By U. Tippler. Saint Francis College, Fort Wayne, Indiana.

Saudi Arabia shows strong political commitment to the Elimination of Malaria from the Arabian Peninsula buy provera 10 mg, endorsed in 2005 by all bordering countries purchase 5mg provera with mastercard. Only 4% of the population is at high risk of malaria and 6% at low risk generic 2.5 mg provera free shipping, while 90% live in malaria-free areas generic provera 5 mg online. Confirmed malaria cases have decreased from an annual average of 36 360 during 2000–2005 to 6072 cases in 2009 (83% reduction) buy 5 mg provera with amex. During same period, with 100% testing of suspected cases, 95% of the reported cases were indigenous and malaria cases declined from an annual average of 55 640 to just 558 cases. Having achieved a substantial reduction in the malaria burden, Sri Lanka is once again in a position to envisage malaria elimination. With a 100% confirmation rate, the number of reported malaria cases decreased from an annual average of 11 449 cases during 2000–2005 to 1371 in 2009 (88% decline). Confirmed malaria cases have decreased from an annual average of 652 during 2000–2005 to only 106 cases in 2009 (84% decline). In the same period, malaria admissions decreased from 1026 to 230 and malaria deaths fell from 32 to 13 (over 60% reduction for both). Morbidity and mortality have been substantially reduced, with a decrease of *75% in the numbers of malaria cases, inpatient malaria cases and deaths in 2009 compared to the average for 2000–2004. Analysis of subnational inpatient data indicate that the higher totals in 2009 resulted from increases in Luapula and Eastern provinces. B: Antimalarial drug policy, 2009 Annex 5: Operational coverage of insecticide-treated nets, indoor residual spraying, and antimalarial treatment, 2007–2009 Annex 6. World Malaria Report 2010 questionnaire: Form for countries in control phase (1) World Malaria Report 2010 Form for countries in control phase Please complete this form before June 30th 2010 and return to : Please note, empty cells will be treated as missing data. Contact information Fill in details below: Country Name of programme Name of person completing the form Function E-mail Phone Fax 2. Completeness of outpatient reporting in 2009 ealth ealth Type of facility included in outpatient reports 2009: centre post ospital polyclinic clinic Click boxes that apply overnment Mission Private ther (specify) Reporting completeness 2009: Of all health facilities supposed to report on outpatients each month, what percentage actually do so? Total confirmed cases 2007 2008 2009 Microscopy (all ages, both active & passive Examined case detection, inpatients & Positive outpatients) P. Cases diagnosed in community 2007 2008 2009 2 Malaria cases detected by community based treatment programs R T examinations R Ts positive 2 Include both confirmed and clinically diagnosed cases. World Malaria Report 2010 questionnaire: Form for countries in pre-elimination and elimination phases (1) orld Malaria Report 20 0 orm for countries in pre elimination and elimination phases Please complete this form before 30 June 2010 and return to: Please note, empty cells will be treated as missing data. Contact information Fill in details below: Country: Name of programme: Name of person completing the form: Function: E-mail: Phone: Fax: 2. Reported cases and deat s 2007 2008 2009 Cases (All ages, both passive & lides examined active case detection) Positive P. World Malaria Report 2010 questionnaire: Form for countries in pre-elimination and elimination phases (2) 5. Completeness of reporting in 2009 ealth ealth Type of facility included in outpatient reports 2009: centre post ospital polyclinic clinic Click boxes that apply overnment Mission Private ther (specify) Please estimate reporting completeness for 2009: Monthly uartely Annually Fre uency of outpatient reporting: - Total number of health facilities expected to report (b) Total number of reports actually received in 2009 (c) Currently imple- ear 6. World Malaria Report 2010 questionnaire: Form for countries in pre-elimination and elimination phases (3). It highlights continued progress made towards reaching international targets for malaria control by 2010 and by 2015. Since 2008, more than 289 million insecticide-treated mosquito nets have been delivered to sub-Saharan Africa, enough to protect three quarters of the 765 million people at risk of the disease. Malaria control is making an important contribution to attaining the health-related Millennium Development Goals. It contains the esophagus, trachea, primary bronchi, thymus gland, heart (pericardial cavity), large blood vessels and lymphatic vessels. It contains stomach, spleen, liver, gallbladder, pancreas, most of the small intestine, most of the large intestine, kidneys, adrenal glands, ureters, and many major blood vessels. Remaining 4% of living matter is composed of: potassium (K), sulfur (S), sodium (Na), chlorine (Cl), magnesium (Mg) and trace elements. Electrical energy: energy of charged particle stored in a particular location, for example a battery 2. First law of thermodynamics: Energy can be neither created nor destroyed, but it can be converted from one form to another. Second law of thermodynamics: As energy forms convert from one form to another, the universe increases in disorder.

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The ester containing compounds are usually inactivated in the plasma and tissues by non-specific esterases generic provera 2.5 mg online. Local anesthetics block the initiation of action + potentials by preventing the voltage-dependant increase in Na conductance purchase provera 5 mg on line. Local anesthetics are used in minor surgery 10 mg provera with amex, dentistry purchase provera 5mg amex, abdominal surgery and painless childbirth order provera 2.5mg line. Methods of administration Uses Drugs Surface anaesthesia Nose, mouth, urinary tract Lidocaine Infiltration anaesthesia Direct injection into tissues to reach nerve Most braches and terminals. Write about mechanism of action and adverse effects of Phenytoin and carbamazepine. The etiologies include Obesity (because chronic calorie intake and prolonged stimulation of β cell causes a decrease in insulin receptor and also adipose tissue and muscle are less sensitive),hereditary,damage of pancreatic tissue, diabetogenic hormones(like growth hormone, thyroid, epinephrine), diabetogenic drugs like Thiazide diuretics, epinephrine, phenothiazines ,Other factors like Pregnancy. The common Signs and symptoms include polydipsia, polyphagia, polyuria, dehydration due to glucosuria. It is severe metabolic disturbance due to insulin deficiency, which results in hyperglycemia, ketonimia and later acidosis. It is characterized by headache, nausea, vomiting, rapid pulse, dry skin, deep breathing, and change in mentation. Hypoglycemic Coma is more serious complication which usually occurs due to excess dose of insulin which produces severe lowering of blood glucose that may leads to coma. The Sign /Symptom are mental confusion, in coordination, paresthesia, convulsion, coma and Signs of sympathetic over activity. Effects of insulin Carbohydrate metabolism Liver: it increases glycogen synthesis from glucose and glucose utilization while decreases gluconeogenesis and glycogenolysis Muscle: it increases glucose uptake, glucose utilization and glycogen synthesis. Adipose tissue: it increases glucose uptake and glycerol synthesis (esterifies fatty acid) Fat metabolism Liver: it increases lipogenesis Adipose tissue: it increases synthesis of triglycerides and synthesis of fatty acid 130 Protein metabolism Liver: it increases protein catabolism Muscle: it increases aminoacid uptake and protein synthesis Other metabolic effect: + ++ It increases uptake of K and Ca into cells and synthesis of nucleic acids There are some factors that increase insulin demand: like Infection, surgery, pregnancy and drugs (those that antagonize actions of insulin glucocorticoids, thyroid hormone, adrenaline) Type of insulin preparation: A. They are also used in the treatment of hyper kalmia due to renal failure Adverse Reaction: can be categorized as Local: Atrophy or hypertrophy at site of injection, local hypersensitivity and secondary infections. First generation: Tolbutamide, Chlorpropamide Second generation: Glibenclamide, Glipizide Mechanism: hypoglycemic action is due to Stimulation of insulin release from β cell, Depression of glucagon secretion, Increase number of insulin receptor, Reduce insulin output from liver (Decrease hepatic gluconeogenesis and glycogenolysis) Pharmacokinetics: They are rapidly absorbed from the gastrointestinal tract. They are also extensively plasma protein bound and are mainly metabolized in the liver. The important toxic effects include: hypoglycemia, allergic skin rash and bone marrow depression, cholestatic jaundice (esp. Alcohol produces “Disulfirum” like action (flushing of the face, severe headache, vomiting etc. Biguinides They potentiate the hypoglycemic action of insulin and sulphonyl ureas but they don’t produce clinical hypoglycemia in diabetics. Biguanides include drugs like metformin and phenformin Mechanism: They do not stimulate the release of insulin. They increase glucose uptake in skeletal muscle, and have effects on glucose absorption and hepatic glucose production. Metformin is largely excreted unchanged in the urine and has a longer duration of action. Side effects: Nausea, vomiting, anorexia, diarrhea, abdominal cramp, lactic acidosis (esp. It also causes ejection of milk through contraction of the myo-epithelial cells around the alveoli of the mammary gland. Pharmacokinetics: It is inactivated orally and absorbed rapidly after intramuscular administration. Use: Induction of labor in women with uterine inertia, Relief of breast engorgement during lactation (few minutes before breast feeding) as nasal spray, Postpartum hemorrhage. Side effect: Oxytocin may cause over stimulation and leads to rupture of the uterus in the presence of cephalo-pelvic disproportion. Prostaglandins They induce labor at anytime during pregnancy but most effective at the third trimester. In female reproductive system prostaglandin E & F are found in ovaries, endometrium and menstrual fluid which is responsible for initiating and maintaining normal birth process.

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The theory was therefore originally called the "Barker Hypothesis" and has recently been renamed as "fetal origins" or "programming" order 2.5mg provera mastercard. Glossary Links 2009 Lecture 23 From Embryology Contents Birth and Postnatal Development Introduction There are a great number of comprehensive buy 10mg provera overnight delivery, scientific and general trusted provera 10 mg, books and articles that cover Parturition discount provera 2.5mg with amex, Birth or Childbirth buy provera 10 mg with visa. Birth or parturition is a critical stage in development, representing in mammals a transition from direct maternal support of fetal development, physical expulsion and establishment of the newborns own respiratory, circulatory and digestive systems. Childbirth Parturition (Latin, parturitio = "childbirth") describes expelling the fetus, placenta and fetal membranes and is probably initiated by fetus not mother. Preterm birth - Risks of preterm birth in abnormal low birth weight (intrauterine growth restriction) and high (large for gestational age) categories are 2- to 3-fold greater than the risk among appropriate- for-gestational-age infants. Respiration Lungs at birth collapsed and fluid-filled - replaced with air by powerful inspiratory movement and absorption through the alveoli Lung epithelia has to rapidly change from its prenatal secretory function to that of fluid absorbtion. Adult rib orientation is oblique (both anterior and lateral views), allows for pump-handle and bucket handle types of inspiration. The adult anatomical remnant of the umbilical vein between the umbilicus and liver is the ligamentum teres. Postnatal closure occurs initially by by smooth muscle contraction and begins at the first breath and is rapid, completed within the first day (about 15 hr after birth). Anatomical closure is much slower occuring by 2–3 weeks after birth (33% of infants), by 2 months (90% of infants) and by 1 year (99% of infants). The adult anatomical remnant of the ductus venosus is the ligamentum venosum (a dorsal fissure on the liver). In recent years there has been some controversy of the relevance and accuracy of some of the criteria used in this test, though many feel it is still an invaluable initial assessment tool particularly where medical services are limited. Different countries and medical services have different policies on not only what will be diagnostically tested, but also how long the test card will be kept following analysis. This incidence is influenced by several factors (diagnostic criteria, gender, genetic and racial factors, and age of the population). However, it is acceptable medical practice not to initiate intensive care if parents so wish, following appropriate counselling. Breech position - occurs in about 3% of fetuses when buttocks or lower limb are presented to the birth canal rather than normal cephalic (head-first) position (presentation). Associated increased - perinatal mortality, perinatal morbidity, recurrence in successive siblings Current research suggests that genetically that both men and women delivered in breech presentation at term could also contribute to an increased risk of breech delivery in their offspring. Normally this meconium is defaecated (passed) postnatally over the first 48 hours and then transitional stools from day 4. Premature discharge into the amniotic sac can lead to mixing with amniotic fluid and be reswallowed by Breech Birth the fetus. Necrotizing Enterocolitis Occurs postnatally in mainly in premature and low birth weight infants (1 in 2,000 - 4,000 births). The underdeveloped gastointestinal tract appears to be susceptible to bacteria, normally found within the tract,to spread widely to other regions where they damage the tract wall and may enter the bloodstream. Stillbirth and Perinatal Death Perinatal period is the early postnatal period relating to the birth, statistically it includes the period up to 7 days after birth. In pregnant women anywhere between 2 - 15% have birth weights of greater than 4000 grams (4 Kg, 8 lb 13 oz). Vertex Presentation (cephalic presentation) where the fetus head is the presenting part, most common and safest birth position. Each topic summary is designed for use in conjunction with the relevant didactic lecture given during the rotation. Original and Review Articles – Original, and review articles are provided for residents who seek a more comprehensive understanding of a topic. We recognize that residency is a busy time, but we hope that you will take the time to read articles relevant to the management of your patients. In order to facilitate learning at many levels, several other educational opportunities are available. Tutorials – These are 20-30 minute sessions offered during the rotation that will provide the resident with hands on experience (e. The goal of morning rounds is to develop treatment plans that can be defended by the best available scientific evidence. In addition, morning rounds are an opportunity for residents to test their knowledge, gauge their progress in critical care education, and recognize the limits of the current medical practice. The faculty and fellows of Boston University Pulmonary and Critical Care section hope that you enjoy your rotation in the medical intensive care unit.

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