睿学教育Wisdome Education

Frank Seghatol-Eslami, MD, FASE

• Assistant Professor of Medicine
• Division of Cardiovascular Disease
• University of Alabama at Birmingham
• Birmingham, Alabama

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Urogenital hiatus Point Ap the measuring spatula is placed Again our imaginary man makes anteroposteriorly along the the 3cm trip up the posterior wall introitis and measures from the where he marks off point Ap menstruation urinalysis buy estrace no prescription. The urethral meatus to the midline of distance this point descends can the posterior hymen women's health center mccomb ms order estrace amex. The diagnosis in women two separate catheters are used with urinary incontinence based for flling and pressure recording women's health issues globally order 1 mg estrace overnight delivery. There is a large intra-abdominal pressure (Pabd) overlap between symptoms and and this pressure could therefore examination and urodynamic also be obtained by inserting the fndings. The cystometrogram usually gives 3 pressure tracings: becomes essential, in a number Pves (bladder pressure), Pabd of women, to enhance diagnostic (abdominal) and Pdet (detrusor accuracy and therefore enable us pressure). The Urodynamics system comprises two catheters, one placed in the the Procedure bladder and another in the rectum, a computer and the urodynamics the test comprises three software and pressure transducers, phases. Free fow phase are measuring appropriately, the woman is asked to arrive when the women coughs, there at the investigation with a full should be no deviation of the bladder. She is then asked to Pdet – only on the vesical line and void on the fowmeter, which is the abdominal line since these usually mounted on a commode, in are both under the infuence privacy. In other part of the test differs from the words, when there is a rise in voiding cystometry, which is done abdominal pressure with coughing, after the flling phase once the the same pressure is transferred bladder is full and the lines are in to the bladder. Bladder flling is commenced once the operator is satisfed that the tracing is technically correct. The patient is asked to report on her frst desire as well as the moment she has a strong desire to void. Filling phase include asking the woman to heel the bladder and rectal lines are bounce, wash hands and cough. The women trace by a fowmeter but if this is asked to cough to check that modality is not available on the the Pdet measurement is correct. If tolerate any more flling, the pump both the vesical and rectal lines is stopped, this is the maximum 24 cystometric capacity. Voiding Cystometry the voiding cystometry phase This is done by asking the patient and therefore parameters such to void while the pressures are as PdetQmax, the detrusor recorded. If the Detrusor pressure curve rises slowly during the flling phase, this would suggest poor compliance. The prevalence increases with the term “overactive bladder” increasing age being 4 percent in was proposed as a way of women younger than 25 years and approaching the clinical problem 30 percent in those older than 65 from a symptomatic rather than years. While not take into account the individual’s life threatening, it can have a lifestyle and any appropriate considerable adverse impact on interventions that can be the quality of lives of those who employed to minimize symptoms. In the past, clinical results investigations are undertaken to of treatment have often been ensure that the correct problem disappointing due to both to poor is being addressed. Urodynamic effcacy and unacceptable adverse studies will confrm (or otherwise) effects. Earlier preparations were a diagnosis of detrusor overactivity not subjected to the current in which case, further trials rigorous randomised controlled of different antimuscarinic trials and, therefore, lack evidence preparations would be desirable, – based data. Comparison of whereas in the absence of drug therapies for this condition proven detrusor overactivity, is diffcult due to the placebo an alternative diagnosis should effect of 30 – 40%, and since the be sought to avoid further response to any of the available ineffectual treatment and, hence drugs is only in the region of 60%, disillusionment and a waste of any differences that are detected resources. Data were are suggestive of urodynamically collected using a population – demonstrable detrusor overactivity, based survey of men and women but can be due to other forms of aged ≥ 40 years, selected from urethro – vesical dysfunction. This adversely affects their possibly because of the mistaken physical and psychological state by opinion that effective treatment is limiting daily activities, intimacy, not available. It is no surprise therefore that the management of improvements in urgency are often stated by people to be the most overactive bladder noticeable response to therapy. Despite sphincteric weakness and detrusor the diffculties, urgency and the overactivity. Data services play a pivotal role in obtained on the basis of 3 – or 4 the management of incontinent – day diaries suggest that short – patients. About 50% of people show positive results with existing gain satisfactory beneft from antimuscarinic therapy. The role of physiotherapy in the treatment of Initial assessment must include urge incontinence remains unclear a thorough history and physical as evidenced by systematic review examination. Urine analysis, and include lifestyle modifcations, microscopy and culture will exclude medications, bladder retraining, urinary infections. Lifestyle modifcations incontinence should commence • the patient should limit with conservative methods before intake of foods and drinks progressing to more complex that may irritate the bladder surgical procedures if these do not or stimulate the production work. Eat high fbre foods activity acting primarily on the such as wholewheat bread M1 and M3 receptor over the M2 and pastas.

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We cannot find complete genes for heavy and light Ig chain determination in the human genome menstruation research 2 mg estrace purchase otc, but each H and L chain are defined by a number of separate genes menstruation phases estrace 2 mg order. The heavy chain variable region has three domains: the V (variable) women's health clinic ringwood 2 mg estrace buy mastercard, D (diversity) and J (joining). These genes are inactive in the cells of non-immune organs and become active only during the T-and Bcell maturation. In the primary immune organs one from these genes (a V, a D and a J) are randomly combined and brought together that a new fusion exon is formed, which determines the H chain variable region. This process is called somatic gene rearrangement and somatic recombination (Figure 7. T-cell receptor somatic gene rearrangement takes place in similar manner that is observed in the case of immunoglobulins. On the other hand, there is somatic hypermutation by which random base-exchange mutations occur in the V region of B cells. This mechanism does not function in other cells, and other genes are not affected, only a ca. This only takes place during the activation of B cells: when it starts to divide after interacting with an antigen, © Sára Tóth. The cells binding the antigen best survive and divide more than the other B cells. This base mismatch not exactly repaired by a variety of mechanisms can result in a number of different mutations. Another case of somatic gene rearrangements is the immunoglobulin class switching. Each H gene contains the C regions of all 5 Ig classes in a chromosomal organization that the C region of IgM is closest to the V region. There is number of different C regions of the IgG and the IgA classes which are further divided into subclasses. Due to fact that the variable region will remain unchanged the antigen specificity will not change either. Its affinity towards the antigen remains unchanged only interacts with other effector molecules. Such diversification mechanisms often result in non-functional Ig genes: they contain either stop codons or the reading frame is shifted. In developing B cells a so-called allelic exclusion mechanism is used in which each B cell only produces one active L chain and one active H chain. However, if a non-functional Ig is created the cell then tries the next H or L gene. This process continues until the active H and L chains are completed, or until all of the genes had been tried (in this case, however, the cell die). Then, although the mutation affects only one gene, the varied symptoms are the consequences of defective methylation of many other genes, i. Genomics Although the science of genomics has a past of several decades, it became well-known only in the last 20 years even for the majority of natural scientists. It is one of the most rapidly developing scientific areas, but still for most people, even for physicians or pharmacists graduated before the 90s, it covers mainly unknown concepts. Because there is a difference between the female and male genomes, since males have two types of sex chromosomes (X and Y), in this definition we have to take this also into consideration. There are possibilities for a number of definitions, but perhaps the simplest is: Genomics is the study of the function, structure and interactions of the genome. Because in English a lot of terms in this area end with “omics”, omics has become a new synthetic term, and been used widespread in biology and related sciences (http:/en. In some definitions genomics is defined as the synonym of molecular systems biology, in which the life is studied on the level of genomic organizations. According to the subject of the genomics, there are several subtypes of genomics, like structural genomics, comparative genomics, plant genomics, human genomics, pharmacogenomics or medical genomics, etc.

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It is divided into two categories: Primary: The woman has never conceived in spite of having regular unprotected sexual intercourse for at least 12 months Secondary: The woman has previously conceived but is subsequently unable to conceive for 12 months despite regular unprotected sexual intercourse menopause natural treatment 2 mg estrace order. Primary amenorrhoea Defnition: Absence of menses at 14 years of age without secondary sexual development or age 16 with secondary sexual development Causes /Risk factors Hypothalamic –pituitary insufcience Ovarian causes Out fow tract/Anatomical womens health specialist stockbridge ga buy 2 mg estrace fast delivery. Dysmenorrhea Defnition: Dysmenorrhea is characterized by: Pain occurring during menstruation 3 women's health center peterborough estrace 2 mg purchase visa. Primary dysmenorrhea In adolscence with absence of pelvic lesions afer 6 months of menarche 6 months afer menarche with the onset of ovular cycles. Alternative • Combined oral estrogen-progestogen contraceptive continued 9-12 months leading to anovulatory cycles if symptoms improve • Surgical treatment: Interruption of pelvic pathway 3. Secondary dysmenorrhea Later in reproductive life Presence of pelvic lesion, such as uterine fbroids or endometrial polyps Pelvic lesions Dyspareunia (pain with intercourse) Pelvic/lower abdominal pain occurring before, during, afer menstruation Pelvic/lower abdominal pain occurring on days 1 and 2 of the menstrual cycle. It occurs mostly the last week before menstruation (premenstrual phase) resolving or markedly improving at menstruation Risk factors Hormone changes over a normal menstrual cycle ( excesses or defciencies of estrogen or progesterone) Side efects caused by the progestogen component of cyclical Hormonal Replacement Terapy Excessive Serotonin and β-endorphins secretion Exaggerated end-organ response to the normal cyclical changes in ovarian hormones. Hormonal therapy • Progesterone supplements (suppositories, pessaries, injections, oral micronized) Ș Duphaston 10mg tabs P. O Dose: 20mg Once daily 11th to 25th day of the menstrual cycle Ș Utrogetan 100mg tabs P. O Dose: 200mg Once daily 16th to 25th day of the menstrual cycle Ș Lutenyl 5mg tabs P. A normal menstrual period lasts 2-7 days and a normal cycle lasts between 21 and 35 days. O Dose: 20mg Once daily 11th to 25th day of the menstrual cycle Ș Utrogetan 100mg tabs P. Breast Cancer Defnition This is a malignant growth that begins in the tissue of the breast in which abnormal cells grow in an uncontrolled way. This is the most common and the second killer in women afer cervical cancer in the world, but can also appear in men. Endometrium cancer Defnition: Endometrium cancer is a growth of abnormal cells in the lining of the uterus, it usually occurs in postmenopausal women (age peak: 40 to 55 years). Ovarian cancer Defnition: Ovarian cancer is the leading cause of death of among all gyneacologic cancer worldwide. More than 90% of ovarian cancers are epithelial origin from the surface (coelomic) epithelium. Causes Age Primary ovarian failure Radiation and drugs Surgery Sheehan syndrome Signs and Symptoms “Hot fushes “(i. Cause Bacterial infections (polymicrobial) Signs and symptoms Asymptomatic Unpleasant fshy smelling vaginal discharges External genital irritation Dysuria. Recomandations Avoid alcohol during treatment with oral metronidazole and for 24 hours thereafer, due to possible disulfram-type reaction. Trichomonal vaginitis Defnition: Trichomonal vaginitis is an infammation of vagina and vulva. Signs and symptoms Dysuria Foul-smelling, frothy vaginal discharge that is most noticeable several days afer a menstrual period. Recommendations Advise sexual abstention until symptoms improve and partner(s) treated Avoid alcohol during treatment with oral metronidazole and for 24 hours thereafer, due to possible disulfram-type reaction. Vulvo-vaginal candidiasis Defnition: Vulvo-vaginal candidiasis is a fungal infammation of the vagina and vulva. Causes Fungus (candida albicans and non-albicans) Signs and symptoms Pruritis vulvae, Whitish curd-like vaginal discharge Vulval irritation Dyspareunia Dysuria. Subfertility, causes, treatment and aoutcomes, Best pract Res clin obstet gynae col,2003,17(2):169-185 3. American academy of family physicians, advanced life support in obstetrics, 2006, Chapter J: Post partum Hemmorhage. American College of Obstetrician and Gynecologists Commitee on Gynecologic Practice.

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During pregnancy this canal is filled with a mucous plug to protect the growing foetus from anything entering the uterus through the vagina menstruation blood color order estrace no prescription. As the cervix starts to dilate in the early stages of labour pregnancy x ray buy estrace with visa, this mucous plug becomes dislodged womens health recipes order estrace pills in toronto, and may be noticed as a slightly blood stained vaginal discharge (a show) by the mother. Provided medical care is readily available, it is probably the perfect solution to childbirth for both mother and child, but because critical problems can arise very rapidly during childbirth (eg. The mother may also require pain relief, particularly in a first birth, and the baby may require resuscitation. Birthing rooms, which have a homely ambience, but are attached to a maternity hospital, are ideal. Home births can be very risky, as even with a woman who has had no problems in previous births, unexpected problems may occur. In both sexes it is an erogenous area in that stimulation of the nipple is sexually stimulating, but in men it serves no other purpose. The nipple contains numerous small muscles that contract to make the nipple erect when stimulated by suckling, plucking, cold or anxiety. In women, 15 to 20 ducts from the milk glands in the breast open through the nipple. The nipple is surrounded by pigmented skin called the areola, which enlarges at puberty, and may darken further (chloasma) after pregnancy or hormonal medication use (eg. The areola contains sebaceous (oil) glands (Montgomery glands) that give it a bumpy appearance, particularly around its edge. Cancer of the breast (Paget’s disease of the nipple) can develop solely in the nipple. It usually starts a few days after the baby starts feeding and can be excruciatingly painful. Preparing the nipples for breastfeeding should lessen the likelihood of this problem. If a crack does appear, soothing creams are available from chemists or doctors to settle the problem, and often the baby will have to be fed from the other breast for a few days or with the aid of a nipple shield until the worst of the discomfort passes. At almost any time during pregnancy, but particularly late in pregnancy, the higher levels of hormones in the body may stimulate premature breast milk production. Hormones in the oral contraceptive pill, or hormone replacement therapy after the menopause, may over stimulate breast tissue to cause a discharge if the dose is too high. The pituitary gland under the brain sends signals to the ovaries to increase or decrease sex hormone (oestrogen) production. A tumour or cancer of the pituitary gland or ovaries may result in excessive hormone levels and breast milk production. Other causes of an abnormal nipple discharge include breast cancer that involves the milk ducts (brown or blood stained discharge), kidney failure (may prevent the excretion of the normal amount of oestrogen and the levels of hormone increase), under or over active thyroid gland (hypothyroidism and hyperthyroidism), Cushing syndrome (over production of steroids, or taking large doses of cortisone) and excessive stimulation of a woman’s nipples for a prolonged period of time may result in a reflex which increases oestrogen levels and results in milk production. Some non-hormonal medications may increase sex hormone production as a side effect. Examples include methyldopa and reserpine (used for serious high blood pressure) and tricyclic antidepressants. The nipple is also inverted if it retreats when the woman tries to express milk by hand. If a woman intends to breastfeed, the doctor will examine the breasts during an antenatal visit, and if the nipples are flat or inverted, a nipple shield may be worn to correct the problem. The shield fits over the nipple drawing it out gently, making it protrude enough for the baby to feed. Stimulating the nipple by rolling it between finger and thumb, and exposing the breasts to fresh air (but not direct sunlight) may also help. It is a shallow dish shape, has a tab handle on one edge and a hole in the centre through which the nipple partly protrudes. A nuchal translucency scan is a form of ultrasound scan that measures the amount of fluid in the nuchal cord in the neck of a foetus between weeks 11 and 14 of pregnancy. An abnormal result indicates a higher risk of the foetus having Down syndrome or other spinal cord defects (eg. It is usually combined with a blood test (triple tests) to measure hormone levels that may also be abnormal in women with a Down syndrome pregnancy. These tests are only indicative and an amniocentesis or chorionic villus sampling is necessary to confirm the diagnosis. Unfortunately, if an abnormality is found, there is no treatment available for the foetus, but the mother is given the option of an abortion.

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Cerebrovascular diseases Learning objectives: at the end of this lesson the student will be able to: 1 breast cancer treatments cheap estrace 1 mg on line. Definition: Syndrome of an abrupt onset of nonconvulsive breast cancer risk factors order genuine estrace online, focal neurologic deficit resulting from sudden interruption of the blood supply to parts of the brain menopause spotting purchase estrace once a day, lasting 24 hours or longer. Etiologic classification 1) Ischemic -stroke accounts for 80 – 90% of all stroke in developed countries a) Embolic b) Thrombotic i) Large vessel disease: resulting from narrowing of cerebral arteries doe to atherosclerosis. Vasculitis resulting thrombus formation 2) Hemorrhagic Stroke: accounts for 10-20 % of cerebrovascualr accidents in developed nations. It is third commonest cause of death in developed world following Coronary heart diseases and cancer. The prevalence and incidence of stroke is also on the rise in developing countries. Major risk factors associated with stroke include • Incidence is higher in men and old age • Hypertension • Smoking • Diabetic mellitus • Hyperlipidemia • Atrial fibrillation • Myocardial infarction • Congestive heart failure • Acute alcohol abuse Approach to a patient with stroke: Goals /Steps 1. Initial Assessment and maintenance of vital functions/stabilizing the patient Stroke should be considered as medical emergency, as it affects vital functions of an individual. For this reason the initial step in management of patients with acute stroke should be rapid assessment and maintenance of vital functions. This includes: 508 Internal Medicine a) Maintenance of air way and ventilation b) Control of blood pressure Acute stroke alters autoregulation of cerebral blood flow, compromising the blood supply to an already damaged brain. Close monitoring of blood pressure and correction of both hypotension and hypertension reduces this risk. Because fever worsens the prognosis of stroke body temperature should be controlled appropriately. Glucose is said to be neurotoxic and it is better avoided in patients with stroke. B Exclude causes of brain dysfunction, which mimic stroke like states like syncope, migraine, hysteria and trauma. Determine Presumptive Diagnosis of Stroke Subtype Numbers of clinical features are useful in determining the type of stroke. A good history taking, and proper physical examination may suggest the possible cause of the stroke. Important historical information includes: • Mode of onset and pattern of progression o Embolisms usually occur suddenly when the patient is awake, most often early in the morning, giving maximum deficit at onset. Very severe headache with altered consciousness without major neurologic deficit may suggest subarachnoid hemorrhage. Physical Examination • Physical Findings may give clue to the type of stroke the patient is suffering from. Confirmation of Diagnosis: different investigations are needed to confirm the diagnosis. Management of specific stroke Goal of Treatment • Interruption of further brain damage • Prevention and management of complication A. General Measures • Admit the patients where close follow up can be given • Continue follow up and maintenance of vital functions. Anticoagulation with heparin should be initiated when the acute phase of stroke is over. Rehabilitation: is a very important part of management, and it shall be started early and include:• Physiotherapy • Occupational and speech therapy. Impairment of consciousness and Coma Learning objectives: at the end of this lesson the student will be able to: 1. Introduction Maintenance of conscious state requires proper functioning of the cerebral hemispheres, reticular activating system found in brain stem and corticothalmic connections. If there is structural, metabolic or toxic insult of diffuse nature to these structures results in alteration of conscious level of different degree. Autonomic functions are relatively well maintained, and a sleep-wake cycle exists. The loss of consciousness in such patients is diffuse bilateral hemispheric impairment, and such patients have normal brainstem function.

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The metabolic events of starvation permit life to continue for months without calorie intake womens health associates boise estrace 1 mg purchase free shipping, depending on the prestarvation stage breast cancer hats purchase cheap estrace. The daily weight loss menstrual fever 2 mg estrace buy free shipping, can range from one pound to several pounds on the stage of starvation. Protein loss ensues, with substantial weight loss, the most easily recognized sign of starvation. Biochemical changes that occur in starvation: • glycogenolysis (hepatic) continues for about 16 hours 56 • hepatic gluconeogenesis takes place using amino acids (especially muscle protein, there is increased urea excretion) • as brain and other tissues use ketone bodies, glucose need is reduced. Ketone bodies also reduce glucose use by muscles, gluconeogenesis, protein catabolism and urine concentration decreases • glutamine is used by the kidney for gluconeogenesis • Proteins are spared to permit maximal starvation; survival requires of at least ½ of muscle proteins. Other Types of Atrophies Increased catabolism in prolonged fever or as result of severe trauma may cause skeletal muscle atrophy. Tumors and cysts of an organ may cause pressure atrophy due to interference with blood flow or function of the tissue, e. Hypoplasia Hypoplasia is a state of failure of the tissue to reach normal size during development. The affected individuals have short limbs, trunk relatively normal length, the head large with bulging forehead and scooped out nose. In some type of dwarfism, the cause may be the reduced production of growth hormone as in Lorain type dwarfism in which growth hormone receptors are defective in some instances cell loss may be due to infection or poisoning. Maternal rubella infection in first trimester may damage the fetal heart and a variety of embryonic defects related to development arrest involving all germ layers. Delayed and disturbed organ genesis produces structural defects of eye, brain, heart, and large arteries. In hypoxic environment with low oxygen tension, there is compensatory hyperplasia of red cells precursors and increased number of circulating red blood cells is an example of compensatory hyperplasia. Hyperplasia is usually found in tissues that have the capability for mitosis, such as epidermis. An example of physiological hyperplasia is the enlargement of the breast in pregnancy in response to hormonal stimulation of target; an abnormal hormonal stimulation of target cell; an abnormally thick endometrium with excessive estrogen; such endometrium may bleed frequently. Metaplsia Metaplasia implies change of one cell type to another that allows the new cells to tolerate environmental stress. In metaplasia there is transformation of one type of differentiated tissue into another. In heavy smokers the surface epithelium of the bronchi changes from normal ciliated pseudo stratified columnar epithelium to stratified squamous. In this example chronic irritation or injury result in adaptive changes in the surface epithelium to a type resistant to smoke. What makes the internal environment, indicate some important variables, to be ` ` maintained within normal range? Elaborate reflex mechanism • autonomic reflex • somatic reflex • endocrine reflex 11. Nerve and muscle cells are excitable tissues developed a specialized use for the membrane potential. Action potentials are brief reversals of membrane potential brought about by rapid changes in membrane permeability. It means separation of electric charges across the membrane, or to a difference in the relative number of cations and anions in the intracellular fluid and extracellular fluid. It is primarily due to differences in the distribution and membrane permeability of sodium, potassium and large intracellular anions. All living cells have a slightly excess of positive charges outside and a corresponding slight excess of negative charges on the inside of its membrane. This pump generates unequal transport for both positive ions, that creates a membrane potential with the outside becoming more positive than the inside. This active transport mechanism pumps three sodium ions out for two potassium ions pumped in. However, 61 most of the potential (80%) is caused by passive diffusion of potassium and sodium ions down their gradients. Concurrent potassium and sodium effects on membrane potential As potassium is more permeable at rest, it influences the resting membrane potential to a greater extent than does sodium. It is slightly less than potassium equilibrium potential because of the weak influx of sodium.

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Diagnosis of Amebic colitis  Gradual onset of bloody diarrhea  Abdominal pain  Fever  Spanning several weeks’ duration  Rectal bleeding without diarrhea can occur womens health newark ohio estrace 1 mg generic, especially in children  Fulminant or necrotizing colitis usually manifests as severe bloody diarrhea and diffuse abdominal pain with evidence of peritonitis and fever womens health problems purchase genuine estrace on line. Children (below 10 years) 35 – 50mg/kg/d in 3 divided doses ehealthforum.com › womens health › birth control forum order on line estrace, indicatively: 1-3 years 100-200mg 8 hourly for 5 10 days ; 3-7 years 100-200mg 6 hourly for 5 -10 days; 710 years200-400mg 8 hourly for 5 -10 days Second choice C: Tinidazole (O): Adult 2g daily as a single dose for 3 consecutive days. Children (below 12 years to 1 year) 30mg/kg as a single dose Diagnosis of Amoebic liver abscess  Fever, right upper quadrant pain, and tenderness of less than 10 days’ duration. Treatment Drug of choice: A: Metronidazole ; Adult 400-800mg (O) 8 hourly for 10 days. In few cases malabsorption syndrome may occur  Extra intestinal manifestations are rare and include allergic manifestations such as urticaria, erythema multiform, bronchospasm, reactive arthritis, and biliary tract disease Investigation: Microscopic stool examination of Giardia intestinalis trophozoites or cysts of infected patient, sensitivity increases on serial 3 samples examination. Indicatively: 1-3 years 500mg/day; 3-7 years 600-800 mg/day; 7-10 years 1g/day for 3 days. Diagnosis  Most patients are asymptomatic  When symptoms occur, they are divided into 2 categories: early (larval migration) and late (mechanical effects)  In the early phase (4-16 days after egg ingestion): Fever, Nonproductive cough, Dyspnea, Wheezing. It is one of the main causes of anaemia in the tropics which is also the major clinical feature. Diagnosis  the majority of patients are asymptomatic 38 | P a g e  the major clinical manifestations are iron deficiency anemia and hypoalbuminaemia. The most common and clinically important pathogenic species in humans is S stercoralis. Distinctive characteristic of this parasite is its ability to persist and replicate within a host for decades while producing minimal or no symptoms in individuals with an intact immune system and its potential to cause life-threatening infection (hyperinfection syndrome, disseminated strongyloidiasis) in an immunocompromised host associated with high mortality rates. Children give the same dose same as for adults Note: Tablets must be chewed Alternatively A: Albendazole: Adults 400mg (O) 12 hourly for 3 days, the medicines may be repeated after 3weeks. Children over 2 years give 15mg/kg/day in 2 divided doses for 3 days (7-10 days for disseminated infection) Note:  Provide antibiotic therapy directed toward enteric pathogens if bacteremia or meningitis is present or suspected  Provide supportive treatment as indicated (eg, intravenous fluids if volume depletion, blood transfusion if gastrointestinal or alveolar hemorrhage, mechanical ventilation if respiratory failure)  Symptomatic treatment should be initiated 40 | P a g e  Pruritic dermatologic manifestations should be treated with antihistamines  Inhaled beta-agonists may improve wheezing 1. Less commonly cestode includes Diphyllobohrium latum (poorly cooked fish) and Hymenolepsis nana (fecal oral contamination by both human and animals especially dogs). Diagnosis  Most tape worm infections are symptomless  the commonest way of presentation is the appearance of proglottides or segments in the stool  There may be mild epigastric discomfort, nausea, weight loss and diarrhea  More specific features depend on the type of the parasite Laboratory Diagnosis: Macro and Microscopic stool examination for ova and parasites. It is indicated for some of the cestodes that release eggs or worm segments directly into the stool. Children 2-6 years, 1g as a single dose after a light meal, followed by a purgative after 2 hours; Children under 2 years, 500mg as a single dose after a light meal, followed by a purgative after 2 hours 41 | P a g e For Hymenolepsis nana Adult and children over 6 years C: Niclosamide 2g as a single dose on the first day, then 1g daily for 6 days. Children 2-6 years C: Niclosamide 1g on the first day as a single dose, then 500mg once daily for 6 days. Latum Adults and children over 2 years C: Niclosamide 510mg/kg as a single dose. A: Albendazole 400mg every 12 hours is recommended for 1-3 months before surgical intervention. Note:  Administer parenteral vitamin B-12 if evidence of vitamin B-12 deficiency occurs with Diphyllobothrium infections  Tablets should be chewed thoroughly before washing down with water. Diagnosis  the clinical manifestation and duration of illness vary markedly from one patient to another 42 | P a g e  the major clinical features are fever, severe headache, drowsiness and muscle pains (myalgia)  the course of paratyphoid tend be to shorter and less severe compared to typhoid  Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death  Survivors may be left with long-term or permanent neuropsychiatric complications. Laboratory diagnosis: the diagnosis of typhoid fever (enteric fever) is primarily clinical. Culture is the criterion standard for diagnosis of typhoid fever with 100% specificity. Culture of bone marrow aspirate; blood and stool cultures should be done within 1 week of onset. Chloramphenicol is contraindicated in the third trimester of pregnancy; it may also cause aplastic anaemia which is irreversible. Infection is through the larval forms of the parasite which is released by freshwater snails. Some of the eggs are passed out of the body in the feces or urine to continue the parasite life-cycle. Others become trapped in body tissues, causing an immune reaction and progressive damage to organs. Diagnosis Schistosoma mansoni  There may be abdominal pain and frequent blood stained stool 43 | P a g e  In chronic form of Schistosoma mansoni; abdominal distention, and vomiting of blood and liver fibrosis (Portal hypertension)  People co-infected with either hepatitis B or C and S mansoni have been shown to have rapid progression of liver disease.

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Attack rate = 90 X 100 = 90 cases of diarrhea per 100 people 100 That means out of 100 people who ate the food served by Ato Alemitegnaw menstruation weight gain order 2 mg estrace, 90 of them developed diarrhea on Tir 8 menstruation gingivitis buy cheap estrace on-line, 1995 menopause 60 years purchase 1 mg estrace free shipping. Uses incidence rate Incidence rate is important as a fundamental tool for etiologic studies of diseases since it is a direct measure of risk. If the incidence rate is 36 significantly higher in one area, then the cause of that disease can be systematically searched. Prevalence rate Prevalence rate measures the number of people in a population who have a disease at a given time. Point Prevalence rate: measures the proportion of a population with a certain condition at a given point in time. Point Prevalence rate = All persons with a specific Condition at one point in time X K Total population Example: One health extension worker conducted a survey in one of the nearby elementary schools on Hidar 10, 1996 to know the prevalence of trachoma in that school. Point prevalence rate= 100 X 100 = 50 trachoma patients per 100 students 200 on Hidar10,1996 That means 50 % of the students in that elementary school were affected by trachoma on Hidar 10, 1996. Uses of prevalence rate Planning health facilities and human resource Monitoring chronic disease control programs like tuberculosis control program 6. Rates whose denominators are the total population are commonly calculated using either the mid interval population or the average population. This is done because population size fluctuates over time due to births, deaths and migration. Population count at the beginning + Population count Average population = at the end of the time interval considered 2 38 Below are given some formulas for the commonly used mortality rates and ratios. Thus, it is high among people who have little health care, chiefly because infections, such as pneumonia, diarrhea and malaria, are common among their infants. That means out of 1000 live births about 97 die before they celebrate their first birth day. Example: In 1996 the total number of children under 5 years of age was 10,000 in “Zone C”. The Maternal Mortality Rate in Ethiopia is estimated to be 871 per 100,000 live births. That means in 100,000 live births, around 871 mothers die each year due to pregnancy related causes. Exercise: 43 the following information is about kebele X which was collected for the year 1999: – Total average population = 40,000 – Total number of live births = 4000 – Total number of deaths = 400 – Total number of deaths before the age of 28 days = 50 – Total number of infant deaths = 200 – Number of women who died from pregnancy related causes = 160 – New cases of tuberculosis = 100 – All cases of tuberculosis = 300 – Deaths from tuberculosis = 60 Based on the above information calculate the following. Sources of Data There are different sources of data on health and health related conditions in the community. The information obtained from these sources is used for health planning, programming and evaluation of health services. Census data are necessary for accurate description of population’s health status and are principal source of denominator for rates of disease & death. It provides information on: Size and composition of a population the trends anticipated in the future. Data was collected on: Age, sex and size of the population Mortality, fertility Language, ethnicity Housing From these data different health indices could be calculated. Crude birth rate, crude death rate, age specific mortality rate and sex specific mortality rate are some of the examples of the indicators that could be calculated. Vital statistics: This is a system by which all births and deaths occurring nationnwide are registered, reported and compiled centrally. There is no nationwide birth and death registration system in Ethiopia but the system should be established in the future. The main characteristics of vital statistics are: Comprehensive – all births and deaths should be registered. Health Service Records All health institutions report their activities to the Ministry of Health through the regional health bureaus. Advantages: Easily obtainable Available at low cost Continuous system of reporting Causes of illness and death available. Notification of Infectious Diseases There are some internationally notifiable diseases. The major problems related to this source (health service records) are low compliance and delays in reporting. Health Surveys Health surveys are studies conducted on a representative sample population to obtain more comprehensive data for monitoring the health status of a population.

Daryl, 60 years: Associated with parasitic infection, allergic conditions, hypersensitivity reactions, cancer, and chronic inflammatory states.

Hernando, 31 years: The particular mechanism that leadstoquantitative e?ects on neutralization remains unclear.

Phil, 53 years: Either way, armed with estimates of θa, θ1, θ2, M1, M2, and T you can say something about: (1) the effective population sizes of the two populations relative to one another and relative to the ancestral population, (2) the relative frequency with which migrants enter each of the two populations from the other, and (3) the time at which the two populations diverged from one another.

Surus, 38 years: The learning activities are designed to further develop your knowledge and are also practical and useful.

Ketil, 33 years: Des Plaines, Ill: American Assosafe method for the initial diagnostic evaluation and ciation for Automotive Medicine, 1990.

Kaelin, 58 years: However, research on smoking disorders and addiction involving opioids or cessation interventions in populations with cosedatives as well.

Pakwan, 56 years: Federal agencies teach pharmacology to graduate, medical, pharmacy, such as the National Institutes of Health and the veterinary, dental, or undergraduate students.

Kamak, 54 years: We’ll talk about this more in just a moment when we get to Weir and Cockerham’s statistics.

Jared, 21 years: The Incidence of Diabetes th Historically, achievements in public health over the 20 century have shifted the focus from communicable diseases to chronic diseases such as 1 diabetes.

Roland, 25 years: Palms and Soles Usually involved, with massive hyperkeratosis and deep fissures in pityriasisrubra pilaris, Sézary’s syndrome, and psoriasis.

References

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