By K. Agenak. Mount Union College.
Yes No Complete course Consider of treatment – alternative (or additional) diagnosis – poor penetrance of antibiotic to site of infection – possible change in antibiotic therapy Figure 43 buy estrace 2mg free shipping menstrual bloating treatment. Current guidelines therefore emphasize the following concentration which one might predict to be bactericidal (e cheap estrace 1 mg line women's health jokes. The dates on by spontaneous mutation) that exist within the bacterial tombstones in Victorian cemeteries should be required read- population by elimination of the sensitive strain by ing for over-enthusiastic prescribers and medical students! Thus the incidence of drug resistance is related to (Whole families of infants died in infancy discount 1mg estrace mastercard menstrual cramps icd 9, followed by their the prescription of that drug buy estrace 2mg with amex menopause symptoms bleeding. In such patients, all dental (plasmids), or by passage of the information by procedures involving dento-gingival manipulation will require bacteriophage (transduction). In this way, transfer of antibiotic prophylaxis, as will certain genito-urinary, gastro- genetic information concerning drug resistance intestinal, respiratory or obstetric/gynaecological procedures. The latest guidelines (2006) by the Working Party of the British Society for Antimicrobial Mechanisms of drug resistance can be broadly divided into Chemotherapy can be found at http://jac. Prophylaxis should be restricted to cases where the or an altered organelle with reduced drug-binding procedure commonly leads to infection, or where properties (e. The antimicrobial agent should preferably be bactericidal and directed against the likely pathogen. The aim is to provide high plasma and tissue concentrations of an appropriate drug at the time of bacterial Most infections can be treated with a single agent. Intramuscular injections can usually be there are situations in which more than one antibacterial drug given with the premedication or intravenous injections at is prescribed concurrently: the time of induction. Many problems in this area arise because • to achieve broad antimicrobial activity in critically ill of failure to discontinue ‘prophylactic’ antibiotics, a patients with an undefined infection (e. Local hospital drug and therapeutics would affect all of the bacteria present; committees can help considerably by instituting sensible • to prevent the emergence of resistance (e. If continued administration is necessary, change to oral • to achieve an additive or synergistic effect (e. Penicillins are excreted it should be restricted to patients who have previously had in the urine. Adverse effects Adverse effects The adverse effects include: Rashes are common and may appear after dosing has stopped. It is acid labile and so must be given parenterally are susceptible to amoxicillin, most Staphylococcus aureus, 50% of (inactivated in gastric acid). Development of resistant β-lactamase-producing strains effects are similar to those of amoxicillin, but abdominal dis- can occur. This injection: is not usually a problem, as these organisms seldom cause dis- ease in otherwise healthy people. Procaine benzylpenicillin – this complex releases tion is important in neutropenic patients (e. Phenoxymethylpenicillin (‘penicillin V’) – this is acid oped and are particularly useful in these circumstances. These stable and so is effective when given orally (40–60% include piperacillin, azlocillin and ticarcillin. Although it is useful for mild infections, blood concentrations are variable, so it is not used in Uses serious infections or with poorly sensitive bacteria. Tablets are given on an empty stomach to improve Their efficacy against Gram-positive organisms is variable and absorption. They are useful against Gram-negative infections, partic- ularly with Pseudomonas and they are also effective against many anaerobes. Combinations of ticarcillin or of piperacillin with β-lactamase Flucloxacillin was developed to overcome β-lactamase-produc- inhibitors designed to overcome the problem of β-lactamase ing strains. Otherwise, it has a similar antibacterial spectrum to formation by Pseudomonas are commercially available. It is used for the treatment of staphylococcal infec- Adverse effects tions (90% of hospital staphylococci are resistant to benzylpeni- These drugs predispose to superinfection. It has a narrow spectrum of activity and cannot be They are given intravenously every 4–6 hours. Their half-lives used alone unless the organism’s sensitivity to aztreonam is range from 1 to 1. Their pharmacology is similar to that of the peni- Pharmacokinetics cillins and they are principally renally eliminated. Aztreonam is poorly absorbed after oral administration, so it is given parenterally. Uses Arguably the most generally useful member of the group is Imipenem, a carbapenem, is combined with cilastatin, which cefuroxime, which combines lactamase stability with activity is an inhibitor of the enzyme dehydropeptidase I found in the against streptococci, staphylococci, H. This enzyme breaks is given by injection eight-hourly (an oral preparation is also down imipenem in the kidney. It is expensive, although spectrum of activity against Gram-positive, Gram-negative and when used against Gram-negative organisms that would other- anaerobic organisms. It is β-lactamase stable and is used for treat- wise necessitate use of an aminoglycoside, this cost is partly ing severe infections of the lung and abdomen, and in patients offset by savings from the lack of need for plasma concentra- with septicaemia, where the source of the organism is unknown. Meropenem is similar to imipenem, but is stable to renal dehy- Of the third-generation cephalosporins, ceftazidime, cef- dropeptidase I and therefore can be given without cilastatin. Imipenem is generally well tolerated, but seizures, myoclonus, confusion, nausea and vomiting, hypersensitivity, positive Adverse effects Coombs’ test, taste disturbances and thrombophlebitis have all About 10% of patients who are allergic to penicillins are also been reported. Some first-generation cephalosporins and can be used to treat central nervous system infection. Some of the third- Pharmacokinetics generation drugs are associated with bleeding due to increased Imipenem is filtered and metabolized in the kidney by dehy- prothrombin times, which is reversible with vitamin K. Imipenem is given intravenously as an infusion in three or four divided daily doses. They are powerful bactericidal agents that are active Aztreonam is primarily active against aerobic Gram-negative against many Gram-negative organisms and some Gram- organisms and is an alternative to an aminoglycoside. Gentamicin is widely used and has a Chloramphenicol inhibits bacterial ribosome function by broad spectrum, but is ineffective against anaerobes, many inhibiting the 50S ribosomal peptidyl transferase, thereby pre- streptococci and pneumococci. Amikacin is more effective than gentamicin for Adverse effects pseudomonal infections and is occasionally effective against These include: organisms resistant to gentamicin. Topical gentamicin or tobramycin anaemia occurs unpredictably with an incidence of eye drops are used to treat eye infections. Chloramphenicol accumulates in neonates (especially if Adverse effects premature) due to reduced glucuronidation in the immature liver (see Chapter 10). Therapeutic monitoring is performed by measuring plasma concentrations before dosing Pharmacokinetics (trough) and at ‘peak’ levels (usually at an arbitrary one hour Chloramphenicol is well absorbed following oral administra- after dosing). Eighth nerve damage is potentially catastrophic tion and can also be given by the intramuscular and intra- and is often irreversible. Drug interactions Pharmacokinetics Chloramphenicol inhibits the metabolism of warfarin, phenytoin and theophylline. Aminoglycosides are poorly absorbed from the gut and are given by intramuscular or intravenous injection. Distinctively, they are effective reduction and/or an increased dose interval is required. Uses include respiratory infections (including Mycoplasma pneumoniae, psittacosis and Legionnaires’ disease), whooping cough, Campylobacter enteritis and non-specific urethritis. It is useful for skin infections, such as low- Chloramphenicol has a broad spectrum of activity and pene- grade cellulitis and infected acne, and is acceptable for patients trates tissues exceptionally well.
Most modern digital cameras and traditional photographic flms are specifcally designed to record images seen in the visible range of light as we see them However order 2 mg estrace otc menopause urinary frequency, it is also possible to record images we cannot see when specifcally illuminated in the shorter ultraviolet range (210 to 400 nm) and longer infrared range (750 to 900 nm) buy estrace 2 mg amex menopause emotions. Since ultraviolet and infrared radiations are outside the visible range of the spectrum cheap 2 mg estrace overnight delivery pregnancy hormone levels, they are commonly referred to as nonvisible light estrace 1 mg cheap menstrual calculator. Recent genera- tions of digital cameras have been designed to allow the recording of pat- terned injuries in skin using both visible light and nonvisible light. While the electronic transfer of light to magnetic recording media is very diferent than exposing photographic flm, for the most part, the techniques utilized for image capture are basically the same. Photography using nonvisible light requires special techniques to record the injury, including an occasional minor focusing adjustment called focus shif3 that provides correction for the optical properties of lenses that were designed primarily to be used for visible light photography (Table 11. It is this refection of visible light that accounts for the colors seen by the human eye. It is the absorption of all colored light by an object that makes that object appear black. A third reaction that occurs, especially when light strikes human skin, is the transmission and scattering of the energy associated with the light through successive layers of cells until the energy of the light is spent and has dissipated. Te fnal reaction, which occurs when light energy strikes an object, is a molecular excitation called fuorescence (Figure 11. Molecules in tissue absorb the energy from light and release that energy as a fuorescent glow. It only lasts as long as the light’s excitation energy is applied, usually about 100 nanoseconds (10–9 seconds). When light energy of various wavelengths strikes human skin, all four of the previously mentioned events can occur simultaneously. Depending on the wavelength of the source of the incident light and the confguration of the camera, lenses, and flters, it is possible to record, individually, any of the four reactions of skin to light energy (Figure 11. Ultraviolet light only penetrates a few microns into skin, whereas infrared light can penetrate skin to a depth of up to 3 mm. By varying the wavelength of incident light used for illumination and setting up the appropriate confgu- ration of the camera, lens, flters, and flm, it is possible to photograph any of the four events that occur. Tis ability creates an opportunity for interest- ing pictures, especially when looking at bruises and other injuries to skin. Sharp surface details can be seen with ultraviolet light, while images well below the surface of the skin can be seen using infrared light. Images created using refected visible light and fuorescence allow other potentially diferent appearances of the patterned injuries to be captured. Te techniques and photographic protocols for documenting injuries to human skin in visible and nonvisible light using flm and digital imaging are vastly diferent. Tese changes from normal to injured to healing states allow discriminatory recording of the contusions illuminated by light sources of various wavelengths. Since the healing process is long term and ongoing, it is sometimes possible to photograph an injury afer that tissue appears to have healed to the naked eye. Similarly, photographing the same injuries over time using both visible and nonvisible light techniques can yield diferent appear- ances of those injuries, which can sometimes add to their evidentiary value (Figures 11. Success in photographing healing bruises over time will depend on sev- eral variables, including the composition of the injured skin, the thickness of the skin, the wavelength and intensity of light used to photograph the damaged area, the equipment used, and the type of flm used. Depending upon the specifc injury, it may be necessary to photographically capture the injuries digitally or with flm, in color and black and white using visible light, as well as nonvisible light. Te injury may also vary in appearance in the photographs of each of these incident light sources and over time if photo- graphed serially. Te location and type of skin injured has profound efects on the ability to photograph the injuries. For example, thick skin of the palm of the hand is usually much easier to photograph immediately afer an injury than afer it has partially healed. Te thick, keratinized covering of the palm of the hand ofen exceeds the ability of most light energy to penetrate enough to record Forensic dental photography 209 Figure 11. Series of photographs showing the appearance of a bitemark on the hip of a sexual assault victim. Note the sig- nifcant increase in the detail of the bitemark discernable in this ultraviolet image. Such cases require fuorescent photography due to the highly fuorescent nature of thick skin. In contrast, thin skin found in areas such as the face or female breast tissue can frequently lend itself to recording injury patterns long afer the visible damage from the injury has faded when viewed under room lighting with the naked eye. Again, this is directly related to the ability of the specifc wavelength light energy to react with the skin to a sufcient depth to record the injury. Forensic dental photography 211 It is important to understand a fnal concept about the physiology of injured skin. In a living victim, at any point in time afer the initial response to injury occurs, the composition of the injured skin is diferent from all other points in time; the skin is continuously changing as the injury heals. Tese changes will afect the response of the tissues to the selected wavelength of light energy over time and may change the appearance of the injured tissue when photographed. Tis is especially true in a living victim but it is also true in a deceased victim, for the frst few days afer death. If the anticipated photographic evidence is not obtained with the frst attempts, one should continue to rephotograph the injuries over time. If the victim is deceased, one should attempt to have the medical examiner or coroner delay any invasive autopsy procedures of the tissues associated with the injury until all attempts to photograph the injury have been exhausted. As previously mentioned, preserv- ing the detail of the injury with photographs may involve a combination of color and black-and-white visible light photographs as well as the use of the nonvisible ultraviolet and infrared photographs. Te photographer should develop a standard technique that includes capturing orientation photographs showing where the injury occurred on the body. Additionally, this protocol should include taking closeup photographs with and without a scale. Te scale serves as a reference to record the relative size of the injuries in the photographs. Tomas Krauss) for the purpose of minimizing photographic distor- tion and ensuring accuracy in measurement (Figure 11. Te photographer should retain the scale used in the photograph should enlargement to life-size reproductions become necessary at some future time. It is essential that the standard technique developed by the forensic photographer include exposing many photographs for each case. One should not be hesitant to use several rolls of flm or create signifcant numbers of digital images for a photo shoot. Manufacturers of flm-based and digital photographic equipment develop and market equipment and supplies that are specifcally designed to have an optimal performance in the 400 to 760 nm range of the electromagnetic spectrum. For the photographer wishing to take pictures in this range of light energy, there is little practice required to ensure highly detailed and sharply focused photographs. By defnition, the object to be photographed is viewed through the lens and the camera automatically adjusts the focus and exposure variables before image capture. Tese types of cameras have been manufactured for optimal photography in the visible light spectrum. Part of that manufacturing process includes coated lenses and fltered fash units that block out the unwanted segments of the nonvisible light spectrum. Most 35 mm cameras have serious size limitations when it comes to recording life-size images. Tis limitation comes from the restricted emul- sion area exposed on the flm (24 × 35 mm rectangle) or the small surface area used in the digital capture device. Since there are very few objects that will ft into that small of an area, considerable enlargement of the photographs may Forensic dental photography 213 Figure 11.
The in- Spoken language problems are referred to by a num- ability to concentrate and loss of memory are also com- ber of labels cheap estrace 1 mg with visa women's health menstrual issues, including language delay 2mg estrace free shipping womens health vero beach, language dis- mon discount estrace 1 mg free shipping menstrual migraine symptoms. Emotional indifference order 1 mg estrace menstruation rituals ancient, withdrawal, lack of atten- ability, or a specific type of language disability. In gener- tion to personal hygiene and appearance, and self-endan- al, experts distinguish between those people who seem to gering behaviors are also possible signs of combat neuro- be slow in developing spoken language (language delay) sis. Individuals suffering from combat neurosis often react and those who seem to have difficulty achieving a mile- to these symptoms by abusing alcohol or drugs. Language Combat neuroses can be a severe mental disorder disorders include stuttering; articulation disorders, such and the potential success of treatment varies consider- as substituting one sound for another (tandy for candy), ably. Some patients are treated successfully with antide- omitting a sound (canny for candy), or distorting a sound pressant and antianxiety medications. For a small per- (shlip for sip); and voice disorders, such as inappropriate centage, however, hospitalization may be required. Consequently it is possible for a defen- dant to be competent for certain kinds of legal proceed- ings, but not for others. There are a number of questions that evaluators Comparative psychology might seek to answer when making a competency deter- mination. A subfield of experimental psychology which fo- Does he appreciate the possible penalties? Does he ap- cuses on the study of animals for the purpose of comparing the behavior of different species. Can he provide mean- Studies of animal behavior have taken two main di- ingful testimony in his own defense? The type of research petence can arise at any point during criminal proceed- most often practiced in the United States has been ani- ings, and may be initiated by the defense, by the prose- mal research, involving the study of animals in laborato- cutor, or by the judge. Prior to 1972, defendants found to ries and emphasizing the effects of environment on be- be incompetent could be confined to mental hospitals havior. European research, by comparison, has been for very lengthy periods of time—sometimes for a more closely associated with the area of inquiry known longer period than they would have served if they had as ethology, which concentrates on studying animals in been found guilty. Supreme Court ruling in 1972 their natural environment and emphasizes the evolution restricted the length of time a defendant could be hospi- of behavioral patterns which are typical of a particular talized because of incompetence to stand trial. Prompting an increase in the study of animal be- havior, ethology has laid the groundwork for an under- Once the question of competence arises, a compe- standing of species-typical behavior and also led to tency evaluation will be conducted. The evaluation typi- progress in relating and contrasting behaviors among cally takes place in a special hospital or clinic. Comparative psychology serves a num- of professionals may be qualified to conduct such exami- ber of functions. It provides information about the genet- nations, including physicians, psychiatrists, psycholo- ic relations among different species, furthers understand- gists, and social workers. There are several different psy- ing of human behavior, tests the limitations of psycho- chological tests or procedures that designed to assist in logical theories, and aids in the conservation of the nat- the assessment of competence to stand trial. It is a 22-item sentence completion test that requires the test-taker to complete sentence stems, such as: “When I go to court, the lawyer will ______________________. Total scores are calculated with a cutoff score that indicates possible incompetence. The ability of a person charged with a crime to un- Another assessment test is the Competency Assessment derstand the nature and purpose of the criminal proceedings. It consists of a detailed face-to-face interview about various aspects of competent function- ing, including an appreciation of the charges and an un- Defendants in a criminal trial must have the ability derstanding of the various roles of the judge, witnesses, (i. This requirement is a long- Research has shown that when competency evalua- standing and fundamental principle of criminal law. Its tions occur, most (70%) of the defendants who are as- purpose is to ensure that defendants can participate sessed are judged competent. The requirement incompetent tend to have been charged with more seri- refers to the defendant’s competence at the time of the ous crimes, compared to defendants in general. They trial, rather than their psychological state at the time of also are likely to have a history of psychosis, to have a the alleged offense. Rationality is a key issue in compe- serious current mental disorder, and to be poorly educat- tency determinations. Once a defendant is judged to be competent, the legal usually lack the ability to understand, communicate, or proceedings are resumed and a trial takes place. Otherwise the United States, where individual rigor and competition defendant is returned to an institution until competency appear to be nationalistic qualities Americans cherish can be restored. If competency cannot be restored within a capitalist-driven society thrives because of the spirited reasonable period of time (e. Ac- being the serial bomber who built homemade bombs that cording to Sigmund Freud, humans are born screaming killed three people and injured many others between for attention and full of organic drives for fulfillment in 1978 and 1995. Initially, according to this view, we com- the proceedings because of a dispute with his lawyers pete for the attention of our parents—seeking to attract it about his defense. His request to represent himself and either from siblings or from the other parent. Thereafter, an attempted suicide provoked concerns about his com- we are at the mercy of a battle between our base impuls- petence. In her report to the court, ever, that this view of the role of competition in human the psychiatrist said that Kaczynski was not suffering behavior may be incorrect. Thomas Hobbes (1588- from any mental defect that could prevent him from un- 1679), one of the great philosophers of the seventeenth derstanding the nature of the charges, or from assisting century, is perhaps best remembered for his characteriza- his lawyers in mounting a defense. On the other hand, tion of the “natural world,” that is, the world before the she noted that he was suffering from paranoid schizo- imposition of the will of humanity, as being “nasty, phrenia. The that those species best able to adapt to and master the nat- Unabomber case provides a good illustration of a situa- ural environment in which they live will survive, has tion in which a psychological disorder did not necessar- suggested to many that the struggle for survival is an in- ily harm the defendant’s ability to participate meaning- herent human trait which determines a person’s success. Darwin’s theory has even been summarized as “survival of the fittest”—a phrase Darwin himself never used—fur- Timothy Moore ther highlighting competition’s role in success. As it has often been pointed out, however, there is nothing in the concept of natural selection that suggests that competition Further Reading Wrightsman, L. Darwin asserted in The Origin of Species that the strug- gles he was describing should be viewed as metaphors and could easily include dependence and cooperation. Many studies have been conducted to test the impor- tance placed on competition as opposed to other values, Competition such as cooperation—by various cultures, and generally An adaptive strategy that pits one person’s interests conclude that Americans uniquely praise competition as against another’s. In 1937, the world- renowned anthropologist Margaret Mead published Co- Psychologists have long been in disagreement as to operation and Competition among Primitive Peoples, whether competition is a learned or a genetic component based on her studies of several societies that did not prize of human behavior. Perhaps what first comes to mind competition, and, in fact, seemed at times to place a nega- when thinking of competition is athletics. One such society was the Zuni Indians of mistake, however, not to recognize the effect competition Arizona, and they, Mead found, valued cooperation far has in the areas of academics, work, and many other more than competition. Psychologists disagree as to whether competition is a learned or genetic component of human behavior. Natural concepts are often learned through the use Conditioned responses develop in a process called of prototypes, highly typical examples of a category— acquisition, in which the natural or unconditioned stimu- like the robin cited above. Some re- concept learning is through the trial-and-error method of sponses develop more quickly than others; similarly, testing hypotheses. The nature of certain item is an instance of a particular concept; they the conditioned response depends on the circumstances then learn more about the concept when they see in which acquisition occurs. This People learn simple concepts more readily than process is called “delayed conditioning” because the un- complex ones. For example, the easiest concept to learn conditioned stimulus is delayed relative to the condi- is one with only a single defining feature. The response is weaker if the condi- est is one with multiple features, all of which must be tioned and unconditioned stimuli begin together, and be- present in every case, known as the conjunctive concept. For example, the concept square is defined by four conditioned response resembles the unconditioned re- sides and four 90-degree angles. People also learn response is not identical to the unconditioned response concepts more easily when they are given positive rather and may be very different.
Chronic diarrhea can occur due to digestive disorders or use of medications that affect bowel function buy estrace 1mg amex premier women's health boca raton. Aside from being unpleasant and embarrassing order estrace 2 mg overnight delivery women's health lose 10 pounds, diarrhea can lead to serious com- plications such as dehydration and nutrient deﬁciencies cheap estrace 1mg with mastercard menstrual vacuum. In some cases it will clear up on its own 2mg estrace breast cancer uggs pink ribbon, and in other cases treatment is necessary to get it under control and prevent complications. However, to prevent dehydration, your doctor will advise you to increase ﬂuid intake. There are special rehydration solutions, such as Gastrolyte and Pedialyte, available in pharma- cies, that contain electrolytes (salt, potassium, and other minerals) that are necessary for health and to prevent dehydration. If you become depleted in these nutrients, it can lead to heart problems and other consequences. Antibiotics destroy both the good and bad bacteria, which can dis- turb the balance of your normal ﬂora in your intestine, leading to overgrowth or potentially dangerous bacteria, such as Clostridium difﬁcile, which can cause very serious diarrhea and requires medical treatment. If lactose intolerance is causing the diarrhea, you will be advised to avoid dairy products or to take lactase (enzyme needed to digest lactose) when eating dairy. There are over-the-counter anti-diarrheal medications, such as Imodium (loper- amide), which can help to slow the diarrhea. However, these drugs should not be used if you have infectious diarrhea as they can prevent your body from eliminating D the offending organism. One study of 41 infants with diarrhea found that carob powder (at a dose of 1 g per kilogram per day) signiﬁcantly improved resolution of diarrhea as compared to placebo. Teas containing chamomile or blackberry, blueberry, or red raspberry leaves can be helpful in alleviating diarrhea because these herbs contain tannins, which have astringent properties. As you start to feel better, eat foods that are nutritious and easy to digest, such as bananas, brown rice, and pota- toes. When your bowel movements have normalized, add more ﬁbre-rich foods back into your diet. Foods to avoid: • Caffeine, alcohol, and spicy foods (hot peppers) are too stimulating to the digestive tract. Fruit juices (especially apple and pear) are high in sugar and should be minimized until you have recovered. Signs of dehydration include excessive thirst, dry mouth or skin, little urination, severe weakness, dizziness or lightheadedness, or dark urine. Signs of dehydration in infants include dry mouth, crying without tears, unusual sleepiness, sunken eyes or cheeks, and skin that doesn’t ﬂatten if pinched and released. Top Recommended Supplements D Multivitamin and mineral complex: Persistent diarrhea can lead to deﬁciencies of vari- ous vitamins and minerals, and taking a multivitamin can help prevent deﬁciencies. Certain nutrients (such as folic acid and zinc) can promote healing of the intestine. Speak to your pharmacist or health adviser for a recommendation as products vary depending on age, activity level, lifestyle, and gender. Probiotics: Regular use of these beneﬁcial bacteria can help prevent traveller’s diarrhea and also help treat infectious diarrhea. Over 13 clinical studies have shown that probiotics can reduce the severity and duration of diarrhea and help prevent it from occurring. Look for a product that provides at least one billion live cells per dosage and is stable at room temperature, such as Kyo-Dophilus. To prevent antibiotic-induced diar- rhea, take your probiotic when you start your antibiotic and for at least two weeks after the antibiotic is ﬁnished. Complementary Supplements Brewer’s yeast: Some research has shown that this supplement can help relieve infectious diarrhea, particularly when caused by Clostridium difﬁcile (associated with antibiotic use). Goldenseal: Has antibiotic properties and contains a chemical called berebine, which pre- vents infectious bacteria from attaching to the gut and blocks the action of toxins produced by bacteria. To reduce your risk, avoid tap water and ice cubes and drink only bottled water and beverages; avoid raw fruits and vegetables unless you can peel them yourself; avoid raw or undercooked meats; use bottled water to brush your teeth; and keep your mouth closed while showering. Tak- ing a probiotic (friendly bacteria) every day while away can also help reduce the risk 208 of traveller’s diarrhea. These beneﬁcial bacteria (such as lactobacilli and biﬁdobacteria) normally live in the colon and inhibit the overgrowth of disease-causing bacteria. See your doctor if diarrhea persists beyond ﬁve days or if you develop dehydration. Diverticula usually develop when weak places in your colon give way under pressure, causing the formation of pouches, which can protrude through the colon wall. These pouches rarely cause problems, so people often don’t realize that they have them. However, if the diverticula become infected (diverticulitis), this can cause abdominal pain, fever, nausea, and change in bowel habits. It is possible to prevent diverticular disease by eating a high-ﬁbre diet and avoid- ing constipation. If diverticulitis occurs, it can cause: • Abdominal pain (severe and sudden onset) • Constipation or diarrhea • Fever, nausea, vomiting • Rectal bleeding Note: Complications of diverticulitis include blockage in the colon and abscess or ﬁstula formation. If a pouch ruptures, the waste material can spill into the abdominal cavity, leading to peritonitis, which is a serious medical problem that needs immediate attention. Prior to the 1900s when reﬁning of grains started, diverticular disease was rare in North America. A high-ﬁbre diet can reduce your risk of diverticular disease and also help prevent ﬂare-ups in those who already have it. For those with mild symptoms, dietary changes and antibiotics for the infection may be all that is needed. During a ﬂare-up, your doctor will advise a temporary low-ﬁbre diet to allow the colon to heal. Surgery is a last resort, but may be necessary for those with bowel obstruction or severely damaged intestine. Foods to avoid: • Fast foods and processed foods contain chemicals that can damage intestinal health. In the past, those with diverticular disease were told to avoid nuts or seeds, but there is no evidence that these foods trigger ﬂare-ups, so they can be enjoyed as part of a healthy diet. Avoid holding it in as that can create dry, hard stools that are hard to pass, increasing colon pressure. Top Recommended Supplements Fibre: Helps prevent constipation and improve bowel function. One study of glucomannan, a water-soluble dietary ﬁbre derived from konjac root, found that it reduced symptoms of diverticular disease. Probiotics: Beneﬁcial bacteria help to reduce the risk of gut infection and also aid digestion and nutrient absorption. Dosage: Take one to three capsules daily of a product that provides at least one billion live cells. Include healthy fats (ﬁsh and ﬂaxseed) and fermented milk products (yogurt and keﬁr) in your diet. Ear infections, known medi- cally as Otitis Media, are a non-contagious infection of the middle ear, just behind the eardrum. If the middle ear becomes inﬂamed from the infection, ﬂuid builds up behind the eardrum, creat- ing a breeding ground for infection. These infections can also occur when there is swelling or problems with the eustachian tubes (the tubes that connect the middle ear to inner nose).