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The conversation should continue until you understand Receiving Feedback what the reviewer had in mind buy 100mcg advair diskus amex asthma treatment by zubaida apa, not until one of you has convinced the other generic advair diskus 100 mcg otc asthma symptoms 4 weeks. Without some limits generic advair diskus 500mcg online asthmatic bronchitis vs copd, you may lose There is an even more important reason to have a con- the opportunity to learn about other issues. Although we appreciate guid- Encourage reviewers to mark up the paper, but go over ance, many of us get bogged down with conflicting these comments in a conversation. Taken at face value, problems identified by tion, not only do you risk missing certain points (scrib- reviewers are generally valid; their proposed solutions, bled-up drafts are often difficult to read), you miss the on the other hand, may be wrong. Take what are clearly There are other important tactics for obtaining good suggestions but think of alternatives for those that feedback. Such feedback only better prepares you for the journal’s Getting Better review process. To give yourself the any time a reviewer is motivated to mark the draft, a opportunity to become a better writer, make the time. To improve the paper, don’t rush the writing • Start writing before your project is com pleted. Too many authors are impatient to get the • Focus your attention on what readers are m ost paper off their desk and onto the editor’s. This opportunity for digestion can be efficiently sched- • Im prove the paper by learning how to get and uled while your internal reviewers are doing their incorporate useful feedback. Sift through the words requirements for manuscripts submitted to biomedical jour- until each can produce a “proper account of itself. Responsibilities of medical jour- clear to the editor (in a cover letter) what you changed, nals to readers. How to encourage a referee: use your word proces- To improve your skills, help others. I would also like to acknowledge the assistance the opportunity to serve as a peer reviewer, particu- given me by the current associate editors of ecp. Suggested citation: United Nations Office on Drugs and Crime, World Drug Report 2016 (United Nations publication, Sales No. It exam- ines the use of the “dark net” and new technologies for drug The session was only the third in the history of the General trafficking, as well as the potential of illicit drug profits to Assembly to focus on drugs, and the resulting outcome fund terrorism and violent extremism. This is a topic of particular relevance: as Governments In the outcome document, Member States reaffirmed their noted in the outcome document, “efforts to achieve the commitment to addressing persistent, new and evolving Sustainable Development Goals and to effectively address challenges in line with the three international drug control the world drug problem are complementary and mutually conventions, which were recognized as allowing States par- reinforcing”. The evidence is clear: illicit drug cultivation and manufacturing can be eradicated only The operational recommendations contained in the out- if policies are aimed at the overall social, economic and come document encompass measures to address demand environmental development of communities; confronting and supply reduction, as well as to improve access to con- drug trafficking and its associated violence requires strong, trolled medicines while preventing their diversion; they transparent and fair criminal justice institutions and tar- cover human rights, youth, children, women and commu- geted efforts to dismantle transnational organized criminal nities and highlight emerging challenges and the need to organizations; prevention and treatment of drug use work promote long-term, comprehensive, sustainable, develop- if they are based on scientific evidence and are gender- ment-oriented and balanced drug control policies and pro- sensitive; and the excessive use of imprisonment for drug- grammes that include alternative development. The text highlights the importance of drug abuse preven- tion and treatment; encourages the development, adoption There is clearly much work to be done to tackle the many and implementation of alternative or additional measures evolving and emerging challenges posed by drugs. The out- with regard to conviction or punishment; and promotes come document and its operational recommendations offer proportionate national sentencing policies, practices and a solid foundation, one built on agreed frameworks, guidelines for drug-related offences. Now the international community must come together to make good on its commitments. This report, as with all of the Office’s expertise and on-the- ground experience in addressing the many aspects of the The World Drug Report 2016, which provides a compre- world drug problem, is at the disposal of Member States hensive overview of major developments in drug markets, as they strive to meet this call to action. This year’s report offers insight into the wide-ranging impact of drugs not only on the health and well-being of individuals, but also on the people around them — families Yury Fedotov and communities. While the challenges posed by new psychoactive substances remain a serious concern, heroin continues to be the drug that kills the most people. Market analysis by drug type 26 Opiates 26 Cocaine 35 Cannabis 43 Synthetic drugs: amphetamine-type stimulants and new psychoactive substances 52 2. Core team Research, study preparation and drafting Coen Bussink David Macdonald Chloé Carpentier Kamran Niaz Liliana M. Dávalos Thomas Pietschmann Philip Davis Martin Raithelhuber Angelica Durán-Martínez Clinton W. The Research and Trend Analysis Branch acknowledges the invaluable contributions and advice provided by the World Drug Report Scientific Advisory Committee, which was formed in 2015 with the following members: Jonathan Caulkins Paul Griffiths Marya Hynes Vicknasingam B. A dotted line represents All uses of the word “drug” in this report refer to sub- approximately the line of control in Jammu and Kashmir stances under the control of the international drug control agreed upon by India and Pakistan. Disputed boundaries (China/India) are repre- All analysis contained in this report is based on the official sented by cross-hatch owing to the difficulty of showing data submitted by Member States to the United Nations sufficient detail. Office on Drugs and Crime through the annual report The designations employed and the presentation of the questionnaire unless indicated otherwise. References to dollars ($) are to United States dollars, unless Countries and areas are referred to by the names that were otherwise stated. R stands for the correlation coefficient, used as All references to Kosovo in the present publication should measure of the strength of a statistical relationship between be understood to be in compliance with Security Council two or more variables, ranging from 0 to 1 in case of a resolution 1244 (1999). Roughly the equivalent of the combined … and encourage the sharing of best practices populations of France, Germany, Italy and the United and lessons learned. Overdose deaths contribute to between roughly a reviews the scientific evidence on polydrug use, treatment third and a half of all drug-related deaths, which are attrib- demand for cannabis and developments since the legaliza- utable in most cases to opioids. The time period shortly tion of cannabis for recreational use in some parts of the after release from prison is associated with a substantially Prevalence of injecting drug use, 2014 or latest available year Percentage of populaton aged 15-64 ≤ 0. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas). With an estimated 33 as a result of drug overdoses), with a mortality rate much million users, the use of opiates and prescription opioids higher than from all causes among the general is less common, but opioids remain major drugs of poten- population. The fact that a sharp increase in heroin use has been documented in some mar- In many countries, prisons remain a high-risk environ- kets (particularly North America) where it was previously ment for infectious diseases, which is a significant concern declining, shows that heroin remains one of the major for prison health. However, despite the high-risk environment and scientific evidence for effective health interventions, there are significant gaps in prevention and treatment services in many prisons around the world. Note: Estimated percentage of adults (ages 15-64) who used drugs in the Note: Estimates are for adults (ages 15-64), based on past-year use. As an overall trend at the global level, the use of cannabis including practices in referrals by the criminal justice has remained stable over the past three years. In some sub- system and an expansion in the provision of treatment for regions, however, particularly North America and Western cannabis in some countries. After a that higher potency cannabis is now more widely available period of stability, since 2010 cocaine use has also been in Europe and the United States, how this might translate rising, mainly because of an increase in cocaine use in into greater harm for cannabis users is not clearly South America. People in treatment for opioid- and regularly, tend to be polydrug users who use more or cocaine-related disorders are typically in their thirties, than one substance concurrently or sequentially. Gender disparities in drug Treatment related to cannabis use has been increasing in use are more attributable to opportunities to use drugs in many regions over the past decade. In Europe, an increase a social environment than to either gender being more or in the numbers in treatment for cannabis use has been less susceptible or vulnerable to the use of drugs. Moreo- observed in several countries, despite a decline in the ver, while in most surveys the prevalence of drug use number of frequent (monthly) users.

Skerratt and Beveridge (1999) reported that man can also acquire the scabies of the Australian wombat purchase 250 mcg advair diskus fast delivery asthma symptoms kids. Sarcoptes of goats seems not to be very host-specific order genuine advair diskus line asthma symptoms during pregnancy, inasmuch as there was a report of one epidemic in goats that then spread to cattle buy advair diskus discount asthma 9 year old, sheep, and dogs, and even- tually affected 42 persons. Nineteen goats and one cow died, but the infestation was self-limiting in some human cases (Mitra et al. Of 48 individuals working with swine infested by Sarcoptes in India, 30 (65%) had signs of scabies, and mites were recovered on 20 persons (67%) (Chakrabarti, 1990). In most cases, the symptoms in humans disappear when the animals are treated and contagion ceases to be constant (Fontaine, 2000). Owing to the dif- ficulty of identifying the origin of the mites, the frequency of zoonotic scabies in man is not known. The furrows are very thin and sinuous and are difficult to observe without the aid of a magnifying glass; they are generally not very abundant and are situated primarily in the interdigital spaces, back of the hand, elbows, axillae, torso, inguinal region, chest, penis, and navel. The most prominent symptom is itching, which is especially intense at night, forc- ing patients to scratch themselves. Such scratching can cause lesions, new foci of scabies and, often, purulent secondary infections. Irritation and pruritis are mani- fested one or two weeks after infestion and are due primarily to a type I allergic reac- tion. Scabies can persist for a long time if not treated; in fact, homologous human scabies is unlikely to heal by itself. It is believed that animal mites do not generally excavate tunnels in human skin and that the infestation is more superficial. This does not, however, explain the sometimes intense itching that zoonotic infestations cause. A researcher who exper- imentally infested herself with canine Sarcoptes was able to confirm by histopatho- logic examination the existence of mite tunnels in her skin (Kummel, cited in Schwartzmann, 1983). The lesion can vary from a pruriginous papular eruption, which is the most common form, to an intense allergic sensitization with the appear- ance of vesicles. In 30 persons infested with swine Sarcoptes, the lesions occurred on hands and legs (Chakrabarti, 1990). Zoonotic sca- bies is unlikely to affect the interdigital folds and external genital organs, which are often affected by homologous scabies. In addition, zoonotic scabies heals by itself and does not last more than one to three weeks. Spontaneous healing is attributed to the fact that the parasites do not multiply or only reproduce for a short time on the heterologous host. An infestation that lasts longer is usually due to ongoing expo- sure and permanent superinfestation. Treatment of the animal species originating the scabies is usually sufficient to eliminate human zoonotic scabies without treatment in a couple of weeks. The Disease in Animals: Sarcoptic scabies in animals generally starts on the head and on areas of the body with delicate skin (Davis and Moon, 1990). In equines, the lesions are observed on the head and neck; in dogs, on the ear flaps, snout, and elbows. As with the human parasites, the animal mites produce an aller- gic sensitization with intense itching and the formation of papules and vesicles. Vigorous scratching by the affected animals causes the vesicles to open and become covered with scales and then scabby plaques, which often ooze a serous liquid. Over time, there is a proliferation of the connective tissue and hyperkeratinization, caus- ing the skin to thicken and form creases. Scabies limited to a small area does not particularly affect an animal’s health, but when it spreads to large areas of the body it can have an adverse impact and even cause death. Source of Infestation and Mode of Transmission: Sarcoptes is transmitted mainly by recently inseminated females before they begin to build their tunnels. In both cases, the skin of the susceptible individual must be in close contact with the skin of the infested indi- vidual. In the case of interhuman transmission of Sarcoptes, the mite has been found on fomites, and thus contagion through contaminated objects seems possible. Since the parasite can survive for several days off an animal’s body on clothing, towels, bedclothes, animal bedding, harnesses, and horse blankets, these objects can serve as sources of infestation. Each animal species is a reservoir of the mite that attacks its own kind, but cross- transmission between species occasionally occurs. Human scabies is transmitted primarily from person to person, but several animals, such as horses, dogs, cattle, bubalids, sheep, goats, swine, camels, and zoo animals, can occasionally transmit it to man. The University of Pennsylvania found that around 33% of dogs with scabies caused infestations in members of their owners’ families (Schwartzmann, 1983). When scabies was still common in domestic ani- mals in the Netherlands, around 25% of the veterinarians in rural areas were infested with Sarcoptes of zoonotic origin. All of the persons who contracted the infestation (people in charge of handling and milking the buffaloes) had intense pruritus a few hours after initial contact with the affected animals (Chakrabarti et al. Zoonotic scabies is not an important public health problem because it resolves spontaneously and is not transmitted between humans. Diagnosis: The presence of sarcoptic scabies is suspected because of intense pru- ritus and typically located lesions. For the specific diagnosis of homologous infes- tations in man and animals, the recommendation is to cover the papules and a scalpel blade with a thin layer of mineral oil so that the mites and skin scales stick to it, scrape five to seven times until a small amount of blood is drawn, and examine the scrapings under a microscope to detect the presence of mites. A solution of 10% to 15% sodium or potassium hydroxide can be added to the microscope slide, which can then be heated slightly for 5 minutes to clarify the cornified cells that hinder observation. Since this procedure is painful for patients, in human cases the recom- mendation is to try and remove the mite from the furrows with a needle. However, the sensitivity of this method is so low that it is almost not worth attempting. Direct examination of the skin with an epifluorescent microscope is also recommended, since this method is quick, painless, and sensitive to the diagnosis of scabies (Argenziano et al. Zoonotic scabies in humans is more difficult to diagnose because the mites are much less numerous and most seem to move about on the skin. Transparent cello- phane tape can be applied to the skin and then examined under a microscope in the hope that a mite has been picked up, but this is not very effective because there is no precise method of determining where the mites are. Control: In order to prevent human scabies of zoonotic origin, infestation of ani- mals must be prevented or contact with animals suspected of being infested must be avoided. It is easier and more effective to treat pets with acaricides in order to erad- icate the infestation. When there is professional contact with animals that may be infested (handling of swine, goats, etc.

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The introduction of snails that compete with the intermediate hosts of the schisto- some has been successful in some areas purchase 500 mcg advair diskus amex asthma symptoms 2 yr old. In Puerto Rico advair diskus 250mcg with visa asthma definition 90937, for example buy cheap advair diskus asthma symptoms 8 weeks, introduction of the snail Marisa cornuarietis, coupled with chemical control, has eliminated B. Unfortunately, this snail can serve as the interme- diate host of Paragonimus westermani (Prentice, 1983). Moreover, changing the environment entails an improved standard of living for the population, more education, and healthier surroundings—objectives that are difficult to achieve. The measures described above are useful when they are incorporated realistically within the framework of a control program. In Venezuela, the Schistosomiasis Control Program was launched in 1945 and prevalence of the infection has fallen from 14% in 1943 to 1. Up until 1982, active cases were diagnosed by fecal examination, which was then followed by treatment, but starting that year, serologic surveys were added because many infections were too mild to be diag- nosed by parasitology. Given that 80% of infected individuals pass fewer than 100 eggs per gram of feces, it is possible that these people maintain foci of infection, thereby undermin- ing control efforts. Biological control using snails that compete with the intermedi- ate hosts has not been totally successful, since B. Indeed, infected snails have been found over an expanse of approximately 15,000 km2 in which the infec- tion was believed to have been eradicated several years ago. As a result, the entire schistosomiasis control strategy in Venezuela has been revised (Alarcón de Noya et al. In Brazil, chemotherapy has been a very important tool for reducing mor- bidity, incidence, and prevalence in endemic areas, but the provision of potable water, sanitary disposal of excreta, and health education still remain the essential requirements for definitive and permanent control (Katz, 1998). Although chemotherapy has been very successful in controlling schistosomiasis, reinfection makes it necessary for people to take the treatment often, sometimes annually. Despite reasonable success in domestic and laboratory animals, vaccines for human use are still far from being effective, both because man does not respond to vaccination the same way that animals do and because the methods used with animals (such as infection with irradiated cercariae) are not directly applicable to man. Indeed, vaccination was not considered a viable alternative for the control of schistosomiasis until recently, when the identification of certain protective antigens and the possibility of producing them as recombinant molecules raised hopes for success in this endeavor (Bergquist, 1998). Morphometric variability of Schistosoma inter- calatum eggs: A diagnostic dilemma. Application of immunodiagnostic assays: Detection of antibodies and circulating antigens in human schisto- somiasis and correlation with clinical findings. Reversibility of Schistosoma man- soni-associated morbidity after yearly mass praziquantel therapy: Ultrasonographic assess- ment. The population biology and epidemiology of schis- tosome and geohelminth infections among school children in Tanzania. Comparison of a digestion-sedimentation tech- nique with the Kato-Katz technique in the detection and quantification of S. A monoclonal antibody-based dipstick assay for diagnosis of urinary schistosomiasis. The epidemiology of a recent focus of mixed Schistosoma haematobium and Schistosoma mansoni infections around the ‘Lac de Guiers’ in the Senegal River Basin, Senegal. Genital manifestations of schistosomiasis mansoni in women: Important but neglected. La bilharziose à Schistosoma intercalatum: con- siderations cliniques et epidemiologiques. Schistosoma mansoni-related morbidity on Ukerewe Island, Tanzania: Clinical, ultrasonographical and biochemical parameters. Introdução recente de esquistossomose mansoni no Sul do Estado de Minas Gerais, Brasil. Do all human urinary infections with Schistosoma mattheei rep- resent hybridization between S. Population biology of Schistosoma mansoni in the black rat: Host regulation and basic transmission rate. Self-diagnosis as a possible basis for treating urinary schistosomiasis: A study of schoolchildren in a rural area of the United Republic of Tanzania. Displacement of Biomphalaria glabrata by the snail Thiara granifera in field habitats in St. Epidemiological and genetic observations on human schistosomiasis in Kinshasa, Zaire. The public health significance of urinary schis- tosomiasis as a cause of morbidity in two districts in Mali. Schistosomiasis mansoni: Immunoblot analysis to diagnose and differentiate recent and chronic infection. Helminth genome analysis: The current status of the filar- ial and schistosome genome projects. The effects of temperature, light and water upon the hatching of the ova of Schistosoma japonicum. Differentiation of the two species is based on the size of the glandular portion of the vagina, the eggs and their pyriform apparatus, and the number of testes. Others accept geographic and host segregation as additional valid criteria (Denegri et al. The gravid proglottids (segments) are much wider than they are long, detach in groups of about 20, and are eliminated in the feces of the primates. The intermediate hosts are oribatid mites of the genera Dometorina, Achipteria, Galumna, Scheloribates, and Scutovertex. The embryo travels to the mites’ body cavity and forms a larva known as cysticercoid. When a monkey ingests an infected mite with its food, digestion of the mite releases the cysticercoids, which mature into adult cestodes in the host’s intes- tine. The Disease in Man and Animals: The infection causes neither symptoms nor lesions in monkeys (Owen, 1992). It is generally also asymptomatic in man, but some cases with abdominal pain, intermittent diarrhea, anorexia, constipation, and weight loss have been reported. In rare cases, severe abdominal pain and intermittent vomiting have been described. Source of Infection and Mode of Transmission: Nonhuman primates, which constitute the natural reservoir of the cestode, acquire the parasitosis by ingesting infected oribatid mites with their food. Man can become infected by accidental ingestion of food contaminated with soil containing infected mites. This occurs when people are in close contact with monkeys kept at home or in zoos, or when there are large numbers of monkeys in the peridomestic environment. Diagnosis: Preliminary diagnosis is based on observation of the proglottids elim- inated in the feces and is subsequently confirmed by microscopic examination of the eggs obtained from the proglottids.

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Folate deficiency has a particularly adverse effect on the neural tube purchase advair diskus no prescription asthma kids mild intermittent, erythrocytes buy advair diskus with mastercard asthmatic bronchitis medications, and epithelial cells of the gastrointestinal tract cheap 500mcg advair diskus overnight delivery asthma definition 2014. The low cost and safety profile of folic acid favor its empiric supplementation in recom- mended doses. Folate defi- ciency leads to impaired cell division, a problem that becomes apparent first in rapidly regenerating tissue (e. Folate is involved in amino acid metabolism, including the synthesis of serine from glycine and the methylation of homocysteine to methionine. Methionine is activated by adenosine triphosphate to produce S-adenosyl- methionine, the primary intracellular methyl donor. It is best to eat fresh fruits and vegetables when- ever possible, since they contain the most vitamins. Dietary folates are a complex and vari- able mixture of compounds that are readily destroyed. Folic acid, pteroylmonoglutamic acid, is the inactive precursor of tetrahydrofolic acid and methyltetrahydrofolate. It is the most oxidized and stable form of folate and is the form used in vitamin supplements and food fortification. However, the other supplemental form, folinic acid, does appear to be more metabolically active. Folinic acid is capable of boosting levels of the coenzyme forms of the vitamin in cir- cumstances in which folic acid has little or no effect. Synthesis of the active forms of folic acid is a complex process requiring several enzymes, as well as adequate supplies of riboflavin (B2), niacin (B3), pyridoxine (B6), zinc, and serine. This is increased to 500 to 520 μg/day in pregnant women and women contemplating pregnancy and drops to 450 μg/day during lactation. An upper limit for folate has been set as 1 mg/day or 1000 μg/day from for- tified foods or supplements. The upper limit of folate applies to folic acid and not to the folate occurring naturally in food. Administration of folic acid during the periconceptional period reduces the risk of neural tube defects. Women Chapter 67 / Folate 537 who have had a neural tube defect detected in a previous pregnancy should take 4 mg/day for 1 month before and 3 months after becoming pregnant. An oral dose of 5 to 10 mg of folic acid for 6 to 12 months often eliminates or controls these symptoms. Folate, 400 μg daily taken as part of a B complex, may help relieve depression by combating high levels of homocysteine and by increasing the efficacy of antidepressants. Poor folate status is believed to create an environment that facilitates expression of a predisposition to cancer, particularly colorectal cancer. Adenomas and a high alcohol intake correlate with an increased risk of colorectal cancer. The effect is 538 Part Three / Dietary Supplements dose-dependent, with a dose of 1 mg of folate per day reducing the relative risk of cancer in patients with ulcerative colitis to 0. Nonetheless, for many individuals, a daily multivitamin that contains folic acid may be part of a reasonable overall cancer prevention strategy. Excess folate intake results in restlessness, and megadoses may alter sleep patterns and cause insomnia. The metabolic relationship between vitamin B12 and folate ensures that a deficiency of one affects the function of the other. Masking of vitamin B12 deficiency with folate supplementation results in improvement of the hema- tologic picture while neurologic damage progresses. Therefore it has been suggested that the safe upper limit of routine folate supplementation in food or tablets is 1 mg/day. In fact, erring on the side of caution, doses of folic acid in excess of 400 μg daily should be avoided until pernicious anemia has been ruled out. In vitamin B12 deficiency, the erythrocyte folate level is low because vitamin B12 is required for folate entry into cells. If both serum folate and serum vitamin B12 levels are low, a combined deficiency should be sus- pected. The serum folate level reflects intake, and the erythrocyte folate level reflects cellular stores. Several drugs such as aminopterin, methotrexate, pyrimethamine, trimethoprim, and triamterene act as folate antagonists. Persons taking anticonvulsants have an increased requirement for folate, but folate supplements may precipitate convulsions in patients with epilepsy. Folic acid in doses approximating 6 mg daily impairs the activity of anticonvulsants, and dose adjustment may be necessary. Folate deficiency associated with alcoholism is due to an inadequate diet rather than a drug interaction. The sequence of deficiency after inadequate intake is sequentially a decrease in serum folate concentration, a decrease in erythrocyte folate con- centration, increased homocysteine levels, megaloblastic changes in bone marrow, and finally impaired production of cells with a rapid turnover (e. Clinical findings include megaloblastic anemia, insomnia, irritability, malaise, apathy, and irritability. Other signs of deficiency are poor memory, cheilosis (cracks is corners of mouth), and glossitis. Mucosal defects result in impaired absorp- tion, further exacerbating folate deficiency. Peripheral neuropathy, tendon hyperreflexia, diarrhea, weight loss, and cerebral disturbances may develop. Fowler B: The folate cycle and disease in humans, Kidney Int 59(suppl 78): S221-S229, 2001. Thompson S, Torres M, Stevenson R, et al: Periconceptional vitamin use, dietary folate and occurrent neural tube defected pregnancies in a high risk population, Ann Epidemiol 10:476, 2000. Clarke R, Armitage J: Vitamin supplements and cardiovascular risk: review of the randomized trials of homocysteine-lowering vitamin supplements, Semin Thromb Hemost 26:341-8, 2000. Prinz-Langenohl R, Fohr I, Pietrzik K: Beneficial role for folate in the prevention of colorectal and breast cancer, Eur J Nutr 40:98-105, 2001. Selhub J: Folate, vitamin B12 and vitamin B6 and one carbon metabolism, J Nutr Health Aging 6:39-42, 2002. Garlic has been used as a culinary herb and medicinal agent for thousands of years. When garlic is roasted, the bulb is cut to expose just the tips of the cloves, then the bulb is rubbed in olive oil, wrapped in silver foil, and baked at 350˚C for 45 minutes. Most of garlic’s medicinal properties are found in the sulfur compounds concentrated in the bulb. Mincing, crushing, or pressing garlic increases the surface area and maximizes production and release of health-promoting compounds; the same applies to onions. In fact, both garlic and onion have been shown to have antimicrobial, antithrombotic, antitumor, hypolipi- demic, antiarthritic, and hypoglycemic properties. When garlic is crushed or chewed, alliin is exposed to the enzyme alliinase and converted into the active compound allicin. It is unsta- ble and, on exposure to heat and/or acid, forms various diallyl and dimethyl sulfides, as well as E-ajoene and Z-ajoene.