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By E. Ressel. University of Missouri-Saint Louis.

However safe malegra dxt 130 mg, if a sinner has a demon of sickness that is causing cancer discount malegra dxt 130mg on-line, arthritis, blindness, deafness, or whatever, are we saying that when that person gets saved, the demon of sickness will automatically leave? The exception to this statement is that this does often occur when healing ministers preach a dual salvation-healing gospel. However, since the vast majority of preachers preach a salvation-only gospel, Jesus normally saves the sinner’s spirit, and leaves his physical body alone. Of course, the implication is if casting out demons ceased when the last apostle died, then the entire present day ministry of casting out demons is fatally discredited. Therefore he said unto them… heal the sick that are therein…And the seventy returned again with joy, saying, Lord, even the devils are subject unto us through thy name. As usual God equipped his preachers with authority and power to prove their message to rational minds, just as He does today. So much so that Jesus had to deflate their euphoric victory with an emphasis on the foundation of salvation. But Jesus said, Forbid him not: for there is no man which shall do a miracle in my name, that can lightly speak evil of me. Apparently he had some success, because the apostles—jealous that some unapproved nobody was muscling in on their turf —shut down his ministry. Jesus corrected the apostles, and told them to get out of this unknown miracle-worker’s business. And the people with one accord gave heed unto those things which Philip spake, hearing and seeing the miracles which he did. For unclean spirits, crying with loud voice, came out of many that were possessed with them: and many taken with palsies, and that were lame, were healed. Demons were dramatically cast out, and many people were healed of palsies and crippling diseases. Casting Demons Out of Sinners The simple fact that this discussion is even necessary shows just how far the church has fallen away from God. If Christians can’t have demons, then naturally they can’t have demons cast out of them. And, yet, they are the very group of people who are absolutely not qualified to receive deliverance from demons. Christians, however, with experience in casting out demons know that deliverance from evil spirits is not an indiscriminant ministry. One is as limited in offering deliverance from demons as one would be offering deliverance from sin. Can one offer deliverance from sin without requiring submission to the Savior, Jesus Christ? Neither can one offer (permanent) deliverance from demons without requiring submission to the Deliverer, Jesus Christ. However, even though deliverance from sin and demons require submission to Jesus Christ, there is a unique aspect of deliverance from demons that must be discussed. Salvation can only be received by consciously repenting of one’s sinful life, and fully embracing Jesus Christ as God and Savior. The scriptures are very plain on this point: “Repent ye, and believe the gospel,” (Mark 1:15) However, with deliverance one can be temporarily (very temporarily) freed of s o m e demons without submitting to Jesus Christ. The reason is salvation is the product of the sinner’s repentance and embracing of Jesus Christ as God and Savior. Deliverance from demons is the product of a Christian commanding the demon to leave its victim. Its arrival or departure is more precisely the mental or physical submission or resistance to a sinful temptation. According to the opponents of deliverance ministry, demons can only be made to leave the ungodly. If this is so, by what authority and on what basis would one cast a demon out of a servant of Satan? Even if a zealous Christian tore into a sinner’s demonic stronghold with persistent commands of faith, and successfully evicted the demon, how long would it be before the demon returned? Although the time span is not discussed in the eviction and return of this demon, Luke 11:24–26 vividly describes this all too common event. Then goeth he, and taketh to him seven other spirits more wicked than himself; and they enter in, and dwell there: and the last state of that man is worse than before. The only exception I can think of is if God, in His great mercy, answers a sinner’s prayer for deliverance as a means of drawing that sinner to repentance. After all, the scripture does say, “Or despisest thou the riches of his goodness and forbearance and longsuffering; not knowing that the goodness of God leadeth thee to repentance,” (Romans 2:4) If God chooses to make an exception to His own rule, that’s His business.

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Reptiles and amphibians (frogs) have been found to carry pathogenic leptospires but are unlikely to play an important epidemiological role generic malegra dxt 130mg on line. In carrier animals buy cheap malegra dxt 130mg online, an asymptomatic infection occurs in the renal tubules, and leptospiruria persists for long periods or even for life, especially in reservoir species. Mode of transmission—Contact of the skin, especially if abraded, or of mucous membranes with moist soil, vegetation—especially sugar- cane—contaminated with the urine of infected animals, or contaminated water, as in swimming, wading in floodwaters, accidental immersion or occupational abrasion; direct contact with urine or tissues of infected animals; occasionally through drinking of water and ingestion of food contaminated with urine of infected animals, often rats; also through inhalation of droplet aerosols of contaminated fluids. Leptospires may be excreted in the urine, usually for 1 month, although leptospiruria has been observed in humans and in animals for months, even years, after acute illness. Preventive measures: 1) Educate the public on modes of transmission, to avoid swimming or wading in potentially contaminated waters and to use proper protection when work requires such exposure. Management of sugarcane fields such as controlled preharvest burning reduces risks in harvesting. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Obligatory case report in many countries, Class 2 (see Reporting). However, prompt specific treatment, as early in the illness as possible and preferably before the 5th day of illness, may reduce duration of fever and hospital stay. Doxycycline (2 times a day 100 mg orally for 7 days), ampicillin or erythromycin can be used in patients allergic to penicillin and for less severe cases. Epidemic measures: Search for source of infection, such as a contaminated swimming pool or other water source; eliminate the contamination or prohibit use. Disaster implications: A potential problem following flooding of certain areas with a high water table. Identification—A bacterial disease usually manifested as meningo- encephalitis and/or septicemia in new-borns and adults; in pregnant women, as fever and abortion. Those at highest risk are neonates, the elderly, immunocompromised individuals, pregnant women and alco- holic, cirrhotic or diabetic adults. The onset of meningoencephalitis (rare in pregnant women) can be sudden, with fever, intense headache, nausea, vomiting and signs of meningeal irritation, or subacute, particularly in immunocompromised or elderly hosts. Endocarditis, granulomatous lesions in the liver and other organs, localized internal or external abscesses, and pustular or papular cutaneous lesions may occur on rare occasions. The normal host acquiring infection may exhibit only an acute mild febrile illness; in pregnant women infection can be transmitted to the fetus. Infants may be stillborn, born with septicemia, or develop menin- gitis in the neonatal period even though the mother may be asymptomatic at delivery. The postpartum course of the mother is usually uneventful, but the case-fatality rate is 30% in newborns and approaches 50% when onset occurs in the first 4 days. In a recent epidemic, the overall case-fatality rate among nonpregnant adults was 35%: 11% in those below 40 and 63% in those over 60. Listeria monocytogenes can be isolated readily from normally sterile sites on routine media, but care must be taken to distinguish this organism from other Gram-positive rods, particularly diphtheroids. Selective enrichment media improve rates of isolation from contaminated specimens. Infectious agent—Listeria monocytogenes, a Gram-positive rod- shaped bacterium; human infections are usually ( 98%) caused by serovars 1/2a, 1/2b, 1/2c and 4b. In Europe, it is often associated with consumption of non-pasteurized milk or milk products including cheese. It often occurs sporadically; several outbreaks have been recognized in recent years. About 30% of clinical cases occur within the first 3 weeks of life; in nonpregnant adults, infection occurs mainly after 40. Asymptomatic infections probably occur at all ages, although they are of importance only during pregnancy. The seasonal use of silage as fodder is frequently followed by an increased incidence of listeriosis in animals. Asymptomatic fecal carriage is common in humans (up to 10%) and can be higher in abattoir workers and laboratory workers who work with Listeria mono- cytogenes cultures. Soft cheeses may support the growth of Listeria during ripening and have caused outbreaks. Unlike most other foodborne pathogens, Listeria tends to multiply in refrigerated foods that are contaminated. Mode of transmission—Outbreaks have been reported in associ- ation with ingestion of raw or contaminated milk, soft cheeses, vegetables, and ready-to-eat meats, such as paˆte´. Papular lesions on hands and arms may occur from direct contact with infectious material. In neonatal infections, the organism can be transmitted from mother to fetus in utero or during passage through the infected birth canal. There are rare reports of nursery outbreaks attributed to contaminated equipment or materials. Incubation period—Variable; cases have occurred 3–70 days following a single exposure to an implicated product. Period of communicability—Mothers of infected newborn in- fants can shed the infectious agent in vaginal discharges and urine for 7–10 days after delivery, rarely longer. Children and young adults generally are resistant, adults less so after age 40, especially the immunocompromised and the elderly.

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Oral thrush − white coating on hard or soft palate and tongue cheap malegra dxt 130 mg visa, causes dysphagia if oesophagus involved buy 130 mg malegra dxt free shipping, occurs in late disease. Diarrhoea of more than 1 months duration, often caused by shigella, salmonella, amoeba; can also be caused by the virus itself (slim or wasting disease). Respiratory Cough of more than 1 months duration, with or without shortness of breath caused by infection with lower tract organisms. Discourage excessive alcohol drinking and smoking • Prompt attention for any health problem • Social Through counselling patients/clients should be helped to cope with the condition. Studies show that the infection due to breastfeeding ranges from 14−29% Breastfeeding provides optimal nutrition, protects from many life−threatening diseases for all children. If a mother chooses not to breastfeed: − ensure that there is enough breast milk replacement − ensure that is an appropriate replacement − ensure that the milk is prepared correctly and hygienically − use a cup and demonstrate to the mother how to feed − ensure that the mother understands that the prepared feeds have to be finished within 6 hrs or be discarded thereafter − ensure proper storage of the prepared feeds. If a mother chooses to breastfeed; 33 − exclusive breastfeeding for limited period of 6 months − sudden weaning − express breast milk and heat 60°C (near boiling point) before giving to baby. Management − Pharmacologic Triple Therapy − using antiretroviral drugs: The main aim of treatment is to suppress the viral load, achieve reconstruction of the immune system and hence improve quality of life. Management of the specific infections is covered in the relevant chapter, however a few are mentioned below: − Pneumonia Most are due to streptococcus. It becomes easier to communicate the results and the patient/client is able to contain the news. These diseases can be transmitted from mother to child (vertical transmission), i. Some can also be transmitted through blood transfusion, contaminated needles, syringes, specula, gloves, skin piercing and cutting instruments. Patient Education • Avoid multiple or anonymous partners, prostitutes or any other person with multiple sex partners • Use condoms correctly e. Gonorrhoea & Urethral Discharge Clinical Features Discharge in anterior urethra with dysuria or urethra) discomfort. In addition, Infection of glans (balanitis) or prepuce (posthitis) by Candida albicans can lead to discharge. Investigations • Diagnosis in male is usually clinical but if confirmation is required a urethral smear is done • Gram stain showing pus cells & intracellular Gram negative diplococci is 95% accurate. Genital Discharge in the Female Causes of vaginal discharge include Candida vulvovaginitis (monilia or thrush), trichomonas vaginitis, and bacterial vaginosis. Endocervical discharge can be caused by−gonorrhoea, chlamydia trachomatis and mycoplasma hominis. Predisposing factors are diabetes mellitus, systemic antibiotics, pregnancy, hormonal oral or injectable contraceptives and decreased host immunity. Associated with itching, burning and soreness during micturition and sexual intercourse. Prevention • People who get recurrent infection should be given concurrent prophylactic treatment whenever broad−spectrum antibiotics are prescribed. Clinical Features Symptoms depend on the severity of the infection and include a frothy, greenish−yellow, foul−smelling discharge. Infection usually involves the vulva, vagina and the cervix may appear reddish and swollen. Investigations • Wet mount preparation demonstrates flagellated protozoa • Trichomonas may also be noted on urine microscopy or pap smear. Not usually associated with soreness, irritation, pruritus burning sensation or dyspareunia. The Commonest causes of endocervicitis are gonorrhoea, chlamydia, trichomonas and herpes simplex virus. Clinical Features Cloudy−yellow vaginal discharge which is non−irritating, non−odorous and mucoid. Abdominal and bimanual pelvic examination should be done to rule out pelvic inflammatory disease. Investigations • Wet mount preparation: look for pus cells, trichomonas and yeasts • Gram−stain of the discharge of endocervical swab (Neisseria gonorrhoea shows Gram negative intracellular diplococci) • Culture for gonorrhoea or chlamydia if available • Pap smear after treatment. Dysuria in the Female Can result from urinary tract infection, vaginitis, or cervicitis. See relevant sections of manual for clinical features, investigations and management. Must be differentiated from urinary tract infection, ectopic pregnancy, threatened abortion, appendicitis, and other causes of acute abdomen. An abdominal & pelvic examination must be done on all cases of lower abdominal pain in women Management • See flow chart and relevant sections of manual. Pregnancy Use either one of the penicillin preparations or erythromycin (see above). Acyclovir 200 mg orally 5 times daily for 7−10 days only reduces the symptoms and their duration and does not prevent recurrences. Clinical Features Lymphogranuloma venereum Several nodes matted together on one or both sides, usually without suppuration. Chancroid tender fluctuant bubo which suppurates leaving an undermined inguinal ulcer should be aspirated before suppuration.

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