By Y. Thorek.
However purchase lexapro 20mg otc anxiety symptoms 9 weeks, rad- Gleason score: The biopsy material is examined under ical surgery is a major operation buy lexapro line anxiety symptoms in 5 year old boy, with a 60% incidence a microscope and a Gleason grade 1 5 (grade 1 being of impotence (compared to 16% preoperatively) and most differentiated buy lexapro cheap online anxiety hot flashes, grade 5 the least) is assigned to the anincreaseinurinaryincontinence. These also cause complications such as acute and chronic ra- two grades are then added together to give the Gleason diation proctitis (diarrhoea, urgency, bleeding), and score (2 10). Complications Metastatic or high grade local disease: Urinary tract infection and renal tract obstruction may r Treatment is for symptoms only (palliative). Ten per r Throughout treatment a multidisciplinary approach cent of all testicular tumours develop in testes which is needed with regard to palliation of symptoms. A family phosphonates are used for bone pain and to prevent history is also a known risk factor as is infertility. Localised radiation is used for bone pain and recently bone-targeting radioisotopes have been Pathophysiology developed for those with multiple metastases. If conned to It appears that these atypical cells are formed early prostate: 80% have 5-year survival and 60% have 10- in gestation and may be inuenced by events in utero. If metastases are present: 20% have 5-year They then lie dormant, until puberty, when they spread survival and 10% have 10-year survival. In some individuals, they become ma- lignant and either develop along the seminomatous or teratomatous line. Introduction to testicular tumours Denition Classication Tumours of the testis may be classied broadly into those The main components of the testis are the germ cells arising from the germ-cell line and those arising from (spermatogonia), the sex cords or seminiferous tubules non-germ cells. Leydig cells normally pro- ducetestosterone,soLeydigcelltumourshavethepoten- Sex tial to produce steroid hormones at levels high enough Males to have systemic effects. Other tumour types include nous spread leads to metastases most commonly in the lymphoma and metastases. A dull ache Scrotal biopsy should be avoided, as this increases the or dragging sensation in the lower abdomen or per- risk of local spread and recurrence. Associated gy- Management naecomastia or lymphadenopathy should be looked Testicular cancer is now one of the most curable solid for, as well as any evidence of metastases, e. A testicular prosthesis may iliac and para-aortic lymph nodes via the spermatic be placed at the time of surgery. Clinical features Howeverinhigher stage disease, this may be postponed As for testicular tumours. Macroscopy/microscopy The tumour appears as a homogeneous rm white mass, amidst normal, brown testis. There are three his- tological subtypes of seminoma, termed classic, anaplas- Denition tic and spermatocytic (British Testicular Tumour Panel) These are testicular tumours of germ-cell origin which depending on the microscopic features: have differentiated along the spermatocytic line. Sheets of large, polygonal cells with clear cytoplasm (vacuo- Incidence/prevalence latedandglycogencontaining)andsmallcentraldark- Mostcommontesticulartumour(40%);2/100,000p. The presence of brous septa contain- ing prominent lymphocytic inltration is a favourable Age prognostic factor. This Aetiology is a rare neoplasm which occurs in slightly older pa- As for testicular tumours. It is not associated with intratubular germ cell mon type to occur in maldescended testes. Despite the apparent histological features of Age aggressiveness they have an indolent growth and show Any. Around 10% of seminomas contain trophoblastic gi- Sex ant cells, and these produce human chorionic go- Males nadotrophin, which may be detectable in the blood. However, this does not appear to affect prognosis, or Aetiology response to treatment. Complications Pathophysiology i Seminomas tend to spread via the lymphatics initially, Teratomas are more aggressive than seminomas, al- to the iliac and para-aortic lymph nodes. Management All patients undergo radical orchidectomy as an initial Clinical features measure. It is associated with a good is treated with further chemotherapy or radiotherapy. There is a higher risk of contralateral which have a variegated appearance due to foci of cancer, but this usually responds well to treatment. Blood-borne prognostic markers are good, down to 48% for poor metastases are a common early feature. Yolk sac elements are often found with other Leydig cell tumour germ cell tumour elements, when they form solid and papillary lesions which consists of micro-sheets and Denition cordsofcells with vacuolated cytoplasm. These are Thisisanon-germcelltumourofthestromaofthetestis, highly malignant and confer a worse prognosis. Complications Sex Spread occurs via the blood stream to lung, liver, brain Male only andbone. If tumour markers do not respond, commonly present with secondary effects such as gy- second choice chemotherapy is tried. Prognosis Macroscopy/microscopy Apart from higher stage disease, the worst prognosis is in Circumscribed, yellow-brown, uniform tumour which those with very high tumour markers and histologically ranges from 1 cm to a bulky mass. Microscopically, the in those which are undifferentiated, vascular invasive or cellsresemble normal Leydig cells sheets or nests of if containing trophoblastic or yolk sac elements. Even large, polygonal cells with round nuclei and abundant for metastatic disease modern treatment has improved granular eosinophilic cytoplasm. Vacuolated cytoplasm, the 5-year survival rates signicantly to over 90% if all or pinkish crystals of Reinke may be seen. The Sertoli cells form the testicular tubules and when stimulated by follicle-stimulating hormone from pu- berty, they are capable of supporting the maturation of Sertoli-cell tumour spermatogonia. Normally they do not secrete sex hor- Denition mones, but tumour cells may secrete low levels of andro- This is a non-germ-cell tumour of the testis, derived gens or oestrogens, but these are very rarely high enough from the Sertoli cells which are part of the seminiferous to cause systemic effects. Macroscopy/microscopy Homogeneous grey-white to yellow masses of variable Age size, which are well circumscribed. Certain histological features Sex predict metastasis; for example multiple mitoses and Male only large cell calcifying cell type. Symptoms Seizures: Features that suggest a seizure include wit- nessed convulsions (one or both sides of the body), post- Headache ictal (post-seizure) confusion, drowsiness and headache. Most headaches of the tongue and urinary incontinence (due to re- do not have a serious cause. The history is the most laxation of the bladder sphincters) and other injuries important diagnostic tool. If there As with most types of pain, specic features that must are warning signs prior to the seizure, e. Auras are un- pain is sometimes generalised, but if focal may be de- usual in other types of ts and faints except for in mi- scribed as frontal, occipital, temporal and either unilat- graine which does not result in loss of consciousness or eral or bilateral. Sudden onset r Notall seizures are due to epilepsy intracranial le- Severe pain r sions such as tumours, stroke and haemorrhage, or ex- Associated neurological abnormalities r tracranial causes such as drugs and alcohol withdrawal Impaired consciousness r are important underlying causes. Seizures r Metabolic causes that must be excluded in any sus- Previous head injury or history of fall or trauma r pected t or faint include hypoglycaemia and hypocal- Signsofsystemic illness caemia. The headache may subside or persist, but is typically at its worst at the dramatic onset. Meningitis A generalised headache classically associated with fever and neck stiffness.
The role of nationwide nosocomial infection surveillance in detecting epidemic bacteremia due to contaminated intravenous fluids cheap 20 mg lexapro otc anxiety 4 weeks after quitting smoking. The epidemiologic field investigation: science and judgment in public health practice buy 10mg lexapro visa anxiety grounding techniques. Eastern Mediterranean Health Journal1996: 2;151-4 Lincoln-Lancaster County Health Department of Health Promotion & Outreach buy 10mg lexapro with mastercard anxiety 5 senses. Mike Ryan, Operationl Aspects of Outbreak Investigation, World Health Organisation, Geneva Ministry of Health. Guideline for the prevention and control of selected epidemic diseases in Ethiopia. Guidelines for the prevention and 179 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia control of meningococcal meningitis epidemic in Ethiopia. Viseral leishmaniasis diagnosis and treatment guideline for health workers in Ethiopia. A preliminary report of the Steering Group of the Second National Prevalence Survey. Practical guidelines for responding to an outbreak of meningococcal disease among university students based on experience in Southampton. Tigray Bureau of Health, Department for the control of malaria and other vector borne diseases. Means of pathogenesis break confirmation and clinical 183 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia problems - including case definition 1. Arthemether-lumefantrine: Tablet containing 20 mg Arthemeter plus 120 mg Lumefantrine in a fixed dose combination. Weigh Age Number of tablets per dose twice daily for 3 days t (kg) (year Day1 Day 2 Day 3 s) Morning Evenin Mornin Evenin Mor Eve g g g ning ning 5-14 3mo 1 1 1 1 1 1 s-2 year s 15-24 3-7 2 2 2 2 2 2 year s 25-34 8-10 3 3 3 3 3 3 year s 189 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia 35+ > 10 4 4 4 4 4 4 year s b) Second-line treatment If a P. Then administer Artemether-Lumefantrine as indicated above or oral quinine if the first drug is not available. However, if a patient has a history of intake of artemether- lumefantrine before complications developed, give quinine tablets 10 mg salt per kg every 8 hours to complete 7 days treatment. Look at the number of malaria cases at specific health facility or district by month for the past 5 years excluding epidemic years. Determine the 3 quartile for the monthly th series by identifying the 4 highest number from the bottom in each data series (since data is ranked in ascending order). This is rd the 3 quartile representing the upper limit of the expected normal number of malaria cases. Plot the 3 quartile for each data series by months for the 5 year period and join the points with a line. Plot the monthly malaria cases that visited a health facility and compare with the third quartile or the norm-chart. If the number is 194 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia rd above the 3 quartile (upper limit), 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.
Many traditional medicines now face extinction with serious consequences for local communities buy 10 mg lexapro with amex anxiety yellow pill. For example discount lexapro online visa anxiety or ms, licorice root cheap generic lexapro canada anxiety symptoms eye pain, without a doubt the most 59 commonly used Chinese herb is now threatened. Licorice root is now grown in less than 60 half its previous area as a result of excessive harvesting and habitat destruction. Where bioprospecting occurs without benefit-sharing or the consent of source communities it is sometimes referred to as "biopiracy". However, guarding these resources has historically proven challenging due to a lack of national and international regulations and the need for law enforcement. A prominent example includes the patenting of turmeric in the United States of America. It is applied as an antiseptic for cuts, burns and bruises, taken internally for digestive disorders, and applied topically for skin disorders. The patent on "Use of Turmeric in Wound Healing" covered "a method of promoting healing of a wound by administering turmeric to a patient afflicted with the wound". The patent application claimed that this was the first use of turmeric for such a purpose. The issuance of this patent generated international controversy, particularly in India, where it was felt that traditional Indian medicine was being misappropriated. The ensuing public outcry prompted the Indian government to request that the patent be revoked on the basis of lack of novelty due to its known traditional use. In helping defeat the patent, the Indian government provided evidence that this use of turmeric was not innovative. Because novelty is a necessary requirement for patent protection, it is now difficult for any party to patent the use of turmeric for wound healing or to require compensation for this use. In the Beijing Declaration, they recognized the role of traditional medicine in the improvement of public health and supported its integration into national health systems where appropriate. The declaration encourages governments to create or improve national policies on traditional medicine. It also promotes improved education, research and clinical inquiry into traditional medicine, as well as improved communication 62 between health care providers. The knowledge of traditional medicine, treatments and practices should be respected, preserved, promoted and communicated widely and appropriately based on the circumstances in each country. Governments have a responsibility for the health of their people and should formulate national policies, regulations, and standards as part of comprehensive national health systems to ensure appropriate, safe and effective use of traditional medicine. Recognizing the progress of many governments to date in integrating traditional medicine into their national health systems, we call on those who have not yet done so to take action. Governments, international organizations and other stakeholders should collaborate in implementing the global strategy and plan of action. Governments should establish systems for the qualification, accreditation or licensing of traditional medicine practitioners. Traditional medicine practitioners should upgrade their knowledge and skills based on national requirements. The communication between conventional and traditional medicine providers should be strengthened and appropriate training programmes be established for health professionals, 63 medical students and relevant researchers. By 2003, that figure had reached 45, while 51 countries reported national policies pending. The same trend is seen 65 with national laws and regulations regarding herbal medicine. In the past decade it has funded more than 2,500 research projects resulting in more than 3,300 scientific articles in peer-reviewed 67 journals. Traditional medicine has historically played a prominent role in the national health care system and remains well integrated with allopathic care. Both systems of medicine receive government support, and the Chinese Constitution was amended in 1982 to state that "both modern medicine and traditional 69 Chinese medicine must be developed. Principles of human rights should be applied to all aspects of traditional healing. Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services. Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right. In conjunction with indigenous peoples, States shall take effective measures to recognize 72 and protect the exercise of these rights. These range from an absence of regulation to highly structured regulation similar to that applied to pharmaceuticals. There is ongoing debate whether marketing exclusivity should be granted in return for data 75 submission. Data-based exclusivity prevents generic drug manufacturers from making use of data submitted in an initial application by an originator pharmaceutical manufacturer for a 76 fixed period of time. In effect, this may extend the exclusivity period for an originator drug 77 beyond the patent term or beyond a finding that a patent is invalid. In applying for regulatory approval of a generic equivalent to an approved on-patent medicine, access to or reliance on the original application for regulatory approval is essential. While generics manufacturers can independently generate new clinical data, this is extremely costly and time-consuming. Also, re-generating clinical test data may be regarded as unethical in that it exposes human subjects to a clinical trial that would add no scientific value, and provides a placebo to some patients in place of a medicine with proven efficacy. Dietary supplement labels may only make health claims, nutrient content claims, and 80 structure/function claims. Health claims describe a relationship between a dietary supplement ingredient and reduced risk of a disease condition, nutrient content claims describe the relative amount of a dietary substance in a product, and structure/function claims describe how supplements may affect the organs or systems of the body without mention of any specific disease. In practice, structure/function claims may promise vaguely worded health benefits that can be similar to claims to treat illness. Examples include calcium builds strong bones and fiber maintains bowel regularity. Claims must be followed by the disclosure that This statement has not been evaluated by the Food and Drug Administration. Manufacturers that want to legally make a claim to treat illness may only do so if their claims are supported by adequate scientific evidence. However, since 2006 dietary supplement manufacturers have been required to report 85 any serious adverse effects within 15 days of knowledge of the event. These rules set requirements for domestically marketed herbs that include meeting specifications for identity, purity, strength, 89 and composition. Complementary and Alternative Medicine in the United States, 258-260 (National Academies Press 2005).
Integrated vector control measures to reduce the population of blackies generic lexapro 5mg with visa anxiety 4 year old, through application of insecticides in vegetation where vectors breed proven 10 mg lexapro anxiety hypnosis, and environmental management to reduce vegetation around fast- owing rivers where people live cheap 5mg lexapro otc anxiety symptoms feeling cold. Personal protective clothing to avoid the bite of blackies by covering exposed skin with clothing and wearing headgear in endemic areas. Community members fully participate in the programme and the drugs are delivered by trained village drug distributors, supervised by Health Extension Workers and Practitioners like you. Rapid case detection and referral, particularly for complicated cases involving sight loss. Encouraging acceptance of the mass drug administration programme is an important health education message that you can deliver in affected communities. It is also known as elephantiasis because of its effects on the legs of infected people. Though the disease is not fatal, it is responsible for considerable disability and distress, causing social stigma among men, women and children. You will learn more about the social consequences of lymphatic lariasis and a non-infectious cause of swelling in the legs (podoconiosis) in Study Session 39. After mating, the females lay millions of eggs which develop into microlaria, completing the lifecycle. The overall effect is to disrupt the lymphatic system, which normally collects tissue uids draining from the body s cells and returns the uid to the blood stream. If the lymphatic drainage is blocked, the lower limbs and sometimes also the genitals become hugely swollen with uid a condition called lymphoedema (pronounced limf-ee-deem-ah ). Infection of the swollen skin folds by bacteria is a frequent cause of very painful attacks. Therefore, if you live in an endemic area and you suspect a case of lymphatic lariasis, you should refer the patient to the nearest health centre for further testing and treatment. Education in the community about the causes and modes of transmission of lymphatic lariasis, and ways to protect themselves from mosquito bites. Encouraging acceptance of the mass drug administration programme is an important health education message that you can deliver if your community is affected. You also have a key role in educating patients about how to prevent and alleviate disabilities and pain due to lymphatic lariasis, as described in the nal part of this study session. You infectious elephantiasis, Study should educate them to wash the affected parts carefully every day, especially Session 39). Advise the patient to exercise the limbs any time and anywhere, as often as possible, to help the uid to exit from their swollen limbs. It is common in communities living near rivers, lakes and streams, where infected people shed Schistosoma eggs when they urinate or defaecate into the water. Schistosoma haematobium affects blood vessels in the bladder and causes pain during urination and bloody urine. Three other Leishmania species cause cutaneous leishmaniasis, which manifests as ulcers in exposed areas of skin. The microscopic microlaria cause skin nodules and can migrate to the eye, causing blindness. The worms block the lymphatic system, causing swelling of the limbs and sometimes the genitals, resulting in severe pain, disability and bacterial infection of thickened skin folds. In this study session, we turn to two communicable diseases found in Ethiopia in which a non-human warm- Taeniasis is pronounced blooded animal transmits the infectious agent to humans. Zoonotic is rabies transmitted to humans by dogs, and taeniasis (or tapeworm disease) pronounced zoo-nott-ik. Diseases in which a warm-blooded animal transmits the infectious agents to humans are known as zoonotic diseases (or zoonoses). Zoonotic diseases are difcult to control because the non-human animal acts as a reservoir of infection that can be passed on to humans. The infectious agent of rabies is a virus in the rhabdovirus family, which attacks the nervous system. Image Library, image 8319) The rabies virus exists in the saliva of the infected animal (as well as in its nervous system) and is transmitted to a person through a bite. Transmission can also be if an infected animal licks a fresh break in the person sskinor mucus membranes, e. Person-to-person transmission is theoretically possible if someone with advanced rabies bites another human, but this is not known to have occurred. After an incubation period usually lasting one to three months, but sometimes even up to one year after the bite, the patient develops symptoms that are similar to many other illnesses fever, headache and general weakness. The speed of progression is faster if the original site of infection was in an area of the body that is close to the spinal cord or brain, e. A dog s saliva travels along the characteristic sign of late-stage rabies in some patients is hydrophobia (fear of nerves to the person sbrain. This form of the disease (known as furious rabies) prevents the patient from drinking and speeds the arrival of death within a few days. There are no tests to conrm rabies with absolute certainty while the patient is still alive. Viruses can be detected by laboratory investigation of the patient s brain after death, but this test is not usually carried out in countries with few resources. The wound should not be sutured (stitched) unless this is essential to stop heavy bleeding. If stitches are required, the wound should not be sutured until after post-exposure prophylaxis has occurred. Post-exposure prophylaxis for rabies If a person is bitten by a dog in countries where rabies is endemic, there is no way of being certain that the animal is free from rabies. The bitten person should be given post-exposure prophylaxis (details of the regimen are described below) as soon as possible after the bite. Every year, around 15 million people receive this treatment worldwide, preventing an estimated 327,000 human deaths from rabies. Details of the vaccines and rabies immunoglobulin mentioned in the table will be described below. Contact category Action Category I: touching or feeding the None animal, licks on intact skin (i. The newer type of vaccine is made from virus-infected cells grown (cultured) in the laboratory and is safer and more effective. The intradermal route has been shown to be as safe and effective as the traditional intramuscular route, and is cheaper because it requires less vaccine. If you are referring someone to a health centre for rabies post- exposure prophylaxis, you should tell the patient and their family that it is essential to return at xed intervals for repeat vaccinations in order to prevent rabies if they have been infected by the bite. The term immunoglobulin refers to a preparation of antibodies made either in humans or in horses who have been vaccinated against rabies. Antibodies from their blood which attack the rabies viruses are harvested and stabilised in an injectable liquid. As much as possible of the dose of rabies immunoglobulin is given into, or as near as possible to, the site of the bite. If there is any remaining in the syringe, it is injected at a different site to elicit active immunity.