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Example 4: Recognition of acute blindness (consultant on development projects) A 38-year-old man worked for a year for an engineering company in Ethiopia as a consultant on development projects discount 0.25 mg digoxin with amex. He was employed to evaluate and supervise a development project in a province where he was exposed to bad sanitation and primitive food production with lack of hygiene cheap digoxin 0.25 mg online, and he frequently visited local health clinics where infections occurred generic digoxin 0.25 mg amex. Furthermore the area was known for an increased risk of developing eye diseases generic digoxin 0.25 mg with visa, including cases of acute blindness. He had several instances of worms and amoebic infections and towards the end of his stay developed increasing vision complaints, which in very quickly developed into blindness in both eyes. The Committee found that the consultant had become blind mainly as a consequence of working on the development project in Ethiopia, where he had been exposed to bad sanitation and poor food hygiene and had been in close contact with persons with infections and viruses that increased the risk of eye diseases and blindness. Example 5: Recognition of chronic hepatitis C (auxiliary nurse exposed to patients blood) A 56-year-old female auxiliary nurse experienced increasing problems with diffuse joint and muscle pain and was tested positive for hepatitis C antibody. It appeared from the examinations that she had never been a drug addict, been a blood donor or received blood transfusions, and she had not been tattooed or pierced. She had worked for many years as an auxiliary nurse in a maternity ward in a hospital and for 6-12 months before the onset of the disease she had worked in a midwife centre. In the maternity ward she had assisted at deliveries and gynaecological examinations. During the deliveries it was sometimes impossible to avoid contact with blood and amniotic fluid, and she furthermore did some cleaning and took blood samples from placentas and umbilical cords after the deliveries. She used syringes and needles, which involved a risk of contact with blood, including stains in her eyes. Her employer confirmed that she had had several syringe injuries and furthermore that there had been an 50 incident when she was spattered with blood on her face and eyes. It was not possible, however, to determine when these incidents occurred, and it was not clear if she had been infected with hepatitis C on one of these occasions. It was not possible to recognise the case on the basis of the list of occupational diseases, there being no specific source of infection. The Committee found that the auxiliary nurses hepatitis C had been contracted mainly as a consequence of her work of assisting at deliveries where she had been in contact, several times, with blood during the deliveries and furthermore had had syringe injuries. Example 6: Claim turned down itching skin (stationing in Kuwait/Iraq, using malaria medicine) A 38-year-old, male employee of the Danish Defence Force was for two periods of approximately 6 months stationed in Kuwait and Iraq. During the stays he developed itching and a reddish rash on his chest, which got worse when exposed to the sun. It appeared that he took malaria-preventive medicine in the form of chlorokin phosphate, but that he stopped doing this as the skin disorder got worse. Some years after the stationing a specialist of skin diseases found that the skin was slightly thickened on his chest (hyper keratosis) and that he had skin irritation (dermal inflammation), but the degeneration could not be diagnosed more specifically, and after some years the skin was normal again. The Committee found that the itching skin problems had been caused, mainly or solely, by being stationed twice in Kuwait and Iraq. The reason was that it was not possible to point to a likely correlation between the itching skin and particular exposures during the stationing. Nor was it likely, from a medical point of view, that there was any correlation between the use of chlorokin phosphate and the described skin problems. The Occupational Diseases Committee The Occupational Diseases Committee is appointed by the Minister for Employment, who appoints the Chairman of the Committee and eight members (appointed for 3 years at a time). The Chairman is appointed after a recommendation made by the National Board of Industrial Injures. The Occupational Diseases Committee makes advisory statements to the National Board of Industrial Injuries regarding Revisions of the list of occupational diseases (section 7(1)(i), 3rd sentence) Decisions on claims reported to the National Board of Industrial Injuries under section 7(1)(ii) The National Board of Industrial Injuries can furthermore obtain from the Committee advisory statements on questions pertaining to occupational diseases. The Committee can furthermore call in special experts to participate in the meetings as advisors. Furthermore there are rules regarding legal incapacity which have the effect that a member of the Committee cannot participate in the processing of claims in which the member has a special interest. In practice the Committee meets at least once a month to take a position on concrete claims regarding occupational diseases, and sometimes they meet more often than that. Besides there are regular meetings about principal discussions of various fields of occupational diseases and about the revision of the list, which must take place at least once every two years. Minutes are made of the meetings of the Committee and of meetings regarding concrete cases. This involves writing drafts for the Committees recommendations in concrete cases which are subsequently discussed on the Committee. Item on the list The following hearing disease is included, according to the stated exposure, on the list of occupational diseases (Group A, item 1): Disease Exposure A. The diagnosis must have been made on the basis of a characteristic audiogram and information on exposure to severe noise in the workplace for at least 5 years. An audiogram shows measurements of the hearing threshold at different frequencies. Normal hearing thresholds are less than or equal to 20 dB across the entire frequency area. When the molecules move, the air in front of them is compressed (pressure increase), and the air behind them is made thinner decreased pressure. The number of sound waves per second is called the frequency and is measured in Hertz (Hz). An increase of 6 dB constitutes a doubling of the sound pressure and an increase of 10 dB constitutes a tripling of the sound pressure. Therefore, in order for the sound to be audible, a 10 dB deterioration in the hearing threshold necessitates a tripling of the sound pressure. Symptoms The person in question experiences a decreased perception of sound, but not necessarily a decreased perception of speech or an actual hearing and communication impairment. A hearing and commu- 54 nication impairment is a loss of hearing that affects the ability to communicate in active daily life. An assessment of the hearing and communication ability is used for determining compensation for permanent injury, but not in connection with the question of recognition. The difference between hearing loss and hearing impairment exists because it is the frequencies 4,000- 6,000 Hz that are first damaged by exposure to noise. The prevailing part of the spoken sound information in the frequency area is under 4,000 Hz. Damage in the frequency area 4,000-6,000 Hz therefore leads to limited problems with regard to the perception of speech. Objective signs Continual exposure to noise typically leads to a dip most pronounced at 4,000 Hz. After several years of exposure to severe noise quite a considerable group will have developed a minor hearing loss at 4,000 Hz. After exposure for some time this damage is aggravated and other frequencies are affected.

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Acute- uveitis buy digoxin 0.25 mg without a prescription, including systemic diseases as well as syndromes phase reactants cheap digoxin 0.25mg without prescription, such as C-reactive protein discount 0.25 mg digoxin free shipping, may be ele- limited to the eye generic 0.25 mg digoxin with mastercard. In patients who present with anterior vated in the plasma, as well as the level of circulating IgA. Inflammatory Bowel Diseases Seronegative Spondyloarthrophaties Ocular manifestations are found in about 2. There is a strong ocular lesions in patients with inflammatory bowel diseases relationship with the presence of the class I antigen consists of using local or systemic corticosteroids. Analyzing retrospectively a cohortof 350patients with spondyloarthropathies in Brazil, Sampaio-Barros et al. Of the extra-articular manifestations, those in The polyarticular form accounts for 3040% of the cases, the skin and the eyes are the most common ones. In reactive juvenile idiopathic enthesitis-related arthritis, and the pre- arthritis and psoriatic arthritis, the most common ocular sence of sacroiliitis is not required for the diagnosis, in the 85. Autoimmune Uveitis 463 pediatric cohort, enthesitis and peripheral asymmetric areas of the uvea. Vasculitis of the retina is the most arthritis of the lower limb is mostly dominant (6, 7, 8). The treatment for iridociclitis con- clitis due to a non-granulomatous anterior uveitis without sists of topical corticosteroids and mydriatics. Isolated pain and redness of the involved eye is the most typical posterior uveitis has been successfully treated with a com- finding. In lot of cases at the time of the diagnosis already bination of ciclosporin and azathioprine. Usually there is an abrupt onset of fever followed by a bilateral subcon- juctival congestion state. In the following days, dryness, Behcet Disease fissuring and redness develop in the lips, along with painful cervical lymphadenopathy. Exanthematic lesions appear Is a systemic vasculitic disease that involves arteries and in the trunk and in palms and soles that frequently develop veins of small and large calibers. A pathogenic role has been imputed on Streptococcal antigens and pro-inflammatory cytokines VogtKoyanagiHarada Syndrome are elevated during attacks. In addition to the eyes, females (14) and in general occurs 2 or 3 years after the typical manifestations involve the ears, the skin and the onset of the other symptoms. Both meningeal irritation, bilateral neuro-sensorial dysacusia eyes are usually involved and non-simultaneous flares can and skin alterations, such as vitiligo, alopecia and polyosis. Types of uveitis according to the anatomic area involved, manifestation and local treatment. In half of the cases with Seronegative spondyloarthrophaties ocular manifestations, the presentation is an acute and Ankylosing spondylitis self-limited granulomatous iridociclitis. The chronic pre- Psoriatic arthritis sentation is mostly seen in older patients with pulmonary Reactive arthritis fibrosis and quiescent systemic disease. Alterations in the Inflammatory bowel diseases Juvenile idiopathic arthritis vitreous can also be seen, like posterior segment periph- Behc et disease lebitis, retinal and choroidal granulomas and lesions of Kawasaki disease the optic nerve, in addition to lacrimary glandular and VogtKoyanagiHarada syndrome conjunctival involvement. It is important to recognize Sarcoidosis sarcoidosis as a cause of uveitis, because it imposes a systemic involvement screening as well as a proper ther- apeutic intervention. International Study Group criteria for the diagnosis strate the hilar adenomegaly, with or without multifocal of Behc et disease (13). Gallium whole body Recurrent oral Minor aphthous, major aphthous or herpetiform scan is used to investigate the hypercaptation in lacrimary ulcerations ulceration observed by physician or patient, glands and orbital area, as well as in salivary glands and which recurred at least three times in 12months period lungs; its value is enhanced when combine with the mea- Also two of the surement of the serum angiotensin-converting enzyme following: level (17). New modalities of local and systemic therapies that are safer and more efficient are ocular diagnosis. The use of intravitreous triamcinolone has uveitis phase that lasts 35 days or several weeks. Then a been proven to be efficacious in patients on immunosup- convalescence phase issues with dyspigmentation of the pressants presenting side effects due to systemic corticos- skin, as well as the uvea and the pigmented retinal epithe- teroids or in those that are non-compliant. Recurrent injections have a short-term actionandhavebeenusedin attacks can happen during the convalescence phase. Vitreous corticosteroids implants corticosteroids and mydriatics, while the posterior form using a small dose of fluocinolone acetonide are indicated responds to periocular or intravitreous corticosteroids. Overall, there were more cases of uveitis associated with etanercept, than with infliximab and adalimumab (19). Sarcoidosis occurs in all age groups, but autoantigen in experimental anterior uveitis. J Immunol 2004; is more common in persons between the ages of 20 and 50 172: 708694. Methotrexate is an effective treatment Prevalence and outcome of juvenile idiopathic arthritis- for chronic uveitis associated with juvenile idiopathic associated uveitis and relation to articular disease. Characterization and outcome of uveitis in idiopathic arthritis-associated uveitis refractory to second- 350 patients with spondyloarthropathies. League of Associations for Rheumatology classification of South Med J 1997; 90: 567. An combined serum angiotensin-converting enzyme and gallium evaluation of baseline risk factors predicting severity in scan in diagnosing ocular sarcoidosis. Ophthalmology 1995; juvenile idiopathic arthritis associated uveitis and other 102: 200711. Patients are typically women between 20 and 50 years of age with no previous history of penetrating ocular trauma. Treatment is based on initial high-dose oral corticosteroids with a low tapering during a minimum period of 6 months. Systemic immunomodulatory agents such as cyclosporine may be used in refractory or corticosteroid non-tolerant patients. The prodromic manifestations point to a viral trigger such as herpes family virus (Epstein-Barr virus, cytomegalovirus). Surprisingly, it is not described in sub- antigens are being analyzed as the target protein of the Saharan African descent (4). Women are affected more disease mainly pointing out to tyrosinase and tyrosinase- frequently than men and there is a clear predominance in related proteins (8). The prodromal phase is characterized by generalized Keratoconjunctivitis sicca syndrome with a few cases ful- symptoms of fever, nausea, and headache which last for 3 filling diagnostic criteria for Sjogren syndrome and a fre- to 5 days. In addition, a diffuse choroiditis associated with exudative retinal detachment Pathological Features and optic disc hyperemia are observed. Swelling of the ciliary body may displace the lens-iris diaphragm forward Classical histopathological findings are a diffuse granulo- with consequent shallowing of the anterior chamber, angle matous bilateral uveitis. The choroid is remarkably thick- narrowing, and an acute increase in intraocular pressure. In the inal pigment epithelial lesions in the mid periphery of the convalescent and chronic phases of the disease, disappear- fundus and retinal pigment epithelial migration, all denot- ance of melanocytes of choroid is described ing the profound melanocyte and pigmented tissue aggres- sion. The recurrence is usually anterior; theless in atypical cases complementary examinations may nevertheless signs of disease activity in the posterior pole be helpful.

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One could expect the extra oxygen to jump across from oil molecules to your fat molecules generic digoxin 0.25mg visa, aging them too soon buy cheap digoxin 0.25 mg on line. Yet it is advisable to take vitamin E (see Sources) generic digoxin 0.25 mg with mastercard, a known anti-oxidant generic digoxin 0.25mg with visa, after taking ozonated oil. Ozonated oil is not generally available in health food stores, and even if it were, it may have a short shelf life. I have not re- searched the effectiveness of ozonated olive oil kept at room temperature for more than a day, or refrigerated for longer than a week, or in the freezer for more than a month. Attach an aerator to the end of your ozonator hose and drop it to the bottom of the olive oil. So you may be tempted to skip the one tablespoon of ozonated olive oil that is required. Remember, it should be taken at least five hours after cysteine to avoid clashing with it. Reap The Benefits Killing Ascaris means you have gotten rid of 1,10- phenanthroline. Without phenanthroline in your vital organs, you are no longer attracting and chelating your precious iron and copper; more will be left for you instead. Without this inter- ference, your bone marrow, liver, and spleen can begin to regu- late your most vital functions again. Killing tapeworm larvae means you have gotten rid of phor- bol and dibenzanthracene from your vital organs, two other powerful mutagens. Without both parasites, p53 mutations are all but gone, only waiting for vanadium (dental) to be removed. Killing rabbit flukes means you are no longer bringing Clostridium nor Streptococcus into your body for distribution to teeth, colon, or tumors. While clostridia are our tumor-causing bacteria, streptococci are our pain-producers. Streptococci produce phenol which not only causes pains of many kinds, but also ages us. Phenol, al- though considered a reducer in regular chemistry, oxidizes our vitamin C into toxic oxidation products that cause wrinkling of skin, cataract formation and other aspects of aging! Perhaps health and youth would stay much longer in humans if we didnt regard Clostridium and Streptococcus as being normal colon flora! Stay Clean In all cases, where I have seen that a cancer victim did not get good results after using the parasite program and zapper de- scribed in The Cure For All Cancers, I found remaining para- sites! So I conclude that the biggest problem for a cancer suf- ferer is the ease with which they can become reinfected from food and their own tumors! The sources of reinfection with Ascaris, tapeworm, and rab- bit fluke eggs are so pervasive, you may reinfect faster than you can eliminate them! A glass of milk, a cheese sandwich or a green salad will reinfect you in five minutes if they are not ster- ilized first. Cancer victims have no ability to kill these para- sitestheir immune powers are gone! For a cancer patient, swallowing a few Ascaris eggs is equivalent to swallowing a few cholera bacteria or the ebola vi- rus. Manure does not simply wash off lettuce and strawberries as you clean them under the kitchen faucet. Remove the bedroom carpet, get a new mattress, dry clean the blankets and small rugs (laundering does not kill Ascaris eggs). Sterilize other carpets with a special stain-free iodine so- lution added to the carpet shampoo mixture (see Recipes). It is a good disinfectant, but supermarket bleach is itself polluted with heavy metals, solvents and dyes; besides, you would get too much chlorine. A one minute dip in very dilute Lugols solution or hydro- chloric acid kills everything it reaches. Our traditional methods of food preparation have never tried to make food sterile. That is why hospitals heat surgical instruments to 250F in a special pressurized oven called an autoclave instead of simply boiling at 212F. Even baking seldom raises the internal temperature of meats or other foods higher than 180F even if the temperature is set to 400! If you neglect sterilizing your fruits and vegetables, you can assume you have Ascaris, tapeworm eggs, and rabbit fluke eggs againimmediately repeat the parasite program. Kosher Foods to the Rescue During my testing foods labeled with a Kosher symbol were found to be far superior in cleanliness and purity. The second, your food, will be discussed in more detail in the Tumor Shrinking Diet chapter. After your body has been cleared of pathogens and toxins, your tumors must shrink. The contents must be detoxified and cleared slowly, in order not to overburden your vital organs. But before going on to the de- tailed instructions, we must pay attention to pain. You may be in excruciating pain, and on morphine because no other painkiller touches it. If a cancer sufferer has decided to give up the battle, this wish should be understood and re- spected. The simple act of pulling infected teeth can reduce the pain to half within hours even though the pain is at the hip or abdomen, far away from the teeth. They reside in numerous little pockets all over our bodies, even if we consider ourselves well, making phenol. When the phenol can no longer be detoxified at some location, it builds up to produce pain. Yet in a week you could be in a lot less pain by taking inositol and oregano oil before meals plus cayenne capsules with meals. Oregano oil may be taken as 3 drops placed in an empty capsule for moderate pain; 20 drops for severe pain, followed by bread. The cayenne dose must be worked up gradually to get to a dosage of six capsules three times a day for three days in a row. It is often due to the presence of asbestos or lanthanide metals, namely, local lack of immune power. I believe our major source of asbestos is food that has rolled along old asbestos-containing conveyor belts. Sticky foods like sugar pick it up and spread it to all sweetened foods in the mar- ketplace. Wherever a minuscule tuft of asbestos lands in your body, there is a location of low immunity because the local white blood cells (our immune soldiers) become coated with ferritin. Lanthanide metals ride along with fruit and vegetable dyes used to intensify their color, and with pesticide.

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The Presidents Committee lionof the 191 million American adults age 16 or older on Health Education defined purchase digoxin 0.25 mg fast delivery, in 1973 quality 0.25mg digoxin, health education at Level 1 order digoxin 0.25mg with mastercard, the lowest literacy level order 0.25mg digoxin. Although many as a process which bridges the gap between health Level 1 adults could perform a number of tasks involv- information and health practices. Each scale reflects a health literacy, then, can be thought of as the currency different type of real-life literacy task. Many factors help to explain why so many adults A 1999 report of the Council of Scientific Affairs of demonstrated English literacy skills in the lowest profi- the American Medical Association refers to functional ciency level defined (Level 1). Twenty-five percent of health literacy as the ability to read and comprehend the respondents who performed in this level were prescription bottles, appointment slips, and the other immigrants who may have been just learning to speak essential health-related materials required to success- English. Nineteen percent of the respondents in Level 1 and benefits; and, ultimately, make decisions and take reported having visual difficulties that affected their action specifically associated with disease prevention ability to read print. A health liter- who demonstrated higher levels of literacy were more ate individual is more apt to know how to answer the likely to be employed, work more weeks in a year, and question How do I keep myself well? Adults in the lowest level on each ondary prevention (prevention of complications or after of the literacy scales (1719%) were far more likely than effects of existing disease), as ineffective communica- those in the two highest levels (4%) to report receiving tion between health providers and patients can result in food stamps. Nearly half (4144%) of all adults in the medical errors due to misinformation about medications lowest level on each literacy scale were living in and self-care instructions. This In a study by Shimouchi and colleagues, literacy fact is more disturbing when one considers that these was identified as a predictor of infant mortality in 97 are the very skills and strategies that often lead to developing countries. These factors affect both the duration and the Health care practitioners efficacy in delivering ser- quality of her life. For example, the average life vices and disseminating information regarding womens expectancy for a woman varies considerably according health is influenced largely by formal education, cul- to her race. In 1997, the average life expectancy for tural beliefs and perceptions about health, and access to white women was 5 years longer than that of African health care information and resources. Tomlinson reports that traditional Historically, women have also been the primary providers are the preferred health care provider for health care providers and health decision-makers for many women, regardless of provider level of literacy or their families. Health com- Women are also the primary caregivers for ill or munication professionals must consider education and disabled family members. In some studies where formal educa- major factor underlying other determinants of health. These findings led literacy affects peoples access to decent jobs and 244 Endometrial Polyps decent incomes. Low-literacy workers are more likely to have unskilled jobs that tend to be more dangerous, Endometrial Polyps Endometrial polyps are leading to a higher than average rate of workplace noncancerous (benign) growths found within the uter- injury. Usually they are asymptomatic and remain and control that people have over their lives, which undetectable for decades. In women without symptoms, may lead those individuals to have limited opportunities they are often found coincidentally when pelvic to make informed choices about their lifestyle resulting ultrasound is performed for unrelated problems. Literacy and health However, in women with abnormal uterine bleeding, goals have a better chance for success when pursued investigation of the bleeding may lead to their detection. Additionally, Suggested Reading one fourth of women with polyps in the tube leading Canadian Public Health Association. National literacy and from the vagina to the uterus (endocervical polyps) will health program. Violence against women Luckily, 99% of polyps removed by hysteroscopy in Mexico: A study of abuse before and during pregnancy. Patient and practitioner literacy and womens plasia) rarely occur within an endometrial polyp. Even though cancer is rarely found within an endometrial polyp, the surgical Suggested Resources removal of the polyps in patients who have abnormal Kirsch, I. The first is to summary of Adult literacy in America: A first look at the results treat menstrual dysfunction and the second is to reliably of the National Adult Literacy Survey. These include special- National Institute on Deafness and Other Communication Disorders. National Library of Medicine, Current helpful in imaging/visualizing the endometrium. Department of Health and Human Services, Office of Womens trial thickness and texture. These quick office-based 245 Endometriosis procedures can reliably determine the presence of because of the large number of patients who have endometrial polyps. The diagnosis of endometriosis can only be Patients who have symptomatic uterine polyps can made by a specialized procedure involving a small tube be offered minimally invasive treatment with removal of that allows visualization inside the uterus/pelvis polyps using a small tube inserted in the uterus (oper- (laparoscopy). This technique permits rapid, safe, ing techniques such as ultrasound lack sufficient sensi- and effective removal of the polyp with minimal anes- tivity and specificity to allow a diagnosis. Because the tube is Most endometrial deposits are found in the pelvis inserted into the vagina for access to the uterus, con- (ovaries, peritoneum, ligaments and structures around the ventional abdominal surgery can be avoided. Deposits outside of the Fortunately, polyps rarely reoccur when removed com- pelvis, including those in the umbilicus, and previous pletely at hysteroscopy. Typically, dys- hysteroscopy in detection of endometrial polyps: Results of a prospective study. The diagnosis in these patients is made at the time of diagnostic laparoscopy for infertility. Imaging modalities are gener- Endometriosis Endometriosis is the presence of ally not useful. This disease affects many women in encouraging reports suggest that specialized tests of the reproductive age group, and chronic pelvic pain blood or fluid in the abdomen (serum and peritoneal associated with endometriosis is one of the most fluid cytokines) might be helpful in the nonsurgical common symptom complexes that gynecologists are diagnosis of endometriosis. Although its etiology has not been conclusively identified, it is generally believed to involve abnormalities in the immune system. There are also a (laparoscopy) or conventional exploratory surgery myriad of associated symptoms, especially those that (laparotomy). The most associated with endometriosis can be difficult to treat commonly used classification of endometriosis is 246 Endometriosis according to the American Society for Reproductive endometriosis, fertility is affected as a consequence of Medicine (formerly American Fertility Society). In this the anatomical distortion of the pelvis caused by adhe- system, the surgeon assigns a certain number of points sions or ovarian cysts, or both. This is based on endometriosis does not damage the lining (luminal the area and depth of endometrial implants in the epithelium) of the fallopian tube and thus surgery is abdominal cavity (peritoneum) or ovary, as well as the more likely to be successful. In minimal or mild cases of extent of fibrous growths (adhesions) on the ovaries, endometriosis, the exact nature of the relation between tubes connecting ovaries to uterus (fallopian tubes), the disease and infertility is unclear. Definitive diagnosis of ovarian endometriomas disease in patients with infertility, it was found that the should be confirmed by microscopic cellular pregnancy rate can double. Pregnancy rates with endometriosis-associated infertility The clinician has to rely on the clinical history and may be improved by laparoscopic surgery for moderate physical exam. Advanced endometriosis is character- modalities are not useful and diagnostic laparoscopy is ized by extensive pelvic distortion that can be corrected still the gold standard. In infertility, surgery has been shown to be effective while medical suppressive therapy has not. Assisted conception has a primary role in moderate and Suggested Reading severe disease. Ovarian response to repeated controlled geon, advanced endometriosis can be managed effec- stimulation in in-vitro fertilization cycles in patients with ovarian tively with short convalescence and excellent long-term endometriosis.