By U. Fadi. Jones International University.

They wrote (3): “Tissue engineering is an interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore claritin 10 mg on line, maintain order 10mg claritin mastercard, or improve tissue function” order 10mg claritin otc. Since then the novel speciality has successfully expanded and excited scientists and clinicians alike cheap claritin 10 mg without prescription. They injected bone marrow cells into irradiated mice buy claritin 10mg line, nodules developed in the spleens in proportion to the number of bone marrow cells injected. Later on, they obtained evidence that these cells were capable of infinite self-renewal, a central characteristic of stem cells (4). Thus, stem cells by definition have two defining properties the capacity of self-renewal giving rise to more stem cells and to differentiate into different lineages under appropriate conditions. Their potential to differentiate into different cell types seems to be more limited (5) (Table 1). The capability for potency and the relative ease to isolate and expand these cells are invaluable properties for regenerative medicine. Several ideas have been put forward to explain stem cell lineage and fate determination. This three-dimensional (3D) microenvironment is thought to control genes and properties that define “stemness”, i. Further studies on the niche might give us a better understanding on the control of stem cell differentiation. Stem cells might be appropriately differentiated cells with the potential to display diverse cell types depending on the host niche. Furthermore, stem cells implanted into a totally different niche can potentially differentiate into cell types of the new environment (7). For example, human neuronal stem cells produced muscle cells when they were implanted in skeletal muscle (8). Bone marrow cells differentiated into neuronal cells when they were transplanted into a neural environment (9,10). This can have clinical implications for example since both liver and pancreas develop from the same embryological line, specific growth factors and culture Topics in Tissue Engineering, Vol. Stem cells for regeneration techniques achieved the “transdifferentiation” of liver cells to islet cells (11). Stem cell Definitions Stem cell A cell with the ability for self-renewal and differentiation potential. Self-renewal Asymmetric cell division which leads to at least one daughter cell which is equal to the mother cell. Commitment Engaging in a defined pathway which leads to differentiation and inability for self- renewal. Progenitor cell A proliferative cell with the capacity to differentiate but with no self-renewal ability. Multipotency Ability to form multiple cell lineages which form an entire tissue, usually specific to one germ layer, e. Plasticity Controversial possibility for adult stem cells to show higher potency in response to different microenvironments. On 17 January 1912 in one of his experiments he placed part of chicken’s embryo heart in a fresh nutrient medium. Every January 17 , the doctors and nurses would celebrate with Carrel, singing “Happy Birthday” to the chicken tissue (12). Even though these cells were unlikely to be embryonic and possibly more related to cord-derived cells, this experiment showed the future potential of tissue culture. The hypoblast forms yolk sac, while the epiblast differentiates into three classical layers of the embryo; ectoderm, mesoderm and endoderm with potential of forming any tissue (Fig. Before their clinical use, ethical and scientific questions need to be resolved, e. In 1869, Paul Langerhans as a medical student observed for the first time beta islet cells as microscopic islands of a different structure in the pancreas (16). These complex mini-organs the pathological site of diabetes have always fascinated transplant and regenerative scientist not just for their complexity but also for their important clinical relevance. Stem cells for regeneration is still nascent, but might lead to breakthrough medical advances. Thus, the discovery of stem cells led us to predict that their use might impact health care more than the discovery of anaesthesia and antibiotics.

If this level of protection is not possible then some form of face mask is needed when with the patient and hand-washing order claritin 10mg without prescription, changing clothes (hot wash) buy 10mg claritin otc, and showering before contact with the healthy claritin 10mg for sale. For strangers arriving particularly during a pandemic consider 10-14 days isolation generic claritin 10 mg amex, followed by clothes burning and a through wash with soap before entering the community discount claritin 10 mg with mastercard. There are no current infectious diseases with longer incubation times than 10-14 days. Provided the newcomer is symptom free at the end of this period you should be safe. However, among the current potential pandemic causes there are not currently carrier states although this needs to be considered. The recent tsunami in southern Asia clearly demonstrates how quickly public health can break down. Despite widespread knowledge even in developing third world countries about the basic principles of public health and hygiene latrines have been dug next to water supplies, water wasn’t being boiled, and in some places no effort was made to burn or dispose of rubbish, and it was just allowed to accumulate. While you can argue that some of this was due to “shell shock” from the disaster itself it just goes to show how the fundamentals can go out the window in a stressful situation. At present there is a heavy reliance on investigations; in a long-term austere situation history and examination will come into their own again. History taking and Examination: With very limited access to investigations the importance of clinical examination will again take on enormous importance. While modern doctors are competent at physical examination there is heavy reliance on special tests, and many of the skills of accurate physical examination have faded. The basics are easily learned from any clinical skills textbook (We recommend Talley and O’Connor, Physical Examination) and with a little practice. It is almost certain that in long-term austere situations that physical examination will come into its own again. The history 95% of the time is all that is required to know exactly what is going on. The examination and investigations may be used to confirm your thoughts, but it’s the history that usually gives you the diagnosis. Investigations: Laboratory tests: Lab tests which are possible in an austere environment are discussed in the Laboratory chapter. These include basic urine analysis, blood typing, and cross matching, and simple cell counts. There are several low-tech ways that are reasonably accurate in diagnosing fractures. Fractures of the long bones (tibia, fibula, femur, humerus, clavicle, ribs, etc), can be diagnosed by either percussion, or a tuning fork, and a stethoscope. A bony prominence on one end of the bone in question is tapped, or the base of a vibrating tunning fork is placed against it, and the stethoscope is applied to the other end. If a fracture exists on one side and not the other the gap in the bone at the fracture site will result in less sound being transmitted so the sound will be somewhat muted on the side of the fracture. To diagnose a hip fracture the sound source is applied to the patella (knee cap) and the stethoscope applied over the pubic symphysis. The technique is less effective on the obese as fatty tissue will absorb sound waves. For long bones running near the surface of the body a fracture can be localized by drawing the tuning fork along the bone slowly (>30 sec, but <60 sec) until a very localized source of pain is identified (<3 cm). A cone formed from rolled paper can act as a substitute for a stethoscope but is less than ideal. Once again, the reality will be that the most useful method for diagnosing fractures will be clinical examination. This is also the case for the clinical chest examination in patients who would previously have had a chest x-ray. Treatment The trick to learn for patient care in a truly austere situation is to do what you can do extremely well. You may not have access to many medications or much equipment but do what you are able to do well and you will save lives. The classic survival cliché is a simple scratch could result in you dying from gangrene infection of the leg. While at the extreme end of the spectrum this may be true cleaning the wound with copious amounts of water and keeping it covered will prevent most infections; if there are signs of infection further good basic wound care, resting the limb, and keeping it elevated for 48-72 hours will further the chances of serious infection all without antibiotics. Now obviously sometimes antibiotics will be lifesaving but you can reduce the reliance on high tech treatment by doing low tech treatments well. Medical supplies/Instruments Bandages and Dressings: Any absorbent material may be used as a dressing and any length of material for a bandage.

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Online assessment in the form of discussion boards/ tutorials and group work and participation will constitute the other 50% of the overall course grade buy 10mg claritin fast delivery. This is taken to represent a formative assessment of learning throughout the programme cheap 10 mg claritin with mastercard. The written assignment should review aspects of palliative care management and should be considered in a specific clinical scenario generic claritin 10mg on-line. Summative works will be approximately 3 discount 10 mg claritin otc,000 words in total and will be approved by the Health Informatics Programme Committee generic claritin 10 mg amex, on the recommendation of the Course Convener. This will be a reflective piece of around 2,000-2,500 words entitled, for example: "Take a learning outcome from your own clinical area and discuss how you would teach, assess and evaluate it; explaining and justifying the reason for your choices". This will be a written case assignment based on a particular patient- focused ethical situation and submitted online. Discussion boards and tutorial contributions will constitute the other 30% of the overall course grade which is also taken to represent a formative assessment of learning throughout the programme. Online assessment through participation in discussion boards, group work (wikis) and interactive materials will constitute the other 10% of the overall course grade and is taken to represent a formative assessment of learning throughout the programme. Within each specialty module students will be assessed by means of:  Critical appraisal of recent journal articles (50%) through a combination of online journal clubs and written online journal article appraisal forms. Students will be encouraged to produce either a short PowerPoint presentation, podcast or audio lecture that can be put online for peer and tutor assessment. This piece should be written in a style appropriate for a general medical (non-specialist) audience. The formatting should be suitable for formal publication and should contain an appropriate review of the literature. Tutors and fellow students will grade presentations with marks allocated in a 60% (tutor) to 40% (student) ratio. Writing skills, awareness of issues relating to plagiarism and referencing will be introduced. Students will be expected to actively use these tools throughout the course to create pieces of solo and group work, for example making presentations, reviewing journal articles and writing short review articles. The tools and resources available to perform thorough and accurate literature researching both within the University library services and on the internet will be introduced. How to conduct literature appraisal and the concept of evidence- based medicine will also be discussed. Students will receive some initial information on statistics that will be developed in later modules. The University’s librarians and a team for transferable skills will be working to tailor this module to students’ needs. Intended learning outcomes At the end of this course candidates should be able to conduct a literature search and critically review research and statistics used in clinical research. Online assessment (participation in interactive modules, discussion boards and group work) will constitute the other 10% of their overall course grade and is taken to represent a formative assessment of learning throughout the programme. Course description This programme aims to ensure that practitioners have a sound understanding of basic pharmacology principles and practices. Pharmacodynamic and pharmacokinetics principles will be taught using clinical examples. Reasons for individual variation, drug monitoring, and types of adverse drug reactions will be discussed using interactive and problem-based scenarios. Students will also learn and reflect on medication compliance: why medication errors occur and how safe prescribing guidelines can be formulated. Students will gain a good understanding of the mechanisms of action and effects of recreational misused drugs. They will discuss common clinical toxicology and poisoning case scenarios, developing analytical reasoning to aid diagnostic and management decisions. Intended learning outcomes At completion of this course the candidate should have sufficient understanding of the basic principles of pharmacology to guide prescribing in a general medical setting. Students should be able to diagnose and initiate appropriate treatment for common clinical toxicology presentations and understand why good prescribing practices are required to ensure patient safety. The basic framework of medicines management—internationally, nationally and locally—should be appreciated.

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It is more suitable for minor to moderate bleeding or ooze over a larger area discount claritin 10 mg with amex, such as an abrasion or skin graft donor site (not an austere indication! It bonds with blood cells to form a clot 10mg claritin fast delivery, and also has some antimicrobial - 181 - Survival and Austere Medicine: An Introduction effect claritin 10mg on-line. There was some concern early on regarding those with seafood allergies best claritin 10mg, but this appears to be unfounded cheap 10mg claritin with mastercard. If you are limited in what you can get, we suggest you purchase and expand in this order. All are good broad spectrum antibiotics and have different strengths and weakness. We suggest you purchase an antibiotic guide, most medical bookshops have small pocket guides for junior doctors detailing which drug to use for which bug and outlining local sensitivities. If allergic to penicillin a macrolide such as Erythromycin can generally be used interchangeably where a penicillin based antibiotic is indicated. It is only a small minority (a few %) of patients who develop a rash who if re-exposed will develop a life threatening allergic reaction. If you are in an disaster situation (with no medical help) with a life saving indication for a penicillin-based antibiotic, and a history of only a mild rash, and no alternative available, it is reasonable to give a single dose of antibiotic and be prepared for an allergic reaction. If you have had a serious allergic reaction before (breathing problems, swollen lips or tongue, low blood pressure, or a wide spread lumpy red rash) then you should avoid - 182 - Survival and Austere Medicine: An Introduction penicillin-based antibiotics under all circumstances and plan your medical supplies accordingly. A reasonable general rule would be 48 hours after resolution of most major symptoms. In the case of a patient who appears not to be responding to treatment, there are a number of possibilities - it is the wrong antibiotic for the infection, it is not reaching the site of infection, concentrations are not high enough (oral vs. Knowledge has a tendency to fade with time and non-use ,and there will always be situations arise that require looking up a procedure, a pictorial reference, a protocol or dosing information. Healthcare practitioners undertake regular continuing education to not only stay abreast of the latest techniques but also to aid in retaining skills not often practiced. Having good reference books on hand may be critical during times when the education system is no longer working or accessible, and when you are facing a situation that calls for new knowledge or reviewing previous training. This section will be divided into three primary areas: the basic must haves; those that support the first category, and everything else. The first category lists those books which by themselves constitute a very comprehensive survival medicine library. The second group represents those works, which expand the capabilities of the library further but are not deemed first line access works. Finally, a third section will list useful references that may be considered later. These latter books round out the library of suggested works and constitute a nice-to-have as opposed to necessary collection. Any one will serve well within its area though one may be selected over another based upon your existing medical skills. These are absolute must haves for anyone just getting started with medical preparedness. The third world environment mimics in many ways the post-disaster level of development many envision should it ever come to pass. The book offers useful information for handling everyday medical problems by unskilled caregivers with minimal access to resources. How to care for the gums, extract, fill or repair teeth, manufacture your own basic dental instruments, and more. Written for remote locations where access to trained medical aid is impractical or even non-existent. Probably the weakest area in any preparedness medical prep is the ability to perform a qualifiable health exam. Having a decent reference to guide you through the more unfamiliar aspects could prove invaluable. After you acquire the first five references above fill out your primary collection with a selection from each group below.

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The primary and secondary prevention of ischemic heart disease through the reduction of cardiovascular risk factors (e buy 10 mg claritin overnight delivery. Pathogenesis 10mg claritin for sale, signs 10 mg claritin amex, and symptoms of the acute coronary syndromes: • Unstable angina claritin 10mg line. The general approach to the evaluation and treatment of ventricular tachycardia and fibrillation buy claritin 10 mg mastercard. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history that differentiates among etiologies of disease, including: • Cardiac risk factors. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease including: • Recognition of dyspnea and anxiety. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that suggest a specific etiology of chest pain: • Stable angina. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to patients. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Patients who go on to end- stage renal disease have high morbidity and mortality, despite advances in dialysis treatment. A rational approach to patients with suspected or known acute renal failure allows students and clinicians to quickly assess the etiology and initiate treatment without unnecessary delay in an effort to prevent the development of chronic kidney disease. Physical exam skills: Students should be able to perform a physical examination to establish the diagnosis and severity of disease, including: • The determination of a patient’s volume status through estimation of the central venous pressure using the height of jugular venous distention and measurement of pulse and blood pressure in the lying/standing position. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to the patient and his or her family. Basic and advanced procedure skills: Students should be able to: • Insert a peripheral intravenous catheter. Respond appropriately to patients who are nonadherent to treatment for renal failure. Appreciate the impact renal failure has on a patient’s quality of life, well- being, ability to work, and the family. Recognize the importance and demonstrate a commitment to the utilization of other healthcare professions in the treatment of renal failure. Developing a logical and practical diagnostic approach to the more common cancers (e. Encountering patients in whom cancer is a diagnostic possibility will stimulate learning of the important clinical presentations and natural histories of these life-threatening conditions. Focusing on cancer diagnosis helps to concentrate the student’s learning and avoids premature immersion in the often very technical and specialized issues of cancer treatment. Current screening recommendations for skin, colorectal, lung, breast, cervical, and prostate cancer. Principle clinical presentations, clinical courses, complications, and causes of death for the most common cancers (e. Basic methods of initial evaluation, including the sensitivity and specificity of basic diagnostic studies and indication for their use, including: • Indications for skin biopsy in a patient with a suspicious skin lesion. Symptoms sometimes seen during end-of-life care and the basic principles of their management (e. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history, that differentiates among etiologies of disease, including: • Unintentional weight loss, fever, bone pain. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Skin examination. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that suggest a specific etiology for: • Unintentional weight loss. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Communication skills: Students should be able to: • Communicate the diagnostic plan and subsequent follow-up to patients. Basic and advanced procedure skills: Students should be able to: • Cervical Pap smear. Management skills: Students should able to develop an appropriate evaluation and treatment plan for patients that includes: • Initial work-up of the symptom, sign, or abnormal laboratory value suspected to be due to cancer. Appreciate the uncertainty and fear patients experience when cancer is a significant diagnostic possibility.

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