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However 40 mg inderal with mastercard hypertension epidemiology, more studies are needed to clarify this issue because of some controversial observations in the literature buy inderal 80 mg pulse pressure waveform. Also generic inderal 40 mg free shipping blood pressure below 100, Danielsson et al (2006) and Jutkiewicz et al (2006) showed the similar results cheap inderal 80mg free shipping arrhythmia lying down. A more reliable approach is needed to correctly elucidate the roles of different opioid receptors in acupuncture therapy for epilepsy. Nitric oxide modulates low-Mg - induced epileptiform activity in rat hippocampal-entorhinal cortex slices (Schuch- mann et al. Abnormal expression of neuronal nitric oxide synthase triggers limbic seizures and hippocampal damage in rat (Bagetta et al. Nitric oxide concentration in rat hippocampus increased after penicillin-induced epilepsy (Huang et al. Different isoforms of nitric oxide synthases from different pathways appeared different functions in acupuncture anticonvulsion. Acupuncture decreased neuronal and inducible nitric oxide synthases but had no effect on epithelial nitric oxide synthase (Yang et al. Acupuncture reduced the severity of the kainic acid-induced epileptic seizure and the rate of neural cell death, and also decreased the expressions of c-Fos and c-Jun induced by kainic acid in the hippocampus. During and after electro-acupuncture treatment, the frequency, amplitude and duration of epileptiform discharges decreased significantly. The frequency and amplitude of epileptic waves were significantly different in comparison with that of the non-electroacupuncture group. Acupuncture may inhibit neural pathway of cholinergic transmission, enhance activity of cholinesterase in caudate nucleus and thalamus, and inactivate Ach (Zou and Ou 1993). Dynamic variation of Ach was observed in the focus of epileptiform discharges induced by topical application of penicillin on rat sensorimotor cortex. Acupuncture decreased the increase of Ach while attenuating epileptiform discharges. Cortical epileptiform discharges induced by penicillin and surface-negative waves of cortical recurrent inhibition induced by antidromic stimulation of pyramidal tract were detected and recorded. Both amplitude and frequency of cortical epileptiform discharges was retarded and recovery of surface-negative waves was delayed. Electric stimulation of dorsal raphe neclei attenuated epileptiform discharges and shortened its duration. When dorsal raphe nuclei were destructed by electrolytic damage, seizure duration prolonged and the antiepileptic effect of electroneedling was reduced. A capillary electrophoresis-electrochemical detection method was used to determine melatonin contents. It had no change in serum in the beginning and then significantly enhanced during seizure crisis. Because melatonin was considered as an antistressor and a natural downregulator of epileptiform activity, the elevation in melatonin level during seizures was postulated to be possibly one endogenous mechanism that counteracts convulsions and seizure-induced stress. Many electroacupuncture types including stimulation of body, facial and auricular point, have anticonvulsant and neuroprotective effects for epilepsy. Stimulation of acupoints on the extremities results in stimulation of the vagus nerve. It may be also the center for afferent pathways of facial, scalp and auricular acupuncture. The neuroprotective pathways of electroacupuncture to hippocampus, thalamus, cortex and amydala may be through the nucleus of the solitary tract via vagus nerve stimulation. Clinical reports have been collected starting from two thousand years ago to present in China. What has been detected in the study of acupuncture and epilepsy is still a corner of an ice-berg. It should be pointed out that the understanding of acupuncture mechanism on epilepsy remains at the very beginning. Experimental data collected above need to be reevaluated by multiple investigators. We should establish a standardized system with stable model, accurate acupoints, time-window, frequency and amptitute of electroacupuncture, to investigate the molecular mechanism of acupuncture at the treatment of epilepsy, including death of neural cells, sprouting, and others. The elucidation of biological basis of acupuncture will help us to further promote acupuncture and develop more effective therapy with or without adjunctive drug. Literatures in English gave opposite evidences, which confused people to have a try even they have intractable seizures. Acupoints, channels and meridians are mysterious concepts to people who seldom touched oriental medicine. The question carried in the mind of Chinese acupuncture physician is also reasonable. Based on Chinese documents, clinical reports and experimental data, they never doubted that patients nonresponsive to antiepileptic drugs should seek for complementary and alternative therapy and acupuncture will be one of the choices. The cognitive gap exists because the biological basis underlying the therapeutic effect of acupuncture on epilepsy remains uncertain. Very less research was conducted on acupuncture and epilepsy in the world up to date compared to research in epileptic field. On one hand, the traditional Chinese theory that acupuncture balances energy and restores harmony—Yin and Yang —within the body is not enough to convince neurobiologists. On the other hand, about 30% of all epilepsy patients cannot achieve adequate seizure control with currently available antiepileptic drugs. The only pathway for acupuncture to carry out its potential missions seems to be the elucidation of acupuncture mechanism. Acknowledgements This work was supported by National Natural Science Foundation of China (No. Biochem Biophys Res Commun 291: 255 260 Binaschi A, Bregola G, Simonato M (2003) On the role of somatostatin in seizure control: Clues from the hippocampus. Tianjin Journal of Traditional Chinese Medicine 21:164 165 (In Chinese) Cole M, Shen J, Hommer D (2002) Convulsive syncope associated with acupuncture. Probl Vet Med 4: 207 211 El Idrissi A, Messing J, Scalia J, Trenkner E (2003) Prevention of epileptic seizures by taurine. Epilepsia 44: 1022 1033 Fu B, Li H (2004) Clinical study of epilepsy treated by medical thread embedding therapy with the application of differentiation of symptoms and signs and principle of point selection in acumoxibustion. Zhen Ci Yan Jiu (Acupuncture Research) 2: 122 125 Gross Tsur V (2003) Use of complementary medicine in children with attention deficit hyperactivity disorder and epilepsy. Acta Physiologica Sinica 42: 140 150 358 12 Effect of Acupuncture on Epilepsy Huang Di Nei Jing (The Yellow Emperor’s Inner Classic) 770 221 B. Seizure 8: 170 174 Koide S, Onishi H, Yamagami S, Kawakita Y (1992) Effects of morphine and D Ala2 Leu5 enkephalin in the seizure sensitive E1 mouse. Acupunct Electrother Res 30: 1 14 Lin H (2001a) Research approaches of acupuncture treatment on epilepsy (in Chinese). Tianjin J Traditional Chinese Medicine 18: 55 56 359 Acupuncture Therapy of Neurological Diseases: A Neurobiological View Lin J (2001b) Efficacy analysis of treatment on 160 cases of epilepsy using catgut implantation at acupoints (in Chinese). Am J Chin Med 22: 11 17 Perez Cruz C, Rocha L (2002) Kainic acid modifies mu receptor binding in young, adult, and elderly rat brain. Adv Exp Med Biol 548: 76 91 Sashihara S, Yanagihara N, Kobayashi H, Izumi F, Tsuji S, Murai Y, Mita T (1992) + Overproduction of voltage dependent Na channels in the developing brain of genetically seizure susceptible E1 mice. Neuroscience 48: 285 291 Schuchmann S, Albrecht D, Heinemann U, von Bohlen, Halbach O (2002) Nitric oxide modulats low Mg2+ induced epileptiform activity in rat hippocampal entorhinal cortex slices. Science 228: 1106 1108 Vezzani A, Hoyer D (1999) Brain somatostatin: A candidate inhibitory role in seizures and epileptogenesis. Clinical J Acupuncture 15: 13 14 Xu F (2002) Efficacy investigation of treatment on 60 cases of epilepsy using catgut implantation at Du channel acupoints (in Chinese). Mol Cell Neurosci 35: 292 301 Yamakawa K (2006) Na channel gene mutations in epilepsy the functional consequences.

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It is not as if you had to use house current which would kill you purchase inderal 40 mg with mastercard heart attack demi lovato lyrics, along with the parasite inderal 80mg mastercard pulse pressure table. Selective Electrocution In twenty minutes (three minutes at six different frequencies) a whole family could get rid of this parasite buy inderal 80mg line arteria uterina. Cancer cases showed that in a few hours the universal cancer marker order inderal 80mg with visa blood pressure 220120, ortho- phospho-tyrosine could be banished from their bodies by killing this same parasite. Most cases of pain got immediate relief if I could identify the correct “bug” and have its frequency found by the next office visit. This seemed to be absolute proof that living things had an essential high frequency output of some kind of energy. If I could kill something as large as an Ascaris worm or intestinal fluke, then perhaps I could kill something even larger, like an earthworm or flea, something I could see with my own eyes in- stead of having to imagine its demise inside my body. Ten minutes at a frequency chosen near the top of their broadcast range seemed to anesthetize them. There was no need to experiment, though, because the parasites we want to kill have characteristic frequencies that do not overlap the characteristic frequencies of a human. Find the resonant frequency of a bacterium, virus or parasite using a slide or dead bit. Treat the living invaders inside the human body with this frequency and in a matter of minutes they are no longer transmitting their own bandwidths—they are dead or sick and will be removed by our white blood cells. Perhaps the department of defense would use this knowledge and develop super high voltage de- vices to kill people (“enemies”) somewhere in the world. Possibly a way could be found to shield yourself from frequencies harmful to humans by wearing a choke (inductor) coil which suppresses these frequencies. Meanwhile, people must be alerted that they can safely kill their invaders and heal their chronic illnesses. Invaders that have been increasing exponentially due to lowered immunity in recent decades. Remember, though, that the true challenge is not to kill our invaders but to regain our health and immunity. The ship of “progress”, of increasingly complex, processed foods and products, must be turned around and simplicity become our goal. Or will daily parasite and pathogen electrocution become another crutch that makes us just enough better that we can continue a detri- mental lifestyle? Perhaps it is the same energy as the Asian chi; perhaps it is merely related to it. Perhaps it is the energy that runs along the meridians discovered eons ago by Asian practitioners. Perhaps it is the energy that faith healers and religious teachers know how to harness, perhaps not. Perhaps it is the energy that psychics perceive and that drives occult phenomena, perhaps not. What is truly amazing is that ordinary persons have discov- ered such energy well ahead of scientists. Persons using the “art” of kinesiology, pendulums, radionics, dousing rods and many other forms of “strange energy” have no doubt harnessed a part of this bioradiation. It is a tribute to the generally high intelligence of common people and to their open-mindedness that they discovered this energy, in spite of opposition from scientists of today. Over a century ago the scientists of Europe proposed the existence of a “life force” called “élan vitale. Young scientists, (including myself) were systematically taught to scorn this idea. Of course we were also taught that a good scientist was unemo- tional, does not scorn ideas, has a completely open mind, and does not rule something out until it is disproved to their satis- faction. The youthfulness of college years is so susceptible to prejudices of all kinds, and the desire for acceptance is so great, that special effort needs to be made to teach neutrality. I was indeed inspired with the phrase “search for truth” but then promptly led down the path of “search for acceptance. Only its frequency was noticed and caught (modulated) in such a way as to be measurable. These amazing properties are due to the capacitive and inductive properties of objects all around us, including our- selves. For years I used a commercial frequency generator to “zap” one pathogen after another. First I made a chart of the frequencies for most of the bacteria and viruses in my collection (over 80, see page 561). Even persons with a simple cold typically had a dozen they tested positive to (not just Adenovirus). Next it was time to tune in the frequency generator to a dozen frequencies for three minutes each. Until you killed your roundworm and your virus, you would keep getting the virus back promptly. He programmed a computer controlled frequency gen- erator to automatically cover all the frequencies populated by all the parasites, viruses, and bacteria, from 290,000 Hz to 470,000 Hz. Arthritis pain, eye pain, colds were improved, but not completely cured overnight. Months later I would find that organisms were transmitting as low as 170,000, and as high as 690,000 Hz. To cover this larger range, spending three minutes for every 1000 Hz, would take 26 hours. But even this method of zapping was not 100% effective for reasons yet to become clear. The purpose was to enable everyone to kill the intestinal fluke at 434,000 Hz with a low cost device. Enough benefit would be derived from zapping at various frequencies that I thought everyone should know how to make one. When I tested it on one of my own bacteria, however, three others at much different frequencies died also! When I tested it on others, even though they had dozens of pathogens, all were killed! Subsequent testing showed it was not due to some unique design, or special wave form produced by the device. Before this I had always set my commercial frequency gen- erator to alternate between positive and negative voltage. Now I tried setting it to alternate between positive and zero voltage (positive offset). It was just as effective as the battery operated frequency generator my son designed. Generating positive offset frequencies is the best way to kill all pathogens quickly. I conclude they had been infecting the parasites, and killing the parasites released them. The second zapping kills the released viruses and bacteria, but soon a few viruses appear again. After a third zapping I never find any viruses, bacteria or parasites, even hours later. And it explains why a single treatment with a frequency generator or zapper frequently gives you a cold! Zapping does not kill shielded organisms such as those that may be in the middle of your stomach or intestines. The electricity travels along the stomach or intestine wall, not through their contents. So zapping is still not perfect, but can bring such manifest relief that everyone should buy or make one.

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Haemophilus requires at least a minute of counterstaining with safranin and is in any case frequently difficult to see in Gram stains of sputum order 80 mg inderal with mastercard blood pressure medication lack of energy. Unless the patient is hospitalised purchase inderal 40 mg otc heart attack 720p movie, bed-ridden buy inderal 80 mg otc blood pressure x large cuff, alcoholic or immunocompromised order inderal 80mg on-line blood pressure medication micardis, and/or the Gram stain shows clear evidence of a lower respiratory tract specimen in which the organism is present together with a significant number of neutrophils, coliforms and non-mucoid strains of Pseudomonas can safely be ignored. In both Staphylococcus aureus and Campylobacter jejuni infections, specimens will typically contain large numbers of leucocytes and erythrocytes. In the case of a Staphylococcus aureus infection, the Gram stain will show large numbers of Gram positive cocci, usually recognisably staphylococci; mannitol salt agar may be used as an isolation medium. Diagnosis and Mangement of Infectious Diseases Page 410 Microscopy In plague infections, the presence of bipolar staining Gram negative rods in lymph node aspirate can be diagnostic. The search for anaerobic bacteria begins with the direct examination by Gram stained smear. This technique provides immediate information regarding the types of organisms present and may be sufficient to permit a presumptive diagnosis and choice of therapy. Pseudomonas and Enterobacteriaceae may be differentiated in Gram stained direct smears. A Gram stain detects urinary tract infections in 2 minutes, with a sensitivity of 97% at 105 cfu/mL (decreased sensitivity at < 105 cfu/mL). Selective media should always be used for isolation, since only 61% of Gram negative and 73% of all anaerobes will be isolated on non-selective media. Using an anaerobic jar, within 30 minutes it is possible to check the system is working by reduction of methylene blue indicator from blue to white, condensation on surface of jar and jar becoming warm. The result of the primary Gram stain should be consulted, noting the number and types of cells present and assessing whether the organisms seen in the Gram stain have grown on culture and vice versa. If Gram stain and culture do not correlate, the Gram stain should be checked and amended if necessary or a further effort made to isolate organisms seen which have not been cultured (eg, prolonged incubation, reinoculating specimen onto more appropriate media). Culture plates should be read in conjunction with each other, noting, for example, whether organisms growing on blood agar also grow on MacConkey or colistin nalidixic acid agar, whether organisms growing on anaerobic plates are also growing on aerobic plates, whether haemolysis differs on blood agar and Gardnerella vaginalis agar. All plates from cutaneous wounds that have moderate to numerous leucocytes seen in the Gram stain and no pathogen isolated should be reincubated for 5 days to check for Mycobacterium or Nocardia. If a patient has chronic ulcers and nothing has been isolated from previous swabs received, these plates should be reincubated also. Enriched chocolate agar + bacitracin grows Haemophilus influenzae well, the bacitracin inhibiting Gram positive organisms, though some Haemophilus iufluenzae strains are also sensitive to it. Colistin nalidixic acid agar grows Gram positive, but not most Gram negative, organisms and can be useful with sputa containing enteric Gram negative bacilli and Pseudomonas. In patients where they are likely to be significant, enteric Gram negative bacilli and Pseudomonas can be isolated on MacConkey agar. Feces: Xylose lysine deoxycholate medium relies on xylose fermentation, lysine decarboxylation and production of H2S for primary differentiation of Salmonella and Shigella from non-pathogenic bacteria. Salmonella shigella agar contains bile salts to inhibit Gram positive organisms and coliforms and relies on lactose fermentation for primary differentiation. Liquid specimens, or specimens submitted with a history of food poisoning after ingestion of seafood, should be screened for Vibrio using thiosulphate citrate bile sucrose agar, on which they produce colonies > 2 mm after 24 h incubation. Clostridium difficile agar consists of blood agar + D-cycloserine and cefoxitin, which inhibit almost all other organisms. The organism should be screened for if there is a history of diarrhoea following use of antimicrobials. Urine: Cystine lactose electrolyte deficient medium supports the growth of all urinary pathogens (with rare exceptions), giving good colonial differentiation and clear diagnostic characteristics. The presence of important contaminants, such as diphtheroids, Lactobacillus and Micrococcus, is also clearly elicited, giving an indication of the degree of contamination. It provides a non-inhibitory diagnostic agar for plate culture of urinary organisms. Suprapubic aspirates, ureteric specimens and other urines for which more extensive treatment is warranted may also be cultured onto enriched chocolate agar, anaerobic media and into thioglycolate broth. Genital Specimens: Blood agar will grow most aerobes found in genital specimens, exceptions being Neisseria gonorrhoeae, which grows poorly after 48 h (Neisseria meningitidis grows well after 24 h), and Haemophilus influenzae, which grows poorly unless Staphylococcus is present, in which case satellitism may be observed (note that other organisms also produce satellitism). Enriched chocolate agar + bacitracin should be set up on females less than 10 years old in case of a Haemophilus influenzae infection. New York City medium contains lincomycin to inhibit Gram positive cocci, amphotericin B to inhibit yeasts, and colistin and trimethoprim to inhibit Gram negative bacilli, and is designed to grow only pathogenic Neisseria. Gardnerella vaginalis agar contains nalidixic acid to inhibit staphylococci, amphotericin B to inhibit yeasts and gentamicin to inhibit Gram negative Diagnosis and Management of Infectious Diseases Page 414 Culture bacilli, and grows Gardnerella vaginalis, streptococci and Lactobacillus. The use of a metronidazole disc on the plate will help to distinguish true anaerobes (nearly all sensitive to metronidazole) from facultative anaerobes (resistant to metronidazole). Vancomycin inhibits Gram positives and kanamycin facultative aerobic Gram negatives. Candida albicans will grow and Enterococcus faecalis will sometimes grow on aged media. Most organisms are classified almost solely on morphological criteria, but classifying bacteria into Bacillus, Micrococcus and Spirochaeta doesn’t get us very far, so such things as atmosphere required for growth, staining properties and biochemical tests are used. It was soon realised that characteristics for classification should be as correlated with other characteristics as possible. This means that some characteristics can be used as key characteristics to rapidly identify an organism—eg, rapid indole production for Escherichia coli. However, this approach has its problems: real exceptions occur to most characteristics for most organisms, supposed key characteristics may be shared by quite dissimilar organisms while varying for quite similar ones, and slight variation in technique can cause wrong results and wildly incorrect identifications. Numerical taxonomy takes an entirely different tack: testing organisms for a large number of characteristics, each of which is given equal weight, and classifying them in clusters of similarity, which form natural taxons. The 20 or so characteristics chosen for each system were those which had been found to be both highly correlative and most constant for the group of organisms for which the system was designed. These systems now constitute the mainstay of bacterial identifications in the clinical laboratory, but key reactions, many using commercial packages, are also frequently used. For many of those organisms for which no simple packaged system exists, tables and/or keys are available which enable identification. Unfortunately, however, genetic classifications are often not very useful clinically. For example, genetically, Escherichia coli and Shigella should be in the same species. If you know the growth characteristics of an organism, its appearance, smell (if any), perhaps a few key biochemical reactions, likely antibiogram, its usual habitat and the circumstances under which it is likely to be isolated in a clinical laboratory, the identification can be rapid and you are unlikely to be misled into error. Most clinical specimens are seeded to a number of different types of media and it is important to compare the growth on the different media. For example, an organism growing on blood agar but not enriched chocolate agar with bacitracin is probably Gram positive; one growing on enriched chocolate agar with bacitracin but not on blood agar (except, perhaps, as pinpoint colonies) is probably Haemophilus; one growing on blood agar and colistin nalidixic acid agar but not MacConkey is Gram positive; one growing on blood agar, colistin nalidixic acid agar and MacConkey is likely to be either Enterococcus faecalis (tiny colonies) or a Pseudomonas species; one growing on blood agar but not colistin nalidixic acid agar or MacConkey is probably a non-Enterobacteriaceae Gram negative; etc. A Gram positive rod appearing overnight, or even in 48 hours, is definitely not a Mycobacterium. On the other hand, a Haemophilus that takes 48 hours to make a feeble growth on enriched chocolate agar from an eye swab may well be suspected of being Haemophilus aegyptius rather than Haemophilus influenzae. Use of colonial characteristics as a criterion has fallen into disfavour in many identification systems. This is largely because such characteristics are difficult to describe in terms that mean the same to all observers, impossible to include in numerical type taxonomies and even difficult to incorporate into keys and tables. However, many bacteria regularly produce colonies that are typical and almost instantly recognisable, reducing identification procedures to one or two simple confirmatory tests, such as Staphyslide for Staphylococcus aureus and indole for Escherichia coli. Equally, if an identification system gives you an identification which does not accord with the appearance of the organism as you know it or as it is described in the texts, you should seriously question that identification. As proved in a survey with Streptococcus milleri, the smell of the growth of some organisms is so characteristic as to approach an absolutely reliable identification procedure.

By U. Folleck. Long Island University.

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