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May 1990 - The first British cat died of BSE. Meldrum said: "There is no reason to be worried. It was just a cat out of seven millions.[135] September 1990 - The "Veterinary Record" reported a pig being infected by BSE. 1998 - Prohibition to use ruminant-derived protein in form of meat and bone meal mbm ; in ruminant feed, which was the main cause of BSE cases in Switzerland and France. The incubation of 5 years caused this prohibition not to show immediate effect. The number of cases of BSE doubled from one year to another until having his peak in 1992. 1999.- Germany has closed his frontiers for living cattle but allowed the import of meat of cattle from Great Britain. 1994.-German veterinary officials stated human safety regarding BSE, existing no possibility of human contamination by consuming BSE-positive beef. This cannot be sustained today and shows how careless BSE meat was officially handled ! 1994.- One case of BSE on a cow in Diepholz Germany, near Osnabr ck ; . This cow had u been imported from Great Britain. German Health Minister Horst Seehover will determine all 5 000 cattle imported from England to be slaughtered. The agriculture lobby did succeed to stop the killing. 1995- Further measures against BSE and prevention to transmission to humans: 1- Slaughter of suspect cases 2- Destruction of carcasses 3- Ban of specified offal 4- Ban on using bovine vertebral column to produce mechanically recovered meat 5- Ban on using beef from cattle over 8 month old. 6- Ban of use of intestines and thymus from calves under 6 month old. 7- Ban of using the entire head. Despite the growing menace of spreading BSE in cattle mainly in France, Portugal and Switzerland the EU Commission is not willing to forbid animal meal made of bones, carcasses, brains, spinal cord, blood, gelatine, lard and marrow as animal feed for pigs, poultry and fish. Ruminants are not allowed any more to be fed with animal meal. Animal feed free of animal meal is now being produced in Germany with main ingredients: Soy bean from USA, Argentina and Brazil. Rapeseed cake from Pakistan, India and Germany, for example, aspirin.

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Since its description in 1935 by Stein and Leventhal, 3 much has been learned about the pathophysiology of PCOS from its neuroendocrine underpinnings4 to an ever-growing understanding of the link between obesity, insulin resistance IR ; and PCOS.5 Based on this current understanding of PCOS, it is important that the patient and medical provider approach management not only toward improving the often troublesome hirsutism and infertility but also toward the long-term risks associated with IR. Indeed, the management of the PCOS patient often will vary over time as the patient enters different stages of life with different goals. In contrast, because of the long-term health implications of IR, the importance of lifestyle modification toward weight management and maintaining adequate physical activity should be the one constant in the management of these patients. Despite the high prevalence of PCOS, the diagnosis and differential diagnosis remains confusing. This is in part due to the lack of a specific diagnostic test for the disorder. Oftentimes the clinical history and a few laboratory tests are enough to make the diagnosis and exclude other entities that may present in much the same way. Once the diagnosis is made, the management options can seem daunting at first. This has become especially true since the link between PCOS and IR has been made i.e., adding the issue of if when insulin sensitizers should be used ; . However, if approached from the standpoint of what the patient and or medical provider is concerned about at any given time, the options seem more manageable. Generally there are but four issues which arise in the management of PCOS patients: regulation of menses, control of hirsutism, fertility issues, and the management of the IR syndrome and its associated risks type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease ; . This review aims to not only clarify the diagnosis of PCOS and the management of its manifestations, but also to stress the importance of taking a life-long approach to the management of the IR syndrome in these often young patients. PCOS is most simply defined as the presence of hyperandrogenism clinically and or biochemically ; and or chronic anovulation in the absence of specific adrenal and or pituitary disease.6 Table 1 outlines the clinical features of PCOS. Hyperandrogenism may present clinically as hirsutism, acne, and or male pattern alopecia. Hirsutism can be defined as the growth of coarse hair on a woman in a male pattern upper lip, chin, chest, upper abdomen, back etc. ; . This is to be distinguished from hypertrichosis that involves a more uniform, whole body distribution of fine hair. Acne related to hyperandrogenism may be difficult to distinguish from normal pubertal acne in an adolescent with PCOS though pubertal acne in general is twice as prevalent in adolescent males versus females and males are more likely to have severe disease.7 Thus, an adolescent female with moderate to severe acne should be investigated for PCOS. Furthermore, the development or persistence of acne into adulthood is unusual and should raise attention. The severity of any of these manifestations is highly variable and may depend on genetic and ethnic differences in the sensitivity to the effects of androgens. The presence of virilization clitoromegaly, deepening voice, increased musculature, or rapidly progressive hirsutism or alopecia ; , however, is not a feature of PCOS, but instead of more severe hyperandrogenism. Chronic anovulation often presents as oligomenorrhea, amenorrhea, dysfunctional uterine bleeding, and or infertility. Interestingly, however, around 20% of patients with PCOS may describe normal menstrual cycles.8 Often, but not always, menstrual abnormalities are long-standing, even since menarche. Other women may only develop menstrual problems later in life, perhaps after significant weight gain. Furthermore, primary amenorrhea is possible although not common. When clinically evaluating a patient for the possibility of PCOS, it is also important to search for signs of IR. Upper-body obesity is a key component of the IR syndrome.9 However, obesity is not required for the diagnosis of PCOS with perhaps only 35% to 50% of these patients being obese.1, 10 Acanthosis nigricans on physical examination is a sign of IR. A personal or family history of type 2 diabetes mellitus or gestational diabetes mellitus, or the presence of hypertension should also be sought in the evaluation. Overall, the criteria for diagnosis of the IR syndrome in women should be evaluated in all patients table 2!

Vise individuals with complex neurobiological illnesses, although many people with mental disorders have ended up there simply because they have no other place to go. Each of these individuals has, in essence, become a casualty of a failed mental health system. Likewise, court practitioners were never intended to require comprehensive knowledge of mental illness and its treatment to successfully fulfill their responsibilities. But the prevalence of people with mental illnesses in the criminal justice system has made that knowledge increasingly indispensable. To that end, this guide can help court practitioners begin to educate themselves about mental illnesses and how to treat such illnesses. But its real value may be in spurring dialogue between court officials, others in the criminal justice system, and their counterparts in the mental health and substance abuse treatment arenas. It is only through consistent collaboration that representatives of these systems can educate each other and effectively serve their shared clientele. The experience of numerous jurisdictions, backed by research, attests to the power of collaboration between the courts and the mental health system. Whether it is through a mental health court, a post-booking diversion program, or another mechanism, when defendants with untreated mental illnesses are stabilized and receive community-based care, their quality of life improves, and they are far less likely to commit subsequent crimes and return before the court. The expansion of these efforts offers the potential for reversing the overrepresentation of people with mental illness in the criminal justice system. More importantly, it holds great promise for people with mental illnesses, their families, and their communities and isoniazid.
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