Karlen G. Adamyan

Karlen Grigori Adamyan (, born 19 January 1937) is an Armenian cardiologist, Doctor of Medical Sciences (1971), Professor (1985), Academician of the Armenian National Academy of Sciences (1996).
In 2009 he was named Honoured Science Worker of the Republic of Armenia.
Career.
Adamyan graduated Yerevan State Medical Institute in 1959. From 1962 to 1965 he was a postgraduate student at the Institute of Cardiology and Heart Surgery of Ministry of Health of the ASSR, after which he started working for the same institute. in 1972-1982 he transferred to the atherosclerotic cardiovascular disease department. In 1979, he became the director of Yerevan Research Institute of Cardiology. in 1995, he became the Head of the Chair of Clinical Cardiology of the National Institute of Health, as well as filled the position of Chief Cardiologist at the Ministry of Health of Armenia (1979-2001).
Author of 497 scientific papers, and 10 monographs.
Adamyan has been credited for developing the functional heart failure concept in cases of atherosclerotic cardiovascular disease and birth defects and for suggesting the classification of the pre-cyclone stage of circulatory collapse. Adamyan has introduced the biomedicine and immunology directions in clinical cardiology. Adamyan main research has been in the fields of primary and secondary prevention of pulmonary hypertension and cardiac ischemic disease.


Intestinal malrotation

Intestinal malrotation is a congenital anomaly of rotation of the midgut. It occurs during the first trimester as the fetal gut undergoes a complex series of growth and development. Malrotation can lead to a dangerous complication called volvulus. Malrotation can refer to a spectrum of abnormal intestinal positioning, often including:
The position of the intestines, narrow mesentery and Ladd's bands can contribute to several severe gastrointestinal conditions. The narrow mesentery predisposes some cases of malrotation to midgut volvulus, a twisting of the entire small bowel that can obstruct the mesenteric blood vessels leading to intestinal ischemia, necrosis, and death if not promptly treated. The fibrous Ladd's bands can constrict the duodenum, leading to intestinal obstruction.
Signs and symptoms.
Signs and symptoms of malrotation vary depending on if the patient is suffering from an acute volvulus or experiencing chronic symptoms.
Complications.
Intestinal malrotation can lead to a number of disease manifestations and complications such as:
Causes.
The exact cause of intestinal malrotation is unknown. It is not definitively associated with a particular gene, but there is some evidence of recurrence in families.
Diagnosis.
Malrotation is most often diagnosed during infancy, however, some cases are not discovered until later in childhood or even adulthood.
With acutely ill patients, consider emergency surgery laparotomy if there is a high index of suspicion.
In cases of volvulus, plain radiography may demonstrate signs of duodenal obstruction with dilatation of the proximal duodenum and stomach but it is often non-specific. Ultrasonography may be useful in some cases of volvulus, depicting a "whirlpool sign" where the superior mesenteric artery and Superior mesenteric vein have twisted.
Upper gastrointestinal series is the modality of choice for the evaluation of malrotation, as it will often show an abnormal position of the duodenum and duodeno-jejunal flexure (ligament of Treitz). In cases of malrotation complicated with volvulus, upper GI demonstrates a corkscrew appearance of the distal duodenum and jejunum. In cases of obstructing Ladd's bands, upper GI may reveal a duodenal obstruction. Although upper GI series is regarded as the most reliable diagnostic test for intestinal malrotation, false negatives may occur in 5% of cases. False negatives are most frequently attributed to radiographer error, uncooperative pediatric patients, or variations in intestinal positioning. In equivocal cases physicians may wish to repeat the upper GI or consider additional diagnostic modalities. Lower gastrointestinal series, may be helpful in some patients by showing the caecum at an abnormal location. CT scan and Magnetic resonance imaging may also aide in the diagnosis of equivocal cases.
The incidence of intestinal malrotation in infants with omphalocoele is low. Therefore, there is little evidence to support the screening for intestinal malrotation in infants with omphalocoele.
Treatment.
Prompt surgical treatment is necessary for intestinal malrotation when volvulus has occurred:
With this condition the appendix is often on the wrong side of the body and therefore removed as a precautionary measure during the surgical procedure.
This surgical technique is known as the "Ladd's procedure", after Dr. William Ladd. Long-term research on the Ladd's procedure indicates that even after surgery, some patients are susceptible to GI issues and may need further surgery.


South African Medical Service

The South African Medical Service (SAMS) was a branch of the South African Defence Force (SADF). In 1994 when the SADF was merged with various other military and armed resistance forces as part of the post-apartheid reforms the SAMS became the South African Military Health Service of the South African National Defence Force. The SAMS operated three hospitals, 1 Military Hospital in Pretoria, 2 Military Hospital in Cape Town, and 3 Military Hospital in Bloemfontein. It also had three specialist institutes; the Institute for Aviation Medicine, the Institute for Maritime Medicine, and the Military Psychological Institute.
History.
The SA Defence Act Amendment Act, No. 22 of 1922 re-organised the Permanent Force. From 1 February 1923 the Permanent Force consisted a number of Corps, including the SA Medical Corps.
By that time three Medical Corps were already in existence, the Transvaal Medical Corps (established in 1903), the Natal Volunteer Medical Corps (established in 1899) and the Cape Medical Staff Corps.
The SAMS was established in July 1979 as a service branch of the SADF. The establishment combined the medical services of the Army, Navy and the Air Force. The head of the SAMS was the Surgeon-General who had the rank of Lieutenant-General. The role of the SAMS was to provide health and medical support services to the SADF, it included a veterinary section that looked after dogs and horses.


Gladstone Institutes

Gladstone Institutes is an independent, non-profit biomedical research organization whose focus is to better understand, prevent, treat and cure cardiovascular, viral and neurological conditions such as heart failure, HIV/AIDS and Alzheimer's disease. Its researchers study these diseases using techniques of basic and translational science. Another focus at Gladstone is building on the development of induced pluripotent stem cell technology by one of its investigators, 2012 Nobel Laureate Shinya Yamanaka, to improve drug discovery, personalized medicine and tissue regeneration.
Founded in 1979, Gladstone is affiliated with the University of California, San Francisco (UCSF) and is located in San Francisco, adjacent to UCSF's Mission Bay campus. Approximately 450 staff members—including more than 300 scientists—work at Gladstone.
History.
Gladstone Institutes was founded in 1979 as a research and training facility housed at San Francisco General Hospital. Under the leadership of Robert Mahley—a cardiovascular scientist recruited from the National Institutes of Health—the institutes was launched with a $8 million trust from the late commercial real estate developer, J. David Gladstone.
In 1991, the institutes expanded its focus to include virology and immunology in response to the growing HIV/AIDS crisis. In 1998 it founded a third institute dedicated to studying neurological diseases.
In 2004 the Gladstone Institutes moved to a new facility in San Francisco's Mission Bay, San Francisco neighborhood. Two years later it founded a center dedicated to translating its biological discoveries into therapies. Three years later and together with Taube Philanthropies and the Koret Foundation, it founded the Taube-Koret Center for Huntington's Disease Research.
In 2010, Dr. Mahley stepped down in order to return to active research. R. Sanders "Sandy" Williams, Dean of the School of Medicine at Duke University, became Gladstone's new president.
In 2011, the S.D. Bechtel, Jr. Foundation helped launch the Center for Comprehensive Alzheimer's Disease Research, while the Roddenberry Foundation helped launch the Roddenberry Stem Cell Center for Biology and Medicine. Also in 2011, the independent and philanthropic Gladstone Foundation formed with the mission of expanding the financial resources for the institutes.
Research programs.
Gladstone scientists focus on three main disease areas: cardiovascular disease, neurological disease and viral/immunological disease. Scientists working in all three disease areas use stem cell technology to advance the understanding, prevention, treatment and cure of disease.
Cardiovascular disease.
Gladstone cardiovascular scientists research the spectrum of cardiovascular disease—including congenital heart disease, congestive heart failure and related metabolic diseases such as diabetes. Scientists utilize developmental, chemical and stem cell biology approaches, as well as genomics techniques.
Current research programs include:
Virology and immunology.
Virology and immunology research at Gladstone is focused primarily on three urgent challenges related to the HIV/AIDS epidemic: preventing viral transmission of HIV with drugs or a vaccine for those at risk of coming in contact with the virus, curing the millions of people who already live with HIV and restoring a normal lifespan to those who are HIV-positive—but who are dying earlier than their uninfected counterparts from diseases of aging.
In addition, the group studies hepatitis C, HTLV and the immunology of viral infections.
Current research programs include:
Neurological disease.
Research at Gladstone focuses on major neurological diseases including: Alzheimer's disease, Parkinson's disease, frontotemporal dementia (FTD), Huntington's disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) and multiple sclerosis. This research incorporates animal models, electrophysiology, behavioral testing and automated high-throughput analyses. In addition, Gladstone investigators seek to accelerate the movement of basic science discoveries into clinical trials with efforts to bridge the so-called "Valley of Death". The research features an emphasis on the "common threads" that link the various diseases and treatments for them.
Current research programs include:
Stem cell technology.
Many research areas build upon the stem cell work of Gladstone Senior Investigator Shinya Yamanaka. After completing his postdoctoral training at Gladstone, Yamanaka discovered induced pluripotent stem cell technology, by which ordinary differentiated adult cells (such as fibroblasts from skin) can be "reprogrammed" into a pluripotent state—i.e., a state similar to embryonic stem cells, which are capable of developing into virtually any cell type in the human body. His discovery of induced pluripotent stem cells, or iPS cells, has since revolutionized the fields of developmental biology, stem cell research and both personalized and regenerative medicine. In 2012 Yamanaka was awarded the Nobel Prize in Physiology or Medicine.
Since Yamanaka's 2006 discovery, scientists have made many advances in iPS technology and continue to conduct research in several areas of stem cell biology.
Current research programs include:
Translational research.
The Gladstone Center for Translational Research facilitates interactions between Gladstone scientists and the biomedical industry—including venture capitalists, biotech firms and large corporations. The Center's primary goal is to translate the results of Gladstone's basic science into therapeutics that help patients with cardiovascular, viral or neurological diseases.
Researchers.
Researchers at the institute include:


Tracheal deviation

Tracheal deviation is a clinical sign that results from unequal intrathoracic pressure within the chest cavity. It is most commonly associated with traumatic pneumothorax, but can be caused by a number of both acute and chronic health issues, such as pneumonectomy, atelectasis, pleural effusion, fibrothorax (pleural fibrosis), or some cancers (tumors within the bronchi, lung, or pleural cavity) and certain lymphomas associated with the mediastinal lymph nodes.
In most adults and children, the trachea can be seen and felt directly in the middle of the anterior (front side) neck behind the jugular notch of the manubrium and superior to this point as it extends towards the larynx. However, when tracheal deviation is present, the trachea will be displaced in the direction of less pressure. Meaning, that if one side of the chest cavity has an increase in pressure (such as in the case of a pneumothorax) the trachea will shift towards the opposing side.
The trachea is the tube that carries air from the throat to the lungs. It is also commonly referred to as the windpipe. The trachea is one of the most important parts of the respiratory system and damage to the trachea can indicate a life-threatening emergency. The normal position of the trachea is straight up and down, running along the center of the front side of the throat. Certain conditions can cause the trachea to shift to one side or the other. This is a medical emergency that requires immediate medical attention to discover the cause of the shift and begin an appropriate course of treatment. There are several causes for a tracheal deviation, and the condition often presents along with difficulty breathing, coughing and abnormal breath sounds. The most common cause of tracheal deviation is a pneumothorax, which is a collection of air inside the chest, between the chest cavity and the lung. A pneumothorax can be spontaneous, caused by existing lung disease, or by trauma. Treatment varies, depending on the severity of the pneumothorax. Smaller pockets of air tend to dissipate on their own, while larger areas can cause complications and are usually vented by a needle in the chest. As soon as the pneumothorax is treated, the tracheal deviation also will resolve itself. A congenital lack of one lung, surgical removal of a lung or pleural fibrosis, which is an inflammation of the lung membranes caused by an infection. As a result of the wide range of causes of tracheal deviation, it is absolutely essential to seek medical attention so that an accurate diagnosis can be obtained.
Treatment.
Since tracheal deviation is a sign as opposed to a condition, treatment is focused on correcting the cause of the finding. In the case of pneumothorax, thoracentesis or chest tube insertion is performed to relieve the pressure within the affected pleural cavity.


Anaerobic infection

Anaerobic infections are caused by anaerobic bacteria. Obligately anaerobic bacteria do not grow on solid media in room air (0.04% carbon dioxide and 21% oxygen); facultatively anaerobic bacteria can grow in the presence or absence of air. Microaerophilic bacteria do not grow at all aerobically or grow poorly, but grow better under 10% carbon dioxide or anaerobically. Anaerobic bacteria can be divided into strict anaerobes that can not grow in the presence of more than 0.5% oxygen and moderate anaerobic bacteria that are able of growing between 2 and 8% oxygen. Anaerobic bacteria usually do not possess catalase, but some can generate superoxide dismutase which protects them from oxygen.
The clinically important anaerobes in decreasing frequency are:
1. Six genera of Gram-negative rods ("Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Bilophila" and "Sutterella" spp.);
2. Gram-positive cocci (primarily "Peptostreptococcus" spp.);
3. Gram-positive spore-forming ("Clostridium" spp.) and non-spore-forming bacilli ("Actinomyces, Propionibacterium, Eubacterium, Lactobacillus" and "Biﬁdobacterium" spp.); and
4. Gram-negative cocci (mainly "Veillonella" spp.) .
The frequency of isolation of anaerobic bacterial strains varies in different infectious sites. Mixed infections caused by numerous aerobic and anaerobic bacteria are often observed in clinical situations.
Anaerobic bacteria are a common cause of infections, some of which can be serious and life-threatening. Because anaerobes are the predominant components of the normal flora of the skin and mucous membranes, they are a common cause of infections of endogenous origin. Because of their fastidious nature, anaerobes are hard to culture and isolate and are often not recovered from infected sites. The administration of delayed or inappropriate therapy against these organisms may lead to failures in eradication of these infections. The isolation of anaerobic bacteria requires adequate methods for collection, transportation and cultivation of clinical specimens. The management of anaerobic infection is often difficult because of the slow growth of anaerobic organisms, which can delay their identification by the frequent polymicrobial nature of these infections and by the increasing resistance of anaerobic bacteria to antimicrobials.
Signs and symptoms.
Anaerobes have been found in infections throughout the human body. The frequency of the host or patient's recovery depends on the employment of proper methods of collection of specimen, their transportation to the microbiology laboratory and cultivation. The recovery of organisms depends on the site of infection and is related to the adjacent mucous membranes microbial flora.
Central nervous system.
Anaerobes are able to cause all types of intracranial infections. These often cause subdural empyema, and brain abscess, and rarely cause epidural abscess and meningitis. The origin of brain abscess is generally an adjacent chronic ear, mastoid, or sinus infection oropharynx, teeth or lungs. Mastoid and ear or infections generally progress to the temporal lobe or cerebellum, while facial sinusitis commonly causes frontal lobe abscess. Hematogenous spread of the infection into the CNS often occurs after oropharyngeal, dental, or pulmonary infection. Infrequently bacteremia originating of another location or endocarditis can also cause intracranial infection.
Meningitis due to anaerobic bacteria is infrequent and may follow respiratory tract infection or complicate a cerebrospinal fluid shunt. Neurological shunt infections are often caused by skin bacteria such as "Cutibacterium acnes", or in instances of ventriculoperitoneal shunts that perforate the gut, by anaerobes of enteric origin (i.e. "Bacteroides fragilis")."Clostridium perfringens" can cause of brain abscesses and meningitis following intracranial surgery or head trauma.
The anaerobes often isolated from brain abscesses complicating respiratory and dental infections are anaerobic Gram-negative bacilli (AGNB, including Prevotella, "Porphyromonas", Bacteroides), "Fusobacterium" and Peptostreptococcus spp. Microaerophilic and other streptococci are also often isolated. Actinomyces are rarely isolated.
At the stage of encephalitis, antimicrobial therapy and utilization of measures to lower the increase in the intracranial pressure can prevent the formation of an intracranial abscess However, after an abscess has emerged, surgical removal or drainage may be necessary, along with an extended course of antimicrobial therapy (4–8 weeks). Some advocate complete drainage of intracranial abscess, while others use repeated aspirations of the abscess., Repeated aspirations of an abscess are preferable in those with multiple abscesses or when the abscess is located in a predominate brain site. Administration of antimicrobials in a high-dose for an extended period of time can offer an alternative treatment strategy in this type of patients and may substitute for surgical evacuation of an abscess.
Because of the poor penetration of many antimicrobial agents through the blood–brain barrier, there are few agents available for the treatment of intracranial infections. The antimicrobials with good intracranial penetration are metronidazole, chloramphenicol, penicillins, and meropenem. Optimally, the selection of antimicrobial is done according to the recovered isolates and their antimicrobial susceptibilities. A substantial improvement in patients' survival rate has occurred after the introduction of computed tomography (CT) and other scans and utilization of metronidazole therapy.
Upper respiratory tract and head and neck infections.
Anaerobes can be isolated from most types of upper respiratory tract and head and neck infection, and are especially common in chronic ones. These include tonsillar, peritonsillar and retropharyngeal abscesses, chronic otitis media, sinusitis and mastoiditis, eye ocular) infections, all deep neck space infections, parotitis, sialadenitis, thyroiditis, odontogenic infections, and postsurgical and nonsurgical head and neck wounds and abscesses., The predominant organisms are of oropharyngeal flora origin and include AGNB, "Fusobacterium" and Peptostreptococcus spp.
Anaerobes involve almost all dental infections. These include dental abscesses, endodontal pulpitis and periodontal (gingivitis and periodontitis) infections, and perimandibular space infection. Pulpitis can lead to abscess formation and eventually spread to the mandible and other neck spaces. In addition to strict anaerobic bacteria, microaerophilic streptococci and "Streptococcus salivarius" can also be present.
"Fusobacterium" spp. and anaerobic spirochetes are often the cause of acute necrotizing ulcerative gingivitis (or Vincent's angina) which is a distinct form of ulcerative gingivitis.
Deep neck infections that develop as a consequence of oral, dental and pharyngeal infections are generally polymicrobial in nature. These include extension of retropharyngeal cellulitis or abscess, mediastinitis following esophagus perforation, and dental or periodontal abscess.
Lung infections.
In adults the most common source of aspiration pneumonia is aspiration of oropharyngeal secretions or gastric contents. In children the most common cause is aspiration of infected amniotic fluid, or vaginal secretions. Severe periodontal or gingival diseases are important risk factors for establishment of an anaerobic pleuropulmonary infection. Progression of the infection from pneumonitis into necrotizing pneumonia and pulmonary abscess can occur, with or without the development of empyema., The infection is often polymicrobial in nature and isolates of community-acquired infection (in 60–80% of cases) are aerobic and anaerobic belonging to the individual's oropharyngeal flora. The anaerobic bacteria commonly recovered are "Prevotella, Porphyromonas, Fusobacterium" and "Peptostreptococcus" spp., and the aerobic bacteria are beta-hemolytic and microaerophilic streptococci. Anaerobic bacteria can also be isolated in about 35% of individuals who suffer from nosocomial-acquired aspiration pneumonia and pneumonia associated with tracheostomy with and without mechanical ventilation, where they are often isolated along with Enterobacteriaceae, "Pseudomonas" spp. and "Staphylococcus aureus". It is important that specimens are obtained in a method that avoids their contamination by the oral micro flora.
Abdominal infections.
Secondary peritonitis and intra-abdominal abscesses including splenic and hepatic abscesses generally occur because of the entry of enteric micro-organisms into the peritoneal cavity through a defect in the wall of the intestine or other viscus as a result of obstruction, infarction or direct trauma. Perforated appendicitis, diverticulitis, inflammatory bowel disease with perforation and gastrointestinal surgery are often associated with polymicrobial infections caused by aerobic and anaerobic bacteria, where the number of isolates can average 12 (two-thirds are generally anaerobes). The most common aerobic and facultative bacteria are "Escherichia coli", "Streptococcus" spp. (including Enterococcus spp.), and the most frequently isolated anaerobic bacteria are the "B. fragilis" group, "Peptostreptococcus" spp., and "Clostridium" spp.
Abdominal infections are characteristically biphasic: an initial stages of generalized peritonitis associated with "Escherichia coli" sepsis, and a later stages, in which intra abdominal abscesses harboring anaerobic bacteria ( including "B. fragilis" group ) emerge.
The clinical manifestations of secondary peritonitis are a reflection of the underlying disease process. Fever, diffuse abdominal pain, nausea and vomiting are common. Physical examination generally show signs of peritoneal inflammation, isuch as rebound tenderness, abdominal wall rigidity and decrease in bowel sounds. These early findings may be followed by signs and symptoms of shock.
Biliary tract infection is usually caused by "E. coli, Klebsiella" and "Enterococcus" spp. Anaerobes (mostly "B. fragilis" group, and rarely "C. perfringens") can be recovered in complicated infections associated with carcinoma, recurrent infection, obstruction, bile tract surgery or manipulation.
Laboratory studies show elevated blood leukocyte count and predominance of polymorphonuclear forms. Radiographs studies may show free air in the peritoneal cavity, evidence of ileus or obstruction and obliteration of the psoas shadow. Diagnostic ultrasound, gallium and CT scanning may detect appendiceal or other intra-abdominal abscesses. Polymicrobial postoperative wound infections can occur.
Treatment of mixed aerobic and anaerobic abdominal infections requires the utilization of antimicrobials effective against both components of the infection as well as surgical correction and drainage of pus. Single and easily accessible abscesses can be drained percutaneously.
Female genital infections.
Female genital tract infections caused by anaerobic bacteria are polymicrobial and include: soft-tissue perineal, vulvar and Bartholin gland abscesses; bacterial vaginosis; endometritis; pyometra; salpingitis; adnexal abscess; tubo-ovarian abscesses; intrauterine contraceptive device-associated infection; pelvic inflammatory disease, which may include pelvic cellulitis and abscess; amnionitis; septic pelvic thrombophlebitis; septic abortion; and postsurgical obstetric and gynecologic infections., Getting adequate microbiological cultures is essential. It is important to avoid contaminating the culture with the normal genital flora. Methods that can ensure adequate cultures are laparoscopy, culdocentesis, or obtaining quantitative endometrial cultures employing a telescoping catheter.
The anaerobes often recovered include "Prevotella bivia, Prevotella disiens", and "Peptostreptococcus, Porphyromonas" and "Clostridium" spp. "Bacteroides fragilis" group is rarely recovered in these infections compared to intra-abdominal infection." Actinomyces" spp. and "Eubacterium nodatum" are often recovered in infections associated with intrauterine devices. Mobiluncus spp. can be associated with bacterial "vaginosis". The aerobic bacteria also found mixed with these anaerobic bacteria include Enterobacteriaceae, "Streptococcus" spp. (including groups A and B), "Neisseria gonorrhoeae", "Chlamydia" spp. and "Mycoplasma hominis". Free gas in the tissues, abscess formation and foul-smelling discharge is commonly associated with the presence of anaerobic bacteria. Treatment of these infections includes the use of antimicrobials active against all of the potential aerobic and anaerobic bacterial pathogens. Antimicrobials against sexually transmissible pathogens should also be administered.
Skin and soft-tissue infections.
The infections that frequently involve anaerobic bacteria include superficial infections, including infected paronychia, infected human or animal bites, cutaneous ulcers, cellulitis, pyoderma, and hidradenitis suppurativa. Secondary infected sites include secondary infected diaper rash, gastrostomy or tracheostomy site wounds, scabies or kerion infections, eczema, psoriasis, poison ivy, atopic dermatitis, eczema herpeticum, infected subcutaneous sebaceous or inclusion cysts, and postsurgical wound infection.
Skin involvement in subcutaneous tissue infections includes: cutaneous and subcutaneous abscesses, breast abscess, decubitus ulcers, infected pilonidal cyst or sinus, Meleney's ulcer infected diabetic (vascular or trophic) ulcers, bite wound, anaerobic cellulitis and gas gangrene, bacterial synergistic gangrene, and burn wound infection. Deeper anaerobic soft-tissue infections are necrotizing fasciitis, necrotizing synergistic cellulitis, gas gangrene and crepitus cellulitis. These can involve the fascia as well as the muscle surrounded by the fascia, and may also induce myositis and myonecrosis.
The isolates found in soft-tissue infections can vary depending on the type of infection. The infection's location and the circumstances causing the infection can also influence the nature of the microorganisms recovered. Bacteria that are members of the 'normal flora' of the region of the infection are often also isolated from lesions involving anaerobic bacteria.
Specimens obtained from wounds and subcutaneous tissue infections and abscesses in the rectal area (perirectal abscess, decubitus ulcer) or that are of gut flora origin(i.e. diabetic foot infection) often to yield colonic flora organisms. These are generally "B. fragilis" group, "Clostridium" spp., Enterobacteriaceae and "Enterococcus" spp. On the other hand, infections in and around the oropharynx, or infections that originate from that location, frequently contain oral flora organisms (i.e. paronychia, bites, breast abscess). These bacteria include pigmented "Prevotella" and "Porphyromonas, Fusobacterium" and Peptostreptococcus spp. Skin flora organisms such as "S. aureus" and "Streptococcus" spp., or nosocomially acquired microorganisms can be recovered at all body locations. Human bite infections often contain "Eikenella" spp. and animal bites harbor "Pasteurella multocida" in addition to oral flora,
Anaerobes infections are often polymicrobial in nature, and sometimes (i.e. decubitus ulcers, diabetic foot ulcer) they are complicated by bacteremia and or osteomyelitis . Infections which are in the deep tissues ( necrotizing cellulitis, fasciitis and myositis) often include "Clostridium" spp., "S. pyogenes" or polymicrobic combinations of both aerobic and anaerobic bacteria. Gas in the tissues and putrid-like pus with a gray thin quality are often found in these infections, and they are frequently associated with a bacteremia and high mortality rate.
Treatment of deep-seated soft-tissue infections includes: vigorous surgical management that includes surgical debridement and drainage. Even though there are no controlled studies that support this approach improvement of the involved tissues oxygenation by enhancement of blood supply and administration of hyperbaric oxygen, especially in clostridial infection, may be helpful.
Osteomyelitis and septic arthritis.
Anaerobic bacteria are often found in oesteomyelitis of the long bones especially after trauma and fracture, osteomyelitis associated with peripheral vascular disease, and decubitus ulcers and osteomyelitis of the facial and cranial bones. Many of these bone infections are polymicrobial in nature.
Cranial and facial bones anaerobic osteomyelitis often originates by the spread of the infection from a contiguous soft-tissue source or from dental, sinus, or ear infection. The high concentration of anaerobic bacteria in the oral cavity explains their importance in cranial and facial bone infections. The high number of gut anaerobes in pelvic osteomyelitis is generally caused by their spread from decubitus ulcers sites. The anaerobic organisms in osteomyelitis associated with peripheral vascular disease generally reach the bone from adjacent soft-tissue ulcers. Long bones osteomyelitis is often caused by trauma, hematogenic spread, or the presence of a prosthetic device.
Peptostreptococcus and "Bacteroides" spp. are the most frequently recovered isolates at all bone infections, including those caused by bites and cranial infection. Pigmented "Prevotella" and "Porphyromonas" spp. are especially common in bite and skull bone infections, whereas members of the "B. fragilis" group are often found in vascular disease or neuropathy. "Fusobacterium" spp., which belongs to the oral microflora, are most often isolated from bites and from cranial and facial bone infections. "Clostridium" spp. are frequently recovered in long bones infections, mostly in association with traumatic wounds. Because "Clostridium" spp. colonize the lower gastrointestinal tract, they can contaminate compound lower extremities fractures.
Septic arthritis due to anaerobic bacteria is frequently associated with contiguous or hematogenous infection spread, prosthetic joints and trauma. Most septic arthritis cases caused by anaerobic bacteria are monomicrobial. The predominant anaerobic bacteria isolated are Peptostreptococcus spp. and "P. acnes" (frequently found in prosthetic joint infection)," B. fragilis" and "Fusobacterium" spp. (frequently found in infections of hematogenic origin), and "Clostridium" spp. (frequently found in infections after trauma).
Bacteremia.
The incidence of anaerobic bacteria in bacteremia varies between 5% to 15%, The incidence of anaerobic bacteremia in the 1990s declined to about 4% (0.5–12%) of all cases of bacteremias. A resurgence in bacteremia due to anaerobic bacteria was observed recently. This is explained by a greater number of anaerobic bacteremia in patients with complex underlying disease or those that are immunosuppressed. The commonest isolates are B. fragilis group (over 75% of anaerobic isolates), "Clostridium" spp. (10–20%), "Peptostreptococcus" spp. (10–15%), "Fusobacterium" spp. (10–15%) and "P. acnes" (2–5%).
The type of bacteria involved in bacteremia is greatly influenced by the infection's portal of entry and the underlying disease. The isolation of "B. fragilis" group and "Clostridium" spp. is often associated with a gastrointestinal source, pigmented "Prevotella" and "Porphyromonas" spp. and "Fusobacterium" spp.with oropharynx and pulmonary sites, "Fusobacterium" spp. with the female genital tract locations," P. acnes" with a foreign body, and "Peptostreptococcus" spp. with all infection sources, but mostly with oropharyngeal, pulmonary and female genital tract locations. The association of these organisms is related to the origin of the initial infection and the endogenous bacterial flora at that site.
The main factors which predispose to anaerobic bacteremia are: hematologic disorders; organ transplant; recent gastrointestinal, obstetric, or gynecologic surgery; malignant neoplasms intestinal obstruction; decubitus ulcers; dental extraction; sickle cell disease; diabetes mellitus; postsplenectomy; the newborn; and the administration of cytotoxic agents or corticosteroids.,
The clinical presentations of anaerobic bacteremia are not different from those observed in aerobic bacteremia, except for the infection's signs observed at the portal of entry of the infection. It often includes fever, chills, hypotension, shock, leukocytosis, anemia and disseminated intravascular coagulation. Clinical features that are characteristic of anaerobicbacteremia include hyperbilirubinemia, metastatic lesions, and suppurative thrombophlebitis. The mortality rate varies between 15% and 30% and can be improved in those who are diagnosed early and receive appropriate antimicrobial therapy and their primary infection when present is resolved.
Neonatal infection.
The newborn's exposure to the maternal vaginal bacterial flora which contains aerobic and anaerobic bacterial flora can lead to the development of anaerobic bacterial infection. These infections include cellulitis of the site of fetal monitoring (caused by "Bacterodes" spp.), bacteremia, aspiration pneumonia (caused by "Bacterodes" spp.), conjunctivitis (caused by clostridia,) omphalitis (caused by mixed flora), and infant botulism. Clostridial species may play a role in necrotizing enterocolitis. Management of these infection necessitates treating of the underlying condition(s) when present, and administration of proper antimicrobial therapy
Causes.
Condition predisposing to anaerobic infections include: exposure of a sterile body location to a high inoculum of indigenous bacteria of mucous membrane flora origin, inadequate blood supply and tissue necrosis which lower the oxidation and reduction potential which support the growth of anaerobes. Conditions which can lower the blood supply and can predispose to anaerobic infection are: trauma, foreign body, malignancy, surgery, edema, shock, colitis and vascular disease. Other predisposing conditions include splenectomy, neutropenia, immunosuppression, hypogammaglobinemia, leukemia, collagen vascular disease and cytotoxic drugs and diabetes mellitus. A preexisting infection caused by aerobic or facultative organisms can alter the local tissue conditions and make them more favorable for the growth of anaerobes. Impairment in defense mechanisms due to anaerobic conditions can also favor anaerobic infection. These include production of leukotoxins (by "Fusobacterium" spp.), phagocytosis intracellular killing impairments (often caused by encapsulated anaerobes) and by succinic acid ( produced by "Bacteroides" spp.), chemotaxis inhibition (by "Fusobacterium, Prevotella" and "Porphyromonas" spp.), and proteases degradation of serum proteins (by Bacteroides spp.) and production of leukotoxins (by "Fusobacterium" spp.).
The hallmarks of anaerobic infection include suppuration, establishment of an abscess, thrombophlebitis and gangrenous destruction of tissue with gas generation. Anaerobic bacteria are very commonly recovered in chronic infections, and are often found following the failure of therapy with antimicrobials that are ineffective against them, such as trimethoprim–sulfamethoxazole (co-trimoxazole), aminoglycosides, and the earlier quinolones.
Some infections are more likely to be caused by anaerobic bacteria, and they should be suspected in most instances. These infections include brain abscess, oral or dental infections, human or animal bites, aspiration pneumonia and lung abscesses, amnionitis, endometritis, septic abortions, tubo-ovarian abscess, peritonitis and abdominal abscesses following viscus perforation, abscesses in and around the oral and rectal areas, pus-forming necrotizing infections of soft tissue or muscle and postsurgical infections that emerge following procedures on the oral or gastrointestinal tract or female pelvic area. Some solid malignant tumors, ( colonic, uterine and bronchogenic, and head and neck necrotic tumors, are more likely to become secondarily infected with anaerobes. The lack of oxygen within the tumor that are proximal to the endogenous adjacent mucosal flora can predispose such infections.
Management.
Recovery from an anaerobic infection depends on adequate and rapid management. The main principles of managing anaerobic infections are neutralizing the toxins produced by anaerobic bacteria, preventing the local proliferation of these organisms by altering the environment and preventing their dissemination and spread to healthy tissues.
Toxin can be neutralized by specific antitoxins, mainly in infections caused by Clostridia (tetanus and botulism). Controlling the environment can be attained by draining the pus, surgical debriding of necrotic tissue, improving blood circulation, alleviating any obstruction and by improving tissue oxygenation. Therapy with hyperbaric oxygen (HBO) may also be useful. The main goal of antimicrobials is in restricting the local and systemic spread of the microorganisms.
The available parenteral antimicrobials for most infections are metronidazole, clindamycin, chloramphenicol, cefoxitin, a penicillin (i.e. ticarcillin, ampicillin, piperacillin) and a beta-lactamase inhibitor (i.e. clavulanic acid, sulbactam, tazobactam), and a carbapenem (imipenem, meropenem, doripenem, ertapenem). An antimicrobial effective against Gram-negative enteric bacilli (i.e. aminoglycoside) or an anti-pseudomonal cephalosporin (i.e. cefepime ) are generally added to metronidazole, and occasionally cefoxitin when treating intra-abdominal infections to provide coverage for these organisms. Clindamycin should not be used as a single agent as empiric therapy for abdominal infections. Penicillin can be added to metronidazole in treating of intracranial, pulmonary and dental infections to provide coverage against microaerophilic streptococci, and Actinomyces.
Oral agents adequate for polymicrobial oral infections include the combinations of amoxicillin plus clavulanate, clindamycin and metronidazole plus a macrolide. Penicillin can be added to metronidazole in the treating dental and intracranial infections to cover "Actinomyces" spp., microaerophilic streptococci, and "Arachnia" spp. A macrolide can be added to metronidazole in treating upper respiratory infections to cover "S. aureus" and aerobic streptococci. Penicillin can be added to clindamycin to supplement its coverage against "Peptostreptococcus" spp. and other Gram-positive anaerobic organisms.
Doxycycline is added to most regimens in the treatment of pelvic infections to cover chlamydia and mycoplasma. Penicillin is effective for bacteremia caused by non-beta lactamase producing bacteria. However, other agents should be used for the therapy of bacteremia caused by beta-lactamase producing bacteria.
Because the length of therapy for anaerobic infections is generally longer than for infections due to aerobic and facultative anaerobic bacteria, oral therapy is often substituted for parenteral treatment. The agents available for oral therapy are limited and include amoxacillin plus clavulanate, clindamycin, chloramphenicol and metronidazole.
In 2010 the Surgical Infection Society and Infectious Diseases Society of America updated joint guidelines for the treatment of abdominal infections.
The recommendations suggest the following:
For mild-to-moderate community-acquired infections in adults, the agents recommended for empiric regimens are: ticarcillin- clavulanate, cefoxitin, ertapenem, moxifloxacin, or tigecycline as single-agent therapy or combinations of metronidazole with cefazolin, cefuroxime, ceftriaxone, cefotaxime, levofloxacin, or ciprofloxacin. Agents no longer recommended are: cefotetan and clindamycin ( Bacteroides fragilis group resistance) and ampicillin-sulbactam (E. coli resistance) and ainoglycosides (toxicity).
For high risk community-acquired infections in adults, the agents recommended for empiric regimens are: meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam, ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime or cefepime in combination with metronidazole. Quinolones should not be used unless hospital surveys indicate >90% susceptibility of "E. coli" to quinolones.
Aztreonam plus metronidazole is an alternative, but addition of an agent effective against gram-positive cocci is recommended. The routine use of an aminoglycoside or another second agent effective against gram-negative facultative and aerobic bacilli is not recommended in the absence of evidence that the infection is caused by resistant organisms that require such therapy.
Empiric use of agents effective against enterococci is recommended and agents effective against methicillin-resistant "S. aureus" (MRSA) or yeast is not recommended in the absence of evidence of infection due to such organisms.
Empiric antibiotic therapy for health care-associated intra-abdominal should be driven by local microbiologic results. Empiric coverage of likely pathogens may require multidrug regimens that include agents with expanded spectra of activity against gram-negative aerobic and facultative bacilli. These include meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam, or ceftazidime or cefepime in combination with metronidazole. Aminoglycosides or colistin may be required.
Antimicrobial regimens for children include an aminoglycoside-based regimen, a carbapenem (imipenem, meropenem, or ertapenem), a beta-lactam/beta-lactamase-inhibitor combination (piperacillin-tazobactam or ticarcillin-clavulanate), or an advanced-generation cephalosporin (cefotaxime, ceftriaxone, ceftazidime, or cefepime) with metronidazole.
Clinical judgment, personal experience, safety and patient compliance should direct the physician in the choice of the appropriate antimicrobial agents. The length of therapy generally ranges between 2 and 4 weeks, but should be individualized depending on the response. In some instances treatment may be required for as long as 6–8 weeks, but can often be shortened with proper surgical drainage.


Vernix caseosa

Vernix caseosa, also known as vernix or birthing custard, is the waxy white substance found coating the skin of newborn human babies. It is produced by dedicated cells and is thought to have some protective roles during fetal development and for a few hours after birth.
Etymology.
In Latin, "vernix" means "varnish" and "caseosa" means "cheesy". The term was first published in 1846 in the "Dunglison Dictionary of Medical Sciences".
In-utero development.
Vernix is produced during a distinct phase of the epidermal development. Around the 21st week of gestation, periderm cells are being shed and replaced with strateum corneum; these shedding mix with secretions of sebum by the sebaceous glands to form vernix, which gradually covers the body in an anteroposterior and dorsoventral pattern. Vernix, in itself, is also believed to aid in the formation of strateum corneum. By early third trimester, the process is complete.
Soon enough, part of the vernix is emulsified by increasing concentrations of pulmonary surfactants and desiccates, only to be consumed by the fetus; a corresponding increase in amniotic fluid turbidity is noticed.
Characteristics.
Composition.
Vernix has a highly variable makeup but is primarily composed of sebum, cells that have sloughed off the fetus's skin and shed lanugo hair. Chemically, it is water (80%), lipids (10%) and proteins (10%). The lipids include ceramides, cholesterol, fatty acids, triglycerides, waxes and sterol esters, squalene, and phospholipids; multiple detailed analyses of the polar components have been done. The protein composition is relatively understudied. Vernix of term infants has more squalene and a higher wax ester to sterol ester ratio than preterm infants.
Morphology.
Vernix is composed of mobile corneocytes embedded in an amorphous lipid matrix. Precise biological mechanisms leading to its formation are hazily known.
The cells are polygonal or ovoid in shape, malleable, and lack nuclei; typical thickness is 1-2 µm. Nuclear ghosts are frequently observed and Acid Phosphatase Activity is nonuniform. Keratin filaments build a scaffold like structure which form a water-storage area. As opposed to stratum corneum, the vernix corneocytes lack desmosomal attachment and the lipid layer is more disordered.
Physical properties.
Vernix is a white viscous cream-like substance in appearance.
The water is not uniformly distributed throughout, but rather exclusively present in the sponge-like corneocytes; despite its high water content, vernix is non-polar (due to lipids) and more vapor-permeable than strateum corneum.
Functions.
Vernix appears in all full term infants but with widely varying body-coverage, while premature and post-mature births generally do not display any.
It is theorized (and observed) to serve several purposes:
Medical uses.
Vernix is used as a reliable site-of-record for measuring cocaine exposure in pregnant women. Using vernix for diagnosing uterine rupture and amniotic fluid embolism has been proposed.
Disorders.
Granuloma and peritonitis of vernix have been observed in Caesarean sections. High volumes of vernix cause Neonatal Aspiration Syndrome.
Other species.
Vernix is thought to be unique to human fetal development; in 2018, vernix-like material was reportedly obtained from pups of Zalophus californianus.


Healthcare Facilities Accreditation Program

The Healthcare Facilities Accreditation Program (HFAP), is a not-for-profit organization meant to help healthcare organizations maintain their standards in patient care and comply with regulations and the healthcare environment. Headquartered in Chicago, HFAP is an accreditation organization with authority from Centers for Medicare and Medicaid Services.
HFAP provides accreditation programs for hospitals, clinical laboratories, ambulatory surgical centers, office based surgery, and critical access hospitals. HFAP also accredits mental health and physical rehabilitation facilities and provides certification for primary stroke centers. HFAP was founded in 1943 by the American Osteopathic Association, a medical organization representing osteopathic physicians.
History.
HFAP was established in 1943 by the American Osteopathic Association (AOA), and began surveying hospitals in 1945. Initially, HFAP provided osteopathic hospitals with accreditation ensuring osteopathic residents received appropriate training. In the mid-1960s the United States Congress decided that accredited hospitals would meet conditions set for participation, and thus automatically participated in newly established Medicare and Medicaid programs. HFAP quickly applied for and was granted said status in 1965. By 2012, HFAP accredited about 214 hospitals in the US. In 2015, ownership of HFAP moved from the AOA to the Accreditation Association for Hospitals/Health Systems (AAHHS).


Amastia

Amastia refers to a rare clinical anomaly in which both breast tissue and nipple are absent. Amastia can be either isolated or complicated with other syndromes such as ectodermal dysplasia, syndactaly (Poland's syndrome) and lipoatrophic diabetes. This abnormity can be classified into various types and each could cause different pathologies. Amastia differs from amazia and athelia. Amazia refers to the absence of one or both mammary glands but the nipples remain present. While athelia refers to the absence of one or both nipples, but the mammary gland remains.
Amastia is presumably due to failure of embryologic mammary ridge development, or incomplete involution. People with amastia often suffer from ectodermal defects, which include various syndromes such as cleft palate, isolated pectoral muscle and abnormal formation of upper limb.
Treatment for female amastia particularly includes psychological guidance and breast reconstruction. Since having breast represents the ability to nursing, amastia may compromise the mental and physical health for female patients. Proper counselling and surgery are required to enable the normal adult life of these individuals.
Classification.
Amastia can be either iatrogenic or congenital. The congenital amastia are further divided into syndromic type and non-syndromic type respectively.
As the definition suggests, syndromic amastia is often associated with obvious symptoms. The common case is hypoplasia of ectodermal tissue, such as hair and skin defects.
On the other hand, non-syndromic amastia, shows no defects in body parts other than breast. This type of amastia can be further classified into unilateral and bilateral amastia. Unilateral amastia can be defined as amastia involving only one side of breast, while bilateral type refers to amastia on both sides of breast. Unilateral amastia is less common than bilateral amastia. Almost all the non-syndromic amastia patients are female.
Signs and symptoms.
Typically, amastia patients have both their nipple and areola missing, and the nipple may be absent on one or both sides of the breasts. Abnormalities are not often associated with the breasts. However, symptoms such as hypertelorism, saddle nose, cleft palate, urologic disorders and dysfunction of muscle, upper and lower limb have been observed. Sometimes several members of a family can be diagnosed as amastia simultaneously, all of them are carriers of mutations in TBX3 gene. This mutation could cause various abnormalities, not only amastia, but also deformation of limb and teeth.
Cases of unilateral amastia are uncommon, and they are often associated with hypoplasia of pectoral major muscle and/or the thorax. Bilateral amastia is more common because it is often associated with other different syndromes. Therefore, the symptoms of bilateral amastia are easier to be diagnosed. Various associated syndromes are listed below.
Associated syndromes.
Amastia, particularly if it is bilateral, often related to various syndromes, including ectodermal dysplasia and Poland's syndrome, which is characterised by anomalies of underlying mesoderm and abnormal pectoral muscle respectively. Other syndromes, such as FIG4 associated Yunis Varon syndrome (MIM 216340), acro-der-mato-ungual-lacrimal-tooth (ADULT) syndrome, TP63 associated limb mammary syndrome (MIM 603543), TBX3 associated ulnar syndrome (MIM 181450) and KCTD1 associated scalp-ear-nipple syndrome (MIM 181270) have  also been clinically observed.
Ectodermal dysplasia.
Ectodermal dysplasia is commonly associated with syndromic amastia. The symptoms of ectodermal dysplasia can be referred to abnormal development of several ectodermal-derived structure such as hair, teeth, nails and sweat glands. Other symptoms may include the inability to sweat, vision or hearing loss, missing or underdeveloped fingers or toes and maldevelopment of breast tissue. Genetic mutations may cause ectodermal dysplasia, and these genes can pass from parents to children. The most common case is the mutation of EDA1 gene which is in X chromosome, and this mutation results in X-linked form hypohidrotic ectodermal dysplasia (XLHED). There is strong association between amastia and XLHED. Over 30% male patients with XLHED have absent nipples. 79% female carriers decrease the ability of breastfeeding. This suggests people with amastia should have a comprehensive skin test to exclude this syndrome.
Poland's syndrome.
Poland's syndrome is a genetic disorder associated with abnormal breast development. The prevalence rate of this syndrome is approximately 1 in 20000 to 30000. Both chest wall and upper limb lost normal function, and this syndrome usually occurs unilaterally. Mild and partial forms of Poland's syndrome are common, which often been undiagnosed because the clinical feature is only breast asymmetry and a horizontal anterior axillary fold, without severe symptoms. Other abnormalities include deformation of ribs, absence of pectoralis muscle, hypoplasia or abnormalities of breast and subcutaneous tissue. Patients may also have webbed fingers on one hand, short bones in the forearm or sparse underarm hair.
Al Awadi/Raas-Rothschild syndrome.
Al Awadi/Raas-Rothschild syndrome is a rare genetic disorder. Symptoms are often associated with absence or maldevelopment of skeletal part of limbs.
Scalp-ear-nipple syndrome.
As the name suggests, Scalp-ear-nipple syndrome is characterized by congenital absence of skin, abnormalities of scalp, malformation of ear structures, and undeveloped nipples.
Mechanism.
Mammary glands are arranged in breasts of the primates to produce milk for feeding offspring. They are enlarged and modified sweat glands. In the embryological development, mammary glands firstly appear after six weeks of pregnancy in the form of ectodermal ridges. The ectodermal ridge grows thicker and compresses to form mesoderm. As the proliferation persists, mesodermal layer continues to form clusters. The clusters grow and become lobules. At the same time, the clusters also form a pit, which protrudes to generate the nipples. Impairment in some of these processes may cause aplasia of the breast tissue, which may result in amastia.
For example, in normal condition, mammary ridge (milk line) would extend from the bilateral axillary tail to the inguinal region. If this extension does not occur in normal way, the breast would not develop successfully.
Amastia may also be caused by the inability of producing parathyroid hormone related protein. The absence of this protein will disrupt the normal development of mammary gland. Therefore, when amastia patients receive medical ultrasound examination, asymmetry or disproportioned mammary tissue may be found.
Causes.
Unilateral amastia is usually caused by Poland's syndrome, which is characterized by one side absence of breast. The absence or dysfunction of pectoralis muscle and ribs are common case. It can also be part of other syndromes as described in the previous contents.
Other causes may include intra-uterine exposure to teratogenic drugs such as dehydroipiandrosterone and methiamozole/carbimazole treatment during first trimester.
For bilateral amastia, the cause has not been well understood so far. It may be related to gene mutation since often patients with bilateral amastia are diagnosed as autosomal dominant and recessive inheritance. Decreasing blood flow in the subclavian artery may also be a cause of amastia.
Amastia can also be caused by injuries. These injuries may happen when patients receive surgery, such as thoracotomy, chest tube placement, or when they are treated by radiotherapy. Improper biopsy or severe burns of breast tissue may also result in amastia.
Genetics.
Congenital amastia can be associated with both autosomal dominant and recessive inheritance. However, in clinical research, autosomal recessive heritage amastia is uncommon.
Mutation of genes may disrupt the normal process and results in abnormity of breast. The protein tyrosine receptor type F gene (PTPRF) is particularly important in nipple-areola region development. PTPRF encodes protein phosphatase which can localize at adherent junction. This phosphatase may also regulate epithelial cell to enable cell- cell interaction. PTPRF is also responsible for growth factor signalling and Wnt pathway. Homozygous frameshift mutation in PTPRF may cause amastia, which suggests the causative relationship between PTPRF defect and syndromic amastia.
Management.
Since bilateral and unilateral amastia may be attributed to different pathologies, appropriate managements should be adopted accordingly. Bilateral amastia can occur in isolation or associated with other disorders. This case is less understood and difficult to treat. On the other hand, Poland's syndrome is the most common cause of unilateral amastia. Managements such as muscle/breast reconstruction and nipple areola relocation should be provided to these patients.
Breast reconstruction.
Surgical treatment for breast defects such as mastectomy is also applicable to treat patients with amastia. Tissue expansion is the most common technique and can be done by using either autologous or prosthetic tissue. For autologous reconstruction, different tissues may be chosen according to patients’ physical condition or their preferences. Prosthetic reconstruction may follow the same principles. Flap reconstruction is another method to rebuild the breast surgically. There are various kinds of flaps to choose depending on different situation.
Nipple areola relocation.
Amastia is often associated with Poland's syndrome, which requires appropriate reconstructive procedure to stabilize chest wall, transfer dynamic muscle and reposition nipple areola region. The treatment of nipple areola relocation provides space for secondary breast enlargement. In this treatment, the tissue expander can be inserted either beforehand or delayed. It can be placed in different parts of body depending on how many overlying soft tissues the patient has. In order to guide the dissection and make sure the correct location of these tissues, marking of the inframammary crease is required before operation.


PATH (global health organization)

PATH (formerly known as "Program for Appropriate Technology in Health") is an international, nonprofit global health organization based in Seattle, with 1,600 employees in more than 70+ offices around the world. Its president and CEO is Nikolaj Gilbert, who is also the Managing Director and CEO of Foundations for Appropriate Technologies in Health (FATH), PATH's Swiss subsidiary. PATH focuses on five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations—to develop innovations and implement solutions that save lives and improve health, especially among women and girls.
PATH's tagline is "Better health moves humanity forward."
PATH was held responsible for malpractices leading to deaths in Tribal Girls from State of Andhra Pardesh in India during Gardasil vaccination testing 30 august,2013 in Upper and Lower Parliaments of India.A committee set up by Government of India did a detailed study of what had happened and deemed its utilisation of State apparatus as "ethical and procedural lapses". It had recommended legal action but Government of India stopped the further testing of Gardasil and issued a pardon, following its long history of colluding with US based multinationals like Union Carbide(responsible for Bhopal Gas Tragedy). Report of Parliamentary Standing Committee of Health and Welfare on Path Foundation Unethical Gardasil Vaccination trials in India
History.
Founded in 1977 with a focus on family planning, PATH soon broadened its purpose to work on a wide array of emerging and persistent global health issues in the areas of health technologies, maternal health, child health, reproductive health, vaccines and immunization, and emerging and epidemic diseases such as HIV, malaria, and tuberculosis.
Since 2000, PATH expanded from about 300 employees and an annual budget of $60 million to, in 2016, a payroll of 1,600 people working in 70+ countries and a budget of $305 million.
PATH is one of the largest nonprofit organizations in global health today.
PATH's headquarters are in the South Lake Union, Seattle neighborhood, close to several other global health organizations including the Bill & Melinda Gates Foundation.
Institute for OneWorld Health.
OneWorld Health was a 501(c)(3) nonprofit drug development organization founded in San Francisco in 2000 by Victoria Hale. In December 2011, OneWorld Health became a drug development program of PATH. What was the Institute for OneWorld Health has become PATH's Drug Development program.
PATH's work.
PATH's vision is "a world where innovation ensures that health is within reach for everyone." Its mission is "to improve the health of people around the world by advancing technologies, strengthening systems, and encouraging healthy behaviors."
PATH is best known for developing and adapting technologies, such as improved vaccination devices and new tools to prevent cervical cancer, to address the health needs of developing countries. It targets health problems, evaluates possible solutions, and assesses whether they would be useful in finding health solutions.
Steve Davis, PATH's President and CEO from 2012 to 2019, described the organization's role as a "bridge-builder and innovator on the global stage."
Health technologies.
PATH develops, adapts, and advances technologies focused on disease diagnostics, drugs, vaccine delivery, nutrition, reproductive health, water and sanitation, and other areas.
Vaccine and pharmaceutical technologies.
One of PATH's more-known technologies is the vaccine vial monitor, a small sticker that adheres to a vaccine vial and changes color as the vaccine is exposed to heat over time. The sticker helps health workers know when a vaccine has reached its preset temperature limit and can no longer be safely used. It promotes more reliable vaccinations as well as cost savings, because health workers no longer have to throw out vaccine just because they suspect it has gone bad. UNICEF requires these monitors on all vaccines it purchases.
Another vaccine technology developed by PATH is the Uniject injection system. The single-dose, autodisabling injection system consists of a needle attached to a small bubble of plastic that is prefilled with medication. The system is designed to prevent disease transmission and enable health workers with only a little training to administer vaccine and other drugs in remote villages.
Nutrition.
PATH develops nutrition-focused innovations such as Ultra Rice, a manufactured, micronutrient-fortified "grain" that can be mixed with rice to fight malnutrition in countries where rice is a staple food. Made of rice flour, micronutrients, and nutrient-protecting ingredients, Ultra Rice can mimic the look and taste of local rice and deliver the specific micronutrients a population needs. Ultra Rice has been produced and tested in several countries, including Brazil, Burundi, and India, where it has been served in school-lunch programs. PATH is working with partners in Cambodia to distribute Ultra Rice through food assistance programs and deepen the evidence base for rice fortification. In Brazil, PATH has partnered with a commercial rice producer to sell Ultra Rice on supermarket shelves and reach 10 million low-income consumers in three years.
Sexual and reproductive health.
Several PATH technologies address sexual and reproductive health, including:
PATH employs a user-driven design process for its reproductive technologies to meet women's specific needs.
Water and sanitation.
PATH looks at ways to improve water quality in developing countries, including helping companies develop low-cost filters, gadgets, and other water-treatment products to stimulate a commercial market and keep prices low.
Vaccines and immunization.
PATH is working with biotechnology and pharmaceutical companies to support the development of vaccines for diseases such as meningitis and pneumonia and to help countries introduce vaccines for childhood illnesses such as rotavirus and Japanese encephalitis.
Meningitis.
PATH and the World Health Organization, through the Meningitis Vaccine Project, led the development of a vaccine called MenAfriVac to end meningitis A epidemics in sub-Saharan Africa, where 450 million people in 26 countries are at risk of the disease. The vaccine was developed by Serum Institute of India and introduced in Burkina Faso, Mali, and Niger in December 2010 to prevent the spread of a strain of meningitis found only in Africa. Within six months, the vaccine eliminated new cases of meningitis A in the areas where it was introduced. By the end of 2012, the vaccine had reached 100 million people in ten countries: Benin, Burkina Faso, Cameroon, Chad, Ghana, Mali, Niger, Nigeria, Senegal, and Sudan. The introduction of MenAfriVac marked the first time that a vaccine was developed for a disease only found in Africa.
Previously used meningitis vaccines had low efficacy and cost USD $80 per dose. The new vaccine has high efficacy against the type of meningitis that is most prevalent in Africa and costs less than $0.50 per dose. The entire vaccination research and development project cost less than US$100 million, about one-fifth the typical cost for developing a vaccine.
In 2012, MenAfriVac was also approved for storage without refrigeration for up to four days, enabling health workers to more easily reach patients in rural villages or in areas with no power.
Rotavirus.
PATH supports the introduction of vaccines against rotavirus in developing countries to protect young children from severe diarrhea. In 2006, PATH helped Nicaragua become the first developing country to introduce rotavirus vaccines within months of their introduction. Former PATH researcher John Wecker noted that rotavirus infections dropped in areas that began to use the vaccine after the WHO recommended its international use in 2009.
PATH also conducts research to show the impact of rotavirus vaccines and help countries choose whether to adopt the vaccines into their immunization programs.
Japanese encephalitis.
PATH is working with India and other countries in the region to introduce an affordable vaccine to protect against Japanese encephalitis—a disease the World Health Organization estimates claims 10,000 to 15,000 lives a year, mostly children, and causes permanent brain damage in many more. In 2006, PATH helped the government of India launch an immunization campaign to reach millions of children in high-risk areas with the vaccine. PATH has also supported successful immunization campaigns in Cambodia, North Korea, and other countries to reach more than 60 million children.
Epidemic diseases.
Part of PATH's work focuses on some of the most widespread and threatening global diseases: malaria, HIV/AIDS, tuberculosis, and influenza.
Malaria.
The PATH Malaria Vaccine Initiative supports several malaria vaccine candidates at various stages of development around the world, including the most advanced candidate, called RTS,S. Researchers are studying RTS,S, made by GlaxoSmithKline, in phase 3 clinical trials among infants and young children in sub-Saharan Africa. Interim results of the study released in 2011 showed the vaccine provided about 50 percent protection against malaria for young children ages 5 to 17 months. Interim study results released in 2012 showed RTS,S reduced cases of malaria among infants by 33 percent. In October 2013, GlaxoSmithKline reported that the experimental vaccine reduced the number of cases amongst young children by almost 50 percent and among infants by around 25 percent, following the conclusion of an 18-month clinical trial. GlaxoSmithKline is set to submit an application for a marketing license with the European Medicines Agency (EMA) in 2014. The new vaccine has the backing of the UN's Swiss-based WHO which states that it will recommend the use of RTS,S for use starting in 2015, providing it gets approval.
Another PATH initiative to address malaria is the Malaria Control and Evaluation Partnership in Africa (MACEPA), which focuses on controlling malaria through the use of insecticide-treated bednets, indoor spraying of insecticides, new diagnostic tools to find infection, and effective medicines for treatment. In Zambia, this work has helped decrease the rate of malaria among children younger than age 5 by 50 percent in two years.
In December 2012, PATH received an award from the US President's Malaria Initiative for a new malaria project focused on "the expansion of high-quality diagnosis and treatment for malaria and other childhood illnesses and infectious diseases."
PATH's Drug Development program, which grew out of an affiliation with OneWorld Health, is advancing a new, semisynthetic form of the malaria drug artemisinin that will bolster the current, volatile botanical supply. In August 2014, PATH and Sanofi announced the release of the first batch of semisynthetic artemisinin. 1.7 million doses of Sanofi's ArteSunate AmodiaQuine Winthrop (ASAQ Winthrop), a fixed-dose artemisinin-based combination therapy will be shipped to half a dozen African countries over the next few months.
HIV.
PATH works in Africa, Asia, and other regions to slow the spread of HIV/AIDS and provide support for people affected by the disease. In Kenya, where PATH has worked for more than 20 years, the organization conducts research into "multipurpose prevention technologies" that can protect women from HIV and pregnancy and provides support groups and health services for married adolescents and other groups at high risk for HIV. It also leads a large project with local governments and community organizations to strengthen and expand services for HIV/AIDS, malaria, tuberculosis, and maternal and newborn health.
Other PATH projects to address HIV in Africa include improving access to HIV treatment and services in Ethiopia and expanding HIV counseling and testing and other services in the Democratic Republic of Congo.
PATH uses behavior change communication techniques to encourage healthy behaviors for HIV prevention. One of the best-known examples is PATH's work with "magnet theater" in Kenya, India, Vietnam, and other developing countries. Named because of its natural pulling power, this interactive street theater draws people in rural communities to clearings, dirt roads, and village centers—any open space where people can gather. There, actors banter with their audiences and pull them into the play, stimulating dialogue about HIV/AIDS and other taboo subjects and helping individuals re-examine behaviors that contribute to poor health.
Maternal and child health.
In addition to its work on vaccines for childhood illnesses, PATH addresses pregnancy complications, nutrition issues, and other health challenges that affect women and children in developing countries and lead to higher rates of illness and death.
In 2012, PATH completed a seven-year project in India focused on safe birth for mothers and babies. PATH worked with local governments and community groups to encourage community leaders, health workers, pregnant women, and families to deliver babies in health centers, rather than at home, and adopt other best practices to protect mothers and their infants during pregnancy, childbirth, and infancy. The project used community outreach approaches including door-to-door clinical surveillance, distribution of printed health materials, and street theater to spread messages about maternal and newborn health.
In South Africa, PATH leads a five-year project to improve the health and development of 750,000 pregnant women and children by encouraging breastfeeding and improving health care for pregnant women and young children.
Where PATH works.
Headquartered in Seattle, Washington, PATH has more than 70 offices in countries around the world. As of December 2012, these countries included Belgium, Cambodia, China, Democratic Republic of Congo, Ethiopia, France, Ghana, India, Kenya, Mozambique, Peru, Senegal, South Africa, Switzerland, Tanzania, Thailand, Uganda, Ukraine, United States, Sénégal, Vietnam, and Zambia.
PATH currently works in more than 70 countries.
Funding and expenses.
PATH's expenses in 2011 were US$284 million, of which more than 40 percent was spent on vaccines and immunization programs and 26 percent spent on emerging and epidemic diseases.
PATH receives funding from foundations, the US government, other governments, nongovernmental organizations, multilateral agencies, and individuals. PATH's budget for 2012 was US $305 million.
In 2010, PATH received the most US foundation grants in the state of Washington and ranked thirteenth among international recipients of US foundation grants.
Charity Navigator, America's largest independent evaluator of nonprofits, upgraded PATH from 3 to 4 (out of 4) stars on December 20, 2019.
Controversies.
In 2012, the NGO was warned by the Indian government after one of its studies involving an HPV vaccine resulted in the alleged death of seven girls belonging to an indigenous community (tribe) in India.
All 7 deaths were later attributed to other causes, including a snake bite, drowning, suicide, and complications from malaria.
In what "The Hindu" called "a shockingly unethical trial", nearly 2,800 consent forms were signed by a hostel warden or headmaster, as the 'guardian'.
The Government of india committee set up after the death of tribal girls filed a report which was quite critical of PATH and how it broke the law of the land. The committee was critical of Indian government unwillingness to take criminal action against PATH . Till now no criminal action has been taken.
"The Committee finds the entire matter very intriguing and fishy. The choice of
countries and population groups; the monopolistic nature, at that point of time, of the
product being pushed; the unlimited market potential and opportunities in the universal
immunization programmes of the respective countries are all pointers to a well planned
scheme to commercially exploit a situation. Had PATH been successful in getting the HPV
vaccine included in the universal immunization programme of the concerned countries, this
would have generated windfall profit for the manufacturer(s) by way of automatic sale, year
after year, without any promotional or marketing expenses. It is well known that once
introduced into the immunization programme it becomes politically impossible to stop any
vaccination. To achieve this end effortlessly without going through the arduous and strictly
regulated route of clinical trials, PATH resorted to an element of subterfuge by calling the
clinical trials as “Observational Studies” or “Demonstration Project” and various such
expressions. Thus, the interest, safety and well being of subjects were completely
jeopardized by PATH by using self-determined and self-servicing nomenclature which is not
only highly deplorable but a serious breach of law of the land. The Committee is not aware
about the strategy followed by PATH in the remaining three countries viz. Uganda, Vietnam
and Peru. The Government should take up the matter with the Governments of these
countries through diplomatic channels to know the truth of the matter and take appropriate
necessary action, accordingly. The Committee would also like to be apprised of the
responses of these countries in the matter.
1.8 Considering the enormity of the wrong doing/criminality involved, and the dilly-dallying
attitude of the Government in taking exemplary corrective action, the Committee took it up for
detailed examination."
Recognition.
In 2003, PATH received the Tech Museum's Dr. Alejandro Zaffaroni Health Award for its work on the Uniject device, a sterile pre-filled, single-use syringe.
Since 2005, PATH has remained on Forbes' top 200 list of the 200 largest charities in America.
For five years running, "Fast Company" magazine in 2008 named PATH as one of the top social entrepreneurs who are changing the world.
In 2009, PATH received the Conrad N. Hilton Humanitarian Prize.
In 2012, PATH was ranked as the sixth best NGO in the world on the "top 100" list published by The Global Journal.
As of March 2019, PATH has been vetted and is in good standing as part of GlobalGiving's GG Rewards program.


Stefan Baley

Stefan Baley (1885–1952) was a Polish psychologist of Ukrainian descent.


James Bieri

James Bieri (born 1927) is a psychologist and biographer who introduced in 1955 the concept of cognitive complexity, derived from his doctoral study with George A. Kelly. Subsequently, integrating ideas from information theory and psychophysics, Bieri and his research team at Columbia University published a volume entitled "Clinical and Social Judgment" (John Wiley, 1966).
After serving in the U.S. Navy, Bieri obtained his undergraduate degree from Antioch College (1950) and his Ph.D. at Ohio State University (1953). He held teaching positions at Harvard University (Department of Social Relations), Columbia University (School of Social Work), City University of New York (Brooklyn College), and the University of Texas at Austin, where he was Professor and Director of the Clinical Psychology Training Program.
Upon retirement, Bieri pursued his interest in English Romantic poetry and in 2005 published a two-volume biography of Percy Bysshe Shelley (University of Delaware Press, 2004 & 2005). A second edition of this work was published in 2008 by Johns Hopkins University Press, Baltimore.


Jean Aicardi

Jean (François Marie) Aicardi (8 November 1926 – 3 August 2015) was a French pediatric neurologist and epileptologist. He was known as one of the most distinguished and respected neuropediatricians of his time. He, along with Alexis Arzimanoglou, created the journal "Epileptic Disorders" in 1999.
Education and career.
He obtained his M.D. degree from the Faculté de Médecine, Paris in 1955. He was a research fellow in Harvard Medical School from 1955 to 1956, and back in France he was an assistant physician at Hôpital des Enfants Malades Paris from 1957 to 1964, and an assistant physician at Hôpital Saint-Vincent de Paul from 1974 to 1979. He was also Maître de Recherche from 1969 to 1986 and Directeur de Recherche from 1986 to 1991 at Institut National de la Santé et de la Recherche Médicale (INSERM). From 1992 to 1998 he was Honorary Professor of Child Neurology at Institute of Child Health, London, UK.
Recognition.
He received many academic honours and distinctions, including:
Bibliography.
He was author or coauthor of many outstanding textbooks, including:
He was editor-in-chief (1994–2004) and founding editor of the journal "Epileptic Disorders" and a member of the editorial boards and a reviewer of other journals, including "Neuropediatrics", "Brain and Development", "Pediatric Neurology", "Journal of Child Neurology", "Epilepsia", "Lancet Neurology" and "Brain".
References.
https://web.archive.org/web/20150905070919/http://www.ilae.org/Visitors/Awards/documents/Aicardi-Jean.pdf


Philippe Sansonetti

Philippe J. Sansonetti (born 9 April 1949) is a microbiologist, Professor at the Pasteur Institute and the Collège de France in Paris. He is the Director of the Inserm Unit 786 (Microbial colonisation and invasion of mucosa) and of the Institut Pasteur laboratory Pathogénie Microbienne Moléculaire.
Education.
Philippe Sansonetti completed General Microbiology, General Virology and Immunology courses at the Institut Pasteur and received his MS degree in Biochemistry/Microbiology from the University Paris VII Diderot in 1978 and obtained his MD degree from the University Paris VI in 1979. After a research fellowship at the Unité de Bactériologie Médicale headed by Léon Le Minor, he undertook a post-doctoral position in the laboratory of Professor Samuel Formal in the Department of Enteric Diseases at the Walter Reed Army Institute of Research, Washington, D.C. He returned to the Pasteur Institute in 1981 to the Enterobacteria Unit (Unité des entérobactéries) where he started his own research group. In 1989, he created and headed the Unité de Pathogénie Microbienne Moléculaire (Molecular Microbial Pathogenesis Unit). He practiced internal medicine at the Institut Pasteur hospital (1981–1985) before becoming head of its outpatient clinic (1985–1995) and then becoming its medical director (1995–1999 and 2004–2007). He was chairman of its Departments of Bacteriology and Mycology (1989–1992) and Cell Biology and Infection (2002–2006).
Sansonetti has held several scientific administration positions at INSERM, French Ministry of Research and Technology, as well as at the World Health Organization where he was chairman of the Steering committee on Diarrheal Diseases Vaccine Development.
Work and honours.
Research performed by Philippe Sansonetti has mainly been focused on the understanding of several aspects of the pathogenesis of "Shigella", a bacterium causing severe diarrhoea. His work spans a large set of disciplines in biology and medicine and ranges from molecular genetics, to cell biology, immunology and the development of vaccines against dysentery. Sansonetti's laboratory has notably shown that "Shigella" pathogenesis is imparted by a large virulence plasmid containing a pathogenicity island encoding a type three secretion system required for entry into epithelial cells; characterised the molecular mechanisms leading to "Shigella" epithelial cell invasion and intracellular motility; demonstrated that "Shigella" kills macrophages by pyroptosis; identified that intracellular bacteria are detected by Nod proteins leading to production of pro-inflammatory cytokines and identified a pool of "Shigella" effectors controlling both innate and adaptive responses. He also actively contributes to the development of vaccine candidates against the major shigellae causing dysentery in the developing world.
Sansonetti is the author of over 500 publications in peer-reviewed journals and has served as an editor of several professional publications for many years. He is considered to be one of the founders of the cellular microbiology field and has launched an eponym scientific publication dedicated to this field. His achievements in science have been recognised by numerous awards, including:
He was appointed a Knight of the National Order of the Legion of Honour Légion d'honneur and Officer of the Ordre National du Mérite. He has also been elected Member of European Molecular Biology Organisation, the French Academy of Sciences, the Deutsche Akademie der Natursforscher Leopoldina, the American Association for the Advancement of Science the US National Academy of Sciences, and corresponding member of the French Academy of Medicine. He is also a Howard Hughes Medical Institute scholar. Since 2008, he has held the position of Professor at the Collège de France, recipient of the Microbiology and Infectious Diseases Chair. His nomination for the Royal Society reads:


Flora (microbiology)

In microbiology, collective bacteria and other microorganisms in a host are historically known as flora. Although microflora is commonly used, the term microbiota is becoming more common as microflora is a misnomer. Flora pertains to the Kingdom Plantae. Microbiota includes Archaea, Bacteria, Fungi and Protists. Microbiota with animal-like characteristics can be classified as microfauna.
History.
The terms "Flora" and "Fauna" were first used by Carl Linnaeus from Sweden in the title of his 1745 work "Flora Suecica and Fauna Suecica". At that time, biology was focused on macroorganisms. Later, with the advent of microscopy, the new discovered ubiquitous microorganisms were fit in this system. Then, Fauna included moving organisms (animals and protist as "micro-fauna") and Flora the organisms with apparent no movement (plants/fungi; and bacteria as "microflora"). The terms "microfauna" and "microflora" are common in old books, but recently they have been replaced by the more adequate term microbiota. Microbiota includes Archaea, Bacteria, Fungi and Protists.
Microflora classification.
Microflora are grouped into two categories based on the origin of the microorganism.
Roles.
Microflora is a term that refers to a community of bacteria that exist on or inside the body, and possess a unique ecological relationship with the host. This relationship encompasses a wide variety of microorganisms and the interactions between microbes. These interactions are often a mutualistic relationships between the host and autochthonous flora. Microflora responsible for harmful diseases are often allochthonous flora.
The modern term is "Microbiome" and include microorganisms that have different roles in ecosystems or hosts, including free-living organisms, or organisms associated to hosts, such animals (including humans) or plants.
Projects.
In 2008, the National Institutes of Health started the Human Microbiome Project designed to help understand the health implications of human bacterial flora. Biologists believe that bacterial flora may play some role in disorders such as multiple sclerosis. Additionally, the study of flora can have industrial benefits such as dietary supplements like probiotics. The living microorganisms in probiotics are believed to have positive effects on health, and have been utilized in studies regarding gastrointestinal diseases and allergies.
In 2014, "The Earth Microbiome project" proposed a broad initiative to identify the diversity and importance of the microbiota in different ecosystems across the planet, including free-living microbiota (in water and terrestrial systems) and host associated-microbiota (associated with plants and animals).


Hans Walter Gruhle

Hans Walter Gruhle (7 November 1880, in Lübben – 3 October 1958) was a German psychiatrist known for his work on the relationship between criminology and psychology.
Gruhle was educated in Leipzig, Würzburg, and Munich, receiving his first doctorate in Munich in 1904 under the supervision of Emil Kraepelin. In 1905, he joined the psychology department at Heidelberg University, remaining there for almost 30 years. Soon after he began working at Heidelberg, he met Max Weber and his wife, Marianne Weber. He subsequently advised Weber's work in the field of experimental psychology. He received his second doctorate, a "habilitation", from Heidelberg.
His most notable work was "Comprehending Psychology" (1948), which discusses the relationship between psychology and other sciences. He also wrote journal articles about such topics as the sterilization of criminals and the utility of the ergograph.


Semen Gluzman

Semen (Semyon) Fishelevich Gluzman (, ; born 10 September 1946, Kyiv) is a Ukrainian psychiatrist and human rights activist.
He is also the president and founder of the "Ukrainian Psychiatric Association", founder of the "American-Ukrainian Bureau for Human Rights", director of the "International Medical Rehabilitation Center for the Victims of War and Totalitarian Regimes", a member of the Council of Experts under the Ukraine's Ministry of Labor and Social Policy. He also is co-chairperson of the "Babi Yar Committee" and former dissident and political prisoner. He holds M.D. qualification.
Biography.
His father was doctor of medical sciences Fischel Abramovich Gluzman (1904—1987). In 1968, he graduated from the Kyiv Medical Institute. After graduation, Gluzman started working in Ukrainian psychiatric hospitals and was offered a position at the Dnipropetrovsk Special Psychiatric Hospital in a city not far from the Black Sea.
Semyon Gluzman was the first psychiatrist in the Soviet Union to openly oppose Soviet abuse of psychiatry against dissenters. In 1971, Gluzman wrote an in-absentia psychiatric report on General Petro Grigorenko who spoke against the human rights abuses in the Soviet Union. Gluzman came to the conclusion that Grigorenko was mentally sane and had been taken to mental hospitals for political reasons. In the late 1970s and early 1980s, Gluzman was forced to serve seven years in labor camp and three years in Siberian exile for defending Grigorenko against the charge of insanity. On 28 November 1977, Amnesty International added Gluzman to its list of 92 members of the medical profession who were imprisoned for their political beliefs. While in prison Gluzman and fellow inmate Vladimir Bukovsky jointly wrote "A Manual on Psychiatry for Dissidents" published in Russian, English, French, Italian, German, Danish.
In the 1980s Gluzman (who is a Jew) turned down offers to migrate to Israel by "people sent from American synagogues" and even Soviet officials.
In 1991, Gluzman founded the Ukrainian Psychiatric Association (UPA) as an independent mouthpiece and created a commission to address grievances about civil rights violations by mental health administrators.
In recognition of his courage and commitment to ethical psychiatry, Gluzman was given the title of a Distinguished Fellow of the American Psychiatry Association and the title of an Honorary Member of the Royal College of Psychiatrists in 1980.
In 2008, Semyon Gluzman was honored with the Geneva Prize for Human Rights in Psychiatry presented to him at the XIV Congress of the World Psychiatric Association in Prague for exceptional courage and adherence to ideals of humanism, for renunciation of using psychiatry against political dissidents as well as for dissemination of ethical principles during the reform of mental health service in Ukraine.
Gluzman coauthored many research papers covering psychiatry in Ukraine, the health consequences of the Chornobyl accident, their risk perceptions, suicide ideation, heavy alcohol use, nicotine dependence, intimate partner aggression.
Gluzman's publications.
Books on Soviet psychiatry
Prose and poetry
Research papers in English without co-authors
Research papers in English with co-authors
Research papers in Russian without co-authors
Research papers in Russian with co-authors
Research papers in Ukrainian
Articles, reports, interviews, chapters in books


Desensitization (medicine)

In medicine, desensitization is a method to reduce or eliminate an organism's negative reaction to a substance or stimulus.
In pharmacology, "drug desensitization" refers to two related concepts. First, desensitization may be equivalent to drug tolerance and refers to subjects' reactions (positive or negative) to a drug reducing following its repeated use. This is a macroscopic, organism-level effect and differs from the second meaning of desensitization, which refers to a biochemical effect where individual receptors become less responsive after repeated application of an agonist. This may be mediated by phosphorylation, for instance by beta adrenoceptor kinase at the beta adrenoceptor.
Application to allergies.
For example, if a person with diabetes mellitus has a bad allergic reaction to taking a full dose of beef insulin, the person is given a very small amount of the insulin at first, so small that the person has no adverse reaction or very limited symptoms as a result. Over a period of time, larger doses are given until the person is taking the full dose. This is one way to help the body get used to the full dose, and to avoid having the allergic reaction to beef-origin insulin.
A temporary desensitization method involves the administration of small doses of an allergen to produces an IgE-mediated response in a setting where an individual can be resuscitated in the event of anaphylaxis; this approach, through uncharacterized mechanisms, eventually overrides the hypersensitive IgE response.
Desensitization approaches for food allergies are generally at the research stage. They include:


Albert Fraenkel

Julius Albert Fraenkel (3 June 1864 – 22 December 1938) was a German physician who helped establish "Streptococcus pneumoniae" as a cause of bacterial pneumonia and championed intravenous ouabain for use in heart failure. The "Albert-Fraenkel-Plakette" (Albert Fraenkel award) is given to German-speaking cardiologists who have excelled in the field.
Born in 1864 in Mußbach an der Weinstraße, Albert was the son of a Jewish merchant. He studied medicine in Munich and Strasbourg (then the German city of Straßburg) in the 1880s. He initially practiced internal medicine and obstetrics, but turned to studying diseases of the lungs after suffering from tuberculosis. He established a tuberculosis sanatorium at Badenweiler in the Black Forest. Fraenkel also first used g-Strophanthin (ouabain) in heart failure, a practice which continues to be advocated by some practitioners in Germany.
Fraenkel's later life was marred by Adolf Hitler's rise to power in Germany. He was stripped of his position as professor at Heidelberg in 1933 and his license to practice medicine was revoked in 1938, three months before his death.


Jean Goulin

Jean Goulin (10 January 1728 – 30 April 1799) was an 18th-century French physician.


Joe Hall Morris

Dr. Joe Hall Morris (1922 – September 11, 2003) was a prominent oral surgeon and educator at the University of Tennessee who is probably best known for developing a Bi-Phase External Fixation Splint. Further key contributions to the field of modern dentistry include the Orthognathic Surgery Simulating Instrument, or OSSI. His work in the biomechanical aspects of oral and maxillofacial surgery have had a profound impact on the fields of maxillofacial trauma and Orthognathic surgery.
Positions held.
Morris became the director of the Oral & Maxillofacial Surgery Program at the University of Tennessee in 1965. He was chairman of the Oral Surgery Department at the University of Tennessee from 1966-1988.
Professional background.
Morris graduated from the University of Tennessee, College of Dentistry in 1945. He trained in oral and maxillofacial surgery at the University of Tennessee. He served as an oral surgeon in the U.S. Army at Fort Benning, Georgia from 1951 to 1953.