By P. Lester. Albertus Magnus College. 2018.
La República extracción de alcaloides ha ﬂuctuado durante el período Islámica del Irán buy amantadine 100 mg free shipping, que importó opio de la India por considerado order 100mg amantadine with mastercard, si bien siguiendo una tendencia descendente primera vez en 2004 discount 100mg amantadine, comunicó la importación de (véase la ﬁgura 3) entre 1998 y 2004, debido a la 10 toneladas en 2007, un 2% del total mundial. Las existencias de la India siguieron siendo las de alcaloides ha crecido ligeramente desde 2004, más elevadas (968,5 toneladas, 82% del total mundial), sumando 642 toneladas (equivalentes a 70,6 toneladas seguidas por las del Japón (103 toneladas), los Estados de morﬁna) en 2007. En el último decenio, los Estados Unidos (62 toneladas), China (29 toneladas) y el Reino Unidos, la India y el Japón, en orden descendente, fueron Unido (16,8 toneladas). Hungría, Francia, la República Democrática Popular de Corea y la República Islámica del Irán, en 13. Por paja de adormidera se entiende todas las partes orden descendente, fueron los únicos países, aparte de la planta de la adormidera después de cortada, excepto de los anteriores, que siguieron empleando opio para las semillas. En la República Islámica del Irán se liberan para acentuado aumento de la demanda de ese alcaloide. En la la extracción de alcaloides grandes cantidades de opio presente publicación, la paja de adormidera obtenida de incautado. Las cantidades liberadas con tal motivo variedades de adormidera rica en morﬁna se denomina aumentaron hasta 2001, año en que alcanzaron las “paja de adormidera (M)” y la paja de adormidera 231 toneladas, disminuyeron mucho en 2002, hasta obtenida de variedades de adormidera ricas en tebaína 31 toneladas, y volvieron a aumentar desde entonces, se denomina “paja de adormidera (T)”. El rendimiento de alcaloide principal (morﬁna o tebaína), algunas de esas alcaloides del opio incautado suele ser menor que el del variedades contienen otros alcaloides, como codeína y opio producido lícitamente8. La concentración de alcaloides en la paja de alcaloides, el opio se consume también en muchos adormidera varía considerablemente de un país produc- países en forma de preparados, principalmente para el tor a otro11. El consumo mundial de preparados denominador común, que es el volumen equivalente de de opio ha ﬂuctuado en torno a 16,6 toneladas de morﬁna o tebaína de la cantidad de paja de adormidera promedio desde 2001. Aunque la transmisión de datos sobre la produc- la India y 1,7 toneladas en Francia. La producción o superiores a 100 kilogramos fueron Nueva Zelandia mundial de paja de adormidera (M) expresada en la (474 kilogramos), Tailandia (280 kilogramos), Alemania cantidad equivalente de morﬁna ha ﬂuctuado ampliamente (270 kilogramos), Sri Lanka (133 kilogramos), Noruega en los 20 años anteriores a 2007 debido a las condiciones (103 kilogramos) y el Brasil (100 kilogramos). Paja de adormidera: producción de Australia, a más baja que la de la paja de adormidera obtenida de la España, Francia, Turquía y otros países , expresada en adormidera cultivada para la producción de alcaloides. En 400 2004 y 2005 España comunicó exportaciones de paja de adormidera (M) al Reino Unido, pero no comunicó 350 ninguna exportación en 2006 y 2007. La cantidad de paja de adormidera (M) utilizada 250 por los principales países consumidores en 2007 ascendió a 22. En ambos países la producción llegó a un nivel máximo del decenio anterior a 2007, los principales países en 2002. España comunicó por primera vez la producción productores fueron Australia, España, Francia y Turquía. China ha comunicado En 2007, el principal productor fue España (75 toneladas, una producción esporádica en los últimos años. Estos cuatro países sumaron unos tres cuartos aproximadamente de la producción mundial. Otros productores importantes de paja de adormidera (M) en 2007 fueron China, Hungría Figura 5. Paja de adormidera: producción de Australia, y el Reino Unido, sumando un 20% de la producción Francia y otros países expresada en la cantidad mundial en equivalente de morﬁna. En España aumentó considerablemente la produc- 110 ción de paja de adormidera (M) en 2007, ampliándose 100 más de dos veces y media la superﬁcie dedicada al cultivo de adormidera para obtener paja de adormidera. En 90 Australia la producción disminuyó ligeramente en 2007, 80 y en Francia y Turquía disminuyó considerablemente. El comercio internacional de paja de adormidera 30 (M) como materia prima ha sido limitado. La República Checa, que cultiva adormidera principalmente para la 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 obtención de semillas, produce paja de adormidera como Año subproducto y la exporta a Eslovaquia, donde se utiliza Australia Francia España Otros para la extracción de alcaloides. Puesto que el contenido efectivo de alcaloides producción mundial de paja de adormidera (T) expresada del concentrado de paja de adormidera puede variar en cantidad equivalente de tebaína durante el período considerablemente, a efectos de comparación y con 1999 a 2007. En 2007, la producción total ascendió ﬁnes estadísticos todos los datos que se reﬁeren al a 107 toneladas13. Australia siguió siendo el principal concentrado de paja de adormidera se expresan en productor de paja de adormidera (T) (70 toneladas, que función de la cantidad del respectivo alcaloide anhidro representan el 65% de la producción mundial), seguida que contiene el concentrado. A continuación se examinan En el cuadro V se muestran las cantidades utilizadas, las cantidades totales de los distintos alcaloides presentes los alcaloides obtenidos de paja de adormidera (T) y los en el concentrado de paja de adormidera, expresados en rendimientos respectivos. Paja de adormidera utilizada con fines decorativos Alcaloide morfina anhidra presente en el concen- 22. Hungría y Austria, siguieron siendo en 2007 los principales exportadores de paja de adormidera 25. En la ﬁgura 6 se importadores principales en 2007 fueron Alemania y los presenta la evolución de la fabricación, las existencias Países Bajos. El concentrado de paja de adormidera es el residuo seco obtenido durante 300 la extracción de alcaloides de la paja de adormidera. Hasta la segunda mitad del decenio de 1990 sólo se 250 fabricaba concentrado de paja de adormidera que contenía morﬁna como alcaloide principal. A partir de 200 entonces se ha comenzado a fabricar concentrado de paja de adormidera que contiene principalmente tebaína 150 u oripavina. El concentrado de paja de adormidera puede 100 contener una mezcla de alcaloides y en los procesos industriales pueden extraerse otros alcaloides además del 50 alcaloide principal. Los diferentes tipos de concentrado de paja de adormidera se denominan de acuerdo con el 0 alcaloide principal que contienen14. Se utiliza también 140 en procesos de fabricación continua para la obtención de codeína. Alcaloide morfina anhidra presente en el concentrado de paja de adormidera: utilización para la fabricación de opiáceos en Australia, los Estados Unidos, Francia y el Reino Unido y utilización a nivel mundial, 26. La fabricación mundial bajó en 2004, pero 360 volvió a subir en 2005 y 2006, a volúmenes superiores 320 a 330 toneladas. A lo largo de los 20 años anteriores a 2007, Australia había sido 200 el principal fabricante, pero en 2007 su puesto pasó a 160 ocuparlo Turquía.
As the good physician will be pleased when he can enliven and keep from ennui the mind of a patient 100mg amantadine with amex, in order to advance a cure which is not encumbered with such obstructions order amantadine 100 mg free shipping, he will in such a case feel more than ever the duty incumbent upon him to do all within the power of his influence on the patient and on his relatives and surroundings order amantadine 100 mg with mastercard, in order to relieve him of grief and vexation. The continuation of the fairest edifice is foolish, when the foundation is being daily undermined, even if but gradually, by the play of the waves. Almost as near, and often nearer yet, to insurability are the chronic diseases, especially with great and rich men, who for some years, besides the use of mineral baths, have passed through the hands of various, often of many, allopathic physicians, who have tried on them one after another all the fashionable modes of cure, the remedies which are so boastingly lauded in England, France and Italy, - all strongly acting mixtures. By so many unsuitable medicines, which are injurious by their violence and their frequent repetition in large doses, the psora which always lies within, even if not combined with syphilis, becomes every year more incurable, as do also the chronic ailments springing from it; and after the continuation of such irrational medical assaults on the organism for several years it becomes almost quite incurable. It cannot well be decided, since these things take place in the dark, whether these heroic unhomoeopathic doses have added, as may be suspected, new ailments to the original disease, which ailments through the largeness of the doses and their frequent repetition have now become lasting and as it were chronic, or whether through abuse there has resulted a crippling of the different faculties of the organism, i. In short, this many-sided disharmony and perversion of parts and of forces most indispensable to life present a chaos of ailments which the homoeopathic physician should not lightly declare curable. If in such cases the sad consequences of these indirect assaults of the old methods of cure were dynamic disturbances only, they would surely either disappear of themselves when the treatment is discontinued, or they ought at least to be extinguished again effectively through homoeopathic medicines. Very likely by these indirect, continuous and repeated assaults on the sensitive, irritable fiber by such injudicious medicinal disease-potencies, which are given in large doses frequently repeated, the vital force is obliged to meet this attack and to endeavor either to dynamically change these tender internal organs which are assaulted so mercilessly, or to reconstruct them materially so as to make them unassailable to such violent attacks, and thus to protect and shield the organism from general destruction. So also in a long continued allopathic treatment, which has no true healing power with respect to the disease, no direct pathic (homoeopathic) relation to the parts and processes concerned in the chronic disease, but internally assaults other delicate parts and organs of the body, in such cases the vital force, in order to protect the whole from destruction, dynamically and organically transmutes these fine organs; i. On the one side the most tender fiber is abnormally thickened or hardened, and the more vigorous fibers consumed or annihilated - thus there arise artificially, adventitious organisms, malformations and degenerations, which at postmortem examinations are cunningly ascribed to the malignancy of the original disease. Only where there are still sufficient vital powers in a body not too much bowed down by age (but where under an allopathic regime do we not find the powers wasted? Such a transformation is, however, only possible to a still energetic vital force, which has been in great part set free from its psora. Only however, under favorable external circumstances, and after the lapse of a considerable time and usually in only an imperfect manner, does the vital force succeed in this almost creative endeavor. Experience proves daily that the more zealously the allopath puts into practice in chronic disease his perverse destructive art (often with great care, industry and persistence), the more he ruins his patients in health and life. He can therefore promise an improvement only after a long period of time, but never a full restoration, even if the vital powers are not (as is so frequently the case) altogether wasted; for where this is the case, he would feel compelled to desist from treatment even at the first glance. First the many chronic medicinal diseases which pass over the fluctuating state of health must gradually be removed (perhaps during a several monthsÕ stay in the country almost without medicine); or they must depart as of themselves through the activity of the vital force, when the antipsoric treatment has to some degree begun, with an improved manner of living and a regulated diet. For who could find remedies for all these ailments artificially produced by a confused mass of strong unsuitable medicines? The vital force must first absorb and reform what it has compulsorily deformed, before the true healer will in time see again before him a partially cleared malady similar to the original one, and which he will then be able to combat. A similar great hindrance to a cure of far-advanced chronic diseases is often found in the debility and weakness into which youths fall who are spoiled by rich parents, being carried away by their superabundance and wantonness, and seduced by wicked companions through destructive passions and excesses, through revellings, abuse of the sexual instinct, gambling, etc. Without the least regard for life and for conscience, bodies originally robust are debilitated by such vices into mere semblances of humanity, and are besides ruined by perverse treatment of their venereal diseases, so that the psora, which frequently lurks within, grows up into the most pitiable chronic diseases, which, even if the morality of the patient should have improved, on account of the depressing remorse, and the little remnant of their wasted vital powers, accept antipsoric relief only with the greatest difficulty. Such cases should be undertaken by homoeopathic physicians as curable only with the greatest caution and reserve. But where the above-mentioned often almost insurmountable obstacles to the cure of these innumerable chronic diseases are not present,* there is nevertheless found at times, especially with the lower classes of patients, a peculiar obstruction to the cure, which lies in the source of the malady itself, where the psora, after repeated infections and a repeated external repression of the resulting eruption, had developed gradually from its internal state into one or more severe chronic ailments. A cure will, indeed, also be certainly effected here, if the above-mentioned obstacles do not prevent, by a judicious use of the antipsoric remedies, but only with much patience and considerable time, and only with patients who observe the directions and who are not too aged nor too much debilitated. In such cases a more intelligent physician, recognizing the circumstances and the natural impulse implanted by the Creator, will give his permission and thus not infrequently render curable a multitude of hysterical and hypochondriac states, yea, often even melancholy and insanity. For experience informs us that in a case of itch arising from a new infection, even when, after several preceding infections and repressions of the eruption, the psora has made considerable progress in the production of chronic diseases of many kinds, the itch which has last arisen, if it has only still kept its full primitive eruption unhindered on the skin, may be cured almost as easily as if it were the first and the only one, i. I have little further to say to the physician already skilled in the homoeopathic art as to how he is to operate in the cure of chronic diseases, except to direct him to the antipsoric remedies appended to this work; for he will know how to use these remedies for this noble end successfully. First of all, the great truth is established that all chronic ailments, all great, and the greatest, long continuing diseases (excepting the few venereal ones) spring from psora alone and only find their thorough cure in the cure of the psora; they are, consequently, to be healed mostly only by antipsoric remedies, i. The homoeopathic physician, therefore, in curing a chronic (non- venereal) disease, and in all and in every symptom, ailment and disorder arising in this disease, no matter what seductive name these may have in common life or in pathology, will usually and especially look to the use of an antipsoric medicine selected according to strictly homoeopathic rules, in order to surely attain his end. The new infection, while the chancre remains undisturbed, may be cured, together with the venereal disease sprung from the former infection, just as easily by a single dose of the best mercurial preparation, as if the first chancre were still present, - provided that no complication with either of the other two chronic miasmata, especially the psoric, has taken place; for in such a case, as has been mentioned above, the psora must first be removed. For if the symptoms occurring during the action of the remedy have also occurred, if not in the last few weeks, at least now and then some weeks before, or some months before in a similar manner, then such occurrences are merely a homoeopathic excitation, through the medicine, of some symptom not quite unusual to this disease, of something which had perhaps been more frequently troublesome before, and they are a sign that this medicine acts deeply into the very essence of this disease, and that consequently it will be more effective in the future. The medicine, therefore, should be allowed to continue and exhaust its action undisturbed, without giving the least medicinal substance between its doses. But if the symptoms are different and had never before occurred, or never in this way, and, therefore, are peculiar to this medicine and not to be expected in the process of the disease, but trifling, the action of the medicine ought not for the present to be interrupted. Such symptoms frequently pass off without interrupting the helpful activity of the remedy; but if they are of a burdensome intensity, they are not to be endured; in such a case they are a sign that the antipsoric medicine was not selected in the correct homoeopathic manner. Its action must then be checked by an antidote, or when no antidote to it is known, another antipsoric medicine more accurately answering its symptoms must be given in its place; in this these false symptoms may continue a few more days, or they may return, but they will soon come to a final end and be replaced by a better help. Least of all, need we to be concerned when the usual customary symptoms are aggravated and show most prominently on the first days, and again on some of the following days, but gradually less and less. This so-called homoeopathic aggravation is a sign of an incipient cure (of the symptoms thus aggravated at present), which may be expected with certainty. This will be decided in the first sixteen, eighteen or twenty days of the action of the medicine which has been given in too large a dose, and it must then be checked, either by prescribing its antidote, or, if this is not as yet known, by giving another antipsoric medicine fitting as well as possible, and indeed in a very moderate dose, and if this does not suffice to extinguish this injurious medicinal disease, another still should be given as homoeopathically suitable as possible. The physician can, indeed, make no worse mistake than first, to consider as too small the doses which I (forced by experience) have reduced after manifold trials and which are indicated with every antipsoric remedy and secondly, the wrong choice of a remedy, and thirdly, the hastiness which does not allow each dose to act its full time. Still ignorant of the strength of its medicinal power, I gave sepia in too large a dose. This trouble was still more manifest when I gave lycopodium and silicea, potentized to the one-billionth degree, giving four to six pellets, though only as large as poppy seeds. It can hardly be given too small, if only everything ill the diet and the remaining mode of life of the patient which would obstruct or counteract the action of the medicine is avoided. The medicine will still produce all the good effects which can at all be expected from a medicine, if only the antipsoric was homoeopathically, correctly, selected according to the carefully investigated symptoms of the disease, and if the patient does not disturb its effects by his violation of the rules.
It provides the largest amount of material buy generic amantadine 100 mg online, and it diagnosis of pulmonary nodules or masses buy 100 mg amantadine with mastercard. This atlas of chest imaging is a collection of interesting tive of speciﬁc buy cheap amantadine 100 mg on-line, major ﬁndings. The associated text is not chest radiographs and computed tomograms of the intended as a comprehensive assessment of the images. Also apparent on the ﬁlm are an endotra- cheal tube (red arrow) and a central venous catheter (black arrow). An area of smaller cavity is in the right lower lobe (located below the consolidation associated with the cavity is seen in the right major ﬁssure, identiﬁed with the yellow arrow) and the larger lower lobe. Note indistinct vasculature, perihilar opacities, and peripheral interstitial reticular opacities. Note the sig- Large right pneumothorax with near complete collapse niﬁcant collapse of the right lung with adhesion to the ante- of the right lung. Note calciﬁed pleural plaques (red arrows), pleural thickening (black arrow), and sub- pleural atelectasis (green arrows). Note the multiple, well-circumscribed Solitary pulmonary nodule on the right (red arrow) with a nodules of different sizes. Note also that the patient has had a left upper lobectomy with resultant vol- ume loss and associated effusion (black arrow). Asthmatics harbor a special type of inflam- Asthma is one of the most common chronic diseases mation in the airways that makes them more respon- globally and currently affects ∼300 million people. The sive than nonasthmatics to a wide range of triggers, prevalence of asthma has risen in afﬂuent countries over leading to excessive narrowing with consequent the past 30 years but now appears to have stabilized, reduced airflow and symptomatic wheezing and dysp- with ∼10–12% of adults and 15% of children affected by nea. In developing countries where the preva- in some patients with chronic asthma, there may be an lence of asthma had been much lower, there is a rising element of irreversible airflow obstruction. The incidence that appears to be associated with increased increasing global prevalence of asthma, the large bur- urbanization. The prevalence of atopy and other allergic den it now imposes on patients, and the high health diseases has also increased over the same time, suggesting care costs have led to extensive research into its mech- that the reasons for the increase are likely to be systemic anisms and treatment. Atopy Outdoor allergens Asthma is both common and frequently complicated Airway hyperresponsiveness Occupational sensitizers by the effects of smoking on the lungs; hence, it is difﬁ- Gender Passive smoking cult to be certain about the natural history of the disease Ethnicity? The commonly held belief that children “grow out Allergens Upper respiratory tract viral infections of their asthma” is justiﬁed to some extent. Long-term Exercise and hyperventilation studies that have followed children until they reach the Cold air age of 40 years suggest that many with asthma become Sulfur dioxide asymptomatic during adolescence but that asthma Drugs (β-blockers, aspirin) returns in some during adult life, particularly in children Stress with persistent symptoms and severe asthma. Adults with Irritants (household sprays, paint fumes) asthma, including those with onset during adulthood, rarely become permanently asymptomatic. The severity of asthma does not vary signiﬁcantly within a given patient; those with mild asthma rarely progress to more severe disease, whereas those with severe asthma usually Patients with asthma commonly have other atopic dis- have severe disease at the onset. An increase in asthma mortality seen in sev- population in afﬂuent countries, with only a proportion eral countries during the 1960s was associated with of atopic individuals becoming asthmatic. This observa- increased use of short-acting β2-adrenergic agonists (as tion suggests that some other environmental or genetic rescue therapy), but there is now compelling evidence factor(s) predispose to the development of asthma in that the more widespread use of inhaled corticosteroids atopic individuals. Major risk commonest allergens are derived from house dust mites, factors for asthma deaths are poorly controlled disease cat and dog fur, cockroaches, grass and tree pollens, and with frequent use of bronchodilator inhalers, lack of rodents (in laboratory workers). Atopy is caused by the corticosteroid therapy, and previous admissions to the genetically determined production of a speciﬁc IgE hospital with near-fatal asthma. A minority of asthmatic patients (approximately 10%) have negative skin test results to common inhalant aller- gens and normal serum concentrations of IgE. Little is understood about the mechanism, but the immunopathology in bronchial biopsies and sputum appears to be identical to that found in atopic asthma. There is some association between res- suggested that lower levels of infection may be a factor piratory syncytial virus infection in infancy and the in afﬂuent societies that increase the risks of asthma. More recently, atypical bacteria such as exposure to infections and endotoxin results in a shift Mycoplasma and Chlamydia spp. Children the mechanism of severe asthma, but thus far, evidence brought up on farms who are exposed to a high level of of a true association is not very convincing. It now seems likely that differ- Diet ent genes may also contribute to asthma speciﬁcally, and The role of dietary factors is controversial. Observa- increasing evidence suggests that the severity of asthma tional studies have shown that diets low in antioxidants, is also genetically determined. Genetic screens with clas- such as vitamin C and vitamin A, magnesium, selenium, sical linkage analysis and single nucleotide polymor- and omega-3 polyunsaturated fats (ﬁsh oil), or high in phisms of various candidate genes indicate that asthma is sodium and omega-6 polyunsaturates are associated with polygenic, with each gene identiﬁed having a small an increased risk of asthma. However, interventional effect that is often not replicated in different popula- studies have not supported an important role for these tions. Obesity is also an independent risk factor many genes is important, and these may differ in differ- for asthma, particularly in women, but the mechanisms ent populations. There is increasing evidence for a complex There is no doubt that air pollutants, such as sulfur diox- interaction between genetic polymorphisms and envi- ide, ozone, and diesel particulates, may trigger asthma ronmental factors that will require very large population symptoms, but the role of different air pollutants in the studies to unravel. For example, the prevalence in East Germany than West Germany despite Arg-Gly-16 variant in the β2-receptor is associated with a much higher level of air pollution, but since reuniﬁca- reduced response to β2-agonists, and repeats of an tion, these differences have decreased as eastern Germany Sp1 recognition sequence in the promoter region of has become more afﬂuent. Indoor air pollution may be 5-lipoxygenase may affect the response to antileukotrienes. The increasing prevalence of asthma, particularly in develop- Allergens ing countries, over the past few decades also indicates the importance of environmental mechanisms interact- Inhaled allergens are common triggers of asthma ing with a genetic predisposition. The airway mucosa is inﬁl- poorly ventilated homes with fitted carpets has been trated with activated eosinophils and T lymphocytes, and implicated in the increasing prevalence of asthma in there is activation of mucosal mast cells. Domestic pets, particularly cats, have inﬂammation is poorly related to disease severity and also been associated with allergic sensitization, but may be found in atopic patients without asthma symp- early exposure to cats in the home may be protective toms. A characteristic ﬁnding is thickening of the base- ment membrane caused by subepithelial collagen deposi- Occupational Exposure tion.