J. David Frank, MBBS, FRCS

• Former Consultant Paediatric Urologist,
• Bristol Urological Institute, Southmead Hospital
• Bristol, United Kingdom

In contrast to her outward appearance of confdence and success blood pressure korotkoff sounds buy midamor visa, Emily constantly feared that people would realize that she actually wasn?t very smart arrhythmia symptoms and treatment discount midamor 45mg without a prescription. Her need for perfect grades was as much a defense against being found out? as it was a means to achieve entry into a good college prehypertension home remedies purchase 45mg midamor. Long before her eating disorder emerged blood pressure chart download software midamor 45 mg with mastercard, Emily cared deeply about achieving perfection and avoiding failure blood pressure chart height purchase midamor in india, as if perfection and failure were the only two options in life fetal arrhythmia 38 weeks discount 45 mg midamor fast delivery. Her eating disorder seems to refect another manifestation of an unrelenting drive to achieve and surpass all external standards. Veronica (see Chapter 3), who carried more water and chopped more wood than anyone else? because she believed she was in a race against all the other novices to show who loved God the most? (Bell, 1985, p. Perfectionism combined with low constraint may contribute to the development of bulimic symptoms (Westen & Harnden-Fischer, 2001). One concern in interpreting results from correlational studies (such as comparisons of personality between women with and without eating disorders) is that the state of illness may afect personality measures (Vitousek & Manke, 1994). Several participants showed signifcant deviations from their normal personality and behavioral functioning. Some, for example, exhibited impulsive behaviors that they had never shown before starvation. Other participants became preoccupied with food and developed eating rituals they had never performed before (see Figure 7. These observations highlight the importance of using caution in interpreting personality function among individuals with current eating disorders as contributing to the illness, given the limited inferences that can be drawn from a cross-sectional design (see Chapter 4). Because of concerns about the potential infuence of eating disorders on person ality function, results from longitudinal studies are particularly valuable. In contrast to per fectionism, high negative urgency?the tendency to act impulsively when distressed?is a prospective risk factor for binge eating (C. Difculties in controlling impulses have been implicated in the chaotic symptoms of women with bu limic symptoms?the oscillation between dietary restraint and binge episodes followed by purging. As de scribed in Chapter 4, higher levels of negative emotionality predicted the development of new-onset eating pathology in a prospective longitudinal study (Leon et al. A tendency to experi ence increased negative emotions could increase the likelihood of using extreme methods to regulate emotions. Further, a tendency to experience changes as particularly stressful could explain why eating disorders most ofen start during adolescence (Leon et al. From this psychological perspective, personality and temperament explain the tenden cies of individuals with eating disorders to experience certain emotional states, while eating disorder symptoms represent learned responses to those experiences. Cognitive and Affective Processes Learning Processes and Eating Disorders Chapter 6 discussed how disordered eating might be learned through modeling or direct in struction within families. This explanatory approach is predicated on the idea that whether or not an individual develops an eating disorder depends on what they are exposed to within their environment. But given the widespread presence of messages reinforcing the thin ideal, why do only some individuals develop disorders of eating? This section addresses both basic processes of learning and how individual diferences in those processes could contribute to vulnerability to developing eating disorders. One type of learning, operant conditioning, may play an important role in the acquisition and maintenance of disordered eating behaviors. In operant conditioning, learned associations between behaviors and their emotional consequences infuence the likelihood that those behaviors will recur. Evidence reviewed above indicates that individuals with eating disorders have altered sensitivity to rewards and punishment (Harrison et al. W e would expect these diferences to infuence acquisition and maintenance of behaviors, including behaviors such as dietary restriction, binge eating, and purging. In operant conditioning, positive reinforcement occurs when desirable consequences of a behavior increase the likelihood that this behavior will recur. This change may result in consider able positive social reinforcement, in the form of compliments and attention. Although all respon dents expressed concern about the patients, 50% reported envy of patients? self-control and discipline concerning food. Further, friends and relatives were more likely to endorse positive than negative statements about the patients? appearance, agreeing more ofen with descriptions of them as slender? (58%), neat? (83%), well groomed? (100%), and fashion able? (100%) than with descriptions such as skinny? (8%), haggard? (8%), and emaciated? (8%). T us both attention and admiration may serve as positive reinforcers of continued food restriction. Although patients fnd binge-eating episodes very upsetting, in treatment they also express a sense of loss when they realize that they may never have binge episodes again afer treatment. He complained that diet pills were fne for curbing appetite, but the perfect diet pill would replace food altogether so that in ad dition to not feeling hungry, he would not need to eat. This would be his perfect diet pill be cause he could not imagine ever being able to stop eating once he started. As an athlete in school, he had always worked out harder and longer than everyone else on the team. Because of this work ethic, he became a star member of the team and eventually its captain. More than any other employee, Jamie would persist in pursuing clients until he landed the deal. However, eating disor ders do not consist solely of pleasurable, rewarding behaviors. To understand the full array of symptoms, one must examine both the consequences of a given behavior and the conse quences that would result from not engaging in the behavior. Like positive reinforcement, negative reinforcement increases the likelihood of a be havior recurring. The behavior prevents such an undesirable consequence or terminates an undesirable experience. For example, self starvation may be negatively reinforced if it contributes to emotional numbing and reduces distress (Kaye et al. Similarly, binge eating may be negatively reinforced if it ofers even a temporary respite from negative feelings (Heatherton & Baumeister, 1991). Although feeling nothing is not necessarily pleasurable, it is preferable to feeling distress. In a meta analysis of studies examining emotional changes immediately before binge episodes, Haedt Matt and Keel (2011) found consistent evidence that an increase in negative afect predicted binge eating. Although purging is not an efective form of weight control, it does decrease anxiety (Haedt-Matt & Keel, 2011). This reduction in anxiety provides power ful negative reinforcement for purging?even in the absence of a binge-eating episode. In reviewing the diary, Valerie was able to see that some purging episodes were triggered by what she had eaten. For example, if she went out to dinner with friends and tried to eat like a normal person? without restricting, she would usually excuse herself afer the entree and go the bathroom to purge before returning to order dessert, which she would also get rid of once she got home. She also purged at home, and there wasn?t always a consistent dif ference between which foods she kept down and which she threw up. Instead, the consistent pattern that emerged was how she felt before and afer the eating episode. Any time that she felt highly anxious before eating, she was very likely to purge afer eating, and afer purging her anxiety would go down. In these instances, it seemed as though she was eating solely to trigger a purging episode to alleviate her anxiety. In addition, sometimes her eating triggered feelings of extreme fullness, which made her feel anxious about becoming fat. In these cases, even if the type and amount of food fell within her accepted rules for being safe,? she would purge to relieve the feelings of fullness and anxiety. These days were marked by lower levels of negative afect and higher levels of positive afect and a general absence of physical discomfort afer eating. Even though purging is not inherently re warding (it does not make Valerie feel happy) it eliminates a range of negative experiences. Haedt-Matt and Keel (2015) recently documented that increases in negative afect preceded episodes on purging in purging disorder, and negative afect decreased afer purging, sup porting the role of negative reinforcement in maintaining this behavior. In many cases, negative reinforcement is more powerful in maintaining a behavior than positive reinforcement is. Each time someone engages in the behavior, that person experiences both the actual and the perceived consequences. In positive reinforcement, the pleasurable consequence is experienced exactly as it is. In negative reinforcement, the consequence is ex perienced both as the actual elimination of something undesirable and as the prevention of something that is undesirable. For example, Valerie experiences her purging as reinforcing be cause it decreases her anxiety and because she believes it prevents her from gaining weight. T us no matter what the real consequences of a negatively reinforced behavior are, each time people engage in the behavior they can conclude that they would have been worse of had they not engaged in it. This assumption may well be wrong; Valerie, for example, was much happier and healthier before she developed purging disorder. The only way to challenge this assumption is to stop the purging so that the person can learn that it does not make life better. However, in the presence of intense fear of gaining weight, giving up purging may seem to be too great a risk. Similarly, eating in front of others or wear ing clothes that reveal weight and shape. These feelings may then inhibit patients with eating disorders from eating in the 109 PsyChologiCal faCtors | 109 presence of others and from joining activities in which their bodies will be exposed. In eating disorders it is ofen easy to perceive the behaviors in which patients engage. However, the behaviors in which they do not engage frequently remain hidden, and many of these inhibited behaviors contribute to signifcant psychosocial maladjustment. In addition, Jamie was far less physically active than he had been when he was younger. However, his therapist observed that he seemed to have considerable time to devote to online gaming. Jamie acknowledged that one of the things he enjoyed about computer games is that his avatar could be muscular and lean and exhibit the physical strength and stamina he felt had slipped away from him over time. Although he wanted to join his friends in pickup games of basketball and soccer, he was too self-conscious about his weight to feel comfortable running in shorts on the court or feld. Similarly, numer ous gym memberships had gone unused because he felt too ashamed of his body to work out in front of others. As with negative reinforcement, behavioral responses to punishment are driven by a desire to avoid negative consequences. In both instances, a temperamental or personality style that predisposes an individual to experience negative emotions would increase the power of these consequences, and increased sensitivity to punishment would inhibit a wide range of behaviors (Harrison et al. For each card, participants made up a sentence using the verb and one of the six pronouns. After the 20th card, the experimenter rewarded the participant for sentences that used either of the first two listed pronouns from the previous card. Results showed a significant positive association between reward sensitivity and frequency of vomiting and purging but not frequency of binge-eating episodes. These results were somewhat surprising as they sug gest that vomiting and purging are linked to positive reinforcement while binge-eating is not, but these results await replication. This kind of clean distinction between rewards and punishment is an artifcial product of a laboratory environment. In real life, good things have some negative consequences, and bad things have some good consequences. Similarly, patients who purge may experience relief from a range of negative experi ences, but the purging itself contributes to shame and a host of medical problems (discussed in Chapter 8). Finally, avoiding social situations out of fear of public eating or of wearing revealing clothing leaves individuals with eating disorders feeling alone and isolated?the very opposite of what they hope to achieve by controlling their eating and weight. T us an important question is how the combination of rewards and punishments infuences the de cision to engage in or inhibit a given behavior in eating disorders. Participants freely draw one card at a time from any of these decks over a series of trials, with the aim of earning as much money as possible. As a result, in the long run it pays of to draw more cards from decks C and D than from decks A and B. Participants demonstrate learning by the extent to which they draw more cards from decks C and D than from A and B over the course of the task. One study sug gested that this problem does not improve with weight restoration (Bodell et al. T us many of the symptoms of eating disorders may be explained by their immediate or perceived consequences. Eating disorders become a trap for many individuals because the harmful long-term consequences are overshadowed by the immediate consequences. As the disorders lead to problems and distress, patients may be pushed further into disordered eating behaviors in an attempt to cope. Diferences in vul nerability to developing eating disorders might therefore be related to how salient immedi ate consequences are, which in turn is related to the psychological dimensions of attention, perception, and evaluation. T at is, women with eating disorders pay more attention to information about food and body weight or shape than do women without eating disorders. Such an unconscious attentional bias might help explain their preoccupations with food, weight, and shape and why negative consequences pertaining to weight and shape seem so much more important to them than do negative consequences in other aspects of life. The Stroop test has been used to evaluate attentional processes in women with eating disorders.

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High?capacity plants that are powered by renewable sources blood pressure log printable cheap midamor, like windmills pulse pressure 14 purchase 45 mg midamor with amex, have been constructed in many dry coastal areas arrhythmia bradycardia order genuine midamor on line. In most developed countries low vs diamond heart attack generic midamor 45 mg visa, a safe and hygienic water supply is secured through a piped network arrhythmia symptoms generic 45mg midamor with visa. Provided that the choice of pipe material for the water quality is adequate 4 arteria aorta buy genuine midamor, excessive release of chemical compounds and ions, or the after growth of microbes can be kept under control. In many developing countries, available surface waters are polluted and municipal water services are unreliable. People living in these countries must often resort to alternative service providers, or store water temporarily accessed through their services in less sanitary tanks. There is also an increase in sales of bottled water, in these and in developed countries alike. Bottled water is however often subject to less strict re? gulations than those for tap water. Managing water resources in a safe and sustainable way has thus become a key priority for the future. At a local level, re? sults from research on water quality, disinfection and distri? bution need to be combined with practical considerations regarding management and training. Ongoing research pro? jects have devised fruitful solutions for developing countries. Access to clean water for consumption and basic sanitation is the single most important factor for human development. But fresh water constitutes only a small percentage of the global water resources and almost half of it is shared between two or more countries. The key to achieving a sustainable development and management of water resources lies in resolving long? term governance challenges; not least to enforce legislation and empower local communities and vulnerable groups. Successful water agreements outnumber conficts over shared waters by almost ten to one. Globally, there are 263 river basins that cross the political boundaries of two or more countries. Waters that cross national borders can carry pollution from upstream to downstream countries, impacting human health and livelihoods. But water also crosses political, admin? istrative, ethnic and climatic boundaries within countries. Upstream users can extract too much water, or use it in? effciently, threatening the quality and quantity of water available for those living downstream as well as the environ? mental needs for water. Climate change, which is already altering the global water cycle at an unprecedented rate, adds further complexity to these challenges through its impacts on the timing, intensity and variability of rainfall, droughts and fooding. The projected sea level rise threatens the safety of coastal populations and imperils the supplies of freshwater upon which they depend. Deteriorating water quality In the near term, shrinking mountain glaciers (as a result of climate change) result in lower dry?season fows, and poten? tially more fooding during the wet season. In the long term, if glaciers completely disappear, overall fows may be substan? tially reduced. Both impacts can have a dramatic effect upon 10 Drinking Water Sources, Sanitation and Safeguarding the water supplies and livelihoods of downstream residents. Broken water pipe, Land use changes can also have a marked effect on water Democratic Republic of Congo. Urbanisation and deforestation affect stream fows: fooding in Bangladesh for example is exacerbated by land use changes in upstream Himalayan countries. In Jakarta, rapid urbanisation of the upper catchment is blamed for frequent fooding in the city, polluting water supplies and causing serious sanitation problems. Even the largest natural water bodies can be adversely affected by human activities. In Mongolia, numerous unregu? lated mining operations have allowed cyanide and mercury to enter watercourses, forcing the closure of small town water supplies and jeopardising Lake Baikal. Drinking Water Sources, Sanitation and Safeguarding 11 Similarly, poverty?driven gold mining operations in the upper reaches of the Pungwe River between Zimbabwe and Mozambique have led to extensive erosion and deteriorated water quality downstream. Miners use mercury in the gold panning process, which has elevated concentrations of mercury and other heavy metals such as lead and cadmium which are bound to the suspended sediments since they exist naturally in the soils. The suspended sediments make the water unsuitable for drinking, washing and irrigation, bury the aquatic fauna, prevent photosynthesis and have effects on the fsh population. Salinisation of freshwater resources is another problem jeo? pardising water supplies, and desalination remains prohi? bitively expensive for most people in the developing world. So much water was being abstracted from the Pungwe River that little freshwater reached the sea at Beira during the dry season. The Swedish International Develop? ment Cooperation Agency (Sida) is supporting transboundary cooperation and strengthening the capacities of local river basin organisations to address these issues through an inte? Return fow from Mafambisse sugar grated water resources management approach. Photo: Bjorn Holgersson For many small island developing nations, relying on a thin lens of fresh groundwater balanced above denser salt water, the water supply situation is even more vulnerable. As sea levels rise many small islands will lose this resource, their only source of fresh water. Poor groundwater management such as the uncontrolled drilling of private water supply boreholes in Lima, Peru allows sea water to penetrate aquifers, rendering them saline and useless. And natural disasters such as tsunamis and storm surges associated with cyclones can food land with salt water and destroy drinking water supplies. Chemical and biological pollution Poor groundwater manage In many countries, regulation of industrial and mining ment and natural disasters discharges is weak, and agricultural practices allow pesticides can make aquifers or drinking and nitrates to contaminate water sources. Acid rain crosses water supplies saline and international borders and pollutes water bodies. A complex system of land holdings in Papua New Guinea meant that only a small minority of residents were consulted in the development of 12 Drinking Water Sources, Sanitation and Safeguarding the Ok Tedi mine near the Indonesian border. But up to 80 million tonnes of tailings entered the river system each year, with elevated levels of heavy metals. Distant residents, both in Papua New Guinea and in Indonesia, have struggled to receive any compensation. But even where sewerage systems are available these are often poorly maintained, or built to too low a design standard to cope with urban growth and climate change. Untreated or poorly treated effuents upstream become the water source for those living downstream, jeopardising public health and the environment and adding signifcant cost to water treatment in downstream water works. At the border town of Malaba in Kenya inadequate sanitation facilities are available for the growing amount of truck drivers awaiting custom clearance. They use plastic bags, so called fying toilets, which are disposed into the river passing the problem downstream to the Ugandan population. Decision making capacity Water specialists have long been aware that water is essential Environmental education to sustainable development, but they are not the ones to is non-existent in many make decisions on development and they do not control countries. Leaders in government are constrained by a range of social, political and fnancial factors that prevent them from safeguarding drinking water supplies. Another reason lies in the fact that environmental education is non?existent in many countries. Government offcials may never have had the opportunity to learn about environmental management, and do not under? stand how to manage their water resources. For example, on Nias Island (in Indonesia) the local govern? ment located a solid waste dump on a hillside above a spring that supplied a town with water. Within two years, oils and other chemicals seeping through the groundwater polluted the spring. Although acting in good faith, local offcials had no understanding of groundwater fow and simply did not realise the problems the dump could cause. Drinking Water Sources, Sanitation and Safeguarding 13 And many communities do not understand the links between sanitation, pollution and health. But parents do not understand why their children are sick, and they are still reluctant to invest in better toilets. Governance and enforcement constraints Climatic changes take place Many environmental problems are by nature chronic, long over a long period of time. Unfortunately most political systems and development pro? grammes operate over much shorter time scales. Investing in climate change mitigation or adaptation measures might bring few immediate benefts. Project managers see little bene? ft in climate change resilience river foods and sea level rise may eventually affect a community, but not within a typical project life cycle or political mandate of a few years. Poor environmental practices harm people especially poor people as well as harming natural resources, plants and animals. But unfortunately many practitioners still see environmental management as a hindrance to development. Environmental safeguards are seen as obstructive and unhelp? ful, and staff are unfamiliar with their implementation. In many cases, the means In many countries, the enforcement of environmental regu? to enforce existing laws and lations is weak. Sometimes the responsibility for enforcement of environmental rules is un? clear; police forces, for example, may see environmental regulation as being outside their mandate. But more com? monly the means to enforce existing laws and permits simply do not exist. Gauging and monitoring networks are inade? quate or poorly maintained, and local authorities lack quali? fed staff, facilities, transport and equipment. The quality and quantity of water resources determine the costs and availability of potable water but in many instances the institutional structures governing water supply and sanitation differ from those responsible for water resources management. Otherwise water catchments will not get the protection they need, deforestation will continue, and more inappropriate developments will be built. Financial challenges Even when water management is recognised as a key issue, Current aid levels for the gaining a high level of political support, there is a failure to water sector are lower than translate this into effective action and increased investment in 1997 in real terms. Too often the returns on water management and investments are underestimated; as a result, the limited resources available are prioritised for other sectors perceived to be more produc? tive. Yet the economic rate of return for each $1 invested in achieving the Millennium Development Goals water and sanitation target was estimated in 2006 at $8. Historically, management of water resources has been crucial in cata? lysing economic growth and development. The recent cholera outbreak in Harare is another example of how severe such problems need to become before politicians and donors are prepared to invest in water supply and sanitation Given the importance of water to poverty alleviation, human and ecosystem health, the management of the water resources becomes of central importance. Key interventions are needed in a wide range of sectors to address these challenges and meet the Millennium Development Goals. Drinking Water Sources, Sanitation and Safeguarding 15 Addressing decision making capacity There are endemic skills shortages in the sector both in developed countries, and more critically, in the developing world. Better environmental education is the key to helping decision makers to learn about the water problems we face, and to help fnd solutions. Water and environmental issues should be mainstreamed into all development programmes, as a cross?cutting issue, and not considered in isolation. Water plays a pivotal role in sustainable development and poverty reduction and cannot be neglected in national adaptation programmes or poverty reduction strategies. Information on water and sanitation coverage, water resources and water quality is still scarce in many countries. Resolving governance and enforcement constraints Resolving the governance challenges must be a key priority if we are to achieve sustainable water resources development and management. Many costly mistakes Most countries have environmental legislation, but few en? can be avoided if polluters force their legislation thoroughly and effectively. Institutional understand that they will responsibilities for enforcement need to be clarifed, and the bear the costs of the rules should be applied fairly and transparently. To achieve better raw water quality, polluter pays/ pollution management systems should be improved and prioritized. Many costly mistakes can be avoided if polluters understand that they will bear the costs of the pollution they cause. Local communities and vulnerable groups should be fully empowered to participate in development programmes. Social 16 Drinking Water Sources, Sanitation and Safeguarding and environmental impact assessments should not be a purely bureaucratic exercise they should be an integral part of all projects, and able to meaningfully infuence project design. To address long term and chronic problems (such as climate change), some governments have established special offces and committees with long?term mandates. These organiza? tions can propose more sustainable solutions and realistic targets. Their independent mandate allows them to consider diffcult issues that might otherwise be overlooked in the normal, short?term political cycle. Solutions to fnancial challenges Water professionals invariably promote their projects for their social and environmental benefts. These are important, but water projects are also some of the best fnancial investments a country can make. Professionals in the water sector need to reach out more to Financial Ministries (and donors) to make the case for more resources. The current global economic recession may impede the Water projects are some necessary investment. On the other hand, many govern? of the best fnancial ments are looking to increase investment in public works to investments a country stimulate the economy and provide employment, and the can make. Water infrastructure has long?term development benefts and helps the poor, who are most at risk during the economic decline. Over the last 60 years more than 300 international water agreements have been reached while there have only been 37 cases of reported confict between states over water. What is even more important, cooperation on shared waters has been shown to help build mutual respect, understanding and trust among countries and to promote peace, security and regional economic growth. There are many examples of international co?operation to Cooperation on shared halt the destruction of water resources. In 2005 a chemical waters has been shown to explosion at Jilin in Northern China caused 100 tonnes of help build mutual respect, benzene to enter the Songhua River, a tributary of the Amur understanding and trust on the Russian border.

If technology has been optimized for the evaluation of both the resistance corresponds to a refractory state pulse pressure variation critical care order midamor 45mg on line. The spe By referring to pathogen-resistant transgenic plants and cialists should include those concerned with shrimp matura vertebrates hypertension 4019 diagnosis purchase midamor mastercard, genetic transformation has been considered for tion blood pressure chart record keeping purchase midamor toronto, larval culture how is pulse pressure used as a diagnostic tool order generic midamor, pathology arteria zygomatica buy cheap midamor 45 mg line, immunology and genetics heart attack upper back pain discount 45mg midamor amex. The shrimp as the way to obtain multi-resistant strains against success of the selection program will depend on the quality bacteria, through the expression of homologous or heterolo of the shrimp culture and on the reliability of the analyses gous genes coding for antibacterial peptides. Strains resist for quantifying selection traits and determining the genetic ant to viruses could be obtained through the expression of markers. Moreover, in Base population common with other organisms, for instance the fruit fly, Dro the base population will include animals from several sophila melanogaster, or the nematode, Caenorhabditis geographic origins and individuals from domesticated? elegans, genetic transformation will be extremely useful for stocks, corresponding generally to animals produced in cap basic research on all the fields of shrimp biology. Compared with quantitative genetics, shrimp genetic transformation is still in the research phase with investiga Genotype-environment interactions tions related to the identification of candidate genes and other Whatever the species, shrimp aquaculture is carried out studies focused on the development of reliable gene transfer in a wide variety of environmental conditions, which makes technology. These topics have been recently reviewed it necessary to consider the possible interactions between (Mialhe et al. However, it is necessary to cre In terms of selection of pathogen-resistant shrimps, quanti ate a hierarchy of the various environmental parameters, since tative genetics and genetic transformation must be consid it is impossible to repeat each selection experiment in all the ered as two complementary approaches. In a country like Ecuador, the most relevant environmental Much important progress has been made for the devel criterion corresponds to salinity, since farms can be located opment of gene transfer technology. Re search is currently focused both on the identification of spe Selection mode cific transposable elements to construct integration vectors the availability of assays to quantify traits for individual and on the evaluation of heterologous viral integration vec and family selection will enable the breeding program to de tors. Fish Shellfish Immunol 5: 597-612 families must be kept in environmental conditions as similar Bachere E, Mialhe E, Noel D, Boulo V, Morvan A, Rodriguez J. Aquaculture 132: 17-32 mals would also have to be tagged and pooled as early as Bachere E, Cedeno V, Rousseau C, Destoumieux D, Boulo V, possible. Aquacult 28: 51-55 Destoumieux D, Bulet P, Loew D, Van Dorselaer A, Rodriguez J, Individual selection, which is relatively efficient for traits Bachere E (1997) Penaeidins, a new family of antimicrobial with high heritabilities, is currently the most frequently ap peptides isolated from the shrimp Penaeus vannamei plied selection method for increased growth rate in (Decapoda). Mol mar Biol Biotechnol 4: 275-283 Estimated Heritabilities for Early Growth Rate of the Black Tiger Prawn, Penaeus monodon, Fabricius 1,3 2 4 5 P. Menasveta 1Angsila Marine Biological Research Station, Department of Marine Science, Faculty of Science Chulalongkorn University, Chon Buri, 20210, Thaiand 2National Aquaculture Genetics Research Institute, Department of Fisheries Ministry of Agriculture and Cooperative, Patum Thani, 12120, Thailand 3Aquatic Resources Research Institute, Chulalongkorn University, Bangkok, 10330, Thailand 4Marine Biotechnology Research Unit, National Center for Genetic Engineering and Biotechnology Ministry of Science Technology and Environment, Phyathai Rd. An artificial insemination technique (male: female = 1: 1) was used to create twenty-one full-sib families in three batches. Growth rates measured as total length at 25 days were significantly affected by batch, rearing conditions and full-sibs family. Effects from batch numbers and replicates were not significant with respect to growth rate at the age of 65 days, but the effect from full-sibs families was. At the age of 25 days, heritability for growth rate measured as total length was 0. Decline in the estimated heritabilites from 25 days to 65 days was partly due to a confounding of common environmental factors in full-sibs variance at the early stage of life which decreased as the animals got older. In any case, this experiment demonstrated a significant genetic component controlling growth rate in the species. Advantages and disadvantages of the method used in this experiment for heritabiliity estimation are discussed. It was concluded that further investigations with a better experimenal design based on a full-sibs mating design were required to obtain better heritability estimates for growth rates of natural stocks of P. With this aim, a three year reseach project was initiated argicultural practice in Thailand. Despite the advanced pro in Thailand in 1996 to develop an appropriate selective breed duction technology being practiced, the production cycle of ing program for P. This prac tice arose historically from the ready availability of inex To calculate heritability, many methods are available. This practice makes it im spring-parent regression and response to selection (Falcomer possible to apply any selective breeding program in order to 1989). Lester (1988) reported on heritabilities with large er improve production efficiency by genetic manipulation. Jarayabhand P, Uraiwan S, Klinbunga S, Tassanakajon A, Srimukda P, Pattanachan P, Panakulchaiwit R, Menasveta P (1998) Estimated heritabilities for early growth rate of the black tiger prawn, Penaeus monodon, Fabricius. Strong influences of environmental factors on lar transported to the shrimp hatchery at Angsila Marine Bio val growth of these penaeid species were mentioned. From this report, the tial stocking densities were controlled at 15,000 nauplii/tank. The larvae were fed in attempt to estimate heritability for growth rate in a natural excess four times a day with a commercial formulated feed stock of P. Analysis of variance for partition of variance components used to calculate heritabilities at 25 and 65 days age in P. Intraclass correlations or nauplii available each day were brought into the station in heritabilities based on full-sibs were calculated. At the age of 25 days, effects from batch number confounded by non-genetic variance components such as and rearing conditions were significant. In this age of 65 days, the parameters batch number and replication experiment, effects of some non-genetic variance compo were not significant and they were dropped from the calcu nents were significant. Partitions of variance used for a certain extent removed from calculations, and this improved calculation of heritabilities at 25 and 65 days are shown in the accuracy of the obtained estimated heritabilities. In both cases, the % variance compo due to low success in artificial insemination. Adjustment for non-genetic ment, only about 55% of the inseminated females spawned. In addition, this experi disease resistance in Pacific White Shrimp (Penaeus vannamei). It in aquaculture, 24-28 June 1997, Institute of Aquaculture, Uni should be pointed out that the best use of estimated herit versity of Stirling, Scotland ability would be when animals were at market size. An abstract of the sixth international symposium preferable to the half-sibs design. To minimize the error terms, on genetics in aquaculture, 24-28 June 1997, Institute of further investigations need to be carried out with a better Aquaculture, University of Stirling, Scotland design. Domestication and Genetic Improvement: What are these and how are these important to Black Tiger Shrimp, Penaeus Finally, a very high phenotypic correlation between total monodon Culture in Thailand? Triploidy induction is one possible way of using genetic manipulation to make stock improvements. It was initially reported to block the extrusion of first or second polar bodies in oocytes of starfish. Domestication and Selective Breeding of Penaeus monodon in Thailand 1 2 3 Boonsirm Withyachumnarnkul, Vichai Boonsaeng, T. Flegel 2 4 Sakol Panyim, Chainarong Wongteerasupaya Departments of 1Anatomy, 2Biochemistry and 3Biotechnology, Faculty of Science Mahidol University, Rama 6 Rd. Bangkok 10400, Thailand 4Department of Biochemistry, Sri Nakarintaraviroj University, Sukumvit Rd. They were reared for one year to become F0 pond-reared broodstock which were then bred to produce F1 offspring. From these broodstock the F2 offspring presently comprise nine full-sibling families. Fecundity of the F1 broodstock was lower than, but approaching that of wild, captured broodstock. The improvement was sufficient to make commercial scale production of postlarvae from these broodstock foreseeable. As in farming of other agricultural spe increased for eight years prior to the years 1995-1997 dur cies, domestication is a better alternative; better because it ing which time there was a leveling-off and even a slight allows for stricter disease prevention and control, and better drop in production. Crop loss has been due to several fac because genetic selection may also be achieved. To a lesser degree, luminescent lection for fast-growing and disease-resistant traits would bacterial infections have contributed to the declining pro be most desirable, as both would decrease the risk of loss duction. This joyed more than doubled production during the interval 1992 finding, and that by Lo et al. In addition to the disease problem, a decline in the growth rate of shrimp pro this report describes progress to date in a 6 year-project duced from currently available wild broodstock has also been aimed at the domestication of P. The offspring (F) were reared for one year and 1 Selection of F stocks then bred to produce F2 offspring in the same manner. Survival rate during this 8 month rearing period percent (~20 pcs) of the shrimp was sacrificed for routine was only 30%. From pond was deemed sufficient grounds to reject all individuals the spawners, the average number of eggs was approximately from that pond for selection. The 2 four 1600 m earthen ponds (one family per pond) where quarantine system was designed and constructed to prevent they were reared for four months before being harvested. Total Number Sampled 463 Means 37 g 40 Standard Deviation 13 Take 65 g+ 20 0 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 grdist in D20 Body Weight (g) Figure 1. Domestication and breeding of Penaeus monodon 75 T o t a l L e n g t h (i n) Number of Fertilization Rate (%) Eggs/Spawner 12 60 1,000,000 10 50 800,000 8 40 600,000 30 6 400,000 20 4 Figure 2. Data on the size, fecundity 2 200,000 10 0 0 and offspring of the pond-reared F1 0 spawners. These shrimp were designated the F1 generation monodon broodstock for the different generations studied. There is a trend of increasing fecundity, most notably for the this time, the spawning rate was 50%. The from 120,000 to 333,000 and the hatching rate ranged from length of the F1 spawners, measured from the base of the 4% to 36%. This size was comparable to that of re-circulating water system and obtained slightly improved wild broodstock. The average number of eggs per spawner was produced more than one million eggs, and most spawned at improved up to 587,000 with a 42. The fertilization rate was variable, ranging from the improvement in fecundity seen here was probably 0% to 95% and averaging approximately 45%. The hatch due to improvements in nutrition and in the environment in ing rate was also variable and averaged at 38%. Miguel (F1 data) Size of the Female (g) 90-200 50-100 80-160 150-200 Spawning Rate (%) >80% ~30%? Dis Aquat Org but such messages might be carried through the optic lobe in 30: 53-72. Yano on reproductive performance of wild ablated Penaeus monodon (1993) reported that a light: dark ratio of 14: 10 h, with an broodstock. In Proceedings of the First International Confer intensity of 3-50 lux was optimum for the promotion of ovar ence on the culture of Penaeid Prawns/Shrimps. Asian Fisher the finding that the F1 generation grew 10% faster than ies Society. However, more data the effect of diet on the reproductive performance of pond are needed to draw definite conclusions, as the environment reared Penaeus monodon Fabricius broodstock. This figure is ment in relation to changes in the external genitalia in captive about one-third of that for wild broodstock. In the future, it is hoped that genetic im Endocrinol Metab 2: 13-19 provement and better culture performance of the fry will Shimma Y (1977) On the lipids of adult carps raised on fresh meal compensate for lower production numbers. This work was supported by the Shrimp Withyachumnarnkul B, Poolsanguan B, Poolsanguan W (1990) Culture Research and Development, Inc. In the Book of Abstracts of Life Sci 51(19): 1470-1484 the Annual International conference & Exposition of the world Withyachumnarnkul B, Pongtippatee P, Ajpru S (1995) N Aquaculture Society. In the Book of Abstracts of the Annual temic baculovirus that occurs in cells of ectodermal and meso International Conference & Exposition of the World dermal origin and causes high mortality in the black tiger prawn Aquaculture Society, p68. Current status of research on yel Thesis for the Master Degree of Science, Faculty of Science, low-head virus and white-spot virus in Thailand. In Proceeding of the Special Session of Shrimp farm acid to highly unsaturated fatty acids. In Abstracts of the 2nd Asia-Pacific Marine Biotech Domestication and breeding of Penaeus monodon 77 nology Conference and 3rd Asia-Pacific Conference on Algal Biotechnology, 7-10 May, 1997, Phuket, Thailand. The organic matter in wastewater canals, water supply canals, the shoreline, and 500 m and 1,000 m from shoreline were 7. From the analysis of Kendall correlation coefficients, every parameter (except available phosphorus) showed positive correlation. The decrease in organic matter content from wastewater canals to the center of the bay was significantly differ ent (P<0. Soil texture analysis showed that the sand content in the bay was affected by the coastal sea outside the bay during monsoon season while the silt content was affected by shrimp farm effluents during shrimp harvesting periods, which were significantly different among the survey stations (P<0. The quantity of shrimp harvesting affected C: N ratios and percentages of clay content in sediments which were also signifi cantly different among the survey stations (P<0. The sampling period was once N and longitude 101 53 101 55 E in Chathaburi province per month for 12 months from June 1994-May 1995. The bay is fringed in the inner parts by settling matter or sediment (gm/m2/day) in the bottle bot mangrove forest which is about 500 800 meters wide from toms was calculated as sediment according to the following landward to seaward edge (Raine 1992). Intensive shrimp equation: farm ponds are located around the bay behind the mangrove area with a total pond area of 348 ponds and approximately S = A x Q x 365/1,000 x 1,000 ton 142. To understand the impact of shrimp farm efflu 2 where S = sediment (ton), A = area (m), Q = settling ent around Kung Krabaen Bay on the surrounding environ 2 matter (sediment), Average per day (gm/m /day). Texture ment, it is important to assess the effect of these nutrients and organic matter were analyzed by the Walkely and Black on sediment quality in the discharge canal and water receiv method (Jackson 1958). This phorus were analyzed by the Kjeldahl method and the method study analysed sediment quality and sediment settling rate of Murphy and Rilly, respectively (Anthanan et al. A in water supply canals, water discharge canals and Kung mixture of soil and water (Soil : water = 1: 1) was used to Krabaen Bay. It was found that the sediment in the pe the total number of sampling or survey stations was 23 riod of the Southwest monsoon (Jun. During the Tookwinas S, Sangrungruang C, Matsuda O (1998) Study on the impact of intensive marine shrimp farm effluent on sediment quality in Kung Krabaen Bay, eastern Thailand. In the decreased with increasing distance from the shrimp farm monsoon season, the sediment was highest at the center of areas. The total nitrogen was highest during shrimp harvest the bay (survey stations 21,22 and 23).

Diseases

• Amelogenesis imperfecta nephrocalcinosis
• Lichen sclerosus et atrophicus
• Ectodermal dysplasia mental retardation syndactyly
• Weismann Netter Stuhl syndrome
• Gastroenteritis, eosinophilic
• Larsen syndrome craniosynostosis
• Spinal muscular atrophy type 3

Examination of fresh ulcer exudate for 10 days) blood pressure questions and answers buy 45mg midamor amex, iodoquinol (diiodohydroxyquin; 650 mg orally motile trophozoites and for E histolytica antigen may yield three times daily for 21 days) pulse pressure formula order midamor 45 mg with visa, and paromomycin (30 mg/kg a diagnosis heart attack kit buy discount midamor 45mg online. Side effects associated with luminal agents bodies are almost always positive blood pressure medication olmetec buy cheap midamor 45 mg online, except very early in the are fatulence with diloxanide froate blood pressure young male purchase cheap midamor on line, mild diarrhea with infection heart attack 5 fragger order midamor cheap. Thus, a negative test in a suspicious case should iodoquinol, and gastrointestinal symptoms with paromomy? be repeated in about a week. Relative contraindications are thyoid disease for iodo? can be used to test serum, with good sensitivity if used quinol and kidney disease for iodoquinol or paromomycin. Examination of stools for Treatment of intestinal amebiasis requires metronida? organisms or antigen is frequently negative; the antigen test zole (750 mg orally three times daily for 10 days) or tinida? is positive in -40% of cases. As imaging studies cannot zole (2 g orally once daily for 3 days for mild disease and distinguish amebic and pyogenic abscesses, when a diagno? 5 days for serious disease) plus a luminal agent (Table 35-6). Metronidazole often induces transient nausea, Detection of organisms in the aspirate is uncommon, but vomiting, epigastric discomfort, headache, or a metallic detection ofE histolytica antigen is very sensitive and diag? taste. The same toxicities and con? cerns probably apply for tinidazole, although it appears to be better tolerated. Fluid and electrolyte replacement is also important for patients with signifcant diarrhea. Surgical management of acute complications of intestinal amebiasis is best avoided whenever possible. Successful therapy of severe amebic colitis may be followed by postdysenteric colitis, with continued diarrhea without persistent infec? tion; this syndrome generally resolves in weeks to months. Alternatives for the treatment of intestinal amebiasis are tetracycline (250-500 mg orally four times daily for 10 days) plus chloroquine (500 mg orally daily for 7 days). Emetine or dehydroemetine, which are not available in the United States, can be given subcutaneously or intramuscularly in a dose of 1-1. Gross pathology showing intestinal are effective but cardiotoxic with a narrow therapeutic range ulcers dueto amebiasis. Outbreaks of diarrhea secondary to contaminated human feces; adequate cooking of food; protection of food water or food. Diagnosis mostly by identifing organisms in spe? cysts are resistant to standard concentrations of chlorine), cially stained stool specimens. These infec? of highly active antiretroviral therapy, particularly with tions occur worldwide, particularly in the tropics and in advanced immunosuppression. Theyare causes of endemic variable, but patients commonly have chronic diarrhea childhood gastroenteritis (particularly in malnourished with frequent foul smelling stools, malabsorption, and children in developing countries); institutional and com? weight loss. In immunocompetent persons, it usually causes a the infectious agents are oocysts (coccidiosis) or spores self-limited watery diarrhea lasting 2-3 weeks, with (microsporidiosis) transmitted from person to person or abdominal cramps, anorexia, malaise, and weight loss. Chronic symptoms may persist for Ingested oocysts release sporozoites that invade and multi? months. In immunocompromised patients, isosporiasis ply in enterocytes, primarily in the small bowel. Coccidian more commonly causes severe and chronic diarrhea, with oocysts and microsporidian cysts can remain viable in the complications including marked dehydration, malnutri? environment for years. Extraintestinal disease has I belli and C cayetanensis appear to infect only humans. C cayetanensis has caused a number of food-borne out? breaks in the United States in recent years, most commonly 3. Cyclosporiasis-C cayetanensis oocysts must undergo a associated with imported fresh produce. Sarcocystis infects period of sporulation of 7 days or more after shedding many species; humans are intermediate hosts (infected by before they become infectious. Therefore, person-to-person ingestion of fecal sporocysts) for some species but defni? spread is unlikely, and spread has typically been due to tive hosts for Sarcocystis bovihominis and Sarcocystis sui? contaminated food (especially fresh produce) and water. Cyclosporiasis causes an illness similar to Cryptosporidiosis is a zoonosis (C parvum principally that described for the other pathogens described in this infects cattle), but most human infections are acquired section, with watery diarrhea, abdominal cramps, nausea, from humans, in particular with C hominus. Symp? ridia are highly infectious and readily transmitted in day toms typically continue for 2 weeks or longer and may care settings and households. Diar? community outbreaks due to contaminated water sup? rhea may be preceded by a fu-like prodrome and followed plies (causing -400,000 illnesses in Milwaukee in 1993) by persistent fatigue. In immunocompromised patients, and are the leading cause ofrecreational water-associated cyclosporiasis is tyically more severe and prolonged, with outbreaks of gastroenteritis. Sarcocystosis-Sarcocystis infection maybe common in in Asia and Africa, Cryptosporidium was the second most some developing countries, but it is usually asymptomatic. In developing countries, disease is primarily lular protozoans that cause a wide spectrum of diseases. Infection is acute watery diarrhea, abdominal pain, and cramps, with mainly by ingestion of spores, but also by direct inocula? rapid resolution in most patients; however, symptoms quite tion of the eyes. In developed coun? ian infections most commonly present as self-limited tries, most patients are adults. Cryptosporidiosis-Treatment of cryptosporidiosis is Otherillnesses in immunocompromised persons associated challenging. An organism in stool using a modifed acid-fast stain; this tech? alternative therapy is pyrimethamine (75 mg orally in four nique is relatively insensitive, and multiple specimens should divided doses) with folinic acid (10-25 mg/day orally). Sarcocystosis-For sarcocystosis, no specific treatment stool evaluation is not high, and multiple samples should is established, but patients may respond to therapy with be examined. Infections with most species, including those stool wet mounts or after modifed acid-fast staining. Mul? causing gastrointestinal and other manifestations, should tiple specimens may need to be examined to make a diag? be treated with albendazole (400 mg orally twice daily for nosis. The organism can also be identified in small bowel 2-4 weeks), which has activity against a number of species, aspirates or biopsy specimens. Diagnosis is by identification of the bees and fsh with microsporidian infections, has shown acid-fast organisms in stool or by identifcation of tropho? benefit in clinical trials at a dose of 20 mg three times per zoites or bradyzoites in tissue biopsies. Electron microscopy is helpful for confirmation of gillin solution (3 mg/mL); this probably should be given the diagnosis and speciation. Adjunctive management may include corticosteroids to decrease inflammation and keratoplasty. Supportive treatment for severe or chronic diar? Water purifcation is important for control of these infec? rhea includes fuid and electrolyte replacement and, in tions. Chlorine disinfection is not effective against crypto? some cases, parenteral nutrition. Immunocompromised patients should boil or fl? fo od, by person-to-person contact, or by anal-oral sexual ter drinking water and should consider avoidance of lakes contact. After the cysts are ingested, trophozoites emerge in gloves, disinfection) should prevent institutional patient? the duodenum and jejunum. Hypogammaglobulinemia, ridial infections are not well understood, but water low secretory IgA levels in the gut, achlorhydria, and mal? purifcation and body substance precautions for immuno? nutrition favor the development of infection. A review of the global burden, novel diagnos? tics, therapeutics, and vaccine targets for cryptosporidium. Intestinal protozoan infections in the immuno? period is usually 1-3 weeks but may be longer. The acute phase may last days or weeks, and is usually self-limited, although cyst excretion may be prolonged. Typical symptoms of chronic disease are abdominal cramps, bloating, fatulence, nausea, malaise, and anorexia. Abdominal cramps, distention, flatulence, and rent; intervening periods may include constipation. Chronic disease can include malabsorption, including fat and protein-losing enteropathy and vitamin deficiencies. General Considerations Giardiasis is a protozoal infection ofthe upper small intes? B. Laboratory Findings tine caused by the fagellate Giardia Iamblia (also called Most patients seek medical attention after having been ill Giardia intestinalis and Giardia duodena/is). In developing countries, young children are traditionally made by the identifcation of trophozoites or very commonly infected. A wet mount of liquid stool may identif the infection is the most common intestinal protozoal motile trophozoites. Sensitivity of stool analysis is not infections leading to 5000 hospital admissions yearly. Sampling of duodenal contents areas, those who swallow contaminated water during rec? with a string test or biopsy is no longer generally recom? reation or wilderness travel, men who have sex with men, mended, but biopsies maybe helpful in veryill or immuno? and persons with impaired immunity. Multiple tests, which identif antigens of the organism occurs in feces as a fagellated trophozo? trophozoites or cysts, are available. Only the cyst form is infectious bythe oral sensitive (85-98%) and specific (90-100%). Under suitable moist, cool conditions, cysts can the treatments of choice for giardiasis are metronidazole survive in the environment for weeks to months. Cysts are (250 mg orally three times daily for 5-7 days) or tinida? transmitted as a result of fecal contamination of water or zole (2 g orally once). Toxicities are as described for treatment of be acquired by other means, since it can survive in moist amebiasis, but the lower dosages used for giardiasis limit environments for several hours. Albendazole (400 mg orally once daily for 5 days) and nitazoxanide (500 mg orally twice daily for 3 days) both appear to have similar efcacy and fewer. Symptoms and Signs are limited, and a recent meta-analysis suggested superi? ority in efficacy of tinidazole over albendazole. Forwomen Nitazoxanide is generally well tolerated but may cause with symptomatic disease, after an incubation period of mild gastrointestinal side effects. Other drugs with activ? 5 days to 4 weeks, a vaginal discharge develops, often with ity against Giardia include furazolidone (100 mg orally vulvovaginal discomfort, pruritus, dysuria, dyspareunia, or four times a day for 7 days), which is about as effective as abdominal pain. Examination shows a copious discharge, the other named drugs but causes gastrointestinal side which is usually not foul smelling but is often frothy and effects, and paromomycin (500 mg orally three times a yellow or green in color. Infammation of the vaginal walls day for 7 days), which appears to have somewhat lower and cervix with punctate hemorrhages are common. Most efficacy but unlike metronidazole, tinidazole, and fura? men infected with T vagina/is are asymptomatic, but it can zolidone is safe in pregnancy. Symptomatic giardiasis be isolated from about 10% of men with nongonococcal should always be treated. In men with trichomonal urethritis, the urethral patients should be considered, since they can transmit the discharge is generally more scanty than with other causes infection. Diagnosis is typically made byidentifing the organism in vaginal or urethral secretions. Newer diagnos? For wilderness or international travelers, bringing water tictests include point-of-care antigen testsand nucleic acid to a boil for 1 minute or fltration with a pore size less amplification assays, both of which offer improved sensi? than 1 mcm are adequate. In day care centers, appropri? tivity compared to wet mount microscopy and excellent ate disposal of diapers and frequent handwashing are specificity. A meta-analysis of the efficacy of albenda? the treatment of choice is tinidazole or metronidazole, zole compared with tinidazole as treatments forGiardiainfec? each as a 2 g single oral dose. Treatment of giardiasis: current status and icities of these drugs are discussed in the section on amebi? future directions. Treatment failure suggests rein? fection, but metronidazole-resistant organisms have been reported. These may be treated with tinidazole, longer courses of metronidazole, furazolidone, or other experi? mental therapies (see Chapter 18). Dermatitis can be caused by human schisto? rhea, and hepatomegaly, progressing to anorexia, somes and, in non-tropical areas, by bird schistosomes that weight loss, and features of portal hypertension. Acute schistosomiasis (Katayama syndrome)-A progressing to hydroureter, hydronephrosis and febrile illness may develop 2-8 weeks after exposure in urinary infections. Presenting urine; biopsy ofrectal or bladder mucosa; positive symptoms and signs include acute onset of fever; head? serology. Acute schistosomiasis usually Schistosomiasis, which affects more than 200 million per? resolves in 2-8 weeks. Chronic schistosomiasis-Many infected persons have persons and about 100,000 deaths annually. The disease is light infections and are asymptomatic, but an estimated caused by six species of trematode blood fukes. Five spe? 50-60% have symptoms and 5-10% have advanced organ cies cause intestinal schistosomiasis, with infection of damage. Asymptomatic infected children may suffer from mesenteric venules: Schistosoma mansoni, which is present anemia and growth retardation. Symptomatic patients with in Africa, the Arabian peninsula, South America, and the intestinal schistosomiasis typically experience abdominal Caribbean; Schistosoma japonicum, which is endemic in pain, fatigue, diarrhea, and hepatomegaly. Over years, China and Southeast Asia; Schistosoma mekongi, which is anorexia, weight loss, weakness, colonic polyps, and fea? endemic near the Mekong River in Southeast Asia; and tures of portal hypertension develop. Late manifestations Schistosoma intercalatum and Schistosoma guineensis, include hematemesis from esophageal varices, hepatic which occur in parts of Africa. Urinary schistoso? causes urinary schistosomiasis, with infection ofvenules of miasis may present within months of infection with hema? the urinary tract, and is endemic in Africa and the Middle turia and dysuria, most commonly in children and young East. Control efforts have dimin? hydroureter, hydronephrosis, bacterial urinary infections ished transmission significantly in many areas, but high and, ultimately, kidney disease or bladder cancer. Humans are infected with schistosomes after contact Microscopic examination of stool or urine for eggs, evalu? with fresh water containing cercariae released by infected ation of tissue, or serologic tests establish the diagnosis. Infection is initiated by penetration of skin or Characteristic eggs can be identifed on smears of stool or mucous membranes. The most widely used stool test is the Kato-Katz migrate to the portal circulation, where they rapidly technique. After about 6 weeks, adult worms mate, and per gram offeces or 10 mL of urine are indicative of heavy migrate to terminal mesenteric or bladder venules, where infections with increased risk of complications. Some eggs reach the lumen of can also be made by biopsy of the rectum, colon, liver, or the bowel or bladder and are passed with feces or urine, bladder. Disease in endemic areas is primarily due to a is 99% forS mansoni, 95% for S haematobium, but less than host response to eggs, with granuloma formation and 50% for S japonicum.

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