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This tendency is inherited as received character most patients have immunologic abnormalities 99 bacteria buy zithrox 500mg with mastercard. Signs and symptoms ¾ Itching infection game online buy zithrox with a mastercard, erythematosus antibiotics korean buy zithrox with mastercard, papulovesiculer lesion ¾ In severe case; exudates, crusting the lesion and elapse ¾ If can happen in, children, adolescent and adult 2. Treatment ¾ Keep the skin dry and clean ¾ Encourage daily bath ¾ Use or denary soap ¾ Avoid application of oil ¾ Wash with normal saline and potassium permanganate ¾ Application of corticosteroid ointment ¾ Teach the patient about the disease ¾ Refer it not improved 156 7. Risk factors On allergic sensitivity to food, house dust, mites, pollens, or small inhalants 3. Characteristics ¾ Red, minute papules and vesicles ¾ Persistent itching ¾ Weeping, oozing, crusting and scaling lesion present ¾ Lichenification (thick and hardened skin) lesion 4. Treatment ¾ Avoid the risk factors ¾ Apply lotion and ointment ¾ Teach the patient about the disease (personal hygiene cleanliness of environment) ¾ Reassure Patient ¾ Arrange follow up 7. Lacerated: are jagged or irregularly wound often associated with much tissue damage and that can be caused by wire, an explosion and stone. Foreign material as cloth, wood, and metal pieces are often driven in to the wound and often not heal quickly and may leave large scar. Cleanse the injured part thoroughly, using plain soap and boiled water which is cooled at room temperature or clean with running water and soap 3. Tell the patient to go to the clinic or hospital if evidence of infection appears. After the bleeding has been controlled apply additional layer of cloth and in the mean time elevated the bleeding part of limbs. Do not remove any layers of cloth that is already found on the wound since it may cause bleeding of the part. Pressure will be apply to supplying vessel, for especial quick action, here you can use your fingers or the palm of your hands to press the supply vessels and then after bleeding is stop dress the wound and based on the severity refer him or her to the clinic. Infected wound the patient with an infected wound should always be under the care of a hospital or health centre so, the health worker has to soaked the foot or the hand in solution of 2 table spoons of salt in to one liter of boiled waters for 15-20 minute, this can help to localized the infection. In any case the health worker should not forget to send or refer the Victim and clinic for assessment and treatment of tetanus. Causative organism ¾ Treponema Vincent ¾ Bacillus fusifornes Transmission – By direct contact and flies 2. Clinical picture ¾ the ulcer become large quickly as the skin and subcutaneous tissue involved ¾ the skin around the edge of the ulcer is hard, hot and tender to touch 3. Complication the ulcer may become very deep down to the bone and ostomyelitis may develop. Management ¾ the goal of the management is to give an emphasis to control the infection and promote healing of the ulcer ¾ Bed rest to enhance wound healing ¾ Encourage the patient to take a good nutrition like vitamin and protein (good diet) ¾ Clean the skin with soap solution and cover it with clean cloth ¾ Refer the patient to nearest clinic or Health centre 5. Prevention ¾ Since the disease appeared as result of malnutrition and poor personal hygiene the health worker has to teach community the importance of personal hygiene and nutrition. The most common areas 159 are sacrum and hip but also in include occipital area, elbow, heels, ankles, scapula and back. Predisposing factors ¾ Immobility (sleeping on one place for long hours) due to chronic debilitating disease ¾ Being incontinence (un able to control urine and feces) ¾ Edema (swelling of body) cause by impaired circulation 2. Clinical Manifestation At early time, the health workers notice that, there is redness, tissue swelling and congestion with a patient complaining discomfort, elevation of skin temperature because of high vasodilatation and then the part of skin progress to dusky, cyanotic blue gray appearance. The goal of management of bed sore Include relief of pressure, improve mobility, and improve nutritional status. Relieving pressure o By frequent change position by using a variety of pads and supportive device to prominent areas 2. Improve mobility Encourage passive and active exercise to increase blood circulation 3.
Cold sites should not be punctured as samples collected from cold sites give falsely high results of hemoglobin and cell counts antibiotic every 6 hours generic zithrox 250mg on-line. Rub the site vigorously with a gauze pad or cotton moistened with 70% alcohol to remove dirt and epithelial debris and to increase blood circulation in the area bacteria vs archaea cheap zithrox 100mg amex. If the heel is to be punctured antibiotics mnemonics purchase generic zithrox, it should first be warmed by immersion in a warm water or applying a hot towel compress. A deep puncture is no more painful than a superficial one and makes repeated punctures unnecessary. The site should not be squeeze or pressed to get blood since this dilutes it with fluid from the tissues. Rather, a freely flowing blood should be taken or a moderate pressure some distance above the puncture site is allowable. Stop the blood flow by applying slight pressure with 46 Hematology a gauze pad or cotton at the site. Disadvantages of Capillary Blood • Only small amounts of blood can be obtained and repeated examinations require a new specimen. Venous Blood Collection A venous blood sample is used for most tests that require anticoagulation or larger quantities of blood, 47 Hematology plasma or serum. Sites of Puncture • the veins that are generally used for venipuncture are those in the forearm, wrist or ankle. The veins in the antecubital fossa of the arm are the preferred sites for venipuncture. They are larger than those in the wrist or ankle regions and hence are easily located and palpated in most people. Puncture of the external jugular vein in the neck region and the femoral vein in the inguinal area is the procedure of choice for obtaining blood. Attach the needle so that the bevel faces in the same direction as the graduation mark on the syringe. The gauge and the length of the needle used depend on the size and depth of the vein to be punctured. The needle should not be too fine or too long; those of 19 or 21G are suitable for most adults, and 23G for children, the latter especially with a short shaft (about 15mm). The point of the needle will thus be embedded in the stopper without puncturing it and loosing the vacuum in the tube. Identify the patient and allow him/her to sit 50 Hematology comfortably preferably in an armchair stretching his/ her arm. Prepare the arm by swabbing the antecubital fossa with a gauze pad or cotton moistened with 70% alcohol. Apply a tourniquet at a point about 6-8cm above the bend of the elbow making a loop in such a way that a gentle tug on the protruding ends will release it. Alternatively, the veins can be visualized by gently tapping the antecubital fossa or applying a warm towel compress. Grasp the back of the patient’s arm at the elbow and anchor the selected vein by drawing the skin slightly taut over the vein. If the needle is properly in the vein, blood will begin to enter the syringe spontaneously. With the syringe and needle system, first cover the needle with its cap, remove it from the nozzle of the 52 Hematology syringe and gently expel the blood into a tube (with or without anticoagulant). With the vacutainer system, remove the tube from the vacutainer holder and if the tube is with added anticoagulant, gently invert several times. Do not let the patient go until the bleeding stops Advantages of Venous Blood • By providing sufficient amount of blood it allows various tests to be repeated in case of accident or breakage or for the all-important checking of a doubtful result.
If the double-stranded break creates fragments with overhanging strands and microhomologous sequences then the repair is most likely correct antibiotic for tooth infection buy 500 mg zithrox. If the fragments have blunt ends antibiotic over the counter generic 250mg zithrox free shipping, then there is a high chance to unite not related pieces and generate structural chromosome abnormality as well virus lokal discount 100 mg zithrox. For error correction homologous recombination repair uses either the correct sequence of the homologous chromosome, or in G2 phase of the cell cycle the sister chromatid already formed as template by an enzyme system similar to that used in the crossing over. Of course, not only various mechanisms for repair are available to protect genome integrity, but inactivation systems as well which can neutralize or inactivate mutagenic agents. Such as the peroxisomal system in which the oxidative and thus mutagenic superoxides are eliminated by superoxide dismutase that converts peroxides H2O2, then catalase cleaves and thus neutralizes it. Mutagenicity tests To avoid the adverse effect of mutations, however, we cannot rely exclusively on cells with evolutionarily integrated repair mechanisms, but everything possible must be done to prevent the production and the marketing materials of any mutagenic effect. According to international regulations, all prospective medicines and chemicals are subjects to the so-called pharmacological safety studies including different types of mutagenicity tests. It is important that the widest possible spectrum of from prokaryotes to eukaryotes, including mammals and human in vivo or in vitro tests be carried out to eliminate the mutagenicity, the mutation-inducing effects. Generally, to detect point mutations bacterial direct tests such as the Ames test are the first, when the test material is directly administered to the appropriate culture of bacterial strains. However, it is also possible that not the test substance itself, but one of its metabolites is mutagenic, in this case mammalian liver microsome fraction containing enzymes necessary for the metabolism is also added to the experimental system. Categories of beneficial, neutral and harmful mutations are used for the assessment of consequences of mutations in population and evolution genetics. Then the mutation is evaluated not from the individual’s point of view but from the survival of the species. However, we must not forget that in this case the mutation is not alone, but in relation to the environment investigated. The best, now classic example is the case of white and black pigmented versions (morphs) of peppered moth (Biston betularia) in England (see http:/en. It also warns that not only the genetic material, but its environment is changing, and that was once beneficial or neutral environment for one of them, it was detrimental to the other, or vice versa. It should be noted also that the wild type / mutant allele discrimination applies to a particular environment, population state and the wild type allele always means the mutant, which is the most common under those circumstances. What is the difference between the causes leading to polyalanine and polyglutamine diseases? Chromosome mutations Cytogenetics is a field of genetics dealing with species or cell specific number of chromosomes, and their structure and characteristic segments, their functional roles, and all the differences namely the chromosomal mutations related to them. Chromosome mutations are changes in the structure or in the number of chromosomes, and since they are relatively rare in this respect they differ from normally occurring common, harmless chromosome polymorphisms. Since both types of chromosome aberrations affecting many genes, and since the size of chromosomes or their affected segments are within the limits of microscopic resolution therefore they can be examined by light microscope, as opposed to gene mutations only be identified by molecular biological techniques. Two aspects of the chromosomal abnormalities are regarded crucial: when and where they happen. While chromosome mutations may be formed during both mitosis and meiosis, those may occur in meiosis, lead to defective gamete formation, and to the birth of affected offspring. Thus their medical significance is greater than that of mitotic chromosome aberrations. From the point of mitotic chromosomal abnormalities it is also important when during development and in what kind of cell they are formed. Mutations occurred during the early cleavage divisions may have serious consequences for the entire organism, while aberrations occurred in a continuously proliferating cell type.
The rapid technique is ideally suited for staining blood films from waiting outpatients and when reports are required urgently treatment for dogs galis order zithrox on line amex. Thin film Field’s staining technique Required Field’s stain A Field’s stain B antibiotic resistance metagenomics discount zithrox generic, diluted 1 in 5 Buffered pH 7 antimicrobial spray trusted 250mg zithrox. Place the slide on a staining rack and cover the methanol-fixed thin film with approximately 0. Add immediately an equal volume of Field’s stain A and mix with the diluted Field’s stain B. The stain can be easily applied and mixed on the slide by using 1ml graduated plastic bulb pipettes. Wipe the back of the slide clean and place it in a draining rack for the film to air-dry. Thick film Field’s staining technique Required Container of fields’ stain A Container of Field’s stain B Two containers of clean water (need not be buffered) Method 1. Holding the slide with the dried thick film facing downwards, dip the slide into Field’s stain A for 5 seconds. Drain off the excess stain by touching a corner of the slide against the side of the container. Wipe the back of the slide clean and place it upright in a draining rack for the film to air-dry. Excessively blue stain • Causes: too thick films, prolonged staining, inadequate washing, too high alkalinity of stain or diluent • Appearance: erythrocytes-blue green, nuclear chromatin-deep blue to black, granules of neutrophils-deeply stained and appear large and prominent. Excessively pink stain • Causes: insufficient staining, prolonged washing, too high acidity of the stain or buffer (exposure of stain or buffer to acid fumes). Precipitate on the film • Causes: unclean slides, drying during the period of staining, inadequate washing of slide at the end of the staining period • Correction: use clean slides, cover the smear with generous amount of the stain, wash the slide until thinner parts of the film are pinkish 84 Hematology Review Questions 1. Describe the appearance of cells and cell components in Romanowskystained thin blood films. Introduction Visual counting of blood cells is an acceptable 86 Hematology alternative to electronic counting for white cell and platelet counts. It is not recommended for routine red cell counts because the number of cells which can be counted within a reasonable time in the routine laboratory will be too few to ensure a precise result. Yet it is still necessary for the technologist to be able to use this method effectively and to know its limitations. Any cell counting procedure includes three steps: dilution of the blood, sampling the diluted suspension into a measured volume, and counting the cells in that volume. The main principles for such examinations are: • Selection of a diluting fluid that not only will dilute the cells to manageable levels but will either identify them in some fashion or destroy contaminant cellular elements. Counting Chambers the hemocytometer is a thick glass slide with inscribed platforms of known area and precisely controlled depth under the coverslip. In the center of the upper surface 87 Hematology there are ruled areas separated by moats/channels from the rest of the slide and two raised transverse bars one of which is present on each side of the ruled area. The ruled portion may be in the center of the chamber (single chamber) or there may be an upper and lower ruled portion (double chamber). The double chamber is to be recommended since it enables duplicate counts to be made rapidly. When an optically plane cover glass is rested on the raised bars there is a predetermined gap or chamber formed between its lower surface and the ruled area (fig. This is called the depth of the chamber and it varies with the type of the chamber.
Diagnosis Patients can present with focal paralysis or motor weakness depending on the brain area affected Neuro-psychiatric manifestations corresponding to the affected area in the brain antibiotics buy online generic zithrox 250 mg with visa, seizures or altered mental status antibiotic lupin 500 buy zithrox 100 mg otc. Note: Diagnosis is predominantly based on clinical findings after exclusion of other common causes of neurological deficit antibiotics for uti nz discount 500 mg zithrox visa. After six weeks of treatment give prophylaxis therapy with Sulphadiazine tabs 500mg 6 hourly + Pyrimethamine tabs 25-50mg /day + Folinic acid tabs 10mg /day. For those allergic to sulphur replace Sulphadiazine tabs with S: Clindamycin capsules 450mg 6 hourly. Diagnosis Early or prodromal clinical features of the disease include apprehensiveness, restlessness, fever, malaise and headache the late features of the disease are excessive motor activity and agitation, confusion, hallucinations, excessive salivation, convulsions and hydrophobia Note: Death is considered as invariable outcome. In addition, patients should receive rabies immune globulin with the first dose (day 0) Tetanus toxoid vaccine see section on Tetanus 208 | P a g e 1. Note: the disease is easily missed in Tanzanian settings due to lack of diagnostic facilities and should therefore be suspected in patients not responding to antibiotics/other treatment. General Management Manage it as for unconscious patients (Control seizures) Treatment B: Acyclovir 10–15 mg/kg (O) every 8 hours for 14–21 days Plus C: Prednisolone 10-20mg (O) daily preferably taken in the morning. It afflicts 5% of the population and is characteristically a disorder of young adults and affects women twice as often as men. Acute anxiety attacks are characterized by sudden onset of tension, restlessness, tremors, breathlessness, tachycardia and palpitations. Chronic anxiety state presents with persistent diffuse anxiety, motor tension, autonomic hyperactivity, unpleasant anticipation and irritability. Common symptoms include palpitations, sweating, trembling or shaking, shortness of breath, feeling of choking, chest pain, nausea, dizziness, and derealization; fear of losing control, fear of dying, parasthesias, and chills. Diagnosis Diagnosed after recurrent (several) panic attacks within a one month period. Treatment the initial aim is to control the panic symptoms and exclude an underlying medical cause. Increase to 10 – 15mg daily in divided doses Note: Do not give the therapy more than two weeks Referral If panic disorder is diagnosed, long-term treatment may be required therefore refer the patient to the mental clinic. Treatment of choice D: Fluoxetine oral 20 mg once a dayfor 6 months–1 year Extended drug treatment over many years and even life-long may be necessary, except where cognitive-behaviour therapy has been successful. M half hourly in 2 hours to a maxmum of 20mg/24 hours till acute attack is controlled. By definition, a diagnosis of bipolar disorder requires either a current or previous episode of mania. An episode of mania is typically characterised by an elevated mood whereby a patient may experience extreme happiness which might also be associated with an underlying irritability. Such mood may be associated with increased energy/activity, talkativeness and a reduction in the need for sleep and features may be accompanied by grandiose and/or religiose delusions. Bipolar disorder causes substantial psychosocial morbidity, frequently affecting patients’ relationships within the family as well as their occupation and other aspects of their lives. Maintenance therapy Under specific circumstances such as past or family history of response and rapid cycling, i. Referral Mixed or rapid cycling biplolar disorder Depressive episodes in bipolar patients not responding to treatment Manic episodes not responding to treatment 2. These include bizarre appearance, reduced motor activity, withdrawal, flattened effect and mood disturbance, delusions and hallucinations. Adjunct treatment Antiparkinsonian drugs should only be used if extrapyramidal side effects occur or at higher doses of antipsychotics likely to cause extrapyramidal side effects. Any of the following can be used: C: Trihexyphenidyl (Benzhexol 5mg once to two times a day (O) last dose before 1400 hours S: Procyclidine 10mg two times a day last dose before 1400 hours Referral First psychotic episode Poor social support High suicidal risk or risk of harm to others Children and adolescents the elderly Pregnant and lactating women No response to treatment Intolerance to medicine treatment Concurrent medical or other psychiatric illness Epilepsy with psychosis 2. For Bradykinesia, rigidity and postural disturbance S: Carbidopa/levodopa 25/100 mg (O) 8 hourly.
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