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A lot of people have now heard the word Candida purchase 5 mg altace amex arteria gastroduodenalis, but for those who have not altace 10mg cheap heart attack hospital stay, Candida Albicans is one of the many bugs which is to buy altace 5mg with mastercard arrhythmia when sleeping be found living in and on all of us cheap 5 mg altace mastercard heart attack hill. It is a fungus, one of the yeast family of organisms, and is best known for causing thrush in the mouths of babies sore white, moist plaques in the mouth and on the tongue, and thrush in the vaginas of women (which is where the babies pick it up, during birth). It can also cause nappy rash, and soreness and itching around the anus and genitals in adults. This yeast lives in small numbers in the gut, and on the skin, especially in warm moist areas. In a healthy person with a strong defence system, Candida keeps its place and does not cause any symptoms. It is so prevalent that at least 90 per cent of children have had exposure to it by the time they are six months old (based on tests done on skin reactions). The most extreme cases of Candida infection in all parts of the body (including the bloodstream, lungs and brain) are in ill people with severely collapsed immunity. Candida is only one of a huge variety of yeasts, viruses and bacteria which live on, in and around us. The large bowel contains several pounds in weight of bacteria, most of which are necessary for the manufacture of some vitamins, the fermentation of undigested food, and the breakdown of mucus. There are some circumstances which may allow Candida to multiply and cause trouble: Factors that Favour Candida Overgrowth. The imbalance of microbes thus created is known as dysbiosis a disharmony of bugs. Although not recognised by many doctors, dysbiosis is known to and treated by veterinarians. Antibiotics used for a short course, and selected to kill specific bugs, such as penicillin for tonsillitis, do less harm. Two conditions for which long-term broad-spectrum antibiotics tend to be prescribed are acne and recurrent cystitis. It is unfortunate that these problems may actually be caused by a Candida infection, and made worse by antibiotics. Another source of long-term antibiotics may be from meat and poultry that comes from intensively-reared animals. Their foodstuff may have antibiotics added to prevent infections that result from poor, overcrowded conditions. The quantity is of course small, but must have some effect on humans over a period of time. Pneumonia used to kill many people, and infection and gangrene killed many thousands in the First World War. In the last two decades there has been a tendency to overprescribe broad-spectrum antibiotics, however, often using them as an umbrella lactic, instead of encouraging the body to overcome what may be quite a minor infection, or for a virus infection which is not touched by antibiotics anyway. So a generation has grown up who may have had antibiotics many times in childhood for ear or throat infections, in adolescence for spots, and as young adults for bouts of flu or bladder infections. Given favourable conditions, Candida can proliferate quite fast, and cause local symptoms. It is thought that Candida may produce toxins by its action on fermenting sugar, producing a nasty substance called Acetaldehyde. This would explain why the symptoms of a bowel Candida infection can resemble those of an alcoholic hangover, i. The ability of Candida to ferment sugar is the basis of the sugar fermentation test used in investigations of the gut. These symptoms may result not from the yeast infection itself, but from hypersensitivity to Candida Albicans. However, there are some clear indications of Candida overgrowth or hypersensitivity. If you answer yes to one or more of the history questions, and have two or more positive symptoms, then it is likely that Candida plays some part in your illness. There is no one reliable blood test that can tell you if Candida Albicans is causing your symptoms. Skin testing with diluted Candida extract produces a positive result in most of the population, so this test does not help. The headaches, irritability, lethargy and lack of concentration that are so common in M. Before studying ways of overcoming Candida infections please understand that: a) not everyone with M. The Anti-Candida Diet the reasons for making changes in how you eat are to deprive Candida of its nourishment, which is sugar, to avoid consuming any other moulds or fungi, and to eat nutritiously to strengthen the natural defences. Now, if you have put into practice the guidelines for healthy eating described in Chapter 11, then you are half way there. A strict anti-Candida diet would also prohibit bread made with yeast, cheese, vinegar, anything else fermented such as soy sauce; it would also restrict carbohydrate intake to about 80 gm a day, and would prohibit milk and its products. What is more important than restricting carbohydrates is to cut out all refined carbohydrates sugar of all kinds and refined flour, and to eat more complex carbohydrates. In practice, a sensible compromise is to have no more than one piece of fresh fruit a day, and to avoid those high in sugar (honeydew melon, bananas) and those with yeasts or the skin (grapes). Any food which is mouldy, so vegetables and fruits should be as fresh as possible Foods Allowed in Moderation. Wholemeal bread ideally none at all if made with yeast for the first four weeks, then perhaps two medium sized slices a day if tolerated (if not, it will probably cause bloating and worsening of symptoms). Fresh fruit On a really strict diet, you would not have anything from this final category, nor any milk or milk products.

Communicability: from one week before to order 2.5mg altace amex blood pressure position three Management and treatment of the patient as per weeks after the onset of paroxysmal coughing 5 mg altace with mastercard blood pressure how to read. Appendices 2 5mg altace amex blood pressure chart vertex, 3 and 4 Epidemiological summary Prevention of cross-infection as per Appendix 1 There are approximately 20?40 million cases of pertussis worldwide each year buy altace 5mg with visa blood pressure quick fix, 90% of them in Health education and health promotion developing countries; there are an estimated As for diphtheria 200 000?300 000 deaths each year. A particularly infectious stage of the illness Spasmodic stage (or paroxysmal stage). The rapid expulsion of air followed by gasping Page 139 for breath through a narrowed glottis results in the characteristic high pitched ?whoop which gives the condition its name. Like measles, pertussis can ?unmask underlying bacteria thus shortening the period of infectivity tuberculosis. This may reduce the possibility of Age groups affected secondary infection (if started early enough). Pertussis may occur at any age but most cases of Antibiotics do not influence the course of the serious illness and death are observed in infants clinical disease unless given within the first 5 days and young children. Prognosis Prevention of spread Pertussis is one of the most lethal diseases in infants Immunization (see Module 2). General infection control measures to prevent the prognosis is worse for children who are spread: see Appendix 1. The Make a list of true and false contraindications prognosis is better for patients over one year of age to vaccination with pertussis. Erythromycin, if given in the early incubation period to close contacts under one year of age, may prevent the disease in selected individual cases. The Role of hospital/community setting difficulty in early diagnosis, the costs, and concerns. Management and treatment of the patient as per related to antibiotic resistance, limit the treatment Appendices 2, 3, and 4 of secondary cases. The virus is one of the paramyxovirus family, and Complications commonly affects bilateral as opposed to unilateral. The virus may spread in usually affects one side (up to 20% of symptomatic the bloodstream to involve other organ systems and cases in postpubertal males). Hepatitis, oophoritis, myocarditis, thyroiditis and the saliva of an infected patient, and by contact nerve deafness are rare but potential complications. As vaccine uptake increases, cases swelling has disappeared tend to occur in older children and unvaccinated adults. Epidemiological summary the virus is present throughout the world and at Prognosis least 50% of infections are asymptomatic. Cases Excellent, even with extensive organ system usually occur in winter and spring. The disease is not considered eradicable and Diagnosis has a low priority in terms of efforts to control it. Mumps virus can be grown in tissue culture the laboratory from Manifestations saliva, urine and cerebrospinal fluid. Acute serum Prodromal symptoms may present 1 or 2 days before can be sent to check for antibody formation. Prevention of spread the effects of mumps are limited by immunizing As the infection progresses there is: childhood populations, this is particularly. It is expected that as vaccine uptake increases cases will occur more predominantly in older children. Methods of screening and contact tracing Nil specific Nursing care See Appendix 2, but specifically. Avoid highly flavoured acidic foods and drinks Role of primary health care team Vaccination and public health education Role of hospital/community setting. The rash may suggest rash which is only of importance given the damage measles on the first day and scarlet fever on the it may cause to the foetus when a mother contracts second. During an Transmission is by airborne droplet spread from epidemic, febrile lymphadenopathy for a week or the nose and throat of an infected patient and from more without a rash may represent over 40% of direct contact with the patient or secretions. The risk of congenital affected by congenital rubella can continue to shed abnormality depends on the time of infection the virus in nose and throat secretions and in urine during pregnancy. The epidemic which occurred in Estonia in 1993 was brought under control following the Manifestations of congenital rubella introduction of rubella vaccination in 1993. Congenital defects of the heart, eyes, and ears was a reported increase in Lithuania in 1994. There may be slight malaise and tender lymph nodes behind the ears and over Age groups affected the occiput for 1?2 days. Older children or adults Anyone who has not had rubella infection or rubella may have arthralgia or polyarthritis affecting small vaccine. Prognosis Erythematous macules appear first on the face and the prognosis for patients with acquired infection spread rapidly over the trunk and extremities. Exclude a patient with rubella from school or work until 7 days after onset of rash. Avoid exposure of pregnant women Screening and contact tracing A rubella antibody test will establish immunity status in exposed women. Pregnant women who are not immune should not normally receive vaccine whilst pregnant but should be immunised following delivery. Inadvertant administration of vaccine in pregnancy congenitally acquired infection is poor. Nursing care Diagnosis Symptomatic Clinical diagnosis is unreliable and the infection can be asymptomatic. Acute rubella can only be Role of primary health care team confirmed with laboratory diagnosis of IgM Ensure uptake of vaccination and public health antibody. Either technique can be used for Role of hospital/community setting men and non-pregnant women. The possibility of termination of pregnancy or very close follow up Health education and health promotion of foetal development should be discussed with Advice to females planning pregnancy to check parents following infection in early pregnancy.

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This infection is very common in pregnant women buy cheap altace 5mg heart attack questions, especially in the last trimester of pregnancy order 10mg altace blood pressure medication for kidney transplant patients, when a variation of progesterone order altace 5 mg without prescription pulse pressure wave, estradiol and glycogen buy cheap altace 2.5 mg line blood pressure medication gout sufferers, associated with an increase in vaginal pH, favors the emergence of these infections. In this case, special attention should be given due to the potential occurrence of contamination of the fetus in the uterus, or even the child during childbirth. On the other hand, it has been observed that, in individuals with diabetes, the incidence of vaginal candidiasis is higher. In men, balanitis, which usually appear after sexual contact, is characterized by the appearance of a rash, more or less prickly, followed by small pustules on rocking groove-preputial discharge, more or less abundant. Although this kind of injury is well defined, in particular cases it can extend to the groin and perianal region. The major factors associated with this type of infections are antibiotic therapies, diabetes and vaginal secretions of the sexual partner [1,17,48]. It is important to avoid the occurrence of this type of intense vaginitis in the last few weeks of pregnancy, because 7 it can complicate and extend to the uterus, infecting the child before birth. At childbirth, or in the first hours of life, it can be observed a widespread rash, maculopapular or pustular-vesicular. During the following weeks after birth, the clinical status may be complicated, extending to other body locations, which usually are treated with local antibiotics [5,42,43,49]. Anal candidiasis this type of infection is characterized by intense itching/pruritus, accompanied by burning sensation, and localized erythema around the anus. Skin may appear macerated with circumscribed lesions, which may eventually invade the intergluteal groove [49 51]. This type of infection is most common in children; despite the frequency in women due to the use of hormonal contraceptives, intimate hygiene products, clothing and their practice of oral and anal intercourse, functioning as transient colonization of local organisms shed from the intestinal tract. As candidiasis can be sexually acquired, males can be affected, because they may acquire infection from the gastrointestinal tract of their partners. However, in some cases, the factors causing that condition are still unknown, but seems that the main problem of this pathogenesis are secondary infections caused by aerobic and facultative anaerobes microorganisms, such as Staphylococcus spp. Nails candidiasis Candida species are not considered normal yeasts on nails flora. Therefore, this type of infection is a sign of colonization (secondary growth) despite primary infections of nail fold and nail bed with Candida species may also occur, which are related to a disease of the nails. The paronychia is characterized by an inflammation, more or less painful, in peripheral skin nail, which appears red and brilliant. Although infrequent in males, this infection can appear in cooks, confectioners and employees of canning factories [1,17,49]. Usually, the nail injury itself, or onyxis (ingrown nail), is secondary to paronychia. It is characterized by a progressive striation, dyschromias (discoloration) and opacity of the nail plate, which ultimately becomes crumbly. This infection appears abruptly and painfully, leading to detachment of the nail and can spread to other nails. Still, it can be observed fungal colonization in interdigital areas, by Candida species, commonly known as digital intertriginous. Preferentially, it is located in the hands and between the ring and middle fingers, although it can also appear in the corners of the fingers. It is commonly associated with professions or occupations in which there is a frequent contact with water. The injury erythema-scaly, itchy and exudative generally is well delimited peripherally and the epidermis appears detached. It is less frequent in feet, but can reach one or more commissures of fingers [1,17,49,50]. Intertriginous can still be located at the level of the submammary, mainly in obese women, suprapubic fold, groin and intergluteal cleft. It is characterized by the appearance of small vesicles and pustules which, by breakage, give rise to exudative red spots [1]. Oral candidiasis Oral and perioral candidiasis is the more common type of acute mucocutaneous candidiasis. It is characterized by the appearance of small spots or whitish papules on 9 the tongue, inside the cheeks and in the palate, forming a creamy and very adherent layer mucosa. In some cases, it may extend up and cover the tongue, palate and pharynx, but also corners of the mouth could be reached. When this happens, it is labeled as angular cheilitis, being evidently a mucosal thickening and cracking. This type of candidiasis particularly affects people with immune system disorders and people with dental prostheses. In children and young people, it may be involved with oral ("thrush") and lingual disease. During pregnancy, Candida species colonization increases 30-40%, depending upon altered immune response, bacterial flora, positive variations of glycogen and pH levels; however, mostly during the normal life cycle, other factors can affect, such as hygiene and oral contraceptive use, which contributes to 5-30% of the infections. In men, up to 10% of these species are found on the genitalia, in the transitional zone, between the mucous membrane and the skin [1,13,18,40,44,46]. There are several factors that contribute to yeast infection, which means that candidiasis, and more especially chronic candidiasis, is a good example of a multifactorial syndrome. In the next steps the major and most important factors are explained namely, decreased digestive secretions, dietary factors, nutrients deficiency, impaired immune system and underlying disease states, impaired liver function, drugs and prolonged use of antibiotics, and altered bowel flora (Figure 1). Therefore, an improvement of digestive secretions is pivotal and, in some cases, is an important step to treat chronic candidiasis. Pancreatic enzymes perform an important role as therapeutic agents enabling an efficient and complete digestion of proteins and other dietary compounds.

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Conditions for Disease Development: Generally discount 5 mg altace fast delivery arteriogram, dodder has a very wide host range and is adapted to altace 5 mg lowest price prehypertension bad a wide range of environments order 2.5mg altace with amex blood pressure 00. Once a seedling makes contact with a host altace 5mg generic prehypertension late pregnancy, it forms sucker-like projections (haustoria) that penetrate plant tissues. Dodder produces small, inconspicuous fowers (often white) that mature and produce two to four yellow to black seeds. Irrigation water and cultivation equipment are common modes of long distance dispersal. Seeds usually germinate in late winter and spring in cold climates, however, germination can continue through the summer. Environmental conditions that favor pepper and eggplant growth are also benefcial to dodder. Control: Immediately remove or burn dodder, along with infested plants upon detection. If an infestation is widespread, apply pre-emergence herbicides, deep-plow Flowers produce seeds that may remain viable many years. Stem internodes are short, and plants are stunted and bushy due to stimulation of axillary buds. Conditions for Disease Development: Little leaf disease is widespread in India, where overlapping crop cycles and weeds ensure high populations of leafhoppers and provide reservoirs for the phytoplasma. Eggplants can be infected at any stage of growth when phytoplasma-carrying leafhoppers are present. Control: Eradicate solanaceous weeds that harbor the vector, and spray insecticides to help reduce leafhopper Infected plants develop shortened internodes and distorted leaves. Rogue symptomatic plants as soon as they are detected to reduce secondary spread of this disease. Viruliferous aphids spread the disease rapidly within a feld for very short periods of time. There is no effective chemical control of this disease because aphids immediately transmit the virus by feeding on infected plants. Conditions for Disease Development: this virus has a wide host range, affecting more than 300 species. Common hosts are tomatoes, beets, peppers, squash, beans, cucurbits, spinach, potatoes, cabbage and alfalfa. Viruliferous leafhoppers migrate seasonally and can be moved long distances by wind. Transplant early or late to escape leafhopper infestations, and increase plant density to compensate Thickened leaves curl upward. Typically, leaves of infected plants develop a mottle or mosaic with dark-green vein banding. Symptom severity is dependent upon the variety, infecting strain and age of the host at the time of infection. Conditions for Disease Development: Peppers, tobacco, tomatoes and weeds such as Physalis spp. Manage aphid populations using refective mulches, stylet oil sprays and insecticides. In mature plants, it is diffcult to achieve complete insecticide coverage of leaves to effectively eradicate all aphids. Infected plants are usually stunted and the fruits distorted with occasional concentric rings. The virus is acquired by aphids and is transmitted from plant to plant in a non-persistent manner. In feld-grown peppers and eggplant, eliminate adjacent weeds and Distorted and mottled fruit. Controlling the aphid vector population with chemical treatment is very diffcult and generally provides limited control. Distribution: Worldwide Symptoms: Symptoms vary depending on the variety infected, the viruses present, environmental conditions and age of plant at the time of infection. Early symptoms may include yellow vein-etching and clearing, and distortion of young leaves. As infection progresses, symptoms of chlorosis, mosaic and mottling develop, and distortion is more prominent. Conditions for Disease Development: the pepper golden mosaic complex is comprised of closely related viruses that infect in many combinations. Pepper huasteco yellow vein and Sinaloa tomato leaf curl are serious diseases of pepper grown in Mexico, where large areas of hot peppers are grown and whitefies are established. Geminiviruses are spread from host to host by whitefies in a persistent manner and are not mechanically Rough and distorted fruit. Consequently, tomatoes can be a source of vector and virus to nearby pepper felds. Control: Overlapping cropping systems make control of these viruses and their vectors very diffcult. Exclude whitefies from nurseries using protective netting or screen houses to grow virus-free transplants. Apply systemic insecticides early to reduce whitefy populations and limit the spread of these viruses. In mature plants, it is Chlorosis and mottling Bright leaf discoloration diffcult to achieve complete insecticide coverage of of foliage. Destroy residual crops after harvest and maintain a host-free period to help manage whitefies and geminiviruses. Pepper mottle virus (PepMoV) Vector: Many species of aphids Distribution: Southern United States, California, Mexico and Central America Mottling and distortion of foliage. Symptoms: Symptoms vary depending on the pepper variety infected, isolate of the virus present, age of plants when infected and environmental conditions.

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Dietary considerations in the treatment of candidiasis [57 discount 10 mg altace otc arteria femoralis profunda,59 generic altace 10 mg otc hypertension 2014,60 buy altace 5 mg lowest price blood pressure medication headache,62 buy altace 2.5 mg overnight delivery blood pressure medication alcohol,97] Food characteristics Food products Refined carbohydrate sources Refined sugars (sucrose, fructose, corn syrup), fruit juice, honey, maple syrup Fungi and/or yeast sources Alcoholic beverages, dried fruits, To avoid cheeses, peanut Lactose and antibiotic sources Dairy products Allergenic foods Dairy products, eggs, chocolate, fried and processed foods, wheat, peanuts To limit Carbohydrate sources Corn and potatoes Vitamin sources Vegetables, fruits (apples, pears, cranberries, cherries, blueberries and To consume other soft fruit) Protein sources Fish, meat and biological poultry Fiber sources Whole grains, ground flaxseeds 41 Table 3. Substances and phytochemicals commonly used in alternative treatment of candidiasis Substance Dosage/Description High-potency complex of multivitamins Hypoallergenic formulas, free of yeasts and minerals formula Zinc picolinate 45 mg/day Selenium 200 ?g/day Caprylic acid Formula of slow liberation (1 g with meals) Probiotics (intestinal flora) Products containing Lactobacillus Fiber supplement Guar gum, pectin or psyllium seeds (1 teaspoon before bedtime) Phytotherapics Dosage/Description Tabebuia impetiginosa (lapacho) 15-20 g of bark in 0. Whereas the longer discourses of the Buddha con tained in the prose sections of the Canon usually pro ceed methodically, unfolding according to the sequen tial structure of the doctrine, the Dhammapada lacks such a systematic arrangement. The work is simply a collection of inspirational or pedagogical verses on the fundamentals of the Dhamma, to be used as a basis for personal edification and instruction. In any given chapter several successive verses may have been spo ken by the Buddha on a single occasion, and thus among themselves will exhibit a meaningful develop ment or a set of variations on a theme. But by and large, the logic behind the grouping together of verses into a chapter is merely the concern with a common topic. In some cases (Chapters 4 and 23) this may be a metaphorical symbol rather than a point of doctrine. There also seems to be no intentional design in the or der of the chapters themselves, though at certain points a loose thread of development can be discerned. The teachings of the Buddha, viewed in their completeness, all link together into a single perfectly 7 coherent system of thought and practice which gains its unity from its final goal, the attainment of deliver ance from suffering. But the teachings inevitably emerge from the human condition as their matrix and starting point, and thus must be expressed in such a way as to reach human beings standing at different levels of spiritual development, with their highly di verse problems, ends, and concerns and with their very different capacities for understanding. This di versity, evident enough already in the prose discourses, becomes even more conspicuous in the highly con densed. The intensified power of delivery can result in apparent inconsistencies which may perplex the unwary. For example, in many verses the Buddha commends certain practices on the grounds that they lead to a heavenly birth, but in oth ers he discourages disciples from aspiring for heaven and extols the one who takes no delight in celestial pleasures (187, 417) [Unless chapter numbers are in dicated, all figures enclosed in parenthesis refer to verse numbers of the Dhammapada. Without a grasp of the underly ing structure of the Dhamma, such statements viewed side by side will appear incompatible and may even elicit the judgment that the teaching is self contradictory. The key to resolving these apparent discrepan cies is the recognition that the Dhamma assumes its formulation from the needs of the diverse persons to 8 whom it is addressed, as well as from the diversity of needs that may co-exist even in a single individual. To make sense of the various utterances found in the Dhammapada, we will suggest a schematism of four levels to be used for ascertaining the intention behind any particular verse found in the work, and thus for understanding its proper place in the total systematic vision of the Dhamma. The four levels are arrived at by dis tinguishing the last aim into two stages: path and fruit. The aim at this level is to show man the way to live at peace with himself and his fellow men, to fulfill his family and social responsibilities, and to restrain the bitterness, conflict and violence which infect human relationships and bring such immense suffering to the individual, society, and the world as a whole. But to dispel any doubts the disciple might entertain as to what he should avoid and what he should cultivate, other verses provide more specific directives. One should avoid irritability in 9 deed, word and thought and exercise self-control (231-234). One should adhere to the five precepts, the fundamental moral code of Buddhism, which teach abstinence from destroying life, from stealing, from committing adultery, from speaking lies and from tak ing intoxicants; one who violates these five training rules ?digs up his own root even in this very world (246-247). The disciple should treat all beings with kindness and compassion, live honestly and right eously, control his sensual desires, speak the truth and live a sober upright life, diligently fulfilling his duties, such as service to parents, to his immediate family and to those recluses and brahmins who depend on the la ity for their maintenance (332-333). A large number of verses pertaining to this first level are concerned with the resolution of conflict and hostility. Quarrels are to be avoided by patience and forgiveness, for responding to hatred by further hatred only maintains the cycle of vengeance and retaliation. The true conquest of hatred is achieved by non-hatred, by forbearance, by love (4-6). One should not yield to anger but control it as a driver controls a chariot (222). Instead of keeping watch for the faults of others, the disciple is admonished to examine his own faults, and to make a continual effort to remove his impurities just as a silversmith purifies silver (50, 239). The sterling qualities distinguishing the man of virtue are generosity, truthfulness, patience, and com passion (223). By developing and mastering these qualities within himself, a man lives at harmony with 10 his own conscience and at peace with his fellow be ings. The scent of virtue, the Buddha declares, is sweeter than the scent of all flowers and perfumes (55-56). The good man, like the Himalaya mountains, shines from afar, and wherever he goes he is loved and respected (303-304). This level begins with the recognition that, to reflective thought, the human situation demands a more satisfactory context for eth ics than mere appeals to altruism can provide. On the one hand our innate sense of moral justice requires that goodness be recompensed with happiness and evil with suffering; on the other our typical experience shows us virtuous people beset with hardships and af flictions and thoroughly bad people riding the waves of fortune (119-120). Moral intuition tells us that if there is any long-range value to righteousness, the im balance must somehow be redressed. This is the law of kamma (Sanskrit: karma), of action and its fruit, which ensures that morally determinate action does not dis appear into nothingness but eventually meets its due retribution, the good with happiness, the bad with suf fering. In the popular understanding kamma is some times identified with fate, but this is a total misconcep tion utterly inapplicable to the Buddhist doctrine. Kamma means volitional action, action springing from intention, which may manifest itself outwardly as bod 11 ily deeds or speech, or remain internally as unex pressed thoughts, desires and emotions. The Buddha distinguishes kamma into two primary ethical types: unwholesome kamma, action rooted in mental states of greed, hatred and delusion; and wholesome kamma.

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