Sanof s approach to philanthropy asacol 400mg generic, through fled to register all (100%) of its newest products the Sanof Espoir Foundation asacol 400mg discount, is strong: it works Monitoring is mainly the responsibility of part- in at least some priority countries (disease-spe- toward long-term change based on local needs order 400mg asacol with visa, ners. Sanof works with international organisa- cifc sub-sets of countries with a particular need and includes impact measurement. These prod- pany builds capacities outside the pharmaceuti- tions conduct regular audits and send the results ucts were frst launched between 1999 to 2016. The organisations are responsible for Sanof has already registered products launched Sant partnership in Cameroon). For structured donation programmes Adapts brochures and packaging to limited Sanof commits to assessing and building capac- Sanof monitors and tracks the reception of extent. Sanof adapts brochures and packaging ity in countries in scope for in-house manufac- donated products. In practice, the company undertakes a rel- tal needs, but does not consider cultural, literacy atively large number of capacity building activ- Involved in numerous emergency relief eforts. In addition, Sanof has provided humanitar- number of activities for building local pharma- ian aid to refugees in multiple countries. For holds a low position in Patents & Licensing, with example, the company supports health workers no indication that it considers engaging in licens- from sub-Saharan African countries with weak ing, and low overall transparency. It has several best and innovative practices: in pricing, including pricing, where it has a new afordability-based patents and capacity building. It has extensively expanded and updated grown, but with comparatively little movement and less col- its access strategy, which it operationalises, e. These belong AstraZeneca can evaluate the impact of its products in its commitment to licensing. AstraZeneca can build tries (disease-specifc sub-sets of countries with and countries/regions. Such part- budesonide (Pulmicort ) can be expanded to nerships can be important for addressing local India, Bangladesh, Nigeria, and China. AstraZeneca of its relevant products while they are still in this could include ticagrelor (Brilinta ), a frst- can apply its new afordability-based pricing the pipeline. This is important for key late-stage line option for preventing atherothrombotic policy to more key products: such as its selec- products, whether developed in-house or via events. This could make AstraZeneca the frst tive beta-2-adrenoreceptor agonists, used in the research partnerships. AstraZeneca Asia/Africa/Australasia Europe Americas has sales in 67 countries in scope. It has gained marketing authorization sis and onchocerciasis, which target high-priority AstraZeneca s portfolio is heavily focused on from the European Medicines Agency for several product gaps with low commercial incentive. Nevertheless, the company s dis- also made specifc commitments to conduct- AstraZeneca the biggest riser. AstraZeneca closure around its marketing programmes and ing R&D in China and Africa, in order to respond is the biggest riser in this area, climbing from related payments only meets minimum legal to the unique needs of people living in those 14th into the top fve. AstraZeneca makes a clear commitment policy positions relating to compulsory licens- to making its intellectual property, compounds Access strategy aligned with corporate strat- ing, intellectual property, product counterfeit- and expertise available for free in a sub-set of egy. However, the com- ing healthcare barriers in low and middle-income try associations and about the board seats it pany has no clear policy for ensuring these fea- countries. However, it does not disclose fnancial tures or other access-oriented terms are sys- pany s core business strategy: access to health- contributions. Initially launched in Kenya, Healthy Although it states that it has taken disciplinary ducted ethically. Heart Africa aims to reach 10 million hyperten- action following violations of its codes of con- sive patients across Africa by 2025: by estab- duct governing lobbying, corruption and market- Innovation: signing on to combat antimicro- lishing new partnerships; ensuring access to ing, it provides no further details. In January 2016, AstraZeneca afordable anti-hypertensive medicines and ser- signed the Declaration by the Pharmaceutical, vices; and by developing local ownership. AstraZeneca Biotechnology and Diagnostics Industries on has an auditing system that uses a mixture Combating Antimicrobial Resistance, thereby Mature access management structures in place. The scope of each audit is The company also has a dedicated incentive based on a market-specifc risk assessment. AstraZeneca shares intellectual property to sup- to achieve access-related targets. These bodies interest, to resolve allegations that it underpaid to help the Drugs for Neglected Diseases initia- fulfl an advisory role, identifying and discussing rebates owed under the Medicaid Drug Rebate tive develop new leads. AstraZeneca is generally less Biggest riser in Pricing, Manufacturing & Drops three places due to breaches of corrup- active than in 2014: its relevant pipeline has Distribution. AstraZeneca drops from 7th to 10th grown, but with comparatively little movement 19th in 2014 to 8th in 2016. This is due to comparatively stronger and less collaborative R&D based on pro-access its innovative approach to equitable pricing and performances from peers. Its rank also refects changes in perfor- the implementation of this approach to products found in breach of civil laws and codes of con- mance among its peers. The company s focus signifcantly increased the number of its prod- areas include public health initiatives, increasing ucts with equitable pricing strategies, taking New public commitment not to fle patents. However, only a third er-middle income countries and upper-middle (31%) of its products have pricing strategies that income countries that together cover 70% of Best practice: manufacturing capacity build- target some priority countries (disease-specifc countries within the scope of the Index. Rather than training sub-sets of countries with a particular need for individual manufacturers, AstraZeneca provides access to relevant products). New commitment to licensing, with clear funding, training and other support to Tianjin exceptions. Although AstraZeneca has not yet University to fll local manufacturing skills gaps. Registration behaviour lags behind advances in licensed a product, it has now set out the situa- Via the university, the company s expertise can pricing. Its policy be shared more widely, to help improve manu- of disease-specifc registration targets. It does excludes licences for products for non-commu- facturing safety standards at the industry level not publish where its products are registered or nicable diseases in lower-middle income coun- in China. The company has fled to permits supply to Least Developed Countries, Innovation: building capacity through Healthy register some (40%) of its newest products in low-income countries and lower-middle income Heart Africa. In 2014, AstraZeneca launched just a few (6%) priority countries (disease-spe- countries. It acknowledges based training for health-workers, and targeted that countries have the right to determine what supply chain management support. For its Healthy Innovation: scale-up of Young Health Heart Africa programme, in East African mar- Patent status disclosure. AstraZeneca has scaled up its kets, AstraZeneca has developed new artwork lishes the status of all patents it holds for high- Young Health Programme. The programme for felodipine (Plendil ), lisinopril (Zestril ) and need products in the high-burden countries focuses on preventing non-communicable dis- lisinopril/hydrochlorothiazide (Zestoretic ), measured by the Index, including publishing the ease among adolescents.
In talking about fibrosis of the lungs it is important to differentiate diffuse fine pulmonary fibrosis order asacol toronto, as in this case discount asacol 400mg amex, and localized pulmonary fibrosis as a result of scarring after an acute inflammatory condition such as pneumonia buy cheapest asacol. Diffuse pulmonary fibrosis can be associated with conditions such as rheumatoid arthritis and can be induced by inhaled dusts or ingested drugs. Further investigations consist of a search for a cause or associated conditions and a deci- sion whether a lung biopsy is warranted. Bronchoscopic biopsies are too small to be rep- resentative or useful in this situation, and a video-assisted thoracoscopic biopsy would be the usual procedure. It would usually be appropriate to obtain histology of the lung in someone of this age. There is some evidence that anti-oxidants such as acetylcysteine improve the outlook and these may be combined with the steroids and azathioprine. In a patient of this age, lung transplantation might be a consideration as the dis- ease progresses. Progression rates are variable and an acute aggressive form with death in 6 months can occur. A subendocardial inferior myocardial infarction was diagnosed and he was treated with thrombolytics and aspirin. This showed severe triple-vessel disease not suitable for stenting, and coronary artery bypass grafting was performed. He is attending a cardiac rehabilitation clinic and he has had no further angina since his surgery. He has a strong family history of ischaemic heart disease, with his father and two paternal uncles having died of myocardial infarctions in their 50 s; his 50-year-old brother has angina. He has bilateral corneal arcus, xanthelasmata around his eyes and xanthomata on his Achilles tendons. He has many clinical features to go with the high cholesterol and prema- ture vascular disease. The homo- zygous condition is rare and affected individuals usually die before the age of 20 years due to premature atherosclerosis. Corneal arcus, xanthelasmata and xanthomata on Achilles tendons and the exten- sor tendons on the dorsum of the hands develop in early adult life. The other major causes of hypercho- lesterolaemia are familial combined hyperlipidaemia and polygenic hypercholesterol- aemia. Familial combined hyperlipidaemia differs from familial hypercholesterolaemia by patients having raised triglycerides. Patients with polygenic hypercholesterolaemia have a similar lipid profile to familial hypercholesterolaemia but they do not develop xanthomata. Hypercholesterolaemia may commonly occur in hypothyroidism, diabetes mellitus, nephrotic syndrome and hepatic cholestasis. This patient is at extremely high risk for further vascular events and especially occlusion of his coronary artery bypass grafts. His risk depends on the combination of his risk fac- tors, and all of these need attention. He should be advised to stop smoking, reduce his alcohol intake (which is also affecting his liver as judged from the raised gamma-glutamyl transpeptidase), take more exercise and eat a strict low-cholesterol diet. He should have pharmacological treatment with a statin but may need combined treatment for this level of hyperlipidaemia. His children should have their lipid profile measured so that they can be treated to prevent premature cor- onary artery disease. There is clear evidence from clinical trials that primary prevention of coronary artery disease can be achieved by lowering serum cholesterol. In patients who have evidence of cardiovascular disease secondary prevention is even more important, aiming for a cho- lesterol level as low as possible. He has a 12-year history of chronic cough and sputum production, but she thinks that these symptoms may have increased a little over the last 8 weeks. He has smoked 20 cigarettes daily for the last 50 years and he drinks around 14 units of alcohol per week. Two years ago he became depressed and was treated with an antidepressant for 6 months with good effect. There are no abnormalities to find in the cardiovascular, respiratory or abdominal systems. Addison s disease might be linked with respiratory problems through adrenal involvement by metastases or tuberculosis. This can be confirmed by measurement of serum and urine osmolarities to show serum dilution while the urine is concentrated. Fluid restriction to 750 mL daily produced an increase in serum sodium to 128 mmol/L with improvement in the confusion and weakness. Such treatment often produces a response in terms of shrinkage of the tumour, improved quality of life and increased survival. Small-cell undifferentiated carcinomas of the lung are fast-growing tumours, usually unresectable at presentation. Her 20-year-old son has asthma and she has tried his salbutamol inhaler on two or three occasions but found it to be of no real benefit. She has tested herself on her son s peak flow meter at home and she has obtained values of about 100 L/min. On direct question- ing she says that the shortness of breath tends to be worse on lying down but there are no other particular precipitating factors or variations through the day. There is a generalized wheeze heard all over the chest but no other abnormalities. It is similar in both inspiration and expiration as shown in the flow volume loop (Fig. The spirometry trace of volume against time in such cases shows a straight line of the same reduced flow right up to the vital capacity. On examination, this airway narrowing is likely to produce a single monophonic wheeze which may be heard over a wide area of the chest. Differential diagnosis of rigid large-airway obstruction The situation may easily be confused with asthma if the peak flow and the wheezing are accepted uncritically. The wheezing in asthma comes from many narrowed airways of different calibre and mass, and the wheezes are often described as polyphonic. The fixed flow in inspiration and expiration in this case suggest a rigid large-airway nar- rowing. If the narrowing can vary a little with pressure changes, then the pattern will depend on the site of the narrowing (Figs 99. If it is outside the thoracic cage, as in a laryngeal lesion, it will be more evident on inspiration. Large-airway narrowing can be caused by inflammatory conditions such as tuberculosis or Wegener s granulomatosis, damage from prolonged endotracheal intubation or by extrinsic pressure such as a retrosternal goitre. The great majority of symp- tomatic lung tumours are visible on plain chest X-ray but central lesions in large airways may not be seen.
Plot the 3 quartile for each data series by months for the 5 year period and join the points with a line purchase 400mg asacol fast delivery. Plot the monthly malaria cases that visited a health facility and compare with the third quartile or the norm-chart order asacol us. If the number is 194 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia rd above the 3 quartile (upper limit) order cheap asacol on-line, this is an indication of a possible malaria epidemic. Example: Number of malaria cases in certain health facility by month for consecutive five years along with rd the median and the 3 quartile for each month for the five year is shown in the table below. Specim ensforlaboratoryconfirm ationforepidem ic pronedisease Suspected disease or Diagnostictest Specim en condition C h olera Isolate V. R ecom m endedcase definitions foruse byhealth facilities andin thecom m unity Disease U se forreporting suspected U se forcom m unity priority diseases by h ealth level facilities C h olera A ny person 5 years ofage or A ny person 5 years of m ore wh o develops severe age or m ore with lots deh ydration or dies from acute ofwatery diarrh ea watery diarrh ea. Diarrh eawith A ny person with diarrh ea and A ny person with blood (sh igella) visible blood inth e stool diarrh ea and visible blood inth e stool M easles A ny person with fever and A ny person with fever m aculo papular(non-vesicular) and rash generaliz ed rash and cough, 201 M anualonInvestigationandM anagem entof E pidem ic ProneD iseasesinE thiopia coryz aor C onjunctivitis (red eyes)orany person in wh om a clinician suspects m easles. M eningitis A ny person with sudden on set A ny person with fever 0 0 offever (> 38. It describes the way the plan should be designed and what issue should be dealt to have a comprehensive plan. This can be also taken as a sample to prepare epidemic preparedness and response plan in the context of specific disease entity using the same steps (see annex 1). Before measles vaccine became available, virtually all individuals contracted measles with an estimated 130 million cases each year. In Ethiopia, 211 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia 1. The disease is characterised by prodromal fever, conjunctivitis, coryza, cough and the presence of Koplik spots (reddish spots with a white centre) on the buccal mucosa. A characteristic red rash appears on the third to seventh day beginning on the face, becoming generalised and lasting 4-7 days. Measles can also lead to life-long disabilities, including blindness, brain damage and deafness. And also it is communicable from slightly before the prodromal period to four days after the appearance of the rash. Measles vaccine induces long-term and probably lifelong immunity in most individuals. Diagnosis: use of standard cased definition (as a clinical case definition in part 1. Classification for management: since case management depends on the severity of disease, the degree of severity of the case must be stated: 214 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia uncomplicated measles: a child with measles and none of the signs or symptoms of complicated disease complicated measles: a child with measles and at least one of the signs or symptoms of complicated disease as per following table. There are three sequential phases for measles immunization programmes as indicated in the figure below. These strategies include improved surveillance in order to understand the changing epidemiology of the disease (e. If an outbreak is anticipated, supplementary immunization activities may be considered. This will be achieved 219 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia through maintaining the number of susceptible individuals in the population below the critical number that helps to sustain transmission of the measles virus. The strategies should: - Drastically and speedily reduce the number of susceptible individuals in those age-groups where most susceptible individuals have accumulated and where the nature of contact among them facilitates virus transmission. This recognition is simpler if a routine surveillance system collects either summary or case-based information on clinical and confirmed cases of measles. The availability of such data allows for the establishment of background activity levels and the establishment of a local outbreak (or 221 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia epidemic) threshold. This threshold value is usually a number of cases in a defined period in excess of (a predetermined) expected number. The attainment of a threshold value should be considered as signalling an outbreak and should trigger specific responses. This is best done by health workers using a suspected measles investigation form, seeking details on cases (e. Outbreaks provide an opportunity to collect data, identify problems and adjust strategies accordingly. The main areas to be dealt with by are: definition of and agreement on response management of response resources for response public information post-outbreak activities 223 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia prediction of, and preparedness for, further outbreaks. The activities to be implemented as a priority during all measles outbreaks will be: to prevent measles complications and deaths through early and effective case management to review epidemiological data and immunization programme in order to identify the cause(s) of the outbreak to increase public awareness of measles infection, treatment and prevention through immunization to strengthen existing routine immunization programmes, with particular attention to the identification of high-risk areas. It is important to keep the public informed about the outbreak and the outbreak response. Public information can be transmitted by a number of simple means, either directly to the community via schools or community meetings, or via the mass media such as radio, newspapers and television. Simple, clear public information material can help to: allay fears convey public health messages regarding appropriate treatment of cases and immunization. It is important that such material: give information on the natural history of measles infection, the care of a child with measles and the signs and symptoms that should prompt a parent to seek expert advice 227 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia encourage parents whose children have had a recent onset of rash and fever to notify health workers give clear information on the age for immunization and on the locations and time- schedule of any vaccination activities. Case definition: a set of standard criteria for deciding whether a person has a particular disease or health related condition, by specifying clinical criteria and limitations on time, place and person. Epidemic: The occurrence of more cases of disease than expected in a given area or among a specific group of people over a specified period of time. Epidemic curve: a histogram that shows the course of a disease epidemic or epidemic by plotting the number of cases by time of onset. Host: a person or other living organism that offers subsistence or lodgment to an infectious agent under natural conditions. Immunity: resistance usually associated with the presence of antibodies or cells having a specific action on the microorganism concerned with a particular infectious disease or on its toxin. Inapparent infection: The presence of infection in a host without recognizable clinical signs or symptoms. Incubation period: a period of sub-clinical or inapparent pathologic changes following exposure, ending with the onset of symptoms of infectious disease. Infection: The entry and development or multiplication of an infectious agent in the body of persons or animals. Mixed epidemic is the type of epidemic usually begins with a common source of infectious agent with subsequent propagated spread. Nosocomial infection: those infections that were neither present nor incubating at the time the patient was admitted. Pandemic: an epidemic occurring over a very wide area(several countries or continents) and usually affecting a large proportion of the population. Pathogencity: the proportion of persons infected, after exposure to a causative agent, who then develop a clinical disease.
Socio-economic status discount asacol 400 mg line, and severity of diarrhoeal diseases proven asacol 400mg, in children under five years of age buy genuine asacol online. The study was a cross sectional survey and standard structured interview schedule was employed. A total of 270 mothers from children with severe, moderate, and mild diarrhoea were interviewed. A high socio- maternal knowledge and attitude but relatively low practices related to diarrhoea were encountered. The study concluded that communication and education for health programmes integrated localized programmes as well as multi- media approach. Defective gastric acid secretion predisposes to abnormal small intestinal bacterial overgrowth and recurrent enteric infection, both conditions may lead to the development of persistent diarrhoea and malabsorption, resulting in malnutrition and growth, failure; and excessive g astric acid secretion may lead to peptic ulceration. Generally, it is measured by aspirating stomach contents with a nasogastric tube after administration gastric stimulant such as pentagastrin. The samples are titrated to neutrality to determine their acid content A simple, non invasive procedure which may be useful a test for gastric acid secretion was developed by Sack and - his coworker in 1985. It is based on the reaction of ingested magnesium metal with gastric acid to produce hydrogen gas, which is detected in exhaled air and belches. Another new, non- 121 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar invasive test of gastric acid secretion was developed for ideal field studies in the developing world, where chronic diarrhoea and undernutrition are common. The test relies on the capacity of the kidney to retain hydrogen ion during acid secretion, leading to a post-prandial urinary alkaline tide. This research is aimed to study the comparison between the basal and stimulated gastric acid secretion and invasive and non-invasive test for gastric acid analysis in Myanmar adults. Thirty apparently healthy Myanmar male volunteers (25-45) years participated in this study. After overnight fasting, they ingested 150mg of magnesium metal suspended in 3ml of glucose syrup and 100rn1 of 7% ethanol on the first day and alcohol without magnesium on second day. Another 11 samples of gastric juice and breath hydrogen were collected after meal for 180 minutes at 15-minute intervals. Acid contents of gastric juice and urine were determined by traditional titration method. Creatinine (median and range) and basal breath hydrogen was 0 (zero) in 20 subjects. Correlation between maximal acid output (15-60) minutes and change in urine acid output/hr is -0. Since the results of both noninvasive and invasive tests were well correlated, it was concluded that Oral Magnesium Breath Hydrogen Concentration and urine acid output determination (non-invasive tests) can be used as alternative to Ryle s tube intubation (invasive test) in studying the gastric acid secretion. After overnight fasting, they ingested 150mg of Magnesium Mg metal suspended in 3ml of glucose and 100ml of 7% ethanol on the first day and alcohol without Mg on second day. Another 11 samples of gastric juice and breath H2 were collected after meal for 180 minutes at 15 minutes intervals. Correlation between maximal acid output (45-90 minutes) and urine acid output per/hr is 0. Since the results of both non-invasive and invasive test were well correlated, it was concluded that Ryle s tube intubation (invasive) can be replaced by non invasive test (Oral Magnesium Breath Hydrogen Test and urine acid output determination) in studying the gastric acid secretion. In this paper the causes of such a problem, their common clinical presentation, diagnosis and different forms therapy are presented as encountered in one s own clinical experience during the past 25 years. This study is aimed to determine the factors which contribute to or associated with early post-operative mortality and morbidity in perforated peptic ulcer disease. In the univariate analysis, factors associated with increase morbidity and mortality were; (1) older age (p=<0. Serum creatinine level is the most significant prognostic factor regarding post operative complications. In view of the influence on morbidity and mortality of factors in this study, risk stratification of patients with perforated peptic ulcers may facilitate their management and improve survival rates. Review of the literature discloses an apparent propensity of these tumors to occur in any age group and had no predilection for either sex and to be associated with upper gastrointestinal bleeding. The importance of sub-clinical malabsorption as a contributing factor to poor nutrition is poorly documented as is its pathogenesis. This thesis evaluates the absorption of rice carbohydrate with respect to 123 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar nutritional status and examines the factors affecting the relationship. Prevalence of rice malabsorption is explored, as is that of another carbohydrate, lactose. Intestinal permeability studies were undertaken, and the concept of altered transit time and its influence on the absorption studied. The impact of sub-clinical malabsorption and its effect on stool frequency was explored and attempts made to correlate abnormalities in the small bowel intestinal mucosal morphology with altered absorption. These changes were set against a background of the general growth pattern of Myanmar children over the past 50 years. Intestinal permeability indices were impaired even in healthy children and small intestinal mucosa abnormalities were detected even at a very young age. However, the bowel function and orocaecal transit time differ little from that of European children. Conclusion: Rice carbohydrate malabsorption is common, as is malabsorption of the disaccharide, lactose. Lactose malabsorption is common at an early age, implying abnormalities of small bowel function and morphology. Small bowel bacterial overgrowth has been documented and associated with rice malsborption, this in turn having an impact on deficits of height, weight and nutritional indices. Abnormalities of small intestinal mucosa have been documented at an early age and there has perhaps been sub-optimal nutrition in Myanmar during the past 50 years. Sub-clinical malabsorption appears to have no impact on the frequency of defaecation. It is likely that improvement in absorption and nutritional indices will depend upon improvements in hygiene, sanitation and health education. Emphasis is made on the research findings which will be of interest to the medical practitioners at the primary and secondary health care levels. A field study was performed to determine the prevalence of lactose malabsorption in Myanmar children and to evaluate the possibility of using breath methane excretion to indicate lactose malabsorption in a field situation. A hydrogen breath test after a lactose meal (2g/kg, maximum 50g) was used as a standard test. Lactose malabsorption was more prevalent when children were weaned before 4 months of age (87. Compared with lactose-tolerant children, those with lactose malabsorption had significantly higher concentrations of breath hydrogen excretion 60 minutes after the lactose test meal. Breath methane excretion was also significantly higher in samples at 120 minutes in children with lactose malabsorption. Breath methane excretion of greater than or equal to 2 parts per million at 180 minutes as a diagnostic test for lactose malabsorption had a sensitivity of 61. The diagnosis is dependent on the use of rice breath hydrogen test which has potential limitations. As methane production has been identified in almost 20% of Myanmar children under age 5, it was possible that an increased carbohydrate load in the colon consequent upon rice malabsorption may provide increased substrate for methanogenic bacteria in the left colon.