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By: William A. Weiss, MD, PhD
- Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
Sex and gender It is important to order viagra capsules 100 mg otc severe erectile dysfunction causes understand the difference between sex and gender purchase 100mg viagra capsules with amex impotence liver disease, as gender roles that are cultur ally designed roles tend to buy viagra capsules 100mg lowest price male erectile dysfunction pills be understood as natural roles viagra capsules 100 mg lowest price erectile dysfunction doctor milwaukee. Key message: Sex and Gender Sex refers to human biological characteristics of being female, male or other (in the case of trans gender or intersex people who do not necessarily recognise themselves in those binary catego ries). Gender refers to the roles, attributes and entitlements assigned to people by society based on their sex. Sexual diversity “All human beings are born free and equal in dignity and rights” states Article 1 of the Universal Declaration of Human Rights. The Universal Declaration of Human Rights recognises the right to sexuality; the right to express one’s sexuality, free from discrimination based on sexual orientation or sexual identity. However, around the world laws continue to criminalize same sex relationships and cross-dressing, represent ing a violation of fundamental human rights, including to privacy and non-discrimination. Human rights are the basic rights and freedoms that belong to every person in the world, from birth until death. They apply regardless of where you are from, what you believe, or how you choose to live your life. Human rights are relevant to all of us, not just those who face repression or mistreatment. They protect you in many areas of your day-to-day life: here are just some of the main rights and freedoms they support: your right to a private and family life as well as expressing your opinions, and your right not to be mistreated or wrongly punished by the state. Human rights also apply to children, however, there are offcial Children’s Rights as well. A summary of the Convention of the Rights of the Child can be found through the link below. Gender equality, equity or justice are important principle that can be used to explain that men and women, as well as people of the third gender, all have equal rights. Defnition Gender equality Defnition Gender justice Gender equality refers to the equal rights, re Gender justice is used to refer to ending the in sponsibilities and opportunities for people of all equalities between women and men that are pro sexes and gender identities. Equality does not duced and reproduced in the family, the commu mean that women, men and others will become nity, the market and the state. It also requires that the same, but that their rights, responsibilities mainstream institutions from justice to econom and opportunities will not depend on their sex, ic policymaking are accountable for tackling the nor gender. Defnition Gender equity Gender equity is used to refer to fair treatment Defnition Sex and gender-based discrimination of women and men, according to their respec Sex and gender-based discrimination refers to tive needs. This may include equal treatment, or any distinction, exclusion, or restriction made on treatment that is different but aiming at acceler the basis of people’s sex and gender, in a way ating de facto equality between men and wom that prevents them from enjoying their funda en. These types of treatment, called “positive mental rights and freedom, even unintentionally. Key message: Equal rights and opportunities Everyone has equal rights and should have equal opportunities, despite their gender, culture, reli gion or age. This means women and girls have the same rights as men and boys, as well as people who do not necessarily recognise themselves in those binary categories. Gender roles Gender is a social construct, this means that these roles are based on cultural and social norms and beliefs. Some of these roles might seem to be related to biological differences (sex), such as a mother taking care of children, but they are not. A father might want to play or take care of his children, but according to the existing gender roles this might make him look weak. The exercises in this chapter help participants to critically look at existing gender roles. Activity: Existing gender roles of boys and girls in your country and village Time: 40 minutes Materials: Flip-chart, markers this is a simple exercise to help participants see the differences between sex and gender by using a practical example of how gender roles are taught by socialization. It is important to understand that our gender roles appear and feel completely natural as we grow up, however they are cultural. Girls and boys are taught their gender roles as normally as they are taught anything else. Girls and boys are taught that they have different roles to play in the family and in the home. For example, children are taught that it is girls and not boys who must help with housework like washing and cooking and that it is the woman’s role to serve the man and that it is the man’s role to be head of the household. Ask the two groups to discuss what it means to grow up as a boy and a girl in their community, starting from birth to about 10 years old. Ask them to think about the different ways that boys and girls are supposed to act, how they are treated, the differences in importance and value between the two as they grow up. For example, during adolescence a girl may be made to take care of her younger siblings, do household chores or expected to be quieter than boys. Now ask the groups to talk about the differences in how adolescent (11 – 18-year-old) girls and boys are treated and the things they are asked to do/their responsibilities. Bring the two groups back together and ask each group to present what they discussed to the main group. Re-iterate from earlier learning that this is sex, which is the biological differences between boys and girls. Ask them to identify in their timeline the biological differences between boys and girls. After a few minutes of discussion on the above ask questions to stimulate discussion about gen der how we socialize girls and boys differently. Explain that gender is what we -culture and community- teach girls and boys about what they can and can’t do. That gender is the social role that each of us is supposed to adhere to and can be changed but our sex cannot be changed.
Kim August 2 buy 100 mg viagra capsules overnight delivery erectile dysfunction case study, 2011; 77: e28-e32 July 7 cheap viagra capsules 100mg on line chewing tobacco causes erectile dysfunction, 2009; 73: e1-e7 177 A 75-year-old woman with visual disturbances and 205 A child with pulsatile headache and vomiting unilateral ataxia L purchase viagra capsules 100 mg with mastercard erectile dysfunction symptoms age. Feske July 19 buy cheap viagra capsules 100 mg doctor for erectile dysfunction in ahmedabad, 2011; 77: e16-e19 August 19, 2014; 83: e89-e94 187 A 55-year-old woman with vertigo: A dizzying 215 A 24-year-old woman with progressive headache and conundrum somnolence D. Jha June 3, 2014; 82: e188-e193 194 A 33-year-old woman with severe postpartum occipital headaches 221 An 87-year-old woman with left-sided numbness N. This book would not have been possible without the encouragement of Patty Baskin, Executive Editor, and the leadership of Dr. Bob Gross, Editor-in-Chief, both of whom have always been tremendous supporters of the Resident & Fellow Section. Finally, and in particular, we acknowledge Kathy Pieper, Managing Editor of Neurology, for her dedication, passion, and commitment to excellence in this project, as in so many others. The quality of the content is superb, submissions are plentiful, and our staff of young editors is enthusiastic and talented. These case discussions are the stuff by which we all learned neurology, and are here collected to educate trainees across the country. This effort also serves as a reminder of the educational mission of the section, which is now giving back to our community beyond its usual publications. Elkind, of extensive “book knowledge”—neuroanatomy, that is at the core of clinical neurology. To see the clinical effects of precise lesions lished in the Clinical Reasoning section describing firsthand, to hear the stories of patients suffering from diverse diagnoses, challenging clinical quandaries, neurologic disease, and to discuss these findings with and daunting management dilemmas. Most were one’s clinical teachers at the bedside: these are the written by residents and fellows, supervised by fac experiences that transform students of neurology into ulty, and are thus geared toward those learning clini clinical neurologists. Many of these fascinating the process of clinical reasoning is learned through cases and the accompanying discussions, however, practice: trying to localize the lesion that explains a pa are likely to be as informative to experienced neurol tient’s symptoms and signs, attempting to reconcile ogists as to trainees. For this anthology we have com disparate elements of the history and examination, piled cases that span the major cardinal presentations judging when to obtain and how to interpret neuro of neurologic disease. Each section begins with a brief diagnostic tests, conferring on complex cases with one’s introduction to the clinical approach for a particular peers and mentors, and seeing the evolution of neuro realm of neurology, but leaves the detailed discussions logic disease and how it may be modified by treatment. Yet such experiences shared between colleagues or We hope that our readers will enjoy the opportu between teachers and students are rarely recorded nity to learn from this collection, case by case. Berkowitz has received speaker honoraria from Stevens Institute for case reports that capture the art and science of of Technology and AudioDigest, and receives publishing royalties for Clin ical Pathophysiology Made Ridiculously Simple,MedMaster,2007andThe clinical neurology. Declarative memory as complex cognitive functions including attention, relies upon the integrity of the Papez circuit in memory, language, visuospatial processing, and the mesial temporal lobes and diencephalon, emotional processing. These are the quintessential including entorhinal cortex, the hippocampus, functions that make us human. In the context of the fornix, the mammillary bodies, the mammil neurologic illness it is possible to witness the extent lothalamic tract, the anterior nucleus of the thal to which the elements of cognition can become frac amus, and the cingulate cortex. Diseases that tured and separable; dysfunction in individual cog affect these structures produce anterograde amne nitive domains helps us to understand their sia, with impaired ability to recall newly encoded fundamental nature. A careful examination of rior temporal lobe, the arcuate fasciculus, and the a patient’s mental state can therefore yield enor Broca area in the inferior frontal lobe. This network mous information about the localization and differ is typically represented in the left hemisphere, but ential diagnosis of lesions affecting the cerebral there may be bilateral or right hemispheric repre hemispheres. Homologous areas in • Arousal relies upon connections from the ascending the right hemisphere contribute to the generation reticular activating system, which originates in the and processing of music as well as prosody of lan rostral brainstem and projects to both thalami and guage. The evaluation of sions in the rostral brainstem or in both hemi language function includes an assessment of flu spheres can impair arousal, placing a patient on a ency, naming, repetition, comprehension, reading, spectrum of states of altered consciousness that in and writing. Lesions in the language networks pro cludes drowsiness, somnolence, obtundation, duce aphasia, which may be characterized as recep a minimally responsive vegetative state, and coma. To evaluate atten • Visuospatial processing relies upon distributed net tional mechanisms, one can observe the patient’s works that compose the “dorsal stream,” which in ability to answer directed questions and avoid dis cludes parietal areas specialized for processing tractions. Lesions that dis assessing digit span, having the patient spell a word rupt right parietal areas and their networks may backwards, or having the patient continue specific produce the clinical syndrome of hemispatial patterns. Higher-order visual processing also relies lateral prefrontal cortex demonstrate impaired on a “ventral stream,” which includes inferior tem attention and working memory. Lesions of the poral areas specialized for processing visual features medial frontal lobes can produce akinetic mutism, of an object, a face, or a scene. Lesions of the orbi formed by the limbic system of the brain, which tofrontal cortex produce disinhibited behaviors that includes the cingulate cortex, amygdala, thalamus, may transgress accepted social norms. These regions contribute to • Memory can be divided into declarative memory consciously experienced emotions but also have (which encompasses episodic memory for auto strong connections with functions unconsciously biographical events and recognition memory for carried out by the autonomic nervous system. Perrier Memory Center of an academic hospital for progres activities autonomously. His past medical history in tation progressed until he ultimately got lost in the C. There was no family history of any psychiat he began making sexually inappropriate comments that ric or neurologic disorders. Address correspondence and the patient’s symptoms began 3 years prior to pre the neuropsychological evaluation upon ad reprint requests to Dr. Karl sentation with memory loss and word-finding difficul mission revealed a severe amnestic syndrome, dif Mondon, Centre Me moire de Ressources et de Recherche, ties. Six months later, his wife observed a progressive ficulties in naming and verbal comprehension, Ho pital Bretonneau, 2 Bd loss of interest in his previous hobbies and increasing visuospatial impairment, a cognitive and behav Tonnelle, 37044 Tours, Cedex, France apathy. Twelve months after symptom onset, the pa ioral prefrontal syndrome, and multimodal visual karl. At the same time, his wife observed a personal neurologic examination was normal.
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Sydenham chorea (St Vitus dance) Regarded as a major neurological manifestation of rheumatic fever buy viagra capsules 100 mg without a prescription impotence quitting smoking. Cardiological aspects • All children should be evaluated for rheumatic cardiac valve disease and if found should commence anti-streptococcal penicillin prophylaxis order viagra capsules 100mg on line icd 9 erectile dysfunction nos. Encephalitis lethargica/post-encephalitic Parkinsonism • A striking picture of extrapyramidal movement disorder (particularly akinesia) and oculogyric crisis with disturbed arousal (prolonged coma and/or disrupted sleep wake cycle) presenting weeks to cheap 100mg viagra capsules otc erectile dysfunction and diabetes ppt years after a febrile illness with sore throat buy viagra capsules 100mg with visa erectile dysfunction natural remedies over the counter herbs. It is possible that a large proportion of encephalitic illnesses that would previ ously have been ‘presumed viral’ are in fact autoimmune in origin. Symptoms re ect dysfunction of the hippocampus (short-term memory loss), the remainder of the limbic system (confusion, seizures, psychosis) and/or brainstem (central hypoventilation), producing a ‘limbic encephalitis’ syndrome. History and examination the following features may present with an acute or subacute onset and not all need be present: • Behavioural change, agitation or neuropsychiatric symptoms: often a uctuating, encephalopathic course. Important differentials include infectious encephalitis, glioma, lymphomatous in ltration, Hashimoto’s encephalopathy. Blood Speci c antibody assays should be requested after discussion with the relevant laboratory. The initial response may be dramatic with an arrest of symptoms and rapid acquisition of lost skills, but relapse can occur and long-term prognosis is not known. Neurological presentation is of diffuse cortical dysfunction: • Seizures, sometimes prolonged, particularly with persisting coma. Initial treatment with steroids often effective, but long-term steroid depend ency is common and alternative steroid-sparing immunosuppression is required. Paraneoplastic syndromes of the nervous system Rare in childhood (most commonly associated with small-cell lung cancer, gynaecological and breast tumours, or Hodgkin’s lymphoma in adults), but developmental of antineuronal antibody tests in a clinical context has allowed prompt recognition and treatment. Examples • Cerebellar degeneration syndromes with anti-Tr and –mGluR antibodies associated with Hodgkin lymphoma. Peripheral nervous system manifestations Commonly involve tumours that derive from cells that produce immu noglobulins. Note: the pattern and severity of the movement disorder may evolve during childhood mimicking a progressive neurological disorder—investigate further if in doubt (see b p. The main justi cation for its retention is a prag matic one relating to planning and provision of services, as these children tend to have similar needs whatever the cause. Classic descriptions of the cerebral palsies Classic categories are based on the predominant movement disorder (spasticity, athetosis, etc. This is a useful framework for epidemiological studies, but inadequate for clinical care of the individual child (see b ‘Classi cations for clinical care’, p. Types of movement disorder Presence not only of spasticity, but often under-recognized concurrent dystonia, dyskinesia/athetosis/hyperkinesia, ataxia, hypotonia. Severity of motor impairment Distinguish and individually quantify spasticity, strength, presence of xed contractures, and coordination. Known neuroimaging ndings • Periventricular leukomalacia, cerebral malformations, etc. Aetiology and risk factors for a cerebral palsy Multiple risk factors and aetiologies often interact, hence the term ‘causal pathway’ to describe this complex process. Evidence against intrapartum hypoxia as the main cause • History of only mild neonatal encephalopathy (Sarnat grade I). Results will focus further investigations; recommended for all children, particularly term-born. Consider Biotinidase de ciency, 3-phosphoglycerate dehydrogenase de ciency, Pelizaeus–Merzbacher, congenital disorders of glycosylation, Menkes, Sjoegren–Larsson, other metabolic leukodystrophies. Involvement of the globus pallidus or caudate is suspicious for metabolic disease (especially mitochondrial disease and organic acidurias). Cortical infarctions Symmetrical parasagittal and parieto-occipital/fronto-parietal watershed lesions can result in spastic quadriparesis. Focal symmet rical infarctions in perisylvian areas can lead to the Worster–Drought phe notype. Cystic encephalomalacia Multiple subcortical cysts and gliosis occur (iT2 signal in remaining white matter); there is septation in the cysts. If diffuse consider neonatal/infantile menin gitis; if there are watershed areas, consider severe perinatal ischaemic injury. Schizencephaly this is a neuronal migration disorder; speci c genes are implicated. Many speci c genetic disorders: can also be caused by early to mid-gestational teratogens. Agenesis of corpus callosum suggests an early gestation insult, typically genetic cerebral dysgenesis. Inferior cerebellar hemisphere atrophy in extreme preterm survivors is associated with increased disability. Vermis atrophy may follow severe perinatal ischaemic injury—associated cortical, basal ganglia and brainstem lesions should be visible. Increases in limb length, and body and limb weight have adverse biomechanical effects on children with precarious mobility. Note that in more severely impaired children (Gross Motor Function Classi cation System (see Figure 4. Change the child’s environment (address discriminatory attitudes or legislation, lack of adapted facilities or appropriate services) and the same child’s participation could dramatically improve without any change in impairment. In situations where we can do little to reduce impairment, devoting energy to improving the environment in which the impaired child lives may have much greater effects on participation. Numerous structured observational scales and questionnaires exist for measuring motor impairments and functions of daily living. Simple and widely used, but not entirely reliable as speed of movement is not speci ed.
The effectiveness of pulsed electrical stimulation in the management of osteoarthritis of the knee: Results of a double-blind viagra capsules 100 mg for sale erectile dysfunction at age 26, randomized safe 100 mg viagra capsules fda approved erectile dysfunction drugs, placebo-controlled buy 100mg viagra capsules fast delivery erectile dysfunction treatment medscape, repeated-measures trial viagra capsules 100 mg visa erectile dysfunction pills in malaysia. Effect of In-Bed Leg Cycling and Electrical Stimulation of the Quadriceps on Global Muscle Strength in Critically Ill Adults: A Randomized Clinical Trial. Stimulation of bone healing in new fractures of the tibial shaft using interferential currents. Is Interferential Current Before Pilates Exercises More Effective Than Placebo in Patients With Chronic Nonspecific Low Back Pain Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation Page 21 of 25 UnitedHealthcare Commercial Medical Policy Effective 01/01/2020 Proprietary Information of UnitedHealthcare. Effectiveness of Interferential Current Therapy in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis. A 3-month, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a highly optimized, capacitively coupled, pulsed electrical stimulator in patients with osteoarthritis of the knee. Microcurrent transcutaneous electric nerve stimulation in painful diabetic neuropathy: a randomized placebo-controlled study. Interferential current therapy in patients with knee osteoarthritis: comparison of the effectiveness of different amplitude-modulated frequencies. Dorsal Root Ganglion Stimulation for the Treatment of Complex Regional Pain Syndrome. Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease. Dose-response relation between neuromuscular electrical stimulation and upper extremity function in patients with stroke. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Interferential therapy electrode placement technique in acute low back pain: a preliminary investigation. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee. Effect of functional electrical stimulation on cardiovascular outcomes in patients with chronic heart failure. Impact of Scrambler Therapy on Pain Management and Quality of Life in Cancer Patients: A Study of Twenty Cases. Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis: A Randomized Trial. Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation Page 22 of 25 UnitedHealthcare Commercial Medical Policy Effective 01/01/2020 Proprietary Information of UnitedHealthcare. Efficacy of microcurrent therapy in the treatment of chronic nonspecific back pain: a pilot study. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Short-term microcurrent electrical neuromuscular stimulation to improve muscle function in the elderly: A randomized, double-blinded, sham-controlled clinical trial. Ultra-low microcurrent in the management of diabetes mellitus, hypertension and chronic wounds: report of twelve cases and discussion of mechanism of action. A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain. One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Long-term effectiveness of neuromuscular electrical stimulation for promoting motor recovery of the upper extremity after stroke. Peripheral nerve field stimulation for the management of localized chronic intractable back pain: results from a randomized controlled study. Electroacupuncture Improves Intestinal Dysfunction in Septic Patients: A Randomised Controlled Trial. Effects of transcutaneous electrical acupoint stimulation on quality of recovery during early period after laparoscopic cholecystectomy. Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: a multisite, retrospective assessment. Functional electrical stimulation for drop foot of central neurological origin: guidance. Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in Intensive Care Unit survivors: A randomized trial. Effects of short-term daily community walk aide use on children with unilateral spastic cerebral palsy. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Efficacy of Selected Electrical Therapies on Chronic Low Back Pain: A Comparative Clinical Pilot Study. Randomized double-blind sham-controlled crossover study of short-term effect of percutaneous electrical nerve stimulation in neuropathic pain. Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation Page 23 of 25 UnitedHealthcare Commercial Medical Policy Effective 01/01/2020 Proprietary Information of UnitedHealthcare. A pilot study of functional electrical stimulation cycling in progressive multiple sclerosis. Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation. Spinal cord stimulation of the dorsal root ganglion for groin pain-a retrospective review. Comparison of the Effects of Contralaterally Controlled Functional Electrical Stimulation and Neuromuscular Electrical Stimulation on Upper Extremity Functions in Patients with Stroke. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial.