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Harry C Dietz, III, M.D.

• Director, William S. Smilow Center for Marfan Syndrome Research Institute of Genetic Medicine
• Professor of Genetic Medicine

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0002765/harry-dietz

Primarily the recode file was developed to define a standardized file that would facilitate cross-country analysis women's health specialists purchase clomid in united states online. However menopause menstrual cycle discount clomid 100mg on line, if a variable is present in one or more phases women health issues buy clomid paypal, that variable has the same meaning in each phase in which it is present menstrual tissue discharge purchase clomid 25 mg otc. If a question is dropped from one phase to another, the name of the variable used for that question is not reusable. If a new question is added to the core questionnaire, a new variable will be added to the recode definition. This dataset is used for calculation of household level indicators such as water and sanitation (see Chapter2). It also includes the characteristics of the households where the individual lives or was visiting. This dataset is used for analysis of education of household members (Chapter 2) and of anthropometry and anemia in children under age 5 (Chapter 11). This dataset is used for fertility (Chapter 5) and mortality (Chapter 8) analysis. This dataset is used to look at child health indicators such as immunization coverage, vitamin A supplementation, recent occurrences of diarrhea, fever, and cough for young children and treatment of childhood diseases (Chapter 10), nutrition of young children (Chapter 11), and malaria prevention and treatment (Chapter 12). In addition to the contextual variables that can be included in analysis from the geospatial covariates, interviewers can also have an effect on the responses to certain survey questions. To permit analysis of interviewer effects on survey responses analysts can also use the characteristics of the fieldworkers. For surveys conducted prior to the change in the recode file definition a file was created containing the score and the quintile variables. The data will be kept as missing in the data file and no imputation for this kind of question will be done. These codes are normally pre coded in the questionnaires, and are consistently used throughout the recode file. For example, dates for vaccinations recorded as having occurred before the birth of the child. The secondary editing team is instructed to first check for clues that could lead to correcting the problem, but if that is not possible, to establish which piece of information is wrong (day, month, or year) and assign the code for Inconsistent to that item. Inconsistent codes are 7, 97, 997, 9997 depending on the variable number of digits. Other special responses may be coded 96 (996, 9996), 95 (995, 9995), 94 (994, 9994), etc. For example, in variable v226 (Time since last period (comp) (months)) code 996 means Never menstruated, code 995 means Before last birth, and code 994 means In menopause. For example, if they are not excluded to calculate the mean age at first sex, eventually the mean will be inflated by ages 96, 97, 98, and 99. Even code 0 would need to be excluded as it would incorrectly deflate the mean age at first sex. For most variables this is a one-to-one conversion, possibly recoding categories. Multiple Response Variables In multiple response questions, the question is asked and the respondent spontaneously begins providing answers. The answers are not read, but the interviewer has to classify the response according to the options available for the question. The interviewer keeps probing for other responses until the respondent says that she has no more answers. For example, some countries include additional categories of health professionals. Multipart Questions In multipart questions the response for the separate parts of the question are usually stored in separate variables in the recode files. As dates are central to the calculation of fertility and mortality rates and the selection of cases for inclusion in other analyses, there is a need for fully specified dates (month and year) for key events. These events are: Date of birth of the respondent Date of first marriage or union Dates of birth of each child Date started using current method of contraception Date current pregnancy started Date of interview Note that date of interview is always fully specified and can have no special values. However, the respondent may not know the exact date of an event, the date (or part of it) may have been left blank by the interviewer, or the date may have been inconsistent with other information. For all of these situations the month and/or year part of the date variables may have either the missing value code or one of the other special codes. Note that although date of current pregnancy started is imputed, the variable included in the recode file is just the duration of pregnancy, calculated by subtracting the imputed date current pregnancy started from date of interview. For simplicity of calculation dates of key events are presented both as month and year and in terms of Century Month Codes. Century month codes are particularly important to check consistency of dates, to calculate intervals between events, and in the imputation of dates when the information for an event is missing or partially complete. Example: Let us see the events for a married, sterilized respondent with three births and with event dates that occurred as shown in the following figure. The advantages of the approach include the following: When checking for consistency, use of the century month codes makes it easy to check not only that the events occurred in chronological order, but also that there should be a minimum interval between them. For example b3 2 b3 1 should be greater or equal to 9 months (the expected duration of a pregnancy). For example, if date of birth for the second child is unknown, that birth should have occurred between the first birth plus nine months, and nine months before the third birth. The Ethiopian calendar consists of 12 months of 30 days, plus one month of 5 days (or 6 days in a leap year). The century month codes in the dataset are all based on the Ethiopian calendar, but squeezing the 13th month into a 12 month calendar. The reference date for surveys in Ethiopia is 1 Maskaram 1900 in the Ethiopian Calendar, which is September 12, 1907 in the Gregorian calendar. The Nepali calendar is made up of 12 months of between 28 and 32 days, and the number of days in a month can vary from year to year. The Afghan calendar is made up of 12 months, the first 6 of which have 31 days, the next 5 months have 30 days, and the last month has 29 or 30 days in a leap year. The century month codes in the dataset are all based on the Afghan calendar with 1300 as the base year, rather than 1900. The reference date of surveys in Afghanistan is 1 Hamal 1300, which is March 21, 1921 in the Gregorian calendar. It should be noted, however, that these are approximate adjustments as the calendars start in the middle of months and dates of events to the day would be required to calculate exact adjustments. Calculating age in months using just month and year of birth and month and year of interview meant that age in months could be off by one month in approximately half of all cases. The Century Day Code is not simple to calculate manually, but it is the same system used in Excel for calculations between dates.

Syndromes

• Infections (present at birth or occurring after birth)
• Avoid perfumes and floral-patterned or dark clothing.
• Changes in alertness (usually more alert in the morning, less alert at night)
• Fever
• Dizziness
• Scar tissue may form in your belly and causes blockage of your intestines
• Did the rash occur after skin injury, bathing, or exposure to sunlight or cold?
• MRI of the head
• Dim and blurred blind spot in the center of vision

In these cases the abdominal examination is nonspe to obtain women's health center fort qu'appelle purchase clomid 50mg fast delivery, especially in young children women's health clinic renton wa generic clomid 25mg visa. Young patients may as cifc menopause black cohosh purchase genuine clomid online, but the lung examination should suggest the diagnosis women's health big book of exercises uk cheap clomid 25 mg on line. The history X-ray studies are of limited usefulness in the routine eval 7 should include a thorough review of symptoms, including a uation of abdominal pain. A Always consider obtaining a pregnancy test in an adoles 8 child with sickle cell anemia is at risk for vasoocclusive crises, cent female with lower or difuse abdominal pain. Children with previous surgeries may have strictures or Appendicitis is a difcult diagnosis. Diarrhea The frst challenge to the practitioner is to identify those 2 (small volume) and urinary frequency or dysuria may also oc cases that may be surgical or life threatening. Be aware that an atypical signs and symptoms include sudden excruciating pain, point or location of the appendix may cause pain in sites other than the difuse severe tenderness on examination, bilious vomiting, in right lower quadrant. The occurrence of emesis before pain voluntary guarding, a rigid voluntary wall, and rebound tender makes the diagnosis of appendicitis unlikely. Afer ruling out potential emergencies, the chronicity and count may be normal or elevated; a lef shif is supportive of the location of the complaint should be considered to narrow the diagnosis. Infamed ab male reproductive organs and can also be used to visualize the 10 dominal lymph nodes occur as a result of viral (adenovi appendix. Afected children look ill Acute unilateral back or fank pain, fever, dysuria, pyuria, and ofen assume a knee-to-chest posture while sitting or lying 11 and urinary frequency suggest pyelonephritis. The etiology may include trauma (including and culture is all that is needed to make a diagnosis. Diagnosis may be confrmed is usually not needed if other diagnoses are being considered. A thorough evaluation, including H and P and screening laboratory studies, will ofen suggest the disorder. Additional In intestinal obstruction, vomiting is usually a predomi 13 signs and symptoms that suggest infammatory bowel disease nant symptom. Pain is a later fnding and is crampy or are anorexia, growth failure, perianal disease, hematochezia, colicky, and rushes of high-pitched tinkling bowel sounds and diarrhea. Celiac disease, or gluten-sensitive enteropathy, is becom 22 When acute gastroenteritis is suggested based on a clinical ing increasingly recognized as a cause of chronic abdomi 15 presentation of vomiting and diarrhea preceding the com nal pain. Tere is infammation of the small intestine due to plaint of difuse abdominal pain and in the absence of any signs exposure to dietary gluten. It classically presents with diarrhea, or symptoms of an acute abdomen, no additional workup is steatorrhea, anemia, abdominal distention, failure to thrive, and indicated. Parents should be counseled about worrisome signs ofen with nonspecifc abdominal complaints. Peptic ulcer disease includes gastric and duodenal ulcers, 17 24 Constipation is the most common cause of chronic and gastritis, and duodenitis. It causes colonic disten tion of epigastric pain, exacerbation with meals, and early sion and painful defecation. If clinical presentation is consistent with the diagnosis, improvement with a trial of therapy is ofen diagnostic. If symp Elements of the H and P examination that suggest an or 18 toms do not respond to treatment, a search for Helicobacter ganic cause of abdominal pain include fever, weight loss or pylori with a urea breath test, serum antibodies, or stool anti growth deceleration, joint symptoms, emesis (especially if gens may be indicated. However, endoscopy with biopsy is the blood or bile-stained), abnormal fndings on physical examina most reliable method. An or Chronic pancreatitis is a rare cause of recurrent abdominal 25 ganic cause should be considered for pain or diarrhea that pain in children. Children experience intermittent epigas awakens a child from sleep, pain that is well localized away from tric abdominal pain, ofen with associated nausea and vomit the umbilicus, and pain that is referred to the back, fank, or ing; symptoms are frequently precipitated by a large meal or shoulders. Serum lipase and amylase levels are not as likely to be elevated as with acute cases. Characteristics include onset Irritable bowel syndrome is characterized by abdominal 26 at age older than 5 years, intermittent or episodic nature, peri pain or discomfort and a variable defecation pattern. The physical examination is always normal or constipation may predominate in the disorder; the abdomi (although patients may appear tired or pale during episodes), nal pain is usually relieved by defecation. The entity remains Lactose malabsorption causes symptoms of abdominal pain a common yet poorly explained afiction of childhood. In Functional dyspepsia describes pain and discomfort in the primary adult-type hypolactasia, symptoms may not develop until 20 upper abdomen. It is characterized by epigastric pain ac 3 to 5 years of age when lactase levels begin to decline. Malabsorption of fructose and sorbitol may occurs in males and is on the lef side. It generally presents as abdominal pain; periph 28 to diagnose most cases of malrotation. The diagnosis is made by demonstrating Ureteropelvic junction obstruction is an uncommon disor 29 decreased porphobilinogen deaminase in erythrocytes and in der, ofen presenting as abdominal pain in children and creased urinary levels of aminolevulinic acid and porphobilinogen. The condition is most commonly seen in cases of recent weight loss, lordosis, prolonged bed rest, or body casting. True vomiting is a forceful ejection of stomach or esophageal In a child with acute-onset, large-volume emesis, fever, contents from the mouth. Rumination is regurgitation rus in particular, vomiting ofen precedes diarrhea by 1 to 2 with rechewing of food. Further studies should be ordered based on sus include other abdominal, respiratory, and neurologic com pected diagnoses. In cases of chronic recurrent vomiting, the frequency is generally greater Pyloric stenosis presents as nonbilious vomiting in the frst 9 than two episodes; children are generally not acutely ill and few weeks of life and progresses in frequency and intensity. In cyclic recurrent vomiting, epi Clinical characteristics include projectile vomiting, later onset sodes are infrequent (#2/week) but are characterized by acute of cofee ground emesis (hematemesis), and poor weight gain. Initially, chronic and cyclic vomiting string sign of contrast medium through the narrowed pylorus. Signs and symptoms of an acute abdomen include sud ingestion of a toxic drug or poison. Older children tend to present with intermittent abdominal or fank pain and ofen with vomiting. A history of of nausea, abnormal funduscopic examination, or a bulging spontaneous resolution afer several hours because of relief of the fontanel in infants. Tese children may experience acute appear as a surgical emergency or a chronic complaint of intermittent episodes of vomiting accompanied by acidosis, abdominal pain or vomiting. Tere may be a family history geal stenosis, volvulus, duodenal webs, annular pancreas) usu of the disorder or of unexplained mental retardation, failure to ally occur acutely in the newborn period but may occur later if thrive, or neonatal deaths. Plain abdominal x-rays plained mental retardation), hepatosplenomegaly, or unusual are recommended initially. For a meta a more defnitive diagnosis but may not be necessary or recom bolic workup, blood and urine should be obtained during epi mended if a need for surgery has already been established. Immuno complain of efortless vomiting, substernal pain, dysphagia, globulin (Ig)E-mediated food allergies may also present with exacerbation with certain foods, and relief with liquid antacids. Gastric stasis and paralytic ileus may be postsurgical or 18 due to a neuropathy or drugs, electrolyte disturbances, The presentation of peptic ulcer disease (gastritis, duo endocrinopathies, or injuries. Pseudo-obstruction is a rare 15 denitis, and gastric and duodenal ulcers) may be classic, chronic disorder of intermittent episodes of ileus. Causes are including epigastric pain, nocturnal awakening, evidence of primarily neuropathic or myopathic. Patients are ofen anxious, afected by familial confict, and not bothered by the vomiting. Eosinophilic esophagitis presents with vomiting, feeding 16 Nausea, dizziness, vertigo, and nystagmus characterize problems, pain, and dysphagia. In reality, abdominal migraine and cyclic vomit Criteria for cyclic vomiting syndrome include: (1) at least 5 ing syndrome ofen have overlapping symptoms. Characteristics attacks in any interval, or a minimum of 3 attacks during a of abdominal migraine include recurrent stereotypical episodes 6-month period, (2) episodic attacks of intense nausea and of midline abdominal pain lasting more than 6 hours, associated vomiting lasting 1 hour to 10 days and occurring at least 1 week pallor, lethargy, anorexia, nausea, and normal laboratory values, apart, (2) stereotypical pattern and symptoms in the individual as well as radiographic and endoscopic studies. The typical mi patient, (3) vomiting during attacks occurs at least 4 times per graine symptoms of headache and photophobia only occur in hour for at least 1 hour, (4) return to baseline health between 30% to 40% of children with the abdominal symptoms.

Patient Education General: Prevent cercarial dermatitis by avoiding prolonged immersion in infested waters and treating infested fresh water streams and lakes with a mixture of copper sulfate and carbonate women's health clinic view royal buy generic clomid 25 mg line, or sodium pentochlorphenate womens health jackson michigan order clomid 50mg visa. Dry briskly after potential exposure to remove cercaria before they have sufficient time to penetrate houston women's health care center generic clomid 100mg amex. Apply 20% copper sulfate solution to the skin and allow to dry prior to potential exposure menstruation urinalysis purchase clomid 100 mg mastercard. It hides in crevices, bedding, or furniture, and normally emerges to feed at night in the dark. Under normal conditions, it feeds about once a week but has been known to survive 6 months to a year without feeding. Objective: Signs Using Basic Tools: Lesion is variable from a small, erythematous macule in non-sensitized individuals to an intensely pruritic papule or wheal, often with a central hemorrhagic dimple, in sensitized individuals. Patient Education General: Eliminate the bug from the environment with insecticides (consult preventive medicine). Centipedes have been reported up to 26 cm long, and are frequently more colorful (red, yellow, black, and blue) than millipedes and thus more likely to be sought as trophies. The legs on the first body segment are modified into fangs that bite and channel venom into prey. Subjective: Symptoms Severe local pain, swelling and redness; swollen, painful lymph nodes; headache; palpitations; nausea/ vomiting; anxiety. No Improvement/Deterioration: Return for fever, or reddening or blackening of the skin. Follow-Up Actions Return Evaluation: Observe for potential secondary infection or tissue blackening (necrosis is uncommon). They range in size from almost microscopic to 30 cm in length, with 100-300 pairs of legs. They are generally brown/black/gray in color, slow moving, nocturnal herbivores that live in humid environments and can be found in soil, leaf litter, under stones or decaying wood. When threatened, they coil up into a ball to protect their more vulnerable underbelly. Millipedes do not have biting mouthparts or fangs, but they secrete an irritating, repellent liquid from pores along the sides of their bodies when they feel threatened. No deaths have been reported from millipede exposures, and it is unlikely that any such exposure, even to a small child, would prove fatal. Assesment: Diagnose based on the history of millipede handling or identification of the specimen. No Improvement/Deterioration: Return promptly for continuing eye pain or deteriorating vision. Evacuation/Consultation criteria: Evacuation not necessary unless conjunctival ulcer is large or does not heal in 24-48 hours. Hymenoptera stings are a nuisance for most victims who usually recover without sequelae. However, because the Hymenoptera are so ubiquitous and live in such close proximity to humans, they are responsible for more human deaths each year than all other venomous animals combined. Alternately, a single sting may provoke a generalized anaphylactic reaction (the proteinaceous venom is a potent activator of the immune system) and death in a sensitized individual, particularly if there was an earlier, milder generalized reaction. Additionally, cross reactions to the venoms of various members of the Hymenoptera family have been reported. For example, an individual who suffers an anaphylactic reaction to a wasp bite may also simultaneously develop anaphylaxis to ant bites. Hymenoptera are social insects that live in colonies or hives located in caves, hollow trees or in the ground. They are most often found among flowers and fruit where they feed, and are probably attracted by bright colors, perfumes and colognes. Bees have a stinger with a specialized tip that not only penetrates the skin and delivers venom, but possesses a barb that anchors the stinger in the skin. Fire ants typically bite and hold onto the victim with their mandibles and then swivel their abdomen in an arc around the fixed mouthparts, inflicting multiple stings. Remove stinger and venom sac intact as quickly as possible (stinging apparatus may actively injects venom into the wound for one minute), regardless of method. Apply local analgesic, antibacterial or steroid ointments as desired (see Symptom: Rash). Other remedies to include ammonia, sodium bicarbonate, and papain (meat tenderizer) have minimal proven effectiveness. Apply topical antibiotic and/or anesthetic creme for secondary infections (see Symptom: Rash). Be prepared to treat for anaphylaxis or anaphylactoid reaction from venom load (see Shock: Anaphylactic). Evacuation/Consultation Criteria: Immediately evacuate cases with anaphylactic or generalized reactions. The best known, the mite Sarcoptes scabiei or scabies, is covered in another section of this of this chapter. When they meet an obstacle in the clothing, like a belt or boot top, they inject an irritating secretion that causes the itching sensation, and then drop off or are scratched off. Assessment: Diagnosis based on clinical morphologic criteria and history of exposure. Benzyl benzoate is an excellent chigger toxicant and remains effective after rinsing, washing, or submersion in water. The female is easily recognized by her coal black globular body and red-orange hourglass marking on the underbelly. A classic dark brown violin-shaped dorsal marking extending from the 3 sets of eyes (rather than 4 seen in other spiders) to the abdomen differentiates it from other brown spiders. Other species of Latrodectus and Loxosceles are found in other areas of the world. Some spiders have neurotoxic venom, which should be treated with antivenin if available. Advanced treatment of bites, including antivenin, requires evacuation to a medical treatment facility. The female mite tunnels into the epidermis layer and deposits her eggs along the burrow. The burrow is the home of the female mite, the papules are the temporary invasion of the developing larvae, and the vesicular response is believed to be a sensitization to the invader. The papules of the genital region may persist for weeks to months after the mite has been cleared. Assessment: Diagnosis based on clinical exam and laboratory/provider isolating evidence from the patient of an infestation-"scabies prep". Patient Education General: Do not clean the hair or body excessively, as this can lead to excessively dry skin and a 4-61 4-62 secondary focus of pruritus. Often the pruritus persists despite normal hygienic routines if the patient has a hypersensitivity to the mite or its products. Follow-up Actions Reevaluation: Repeat examination for those with continued nocturnal exacerbation of their pruritus. This is the feeding time of the scabies mite and will help differentiate between a hypersensitivity reaction and persistent infestation. Pediculus humanus corporis (body louse): localized or generalized pruritus on the torso. Objective: Signs Using Basic Tools: Head Lice: <10 organisms usually identi ed with naked eye or hand lens. The nit (1 mm oval, gray, rm capsule) cemented to the hair is the egg remnant of a hatched louse. Small erythematous papules at the sites of feeding, especially in the periumbilical area. Maculae caeruleae are non-blanchable blue to gray macules, 5-10 mm in diameter, at the site of a bite that result from the breakdown of heme by the louse saliva. Assessment: Diagnose based on clinical ndings and con rm with identi cation of lice or nits. Differential Diagnosis irritant or allergic dermatitis, arthropod reaction, seborrheic dermatitis, scabies, eczematous dermatitis, folliculitis. Clothing items that cannot be washed should be sealed in an airtight bag for 2 weeks or dry-cleaned. Secondary: Relieve pruritus with oral antihistamines, cool baths or compresses, and topical steroids.

Spinal cord injury is too difcult and too expensive to go-it-alone and there is no room for failure due to ill-conceived planning or lack of cutting-edge spinal cord Dr menstrual ovulation cycle calculator generic 100 mg clomid mastercard. Current measures are not sensitive enough to pick up subtle changes in the hand and upper limb menstrual water weight gain discount clomid online mastercard. This more sensitive measure will enable researchers to better understand the benefts of new treatments womens health news 50mg clomid otc. As the patient regains function pregnancy 9th month order genuine clomid, improvements in sitting, standing, reaching, grasping or walking occur. While most of the data collected on treadmill locomotion has featured people with incomplete cervical and thoracic injuries, the program is now open to those with complete injuries. A signifcant number who were unable to walk when they entered the program are now able to walk. For others, there are signifcant improvements in trunk control, endurance, speed of walking and balance, which translate into better ability to perform activities of daily living and reduced dependence on caregivers; there are measurable improvements in cardiovascular, pulmonary, and bladder function, and increased bone density. Kouri puts himself through the paces at a facility he and his family created, Next Step Fitness near Los Angeles. Kouri, born in Sweden and raised in New York, broke his neck in 2006 diving into the Pacifc and hitting a sandbar. Said Kouri, I wanted a proactive, progressive place, not one where you just learn how to live your life in a wheelchair. He and Susan soon discovered that there were no locomotor training sites on the West Coast. He has a complete C7-T1 spinal cord injury, and no muscle control below mid-chest. In 2011, fve years after his injury, an epidural stimu lator was surgically placed over his lumbar spinal cord; when turned on, Summers was able to rise up from his chair, fully bear his weight, and stand unassisted. The epidural stimulation did not directly afect his leg muscles; it activated circuits of the spinal cord not controlled by the brain; he was able to animate his lower extremities because the stimulation made the spinal cord more sensitive to sensory cues. The research team was surprised by this, speculating that this recovery of function may have been caused by the epidural stimulation awakening residual but weak spinal nerves. Summers also had functional gains in bladder control, sexual function, and temperature regulation. Since the frst experiment, several other completely injured subjects have under gone epidural stimulation; the scientists report similar results: All regained function when the lumbar cord was stimulated. Scientists speculate on what might come next: Imagine taking this training-based recovery and then adding some yet-to come biological or regenera Susan Harkema, Ph. In the few years since this discovery, evidence has emerged that these stem cells can become almost any of the 350 known specialized cells of the body; this leads to the notion that stem cells can repair or replace cells or tissues that are damaged or destroyed by disease and injuries. Stem cell: A cell from the embryo, fetus, or adult that, under certain conditions, has the ability to reproduce itself for long periods or, in the case of adult stem cells, throughout the life of the organism. A stem cell can give rise to specialized cells that make up the tissues and organs of the body. Pluripotent stem cell: A cell that can develop and self-replicate, from the embryonic germ layers, from which all cells of the body arise. Since these cells are specifc to the donor, this increases compatibility if such cells were to be used for therapies, thus forming the basis for personalized medicine. Embryonic stem cell: Derived from embryos that develop from eggs that have been fertilized in vitro in a fertilization clinic and then donated for research purposes with informed consent of the donors. The current challenges: to direct diferentiation of embryonic stem cells into specialized cell populations; to devise ways to control their proliferation once placed in people. Diferentiation: the process by which an unspecialized cell (such as a stem cell) specializes into one of the many cells that make up the body. During diferentia tion, certain genes become activated and others are inactivated in an intricately regulated fashion. Adult stem cells are capable of making iden tical copies of themselves for the lifetime of the organism. These cells have been identifed in brain, bone marrow, peripheral blood, blood vessels, skeletal muscle, skin, teeth, heart, gut, liver, ovarian epithelium, fat and testis. Progenitor or precursor cell: this type of cell can occur in fetal or adult tissues and is partially specialized. When a progenitor/precursor cell divides, it can form similar cells or it can form two specialized cells, neither of which is capable of replicating itself. Somatic cell nuclear transfer (also known as therapeutic cloning): this process involves removing the nucleus of an unfertilized egg cell, replacing it with the material from the nucleus of a somatic cell. Between newspaper headlines and Internet testimonials, it is indeed tempting to think cures are right around the corner. Not enough is known about how stem cells work; moving from research to the clinic is long and complicated. Clouding the picture are high expectations for stem cells, fueled by lots of Internet noise. There are many clinics outside the United States and outside mainstream medicine that ofer, for large fees, unproven stem cell therapies. None of these clinics can back up claims of recovery with published, credible science. Before you or someone you know considers such a treatment, be a responsible consumer; make an efort to understand the risks. Please visit the Closer Look At Stem Cells website from the International Society for Stem Cell Research, In general, those muscles closer to the center of the body are more affected than those farther away. Onset occurs after the age of eighteen months and most often between the ages of five and fifteen. Weak ness of the muscles of chewing and swallowing is rare, and respiratory effects are generally not as severe as in the first two forms. Braces or surgery may also help to counteract scoliosis, or curvature of the spine. Scientists hope to characterize the genes, study gene function and disease course, and find ways to prevent, treat, and, ultimately, cure these diseases. Tumors are classified as benign (noncancerous) if the cells that make up the growth are similar to normal cells, grow slowly, and are confined to one location. Tumors are malignant (cancerous) when the cells are different from normal cells, grow quickly, and can spread easily to other locations. These include lung, breast, prostate, head and neck, gynecologic, gastro intestinal, thyroid, melanoma, and renal cell carcinoma. When new tumors begin within the brain or spinal cord, they are called primary tumors. Instead, most tumors are caused by out-of-control growth among cells that surround and support neurons. Some of the possible causes under investigation include viruses, defective genes, and chemicals. About 10,000 Americans develop primary or metastatic spinal cord tumors each year. Although spinal cord tumors affect people of all ages, they are most common in young and middle-aged adults. Brain and spinal cord tumors cause many diverse symptoms, which generally develop slowly and worsen over time. Some of the more common symptoms of a brain tumor include headaches; seizures (a disruption of the normal flow of brain cell electricity that can lead to convulsions, loss of consciousness, or loss of bladder control); nausea and vomiting; and vision or hearing problems.

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