F. Zuben. Oklahoma State University Tulsa.
Song et al (1990b) studied the effect of acupuncture on angiotensin Ċ in 20 rabbits with hemorrhagic shock by femoral artery bloodletting order aspirin 100pills amex pain treatment center of the bluegrass lexington ky. However generic aspirin 100 pills pain medication for dogs rimadyl, 30 min after the shock discount aspirin 100pills without prescription pain home treatment, the level of plasma angiotensin Ċ significantly increased to 64. The level was even higher at 60 min after the shock, but was significantly lower in the acupuncture group. This may be beneficial in the early period of shock for recovering blood volume and redistributing the blood to important organs like the brain, heart, and kidney. In the non-acupuncture group, the angiotensin Ċ level was high, while the blood pressure decreased. In contrast, in the acupuncture group, the blood pressure increased, while the level of angiotensin Ċ was relatively lower. The authors interpreted that an increase in the angiotensin Ċ level might be beneficial to the body at the beginning of hemorrhagic shock, but an over-increase may not be necessarily helpful to the body. However, under the condition of shock, the vasoconstriction of the microcirculatory arteries deteriorates microcirculation. The contents of oxytocin in the hypothalamus, antepituitary, and postpituitary tissues were measured by radioimmunoassay. With the same intensity, higher-frequency stimulation was observed to be better than the lower-frequency stimulation, and with the same frequency, higher-intensity stimulation was better than the lower- intensity stimulation. Hu et al (1999) also detected 2+ 2+ intracellular free calcium ([Ca ]i) and free magnesium ([Mg ]i) ions in the 2+ cardiac myocytes in the same model, and found that [Ca ]i was significantly 2+ decreased, while [Mg ]i was increased with a significant decrease in the ratio of 2+ 2+ [Ca ]i/[Mg ]i. Thus, the authors thought that free calcium and magnesium ions in the cardiac myocytes might play a role in regulating the blood pressure in hypotension during acupuncture therapy. The mechanistic research has shown that acupuncture signals are transmitted through the nervous pathway and integrated into the brain, and the output signals regulate the balance of the body fluid and electrolytes, endocrine secretion, gene expression, and many other factors. In spite of the remarkable achievements in this field, many shortfalls exist in the earlier studies. In the clinical literature, the main problems include the small sample size and lack of convincing data of the control. Similarly, in the basic research, there were some flaws in the design of some experiments and data interpretation. For example, some investigators misinterpreted the results or 317 Acupuncture Therapy of Neurological Diseases: A Neurobiological View made wrong conclusions. In this chapter, we have tried to summarize and present comprehensive information on this topic. However, this does not necessarily mean that we agree with all the explanations and conclusions presented in the original articles. Advanced studies on this interesting subject with new techniques and rigorous randomized controlled trials may provide better knowledge on acupuncture regulation of cardiovascular system and help us to better understand the mystery of acupuncture therapy, and eventually provide some clues for new solutions to cardiovascular disorders. Shanghai Journal of Acupuncture and Moxibustion 25(3): 15 16 (in Chinese with English abstract) 318 11 Acupuncture Therapy for Hypertension and Hypotension Chen S, Zhang S, Gong Y, Dai K, Sui M, Yu Y, Ning G (2008) The role of the autonomic nervous system in hypertension: a bond graph model study. Shanghai Journal of Acupuncture and Moxibustion 16(2): 30 31 (in Chinese with English abstract) Goldblart H (1934) Studies on experimental hypertension: production of persistent elevation of systolic blood pressure by means of renal ischemia. Am J Hypertens 22: 122 128 Li P (1986) Suppression effect of electric acupuncture on experimental boost pressure reaction and arrhythmia in ventrolateral medulla. Chinese Acupuncture and Moxibustion 19: 227 230 (in Chinese with English abstract) Li P (2002) Neural mechanisms of the effect of acupuncture on cardiovascular diseases. Journal of Hubei College of Traditional Chinese Medicine 2(4): 53 55 (in Chinese) Li J, Lin Q, Li P (1993) Effect of somatic nerve stimulation on blood pressure in normotensive and haemorrhagic rats. J Appl Physiol 106: 620 630 320 11 Acupuncture Therapy for Hypertension and Hypotension Lithell H (1995) Metabolic aspects of the treatment of hypertension. Science Press, Beijing Liu D, Fan S, Shen Y (2003) Empirical study of acupuncture on hypertensive disease. Prog Cardiovase Dis 17: 51 Research group of Anhui medical college (1960) Effects of acupuncture on blood pressure of normal animal and chronicity experimental hypertension. Acta Chinese Medicine and Pharmacology 4(1): 18 20 (in Chinese with English abstract) Wang Y (1996) Syndrome differentiation treatment of 95 hypertension by Acupuncture. Jiangsu Medicine 11(6): 34 36 (in Chinese) Xia Y (1989) Pressor effect of naloxone in acute experimental rabbits. Chinese Journal of Pathophysiology 4: 33 (in Chinese with English abstract) Yao T (1993) Acupuncture and somatic nerve stimulation: mechanism underlying effects on cardiovascular and renal activities. Brain Res 240: 77 85 Yi S, Hiromi M, Shingo H, Hiroyuki S (2003) Pressor effect of electroacupuncture on hemorrhagic hypotension. Acupuncture Research 10: 304 309 (in Chinese with English abstract) Zhang W (1999) Recently study in hypertension treatment by acupuncture and moxibustion. Chinese Acupuncture and Moxibustion 5: 301 305 (in Chinese with English abstract) 325 12 Effect of Acupuncture on Epilepsy Ru Yang and Jieshi Cheng State Key Laboratory of Medical Neurobiology, Shanghai Medical College of Fudan University, Shanghai 200032, P. China Summary Acupuncture has been used for suppression of epileptic seizure for more than two thousand years in Chinese medicine. Also, significant progress towards elucidating the biological basis of the acupuncture suppression has been made in the past several decades. This chapter will summarize the clinical applications and the experimental studies on acupuncture therapy for epilepsy. The therapeutic methods of acupuncture or simulated acupuncture include fine acupuncture, catgut implantation at acupoints, acupuncture plus Chinese herbs and many others. Most reports showed that acupuncture induced remarkable efficacy although there was negative evidence in some of the studies. Optimizing acupuncture conditions including delivery ways, acupoints and stimulation parameters may further improve the efficacy of acupuncture therapy for epilepsy. In animal models, neurobiological insights into the underlying mechanism have been achieved by a variety of modern approaches including biochemical, molecular, electrophysiological, immunological techniques as well as electroencephalogram and power spectra. Accumulating data have showed that acupuncture suppress epileptic seizure through regulation of several neurotransmitters/modulators and their receptors including excitatory (e. However, the cellular and molecular basis of acupuncture therapy for epilepsy is far away from well understanding. Keywords seizure, acupuncture, electroencephalogram, excitatory amino acids, inhibitory amino acids 12. The neurophysiologic disorder of cerebral function leads to paroxysmal derangement 12 Effect of Acupuncture on Epilepsy of epileptic seizure. Different occurrences of seizure activity in different regions of the brain cause different patterns of pathophysiologic behavior. Seizure can be involved with instant loss of consciousness that might be undetectable to the patient or a witness nearby. It can also be associated with severe symptoms, such as a several-second-lasting jerking of entire body induced by a grand mal tonic-clonic seizure.
It is important to examine all adults living in the family home order aspirin with mastercard treatment guidelines for chest pain, particularly the grandparents order 100 pills aspirin otc allied pain treatment center news, one of whom may be the infector purchase aspirin pain treatment for osteoporosis. Controlled trials in several Western Heaf head will be released and protrude 2mm into countries, where most children are well nourished, the skin. Discrete induration of three or The tuberculin skin test 0 fewer needle sites is acceptable. Heaf test (or multiple puncture test), and Induration around each needle site merging with 2. Heaf gun, disposable Heaf heads (paediatric and Individuals who have not previously received standard). The immunised there is no evidence of the characteristic vaccine must be given strictly intradermally with scar. If the skin is visibly dirty it should be swabbed with spirit Those individuals with a Heaf grade 2, or Mantoux and allowed to dry. The Heaf grades 3 or 4, and Mantoux tests of 15 mm needle can usually be seen through the epidermis. If little resistance is felt when injecting, (For a further guide on skin testing and screening the needle is too deep – stop injecting, withdraw of high-risk groups such as new immigrants and and recommence at the correct depth. In Since chemotherapy treatment of tuberculosis has some specialized hospitals, a negative pressure already been discussed, this section will concentrate ventilation system may be available for nursing mainly on infection control issues. The negative psychological effects of isolation can be minimized by careful planning prior to Respiratory precautions prevent the spread of admitting the patient. Isolation of the patient is usually should be given to providing some recreation: recommended for a minimum of two weeks after radios and books or magazines the patient would commencing chemoprophylaxis. Three negative sputum smear toys from any patient in an isolation room as there specimens at a minimum of 24 hours apart and is a low, theoretical risk of cross-infection. Papers resolution of the cough are required before allowing should be discarded as household rubbish and toys the patient home. It is not necessary to heat treat books Out-patient clinics following use by a known infected patient. The coordinated to minimize cross infection to other mattress and pillows should be protected by patients. Any therapeutic overlay or potentially infectious or known infectious patients pressure relieving equipment must also be washable attend other departments, for example X-ray. When sputum samples are obtained in the clinic A comfortable washable chair and footstool to this should be done in a well ventilated area away allow the patient to sit out of bed should be from other vulnerable patients (see further notes provided, as should a washable chair for visitors. The movement of furniture in and out of the room during the isolation period should be minimised Page 185 In-patient treatment because everything in the room may be considered Isolation potentially infected until cleaned and disinfected. Equipment for monitoring the patient’s clinical Module 6 Page 185 condition should be available in each room and to be disposed of as contaminated and potentially kept there until he is discharged. Ideally, the patient should have his own en suite Patient clothing should be washed at normal toilet or a commode within the isolation room to temperatures. If soiled, place in a water soluble or reduce the cross infection risks in communal toilets water-soluble membrane bag to protect care staff or bathrooms. This should have hot and cold or bin with a lid to place soiled items in and do running water, liquid soap for staff use and paper not open them until reaching the laundry - lift the hand towels for staff use. If there is no washbasin clothes directly into the washing machine taking within the room a second member of staff will care not to shake the items out. Clothing should have to bring a basin of water to the door when be dried and ironed at the recommended the first one leaves. The wash wash programme to allow extra water to cloths may be disposable or changed daily and mechanically reduce the soiling. Remember that sunlight aids disinfection, and then steam iron to Now carry out Learning Activity 9. Alternatively, the items could be tumble-dried and ironed at a lower Care of bedclothes, clothing, and other linen temperature. Staff and caregivers should wear disposable gloves and plastic aprons when removing any used Coughing and obtaining sputum samples bedclothes from the bed. Wash and dry handkerchiefs or other disposable paper to cover hands carefully after taking off gloves. Bed linen (sheets, towels, cotton sheets or quilts) Sputum samples should be transported in plastic should be washed in a hot temperature load, as bags and labelled High Risk. Page 186 Module 6 Any contaminated paper handkerchiefs should be at a registered disposal site. The easiest way to dispose of the waste is by burning Items such as flowers, newspapers or paper waste or incineration as clinical waste. If sputum containers are used they must be handled Care in the community with caution. Disposable-type containers can be Patents who are cared for in their own home while incinerated. Re-useable ones may be emptied into still infectious need simple infection control a sluice or toilets taking great care not to splash precautions: the surrounding environment. The used container • Adequate ventilation of the room where the may be reprocessed in a washer/disinfector machine patient is coughing. Empty the sputum into the sluice or Last offices/last rites toilet as mentioned previously. Clean container by Infection control precautions are also necessary immersing it in a bowl of detergent and warm during last offices. The deceased should be handled water, rinse with cold water and then immerse in with care to minimize the risk of exhalation of disinfectant for the required time. Funeral directors, religious elders and those cold water prior to leaving to air dry and then reuse. Training in the use of If an autopsy is required to confirm the cause of disinfectants must be given as part of the Infection death, the pathologist must be advised of the Control Induction programme for new staff. A body bag may be Waste that is not contaminated by sputum, blood or requested for transport of the deceased to the body fluids such as bronchial secretions, does not need mortuary. The body bag should be clearly labelled to be treated as clinical or High Risk Waste. Page 187 Clinical waste should be burnt or incinerated by an approved method or may be treated by steam A summary of infection control procedures can be and microwave to disinfect prior to deep landfill found in Appendix 3. If contaminated with bronchial secretions disinfection is necessary (see Disinfectant Policy) •care of linen – treat as soiled unless contaminated with bronchial secretions, when it should go into a water-soluble bag and as hot a wash as the fabric will tolerate • disposal of rubbish – treat as clinical type waste if contaminated by sputum • cleaning – routine cleaning • investigations – contact Head of Department prior to moving out of the isolation room – observe precautions en route and in other clinical areas •specimens - avoid contamination of outside of container; label sputum specimens “High Risk” and transport in plastic specimen bag • terminal cleaning – routine cleaning only required. Since there are so many important issues that need to be discussed, the Module is divided into two parts: Part I. Female genito-urinary tract Kidney Kidney Ureter Ureter Seminal vesicle Fallopian tube Bladder Ovary Rectum Uterus (womb) Anus Bladder Urethra Rectum Urethra Vagina Anus Diagram 3. Sexually transmitted infections are a Nurses and midwives need to be aware of the role major public health problem, not only because they gender plays in discussions regarding sexual health are a cause of far reaching morbidity, affecting and sexuality in general. In the European Region, This may make us embarrassed about talking about particularly in parts of Eastern Europe, there has sex, or about certain aspects about sex.
Chancres (of syphilis) are typically painless anonymous testing site and be tested anony- unless they become infected by bacteria discount aspirin 100 pills fast delivery jaw pain tmj treatment. Chancroid mously (the identifying information is not linked can cause painful anal (and genital) ulcers buy aspirin 100pills without prescription low back pain treatment video. According Other states tried to do case surveillance without to Centers for Disease Control and Prevention esti- name identiﬁers by using codes designated for mates discount aspirin narcotic pain medication for uti, in 1996, about two-thirds of all infected nonsurveillance purposes. Several subsequent studies could anonymous sites, and those who use home collec- not ﬁnd a code system that worked as well as tion kits, but the popularity of anonymous testing name-based methods. Some contend that view of the fact that some sexually transmitted treatment failure is probably caused by the preex- diseases are developing resistance to currently istence of resistant mutants, but it may also be used drugs. A retro- treatment and represented 10 cities in North virus uses the enzyme reverse transcriptase to syn- America (1995–2000). Insisting on one’s “right to has contact with blood, feces, or other bodily ﬂu- know” is understandable, considering the enor- ids; and maintaining good overall health. Decades ago, genital sexual contact is viewed as somewhat less the California Supreme Court found in Tarasoff v. This has led to the context that may act as a trigger for risk behavior changing of some U. Most doms, early sexual activity, excessive use of alco- agree, however, that the strongest claim to a right hol and substances that impair judgment, sex to know is that of people who are conducting ongo- with partners who have multiple partners, and ing sexual or needle-sharing relationships. The act supported development of systems of risk control In relation to sexually transmitted care that respond to local needs and resources. He died at age 19 on April 8, active people can control their risk of infection to 1990, a few months before Congress passed the some degree by avoiding the main modes of trans- act. As part of the federal budget, it is administered by the Health Resources risky behavior According to a report on trends and Services Administration (part of the U. Deep kissing is considered a moderate-risk soon as possible to achieve better and longer-last- activity. Forms of low-risk sex include self-mastur- ing results, it is important to spread information bation, mutual masturbation, and dry kissing. Safe that makes people more likely to seek testing and sex became a household term after the ﬁrst few treatment early. It also can be transmitted by contact with skin or infested sheets, towels, or even furniture. During this time, the person may pass • Setting up projects that promote knowledge of the disease unknowingly to a sex partner or some- serostatus and prevention and care for those liv- one with whom he or she has close contact. Small red bumps or lines involvement (Partnership Council and Leader- appear on parts of the body where the female sca- ship Action Alliances). To recommends that specific content of prevention make a diagnosis, a physician can take a scraping programs be determined by local communities so of the irritated area and examine it under a micro- that they will be in line with parental and com- scope to look for the presence of a mite. Treatment screening Testing that can be done to evaluate Ectoparasiticide cream (Permethrin) or scabicide for the presence of sexually transmitted diseases lindane lotion can be used to treat scabies. Var- partners and family members of the affected indi- ious types of tests are used to determine whether vidual should be treated, too. The lotion is applied an individual has contracted a sexually transmit- at bedtime to all skin below the neck and then ted disease. Permethrin can are numerous forms of medical screenings, be repeated in seven days if necessary. Itching including the mammogram, which screens for resolves in two to three weeks. Some patients use breast cancer; colonoscopy, which screens for a sulfur preparation to treat scabies, which works colon cancer; and the Pap smear, which screens but has an objectionable smell and leaves a lin- for cervical cancer. Pregnant women and young children should not self-talk A method used to encourage oneself; use lindane. This icated lotion, the person who has scabies is no practice can be helpful to people who have sexu- longer contagious. It is important, however, to ally transmitted diseases, in that positive thinking make sure all mites have been eliminated from can provide a greater sense of empowerment over bedding and clothing by washing with hot water. Besides decreasing the spread of sexually transmitted dis- sperm, it contains ﬂuids from the testicles, prostate, eases, school-based efforts are critical because and seminal vesicles. Each ejaculate may contain school is often the site where sex-related infor- up to 500 million sperm. Fertilization, required for mation is spread among young people and thus pregnancy, is the fusion of a spermatozoon and an becomes a key portal for sexual activity that can ovum (egg). A prostate infection and these programs, it does highlight curricula that infections in the urethra can cause blood in the sexual assault and sexual abuse 193 semen. Another possible cause is prostate cancer, sexual accommodation The act of accommodat- which only rarely causes blood in the semen. Seroconversion time is the acts) involving a betrayal of trust by an adult per- period required for detectable antibodies to develop once an infection has occurred. Typically, petrator with a minor or unwilling party; this may the body takes a few days or weeks to react to a include a single instance or activity over a long foreign substance such as a virus and develop period. Department of Health and Human Ser- ease such as herpes by looking for antibodies in the vices issues recommendations for treating people blood or serum. Blood tests can be done even who have been sexually assaulted or abused, lim- when no symptoms are apparent or after symp- ited to the identiﬁcation and treatment of sexually toms are gone. If antibodies are dis- for forensic purposes and the management of covered in the blood, they indicate that a person potential pregnancy or physical and psychological has been exposed to or infected with the disease trauma are not included. There because the infection could have been acquired are many kits available in the marketplace that do before the assault. Remember, too, that The diseases most often diagnosed in women after a person is exposed to herpes, herpes anti- who have been sexually assaulted are trichomoni- bodies may not show up in the blood for any- asis, bacterial vaginosis, chlamydia, and gonor- where from two weeks to three months. Exam- women because of the possibility of ascending ples are vibrators and dildos. In they may be reassured by treatment or prophylaxis addition, if a person is exposed to hepatitis B virus for possible infection. The following prophylactic during an assault, postexposure administration of regimen is recommended: hepatitis B vaccine and hepatitis B immune glob- ulin can prevent infection. Hepatitis B vaccine should be given to victims of sexual assault at the time of the initial • Cultures for Neisseria gonorrhoeae and Chlamy- exam. Follow-up doses of vaccine should be dia trachomatis are made from specimens col- administered one to two and four to six months lected from any sites of penetration or attempted after ﬁrst dose. If a nonculture test is used, a positive test result should be veriﬁed with another test. Because of these week follow-up visit, unless prophylactic treatment results and the effectiveness of antiretroviral was already provided. Most In children, finding sexually transmissible people probably beneﬁt from prophylaxis because agents after the neonatal period is indicative of follow-up for sexual assault victims is difﬁcult, and sexual abuse. Exceptions are the following: sexual ethics 195 • Rectal or genital infection with chlamydia that third follow-up 12 weeks after the sexual event. When the only evidence of men for Trichomonas vaginalis (presence of clue sexual abuse is the isolation of an organism or the cells in the wet mount or a sign such as a posi- detection of antibodies to a sexually transmissible tive whiff test ﬁnding suggest bacterial vaginosis agent, ﬁndings should be conﬁrmed and implica- in girls with vaginal discharge) tions scrutinized. The determination of whether sexual abuse has occurred should be made by peo- • Collection of a serum sample to be tested imme- ple who are experts in evaluating abused and diately, preserved for later analysis, and used as assaulted children.