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The primary reservoir hosts for most Leptospira species are wild mammals discount duloxetine 30mg fast delivery, particularly rodents purchase 40mg duloxetine with mastercard, in which they cause little or no clinical disease buy duloxetine 30mg overnight delivery. Leptospirosis is most commonly transmitted indirectly through contact with contaminated water or soil but can also be transmitted directly between mammalian hosts. It is mainly endemic in countries with humid subtropical or tropical climates and is a notable cause of morbidity and mortality in humans and animals in the western hemisphere. It occurs most commonly during the rainy season in the tropics and in the summer and autumn in temperate regions. Conditions leading to an increase of contaminated surface water or soil, such as rain, floods and disasters increase the risk of leptospirosis and may result in epidemics. In addition, during periods of drought, risks of infection may increase in association with the attraction of both humans and animals to water bodies. In humans, the range of symptoms is very wide and variable, from mild non- specific signs to lethal infection. There are over 200 pathogenic serovars with many being host adapted to wildlife species in which they cause little clinical disease. Most commonly found in many species of wild and domestic animals including rodents, cattle, sheep, goats, pigs, horses and dogs. Humans, particularly those working in or close to water, are very susceptible to illness caused by certain strains. Geographic distribution Occurs worldwide but most commonly in temperate or tropical climates with high rainfall. The highest concentrations of cases are often in developing countries where wet farming and rodent populations combine and where freshwater floods may occur. Leptospirosis is particularly prevalent in warm and humid climates, marshy or wet areas, and in regions with an alkaline soil pH. How is the disease Infection is acquired through direct contact with infected urine or indirect transmitted to animals? Occasionally, infection can spread through the inhalation/ingestion of aerosolised urine or water. Transmission may also occur through contact with infected normal, aborted or stillborn foetuses, or vaginal discharge and placental fluids. How does the disease Infection is spread from one animal group to another by an infected animal spread between groups of which will shed the bacteria into the environment, most commonly in urine. Infection is maintained through survival of bacteria in the kidney of a reservoir host, where they are protected from the host’s immune response. How is the disease Infection is acquired through contact with water, food or soil contaminated transmitted to humans? Bacteria may be ingested or may gain entry across intact mucous membranes or broken skin. In accidental hosts symptoms may be very variable, and depend, in part, on the bacterial strain involved. Initial clinical signs are generally non-specific and include lethargy and anorexia, associated with fever. Disease may progress to septicaemia and in some cases may result in death of the host. Infection during pregnancy may result in abortion, still-birth, weak offspring or infected but healthy offspring. In horses, many infections are subclinical and eye disease is the most common symptom. During the initial incubation period of roughly seven days (range 2-19), signs are non-specific and include fever, headache, chills, a rash and muscular pain. The kidneys and liver are common target organs and symptoms might include vomiting, anaemia and jaundice. Recommended action if Contact and seek assistance from human and animal health professionals suspected immediately if there is any illness in people and/or livestock. Diagnosis Clinical diagnosis is not straightforward due to the non-specific nature and wide variability in symptoms observed.

Afterward order duloxetine 20mg on-line, Compound Medicines in the Trotula Ensemble  having squeezed it all out in a sack best duloxetine 60mg, drain [the mixture] well order 30 mg duloxetine overnight delivery. Potio Sancti Pauli (¶): Potio Sancti Pauli is called potio from potando [drink- ing], sancti Pauli because Saint Paul created it. This is the same potion which the Romans called potio maior, because Paul the Great modified it. Properly it is given to epileptics, cataleptics, analeptics, and those suffering in the stom- ach; it is given with wine in which incense or mixed peony has been cooked. This potion is given with Esdra11 in the wintertime and in the springtime to those suffering from quartan fever. It cures when given before the hour of crisis with wine in which felwort or golden gorse and castoreum have been cooked. It likewise heals those suffering from diseases of the windpipe and paralytics when given with wine in which sage or castoreum has been cooked. Take three drams and one scruple of natron; one dram and one scruple each of castoreum, antimony, houseleek, cloves, laurel berry, willow, wild celery, parsley, fennel, wild carrot, and stavesacre; three scruples each of sweet flag, myrobalans, licorice, vitriol, peony, and pellitory; one scruple and eighteen grains of costmary, colocynth, agaric, mastic, both long and round aristolochia, roses, juice of wild cabbage, hazelwort, wood sage, cuckoopint, dittany, basil, bear’s breech, horsemint, oregano, penny- royal, wall germander or hyssop, savory, white pepper and black pepper and long pepper, and rue seed; one scruple and four grains each of watercress and frankincense; one scruple each of balsam, spikenard, saffron, camel grass, Chi- nese cinnamon, myrrh, opoponax, sulfur, mandrake, felwort, malt, spurge, poppy, and cormorant blood; one scruple minus four grains each of cinnamon, cloves, ginger, marking nut, bark of the balsam tree, rhubarb, hog’s fennel, fruit of the balsam tree, calamite storax, serapinum gum, hazelwort, dragon’s blood, hare’s rennet, sheep’s and goat’s and veal rennet, bear’s gall, goose blood, and petroleum; seven drams and four grains of cowslip; and honey as needed. This is given in the evening, in the amount of a hazelnut, or with the above- mentioned decoctions, to those suffering from diseases of the head. It is called rosata from roses; novella [new] in contrast to the old rosata, which had tibar, that is, mercury. Take one ounce and one dram and two and a half scruples each of rose, sugar, and licorice; two drams, two scruples, and two grains of cinnamon; one scruple and eight grains each of cloves, spike-  Appendix nard, ginger, galangal, nutmeg, zedoary, storax, watercress, and wild celery; and honey as needed. But if you wish to use it as a purgative, you should employ two scruples of Levant scammony and it will work more forcefully. Take three drams, three grains, plus a third of one grain of aloe; three drams each of cinnamon, wall germander, and sweet flag; two drams and sixteen grains each of saffron, cassia tree bark, and rhubarb; two and a half drams of agaric; one and half drams of spikenard, costmary, mastic, hazelwort, silphium,12 squill, asafetida, ammoniacum, bdel- lium, Indian electuary, St. It is made against the most serious diseases of the whole human body: for epileptic conditions, cataleptic, apoplectic, cephalargic, stomach-related, and migrainous. It is best for respiratory, asthmatic, blood-spitting,13 jaundiced, dropsical, perip- neumonic, and intestinal conditions, and for those having wounds in the in- testines. It improves leprous lesions and variolas and periodic chills and other diseases of long standing. It is especially good against all kinds of poisons and the bites of serpents and reptiles. But the quan- tity and quality of the doses for each disease are different, and they are written at the end. Take two drams and two scruples of tro- ches made from squill; two drams of long pepper; one dram and one scruple each of troches of Tyre and diacorallum;15 one scruple and seven grains of bal- Compound Medicines in the Trotula Ensemble  sam wood; one scruple and fourteen grains each of juice of opium poppy, agaric, Florentine iris, rose, crow garlic, wild turnip seed, cinnamon, and juice of the balsam tree; one scruple and seven grains each of rhubarb, wax, spike- nard, costmary, camel grass, ginger, cassia tree bark, calamite storax, myrrh, turpentine, frankincense, calamint, dittany, French lavender, wall germander, roots of creeping cinquefoil, parsley, and white pepper; one scruple each of cloves, gum arabic, sweet flag, burnt vitriol, serapinum gum, sealed earth or Armenian bole, juice of dodder, Celtic nard, germander, felwort, hog’s fen- nel, balsam fruit, poppy, wild celery, fennel, wild caraway, sermountain, gar- den cress, garden cress seed, anise, and St. Grind those things that need to be ground, and having melted the gums in wine, mix with the powder and with sufficient honey or grind with the spices. It is given in the amount of a hazelnut with lukewarm water to those suffering from apoplexy, scotomia, cephalargia, migraines, hoarseness of the voice, and chest pains; for these, it should be given with honey or gum tragacanth so that it can be toler- ated by the mouth. For those with blood-spitting conditions of the chest and disease of the lung, give it in a ptisan. For those with peripneumonia, give it with the juice or a decoction of white hore- hound. For nephritics, those suffering from stones, and cholerics, give it with a decoction of gromwell, and wild or domestic celery. For those suffering from conditions of the windpipe, give it with the juice or a decoction of meadow rue. For poisons and for bringing on the menses or the fetus, give it with warm wine, or with mulsa made with water in which mint or sweet basil has been cooked. And for those suffering from a periodic chill and all other diseases, give it with lukewarm water. It is given for pain of the stomach in men and women with water in which fennel seeds, anise, and mastic have been cooked. It is [also] given for disorder of the womb caused by frigidity if it is drunk mixed with wine in which mugwort has been cooked. It also provokes the menses if it is made with well-ground mugwort  Appendix and mixed with musk oil.

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Warm the urine by pouring it into a glass container duloxetine 30 mg lowest price, then place the jar in a container of hot water buy duloxetine 60mg cheap. While lying down buy duloxetine 20 mg without a prescription, place wet compress over the affected area and cover with a clean folded towel. Keep the compress applied for as long as possible, reapplying warm urine as needed to keep the compress wet. Urine compresses have also been reported to be effective for many internal disturbances and for arthritic and rheumatic pains. Wounds, Burns And Abrasions As so many research and clinical studies have shown, urea is a tremen-dously effective anti-bacterial agent and an excellent healing treatment for wounds and burns of all types. Saturate a thick gauze bandage or cotton pad with fresh urine, place it over the wound or bum and secure it with additional gauze; cover with plastic or soft towel to prevent leakage. Reapply fresh urine with clean medidne dropper directly onto the existing inside compress. Urine is also known to prevent scarring, so keep the urine pack applied as long or as often as possible until healing is complete. The pain is quickly relieved and the burn or wound heals rapidly without scarring. Eye And Nose Drops There are reports from people who have used urme drops for both eye and nose drops, for relief of eye itching or inflammation, or for nasal congestion. In both cases, make certain that you are using fresh, clear, normal urine only and that the acidity factor of the urine is normal (see previous section on Monitoring Your pH in this chapter). A compress of fresh normal urine is also excellent for external eye inflammations such as styles. As the research studies indicate, oral or injected urea has been shown to be extremely effective and safe in treating cases where excess fluid production is a problem (see pgs. Using urea in conjunction with natural urine therapy can be discussed with your doctor, once he or she has been made aware of the research findings relating to urea and urine therapy. Oral urine therapy also allows for slower application and absorption which can decrease any possible de-toxifying symptoms. Gradual introduction of urine therapy, or any medical therapy is always important, but even more so if you have a history of poor nutrition or chronic, serious illnesses which weaken the body and 205 promote poisons and toxins in the system. Introducing a new therapy too rapidly places a strain on an ah-eady weakened system and can cause a sudden release of toxins that may make you feel ill unnecessarily. As clinical studies have demonstrated, oral urine or urea can be fust as effective for non-emergency cases as injected urine. However, if your situation is extremely severe, urine injections can definitely be of benefit. As several of the dinical studies showed, urea, even in large doses, has been found to be harmless to the body, Researchers, (Urea - New Use of An Old Agent), reported that they safely administered urea daily to several patients for a period ranging from several day» to weeks, and in some cases, even several months, without any side effects, in doses ranging from 100 mg. Uric acid, usually thought to be a toxic waste product of the body, has been found by researchers to actually be a natural body defense against cancer and aging, allowing us to 206 live much longer than other mammals (Omni Magazine article, 1982). Most people think that uric add causes gout, but strictly speaking, it is not the uric add alone that causes the gout, but rather an overall, ongoing and chronic overaridity in the body which can be caused by many different factors including improper, overly-arid diet, kidney, liver and adrenal disorders, obesity, diabetes, chronic stress, undereating (anorexia), etc. Normally, the amount of uric add contained in urine is not a problem during urine therapy, because the body will excrete the amount it does not need. If you fed that you have a problem with chronic, ongoing overacidity (see section on Monitoring Arid/Alkaline Levels in this chapter), make certain that you decrease or eliminate meat while using urine therapy. Also, improve your diet by eating more alkaline foods, and decreasing arid foods before and after you start on urine therapy. Monitor your add/alkaline level with pH strips to determine when your pH has returned to a normal or more balanced condition. In cases of chronic addosis (over-acidity), do not do extended urine fasts or ingest large quantities over long periods of time.

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Constantine arrived in Salerno around the year  but soon buy duloxetine 30 mg line, at the recommendation of Alfanus cheap duloxetine 60 mg on-line, moved to the Benedic- tine Abbey of Monte Cassino order 20 mg duloxetine otc, with which Alfanus had intimate ties. Constan- tine became a monk and spent the rest of his life in the rich, sheltered confines of the abbey, rendering his valuable cache of Arabic medical texts into Latin. He translated at least twenty works, including the better part of ‘Alī ibn al- ‘Abbās al-Majūsī’s Pantegni (a large textbook of general medicine) plus smaller, more specialized works on pharmaceutics, urines, diets, fevers, sexual inter- course, leprosy, and melancholy. Written by a physician from Qayrawān (in modern-day Tunisia) Introduction  named Abū Ja‘far Aḥmad b. Its sixth book was devoted to diseases of the reproductive organs and the joints, and it was upon this that the author of the Salernitan Conditions of Women would draw most heavily. Beyond their length, they had introduced into Europe a rich but difficult vocabulary, a wealth of new pharmaceuticals, and a host of philo- sophical concepts that would take medical thinkers years to fully assimilate. Yet ultimately, the availability of this sizable corpus of new medical texts would profoundly change the orientation of Salernitan medicine. The medical writings of twelfth-century Salerno fall into two distinct categories. Embodying the dictum that ‘‘medicine is divided into two parts: theory and practice,’’ twelfth-century Salernitan writings can be classified as either theoretical or practical. Salernitan medicine was distinguished by its em- phasis on what can properly be called a ‘‘philosophical medicine. A curriculum of basic medi- cal texts to be used for introductory instruction seems to have formed just after . Later to be called the Articella (The little art), this corpus initially comprised five texts, among which were Constantine’s translations of Ḥunayn ibn Isḥāq’s Isagoge (a short handbook that introduced the student to the most basic principles of medical theory) and the Hippocratic Aphorisms and Prog- nostics. Two additional works recently translated from Greek—Philaretus’s On Pulses and Theophilus’s On Urines—were also included. Gariopontus’s Pas- sionarius may have served as the first text to be subjected to this kind of intense analysis, though at least by the second or third decade of the century extended commentaries were being composed on the Articella as well. The reintroduction of alphabeti- zation for pharmaceutical texts, for example, made it possible for Salernitan writers to absorb some small portion of the wealth of pharmacological lore that Constantine had rendered into Latin. The organizational benefits that written discourse provided were equally evident in the Salernitan masters’ Practicae. These were veritable medical en- cyclopedias, usually arranged in head-to-toe order, encompassing all manner of diseases of the whole body. Copho in the first half of the twelfth century, Johannes Platearius in the middle of the century, and Archimattheus, Bar- tholomeus, Petrus Musandinus, Johannes de Sancto Paulo, and Salernus in the latter half of the century all wrote their own compendia of cures. These practi- cae replicated the Arabic encyclopedias in including sections on women’s dis- eases (usually placed after diseases of the male genitalia), yet at the same time they showed considerable originality in devising their own therapeutic pro- grams. None of these male writers, however, broke new ground in his catego- rization of gynecological disease. Salernitan anatomical writers did de- vote considerable attention to the anatomy of the uterus and the ‘‘female tes- ticles’’; that these descriptions became increasingly more detailed over time owes not to inspection of women’s bodies, however, but to the assimilation of bits and pieces of anatomical and physiological lore from a variety of other written sources. Nicholaus, the author of the most important text on compound medicines, promised his readers that by dispensing the medicines described in his text, ‘‘they would have an abundance of money and be glorified by a multitude of friends. These men began to style themselves as ‘‘healer and physician’’ (medicus et physicus) and later simply as ‘‘physician. Yet even as cer- tain practitioners were able to enhance their social status through their learn- ing, there continued to exist in Salerno traditions of medical practice that par- took little or not at all in the new learned discourses. It is clear that religious and even magical cures continued to coexist alongside the rationalized prac- tices of physical medicine. There were, moreover, as we shall see in more detail later, some women in Salerno who likewise engaged in medical practice; these women apparently could not avail themselves of the same educational privi- leges as men and are unlikely to have been ‘‘professionalized’’ in the same way as their male counterparts. There was, in any case, no regulation of medical practice in this period (licensing was still a thing of the future),59 so to that degree the ‘‘medical marketplace’’ was open.

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