Lincocin

William B. Hillegass, MD, MPH, FACC, FSVMB

• Associate Professor, Interventional Cardiovascular
• Section, University of Alabama at Birmingham
• Birmingham, Alabama

Hyperthyroidism is characterized by an increased metabolic rate symptoms 14 dpo buy lincocin in united states online, which causes weight loss symptoms 3 days after conception order lincocin 500 mg line, increased appetite medicine lookup buy discount lincocin 500 mg on-line, fatigue medications erectile dysfunction order lincocin paypal, emotional disturbances symptoms kidney problems discount 500 mg lincocin with amex, heat intolerance treatment management system generic lincocin 500 mg with visa, sweating, muscle weakness and diarrhea. Maintenance dose 5mg for up to one year Toxic Nodular Goitre Can be treated with antithyroid drugs and surgery or radio-iodine C: Carbimazole 40mg (O) once daily for 3 weeks then 20mg daily for 3 weeks. Iron deficiency is mainly due to blood loss secondary to haemorrhage, malabsoption and hookworm infections. Iron deficiency anaemia A: Ferrous sulphate200 mg (O) every 8 hours Children5 mg/kg body weight every 8 hours. Pyruvate kinase deficiency c) Haemoglobin -Abnormal haemoglobin such as HbS, C, Unstable Hb Clinical features the disease may occur at any age and sex Patient may present with symptom and features of Anaemia Symptoms are usually slow in onset however rapidly developing anaemia can occur Splenomegaly is common but no always observed Jaundice Treatment i. Immunosuppressive drugs for the patients who fail to respond to corticosteroids and splenectomy. Symptoms may include anaemia, dactylitis, recurrent infections, impaired growth and development. Crises Three distinct types of crises develop in patients with sickle cell disease Vaso-occlusive or painful crises are more common occurring with a frequency from almost daily to yearly. It is important to distinguish between painful crises and pain caused by another process Aplastic crises occurs when erythropoiesis is suppressed Sequestration crises occurs in children or occasional in adult with an enlarged spleen due to massive pooling of red cells in the spleen Treatment Guidelines Nonspecific measures A: Folic acid 5mg once daily Specific measures S: Hydroxyurea 15mg/kg/day. Maximum dose: 35mg/kg Management of Complication Patients undergoing vascular crises should be kept warm and given adequate hydration and pain control (Inj pethedine 100mg 6hrly, Oral morphine 5mg/kg) and oxygen Acute chest syndrome is a life threatening complication and empiric antibiotics should be given. Usually asymptomatic but liable to haemolysis if incriminated drugs or foods are taken. Treatment Guidelines Avoid incriminated agents/foods or drugs Transfusion of packed red blood cells in severe anaemia. Most frequent haemorrhage involves joints or muscles and bleeding parttens differ with age: Infants usually bleed into soft tissues ar from the mouth but as the boy grows, characterist joint bleeding becomes more common. Frequent spontaneous haemarthrosis factor is needed several times Moderate 2-5%of normal 1Haemorrhage secondary 0. Patients present with a history of easy bruising, menorrhagea, gum bleeding and spontaneous joint bleeding in severe form. In the acute form massive activation of coagulation does not allow time for compensatory increase in production of coagulant and anticoagulant factors. Patients present with bleeding manifestation, extensive organ dysfunction, shock, renal corticle ischemia, coma, delirium and focal neurological symptoms. Clinical feature for adult thrombocytopenia appears to be more common in young women than in young men but amoung older patients, the sex incidence may be equal. Most adult patient presents with a long history of purpura, menorrhagia, epistaxis and gingival haemorrhage. Treatment of Venous Thromboembolism Long term anticoagulation is required to prevent a frequency of symptomatic extension of thrombosis and/or recurrent venous thromboembolic events. Warfarin is started with initial heparin or clexane therapy and then overlapped for 4-5days. We will exclude maxillo-facial injuries and eye injuries from this discussion (Ref this to eye section). Mortality is increased if hypotension or airway/breathing problem is not adequately solved. Exclude fractures by performing appropriate X-rays Note Referral must not be delayed by waiting for a diagnosis if treatment is logistically impossible Closed injuries and fractures of long bones may be serious and damage blood vessels Contamination with dirt and soil complicates the outcome of treatment I. Maximum of 4 doses per 24 hours Plus S: Cloxacillin 500mg 6 hourly for 7 days Plus B: Tetanus prophylaxis: 0. In children less than 6 months calculate dose by weight Perform X-ray to rule out dislocations or sublaxations 2 Referral If Severe progressive pain. Hemorrhagic shock may ensue in situations involving multiple fractures or pelvic ring fractures. Paralysis may be associated, often been brought by improper transfer of the patient to the hospital. Thus lion, tiger, leopard, hyena, bear, elephant, hippopotamus, buffalo, wolf and wild pig are examples of the wild animals that have bitten man. Clinical features of these bites arise from the pathology inflicted by teeth, tusks, claws and horns. Severe facial and eye innuries are common and pneumothorax, hemothorax, bowel perofration and compound fractures have occurred. Treatment Emergency surgery is often needed Replace any blood lost Treat complications of injury. Symptoms:Most bites and stings result in pain, swelling, redness, and itching to the affected area Treatment and Management Treatment depends on the type of reaction Cleanse the area with soap and water to remove contaminated particlesleft behind by some insects Refrain from scratching because this may cause the skin to break down and an infection to form Treat itching at the site of the bite with antihistamine Give appropriate analgesics Where there is an anaphylactic reaction treat according to guideline. If area burnt is larger than 10% of body surface then this is extensive because of fluid loss, catabolism, anaemia and risk of secondary infection. In such cases refer to secondary or tertiary level health care centre Children give A: Paracetamol 10 mg/kg every 8 hours Plus C: Procaine Penicillin 0. Foreign bodies introduced through the mouth (or nose) may be arrested in the larynx, bronchial tree, oesophagus or stomach. Foreign bodies in the stomach rarely produce symptoms and active treatment is usaullynot required. Decision of treatment for carcinoma of the cervix is best done in hospital under specialist care. Primary prevention (screening) and early detection: Vaccination is now available Avoid early sex. Histology: Usually Adenocarcinoma Others: Clear cell, small cell carcinomas, sarcomas. Decision of treatment for the uterine carcinoma is best done in hospital under specialist care. Chemotherapy regimen for leiomyosarcoma: 2 S: Adriamycin 40mg/m single agent every 3 wks x 6. Decision of treatment for the vulvo-vaginal carcinoma is best done in hospital under specialist care. Regional/zonal or tertiary depending on treatment expertise Treatment: Predominantly surgical. Radiotherapy: Post operative radiotherapy is indicated for high risk recurrence (positive 265 P a g e margins and nodal involvement). Patient presents with abnormal vaginal bleeding during or after pregnancy associated with a large-for-date uterus. Referral: All patients must be referred to a gynecologist for evaluation and decision on mode of treatment. Decision of treatment for malignant trophoblastic tumours is best done in hospital under specialist care. However increasing abdominal distension, palpable mass in the abdomen, pain and presence of ascites are all late signs. Histologies of epithelial tumours: Serous (cyst) adenoma, mucinous (cyst) adenoma, endometrioid adenocarcinoma, clear cell adenocarcinoma, granulosa cell tumour, theca cell tumour, sertoli-Leydig cell tumour, mixed tumours. If total tumour removal is not possible, then maximum debulking (cyto-reductive) surgery should be done. Chemotherapy Adjuvant chemotherapy: Is indicated for all unfavourable histologies as well as advanced stages. The most common warning sign of skin cancer is a change in the appearance on exposed areas of the skin, such as a new growth or a sore that will not heal. Surgery: the aim of sugery is total local excision where possible; wide local excision and graft; amputation sometimes is required. Locally destructive methods such as curetting, desiccating or cryotherapy may be emplyted. Radiotherapy: Indication: Positive margin, high grade disease or inoperable tumour. Chemotherapy: S: Topical 5 fluorouracil for very superficial lesions or carcinoma in situ. Detection/Prevention: Frequent self-check or screening exercise and prompt treatment of early keratotic changes. Investigation: None or minimal if lesion is small Radiological: Chest x-ray in case of clinically suspected lung involvement or abdominal ultrasound in case of suspected liver metastases. Detection/Prevention: Frequent self-check or screening exercise and prompt treatment of naevus. May use large fractions: 30Gy/6F/1 wk Excision margins are involved or very close Palliative intent (brain mets, fungation or profuse bleeding, bone pain, etc) 2. Treatment: Chemotherapy: Adults: S: Adriamycin 40mg/sq m i/v D1 Plus S: Vincristine 1. Note: Sequential hemibody irradiation is sometimes necessary for aggressive disease. They may interfere with vital functions such as: Respiratory, swallowing, sight, speech and mastication. Important aetiological factors include excessive intake of tobacco either by smoking or chewing and alcohol intake (particularly spirits). Other features include: Non-healing ulcers, lymphadenopathy, hoarseness, pain and difficult in swallowing. Decisions of treatment for head and neck tumours are best discussed at Tumour board. Surgery: Partial or total laryngectomy is for advanced stages only where voice is compromised. Tumour present as goiter and can remain silent for decades without any discomfort. Clinical features: Presence of a thyroid mass or scar, laryngeal nerve palsy, hoarseness, dyspnoea, dysphagia. Treatment Radioactive iodine ablation Further thyroxine replacement therapy (for life). Symptoms: Difficult in swallowing (dysphagia) is the commonest symptom which is associated with weight loss and poor performance status. Dilatation with or without intubation should always be considered to ensure continued ability to swallow. Look for pallor, weight loss, supraclavicular foss nodes, abdominal and rectal examination, epigastric mass, hepatomegally, periumbilical nodes. Surgery: Total or partial gastrectomy, bypass with or without tumour removal eg gastrojejunostomy. There is a strong association of this cancer and hepatitis B infection and/or alcohol consumption. Right upper abdominal swelling and pain often associated with weight loss, fever, jaundice. Histology: Hepatocellular carcinoma 90%, Cholangiocarcinoma 7%, Hepatoblastoma, angiosarcoma, sarcomas 3%. Anatomic extent of involvement: A: One lobe only; B: Two lobes; C: Metastatic disease; D: Cirrhosis. Surgery: Lobectomy where feasible Chemotherapy is not effective; However single agent Doxorubicin is used. Early stages may be superior to surgery in the sense that sphincter function is preserved. Detection/Prevention Any woman particularly at the age of 50 years should undergo mammography annually Anyone with familial risk ought to start earlier Self breast examination on monthly basis 7. This may be visible to the naked eye gross hematuria or detectable only by microscope. Other possible symptoms include: Dysuria or increased frequency and bilharzia exposure, weight loss and anaemia. Decisions of treatment for urinary bladder tumour are best discussed at Tumour board. Treatment: Surgery: Total cystectomy is mutilating and causes poor quality of life. Prostate cancer is associated with circulating testosterone and family history is significant in a very small percentage of patients. Bilateral orchidectomy is a surgical procedure which aims at surgical castration Hormonal therapy: May be given as the sole treatment for patients deemed unfit for surgery. Alternatively hormonal therapy is used as adjunct to other treatments with the intention of reducing the chance of local recurrence or metastatic disease. Palliative radiotherapy is valuable to bone metastases, massive haematuria, spinal cord compression, pathological fracture, etc as indicated. Detection/Prevention: Prostate cancer is among the cancers in human beings which could be prevented by screening procedures. Lymphocytes are in the lymph nodes and other lymphoid tissues (such as the spleen and bone marrow). Clinical features: Peripheral lymph node enlargement (commonest site neck 281 P a g e Hepatomegally and/or splenomegally in advanced stages.

Intern should sign-out to the on-call team if they have clinic that afternoon and their resident is post-call from an overnight shift medications 2355 quality 500mg lincocin. After clinic medications qid buy lincocin online, the intern should return to get an update on their patients and answer any questions the on-call team has before leaving for the day treatment uti trusted lincocin 500 mg. Resident should sign-out verbally or by email to the weekend resident covering for them 5 medications that affect heart rate buy lincocin 500 mg line. The weekend resident may have the responsibility of writing progress notes and needs to be familiar with the patients symptoms 9dpo generic lincocin 500mg with visa. Off-service note: when Interns change rotations symptoms uterine prolapse discount 500 mg lincocin amex, off-services notes must be written for patients who have been on the service for more than 48hrs. Off service notes must be written or typed using the yellow progress notes in the same format as a discharge summary (this will assist your colleagues when they have to write transfer summaries). The plan does not have to be perfect but should be made in conjunction with the resident. Again, the resident needs to judge the urgency in seeing patients between these times. Patients called between 5:30-6:00am are added to the service of the incoming day-call team. If this admission cap has not been reached, the post day-call intern can receive patients from night-call for a total of 5 new patients within 48 hours. However, a resident can keep only 10 new patients, and should give the remaining 2 to the other team. This dictated note needs to be dictated as an H&P by the intern for the intensivist (Datta/Liff/Ali/Tanios/Farhat/Sehgal). In the chart, there needs to be 2 notes written, one H&P by the intern and a modified H&P with own exam by the resident. Please be sure that the private physicians responsible for these patients have been contacted regarding the transfer. If a patient was accepted to the floor by night float and decompensated during the night or before the primary team sees the patient, then that patient is assigned to the on-call ward team when ready for transfer (does not go back to the original team). Clinic requirements Interns are required to attend day of continuity clinic twice a month. After 48 hours, the patient will be transferred to the ward team who is on call that day. Do not downgrade patients that Ward attendings have upgraded without speaking to an attending first. Consultation services (cardiology, neurology, nephrology, pulmonary) 6 new consultations may be seen in a 24 hour period with a total service responsibility of 10 patients. Non-Housestaff patients As a courtesy, ward interns/residents address problems at night at the request of private attendings. Housestaff should assist whenever needed, communicate with the attending, and document interventions. However if you are nearby the code, please go and see if they need help as you might be the only/first doctor on the scene. There are ways to help with codes without taking space in the room; interns and residents from the other call team can find information about the patient from the chart, call attendings, or call family members while their counterparts manage the code. This is a system of backup coverage for interns and residents whose absence is necessary due to extreme circumstances (typically illness or family emergency). It is the responsibility of the resident and intern to call the chief resident as soon as they believe there is a need (or possible need) to activate back-up coverage. It will also facilitate the transition, if the resident and the intern can first contact the back-up resident(s) and intern(s) to finalize the replacement plan. The program cannot require that the absent resident or intern work extra shifts to pay back the backup resident upon returning to work. However, in good faith, the resident or intern should payback the backup person whenever possible. Duty Hours 23 Residents and interns are required to log duty hours in MyEvaluations. Rotation Evaluations Residents and interns are to promptly complete rotation evaluations in MyEvaluations. Feedback is important in order to make changes to the Residency Program, so please be honest in your evaluations. Chief Resident Assignments Please feel free to address any questions/concerns/comments with the Chief Residents. Any time (day or night), please feel free to call us with any questions or concerns you may have. Residents and Interns are required to attend at least one half day of clinic a week. Also, please be aware that didactic sessions may be planned prior to clinic in the morning. Check with the Clinic Attending regarding the schedule of didactic sessions for the month. You are still required to attend, but the Clinic Attending might dismiss you early. Paperwork (in order of priority: orders, prescriptions, lab forms, referrals for procedures or consultants, progress note) iii. See patient with attending (Note: it is highly recommended that orders and prescriptions be entered while seeing the patient in the room with the attending) 4. In order of priority: (1)assigned continuity resident (2)language preference (3)resident who saw patient previously ii. It is the discretion of the clinic attending to re-assign patients depending on patient flow. For anemia patients, write if acute or chronic if any drop in Hct, and any specific etiology. Document counseling of diet and lifestyle modifications and counseling of smoking cessation. All consults/referrals, imaging studies, and other special testing require a form that needs to be completed Continuity is essential You need continuity of care for your assigned patients. If your patient is to be seen in three months, do not write in the orders follow up with Dr. Have the facesheet with the insurance information ready when you call for the appointment (call the clinic personally to schedule the appointment). Jeffrey Power will send an e-mail at the start of the year containing further instructions, and it is imperative that all forms and live scanning be done in a timely fashion, or you may not be able to start your rotation on time. Make sure you get all your paperwork done and passwords activated before you start (otherwise you will not have access to anything). You need the password to print progress notes, admission orders, or transfer orders. Delete the cc number (3105011350 for night float) and your pager will be unforwarded. Flag the order by folding them in a triangular pattern down the middle and then placing them in the appropriate order rack. Usually a signature will suffice, but you may also choose to write in a few addenda. Note that your composite patient list is populated by the data that is entered here. Simply print out your list, write your cell phone number atop the first page, and place it in the stack in the lounge. You still need to sign out appropriately to the ward call resident, but the night float resident will call you in the afternoon to receive signout. Other patients will either be in the seating 32 area or on a gurney in the hallway. Print out admissions orders by going into Affinity and expanding the pre-printed forms section. Go in to Affinity and record a new H&P therein in the same manner that you would copy the progress note for a pre-existing patient. The medicine-related services consult dropbox is located in the charting area of 5E. Note: read the consult instructions the dropbox carefully to determine if you will need to contact the fellow/resident before dropping off the form. In general, if the patient does not have prior follow-up, schedule them first for a discharge clinic appointment with a medicine resident. If indicated, you will then need to contact the respective fellows to obtain approval for subspeciality clinic appointments. Do this by paging the fellow and confirming the appointment, then physically find him/her in order to have the green clinic form signed. Ultrasound: Ordering an ultrasound requires approval by the radiology resident or attending. Nuclear medicine: Order nuclear medicine studies in a similar fashion but with the gold requisition form and by calling 2842. Interventional services: For interventional services, go the rads reading room on the 2nd floor and speak with a resident or attending therein to obtain approval. Note: vancomycin trough level monitoring and adjustment needs to be done manually. Consider the following 3criteria: 36 substernal chest discomfort with characteristic quality and duration provoked by exertion or emotional stress relieved by rest or nitroglycerin Typical chest pain fulfills all 3 of the criteria Atypical chest pain fulfills 2 of the 3 criteria Non-anginal chest pain fulfills 1 or 0 of the criteria 3. Patients are considered to be at low risk with a score of 0 to 2; intermediate risk with a score of 3 to 4; and high risk with a score of 5 to 7. Stress exercise or pharmacologic testing yields greater results for the intermediate probability test group patient (25-75%). If your patient is able to exercise, exercise stress echo testing is an excellent option. Always choose exercise stress testing if your patient is capable of exercising as it is more physiologic and therefore preferred. Dobutamine stress echo testing can be utilized for a majority of patients and those patients who have contraindications to taking vasodilator medications, patients who are currently taking theophylline, and who have consumed caffeine prior to testing. The action of insulin causes potassium to rush back into the intracellular space, and life-threatening arrhythmias may ensue if this is not corrected beforehand. Obtain vital signs If hypotensive, go to hypotension section and examine pt immediately 2. Source Control o Identify sites of infection amenable to surgical intervention (debridement) and remove vascular access devices that are a likely source of infection. Fluid Therapy o Crystalloids and colloids are equivalent for fluid resuscitation in sepsis, although crystalloids are significantly less expensive. Steroids o If hypotension is poorly responsive to fluids and pressors, consider the addition of steroids. Indications for emergent dialysis: severe volume overload, electrolyte abnormalities (K+, Phos), metabolic acidosis, symptomatic uremia, toxin elimination (ethylene glycol). Na < 129 may give altered mental status Na < 120 may cause seizures/arrhythmias Approach to Hyponatremia Assess patient for pseudohyponatremia caused by very high glucose Correct Na 1. If refractory after 60 min, consider pentobarbital coma (need anesthesia and neuro) 8. As above for plateau pressures, but also correlates with airway resistance and patient effort/resistance bucking. See the green book for diagnostic criteria and follow the stepwise changes in vent settings according to the charts below. Restrict use of Milrinone to decompensated failure or cardiogenic shock with B-blocker use; use only Dobutamine to augment cardiogenic shock that occurs in the setting of septic (distributive) shock. Additionally, Vasopressin operates at a receptor that is distinct from those being maxed out by sympathomimetic agents. Restrict its use either to patients on chronic steroids or to those with demonstrated relative insufficiency (Cort Stim). What do you think is going on (your diagnosis; if unknown, what is on your differential) Do you have any lab or studies pending: # If you have a positive finding, what do you want your cointern/resident to do for your patient

Pathogens can often dwell for quite some time within the host organism without causing disease symptoms medications adhd buy generic lincocin 500 mg online. Humans began to show their pathogenic potential toward the planet during the 1950s medicine hat horse purchase 500 mg lincocin, ravenously devouring natural resources and discarding waste into the environment with utter carelessness treatment efficacy order 500mg lincocin overnight delivery. From 1990 to 1997 symptoms toxic shock syndrome order lincocin with amex, human global consumption grew as much as it did from the beginning of civilization until 1950 treatment for strep throat buy generic lincocin online. In fact treatment centers of america generic lincocin 500mg on line, the global economy 1 grew more in 1997 alone than during the entire 17th century. By the end of the 20th century, our consumptive and wasteful lifestyles had painted a bleak global picture. Fisheries are collapsing, farmland is eroding, rivers are dry 3 ing, wetlands are disappearing and species are becoming extinct. Furthermore, the human population is now increasing by 80 million each year (roughly the population of ten Swedens). Population growth without foresight, management and respect for the environ ment virtually guarantees increased consumption and waste with 4 each passing year. The natural background rate of extinctions is estimated to be about one to ten species per year. Of 242,000 plant species surveyed by the World Conservation Union in 1997, one out of every eight (33,000 species) 6 was threatened with extinction. Why would we disregard our host organism, the Earth, as if we were nothing more than a disease intent upon its destruction We embrace the idea that more is better, measuring success with the yardstick of material wealth. We would require no less than three planet Earths to sustain the 7 entire world at this level of consumption. There are those who scoff at the idea that a tiny organism such as the human species could mortally affect such an ancient and immense being as Mother Earth. Our next door neighbor, the Red Planet, apparently was once covered with flowing rivers. Will it be our legacy in this solar system to leave behind another lonely, dead rock to revolve around the sun To put it simply, the human species has reached a fork in the road of its evolution. We can continue to follow the way of disease-causing pathogens, or we can chart a new course as dependent and respectful inhabitants on this galactic speck of dust we call Earth. The former requires only an ego centric lack of concern for anything but ourselves, living as if there will be no future human generations. The latter, on the other hand, requires an awareness of ourselves as a dependent part of a Greater Being. Spoil or destruction, done or permitted, to lands, houses, gar dens, trees, or other corporeal hereditaments, by the tenant thereof. Any unlawful act or omission of duty on the part of the tenant which results in permanent injury to the inheritance. Much of our waste A consists of organic material including food residues, munic ipal leaves, yard materials, agricultural residues, and human and livestock manures, all of which should be returned to the soil from which they originated. These organic materials are very valuable agri culturally, a fact well known among organic gardeners and farmers. Feces and urine are examples of natural, beneficial, organic materials excreted by the bodies of animals after completing their digestive processes. When recycled, they are resources, and are often referred to as manures, but never as waste, by the people who do the recycling. Otherwise, one could refer to leaves in the autumn as tree waste, because they are no longer needed by the tree and are discarded. Ironically, leaves and grass clippings are referred to as yard waste by some compost professionals, another example of the persistent waste mentality plaguing our culture. Humans cre ate waste because we insist on ignoring the natural systems upon which we depend. We are so adept at doing so that we take waste for granted and have given the word a prominent place in our vocabulary. We have kitchen waste, garden waste, agricultural waste, human waste, municipal waste, biowaste, and on and on. Yet, our long-term survival requires us to learn to live in harmony with our host planet. This also requires that we understand natural cycles and incorporate them into our day to day lives. As we progressively eliminate waste from our living habits, we can also pro gressively eliminate the word waste from our vocabulary. Humanure originat ed from the soil and can be quite readily returned to the soil, especial ly if converted to humus through the composting process. A clear distinction must be drawn between humanure and sewage because they are two very different things. Sewage can also contain a host of contaminants such as industrial chemicals, heavy metals, oil and grease, among others. This recycling of organic residues for agricultural purposes is fundamen tal to sustainable agriculture. Yet, spokespersons for sustainable agri culture movements remain silent about using humanure for agricul tural purposes. Perhaps the silence is because there is currently a profound lack of knowledge and understanding about what is referred to as the human nutrient cycle and the need to keep the cycle intact. The human nutrient cycle goes like this: a) we grow food, b) we eat it, c) we collect and process the organic residues (feces, urine, food scraps and agricultural materials) and d) we then return the processed organic material back to the soil, thereby enriching the soil and enabling more food to be grown. This is a process that mimics the cycles of nature and enhances our ability to survive on this planet. In order to keep the cycle intact, food for humans must be grown on soil that is enriched by the continuous addition of organic materials recy cled by humans, such as humanure, food scraps and agricultural residues. By respecting this cycle of nature, humans can maintain the fertility of their agricultural soils indefinitely, instead of depleting them of nutrients, as is common today. Instead, we deplete our soils of nutrients by discarding organic materials as waste, rather than returning them back to the soil. We in the United States each waste about a thousand pounds of humanure every year, which is discarded into sewers and septic systems throughout the land. Much of the discarded humanure finds its final resting place in a landfill, along with the other solid waste we Americans discard, which, coincidentally, also amounts to about a thousand pounds per person per year. For a population of 305 mil lion people, that adds up to nearly 305 million tons of solid waste per sonally discarded by us every year, at least half of which would be valuable as an agricultural resource. Interestingly, the lined landfills bear an uncanny resemblance to gigantic disposable diapers. We conveniently flush our toilets, and the resultant sewage sludge is transported to these landfills, tucked into these huge disposable dia pers and buried. Sewage consists of humanure collected with hazardous materials such as industrial, medical and chemical wastes, all carried in a common waterborne waste stream. When raw sewage was used agriculturally in Berlin in 1949, for example, it was blamed for the spread of worm-related dis eases. In the 1980s, it was said to be the cause of typhoid fever in Santiago, and in 1970 and 1991 it was blamed for cholera outbreaks 2 in Jerusalem and South America, respectively. When we combine our manure with other organic materials such as food and farming byproducts, we can achieve a blend that is irresistible to certain ben eficial microorganisms. Throughout the United States, food losses at the retail, consumer and food services 3 levels are estimated to have been 48 million tons in 1995. Instead, only a small percentage of our discarded food is being composted in 4 the U. The Organization for Economic Cooperation and Development, a group made up primarily of western industrial coun tries, estimates that 36% of the waste in their member states is organ ic food and garden materials. If paper is also considered, the organic share of the waste stream is boosted to nearly an incredible two thirds! In developing countries, organic material typically makes up 5 one half to two thirds of the waste stream. It is becoming more and more obvious that it is unwise to rely on landfills to dispose of recyclable materials. Of the ten thousand landfills that have closed since 1982, 20% are now listed as hazardously contaminated Superfund sites. A 1996 report from the state of Florida revealed that groundwater contamination plumes from older, unlined landfills can be longer than 3. Organic material disposed of in landfills also creates large quantities of methane, a major global-warming gas. Tipping fees (the fee one pays to dump waste) at landfills in every region of the U. In fact, since then, they have increased 8 300% and are expected to continue rising at this rate. In Brazil, for example, 99% of the solid waste is dumped into landfills 9 and three fourths of the 90,000 tons per day ends up in open dumps. In fact, the global area of agricultural land is steadily decreasing as the world loses, for farming 10 and grazing, an area the size of Kansas each year.

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Diseases

• Esophageal atresia associated anomalies
• Incontinentia pigmenti achromians
• Glycogen storage disease type 9
• Cortes Lacassie syndrome
• Chudley Mccullough syndrome
• Borjeson syndrome
• Ectrodactyly ectodermal dysplasia cleft syndrome
• Tracheoesophageal fistula symphalangism
• Chalazion
• Brachycephaly deafness cataract mental retardation