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The frequency of the Beta thalassemia is also a possible cause of disorder has been found to be 1 buy kamagra polo without a prescription. This is a cause of arterial Homocystinuria has a prevalence of three per and venous occlusions cheap kamagra polo 100 mg mastercard, recurrent spontaneous million inhabitants cheap 100 mg kamagra polo overnight delivery. One-third of patients have a miscarriages purchase kamagra polo visa, and biological changes such as venous or arterial event during their life. It is more It may be primary or associated with a clearly frequent to find a slight increase in plasma defined systemic disorder such as systemic lupus homocysteine (>15 mmol/l), which is more a erythematosus. Folic acid supplementation to various mechanisms: prothrombotic state, reduces the serum level of homocysteine, but Libman-Sachs endocarditis or early atheroma. It causes an endothelial Progressive external ophthalmoplegia with ptosis, 211 vasculopathy followed by cerebral ischemia [55]. Section 3: Diagnostics and syndromes muscular pain at exercise, lactic acidosis after Susac syndrome (or Sicret syndrome) is a exercise, presence of ragged red fibers on muscle rare disease occurring in young women of biopsy, cataract, hypogonadism, diabetes mellitus, unknown pathogenesis consisting of a triad hypothyroidism and cardiomyopathy are the with retinal arterial occlusion, hearing loss by other manifestations of the disease. Fundoscopic examination gynecological and cardiac surgery or diving reveals a typical vasculopathy [63]. The clinical picture consists of acute respiratory failure and acute diffuse Cerebral ischemia of undetermined encephalopathy, preceded by severe anxiety and dyspnea [56]. In a few minutes the patient and unknown causes develops tachycardia, seizures and coma, leading Before classifying a patient in this category it is to death [56]. As soon as the diagnosis is suspected important to be sure that the diagnostic work-up the patient should be turned onto the left side. Amniotic emboli occur after difficult deliveries in Sometimes the etiology is found during the follow-up. The patient develops acute pulmonary edema and seizures Risk factors for stroke in the young [11, 57]. Fat emboli occur in long bone fractures or Classic risk factors liposuction surgery [58]. Classic risk factors for stroke (arterial hypertension, smoking and hypercholesterolemia) are also risk Choriocarcinoma factors in the young, but the attributable risk is lower Choriocarcinoma is a malignant trophoblastic tumor than in older patients. More specific risk factors in the young Rare causes of cerebral ischemia in young people Oral contraceptive therapy of undetermined mechanism Oral contraceptive therapy increases the risk of ische- Sweet syndrome (acute febrile neutrophilic mic stroke even with compounds with low-dose estro- dermatosis) is a dermatological disorder gens: the relative risk of cerebral ischemia is 2. This dermatological case of cerebral ischemia can be attributed to oral disorder has accompanying features of systemic contraceptive therapy for 5880 women without vas- inflammation such as fever, conjunctivitis or other cular risk factors treated during 1 year [64]. Migraine Kawasaki syndrome is a panarteritis of arteries of Migraine is associated with a relative risk of ischemic 212 intermediate and small caliber that may lead to stroke of 3. Those studies used different age aura and stroke is not an artifact, although none of limits, and may have suffered recruitment bias in these studies can be considered as providing a definite specialized centers [7, 10, 25, 73]. It is less clear whether migraine studies were conducted in small samples, were retro- without aura is associated with stroke or whether spective, had a partial follow-up [15, 19, 22, 23, 71, 73, the association is restricted to migraine with aura. The concept Mortality of migrainous infarct is not proven: it requires exclu- The mortality rate is low in the short and intermedi- sion of other causes and a typical temporal relation- ate term [7, 8, 10, 15–23, 25, 73]. In the Lille cohort ship, the neurological deficit being a prolongation of a of 287 patients aged between 15 and 45 years, with a typical aura. A study per year during the next 2 years, and that of myocar- conducted in high-risk women, i. In cervical artery already had an ischemic stroke, showed no significant dissections the risk of recurrent stroke is very low increase in incidence of recurrent stroke during [2, 38, 39, 76, 77]. Stroke occurring during pregnancy is one of the leading causes of Epilepsy maternal death [68–70]. Epilepsy is more frequent after an ischemic stroke in a Classic risk factors for stroke: arterial hypertension, young patient than stroke recurrence, with a risk at smoking, hypercholesterolemia. Most patients had Migraine: the relative risk of ischemic stroke is post-stroke epilepsy and the first seizure during the 3. Quality of life Outcome Even if most patients remained independent, many Studies that evaluated the long-term outcome of of them lost their job or divorced during the 3 years young stroke patients are heterogeneous and can after the ischemic stroke [7]. Their findings are influenced systematic evaluation it is difficult to identify the by the inclusion or not of all types of stroke, includ- reason, but depression, fatigue, mild cognitive or 213 ing intracerebral ischemia [10, 19, 23, 71, 72], behavioral changes or alteration in social cognition Section 3: Diagnostics and syndromes are likely explanations. Stroke prevention measures should in young people are frequently associated with a take into account that short- and long-term mortality decline in quality of life that is not explained by rates are low, and that the overall risk of new vascular handicap [5, 7, 17]. The specificities of stroke prevention in young adults are the following: (i) oral contraceptive therapy Pregnancy after an ischemic stroke should be avoided in most cases; (ii) in the absence of A multicenter French study [79] conducted with 373 evidence-based data, cervical artery dissections may consecutive women who had an ischemic stroke be treated either by antiplatelet therapy or by anti- between 15 and 40 years of age and followed-up over coagulation [80], but, because of the low rate of recur- a 5-year period found an overall risk of recurrent rence after the 4th week, there is no reason to give stroke of 0. Risk of epilepsy after an ischemic stroke attitude is inappropriate at that time; (vi) young is 5–7% at 3 years. Behavioral changes and dystonia women should be informed what to do in the event in children are frequent sequelae. Secondary prevention after ischemic An important question that remains unanswered stroke in young adults is how long young patients should receive antiplatelet The main characteristics of ischemic stroke occurring therapy after an ischemic stroke when the diagnostic in young patients, i. Due to the low risk of recurrence outcome and interference with hormonal life in in patients without any risk factor, the reasons for women (contraception, pregnancy and future meno- continuing antiplatelet therapy for more than a few pause), influence secondary prevention after stroke. As for elderly subjects, secondary prevention meas- ures mainly depend on the presumed cause. For this Secondary prevention measures mainly depend on the presumed cause and consist of an optimal reason, an extensive and early diagnostic work-up is management of vascular risk factors, an appropri- required, as well as an extensive evaluation of risk ate antithrombotic therapy and removal of the factors. Chapter 14: Ischemic stroke in the young and in children Chapter Summary Specificities of stroke prevention in young adults: oral contraceptive therapy should be avoided in Diagnostic work-up (additionally to the standard most cases; cervical artery dissections may be treated work-up as in older patients): either by antiplatelet therapy or by anticoagulation Intensive patient interview about the presence of (oral anticoagulation only for a few weeks); due to headache, tinnitus, drug abuse, family history; the low risk of recurrence in patients without any careful skin examination; careful fundoscopic risk factor, the reasons for continuing antiplatelet examination; and in selected patients serology therapy more than a few years are rather weak. Treatment and secondary Post-irradiation cervical arteriopathies prevention of stroke: evidence, costs, and effects on Cervical fibromuscular dysplasia of cervical individuals and populations. Global mortality, disability, Intracranial dissections and the contribution of risk factors: Global Burden Moyamoya of Disease Study. High stroke incidence in the prospective community-based disorder L’Aquila registry (1994–1998). Incidence and Post-partum cerebral angiopathy and eclampsia survival rates during a two-year period of intracerebral Unruptured aneurysms of intracranial arteries and subarachnoid haemorrhages, cortical infarcts, Hematological disorders lacunes and transient ischaemic attacks. The Stroke Metabolic disorders such as Fabry disease, homo- Registry of Dijon: 1985–1989. Clinical outcome Choriocarcinoma in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Ischemic stroke in patients cervical artery dissection, and in non-industrialized under age 45. Incidence and short-term outcome of cerebral infarction in young adults in western Norway. Long-term prognosis Secondary prevention measures mainly depend on of cerebral ischemia in young adults. National the presumed cause and consist of optimal manage- Research Council Study Group on Stroke in the ment of vascular risk factors, an appropriate anti- Young. Incidence and causes antithrombotic agents, depending on the cause), of strokes associated with pregnancy and puerperium. Trial of Org 10172 in Acute Stroke developments in childhood arterial ischaemic stroke. Guidelines for management of ischaemic stroke and atherosclerosis and ischemic stroke in young patients. Ischemic association of atrial vulnerability with atrial septal stroke in young adults. Experience in 329 patients abnormalities in young patients with ischemic stroke enrolled in the Iowa Registry of stroke in young adults. Stroke in the young in South prevalence of atrial septal aneurysms in patients with Africa – an analysis of 320 patients. Natl Med J India 1997; autosomal dominant arteriopathy with subcortical 10:107–12. Fetal bradycardia and spontaneous cervical artery dissection: a case-control disseminated coagulopathy: atypical presentation of study. Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis. Janssens E, Hommel M, Mounier-Vehier F, Leclerc X, in Kawasaki syndrome and management of its Guerin du Masgenet B, Leys D. Accidents vasculaires cérébraux de la grossesse et du Susac-Syndrom: Fallberichte und Literaturübersicht. Antithrombin, protein C and protein S levels in 127 consecutive young adults with ischemic stroke. Marini C, Totaro R, De Santis F, Ciancarelli I, follow-up of occlusive cervical carotid dissection.

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Authentic examples from health forum boards are analysed by means of Discourse Analysis in order to understand how participants construct attitude and commitment toward advice buy kamagra polo 100mg free shipping, opinions and suggestions (Bybee et al kamagra polo 100 mg without a prescription. Finally generic kamagra polo 100mg free shipping, a survey is undertaken in order to understand whether this credibility works buy discount kamagra polo on-line, and if so how it affects people’s beliefs and behaviour in relation to their health. This participatory web phenomenon has emerged so quickly and widely that research has generally focused much more on various features, user responses, and design characteristics than on theoretical explanations for the causes and effects associated with their use. In particular, forum benefits include providing support, understanding, praise, and reinforcement as well as a place to find intervention options, negotiating plans, and/or general assistance. Although it is unlikely to supplant the role of trusted healthcare- providers, the Internet has found an important place in people’s reper- tory of health information sources. The Internet offers confidential and convenient access to an unprecedented level of information about a diverse range of subjects, and over time its perceived credibility has increased. Unsurprisingly, children and adolescents also use the Credibility and Responsibility in User-generated Health Posts 193 Internet as a resource for health information (Borzekowski/Rickert 2001), since the Internet enables users to explore topics (like sexual health) in a confidential and anonymous manner, which is an additional comfort for them. Behind the label ‘doctor’, there is either an individual person with a medical training or a group of general practitioners/specialists, who run these pages and offer their help in response to users’ posts. The net works as a source for a new medical support system, in which health-care professionals help with the translation of codified information, the validation of self-care practices and with biosocial symptoms. Doctors certainly still need to see and speak with the patient in order to diagnose or prescribe remedies, but the medical support is evolving into a different model on the net, represented by a mutually respectful one-to-many dis- course. Forums provide advice, exempla (when presenting personal history to illustrate a point), interpretations (in the case of re-description of others’ narratives, and possible (self-) diagnosis), recommendations and medical questions/requests for help. Participation varies between one- to-one, one-to-many and many-to-many structures, which are mostly public although there is a high degree of nicknames that guarantee anonymity. People participating in these communities generally have very heterogeneous roles and statuses in real life, but it is very rare for participants to introduce themselves or 194 Marianna Lya Zummo talk about their job in real life, unless it is specifically asked or they need it to support their claim (“since I’m a nurse”, “I’m a registered nurse”). Most participants tend to socialise when the goal of their interaction is seeking support, but when the goal is seeking information, they use the site in a very personal way, and once they have obtained it there is no further active participation. In this way, the activity evolves from information exchange to problem solving, and it is regulated with norms established by moderators, who ensure language appropriateness and balance in participants’ behaviour. In his study of online groups dealing with disabilities, Finn (1999) divided posts into two domains: socio-emotional messages (including expres- sion of feelings, provision of support, and friendship) and task-orien- tated messages (including requests for or provision of information, and problem solving). Another common theme is searching for information on treatment options, clinical trials, side effects, alternative therapies, and other issue-related information. The other Credibility and Responsibility in User-generated Health Posts 195 two most commonly occurring themes are patients offering messages of encouragement and emotional support, and patients expressing gratitude to the members of the community. Bias and critics In health forums people form support groups to share experiences and feelings, and they are able to recount their success stories and failures according to a ‘gather, share and learn’ paradigm. One of the main worries concerning these spaces has been the unmonitored information provided by users who do not have any medical training and do not/cannot take responsibility for the use of their posts. These user-generated statements may offer new insights and supplementary information, but some of the sources may also be less reliable (Winter/Krämer 2012: 80). Issues related to health care information systems include ques- tions of ownership, integrity, availability, source control and errors/ 196 Marianna Lya Zummo omissions. As with some of the studies of online support groups, analysis of web pages raises significant questions about the relevance, coverage, and legitimacy of a lot of Internet health information (Rice/Katz 2001: 31). Concerns about the quality of the information include inexpensive and easy publishing, anonymity and speed since news breaks so quickly that publishers are less rigorous with their fact checking (Rice/Katz 2001: 57). Considering the credibility that is attributed to these forums, it is necessary to avoid any form of speculative interest, damaging behaviour or misleading information. In fact, critics question the quality of online health information, and its biomedical accuracy (Lewis 2006; Deshpande/Jadad 2009), and a sort of unease is expressed about the shift from a doctor-to-patient to a users-to-users framework, in terms of authorship of and responsibility for statements, since the Internet influences health beliefs and behaviour. A different perspective: biomedical knowledge and experiential function A different perspective is now emerging in the latest studies dealing with health posts. Even though avoiding medical terminology when communicating with patients has been recom- mended, in patient forums for various chronic illnesses, a widespread use of expert biomedical terminology and acronyms is found (Fage- Butler/Nisbeth Jensen 2013; Zummo 2014). The terminology is used without glossing, suggesting that in the context of forums, acronyms and specialist terms are not considered beyond other patients’ grasp. Furthermore, a study by Fage-Butler and Nisbeth Jensen (2013) on informational and relational aspects of patient-patient (p-p) communication illustrates how this communication has striking Credibility and Responsibility in User-generated Health Posts 197 similarities with aspects of doctor-patient (d-p) communication as it includes the sharing of biomedical knowledge on diagnosis, managing illness and treatment. P-p communication also clearly comprises aspects that cannot be met in traditional d-p communication as it incorporates experiential knowledge, empathetic support drawing from common experience and ‘we-ness’ or group solidarity. In particular, a significant finding of their analysis is that respondents often possess considerable biomedical knowledge, which is acquired from sources such as doctors, other patients and journal articles, and which is evident in the way they use very specialised terminology and acronyms. They also found several examples where respondents adopt a role similar to that of the doctor in a clinical situation: they ask clarifying questions, request further information and suggest treatment. As suggested, “the patient forum facilitates the sharing of experiential knowledge, a function which is not fulfilled in clinical encounters where doctors lack the knowledge that is derived from having and experiencing the condition concerned” (Fage-Butler/Nisbeth Jensen 2013: 35), and “patients may be better historians of their illnesses and so their rich and accurate ac- counts of symptoms can make a difference to the quality of health care delivery” (Sarangi 2001: 5). On the basis of these two different perspectives on the role of forums, this study investigates whether health posts can be associated with credibility and whether they co-construct knowledge that may be perceived as ‘quality’, at least in its practical use. The simplicity of acquiring and publishing online information raises serious questions about users’ ability to discern (credibility) and produce (responsibility) quality online information. This study exam- ines two sources of credibility, namely the origin of the information and the way people express authority in their posts, which legitimize the participant in the role of respondent. Following the study of this area, the dimension of epistemic modality (involving the writer in a marked commitment to the truth of the proposition), the evidentiary validity and in particular the degree of certainty, are analysed. Chafe (1986) identifies four areas within the evidential system: the reliability of information, the probability of its truth, the modes of knowledge, and the source, thus including epistemic modals as markers of judgments. The degree to which the speaker has a commitment to the validity of the information as well as inferential or personal experiences classify different epistemological stance (Mushin 2001). These studies were among those which strongly contributed to the analysis of evidential and epistemic modal qualification, which foreground speaker’s assessments and commitment to the truth of the utterance expressed. The expression of authorial stance (the ways in which an author or speaker overtly expresses attitudes, feelings, judgements, or Credibility and Responsibility in User-generated Health Posts 199 commitment, according to Biber/Finegan 1993) is studied on the basis of an analysis of pronominal self-reference items, adjectives and grading adverbs. Finally, a small-scale survey of people in Italy aged 18-33, examining young adults’ beliefs about the credibility of information available on Italian health forums and the reason why they choose to evaluate information as credible is presented. The survey involves 121 participants in an academic course, who have been considered to be representative of young adults between the ages of 18 and 33 years. Assessing credibility The aspect of knowledge and information diffusion offered by online health pages is of paramount importance to individuals who want to find possible reasons and solutions for their health issues. By reading patients’ complaints about similar health issues, users gain reassurance and information that would otherwise be neglected without a face-to-face medical encounter. It follows that users must learn to critically analyse and distinguish reliable information from chitchat, superstitions and home made diagnoses and remedies. On participatory websites such as blogs, forums, or wikis, one increasingly finds information that has been communicated by laypersons rather than experts or professional journalists. Winter and Krämer (2012) investigate several factors that influ- ence readers’ selection of user-generated content on participatory websites, adapting research on persuasion. A two-sided summary, which indicates that both positions on a controversial issue are being considered, may appear more attractive to readers who are motivated to reach an informed position. Construction and legitimization of roles in online health communities In d/p sites’ framework, the interaction of net users (willing to show and tell their health issues) and doctors (with their sympathetic authority), as well as the silent readers (those who read the posts without actually participating in the discussion) have a relationship in which net users contribute to the formation of medical knowledge and forge a modern sense of appropriation of health information and of doctor/patient exchange. In laymen-to-laymen forums, knowledge communication is practiced in communities in which knowledge and experience are shared to create new knowledge (Wenger 1999). Such digital environments allow people to play the roles of both information source and receiver, as they give, share and critique the content of forum posts. This game has profound implications for how people construct and evaluate credibility, in particular when it comes to their limited ability to discern quality information due to a stressed emotional state, which is often the background to an online health fact search. According to Fage-Butler and Nisbeth Jensen (2014), in online health forums p-p communication has striking similarities with aspects of d-p Credibility and Responsibility in User-generated Health Posts 201 communication, as it includes the sharing of biomedical information on diagnosis, suggesting treatment action and giving treatment advice. See for example: (1) 1st User: [asks for some details] 2nd User: […] strong vasoconstrictors and not to anything that regulates neu- ronal excitability or neurotransmitters, they think nortriptyline worked only because serotonin is a vasoconstrictor […]; Moderator: Hi, Christine, and welcome! In addition, people also take up position towards their utterances and in extreme case they even question doctors’ treatments: (3) Macca, 100 mg a day was your starting dose? Not to play doc- tor, but the usual starting dose is 25 mg, to be increased in 25 mg increments every 1-2 weeks or even longer depending on patient tolerance. However, the study also illustrates that respondents use disclaimers which are expressed when acknowledging lay status and which, in a way, downgrade their position to semi-experts. However, if authority implies expertise and experience, the forum respondents may increase their credibility, since “patient-patient communication clearly com- 202 Marianna Lya Zummo prises aspects that cannot be found in traditional doctor-patient com- munication, as it incorporates experiential knowledge, empathetic support drawn from common experience and ‘we-ness’ or group solidarity” (Fage-Butler/Nisbeth Jensen 2013: 35).

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Lung purchase kamagra polo pills in toronto, in which chilus a nodular tumor formation is seenwith a size about 10 cm emanating from a wall of the bronchus and sprouting into the surrounding lung tissue cheap kamagra polo online american express. Preparation of the esophagus discount 100mg kamagra polo fast delivery, the upper half of which shows saccular extension of its wall order genuine kamagra polo line, with communicating lumens – pulsating diverticulitis. Shown are several shallow ulcers with a round shape, sizes from 1 mm to 2 cm, with slightly raised edges and a smooth hollow bottom with black color. In the small gastric curvature seen ulcerative defect with irregular oval, raised, solid and well- contouring edges. Part of the stomach wall which is engaged by exophytic tumor with rounded shape, gray-whitish in color and shaped with a central ulcerative defect. Diffusely scattered nodules with a size of lentil to a pea stand out above the hepatic parenchyma. A single rounded concretion with a brownish color and uneven surface is presented in its lumen. Fragment of the trachea and part of ascending aorta with her trunk out of vessels. The two bodies are prorastnati the periphery of highly enriched, and sivkavobeleznikavi srastnali packages in lymph nodes with uniform structure. Highly enlarged spleen with a longitudinal length about 18 cm, dark brown in color. Subkapsularno and cut her face are visible off-white nodular structures (tumor infiltration) with sizes of up to lentil beans, imparting a characteristic diversity of the body. The outer surface is uneven with small retention cysts and extensive shallow depressions with grayish-brown bottom. The cut surface is dominated by theexpansion and deformation of pyelon and calices. At places, the atrophic process is particularly strong and parenchyma remained as a thin strip - significant hydronephrosis. Strongly and equally enlarged kidneys with longitudinal length about 20 cm Their color is white, the capsule is tense. The surface is very uneven because of numerous thin-walled cystic formations in size from 1 to 3-4 cm, filled with clear contents. Preparation of kidney, in which upper pole large spherical tumor is visible, well distinct from the renal parenchyma by pseudocapsule. Preparation of bladder prostate significantly larger at the expense of its three parts. The bladder has a thickened wall and mucosal rough appearance due to pathological hypertrophy of the muscles. Open bladder filled with papillary-polypotic formation of broad-based, infiltrating bladder wall. The surface of the tumor is uneven, covered with short, thick and brittle papillae. Germ-cell tumor presented in the form of nodular mass, poorly demarcated from the testis which has increased in size. Uterine cavity is filled by a mass resembling a semi-dry grapes - bubbles with sizes and lentil seeds, brownish in color, captured in thin stalk. The latter is fully covered and distorted by nodular, gray-white tumor formation with unclear boundaries. In the cut sections infiltrative growth is seen- whitish tumor strands, sprouting in myometrium and cervix. The front third of the uterine body shows exophytic tumor mass with papillae, gray-whitish in color, with fields of bleeding and necrosis originating from the endometrium and spreading to the fundus and cervix. Bilateral cystic ovarian metastases from primary tumors of the digestive system (stomach, colon), breast and others. The ovaries are highly increased in size, deformed, with a smooth, nodular surface. Among the fatty tissue of non-lactating mammary gland is found a thick, nodular formation with irregular contours, apparently infiltrating the surrounding tissue (skin and fat). Increased levels of growth hormone in adults, most commonly due to pituitary adenoma, lead to viscero-megaly. Furthermore, hypertrophic taste papillae are seen, making the surface uneven and rough. Presented are hyperplastic nodules of different size, each separated with whitish connective tissue strands. They can be: - Cystic – light-brown filled with jelly-like colloid; - Dark brown to black in hemorrhages; - Whitish and very dense in cartilage and bone degenerative metaplasia and calcinosis. The kidneys are reddish brown in color and slightly enlarged, unlike vascular nephrosclerosis. The cortex is finely granular and its border with the pyramids does not appear well. Derived from the latter, round, encapsulated, well- delimited tumor with gray-yellowish color is seen. In the cortex, the area adjacent to the tumor shows deep depression - atrophy of pressure. In the left Ponto-cerebellar angle is clearly visible distinct tumor with a slightly uneven surface, gray-pink. The soft meninges in the area of the brain and the bridge feet are swollen, turbid, with yellowish granular fibrinous exudate. From the lung chilus are seen large cavities (caverns) with fibrotic walls and uneven inner surface. In lymph nodes, which are slightly enlarged, yellow-gray fields are visible of caseos necrosis and anthracotic pigment. The amendments represent one of the forms (phases) of secondary pulmonary tuberculosis. The cut surface of the kidney with several broken pyramids which parenchyma is replaced by white- yellow fragile substance (caseous necrosis). The process started in the outer medulla and is ahead in the direction of the papillae, two of which are with ulcerative changes. It is a type of extra- Учебна програма за специалност “Медицина” 228 pulmonary tuberculosis with hematogenous localization. The preparation shows the output tract of the left ventricle and the ascending part of aorta. Just above the aortic valve, the aorta is enlarged and saccular- saccular aneurysm. Intima is uneven, with many different yellowish plaques - the picture looks like bark. Pathological process has damaged the cuspids of the aortic valve - insufficiency has developed. The cavity of the left ventricle is significantly enlarged and its walls are thickened - eccentric hypertrophy. The students are acquainted with the mechanisms of innate and acquired immunity; with the changes of immune status parameters and their clinical meaning; congenital and acquired immunodeficiency conditions and diseases; hypersensitivity reactions; autoimmune reactions and diseases; tumor immunology; transplant immunology; reproduction violations; infectious immunology. Students are introduced to the discipline clinical immunology; the role between other disciplines is underlined; the meaning to general medicine as well. Acquaintance with the most important aspects of immune response and its changes, leading to diseases. Mastering of principles, main point and clinical meaning of immunological tests for diagnosis. Learning of indications for immunomodulation therapy, drug monitoring, monitoring of activity of immune disease. Phagocytosis – stages, clinical meaning, methods for detection of phagocyte activity and its violations. Humoral factors of innate immunity – complement, lysozyme, interferons, acute-phase proteins. Types and forms of immune response, depending on the antigen (development of immune Study programme Medicine specialty 231 response against extracellular and intracellular antigens).

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However cheap kamagra polo online master card, when he confronted Sharp with the reality of his massively failing business buy 100 mg kamagra polo visa, Sharp seemed confident that the Bergen Bank would pour in more money discount 100mg kamagra polo with visa. Barker told Sharp that he would stay if the Bergen Bank would immediately put another half a million pounds in; this Barker believed would be enough to enable him to turn the business round in the short term buy 100mg kamagra polo with visa. Regaining the confidence of the Bergen Bank could only be done by Barker being honest with them. The Bank, one of the biggest in Norway, demanded weekly reports from Barker and continuous information about whether or not he was pulling the business round. When Philip Barker had been at Brownings for ten days, it occurred to him that Dr Sharp was not changing his attitudes. The man was his own worst enemy; he continued to spend, inspired by dream-like visions of worldwide expansion. Barker was finding Sharp to be a kind of Walter Mitty character; on occasions he could be insufferably arrogant, while on the other hand he gave willingly and amply of his time and skills to charitable work. Some went as far as to defend his eccentricity as being unremarkable, even expected, in a top consultant. Philip Barker took his responsibility as Managing Director of Brownings very seriously. He could see that, if Dr Sharp continued acting in the way he had been, his chance of turning the company round was slight. Two weeks after being employed as Managing Director, Philip Barker sacked Dr Sharp from being a salaried employee of the company and a member of its board. The choice was simple, Barker told Sharp: either he agreed to a demotion or Barker would get the Bank to close down the business. He was no longer a permanent employee and he would have to give up his position on the board. Sharp was furious; he tried unsuccessfully to hold on to his position on the board, and when he failed to regain control, he drifted into a slough of despond. A pathology laboratory in Wimpole Street was almost entirely concerned with blood testing and various assays, mainly for the doctors in the Harley Street area. Philip Barker had come into Brownings two and a half years after it had been set up. When he had visited the Hospital and been shown round at the end of January, he had seen a modern and well-equipped laboratory. In the first week that Barker began work, he lunched at the London Bridge Hospital with Dr Sharp and his locum, Dr Aileen Keel. Dr Keel was the consultant haematologist and director of pathology at the private Cromwell Hospital. Dr Sharp met Peter Baker and then introduced him to Philip Barker after he said that he wished to proceed with the treatment and wanted an idea of the cost. Philip Barker had told Sharp that in future, he, Barker, would be responsible for all finances. The treatment, as he understood it, would not harm him and it might well extend his life. Sharp had told Barker that the beauty of the treatment was that it could do no harm. But Philip Barker was the new Managing Director of a laboratory services business and not a doctor. Without giving Peter Baker any medical advice, which he did not have, Barker tried to put him at ease. This invoice was sent to Baker ten days later, with a covering letter referring Baker to a Dr Pearl, for further consultation and tests. He never went to see Dr Pearl and when I tried to contact him a few weeks later, I found that he had given a false address. Later Campbell admitted in his Capital Gay article that Dr Helbert and Peter Baker had decided to set up Dr Sharp. Campbell was later to make much of the conversation which had taken place between Philip Barker and Peter Baker. He accused Barker of pressurising Baker into accepting the treatment at massive cost. In fact Philip Barker had nothing to do with the clinical treatment of Peter Baker, and Dr Sharp understood only that the patient had been properly referred to him by Dr Helbert. He had contacted the management of the London Bridge Hospital and discussed with them the need for an expert committee which would discuss ethical questions. Although Pinching claims to have known nothing about Dr Sharp charging patients, or any unethical behaviour, for some reason, he willingly discussed at great critical length with a journalist the work of another doctor who had previously tried to elicit his support. In fact, Jabar Sultan, apparently still hoping Dr Pinching would help him, phoned Pinching not long after Pinching had discussed his work with Campbell. Dr Pinching did not mention his meeting with Campbell and passed Sultan on to Dr Gazzard. After all, if what Dr Sharp was doing was so dangerous or so evil, there was a real need to stop new patients being treated. It appears, however, that Dr Pinching preferred to work with Duncan Campbell, than to approach the matter of Dr Sharp either through Jabar Sultan or the proper professional channels. This man came accompanied by Duncan Campbell posing under the assumed name of Duncan Sinclair. What Campbell wanted to prove by his visit to Dr Sharp with a bogus patient is not entirely clear; it was evident by then that Dr Sharp was charging patients, because he had given bills to three patients, all of whom Campbell knew about. Again Barker was put in an invidious position; he told them a number of times he was not a doctor, despite being addressed as such by Campbell. It was a serious error for Philip Barker to make; however, he had not been with Brownings when those patients had been treated, and he knew nothing about their cases or their treatments. While Campbell and his friend were milking the interview for any apparently incriminating evidence they could get, Philip Barker, who should not even have been meeting with them, was simply wanting to get on with his work. Although this twenty seconds was represented as continuous speech, it had in fact been taken from four different parts of the tape edited together to give a false impression of the conversation. This consultation with Sharp on the following day was entirely an attempt to entrap him. Dr Sharp gave the patient a competent case interview, but would inevitably have wanted to consult his previous medical records before beginning treatment. Again, Dr Sharp is cautious even about short-term health benefits achieved by the treatment. He also felt instinctively that patients who were given immunotherapy should not be charged. He decided that the best way of inducing such patients into the Hospital for the treatment was to bring the case before a panel, which could then help to identify charitable funds for their treatment. He also asked Jabar Sultan to inform him of the progress of all the work which he was involved in. On the advice of Dr Keel, Barker wrote to a Professor Levinsky, asking for his professional opinion on A1. On March 16th, Philip Barker wrote a letter to Sharp, stopping his consultancy and telling him not to treat any more patients. As a consequence of these changes, it became essential to contact the bogus patient that Duncan Campbell had brought with him, in order to inform him of treatment changes. Dr Keel and Philip Barker decided to tell the patient that he should see Dr Keel for a second consultation and that, if she decided he could still be treated, as part of a new policy, charitable funds would be identified to pay for this. Somewhat nonplussed, Campbell accepted the offer of a free consultation on behalf of his patient friend. Having got a new name, that of Dr Keel, from Philip Barker, Campbell rang her and fixed up an appointment, with the clear intention of secretly tape recording her and then writing her into his ignoble conspiracy. In just the same way mat Dr Aileen Keel co-operated with Philip Barker, ultimately to the detriment of Dr Sharp, so did Jabar Sultan. Straying from his managerial function, he had even introduced a more ethical and stable approach to testing Adoptive Immunotherapy. The article has similarities with the undistilled report of the prosecution case put in the first hour of a six-month court case. It is an utterly subjective piece of writing masquerading as an objectively researched overview. At the heart of the article are two motifs: firstly that of Dr Sharp as a contemporary Dr Death, spreading sickness through the back streets, with shady and unhygienic practices. Secondly the Dr Sharp who behaved more like a circus barker than a doctor, drawing in the patients with bold and embellished lies about cures.