories of long-held knowledge. In Italy, recent scholarly interest in the biomedical value of traditional herbal reme- dies provides some sense of the continuation and decline of this aspect of folk medical tradition in the early third millennium. In one mountainous region of central southern Italy, researchers found that practical knowledge of traditional natural remedies for human ailments was quickly being lost, and the last in a long line of local folk healers had died in 2001. Elderly female family members were still using a few remedies, such as adminis- tering stinking tutsan (Hypericum hircinum) for colds. They gathered the plant from the surrounding area and dried and stored it for winter. Yet older people still know of and reminisce about the great efficacy of well-known remedies even if they are no longer used, remedies such as the latex of sea spurge (Euphorbia paralias) used by fishermen in central Italy for assuaging the bite of weever fish. In the hilly Molise region of central southern Italy, for example, folk veterinary medicine had apparently disappeared by 2003, whereas it has recently been described as ‘alive and well’ in some communities in the Alto Tirreno Cosentino area of southern Italy. A study of mountain communities in Galicia in the 1990s found that traditional plant remedies were primarily used by stockfarmers distrustful of veterinarians. In the 1980s French ethnographers found ‘charming’ alive and well in Brittany and other parts of the country,65 and it was also being practised in the farming communities of Lower Saxony, Germany. At this point it is important to stress the distinc- tion between folk illness and folk medicine. Post- war Norway developed one of the best healthcare systems in the world, but, as research in the 1970s and 1980s shows, this by no means usurped some folk medical therapies. In Norway layers-on of hands, religious healers and herbalists continued to be consulted. Old factors for the preservation of folk medical traditions, such as geographical isolation, cost and the impotence of the ‘official’ alternative, are no longer as relevant. That said, with regard to the last, numerous people today continue to cope with incurable and terminal illnesses by resorting to alternative therapies. The importance of print for understanding the history of European folk medicine was highlighted earlier, and it needs to be stressed again in relation to the continuance of folk tradition in our modern, highly literate society. Although the oral tradition may be on the verge of extinction, and with it the loss of much unrecorded local knowledge, more generalised Traditional European folk medicine | 39 published accounts of the oral medical tradition provide an enduring record that is easily accessible to all.
The test is In the 1950s safe bupropion 150mg, however cheap 150mg bupropion with amex, the popularity of behaviorism scored by professionals who consider a variety of fac- began to decline bupropion 150mg discount. The first sustained attack on its tenets tors order 150 mg bupropion otc, including form, shape, pattern, and orientation on was made by Noam Chomsky (1928-), a renowned lin- the page. Other psychologists soon began to question the role of Further Reading cognition in behavior. Today, many psychologists debate the extent to which cognitive learning and behavioral learning affect the development of personality. See also Behavior modification; Behavior therapy Bestiality Further Reading See Paraphilias Donahoe, John W. Biology and Human Behavior: The Neu- Austrian-born American psychologist known for his rological Origins of Individuality. Children of the Dream (1969) an- alyzes communal childrearing methods on an Israeli kib- butz and their implications for American family life. The Uses of Enchantment (1976) argues for the importance of fairy tales in a child’s development. Bettelheim’s later books include On Learning to Read: The Child’s First Fascination with Meaning (1981) and Freud and Man’s Soul (1982). A full professor at the University of Chica- go from 1952, Bettelheim retired from both teaching and directorship of the Orthogenic School in 1973. Follow- ing the death of his wife in 1984 and after suffering a stroke in 1987, Bettelheim committed suicide in 1990. Bilingualism/Bilingual education Use of a language other than English in public school classrooms. The 1970s saw record levels of im- Chicago, and then an associate professor at Rockford migration, bringing an estimated 4 million legal and 8 College from 1942 to 1944. To accom- modate this dramatic surge in the nation’s population of In 1943, Bettelheim gained widespread recognition foreign language speakers, language assistance has been for his article, “Individual and Mass Behavior in Ex- mandated on the federal, state, and local levels in areas treme Situations,” a study of human adaptability based ranging from voting and tax collection to education, so- on his concentration camp experiences. Altogether, over 300 been both lauded and criticized—of unconditionally ac- languages are spoken in the United States. Love Is Not Enough (1950), Tru- ants from Life (1954), and The Empty Fortress (1967) are Organized opposition to bilingualism, which collec- based on his work at the Orthogenic School. The In- tively became known as the English-Only movement, formed Heart (1960) deals with Bettelheim’s concentra- began in the 1980s. Hayakawa of Cali- teachers also help the students improve their skills in fornia introduced a constitutional amendment to make their native language. Two influential the students’ native languages not only to teach them the English-Only lobbying groups were formed: U. Eng- standard curriculum but also for special classes about lish, in 1983, and English First, in 1986. Two-way the passage of Proposition 63, English became the offi- or dual language programs enroll students from different cial language of California. By the mid-1990s, 22 states backgrounds with the goal of having all of them become had passed similar measures. For House of Representatives, by a margin of 259-169, example, Spanish-speaking children may learn English passed a bill to make English the official language of the while their English-speaking classmates learn Spanish. They accuse school systems of continu- fire is bilingual education, which costs taxpayers an esti- ing to promote bilingual programs to protect the jobs of mated $200 million a year in federal funds and billions of bilingual educators and receive federal funding allocated dollars in state and local expenditures. As evidence of this charge, they cite tion programs, which allow students to pursue part of barriers placed in the way of parents who try to remove their study in their first language and part in English, their children from bilingual programs. The constitu- in New York City have claimed that their children are tionality of bilingual education was upheld in a 1974 being railroaded into bilingual programs by a system that Supreme Court ruling affirming that the city of San Fran- requires all children with Spanish surnames, as well as cisco had discriminated against 18,000 Chinese-Ameri- children of any nationality who have non-English-speak- can students by failing to make special provisions to help ing family members, to take a language proficiency them overcome the linguistic barriers they faced in exam. However, the court did not specify what these quired to enroll in bilingual classes even if English is the provisions should be, and educators have evolved several primary language spoken at home. Critics of bilingual in- different methods of instruction for students with first struction also cite a 1994 New York City study that re- languages other than English. English, and the students are expected to pick up the lan- In spite of the criticism it has aroused, bilingual edu- guage through intensive exposure. Defend- gual, the students may be allowed to ask questions in ers cite a 1991 study endorsed by the National Academy their native language, but the teacher is supposed to an- of Sciences stating that children who speak a foreign lan- swer them in English. A later study, con- ual approach to mastering English, using it in conjunction ducted at George Mason University, tracked 42,000 chil- with the student’s first language.