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However voveran sr 100mg mastercard, it has been efective oral cephalosporins) for treating gonococcal infections of the in published clinical trials purchase 100mg voveran sr free shipping, curing 98 generic voveran sr 100 mg otc. Spectinomycin and if reported discount voveran sr 100 mg without prescription, treat these patients with ceftriaxone because has poor efcacy against pharyngeal infection (51 discount voveran sr 100 mg on line. Azithromycin 2 g orally is efective against uncomplicated Single-dose injectible cephalosporin regimens (other than gonococcal infection (99. None of the recommended because several studies have documented treat- injectible cephalosporins ofer any advantage over ceftriaxone ment failures, and concerns about possible rapid emergence of for urogenital infection, and efcacy for pharyngeal infection antimicrobial resistance with the 1-g dose of azithromycin are is less certain (306,307). Some evidence suggests that cefpodoxime 400- Pharynx mg orally can be considered an alternative in the treatment of Most gonococcal infections of the pharynx are asymp- uncomplicated urogenital gonorrhea; this regimen meets the tomatic and can be relatively common in some populations minimum efcacy criteria for alternative regimens for urogenital (103,278,279,314). Few antimicrobial regimens, including 400 mg orally was found to have a urogenital and rectal cure rate those involving oral cephalosporins, can reliably cure >90% of of 96. Gonococcal strains patients should be treated with a regimen with acceptable with decreased susceptibility to oral cephalosporins have been efcacy against pharyngeal infection. Most infections allergy and occur less frequently with third-generation cepha- result from reinfection rather than treatment failure, indicat- losporins (239). In those persons with a history of penicillin ing a need for improved patient education and referral of sex allergy, the use of cephalosporins should be contraindicated partners. Clinicians should advise patients with gonorrhea to only in those with a history of a severe reaction to penicillin be retested 3 months after treatment. Retesting losporin allergy, providers treating such patients should consult is distinct from test-of-cure to detect therapeutic failure, which infectious disease specialists. Cephalosporin treatment following Efective clinical management of patients with treatable desensitization is impractical in most clinical settings. Patients Pregnancy should be instructed to refer their sex partners for evaluation As with other patients, pregnant women infected with N. Because spectinomycin is not available in the 60 days before onset of symptoms or diagnosis of infection in United States, azithromycin 2 g orally can be considered for the patient should be evaluated and treated for N. If a patient’s last sexual inter- cin or amoxicillin is recommended for treatment of presump- course was >60 days before onset of symptoms or diagnosis, tive or diagnosed C. Resistance Use of this approach (68,71) should always be accompanied by Suspected treatment failure has been reported among per- eforts to educate partners about symptoms and to encourage sons receiving oral and injectable cephalosporins (300–304). For male patients informing Terefore, clinicians of patients with suspected treatment fail- female partners, educational materials should include informa- ure or persons infected with a strain found to demonstrate in tion about the importance of seeking medical evaluation for vitro resistance should consult an infectious disease specialist, conduct culture and susceptibility testing of relevant clinical Vol. Gonococcal Meningitis and Endocarditis Persons treated for gonococcal conjunctivitis should be treated presumptively for concurrent C. Te infection is complicated occasionally by perihepatitis Patients should be instructed to refer their sex partners and rarely by endocarditis or meningitis. Gonococcal Infections Among Infants Treatment Gonococcal infection among infants usually is caused by Hospitalization is recommended for initial therapy, espe- exposure to infected cervical exudate at birth. It is usually an cially for patients who might not comply with treatment, acute illness that manifests 2–5 days after birth. Te preva- for those in whom diagnosis is uncertain, and for those lence of infection among infants depends on the prevalence of who have purulent synovial efusions or other complica- infection among pregnant women, whether pregnant women tions. Examination for clinical evidence of endocarditis and are screened for gonorrhea, and whether newborns receive meningitis should be performed. Less severe manifestations include rhinitis, vaginitis, urethritis, Recommended Regimen and reinfection at sites of fetal monitoring. Gonococcal oph- newborns thalmia is strongly suspected when intracellular gram-negative Sepsis, arthritis, and meningitis (or any combination of diplococci are identifed in conjunctival exudate, justifying these conditions) are rare complications of neonatal gonococcal presumptive treatment for gonorrhea after appropriate cultures infection. A defni- aspirate provide a presumptive basis for initiating treatment tive diagnosis is vital because of the public health and social for N. Nongonococcal or presumptive identifcation of cultures should be confrmed causes of neonatal ophthalmia include Moraxella catarrhalis with defnitive tests on culture isolates. Prophylactic Treatment for Infants Whose Mothers Have Gonococcal Infection other Management Considerations Infants born to mothers who have untreated gonorrhea are Simultaneous infection with C. Both mother and infant should be tested for chlamydial infec- Recommended Regimen in the Absence of Signs of Gonococcal Infection tion at the same time that gonorrhea testing is conducted (see Ophthalmia Neonatorum Caused by C. Follow-Up other Management Considerations Infants who have gonococcal ophthalmia should be hospi- Both mother and infant should be tested for chlamydial talized and evaluated for signs of disseminated infection (e. Management of Mothers and Their Sex Partners Te mothers of infants who have gonococcal infection and the mothers’ sex partners should be evaluated and treated Vol.

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The main characteristics of vital statistics are: Comprehensive – all births and deaths should be registered voveran sr 100mg amex. Health Service Records All health institutions report their activities to the Ministry of Health through the regional health bureaus generic 100mg voveran sr amex. Advantages: Easily obtainable Available at low cost Continuous system of reporting Causes of illness and death available order 100 mg voveran sr mastercard. The major problems related to this source (health service records) are low compliance and delays in reporting order 100 mg voveran sr overnight delivery. Health Surveys Health surveys are studies conducted on a representative sample population to obtain more comprehensive data for monitoring the health status of a population buy 100mg voveran sr with mastercard. Advantages of surveys based on interview: They are more representative of the health condition of the community. Documentary sources - Clinical records and other personal records, death certificates, publications etc. If you want to know the number of people in your kebele who are properly using latrines, which method of data collection would be appropriate? When the disease occur as epidemic, outbreak, and pandemic it is considered as excess of what is expected. Epidemic: The occurrence of disease or other health related condition in excess of the usual frequency in a given area or among a specific group of people over a particular period of time. There is no general rule about the number of cases that must exist for a disease to be considered an epidemic. If the number of cases exceeds the expected level on the basis of the past experience of the particular population, then it is an epidemic. An epidemic may cover a small area within a city, or an entire nation or may have a worldwide distribution. Common Source Epidemics:- Disease occurs as a result of exposure of a group of susceptible persons to a common source of a pathogen, often at the same time or within a brief time period. When the exposure is simultaneous, the resulting cases develop within one incubation period of the disease and this is called a point source epidemic. Food borne epidemic following an event where the food was served to many people is a good example of point source epidemic. If the exposure to a common source continues over time it will result in a continuous common source epidemic. A waterborne outbreak that spreads through a contaminated community water supply is an example of a common source epidemic with continuous exposure. The epidemic curve may 55 have a wide peak because of the range of exposures and the range of incubation periods. It can occur through direct person to person transmission or it can involve more complex cycles in which the agent must pass through a vector as in malaria. Propagated spread usually results in an epidemic curve with a relatively gentle upslope and somewhat steeper tail. When it is difficult to differentiate the two types of epidemics by the epidemic curve, spot map (studying the geographic distribution) can help. Mixed Epidemics:- The epidemic begins with a single, common source of an infectious agent with subsequent propagated spread. Steps in Epidemic Investigation There is no fixed step in the investigation of epidemics but the following step can be considered as one option. Preparations can include: Investigator must have the appropriate scientific knowledge, supplies, and equipment to carry out the investigation. It might be difficult for the health extension worker to fully investigate the epidemic, hence, he/she should inform and involve other high level health professionals from the outset. Verify (confirm) the existence of an epidemic This initial determination is often made on the basis of available data. Compare the number of cases with the past levels to identify whether the present occurrence is in excess of its usual frequency. For example the already collected blood film slides can be seen by laboratory experts to check whether the initial report was correct. It is important to investigate the index case (the first case that comes to the attention of health authorities) and other early cases.

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They also potentiate the effects of β- receptor agonists and inhibit the lymphocytic-eosinophilic airway mucosal inflammation Effects on airway • decreases bronchial reactivity • increases airway caliber • decreases frequency of asthma exacerbation and severity of symptoms The corticosteroids commonly used are hydrocortisone voveran sr 100mg free shipping, predinisolone 100 mg voveran sr mastercard, beclomethasone 100 mg voveran sr otc, triamcinolone and etc cheap voveran sr 100 mg mastercard. Aerosol treatment is the most effective way to decrease the systemic adverse effect of corticosteroid therapy order 100 mg voveran sr visa. Abrupt discontinuation should be discouraged because of the fear of adrenal insufficiency. Types: - Useful productive cough o Effectively expels secretions and exudates - Useless cough o Non-productive chronic cough o Due to smoking and local irritants Anti-tussives are drugs used to suppress the intensity and frequency of coughing. Central anti- tussives - Suppress the medullay cough center and may be divided into two groups: o Opoid antitussive e. Peripheral antitussives - Decrease the input of stimuli from the cough receptor in the respiratory passage. Ipecac alkaloid, sodium citrate, saline expectorant, guanfenesin, potassium salts Mucolytics are agents that liquefy mucus and facilitate expectoration, e. Mechanism of Action Mucus membrane decongestants are α1 agonists, which produce localized vasoconstriction on the small blood vessels of the nasal membrane. Clinical uses: Used in congestion associated with rhinitis, hay fever, allergic rhinitis and to a lesser extent common cold. Short acting decongestants administered topically – phenylepherne, phenylpropanolamine 2. Long acting decongestants administered orally - ephedrine, pseudoephedrine, naphazoline 3. Long acting topical decongestants o Xylometazoline o oxymetazoline 83 Side effects: 1. Tachycardia, arrhythmia, nervousness, restlessness, insomnia, blurred vision Contraindications 1. Drugs used in Acid-peptic disease: Acid-peptic disease includes peptic ulcer (gastric and duodenal), gastroesophageal reflux and Zollinger – Ellison syndrome. Peptic – ulcer disease is thought to result from an imbalance between cell – destructive effects of hydrochloric acid and pepsin and cell-protective effects of mucus and bicarbonate on the other side. Pepsin is a proteolyic enzyme activated in gastric acid, also can digest the stomach wall. A bacterium, Helicobacter pylori is now accepted to be involved in the pathogenesis of ulcer. In gastroesophageal reflux, acidic stomach contents enter into the esophagus causing a burning sensation in the region of the heart; hence the common name heartburn, or other names such as indigestion, dyspepsia, pyrosis, etc. They are used as gastric antacids; and include aluminium, magnesium and calcium compounds e. Calcium compounds are effective and have a rapid onset of action but may cause hypersecretion of acid (acid - rebound) and milk-alkali syndrome (hence rarely used in peptic ulcer disease). All gastric antacids act chemically although some like magnesium trisiolicate can also act physically. Antacids act primarily in the stomach and are used to prevent and treat peptic ulcer. Antisecretory drugs include: • H 2-receptors blocking agents such as cimetidine, ranitidine, famotidine, nizatidine. Common adverse effects: muscular pain, headache, dizziness, anti- androgenic effects at high doses such as impotence,gynecomastia,menstrual irregularities. Drug interactions may occur when it is co-adminstered with warfarin, theophylline, phenytoin, etc. Anticholinergic agents such as pirenzepine, dicyclomine Major clinical indication is prevention & treatment of peptic ulcer disease, Zollinger Ellison syndrome, reflux esophagitis. However, they are combined with H2-antagonists to further decrease acid secretion, with antacids to delay gastric empting and thereby prolong acid – neutralizing effects, or with any anti-ulcer drug for antispasmodic effect in abdominal pain. Locally active agents help to heal gastric and duodenal ulcers by forming a protective barrier between the ulcers and gastric acid, pepsin, and bile salts. Laxatives and cathartics (purgatives) Laxatives and cathartics are drugs used orally to evacuate the bowels or to promote bowel elimination (defecation). The term cathartic implies strong effects and elimination of liquid or semi liquid stool.

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Osteoclasts (multinucleated giant cells with acidophilic cytoplasm buy cheap voveran sr 100 mg online, related to the process of bone resorption) may also be seen near the osteochondral junction voveran sr 100 mg low price. Calcifying cartilage and rows of hyaline cartilage cells are present and 20 extend into the cartilage of the proximal end of rib buy cheap voveran sr 100 mg line. Is the osseous lamella adjacent to the Haversian canal the youngest or the oldest lamella of a particular osteon? Be sure you know how cartilage and bone differ morphologically cheap voveran sr 100 mg mastercard, functionally 100mg voveran sr fast delivery, and with respect to blood supply. Note the connective tissue has begun to condense as a fibrous periosteum on either side of the anastomosing trabeculae of the growing bone. The trabeculae surround large spaces (primitive marrow cavities) containing embryonic connective tissue, thin-walled blood vessels, and nerves. In active regions, a unicellular row of osteoblasts (each with an eccentric nucleus and strongly basophilic cytoplasm) lines the surface of the trabeculae. Within the trabeculae, notice osteocytes in their lacunae and the woven bone matrix, which, unlike that of mature bone, is unevenly stained pink and exhibits a patchy basophilia. Later, minerals are deposited as minute hydroxyapatite crystals (calcium phosphate salts) in close association with the collagenous fibers to form a solid rigid matrix. In a typical adult long bone, one can distinguish grossly a cylindrical shaft or diaphysis of compact bone (with a central marrow cavity) and, at the ends of the shaft, the epiphysis, each consisting of spongy bone covered by a thin peripheral shell of compact bone. In the growing long bone, the epiphysis and the diaphysis are united by a transitional zone called the metaphysis. A hollow cylinder called the periosteal collar forms through intramembranous ossification around the middle of the cartilage model. The primary center of ossification begins with calcification of matrix at the diaphysis and eroding by blood vessels. The osteoprogenitor cells differentiate into osteoblasts and begin depositing matrix, forming spicules. Secondary centers of ossification begin in the epiphysis at each end with invasion by blood vessels 22 23 Growth at the epiphyseal plate: Passing from the articular end of the cartilage toward the ossification center of the diaphysis, the following zones are encountered in succession in the growth plate: 1) zone of reserve cells: A thin layer (3-6 cells wide) of small, randomly oriented chondrocytes adjacent to the bony trabeculae on the articular side of the growth plate. Mitotic figures are present and the axis of the mitotic figure usually is perpendicular to that of the row of chondrocytes. In the epiphyses where growth in length is occurring, note the zones of reserve cells, proliferation, maturation, hypertrophy, calcification, ossification and resorption. The zone of endochondral ossification spreads from the primary ossification center toward the ends of the cartilage. Recall that this bone is growing in width by apposition and remodeling along the periosteum and the endosteum. This increase in length and extension of the primary ossification center results in a sequence of changes in the chondrocytes of the epiphyses, which is similar to that described for the establishment of the primary center. In the epiphyseal growth plate, observe the zones of reserve cells, proliferation, maturation, hypertrophy, calcification, ossification and resorption. When growth ceases, the epiphyseal disk is entirely replaced by spongy bone and marrow (“closure of the epiphyses”), resulting in a visible epiphyseal line. In synovial or diarthrodial joints, articular cartilage caps the ends of the bones, which are kept apart by a synovial cavity filled with synovial fluid. The articulation is enclosed by a dense fibrous capsule, which is continuous with the periosteum over the bones. Internal to this is the synovium, a secretory membrane formed by a layer of collagenous fibers interspersed with flattened fibroblasts (synovial cells). The connective tissue elements include the meninges, which surround the central nervous system; capsules surround some sense organs and ganglia; and the endo-, peri-, and epineurium of peripheral nerves. Meninges Dura mater Arachnoid mater Grey matter Subarachnoid space Cerebral cortex Pia mater White matter 26 The detailed structure and function of the nervous system will be studied during the neurosciences course. The following class slides and electron micrographs will serve to acquaint you with nervous tissue as one of the four basic tissues. Spinal cord #85 Spinal Cord, Cross section (Nissl stain) At low power identify the centrally located butterfly or H- shaped arrangements of the gray matter.

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