Duetact

By F. Baldar. University of Bridgeport. 2018.

Haemophilus Influenzae type B Vaccine The Haemophilus vaccine has been shown to be immunogenic in patients with impaired splenic function associated with sickle cell anemia (62) buy duetact 17mg diabetes mellitus hypertension. The specific concentration of antibody required in patients lacking a spleen is not known discount 16mg duetact with amex diabetic diet for pregnancy. Previously non- vaccinated persons older than 59 months having high-risk condition like functional or anatomic asplenia should be given at least one pediatric dose of a HiB conjugate vaccine (63). Meningococcal Vaccine The quadrivalent, unconjugated capsular meningococcal vaccine (type A, C, Y, and W135) is immunogenic in the asplenic patient but less so in those patients who are also treated with chemotherapy and radiotherapy (64). Vaccine is recommended for persons with increased risk of meningococcal disease, including persons with functional or anatomical asplenia. The efficacy and importance of meningococcal vaccination in splenectomized individuals is unknown. The antibody levels rapidly decline in two to three years and postsplenectomy patients will always be at risk, revaccination may be considered five years after receipt of the first dose. The quadrivalent conjugated meningococcal vaccine is used for routine immuni- zation of adolescents and persons 2 to 55 years of age who are at increased risk of meningococcal disease, which includes asplenia (65). The exact duration of protection is unknown but is longer than polysaccharide vaccine. Influenza Vaccine Annual administration of influenza virus vaccine is recommended in asplenic or hyposplenic individuals to prevent the primary disease as well as complications of secondary bacterial infections (33). Chemoprophylaxis The first one to three years after splenectomy is the most important time for the risk of infection and mortality. Therefore, the institution of antibiotic prophylaxis in this period is likely to reduce morbidity and mortality. The risk of infection declines significantly beyond that time, and continuing antibiotic prophylaxis would provide lesser benefits. Since most patients are unwilling to take antibiotics lifelong, they should be persuaded to take antibiotics for at least three years, in addition to vaccines as described above. The likelihood of a second or third infection is high in the first six months after a first infection and antibiotic prophylaxis could offer the most benefit in this period for patients who have had a first severe infection (66). Some guidelines advocate continuing the antibiotic prophylaxis in children for five years or until the age of 21. Compliance is a problem in long-term prophylaxis in adults as is the inevitable selection for colonization with nonsusceptible pathogens. A single daily dose of penicillin or amoxicillin is the regimen of choice, but these antibiotics will not protect against organisms resistant to penicillin. Cefotaxime or ceftriaxone have been recommended as presumptive treatment for symptomatic patients who have been taking antibiotic prophylaxis or those with strains known to show intermediate resistance to penicillin (33,67). Self-treatment The other strategy is the provision of standby antipneumococcal antibiotics, i. Working party of the British Committee for Standards in Hematology Clinical Hematology Task Force. Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Purpura fulminans and symmetrical peripheral gangrene caused by Capnocytophaga canimorsus septicemia: a complication of dog bite. An asplenic woman with evidence of sepsis and diffuse intravascular coagulation after a dog bite. Managing patients with an absent or dysfunctional spleen: guidelines should highlight risk of salmonella infection in sickle cell disease. Recurrent and prolonged fever in asplenic patients with human granulocytic ehrlichiosis, Quart J Med 2000; 93:198–201. Falciparum malaria after splenectomy: a prospective controlled study of 33 previously splenectomized Malawian adults. The syndrome of asplenia, pneumococcal sepsis and disseminated intravascular coagulation. Overwhelming post splenectomy infection with Plesiomonas shigelloides in a patient cured of Hodgkin’s disease.

For the air generic 16mg duetact with mastercard diabetes webmd, passing through the vessels purchase duetact 17 mg otc diabetes neuropathy in dogs, itself rises and brings up with it the thinnest part of the blood. The moisture mixing with the air becomes white, for the air being pure is seen through thin membranes. When then will the victims of this dis- ease rid themselves of their disorder and the storm that attends it? When the body exercised by its exertions has warmed the blood, and the blood thoroughly warmed has warmed the breaths, and these thoroughly warmed are dispersed, breaking up the congestion of the blood, some go out along with the respiration, others with the phlegm. The disease finally ends when the foam has frothed itself away, the blood has re-established itself, and calm has arisen in the body. Air causes the blood to become chilled, it flows more slowly and therefore it is less capable of providing the body with ‘consciousness’. Another interesting factor is the comparison with sleep: a non-pathological state is employed to illustrate a more serious disorder resulting from the same physiological mechanism. Sleep is a result of the digestion of food: after consumption food is carried to the centre of the body and ‘cooked’ or digested by the heat of the heart. The process of cooking gives rise to the evaporation (anathumiasis) of food; the air (pneuma), saturated by these hot vapours, is carried upwards from the heart to the brain and causes the head to become heavy. Thus the heart is chilled, which is what actually causes the sensory faculties to fail (the ‘formal cause’, i. An indication of this is that in early youth the upper parts of the body are larger in comparison with the lower, which is due to the fact that growth takes place in the upward direction. Hence too they are liable to epilepsy, for sleep is like epilepsy; indeed, in a sense, sleep is a type of epileptic fit. This is why in many people epilepsy begins in sleep, and they are regularly seized with it when asleep, but not when awake. For when a large amount of vapour is borne upwards and subsequently descends again, it causes the blood vessels to swell and it obstructs the passage through which respiration passes. The main argument is that epilepsy is viewed as tightness of the chest or suffocation generated by the obstruction of the airways: the ‘passage through which breath flows’ is unlikely to refer to anything else but the windpipe. One air current, the air saturated by food vapours, obstructs the other, respiration. Aristotle does not speak about disorders in perception that are among the symptoms of epilepsy (and which apparently can be explained as analogous to the state of sleep, that is, as a result of the heat of the heart becoming chilled). Yet he does make selective use of empirical data by stating that young children are particularly prone to the disease (a widely known fact in antiquity) and that the disease often manifests itself during sleep. Both consider the heart to be the seat of the mind, but both also attribute an important role to the brain and to the mediation between the two by what they call ‘psychic pneuma’: Praxagoras says that it [i. Diocles himself, too, thinks that it is an obstruction occurring around the same place, and that for the rest it happens in the same way as Praxagoras says it occurs. In all other respects the explanations are virtually identical: the basic thought is that the passages through which the breath flows are obstructed or blocked; the obstruction is caused by phlegm (phlegma). Furthermore, Diocles and Praxagoras are the only doctors from the period concerned of whom we know some of the therapeutic measures they took in case the disease occurred. The authors of On the Sacred Disease and On Breaths restrict themselves to some very general remarks on curing the dis- ease (by restoring the balance between the four primary qualities hot, cold, dry and wet; curing it by means of contrasting qualities). Diocles, on the other hand, is known to have based his treatment on the type of cause he established for the disease: purgative measures to remove phlegma, walking 36 ‘Anonymus Parisinus’ 3 (published by I. Heart, brain, blood, pneuma 135 and carrying around for those who contracted the disease due to their phys- ical constitution, bleeding for those who contracted it by eating meat or due to dipsomania. On the other hand, Caelius Aurelianus is a sufficiently uncongenial informant for us to assume that Diocles provided more than just some vague indications. The examples given show how each of the authors mentioned arrives at a different explanation of epilepsy, based on an a priori view on the physical aspects of cognitive processes, and how in their opinion the empirically perceptible symptoms of the disease can be fitted into this explanation. There is no empirical verification of such presuppositions in the modern sense of the word, apart from a rather haphazard use of empirical facts (yet not discovered in any targeted way), employed in the author’s own defence or in his criticism of rival views. Much has been written about the reasons for this scientific attitude; in this respect it should be noted that systematic attempts at falsifying theories by gathering counter-examples in empirical reality were the exception rather than the rule in antiquity.

Yet the substantial similarity between Diocles’ criticism of the first claim and the critical remarks of the author of the Hippocratic text On Regimen 2 cheap 16mg duetact fast delivery diabetes y alcohol consecuencias. Those that are bitter are rather diuretic buy 16 mg duetact diabetes type 2 research, while some of them also have a relaxing effect on the belly. Those that are sour, excretions’ (Mnhs©qeov dì ¾ ìAqhna±ov –n tä€ perª –destäná ‘o¬ ‰luko©’, fhs©n, ‘kaª gluke±v cumoª p†ntev Diocles of Carystus on the method of dietetics 89 While it has also been argued very frequently that Diocles here shares the sceptical attitude towards theoretical approaches of dietetics found in the treatise On Ancient Medicine,35 Fredrich’s view that the third claim Diocles is criticising corresponds with the actual practice of the writer of On Ancient Medicine has been received with mixed feelings. As for On Ancient Medicine, this seems to misunderstand both the claims that Diocles is opposing (especially claim one) and Diocles’ own position. The scope of the Diocles fragment is rather different from what is at issue in On Ancient Medicine. Diocles does not object to the postulation of warm and cold, nor does he object to referring to these pos- tulates as causes per se: he simply warns against premature generalisations. His argument allows for cases in which a thing’s having the quality hot causes it to produce such-and-such an effect, but he points out that this does not imply that all things that have that quality produce that effect (for instance because of the combination with other factors, or because it is only an incidental cause), nor that all cases where this effect is produced are due to this very quality. Diocles points out that one should look for the essential cause: sweet things may cause certain effects, but not necessarily so and not in so far as they are sweet. Nor does Diocles make the distinction between Ëp†gousi t‡v koil©av, o¬ dì ½xe±v kaª drime±v lÅousi tŸn oÎrhsin. On Mnesitheus being a possible target see Smith (1980) 444, and von Staden (1992) 240; a more sceptical attitude is taken by Bertier (1972) 30–1. Denn erstens wird dort nur zu einem geringen Teil eine Erklarung fur die Wirkung bestimmter¨ ¨ Nahrungsmittelgegeben,undzweitensliegtdiesenAusfuhrungenkeinstrenghypothetischesSchema¨ zugrunde(imGegensatzzurFeuer-Wasser-TheoriedeserstenBuches). Besides, there are more general reasons which should make us reluctant to associate Diocles with the author of On Ancient Medicine. The picture of Diocles that emerges not just from this single fragment, but from the more than two hundred that are preserved from him, shows that in matters of physiology and pathology Diocles’ opinions display many speculative characteristics in whose company the author of On Ancient Medicine would have felt himself quite uncomfortable. Diocles’ acceptance of the four primary qualities and of concepts such as innate pneuma and humours is frequently attested, and his use of them in the causal explanation of diseases in his work Affection, Cause, Treatment (P†qov, a«t©a, qerape©a) is well documented. Fragment 176 does not present itself as (nor claims to be) a methodological programme for medical science as a whole: it is concerned with dietetics, with the powers of foodstuffs and with the practical prob- lems the physician has to face. It is far from self-evident that what Diocles says here also applies to anatomy, pathology and general physiology – or even if it would apply, what the implications of this would be. He points out that there are many cases in which causal 37 On Diocles’ physiology see frs. A large number of Diocles’ aetiological views on diseases arereportedinthetreatiseonacuteandchronicdiseasesbytheso-calledAnonymusParisinusFuchsii, edited by Garofalo (1997). Although we should take into account the possibility that in many cases it is the Anonymus who is responsible for the precise wording of the aetiologies, the testimonies nevertheless point to a sophisticated use of causal explanation by Diocles in dealing with diseases. The question of the reliability of the Anonymus (which is too often approached from an a priori negative point of view, for instance by Kudlien (1963) 462) can only be answered on the basis of an unbiased study of the whole text, which has only recently been made available in its entirety by Garofalo (1997); see also van der Eijk (1999b). Diocles of Carystus on the method of dietetics 91 explanation is impossible, and that there are also cases in which it may be possible, but unnecessary for practical purposes – and one could imagine that in this respect the author of On Ancient Medicine would not have been too happy with Diocles’ criticism of claim three, for On Ancient Medicine is one of the first among the Hippocratic treatises to proclaim the urgency of stating the cause in dietetics. As for On Regimen, I believe that Fredrich was right in detecting a very strong, almost indiscriminate application of the search for causes in the chapters on the powers of foodstuffs of this treatise (40–56). The use of words indicating causal links such as ‘because’, ‘since’, ‘as a result of’ (di»ti, Œte, Âti, di†) in these sections is very frequent indeed. But it is especially the nature of these explanations which calls for consideration, for the fact is that many of them suffer from defects that might be interpreted as provoking the kind of criticism Diocles is expressing, such as circularity – no clear distinction being made between the level of qualities and that of powers – shifting the problem, and tautology – explanandum and explanation being stated in the same terms. It warms, because it is vinous, moistens because it is nutritious, and sends to stool because it is sweet and moreover boiled-down’); 2. The most prominent instances where the importance of causal explanation is stated are: 20. Considering these examples, we may be inclined to say that Diocles’ warnings against too automatic an application of causal explanation, as well as his prescription (in section 11 of fr. It rather seems to me that Diocles is arguing against what he believes to be – in the context of dietetics – some undesirable consequences of the search for causes or principles, or to put it in other words, against too strict an application of what in itself – and in Diocles’ opinion too – remains a sound scientific procedure. These consequences seem to have pervaded Greek scientific thought in the fourth century to such an extent that opposition to it was also expressed by Aristotle and Theophrastus (in their case, the opposition is probably directed against certain tendencies in the early Academy). There are a number of passages which reflect a similar awareness in Aristotle and Theophrastus of the limits of causal explanation. Theophrastus, Metaphysics 9 b 1–13: ‘Wherefore this too is problematical or at any rate not easy to say, up to which point and of which entities one should seek the cause, in the objects of sense and in the objects of thought alike: for the infinite regress is foreign to their nature in both cases and destroys our understanding.

To the Greek thinkers cheap duetact 17mg visa diabetes drugs, areas such as those mentioned above represented aspects of natural and human reality just as interesting and significant as the movements of the celestial bodies buy cheap duetact 17 mg line diabetes medications mechanism of action, the origins of earth- quakes or the growth of plants and trees, and at least equally revealing of the underlying universal principles of stability and change. Nor were their interests in the medical area limited to theoretical study or the pursuit of knowledge for its own sake without extending to ‘clinical’ or ‘therapeutic’ practice. Some are known to have put their ideas into practice, such as Empedocles, who seems to have been engaged in considerable therapeutic activity, or Democritus, who is reported to have carried out anatomical research on a significant scale, or, to take a later example, Sextus Empiricus, who combined his authorship of philosophical writings on Scepticism with medical practice. Such connections between theory and practical application, and such combinations of apparently separate activities, may still strike us as re- markable. Nevertheless we should bear in mind, first, that especially in the period up to about 400 bce (the time in which most of the better-known Hippocratic writings are believed to have been produced), ‘philosophy’ was hardly ever pursued entirely for its own sake and was deemed of considerable practical relevance, be it in the field of ethics and politics, in the techni- cal mastery of natural things and processes, or in the provision of health and healing. Secondly, the idea of a ‘division of labour’ which, sometimes implicitly, underlies such a sense of surprise is in fact anachronistic. We may rightly feel hesitant to call people such as Empedocles, Democritus, Pythagoras and Alcmaeon ‘doctors’, but this is largely because that term conjures up associations with a type of professional organisation and spe- cialisation that developed only later, but which are inappropriate to the actual practice of the care for the human body in the archaic and classical period. The evidence for ‘specialisation’ in this period is scanty, for doctors 20 See, e. As we get to the Hellenistic and Imperial periods, the evidence of specialisation is stronger, but this still did not prevent more ambitious thinkers such as Galen or John Philoponus from crossing boundaries and being engaged in a number of distinct intellectual activities such as logic, linguistics and grammar, medicine and meteorology. It is no exaggeration to say that the history of ancient medicine would have been very different without the tremendous impact of Aristotelian science and philosophy of science throughout antiquity, the Middle Ages and the early modern period. Aristotle, and Aristotelianism, made and facilitated major discoveries in the field of comparative anatomy, physiology, embryology, pathology, therapeutics and pharmacology. They provided a comprehensive and consistent theoretical framework for re- search and understanding of the human body, its structure, workings and failings and its reactions to foods, drinks, drugs and the environment. They further provided fruitful methods and concepts by means of which medical knowledge could be acquired, interpreted, systematised and com- municated to scientific communities and wider audiences. And through their development of historiographical and doxographical discourse, they placed medicine in a historical setting and thus made a major contribu- tion to the understanding of how medicine and science originated and developed. Aristotle himself was the son of a distinguished court physician and had a keen interest in medicine and biology, which was further developed by the members of his school. Aristotle and his followers were well aware of earlier and contemporary medical thought (Hippocratic Corpus, Diocles of Carystus) and readily acknowledged the extent to which doctors con- tributed to the study of nature. This attitude was reflected in the reception of medical ideas in their own research and in the interest they took in the historical development of medicine. It was further reflected in the extent to which developments in Hellenistic and Imperial medicine (especially the Alexandrian anatomists and Galen) were incorporated in the later history of Aristotelianism and in the interpretation of Aristotle’s works in late anti- quity. Aristotelianism in turn exercised a powerful influence on Hellenistic and Galenic medicine and its subsequent reception in the Middle Ages and early modern period. Introduction 15 Yet although all the above may seem uncontroversial, the relationship between Aristotelianism and medicine has long been a neglected area in scholarship on ancient medicine. The medical background of Aristotle’s biological and physiological theories has long been underestimated by a majority of Aristotelian scholars – and if it was considered at all, it tended to be subject to gross simplification. These attitudes appear to have been based on what I regard as a misun- derstanding of the Aristotelian view on the status of medicine as a science and its relationship to biology and physics, and on the erroneous belief that no independent medical research took place within the Aristotelian school. Aristotle’s distinction between theoretical and practical sciences is sometimes believed to imply that, while doctors were primarily concerned with practical application, philosophers only took a theoretical interest in medical subjects. It is true that Aristotle was one of the first to spell out the differences between medicine and natural philosophy; but, as I argue in chapters 6 and 9, it is often ignored that the point of the passages in which he does so is to stress the substantial overlap that existed between the two areas. And Aristotle is making this point in the context of a theoretical, physicist account of psycho-physical functions, where he is wearing the hat of the phusikos, the ‘student of nature’; but this seems not to have prevented him from dealing with more specialised medical topics in different, more ‘practical’ contexts. That such more practical, specialised treatments existed is suggested by the fact that in the indirect tradition Aristotle is credited with several writings on medical themes and with a number of doctrines on rather specialised medical topics. And as I argue in chapter 9, one of those medical works may well be identical to the text that survives in the form of book 10 of his History of Animals. Such a project would first of all have to cover the reception, transformation and further development of medical knowledge in the works of Aristotle and the early Peripatetic school. This would comprise a study of Aristotle’s views on the status of medicine, his characterisation of medicine and medical practice, and his use and further development of medical knowledge in the areas of anatomy, physiology and embryology; and it would also have to comprise the (largely neglected) medical works of the early Peripatos, such as the medical sections of the Problemata and the treatise On Breath, as well as the works of Theophrastus and Strato on human physiology, pathology and embryology.