Libri sul tema "Urine humaine"

This chapter provides an overview of transport processes, describing both the membrane proteins that effect transepithelial solute flux and the systems that allow integrated regulation of electrolyte transport. The emphasis is on the physiological mechanisms but links to human diseases are made in order to illuminate fundamental principles of control. The key transport proteins and encoding genes are listed. First, the major transport pathways and regulatory features for each nephron segment are described. The focus here is on the transepithelial flux of sodium, potassium, and water. In the second part, other important aspects of renal homeostasis, including urine concentration and acid–base balance, are summarized.

Human survival (on a biochemical level) depends on the body’s critical ability to regulate the osmolality and salinity of extracellular fluid. When functioning in a normal state, the osmoregulatory system stringently maintains the serum sodium in a narrow range. Alterations in the serum sodium and water balance have significant and sometimes life-threatening impact on patients—especially when they occur in conjunction with serious intracranial pathology. This chapter, including the case discussion, illustrates the conundrum of hyponatremia and high urine output states complicating neurological illness. A thorough understanding of the pathophysiology, assessment, and treatment of these conditions is essential for the timely delivery of care and optimal patient outcomes.

The urea cycle is the primary nitrogen disposal pathway in humans. The urea cycle requires the coordinated function of six enzymes and two mitochondrial transporters to catalyze the conversion of a molecule of ammonia, the α-nitrogen of aspartate and bicarbonate into urea. Whereas ammonia is toxic, urea is relatively inert, soluble in water, and readily excreted by the kidney in the urine. The accumulation of ammonia and other toxic intermediates of the cycle lead to predominantly neurological sequelae. All of the genes have been identified. The disorders may present at any age from the neonatal period to adulthood, with the more severe patients presenting earlier in life. Patients are at risk for metabolic decompensation throughout life, often triggered by illness, fasting, surgery and postoperative states, peripartum, stress, and increased exogenous protein load. This chapter addresses common somatic and neurological presentation, differential diagnosis, laboratory testing, and treatments.

The genus Mycobacterium contains over a hundred species including the M. tuberculosis complex and M. leprae, the causative agents of, respectively, tuberculosis and leprosy. The many other species are environmental saprophytes, present particularly in free and piped water sources, and some species are causes of opportunist disease in humans, especially in those who are immune compromised.The genitourinary tract is a common site of both primary and post-primary tuberculosis. In most cases of renal tuberculosis there are gross lesions consisting of caseating granulomas from which tubercle bacilli enter the urinary tract, often with the development of secondary lesions in the ureters, bladder, epididymis, and testis. Tuberculous interstitial nephritis is a less common condition with an insidious course and may result in renal failure. The urine is often negative for tubercle bacilli, emphasizing the need for biopsy in those with renal insufficiency.The risk of developing pulmonary or disseminated tuberculosis after infection is greatly enhanced by any form of immune compromise including renal failure and post-renal transplant immunosuppression.

Leptospirosis is one of the most prevalent zoonotic diseases worldwide. Pathogenic spirochaetes are shed in the urine of infected mammals to the environment. Humans are infected through contact with contaminated material. Leptospirosis is more prevalent in tropical and subtropical areas, but exists in all continents except Antarctica. The disease is difficult to diagnose and hence frequently neglected. Its clinical picture ranges from a mild flu-like disease to a life-threatening form with pulmonary haemorrhage, liver failure and acute kidney injury (AKI), called Weil disease, which may affect 10% of those with clinical disease. Typically, fever, myalgia and headache progress to nausea and vomiting, jaundice, red eyes, and other manifestation affecting skin, brain, and other organs.Kidney involvement, characterized by acute tubulointerstitial nephritis, is nearly universal. It may be clinically manifested as a tubulopathy with urinary electrolytes wasting, hypokalaemia and hypomagnesaemia and/or as AKI, which is more frequently non-oliguric. Antibiotic therapy may reduce hospitalization time and AKI frequency. Otherwise management is supportive, including timely and adequate dialysis support.

Asiatic schistosomiosis is a very old disease with Schistosoma japonicum eggs found in human remains > 2000 years old from Hunan and Hubei provinces in China (Mao and Shao 1982). The original description of Asiatic schistosomiosis was made by Fujii in 1847 (Sasa 1972). The life cycle was fi rst described by Kawanashi (1904) who noted trematode-like eggs in cat faeces. The same year, Katsurada recovered adult worms from a cat from Katayama, Japan (Okabe 1964). Fujinami and Nakamura (1909) first reported skin infection with S. japonicum cercariae of different mammals, and Miyairi and Suzuki (1914) discovered that Oncomelania hupensis served as intermediate host where miracidia developed into sporocysts and further into cercariae (Jordan 2000). The snail hosts of S. japonicum were discovered in China by Faust and Meleney (1923), The Philippines by Tubangui (1932) and in Indonesia by Carvey et al. (1973). In addition to the skin as the principal route of infection, Suda (1924) described oral infection and several authors described the intrauterine route of infection. (Okabe 1964; Sasa 1972).Following the understanding of the lifecyle, control measures including wearing closely woven clothing, composting of faeces with urine for at least 14 days, replacing cattle with horses, killing of rodents especially rats, killing of snails by lime, copper sulphate or salt water, were proven to have some efficacy. In Japan, an effective integrated control programme started after Second World War with the last human case being reported in 1978 (Jordan 2000 ). The National Schistosomiosis Control Programme in China started in 1955 and at that time more than 10 million people were infected with S. japonicum (Wu 2002). Emetine and antimony potassium tartrate were among the first drugs with proven efficacy against schistosomiosis in humans. Later antimony and finally praziquantel and artemether have been introduced as highly effective drugs with only minor adverse effects (Wu 2002).

Mycobacterium leprae, the causative agent of leprosy, is one of over a hundred species of Mycobacteria. The many other species are environmental saprophytes, present particularly in free and piped water sources, and some species are causes of opportunist disease in humans, especially in those who are immune compromised.In 2009, world-wide notifications of leprosy amounted to 244,796 new cases, a significant fall compared with 514,718 in 2003. Elimination of leprosy as a public health problem, defined as a prevalence of registered cases of under 1 per 10,000 population, has been achieved in many countries where leprosy was once highly endemic, and most others are close to reaching this stage.Direct bacterial invasion of the kidney is rare in leprosy but renal amyloidosis and various forms of glomerulonephritis are common, especially those with multibacillary forms of the disease.Renal disease due to environmental mycobacteria is very rare but as these bacteria are frequently present as contaminants of the lower urethra and external genitalia, care is required to distinguish disease from contamination of urine samples.The risk of generalized disease due to environmental mycobacteria is increased by any form of immune compromise including renal failure and post-renal transplant immunosuppression.

Leptospirosis is one of the most widespread and important zoonotic pathogens and is of global medical and veterinary importance. Clinical disease ranges from mild self-limiting influenza – like illness to fulminating repeats-several failure.It is caused by bacterial spirochaetes of the genus Leptospira, family Leptospiraceae. Pathogenic Leptospira interrogans strains, of which there are over 230 serovars in 24 serogroups, are morphologically identical in that they are thin, helical highly motile Gram-negative bacteria, hooked at one or both ends.Natural hosts of pathogenic strains, generally referred to as serovars, may cause infection in man and include wild animals (rodents), livestock (cattle and pigs) and pets (dogs). Most, if not all mammals may become long-term carriers (maintenance hosts). Leptospires become located in the renal tubules and excreted in the urine of infected reservoir animals, humans becoming infected through broken skin, mucous membranes and the conjunctivae.Leptospirosis is most commonly found in tropical or sub-tropical countries in both urban and rural settings. It causes major economic losses, to the highly intensive cattle and pig industries in developed countries, primarily through their effects on reproduction. It is still an important occupational disease risk for people working in agriculture or those living in unsanitary conditions. It is increasingly recognised as a recreational and travel-associated disease.

The class or order Microsporidia was elevated in to the phylum Microspora by Sprague and Vavra (1997) and Sprague and Becnel (1998) subsequently suggested that the term Microsporidia instead be used for the phylum name. Miicrosporidia, i.e. Nosema bombycis, were first described about 150 years ago as the cause of the disease pebrine in silkworms. In 1922, there were descriptions of gram-positive spores consistent with microspordiosis in the brain of rabbits that were being used for investigations on poliomyelitis (Wright and Craighead 1922). From 1923 to 1926, Levaditi and colleagues studied the organisms seen by Wright and Craighead, which they named Encephalitozoon cuniculi, recognizing them as Microsporidia and demonstrating their lack of host specificity by transmitting infections from rabbits to mice, rats and dogs (Levaditi et al. 1923). Microsporidia were clearly confirmed of being a cause of human disease in 1959 (Matsubayashi et al. 1959), when they were isolated from the cerebrospinal fluid of a 9 year old boy with encephalitis with seizures, coma, and fever lasting about 25 days. Bergquist et al. (1984) reported a 2 year old child with encephalitis and seizures who had Encephalitozoon spores in urine and Margileth et al. (1973) isolated the microsporidium Anncaliia (Nosema) connori from a 4 month old athymic male infant who died with severe diarrhoea and malabsorption. Microsporidia can produce a wide range of clinical diseases. A diarrhoeal syndrome associated with microsporidiosis and HIV infection was reported by Desportes et al. (1985) and the number of articles describing human disease increased rapidly after 1990. In addition to gastrointestinal tract involvement, it has been recognized that Microsporidia can infect virtually any organ system; and patients with encephalitis, ocular infection, sinusitis, myositis, and disseminated infection are well described in the literature.

Hantaviruses (genus Hantavirus, family Bunyaviridae) are rodent- and insectivore-borne zoonotic viruses. Several hantaviruses are human pathogens, some with 10-35% mortality, and cause two diseases: hemorrhagic fever with renal syndrome (HFRS) in Eurasia, and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Hantaviruses are enveloped and have a three-segmented, single-stranded, negative-sense RNA genome. The L gene encodes an RNA-dependent RNA polymerase, the M gene encodes two glycoproteins (Gn and Gc), and the S gene encodes a nucleocapsid protein. In addition, the S genes of some hantaviruses have an NSs open reading frame that can act as an interferon antagonist. Similarities between phylogenies have suggested ancient codivergence of the viruses and their hosts to many authors, but increasing evidence for frequent, recent host switching and local adaptation has led to questioning of this model. Infected rodents establish persistent infections with little or no effect on the host. Humans are infected from aerosols of rodent excreta, direct contact of broken skin or mucous membranes with infectious virus, or rodent bite. One hantavirus, Andes virus, is unique in that it is known to be transmitted from person-to-person. HFRS and HCPS, although primarily affecting kidneys and lungs, respectively, share a number of clinical features, such as capillary leakage, TNF-, and thrombocytopenia; notably, hemorrhages and alterations in renal function also occur in HCPS and cardiac and pulmonary involvement are not rare in HFRS. Of the four structural proteins, both in humoral and cellular immunity, the nucleocapsid protein appears to be the principal immunogen. Cytotoxic T-lymphocyte responses are seen in both HFRS and HCPS and may be important for both protective immunity and pathogenesis. Diagnosis is mainly based on detection of IgM antibodies although viral RNA (vRNA) may be readily, although not invariably, detected in blood, urine and saliva. For sero/genotyping neutralization tests/RNA sequencing are required. Formalin-inactivated vaccines have been widely used in China and Korea but not outside Asia. Hantaviruses are prime examples of emerging and re-emerging infections and, given the limited number of rodents and insectivores thus far studied, it is likely that many new hantaviruses will be detected in the near future.

Abstract This book asks how early Christian monastic writers conceived of, represented, and experienced spiritual direction, and its central argument is that they did so medically. Late antique monastic formation took place through asymmetrical relationships of governance and submission worked out in confession, discipline, and advice. This study situates those practices against the cultural and intellectual world of the late antique Mediterranean. In conversation with a biopsychosocial model of health and Urie Bronfenbrenner’s “bioecological” model of development, the first chapter explores the logic of Galenic medicine (2nd c.): the goal of good health, a widely ranging theory of human nature, diagnostic strategies, and therapeutic techniques. The next four chapters show how this logic operates in Evagrius Ponticus’ (4th c.) interpretation of dream imagery and demonic attack, in John Cassian’s (5th c.) analysis of wet dreams, in Cassian’s nosology of vices, and in John Climacus’ (7th c.) demonic pathologies of passions. The second half of the book engages Paul Ricoeur’s theory of metaphor to show that spiritual directors claim trust and obedience by cultivating expertise along medical lines. This begins with a study of self-representation and popular perceptions of physicians as experts over human bodies and souls, which is then applied to Basil of Caesarea’s (4th c.) advice on when and whether ascetic Christians should seek medical assistance, to Cassian’s tales of spiritual direction in Egyptian monasticism and the Apostle Paul’s therapeutic hierarchy, and to John Climacus’ multiple metaphors of spiritual direction in a monastery reconceived as clinic.

Byzantine medicine is still a little-known and misrepresented field not only in the wider arena of debates on medieval medicine but also among Byzantinists. Byzantine medical literature is often viewed as ‘stagnant’ and mainly preserving ancient ideas; and our knowledge of it continues to be based to a great extent on the comments of earlier authorities, which are often repeated uncritically. This book presents the first comprehensive examination of the medical corpus of, arguably, the most important late Byzantine physician John Zacharias Aktouarios (c.1275–c.1330). The main thesis is that John’s medical works show an astonishing degree of openness to knowledge from outside Byzantium combined with a significant degree of originality, in particular, in the fields of uroscopy, pharmacology, and human physiology. The analysis of John’s edited (On Urines and On Psychic Pneuma) and unedited (Medical Epitome) works is supported for the first time by the consultation of a large number of manuscripts. The study is also informed by evidence from a wide range of medical sources, including previously unpublished ones, and texts from other genres, such as epistolography and merchants’ accounts. The contextualization of John’s works sheds new light on the development of Byzantine medical thought and practice, and enhances our understanding of the late Byzantine social and intellectual landscape. Finally, John’s medical observations are also examined in the light of examples from the medieval Latin and Islamic worlds, placing his medical theories in the wider Mediterranean milieu and highlighting the cultural exchange between Byzantium and its neighbours.

La presente obra es un avance del proyecto de investigación “El Crimen de Tortura en Colombia” realizado en el marco del Grupo de Investigación Estudios de Bioética, Ecología Humana y Ecología Política - Consciencia - de la Facultad de Derecho de la Universidad Libre. La tortura en Colombia ha existido, incluso antes del nacimiento de nuestra nación, si bien es cierto el tipo penal de tortura es más reciente, su práctica ha sido un factor común en el transcurrir de estos más de dos siglos. El primer capítulo del texto realiza una aproximación histórica a la tortura como técnica corporal de dominación y control social en Colombia desde la época de la colonia, donde la narración que hizo Bartolomé de Las Casas en su Brevísima relación de la destrucción de las Indias, pone de manifiesto las diversas formas de tormentos a las que fueron sometidos los indígenas que poblaban estas tierras. A partir de ese momento, se han escrito en los cuerpos de miles de personas los lenguajes más despiadados y crueles y las páginas más nefastas de la historia de nuestro país, este capítulo también analiza el período de consolidación del proyecto republicano y las guerras civiles decimonónicas. Ulteriormente, se detiene en la época de la llamada Violencia, donde las clases dominantes del país indujeron a los sectores más pobres de la sociedad a enfrentar de manera violenta a sus vecinos, amigos e incluso parientes. Hicieron creer a los sectores populares que el país estaba dividido en dos bandos y necesariamente cada familia debida escoger uno de ellos: Liberal o Conservador. Se presentaron formas de violencia incompresibles y el empleo de “rituales macabros, como el descuartizamiento de hombres vivos, las exhibiciones de cabeza cortadas y la dispersión de partes de cuerpos por los caminos rurales, que aún perviven en la memoria de la población colombiana, le imprimieron su sello distinto a ese periodo” (Uribe, 2004). Varios investigadores han desentrañado la fórmula de extrema crueldad que se utilizó en muchas regiones del país “Matar, rematar, contramatar”, matar con el mayor dolor para la víctima, luego colocar todo tipo de marcas sobre los cuerpos, muchas veces aún con vida y luego colocar sus órganos o algunas de sus partes en algún sitio y creando montículos con sus viseras para enviar mensajes de terror a los demás miembros de ese colectivo. Pero no era suficiente destrozar el cuerpo, prolongar la muerte, hacer sufrir a la víctima e insultarla El cuerpo de la víctima, aún parecía un escenario de inmensas ritualidades dispuestas a causar terror. “Los muertos debían quedar bien muertos, y por ello se decapitaba a los cadáveres ya que se creía que «el muerto no estaba muerto mientras tuviera la cabeza sobre los hombros»” (Uribe, 2004). Por otro lado, los centros carcelarios y penitenciarios de nuestro país son diariamente escenarios de actos de tortura contra los reclusos y reclusas. Prácticas como las golpizas; el uso de armas taser y bombas de gas; internamientos prolongados en las llamadas Unidades de tratamiento Especial UTEs; la negación a los servicios médico-asistenciales ante enfermedades que requieren tratamiento especial; la violación sexual, etc., se han convertido en algo cotidiano en todos los centros de reclusión. Este tipo de prácticas se producen a gran escala incluso en los centros de reclusión para menores infractores. En el centro detención de menores El Redentor, ubicado en el sur occidente de Bogotá, el 8 de octubre de 2018 fueron grabados en video siete (7) servidores públicos de la Policía Nacional sometiendo a golpizas y tratos crueles, inhumanoS y degradantes que la Fiscalía General de la Nación calificó inicialmente como tortura (Fiscal, 2018). Por lo anterior, el segundo capítulo del libro se centra en los hechos de tortura que se cometen en los centros de reclusión y cárceles del país, particularmente, alrededor de los esfuerzos de las organizaciones colombianas que promueven los derechos de la población privada de la libertad, puntualizando en la labor de la Defensoría del Pueblo como la entidad que defiende y garantiza el derecho de los reclusos a no ser sometidos a tratos crueles, inhumanos y degradantes u otros constitutivos de tortura. De esta manera, el doctor José Manuel Díaz caracteriza las estrategias de la Defensoría del Pueblo desde un enfoque cuasiconstructivista de la garantía de los Derechos Humanos que reconoce el valor de las acciones conjuntas entre autoridades estatales y actores sociales nacionales (sub-estatales) en la generación de estándares mínimos para su prevención y protección. Con este propósito, el texto brinda una aproximación conceptual a la tortura y los tratos crueles, inhumanos y degradantes y describe el fenómeno generalizado de la tortura en algunos centros penitenciarios y carcelarios del país, para luego, exponer la funcionalidad y eficacia de planes de acción con enfoque cuasi-constructivista –como el mecanismo de denuncia implementado en el establecimiento penitenciario y carcelario de máxima seguridad de la ciudad de Valledupar–, en la defensa de los derechos humanos de las personas privadas de la libertad. En el tercer capítulo del libro, la doctora Bolívar aborda uno de los temas más inquietantes y menos trajinados, desde el punto de la calificación jurídica, de lo que podemos considerar un acto constitutivo de tortura; en qué circunstancias la violencia sexual –en este caso la que se ejerce por razón de género– puede considerarse como una forma de tortura, esto es, qué características debe revestir una agresión sexual para que podamos considerarla –jurídicamente– a partir de tratados internacionales de derechos humanos, conceptos de órganos internacionales y pronunciamientos judiciales de tribunales internacionales de derechos humanos, como mecanismo de tortura. Lo anterior le permitirá al lector reconocer en qué circunstancias este tipo de violencia contra las mujeres “se constituye como expresión instrumental de la tortura, y puede denominarse, tramitarse procesalmente y resolverse judicialmente como tortura sexual”. Finalmente, incluimos en uno de los anexos el concepto del Ministerio de Justicia y del Derecho donde señala las razones jurídicas por las cuales el Estado colombiano debe ratificar el Protocolo Facultativo a la Convención Contra la Tortura. En este sentido, no se entiende cómo el órgano del Estado competente en los temas de política criminal y penitenciaria emite un concepto favorable y el Ministerio de Relaciones Internacionales se niega sistemáticamente a acatar este concepto e iniciar los procesos para la ratificación del Protocolo. Miles de Personas Privadas de la Libertad víctimas de tortura esperan del Gobierno Nacional una decisión humanitaria, centrada solo en el principio “Pro Homine” y no en consideraciones de oportunidad política. Esperamos que este texto sea el primero de una serie de publicaciones para visibilizar este crimen que efectivamente se encuentra tipificado en el artículo 178 del Código Penal, pero sobre el que existen un escaso número de sentencias condenatorias.