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By I. Topork. Mayville State University. 2019.

As Pellegrino puts it “medicine is the most humane of sciences buy 25mg benadryl, the most empiric of arts generic benadryl 25mg on-line, and the most scientifc of humanities. Although Pellegrino emphasizes the importance of the medical hu- manities, he recognizes as well that many have held uncritical and unreal- istic expectations regarding what the humanities can ofer. Medical humanism has achieved the status of a salvation theme, which can absolve the perceived “sins” of modern medicine. The list of those sins is long, varied, and often contradictory: overspecialization; tech- nicism; overprofessionalization; insensitivity to personal and socio- cultural values; too narrow a construal of the doctor’s role; too much “curing” rather than “caring”; not enough emphasis on prevention, patient participation, and patient education; too much science; not enough liberal arts; not enough behavioral science; too much eco- nomic incentive; a “trade school” mentality; insensitivity to the poor and socially disadvantaged; overmedicalization of everyday life; in- humane treatment of medical students; overwork by house staf; def- ciencies in verbal and nonverbal communication. His ability to locate and appreciate refectively the strengths and limitations of the humanities is undoubtedly rooted in his concerns for the philosophy of medicine as a grounding perspective. The Collection: An Overview This volume opens with an exploration of the philosophical founda- tions of medicine and the medical profession under the rubric “Toward a Philosophy of Medicine. The three essays in the frst sub- section range from two that examine the conceptual foundations of the © 2008 University of Notre Dame Press An Introduction feld (“What the Philosophy of Medicine Is” and “Philosophy of Medicine: Should It Be Teleologically or Socially Construed? In the opening essay, Pellegrino draws a careful distinction among (1) philosophy and medicine (i. By em- ploying a historical overview and conceptual analysis of philosophy’s en- gagement with medicine, Pellegrino shows the integrity of the feld, the philosophy of medicine. This he understands to be concerned with “the phenomena peculiar to the human encounter with health, illness, disease, death, and the desire for prevention and healing. Wildes that Pellegrino construes the philosophy of medicine too narrowly by excluding medical logic, medical epistemology, and the examination of concepts of health and disease. This omission, as Pellegrino argues, is justifed in that these issues are not peculiar to medi- cine and therefore do not specifcally defne a philosophy of medicine. Pellegrino responds as well to Wildes’ criticism of the teleological charac- ter of Pellegrino’s account of the philosophy of medicine. In the last of the frst three essays, “The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Profes- sions,” Pellegrino investigates the internal morality of clinical medicine and how it defnes the character of medicine, the object of the philosophy of medicine. Here Pellegrino begins an analysis of the good of the patient, which he de- velops further in other chapters in this volume, but especially in “Moral Choice, the Good of the Patient, and the Patient’s Good. The four essays in the second part of the section concerning the phi- losophy of medicine address the relationship between medicine and hu- manism, as well as the proper role of physicians. In “Humanistic Basis of Professional Ethics,” Pellegrino argues that a “more reliable source for a more humanistic professional ethics resides in the existential nature of ill- ness and in the inequality between physician and patient intrinsic to that state. This theme is taken up with a special focus on the intrusion of the market and concerns for proft in the contempo- rary character of health care in “The Commodifcation of Medical and Health Care: The Moral Consequences of a Paradigm Shift from a Profes- sional to a Market Ethic. The question is whether the ethic of the market- place or an ethic built primarily on the physician’s commitment to the healing and care of the patient will defne medicine. These concerns are explored further, as Pellegrino addresses the goals of medicine in “Medicine Today: Its Identity, Its Role, and the Role of Phy- sicians. Drawing on Aristotle, Aquinas, and Leon Kass, he looks with care at the nature of the medical good, the patient’s perception of that good, the good for humans, and the spiritual good. All of this he brings together in an investigation of the proper role of physicians, which he defnes in terms © 2008 University of Notre Dame Press An Introduction of their relationship to patients and their mutual determination of the ends of medicine. As Pellegrino puts it, “physicians do not determine the ends of medicine; it is their task to realize these ends in a specifc clinical encounter with a particular patient. Physicians are charged with ascer- taining, together with the patient, the content of the end of healing. Note, the content of healing is not a social construction of the end, but it accepts healing as an end. This section closes with a quasi-autobiographical essay (“From Medi- cal Ethics to a Moral Philosophy of the Professions”) in which Pellegrino reviews his work from the 1940s to the present, tying his personal journey to the cultural developments that fed the need for a moral philosophy of the health care professions. As he shows, our current condition is charac- terized by the need “to ‘recapture’ the idea of professional commitment. Without a reconstruction of the moral foundations of the idea of a profes- sion, [this efort] cannot be fully successful. But it is through professionals that bioethics becomes a beneft or a danger for every human being in a technological society. A philosophy of the profession that grounds the ethics of the professions is therefore more than an idle academic exercise. He distin- guishes among four themes bearing on the nature of the good: (1) “the pa- tient’s concept of ultimate good,” (2) “biomedical or techno-medical good,” (3) “the patient’s concept of his own good,” and (4) “the good of the patient as a person. He draws as well from Aristotle’s account of the good, thus estab- lishing connections among the philosophical traditions, understandings of the good, and good clinical decision making. This essay provides a careful analysis of the implications of diferent senses of autonomy for diferent models of the physician-patient relationship. In so doing, Pellegrino lays out cardinal conficts between autonomy and benefcence, and between autonomy and justice.

Prognosis Slowly progresses to chronic liver disease with risk of ful- Hereditary haemochromatosis minant hepatic failure benadryl 25mg mastercard, cholangiocarcinoma and hepa- tocellular carcinoma buy 25 mg benadryl with amex. 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.

Thus discount 25mg benadryl amex, it seems logical to base estimated values for energy intake on the amounts of energy that need to be consumed to maintain energy balance in adult men and women who are maintaining desirable body weights generic 25mg benadryl visa, taking into account the incre- ments in energy expenditure elicited by their habitual level of activity. There is another fundamental difference between the requirements for energy and those for other nutrients. Body weight provides each indi- vidual with a readily monitored indicator of the adequacy or inadequacy of habitual energy intake, whereas a comparably obvious and individualized indicator of inadequate or excessive intake of other nutrients is not usually evident. Energy Balance Because of the effectiveness in regulating the distribution and use of metabolic fuels, man and animals can survive on foods providing widely varying proportions of carbohydrates, fats, and proteins. The ability to shift from carbohydrate to fat as the main source of energy, coupled with the presence of substantial reserves of body fat, makes it possible to accom- modate large variations in macronutrient intake, energy intake, and energy expenditure. The amount of fat stored in an adult of normal weight com- monly ranges from 6 to 20 kg. Large daily deviations from energy balance are thus readily tolerated, and accommodated primarily by gains or losses of body fat (Abbott et al. Coefficients of variation for intra-individual variability in daily energy intake average ± 23 percent (Bingham et al. Thus, substantial positive as well as negative energy balances of several hundred kcal/d occur as a matter of course under free-living conditions among normal and overweight subjects. This standardized metabolic state corresponds to the situation in which food and physical activity have minimal influence on metabolism. A recent re-evaluation of all available data performed by Henry (2000) has led to a new set of predicting equations. Thermic Effect of Food It has long been known that food consumption elicits an increase in energy expenditure (Kleiber, 1975). Activation of the sympathetic nervous system elicited by dietary carbohydrate and by sensory stimulation causes an additional, but modest, increase in energy expendi- ture (Acheson et al. The increments in energy expenditure during digestion above baseline rates, divided by the energy content of the food consumed, vary from 5 to 10 percent for carbohydrate, 0 to 5 percent for fat, and 20 to 30 percent for protein. Consumption of the usual mixture of nutrients is generally considered to elicit increases in energy expenditure equivalent to 10 percent of the food’s energy con- tent (Kleiber, 1975). Thermoregulation Birds and mammals, including humans, regulate their body tempera- ture within narrow limits. This process, termed thermoregulation, can elicit increases in energy expenditure that are greater when ambient tempera- tures are below the zone of thermoneutrality. The environmental tem- perature at which oxygen consumption and metabolic rate are lowest is described as the critical temperature or thermoneutral zone (Hill, 1964). Because most people adjust their clothing and environment to maintain comfort, and thus thermoneutrality, the additional energy cost of thermo- regulation rarely affects total energy expenditure to an appreciable extent. However, there does appear to be a small influence of ambient tempera- ture on energy expenditure as described in more detail below. In very active individuals, 24-hour total energy expenditure can rise to twice as much as basal energy expenditure (Grund et al. The efficiency with which energy from food is converted into physical work is remarkably constant when measured under conditions where body weight and athletic skill are not a factor, such as on bicycle ergometers (Kleiber, 1975; Nickleberry and Brooks, 1996; Pahud et al. For weight-bearing physical activities, the cost is roughly proportional to body weight. In the life of most persons, walking represents the most significant form of physical activity, and many studies have been performed to deter- mine the energy expenditures induced by walking or running at various speeds (Margaria et al. Walking at a speed of 2 mph is considered to correspond to a mild degree of exertion, walking speeds of 3 to 4 mph correspond to moderate degrees of exertion, and a walking speed of 5 mph to vigorous exertion (Table 12-1, Fletcher et al. Over this range of speeds, the increment in energy expenditure amounts to some 60 kcal/mi walked for a 70-kg individual, or 50 kcal/mi walked for a 57-kg individual (see Chapter 12, Figure 12-4). The increase in daily energy expenditure is somewhat greater, how- ever, because exercise induces an additional small increase in expenditure for some time after the exertion itself has been completed. Taking into account the dissipation of 10 percent of the energy consumed on account of the thermic effect of food to cover the expenditure associated with walking, then walking 1 mile raises daily energy expenditure to 76 kcal/mi (69 kcal/mi × 1. Since the cost of walking is proportional to body weight, it is convenient to consider that the overall cost of walking at moderate speeds is approximately 1. Energy expenditure depends on age and varies primarily as a function of body size and physical activity, both of which vary greatly among individuals. Recommendations about energy intake vary accordingly, and are also subject to the criterion that an individual adult’s body weight should remain stable and within the healthy range. However, it is now widely recognized that reported energy intakes in dietary surveys underestimate usual energy intake (Black et al. A large body of literature documents the underreporting of food intake, which can range from 10 to 45 percent depending on the age, gender, and body composition of individuals in the sample population (Johnson, 2000). Low socioeconomic status, characterized by low income, low educational attainment, and low literacy levels increase the tendency to underreport energy intakes (Briefel et al. Ethnic differences affecting sensitivities and psychological perceptions relating to eating and body weight can also affect the accuracy of reported food intakes (Tomoyasu et al.

Uric acid order benadryl 25 mg on-line, which was mentioned previously generic benadryl 25mg overnight delivery, has also been discovered to destroy free radicals which are thought to contribute to the development of cancer. Its nutritional benefits alone are phenomenal, not to mention the immense value of its innumerable other health-promoting, therapeutic agents. In 1975, it was reported that urine studies are done on all urology patients at the Mayo Clinic to help detect cancer: "Cancer cells from early-stage urinary system tumors appear in the urine, which allows for detection of such new tumors before they are readily perceived by other diagnostic methods. Your Own Perfect Medicine Cells of urine sediment have been used in the same way that vaginal smears have been used to gain information on ovarian functioning. As a matter of fact, it was reported in 1971 that urine testing was actually shown to detect more cases of abnormal cell activity than the usual cervical Pap smear. Urine testing for urinary tract malignancies is a safe, easy procedure which can replace or supplement other forms of cancer detection. The idea of drinking urine for medicinal purposes certainly takes some getting used to, but consider the facts about urine. While under treatment, patients reported an absence of viral diseases (flu, colds, etc. On a few patients who exhibited low T-cell counts, the T-cell population was restored to normal after finishing their treatment. But one thing we do all know about allergies is that now almost everyone has one – or more. All of us know that our body produces white blood cells that search out r and destroy harmful bacteria or viruses in the body, but in the case of 169 most allergies, for some reason, the white blood cells attack substances that may be no threat to the body at all. Pollen is a natural, vital substance in our environment which we normally breathe in with no problem. No problem, that is, for some people – but a big one for those whose immune systems identify it as a foreign and health-threatening sub-Your Own Perfect Medicine stance; then the sneezing, sinus congestion and headaches, etc. But in reality, more and more people today are discovering that foods that are great for everyone else produce often violent, negative reactions in their bodies. No one knows the answer to that, but what scientists do know is that when the immune system does identify a substance as a threatening foreign protein in the body, it sends out specific white blood cells (T and B lymphocytes) to attack it. The "B" cells search out, identify and actually bind with the foreign protein (called an allergen or antigen), while the "T" cells rapidly divide, producing antibodies and large numbers of new T cells that will also be programmed to attack this antigen. In immunology, which is 170 the study of immune system functions, this allergic response is referred to as the antigen-antibody conflict. These auto-immune diseases are, of course, damaging to the body and in some cases can even be life-threatening. And what is more disconcerting, allergies and related disorders are becoming more and more prevalent in our industrialized societies. Researchers and doctors who deal with allergies, called immunologists, largely believe that allergies are essentially induced by unidentified weaknesses or alterations in the immune system. When the immune system is weakened or impaired, its ability to distinguish between harmless and harmful substances also becomes impaired. So your "r+The Research Evidence and Case Studies 171 white blood cells, whose work it is to search out and destroy harmful proteins in the body, may begin to attack even ordinarily beneficial or benign proteins such as those that come from normal foods. Immunologists also speculate that because our bodies are now exposed to enormous numbers of new chemical substances in our modem industrialized societies, that the immune system can become overwhelmed in its efforts to identify and deal with each new substance: "It has been estimated that in the industrialized countries, man comes in contact with 150,000 man-made substances; pesticides, plastics, chemicals, etc. Many people with simple or severe allergies get extremely discouraged 172 because they spend a fortune going from doctor to doctor without getting results. Identifying the specific antigen that a person is reacting to is a huge headache for doctors and their patients. Researchers have discovered that urine contains specific anti-allergen antibodies that are manufactured by the body itself and that when re-introduced back into the body through urine therapy, the allergic response is stopped. Your Own Perfect Medicine In extensive clinical testing with urine therapy on allergy patients, both in Europe and the U. The following reports demonstrate the seriousness with which urine therapy has recently been utilized in the field of allergy treatment and research. As medical researchers have discovered, allergic responses are caused 173 by "renegade" white blood cells that inappropriately attack substances even when they may be no threat to the body. So it is the activity of these renegade white blood cells, called antigen receptors, that needs to he corrected in order to cure the allergy. By injecting the receptors, it has been possible to induce antibody against the antigen receptors which can then limit or even abort an ongoing allergic response. Realizing that the urine of allergic individuals contains the allergy-causing white blood cells, allergy researchers, as in the next report, reasoned 174 that by giving allergic individuals their own urine internally, their bodies would develop antibodies to the renegade white blood cells contained in the urine which would then stop the allergic response. The Research Evidence and Case Studies This was an award-winning report delivered at the Oxford Medical Symposium in March, 1981, dealing with the treatment of allergies with urine therapy. Nancy Dunne was medical advisor to the Irish Allergy Treatment and Research Association, founder of the Irish Orthomolecular Medical Association and a member of several allergy research societies: "A simple technique for treating allergies — Auto-Immune Urine Therapy (A. Fife, a 175 neuropsychiatrist for 40 years had, some years previously, been forced to resign from his practice through ill health.