Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender and swollen joint. Pain comes on reaching maximal intensity in less than 12 hours; the joint at the base of the big toe is affected in about half of cases. It may result in tophi, kidney stones, or kidney damage. Gout is due to persistently elevated levels of uric acid in the blood; this occurs from a combination of diet, other health problems, genetic factors. At high levels, uric acid crystallizes and the crystals deposit in joints and surrounding tissues, resulting in an attack of gout. Gout occurs more in those who eat meat or seafood, drink beer, or are overweight. Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint. Blood uric acid levels may be normal during an attack. Treatment with nonsteroidal anti-inflammatory drugs, steroids, or colchicine improves symptoms. Once the acute attack subsides, levels of uric acid can be lowered via lifestyle changes and in those with frequent attacks, allopurinol or probenecid provides long-term prevention.
Taking vitamin C and eating a diet high in low-fat dairy products may be preventive. Gout affects about 1 to 2% of the Western population at some point in their lives, it has become more common in recent decades. This is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, changes in diet. Older males are most affected. Gout was known as "the disease of kings" or "rich man's disease", it has been recognized at least since the time of the ancient Egyptians. Gout can present in multiple ways, although the most common is a recurrent attack of acute inflammatory arthritis; the metatarsal-phalangeal joint at the base of the big toe is affected most accounting for half of cases. Other joints, such as the heels, knees and fingers, may be affected. Joint pain begins during the night and peaks within 24 hours of onset; this is due to lower body temperature. Other symptoms may occur along with the joint pain, including fatigue and a high fever.
Long-standing elevated uric acid levels may result in other symptoms, including hard, painless deposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may lead to crystals precipitating in the kidneys, resulting in stone formation and subsequent urate nephropathy; the crystallization of uric acid related to high levels in the blood, is the underlying cause of gout. This can occur because of diet, genetic predisposition, or underexcretion of urate, the salts of uric acid. Underexcretion of uric acid by the kidney is the primary cause of hyperuricemia in about 90% of cases, while overproduction is the cause in less than 10%. About 10% of people with hyperuricemia develop gout at some point in their lifetimes; the risk, varies depending on the degree of hyperuricemia. When levels are between 415 and 530 μmol/l, the risk is 0.5% per year, while in those with a level greater than 535 μmol/l, the risk is 4.5% per year.
Dietary causes account for about 12% of gout, include a strong association with the consumption of alcohol, fructose-sweetened drinks and seafood. Among foods richest in purines yielding high amounts of uric acid are dried anchovies, organ meat, dried mushrooms and beer yeast. Chicken and potatoes appear related. Other triggers include physical surgery. Studies in the early 2000s found. Moderate consumption of purine-rich vegetables are not associated with gout. Neither is total consumption of protein. Alcohol consumption is associated with increased risk, with wine presenting somewhat less of a risk than beer or spirits. Eating skim milk powder enriched with glycomacropeptide and G600 milk fat extract may reduce pain but may result in diarrhea and nausea; the eating or drinking of coffee, vitamin C, dairy products, as well as physical fitness, appear to decrease the risk. Vitamin C supplements do not appear to have a significant effect in people who have established gout. Peanuts, brown bread, fruit appear protective.
This is believed to be due to their effect in reducing insulin resistance. Gout is genetic, contributing to about 60% of variability in uric acid level; the SLC2A9, SLC22A12, ABCG2 genes have been found to be associated with gout and variations in them can double the risk. Loss-of-function mutations in SLC2A9 and SLC22A12 causes low blood uric acid levels by reducing urate absorption and unopposed urate secretion; the rare genetic disorders familial juvenile hyperuricemic nephropathy, medullary cystic kidney disease, phosphoribosylpyrophosphate synthetase superactivity and hypoxanthine-guanine phosphoribosyltransferase deficiency as seen in Lesch–Nyhan syndrome, are complicated by gout. Gout occurs in combination with other medical problems. Metabolic syndrome, a combination of abdominal obesity, insulin resistance, abnormal lipid levels, occurs in nearly 75% of cases. Other conditions complicated by gout include lead poisoning, kidney failure, hemolytic anemia, solid organ transplants, myeloproliferative disorders such as polycythemia.
A body mass index greater than or equal to 35 increases male risk of gout threefold. Chronic lead exposure and lead-contaminated alcohol are risk factors for gout due to the harmful effect of lead on kidney function. Diuretics have been assoc
Credo Reference or Credo is an American company that offers online reference content by subscription and partners with libraries to develop information-literacy programs or produce library marketing plans and materials. Founded in 1999, Credo Reference provides full-text online versions of over 3,500 published reference works from more than 100 publishers in a variety of major subjects; these include subject dictionaries as well as encyclopedias. The company's customers are libraries, library systems, k-12 schools, universities, which subscribe to the service for their patrons' use. In 2010, a review of general reference sources by Library Journal focused on Credo Reference and three similar services; the review noted Credo Reference’s internal linking within the site from one reference work to another. The company was founded as Xrefer in 1999. Xrefer provided free access to several dozen reference works. In 2002, Béla Hatvany, founder of Computer Library Services and Silverplatter, invested in Xrefer and funded the company’s transition to becoming an online reference database product for libraries.
The company established an office in Boston, MA USA, which would become its headquarters. The name Credo Reference was adopted in June 2007. Golderman, Gail. "eReviews: General Reference Sources and Short Takes", Library Journal.com, Oct 15, 2010. Official website
The Tasman River is an alpine braided river flowing through Canterbury, in New Zealand's South Island. The river's headwaters are in Aoraki/Mount Cook National Park, where it is the outflow of the proglacial Tasman Lake, it is fed by the glacial waters of the tributary Murchison River, from Murchison Glacier, the short Hooker River, an outflow of the proglacial lakes of the Hooker and Mueller glaciers. The Tasman River flows south for 25 kilometres through the wide flat-bottomed Tasman Valley in the Southern Alps and into the northern end of the glacial lake Pukaki, this forming part of the ultimate headwaters of the Waitaki hydroelectric scheme. List of rivers of New Zealand