What are bone and joint health?

Overview

Many diseases and conditions affect the bones and joints, yet
the treatment of these diseases and conditions with complementary and alternative
medicine (CAM) has yet to be evaluated extensively by clinical studies; thus,
variability of results among studies is typical.

“Arthritis” is the general term for joint inflammation and is
the primary distinguishing feature of joint disorders. CAM seeks to reduce
inflammation regardless of the cause of arthritis. Osteoarthritis, also known as degenerative joint disease, is
the most common disorder involving joint movement. Not limited to old age,
osteoarthritis can result from a complex interaction of mechanical, biological, or
genetic factors that result in the depletion of joint cartilage. Rheumatoid
arthritis is an autoimmune disease in which the
immune
system attacks the tissues surrounding and cushioning the
joint, eventually affecting the cartilage and bones of the joints. Gout and
bursitis also affect the joint.

Some diseases affecting the joint also affect other tissues and organs. These
diseases include systemic lupus erythematosus, fibromyalgia, and ankylosing
spondylitis. Another disorder, osteoporosis, is the decrease
in density of many different bones of the body and does not affect the joint.
Osteoporosis is often confused with osteoarthritis, yet they are very different
medical conditions with little in common.

Osteoarthritis

Osteoarthritis (OA) is distinguished by degeneration of joint cartilage and
adjacent bone, leading to pain, difficulty in movement, and stiffness. OA can
affect any joints in the body, including knees, hips, shoulders, vertebrae,
fingers, toes, and the temporomandibular joint, which is in the jaw. Standard
treatments consist of exercise or physical therapy programs, analgesic
drugs or corticosteroids for pain, and, as a last resort, joint
replacement surgery.

None of the standard treatments regenerate lost or damaged cartilage.
Cartilage is composed of collagen and proteoglycan. Collagen
is a large fibrous protein, whereas proteoglycan consists of a core protein with
linkages to many long-chain carbohydrates known as glycosaminoglycans. Chondroitin
sulfate is the glycosaminoglycan found in collagen. Because chondroitin sulfate is
an integral part of collagen, and glucosamine is an essential metabolic
intermediate in the formation of collagen, it was reasoned that providing these
compounds to persons with joint disorders would serve as a stimulus for the
formation of collagen.

Considerable research has been reported on the effectiveness of glucosamine and
chondroitin sulfate in halting and reversing joint degeneration. Although earlier
research did indeed seem to show effectiveness, there were some questions about
research design and methodology. Recent studies were more rigorous in nature,
involving larger numbers of persons and using the gold standard of clinical
trials: randomized, double-blind, and placebo-controlled
trials. Meta-analyses compile the data from many studies for
overall statistical analyses. In the case of glucosamine and chondroitin, recent
analyses do not support much benefit from their use.

A review article in 1998 reported on studies that evaluated the effectiveness of glucosamine and chondroitin sulfate in reducing pain symptoms in OA. Most studies showed that persons receiving glucosamine had a reduction in pain score, compared with those receiving placebo. Fewer studies were reported on the effectiveness of chondroitin sulfate, but the compound appeared to produce what were called favorable outcomes. An analysis reported in 2003 found that glucosamine was significant in alleviating pain and in maintaining cartilage, while chondroitin was effective in some indices of pain reduction.

Another review in 2008 studied the results of twenty-five randomized controlled studies involving 4,963 persons. When all studies (including older studies) were analyzed, glucosamine improved pain more than did a placebo after six months. When the analysis was restricted to higher-quality studies with adequate blinding (in which neither the persons studied nor the researchers knew the identity of the treatments), no benefit was observed.

A meta-analysis was reported in 2007 on twenty trials
evaluating the effectiveness of chondroitin sulfate for reducing symptoms of OA.
Heterogeneity among the trials made analysis difficult, but when only large,
methodologically sound trials were included in the analysis, no significant
benefits of chondroitin were found.

A two-year study reported in 2006 evaluated the effectiveness of glucosamine and chondroitin sulfate on slowing structural damage of knee OA. Measurements of joint space width (cartilage depletion) were used as measures of structural damage. At the two-year stage of treatment, no statistical differences were found among the treatments, compared with the placebo control. The combination of glucosamine and chondroitin may be less active, compared with their individual effects. Persons with less severe OA at the beginning of the study tended to show less joint loss than those using a placebo.

A large glucosamine/chondroitin arthritis intervention trial (GAIT) involved 1,583 persons. After twenty-four weeks of treatment, glucosamine or chondroitin singly or in combination did not show the significant 20 percent reductions in knee pain, compared with placebo, although the groups did show numerical improvements over placebo. A subgroup of persons with moderate to severe pain at the beginning of the study showed a significant reduction in pain, compared with placebo.

A companion GAIT trial studied the effect of glucosamine and chondroitin singly or in combination on progressive loss of joint space width (JSW). At two years, no treatment achieved statistically significant differences in JSW loss, compared with placebo, although the placebo had less JSW loss than anticipated.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disorder in which the immune
system attacks the tissues lining the joints, causing swelling, pain, and
stiffness. Rheumatoid arthritis can eventually affect the bones and cartilage in
the joints.

CAM seeks to alleviate the symptoms of rheumatoid arthritis without attempting cures for the underlying causes. Mind/body techniques, such as relaxation, imagery, and biofeedback, can improve symptoms such as pain, psychological state, physical function, and ability to cope. In terms of dietary supplements, some clinical studies have shown that omega-3 fatty acids may be beneficial in reducing the inflammation of rheumatoid arthritis. Preliminary evidence suggests that gamma linolenic acid can have the same effect.

Tai
Chi is a traditional martial art that combines slow and
gentle movements with mental focus. A twelve-week study showed that Tai Chi
improved muscle function in lower limbs in persons with RA. Persons using Tai Chi
experienced improved psychosocial benefits such as less pain and improved posture,
balance, and coordination.

Other Joint Diseases and Conditions

Gout. Gout is a recurrent, acute inflammation
of peripheral joints, such as the big toe, instep, ankle, knee, wrist, and elbow.
The condition is caused by deposits of monosodium urate crystals in cartilage,
tendons, and ligaments and can become chronic with joint deformities. CAM focuses
on the diet and includes recommendations such as avoiding foods with high purine
content (such as beef, organ meats, sardines, and anchovies), eating cherries,
taking fish oil supplements, minimizing alcohol consumption, and drinking eight
glasses of water per day.

Systemic lupus erythematosus. Systemic lupus erythematosus
(SLE) is an autoimmune disease in which antibodies
attack connective tissue cells. Connective tissue serves to support and connect
organs, muscles, joints, and other body parts. Because connective tissue is
widespread, the organs affected and symptoms observed are also broad. The vast
majority of persons with SLE experience joint pain and swelling.

A few studies have indicated that dehydroepiandiosterone (DHEA) may lead to decreased symptoms of lupus. Persons with lupus have abnormally high levels of estrogen metabolites and low levels of testosterone. DHEA may control these hormone abnormalities and may have effects on immune system components, such as a decrease in pro-inflammatory cytokines. Preliminary studies have also indicated a beneficial effect of omega-3 fatty acids in fish oils on reducing abnormal levels of the immune components cytokine and interleukin.

Fibromyalgia. Fibromyalgia (FM), or fibromyalgia
syndrome, is a disorder characterized by chronic pain, tenderness, and stiffness
in soft tissues, including muscles, tendons, and ligaments. FM most commonly
affects women, and its cause is unknown. Some believe the disorder is triggered by
physical or mental stress. Other symptoms of the disorder include severe fatigue,
nonrestorative sleep, irritable bowel syndrome,
depression, and cognitive difficulty (also called brain
fog).

CAM seems to be particularly useful in treating FM because conventional
therapies, namely drugs, are only partially effective and may have undesirable
side effects. The treatments focus on the overall health of the person with FM,
including his or her emotional state and nutritional health, and how these states
can affect the condition. A review article found the largest improvements occurred
with mind/body techniques, such as biofeedback, hypnosis, and
cognitive
behavioral therapy, especially when they were part of a
multidisciplinary approach to treatment. Acupuncture
was only moderately effective, while manipulative techniques such as chiropractic
and massage were least effective. Another study, however, showed that just twenty
minutes of moderate-pressure massage can lessen the flow of chemicals associated
with pain and stress while increasing production of serotonin, a nerve transmitter
that improves mood.

Osteoporosis

Osteoporosis (OP), or “porous bone,” is the gradual
weakening of bone structure caused by the depletion of calcium and other minerals.
The condition can lead to bone fractures. Fractures are most common in the arm
bone, vertebrae, and hip. Women are more subject to OP than men, but before
menopause, estrogen secretion provides a protective effect against OP. For both
prevention and treatment of OP, emphasis is placed on consuming adequate calcium
and vitamin
D and engaging in weight-bearing exercises. Prevention is
more successful than treatment.

Estrogen therapy was common practice for postmenopausal women because of the
beneficial effects in preventing hot flashes and reducing OP. However, a large
Women’s Health Initiative Study concluded that the health risks of estrogen
therapy exceeded its benefits. In the search for alternatives to estrogen therapy,
attention has focused on the use of dietary isoflavones. Isoflavones are
non-nutritive compounds found in relatively large amounts in soybeans. The most
common isoflavones are genistein and daidzein. They are also known as
phytoestrogens, because they are similar in structure to estrogens and have weak
estrogenic activity. Researchers have shown that isoflavones bind to estrogen
receptors in osteoblast (bone-forming) cells, although in a manner different from
estrogen. As a result, isoflavones were characterized as selective estrogen
receptor modulators that could provide some of the beneficial effects of estrogen
without the negative effects. Isoflavones could also inhibit osteoclast
(bone-breakdown) cells by decreasing acid secretion or regulatory enzyme
activities.

A review article summarized the results of two double-blind, randomized-control studies and one case-control study. Those persons receiving isoflavone treatments showed improvements in bone mass and reductions in the loss of bone mass, compared with those persons in the control group.

Another study evaluated the effect of isoflavones on bone resorption. Subjects were provided with radioactive calcium and three levels of isoflavones in a double-blind, randomized-control study. Serum and urinary samples were taken and analyzed for radioactive calcium to determine the rate of bone resorption (loss). Isoflavones did not have any influence on bone resorption.

Another study compared the effect of isoflavones on bone mineral density (BMD) in men and women. The results showed that isoflavones had a modest benefit in preserving spine but not hip BMD in women.

Bibliography

Beers, Mark H., ed. The Merck Manual of Medical Information, Second Home Edition. Whitehouse Station, N.J.: Merck Research Laboratories, 2003. This is the layperson’s version of professional Merck Manual of Diagnosis and Therapy. Provides an excellent discussion of bone and joint disorders.

Brynin, Rona. “Soy and Its Isoflavones: A Review of Their Effects on Bone Density.” Alternative Medicine Review 7, no. 4 (2002): 317-326. Describes the nature of soy isoflavones and relevant studies to evaluate the effect of isoflavones on bone density.

Clegg, Daniel, et al. “Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis.” New England Journal of Medicine 354 (February 23, 2006): 795-808. Reports on the effect of glucosamine and chondroitin on pain alleviation in GAIT studies.

Kelly, Gregory. “The Role of Glucosamine Sulfate and Chondroitin Sulfates in the Treatment of Degenerative Joint Disease.” Alternative Medicine Review 3, no. 1 (1998): 27-39. Describes the structure and metabolism of glucosamine and chondroitin and discusses relevant clinical trials.

National Center for Complementary and Alternative Medicine. “Rheumatoid Arthritis and CAM.” Available at http://www.nccam.nih.gov/health/ra. Provides a summary of all CAM methods that treat symptoms of rheumatoid arthritis.

Reichenbach, Stephan, et al. “Meta-analysis: Chondroitin for Osteoarthritis of the Knee or Hip.” Annals of Internal Medicine 146 (2007): 580-590. Concludes that chondroitin showed no benefit for osteoarthritis in those studies that were large and well designed.

Sawitzke, Allen, et al. “ The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis.” Arthritis and Rheumatism 58, no. 10 (2008): 3183-3191. Reports on the effect of glucosamine and chondroitin on reducing cartilage loss in osteoarthritis in GAIT studies.

In "Stopping by Woods on a Snowy Evening," what does the poet say about the owner of the woods?

The entire first stanza of “Stopping by Woods on a Snowy Evening” refers to the owner of the woods where the narrator has stopped to watch the falling snow. “Whose woods these are I think I know. / His house is in the village though; / He will not see me stopping here / To watch his woods fill up with snow.” At the very least, we learn that the property owner does not live on the premises, out here in the country. He lives in the village instead. This could imply that he doesn’t care much about what goes on in his woods – for good or for bad. The narrator knows that no one will wonder about what he’s doing. No one will come rushing out a door and ask him to explain himself. The owner and the narrator must not be friends, or even mere acquaintances. Does one have a higher social standing than the other? I think you could make an argument either way.

How would Gulliver, from Jonathan Swift's Gulliver's Travels, describe the people of Lilliput: their manner of living, their skills, and system of...

Gulliver admires many aspects of life in Lilliput and really doesn't take major issue with much until the emperor asks him to decimate the Blefuscudian fleet (a request he refuses because he cannot bring himself to enslave a free people).  Thus, if I were Gulliver, I would be highly complimentary of their military discipline, as he is.  Further, I would be greatly entertained by the rope-dancers, those Lilliputians who are competing for positions at court, as he expresses how enjoyable he finds them as well as the stick jumpers (he sees no irony in their method of choosing people for these important offices). 

Gulliver does find the Lilliputians' struggles concerning which end of the egg to crack somewhat unnecessary, especially as it has caused such discord in the empire.  He says that each man ought to be able to decide according to his own conscience which side of the egg to crack, and so he would likely describe the Lilliputians as being picky or a bit inflexible in this case (even though he seems desirous to avoid criticizing them).  However, Gulliver seems to think highly of their legal system which, unlike England's, includes both reward for good behavior and punishment for bad. 

Ultimately, Gulliver is somewhat disillusioned by the events that result in his escape from Lilliput -- after he pees on the palace to put out a fire that threatened to destroy the entire structure, he is the subject of a conspiracy to indict him for treason. Therefore, he would likely describe these events with some confusion and sadness, because he is disappointed by the fact that his good services to the crown seem to count for so little now.

What is the conflict between faith and culture in Ambiguous Adventure by Cheikh Hamidou Kane?

The conflict of faith vs. culture in Ambiguous Adventure is technically correct; however, that is a very general way to describe it. One can be a bit more specific by saying the conflict is one of religion vs. greed. An even better (and more specific) description would be to say it is a conflict between Senegalese Islam vs. European (specifically French) materialism. 

As the main character, Samba, learns more about his Islamic faith from his teacher Thierno, it becomes harder for Samba to reconcile his faith with the destructive forces of French colonization that have ravaged Senegal. The reader learns this mostly through dialogue between Samba and many philosophers in his native Senegal. Samba is passionate about his call to become a teacher of Islam, but he is surrounded by a throng of French schools that counteract Islamic teaching. The Most Royal Lady (who is actually Samba’s aunt) eventually insists Samba attend one of these schools. Continuing his passion for his studies, Samba excels at school and eventually studies in Paris. Unfortunately, through his success, Samba becomes more distant from Islam. The schools, of course, are designed to get the Diallobe ready for the comforts of materialism encouraged by European greed. In my opinion, the conflict can best be exemplified by a quote from Samba’s father (the Knight), who admits Samba is drifting away “because of this egoism which the West is scattering abroad.” The Knight eventually calls Samba back to Senegal only to find Samba is alienated from his original culture due to Western attempts at assimilation.   

The novel is an “ambiguous adventure” because there is no resolution of the conflict. Because Samba dies (at the hand of a mentally ill man who thinks Samba has offended his former teacher by not praying at his gravesite), Samba can no longer help the Diallobe determine the importance of faith vs. culture.

What is acute cystitis?

Definition

The urinary tract normally contains no microorganisms. However, sometimes bacteria or yeast from the lower gastrointestinal tract or rectal area enter the urinary tract, usually through the urethra (the tube that allows urine to pass from the bladder). If bacteria or yeast cling to the urethra, they can multiply and infect the urethra. They then travel up and infect the bladder with a condition called acute cystitis.

Causes

Most cases of cystitis are caused by bacteria from the rectal area. In
women, the rectum and urethra are fairly close to each other. This makes it relatively
easy for bacteria to make their way into the urethra. Some women develop cystitis
after a period of frequent sexual intercourse. This happens because bacteria enter
the urethra during sex and cause infection.

Risk Factors

Risk factors for acute cystitis include being sexually active; using a
diaphragm for birth control; condom use (this may also increase infection rates in women,
especially when Nonoxynol-9-coated condoms are used); menopause; abnormalities of
the urinary system, including vesicoureteral reflux or polycystic
kidneys; paraplegia and other neurologic
conditions; sickle-cell disease; history of kidney transplant; diabetes
type 1 and type 2; kidney stones; enlarged prostate; weak immune system; bladder
catheter in place or recent instrumentation of the urinary system; tight underwear
and clothing; and chemicals in soaps, douches, and lubricants. Women are at higher
risk for acute cystitis.

Symptoms

The symptoms of cystitis, which vary from person to person and can range from
mild to severe, include frequent and urgent need to urinate; passing only small
amounts of urine; pain in the abdomen or pelvic area, or in the low back; burning
sensation during urination; leaking urine; increased need to get up at night to
urinate; cloudy, bad-smelling urine; blood in the urine; low-grade fever; and
fatigue.

Screening and Diagnosis

A health care provider will ask about symptoms and medical history, perform a
physical exam, and test the urine for blood, pus, and bacteria. If bacteria are
present in the urine, it is likely that cystitis will be diagnosed. Children and
men who develop cystitis may require additional testing. In these cases, a
cystoscope is used to check for structural abnormalities of the urinary
system that predispose a person to infection.

Treatment and Therapy

Bacterial cystitis is treated with antibiotic drugs. Antibiotics
(usually trimethoprim/sulfamethoxazole, nitrofurantoin, or fluoroquinolones) will
be prescribed for at least two to three days and perhaps for as long as several
weeks. The length of the treatment depends on the severity of the infection and
the patient’s personal history. Symptoms should subside in about one or two days.
To ensure that the infection has disappeared, the health care provider will again
test the patient’s urine.

Recurrent infections might be treated with stronger antibiotics or over more time. Low-dose antibiotics, which are prescribed as a preventive measure, might be prescribed either for daily use or for use after sexual intercourse. Patients with recurrent infections could be referred to a specialist.

Phenazopyridine (Pyridium) is a medicine that decreases pain and bladder spasms. Taking phenazopyridine will turn urine and sometimes sweat an orange color. This medication is generally available without a prescription and can relieve symptoms effectively while the patient waits for medical treatment to work.

Prevention and Outcomes

The chance of having cystitis can be lessened by preventing bacteria from entering the urinary tract. Of the following logical and commonly recommended steps, only the use of cranberry juice has been clearly shown to be of value in reducing infection risk. One should drink large amounts of liquids; urinate when having the urge; empty the bladder and then drink a full glass of water after having sexual intercourse; wash the genital area daily; wipe from front to back (for women) after having a bowel movement; avoid using douches and feminine hygiene sprays; drink cranberry juice (which may help prevent and relieve cystitis); and avoid wearing tight underwear or clothing.

The foregoing prevention recommendations apply largely to healthy young women at risk for bladder infections. Those with some of the unusual risk factors, or women for whom the foregoing suggestions do not reduce recurrence, might find that other medically recommended prevention techniques help.

Bibliography

Kahn, B. S., et al. “Management of Patients with Interstitial Cystitis or Chronic Pelvic Pain of Bladder Origin: A Consensus Report.” Current Medical Research and Opinion 21, no. 4 (2005): 509-516.

Katchman, E. A., et al. “Three-Day Versus Longer Duration of Antibiotic Treatment for Cystitis in Women: Systematic Review and Meta-Analysis.” American Journal of Medicine 118, no. 11 (2005): 1196-1207.

Parsons, M., and P. Toozs-Hobson. “The Investigation and Management of Interstitial Cystitis.” Journal of the British Menopause Society 11, no. 4 (2005): 132-139.

Phatak, S., and H. E. Foster, Jr. “The Management of Interstitial Cystitis: An Update.” Nature: Clinical Practice in Urology 3 (2006): 45-53.

Schrier, Robert W., ed. Diseases of the Kidney and Urinary Tract. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.

“Gothic literature is fascinated with monsters and monstrous figures.” Consider the significance of this statement in the light of two or...

Angela Carter’s Gothic-inspired short story collection The Bloody Chamber is a work that illustrates Carter’s fascination with monsters, monstrous figures, and, more specifically, monstrous women. Carter casts many of the women in her stories as marginalized, ghastly women with horrific features. This is especially interesting in part because she utilizes Gothic tropes to tell her stories, and also because the women in Carter’s stories reflect the liminal position women hold in patriarchal discourse. A striking instance of a monstrous woman occurs early in the collection with “The Tiger’s Bride.” A young woman’s father gambles her away to a mysterious being merely known as The Beast. By the end of the story, however, the young woman embraces the monstrous being that has been lurking within her all along. In a Gothic twist, the woman only becomes fulfilled after she has accepted her status as a monster:

“And each stroke of his tongue ripped off skin after successive skin, all the skins of a life in the world, and left behind a nascent patina of shining hairs. My earrings turned back to water and trickled down my shoulders; I shrugged the drops off my beautiful fur” (67).

Another interesting case of a woman acting as a monster is in “The Lady of the House of Love.” The sensual female vampire is condemned to a life of loneliness, occupying an obviously Gothic castle like a wispy Poe heroine. She inhabits a liminal space between living and dead, animal and human:

“She herself is a haunted house. She does not possess herself; her ancestors sometimes come and peer out of the windows of her eyes and that is very frightening. She has the mysterious solitude of ambiguous states; she hovers in a no-man's land between life and death.... The beastly forebears on the walls condemn her to a perpetual repetition of their passions” (103).

These obviously Gothic monsters are pervasive influences in Carter’s stories. She uses these monstrous figures, and specifically monstrous women, in order to establish Gothic tropes and question women’s marginalized position in patriarchal society.

`int (dt)/(t^2 sqrt(t^2 - 16))` Evaluate the integral

`int1/(t^2sqrt(t^2-16))dt`

Let's evaluate the integral by applying integral substitution,

Let `t=4sec(u)`

`=>dt=4tan(u)sec(u)du`

Plug the above in the integral,

`int1/(t^2sqrt(t^2-16))dt=int(4tan(u)sec(u))/((4^2sec^2(u)sqrt(4^2sec^2(u)-16)))du`

`=int(4tan(u)sec(u))/(16sec^2(u)*4sqrt(sec^2(u)-1))du`

`=inttan(u)/(16sec(u)sqrt(sec^2(u)-1))du`

Now use the identity:`sec^2(x)=1+tan^2(x)`

`=1/16inttan(u)/(sec(u)sqrt(1+tan^2(u)-1))du`

`=1/16inttan(u)/(sec(u)tan(u))du`

`=1/16int1/sec(u)du`

`=1/16intcos(u)du`

Now use the standard integral:`intcos(x)dx=sin(x)+C`

`=1/16sin(u)+C`

We have used `t=4sec(u)`

`=>u=arcsec(t/4)`

Substitute back u in the solution,

`=1/16sin(arcsec(t/4))+C`

Simplify the above by assuming the right triangle with angle `theta=arcsec(t/4)`

Hypotenuse is t and adjacent side is 4, Opposite side(O) can be found by using pythagorean identity,

`4^2+O^2=t^2`

`O^2=t^2-16`

`O=sqrt(t^2-16)`

`sin(theta)=sqrt(t^2-16)/t`

Hence the solution is `1/16(sqrt(t^2-16)/t)+C`