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By: S. Aschnu, M.A., Ph.D.

Medical Instructor, Midwestern University Arizona College of Osteopathic Medicine

Mothers who register their newborns within 60 days from the birth (births inside the territory of the Republic of Albania) or within 90 days (births from Albanian citizens outside Albania) receive a monetary reward prostate cancer organizations buy casodex once a day. When a baby is born prostate zinc supplement order casodex 50 mg online, the two recognized options for registering the sex ­ traditionally and mostly recognized by the medical staff ­ are "male" and "female" prostate cancer 3rd stage buy casodex toronto. So, based on the will and desire of the parents, the registration of the sex of an intersex baby is still based on the two recognized options. In some specific cases, the term "hermaphrodite" is also used, but this denies the further registration of the birth in the civil status office, since there are only the two recognized options for sex in the electronic register of 77 ec. In practice, having the sex of a baby registered as hermaphrodite means that the birth will not be registered at all. After the birth, parents and the baby are referred to the primary health care paediatric department called "Konsultore". According to available information, the numbers vary every year; for example, nine intersex babies were born in 2013, two in 2014 and five in 2015. I got very irritated and I remember it was very difficult to explain to them that the baby was not abnormal; that the child was healthy and everything would be resolved in the future - Gynaecologist in Tirana, Albania 82 In Albania, a medical multidisciplinary team working with intersex babies and children does not exist. Few specialists participate in the process of medical treatment and verbally agree on which tests and analysis to conduct. He also commented that when parents bring their intersex baby or child to him at an early age, he can help them by performing the surgery. But in some cases, the parents bring their intersex child to the hospital at an advanced age, when he cannot treat them successfully. In his opinion, early consultation with a doctor is considered important for two reasons: to identify the sex of the child as soon as possible and thus lower the possibility of confusion during the gender development of the child and to avoid any health complications. The doctor also stated that in the last few years there are just a few surgeries performed on intersex babies. In Albania, hypospadias (a congenital disorder of the urethra where the urinary opening is not at the usual location on the head of the penis) is not considered as an intersex condition. The hospital keeps a registry with information and number of babies born with hypospadias. Information that the baby is born intersex (hermaphrodite) is included in the hospital discharge paper. The plan (which according to Albanian law is now legislation to be enforced) will focus on three main interventions: 1. The medical staff that assisted the birth of the child reported the sex as "male" based on their understanding. After the intervention, the child was defined as female and prescribed to continuously take medication. The case will be decided in court, with a request to change the sex marker in the birth certificate from "male" to " female". Law on Civil Status"), but no reference was found in relation to intersex individuals. The parents kept his variations of sex characteristics as a secret and they did not register the child. Since the child was unregistered, he could not attend school and could not access health care. Albanian law does not provide any possibility to be registered other than as "male" or " female". The medical professionals performed several tests, one of them was karyotype, 89 after which a doctor concluded that the child is female. Based on the medical report, the child was registered as a " female" (the child was not involved in the decision-making; he was not asked about his/her identity). The parents want to change the sex marker in the birth certificate from " female" to "male", because the child has been raised as a boy and behaves like a boy. The medical team is not multidisciplinary and they do not follow internal written protocols. In Albania, there are no provisions that specifically address the human rights of intersex people. In anti-discrimination law, sex characteristics are not listed possible grounds of discrimination.

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Many patients seeking treatment of alcohol dependence manifest cognitive abnormalities (1148­1150) mens health 2 minute drill purchase casodex line. Chronic prostate cancer nclex questions best order casodex, heavy drinkers can experience an alcoholic dementia with characteristic cognitive deficits that include impairment in short- and long-term memory mens health 4 week six pack purchase casodex 50mg amex, abstract thinking, judgment, and other higher cortical functions as well as personality change. Neuropathological abnormalities in the frontal lobes, in the area surrounding the third ventricle or diffusely through the cortex, have been reported. For such patients, family members or other responsible parties should be actively involved from the beginning of and throughout the course of treatment. In patients who remain abstinent, reversal of alcohol-induced cognitive disturbance is often observed over time (1154, 1155). Peripheral neuropathy is common, occurring in up to 33% of hospitalized individuals with an alcohol use disorder, with an even greater proportion of alcohol users showing electrophysiological evidence of peripheral nerve damage (1157). Symptoms of alcoholic neuropathy typically include sensory loss, paresthesias, a burning sensation of the feet, numbness, cramps, weakness, calf pain, and ataxia. Ataxia in alcohol-dependent patients can also occur due to cerebellar dysfunction. Ocular abnormalities include nystagmus, eye muscle palsies, and pupillary abnormalities. Lesions in the mammillary bodies and thalamic nuclei may be the result of vitamin deficiencies or the direct toxic effects of alcohol. These neurological complications should be treated vigorously with B complex vitamins. Some patients may require treatment with B complex vitamins over a prolonged period, and improvements may continue to occur up to 1 year after treatment is begun (1161). Alcoholic hallucinosis during or after cessation of prolonged alcohol use may respond to antipsychotic medication. Unlike the visual hallucinations that may occur during alcohol withdrawal, these are primarily auditory and occur in conjunction with a clear sensorium (1162). Alcoholrelated disorders may have specific adverse effects on the health of the pregnant woman, the course of the pregnancy, fetal and early child development, and parenting behavior. Some children with this disorder will exhibit the characteristic features of fetal alcohol syndrome, including low birth weight, poor coordination, hypotonia, neonatal irritability, retarded growth and development, craniofacial abnormalities (including microcephaly), cardiovascular defects, mild to moderate retardation, childhood hyperactivity, and impaired school performance (586, 972, 1165, 1166). Others will not have the classically described features of fetal alcohol syndrome but will exhibit cognitive and behavioral effects of in utero alcohol exposure (587, 1163, 1164). Thus, the goals in treating pregnant women with an alcohol use disorder include eliminating the use of alcohol, treating any comorbid psychiatric or general medical disorders, guiding the patient safely through the pregnancy, facilitating appropriate parenting behavior, and motivating the patient to remain in treatment after delivery to minimize the risk of relapse. Furthermore, although the overall prevalence of marijuana use has remained stable over the past decade, the initial age at onset of marijuana use has been declining (1169) and the prevalence of marijuana abuse or dependence has increased significantly, perhaps due to an increased potency of available marijuana (1170). Marijuana use is often considered benign, but it has been associated with a number of psychological, behavioral, and social problems. Marijuana use is common and can be problematic in individuals with other psychiatric disorders, including major mood, anxiety, and personality disorders (1171­1174). Cannabis use can precipitate initial episodes of psychosis in vulnerable individuals (1175) and is associated with an earlier age at first psychotic episode in male patients with schizophrenia, 6. Cannabis abuse or dependence is highly associated with increased risk of other substance dependence (1177). Contrary to the popular belief among laypeople and professionals that treatment for cannabis dependence is usually neither needed nor sought, the demand for such treatment at substance use disorder programs doubled between 1992 and 1998 in the United States. The percentage of illicit drug abuse treatment admissions for marijuana (23%) approximated that for cocaine (27%) and heroin (23%) (1178). Despite this, the treatment of marijuana abuse and dependence is a comparatively understudied area to date. Inpatient treatment is most likely to occur if the individual is hospitalized for another psychiatric disorder, including another substance use disorder. Treatment of Patients With Substance Use Disorders 103 Copyright 2010, American Psychiatric Association. However, interest in treatment has grown as evidence from animal and clinical studies has suggested that a withdrawal syndrome occurs if chronic heavy use of cannabis or tetrahydrocannabinol is discontinued (1179­1181). The magnitude and severity of these symptoms appear substantial, and their onset and time course appear similar to those of other substance withdrawal syndromes.