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Multiple sclerosis is by and large a disorder of the central nervous system and does not affect peripheral nerve conduction studies asthma definition zephyr discount singulair on line. Nerve conduction studies can show both demyelinating and denervation features in vitamin B12 deficiency asthma vcd treatment purchase singulair 5 mg visa. Intramuscular administration of vitamin B12 is the most effective way of treating this condition and can reverse or stop the neurologic features asthma symptoms 3 weeks singulair 10mg line. Cobalamin (vitamin B[12]) in subacute combined degeneration and beyond: traditional interpretations and novel theories asthma symptoms for adults order singulair with a mastercard. As he looked at his textbook, he realized he was having difficulty reading through his left eye. He had no pain in his right eye and had no headache, dizziness, pain, or numbness. Considerations Optic neuritis usually is associated with an acute, usually unilateral, loss of visual acuity or visual field or both. Ninety percent of patients with optic neuritis have ocular pain, usually with eye movement. This disturbance can occur at any age but usually occurs in young adults, younger than 40 years old. Within several weeks following onset of symptoms, approximately 90% of patients with optic neuritis experience visual improvement to normal vision, or only marginal compromise. Some patients have residual deficits in contrast sensitivity, color vision, depth perception, light brightness, visual acuity, or visual field. The patient in this case should see a physician, have a careful neurologic assessment, and have blood studies. Lumbar puncture for assessment of possible demyelinating disease might also be necessary. Differential diagnosis: congenital, hereditary, infectious, inflammatory, infiltrative, ischemic, demyelinating (optic neuritis), and compressive etiologies. Optic neuritis: A general term for idiopathic, inflammatory, infectious, or demyelinating optic neuropathy. Patients have symptoms because of compromise of the optic nerve, but the optic nerve appears normal. It is one of the causes of acute loss of vision associated with pain mainly because of demyelination and can be idiopathic and isolated. Epidemiology Whites of northern European descent are affected eight times more frequently than blacks and Asians. The condition is rare in children and is usually related to a postinfectious or parainfectious demyelination. In patients older than 50 years of age, optic neuritis is less common and can be mistaken for ischemic optic neuropathy, which is more common in persons in this age group. Etiologies and Clinical Presentation Patients with optic neuritis experience an acute, usually unilateral loss of visual acuity or compromise of visual field; sometimes, they have both a loss of acuity and field compromise. These symptoms usually occur suddenly but can worsen over the next several days to weeks. Examination reveals decreased visual acuity or visual field compromise (or both), and an afferent pupillary defect. This dilated pupil does not constrict well to direct light and, when light is directed into that eye, the pupil of the other (normal) eye does not contract, signifying afferent compromise of light to the involved eye. However, when light is directly shined into the normal eye, not only does the pupil of that normal eye constrict, but the (already dilated) pupil of the involved eye constricts, signifying that the efferent output to the pupil of the involved eye is normal. The etiology of optic neuritis is usually idiopathic or caused by demyelinating disease. Diagnosis the diagnosis of optic neuritis is usually made on clinical grounds, supplemented by ophthalmologic examination findings.

Thus asthma mucus generic 5mg singulair with mastercard, simply adjusting output prices through measures such as dismantling marketing boards that taxed producer food prices does little to promote intensification and discourage farmers from expanding their agricultural areas asthma treatment types purchase 5 mg singulair visa. Hence asthma treatment for cats cheap singulair online, input markets asthma yeast purchase singulair 4mg with mastercard, seasonal financing and rural non-farm labour markets can all play key roles in stemming deforestation. However, non-farm activity can be a two-edged sword with respect to intensification. On the one hand, if non-farm activities pay more than farm activities and/or help to reduce income risk, then non-farm activities compete for cash and labour with farming. This also implies that farmers may eschew labour-intensive agricultural technologies even in the face of farm labour surpluses and choose labour-saving technologies if they can afford to adopt them. Low (1986) shows, in a case-study of hybrid maize adoption in Botswana, that farmers deliberately choose labour-saving technologies to free labour for lucrative non-farm work. Where conservation measures require substantial labour, the desire to engage in off-farm activities to diversify income sources might undermine the sustainability strategies. At the same time, to a certain extent, non-farm activities can act as an escape valve from labour/land pressure. Similarly, households do not automatically use labour liberated from the farm to bring more land under the plough. On the other hand, non-farm income is often a key source of cash for many African rural households. Given weak rural financial systems, non-farm 238 Thomas Reardon and Christopher B. Whether households will invest non-farm income in capital-led intensification is an empirical question. It depends on the characteristics of the local labour market as well as the profitability of alternative investment opportunities. There is ample evidence, however, that non-farm income is poorly distributed across households. Since they have little access to non-farm income and lack the means to purchase farm inputs, the poorest households are forced to depend on the land. So those with the least capacity to finance investment independently also have the poorest access to non-farm substitutes. Rising farm productivity induces a disproportionately large demand for non-agricultural goods and services and rural non-farm activities expand as a result. Ahmed and Hossain (1990) have demonstrated this effect in the Green-Revolution rice areas of Bangladesh. We conjecture that similar effects occur in African settings where farm productivity increases. Hence, provided that the basic rural market infrastructure is in place, the multiplier effects in general equilibrium probably shield the forests, wetlands and ranges from falling prey to increased agricultural productivity. Historically and worldwide, increased farm productivity leads to reduced employment in agriculture, as industries enjoying higher income elasticities of demand absorb increased labour. Too often, policy-makers tend to assume what the effects of changes in output and input prices will be, without empirically testing those assumptions. We contend that the major macro and sectoral policy changes associated with structural adjustment have had ambiguous and often disappointing effects, generating quite mixed farm-level impacts on intensification patterns. Macro-level policy reforms Macro reforms have analytically indeterminate effects on the incentives facing farmers. This depends on how tradable the outputs and inputs are, on the extent to which governments tax away gains from trade rather than passing them on to farmers and on the size of the margins in private commerce. Devaluation can also raise marketing costs and producer price risk, as it did in Madagascar (Barrett, 1999). But market liberalization can also convert interior markets into enclaves, raise transport costs and the prices of imported inputs and increase price risk. The evidence from a number of African rural areas suggests that liberalization favours market concentration and creates barriers to entry in certain markets that tend to produce greater price instability. It also shows that devaluations have ambiguous effects on farm profitability and on input use (Barrett, 1997, 1999). The limited available evidence suggests that state intervention lowered the mean and variance of agricultural product prices, while liberalization has increased both expected prices and price variability (Barrett, 1997). Price instability can undermine farm investment, even where liberalization raises average medium-term output prices, because price instability discourages investments in quasi-fixed capital (Barrett and Carter, 1999). Price instability also reduces inter- and intrafarm diffusion of yield-increasing technologies, and thus slows down the adoption of technology (Kim et al.

Malalai was accused of insulting the parliament and suspended until the end of her term in 2009 asthma wheezing cheap singulair 10 mg mastercard. Kaftar probably never meant to strike a blow for gender equality asthma treatment step up discount singulair 5 mg on-line, but over the years she has shown that an Afghan woman can make just as tough and ruthless a warlord as her male counterparts asthmatic bronchitis 15 order singulair with a mastercard. Now 55 asthmatic bronchitis 38 discount singulair, Kaftar has fought almost everyone from the Russians and the Taleban to the present government of President Hamed Karzai. Legend has it that she became a fighter by accident, when she grabbed a gun to kill the Soviet soldiers who had shot her son during the mujaheddin war of the Eighties. Her success later led to her appointment as local commander for the Jamiat-e-Islami faction, whose military leader was Ahmad Shah Massoud. After Taleban forces captured Kabul in 1996 and pushed north, Kaftar claims to have commanded 2,000 armed men resisting their advance. According to local residents and officials, she had more than 200 armed men under her command. There is a small, hidden Christian community; there are no reliable figures on its size, but estimates range from 500 to 8,000. In addition, there are small numbers of adherents of other religious groups, mostly Buddhist foreigners. Even at their peak, these non-Muslim minorities constituted less than one percent of the population. Most of the small Hindu and Sikh populations, which once numbered approximately 50,000 persons, took refuge abroad during the many years of conflict; however, there is a small population of native-Afghan Hindus and Sikhs that never left. For the last 200 years, Sunnis often have looked to the example of the Darul Uloom madrassah [religious school] located in Deoband near Delhi, India. Additionally, Deobandi scholars often have opposed what they perceive as Western influences. Much of the population adhered to Deobandi-influenced Hanafi Sunnism, but a sizable [sic] minority adhered to a more mystical version of Islam, generally known as Sufism. Sufism centers on orders or brotherhoods that follow charismatic religious leaders. Sunni Muslim Pashtuns centered around the city of Kandahar and dominated the south and east of the country. Several high-profile cases involving religious freedom sparked demonstrations in major cities during the period covered by this report [2007]. Followers of other religions are free to exercise their faith and perform their religious rites within the limits of the provisions of law. During the reporting period, moderates in the Government opposed attempts by conservative elements to enforce rules regarding social and religious practices based on their interpretation of Islamic law. There are no laws forbidding the practice, even though it is viewed by authorities and society as contrary to the beliefs of Islam. There were unconfirmed reports of attempts to arrest Afghan Christians involved in proselytism. The Government worked on revising the penal code to bring it in line with international standards during the reporting period. Blasphemy is a capital crime, and authorities could punish blasphemy with death, if committed by a male over age 18 or a female over age 16, who is of sound mind. Those accused of blasphemy are given three days to recant their actions and could otherwise face death by hanging. Although it primarily was concerned with reconciliation of former Taliban combatants, it also expressed concern about religious intolerance. The Government responded positively to international approaches on human rights, including religious freedom, and worked effectively. The Constitutional Commission also included a Hindu member to represent non-Muslim religious minorities. While women have always had the right to attend mosques, separate areas had to be designated for them. The new initiative provided for such spaces in larger mosques where room was available. During the reporting period, the Ministry of Foreign Affairs organized seminars for religious leaders to promote moderate views about the role of women in Islam. Approximately 20 religious leaders attended the seminars, which sparked continued discussion on the topic.

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