By W. Julio. Virginia Intermont College. 2019.
Francis Visith Sitprija ropical nephrology is no longer a regional issue purchase 7.5 mg olanzapine free shipping. W ith the enor- mous expansion of travel and immigration cheap olanzapine 20 mg amex, the world has become Ta global village. Today, a health problem in a particular region has worldwide repercussions. Typical examples are the acquisition of malaria in European airports, renal disease associated with herbal medications, and increasing encounters of parasitic infections in immunocompromised persons [1–3]. Lessons learned from the study of tropical diseases have considerably enriched worldwide medical knowledge of the basic and clinical aspects of nontropical diseases. Examples include better understanding of macrophage function in vitro, the role of cytokines in acute renal failure, and the importance of immunoglobulin A deposits in the progression of glomerular disease [4–7]. The so-called typical tropical nephropathies are broadly classified as infective or toxic. Infective nephropathies include renal diseases associat- ed with endemic bacterial, viral, fungal, and parasitic infections. Toxic tropical nephropathies include exposure to poisons of animal origin, such as snake bites, scorpion stings, and intake of raw carp bile, and plant ori- gin, such as certain mushrooms and the djenkol bean. Tropical bacterial infections often are associated with renal complica- tions that vary according to the causative organism, severity of infection, and individual susceptibility. The principal acute infections reported to affect the kidneys are salmonellosis, shigellosis, leptospirosis, melioidosis, C H A P T ER cholera, tetanus, scrub typhus, and diphtheria [8–16]. Renal involvement in mycobacterial infections such as tuberculosis and leprosy usually pur- sues a subacute or chronic course [17–19]. The respective renal pathologies include cosis, which occurs in underdeveloped tropical regions, partic- glomerular, microvascular, and tubulointerstitial lesions. Also described is The pathogenesis of renal complications in tropical bacterial ochratoxin, a fungal toxin often incriminated in the pathogen- infections is multifactorial. The principal factors are direct tis- esis of Balkan nephropathy. Ochratoxin also contributes to pro- sue invasion by the causative organisms and remote cellular and gressive interstitial nephropathy in Africa. The rela- Three ways exist by which parasitic infections cause renal tive significance of the different pathogenetic mechanisms disease: 1) direct physical invasion of the kidneys or urinary varies with the causative organism.
Defensive aggression is generally seen within adoption cheap olanzapine 7.5 mg line, and family studies all suggest a genetic influence the normal range of human behavior cheap olanzapine 5 mg otc. However, premedi- underlying aggression (5), with heritability estimates for di- tated and impulsive aggressive behaviors are commonly mensional measures of aggression ranging from 44% to viewed as pathologic. Ametaanalysis of more than 20 twin studies Aggression may be measured as both a dimensional and confirmed a substantial role for a genetic influence underly- a categoric variable. However, whereas aggressive behavior ing aggression (6). Although behavioral genetic studies to (or the tendency to behave aggressively) is truly dimen- date have not attempted to distinguish among aggression sional, it is difficult to estimate the societal relevance of subtypes, impulsive aggression appears to be quite distinct aggressive behavior using dimensional assessments. Overall, the recurring theme tegoric variable, aggressive subjects ('cases') may be emerging from more than 20 years of empiric research is counted in populations of interest. For example, the current that 'impulsive aggression' demonstrates the most consis- age-adjusted rate for homicide in the United States is 0. With respect to physical assault, approximately one- correlates (7,8) and psychopharmacologic treatment (9,10). From these figures, it may be estimated that approxi- tonin (5-hydroxytryptamine or 5-HT) system, although mately 35 million adults in the United States have engaged limited data is now emerging for a role for other central in at least one serious act of aggression. The rate of individu- systems involving catecholamines, steroids, neuropeptides, als demonstrating 'recurrent, problematic, aggression' is and cholesterol and fatty acids. Using DSM-IV intermittent explosive dis- neuropsychopharmacologic data relevant to these systems order (IED) as a proxy for 'recurrent, problematic, aggres- and concludes with a discussion of the psychopharmacology sion,' Zimmerman et al. Including borderline and antisocial personality- disordered patients, who are also quite aggressive, increases NEUROPSYCHOPHARMACOLOGY OF this number to about 13% of psychiatric outpatients. Re- AGGRESSION gardless, these data suggest that the lifetime prevalence of recurrent, problematic, aggressive behavior may be 1% or Serotonin higher (at least 2. The hypothesis that 5-HT modulates impulsive aggressive Research into the etiologic determinants of both preme- behavior in humans was first advanced in the same year by both Sheard et al. The former group demonstrated that treatment with lithium carbonate Emil F. Coccaro: Department of Psychiatry, University of Chicago, (an agent with putative 5-HT–enhancing properties), but Pritzker School of Medicine, Chicago, Illinois.
Overall generic olanzapine 10mg with mastercard, these studies reward dysfunction hypothesis resting on a consideration of are consistent with the findings related to reduced tissue the impact of PFC dysfunction on mechanisms underlying volume on MRI discount 10mg olanzapine with visa, reductions in cortical metabolism with reward. The PFC input into limbic structures responsible fluorodeoxyglucose (FDG)-PET (242), and information for reward is critical to the experience, anticipation, and processing deficits in ERP studies (265). The activation of PFC outputs plies a connection between alterations in brain structure, to limbic structure causes a release of glutamate that may function, and behavior related to alcoholism. From this perspective, PFC activation serves THE INTERPLAY OF THE NEURAL as a 'brake' on reward mechanisms. In fact, it is tempting CIRCUITRY AND NEUROCHEMISTRY OF to think of this PFC-NAc interplay as a pathway contribut- ALCOHOLISM: IMPLICATIONS FOR ing to the capacity of human judgment to restrain impulsive TREATMENT reward-related behavior. Yet abnormal PFC input would also be expected to disturb NAc function with respect to Ethanol has multiple specific effects on amino acid, mono- both the processing of rewarding stimuli generally and drugs amine, and neuropeptide neurotransmitter systems, and of abuse in particular. Thus, it may not be surprising that 1436 Neuropsychopharmacology: The Fifth Generation of Progress the familial vulnerability to alcoholism is associated with ality disorder and alcohol-induced aggression. Alcohol Clin Exp both PFC functional deficits and alterations in the capacity Res 1998;22:1898–1902. Effect of drugs and alcohol on psychomotor skills of drugs representing multiple component actions of related to driving. Complications of alco- aversive experiences in humans. If so, then genes controlling hol withdrawal: pathophysiological insights. Alcohol Health Res corticolimbic neurodevelopment and genes encoding the World 1998;22:61–66. Symptomatology in alcoholics at various stages of abstinence. Alcohol Clin Exp tion may provide a diversity of potential foci for the study Res 1985;9:505–512.