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The vaccine is unstable at also be delayed with recurrence of the symptoms room temperature and must be kept refrigerated anxiety girl cartoon order genuine atarax on-line. Recurrence is more It should be emphasized that whilst these vaccines likely to occur after inadequate treatment anxiety signs 25 mg atarax. Consequently strict food anxiety symptoms mimic heart attack purchase 10mg atarax with mastercard, water and personal Role of primary health care team hygiene protection continue to be of great • Education regarding food, water and personal importance. Blood • Awareness of the risks and management of patient cultures can provide early confirmation; the with carrier status organism can then be tested for antibiotic sensitivity. Stool and urine culture may also be Role of health education and health promotion performed from one week following confirmation • Heighten public awareness of the disease and of the disease. Water and food samples from its prevention suspected sources also need to be tested. The virus most commonly invades Paratyphoid usually has a shorter incubation period, the gastrointestinal tract and a viraemic illness may with diarrhoea from the onset, a more abundant develop. In some cases the virus invades and rash and less commonly develops intestinal destroys the anterior horn cells of the spinal cord. In the most severe cases, the virus attacks the motor neurons of the brainstem, causing difficulty in breathing, swallowing and speaking. Modes of transmission • the faecal-oral route, particularly in areas where there is poor food and water hygiene. Communicability Cases are most infectious from 7–10 days before and after onset of the illness, although the virus may be shed in the faeces for up to six weeks or even longer. Epidemiological summary It is thought that poliomyelitis first occurred nearly 6000 years ago in the time of the ancient Egyptians. Evidence for this theory lies in the withered and deformed limbs of some Egyptian mummies. Since the development of the polio vaccine in the mid1950s, cases of poliomyelitis have diminished dramatically. The disease was brought under control and practically eliminated as a public health problem in industrialized countries. Today the disease has been eradicated from large parts of the world; the key remaining reservoirs of Page 80 Module 3 virus transmission • the level of damage to the spinal cord determines are in South Asia the muscles affected. However, muscles of the lower and sub-Saharan limbs are more frequently paralyzed. However, • Contractures can occur, the most common being outbreaks still flexion contractures of the hip and knee, and equinus occur and in deformity of the ankle. Two billion children have now been fully in swallowing and speaking, and reduced immunized worldwide. In the meantime, countries free from poliomyelitis must continue to vaccinate in order Age groups affected to prevent the virus reestablishing itself if reintroduced Polio can affect any age and the illness is more severe from other countries. However, the virus most commonly affects children 3 years and under with Manifestations over 50% of all cases occurring in this age group. The disease can follow three pathways: • Asymptomatic illness, which produces Prognosis seroconversion and life long immunity to the virus. Although paralytic poliomyelitis is rare, two thirds Non-paralytic poliomyelitis, which produces mild fluof those who develop severe symptoms will be left like illness with fever, pharyngitis and mild diarrhoea. Severe disability Sometimes viral meningitis with fever and headache is less common in children. Death from poliomyelitis develops, but improves after a few days with complete is usually related to respiratory failure, for which there recovery. Secondary attacks are • Paralytic poliomyelitis, which commences with very rare, but occasionally deterioration of muscle mild illness as described above with a brief period of power and bulk can present many years later. Destruction of the anterior Diagnosis horn cells of the spinal cord and the brain stem occur. High or rising titres of polio serum • A lower motor neurone paralysis can develop, antibodies can also be used as a means of diagnosis. There is no available drug therapy for the treatment Page 81 • Overexertion or trauma at this time (strenuous of poliomyelitis. However, symptomatic treatment exercise or injections) can increase the likelihood in the form of muscle relaxants and analgesia in the of paralysis to these muscles. Antibiotics can • Tracheotomy and positive pressure ventilation also be used to treat the occurrence of a secondary may be required in cases of severe respiratory bacterial infection in the chest or bladder. This is dependent upon: • Regular physiotherapy is necessary; following the • Adopting good food, water and personal acute phase, to help improve muscle recovery.

See the column on the right • Do not let your baby get too increased if your baby: for advice on sleeping positions anxiety symptoms fatigue cheap atarax 10mg visa. Twins anxiety symptoms adults buy cheapest atarax, triplets or more can have 37 weeks) anxiety symptoms in dogs 10 mg atarax free shipping, or specific sleeping issues and it may • Place your baby in the ‘feet to • was of low birth weight be difficult for you to get them foot’ position. The Multiple Births There is also a risk that you might Foundation and Tamba (see pages the safest place for your roll over in your sleep and suffocate 183 and 188) have information baby to sleep is on their your baby, or that your baby could that you may find useful. They can back in a cot in a room get caught between the wall and sleep in the same cot – there is with you for the first the bed, or could roll out of an adult information from Tamba on six months. The outside of the mattress should • Even in winter, most babies who be waterproof. Cover the mattress If you are pregnant and want are unwell or feverish do not with a single sheet. Feeding Babies exposed to cigarette smoke Breastfeeding your baby reduces the after birth are also at an increased risk of cot death. Nobody should Don’t let your baby everything you need to know about smoke in the house, including overheat. Don’t let your baby get too hot (or too cold) Overheating can increase the risk of cot death. Babies can overheat because of too much bedding or clothing, or because the room is too It is possible that using a dummy at hot. Remember, a folded blanket the start of any sleep period reduces counts as two blankets. Do not begin check your baby, make sure they to give a dummy until breastfeeding are not too hot. If your baby is is well established, usually when sweating or their tummy feels hot your baby is around one month to the touch, take off some of the old. Don’t worry if your baby’s your baby is between six and Don’t let your baby’s head hands or feet feel cool – this 12 months old. Babies whose heads are covered • It is easier to adjust the with bedding are at an increased temperature with changes risk of cot death. If your baby is sleeping your baby sleeps a lot, wake them peacefully, always regularly for a drink. See the section on illnesses on Organise the place where page 145 for guidance on when you change your baby so that you should get help. Water is fine for cleaning Monitors a nappy is on a changing mat or your baby’s bottom but you may Normal healthy babies do not need towel on the floor, particularly if you want to use wipes or lotion for a breathing monitor. That way, convenience when you are away find that using a breathing monitor if you take your eye off your baby from home. However, there is for a moment to look after another • You may want to use a cream, such no evidence that monitors prevent child, your baby cannot fall and as zinc and castor oil cream, which cot death. If you are using a the skin clean and dry, especially changing table, keep an eye on your with disposable nappies, since cream baby at all times. If it’s dirty, wipe reducing the risk of cot away the mess from your baby’s • If you are using a cloth nappy, death, or to buy a simple bottom with tissues or cotton wool. Babies vary a lot Most babies get a sore bottom in how often they Nappy hygiene or have nappy rash at some time, pass stools. Disposable nappies bowel movement at or around each Nappy rashes are caused by contact If the nappy is dirty, flush the feed; some can go for several days between sensitive skin and soiled contents down the toilet. Don’t put babies produce at least one stool and change their nappies more anything but nappies in this bag. Better still, give your Fasten the bag and put it outside baby time without a nappy and When to get help in your bin each day. Keep a Most small babies strain and go Cloth nappies spare nappy handy to mop up any red in the face, or even cry, when • If the nappy is dirty, flush the accidents. For example, it is normal Immediately after birth and for the • Wash nappies every two to three for some babies to have very runny first few days, your baby is likely days. But ask your doctor, midwife to pass a sticky, greenish-black on your nappies, but a 60ºC or health visitor if you notice any substance. If you did not big changes, such as stools: and it is the waste that has collected soak the nappies before, add an in your baby’s bowels while they • becoming very frequent and antibacterial nappy cleanser to your were in your uterus. As your baby begins to digest milk, • being very smelly Don’t use enzyme (bio) washing the stools will change. They will • changing colour to become powders or fabric conditioner as become more yellow or orange green, white or creamy.

It is also severe and explosive in quality lasting 30 min to 2hrs anxiety 4 weeks after quitting smoking cheap 25 mg atarax otc, subsiding abruptly anxiety grounding techniques buy 10mg atarax visa. Preventions/prophylactic therapy: clusters attacks can be prevented effectively by: 496 Internal Medicine • Prednisolone anxiety 5 senses buy 10mg atarax with mastercard, Lithium, Methysergide, Ergotamine, Sodium valproate and verapamil C) Tension headache (Tension type headache ) • Most common cause of headache in adults • Common in women than men • Can occur at any age, but onset during adolescence or young adulthood is common. Etiology: various precipitating factors may cause tension headache in susceptible individual including. Clinical feature • Tension headache is characterized by mild or moderate, bilateral pain. Headache is a constant, tight, pressing or band like sensation in the frontal, temporal, occipital or parietal area. If treatment is unsatisfactory addition of caffeine or other analgesic is beneficial. Physical Therapy: different techniques can be used including Hot or cold application Positioning Stretching exercises Traction Massage 3. Psychological Therapy • Includes reassurance, Counseling, relaxation, stress management programs and biofeedback techniques reduce both the frequency and severity of chronic headache. D) Headache Associated with Brain Tumor • About 30% of patients with brain tumor present with headache. Headache of brain tumor is usually intermittent dull aching, moderate intensity which worsens with time. It disturbs sleep in about 10% of patients, exacerbated by exertion and postural changes. Clinical feature • Typical presenting symptom includes headache, polymyalgia rheumatica, jaw claudication, fever and weight loss. Diseases of the Spinal cord Learning objectives: at the end of this lesson the student will be able to: 1. The white matter contains ascending sensory and descending motor fibers and gray matter contains nerve cell bodies. Generally diseases of spinal cord are characterized by: • the presence of a level below which motor/sensory and/or autonomic function is disturbed. Motor disturbance causes weakness (paraplegia, quadriplegia), spasticity, hypereflexia and extensor plantar response, which is due to disruption of descending corticospinal fibers. Impaired sensation results from disordered function of ascending spinothalamic and dorsal column pathways. Autonomic disturbance leads to disturbed sweating, bladder, bowel and sexual dysfunction. This cereal has neurotoxin which causes paraparesis when consumed in large amount for relatively long period of time. Neoplastic spinal cord compression May be classified as: 1) Extramedullary: tumor outside the spinal cord. Usually results from metastasis to adjacent vertebral bone or direct compression of the spinal cord. Is effective even for classically radio-resistant tumors Prevents new weakness and may give recovery of function Surgery: decompression or vertebral body resection Useful especially for intradural and intramedullary tumors Note: Treatment should be started as soon as possible (with in 12 hrs). Fixed motor deficits (paraplegia or quadriplegia), once established for > 12 hrs, do not usually improve, and beyond 48 hrs the prognosis for substantial motor recovery is poor. Tuberculosis of the spine (Pott’s disease) • One of commonest causes of myelopathy in developing countries where Tuberculosis is endemic, Ethiopia. Imaging studies • Plain radiograph show characteristically destructive process of the vertebrae, involvement of disc space with deformity. Prolapse of intervertebral disc • It occurs due to trauma, sudden severe strain or degenerative changes. Clinical feature Localized back pain aggravated by straining with or without • Radiculopathy • Segmental sensory loss • Changes in deep tendon reflexes (asymmetrical) Straight leg raising sign is positive: the patient will have back pain, when stretched leg is raised / flexed at the hip joint. Transverse Myelitis It is an acute or sub acute inflammatory disorder of the spinal cord. Metabolic and toxic myelopathies i) Subacute combined degeneration of spinal cord • Neurologic disease mainly affecting the spinal cord, resulting from severe Vit-B12 deficiency.

Students seeking special consideration should be able to provide medical certificates anxiety untreated 10 mg atarax with visa. Firstly anxiety symptoms requiring xanax atarax 10 mg free shipping, an introduction to the course anxiety blanket atarax 10mg with visa, its content and assessment and an opportunity to ask questions. Secondly, some historic background to the subject and related current Australian trends. Development in the early 20th century can also be seen in some Historic Movies 1920-1960 (http:/embryology. Late 20th Century There are too many embryological breakthroughs in the late 20th century to briefly list here. Remember that these award dates reflect findings that have proven to be scientific key breakthroughs from earlier dates. Trisomy 18 or Edward Syndrome multiple abnormalities of the heart, diaphragm, lungs, kidneys, ureters and palate 86% discontinued (More? Renal Agenesis/Dysgenesis reduction in neonatal death and stillbirth since 1993 may be due to the more severe cases being identified in utero and being represented amongst the increased proportion of terminations (approximately 31%). N Persaud Chapter 2 Larsen’s Human Embryology Chapter 1 Lectopia Lecture Audio Lecture Date: 28-07-2009 Lecture Time: 12:00 Venue: BioMed E Speaker: Mark Hill Cell Division and Fertilization (http:/lectopia. The eukaryotic cell cycle is regulated by 2 protein families known as cyclins and cyclin-dependent kinases. Meiosis occurs only in germ cells (sperm=spermatozoa and egg=oocyte), producing genetically different progeny. Prophase I is divided into five phases: Leptotene chromosomes start to condense. Zygotene homologous chromosomes become closely associated (synapsis) to form pairs of chromosomes consisting of four chromatids (tetrads). Pachytene crossing over between pairs of homologous chromosomes to form chiasmata (form between two nonsister chromatids at points where they have crossed over) Diplotene homologous chromosomes begin to separate but remain attached by chiasmata. Diakinesis homologous chromosomes continue to separate, and chiasmata move to the ends of the chromosomes. Prometaphase I Spindle apparatus formed, and chromosomes attached to spindle fibres by kinetochores. Metaphase I Homologous pairs of chromosomes (bivalents) arranged as a double row along the metaphase plate. The arrangement of the paired chromosomes with respect to the poles of the spindle apparatus is random along the metaphase plate. The number of possible arrangements is 2n, where n is the number of chromosomes in a haploid set. Human beings have 23 different chromosomes, so the number of possible combinations is 223, which is over 8 million. Comparison of Meiosis/Mitosis McGraw-Hill Animation comparing Mitosis and Meiosis (http:/highered. Recent research in mice suggest that the position of oocyte polar body may influence fertilization site. Abnormalities the most common chromosome abnormality is aneuploidy, the gain or loss of whole chromosomes. Fertilization is the complete process resulting in the fusion of haploid gametes, egg and sperm, to form the diploid zygote. Spermatozoa Capacitation following release (ejaculation) and mixing with other glandular secretions, activates motility and acrosome preparation. Endocrinology Diagram of the comparative anatomy of the male and female reproductive tracts (http:/www. The acrosome reaction that occurs when a mammalian sperm fertilizes an egg (http:/www. How the cortical reaction in a mouse egg is thought to prevent additional sperm from entering the egg (http:/www. Francis-West Chapter 1 Online Textbooks Developmental Biology by Gilbert, Scott F. Regulation of the Eukaryotic Cell Cycle Regulation of the Eukaryotic Cell Cycle (http:/www.

It allows researchers to conduct in-depth explorations of key issues and concepts across cultural boundaries anxiety wrap order generic atarax on line, and to advance theory and practical application of the qualitative sciences anxiety xanax side effects buy on line atarax. In its widest sense anxiety coach 10mg atarax with visa, research comprises all of the processes, procedures and techniques that allow a researcher to select, collect, record, manage and analyse ethnographic data within the framework of a theory (Trotter, 1991, Bernard 1988, Werner and Schoepfle 1987). Ethnography has been simultaneously viewed as a means and an end, or both a process and a product (Johnson 1990). As a process, ethnography constitutes a set of strategies for data collection, rather than a single methodological approach. As such, the approaches may include both qualitative and quantitative methods and involve data that are from both primary and secondary data sources. The ultimate aim or product of ethnography is a written representation all of the key aspects of a society, culture or social scene. Intensive field research provides the ethnographer the opportunity to observe, record and ask questions about ordinary events from the time people get up when they turn in at night. While field work should be long enough to ensure that major cultural beliefs and behaviours are identified, shorter sessions are often possible when important cultural parameters are better known or when the research focus is a specific area of behaviour (Trotter, 1991). Room (1992), describes the place of drug and alcohol studies within classical ethnographic projects as one dimension of the holistic description of the culture, often without specific emphasis on this cultural dimension over any other. In some cases, this approach creates a de-emphasis on the problematic aspects of drug abuse by limiting their importance or prominence within the overall description of a culture. In other cases this approach strongly identifies the global parameters of drug abuse as a cross cultural problem. The classic ethnographic approach can be contrasted with more recent use of this methodology to focus on the place of drugs in a culture or on particular subcultures of drug users. The New York City based Unit consists of a supervisor with training on ethnographic techniques and several researchers with a history of substance abuse. The authors state that the researchers knowledge of street language and drug behaviour enables them to capture information that would escape most observers. This allows the Unit to gather the following information on an on-going basis: kinds and amounts of drugs being sold, offered and used; number of sellers and users; costs and variability on prices; location of sales; shifts in the drug scene; labels and other identifying marks on illicitly sold drugs; information on the sale and use of drug paraphernalia; general characteristics of sellers/ users and attitudes and opinions among sellers/ users on the drug scene. This technique has been widely used to establish data on drug use practices that are complex and difficult to understand from interview data alone. Some examples include data on how drug exchanges and needle sharing patterns occur, or how the exchange of sexual favours is important in crack houses. It is an important method for determining the similarities and differences between what people say they do (their ideal model of culture) and what actually happens when they use drugs (real culture in context). These types of studies have been invaluable in developing empirically based, in addition to theoretically based, intervention programmes. One example of this is the Needle Hygiene Project, conducted by the National Institutes on Drug abuse Co-operative Agreement Program (Needle et al. Direct observations of injection drug use were conducted at five sites around the country. The behaviours being observed included needle cleaning practices, sharing of injection equipment, and all of the processes associated with preparing drugs for injection. Leal was able to gather data which started with the initial phases of children working in the streets, dropping out from school and leaving the family, through all of the stages of development in this street culture. The authors report the social interactions that enabled children as young as eight years of age to survive in very violent environments, noting that prostitutes were providing affection and a substitution for the mother role, while the young adults were teaching them how to get drugs, run away from the police, and to use local welfare institutions to fulfil their basic needs. This type of life cycle research can produce very useful information based on observations alone, or on observations combined with ethnographic interviewing techniques. One is the direct observation of drug use behaviour (described above), and the other is in-depth qualitative interviewing using either exploratory or systematic data collection methods. The intensive and extensive combination of these two approaches is called “participant observation” in anthropology. Bernard (1988) states that participant observation is the core element in ethnographic research. It involves establishing rapport in a new community and learning to act in a way that people will perform their normal activities regardless of the ethnographers presence.

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