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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Brian G. Blackburn, MD
Fortunately depression scrip definition escitalopram 10 mg with amex, these figures should decrease as public health programs using preventive interventions with iodized oil (oral or intramuscular injection) salt depression symptoms after death of loved one buy escitalopram 20mg line, bread bipolar depression laziness buy escitalopram 20mg amex, water mood disorder youth order 20 mg escitalopram fast delivery, or even sugar have an impact. Toxicity A wide range of iodine intakes is tolerated by most individuals, owing to the ability of the thyroid to regulate total body iodine. Over 2 mg iodine/day for long periods should be regarded as excessive or potentially harmful to most people. Such high intakes are unlikely to arise from natural foods, except for diets that are very high in seafood and/or seaweed or comprising foods contaminated with iodine. Iodine-induced thyrotoxicosis (hyperthyroidism) and toxic nodular goiter may result from excess iodine exposure in these individuals. Hyperthyroidism is largely confined to those over 40 years of age and symptoms are rapid heart rate, trembling, excessive sweating, lack of sleep, and loss of weight and strength. Individuals who are sensitive to iodine, usually have mild skin symptoms, but very rarely fever, salivary gland enlargement, visual problems, and skin problems, and, in severe cases, cardiovascular collapse, convulsions, and death may occur. The occurrence of allergic symptoms, for example to iodine medications or antiseptics, however, is rare. It is characterized by goiter and profound deafness in childhood and is caused by mutations in the Pendrin gene located on chromosome 7. The gene codes for pendrin, a transporter protein for chloride/ iodine transport across the thyroid apical membrane. Assessing status the critical importance of iodine for the thyroid indicates that iodine status is assessed by thyroid function. Concentrations of T4 decline in more severe iodine deficiency whereas T3 concentrations decline only in the most severe of iodine deficiencies. Dietary intakes and requirements Requirements in infancy and childhood range from 40 to 150 g iodine/day. Adult requirements are estimated at 150 g iodine/day, increasing to 175 and 200 g/day for pregnancy and lactation. Under normal circumstances, about 90% of iodine intake is from food, with about 10% from water. The concentration of iodine in most foods is low and, in general, reflects the iodine content of the soil, water, and fertilizers used in plant and animal production. Seafoods and seaweed concentrate iodine from seawater and are particularly rich sources. In some populations, milk has become a major source of iodine, owing to the use of iodized salt licks and iodine-enriched cattle feed for dairy herds. Minor amounts may come from adventitious contamination from iodophor disinfectants (teatdip). Iodine-enriched cattle feed will also increase the iodine content of meat for beef herds raised on concentrated feedstuffs. Processed foods contribute some additional iodine from food additives, such as calcium iodate used in the baking industry. Micronutrient interactions From a public health viewpoint, the most important metabolic interaction of iodine with other micronutrients is with selenium. Adequate selenium status is essential for thyroid hormone metabolism and, therefore, normal growth development, by ensuring sufficient T3 supply to extrathyroidal tissues. In addition, both nutrients are required for normal reproduction, normal gene expression, synthesis of zenobiotic and metabolizing enzymes in the liver, and normal tolerance against cold stress. It is possible that hypothyroidism associated with suboptimal selenium status may explain some of the etiology of cardiovascular disease and certain cancers. Hypothyroidism is associated with deficiencies of other trace elements, including zinc, iron, and copper, 226 Introduction to Human Nutrition while there are close metabolic relationships at the molecular and transport levels between iodine and vitamin A. Manganese is a component of numerous complex minerals, including pyroluosite, rhodochrosite, rhodanite, braunite, pyrochite, and manganite. Chemical forms of manganese in their natural deposits include oxides, sulfides, carbonates, and silicates. Anthropogenic sources of manganese are predominantly from the manufacturing of steel, alloys, and iron products. Manganese is also widely used as an oxidizing agent, as a component of fertilizers and fungicides, and in dry cell batteries. The permanganate is a powerful oxidizing agent and is used in quantitative analysis and medicine. It can exist in 11 oxidation states from -3 to +7, with the most common valences being +2, +4, and +7. The +2 valence is the predominant form in biological systems, the +4 valence occurs in MnO2, and the +7 valence is found in permanganate. Absorption, transport, and tissue distribution the total amount of manganese in the adult human is approximately 15 mg. Up to 25% of the total body stores of manganese may be located in the skeleton and may not be readily accessible for use in metabolic pathways. Relatively high concentrations have been reported in the liver, pancreas, intestine, and bone. Intestinal absorption of manganese occurs throughout the length of the small intestine. Mucosal uptake appears to be mediated by two types of mucosal binding, one that is saturable with a finite capacity and one that is nonsaturable. Manganese absorption, probably as Mn2+, is relatively inefficient, generally less than 5%, but there is some evidence of improvement at low intakes. High levels of dietary calcium, phosphorus, and phytate impair the intestinal uptake of the element but are probably of limited significance because, as yet, no well-documented case of human manganese deficiency has been reported. Systemic homeostatic regulation of manganese is brought about primarily through hepatobiliary excretion rather than through regulation of absorption. Manganese is taken up from blood by the liver and transported to extrahepatic tissues by transferrin and possibly 2-macroglobulin and albumin. Urinary excretion of manganese is low and has not been found to be sensitive to dietary manganese intake. Metabolic function and essentiality Manganese is required as a catalytic cofactor for mitochondrial superoxide dismutase, arginase, and pyruvate carboxylase. It is also an activator of glycosyltransferases, phosphoenolpyruvate carboxylase, and glutamine synthetase. Deficiency symptoms Signs of manganese deficiency have been demonstrated in several animal species. Symptoms include impaired growth, skeletal abnormalities, depressed reproductive function, and defects in lipid and carbohydrate metabolism. It has been suggested that manganese deficiency has never been observed in noninstitutionalized human populations because of the abundant supply of manganese in edible plant materials compared with the relatively low requirements of mammals. A male subject was fed a purified diet deficient in vitamin K, which was accidentally also deficient in manganese. Feeding this diet caused weight loss, dermatitis, growth retardation of hair and nails, reddening of black hair, and a decline in concentrations of blood lipids. Manganese deficiency may be more frequent in infants owing to the low concentration of manganese in human breast milk and varying levels in infant formulae. Toxicity has been observed only in workers exposed to high concentrations of manganese dust or fumes in air. For example, mine-workers in Chile exposed to manganese ore dust developed, Minerals and Trace Elements 227 possibly as a result of inhalation rather than ingestion, "manganic madness," manifested by psychosis, hallucinations, and extrapyramidal damage with features of parkinsonism. Assessing status Progress in the field of manganese nutrition has been hampered because of the lack of a practical method for assessing manganese status. Blood manganese concentrations appear to reflect the body manganese status of rats fed deficient or adequate amounts of manganese, but consistent changes in blood or plasma manganese have not been observed in depleted or repleted human subjects. Concentrations of manganese in crops are dependent on soil factors such as pH, whereby increasing soil pH decreases plant uptake of manganese. Products of animal origin such as eggs, milk, fish, poultry, and red meat contain low amounts of manganese (Table 9. Insoluble molybdenum compounds include molybdenum dioxide and molybdenum disulfide.
The translation of evidence into practice can be advanced through the use of shared decision-making since shared decision-making results in evidence being incorporated into patient and clinician consultations depression tumblr buy escitalopram 20 mg overnight delivery. Evidence-based guidelines may recommend the use of shared decision-making for decisions in instances where the evidence is equivocal depression kid generic 10 mg escitalopram with amex, when patient action or inaction (such as medication adherence or lifestyle changes) can impact the potential outcome depression lies buy cheap escitalopram 10mg on-line, or when the evidence does not indicate a single best recommendation anxiety 6 weeks postpartum discount escitalopram 10 mg fast delivery. It is ideal to involve caregivers and family members in these conversations as well. Family members and caregivers can participate in discussions, ask questions, hear content the patient may miss and provide invaluable support in decision follow-through. Although only patients and clinicians are specifically mentioned throughout this document for brevity purposes, this does not diminish the importance of caregivers and families in patient-centered care. Both the patient and the clinician bring expertise to the shared decision-making conversation. When conversations discussing options occurs, patients and clinicians are actively engaged while considering the attributes and issues of the available options. This empathic approach results in the clinician and patient co-creating a decision and a plan of care (adapted from Montori, V. Decision aids can be supportive of this conversation when they communicate the best available evidence to inform the patient and clinician discussion. Without a conversation, clinicians may make assumptions about what the patient prefers. Difficulty in initiating a conversation is cited by patients and clinicians as one of the barriers to shared decision-making. These skills need to be used artfully to address all aspects of the person involved in making a decision: cognitive, affective, social and spiritual. Listening skills Encourage patient to talk by providing prompts to continue such as go on, and then? The clinician should use their own words rather than just parroting what they heard. Reflection of feelings usually can be done effectively once trust has been established. The clinician should condense several key comments made by the patient and provide a summary of the situation. This assists the patient in gaining a broader understanding of the situation rather than getting mired down in the details. The most effective times to do this are midway through and at the end of the conversation. An example of this is "You and your family have read the information together, discussed the pros and cons, but are having a hard time making a decision because of the risks. Questioning Skills Diagnosis and Treatment of Osteoporosis Ninth Edition/July 2017 Open and closed questions are both used, with the emphasis on open questions. Open questions ask for clarification or elaboration and cannot have a yes or no answer. Verbal tracking, referring back to a topic the patient mentioned earlier, is an important foundational skill (Ivey & Bradford-Ivey). Information-Giving Skills Providing information and providing feedback are two methods of information giving. Information giving allows a clinician to supplement his or her knowledge and helps to keep the conversation patient centered. More than one of these opportunities may present at a time, and they will occur in no specific order. Table 1 Return to Table of Contents Institute for Clinical Systems Improvement Diagnosis/prognosis changes: Additional diagnoses, improved or worsening prognosis. Change or decline in health status: Improving or worsening symptoms, change in performance status or psychological distress. Change or lack of support: Increase or decrease in caregiver support, change in caregiver, change in caregiver status, change in financial standing, difference between patient and family wishes. Disease progression: Change in physical or psychological status as a result of the disease progression. Clinician/caregiver contact: Each contact between the clinician/ caregiver presents an opportunity to reaffirm with the patient that the care plan and the care he or she is receiving are consistent with his or her values. Request for support and information: Decisional conflict is indicated by, among other things, the patient verbalizing uncertainty or concern about undesired outcomes, expressing concern about choice consistency with personal values, or exhibiting behavior such as wavering, delay, preoccupation, distress or tension. Support resources may include health care professionals, family, friends, support groups, clergy and social workers. When patient expresses a need for information regarding options and their potential outcomes, the patient should understand the key facts about the options, risks and benefits, and have realistic expectations. Advance Care Planning: With the diagnosis of a life-limiting illness, conversations around advance care planning open up. This is an opportune time to expand the scope of the conversation to other types of decisions that will need to be made as a consequence of the diagnosis of a life-limiting illness. Consideration of Values: the personal importance a patient assigns potential outcomes must be respected. If the patient is unclear how to prioritize his or her preferences, value clarification can be achieved through the use of decision aids, detailing the benefits and harms of potential outcomes in terms of how they will directly affect the patient, and through collaborative conversations with the clinician. Trust: the patient must feel confident that his or her preferences will be communicated to and respected by all caregivers. Care Coordination: Should the patient require care coordination, this is an opportune time to discuss the other types of care-related decisions that need to be made. Further, the care delivery system must be capable of delivering coordinated care throughout the continuum of care. It helps get the shared decision-making process initiated and provides navigation for the process. Patients use the map to prepare for decision-making, to help guide them through the process and to share critical information with their loved ones. Measuring shared decision-making remains important for continued adoption of shared decision-making as a mechanism for translating evidence into practice; promoting patient-centered care; and understanding the impact of shared decision-making on patient experience, outcomes and revenues. These two tools measure different aspects of shared decision-making, as described below. In other words, it provides information on how likely a patient may be experiencing decisional conflict. Shared decision-making is a useful mechanism for translating evidence into practice. This committee has adopted the Institute of Medicine Conflict of Interest standards as outlined in the report, Clinical Practice Guidelines We Can Trust (2011). Where there are work group members with identified potential conflicts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Conflict of Interest committee or requested by the work group. Funding Source the Institute for Clinical Systems Improvement provided the funding for this guideline revision. The goal of this report is to solicit feedback about the guideline, including but not limited to the algorithm, content, recommendations and implementation. The public is invited to comment in an effort to get feedback prior to its finalization. The work group would like to thank all those who took time to thoughtfully and thoroughly review our draft and submitted comments for the Diagnosis and Treatment of Osteoporosis. No invited review was done for the Diagnosis and Treatment of Osteoporosis guideline. Patient advisors who serve on the council consistently share their experiences and perspectives in either a comprehensive or partial review of a document. Monahan was initially a member of the work group but due to changes in employment during the revision, could no longer participate as a work group member. Following the review, the guideline was updated to include information on abaloparatide. Patients and families are urged to consult a health care professional regarding their own situation and any specific medical questions they may have. Document Development and Revision Process the development process is based on a number of long-proven approaches and is continually being revised based on changing community standards.
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In 1941 prenatal depression symptoms uk discount 20mg escitalopram, a group of leading physiologists depression names order escitalopram 5mg without prescription, biochemists and medical scientists recognized that the emerging discipline of nutrition needed its own learned society and the Nutrition Society was established mood disorder in children buy discount escitalopram 20mg on line. Our mission was depression analysis test buy 20mg escitalopram with amex, and remains, "to advance the scientific study of nutrition and its application to the maintenance of human and animal health". The Nutrition Society is the largest learned society for nutrition in Europe and we have over 2000 members worldwide. You can find out more about the Society and how to become a member by visiting our website at We now have the opportunity to obtain a much better understanding of how specific genes interact with nutritional intake and other lifestyle factors to influence gene expression in individual cells and tissues and, ultimately, affect our health. Knowledge of the polymorphisms in key genes carried by a patient will allow the prescription of more effective, and safe, dietary treatments. At the population level, molecular epidemiology is opening up much more incisive approaches to understanding the role of particular dietary patterns in disease causation. This excitement is reflected in the several scientific meetings that the Nutrition Society, often in collaboration with sister learned societies in Europe, organizes each year. We provide travel grants and other assistance to encourage students and young researchers to attend and participate in these meetings. Throughout its history a primary objective of the Society has been to encourage nutrition research and to disseminate the results of such research. Our first journal, the Proceedings of the Nutrition Society, recorded, as it still does, the scientific presentations made to the Society. Shortly afterwards, the British Journal of Nutrition was established to provide a medium for the publication of primary research on all aspects of human and animal nutrition by scientists from around the world. Recognizing the needs of students and their teachers for authoritative reviews on topical issues in nutrition, the Society began publishing Nutrition Research Reviews in 1988. In 1997, we launched Public Health Nutrition, the first international journal dedicated to this important and growing area. All of these journals are available in electronic, as well as in the conventional paper form and we are exploring new opportunities to exploit the web to make the outcomes of nutritional research more quickly and more readily accessible. To protect the public and to enhance the career prospects of nutritionists, the Nutrition Society is committed to ensuring that those who practice as nutritionists are properly trained and qualified. Graduates with appropriate degrees but who do not yet have sufficient postgraduate experience can join our Associate Nutritionist registers. We undertake accreditation of university degree programs in public health nutrition and are developing accreditation processes for other nutrition degree programs. Just as in research, having the best possible tools is an enormous advantage in teaching and learning. This is the reasoning behind the initiative to launch this series of human nutrition textbooks designed for use worldwide. This was achieved by successfully launching the first series in multiple languages including Spanish, Portuguese and Greek. The Society is deeply indebted to Professor Mike Gibney and his team of editors for their tireless work in the last 10 years to bring the first edition of this series of textbooks to its successful fruition worldwide. We look forward to this new edition under the stewardship of Dr Susan Lanham-New in equal measure. Professor Ian McDonald President of the Nutrition Society Preface the Nutrition Society Textbook Series started ten years ago as an ambitious project to provide undergraduate and graduate students with a comprehensive suite of textbooks to meet their needs in terms of reference material for their studies. By all accounts the project has been successful and the Nutrition Society Textbook Series have been adapted by all of the best academic nutrition units across the globe. This second edition of Introduction to Human Nutrition is an update of the very basic foundations for the study of human nutrition. Although little has changed, all authors have made whatever updates are necessary and we have made some re-arrangements of some chapters. The study of human nutrition at universities across the globe is rapidly expanding as the role of diet in health becomes more evident. Indeed, the sequencing of the human genome has highlighted the narrower range of genes controlling human biology, emphasising the critically important role of the environment including diet in human health. Moreover, we now recognize the important role that diet plays in interacting with our genome both in utero and in the immediate period of post natal development. The study of human nutrition needs a solid base in the physiology and biochemistry of human metabolism and that is the basis of the textbook Nutrition and Metabolism. Firstly, many will use this book as an introduction to human nutrition and go no further. Students in pharmacy, food science, agriculture and the like may take introductory modules to human nutrition and leave the subject there but be well informed in the area. Those who will go on to study human nutrition will find within this textbook an introduction to the many areas of diet and health that they will go on to study in greater depths using the remaining textbooks in the Nutrition Society series. Besides the basic biology, students will be introduced to the concept of food policy and to the dual challenges to the global food supply, both over and under nutrition. As I write, I am handing over the leadership of the Nutrition Society Textbook Series to Dr Susan Lanham-New at the University of Surrey who has agreed to take on this important task for the Society. I would like to thank all those with whom I have worked with on this project and to wish Sue and her new team all the very best. Very special thanks must go to Mike Gibney and Julie Dowsett, for their effort and dedication in seeing this textbook of the second edition through to publication. It can be used to promote health and well-being, to prevent illhealth and to treat disease. There are, however, many areas where more information is needed to solve global, regional, communal and individual nutrition problems. As apprentices in nutrition science and practice students will learn how to collect, systemize, and classify knowledge by reading, experimentation, observation, and reasoning. For millions of years the quest for food has helped to shape human development, the organization of society and history itself. It has influenced wars, population growth, urban expansion, economic and political theory, religion, science, medicine, and technological development. During this period, nutrition was studied from a medical model or paradigm by defining the chemical structures and characteristics of nutrients found in foods, their physiological functions, biochemical reactions and human requirements to prevent, first, deficiency diseases and, later, also chronic noncommunicable diseases. Since the late 1980s nutrition has experienced a second renaissance with the growing perception that the knowledge gained did not equip mankind to solve the global problems of food insecurity and malnutrition. The emphasis shifted from the medical or pathological paradigm to a more psychosocial, behavioral one in which nutrition is defined as a basic human 2 Introduction to Human Nutrition right, not only essential for human development but also as an outcome of development. In this first, introductory text, the focus is on principles and essentials of human nutrition, with the main purpose of helping the nutrition student to develop a holistic and integrated understanding of this complex, multifaceted scientific domain. For an understanding of how humans obtain and utilize foods and nutrients from a molecular to a societal level, and of the factors determining and influencing these processes, the study and practice of human nutrition involve a spectrum of other basic and applied scientific disciplines. These include molecular biology, genetics, biochemistry, chemistry, physics, food science, microbiology, physiology, pathology, immunology, psychology, sociology, political science, anthropology, agriculture, pharmacology, communications, and economics. Nutrition departments are, therefore, often found in Medical (Health) or Social Science, or Pharmacy, or Agriculture Faculties at tertiary training institutions. The multidisciplinary nature of the science of nutrition, lying in both the natural (biological) and social scientific fields, demands that students of nutrition should have a basic understanding of many branches of science and that they should be able to integrate different concepts from these different disciplines. It implies that students should choose their accompanying subjects (electives) carefully and that they should read widely in these different areas. For this, a conceptual framework of the multidisciplinary nature of nutrition science and practice may be of value. Such a concep- tual framework, illustrating the complex interactions between internal or constitutional factors and external environmental factors which determine nutritional status and health, is given in Figure 1. For example, glucose, a carbohydrate macronutrient, increases transcription for the synthesis of glucokinase, the micronutrient iron increases translation for the synthesis of ferritin, while vitamin K increases post-translational carboxylation of glutamic acid residues for the synthesis of prothrombin. Nutrients, therefore, influence the synthesis of structural and functional proteins, by influencing gene expression within cells. Nutrients also act as substrates and cofactors in all of the metabolic reactions in cells necessary for the growth and maintenance of structure and function.
Red cell counts may reveal erythrocytosis and elevated hematochrit in chronic hypoxemic patients depression test black dog buy escitalopram 5 mg with amex. The pattern of physiologic abnormality in each patient depends to some extent on the relative severity of intrinsic bronchial disease and emphysema depression storage hydrology definition buy cheap escitalopram 20mg online. In patients with chronic bronchitis depression jw.org purchase 5mg escitalopram overnight delivery, severe hypoxemia may be noted relatively early depression symptoms health canada 10mg escitalopram for sale. Avoidance of bronchial irritants, especially cessation of smoking, is of primary importance. The course can be repeated at the first sign of recurrence of bronchial infection. Oxygen should be given in such patients with hypoxia, and in severe cases a portable oxygen therapy (16 hrs /day) for home use is recommended. Antidepressants may be necessary but they should be used cautiously to avoid sedation. If sputum becomes purulent, a course of broad-spectrum antibiotics should be given. Phlebotomy 189 Internal Medicine should be done when the hematocrit level is very high (above 55%) and patients are symptomatic. Design appropriate methods of prevention of bronchiectasis Definition: It is a pathologic, irreversible destruction and dilatation of the wall of bronchi and bronchioles, usually resulting from suppurative infection in an obstructed bronchus. The sputum typically forms three layers when collected in a glass container: the upper layer is foam (mucus), the middle one is liquid and the lower one is sediment. In advanced disease patients have progressive dyspnea, massive hemoptysis and cough occurs at any time of the day and produces large volume of khaki colored sputum with accompanying cyanosis and clubbing. Obtaining a history of recurrent pulmonary infections ultimately followed by chronic recurrent cough and production of copious purulent sputum may suggest a diagnosis of bronchiectasis. Additional findings like cyanosis, clubbing and signs of right heart failure appear late. Chest x-ray usually shows peribronchial fibrosis or it can have a honeycomb appearance. Segmental lung collapse may be observed in parts of the lung affected by bronchiectasis. However, medical therapy is the mainstay of treatment and include 1) Control of respiratory infections: a. Broad spectrum antibiotics that should be given whenever signs of pulmonary infection appear and symptoms are exacerbated (Ampicillin, tetracycline or erythromycin), b. Design appropriate methods of prevention of lung abscess Definition: lung abscess is defined as collection of pus within a destroyed portion of the lung. The anaerobic abscess is the commonest and usually follows periodontal diseases (gingivitis, pyorrhea) or aspiration of oropharyngeal/gastric contents. The development of features of lung abscess within 1-2 weeks after bacterial pneumonia, possible aspiration or bronchial obstruction is usually reported. Patients will have cough with sudden expectoration of massive purulent and foul smelling sputum, high grade fever, and sweating with occasional hemoptysis. Diagnosis: When patients present with the typical manifestations outlined above, the diagnosis of lung abscess may not difficult. However, it should be confirmed by chest x-ray by 193 Internal Medicine demonstrating parenchymal infiltrates with cavity containing air-fluid level. Bronchoscopes and experts who can do such procedures are available only in specialized hospitals. Pleurisy and Pleural Effusion Learning Objective: At the end of this unit the student will be able to 1. Give treatment for pleural effusions at the primary care level Definition: pleural effusion is the presence of excess fluid in the pleural space. Pleural effusions are classified as transudates and exudates based on laboratory analysis of the fluid. Transudative effusion: results from elevations in hydrostatic pressure or decrease in oncotic pressure. Pleurisy commonly occurs in infections such as pneumonia, infections of the esophagus, mediastinum or sub-diaphragmatic areas, traumatic injuries, and extension of infections from adjacent organs. Clinical findings and diagnosis Pleuritic chest pain and dyspnea are the most common symptoms, but many pleural effusions are asymptomatic and discovered on physical examination or chest x-ray. Physical examination on the affected side discloses the presence of decreased chest motion, absent tactile fremitus, percussion dullness, and decreased or absent breathes sounds. It demonstrates the presence of pleural fluid as homogenous opacity with a meniscus-sign and obliteration of the costophrenic angle. Large pleural effusions may result in complete opacification of the hemithorax and mediastinal shift to the opposite side. The best way to identify and localize a loculated pleural effusion is with ultrasonography. Microscopic examination of the fluid is important including Gram stain and culture (if possible). Exudative effusions have at least one of the following characteristics, whereas transudates have none of these: o o o Pleural fluid protein/ serum protein > 0. Definitive treatment of pleural effusion requires identifying the underlying condition and administration of specific therapy. Parapneumonic effusions and other bacterial infections in the pleural space should be treated with long course of antibiotics. Neoplasms of the lung Learning Objective: At the end of this unit the student will be able to 1. All lung neoplasms are very aggressive, invasive and widely metastasizing commonly to liver, adrenals brain and bones; they also produce bioactive hormones and other products. Others present with symptoms referable to metastasis before local pulmonary symptoms. About 10 - 15% of lung tumors are detected by chance (a coin shaped lesion on chest x-ray).
For example great depression definition economics buy 10 mg escitalopram overnight delivery, some pathogenic organisms elaborate toxins and enzymes that facilitate the invasion of the host and are often responsible for the disease state and many bacteria are encapsulated with polysaccharides that allow them to invade and deposit in the absence of specific antibodies depression iq test order escitalopram 5 mg with amex. Immune response: Is a defense mechanism developed by the host for recognizing and responding to microorganisms depression line definition buy escitalopram 10 mg on-line. Innate immunity (Natural Immunity): Is first line of defense and serves to protect the host with out prior exposure to the infectious agent anxiety 4 year old buy escitalopram 20 mg on-line. Examples of Innate immunity include skin and mucous mebrane, phagocytoses by macrophages and nutrophils, complement system etc Acquired (Adaptive) Immunity: Is specific immune mechanism developed against a particular organism. Laboratory diagnosis the lab diagnosis of infections requires the demonstration, either 1. Plasmodium species in blood films) or the growth of microorganisms in the laboratory. Treatment; Optimal therapy for infectious diseases requires a broad knowledge of medicine and careful clinical judgment. Life threatening infections such as bacterial meningitis and sepsis require urgent initiation of therapy often before a specific infective organism is identified. Antimicrobial agents must be chosen empirically and must be against the range of potential infectious agents consistent with the clinical condition. In contrast, good clinical judgment sometimes dictates withholding of antimicrobials in a self limited process or until a specific diagnosis is made. Malaria Learning Objective: At the end of this unit the student will be able to 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) Definition Malaria is a protozoal disease transmitted to man by the bite of the female anopheles mosquitoes. Explain the pathogenesis malaria Identify the clinical features of the different malarial diseases List the common complications of malaria. Describe the most commonly used tests for the diagnosis of malaria Make an accurate diagnosis of malaria Treat malaria at the primary care level with appropriate drugs Design appropriate methods of prevention & control of malaria N. The disease is prevalent in 75% of the country with over 40 million people at risk. Immunity against disease is hard won and during adulthood most infections are asymptomatic. The female anopheles mosquitoes carry the plasmodium parasite and discharge into human body during feeding on a blood meal. Therefore, transmission is common in lowlands during rainy season, especially with migration of nonimmuned individuals to these areas. The sporozoites are transported to the liver by the blood where they invade liver cells and undergo asexual reproduction. When the parasites reach certain density in the blood, the symptomatic stage begins. These dormant forms (hypnozoites) are causes of relapses that characterize infection in these two species. This makes detection of mature forms difficult, and only ring forms and gametocytes can be found on peripheral blood films. Sequestration is not a feature of other species of malaria and all stages of the parasite can be seen in the peripheral blood film. Classically malaria manifests in regular paroxysms of high grade fever, chills and rigor, occurring every 2 days in P. Malarial febrile paroxysms (which are due to rupture of schizonts and release of pyrogens) typically have 3 stages the "cold stage" the patient feels intensely cold & has shivering. It is characterized by vasoconstriction of vessels & the temperature rises rapidly. The "sweating stage" patient will have profuse sweating & become very much exhausted 9 Internal Medicine Physical Findings Uncomplicated infection has few physical findings except fever, malaise, and mild anemia, a palpable spleen and liver and mild jaundice e especially in children. Severe and complicated Malaria Is defined as life threatening malaria caused by P. To protect from later recurrences, chloroquine therapy should be followed by:Primaquine: (dose: 15 mg/day over 2 weeks), which is effective against liver forms and gametocytes. In-vivo therapeutic efficacy and safety baseline study on artemether-lumefantrine was also conducted in 4 sites by enrolling 213 subjects and after a follow-up period of 14 days, no treatment failure cases and drug side effects were reported i) Treatment of uncomplicated falciparum malaria: oral drugs are used can be used In most tropical countries since resistance to chloroquine and Sulfadoxine-pyrimethamine is well documented other drugs are recommended. Tablet containing 20 mg Artemether plus 120 mg Lumefantrine in a fixed dose combination. Dose: 15mg/kg followed by second dose of 10mg/kg after 8-12 hr Side Effects: Nausea, abdominal cramp, vertigo, insomnia, sometimes acute psychosis and convulsion d) Sulfadoxine-pyrimethamine (oral). Due to high prevalence of resistance to this combination, it is not recommended for treatment of P. Maintenance does: Twelve hours after the start of the loading dose, give quinine 10 mg salt/kg of body weight in dextrose saline over 4 hours. Quinine dihydrochloride 20 mg salt per kg loading dose intramuscularly divided in to two sites, anterior thigh). Consider transfusion in severe falciparum malaria with high parasitemia (> 20% of erythrocytes affected by plasmodium) Check renal function tests and blood sugar (beware of hypoglycemia). For comatose or unconscious patients proper nursing care is mandatory Position the patient on his/her sides; turn every 2 hours to avoid bed sores. Avoid fluid overload Monitor blood glucose regularly Ensure adequate nutrition Chronic Complications of Malaria Tropical Splenomegaly Syndrome (Hyperreactive malarial Splenomegaly) It is a syndrome resulting from an abnormal immunologic response to repeated infection. Design appropriate methods of prevention and control of typhoid fever Definition: Typhoid fever is a systemic infection characterized by fever and abdominal pain caused by dissemination of Salmonella typhi and occasionally by S. Thus enteric fever is transmitted only thorough close contact with acutely infected individuals or chronic carriers through ingestion of contaminated food or water. At this stage the 17 Internal Medicine Salmonellae disseminate throughout the body in macrophages via lymphatic and colonize reticuloendothilial tissue (liver, spleen, lymph nodes, and bone marrow). Patients have relatively fewer or no signs and symptoms during this initial incubation period. Signs and symptoms, including fever and abdominal pain result when a critical number of bacteria have replicated. The clinical phase of the disease depends on host defense and bacterial multiplication. The manifestation is dependent on inoculum size, state of host defense and the duration of the disease. The Severity of the illness may range from mild, brief illness to acute, severe disease with central nervous system involvement and death. Headache, malaise, Abdominal pain Initially diarrhea or loss stole followed by constipation in adults, diarrhea is dominate feature in children Relative bradycardia Splenomegally Hepatomegaly "Rose spots" not commonly seen in black patients. In whites it appears as small, pale red, blanching macules commonly over chest & abdomen, lasting for 2-3 days.
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