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Reduction in the natural input of wood (leaf litter, branches and logs) to waterways is problematic because the presence of wood in the stream channel alters flow patterns, creates scour pools in running-water systems and can serve as important habitat for many fish and other aquatic species (Gregory et al. By partially restricting flow and trapping sediment, wood accumulations also help develop and maintain riverfloodplain connections, which further increases habitat complexity (Wohl et al. Groundwater regimes Aquifers supply drinking water to billions of people, water for irrigation of agricultural land and groundwater seepage into rivers, upon which many ecosystems depend (Gleeson et al. Broadly, three semi-independent processes lead to the degradation of aquifers: (1) depletion of aquifer storage due to over-pumping and its effects in reducing both groundwater levels and freshwater availability to terrestrial and aquatic ecosystems, particularly during dry periods; (2) groundwater salinization when salts and nutrients are flushed from subsurface soils during recharge by rain or irrigation, and sometimes in upper estuaries when upstream freshwater inflows have been depleted and salt water intrusion occurs; this usually, but not exclusively, occurs in coastal aquifers; (3) inputs of pollutions from point sources, such as urban and industrial wastes and chemicals, or from diffuse nonpoint sources, less concentrated but widespread, including nutrients and pesticides from agriculture (Foster & Chilton, 2003; Morris et al. Subsidence caused by ground water extraction is increasing with human use of ground water (Galloway et al. Increased runoff is the major cause of land degradation through gradual erosion (see Section 4. The resulting sediment and soil chemical transport leads to reduction in blue water quality through clogging of water ways and filling pools and lakes, covering the original water bed with consequent effects on water biota (Allan et al. An estimated 80% of aquifers have a groundwater footprint less than their area, so the net global withdrawal is driven by a few heavily exploited aquifers. Aquifers that are stressed by withdrawals an order of magnitude more than the global average include the upper Ganges, Arabians, south Caspian and Nile Delta. Status and trends in surface water Mass balance estimates show that the global continental freshwater discharge for a 13-year period (1994-2006) increased by 540 km3 yr-1, largely attributed to an increase of global-ocean evaporation (768 km3 yr-1). Inter-annualto-multi-decadal variation in discharge was found to be directly related to precipitation (Dai et al. Changes in land cover and land use were second in importance in affecting discharges over the 20th century, particularly in the tropics. However, the exact effects of different land-cover and/or use changes are uncertain and experts differ on the effects of tropical deforestation (Gerten et al. The magnitude of the effects of irrigation and storage in reservoirs and other human activities on annual global river flows is uncertain (Liu et al. The largest areas of uncertainty are in most areas of Asia and the northern countries of the Mediterranean basin. Sustained growth of these flux rates into long-term trends would indicate an increase in the intensity of the hydrologic cycle (Syed et al. Loss of habitat associated with these activities has had a dramatic impact on aquatic biodiversity, freshwater ecosystem services and the flux of materials that influence global processes (Dudgeon, 2013; Roy et al. Although less than 10% of the total annual renewable bluewater is withdrawn for human activities (mainly irrigation, industry and drinking), 2. Status and trends in evapotranspiration Global plant transpiration (green water flow) has reduced by 7. The capacity of cropland soils to retain water in the root-zone is affected by the amount of soil organic matter and, while there are no global surveys, it has been estimated that croplands have lost 3050% of their organic matter content (Lal, 2002) as a result of intensive tillage. The loss was higher in inland wetlands (61%) as opposed to coastal wetlands (46%). The study shows that the annual rate of wetland loss in the 20th and 21st increased ten-fold than that before the 18th century (-0. Although the trend between 1970 and 2008 shows higher losses from Europe and Asia, the overall loss during the 20th and 21st was largest in Europe and North America; 56% loss relative to 1900. A similar trend is found in the Living Planet Index (World Wildlife Fund, 2016) for wetland-dependent species, where species abundance decreased 39% (range: -8 to -60%) between 1970 and 2012 (Figure 4. The global trends of wetland extent between 1970 and 2008 included more than 1,000 wetlands from 170 studies (Leadley et al. The Living Planet Index includes data on population abundance for 706 inland wetlands populations of 308 freshwater species monitored across the globe between 1970 and 2012. Wetland degradation usually involves an alteration of the hydrological regime, either completely disrupting it.

International Journal of Biodiversity Science, Ecosystem Services & Management, 7(4), 301318. Why Environmental Liability Regimes in the United States, the European Community, and Japan Have Grown Synonymous with the Polluter Pays Principle. Use of ecosystem services economic valuation for decision making: Questioning a literature blindspot. Biodiversity Scenarios: Projections of 21st century change in biodiversity and associated ecosystem services. Low Dose Organochlorine Pesticides and Polychlorinated Biphenyls Predict Obesity, Dyslipidemia, and Insulin Resistance among People Free of Diabetes. The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries. Development and validation of a global database of lakes, reservoirs and wetlands. A Framework for Evaluating the Effects of Human Factors on Wildlife Habitat: the Case of Giant Pandas. Integrated Seed Sector Development in Africa: A Conceptual Framework for Creating Coherence Between Practices, Programs, and Policies. Farmers, seedsmen, and scientists: Systems of agriculture and systems of knowledge. Collective Action for Smallholder Market Access: Evidence and Implications for Africa. Fuzzy concepts, scanty evidence, policy distance: the case for rigour and policy relevance in critical regional studies. Major Research Paper for the Master of Arts in Globalization Studies and the Water Without Borders Collaborative Graduate Program in Water. Reconstructing the good farmer identity: shifts in farmer identities and farm management practices to improve water quality. Hard choices: Making trade-offs between biodiversity conservation and human well-being. Economic valuation of land restoration: the case of exclosures established on communal grazing lands in Tigray, Ethiopia. Commitment of farmers to environmental protection: From social pressure to environmental conscience. Current State and Trends: Findings of the Condition and Trends Working Millennium Chapter 22. Global protected area expansion is compromised by projected land-use and parochialism. Changes in Pore Water Quality After Peatland Restoration: Assessment of a Large-Scale, Replicated Before-After-Control-Impact Study in Finland. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Interrogating the technocratic (neoliberal) agenda for agricultural development and hunger alleviation in Africa. Ecological resilience, robustness and vulnerability: how do these concepts benefit ecosystem management? From the" Duck Pond" to the Global Commons: Increasing Awareness of the Supranational Nature of Emerging Environmental Issues. Weathering Uncertainty: Traditional Knowledge for Climate Change Assessment and Adaptation. Globalization of the Amazon soy and beef industries: opportunities for conservation. Conservation Biology: the Journal of the Society for Conservation Biology, 20(6), 1595-1603. The price of protein: Review of land use and carbon footprints from life cycle assessments of animal food products and their substitutes. Fighting against ourselves: efforts to combat desertification and land degradation, 10 Currents.

Fever It is an elevation of body temperature above the normal circadian variation as a result of the change in the thermoregulatory centre, located in the hypothalamus. Physiological Variation of Temperature In a menstruating woman, the early morning temperature is subnormal in the two weeks preceding ovulation. In hectic or septic type of intermittent fever, the diurnal variation is extremely large, as occurs in septicaemia. Borrelia infection and rat bite fever: Both are associated with several days of fever followed by several days of afebrile period and then the cycle repeats. Cyclic neutropenia: Cyclic neutropenia accompanied with fever occurs every 21 days. Central nervous system damage: It is common in cerebral haemorrhage, status epilepticus, and hypothalamic injury. It is a medical emergency, since they are prone for sudden cardiorespiratory arrest. Pontine haemorrhage Rheumatic fever Meningococcal meningitis Septicaemia Cerebral malaria. Treatment It is treated with parenteral anti-pyretics to set the elevated thermostat set point to a lower level. Malignant hyperthermia is an inherent abnormality of skeletal muscle cell sarcoplasmic reticulum which is unable to store calcium ion. Hyperthermia is triggered by use of inhalation anaesthetics (Halothane, Cyclopropane) and muscle relaxants (Succinylcholine). Treatment of the above mentioned hyperthermias is by withdrawal of the offending agents. Central muscle relaxant (Dantrolene sodium) is helpful in the last two conditions. Ultrasound: Excellent imaging is procured in thin individuals and poor imaging in obese individuals. Primary afferent nociceptors (pain receptors) are A-delta (small myelinated) and C (unmyelinated) fibres. Pain in Acute Aortic Dissection the pain is of abrupt onset, reaches a peak rapidly and is felt in the centre of the chest and/or the back depending on the site of aneurysm. This pain lasts for many hours and is not aggravated by changes in position or respiration. Pleural Pain It is a sharp, knife like, localised superficial pain, aggravated by deep inspiration and coughing due to stretching of the inflamed parietal pleura and is relieved by lying down on the affected side due to restricted movement of chest on the same side. In diaphragmatic pleurisy, pain arising from central tendinous portion of the diaphragm is felt characteristically at the tip of the shoulder, trapezius ridge and the neck since the central part of diaphragm receives sensory supply from phrenic nerve (C3, 4, 5). Pain may radiate down to upper abdomen when peripheral part of diaphragmatic pleura (supplied by 6th to 12th intercostal nerves) is involved simulating acute abdomen. Musculoskeletal Pain Costo-chondral and chondro-sternal articulations are most common sites of anterior chest pain. Pain may be darting and lasts for a few seconds or it may be a dull ache enduring for hours or days. Neuropathic Pains Neuropathic pains have an unusual burning, tingling or electric shock like quality. Pain is triggered by very light touch and on examination, sensory deficit is characteristically present in the corresponding dermatome. Angina Pectoris It is a midline retrosternal constrictive, compressive or squeezing diffuse pain lasting for 3-15 minutes.

Note Stool examination is sensitive on anaerobic culture facilities which reveals toxigenic and non toxigenic strains Enzyme immunoassays are available for toxins A and B in stool Sigmoidoscopy is highly specific if lesion is seen but insensitive compared to the above. Diagnosis Abdominal discomfort of at least 3 months duration Bloating or feeling of distension Altered bowel habits (constipation and/or diarrhea) Exacerbations triggered by life events. Diagnostic Considerations Hematology and biochemistry studies Stool microscopy Colonoscopy with biopsy 57 P a g e Treatment Refer patients to specialized centers for proper evaluation and management. Relief of pain due to abdominal cramps A: Hyoscine butyl bromide 20mg (O) four times a day Relief of anxiety that may be making symptoms worse C: Diazepam 5-10 mg (O) 8 hourly Give short and infrequent courses only, in order to avoid dependance. Although presenting symptoms, such as diarrhea and weight loss may be common, the specific causes of malabsorption are usually established based on physiologic evaluations. The treatment often depends on the establishment of a definitive etiology for malabsorption. Etiologic examples include pancreatic insufficiency, bacterial overgrowth, celiac disease, tropical sprue, lactase deficiency, diabetic enteropathy, thyroid disease, radiation enteritis, gastrectomy and extensive small bowel resection. Diagnosis Depending on etiology, presentation may collectively include: Diarrhoea a commonest symptom which is frequently watery Steatorrhea due to fat malabsorption; characterized, by the passage of pale, bulky, and malodorous stools. Bleeding disorders (Ecchymosis, melena, and hematuria) due to vitamin K malabsorption and subsequent hypoprothrombinemia. Metabolic defects of bones (osteopenia or osteomalacia) due to vitamin D deficiency. Vitamin malabsorption can cause generalized motor weakness (pantothenic acid, vitamin D) or peripheral neuropathy (thiamine), a sense of loss for vibration and position (cobalamin), night blindness (vitamin A), and seizures (biotin). Treatment Patients should be referred to specialized centers for proper evaluation and definitive management Two basic principles underlie the management of patients with malabsorption, as follows: o the correction of nutritional deficiencies o When possible, the treatment of causative diseases Nutritional support o Supplementing various minerals, such as calcium, magnesium, iron, and vitamins, which may be deficient in malabsorption, is important o Caloric and protein replacement also is essential o Medium-chain triglycerides can be used as fat substitutes because they do not require micelle formation for absorption and their route of transport is portal rather than lymphatic o In severe intestinal disease, such as massive resection and extensive regional enteritis, parenteral nutrition may become necessary. Treatment of causative diseases o A gluten-free diet helps treat celiac disease o A lactose-free diet helps correct lactose intolerance; supplementing the first bite of milk-containing food products with Lactaid also helps o Protease and lipase supplements are the therapy for pancreatic insufficiency o Antibiotics are the therapy for bacterial overgrowth o Corticosteroids, anti-inflammatory agents, such as mesalamine, and other therapies are used to treat regional enteritis. It may present as acute pancreatitis, in which the pancreas can sometimes heal without any impairment of function or any morphologic changes, or as chronic pancreatitis, in which individuals suffer recurrent, intermittent attacks that contribute to the functional and morphologic loss of the gland. Common risk factors which trigger the acute episode are presence of gallstones and alcohol intake. Diagnosis Severe, unremitting epigastric pain, radiating to the back Nausea and vomiting 59 P a g e Signs of shock may be present Ileus is also common Local complications: inflammatory mass, obstructive jaundice, gastric outlet obstruction Systemic complication: sepsis, acute respiratory distress syndrome, acute renal failure Diagnostic considerations Serum amylase, in counts over 1000U/L, but poor correlates with disease severity. Treatment Prompt referral to specialized centers with intensive care facilities is recommended Principles of management include expertise supportive therapy: o Nil per oral regimen for few days up to weeks is indicated depending on severity. The most common cause for such a condition is long-term excessive alcohol consumption. Diagnosis the most common symptom is upper abdominal pain that may be accompanied by nausea, vomiting and loss of appetite As the disease gets worse and more of the pancreas is destroyed, pain may actually become less severe During an attack, the pain often is made worse by drinking alcohol or eating a large meal high in fats. This can lead to weight loss, vitamin deficiencies, diarrhea and greasy, foulsmelling stools. Over time, a damaged pancreas also can fail to produce enough insulin, which results in Diabetes. Improving food absorption - the patient should be recommended to follow a low-carbohydrate, high-protein diet that also restricts some types of fats. Once digestive problems are treated, patient will usually gain back weight and diarrhea improves. Another way is by giving the patient pancreatic supplements containing digestive enzymes. Treating diabetes - Treat diabetes with careful attention to diet to help keep blood sugar levels stable. Acute peritonitis is most often infectious usually related to a perforated viscus (secondary peritonitis); primary or spontaneous peritonitis refers to when no intraabdominal source is identified. Acute peritonitis is associated with decreased intestinal motility, resulting in distention of the intestinal lumen with gas and fluid. The accumulation of fluid in the bowel together with the lack of oral intake leads to rapid intravascular depletion with effects on cardiac, renal, and other systems.