Endep

Derek Michael Fine, M.D.

• Director, Nephrology Fellowship Program
• Associate Professor of Medicine

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0007605/derek-fine

A review of rubefacients containing salicylates found nine trials on a total of around 600 patients treatment quadriceps strain discount endep 50 mg on-line. It concluded that these products appear to be efective for acute pain medications covered by blue cross blue shield buy generic endep 10mg on-line, but have moderate to poor efcacy for musculoskeletal and arthritic pain treatments yeast infections pregnant cheap endep online visa. Infection is limited to humans; threadworms are not transferable to or from animals treatment thesaurus purchase endep once a day. It most commonly afects children symptoms with twins buy discount endep 50 mg online, due to their poor attention to personal hygiene symptoms jaw cancer discount endep 75 mg, but can afect whole families. The female lays large numbers of eggs with irritant mucus at night, which causes intense itching and promotes scratching by the host. Re-infection occurs when eggs are ingested from contaminated hands and exposed to the action of digestive juices in the upper intestinal tract. This can be either around the perianal area, most easily seen at night or, more rarely, on the faeces. If there is a persistent or heavy infestation, appetite loss, weight loss, insomnia, irritability and enuresis may occur. Diferential diagnoses In adults perianal itching may be due to haemorrhoids, eczema or irritants such as deodorants. Treatment options Hygiene measures alone may be considered when drug treatment is not wanted or is not recommended. Where anthelmintics are used, all members of the household should be treated simultaneously. It is usually given as a single oral dose, but ofen needs to be repeated afer two to three weeks if re-infection occurs. Mebendazole acts by inhibiting the uptake of glucose by the worms, causing immobilisation and death. Transient abdominal pain or diarrhoea can occasionally occur, especially in people with heavy infestations. The female louse lays her eggs (smaller than a pinhead) on the hair shaf near the scalp surface. Eggs attached to hairs, whether hatched (nits) or unhatched, are not proof of active infection, because eggs may retain a viable appearance for weeks afer death. Infestation is more likely in school children, with risks increased in children with more siblings, longer hair and of lower socio-economic group. Lice are transmitted through close head to head contact therefore family and friends should be advised to check for signs of infestation. Although itch is a common presenting symptom, it can take up to three months for the itch to develop and the infestation will be asymptomatic until then, only being detected by examination of the hair and scalp. Diferential diagnoses Seborrhoeic scales, hair casts, and hair spray (which can all be brushed of) may be confused with nits (which stick to the hair and cannot be removed by ordinary brushing). Treatment options There should be two applications of insecticide seven days apart to ensure treatment of louse nymphs emerging from eggs not killed by the first treatment. Treatment failure can occur when only one application is used or if insufcient product is applied. Observation of lice samples stuck onto plain white paper with sticky tape will provide useful information. Lice of all ages will be seen afer insecticide treatment if resistance is a problem. Re-infestation is possible if all contacts have not been traced or have not carried out eradication treatment. If treatment failure is suspected, a diferent insecticide should be used, at least three weeks afer the last application of insecticide. This mosaic strategy is now preferred to the policy of rotating insecticides on a district-wide level. The lotion should be allowed to dry naturally and patients should be warned not to use a hair dryer because the lotions are flammable. Avoid swimming directly before and during use of the lotions as the chlorine inactivates the insecticides. Most studies examining the efectiveness of head lice treatments are of poor quality; however malathion. However, in one trial where there was a high incidence of insecticide resistance, wet combing was more efective than malathion or permethrin. Lice move rapidly away from any disturbance in dry hair, whereas wet hair, especially with the addition of conditioner, renders them motionless. Wet combing with a plastic detection comb plus conditioner should be performed every four days over at least a two-week period until no lice are seen on three consecutive sessions. It is time-consuming but a useful option for infestations in those who are pregnant or breastfeeding or for children under the age of two. Hedrin (4% dimeticone) lotion acts by a physical process to cover the lice and disrupt their ability to manage water balance. There was no statistically significant diference between the treatments with a positive outcome in 70% of Hedrin users and 75% of phenothrin users. Irritant reactions occurred significantly less with Hedrin (2%) than with phenothrin (9%). The comb passes an electric current through anything caught in its teeth which kills lice but not eggs. The teeth tend to clog up and debris must be removed before reactivating the current. Long hair should be worn tied up and fringes tucked away when there is an outbreak at a school or nursery. Bedding and clothes do not need specific laundering since lice cannot live for very long away from the heat and blood of the head. Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. This ofen appears as small red papules between fingers and toes, on the wrists and ankles, around the nipples and around the buttocks and genitals. Burrows may be seen as fine, silvery lines, about 2-15 mm in length, with the mite at the closed end, sometimes seen as a dark point. In children and the elderly, the burrows may also be present on the face, neck and scalp. Other family members are likely to sufer from similar symptoms as it is easily transmitted by close physical contact and this ofen helps to confirm diagnosis. Diferential diagnoses Eczema, contact dermatitis or insect bites are all possible conditions that may have a similar appearance. All members of the household and any close physical contacts, including sexual contacts should be treated simultaneously, even if they are asymptomatic, as symptoms do not appear until two weeks afer infestation. Applications should not take place afer a hot bath as this increases the likelihood of systemic absorption. For both products, apply over the whole body (including scalp, neck, face and ears) and wash of afer 8 to 12 hours. If hands are washed within eight hours of application, the product should be re-applied. Crotamiton cream or liquid (Eurax) may help sooth and relieve skin irritation, but has poor efcacy when compared to permethrin for the treatment of scabies. A sedative antihistamine for night time use to relieve the itching may be helpful, especially if the skin is becoming excoriated and there is increased risk of secondary bacterial infection. This is a rare form of scabies, characterised by crusted lesions and scaly plaques located mainly on the hands, feet, scalp, and other pressure-bearing areas with hyperkeratosis possibly occurring. There may be hundreds to thousands of female mites present in an afected patient, making it more resistant to standard treatment and more easily transmitted. It can take two to three weeks to clear as mites remain embedded in skin afer treatment. Attack rate within family is 30-40% (this means that where there is a primary source of infestation amongst a household, between 30-40% of the family members are also likely to become infected) but not everyone develops as florid symptoms. It is therefore less useful as a diagnostic aid, but indicates necessity to treat the whole household. Following a primary infection, probably in childhood, the virus remains in a latent state in the sensory nerve ganglia and can be re-activated by a number of possible trigger factors. Cold sores (herpes labialis) usually occur on the face, particularly around the mouth and nose and tend to reoccur in the same place. The early (prodromal) signs are tingling, itchy or numb feelings followed by the development of a group of small red fluid-filled vesicles, which may coalesce, burst and crust over. Diferential diagnoses Lesions inside the mouth may be confused with aphthous ulcers. Patients should be referred for definite diagnosis and consideration of systemic antiviral treatment. The appearance of axial cheilitis is very similar to the lesions of herpes simplex: prodromal signs are generally felt with cold sores and axial cheilitis is more common in the very young and the elderly. Treatment options Although cold sores are self-limiting, many suferers seek treatment due to discomfort and the physical appearance. Topical antiviral agents, such as aciclovir (Zovirax) and penciclovir (Fenistil), can speed up the healing process if started as soon as the prodromal phase begins. Penciclovir should be applied at two hourly intervals, up to eight times daily, for four days. Trials have shown that both topical aciclovir and penciclovir reduced healing time compared to placebo and topical penciclovir reduced the duration of pain and symptoms compared with placebo. Topical anaesthetics or oral analgesics may be useful for relief of painful lesions. Cold sores are highly infectious and care should be taken not to spread the infection. Wash hands afer touching the lesion or applying cream and avoid touching the eyes. Application of sunscreen to the lips or sensitive areas is sensible for prevention if exposure to the sun is likely. Oral anti-viral treatments are indicated in exceptional circumstances only, where recurrence is frequent and severe. Following an episode of chickenpox, usually in childhood, the varicella zoster virus remains dormant in the nerves until it is reactivated in later life. Precise triggers for reactivation of the virus are not known; however, it is more common in the elderly and those who are immunosuppressed due to disease, drug treatment or stress. The painful, blistering rash usually afects one specific area of the body and does not cross the midline. Some patients experience prodromal symptoms for 48-72 hours or more before the rash develops. The rash appears as red spots which quickly turn into blisters containing the virus. New blisters may continue to develop for up to a week afer the rash first appears. If the area afected involves or is approaching the eye, patients should also be urgently referred. Diferential diagnosis Depending on the area afected prodromal pain can be confused with other painful conditions such as myocardial infarction, cholecystitis or renal colic. Herpes simplex may present in a single cluster of vesicles whereas there are usually multiple clusters along the dermatome (the area served by a single spinal nerve) in herpes zoster. Depending on the severity and the area afected, impetigo may look similar but would not be associated with the severe pain characteristic of shingles. Benefits may still be obtained from treatment started up to one week afer the rash appears, particularly if the patient is at greater risk of severe shingles or complications. Clinical features suggesting a high risk include older age, immunosuppression, continued vesicle formation or severe pain. If the eye is involved, prompt treatment and urgent referral to an ophthalmologist are usually recommended. Treatment may not be required for patients who are otherwise well under the age of 50 with mild truncal symptoms. Aciclovir 800mg five times a day for 7-10 days is usually the first line treatment; although a seven-day course of valaciclovir 1g three times a day or famciclovir 250mg three times a day is also efective. These should be applied for up to 20 minutes at a time until the blisters stop oozing. Although shingles cannot be spread from one person to another, contact with weeping blisters can cause chickenpox in those who have never had it. Unless the afected area can be completely covered, a patient with shingles should remain away from school or work until the blisters have completely crusted over. Particular care should be taken to avoid others who are pregnant or immunosuppressed. Human fungal infections are caused by two groups of organisms; dermatophytes and yeasts. The yeast most commonly encountered is Candida albicans, while pityriasis (tinea) versicolor is caused by a yeast-like organism that is considered to be a normal skin commensal. Factors which increase the likelihood of transmission of fungal skin infections are skin moisture, sweating, friction and maceration. Each common presentation of fungal skin infection is considered separately; although similar agents are used in their management. Note: Vaginal thrush is considered under Obstetrics Gynaecology and Urinary Tract Infection chapter, section 6. Oral thrush and axial cheilitis are considered in the Ear, Eyes and Oral Health chapter, sections 7.

Nevertheless medications knee best buy endep, this category of scars is out of the scope of our chapter and medications names buy endep mastercard, therefore medicine used for anxiety order 25 mg endep with visa, will not be discussed further medicine used to induce labor buy endep 50mg fast delivery. It was found to have good interinvestigator reliability symptoms 10 days before period purchase genuine endep line, although it did not focus on ice-pick- symptoms 5 days post embryo transfer order endep 25 mg online, rolling-, or boxcartype scars specifically, but rather on variations of atrophic and hypertrophic scars. Points are assigned to each respective category and totaled within the range of a minimum of 0 to a maximum of 84. The same physicians also outlined a qualitative (rather than quantitative) grading system (13) that is simpler for quick, daily use. It distinguished four grades for level of disease: (1) macular, (2) mild, (3) moderate, and (4) severe. Subdivisions of macular disease are erythematous, hyperpigmented, or hypopigmented, and those of mild to severe disease are atrophic and hypertrophic. They are usually void of hair follicles concept of abnormal wound healing due to longer persistence and other functioning adnexal glands. The characteristic cytokine expression profile of midchest area) in patients who deny any preceding trauma. Although in size from papules a few millimeters in diameter to ball size an equally strong inflammatory response develops with a preor larger. They project usually sion of acute-phase reaction and proapoptotic genes by these more than 4 mm above the level of the surrounding skin but T cells. This may explain the large degree of cell apoptosis and matrix digestion observed when a polarized Th1 new insigHts into tHe molecular biology of cell response is prolonged. Normal cellular proliferation in skin is regulated the chemotaxis of fibroblasts to the site of inflammation to by growth-promoting protooncogenes counterbalanced by begin the production of extracellular matrix proteins. In pathological keloidal fibroblasts resist physiologic cell death and, therefore, conditions such as fibrosis, elastic fibers may be present in even continue to proliferate and produce collagen. The mechanism of these observed significantly greater scar hypertrophy and cellular changes in microfibril composition remains poorly understood. The located in the middle or deeper layer of the scar, and are oriacceleration of the remodeling process possibly through the ented along the tension lines of the scar. Making the correct diagnobetween granulation tissue and the formation of scar after tissis in ambiguous cases is important because this may be crucial sue injury. Furthermore, only overlapping of the silicone sheet or the immaturity of the scars. Clinicians muscle cells may represent an important element in the pathorecommend that the silicone elastomer sheeting be in contact genesis of contraction. At present, pressure therapy is a preferred available over the years with variable success. They are mainly method for conservative management of scars, especially in divided into two big groups: surgical and nonsurgical treathypertrophic burn scars, to increase thinning and improve pliments that can be utilized either as single-use or as combined ability of the scars. More information 18 to 24 hours a day with a pressure between 24 and 40 mmHg on the use of other treatments such as retinoids, intralesional until the scar matures. There are several routes of administration: when the keloid to be treated is fairly large. Furthermore, this characteristic is associated with questionable rate of absorption. Radiation use is derived from the destruction of means the maximum treatable scar surface is approximately 40 fibroblast vasculature, decrease of fibroblast activity, and local cm2. A Japanese because such patients are known to have propensity for such study involving 38 patients with keloids (ear, neck, and upper a response. If undertaken, some recommend that the incision lip) who were treated with surgical excision and postoperative is done within the lesion boundaries to prevent further extenirradiation on average day 4. Recurrence would be more to reduce overall size or debulk rather than rate was 21. Thus, it was concluded that surgical excision plus electron used in the areas if desired or needed. In scar management, the use of lasers rated by both independent assessors and patients, when laser has gained significance. With the use of first carbon dioxide resurfacing was done after punch excision of scars. The primary object of cryotherapy is to induce ischemic is possibly due to decreasing vascularity. As a result, the cellular refer to other cellular alterations, specifically collagen architecdestruction and anoxia promotes shrinkage of the hyperture. One study reported over 50% observing pigmentation and/or erythema improvement, found scar volume reduction after one intralesional treatment in incidental improvement in scar texture and elevation. This was hypertrophic and keloidal scars most likely a result from decreased perfusion and nutrition and/or males. There are multiple options that can be tailored to with resultant anoxia, cell death, and enzymatic changes. It was found that there was improvement of hyperlaser or energy-derived therapies that need further verification trophic and atrophic scar regions as exhibited by flattening and for efficacy and safety. Currently, the utmost goal is significant reappearance of skin markings, respectively. Inflammation brotic cytokines that are reported to have beneficial therapeutiin acne scarring: a comparison of the responses in lesions cal effect in abnormal scars because they cause a decrease of the from patients prone and not prone to scar. Acne scarring: a classificagested that improvement of hypertrophic scars after injection is tion and review of treatment options. Acne scarring: a review and current treatment burn scars in 78% of the patients after interferon therapy. The keloid phenomenon: progress toward a solutherapeutic agents can be found elsewhere. Keloid-derived logical and immunochemical differences between keloid fibroblasts show increased secretion of factors involved in and hypertrophic scar. Hypertrophic scar forgers of immune polarization: excessive type 1 and type 2 mation is associated with an increased number of epidercytokine responses induce distinct forms of lethal immumal Langerhans cells. Transforming tion and curative management of hypertrophic scar forgrowth factor beta in thermally injured patients with mation. Prevalence of hypertropossible relationship with scarless healing in human fetal phic scar formation and its characteristics among the Chiskin. Fibrilthe efficacy of the 585-nm flashlamp-pumped pulsed-dye lin-1 and elastin are differentially expressed in hypertrophic laser and silicone and g. Alterlogic effects, clinical efficacy, and safety of silicone elasation of argon laser-induced scars by the pulsed dye laser. Myofibroblasts compression on hypertrophic scars: prostaglandin E2 and apoptosis in human hypertrophic scars: the effect of release. The resurfacing and punch excision in the treatment of facial effects of onion extract on hypertrophic and keloid scars. Use of onion extract, enhancing the involution of hypertrophic scars and keloheparin, allantoin gel in prevention of scarring in Chinese ids. Keloids and hyperfor cancer chemoprevention by some anti-inflammatory trophic scars. Laser treatment of hypertrophic scars, keloids, in keloid-derived fibroblasts by quercetin: its therapeutic and striae. Laser treatment Dietary long-chain n-3 fatty acids for the prevention of of erythematous/hypertrophic and pigmented scars in 26 cancer: A review of potential mechanisms. Postacne scarring is significant in during their lifetime, with the peak incidence reported to be that its presence is particularly devastating to some patients and between the ages of 14 and 17 years for females and 16 and 19 may in certain cases be a risk factor for suicidal ideation. One study evaluating patients with a mean age Epidemiologic data on acne scarring is limited, and the true of 39. This is because the not available on the relative prevalence rates of different types epidemiologic data are based predominantly on those patients of acne scarring. Acne scarring reptherapies for acne that are either ineffective, are not properly resents the form of permanent sequelae from acne that is overall correlated with the severity of their disease, and are not optithe most challenging to treat as outcomes may be variable, and mally monitored. As a result, their acne persists or worsens, the extent of improvement is usually only partial, depending on allowing for additional development of new acne lesions, thus the type and extent of scarring that is present. One study showed that overall, approximately 16% Ultimately, the amount, type, and depth of scarring are of patients with acne seek proper treatment, and among those dependent on the location, nature, and intensity of the response seeking such help, 74% wait greater than 12 months, 12% wait to inflammation of the individual host. Fibrosis and varying degrees of physiologic associations with the development of hypertrophic change in skin texture ensue after collagen and other dermal acne scars include altered expression of transforming growth matrix components are damaged by the inflammation of acne. Epidermal dase A, prostaglandin D2, tryptase, and histamine, as well as damage does not result in scarring but may produce persistent altered microvascular regeneration. This leads to augmented production of several oid), often in combination, along with systemic therapy. ToPiCal CorTiCosTeroids and aCne sCarring Whether or not the use of topical retinoids improves acne Intralesional triamcinolone injection for treatment of hyperscars that are already present has not been evaluated or quantrophic and keloidal scars is well established based on clinical tified in an appropriately controlled study. It is likely to be more effective if a high-potency topical ing of skin around areas of acne scarring through treatment of corticosteroid is used as compared to a low-potency formulaunderlying acne and reduction in inflammation. Long-term topical corticosteroid application is not recomthere is no cogent evidence demonstrating that topical retinoids mended as local side effects, such as atrophy and telangiectasia, fi4 topical therapy for acne scarring may occur in the skin surrounding the area of the scar due to 5. Management of post-acne scarring: what are the ToPiCal CosmeCeuTiCals and aCne sCarring options for treatmentfi The psychosocial impact of skin disease: an saging the contents into scars is a common practice among the overview. Acne vulgaris and psyConcern has been raised regarding whether or not applicachological impact on high school students. Acne scarring: a classificais finally dependent on what transpires during the dermal tion system and review of treatment options. Acne scarring: treatment and managecomponents are incorporated into the dermal network durment. Beliefs and perceptions of patients repair process is relatively complete, and any resulting fibrosis with acne. Induction of proinflammatory whether or not the agent is capable of reducing the extent of cytokines by a soluble factor of Propionibacterium acnes: scar development by appropriately modulating one or more implications for chronic inflammatory acne. Activation of toll-like recepreferenCes tor-2 in acne triggers inflammatory cytokine responses. Philadephia: Elsevierin acne vulgaris: consumption of complement by comeMosby, 2008: 41. Matrix metalized, controlled, investigator-blinded follow-up of a recent loproteinases: a review. Optimal management of acne to prevent scartazarotene and minocycline maintenance therapies in ring and psychological sequelae.

Beta-2-agonists are taken on an as-needed basis to reverse the bronchoconstricton and relieve the symptoms medicine used during the civil war discount 10mg endep otc. Ideally treatment non hodgkins lymphoma discount endep american express, relievers should not be required if the asthma is well controlled symptoms thyroid problems order endep american express, and an increased use of reliever medicaton is a sign of deterioratng control and increased infammaton symptoms pregnancy cheap endep online american express. Poor inhaler technique results in an inadequate delivery of medicaton to the airways and an increased depositon of medicaton in the mouth symptoms of the flu purchase endep paypal, resultng in poor symptom control medications causing hair loss purchase 75mg endep fast delivery. Management of exacerbations Guidelines for the management of exacerbatons of asthma provide a step-wise management programme based on the symptoms and the response to beta-2-agonists, involving a combinaton of controllers and relievers to relieve the symptoms and reduce infammaton (see htp:// Asthma educaton includes being sensitve to the partcular informaton needs and difcultes of individual patents. Atending to their fears, exploring their expectatons and sharing informaton underpin a partnership approach to guided self-management. Specifc informaton should be provided on the conditon and the reliever and controller medicaton. Verbal informaton should be supported by writen informaton and contact details for the local asthma support group. One excepton to this rule is when it is linked with an inherited defciency of alpha-1-anttrypsin. Pathophysiology Pathological changes include chronic infammaton, an increased number of infammatory cells and structural changes as a result of injury and repair. Bronchodilator medicatons form the basis of symptom relief and improvement of exercise tolerance. These include beta-2-agonists, antcholinergic agents and methylxanthines, which may be used in combinaton. Inhalatonal treatment is preferred both for its efectveness and to minimise side efects. Long-actng inhaled antcholinergics reduce the rate of exacerbatons and improve the efectveness of pulmonary rehabilitaton. Up to 75% of exacerbatons are infectve (bacterial or viral); other causes include air polluton, increased comorbidity and poor medicaton adherence (Miravitlles 2010). In additon, patents may also experience chest tghtness, fuid retenton and confusion. However, this has to be balanced against the risk of complicatons from their regular use. Oxygen therapy is indicated for the management of hypoxaemia; an oxygen saturaton of over 90% is acceptable. Rapid assessment units, early discharge and hospital at home programmes are increasingly being developed to support the treatment of patents with acute exacerbatons at home. Patents with advanced disease experience poor symptom control, isolaton, guilt, stgma, anxiety and depression (Andenaes et al. Palliative care Palliatve care is an approach to care that, through the preventon and relief of sufering, seeks to improve the quality of life of patents and their families facing problems associated with life-threatening illness. Conversatons of this nature develop over tme and should be encouraged when the patent is stable and able to partcipate fully in exploring possible treatment interventons, such as mechanical ventlaton. In additon to communicaton needs, the patent may also require nursing care to address breathlessness, relaxaton and breathing exercises, sputum clearance, cough, smoking cessaton, oxygen and medicaton management, anxiety and depression, pain, nutritonal support and social, psychological and emotonal support. Bronchiectasis is usually localised to one lung segment or lobe but may spread over tme to other parts of the same lung as a result of unresolved infectons. A prompt treatment and resoluton of infectve exacerbatons, the preventon of further infectons, Part 2 Adult Medical and Surgical Nursing possibly with the prolonged use of antbiotcs, and bronchial clearance underpin treatment plans (Drain & Elborn 2011). The abnormal gene is subject to autosomal recessive inheritance, meaning that both parents must be carriers for the conditon to be inherited by their child. Assessment and management As a consequence of the multsystem involvement, patents require management of gastrointestnal, pancreatc and hepatc complicatons in additon to respiratory problems. Poor secreton clearance from the airways results in recurrent infectons, damage to the bronchi, the development of bronchiectasis and respiratory failure. The respiratory tract is colonised with bacteria that must frequently be treated combinatons of antbiotcs; resistance is a signifcant challenge. With bronchiectasis and as a result of exacerbatons, there is progressive scarring of the lungs and colonisaton with pathogens. Antbiotc resistance develops, and management of exacerbatons requires the involvement of a microbiologist to explore treatment optons. Over the past decade, however, early diagnosis and signifcant advances in treatment have resulted in more patents surviving early adulthood. As respiratory symptoms increase with loss of lung functon, intensive nutritonal support is needed. When respiratory failure and end-stage lung disease develop, patents are assessed for lung transplant, but many do not meet the criteria. End of life care may be especially challenging as patents may be focused on lung transplantaton and unable to consider death and dying. Pathophysiology When the lungs fail to maintain sufcient arterial oxygenaton or carbon dioxide eliminaton, respiratory failure can occur. Low amounts2 of carbon dioxide as a result of hyperventlaton result in hypocapnia or respiratory alkalaemia. In type I respiratory failure, hypoxaemia is present but there is no associated hypercapnia. Assessment and management Type I respiratory failure is managed by oxygen therapy and treatment of the underlying conditon. However, oxygen therapy should be reduced as the patent shows clinical improvement. Hypercapnia may play a more limited role in triggering inspiraton, but instead a fall in oxygen concentraton will trigger inspiraton. Medicaton management also includes inhaled and possibly intravenous bronchodilators, beta-2agonists and antcholinergic agents, and intravenous and inhaled cortcosteroids. Diuretcs may be required, and opiates and anxiolytcs may be necessary for breathlessness and anxiety. Part 2 Adult Medical and Surgical Nursing Oxygen therapy and ventilation Oxygen is a drug that is prescribed to correct hypoxaemia. Venturi masks are a more accurate means of delivering oxygen than nasal prongs, but this must be balanced against patent comfort. Oxygen must be used with care because, for some patents, their respiratory drive depends on their degree of hypoxia rather than the usual dependence on hypercapnia. Uncontrolled oxygen therapy can therefore lead to a suppression of respiratory drive, carbon dioxide narcosis and respiratory arrest. Ideally, oxygen is delivered via a facemask at an inspiratory fow rate of between 24% and 35%. The management of dyspnoea, airway clearance and impaired gas exchange is essental. Administraton of bronchodilators, cortcosteroids, diuretcs and possibly opiates and anxiolytcs should be as prescribed. Lung cancer Defnition Lung cancer refers to malignancies that originate in the airways or pulmonary parenchyma. Epidemiology Lung cancer is the third most common form of cancer across Europe and is the most lethal (Wilking & Jonsson 2008). For those patents who are diagnosed early and before symptoms occur, the 5-year survival is greater. An increased understanding of the biology of lung cancer in tandem with recent developments in both diagnostc techniques and treatments raises hopes for improved prognosis, if not cure. Classifcation Malignant lung tumours are classifed into three major groups, as shown in Table 12. Clinical manifestations Symptoms of lung cancer include cough, haemoptysis, chest pain and/or shortness of breath. Breathlessness may be accompanied by stridor as a result of the tumour pressing on the trachea or main bronchi. Diagnosis the Natonal Insttute for Health and Clinical Excellence (now the Natonal Insttute for Health and Care Excellence) has set out guidelines for the diagnosis and management of lung cancer (htp:// Assessment and management Patents with small cell lung cancer are treated with chemotherapy in combinaton with thoracic radiotherapy. Patents with non-small cell lung cancer may be assessed for surgical resecton followed by chemotherapy. Performance status is a measure to determine the overall health of the patent and is linked with prognosis and treatment choices. Part 2 Adult Medical and Surgical Nursing Communication Given the poor prognosis and ofen late diagnosis, the inital breaking of bad news and exploraton of treatment optons is partcularly challenging for healthcare professionals, patents and their loved ones. For these reasons, guidelines on communicaton in lung cancer promote the use of decision aids, the ready availability of a lung cancer nurse specialist, and the documentaton of any discussion on treatment optons. Once a diagnosis of lung cancer has been confrmed, the patent faces uncertainty, and possibly extensive and radical medical treatment, with all its intended and unintended consequences. Symptoms of dyspnoea, recurrent infecton, fatgue, pain and weight loss should be explored with the patent. Assessment and care should determine the available support at home and in the community for dealing with the conditon and its efects in the short, medium and longer term, including the efects of treatment regimens. Palliative care Palliatve care should be incorporated into the care needs assessment once the diagnosis has been confrmed. This enables the management and support of complex symptoms even if the patent is responding to treatment and has a promising prognosis. Nursing care of conditions related to the respiratory system Chapter 12 Elkington, H. Global Initatve for Asthma Management (2010) Global Strategy for Asthma Management and Preventon 2010 (update). Global Initatve for Chronic Obstructve Disease (2010) Global Strategy for the Diagnosis, Management, and Preventon of Chronic Obstructve Pulmonary Disease (Updated 2010). Natonal Clinical Guideline Centre (2010) Chronic Obstructve Pulmonary Disease: Management of Chronic Obstructve Pulmonary Disease in Adults in Primary and Secondary Care. Natonal Insttute for Clinical Excellence (2006) Brief Interventons and Referral for Smoking Cessaton in Primary Care and Other Setngs. Natonal Insttute for Health and Clinical Excellence (2011) the Diagnosis and Treatment of Lung Cancer (Update). Anatomy and physiology the cardiovascular system consists of two main components: the heart and the blood vessels. The heart is a muscular pump that provides the pressure necessary to propel blood throughout the body. The blood vessels are a closed system of tubes that carries blood away from the heart, transports it to the tssues of the body and then returns it to the heart. The walls of the heart are composed of a thick layer of cardiac muscle known as the myocardium. The myocardium is covered externally by the epicardium and internally by the endocardium. The heart is divided into four chambers: two upper atria and two lower ventricles (Figure 13. The two atria and two ventricles are separated by the septum (Tortora & Derrickson 2009). Part 2 Adult Medical and Surgical Nursing and ventricles on both sides of the heart. The tricuspid valve is located on the right-hand side, and the bicuspid, ofen called the mitral valve, is located on the lef.

Measuring the impact of this increased coverage will inform future strategies of the National Malaria Control Program and its 1100 partners treatment plan goals and objectives buy 25 mg endep. Owing to limited healthcare in the most remote communities medications diabetic neuropathy purchase endep 25mg line, where malaria is highest data symptoms wisdom teeth trusted 10mg endep, we could not assess trends in parasite prevalence medications while breastfeeding buy discount endep 25mg online, but the prevalence and the reach of public and formal health services is most stretched treatment episode data set buy generic endep line. During the evaluation period medicine lodge kansas purchase endep 50mg with amex, indicators treatment, counselling, reporting, stock, etc. Differences in quality scores among different provider Alexandra Urman, Brian Vesely, Jennifer M. Kooken 1Military Malaria Research Program, Malaria Vaccine Branch, Walter Reed types and different geographic regions were also observed. Nana1, Johanna Karemere2, Olivier Kakesa2, Jacques proteomics approach we able to analyze the complete proteomic profle Emina3, Joris Losimba Likwela4, Aboubacar Sadou5, Mame Niang6, of Plasmodium parasites, assessing proteins that are involved in almost Michael Humes7, Yazoume Ye1 every biological pathway. While the malaria incidence has for Research in Tropical Medicine and Community Development, Nairobi, decreased in the intervention areas in 2016 compared to 2013, data from Kenya the control areas showed an increase in incidence in 2016 compared to 2013 pre-spray data. One plausible reason is that bed nets are not greater reduction, 30% decrease in malaria incidence. The data were analyzed Sangare1, Dade Ben Bouye Haidara2, Vincent Sanogo3, Bassi using multiple logistic regression analysis. Of 694 children observed, 510 Coulibaly2, Jules Mihigo4, Erin Eckert5, Moustapha Coulibaly2, (73. We have selected 2 sites, Selingue in the south of the Sudanese and Missira in the north 1104 sudanese regions. Baseline data was collected in 2016 from Selingue prior to regions of Madagascar, to reduce malaria transmission. Thus in 2017, we enrolled 240 children between coverage among the eligible structures was above 90% for all campaigns August and November. The Chi square test for trend in these districts by comparing epidemiological data from three sprayed was performed using GraphPad Prism showed that the impact was marked astmh. Data come from a randomized twovillage trial in Nigeria with epidemiological outcomes. Hounkpe Dos Santos1, Martin Akogbeto2, Yves Cyaka5, Alexis Written informed consent was obtained, and focus groups were recorded. Transcripts were prepared and discussion in local 4 Malaria Initiative, Cotonou, Benin, U. Adequate Echodu1, Yeka Adoke4 therapeutic coverage was also linked to the type of adverse drug reactions 1Pilgrim Africa, Kampala, Uganda, 2Infectious Diseases Research reported; 30. Onuoha3, Solofo Razakamiadana4, Elsa Nhantumbo5, Alain Data was analysed using thematic analysis. The Nvivo software programme was used to aggregate the data 4 5 Jhpiego, Antananarivo, Madagascar, Jhpiego, Maputo, Mozambique, by codes and to assist with fndings presentation. Overall, fourteen key 6 Jhpiego, Kinshasa, Democratic Republic of the Congo informants were interviewed; four from Katakwi district and fve each from Kapujan and Toroma sub-counties. Adult mosquitoes were collected using human landing catches in the surrounding communities Issaka Sagara1, Hamma Maiga1, Mahamadou Kaya1, Seydou at both the intervention and control communities. The proportion of Traore1, Sanga Goro1, Moussa Traore1, Drissa Coulibaly1, Hamidou breeding habitats with mosquito pupae in the intervention sites dropped Niangaly1, Abdoulaye Ongoiba1, Mathias Dolo1, Khalid Beshir2, from 30% at baseline to an average of 3% after six months of treatment Colin J. Sutherland2, Paul Snell2, Diahara Traore3, Vincent Sanogo3, while that of the control sites increased from 0% to an average of 25. Patrice Coulibaly4, Eric Hubbard4, Boubacar Dao5, Ogobara A total of 1,651 mosquitoes were collected during this period. The construction of housing units which 5World Bank, Bamako, Mali led to the increase in vector densities at the surrounding communities was signifcantly reduced by the application of larvicide. In addition, routine individual malaria data from rounds of indoor residual spraying and one community also received health center registers as well the birth histories surveys from women were several rounds of mass drug administration of antimalarials. A generalized linear spatial model was ft to resistance will be available and presented. In 2017, the government of Equatorial Guinea created new districts on Bioko Island and embarked on the construction Despite many malaria programmatic interventions in the northern region of social housing units in these districts. This study evaluated the impact of Sierra Leone malaria parasitaemia remains high. Mosquitoes breeding habitats at the construction sites of 13 in children under age 5 ranges from 21% in the western region to 52% in the northern region. Fatunmbi effective in preventing early recurrence and may also improve blood 1National Malaria Control Programme, Kampala, Uganda, 2World Health schizontocidal effcacy against chloroquine resistant P. Organization, Kampala, Uganda Uganda is one of the malaria high burden countries in the world. Chu1, Germana Bancone1, Widi Yotyingaphiram1, Emily as part of efforts of the National Malaria control Program to achieve zero Gerth-Guyette2, Gwen Ambler2, Michael Kalnoky2, Gonzalo death due to malaria in Uganda. On a Plasmodium vivax is estimated to be responsible for over 100 million weekly basis surveillance data is extracted from the national databasethe clinical infections annually. Arm 1a will receive Malaria mortality has reduced in selected districts with a range of 1-2 primaquine for 14 days and Arm 1b will receive chloroquine for 3 days deaths per month. Field trials are planned to take place Chris Drakeley2, Fe Esperanza Espino3 in the swampy rice paddy terrain of southeast Tanzania. This Charlotte Gryseels1, Melanie Bannister-Tyrrell1, Rene Gerrets2, study aims to develop and establish an integrated surveillance tool for Koen Peeters Grietens1 enhanced malaria control and elimination activities. Health facility-based 1Institute of Tropical Medicine, Antwerp, Belgium, 2Amsterdam Institute of surveys were conducted in Palawan, Occidental Mindoro and Bataan, Social Science Research, Amsterdam, Netherlands representing 3 areas of differing disease burden, to assess the magnitude of the proportion of infections missed by routine surveillance. The study is continuing to work closely with of novel technologies to achieve further reductions in malaria transmission. We therefore also use the concept of appropriateness as an analytical lens to examine the Zachary A. Pen3, Panha Kimsean3, Son such as larviciding, in addition to the indoor preventative measures, Sak4, Setha Tan4, Alina Gagu2, Markus Werner2, John Hustedt5, Po can decrease, and possibly even eliminate, the number of malaria cases Ly1, Siv Sovannaroth1, Mony Srey2, Bun Sour3, Colin Ohrt2, Rithea worldwide. It is infeasible, however, to continuously survey for standing Leang1 water locations in expansive remote areas where malaria cases often 1 National Center for Parasitology Entomology and Malaria Control, Phnom crop up. In Vietnam, we developed methods Adherence to reactive case treatment can be improved by employing to rapidly eliminate malaria; we will replicate/extend the methods in a systemic approach and engaging the necessary key stakeholders and Cambodia. An approved research protocol with six objectives is in place; community structures. The objectives/brief methods include: 1) Well-characterized malaria 1124 patients, malaria transmission Foci, reporting and response approaches. Survey and drug testing methods routinely used Senyatso2, Styn Jamu3, Tjantilili Mosweunyane2 by the Cambodia Ministry of Health standard operating procedures will be evaluated. Our initial fndings based on interviews with provincial health staff, Malaria Programme, Ministry of Health and Wellness, Gaborone, village heath workers and security forces reveal that malaria increased Botswana, 3Q Partnership Inc. Current usage locally infected cases confrmed in case-based surveillance between 2013 of insecticide treated nets in forest risk areas appears to be very low. Botswana has reoriented Challenges with antimalarial drug adherence have been identifed. Security its program towards elimination since 2010, but the surveillance system personnel protecting the forest have been identifed as a neglected has gaps that hinder an understanding of the geographic limits and drivers population, a probable malaria transmission reservoir and a group who of transmission. This inhibits deployment of targeted and aggressive can really help malaria elimination personnel understand the situation interventions, which are critical to increasing effciency of resources in high risk areas. We will present study results and present methods to and accelerate efforts towards elimination. To understand community attitudes high-resolution malaria transmission maps and the identifcation of malaria towards the intervention, we explored through an anthropological study transmission drivers. In the pre-trial questionnaire administered, 70% of respondents mentioned malaria could be hidden 1125 in the body without symptom appearance. Respondents further mentioned mosquitoes, hot sun and hard work as the triggers for symptom development but this knowledge 1National Institute of Malariology, Parasitology and Entomology, Hanoi, was surrounded by doubt and uncertainty. As a result of the uncertainty, Vietnam, 2Ninh Thuan Center of Malaria Parasitology and Entomology, taking treatment for an asymptomatic condition was perceived acceptable Ninh Thuan, Vietnam, 3Institute of Tropical Medicine Antwerpen, only when the disease status could be confrmed. However with high Antwerpen, Belgium treatment adherence (92%) reported for the intervention where there Residual malaria transmission remains in specifc hotspots in mountainous was no screening provided for asymptomatic cases, knowledge on areas in south-central Vietnam despite the success of standardized control asymptomatic carriage was not seen as a crucial reinforcing factor. Mobility factors and the therapy choice were 4 5 stemmed from the complex interethnic relations with Kinh, the dominant Surasak Sawang, David Sintasath 1Bureau of Vector Borne Disease, Department of Disease Control, Ministry ethnicity. Mobility patterns related to subsistence farming revealed social of Public Health, Nonthaburi, Thailand, 2World Health Organization, boundaries that were at odds with regulations on forest management Thailand Country Offce, Nonthaburi, Thailand, 3International Development and sedentary farming. Agency for International constrained trust in the health system for Raglai people. Bangkok, Thailand In 2001, Thailand established malaria posts to provide free community1126 based malaria testing and treatment services without the need for licensed medical workers. The expanded role of malaria posts included supervised include routine forestand feld-based work, sleeping outdoors, and treatment, behavior change communication, and distribution of longfrequent travel to local worksites. However, some gaps exist, diversity, a broadly mixing population and no evidence for recent especially in targeting interventions to vulnerable populations at the bottlenecks due to enhanced interventions. Ivermectin, an endectocidal drug, has genome sequencing to gain higher resolution of these populations. Thin Ko2, Moe Moe Aye3, Nan Aung3, treated cattle can drastically decrease vector densities and alter mosquito Christopher Lourenco3, Arnaud Le Menach3, Aung Thi2, Sarah population compositions in village settings. Thereafter, six villages in Krong Pa district, Gia Lai province, Vietnam will be randomized as control or treatment sites. In intervention Malaria cases in Ayeyarwady, a delta region in the southwest of Myanmar, villages, the herds of all consenting households will be treated with a 1% have decreased by 86% from 2011 to 2016, but exposure to forested ivermectin (at standard veterinary dosing). Reduction in captures from cattle-baited traps will geographic concentration of cases and perceived link between forest be the primary endpoint; secondary endpoints will be changes in vector exposure and malaria, limitations of surveillance data prevent a thorough composition. Finally, the feasibility and acceptability of the intervention understanding of the risks for contracting malaria in this region. Daniels, Controls presented to selected points of care with fever but received a Mary-Carmen Frinwie1, Ngum Ndeh1, Judith K. In some endemic settings, this study identifed critical areas of high malaria burden and provided information on the genetic diversity of the parasite, which will inform evidence that extended time in forested areas contributes to malaria risk. This study characterized the Further exploration of risk around forest worksites should include a focus genomic diversity of Plasmodium falciparum populations from different on extended stays, specifc occupations, and travel patterns to optimize altitudinal zones, with a view to identifying population substructure due to interventions. Principal component analysis of individual allele London School of Hygiene & Tropical Medicine, London, United Kingdom, 2Save the Children International, Zomba, Malawi, 3College of Medicine, frequencies did not identify any parasite population substructure accruing 4 to varying minor alleles in time and space. The overall pairwise Fst of Blantyre, Malawi, Save the Children International, Lilongwe, Malawi, 5Ministry of Health, Lilongwe, Malawi, 6Ministry of Education Science and parasite populations across the three altitudinal zones and between 2013 astmh. It allows for real-time data capture from estimated by calculating the difference in outcomes between the groups. Sharing experiences in all participants are included in the group to which they were assigned, the development and identifcation of key attributes for the new Malaria whether or not they received their allocated intervention. The intervention involved training teachers to diagnose and treat uncomplicated malaria in learners using rapid diagnostic tests and In many Southeast Asian settings, forest-going is a high-risk behavior for artemisinin-based combination therapy as part of a Learner Treatment individual malaria infection and community transmission. Of interest and mass drug campaigns, often fail to reach forest-goers, leading is the treatment effect among pupils who potentially had malaria, and to challenges for elimination programs. In this study, we build a of treatment as the odds ratio for absenteeism among compliers in the mathematical model of a transmission system that includes both villages intervention arm relative to potential compliers in the control arm. The model is used to inform how forest transmission analysis provided no evidence of an effect of the intervention on school and migrant movement can sustain malaria in Southeast Asian settings attendance. Moonasar 1 2 Munguambe2, Helena Marti1, Lidia Nhamussua2, Wilson Simone2, National Department of Health, Pretoria, South Africa, Clinton Health 1 2 Access Initiative, Pretoria, South Africa, 3KwaZulu-Natal Provincial Francisco Saute, Pedro Aide 4 1Barcelona Institute for Global Health Centro de Investigacao em Saude Department of Health, Jozini, South Africa, Mpumalanga Provincial 5 de Manhica, Manhica, Mozambique, 2Centro de Investigacao em Saude de Department of Health, Nelspruit, South Africa, Limpopo Provincial Department of Health, Tzaneen, South Africa, 6National Department of Manhica, Manhica, Mozambique Health; University of Pretoria, Pretoria, South Africa Since 2015, a malaria elimination pilot program has been undergoing Strengthening the surveillance system has been a fundamental pillar in Magude district. Using a structured disease surveillance and monitoring and evaluation of interventions. Data together with sustainability and feasibility of implementation at the presented is preliminary. The integration of these myriad malaria data streams into a from August to November 2017. In comparison with contacts, passively detected and visualize cases and intervention coverage for a given location, as cases were more likely to be male (odds ratio=1. Two rounds of routine data quality audits malaria cases after two years of interventions aiming at elimination in the across 14 districts of Southern Province captured malaria indicator data south of Mozambique. Taking into account entomological and climate values recorded in health facility paper registers and those submitted to data may shed new light on further risk factors. Continuing analysis will include the number of imported cases risks hiding pockets of ongoing transmission additional data for Q4 2016/Q1 2017 and explore reporting rates and whilst underestimating the number may waste valuable resources. Suresh1, Beatriz Galatas2, Prashanth Selvaraj1, Milen associated with this designation. Our approach indicates that there is Nikolov1, Amelia Bertozzi-Villa1, John Miller3, Busiku Hamainza4, considerable uncertainty and possible misclassifcations in the origins of Caterina Guinovart2, Helena Marti-Soler2, Pedro Aide2, Francisco infection for many cases in the dataset. Our analysis highlights the diffculty with determining the origins 5 Control Centre of Zambia, Lusaka, Zambia, Centro de Investigacao em of infection for countries nearing elimination. A beneft of applying the methodology we present here Elimination of malaria in most endemic environments requires the is that this uncertainty can be explicitly expressed and included in summary coordination of time-limited interventions, such as indoor residual spraying statistics and future analyses. Our approach could then produce real-time fne-scale maps we are motivated to identify the minimal combination of interventions that of endemicity to enable targeting of local reservoirs of infection to hasten can reliably achieve elimination in a given malaria context. Miller, Jeff Bernson, Michael decreases in the incidence of malaria infections, transmission has not Hainsworth5 been completely interrupted everywhere. We increasingly emphasized the importance of timely, accurate malaria then simulate a set of potential intervention scenarios to identify those surveillance data to inform malaria control and elimination efforts.

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These efforts will help to identify medicine ok to take during pregnancy buy cheap endep line, target predicted by Schmalhausen`s law treatment kidney infection cheap endep 50 mg line, the principle stating that organisms are and manipulate epidemiologically important traits and to develop potential more sensitive to small changes in environmental variables whose average new strategies for vector control medicine 6 year generic endep 10 mg online. Shyam Sundar Trotman3 medications bad for kidneys discount endep 10mg mastercard, Roche Mahon3 xerogenic medications generic 25 mg endep otc, Shelly-Ann Cox3 medicine runny nose buy generic endep 10mg on-line, Leslie Rollock4, Marquita Gittens-St. Carlson6, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India Sadie J. In the present study, we investigated 4 Meteorology and Hydrology, Bridgetown, Barbados, Ministry of Health, the role of L. Michael, Barbados, Georgetown University, was performed using 10 male and 30 female P. We found varying sand fy feeding response (3-94%, diseases, in particular, dengue fever. Following detection of suspected Zika parasites in suffcient numbers to promote infections in vector sand fies. Orengo hotspots of transmission activity enables public health agencies to target Ponce Health Sciences University, Ponce, Puerto Rico mosquito control efforts, strengthening the capacity to curtail outbreaks In 2017 and 2018 the distribution of mosquitoes has varied due to and respond to , and reduce, the threat of emerging mosquito-borne environmental and climatic factors, such as Hurricane Maria. Moving forward, we recommend further objectives: 1) Evaluate the environmental and climatic factors related to incorporation of spatially explicit methods of outbreak detection into the density and distribution of mosquitoes during the dry period of 2017 existing surveillance frameworks. As a region of Puerto Rico, the hotpots were statistically different compared consequence of a wide range of mosquito breeding habitats globally, to the coldspots (z score > 2. The hotspots and coldspots the high abundance of competent arboviral vector species in existence, maintained a pattern of grouped values (p<0. Adjusting for collected and lacking international mosquito control infrastructure, arboviral samples the hotpots were not statistically different compared to the diseases cause an estimated 300 million infections and 500,000 deaths coldspots (z score = -1. While effective insecticides exist, modest vector control environmental factors, climatic factors, and the entomological index leads department budgets prohibit their broad distribution, warranting costto knowing the distribution of mosquitoes and being able to carry out effective measures for enhanced and targeted insecticide applications. Tano7, Jean Birba2, Razack Adeoti5, Tohnain We employed a variety of remoting sensing techniques including objectN. Toe2, Martin Geier8, Lora oriented image classifcation, vegetation and water indices, and spectral Forsythe1, Roch K. Dabire2, Rousseau Djouaka5, Gabriella Gibson1 readings for enhanced classifcation. This unique project brought together a diverse group of experts in an innovative way to tackle one of the most 1Natural Resources Institute, University of Greenwich, Chatham Maritime, important public health concerns of our time. Some1, Maggy domestic transmission risk and evaluating outdoor control interventions T. Serge Yerbanga1, Thierry Lefevre4, Karine and is particularly important in pre-elimination settings or where Mouline4, Karidia Werme1, Floyd Dowell5, Roch K. Churcher2 for measuring outdoor biting suffer from serious ethical and technical 1 limitations. We conducted a simultaneous participatory technology of vector control against malaria. Mosquitoes with salivary gland assessment to determine the user acceptability of each method, focusing sporozoites can be identifed by microscopy following manual dissection, on ease of use, perceptions of risk and confdence. The overall predictive accuracy for differentiating sampling method for malaria vectors. Keven1, Michelle Katusele2, Rebecca Vinit2, Daniela has the potential to be used to measure sporozoite prevalence though R. Transmission of these disease-causing agents is koliensis is highly anthropophilic. Of 79 individual people identifed in 214 dependent upon the existence of competent arthropod vectors that have human-fed Anopheles farauti blood meals from one of the villages, only the capability to maintain the pathogen, then transmit it to a subsequent a few people (13%) contributed to most (64%) blood meals, indicating host. Multiple studies of vector competence have suggested that the non-random human host selection. Anopheles landings per person-night interaction between pathogens and the mosquito immune system plays (an estimate of bites per person-night) and Anopheles density per barrier a role in determining competence of the mosquito as a disease vector. The number of landings on humans was greater outdoors larger study investigating the effects of larval diet on vector competence. Alternative vector control methods such as treatment of domestic expression at the transcriptomic level. Arboviruses transmitted by mosquitoes are a signifcant cause of mortality 889 throughout the world. Mosquitoes were reared as part of a Gene-drive based vector control methods are a rapidly developing tool larger study investigating the effects of larval diet on vector competence. Often however, due to gaps in general trend being down-regulation of genes following viral infection our knowledge, mathematical modelling of gene drive systems makes and under nitrogen-poor rearing conditions. These results represent highly simplifying assumptions about key aspects of mosquito ecology. We developed a discrete-time stochastic model of mosquito population dynamics, which incorporated the random, temporal clumping of egg laying. From this we were able to better quantify the relationship between clumping of egg laying and densitydependent regulation of larval populations, and thus refne estimates of the mosquito reproduction number, Rm a key determinant of the predicted impact of gene-drive interventions. In a frst experiment, the entire room thus making establishment and spread of gene-drive constructs more likely was coated, and adult mosquitoes (both sexes) and different physiological than predicted by models assuming higher Rm values. The current series of experiments employs of Tropical Medicine, Liverpool, United Kingdom, 3Big Data Institute, a video system to track mosquito movement and resting preferences in a University of Oxford, Oxford, United Kingdom more complex environment, incorporating modular 3D shapes (simulated Mosquito-borne diseases represent a substantial portion of the total global furniture) and cryptic resting sites. Yet, little is known about the be infectious, leading to a relationship between parity and prevalence circulating virus strains, limiting our understanding of viral transmission that will vary depending on mosquito species and both infection and dynamics. The subjects were participants in our study widely used but can be hard to estimate, our results describe a method of pediatric arboviral disease burden, who presented with fever to of direct calculation from mosquito data and allow investigation of either of two regional health centers that served the communities of the potential impact of vector control measures. We used the MiSeq platform (Illumina, San Diego, between human and vector prevalence across a range of diseases. These data provide valuable insight into the evolution of Luca Facchinelli1, Rosangela M. McCall1 1Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 2Instituto Aggeu Magalhaes, Fiocruz Pernambuco, Recife, Brazil, 3University of Warwick, Coventry, United Kingdom the peridomestic behavior of Aedes aegypti, the primary mosquito vector of arboviruses to humans, is often speculated or unknown despite the considerable body of literature available. Bishop-Lilly, Michael Wiley, Gustavo Palacios, Theron 4 3 2 1 that antibodies from previous infection with heterologous faviviruses Hamilton, Brett Forshey, Richard G. Macareo, 1 1 may confer protection against symptomatic dengue disease, as opposed Alden L. In unadjusted logistic regressions, age <18 years, income over $25,000/year, recent febrile illness, and having a septic tank (Chi2 and are widely used in public health laboratories. Different protocols/ pipelines have been developed for pathogen identifcation and p-values = 0. Adenovirus, infuenza, Zika, 2 3 Carlos Barragan Galvez, Jose Luis Maravillas Montero, Humberto dengue, chikungunya, and Japanese encephalitis viruses, Acinetobacter 4 5 2 Lanz Mendoza, Jesus Valenzuela, Leticia Cedillo Barron baumannii, and Klebsiella Pneumoniae were identifed. These fndings suggest that dengue viral replication begins in Caitlin Cotter1, Aifli J. Fibroblasts are abundant cells in the skin capable of responding to Anesi4, Matthew J. Further, we observed a higher viral titer in the supernatants of fbroblasts from different donors, which were infected and astmh. In Kenya, however, their occurrence is often protein responsible for this effect was a 34 kDa protein. We observed an underreported due to the low awareness by public healthcare providers increase in the infection of fbroblasts in the presence of this protein. In 2015, a longitudinal prospective was partially responsible for this effect and that pre-incubation of the cohort study of 1378 non-clinical subjects aged 2fi17 years was initiated whole extracts was able to further increase in the viral load, we sought to in western Kenya (Chulaimbo and Kisumu villages). Morrison3, that this sub-population belongs to the school-going age bracket thus Mariana Leguia4 increased duration of exposure to the biting by the vector hence high 1 transmission. However, data addressing fnescale spatial dynamics of virus spread are rarely available. Local variations in climate thus naturally induce signifcant 2008 Iquitos epidemic was seeded via Ecuador (prob = 0. The arboviruses in environmentally distinctive settings has only been partially central subdistrict of Iquitos, which is the most populous, occupied the explored. To this end, we constructed a climate-dependent individualmost ancestral tree space, suggesting it was the origin of epidemic strains based model to compare the effects of precipitation and temperature sampled in the peripheral, less populated districts of Belen, San Juan and on the timing and magnitude of several epidemic outbreaks of dengue, Punchana. Following introduction into the periphery, localized transmission chikungunya and zika, across climatically different regions of Brazil from was estimated to last a maximum of 2. Importantly, we transmission chains, fne-scale persistence and a gravity dynamic of virus also fnd that the relative effects of different climate variables is strongly spread, supporting a hypothesis of substantial peri-domestic transmission dependent on the specifc environmental setting, with temperature or that has major relevance for transmission control. This further implies that estimation of the latency period 897 between peak annual rainfall, for example, and the timing of an arboviral disease outbreak must be determined at a local scale. Musaki1, Elysse Grossi-Soyster2, Bryson Ndenga1, local climatic dependencies when generalizing disease suitability or Francis Mutuku3, Desiree A. The chimeric reporter virus seed Overall, an etiological agent was identifed in 46. Using human clinical detected in all three states of Assam, Uttar Pradesh and West Bengal. Vaccination coverage of Nacional de Diagnostico y Referencia, Ministry of Health, Managua, 80% led to a decrease in the number of cases on a city-wide scale and Nicaragua had varied effects on a sub-city scale. It was found that under uniform With an estimated 400 million infections and approximately 100 million vaccination across two districts of the city with differential transmission cases each year, dengue is the most common arboviral infection. Overall, the new control and prevention strategies, including vaccination programmes identifcation of novel biomarkers of infection severity, such as sialic acid, and the release of Wolbachia-infected mosquitoes. Cardoso3, Uriel Jakarta, clinically-confrmed, hospitalized cases of dengue haemorrhagic C. This hypothesis was raised varying assumptions about the contribution of primary, secondary and based on analysis of long-term surveillance data showing a substantial post-secondary dengue infections to the observed disease incidence. Andrade1, Douglas Widman2, Ellen Young2, Aravinda the number of reported dengue cases in 2017 was the lowest reported de Silva3, Ralph Baric2, Eva Harris1 since 2008. In preliminary data from the Nicaraguan and Sri different faviviruses causes endothelial barrier dysfunction and vascular Lankan populations, the polyclonal responses of 80% (8/10) and 90% leakage in a tissue-dependent manner. Specifc inhibitors of clathrinand dynamin-dependent endocytosis and inhibitors 1Manipal Academy of Higher Education, Udupi, Karnataka, India, 2U. Delhi, India Dengue is a major public health problem potentially affecting 50 million people worldwide. The epidemiology of dengue in India is complex and has substantially changed over the years in terms of circulating serotypes, severity, and geographic spread. Based on presence up to 390 million infections per year, of which 100 million cases are of IgG antibodies in acute serum, 43% cases were secondary dengue. In contrast, more recent work suggests a key protective role activity May to December. Amanda Murphy1, Jenarun Jilip2, Timothy William2, Marilyn High-dimensional phenotypic profling reveals a distinctive and highly Maluda2, Giri S. Current efforts in our laboratory are aimed at investigating In South East Asia, dengue epidemics have increased in size and the infuence of antigenic exposure in primary versus secondary dengue geographical distribution in recent years. In Malaysia, regular outbreaks infection in driving these two opposing memory T cell signatures. While the majority of control efforts have focused on preventing 911 dengue in urban areas, transmission dynamics are poorly understood in more rural states, or where urban and rural areas overlap. Jarman3, Sopon Iamsirithaworn4, Anon in both urbanised cities and rural villages from late 2014 to 2016. Each family comprised of at least a pregnant female, her newborn child, one child aged below 18 years old, and one grandparent. Blood specimens were collected at enrollment; 73 families (416 individuals) underwent a frst scheduled follow up blood collection astmh. Among newborns (as measured in cord quantify dengue transmission intensity as they capture both symptomatic blood), 85. There was signifcant clustering of infection and reporting probabilities from age-stratifed case-notifcation seroconversions within family units (p<0. The maximum seroconversion rate was (department and district-level, respectively). We found large spatial and observed in individuals aged 16-20 years (34%), followed by children aged temporal heterogeneity in transmission intensity within and between 0 to 5 years (20%). The lowest seroconversion rate was in adults aged departments, with the highest transmission intensity clustered in the 31-50 years (3%). This study demonstrates ongoing high incidence of North and Central-Western parts of Colombia. Reporting rates also varied substantially between and 912 within departments, suggesting differences in healthcare accessibility, coverage and health-seeking behaviour. Weg, vector mortality rate and vector competence to determine the proportion 2 3 Kamchai Rungsimanphaiboon, Angkhana Ouppapong, Surachai of infected vectors that eventually become infectious. Rothman, Sharone Green transmission kinetics among arbovirus strains, are rarely taken into account 1 2 in epidemiological models. Using a stochastic agent-based model across studies have reported differences in clinical features of adult and to compute time-dependent individual transmission probabilities, we pediatric dengue. However, these differences may be due to other factors, predict that the observed variation in systemic mosquito infection kinetics such as virus transmission and host genetic differences. To better defne drives signifcant differences in the probability of dengue outbreak and characteristics of dengue in adults and children in the same geographical the number of human infections. Suspected dengue cases were variation can contribute to the risk and magnitude of dengue outbreaks. Between March 2016 and kinetics contributes to improve our understanding of heterogeneities in September 2017 seventy-nine cases were enrolled, 64 were confrmed arbovirus epidemiological dynamics.