In the first two volumes of this work, Paul Ricoeur examined the relations between time and narrative in historical writing, fiction, and theories of literature. This final volume, a comprehensive reexamination and synthesis of the ideas developed in volumes 1 and 2, stands as Ricoeur's most complete and satisfying presentation of his own philosophy.

Time and Narrative

A pioneering attempt to relate the theory of literary fiction to a more general theory of fiction, using fictions of apocalypse as a model. This pioneering exploration of the relationship of fiction to age-old conceptions of chaos and crisis offers many new insights into some of the most unyielding philosophical and aesthetic enigmas. Examining the works of a wide range of writers from Plato to William Burroughs, Kermode demonstrates how writers have persistently imposed their \"fictions\" upon the face of eternity and how these have reflected the apocalyptic spirit.

Frank Kermode and the Invented World@@@The Sense of an Ending: Studies in the Theory of Fiction

Summary: Blastocystis is an unusual enteric protozoan parasite of humans and many animals. It has a worldwide distribution and is often the most commonly isolated organism in parasitological surveys. The parasite has been described since the early 1900s, but only in the last decade or so have there been significant advances in our understanding of Blastocystis biology. However, the pleomorphic nature of the parasite and the lack of standardization in techniques have led to confusion and, in some cases, misinterpretation of data. This has hindered laboratory diagnosis and efforts to understand its mode of reproduction, life cycle, prevalence, and pathogenesis. Accumulating epidemiological, in vivo, and in vitro data strongly suggest that Blastocystis is a pathogen. Many genotypes exist in nature, and recent observations indicate that humans are, in reality, hosts to numerous zoonotic genotypes. Such genetic diversity has led to a suggestion that previously conflicting observations on the pathogenesis of Blastocystis are due to pathogenic and nonpathogenic genotypes. Recent epidemiological, animal infection, and in vitro host-Blastocystis interaction studies suggest that this may indeed be the case. This review focuses on such recent advances and also provides updates on laboratory and clinical aspects of Blastocystis spp.

New insights on classification, identification, and clinical relevance of Blastocystis spp.

Magnesium is the fourth most abundant cation in the body and plays an important physiological role in many of its functions. Magnesium balance is maintained by renal regulation of magnesium reabsorption. The exact mechanism of the renal regulation is not fully understood. Magnesium deficiency is a common problem in hospital patients, with a prevalence of about 10%. There are no readily available and easy methods to assess magnesium status. Serum magnesium and the magnesium tolerance test are the most widely used. Measurement of ionised magnesium may become more widely available with the availability of ion selective electrodes.

Magnesium deficiency and hypomagnesaemia can result from a variety of causes including gastrointestinal and renal losses. Magnesium deficiency can cause a wide variety of features including hypocalcaemia, hypokalaemia and cardiac and neurological manifestations. Chronic low magnesium state has been associated with a number of chronic diseases including diabetes, hypertension, coronary heart disease, and osteoporosis. The use of magnesium as a therapeutic agent in asthma, myocardial infarction, and pre-eclampsia is also discussed.

Hypermagnesaemia is less frequent than hypomagnesaemia and results from failure of excretion or increased intake. Hypermagnesaemia can lead to hypotension and other cardiovascular effects as well as neuromuscular manifestations. Causes and management of hypermagnesaemia are discussed.

Magnesium Metabolism and its Disorders

https://www.hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf

The importance of the refeeding syndrome

• Four studies were conducted, each determining the frequency of hypomagnesemia in patients already found to have one abnormal electrolyte determination. Hypomagnesemia occurred in 42% of patients with hypokalemia, 29% of patients with hypophosphatemia, 27% of patients with hyponatremia, and 22% of patients with hypocalcemia. These observations suggest that detection of either hypokalemia, hypophosphatemia, hyponatremia, or hypocalcemia, all of which are routinely available determinations, should alert the clinician to order serum magnesium determinations because of the frequent association of hypomagnesemia with these electrolyte perturbations. Optimally, levels of serum Mg should be determined on a routine basis because of the frequency of the occurrence of hypomagnesemia in hospitalized patients. (Arch Intern Med1984;144:1794-1796)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=INTEMED&articleId=604813&pdfFileName=archinte_144_9_019.pdf

Predictors of clinical hypomagnesemia. Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia.

Excerpt Originally named and classified as fungus by Brumpt (1),Blastocystis hominishas recently been reclassified as a parasite (2). In addition,B. hominishas recently been reported as pathogenic ...

Blastocystis hominis Infection Presenting as Recurrent Diarrhea

• To evaluate the efficacy and safety of a simple approach to intravenous (IV) phosphorus therapy, ten adult patients with severe hypophosphatemia (≤ 1 mg/dL) and normal renal function were studied prospectively. They were treated with a solution containing 9 mmole of phosphorus as monobasic potassium phosphate (KH 2 PO 4 ), infused continuously every 12 hours. Serum phosphorus, potassium, and calcium levels and urinary excretion of phosphorus were measured every 12 hours. The serum phosphorus level was significantly improved at 12 hours, more than 1 mg/dL in all patients at 36 hours, and normal in six patients at 48 hours. The serum potassium level was never above normal, and serum calcium levels declined in only one patient. Administration of 9 mmole of phosphorus as KH 2 PO 4 every 12 hours is both safe and efficacious IV therapy for severe hypophosphatemia in the adult patient with normal renal function and without hyperkalemia or hypercalcemia. ( Arch Intern Med 1981;141:885-887)

Efficacy of intravenous phosphorus therapy in the severely hypophosphatemic patient.

Background: Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion. Purpose: The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine. Methods: Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students’ attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course. Results: Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as...

Meeting the Family: Promoting Humanism in Gross Anatomy

To evaluate the efficacy and safety of a simple approach to intravenous phosphorus therapy, we prospectively studied ten adult patients with severe hypophosphatemia (less than or equal to 1 mg/dl), two or more clinical reasons for the hypophosphatemia, and normal renal function. They were treated with a solution containing 0.32 mmol of phosphorus per kilogram of body weight. This amount of phosphorus was infused intravenously over 12 hours and repeated every 12 hours until the serum phosphorus was greater than or equal to 2 mg/dl. The serum phosphorus, potassium, magnesium, and calcium levels were measured at six hours, 12 hours, and every 12 hours thereafter. The serum phosphorus level was greater than or equal to 2 mg/dl in one patient at six hours, three patients at 12 hours, three patients at 24 hours, four patients at 36 hours, and one patient at 48 hours. The serum calcium was measured every 12 hours and at no time was any patient dangerously hypocalcemic. Administration of 0.32 mmol of phosphorus per kilogram of body weight intravenously over a 12-hour period is both efficacious and safe in severely hypophosphatemic patients with multiple causes of hypophosphatemia, normal renal function, and no hypercalcemia.

Jerry B. Vannatta

Papers

Predictors of clinical hypomagnesemia. Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia.

Blastocystis hominis Infection Presenting as Recurrent Diarrhea

Efficacy of intravenous phosphorus therapy in the severely hypophosphatemic patient.

Meeting the Family: Promoting Humanism in Gross Anatomy

High-dose intravenous phosphorus therapy for severe complicated hypophosphatemia