born of man and woman short story pdf

Born of man and woman short story pdf

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Born of Man and Woman

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Born of Man and Woman

Anderson, Nesli Basgoz, Howard M. The acquired immunodeficiency syndrome AIDS wasting syndrome is a devastating complication of human immunodeficiency virus HIV infection characterized by progressive weight loss and severe inanition.

In men, the wasting syndrome is characterized by a disproportionate decrease in lean body mass and relative fat sparing. In contrast, relatively little is known about the gender-specific changes in body composition that characterize AIDS wasting in women.

Lean, fat, and muscle masses were determined by dual energy x-ray absorptiometry and urinary creatinine excretion. The body mass index was Lean body mass indexed for height was In contrast, fat mass indexed for height was decreased significantly among patients in both the EW and LW groups[ 8.

Estradiol levels were lower among subjects with amenorrhea Mean free testosterone, but not total testosterone, levels were decreased in subjects with EW and LW compared to those in age-matched healthy controls, but not compared with those in NW[ 0. These data demonstrate that women lose significant lean body and muscle mass in the late stages of wasting.

However, in contrast to men, women exhibit a progressive and disproportionate decrease in body fat relative to lean body mass at all stages of wasting, consistent with gender-specific effects in body composition in AIDS wasting.

In addition, these data demonstrate that androgen deficiency is common in women with AIDS wasting and may contribute to decreased muscle mass in this population. In men, the wasting syndrome is a catabolic state characterized by the disproportionate loss of lean body mass with relative fat sparing 1 , 2.

Although women make up an increasing percentage of HIV-infected patients 3 , 4 , relatively little is known about the gender-specific pattern of change in body composition, hormonal function, and energy metabolism in this population.

Gender-specific differences in gonadal steroid levels and GH secretory dynamics exist between men and women 5 — 7 and may affect body composition and endocrine function in women with AIDS.

However, the number of women studied was small, gender-specific hormonal changes were not characterized, and the relationship to stage of wasting was not investigated. In this study we compared lean, fat, and muscle masses in women with AIDS wasting, age-matched nonwasting HIV-positive women, and normal controls.

Our findings demonstrate that in contrast to men, women lose fat mass disproportionately to lean mass in the early and late stages of AIDS wasting. Androgen levels are decreased significantly in this population and correlate with decreased muscle mass. These findings demonstrate gender-specific changes in body composition and hormonal function unique to women with AIDS wasting.

Percent IBW was determined from measured weight and height 8. Subjects had been free of acute opportunistic infection for at least 6 weeks before admission. None of the subjects had been taking Megace, estrogen, ketoconazole, glucocorticoid, or anabolic agents within 3 months before admission. Subjects with regular menses were studied in the early follicular phase.

All subjects gave written consent as approved by the Subcommittee on Human Studies of the Massachusetts General Hospital. Body composition analysis. Fat and lean body mass were determined by dual x-ray absortiometry DXA using a Hologic densitometer Hologic, Waltham, MA and indexed for height by dividing by the square of the height in meters to permit a comparison between the groups. Expected muscle mass was determined from height 10 , Hormonal assessment and immune function.

Gonadal function was assessed by self-report of menstrual history recall over 3 months and serum total and free testosterone, estradiol, SHBG, gonadotropin, and DHEAS levels. Subjects who had not had a period within the last 3 months before admission were categorized as amenorrheic. One subject with a known prior history of chemotherapy and elevated FSH was precluded from the analysis.

The GH axis was evaluated in three ways: 1 frequent sampling every 20 min from — h, 2 stimulation testing with arginine hydrochloride 0. Immune function was determined by CD4 count. Nutritional assessment. Subjects were placed on an isocaloric, meat-free, but protein-substituted, diet for 3 days before and during the in-patient protocol.

In addition, calorie and protein intakes were monitored on a daily basis and modified to match those reported in the out-patient food records. Normal controls. Laboratory methods. GH was measured by a two-site radioimmunometric assay with an intraassay CV of 2. Statistical analysis. BMI decreased with successive stages of wasting Fig.

In contrast, fat mass indexed for height was decreased significantly among subjects in the EW and LW groups Fig. Expressed as kilocalories of energy expended per kg wt, energy expenditure tended to increase with the severity of wasting, but these changes did not reach statistical significance [ Albumin and prealbumin levels were relatively low, but were not different among the groups [albumin: 3.

C], but were not different by menstrual status. Total testosterone levels tended to be lower in the amenorrheic than in the eumenorrheic subjects Gonadotropin levels were not different by wasting category or menstrual status Table 1. Free testosterone, but not total testosterone, levels Table 1 were decreased significantly in subjects with early and late wasting compared to those in age-matched healthy controls Fig.

No significant differences in mean overnight GH levels or GH response to arginine or IGF-I were observed by wasting category or in comparison with the control group Table 1.

Comparison of free testosterone levels between the groups. In this study we show that women with AIDS wasting lose fat disproportionately to lean mass and demonstrate that androgen deficiency may contribute to the loss of muscle mass associated with wasting in this population. In this study, we show that a significant loss of body fat, but not lean body mass, occurs in women with relatively early wasting. With advanced wasting, both lean body and fat mass are decreased to a significant degree, but the loss of body fat remains disproportionate to that of lean.

In addition, we observed that the loss of muscle mass was significant and correlated with androgen levels in the later stages of wasting. In contrast to data from Kotler et al. There was no significant difference in REE between the groups by stage of wasting, but energy expended per kg wt tended to increase, rather than decrease, as expected with increased severity of wasting These data suggest that REE is increased in HIV-infected women, increasing the likelihood of weight loss during secondary infections when caloric intake is decreased The changes in body composition in women with AIDS wasting are similar to those seen in simple starvation, with loss of fat more than lean This is in contrast to the data previously reported in men with AIDS wasting, in whom the loss of lean is more significant than that of fat 1 , One potential explanation for this finding is that normal women have a relatively higher percentage of body fat at baseline than men 19 and, therefore, lose fat preferentially with weight loss, as suggested by Forbes et al.

Finally, chronic diarrhea and microsporidiosis were prevalent in prior studies of body composition in men with AIDS wasting 1 , 2 and may contribute to the disproportionate loss of lean body mass in this population.

These data contrast with those reported by Chirgwin et al. These data suggest that the overall prevalence of amenorrhea in women infected with HIV disease is relatively higher among patients with weight loss than in previous reports of asymptomatic women with HIV disease.

Furthermore, we found that amenorrhea is associated with a decreased muscle mass independent of weight or CD4 count, suggesting that gonadal dysfunction may be a factor in the critical loss of lean body mass in late stage wasting.

Decreased testosterone levels among the amenorrheic patients may have contributed in part to the lower muscle mass in this group. In addition, we investigated the GH axis to determine whether gender-specific differences in GH secretion might in part explain body composition changes in women with AIDS wasting.

For example, increased GH secretion in women compared to men may be related to estrogen effects on the hypothalamic release of somatostatin 5 — 7 , Furthermore, there were no differences in these parameters between the amenorrheic and eumenorrheic patients, and no correlation between GH and body composition. Of note, we did not observe a significant difference in GH or IGF-I levels in women with advanced wasting compared to aged-matched healthy controls.

These data suggest that the relative degree of acquired GH resistance as a function of weight loss is less severe in women than men, and this may explain in part why fat mass is lost disproportionately to lean mass in women with AIDS wasting.

Additional studies comparing directly GH secretory dynamics between men and women with AIDS wasting are necessary to further investigate the clinical significance of this observation. These data demonstrate that women with AIDS wasting are androgen deficient compared to age-matched controls and suggest that androgen deficiency may contribute to the loss of muscle mass in this population. The mechanisms of decreased free testosterone levels in our subjects are not clear.

Eumenorrheic subjects were studied in the early follicular phase. In healthy ovulating women, there is a small cyclicity in androgen levels during the menstrual cycle, but this is less than the variation in estrogen SHBG levels were significantly increased compared to control values, suggesting that sex steroid binding levels are increased in women with AIDS. One potential explanation for the observation of decreased androgen levels in this population is the effect of chronic illness on gonadal function Subjects in this study were not taking Megace or other medication and had no known conditions other than HIV that may have predisposed them to decreased androgen levels In addition, subjects with acute opportunistic infection or on a new retroviral agent were excluded.

Gonadotropin levels were low, consistent with hypogonadotropic hypogonadism and an effect of illness on the hypothalamic-pituitary-gonadal axis. Alternatively, decreased adrenal androgen function might contribute to decreased free testosterone levels in this population.

DHEAS levels were decreased significantly among subjects with advanced wasting and were highly correlated with free testosterone levels. The significance of decreased androgen levels with respect to changes in body composition in women with AIDS wasting has not previously been investigated. In this study, we demonstrate a significant correlation between muscle mass and free testosterone levels and between muscle mass and DHEAS levels in women with AIDS wasting, suggesting that physiological androgen deficiency may contribute to body composition changes with wasting in this population.

In addition, decreased androgen levels among the patients with wasting suggest a critical level of testosterone below which wasting may occur. These data are in agreement with limited data in other populations which suggest that androgens play a role in the maintenance of lean body mass in women as well as men. For example, in postmenopausal women, androgen levels are correlated with muscle mass and strength 34 , and improve with exogenous androgen treatment A similar relationship between androgen levels and lean body mass was recently reported by our group in hypogonadal men with AIDS wasting Taken together, these data are the first to suggest that physiological androgen deficiency occurs in women as well as men with AIDS wasting and suggest that this deficiency may have clinical relevance with respect to the loss of muscle mass seen in the later stages of wasting.

In contrast to androgens, estrogen levels were not correlated with indexes of body composition in our patients, consistent with the known effects of androgens, but not estrogens, to mediate changes in lean body mass and whole body proteolysis in other populations These data suggest that women with AIDS wasting, like men, lose a critical amount of lean body and muscle mass with advanced disease.

In contrast to men, however, loss of fat mass is disproportionately greater than loss of lean mass in women and is evident even at the early stages of wasting. These are the first data to demonstrate that androgen deficiency is common among women with AIDS wasting and may contribute to the critical loss of muscle mass in this population. In addition, these data demonstrate that muscle mass is lower among amenorrheic than eumenorrheic women with AIDS wasting, suggesting a heretofore unrecognized association between gonadal function and body composition in this population.

Additional longitudinal cohort studies are needed to investigate further the mechanisms and clinical significance of gender-specific changes in body composition and to investigate the potential utility of physiological androgen replacement to build lean body and muscle mass in women with AIDS wasting. The investigators thank the nurses and nutrition staff of the General Clinical Research Center for their dedicated patient care, Dr.

David Schoenfeld for biostatistical advice, and Mr.

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Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability including accessibility and affordability , and acceptability. Voluntary informed choice of contraceptive methods is an essential guiding principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods. In choosing a method of contraception, dual protection from the simultaneous risk for HIV and other STDs also should be considered. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant.

Richard Matheson is known for his unusual and interesting stories. Some of them were adapted into episodes of The Twilight Zone. An unidentified narrator, a child, tells their story through diary entries. The child is chained up in the basement, and has to keep out of sight or be beaten. A hand addressed package is left at the door of Arthur and Norma Lewis. Inside is a contraption with a button on it, and a note saying that Mr. Steward will call on them at 8 PM.

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BORN OF MAN AND WOMAN Richard Matheson X — This day download PDF Born To Be Different: The path meant for a man, taken by. E-book.


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It was his first professional sale, written when he was twenty-two years old. It became the title piece in Matheson's first short story collection in The story is written in the form of an internal "diary" in broken English kept by what the reader presumes is a deformed child gender unspecified chained in the basement by its violently abusive parents the story makes it clear that the man and woman who have imprisoned the child are its biological parents when the child recalls the man commenting about how, in stark contrast to the child, "Mother [is] so pretty and me decent[-looking] enough. The child-narrator can sometimes pull its chain from the wall and observe the outside world through the basement window.

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XXX — This day father hit in the chain again before it had light. I have to try pull it out again. He said Iwas bad to come upstairs. He said never do that again or he would beat me hard. That hurts. I hurt.

Anderson, Nesli Basgoz, Howard M. The acquired immunodeficiency syndrome AIDS wasting syndrome is a devastating complication of human immunodeficiency virus HIV infection characterized by progressive weight loss and severe inanition. In men, the wasting syndrome is characterized by a disproportionate decrease in lean body mass and relative fat sparing. In contrast, relatively little is known about the gender-specific changes in body composition that characterize AIDS wasting in women. Lean, fat, and muscle masses were determined by dual energy x-ray absorptiometry and urinary creatinine excretion.

Free Graphic Novels They depict characters and scenes as a normal comic-strip would, with captions for words, but with longer, more in depth stories. After assisting the U.

Sex and gender: What is the difference?

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