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The civilian leadership is amenable to a sharp turn in nuclear policy precisely because its standpoint is political, unhampered by the arcane verbiage of deterrence doctrine. Moreover, if it cracks the disarmament whip, neither the generals nor the missile makers have the clout to resist. Apart from tightening physical security over nuclear materials, the Government of India has strengthened its legal framework, which has been in existence since the passing of the Atomic Energy Act of 1948 and encompasses laws regulating exports. In 2005, the Indian Parliament passed the Weapons of Mass Destruction and their Delivery Systems (Prohibition of Unlawful Activities) Act, which aims to contain the risk of proliferation of all weapons of mass destruction. It provides for heavy fines and imprisonment of persons found guilty of transgressions. India has also engaged in a series of initiatives with the United States to contain the terrorist threat. This yielded cooperation in numerous areas, such as legislative and administrative changes, interdiction of terrorist finance networks, counterterrorism training, and aviation security. In January 2002, India joined the Convention on the Physical Protection of Nuclear Materials. There is evidence that in the past, as noted above, Pakistan has been the beneficiary of illegal proliferation activities, obtaining assistance from China in its quest for the bomb. Notwithstanding Chinese assurances, such concerns have not disappeared altogether. Second, Indians fear that loose Pakistani controls may result in the acquisition of nuclear capabilities by terrorists bent on wreaking havoc in Indian territory. And, third, the proliferation of illegal nuclear commerce has the potential to unravel the nuclear nonproliferation regime and generate instability. But India has favored engagement rather than the imposition of sanctions and has opposed the use of force against Iran. Minister for External Affairs Pranab Mukherjee made this plain in February 2008: "We do not wish to see the emergence of additional nuclear weapon states, for it will only further endanger international security. Following a series of crises, Pakistan, like India, has realized the difficulty of attempting to use coercion in a nuclear weapons environment. India and Pakistan already have in place a series of nuclear confidence building measures and a continuing dialogue on a range of political and security issues. In the past, India has rejected limited multilateral frameworks such as nuclear weapons free zones, but these were unacceptable precisely because they were not universal and comprehensive. First, sections of the Pakistani ruling elite may prefer to retain the option of keeping up the pressure on India by supporting terrorist groups active in Kashmir. Pakistanis will tend to counter that the resolution of the Kashmir issue is a prerequisite, but such arguments are not convincing. India and China have been able to improve relations significantly despite a long-standing border dispute. India will have to engage with Pakistan with respect to this concern and India may have to provide security assurances on this score as part of a larger bargain. This also points to a critical issue closely linked with nuclear disarmament more broadly: the effects it would have on the balance of conventional forces would be particularly discomfiting for those who see themselves ending up at a disadvantage. India will therefore insist that China be included in any nuclear disarmament talks at the same stage as it is involved. The participation of China (and Pakistan) would meet the most direct Indian security concerns, since its main adversaries would be committed to a common process of restraint and transparency. Ideally, the language should eschew reference to the legal status of the participants in the newly launched process. Yet it has been based on a set of three consistent principles: (1) that nuclear weapons are morally objectionable because they are indiscriminate and inhumane; (2) that in a practical sense they are dangerous weapons because their potential for damage far exceeds their contribution to security; and, (3) that nuclear disarmament must be universal and complete. Though long regarded as idealistic and unrealizable, these principles are in fact realistic, as they combine a desired moral objective with an emphasis on the practical effects of the weapons and on recognition that the unique possession of a class of weapons by any one state is a potential threat to all others. Thus, India has rejected any arms control/disarmament arrangements that it views as discriminatory and hence at least potentially violative of its security in an anarchic world. India also advocated a comprehensive test ban, but, as noted earlier, backed away when its open door policy toward nuclear weapons came under pressure.

If neighbors were intent on developing nuclear weapon technology, it behooved Turkey, at the very least, to acquire peaceful forms of nuclear technology. Strong opposition to such plants exists, however, which makes it difficult politically for the government to go forward without paying a high political price. Built in 1962 and upgraded subsequently to a 5 megawatt research reactor, it provides isotopes and other services to the medical industry. The other two experimental facilities are situated near Ankara are straightforward research laboratories. Nuclear energy is an attractive source for Turkey given that it has to import almost all of its energy needs from abroad. However, both the discussion of climate change and the potential unreliability of its energy partners, including Iraq, Russia, Azerbaijan and Iran, have spurred Turkey to take a new look at nuclear power. In 2006, the Turkish Prime Minister announced that Turkey would soon start building three nuclear plants that would become fully operational by 2015. However, these hopes are unlikely to materialize because of domestic opposition; the costs are high and there seems to be a lack of interest on the part of would-be investors. In September 2008, the government received only one bid for its Akkuyu tender on the Mediterranean coast. As part of a broader set of agreements on energy projects, Turkey and Russia agreed to reopen talks on civilian nuclear cooperation. Bush, when sending the bill to Congress, commented that the agreement would "serve as a strong incentive for Turkey to continue its support for nonproliferation objectives and enact future sound nonproliferation policies and practices. Its reemergence may be due to American concerns that Turkey, pressured by growing domestic energy demand, will increasingly be tempted to seek Iranian gas sources. However, what can be surmised from the discussion above is that Turkey would welcome such an initiative precisely because, in the absence of nuclear-armed countries, its industrial and conventional military prowess would help increase its influence in its immediate region and beyond. Provided that all countries embark on such an initiative, Turkey can rightfully calculate that it stands to benefit, especially if Iran and Israel are de-nuclearized. Mustafa Kibaroglu argues that the benefits derived from these weapons (deterrence and, more importantly, the traditional argument that they represent an investment in good relations with the United States) would be exceeded by the benefits of their removal. The weapons not only represent a hazard, he maintains, and represent a roadblock to a greater, region-wide nuclear free zone initiative, but more importantly permit the Iranian regime to use the nuclear weapons stored at the Incirlik base as a justification for their own program. However, were it not to trust the Europeans, then it would also forsake its place within Europe. Opposition to nuclear power plants has already led to the cancellation of one proposed project. Comparable figures for Egypt are 39 and 43 percent; Iran has 50 and 18 percent; and a world-wide average of 50 and 26 percent respectively. While these figures for Turkey are above the mean, interestingly, the percentage of the Turkish population who are in strongly opposed to a treaty abolishing nuclear weapons (5 percent) are among the lowest in the world. As a result, it is not evident what consequences there will be if additional countries are willing to make their own deals on nuclear power and weapons, as suggested by James Russell. Turkey might also interpret the waning of American power as a reason to pursue a nuclear option, particularly in the face of an Iranian bomb and additional proliferation in the Middle East. Lippman, "Saudi Arabia: the Calculations of Uncertainty," in Kurt Campbell, Robert J. Einhorn, "Egypt: Frustrated but still on a Non-Nuclear Course," in Campbell, Einhorn and Reiss, op. Leon Fuerth, "Turkey: Nuclear Choices amongst Dangerous Neighbors," in Campbell, Einhorn and Reiss, op. Gareth Jenkins, "Syria Proposes Nuclear Cooperation with Turkey," Eurasia Daily Monitor (Jamestown Foundation), June 16, 2008. Erkan Erdogdu, "Nuclear Power in Open Energy markets: A Case Study of Turkey," Energy Policy 37 (2007), page 3069.

They are not readily excreted in the urine, and significant quantities are stored in the liver and adipose tissue. Nutritional anemias-those caused by inadequate intake of one or more essential nutrients-can be classified according to the size of the red blood cells or mean corpuscular volume observed in the individual (Figure 28. Microcytic anemia, caused by lack of iron, is the most common form of nutritional anemia. The second major category of nutritional anemia, macrocytic, results from a deficiency in folic acid or vitamin B12. Folate and neural tube defects in the fetus: Spina bifida and 375 A Normal marrow anencephaly, the most common neural tube defects, affect approximately 4,000 pregnancies in the United State annually. Folic acid supplementation before conception and during the first trimester has been shown to significantly reduce the defects. Adequate folate nutrition must occur at the time of conception because critical folate-dependent development occurs in the first weeks of fetal life - at a time when many women are not yet aware of their pregnancy. Food and Drug Administration has authorized the addition of folic acid to enriched grain products, resulting in a dietary supplementation of about 0. It is estimated that this supplementation will allow approximately 50% of all reproductive-aged women to receive 0. However, there is an association of high-dose supplementation with folic acid (>0. When the vitamin is deficient, unusual fatty acids accumulate and become incorporated into cell membranes, including those of the nervous system. Structure of cobalamin and its coenzyme forms Cobalamin contains a corrin ring system that differs from the porphyrins in that two of the pyrrole rings are linked directly rather than through a methene bridge. Cobalt is held in the center of the corrin ring by four coordination bonds from the nitrogens of the pyrrole groups. The remaining coordination bonds of the cobalt are with the nitrogen of 5,6-dimethylbenzimidazole and with cyanide in commercial preparations of the vitamin in the form of cyanocobalamin (Figure 28. Distribution of cobalamin Vitamin B12 is synthesized only by microorganisms; it is not present in plants. Cobalamin is present in appreciable amounts in liver, whole milk, eggs, oysters, fresh shrimp, pork, and chicken. However, in vitamin B12 deficiency, the utilization of the N5-methyl form of tetrahydrofolate in the B12-dependent methylation of homocysteine to methionine is impaired. Because the methylated form cannot be converted directly to other forms of tetrahydrofolate, folate is trapped in the N5-methyl form, which accumulates. As a result, it may take several years for the clinical symptoms of B12 deficiency to develop in individuals who have had a partial or total gastrectomy (who, therefore, become intrinsic factor-deficient, see p. Ascorbic Acid (Vitamin C) deficiencies in patients who fail to absorb the vitamin from the intestine. Malabsorption of cobalamin in the elderly is most often due to reduced secretion of gastric acid and less efficient absorption of vitamin B12 from foods. This disease is most commonly a result of an autoimmune destruction of the gastric parietal cells that are responsible for the synthesis of a glycoprotein called intrinsic factor. Normally, vitamin B12 obtained from the diet binds to intrinsic factor in the intestine (Figure 28. The bound cobalamin is transported into the mucosal cell and, subsequently, into the general circulation, where it is carried by B12-binding proteins. Lack of intrinsic factor prevents the absorption of vitamin B12, resulting in pernicious anemia. Patients with cobalamin deficiency are usually anemic, but later in the development of the disease they show neuropsychiatric symptoms. Therapy must be continued throughout the lives of patients with pernicious anemia.

F, Verapamil and Adriamycin in the Treatment of Drug-Resistant Ovarian Cancer Patients, "Journal of Clinical Oncology", Vol. A, Lysis of autologous melanoma cells by tumor-infiltrting lymphocytes: association with clinical response. Protection effects of Aloe arborescens on Skin Injury induced by X-irradiation, Yakagaka Zasshi, 110 (1), pp. Protection effects of various extracts on crude drugs on skin injury induced by X-irradiation Yakagaka Zasshi, 109, iss2, pp. Relation between their chemical constitution and hemolytic and antifungal activities, Journal of Science, Food and Agriculture, 22, pp. Protective effect of various extracts on crude drugs on skin injury induced by X-irradiation, Yakugata Zasshi, Vol. A, marzo 2002 623) Paolo Pigozzi: Il Cibo che cura: 100 disturbi 100 soluzioni, Demetra S. Guida pratica e completa agli alimenti che aiutano a curare numerosi disturbi, Demetra s. Shaul: Regulation of lysine synthesis in transgenic potato plants expressing a bacterial dihydrodipicolinate synthase inthreir chloroplasts; Rehovot, Israel; Plant Mol. The amazing juicing programme for cancer and other illnesses", by Charlotte Gerson and Morton Walker, Thorsons ed. Dissertation of the faculty of chemistry and pharmacy of Ludwig Maximilians University, Munich, May 1984. Protoberberine alkaloids from the roots of Cissampelos pareira Linn, Experientia, october 15, 1968. Maaitenina, novo antimicrobiano con acao antineoplastica, isolade de celastracea de pernambuco. Seminar on the Development of Drugs from Medicinal Plants, Organized by the Department of Medical Science Department at Thai Farmer Bank, Bangkok Thailand, 1982, 129 873) Veira J. Horhammer, Pharmacognosy and Phytochemistry, New York, Springer Verlag, 1971, pp. Active components of a Paraguayan crude drug, paraparai mi, Phyllanthus niruri, Chem. Geraniin, an angiotensinconverting enzyme inhibitor from "paraparai mi", Phyllanthus niruri, J. Preparation of amino acid conjugates of betulinic acid with activity against human melanoma. Discovery of betulinic acid as a selective inhibitor of human melanoma that functions by induction of apoptosis. Food and Nutrition Board, Division of Biological Sciences, Assembly of Life Sciences. Washington D: National Academy Press; 1981 397 1058) Flora Manufacturing and Ditributing files, Academy of Agricultural Sciences pof the Russian Federation Research & Manufacturing Association. Unpublished report, 1997 1059) the University of Texas Houston Center for Alternative Medicine Research in Cancer. Alternative/ complementary medicine: implications for patients-provider communication. Nixon, Garlic: A Review of Its Relationship to Malignant Disease, Preventive Medicine 19:346-361 (1990), 350. Eng, Antifungal Activity in Human Urine and Serum after Ingestion of Garlic (Allium sativum), Antimicrob Agents Chemother 23(5):700-702 (1983). Draft, Status Report of Year One Operations, University of Texas Center for Alternative Medicine Research, September 9, 1996, 45. Singh, Differential Induction of Glutathione Transferase Isoenzymes of Mice Stomach by Diallyl Sulfide, a Naturally Occurring Anticarcinogen, Cancer Letters 57(2):121-9 (1991 May 1). Lin, Thioallyl Compounds: Potent Inhibitors of Cell Proliferation, Biochimica et Biophysica Acta 1221(1):73-7 (10 March 1994) 1082).

Tricuspid stenosis is almost always the result of rheumatic fever and is frequently associated with mitral and aortic valve disease, which tends to dominate the clinical picture. Tricuspid regurgitation is usually functional and secondary to dilatation of the right ventricle (and hence tricuspid valve ring) in severe right ventricular failure. Much less commonly it is caused by rheumatic heart disease, infective endocarditis or carcinoid syndrome (p. Pulmonary regurgitation results from pulmonary hypertension and dilatation of the valve ring. Occasionally it is the result of endocarditis (usually in intravenous drug abusers). Auscultation reveals an early diastolic murmur heard at the upper left sternal edge (Graham Steell murmur), similar to that of aortic regurgitation. Pulmonary stenosis is usually a congenital lesion but may present in adult life with fatigue, syncope and right ventricular failure. Infective endocarditis Infective endocarditis is an infection of the endocardium or vascular endothelium of the heart. Aetiology Streptococcus viridans, Staphylococcus aureus and enterococci are common causes (Table 10. Culture-negative endocarditis is particularly likely with organisms which are difficult to isolate in culture: Coxiella burnetii (the cause of Q fever), Chlamydia spp. Pathology A mass of fibrin, platelets and infectious organisms form vegetations along the edges of the valve. Virulent organisms destroy the valve, producing regurgitation and worsening heart failure. Embolization from rightsided endocarditis causes pulmonary infarction and pneumonia. Immune complex deposition in the joints causes arthralgia and, in the kidney, acute glomerulonephritis. Microscopic haematuria occurs in 70% of cases but acute kidney injury is uncommon. Endocarditis should always be excluded in any patient with a heart murmur and fever. Special culture techniques are occasionally necessary if blood cultures are negative. Small vegetations may be missed and a normal echocardiogram does not exclude endocarditis. Diagnostic criteria the Duke classification for diagnosis of endocarditis relies upon major and minor criteria (see Table 10. Possible endocarditis is diagnosed if there is one major and one minor criterion or three minor. While awaiting the results of blood cultures, a combination of intravenous benzylpenicillin and gentamicin is given unless staphylococcal endocarditis is suspected, when vancomycin should be substituted for penicillin. Subsequent treatment depends on the results of blood cultures and the antibiotic sensitivity of the organism. Antibiotic doses are adjusted to ensure adequate bactericidal activity (microbiological assays of minimum bactericidal concentrations). Surgery Surgery to replace the valve should be considered when there is severe heart failure, early infection of prosthetic material, worsening renal failure and extensive damage to the valve. Aetiology Pulmonary hypertension occurs due to an increase in pulmonary vascular resistance or an increase in pulmonary blood flow.