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Ceftrioxone 100-150mg/kg as stat dose than in two dived doses 12 hourly + Steroid Change antibiotics according to C/S report and response erectile dysfunction 23 order red viagra uk. Toxoplasmosis Pyrimethamine 2mg/kg/24 hours in two divided doses X 2 days than 1mg/kg/ on alternate day what std causes erectile dysfunction quality red viagra 200 mg. Blood specimen should be collected within 4 days after onset of illness for isolation of virus and at least 5 days after onset of illness for detection if 1g M antibodies purchase erectile dysfunction drugs purchase cheapest red viagra and red viagra. A second convalescent sample should be collected 10-14 days after the first sample erectile dysfunction treatment center buy generic red viagra 200 mg online. Following precautions need to be taken when samples are collected: 1) Blood/Serum i) Equipment required 5ml vacutainer tube(non-heparinized) with 23g needle/5ml syringe with needle 5ml blood collection tube if syringe and needle are used for blood collection Disposable gloves and face mask Tourniquet Sterlized swabs Sterile serum storage vial Specimen labels erectile dysfunction treatment pdf order red viagra 200 mg mastercard, marker pen Band aid Zip lock plastic bags Lab request form Cold box(vaccine carrier) with ice pack First aid kit ii) Collection procedure Collect 5ml blood in a sterile tube labelled with patient identification and date of collection erectile dysfunction trimix cheap red viagra 200mg online. Transportation Specimen should be transported to laboratory as soon as possible, do not wait for collection of additional specimen. In vaccine carrier use frozen packs along the sides and place specimen in the centre. Repeated freezing and thawing should be avoided as it affects the stability of IgM. The details should be filled in clear and neat writing and all the information in the proforma should be provided. Epidemics of Viral Encephalitis demand a clinical diagnosis about the causative Virus for controlling the epidemic at the earliest and for asking for the specific test. Simple clinical observations help in assessing the depth of coma, planning emergency measures necessary to save the child, limit disability, prognosticate and to initiate epidemic control measures. This must be followed by neurological examination for any localizing signs and to plan for the urgent investigations for a final diagnosis. Exclusion of treatable conditions like Cerebral malaria, Epidemic Brain Attack, Meningoencephalitis, Herpes simplex virus encephalitis, Varicella / Zoster encephalitis, Metabolic causes of encephalopathy, Tuberculous Meningitis is extremely important since they require prompt additional specific treatment. Hypoxia is alleviated by intubation, positive pressure ventilation, and ensuring an arterial Pao2 of 65 mm Hg or better. Data Questionnaire filling Data Questionnaire Form For Epidemic Encephalitides Name: Age: Sex: Full Address: 2. Duration of S/S less than 4 days Fever: Y / N Loss of Consciousness / Abnormal behavior: Y/N Abdominal Pain: Y/N Diarrhea: Y/N Rash: Y / N Focal / Asymmetrical Symptoms/Signs: Y / N 24 Chapter-5 5. The difference is in how the two conditions affect the body, contributing to the difference in symptoms. While both emphysema and chronic bronchitis are both ailments of the pulmonary system, they affect different parts of the lungs, causing different symptoms. Emphysema results when the alveoli are destroyed, usually because of cigarette smoking or some other chemical that is inhaled. The alveoli are small sacs located at the end of the respiratory tree and are where the exchange of oxygen and carbon monoxide take place. They lose their elasticity which causes air to become trapped inside them this explains why exhaling is difficult for a person with emphysema and the damage progressively worsened over time. Mucus forms when the airways are irritated and inflamed, this mucus makes it harder to breath. This causes an increased strain on the heart, eventually leading to right sided heart failure and edema. Trachea Bronchus (large Over time the air sacs (windpipe) airway) get stiff and will not Right lung Alveoli let oxygen into and Bronchioles carbon dioxide out of Left lung (small airways) your blood. Com o decorrer Pulmao direito Alveolos do tempo os sacos de Bronquiolos ar fcam rigidos e nao Pulmao esquerdo (vias aereas permitem a entrada de menores) oxigenio e a saida de dioxido de carbono do Diafragma seu sangue. With the help of your health care team, you can manage the disease to slow its progress. Com a ajuda da equipe de profssionais de saude responsavel pelo seu tratamento, e possivel controlar a doenca e desacelerar a progressao da mesma. Converse com os profssionais da equipe que cuidam de sua saude sobre suas duvidas e preocupacoes. You should always seek the advice of your doctor or other qualifed health care provider before you start or stop any treatment or with any questions you may have about a medical condition. Das Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna-800007, India *Corresponding author A B S T R A C T the first epidemic outbreak of Acute Encephalites Syndrome appeared in North K e y w o r d s Bihar districts during 2011 particularly among poorest community in the pediatric age group. The topography of the affected villages epidemic; was studied using standard questionnaire. The disease appeared in pediatric age brain fever; group (median 5 years between 3 months to 10 years) coinciding with the litchi litchi season; (Litchi chinensis) fruit season. Heat stroke was suspected as major possible factor coinciding with litchi season i. Man is the accidental infectious causes and most are considered host and dead end for the transmission of as viral encephalitis (Jmor et al. It is a leading cause of viral onset of the disease during the particular encephalitis in Asia with 30,000-50,000 season of the year. In1976, wide 26 7 0 N/85 24 0 E situated at the spread outbreaks were reported from elevation of 170 and stretched in an area Andhra Pradesh, Assam, Karnataka, Tamil of 13122. The usually coincide with monsoons and post information on topography of the affected monsoon period when the vector density is area, demography, differential diagnosis high (Ministry of Health and Family and other relevant informations were Welfare, 2009). High vaccine coverage using flash light and mouth aspirator after along with active surveillance is essential. The June 2011 at Muzarffarpur district with diagnosis and treatment data of the patient high attack rate and comparatively with was taken at treating hospitals. An epidemic investigation was carried out to explore the study was conducted in accordance the possible causative factors for sudden with the current version of the Declaration 532 Int. However in guideline of the biomedical research on the outbreak at Gorakhpur, India 93. Informed cases were below age group of 15 years written consent was taken from adult (Singh et al. The progression was found increasing th collection of data was made on different gradually and reaching to the peak on 6 aspects of the study like clinical, day started declining gradually reaching to th epidemiological and entomological in the baseline on 14 day (Fig-3) conciding rural Bihar, India, following the with rainfall (Fig-4). Only one or two cases were change of personality, paralysis, back found in each affected village. A total of pain, sleepiness that progressed to coma or 85 cases were reported, out of which 55 death. Out of provisional diagnosis of Encephalopathy these 81% of the cases were from was made and the differential diagnosis Muzaffarpur and rest were from adjacent like viral meningitis, tuberculosis districts like Sitamarhi, Sheohar and East meningitis, heat stroke, malaria, bacterial Champaran. The after taking written informed consent from median age of the patients was found to be the parents and the results were 5 years ranging between 3 months to 10 inconclusive. Acyclovir was given children from house to orchard and vice 0 in two patients who were Herpes Simplex versa. Their source of drinking water given for convulsions intravenously in a was hand pump. People generally rest in loading dose of 20 mg/kg in Normal shadow of the litchi orchards in the day Saline (0. Paracetamol injections and cold sponging was also Bats were found in large number resting done for control of fever. Most of these fruits might causes of such cerebral fever were have been rotten due to some kind of scrutinized. It was this incidence coincides with large scale reported by the parents of affected patients production of litchi, a very famous in course of investigation that some seasonal fruit grown in part of the state children had eaten fallen fruits in the with a high demand of export worldwide. The the incident cases with that of quantum of possibility of transmission of pathogen production of litchi is depicting a strong through this rout cannot be ignored. The first outbreak of NiV was reported in Malaysia and the high quantum of production of litchi subsequently eight out breaks have been fruit might not be directly acting as a reported from India and Bangladesh since causative factor, but some other 2001. This virus is transmitted from ecological, environmental and behavioral human to human also. There, it was factors might have some indirect effect suggested to make efforts to prevent that could be acting as causative factors transmission focused on decreasing bat for high incidence of disease among the access to date palm sap and reducing populations residing by the orchard. Hence, there could be factors were also found associated with the possibility of getting infection through disease outbreak (Paireau et al. These conditions could cause References highly conducive and favorable conditions for the growth of bacterial or fungal Bouchama, A. Epidemiological studies on the gelidus, Mansonia uniformis, Anopheles encephalitis epidemic in Bankura. Acknowledgement the incidence of acute encephalitis syndrome in Western industrialised Authors are thankful to Mr. Transmission of Human Pandey S, Kumar P, Singh K, Kumar Infection with Nipah Virus. Illustrated keys to species of Culex (Culex) associated with Japanese encephalitis in southeast Asia (Diptera:Culicidae). Entomo virological study of a suspected Japanese encephalitis outbreak in Muzaffarpur district, Bihar, India. Public health programs and policies that focus on tobacco-use prevention and cessation, reducing occupational exposure to dusts and chemicals, and reducing other indoor and outdoor air pollutants are critically important. Management should include smoking cessation and abstinence; limiting exposure to secondhand smoke, dusts, fumes, and gases; pharmacological treatment with bronchodilators and corticosteroids; supplemental oxygen therapy; pulmonary rehabilitation; collaborative self-management; and surgery (8). To accomplish these goals, the workgroup proposed the following objectives, strategies, and actions based on a detailed, scientifc rationale. Investigation of proper training and clinical use of spirometry and evidence-based treatment modalities is also warranted. Rationale Extensive programs for the public, health care professionals, and provider systems already exist to prevent and treat the consequences of tobacco use. American Toracic Society statement: occupational contribution to the burden of airway disease. Strategy 3 Improve the ability of federal agencies to collect, analyze, and report health care data from electronic health records. Because of their slow evolution and chronic nature, chronic diseases present opportunities for prevention. Care for patients with chronic diseases should be an integral part of the activities of health services, alongside care for patients with acute and infectious diseases. Chronic respiratory diseases are a group of chronic diseases affecting the airways and the other structures of the lungs. Hundreds of millions of people around the world suffer from preventable chronic respiratory diseases. This report focuses on the following preventable chronic respiratory diseases and their risk factors: Asthma and respiratory allergies. Surveys in nine countries, in 76 primary health care facilities, among which 54 (71. The number of primary health care facilities, involving 29 399 respiratory patients, showed that the proportion of patients with respiratory symptoms, among those over 5 years of age, who visited primary health care centres ranged from 8. Table 5 Proportion of patients with respiratory symptoms among all patients (aged 5 years and older) who visited primary health care facilities for any reason Males Females Argentina 36. The prevalence of asthma has increased following changes to a modern, urban lifestyle. Asthma is a chronic inammatory disorder of the airways, usually associated with airway hyper-responsiveness and variable airow obstruction, that is often reversible spontaneously or under treatment (50). Asthma is often associated with rhinitis, an inammation of the nasal mucosa (51). Using a conservative denition, it is estimated that as many as 300 million people of all ages and all ethnic backgrounds suffer from asthma. The world map of the prevalence of asthma (Figure 4) is based on these two studies (15). Figure 4 World map of the prevalence of clinical asthma Proportion of population (%) 10. For the past 40 years, the prevalence of asthma has increased in all countries in parallel with that of allergy.

Shorter sessions are often a good idea for younger or more developmentally delayed children and are often necessary in school settings impotence urology red viagra 200 mg without a prescription. Longer sessions allow the therapist to address more content and/or use part of the time to meet with parents and are usually favored by play therapists working in agencies or in private practice erectile dysfunction treatment photos buy red viagra 200 mg on line. LeBlanc and Ritchie (2001) found that the effects of play therapy reached their peak at about 30 sessions However erectile dysfunction 43 quality 200mg red viagra, Bratton erectile dysfunction drugs over the counter canada buy red viagra paypal, Ray reasons erectile dysfunction young age cheap red viagra 200mg with mastercard, and Rhine (2005) found that play therapy sessions were effective for as many as 35 sessions erectile dysfunction doctor seattle red viagra 200mg sale. Longer periods of time may be needed in working with children with disabilities when they have trouble mastering the target skills or generalizing their gains to life outside the playroom. The pretreatment assessment includes interviews with teachers, caregivers, and other signifcant adults who interact with or provide care to the child. Gitlin-Werner, Sandgrund, and Schaefer (2000) provide an extensive overview of assessment instruments used in play therapy preassessment. Her scale helps to identify developmental delays that may be particularly relevant to play ther apy treatment planning. Children are provided with four groups of toys and their play is assessed by examining qualitatively different categories of developmentally sequenced play activities. She provides a helpful review of the developmental assessment literature with charts indicating both average development characteristics by age group and characteristics of children with disabil ities. Included in her discussion of disabilities are developmental delay, language impairment, hearing impairment, and visual impairment. In addition, Vig (2007) provides brief directions for using play observationsin practice settings, identifying developmentalages and stages, identifying indications of disabilities, and discussing how to conduct a play observation session. When using group play therapy with children with disabilities, it is important for the play therapist to screen the children to ensure they are placed in groups based their having compati ble strengths, weaknesses, and needs. In addition, children with disabilities may represent a more vulnerable group, and extra care may need to be taken to protect them from physical and psy chological trauma in the group context, such as being overwhelmed by the interaction required or being bullied. In summary, focused pretreatment assessment allows the play therapist to develop an individu alized treatment plan for a child with disabilities. The treatment plan is a description of long and short-term goals stated in a measureable manner and includes the methods to be used in address ing those goals. Most agencies have policies governing how these are to be written so they meet federal, state, and third-party payer requirements. A simple treatment plan needs to have contact and identifying information for the child and caregiver and statements of the problem/concern, long-term goal, short-term objectives, the treatment(s) chosen, and criteria for termination. An extensive look at the play therapy literature from the early 1900s to the present fnds an extensive selection of single case studies supporting the effcacy of play therapy for children with disabilities (Uni versity of North Texas Center for Play Therapy, 2014). While there is a large number of articles researching interventions with children with disabilities, there is a dearth of articles that expressly are focused on the outcome of play therapy with these children. One of the diffculties with much of the current research is related to the narrow focus of many of the studies. The other problem has to do with the failure to specifcally assess for, diagnose, or report specifc disabilities in the populations under study. Children may be included who did, indeed, have specifc learning dis abilities, but these were not assessed as part of the study. These two oversights in the research literature make it diffcult to examine the studies presented for specifc interventions that can be recommended for use by play therapists working with children with disabilities. In spite of this dilemma, play therapy remains a well-documented approach for treating children with dis abilities (Bratton et al. A sampling of studies found flial therapy effective for use with children with learning disabilities (Kale & Landreth, 1999), those who were deaf and hard of hearing (Smith & Landreth, 2004), and those with cerebral palsy (Cohen, Biran, Aran, &Gross-Tsur, 2008). Wickstrom (2009) agreed that many studies have demonstrated the effectiveness of the approach. Tarver-Behring and Spagna (2004) advocate for the use of group work with children with disabilities to address social and emotional areas of diffculty. Specifcally, they suggest that groups build positive self-esteem; model appropriate ways to express feelings, alternative problem solv ing, and appropriate positive behavior; and can be vehicles for providing education about specifc disabilities. At this writing, an extensive search of the literature did not locate any studies that specifcally assess the effectiveness of group play therapy for children with disabilities. In general, play therapy has been shown to be effective in treating a wide range of prob lems. The research continues to indicate the effcacy of play therapy to multiple disorders, disabilities, and diffculties of childhood. While children with disabilities experience many of the same diffculties as their physically able counterparts, they also face some unique challenges. They may have academic issues or face both physical and social barriers in the world at large. To be an effective play therapist for children with disabilities requires both some specialized training and some unique personality characteristics. Play therapists working with this popula tion need to be well informed regarding the medical, legal, and mental health issues commonly faced by these children. They also need to have been trained and supervised in the specifc play interventions best suited to children with disabilities. On a personal level, play therapists must be aware that children with disabilities pose unique problems that demand creative and patient interventions. On a theoretical level, no one theory of play therapy appears to be best for all children with disabilities, but some play therapy theories may more readily accommo date the needs of this population. Finally, the playroom itself may need to be set up to accommodate the diverse abilities and limitations with which these children present. Emotional and behavioural problems in children with visual impairment, intellectual and multiple disabilities. Assessing social dysfunction: the contributions of laboratory and performance-based measures. Self-esteem of children and adolescents with physical disabilities: Quan titative evidence from meta-analysis. A therapeutic model for supporting fami lies of children with a chronic illness or disability. Interaction of social and play behaviors in preschoolers with and without pervasive developmental disorder. The trajectory of psychiatric disorders in young people with intellectual disabilities. Psychopathology and intellectual disability: the Australian child to adult longitudinal study. The world of play therapy literature: A defni tive guide authors and subjects in the feld. The process of systemic change in flial therapy: A phenomenological study of parent experience. A myriad of traumatic experi ences can adversely affect children, including natural disasters, acts of mass violence, child abuse and neglect, and domestic violence. While natural disasters such Hurricane Katrina and the 2010 Haiti earthquake can be traumatizing to children, the harshest of traumas on children are those involving interpersonal trauma, primarily child abuse and neglect, domestic violence, and acts of mass violence, such as the terrorist attacks of September 11, 2011, and the 2013 school shooting in Newtown, Connecticut. For the purposes of this chapter, interpersonal trauma is defned as any traumatic event a child experiences that is clearly caused by another person. In this chapter, characteristics of interpersonal trauma, including child abuse and crimes against children, are defned, and it is illustrated why play therapy is an appropriate approach for working with child survivors of interpersonal trauma. Second, play therapy approaches with demonstrated effectiveness in alleviating the symptoms of child survivors of interpersonal trauma are reviewed. Fourth, specifc techniques and strategies known to facilitate growth and healing for child survivors of interpersonal trauma are explored. Finally, the research and evidence base for the use of play therapy in the treatment of interpersonal trauma are discussed. In the case of interpersonal trauma, direct experience can include child physical or sexual abuse, kidnapping, being held hostage, torture, human-made disasters, and severe motor vehicle accidents. Witnessing can include threatened or serious injury, unnatural death, physical or sexual abuse of another person due to violent assault, domestic violence, accident, and trauma happening to others, particularly a primary caregiver. Learning of a traumatic event or accident happening to a close friend or family member may include hearing about a violent personal assault, suicide, or a serious accident or injury. Repeated or extreme exposure to adverse details may include hearing the story reiterated or seeing the traumatic event repeatedly on television or the Internet. They learn about themselves and the world around them through their interpersonal relationships with signifcant others in their lives. Younger children desire close relationships with adults, in particular with their parents and teachers. In mid-childhood, children begin to develop social hunger, the desire to build signifcant relationships with peers, which continues to grow through adolescence. Recent advances in neuroscience provide insight to the effects of trauma, supporting much of what play therapists have noted anecdotally. Interpersonal trauma is a form of psychological trauma that involves the breaking of trust due to death, abandonment, abuse and neglect, or domestic violence (Findling, Bratton, & Hen son, 2006). Relational trauma, a specifc form of interpersonal trauma, involves the rupturing or severing of interpersonal relationships with signifcant others, and in the case of children, interpersonal trauma frequently involves a primary caregiver (Dayton, 2000). Children who experience relational trauma may feel isolated and experience a range feelings, thoughts, and physical sensations that are both confusing and frightening (Gil, 2010). In response to interpersonal trauma, children often experience a sense of betrayal as result of a person they love either being the source of their pain or failing to protect them from pain (Shaw, 2010). Young children are particularly vulnerable to traumatic events (Shaw, 2010) because they lack the cognitive ability to process intrusive and distressing experiences (Dass-Brailsford, 2007). In addition, childhood is a time of great development across all domains of growth. Trauma affects children holistically, and traumatic events can severely interrupt their development (van der Kolk, 2005). When children experience trauma during a developmental sensitive period, their opportunities to achieve full development in that area are greatly inhibited; in more severe cases, children may never reach their full potential.

This is not serious and will generally subside over a period of about half an hour erectile dysfunction hypogonadism proven 200 mg red viagra. Further information on the drug Ciprofoxacin is contained in the Product Information Leafet erectile dysfunction exercises cheap red viagra american express. If you or any member of the family develop fever erectile dysfunction cure buy discount red viagra 200 mg, headache impotence from diabetes generic red viagra 200 mg without a prescription, vomiting impotence age 45 200 mg red viagra sale, neck pain treatment of erectile dysfunction in unani medicine cheap red viagra 200 mg with mastercard, dislike of bright lights, a red purple rash which does not fade on pressure, dizziness or any other symptoms mentioned in the enclosed leafet on meningococcal disease, contact your family doctor immediately and bring this letter with you. If you have any queries, please contact one of the Public Health doctors at the number above. Yours sincerely, Senior Medical Offcer -100 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) appenDix 5 Examples of Vaccination Information the following examples of letters and leafets can be adapted locally to refect specifcs appropriate to community, situation and disease type. Following close contact with a suspected case of Meningococcal disease, there is an extremely low risk of catching the infection. Immunisation with a vaccine is recommended for adults and children of two months of age and over who are close contacts of a case of meningococcal disease caused by Group B strain of the meningococcal germ. Immunisation is recommended for children from two months of age, and for at risk adults. Children up to 1 year of age require two doses of vaccine at least two months apart and a further dose at 12 months of age. Will this vaccination eliminate the possibility of developing meningitis or septicaemia Undergoing vaccination will reduce the possibility of developing meningitis or septicaemia. Therefore it is very important that you should still remain alert for the symptoms and signs of meningococcal disease (as outlined in the leafet) and seek medical help as early as possible if you are concerned. If your child is aged less than 12 months, please ensure that he/she completes the course of three doses recommended as part of the childhood immunisation programme (third dose at 12 months). Yours sincerely, Senior Medical Offcer -101 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Example menc immunisation against meningococcal Disease group c Why vaccination Immunisation with a vaccine is recommended for adults and children of two months of age and over who are close contacts of a case of meningococcal disease caused by Group C strain of the meningococcal germ. Children up to 1 year of age require one dose of vaccine and a further dose at 13 months of age. Children or adults who received a MenC vaccine more than one year before are recommended a booster. If your child is aged less than 12 months, please ensure that he/she completes the course of doses recommended as part of the childhood immunisation programme. Following close contact with a suspected case of Meningococcal disease, there is and extremely low risk of catching the infection. Immunisation with the A,C,Y, W135 vaccine is recommended for adults and children who are close contacts of a case of meningococcal disease caused by Group A, W135 or Y strain of the meningococcal germ. Menveo vaccine is the name of the vaccine currently recommended after exposure to an individual diagnosed with group A, W135 or Y meningococcal disease. Other quadrivalent meningococcal vaccines may also be used if Menveo is not available. Two doses of Menveo, given at one month intervals, are needed for children who are less than one year of age. This vaccine is also recommended for individuals undertaking the Hajj pilgrimage to Mecca. Vaccination should be postponed in individuals suffering from an acute febrile illness or in pregnant women; hypersensitivity to the vaccine or any of its components; if you are pregnant or breastfeeding What are the possible side effects from vaccination There are possible side effects including localised redness can occur lasting 1-2 days at the site of the injection. If you or your child develops side effects following vaccination and you are concerned, it is advisable to seek medical advice. If you (or your family) are ever in contact with meningococcal disease again, please inform the doctor that you have received the vaccine and the approximate date that you received the vaccine. Yours sincerely, Senior Medical Offcer -103 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Vaccination administration record for patient this record should be given to the patient at the time of vaccination, to hold for their own fles. Alternatively, if they have an immunisation book the vaccine can be entered there, as a record of their immunisation. Patient Name Patient date of Birth Vaccine Type1 Date given Site2 Batch Manufacturer Leafet Vaccinator (dd/mm/yyyy) number name given signature (v) Meningococcal vaccine How to complete this record for the patient 1. Date: June 2011 from Clinical Guidelines for Bacterial Meningitis -104 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) appenDix 6. Examples of Templates for Letters For schools re contact with case, prophylaxis etc. The following examples can be modifed to suit local needs and are given only as examples. We have given a two day course of rifampicin as prophylaxis along with instructions. Rifampicin may accelerate the metabolism and may reduce the activity of oral anticoagulants or anticonvulsants. It is recommended that when meningococcal infection is suspected, a single dose of benzylpenicillin should be given immediately intramuscularly or (preferably) intravenously. Yours sincerely, Senior Medical Offcer -110 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Letter informing student of meningococcal case in his/her college Date / / Dear Student, I wish to inform you that a case of meningococcal disease has occurred in a student at your college. While it is very unlikely that there will be further cases in the college, it is important to be aware of the symptoms of this illness these include headache, high temperature, vomiting, neck pain, dislike of bright lights, a red purple rash which does not fade on pressure and dizziness. Should you need any further information, please contact your student health services, general practitioner or a public health doctor at the above address/phone number. Yours sincerely, Senior Medical Offcer -111 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Workplace letter Letter informing workplace colleagues of a case of meningococcal disease Date / / To whom it may concern: I wish to inform you that a case of meningococcal disease has occurred in a person at your workplace. Should you need any further information, please contact your general practitioner or a public health doctor at the above address/phone number. Yours sincerely, Senior Medical Offcer -112 Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) appenDix 7. Other causes of meningitis include pneumococcal disease, Hib and group B streptococcal disease. Meningitis is an infammation of the meninges, which is the name given to the covering layer of the brain and spinal cord. Septicaemia is a form of blood poisoning caused by the same organism that causes meningitis. There are several different types of Neisseria meningitidis, these include groups A, B, C, W135 and Y. Symptoms and signs in adults and older children Classical symptoms and signs would include temperature, severe headache, neck stiffness, nausea and/or vomiting, dislike of bright lights, drowsiness and joint or muscle pains. Symptoms and signs in babies and infants Classical symptoms and signs of meningitis such as dislike of bright lights and neck stiffness are uncommon and diffcult to determine in infants and small children. If bacteria enter the bloodstream, they can release toxins, which can damage the walls of blood vessels causing a leakage of blood under the skin. It may start as tiny blood spots which look like red pin-prick type marks which if untreated can spread to form bruises or blood blisters. The bacteria which cause meningococcal meningitis and meningococcal septicaemia are common and can live naturally in the back of the nose and throat. It is spread by respiratory droplets, which are most effciently generated by coughing, sneezing and mouth kissing. Peak carriage rates may occur in the 15-19 year old group of whom 25% are carriers. Only a small minority of carriers will develop meningitis or septicaemia after an incubation period of 2-3 days. Invasive meningococcal disease may occur at any age but is most common in infancy and early childhood with an additional smaller peak of disease activity in adolescents and young adults. In Ireland the infection typically shows a seasonal variation with the majority of cases occurring in winter and early spring. The earlier the diagnosis, the earlier treatment with antibiotics can begin and therefore the greater chance that the person will make a full recovery. Early diagnosis is the key so if you suspect that someone may have meningitis or septicaemia seek medical attention immediately. Vaccines are available for some of the different types of Neisseria meningitidis bacteria, There is a vaccine to prevent MenC disease that is given routinely in infancy at 4, 6 and 13 months of age. There is also a vaccine that is used to protect against groups A, B, C, W135 and Y that is recommended for individuals travelling to areas where there is an increased risk of exposure to these groups. Meningococcal disease can be treated with effective antibiotics, but it is important that these are started as soon as possible. People who are very close contacts (such as family contacts or other close contact) of the ill person are given antibiotics (one dose or a very short course) in order to prevent further cases of the illness. These antibiotics will also kill the bacteria that normally help the body fght infection, so they are only given when absolutely necessary. This bacterium is the most common bacterial cause of community-acquired pneumonia and a common cause of bacteraemia and meningitis in children and adults. People can get infected by person-to-person spread, usually through respiratory droplet spread, but may be by direct oral contact or indirectly through articles contaminated with respiratory discharges. The bacteria is spread through contact between persons who are ill or who carry the bacteria in their throat (often without being ill). It is extremely rare for healthy people to catch the infection from a relative or a member of their household. In recent years many pneumococci have become resistant to some of the antibiotics used to treat pneumococcal infections; high levels of resistance to penicillin are uncommon. Pneumococcal Conjugate Vaccines are used in the childhood immunisation schedule at 2, 6, and 12 months. These vaccines are used in children because they are more suitable for children than the polysaccharide vaccines. If two or more cases of serious pneumococcal disease are identifed in a closed setting (household, school or other closed environment) there may be a slightly increased risk of developing the infection among the close contacts. In these circumstances close contacts may be offered antibiotics and sometimes immunisation as a precautionary measure if appropriate. People with viral meningitis may have severe symptoms but they usually recover completely. The symptoms of bacterial meningitis may be identical, particularly in the early stages of the disease. For this reason it is important that if you think that your child may have meningitis you should contact your doctor as soon as possible. The viruses that cause viral meningitis are contagious and can be easily spread from person to person. However, most people who get infected with these viruses do not become ill, or else just develop a mild cold or rash with a slight fever. The most common cause is an enterovirus infection (either an echovirus or coxsackie virus). Less commonly reported (or very rare nowadays) viruses include the following; poliovirus, mumps virus, herpes simplex type 2 virus, herpes zoster, infuenza types A or B, arbovirus, rubella, Epstein Barr virus. Guidance for the early clinical and public health management of meningococcal disease in Australia. Public health management of sporadic cases of invasive meningococcal disease and their contacts. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information. Death from invasive meningococcal disease following close contact with a case of primary meningococcal conjunctivitis. Infuence of serogroup on the presentation, course, and outcome of invasive meningococcal disease in children in the Republic of Ireland, 1995-2000. Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study. Dexamethasone treatment in adults with pneumococcal meningitis: risk factors for death. A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Rapid diagnosis of acute meningococcal infections by needle aspiration or biopsy of skin lesions. The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica.

This cell impotence 35 years old cheap 200mg red viagra amex, containing the combined genetic information from both parents erectile dysfunction consult doctor order red viagra 200mg fast delivery, is referred to as a zygote impotence because of diabetes buy red viagra 200 mg overnight delivery. The inner group of cells erectile dysfunction drugs cheap 200mg red viagra free shipping, or embryonic disk will become the embryo erectile dysfunction drugs pictures 200 mg red viagra mastercard, while the outer group of cells erectile dysfunction pills for high blood pressure purchase red viagra 200mg overnight delivery, or trophoblast, becomes the support system which nourishes the developing organism. Approximately 50-75% of blastocysts do not implant in the uterine wall (Betts et al. Some of the reasons for this include the egg and sperm do not join properly, thus their genetic material does not combine, there is too little or damaged genetic material, the zygote does not replicate, or the blastocyst does not implant into the uterine wall. The placenta is a structure connected to the uterus that provides nourishment and oxygen from the mother to the developing embryo via the umbilical cord. Growth during prenatal development occurs in two major directions: from head to tail called cephalocaudal development and from the midline outward referred to as proximodistal development. This means that those structures nearest the head develop before those nearest the feet and those structures nearest the torso develop before those away from the 44 center of the body (such as hands and Figure 2. The head develops in the fourth week and the precursor to the heart begins to pulse. However, by the end of this stage they disappear and the organism takes on a more human appearance. Some organisms fail during the embryonic period, usually due to gross chromosomal abnormalities. As in the case of the germinal period, often the mother does not yet know that she is pregnant. It is during this stage that the major structures of the body are taking form Photo by Lunar Caustic making the embryonic period the time when the organism is most vulnerable to the greatest amount of damage if exposed to harmful substances. Potential mothers are not often aware of the risks they introduce to the developing embryo during this time. The embryo is approximately 1 inch in length and weighs about 8 grams at the end of eight weeks (Betts et al. The Fetal Period From the ninth week until birth, the organism is referred to as a fetus. By the third month, the fetus has all its body parts including external genitalia. In the following weeks, the fetus will develop hair, nails, teeth and the excretory and digestive systems will continue to develop. The respiratory system continues to develop, and reflexes such as sucking, swallowing and hiccupping, develop during the 5th month. The first chance of survival outside the womb, known as the age of viability is reached at about 24 weeks (Morgan, Goldenberg, & Schulkin, 2008). The majority of the neurons in the brain have developed by 24 weeks, although they are still rudimentary, and the glial or nurse cells that support neurons continue to grow. At 24 weeks the fetus can feel pain (Royal College of Obstetricians and Gynecologists, 1997). The fetus gains about 5 pounds and 7 inches during this last trimester th of pregnancy, and during the 8 month a layer of fat develops under the skin. This layer of fat serves as insulation and helps the baby regulate body temperature after birth. The fetus continues to gain weight and grow in length until approximately 40 weeks. The location of these stem cells in the embryo is referred to as the neural plate. By the end of the third week, two ridges appear along the neural plate first forming the neural groove and then the neural tube. By the end of the embryonic period, or week eight, the neural tube has further differentiated into the forebrain, midbrain, and hindbrain. Brain development during the fetal period involves neuron production, migration, and differentiation. From the early fetal period until midgestation, most of the 85 billion neurons have been generated and many have already migrated to their brain positions. Neurogenesis, or the formation of neurons, is largely completed after five months of gestation. One exception is in the hippocampus, which continues to develop neurons throughout life. Neurons that form the neocortex, or the layer of cells that lie on the surface of the brain, migrate to their location in an orderly way. Neural migration is mostly completed in the cerebral cortex by 24 weeks (Poduri & Volpe, 2018). Once in position, neurons begin to produce dendrites and axons that begin to form the neural networks responsible for information processing. Regions of the brain that contain the cell bodies are referred to as the gray matter because they look gray in appearance. The axons that form the neural pathways make up the white matter because they are covered in myelin, a fatty substance that is white in appearance. Although cell differentiation is complete at birth, the growth of dendrites, axons, and synapses continue for years. The developing child is most at risk for some of the severe problems during the first three months of development. Unfortunately, this is a time at which many mothers are unaware that they are pregnant. Today, we know many of the factors that can jeopardize the health of the developing child. Teratogens are environmental factors that can contribute to birth defects, and include some maternal diseases, pollutants, drugs and alcohol. Factors influencing prenatal risks: There are several considerations in determining the type and amount of damage that might result from exposure to a particular teratogen (Berger, 2005). For example, the ears and arms reach their critical periods at about 6 weeks after conception. If a mother exposes the embryo to certain substances during this period, the arms and ears may be malformed. This is suggested by fraternal twins exposed to the same prenatal environment, but they do not experience the same teratogenic effects. The genetic make up of the mother can also have an effect; some mothers may be more resistant to teratogenic effects than others. It is believed that the Y chromosome, which contains fewer genes than the X, may have an impact. Alcohol use during pregnancy is the leading preventable cause of intellectual disabilities in children in the United States (Maier & West, 2001). Alcohol consumption, particularly during the second month of prenatal development but at any point during pregnancy, may lead to neurocognitive and behavioral difficulties that can last a lifetime. When a pregnant woman smokes the fetus is exposed to dangerous chemicals including nicotine, carbon monoxide and tar, which lessen the amount of oxygen available to the fetus. A woman being exposed to secondhand smoke during pregnancy has also been linked to low birth weight infants. Rehan, Sakurai, and Torday (2011) found that prenatal exposure to thirdhand smoke played a greater role in altered lung functioning in children than exposure postnatally. Prescription/Over-the-counter Drugs: About 70% of pregnant women take at least one prescription drug (March of Dimes, 2016e). A woman should not be taking any prescription drug during pregnancy unless it was prescribed by a health care provider who knows she is pregnant. Some prescription drugs can cause birth defects, problems in overall health, and development of the fetus. Over-the-counter drugs are also a concern during the prenatal period because they may cause certain health problems. For example, the pain reliever ibuprofen can cause serious blood flow problems to the fetus during the last three months. It is difficult to completely determine the effects of a particular illicit drug on a developing child because most mothers who use, use more than one substance and have other unhealthy behaviors. These include smoking, drinking alcohol, not eating healthy meals, and being more likely to get a sexually transmitted disease. The use of cocaine is connected with low birth weight, stillbirths and spontaneous Source abortion. Heavy marijuana use is associated with problems in brain development (March of Dimes, 2016c). Other complications of illicit drug use include premature birth, smaller than normal head size, birth defects, heart defects, and infections. Additionally, babies born to mothers who use drugs may have problems later in life, including learning and behavior difficulties, slower than normal growth, and die from sudden infant death syndrome. Children of substance abusing parents are also considered at high risk for a range of biological, developmental, academic, and behavioral problems, including developing substance abuse problems of their own (Conners, et al. Women who use drugs or alcohol during pregnancy can cause serious lifelong harm to their child. Some people have advocated mandatory screenings for women who are pregnant and have a history of drug abuse, and if the women continue using, to arrest, prosecute, and incarcerate them (Figdor & Kaeser, 1998). The policy required patient education about the harmful effects of substance abuse during pregnancy. In July 2014, Tennessee enacted a law that allows women who illegally use a narcotic drug while pregnant to be prosecuted for assault if her infant is harmed or addicted to the drug (National Public Radio, 2015). According to the National Public Radio report, a baby is born dependent on a drug every 30 minutes in Tennessee, which is a rate three times higher than the national average. However, since the law took effect the number of babies born having drug withdrawal symptoms has not diminished. Critics contend that the criminal justice system should not be involved in what is considered a healthcare problem. Grossman and Slutsky (2017) found that babies born in Flint Michigan, an area identified with high lead levels in the drinking water, were premature, weighed less than average, and gained less weight than expected. Radiation can also build up in body areas close to the uterus, such as the bladder. This is why women are cautioned about the amount and type of fish they consume during pregnancy. Toxoplasmosis: the tiny parasite, toxoplasma gondii, causes an infection called toxoplasmosis. A healthy immune system can keep the parasite at bay producing no symptoms, so most people do not know they are infected. As a routine prenatal screening frequently does not test for the presence of this parasite, pregnant women may want to talk to their health-care provider about being tested. Toxoplasmosis can cause premature birth, stillbirth, and can result in birth defects to the eyes and brain. While most babies born with this infection show no Source symptoms, ten percent may experience eye infections, enlarged liver and spleen, jaundice, and pneumonia. To avoid being infected, women should avoid eating undercooked or raw meat and unwashed fruits and vegetables, touching cooking utensils that touched raw meat or unwashed fruits and vegetables, and touching cat feces, soil or sand. If women think they may have been infected during pregnancy, they should have their baby tested. Sexually Transmitted Diseases: Gonorrhea, syphilis, and chlamydia are sexually transmitted infections that can be passed to the fetus by an infected mother. Mothers should be tested as early as possible to minimize the risk of spreading these infections to their unborn child. There are some measures that can be taken to lower the chance the child will contract the disease. However, the long-term risks of prenatal exposure to the medication are not known. German measles (or rubella): Rubella, also called German measles, is an infection that causes mild flu-like symptoms and a rash on the skin. However, only about half of children infected have these symptoms, while others have no symptoms (March of Dimes, 2012a). If the mother contracts the disease during the first three months of pregnancy, damage can occur in the eyes, ears, heart or brain of the unborn child. Deafness is almost certain if the mother has German measles before the 11th week of prenatal development and can also cause brain damage. Women in the United States are much less likely to be afflicted with rubella, because most women received childhood vaccinations that protect her from the disease. Maternal Factors Mothers over 35: Most women over 35 who become pregnant are in good health and have healthy pregnancies.

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