American Urological Association - Early Detection of Prostate Cancer. H. Ballentine Carter, Peter C. Albertsen, Michael J. Barry, Ruth Etzioni, Stephen J. Freedland, Kirsten Lynn Greene, Lars Holmberg, Philip Kantoff, Badrinath R. Konety, Mohammad Hassan Murad, David F. Penson and Anthony L. Zietman. Purpose. This guideline addresses prostate cancer early detection for the purpose of reducing prostate cancer mortality with the intended user as the urologist. The Evolution of the Human: The universe is constructed from a multitude of various materials. It is dynamic in form and shape due to a multitude of various. Homo erectus migrated from out of Africa via the Levantine corridor and Horn of Africa to Eurasia during the Early Pleistocene, possibly as a result of the operation. Watch breaking news videos, viral videos and original video clips on CNN.com.
This document does not make a distinction between early detection and screening for prostate cancer. Early detection and screening both imply detection of disease at an early, pre- symptomatic stage when a man would have no reason to seek medical care –an intervention referred to as secondary prevention. In the US, early detection is driven by prostate specific antigen (PSA)- based screening followed by prostate biopsy for diagnostic confirmation. While the benefits of PSA- based prostate cancer screening have been evaluated in randomized- controlled trials, the literature supporting the efficacy of DRE, PSA derivatives and isoforms (e. PCA3) for screening with the goal of reducing prostate cancer mortality provide limited evidence to draw conclusions. While some data suggest use of these secondary screening tools may reduce unnecessary biopsies (i. However, the likelihood of a future population- level screening study using these secondary screening approaches is highly unlikely at least in the near future. Therefore, this document focuses only on the efficacy of PSA screening for the early detection of prostate cancer with the specific intent to reduce prostate cancer mortality and not secondary tests often used after screening to determine the need for a prostate biopsy or a repeat prostate biopsy (e. PSA isoforms, PCA3, imaging). The framework for this guideline follows that of the Institute of Medicine (IOM) recommendations for guideline development, including a systematic review of the evidence by a multidisciplinary panel. While the evidence that guideline panels evaluate may be the same, the weighting of the evidence and the Panel's perspective can be very different (e. Figure 1). It is important to note that the guideline statements listed in this document target men at average risk, defined as a man without risk factors, such as a family history of prostate cancer in multiple generations and/or family history of early onset below age 5. African American race. Because the harm- benefit profile of PSA- based prostate cancer screening is highly age dependent, guideline statements included in this document target four index patients; these age ranges were chosen to correspond to age ranges tested in randomized trials and data from population and simulation studies. Four Index Patients. Men < 4. 0 years of age. Men age 4. 0- 5. 4 years. Men age 5. 5- 6. 9 years. Men age 7. 0+ years. Figure 1: Influence of evidence and interpretation on policy creation. Methodology. Consistent with AUA published guideline methodology,3 the process started by conducting a comprehensive systematic review. The AUA commissioned an independent group to conduct a systematic review and meta- analysis of the published literature on prostate cancer detection and screening. The protocol of the systematic review was developed a priori by the expert panel. The search strategy was developed and executed by reference librarians and methodologists and spanned across multiple databases including Ovid Medline In- Process & Other Non- Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials and Scopus. Controlled vocabulary supplemented with keywords was used to search for the relevant concepts of prostate cancer, screening and detection. The search focused on DRE, serum biomarkers (PSA, PSA Isoforms, PSA kinetics, free PSA, complexed PSA, pro. PSA, prostate health index, PSA velocity, PSA doubling time), urine biomarkers (PCA3, TMPRSS2: ERG fusion), imaging (TRUS, MRI, MRS, MR- TRUS fusion), genetics (SNPs), shared- decision making and prostate biopsy. The expert panel manually identified additional references that met the same search criteria to supplement the electronic search. The outcomes of interest were also a priori determined by the Panel and included prostate cancer incidence, mortality, quality of life, the diagnostic performance of each of the tests and the harms of testing (premature death and complications from testing and biopsy). Modeling studies were included when original studies were limited by follow- up time and screening protocols. The methodology team independently rated the methodological quality of the studies and provided an overall judgment of the whole body of evidence based on their confidence in the available estimates of effect. The framework for rating the quality of evidence is an adaptation and modification. GRADE framework (Grading of Recommendations, Assessment, Development and Evaluation). In this adaptation, the AUA rates the quality of evidence as high, moderate or low (A, B or C). The strength of a statement was rated according to AUA guideline methodology as further described below. The confidence in the estimates of effect (quality of the evidence) was determined based on study quality, imprecision, indirectness, inconsistency and the likelihood of reporting and publication bias. The methodology team summarized the data with an explicit description of study characteristics, methodological quality, main findings and the quality of the evidence (confidence in the estimates). The methodology team attended panel meetings and facilitated incorporation of the evidence into the guideline. AUA Nomenclature: Linking Statement Type to Evidence Strength. The AUA nomenclature system explicitly links statement type to body of evidence strength and the Panel's judgment regarding the balance between benefits and risks/burdens (see Table 1). Standards are directive statements that an action should (benefits outweigh risks/burdens) or should not (risks/burdens outweigh benefits) be undertaken based on Grade A or Grade B evidence. Recommendations are directive statements that an action should (benefits outweigh risks/burdens) or should not (risks/burdens outweigh benefits) be undertaken based on Grade C evidence. Options are non- directive statements that leave the decision to take an action up to the individual clinician and patient because the balance between benefits and risks/burdens appears relatively equal or appears unclear; Options may be supported by Grade A, B or C evidence. For some clinical issues, little or no evidence may exist from which evidence- based statements can be constructed. In such instances, the Panel may provide guidance in the form of Clinical Principles or Expert Opinions with consensus achieved using a modified Delphi technique if differences of opinion exist among Panel members. A Clinical Principle is a statement about a component of clinical care that is widely agreed upon by urologists or other clinicians for which there may or may not be evidence in the medical literature. Expert Opinion refers to a statement, achieved by consensus of the Panel, that is based on members' clinical training, experience, knowledge and judgment and for which there is no evidence. In the case of this guideline, such statement types were not included. The completed evidence report may be requested through the AUA by emailing guidelines@AUAnet. Table 1: AUA Nomenclature. Linking Statement Type to Evidence Strength Standard: Directive statement that an action should (benefits outweigh risks/burdens) or should not (risks/burdens outweigh benefits) be taken based on Grade A or B evidence. Recommendation: Directive statement that an action should (benefits outweigh risks/burdens) or should not (risks/burdens outweigh benefits) be taken based on Grade C evidence. Option: Non- directive statement that leaves the decision regarding an action up to the individual clinician and patient because the balance between benefits and risks/burdens appears equal or appears uncertain based on Grade A, B or C evidence. Clinical Principle: a statement about a component of clinical care that is widely agreed upon by urologists or other clinicians for which there may or may not be evidence in the medical literature. Expert Opinion: a statement, achieved by consensus of the Panel, that is based on members' clinical training, experience, knowledge, and judgment for which there is no evidence. Quality of Individual Studies and Determination of Evidence Strength. The systematic review included over 3. In brief, six well known randomized trials addressed the question of mortality benefit of prostate cancer screening. Considering various methodological limitations and biases, the estimate for the effect of screening (versus no screening) on prostate cancer- specific mortality was obtained from the European Randomized Study of screening for Prostate Cancer (ERSPC). The quality of the evidence was moderate for benefits and high for harms in men aged 5. RCTs). Follow- up was quite limited, and quality of evidence was low on screening benefits in men outside of this age range, population subgroups with greater than average risk of the disease and screening protocols different from those used in the ERSPC. Modeling studies were considered by the Panel to address these issues. A modeling study considers disease progression as a process of clinical or prognostic states and aims to estimate the rates of progression through these states in the absence of screening. Given the rate estimates, different screening protocols can be superimposed and their tradeoffs projected via computer simulation. To validate the models, specific screening protocols used in published studies can be considered and the model- projected incidence patterns compared with those observed in these studies. The primary model considered by the Panel.
0 Comments
Oz and the 3. 0- Day Diet Plan. Most detox diets limit your intake to juice or a special tea. But celebrity cardiologist Dr. Mehmet Oz recommends a 3. Even though the diet was created by a doctor - - Dr. Alejandro Junger - - be sure to consult your personal physician before you begin to discuss the pros and cons of Dr. Oz's 3. 0- Day Diet Plan. The 3. 0- day detox diet plan endorsed by Dr. Oz is aimed at improving digestion to boost your body's natural ability to detox itself. On the diet, you eat three meals a day - - a shake for breakfast, then a regular lunch and light dinner - - plus snacks as needed. Your meal plan should contain a minimum of 1,2. The Detox Diet to Burn Fat and Lose Weight Fast. Change your life in less than two weeks! The detox plan to radically reboot your system and burn fat. This week, Dr. Mehmet Oz, host of "The Dr. Oz Show," sat down to explain to senators why he, as a surgeon and popular doctor, promotes what some experts have called. Oz’s Complete Guide to Turn Back the Clock. It’s not too late to erase the errors of your youth! Oz reveals all the tools you need to turn back the clock. Recently, a member of Dr. Bert’s AC/Fast-5 Diet Facebook group mentioned that supporting Dr. Bert’s work was a good gesture. That statement really struck me. After your last meal, you're encouraged to fast for 1. You're allowed to drink water or herbal tea during the 1. Although rest is an important part of the program, you're encouraged to enjoy a 2. The 3. 0- day diet plan also offers additional suggestions to help the detox process, such as drinking plenty of water to flush the kidneys, saunas to increase the release of toxins through sweat and jumping rope or deep breathing to get your lymph system going. The plan also works on helping you become more mindful of your hunger, especially when snacking. Junger explains that snacking may be more about feelings than an actual need to eat, and suggests your meals should be enough to keep you satisfied. The 3. 0- day diet plan isn't overly restrictive. In fact, it's filled with a variety of foods from most of the food groups, but it eliminates foods linked to allergies and intolerance such as gluten, wheat, peanuts, soy, eggs and dairy, and those that might cause digestive problems. You can eat fruits and vegetables, beans and lentils and gluten- free grains such as brown rice and quinoa. Wild fish and organic poultry are also allowed, along with nuts, seeds and coconut oil. Stevia can be used as a sweetener, and you can use plant- based protein powders in your morning shakes if you're a vegetarian or if you just need more protein. Other foods not allowed include processed foods, red meat, coffee, soda, sugar, whey protein, corn oil and creamed vegetables. Although weight loss is part of the plan, the makers of the diet provide serving suggestions and encourage you to be mindful of your appetite and hunger, and stop eating when you're 8. Your breakfast shake might include a berry and greens smoothie made up of berries, spinach, coconut milk, coconut oil and protein powder or a mango and cardamom smoothie consisting of fresh mango, coconut water, coconut flakes and cardamom. Her work has been. The plan provides numerous shake recipes in a variety of flavors. Lunch is your largest meal, and the plan offers a number of options such as fish tacos, hummus chicken with brown rice and turkey lettuce wraps. For dinner, you might like carrot and avocado soup with a salad or quinoa tossed with roasted vegetables. Kale chips and roasted chick peas are just a couple of the snack options on the plan. The 3. 0- day detox diet promotes your body's natural ability to detox itself by supporting the organs responsible for detoxing, including your kidneys, liver and digestive system. However, even though it's filled with nutrient- rich foods, it's not the right diet for everyone. The plan isn't recommended for women who are pregnant or nursing, anyone under 1. And since it bans dairy, you'll have to get your calcium from other sources. The leafy greens and beans provide small amounts, but you might want to include calcium- fortified plant- based almond or rice milk in your morning shake. And since you only get one shake a day, talk to your doctor to see if you'll need a calcium supplement too. Also, like any weight- loss plan, you might regain any weight you lost once you go back to your usual eating habits. To minimize regain, incorporate some of things you learned over the 3. Gallstones Diet: Easy Tips to Follow. The gallstones diet is your answer to help prevent gallstones from forming in your gallbladder. To free you from the discomfort associated with getting gallstones, here are a few things you should change in your diet. Increase your Fiber Intake. Instead of eating a fatty meal, substitute it with foods high in fiber. Some sources of fiber include fruits and vegetables. A Healthy Rat Diet (May 2007) by Carole Nelson with permission from Lil Ratscals Rattery (www.lilratscal.com) A proper diet is essential for your rat’s good health. The fancy rat is a domesticated rat (Rattus norvegicus), which is the most common type of pet rat. The name fancy rat derives from the idea of animal fancy (promotion. Home Remedies for Pets Pet Remedy Charts are a step-by-step holistic home healthcare system, which offers natural treatments for dogs, for cats, for horses, for birds. Melissa Kaplan's Herp Care Collection Last updated January 1, 2014. Caring for Corn Snakes. Elaphe guttata ©1994 Melissa Kaplan. Individuals & rescue groups can post animals free." ! A demand-type water bottle to provide clean water at all times. A dish may be used only in emergencies as your pet will immediately spill the water or push shavings. Find photos of Rats for adoption near you. Read profiles of Rats personalities. Give a healthy Rat a home. Why buy a Rat for sale when you can adopt? In the wild, hedgehogs are primarily insectivores, but they will often eat whatever is available. Hedgehogs have been known to eat insects, slugs, baby mice. Keeping Pet Rats: A Short Guide Pet rats, when given the correct care and management, are by far the most intelligent, affectionate, and responsive of. Ferret Extreme Diet Your ferret will love this crunchy, natural diet made with whole animal protein. Loaded with natural. Including fiber in your gallstone diet helps increase the movement of your digestive tract, thus eliminating excess fats and toxins in your body. Although fiber may not eliminate gallstones totally, it can reduce their number and make you feel better. Eat Small Frequent Meals. The diet for gallstones suggests that you eat small but frequent meals. Avoid over- eating, as it can stress your gallbladder. Instead of three full meals, you can distribute your meals into six small portions throughout the day. Avoid eating too much at night. If you ate too much, do not go to sleep right away. The pressure in your stomach can radiate to the nearby liver and gallbladder and cause you more pain. Drink More Fluid. Increase your water intake to help dissolve the stones and flush them out from your body. Ginger. When treating your gallstones, incorporate more ginger in your diet. Ginger aids in the digestion of fats. Add it to your regular recipes. This will help with your gallstones treatment. Foods to Avoid with Gallstones. Fatty foods. Since bile helps your body digest fats, a problem in your gallbladder (like gallstones) can lead to a malfunction in fat digestion. If left untreated, the stress experienced can exacerbate your pain. When you plan your meal, reduce your fat intake. You must also learn to substitute your fatty ingredients with low fat alternatives. Instead of frying, just boil or grill your food to reduce the amount of fats. With less stimulation for bile secretion, you can let your gallbladder rest and reduce the symptoms associated with the disorder. Processed foods. Other gallstones foods to avoid in your diet are processed and preserved foods. The high sodium in them can build- up in your body and worsen your condition. Choose fresh ingredients at all times. Avoid these drinks too. Avoid alcoholic, carbonated and caffeinated beverages. They will only increase the movement of your gallstones and lead to blockage. Final Thoughts. A good complement to any gallstone diet is following through with a cleanse that will help get rid of those painful gallbladder attacks. One resource which combines a good cleansing procedure with a diet is the Gallstone Removal Report. In any case, the gallbladder is an important organ in your body. When you experience pain and other problems with it, start adopting the gallstones diet, treat the problem and free yourself from the symptoms. You may also like. Some types of kidney damage occur through activation of the immune system causing inflammmation. Lupus (SLE) affecting the kidney, vasculitis, and Goodpasture's. In nephrotic syndrome, a variety of disorders cause proteinuria, often resulting in marked edema and hypoalbuminemia. Hyperlipidemia is a common associated finding. How is lupus treated? Learn more here. Lupus symptoms vary from one person to another. In many cases, the best treatment approach is with a health care team that. INTRODUCTION: Exogenous lipoid pneumonia (ELP) is caused by the inhalation of animal fats, vegetable or mineral oil. It is commonly seen in patients at high risk for. Partners MS Center is located at the Brigham and Women's Hospital, Harvard Medical School. We focus on the care of patients with multiple sclerosis and other. A diagnosis of hypermobility is made when a physical exam shows excess range of motion of certain joints. Your doctor will check for other features that suggest your. What are the symptoms of kidney problems associated with Lupus? Is pain associated with the problem? Brentwood, MO The unfortunate problem with Lupus related.Lupus Nephritis: Practice Essentials, Background, Pathophysiology. Yung S, Chan TM. Anti- DNA antibodies in the pathogenesis of lupus nephritis- -the emerging mechanisms. Autoimmun Rev. 7(4): 3. Davidson A, Berthier C, Kretzler M. Pathogenetic mechanisms in lupus nephritis. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus and Related Syndromes. Philadelphia, PA: Elsevier Saunders; 2. Mechanisms of progression of renal damage in lupus nephritis: pathogenesis of renal scarring. Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2. 00. Feb 2. 8. 3. 58(9): 9. Update on human systemic lupus erythematosus genetics. Curr Opin Rheumatol. Nath SK, Kilpatrick J, Harley JB. Genetics of human systemic lupus erythematosus: the emerging picture. Curr Opin Immunol. Wong M, Tsao BP. Current topics in human SLE genetics. Springer Semin Immunopathol. Harley JB, Kelly JA, Kaufman KM. Unraveling the genetics of systemic lupus erythematosus. Springer Semin Immunopathol. Harley JB, Alarc. Genome- wide association scan in women with systemic lupus erythematosus identifies susceptibility variants in ITGAM, PXK, KIAA1. Collaboration, genetic associations, and lupus erythematosus. N Engl J Med. 2. 00. Feb 2. 8. 3. 58(9): 9. Kaiser R, Criswell LA. Genetics research in systemic lupus erythematosus for clinicians: methodology, progress, and controversies. Curr Opin Rheumatol. Mohan C, Adams S, Stanik V, Datta SK. Nucleosome: a major immunogen for pathogenic autoantibody- inducing T cells of lupus. Muller S, Dieker J, Tincani A, Meroni PL. Pathogenic anti- nucleosome antibodies. Interferon pathway activation in systemic lupus erythematosus. Curr Rheumatol Rep. The type I interferon system in systemic lupus erythematosus. Arthritis Rheum. 5. The innate immune system in SLE: type I interferons and dendritic cells. Arbuckle MR, Mc. Clain MT, Rubertone MV, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med. 2. 00. Oct 1. 6. 3. 49(1. Hanly JG, O'Keeffe AG, Su L, Urowitz MB, Romero- Diaz J, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford). Galindo- Izquierdo M, Rodriguez- Almaraz E, Pego- Reigosa JM, et al. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine (Baltimore). Lim SS, Drenkard C. The Epidemiology of Lupus. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus and Related Syndromes. Philadelphia, PA: Elsevier Saunders; 2. Lupus nephritis in children. Brunner HI, Gladman DD, Iba. Difference in disease features between childhood- onset and adult- onset systemic lupus erythematosus. Arthritis Rheum. 5. Bogdanovic R, Nikolic V, Pasic S, Dimitrijevic J, Lipkovska- Markovic J, Eric- Marinkovic J. Lupus nephritis in childhood: a review of 5. Pediatr Nephrol. 1. Clinical and epidemiologic features of lupus nephritis. Wallace DJ, Hahn BH, eds. Dubois' Lupus Erythematosus and Related Syndromes. Philadelphia, PA: Elsevier Saunders; 2. Faurschou M, Mellemkjaer L, Starklint H, et al. High risk of ischemic heart disease in patients with lupus nephritis. J Rheumatol. 3. 8(1. Rianthavorn P, Buddhasri A. Long- term renal outcomes of childhood- onset global and segmental diffuse proliferative lupus nephritis. Pediatr Nephrol. 3. Pisetsky DS, Gilkeson G, St. Systemic lupus erythematosus. Diagnosis and treatment. Med Clin North Am. Grande JP, Balow JE. Renal biopsy in lupus nephritis. Smith EM, Jorgensen AL, Midgley A, Oni L, Goilav B, Putterman C, et al. International validation of a urinary biomarker panel for identification of active lupus nephritis in children. Pediatr Nephrol. Anti- nucleosome antibodies in patients with systemic lupus erythematosus of recent onset. Potential utility as a diagnostic tool and disease activity marker. Rheumatology (Oxford). Su Y, Jia RL, Han L, Li ZG. Role of anti- nucleosome antibody in the diagnosis of systemic lupus erythematosus. Clin Immunol. 1. 22(1): 1. Bigler C, Lopez- Trascasa M, Potlukova E, Moll S, Danner D, Schaller M, et al. Antinucleosome antibodies as a marker of active proliferative lupus nephritis. Am J Kidney Dis. 5. Marto N, Bertolaccini ML, Calabuig E, Hughes GR, Khamashta MA. Anti- C1q antibodies in nephritis: correlation between titres and renal disease activity and positive predictive value in systemic lupus erythematosus. Ann Rheum Dis. 6. Sinico RA, Radice A, Ikehata M, Giammarresi G, Corace C, Arrigo G, et al. Anti- C1q autoantibodies in lupus nephritis: prevalence and clinical significance. Ann N Y Acad Sci. Sinico RA, Rimoldi L, Radice A, Bianchi L, Gallelli B, Moroni G. Anti- C1q autoantibodies in lupus nephritis. Ann N Y Acad Sci. Mok CC, Ho LY, Leung HW, Wong LG. Performance of anti- C1q, antinucleosome, and anti- ds. DNA antibodies for detecting concurrent disease activity of systemic lupus erythematosus. Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol. Houssiau FA, Ginzler EM. Current treatment of lupus nephritis. Dooley MA, Falk RJ. Immunosuppressive therapy of lupus nephritis. Dooley MA, Ginzler EM. Newer therapeutic approaches for systemic lupus erythematosus: immunosuppressive agents. Rheum Dis Clin North Am. Kronbichler A, Neumann I, Mayer G. Moderator's view: the use of calcineurin inhibitors in the treatment of lupus nephritis. Nephrol Dial Transplant. Mok CC, Jayne D. Pro: The use of calcineurin inhibitors in the treatment of lupus nephritis. Nephrol Dial Transplant. Fernandez Nieto M, Jayne DR, Mok CC. Con: The use of calcineurin inhibitors in the treatment of lupus nephritis. Nephrol Dial Transplant. The Hopkins Lupus Pregnancy Center: ten key issues in management. Rheum Dis Clin North Am. Moroni G, Doria A, Giglio E, Tani C, Zen M, Strigini F, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 2. A prospective multicenter study. J Autoimmun. American college of rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken). A long- term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group. Joint European League Against Rheumatism and European Renal Association- European Dialysis and Transplant Association (EULAR/ERA- EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 7. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong- Guangzhou Nephrology Study Group. N Engl J Med. 2. 00. Oct 1. 9. 3. 43(1. Ginzler EM, Dooley MA, Aranow C, Kim MY, Buyon J, Merrill JT. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med. 2. 00. Nov 2. 4. 3. 53(2. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med. 3. 50(1. Appel GB, Contreras G, Dooley MA, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med. 1. Ciruelo E, de la Cruz J, Lopez I, Gomez- Reino JJ. Cumulative rate of relapse of lupus nephritis after successful treatment with cyclophosphamide. Arthritis Rheum. 3. Somers EC, Marder W, Christman GM, Ognenovski V, Mc. Cune WJ. Use of a gonadotropin- releasing hormone analog for protection against premature ovarian failure during cyclophosphamide therapy in women with severe lupus. Arthritis Rheum. 5. Dooley MA, Jayne D, Ginzler EM, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med. 2. 01. Nov 1. 7. 3. 65(2. Tamirou F, D'Cruz D, Sangle S, Remy P, Vasconcelos C, Fiehn C, et al. Long- term follow- up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis. Ann Rheum Dis. 2. Mar 1. 0. Mok CC, Ying KY, Yim CW, Ng WL, Wong WS. Very long- term outcome of pure lupus membranous nephropathy treated with glucocorticoid and azathioprine. Silverman GJ. Anti- CD2. Arthritis Rheum. 5. Looney RJ, Anolik JH, Campbell D, Felgar RE, Young F, Arend LJ. B cell depletion as a novel treatment for systemic lupus erythematosus: a phase I/II dose- escalation trial of rituximab. Arthritis Rheum. 5. Leandro MJ, Cambridge G, Edwards JC, Ehrenstein MR, Isenberg DA. B- cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 2. Rheumatology (Oxford). Ng KP, Leandro MJ, Edwards JC, Ehrenstein MR, Cambridge G, Isenberg DA. Repeated B cell depletion in treatment of refractory systemic lupus erythematosus. Ann Rheum Dis. 6. Merrill JT, Neuwelt CM, Wallace DJ, et al. Efficacy and safety of rituximab in moderately- to- severely active systemic lupus erythematosus: the randomized, double- blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 6. Looney RJ, Anolik J, Sanz I. New therapies for systemic lupus erythematosus: cellular targets. Rheum Dis Clin North Am. Abetimus sodium (riquent) for the prevention of nephritic flares in patients with systemic lupus erythematosus. Rheum Dis Clin North Am. Kirou KA, Salmon JE, Crow MK. Soluble mediators as therapeutic targets in systemic lupus erythematosus: cytokines, immunoglobulin receptors, and the complement system. Rheum Dis Clin North Am. Haarhaus ML, Svenungsson E, Gunnarsson I. Ofatumumab treatment in lupus nephritis patients. Clin Kidney J. 9 (4): 5. Wallace DJ, Stohl W, Furie RA, et al. A phase II, randomized, double- blind, placebo- controlled, dose- ranging study of belimumab in patients with active systemic lupus erythematosus. Arthritis Rheum. 2. Sep 1. 5. 6. 1(9): 1. Care of the Lupus Patient. Lupus symptoms tend to present themselves according to the body system affected. These symptoms vary over time in intensity and duration for each patient as well as from patient to patient. To effectively care for a lupus patient, the nurse or other health professional needs an up- to- date knowledge and understanding of the disease, its many manifestations, and its changing and often unpredictable course. This article provides an overview of general and system- specific lupus manifestations and identifies potential problems. Suggested health care interventions for the nonhospitalized lupus patient are given. Many of these interventions can be modified for the hospitalized patient. The information and nursing interventions described in this article are not meant to be inclusive, but to provide the practitioner with guidelines for developing a care plan specific to the needs of each lupus patient. As a care plan is developed, the health professional should keep in mind the importance of frequently reassessing the patient's status over time and adjusting treatment to accommodate the variability of SLE manifestations. An additional and very important element of working with the lupus patient is to incorporate the patient's needs and routines in the plan of care. Adjusting nursing interventions and medical protocols to the patient's needs not only recognizes the value of the patient as an authority on her or his own illness but also can improve patient compliance and result in an improved quality of life. Working together, the care provider and the patient have much to offer each other. The rewards are tremendous for the patient and family as independence is gained and the trust in the ability to care for oneself is strengthened. Continued. Systemic Lupus Erythematosus. General Manifestations. Fatigue, fever, psychological and emotional effects. Specific Manifestations. Dermatologic: Butterfly rash, photosensitivity, DLE, subcutaneous LE, mucosal ulcers, alopecia, pain and discomfort, pruritus, bruising. Musculoskeletal: Arthralgias, arthritis, other joint complications. Hematologic: Anemia, decreased WBC count, thrombocytopenia, lupus anticoagulants, false- positive VDRL, elevated ESR. Cardiopulmonary: Pericarditis, myocarditis, myocardial infarction, vasculitis, pleurisy, valvular heart disease. Renal: Asymptomatic microscopic renal involvement, renal failure, fluid and electrolyte imbalance, urinary tract infection. Central Nervous System (CNS): General CNS symptomology, cranial neuropathies, cognitive impairment, mental changes, seizures. Gastrointestinal: Anorexia, ascites, pancreatitis, mesenteric or intestinal vasculitis. Ophthalmologic: Eyelid problems, conjunctivitis, cytoid bodies, dry eyes, glaucoma, cataracts, retinal pigmentation. Other Key Issues. Pregnancy: Lupus flare, miscarriage or stillbirth, pregnancy- induced hypertension, neonatal lupus. Infection: Increased risk of respiratory tract, urinary tract, and skin infections; opportunistic infections. Nutrition: Weight changes; poor diet; appetite loss; problems with taking medications; increased risk of cardiovascular disease, diabetes, osteoporosis, and kidney disease. Systems Potentially Affected by Lupus. General Manifestations of SLEOverview. Fatigue is a nearly universal complaint of patients with SLE even when no other manifestations of the disease are present. The cause of this debilitating fatigue is not known. The patient should be evaluated for factors that may exacerbate fatigue, such as overexertion, insomnia, depression, stress, anemia, and other inflammatory diseases. Fatigue in SLE patients may be lessened by adequate rest, healthful diet, exercise, and attention to psychosocial factors. Many patients with SLE experience changes in weight. At least one- half of patients report weight loss before being diagnosed with SLE. Weight loss in SLE patients may be attributed to a decreased appetite, side effects of medications, gastrointestinal problems, or fever. Weight gain can occur in some patients and may be due in part to prescribed medications, especially corticosteroids, or fluid retention from kidney disease. Episodic fever is experienced by more than 8. SLE patients, and there is no particular fever pattern. Although high fevers can occur during a lupus flare, low- grade fevers are more frequently seen. A complicating infection is often the cause of an elevated temperature in a patient with SLE. The patient's WBC count may be normal to elevated with an infection, but low with SLE alone. However, certain medications, such as immunosuppressives, will suppress the WBC even in the presence of fever. Therefore, it is important to rule out other causes of a fever, including an infection or a drug reaction. Urinary and respiratory infections are common in SLE patients. Continued. Psychological and emotional effects, such as grief, depression, and anger, are commonly experienced by lupus patients. These can be related to the outward changes, such as skin alterations, caused by the disease as well as by other aspects of the disease and its treatment. It is important for health professionals to be alert to potential psychological repercussions and to assist in alleviating them. Potential Problems. Inability to complete activities of daily living (ADL) because of fatigue, weakness, and psychological difficulties. Changes in weight. Fever. Nursing Interventions. Objective: Minimize Fatigue. Assess patient's general fatigue level. Assess for the presence of depression, anxiety, and other stressors. Conduct assessment to determine patient's daily activities that contribute to fatigue. Help patient to develop an energy- conserving plan for completing daily and other activities and work. Suggest planning for rest periods as needed throughout the day to conserve energy. Encourage patient to get 8- 1. Encourage exercise as tolerated. Objective: Maintain Weight at Optimal Range. Assess patient's prescription and non- prescription drug regimen and dosages. Assess the patient's usual daily dietary intake by asking her or him to keep a food diary. Develop a dietary plan with the patient that encourages healthful eating. If the patient has nutrition- related lupus complications, refer her or him to a registered dietitian for specialized counseling. Encourage exercise as tolerated. Record patient's weight at each visit. Instruct patient to weigh herself or himself at home once a week and record it. Potential Physiological Manifestations. Fatigue. Weight gain or loss. Fever - - increased temperature over normal baseline. Elevated WBCPotential Psychological Manifestations. Lowered self- esteem. Negative feelings about body. Decreased confidence. Feelings of decreased self- worth. Depression. Feelings of sadness, hopelessness, helplessness. Difficulty in completing self- care activities, caring for children, maintaining a household, and other activities of daily living (ADL)Inability to maintain full- or part- time employment. Decreased social activities. Lack of energy or ambition. Irritability. Impaired concentration. Crying. Insomnia. Suicidal thoughts. Objective: Teach Patient to Recognize Fever and Signs and Symptoms of Infection. Assess patient's prescription and non- prescription drug regimen and dosages. Monitor patient's WBC count. Teach patient to monitor temperature during a lupus flare. Teach patient to look for signs and symptoms of infection, particularly urinary and respiratory infections. The classic sign of SLE is the . This rash ranges from a faint blush to a severe eruption with scaling. It is photosensitive, and it may be transitory or fixed. Between 5. 5 and 8. Other rashes may occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands. DLE is seen in 1. SLE. Subacute cutaneous LE, seen in about 1. SLE patients, produces highly photosensitive papules that itch and burn. Skin changes, especially the butterfly rash and subacute cutaneous LE, can be precipitated by sunlight. Some patients may develop mouth, vaginal, or nasal ulcers. Hair loss (alopecia) occurs in about one- half of SLE patients. Most hair loss is diffuse, but it may be patchy. It can be scarring or nonscarring. Alopecia may also be caused by corticosteroids, infection, or immunosuppressive drugs. Raynaud's phenomenon (paroxysmal vasospasm of the fingers and toes) frequently occurs in patients with SLE. For most patients, Raynaud's phenomenon is mild. However, some SLE patients with severe Raynaud's phenomenon may develop painful skin ulcers or gangrene on the fingers or toes. Continued. Varying levels of pain and discomfort due to skin alterations may occur. Pruritus accompanies many types of skin lesions. Attacks of Raynaud's phenomenon can cause a deep tingling feeling in the hands and feet that can be very uncomfortable. Both pain and itching may affect a patient's ability to carry out activities of daily living (ADL). Skin alterations in the lupus patient, particularly those of DLE, can be disfiguring. As a result, patients may experience fear of rejection by others, negative feelings about their body, and depression. Changes in lifestyle and social involvement may occur. Potential Problems. Alteration in skin integrity. Alopecia. Discomfort (pain, itching)Alteration in body image. Depression. Nursing Interventions. Objective: Minimize Appearance of Lesions. Document appearance and duration of lesions and rashes. Teach patient to minimize direct exposure to UV rays from sun and from fluorescent and halogen light bulbs. Patients who are allergic to PABA will need to find a PABA- free sunscreen. Provide information on hypoallergenic concealing makeup. Instruct patient to avoid topical applications, such as hair dyes and skin creams, and the use of certain drugs that may make her or him more sensitive to the sun. Objective: Alleviate Discomfort. For patients with mouth lesions, suggest a soft- food diet, lip balms, and warm saline rinses. Instruct patient to take medications that may help to alleviate discomfort and itching as ordered. DASH diet: Healthy eating to lower your blood pressure. DASH diet: Healthy eating to lower your blood pressure. The DASH diet emphasizes portion size, eating a variety of foods and getting the right amount of nutrients. Discover how DASH can improve your health and lower your blood pressure. By Mayo Clinic Staff. DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is a lifelong approach to healthy eating that's designed to help treat or prevent high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium. By following the DASH diet, you may be able to reduce your blood pressure by a few points in just two weeks. Over time, your systolic blood pressure could drop by eight to 1. Because the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes. Everyone talks about DASH Diet, but what exactly is it? Today there are a plethora of diets to choose from that claim to lower blood pressure. But with so many. DASH diet: Sodium levels. The DASH diet emphasizes vegetables, fruits and low- fat dairy foods — and moderate amounts of whole grains, fish, poultry and nuts. In addition to the standard DASH diet, there is also a lower sodium version of the diet. You can choose the version of the diet that meets your health needs: Standard DASH diet. You can consume up to 2,3. Lower sodium DASH diet. You can consume up to 1,5. Both versions of the DASH diet aim to reduce the amount of sodium in your diet compared with what you might get in a typical American diet, which can amount to a whopping 3,4. The standard DASH diet meets the recommendation from the Dietary Guidelines for Americans to keep daily sodium intake to less than 2,3. The American Heart Association recommends 1,5. If you aren't sure what sodium level is right for you, talk to your doctor. DASH diet: What to eat. Both versions of the DASH diet include lots of whole grains, fruits, vegetables and low- fat dairy products. The DASH diet also includes some fish, poultry and legumes, and encourages a small amount of nuts and seeds a few times a week. You can eat red meat, sweets and fats in small amounts. The DASH diet is low in saturated fat, cholesterol and total fat. Here's a look at the recommended servings from each food group for the 2,0. DASH diet. Grains: 6 to 8 servings a day. Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1 slice whole- wheat bread, 1 ounce dry cereal, or 1/2 cup cooked cereal, rice or pasta. Focus on whole grains because they have more fiber and nutrients than do refined grains. For instance, use brown rice instead of white rice, whole- wheat pasta instead of regular pasta and whole- grain bread instead of white bread. Look for products labeled . The DASH diet isn't only about a reduction in salt intake, but also a therapeutic eating approach in the management of blood cholesterol, blood pressure, insulin. Many health problems improve with healthy eating. Doctors recommend the DASH diet eating plan to lose weight and prevent hypertension. Find out more. How to Lose Weight With the DASH Diet. The DASH diet, the Dietary Approaches to Stop Hypertension diet, is mainly used to lower blood pressure and cholesterol, but it. Keep them this way by avoiding butter, cream and cheese sauces. Vegetables: 4 to 5 servings a day. Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fiber, vitamins, and such minerals as potassium and magnesium. Examples of one serving include 1 cup raw leafy green vegetables or 1/2 cup cut- up raw or cooked vegetables. Don't think of vegetables only as side dishes — a hearty blend of vegetables served over brown rice or whole- wheat noodles can serve as the main dish for a meal. Fresh and frozen vegetables are both good choices. When buying frozen and canned vegetables, choose those labeled as low sodium or without added salt. To increase the number of servings you fit in daily, be creative. In a stir- fry, for instance, cut the amount of meat in half and double up on the vegetables. Fruits: 4 to 5 servings a day. Many fruits need little preparation to become a healthy part of a meal or snack. Like vegetables, they're packed with fiber, potassium and magnesium and are typically low in fat — coconuts are an exception. Examples of one serving include one medium fruit, 1/2 cup fresh, frozen or canned fruit, or 4 ounces of juice. Have a piece of fruit with meals and one as a snack, then round out your day with a dessert of fresh fruits topped with a dollop of low- fat yogurt. Leave on edible peels whenever possible. The peels of apples, pears and most fruits with pits add interesting texture to recipes and contain healthy nutrients and fiber. Remember that citrus fruits and juices, such as grapefruit, can interact with certain medications, so check with your doctor or pharmacist to see if they're OK for you. If you choose canned fruit or juice, make sure no sugar is added. Dairy: 2 to 3 servings a day. Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and protein. But the key is to make sure that you choose dairy products that are low fat or fat- free because otherwise they can be a major source of fat — and most of it is saturated. DASH Diet - DASH for Health is a healthy diet plan created to help you lose weight and get a healthy heart using the DASH Diet program.Examples of one serving include 1 cup skim or 1 percent milk, 1 cup low fat yogurt, or 1 1/2 ounces part- skim cheese. Low- fat or fat- free frozen yogurt can help you boost the amount of dairy products you eat while offering a sweet treat. Add fruit for a healthy twist. If you have trouble digesting dairy products, choose lactose- free products or consider taking an over- the- counter product that contains the enzyme lactase, which can reduce or prevent the symptoms of lactose intolerance. Go easy on regular and even fat- free cheeses because they are typically high in sodium. Lean meat, poultry and fish: 6 servings or fewer a day. Meat can be a rich source of protein, B vitamins, iron and zinc. Choose lean varieties and aim for no more than 6 ounces a day. Cutting back on your meat portion will allow room for more vegetables. Trim away skin and fat from poultry and meat and then bake, broil, grill or roast instead of frying in fat. Eat heart- healthy fish, such as salmon, herring and tuna. These types of fish are high in omega- 3 fatty acids, which can help lower your total cholesterol. Nuts, seeds and legumes: 4 to 5 servings a week. Almonds, sunflower seeds, kidney beans, peas, lentils and other foods in this family are good sources of magnesium, potassium and protein. They're also full of fiber and phytochemicals, which are plant compounds that may protect against some cancers and cardiovascular disease. Serving sizes are small and are intended to be consumed only a few times a week because these foods are high in calories. Examples of one serving include 1/3 cup nuts, 2 tablespoons seeds, or 1/2 cup cooked beans or peas. They're high in calories, however, so eat them in moderation. Try adding them to stir- fries, salads or cereals. Soybean- based products, such as tofu and tempeh, can be a good alternative to meat because they contain all of the amino acids your body needs to make a complete protein, just like meat. Fats and oils: 2 to 3 servings a day. Fat helps your body absorb essential vitamins and helps your body's immune system. But too much fat increases your risk of heart disease, diabetes and obesity. The DASH diet strives for a healthy balance by limiting total fat to less than 3. Examples of one serving include 1 teaspoon soft margarine, 1 tablespoon mayonnaise or 2 tablespoons salad dressing. Saturated fat and trans fat are the main dietary culprits in increasing your risk of coronary artery disease. DASH helps keep your daily saturated fat to less than 6 percent of your total calories by limiting use of meat, butter, cheese, whole milk, cream and eggs in your diet, along with foods made from lard, solid shortenings, and palm and coconut oils. Avoid trans fat, commonly found in such processed foods as crackers, baked goods and fried items. Read food labels on margarine and salad dressing so that you can choose those that are lowest in saturated fat and free of trans fat. Sweets: 5 servings or fewer a week. You don't have to banish sweets entirely while following the DASH diet — just go easy on them. Examples of one serving include 1 tablespoon sugar, jelly or jam, 1/2 cup sorbet, or 1 cup lemonade. When you eat sweets, choose those that are fat- free or low- fat, such as sorbets, fruit ices, jelly beans, hard candy, graham crackers or low- fat cookies. Artificial sweeteners such as aspartame (Nutra. Sweet, Equal) and sucralose (Splenda) may help satisfy your sweet tooth while sparing the sugar. But remember that you still must use them sensibly. It's OK to swap a diet cola for a regular cola, but not in place of a more nutritious beverage such as low- fat milk or even plain water. Cut back on added sugar, which has no nutritional value but can pack on calories. DASH diet: Alcohol and caffeine. Drinking too much alcohol can increase blood pressure. The Dietary Guidelines for Americans recommends that men limit alcohol to no more than two drinks a day and women to one or less. The DASH diet doesn't address caffeine consumption. The influence of caffeine on blood pressure remains unclear. But caffeine can cause your blood pressure to rise at least temporarily. If you already have high blood pressure or if you think caffeine is affecting your blood pressure, talk to your doctor about your caffeine consumption. April 0. 8, 2. 01. In brief: Your guide to lowering your blood pressure with DASH. National Heart, Lung, and Blood Institute. Accessed March 7, 2. Hypertension. First consult. Accessed March 7, 2. Sheps SG, ed. Mayo Clinic: 5 Steps to Controlling High Blood Pressure. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2. Zeratsky KA (expert opinion). Mayo Clinic, Rochester, Minn. March 1. 1, 2. 01. Kwan M W- M, et al. Compliance with the Dietary Approaches to Stop Hypertension (DASH) diet: A systematic review. Executive summary: Dietary Guidelines for Americans, 2. Department of Health and Human Services. Accessed March 7, 2. Sodium and food sources. Centers for Disease Control and Prevention. Accessed March 7, 2. Top 1. 0 sources of sodium. Centers for Disease Control and Prevention. Accessed March 7, 2. An error occurred while setting your user cookie. Please set your. browser to accept cookies to continue. This cookie stores just a. ID; no other information is captured. Accepting the NEJM cookie is.
Why should I sign up for WebMD? With a WebMD Account you can: Track your way to weight loss success; Manage your family's vaccinations; Join the conversation. The Diamond Level of membership represents the ideal EzineArticles Expert Author and is the highest level of authorship that can be obtained on EzineArticles. Syrai, This salad diet is a similar approach that Lyle McDonald takes in his book The Rapid Fat Loss Handbook. This is probably the best book I’ve ever read on. The Recent Evolutionary Introduction of Milk and Dairy. One of the rewarding benefits of having written a diet book that has become internationally known is the. Cheap cheap fish! The above is an ad (from one of the large supermarket chains in France) for the fish known as Pangas (also called, Pangasius, Vietnamese River. The Whole Soy Story. In The Whole Soy Story, you'll find: The real reasons why soy is NOT a health food. Shocking personal accounts of real people whose health. Lena Dunham Reveals Huge New Tattoos After Latest Health Scare, Saying It Gives Her a Sense of 'Control'. Tiger Fitness Bodybuilding & Workout Supplements, Whey Protein Powder. Treat others as you would like to be treated. Inspire others to reach their goals. Loren Cordain does the maca root share all the same anti-nutritional properties of other brassicas and can you consume maca powder on a Paleo diet? ECA Xtreme Ephedra by Hi-Tech is a highly effective diet pill to promote weight-loss & supress your appetite. Buy ECA Extreme Ephedra for $29.99 & read reviews online. I’m not saying all cancer is fostered by a poor diet, but certainly a ton of it is. Not to necessarily disagree, but could you please say. Buy Weight Loss Diet Pills, Body Detox Products, Prohormones & Bodybuilding Supplements at SuperHealthCenter.com. Buy Diet Pills with Ephedra, Best Indoor Tanning Lotions & Prohormones on Sale Online at i-Supplements. Learn about weight loss with diet pills with ephedra and build. Go above and beyond. Educate yourself by always seeking knowledge. Reach beyond your grasp and always think big. Stay focused and always take pride in everything you do. Anabolic Steroids - Steroid. Forums. 46. 34. 3 Spammers Denied Registration. Spammers Permanently Banned. Spammers submitted to Stop. Forum. Spam. 30. 5 Spammers submitted to Akismet. Spammy Posts Automatically Moderated. Song of Myself. Won't you help support Day. Poems? 1. 81. 9- 1. I celebrate myself, and sing myself. And what I assume you shall assume. For every atom belonging to me as good belongs to you. I do not know what it is any more than he. I do not laugh at your oaths nor jeer you; ). The President holding a cabinet council is surrounded by the great. Bray Terminal Macros Diet PlannerOn the piazza walk three matrons stately and friendly with twined arms. The crew of the fish- smack pack repeated layers of halibut in the hold. The Missourian crosses the plains toting his wares and his cattle. As the fare- collector goes through the train he gives notice by the. The floor- men are laying the floor, the tinners are tinning the. In single file each shouldering his hod pass onward the laborers. Seasons pursuing each other the indescribable crowd is gather'd, it. Seventh- month, (what salutes of cannon and small arms!). Seasons pursuing each other the plougher ploughs, the mower mows. Off on the lakes the pike- fisher watches and waits by the hole in. The stumps stand thick round the clearing, the squatter strikes deep. Flatboatmen make fast towards dusk near the cotton- wood or pecan- trees. Coon- seekers go through the regions of the Red river or through. Tennessee, or through those of the Arkansas. Torches shine in the dark that hangs on the Chattahooche or Altamahaw. Patriarchs sit at supper with sons and grandsons and great- grandsons. In walls of adobie, in canvas tents, rest hunters and trappers after. The city sleeps and the country sleeps. The living sleep for their time, the dead sleep for their time. The old husband sleeps by his wife and the young husband sleeps by his wife. And these tend inward to me, and I tend outward to them. And such as it is to be of these more or less I am. And of these one and all I weave the song of myself. I resign myself to you also- -I guess what you mean. I behold from the beach your crooked fingers. I believe you refuse to go back without feeling of me. We must have a turn together, I undress, hurry me out of sight of the land. Cushion me soft, rock me in billowy drowse. Dash me with amorous wet, I can repay you. I will accept nothing which all cannot have their. I am possess'd! Iowa, Oregon, California? O welcome, ineffable grace of dying days!
I plead for my brothers and sisters. Comment on Day. Poems? If you are like us, you have strong feelings about poetry, and about each poem you read. Let it all out! Comment on this poem, any poem, Day. Poems, other poetry places or the art of poetry at Day. Poems Feedback. Won't you help support Day. Poems? Click here to learn more about how you can keep Day. Poems on the Web . All rights reserved. The authors of poetry and other material appearing on Day. Poems retain full rights to their work. Bray Terminal Macros Diet ResultsCurrent File (2) 2014/10/28 2014/11/12 John Wiley & Sons Information Technology & Software Development Adobe Creative Team. Adobe Press Digital Media. To link to this poem, put the URL below into your page: <a href="http:// of Myself by Walt Whitman</a> Plain for. Any requests for publication in other venues must be negotiated separately with the authors. The editor of Day. Poems will gladly assist in putting interested parties in contact with the authors. Deidre Hall - IMDb. Deidre Hall has emerged as one of America's most beloved actresses, who delighted her fans in August 1. NBC- TV's number one daytime program, Zeit der Sehnsucht (1. Hall created the role of . In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years. Lydia Dziubanek Lost 80 Pounds: Demi Lovato Height Weight Body Statistics / Measurements. Demi Lovato Height -161 cm, Weight -58 kg, Measurements -34-27-36, Bra Size -32B, Favorite Things. Evans Fitness Club in Augusta GA offers personal training, workout equipment and cardio classes to help you get into shape! Contact EFC in Evans GA today! Cindy was raised in a strict religious environment. Her family, boyfriend, and most of her social circle were all devout Christian fundamentalists. Katie Couric first broke the news on " Katie" Friday. Get the scoop on your favorite Black celebrities, including celeb couple news, celebrity moms and photos of stars spotted out and about. Tony and Cynthia Brazelton Ministries (TCBM) is the world-wide outreach of ministry of Victory Christian Ministries International (VCMI). The vision God has placed in. The Texarkana Gazette is the premier source for local news and sports in Texarkana and the surrounding Arklatex areas. Download - Update. Star - Update. Star. Download the. free trial version below to get started. Double- click the downloaded file. Update. Star is compatible with Windows platforms. Update. Star has been tested to meet all of the technical requirements to be compatible with. Windows 1. 0, 8. 1, Windows 8, Windows 7, Windows Vista, Windows Server 2. Windows. XP, 3. 2 bit and 6. Simply double- click the downloaded file to install it. Your body is capable of generating electricity, and this ability is actually a key part of your achieving health. Electricity allows your nervous.Update. Star Free and Update. Star Premium come with the same installer. Update. Star includes support for many languages such as English, German, French, Italian, Hungarian, Russian and many more. You can choose your language settings from within the program. Agreed States residents tepid $469.5 million on online dating and personals in 2004, and during $500 million in 2005, the largest arm of Create custom t-shirts and personalized shirts at CafePress. Use our easy online designer to add your artwork, photos, or text. Design your own t- shirt today! UpdateStar is compatible with Windows platforms. UpdateStar has been tested to meet all of the technical requirements to be compatible with Windows 10, 8.1, Windows 8. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
September 2017
Categories |