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In some cases Wilmanns also observed childhood enuresis meldonium 500mg generic symptoms magnesium deficiency, pavor nocturnus discount meldonium 500mg visa medicine 014, cramps buy meldonium 250mg with amex symptoms colon cancer, etc. He found no evidence of low intelligence; indeed the intelli gence of such individuals was above average and often associated with creative talents (poetry and music). In personality they were sensitive and showed a sense of delicacy (feinfuhlig) (p. Oversensitivity made them vulnerable to subtle changes in their environment that often went unnoticed by others. He found them to have increased efficiency without any loss of quality in their work, to be generous and lacking in any sense of being abnormal or sick. Like Kahlbaum and Hecker, Wilmanns also drew a clear distinction between hyperthymia, dysthymia and cyclothymia (p. Angst the early Jung (1904) recorded in detail a number of cases of manic mood changes (manische Verstimmung), patients characterized by a stable submanic complex of symptoms, which had mostly developed in youth and lasted many years without remission. Jung found that exacerbations could occur in the course of their disorder and saw the social restlessness and social problems, the alcoholism, delinquency, and what he termed the "moral insanity" characterizing these patients as submanic symptoms. In parallel with this clinical empirical work on cyclothymia and hyper thymia, there was, at the beginning of this century, considerable background controversy over the relationship between temperament or character and psychoses, the main protagonists being Tiling (1904) and Neisser (1905). Tiling considered the individual disposition (temperament/character/indi vidual personality) or Anlage to be the sole factor in determining the constel lation of symptoms (Symptombilder) and their course. In contrast, Neisser refused all psychological explanations of the psychoses, although he admitted their influence in the case of personality disorders. Kretschmer saw psychoses as intersections in a network of physical and characterological constitutional relationships and regarded psychoses as no more than the accentuation of normal subtypes of temperament (p. Referring explicitly to the work of Hoffmann (1921) (see below), Kretschmer stressed that the temperamental subtypes could often better be observed in close relatives than in patients (p. Among manic-depressive patients three subtypes of temperament were found most frequently: (1) social, kind-hearted, friendly and warm-hearted; (2) cheerful, humorous, lively and fiery; (3) quiet, calm, taking things to heart (schwernehmend) and tenderhearted (weich). These correspond to his cyclothymiccycloid, hypo manic and depressive temperaments. As von Zerssen and Possl (1990) wrote: "For seven decades of the 20th century, research on the premorbid personality of psychotic patients were based on the concept of manic-depressive and schizophrenic psychosis forming two nosologically distinct entities (Kraepelin 1913). Hence, the aim was to search for a homogeneous premorbid personality structure for each of these two disorders. Among those who contributed to this process was the important school of Wernicke, Kleist and Leonhard. His pupil Kleist (1926) described subtypes of cycloid psychosis and in 1953 created the concept of unipolar psychoses (recurrent mania, recurrent depression), maintaining that bipolar psychoses stemmed from an affinity between the two unipolar psychoses, which explained their frequent co-occurrence. In 1930 Kleist had already posited a relationship between three polar groups of temperaments and three corresponding polar psychoses: (1) the 186 J. Angst hypomanic (sanguine) and depressive (melancholic) temperament, which corresponded to mania and depression (Gemutskrankheiten); (2) the motility temperaments, the lively (choleric) and sluggish, correlating with the hyper kinetic and akinetic motility psychoses; and (3) the mentally alert and mentally lazy thought temperaments, correlating with the two polar confu sional psychoses (agitated confusion and stupor) (Kleist 1926). These authors hypothesized that if manic-depres sive disorder could also take a monopolar course (the term used by Leonhard et al. Among the siblings and parents of bipolars they found a preponderance of hypomanic and cyclothymic temperaments and psychopathies, and in the relatives of mel ancholies and depressives sub-depressive temperaments and psychopathies were found to predominate (Table 2). They interpreted their findings as confirmation of the monopolar-bipolar dichotomy, and believed somewhat questionably that these affective temperaments would unspecifically promote the manifestation of the disorder. They concluded that, among relatives, cyclothymia could manifest instead of manic-depressive disorder and a depressive temperament instead of depression and melancholia. He wrote: "in the vast majority of affective temperaments there appears confirmation of the notion, expressed in earlier work, that a phasic psychosis breaks out only if it coincides with one of these tempera ments" (Leonhard 1965, p.

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Human activities generate anthropogenic arsenic compounds through the formulation of herbicides discount meldonium 250mg on line treatment 6th feb cardiff, pesticides discount 250 mg meldonium with visa medicine 122, and fertilizers (Ferguson & Gavis buy meldonium on line amex symptoms dizziness nausea, 1972). Riveros et al (2001) rigorously reviewed the arsenic generation problems and disposal practices of the metallurgical industry. Arsenic waste generated from various metal extractions and refining operations is a serious problem (Dutre & Vandecasteele, 1998). Natural water can be contaminated by the discharge of arsenic through geochemical processes: dissolution of iron oxyhydroxides containing arsenic under reducing conditions, oxidation of arsenic-bearing minerals, and desorption of arsenic by a competing ligand,. This thesis follows the style and format of the Journal American Water Works Association. In particular, 70 million people in Bangladesh have been poisoned due to naturally occurring arsenic in wells used for drinking water sources (Lepkowski, 1998). Highly elevated concentrations of arsenic (greater than 1 mg/L) have been commonly detected in the area. Consequently, arsenic treatment of contaminated surface and groundwater is very important in order to supply people with good standing drinking water. Recently, more attention has been paid to arsenic removal in water treatment due to the U. Thus, appreciable volumes of arsenic contaminated residuals are expected to be produced which may require further treatment and handling prior to ultimate disposal. Landfill disposal is generally considered to be the best choice for arsenic-contaminated residuals, but treatment of the residuals may be necessary to meet landfill regulations: 1. Arsenic behavior in soils and wastes are similar to residuals since both are solid-phase media. To characterize field samples of arsenic containing residuals to understand the release of arsenic in natural environments 2. To develop methods to suitably bind the arsenic in order to eliminate or minimize leaching 3. To investigate the feasibility of applying solidification/stabilization (S/S) for arsenic bearing residuals. However, organo-arsenical compounds are generally accepted as a minor fraction of the total dissolved As. Thus, organic species (methylated arsenic) are commonly considered to be of little significance in waters compared with the inorganic species (Sadiq, 1997; Anderson & Bruland, 1991). Arsenic compounds exist in common aqueous environments as oxygen combined forms due to the high affinity (Langmuir, 1997a). The pH and Eh relationship is very important in understanding arsenic removal from water, arsenic immobilization/stabilization on solid phases as well as the distribution of arsenic species in water. Normally, the Eh values of surface water and ground water are high and low, respectively. Meng et al (2001) pointed out that three redox zones can be divided according to the arsenic mobility: an adsorption zone at pe > 0, a mobilization (transition) zone at 4. The three redox zones (oxidizing, mildly reducing, and very reducing) for arsenic mobility 7 like the above were also suggested by several investigators (Carbonell-Barrachina et al, 1999; Masscheleyn et al, 1991). For example, the effects of coexisting solutes such as iron, aluminum, phosphates, silicates, carbonates, organic arsenic, and biotic redox reactions are not considered. Several field investigations demonstrated that the pE/pH diagram for arsenic were oversimplified or were not accurately described (Williams et al, 1996; Korte & Fernando, 1991; Cullen & Reimer, 1989). Several researchers explaine that the control of redox reactions, kinetically slow, might result in this disagreement (Peterson & Carpenter, 1983; Andreae, 1981). Therefore, under the coexistence of oxidized sulfur and reduced iron simultaneously, a substantial concentration of soluble arsenic can be present (Korte & Fernando, 1991). To humans, arsenite is about 60 times more toxic than arsenate (Ferguson & Gavis, 1972).

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Observations of skin lesions following low chronic exposure have suggested that these characteristic dermal changes are sensitive indications of the toxic effects of inorganic arsenic buy 500mg meldonium free shipping medications for migraines. Available epidemiological studies indicate a positive relationship between high concentrations of inorganic arsenic in drinking-water and sensitive end-points for peripheral and central neurotoxicity cheap 250mg meldonium amex treatment jokes. There is some evidence that exposure of children to inorganic arsenic in areas with elevated arsenic concentrations (>50 g/l) in drinking-water produces effects on cognitive performance discount meldonium 250mg without prescription treatment depression, but so far this is not conclusive. The association between blackfoot disease and inorganic arsenic exposure has been confirmed by many studies, but blackfoot disease has been reported primarily in an area along the south-western coast of Taiwan, China, where arsenic contamination in well water is very high (170880 g/l). Except for blackfoot disease, the reported associations between inorganic arsenic exposure and cardiovascular disease prevalence/mortality and other cardiovascular end-points currently do not provide sufficient evidence of causality and are not considered pivotal for the assessment. Studies conducted in Bangladesh and Taiwan, China, indicated an extra risk of diabetes among high-exposure populations. In addition, recent findings suggest that in utero arsenic exposure impaired child thymic development and that enhanced morbidity and immunosuppression might occur. However, as a result of limitations in the studies, the relationship between arsenic exposure and these outcomes remains uncertain. For this evaluation, studies were preferred that included documentation of exposure from drinking-water both at higher concentrations (e. This was in order to assess effects across a broad gradient of exposure and to avoid extrapolation below the observed range in the doseresponse modelling. For skin cancer, three of the four most recent studies of low-level exposure utilized toenail arsenic as a biomarker of exposure; however, the relationship between toenail arsenic and total dietary exposure to inorganic arsenic remains uncertain. Further, as arsenic-related skin lesions may be a possible precursor to skin cancer and have been reported at lower concentrations of arsenic in drinking-water compared with skin cancer, the Committee considered the data for skin lesions to be a more sensitive adverse effect than skin cancer. Thus, pivotal data were identified from epidemiological studies reporting a positive association with arsenic exposure and these effects. However, the great majority of exposure occurs through naturally contaminated groundwater, through drinking-water, water used in food preparation and water used to irrigate food crops, particularly rice. It is technically feasible to achieve arsenic concentrations of 5 g/l or lower using any of several possible treatment methods. However, this requires careful process optimization and control, and a more reasonable expectation is that 10 g/l should be achievable by conventional treatment (e. The ideal solution is to use alternative sources of water that are low in arsenic. However, it is important that this does not result in risk substitutionfor example, if the alternative water source, although low in arsenic, increases exposure to waterborne pathogens and results in acute gastrointestinal infections, which are a major source of mortality and morbidity in many parts of the world (Howard, 2003). This is important for most alternative water sources other than water from tube wells. Screening for arsenic and other possible chemical contaminants of concern that can cause problems with health or acceptability, including fluoride, nitrate, iron and manganese, is also important to ensure that new sources are acceptable. Occasional screening may also be required after a source is established to ensure that it remains safe. Where there are large urban supplies, resources are often available to treat water to remove arsenic or to exploit alternative low-arsenic sources, such as surface water that can be treated to avoid microbiological and other hazards. These low-arsenic sources can be used to blend with higher-arsenic sources to lower the concentration to acceptable levels while still retaining the resource. Many of the major problems lie in rural areas, where there are many small supplies, sometimes down to the household level.

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The actual numbers cheap meldonium 250mg mastercard symptoms before period, indicated by these estimated risks buy meldonium 500 mg overnight delivery symptoms flu, would be very difficult to detect by current epidemiological methods buy discount meldonium 250mg on line illness and treatment. It remains possible that the estimates of cancer risk associated with various arsenic intakes are overestimates. The concentration of arsenic in drinking-water below which no effects can be observed remains to be determined, and there is an urgent need for identification of the mechanism by which arsenic causes cancer, which appears to be the most sensitive toxicity end-point. The practical quantification limit for arsenic is in the region of 110 g/l, and removal of arsenic to concentrations below 10 g/l is difficult in many circumstances. In view of the practical difficulties in removing arsenic from drinking-water, particularly from small supplies, and the practical quantification limit for arsenic, the guideline value of 10 g/l is retained as a goal and designated as provisional. In these circumstances, there is a possibility that adverse effects could occur as a result of exposure to inorganic arsenic from water and food, but these would be at a low incidence that would be difficult to detect in epidemiological studies. Therefore, given that, in many countries, even the provisional guideline value may not be attainable, it is retained on the basis of treatment performance and analytical achievability with the proviso that every effort should be made to keep concentrations as low as reasonably possible. Carmignani M, Boscolo P, Castellino N (1985) Metabolic fate and cardiovascular effects of arsenic in rats and rabbits chronically exposed to trivalent and pentavalent arsenic. Hazell T (1985) Minerals in foods: dietary sources, chemical forms, interactions, bioavailability. Ottawa, Ontario, Department of National Health and Welfare, Bureau of Chemical Safety. Arsenic, drinking-water and health risks substitution in arsenic mitigation: a discussion paper. Accidental exposure or overexposure to pesticides can have seri ous consequences. While most pesticides can be used with relatively little risk when label directions are followed, some are extremely toxic and require special precautions. The Poison Control Centers receive about 90,000 calls each year related to pesticide exposures. Pesticides are re sponsible for about 3 percent of all accidental exposures to children 5 years and younger and about 4 percent for adults. In addition, pesticides are the cause of about 3 percent of childrens deaths reported to the Poison Control Centers. Routes of Exposure Pesticides can enter the human body three ways: 1) der mal exposure, by absorption through the skin or eyes; 2) oral exposure, through the mouth; and 3) through inhalation or respiratory exposure, by inhaling into the lungs. Absorption will contin parts of the body based on the absorption ue as long as the pesticide remains in contact with the skin or of parathion into the forearm over 24 eyes. Maiback and Feldman (1974) measured the amount of the pesticide parathion absorbed by diferent parts of the human body over 24 hours. Pesticides can be ingested by accident, It is easy to transfer pesticide residues from one part of through carelessness, or intentionally. For example, residues can be inadver cidental oral exposure occurs when a pesticide is taken from The Board of Regents of the University of Nebraska. A pesticide stored in a food or beverage con describes the dose of pesticide that will kill half of a group tainer can be especially inviting to a child. When pesticides of test animals (rats, mice, or rabbits) from a single exposure are managed and stored properly, children should not be able or dose by a dermal, oral, or inhalation route. Some pesticides can cause serious damage of the pesticide to kill half of the test animals.

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