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Prime Minister Modi himself has called journalists "news traders" treatment in statistics purchase generic agarol laxative line, one minister has called them "presstitutes" and another has said journalists should stop asking questions symptoms quivering lips purchase agarol laxative cheap online. Neither country has come to terms with the profound changes resulting from Partition and the creation of Pakistan in 1947 symptoms 2 days after ovulation buy agarol laxative with american express. Both hold Kashmir as a prized possession to justify their own nation-building rationale symptoms gerd purchase agarol laxative 120ml without a prescription. India needs Kashmir, the Muslim-majority state, to prove its secular credentials and to counter the idea that religion constitutes nationality. For Pakistan, Kashmir represents its unfinished agenda of carving out a nation state that includes all Muslim-majority regions. The competitive reasoning, supported by the media, seems oblivious to the daily injuries both countries inflict on the people of Kashmir. One challenge in writing about the media and Indo-Pak relations is that it conflates all media - good, bad and indifferent - into a monolith. For a decade Panos South Asia (the network of independent nongovernmental institutes) has brought together Indian and Pakistan editors for open and frank discussions. The first, in Nagarkot, Nepal in 2002, occurred when Indian and Pakistani troops were engaged in an eyeball-to-eyeball confrontation. The retreat was organised in collaboration with the Kathmandubased journal Himal Southasian that has remained our partner. Star reporters in the war spoke about their experiences while the political personalities gave important behind-the-scenes details. In the nuclear meeting, at Bellagio on Lake Como, Italy, the Pakistan representatives came up with the problem of lack of access to accurate and timely information. They were given material and sources by some of their Indian counterparts who had been covering the issue for a longer time. Political leaders from Indian Kashmir and Pakistani Kashmir set off the discussions. The editors came up with some constructive suggestions that the two leaders then carried on world tours immediately after. There were many conciliatory noises later from both governments, suggesting out-of-the-box solutions. One, to permit cross-border trade between the two Kashmirs, has just been implemented. Two former Indian foreign secretaries, Shyam Saran and Shivshankar Menon, acknowledge that this initiative helped to get domestic media support. Most importantly, some media decided they would stop using the terms India Occupied and Pakistan Occupied Kashmir, opting instead for the more neutral terminology of Indian Administered and Pakistan Administered Kashmir. The retreat in Barcelona, Spain, the seventh, came as the geo-political environment had changed dramatically within a year. Two former foreign secretaries of India and Pakistan, Salman Haidar and Shamshad Ahmad, joined a very high-powered team of editors and proprietors from both sides. While discussions tended to get heated, it all came together as an incisive analysis of current forces at play within the region. One of the key truths to emerge from the retreats was the fact that domestic constituencies for peace need to be nourished, and without adequate home support no regime in Delhi or Islamabad can keep the peace process on track. The Establishments in both countries have openly acknowledged that the softening of "nationalist rhetoric" by influential sections of the media - a direct result of the retreats - has helped them to revive the peace process every time it gets stymied by some event like a bomb blast or an act of terror. The success of these interactions is valued by major publications in India and Pakistan. A media conference, "Talking Peace", was convened in Karachi by Aman ki Asha, a joint initiative of the Jang Group of Pakistan and the Times of India Group, to present our experience of bringing senior media functionaries together and its impact on the quality of reports and analysis. Participants agreed on the need to create more empathy for each country and the need for more cross-border information. We suggested broadening coverage beyond geopolitics, ensuring a more rigorous reportage of economic, infrastructure and cultural issues. Training workshops for reporters on specific issues like Kashmir, water, and terrorism, for example, would help raise the level of reporting in general. We suggested the development of a mutually agreed code of ethics and guidelines on issues of mutual concern and the development of a website that would allow better cross-border engagement between journalists.
Generalized withdrawal seizures rarely require aggressive pharmacologic intervention beyond that given to the usual pt undergoing withdrawal medicine cabinets proven agarol laxative 120ml, i medicine keppra discount 120 ml agarol laxative with mastercard. These include education about alcoholism and instructing family and/or friends to stop protecting the person from the problems caused by alcohol medications for ptsd order discount agarol laxative on-line. A third component treatment 4 sore throat order 120ml agarol laxative, called relapse prevention, helps the person to identify situations in which a return to drinking is likely, formulate ways of managing these risks, and develop coping strategies that increase the chances of a return to abstinence if a slip occurs. There is no convincing evidence that inpatient rehabilitation is more effective than outpatient care. These receptors mediate the opiate effects of analgesia, euphoria, respiratory depression, and constipation. Endogenous opiate peptides (enkephalins and endorphins) are natural ligands for the opioid receptors and play a role in analgesia, memory, learning, reward, mood regulation, and stress tolerance. The prototypic opiates, morphine and codeine, are derived from the juice of the opium poppy, Papaver somniferum. The semisynthetic drugs produced from morphine include hydromorphone (Dilaudid), diacetylmorphine (heroin), and oxycodone. The purely synthetic opioids and their cousins include meperidine, propoxyphene, diphenoxylate, fentanyl, buprenorphine, tramadol, methadone, and pentazocine. All of these substances produce analgesia and euphoria as well as physical dependence when taken in high enough doses for prolonged periods of time. In larger doses, markedly decreased respirations, bradycardia, pupillary miosis, stupor, and coma ensue. Additionally, the adulterants used to "cut" street drugs (quinine, phenacetin, strychnine, antipyrine, caffeine, powdered milk) can produce permanent neurologic damage, including peripheral neuropathy, amblyopia, myelopathy, and leukoencephalopathy; adulterants can also produce an "allergic-like" reaction characterized by decreased alertness, frothy pulmonary edema, and an elevation in blood eosinophil count. Chronic Effects Chronic use of opiates will result in tolerance (requiring higher doses to achieve psychotropic effects) and physical dependence. Withdrawal Withdrawal produces nausea and diarrhea, coughing, lacrimation, mydriasis, rhinorrhea, diaphoresis, twitching muscles, piloerection, fever, tachypnea, hypertension, diffuse body pain, insomnia, and yawning. Relief of these exceedingly unpleasant symptoms by narcotic administration leads to more frequent narcotic use. Narcotic Abuse Overdose High doses of opiates, whether taken in a suicide attempt or accidentally when its potency is misjudged, are potentially lethal. Symptoms include miosis, shallow respirations, bradycardia, hypothermia, and stupor or coma. Treatment requires cardiorespiratory support, using intubation if needed, and administration of the opiate antagonist naloxone (0. Withdrawal One treatment approach to withdrawal is the administration of any opioid. Thus, pharmacologic treatments often center on relief of symptoms of diarrhea with loperamide, of "sniffles" with decongestants, and pain with nonopioid analgesics. Comfort can be enhanced with administration of the 2-adrenergic agonist clonidine in doses up to 0. An ultrarapid detoxification procedure using deep sedation and withdrawal precipitated by naltrexone has many inherent dangers and few, if any, advantages. Opioid Maintenance Methadone maintenance is a widely used treatment strategy in the management of opiate addiction. This level is optimally effective in blocking heroin-induced euphoria, decreasing craving, and maintaining abstinence from illegal opioids.
The characteristic "swishing" sound of the blood flow indicates a patent venous system medicine 2020 order agarol laxative 120 ml without prescription. These are performed with the use of blood pressure cuffs medications not to take with blood pressure meds buy 120ml agarol laxative with mastercard, which are placed around the thigh medicine articles discount 120 ml agarol laxative fast delivery, calf medicine hat news cheap agarol laxative 120 ml mastercard, and ankle. A conductive paste is applied to the skin overlying the artery distal to the cuffs. The proximal cuff is inflated to a level above systolic blood pressure in the normal extremity. The Doppler ultrasound transducer is placed immediately distal to the inflated cuff. The highest pressure at which blood flow is detected by the characteristic "swishing" Doppler signal is recorded as the blood pressure of that artery. Inform the patient that the physician must interpret the studies and that results will be available in a few hours. Abnormal findings Venous occlusion secondary to thrombosis or thrombophlebitis Venous varicosities Small or large vessel arterial occlusive disease Spastic arterial disease. During this study, dye is injected into the venous system of the affected extremity. Obstruction to the flow of dye or a filling defect within the dye-filled vein indicates that thrombosis exists. A positive study accurately confirms the diagnosis of venous thrombosis; however, a normal study, though not as accurate, does make the diagnosis of venous thrombosis very unlikely. Venography is also used to identify venous stenosis caused by external obstruction or indwelling catheter-induced thrombosis. Often both extremities are studied, even though only one leg is suspected of containing deep vein thrombosis. Injection of the iodinated contrast may cause renal failure, especially in the elderly. The patient is taken to the radiology department and placed in a supine position on the x-ray table. A tourniquet is frequently placed on the leg to prevent filling of the superficial saphenous vein. As a result, all of the dye goes toward filling the deep venous system, which contains the most clinically significant thrombosis that can embolize. Tell the patient that the venous catheterization is only as uncomfortable as a cutaneous heel stick. V Abnormal findings Obstructed venous systems Acute deep vein thrombosis notes 982 viral cultures viral cultures Type of test Blood; urine; stool; throat; skin lesions Normal findings No virus isolated Test explanation and related physiology Viral infections are the most common infections affecting children and adults. Definitive diagnosis of viral disease is made by culture of the virus (discussed here). Cultures obtained in the first few days after symptoms appear offer the best chance of identifying the infective culture. Different viruses vary greatly in their ability to grow in specific cell cultures. Procedure and patient care Before Explain the method of collection of the specimen to the patient. After Explain that the patient may still be infectious and should minimize exposure to others. Testing is done in the clinical setting when a patient has severe symptoms contributing to significant morbidity. Testing is also performed for epidemiologic reasons to identify a viral outbreak and its extent. Finally testing can indicate immunity after exposure to the virus or a vaccination.
The major manifestations of the hepatic porphyrias are neurologic (neuropathic abdominal pain medications on backorder safe agarol laxative 120 ml, neuropathy medications with codeine purchase agarol laxative 120 ml fast delivery, and mental disturbances) medications like abilify proven agarol laxative 120ml, whereas the erythropoietic porphyrias characteristically cause cutaneous photosensitivity medicine man pharmacy purchase 120 ml agarol laxative amex. Laboratory testing is required to confirm or exclude the various types of porphyria. However, a definite diagnosis requires demonstration of the specific enzyme deficiency or gene defect. Manifestations include colicky abdominal pain, vomiting, constipation, port-wine colored urine, and neurologic and psychiatric disturbances. Clinical and biochemical manifestations may be precipitated by barbiturates, anticonvulsants, estrogens, oral contraceptives, alcohol, or low-calorie diets. Narcotic analgesics may be required during acute attacks for abdominal pain, and phenothiazines are useful for nausea, vomiting, anxiety, and restlessness. Treatment between attacks involves adequate nutritional intake, avoidance of drugs known to exacerbate the disease, and prompt treatment of other intercurrent diseases or infections. It is due to deficiency (inherited or acquired) of hepatic uroporphyrinogen decarboxylase. Photosensitivity causes facial pigmentation, increased fragility of skin, erythema, and vesicular and ulcerative lesions, typically involving face, forehead, and forearms. Porphyria Cutanea Tarda Avoidance of precipitating factors, including abstinence from alcohol, estrogens, iron supplements, and other exacerbating drugs, is the first line of therapy. The skin manifestations differ from those of other porphyrias, in that vesicular lesions are uncommon. Redness, swelling, burning, and itching can develop within minutes of sun exposure and resemble angioedema. Chronic skin changes may include lichenification, leathery pseudovesicles, labial grooving, and nail changes. Protoporphyrin levels are increased in bone marrow, circulating erythrocytes, plasma, bile, and feces. Cholestyramine or activated charcoal may promote fecal excretion of protoporphyrin. Clinical Features Hepatic disease may present as hepatitis, cirrhosis, or hepatic decompensation. In other pts, neurologic or psychiatric disturbances are the first clinical sign and are always accompanied by Kayser-Fleischer rings (corneal deposits of copper). Dystonia, incoordination, or tremor may be present, and dysarthria and dysphagia are common. In about 5% of pts, the first manifestation may be primary or secondary amenorrhea or repeated spontaneous abortions. Diagnosis Serum ceruloplasmin levels are often low, and urine copper levels are elevated. For initial neurologic therapy, trientine and zinc are recommended for 8 weeks, followed by therapy with zinc alone. Zinc treatment does not require monitoring for toxicity, and 24-h urine copper can be followed for a therapeutic response. Trientine may induce bone marrow suppression and proteinuria, and free serum copper levels (adjusting total serum copper for ceruloplasmin copper) must be followed for a therapeutic response. The goal of the mental status exam is to evaluate attention, orientation, memory, insight, judgment, and grasp of general information. Attention is tested by asking the pt to respond every time a specific item recurs in a list. Memory can be tested by asking pt to immediately recall a sequence of numbers and by testing recall of a series of objects after defined times.
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