This is a wedding comedy where the bride appears in her red knicker with her red bra on her wedding day.The unexpected happens when a child attempting to get a piece off the wedding cake makes it fall down.The ushers devise other means of having another wedding cake.The ex-girlfriend of the bride groom invades the wedding reception and beats up and fights the newly wedded bride.Matters are solved when the bride groom takes her by the hand and kisses her and after her re assurance she drives away.The story ends when speeches are going to be made.
The book is a set of pieces of advice given by a parent to his children on the source of suffering to human kind and the source of suffering to people in developing countries.
2 True Stories of Different Women Who Struggled With Epilepsy and Abuse And how they bravely fought their way back .. This book will encourage you to face the world and get help with your struggles . No matter what know there is Hope .
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Viver sem medo, permitir-se renovar. Aceitar o amor como um sentimento sem prender-se a regras de gênero, cor, religião ou outro rótulo. Deixar fluir no momento em que se torna presente. Entregar-se dando valor aos nossos verdadeiros valores.Reconhecer nossas fraquezas e principalmente saber virar a pagina sem aumentar as cicatrizes.Um novo olhar pintando um mundo de certezas e novos roteiros. Esta ficção na categoria romance aconteceu na década de 80. Foi escrita em uma linguagem acessível. O texto apresenta narrativa e diálogos diretos. O tema é uma nova proposta de enxergarmos tudo à nossa volta desde que tenhamos um entendimento. A história se desenvolve com duas personagens principais, sendo que a mais jovem tinha problemas de relacionamento com as pessoas, dona de uma personalidade forte e geniosa, onde para ela o mundo era para lhe servir. A outra personagem sete anos mais velha, era equilibrada e tinha os pés no chão. Sabia o que queria e era determinada ao alcançar. Um acontecimento inesperado coloca as duas em uma nova etapa da vida, dois polos contrários que buscam uma nova alternativa de serem felizes. O enredo envolve comportamento e as diferentes formas de se avaliar a vida, onde deixa claro que o mundo é além do próprio umbigo, a mensagem é clara. O que julgamos como erros, ou porque não deu certo são os reflexos de nossas ações, e mesmo parecendo ruim a um primeiro momento pode ser o começo de outra etapa favorável. O amor é descrito de forma inteligente onde o que importa é o sentimento sem ser rotulado. Aborda também mentiras, AIDS, conflitos familiares, drogas, suicídio e homossexualismo. Durante a história nota-se uma evolução nos personagens. Mesmo tendo sido elaborada em outra década, houve cuidado para ser fiel aos costumes da mesma, e o que chama atenção é que todos os temas abordados são atuais e talvez daqui a uma ou duas décadas ainda estaremos esbarrando nos mesmos questionamentos. A história é envolvente e nos traz um novo olhar na dinâmica da vida.A diferença está em saber ou não voar.
A story about two boy's who are best friends. One day when they are playing hide and seek, one of the boys comes face to face with his biggest fear, but can his best friend help him to overcome his biggest fear once and for all.
25 poems are written from the various themes of poetry. This is the second volume in the series. Read along and enjoy!
A man who falls in love with two women through serendipity ends up living with both women. Although legally married to only one, he has children with both women. The District Attorney finds out and has him arrested. The subsequent trial captures the nation's attention as it pits religious values against government rights.
Princess was a happy little girl.But soon her parent's faith in God was to be tested.She became ill and was struck by a paralysing illness.Princess was taken to the hospital.The doctors did their best and her mum prayed.Princess was latter healed.She went to college and latter married and became a successful banker.This is a story to encourage every mum and dad with a little boy or girl sick on the bed not to give up.In these times when people have lost all the faith they have in God there is still hope for our world in situations that seem impossible, if only we can rekindle our belief that there is someone bigger and higher than every difficulty. With this belief we will always overcome.Read this story for young children,teenagers or adults facing challenging situations and find some encouragement in the story of others who were victorious.
A los pies del placer es una novela romántico-erótica que recorre la vida amorosa de Julián Sánchez, un joven al que le costaba relacionarse con el sexo opuesto hasta que, a los 19 años, debuta sexualmente luego de una borrachera en casa de un amigo.Descubre entonces su facilidad para detectar, en cada mujer con la que se relaciona, sus preferencias sexuales sin necesidad de que ellas se lo indiquen, aunque con Analía, su primer amor importante, descubre que a veces eso no es suficiente para retener a quien se ama. No obstante, la que verdaderamente lo inicia en los vericuetos del placer sexual es una mujer bastante mayor que Julián, que le demuestra que el deseo sexual puede permanecer intacto más allá de la edad. La novela revela su evolución profesional, personal y su experiencia en dar goce, aunque cuando se enamora profundamente de una joven comprende que el placer que surge a través de la unión sexual con la persona amada supera cualquier estrategia aprendida en ese ámbito. A pesar de esto, una acción errónea de su parte le hará perder a su gran amor, ante lo cual intentará, por todos los medios, volver a encontrarla.
William Shakespeare's most popular comedy “A Midsummer Night’s Dream” was written around 1594 or 1595. Most critics believe the play was written for and performed at an aristocratic wedding, with Queen Elizabeth I in attendance. It features three interlocking plots, connected by a celebration of the wedding of Theseus, Duke of Athens and the Amazonian queen Hippolyta. “The course of true love never did run smooth,” comments Lysander, articulating one of A Midsummer Night’s Dream’s most important themes—that of the difficulty of love.This work is widely performed around the world, and no wonder - it's about the world's most popular pastime, falling in love.
In the gathering 18 - I settled as a dr. at one of the wealthiest of our great Humanities towns, which I faculty specify by the primary L--. I was yet young, but I had acquired some reputation by a able work, which is, I count on, still amongst the received jurisdiction on the subject of which it treats.
After she got fired, found out her boyfriend was cheating on her and her parents are getting a divorce, Emma Willis is intent to change her life-upside down.She wasn’t going to be a shy girl next-door anymore and she may just explore her naughty side with a gorgeous stranger from the bar. Note: All characters in this 3.100 word story are of legal age and consent. For 18+ only.
A Poetic World Perspective According to King David In a virtual world where writing, reading, and independent thinking is the exception, and the ruling principle is to maintain the status quo, reading poetry is becoming obsolete. So what can reading poetry do for you?Maybe life should be about the collective good, not “solely” about YOU! If our institutions were fair and functional, virtually everyone would be able to earn a livable wage doing what they love doing.Why aren’t you following your passion? Think before answering! I see three reasons why most of us can’t go from present to passion:1.LACK OF FAITH-We lack the faith of a mustard seed. We worship manmade God called money.2.LACK OF COURAGE-We lack the courage to act in accordance with our instincts. That small voice within is greater than any gadget you will ever own, so listen up!3.LACK OF LOVE-We can’t stay positive in a world that is constantly bombarding us with negative programming. We allow the less than “one percenters” to divide us, vis a vi, propaganda, fear mongering, and playing on our greed. Most of us are not working to create a level playing field, we are trying to “get ours” at your expense, and in return we all get played.Fortunately, reading truly independent writers is one of the most effective ways to jump-start your journey back to divinity. Once you have thought provoking ideas running through your brain, your begin to think for yourself and you start to ponder who you are and what is your purpose (LEGACY)I believe that each of us was born to answer a prayer. You are here to make the world, the society, and your community a better place to live. You are far more than the grand total of your consumption. Lastly, we have organized this book of poetry into seven (7) perfect chapters and ten (10) categories:1.Wisdom & Introspective2.Slave Virtues3.Motivational Hope4.Love & Spirituality5.Straight Up Racism6.Freedom Fighter & Timeless7.PoliticsYou will naturally be drawn to your favorite topics based upon who you are. However, make sure you read some of the poetry from categories that you are not typically attracted to because their words will make you think outside your comfort zone. Lastly, be inspired to read, enjoy, share, and debate
This book describes Abnormal High Fever, Diagnosis and Treatment and Related DiseasesMalignant hyperthermia (or abnormal high fever) is an genetic disorder that produces a rapid increase in body temperature (fever) and severe muscle contractions (myalgia) when the affected person is provides with general anesthesia.This disorder is not the same as hyperthermia due to medical emergencies such as heat stroke.This is a rapid rise in temperature normally activated by an anesthetic and tends to be lethalIt is an inherited myopathy caused by a genetic mutation. Linkage studies reveal that in the majority of families the defect is in the ryanodine receptor gene (RYR1) at chromosome 19q13.1Malignant hyperthermia is an autosomal dominant trait, indicating it needs only one parent carrying the disorder for a child to inherit the disorder. It may be linked with muscular diseases such as multi-mini-core myopathy and central core disease.A form of malignant hyperthermia is produced by a defect in the ryanodine receptor (RYR1) geneMalignant hyperthermia (MH) reactions happen with the onset postponed for several hours into anesthesia using:1. Halothane especially,2. Desflurane,4. Sevoflurane, and5. IsofluraneIt has been limked with:1. Myotonia congenita 2. Duchenne muscular dystrophy and3. Becker's muscular dystrophy.Non-depolarizing neuromuscular blockers such as pancuronium are harmless.Nitrous oxide and barbiturates such as thiopental are safe.Symptoms are:1. Rapid rise in temperature to 105 degrees F or higher2. Muscle rigidity and stiffness3. Dark brown urine (myoglobulin)4. Muscle ache without obvious exercise to explain sore musclesOnset may be during or within a few hours after anesthesia.Spasm of the masseter muscle is often first noted.There is muscular rigidity despite a paralyzing agentThere is tachycardia and the skin is flushed.There is hypoxia, hyper-capnea and a metabolic acidosis.Temperature may rise above 40° but normo-thermia does not exclude the condition. Diagnosis:There can be a family history of malignant hyperthermia or non-explained death during anesthesia.Genetic testing is used to institute a diagnosis, but the caffeine halothane contracture test (CHCT) is the criterion standard.Diagnosis is made by the muscle biopsy.Caffeine, halothane, succinylcholine and raised potassium induce amplified contractions.DNA testing cannot be used as the only test for MH susceptibilityTreatmentFor an episode of malignant hyperthermia, a cooling blanket can help reduce fever. The treatment with a drug called dantrolene throughout events of malignant hyperthermia has largely decreased the number of deaths.Dantrolene, the antidote, decreases the loss of calcium from the sarcoplasmic reticulum in the skeletal muscle and restores normal metabolismFluids given orally and intravenously, and certain medicines, are important for maintaining the kidney function during an acute episode.1.Call for help, as management can be difficult and complex for one person.2.Switch from volatile anesthetics to alternative forms of anesthesia.3.Give 100% oxygen and adjust ventilation according to blood gas analysis and end expiratory pCO2.4.Deepen anesthesia with opioids, benzodiazepines, barbiturates or propofol.5.Monitor blood gases, electrolytes, CK, myoglobin and lactate.6.Stop surgery if it is elective and if there are signs of masseter spasm or a fulminant crisis.7.Continue surgery, if there is no hyper-kalemia, no acidosis and there are no triggers.8.Intravenous dantrolene should be given but prophylactic administration of dantrolene is now regarded as obsolete.9.Arrhythmia may be treated with a beta-blocker or lidocaine.TABLE OF CONTENTIntroductionChapter 1 Abnormal High FeverChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Heat StrokeChapter 8 HypothermiaEpilogue
Achilles tendon rupture is the rupture following inflammation of the Achilles tendon. Damages to the Achilles tendon are frequent among people of all ages.Achilles tendon pathologies are rupture and tendonitis.Other tendon disorders are:1. Paratenonitis: Featured by paratendon inflammation and thickening, and fibrin adhesions 2. Tendinosis: Featured by intra-substance disarray and degeneration of the tendon The rupture to the tendon is normally caused by a sudden and immediate plantar-flexion of the ankle or if the foot moves in a direction outside its regular motion.Other reasons or causes of rupture or Achilles tendon tear are:1. Excess stress on the tendon brought on in one act or by years of usage,2. Putting too much effort in a single action after a long rest of the tendon and severe sports.3. Some antibiotics also weaken the tendons in the body, particularly the Achilles tendon.4. Patients have injected steroids directly into the Achilles tendonThe rupture is often linked with Symptoms:1. Sudden difficulty of movement of the Achilles tendon2. Swelling of the Achilles tendon involved at the lower leg and heel3. Local tenderness and gap in the involved Achilles tendon4. Inability to move the involved footUltrasonography can recognize a ruptured Achilles tendonOther tests are:Simmond’s TestNeedle testCalf Squeeze testKnee Flexion TestHeel Raise testSphygmomanometer TestTreatment:Medical treatment for a patient with an Achilles tendon rupture is rest, control of pain, serial casting, and physiotherapyrehabilitation to maximize functionAchilles tendon Surgery Types1. Open Achilles tendon SurgeryThe surgeon makes only one incision which is normally about 5 cm long and makes sure that all the torn fibers in the tendon are sutured back together and then left to recover.Percutaneous Achilles tendon SurgeryIn this surgery, a number of small incisions are performed by the surgeon.These incisions make for quicker healing and also permit the surgeon to see the complete length of the tendon and suture it back together.The Achilles tendon surgery also is dependent on the type of tear or Achilles tendon rupture of the patient.The two types of Achilles Tendon Ruptures are:1. Chronic TearA tear is regarded chronic if the muscle is shortened.It has been weeks or months since the rupture and the patient has still not had it surgically repaired.In this patient, the most important factors are the distance of separation present and the amount of the gap present between the tendons.Acute TearAn Achilles tendon tear is acute if the patient informs a doctor within a couple of weeks of the injury that ruptured his Achilles tendon.In most acute tear cases, the separation is pretty negligible and the ends of the tendon can be sutured back together.With the enlargement in the gap, more extreme measures are to be taken.This can range any thing between using a simple strip of the present injured tendon to using a dissimilar tendon for tendon transfer or discussing with a tissue bank about an Achilles tendon graft.Tendon TransfersTendon transfers are not done widely, as it is performed only when the gap present is very wide. The tendon used during the transfer is normally the next strongest tendon present in the leg.This is the flexor hallucis longus, the muscle available next to the big toe.An Achilles tendon surgery provides the best results only if the procedure is done at the earliest. TABLE OF CONTENTIntroductionChapter 1 Achilles Tendon RuptureChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Achilles TendonitisChapter 8 Plantar FasciitisEpilogue
This book describes Adhesive Capsulitis, Diagnosis and Treatment and Related DiseasesAdhesive Capsulitis is also known as Frozen Shoulder Syndrome (FSS), a disorder of the shoulder featured by the slow onset of pain and restricted shoulder movement.Adhesive capsulitis of the shoulder produces pain and stiffness in the shoulder.Over time the shoulder becomes very stiff to move and is called frozen.It is likely to be chronic and full recovery may require several months.Primary idiopathic Adhesive Capsulitis is often linked with other disease such as diabetes and may be the first presentation of diabetes mellitus.Patients with systemic diseases such as thyroid diseases and Parkinsonism have a higher risk of adhesive capsulitis.Secondary Adhesive Capsulitis can happen after shoulder injuries or immobilizations e.g., rotator cuff injuries, sub-acromial impingement, biceps tenosynovitis, and cardiac tendonitis.These patients develop pain from shoulder pathology leading to reduced movement in the shoulder and thus developing Adhesive Capsulitis.The most important sign of Adhesive Capsulitis is being unable to move the shoulder either by the patient or with the help of someone else.It progresses in three stages:a. FreezingIn the freezing stage the shoulder slowly has more and more pain that typically worsens at night.As the pain worsens, the shoulder loses range of motion.Freezing normally lasts from 2 to 9 months.b. FrozenPainful symptoms may actually become better during this stage but the stiffness and tightness remains.There is a typical progressive loss of gleno-humeral flexion, abduction, internal rotation, and external rotation.For the 4 to 12 months of the frozen stage daily activities of the shoulder may become very difficult.c. ThawingShoulder range of motion slowly gradually returns during the thawing stage.Complete return to normal or close to normal strength and motion usually takes from 6 months to 2 years.While adhesive capsulitis is self limiting usually resolving in 1- years, it can persists, presenting symptoms that are often mild pain, the most frequent complaint.CauseThe exact cause is unknown but several conditions have been blamed:Bicipital tenosynovitisRotator cuff tendonitis Reflex sympathetic dystrophyTraumaImmobilizationDiabetesSymptoms:PainDecreased motion of the shoulderStiffnessDiagnosis:People with Adhesive Capsulitis have restricted range of shoulder motion both actively and passivelyMagnetic resonance imaging (MRI) and ultrasound can create better images of problems with soft tissues such as a torn rotator cuff, not for Adhesive CapsulitisConservative treatment:1.Initial phase:RestMoist heatPain killers such as NSAIDMuscle relaxantInjection of local anesthetic and long acting steroid 2.Mobilization phase:Physiotherapy such as traction, shortwave diathermyGradual mobilization and exercises3.Maintenance phase:Continual exercises of the shoulder musclesAvoidance of strain on the muscles of the shoulderSteroid injections plus physical therapy can improve the range of motion.It can take a few weeks to see improvement in the Adhesive Capsulitis.It may take as long as 6 to 9 months for complete recovery.Physical therapy is intense and needs to be done every day.Left untreated the condition very often improves by itself within 2 years with little loss of motion.Risk factors for Adhesive Capsulitis such as diabetes or thyroid problems should also be treated.4.Surgery may be recommended if non-surgical treatment is not effectiveArthroscopic surgery can also be used to cut the tight ligaments and remove the adhesions from the shoulderTABLE OF CONTENTIntroductionChapter 1 Adhesive CapsulitisChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Rotator Cuff InjuriesChapter 8 Shoulder DislocationEpilogue
Recently I have an elderly patient who is unable to ejaculate even though he is able to manage an erection.His wife felt that is unusual and wonder whether there is a blockage in the seminal ducts.He is also depressed because he felt that he should be able to ejaculate.What is Anejaculation?Anejaculation is a disorder typically featured by the absence of ejaculation.Anejaculation is described as the inability to ejaculate semen; the word means “no ejaculation.”With this disorder, a man can produce sperm but cannot ejaculate or expel them during normal ejaculation even though anejaculation often is accompanied with normal orgasmic sensation.Anejaculation can be placed into several categories:1. Situational anejaculation is when a man can ejaculate in some circumstances but not in others.Often, this type of anejaculation is caused by stress in situations such as being in the fertility clinicAlso, if a man can ejaculate during intercourse but cannot ejaculate through masturbation2. Total anejaculation: Total anejaculation is when a man is not able to ejaculate semen either during intercourse or by masturbation, at home or in the clinic. Total anejaculation also can be divided into: a. Anorgasmic anejaculation - A man who can not reach an orgasm while awake, but can reach orgasm, and ejaculation, while asleep at night.In these patients, psychological factors rather than physical ones tend likely to cause the disorderb. Orgasmic anejaculation - A man can reach and achieve orgasm, but cannot ejaculate semen.This failure to release semen can be because of a blockage in the tubes or damage to the nervesAnejaculation can also be categorized as primary or secondary.1. Primary anejaculation is when ejaculation has never been experienced in a man's entire lifetime 2. Secondary anejaculation is when a man is unable to ejaculate after he has the experience of normal sexual functioningThe causes can be psychological and physical.1. Psychological anejaculation is normally anorgasmic i.e. not accompanied by orgasm.2. Physical or organic anejaculation can happen due to neurogenic and obstructive causesSpinal cord injuriesa. Disorders that involve the nervous system2. Traumatic injury or infection to the pelvis area3. Surgical treatment needing the removal of lymph nodes located in the groin4. Surgeries that may produce damage to the pelvic areaPsychological factors can play a part (e.g. anxiety, fear of causing pregnancy)Diagnosis is by absence of sperm ejaculate.Post-ejaculation urine analysis is done to see if there is sperm in the urine sample.When the urine sample contains sperm, the patient will be treated for RE (retrograde ejaculation).When the post-ejaculation urine does not contain sperm the patient will be given treatment for AE.There are several methods of treatment for men with anejaculation; the main focus of which is to retrieve sperm for artificial insemination.If situational anejaculation is because of psychological causes it can often be treated by simple methods such as psychological or sexual counseling.When the cause of anejaculation is because of a physical disorder then the patient will have to discuss with the doctor to find out exactly what is happening and what action can be taken.The treatment is dependent on the cause and includes psychosexual counseling, drugs such as ephedrine and imipramine, vibrator therapy and electroejaculationThe last is a method in which an electrical current is applied to the ejaculatory organs to stimulate ejaculation.Success rates are nearly 100 %.Vibrator stimulation leads to ejaculation in about 60% of men.A block due to infection can occasionally be cleared by surgery.TABLE OF CONTENTIntroductionChapter 1 AnejaculationChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Male OrgasmChapter 8 Sexual IntercourseEpilogue
Angioplasty is a non-surgcal intervention to open narrowed or blocked coronary arteries that carry blood to the heart.A coronary artery stent is a small, metal mesh tube that inflates to keep open a coronary artery.A stent is often inserted during or instantly following angioplasty.It assists to prevent the artery from closing up again.A drug-eluting stent has medicine implanted in it that assists to prevent the artery from closing in the long term.Angioplasty:The patient may also be given medicine that calms down the patient, and blood thinning medicines to prevent a blood clot from developing.The patient will stretch out on a padded table.The doctor will place a flexible tube (catheter) through a surgical incision into an artery.Occasionally the catheter will be inserted in the arm or wrist, or in the upper leg or groin area.The patient will be conscious during the intervention.The doctor will make use of live x-ray pictures to guide the catheter up into the heart and arteries.A dye will be injected into the body to show up blood flow through the arteries.This assists the doctor see any obstructions in the blood vessels that go to the heart.A guide wire is passed into and across the obstruction.A balloon catheter is thrust over the guide wire and into the blockage.The balloon on the end is inflated (blown up).This opens the obstructed vessel and reestablishes proper blood flow to the heart.A wire stent (mesh tube) may then be inserted in this obstructed area.The stent is placed along with the balloon catheter.It widens when the balloon is inflated.The stent is kept there to help maintain the artery open.Reasons for the InterventionArteries can become constricted or obstructed by deposits called plaque.This disorder is called atherosclerosis.Angioplasty may be utilized to treat:1. Obstruction in a coronary artery during or after a heart attack2. Obstruction or constriction of one or more coronary arteries that places the patient at danger for a heart attack3. Constricted blood vessels that decrease blood flow and produce persistent chest pain (angina) that medicines do not manage.Not every blockage can be treated with angioplasty.Some patients who have several obstructions or blockages in certain positions may require coronary bypass surgery.Investigations before AngioplastyAn angiogram or angiography is a medical imaging method to look for any blocks, narrowing, dilatations and structural anomalies of heart blood vessels.This intervention is used to identify the need for angioplasty.This is a diagnostic investigation that is done after a patient displays atherosclerosis symptoms.Using an angiogram, the arteries, veins, and the four chambers of the heart are observed by injecting radio-opaque dye (identified by X-rays) into the body.The risks of angioplasty and stent insertion are:1. Allergic reaction to the drug eluding stent, the stent material, or the x-ray dye2. Bleeding or clotting in the area where the catheter was inserted3. Blood clot4. Clogging of the inside of the stent5. Damage to a heart valve or blood vessel6. Heart attack7. Kidney failure (higher danger in people who already have kidney disorders)8. Irregular heartbeat (arrhythmias)9. Stroke (rare) The Angioplasty Recovery PhasePatients are often discharged on the same day or instantly next day after an angioplasty intervention.They may go back to doing routine activities within a week of the intervention1. Bathing/Getting Dressed – Same day after discharge2. Walking (With Help) - 6 hours later3. Cycling - 2 weeks later4. Returning To Work (normally after 7-10 days)5. Sex – 3 to 4 days later6. Driving - 7-10 days laterTABLE OF CONTENTIntroductionChapter 1 AngioplastyChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Coronary Heart DiseaseChapter 8 AtherosclerosisEpilogue