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By C. Navaras. Cornell College, Iowa.

Purpose and Use of the Module A big challenge in the training of well-versed health professionals in the different higher institutions in Ethiopia has emanated from the serious shortage of adequate number of contextual reference materials cheap kamagra gold 100mg on-line. To add to this problem cheap 100 mg kamagra gold otc, even the available reference materials sometimes fail to address the most important learning issues of the Ethiopian students kamagra gold 100mg fast delivery. However buy discount kamagra gold 100 mg on line, up to this day discount 100 mg kamagra gold mastercard, efforts geared towards the preparation of reference materials by instructors in the different institutions in order to reduce this problem have remained meager. This module is prepared to help students develop knowledge, attitudes and skills required in their practice areas through active learning. Technologist) to be able to recognize and manage the important food-borne diseases as well as to prevent them from occurring from the outset. Besides, it is believed that those already engaged in the service delivery working in different health facilities will benefit as well from reading this module. All individuals taking time to look at this document are reminded of the importance of consulting standard textbooks on the subject whenever possible, since this module is by no means meant to replace them. Directions for Using the Module Before starting to read this module, please follow the directions given below: 1 1. Note: You may refer to the list of abbreviations and glossary shown in Unit Five for terms that are not clear. What are the three most important basic principles in the prevention and control of food-borne diseases? Any patient suspected to have cholera should be immediately referred to a higher center for better care. In the management of patients with cholera, fluid replacement is less important than antimicrobial therapy. Which one of the following can be taken as an objective data when assessing a patient with food borne diseases? During the nursing care for a patient with diarrhea secondary to food borne diseases, caffeine and carbonated beverage is limited because: A. One of the following nursing interventions is not carried out for a patient with poisoning related to the ingestion of contaminated food with chemical poisons and poisonous plants. Induction of vomiting is not recommended after ingestion of caustic substances or petroleum distillates A. Identify an incorrect statement about the nutritional management of the patient with food borne diseases that has diarrhea. Which one of the following nursing interventions is used to reduce anxiety of a patient with diarrhea secondary to food borne diseases? Providing an opportunity to express fears and worry about being embarrassed by lack of control over bowel elimination. Provision of isolation according to the general rule of body substance isolation, or individual institution adaptation of isolation. For Environmental Health Officers Read the following questions carefully and give the appropriate answer. For Medical Laboratory Technologists Write the letter of your choice for the following questions on separate answer sheet. Food- borne diseases are known to be responsible for a large proportion of adult illnesses and deaths; more importantly, as sources of acute diarrheal diseases, they are known to claim the lives of overwhelming numbers of children every day. In developing countries like Ethiopia, the problem attains great proportions due to many reasons; basic among which are poverty and lack of public health awareness. Although well-documented information is lacking regarding the extent of food-borne diseases in the country, and many cases and outbreaks are unrecognized or unreported, they are unquestionably one of the major reasons or why people of all ages seek medical help. Most food-borne diseases manifest with gastrointestinal symptoms and signs, the latter being uniformly among the top diagnoses in health facilities at all levels. Besides, they commonly lead to epidemics that result in the losses of many lives, accompanied with severe economic repercussions. In these modern days, in which food is usually not consumed immediately following and/or at the site of production, the risks of food-borne diseases are becoming increasingly important; the concern is obviously much more in areas where food storage and preparation safety measures are far below the optimum. The role of well-trained health professionals not only in the prevention and control of food- borne diseases, but also in the recognition of individual cases as well as outbreaks and their timely and proper management in order to reduce mortalities and morbidities is very crucial. Learning Objectives General Upon completion of this module, the learner will be able to recognize, prevent and manage food-borne diseases.

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However buy 100 mg kamagra gold otc, during the initial steps of infection order kamagra gold 100 mg visa, antibodies alone or in conjunction with the proper cytokines may provide important functions kamagra gold 100mg for sale, such as prevention of entry of bacteria at mucosal surfaces cheap kamagra gold 100mg fast delivery. Even though the issue remains controversial discount kamagra gold 100 mg without a prescription, the role of antibodies in intracellular bacterial infections has gained renewed attention. Lately, their participation in the control of acute infec- tions, such as chlamydial respiratory infection (Skelding 2006), and chronic infec- tions produced by Actinomycetes, including M. More recently, individual purified antigens have also been assayed, including proteins, lipopoly- saccharides and glycolipids, i. To date, however, no test has shown sufficiently high sensitivity and specificity values for diagnostic purposes (Al Zahrani 2000, Bothamley 1995, Singh 2003, Raqib 2003, Julián 2004, Lopez-Marin 2003, see also chapter 13). This enhanced anti-mycobacterial activity of phagocytes by antibody-coated bacilli is extremely important in the context of mucosal immunity. IgG and IgA antibody classes have been shown to be present in the mucosal secretions of the human lower respiratory tract (Boyton 2002). Intranasal inoculation of mice with an IgA monoclonal antibody against alpha crystallin protein reduced the M. Both monomeric and polymeric IgA reduced cfu to the same extent, sug- gesting that the antibody may target the Fc alpha receptor (Fc-αR) rather than polymeric immunoglobulin receptor (poly-IgR) in infected lung macrophages. As expected, protection was of short duration, probably due to the rapid degradation of the intranasally-applied IgA. Instead of a 10-fold reduction in cfu, a 17-fold reduction was observed, as well as lower granulomatous infiltration of the lungs. The mecha- nisms of control of the bacterial load seem to be associated with granular exocyto- sis involving perforin and granzymes. In the last few years, however, γδ T cells proved to be relevant for the regulation of the immune response. Indeed, when these cells are eliminated by genetic manipulation or by using a specific monoclonal antibody, inflammatory damage is accelerated in the lungs of mice infected with M. Like dendritic cells, they can process and efficiently present antigens and give the co-stimulating signals needed to induce proliferation of αβ T cells (Brandes 2005). As noted, γδ T cells act as a link between the innate immune response and the adaptive immune response, although other roles played by these cells still remain unknown. This treatment regimen is not a realistic option in limited-resource coun- tries, or even in large cities of developed countries, because after a few weeks of treatment the patients start to feel well again and stop taking the drugs. The first is that the antibiotics kill the vast majority of the bacilli within a few days, but per- sisting bacteria are not killed by the drugs. These persisting bacilli may be in a true stationary phase with very low metabolism, and may be non-replicating or repli- cating very slowly (latent infection). The other reason is the necrotizing tissue response that is analogous to the Koch phenomenon (Koch 1891). Robert Koch 172 Immunology, Pathogenesis, Virulence demonstrated that the intradermal challenge of guinea pigs with whole organisms or culture filtrate, four to six weeks after the establishment of infection, resulted in necrosis at both the inoculation site and the original tuberculous lesion site. In fact, this treatment was shown to have extremely severe consequences associated with extensive tissue necrosis and was discontinued (Anderson 1891). Still today, the task for the researchers working in this field is to understand the differences be- tween protective immunity and progressive disease, including the Koch phenome- non (Rook 1996). Similar abnormalities are also observed in the lungs of Balb/c mice, which have been experimentally infected via the trachea with a high dose of M. Thus, during early infection (first month) there is a predominance of Th1 cells, while during progressive disease a mixed Th1/Th2 pattern exist in this animal model. When pre-sensitized with 10 cfu of Mycobacterium vaccae, a sapro- phytic, highly immunogenic mycobacteria, mice infected with M. In sharp contrast, when 9 pre-immunized with a higher dose of the same mycobacterial preparation (10 cfu), mice develop a response with a mixed Th1/Th2 pattern that leads to increased se- verity of infection with the disease, and death (Hernandez-Pando 1994, Hernandez- Pando 1997). Tuberculosis pathogenesis and pathology related to the immune response 175 resistance or susceptibility to M. The nature, route, and dose of mycobacterial exposure depend on where and how an individual lives, because mycobacteria are not part of the usual commensal flora of human beings. These questions will be addressed in the next section, but it is certain that there are many significant participant factors that we do not yet know about, and their characterization will contribute significantly to the knowledge of the immunopathology and control of this significant infectious disease. An increase in antigen load is clearly a participating factor, as shown by the striking linkage of the Th1/Th2 balance to the dose after immunization with particulate antigens such as mycobacteria (Hernandez-Pando 1994) or Leshmania (Bretscher 1992). Indeed, Th1 cell apoptosis can partly be in- duced by foamy macrophages through a Fas/Fas ligand mechanism. Due to these properties, foamy macrophages are long-lived cells that harbor mycobacteria for long periods, and at the same time are a significant source of immunosuppress- ing cytokines that facilitate bacilli proliferation.

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Despite these complicated factors cheap kamagra gold 100 mg visa, considerable insight may be gained from understanding the elementary principles of fluid mechanics as they pertain to simpler physical systems discount kamagra gold 100 mg free shipping. Such principles will be expanded in this chapter to explain the interrelationships among the velocity of blood flow purchase 100 mg kamagra gold, blood pressure order 100mg kamagra gold with mastercard, and dimensions of the various components of the systemic circulation buy kamagra gold 100 mg overnight delivery. Blood flows out of the heart (the region of higher pressure) into the closed loop of blood vessels (a region of lower pressure. As blood moves through the system, pressure is lost because of friction between the fluid and the blood vessel walls. The highest pressure in the vessels of the circulatory system is found in the aorta and systemic arteries as they receive blood from the left ventricle. The lowest pressure is found in the venae cavae, just before they empty into the right atrium. Pressure gradient in the blood vessels [The mean blood pressure of the systemic circulation ranges from high 93 mmHg in the arteries to a low of a fewmmH in the venae cavae. For instance, if the pressure at both ends of the segment were 100mmHg, there would be no flow. The flowing equation, derived by the French physician Jean Leonard Marie Poiseuille, shows the relationship between these factors: 8 L η R= —— 4 π r Because the value of 8/π is a constant, the relationship can be rewritten as: L η R ∞ —— 4 r This expression says that resistance increases as the length of the tube and the viscosity of the fluid increase but decreases as the radius increases. How significant are length, viscosity, and radius to blood flow in a normal individual? The length of the systemic circulation is determined by the natomy of the system and is essentially constant. The viscosity of blood is determined by the ratio of red blood cells to plasma and by how much protein is in the plasma. Normally, viscosity is constant, and small changes in either length or viscosity have little effect on resistance. This leaves changes in the radius of the blood vessels as the main contributor to variable resistance in the systemic circulation. Thus, a small change in the radius of a tube will have a large effect on the flow of a liquid through that tube. Thus, veins serve as a blood reservoir, as well as transport passage back to the heart. Smaller veins converge into fewer but larger radii vessels, the velocity of blood flow increases as the blood moves toward the heart. Veins also serve as a large blood reservoir and because their storage capacity, they are called as “capacitance vessels”. As they have abundant collagen tissue, veins have little elasticity in comparison to arteries. Because of these properties, veins are highly distensible or stretchable, and have little elastic recoil. They distend well to accommodate additional amount of blood with only a little rise in venous pressure. Veins with extra amount of blood simply stretch to accommodate without tendency to recoil. When demands for blood are low, the veins can store extra blood as ‘reserve’, because of passive dispensability. As per Frank- Starling’s Law, increased venous return induces an increase in stroke volume of the heart. Therefore, a balance exists between the capacity of the veins, the extent of venous return, and the cardiac output. If more blood remains in the veins instead of being returned to the heart, such storage reduces the effective circulating volume. On the contrary, if venous capacity reduces, more blood returns to the heart, and continues circulating. Venous return refers to the volume of blood entering each atrium per minute from the veins. Since atrial pressure is ‘0’ mm Hg, a small but adequate driving force/pressure promotes the blood flow through large diameter and low resistance veins. Most of these factors influence the pressure gradient between the veins and the heart. Effect of Sympathetic Activity on Venous Return Veins are less muscular, have little muscle tone, but venous smooth muscles are richly supplied with sympathetic adrenergic vasoconstrictor fibers. Sympathetic stimulation produces venous vasoconstriction, elevating venous pressure, which in turn increases the pressure gradient to drive more blood from the veins into the right atrium.

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