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Coreg

By I. Faesul. Greenleaf University. 2018.

After allowing some 5-10 minutes for this application to dry the patient can re-dress in clean clothes buy generic coreg 12.5mg on-line blood pressure medication starting with m. Only in rare cases does dermatitis result from the use of benzyl benzoate and this is more likely to happen in young children order coreg 12.5 mg with amex blood pressure jnc. Mitigal is a yellowish oily liquid sulphur preparation, which is painted undiluted over the body from the neck downward for one week. It is slow in its action and usually about three treatments 24 hours apart are recommended for a complete cure. It has been combined with soap and sold as temosol soap, and in this from, when regularly used in washing and bathing, it has a slow curative effect and also acts as a prophylactic. Although these two sulphur preparations and benzyl benzoate are still used, a better treatment for scabies consists of applying a 1% gama bezene haxachloride cream or lotion, 1% Malathion aqueous emulsion or 5% permethrin cream (Elimite). Permethrin actually should be used very carefully especially when applied to infants and small children. More recently it has been shown that ivermectin given, as a single oral dose of 100-200 μg/kg body weight is effective in killing scabies mites. The density of house dust mite allergens can be assessed by a test, which measures the concentration of mite excreta in dust. Mites and associated fungi can be controlled by decreasing the humidity in rooms, improving ventilation and removing dust. Bedrooms and living rooms should be aired regularly, or other measures should be taken to reduce dampness. The shaking of bedclothes and frequent washing of sheets and blankets reduce the availability of food and therefore the number of mites. General insecticides used for pest control are not effective but a special product containing benzyl benzoate is available, which destroys mites when applied to mattresses, and upholstery. Leishmaniasis Leishmaniasis is a term used to describe a number of closely related diseases caused by several distinct species, subspecies and strains of leishmania parasites. The epidemiology of leishmaniasis is complex, involving not only different parasite species but also strains of parasites. The epidemiology of this disease is largely determined by: o The species of sandflies, their ecology and behavior; o The availability of a wide range of hosts; 141 o The species and strains of leishmania parasites. It is characterized by typical ulcer that starts as a nodule at the site of bite, and then a crust develops in the middle followed by ulcer. Case treatment Simple cutaneous leishmaniasis usually heals without treatment and renders the person immune to other infections with the same parasite species. It is recommended that personal protection measures be taken, such as repellents, fine mesh screens, insecticide treated clothing and/ or insecticide-treated bednets are used. Application of basic sanitation This is aimed at abolishing the breeding sites around human habitation, such as proper disposal of refuse and rubbish heaps; filling of cracks and holes in the soils and walls. Control of Animal Reservoir In Ethiopia, control measures were carried out against the rock hyrax, a wild animal reservoir of leishmaniasis, where by reduction of the prevalence of leishmaniasis has occurred. Therefore, it is essential to become familiar with foods that heal, vegetable juices, and fats that heal, unrefined sea salts. Psychophysical activities will help you balance your body and will help you relief accumulated stress. Atopic refers to a group of diseases where there is often an inherited tendency to develop other allergic conditions, such as asthma and hay fever. This module is intended to be used by health extension workers and is believed to provide them with basic information that is not included in the core module. However, it is essential to undertake the management, prevention and control activities on common skin infections. Directions for using the module ¾ Prior to reading this satellite module please be sure that you have completed the pretest and studied the core module. In the community, those patient who develop bed sore as a result of chronic illness, can be well managed by health worker through a) Frequent changing position b) Providing bed bath and back care c) Not allow to eat that much vitamin and protein until the wound is healed d) All except C e) None of the 6. As being the health worker of the community, all activity has to be carried out respect to leprosy disease patient except: a) Teach the patient about disease b) Avoid any discrimination and stigmatization from the community c) Treat any skin reaction that occurred from disease process d) Teach the patient, on how to protect his/her wound form danger e) None of the above 146 8. Which of the following is the role of health worker who is dealing with a patients having wound secondary to accident? Scabies is a disease caused by an arthropod called scabies mite; therefore it is not acquired by close contact with an infected individual. General objective The general objective of this module is to equip health extension workers with the knowledge and skills needed to deal with the management, prevention and control of common skin diseases. Specific objectives After complete reading of this module, health extension workers will be able to: ¾ Describe common skin infections ¾ Explain the management of common skin infections ¾ Mention important prevention and control measures ¾ Portray the significance of hygienic behavior in the mitigation of common skin disease. The skin and its parts The major components of the system are the following: ¾ Skin ¾ Hair ¾ Nails These components not only reflect person’s general health status, they also serve as indicators of more general disturbances. The Skin ¾ The skin is the boundary between ourselves (the internal organs) & what is around us) ¾ It reflects internal changes and reacts to changes in the environment ¾ It is composed of tissue that: - Grows - Differentiates & - Renews itself The entire layer of the epidermis is replaced about every 15 to 30 days, depending on its location. Causes: - Streptococcus - Staphylococcus ¾ Although impetigo is seen at all ages, it is particularly common in children living in poor hygienic condition.

Treatment - Incision & suction (source of controversy because of tissue damage & it is better to use with a vacuum pump) - Antivenoms (definitive) b) Plant toxins Many species of plants contain toxic chemicals order coreg 12.5mg visa blood pressure normal readings. There are many well known plant toxins ranging from the irritant formic acid found in nettles to more poisonous compounds such as atropine (atropa belladonna) buy cheap coreg 25mg on-line blood pressure chart evening. The concentration of toxic chemicals is variable among the same species & different species. Used to remove unwanted compounds of low relative molecular mass from the circulation. Used for solvent extraction or other procedures requiring mixing of relatively large quantities of material. Used for solvent extraction and 104 Toxicology other procedures requiring efficient mixing of relatively small quantities of material (up to about 10 ml total volume). Nitric acid- Sub-boiling redistilled ultra pure concentrated nitric acid is required to prepare the reagents. Calibrators- The calibrators are prepared from a stock reference solution containing lead at 1000 µg/mL, and then diluted further with diluent to achieve final concentrations of 106 Toxicology 10, 20, 40, and 60 µg/dL, which are used to calibrate the instrument as described below. Reconstitute the extract in 100 µl of methanol and spot 20 µl on a column marked on the plate. Develop the chromatogram (10-cm run) using cyclohexane: acetone: chloroform (saturated tank) and allow to dry. Spray the plate with 4-(p-nitrobenzyl) pyridine solution and heat, preferably in an oven, at 110°C for 30 minutes. Add 100 mg of activated charcoal to 100 g of anhydrous sodium sulfate, mix thoroughly and heat in an evaporating basin at 100°C for 8 hours. Standard solution preparation for qualitative assay of barbiturates Solutions containing barbital at concentrations of 5, 10, 25 and 50 mg/l in blank human plasma, prepared by dilution from an aqueous solution of barbital sodium (1. Ammonium hydroxid, 4 mol /L - Dilute 284 mL of concentrated ammonium hydroxide to 1 L with deionized water. Acetaminophen stock reference solution, 1000 mg/L - Dissolve 100 mg of acetaminophen in 20 mL of methanol and then dilute to 100mL with deionized water. Calibrator - Dilute the acetaminophen stock reference solution with deionized water to provide working calibrators of 20 and 100 µg/mL. Mobile phase: sodium acetate buffer/acetonitrile (92/8) by volume) - Add 80 mL of acetonitrile to a 1-L volumetric flask and dilute to volume with 0. Atomic Absorption spectrophotometer for quantitative analysis of Lead • A good-quality graphite furnace atomic absorption spectrometer is required for analysis. The graphite furnace requires a L’vov platform to give optimal sensitivity and accuracy. Zeeman’s background correction is useful to reduce the effect of background to a minimum. Supplies for spectrophotometer for quantitative analysis of Lead • Polypropylene pipette tips, specimen cups, and Teflon reagent storage bottles are required. Before use, they are leached in 10% nitric acid for 1 week and rinsed in triple- distilled water. The recommended definition of microscopic hematuria is three or more red blood cells per high-power field on microscopic evaluation of urinary sediment from two of three properly collected urinalysis specimens. Differential diagnosis Hematuria is a manifestation of a myriad of varied clinical diagnoses ranging from exercise-induced to cancer-related. The differential diagnosis can be classified on the basis of site of origin as shown below: Origin Etiologies Glomerular Acute glomerulonephritis, lupus nephritis, benign familial hematuria, Berger’s disease, Goodpasture’s disease, exercise hematuria. History should include nature of hematuria whether intermittent / continuous, total / initial / terminal, or episodic. Lower urinary tract symptoms (poor stream, frequency, urgency, nocturia, incontinence, dysuria, etc. Pain, location (flank, groin, suprapubic, other), nature and other characteristics. General physical examination and a focused examination pertaining to genitourinary system. In female the technique is similar but requires more attention as chances of contamination are much higher. In case the specimen is not satisfactory, suprapubic aspiration may be done (easy in small children because intra-abdominal location of bladder). Ten milliliters of the second aliquot of urine is centrifuged at 2000rpm for 5min, and supernatant is discarded. The sediment is re-suspended, a drop of which is examined under microscope for cells, crystals and casts. Hematuria must be interpreted as part of complete urine analysis, as presence of other anomalies e. Management: rd After complete evaluation approximately overall, 1/3 will have origin in kidney and the rest in middle and lower urinary tract. As general practitioners are the frequently the first contact clinicians, they should perform the initial workup (urine analysis, urine culture, ultrasonography) and based on the presentation and these investigation. Those patients diagnosed with a malignancy/renal stone as the cause, need appropriate urology referral to a higher center for further evaluation and management.

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Briefly quality 25 mg coreg prehypertension american heart association, several 100-fold serial bacilli dilutions are inoculated into drug-containing and drug-free (control) media discount coreg 25 mg with mastercard hypertension 2013. The number of colonies obtained in the drug-containing and control media are enumer- ated and the proportion of resistant mutants is then calculated. When performed in Löwenstein-Jensen medium tubes, the test is first read after 28 days of incubation at 37°C. If the proportion of resistant bacteria is higher than 1 % for isoniazid, rifampicin and para-aminosalycilic acid, or 10 % for the other drugs, the strain is considered resistant and the results are final; otherwise, the test is read again at 42 days of incubation to assess if the strain is susceptible to a certain drug (Heifets 2000). Results are interpreted after 21 days of incubation or even earlier if they show the strain to be resistant (Kent 642 Drug Resistance and Drug Resistance Detection 1985). Table 19-3: Critical concentration of main antibiotics in the proportion method (µg/mL) Antibiotic Löwenstein-Jensen 7H10 agar 7H11 agar Isoniazid 0. For the performance of the test, parallel sets of tubes containing two-fold dilutions of the tested drug are then inoculated with a stan- dardized inoculum of both test and reference strain. Methods for detection of drug resistance 643 An isolate with a resistance ratio value of 2 or less is considered susceptible, while a resistance ratio of 8 or more defines the isolate as resistant (Kent 1985, Heifets 2000). The absolute concentration method This method uses a standard inoculum of the test strain grown in a two-fold dilu- tion drug-containing media and drug-free control. The resistance of a strain is ex- pressed in terms of the lowest concentration of a certain drug that inhibits all or almost all the growth of the strain. The critical concentrations included in the me- dium are similar to the ones used in the proportion method (see Table 19-3) but the drug concentration considered as ‘critical’ should be determined in each laboratory (Heifets 2000). For the interpretation of the test, the reading is performed after 4 weeks of incubation at 37°C, or at 5-6 weeks if there is not enough growth. A strain is considered to be susceptible if the number of colonies on the drug- containing medium is less than 20 with a 3+ or 4+ (confluent) growth on the drug- free control. In the presence of a certain drug, susceptibility can be measured by inhibition of the daily increases in the growth index. For the performance of the test, a test vial containing the drug under study and a drug-free control are inocu- lated with a standard inoculum and incubated at 37°C. Since two control vials are inoculated with a 100-fold serial dilution of the inoculum, results can be interpreted as in the proportion method with the 1 % proportion of growth. More recently, critical concentrations for second-line drugs have also been pro- posed and tested successfully for most drugs in a multicenter evaluation (Pfyffer 1999). It is based on fluorescence detection of mycobacterial growth in a tube containing a modified Middlebrook 7H9 medium together with a fluorescence quenching-based oxygen sensor embedded at the bottom of the tube. In the manual system, for the performance of the test a drug-containing tube and a control tube are inoculated with the standardized mycobacterial suspension and incubated at 37°C (day 0). The presence of an orange fluorescence in the drug- containing tube at the same time as in the control tube or within two days of posi- tivity in the control is interpreted as resistance to the drug; otherwise, the strain is considered to be susceptible. The test is valid if the growth control gives a positive th signal until the 14 day of incubation (day 12) (Palomino 1999). For the performance of the test, drug- containing and drug-free control vials are inoculated with a standardized inoculum of the M. All readings are performed inside the machine and the results are printed as susceptible or resistant (Ardito 2001). Other automated systems, such as those already described in Chapter 14, have been used for the rapid detection of drug resistance in M. Recent developments of phenotypic formats for rapid drug re- sistance detection will be presented in section 19. It was performed several years ago by manual procedures, but in our days, it is performed with automatic sequencers (Victor 2001). As with other genotypic tests, there is interest in the application of these techniques directly to sputum samples. Oligonucleotides specific for wild type and mutant alleles of selected codons in the genes rpoB, inhA, ahpC, rpsL, rrs, embB, were immobilized on a nylon membrane. For validation of the test, the membranes were sent to seven laboratories in different geographical locations. Different probes have been used for detection, such as the TaqMan probe, Fluorescence Resonance Energy Transfer probes, molecular beacons and biprobes (Shamputa 2004). The main disadvantages would be the requirement for expensive equipment and reagents, and the need for skilled technical personnel. For the time being, and due to the high cost involved, the use of microarrays for detecting drug resistance in M. Phage-based methods There are currently two formats of phage-based assays that have been described for the rapid detection of drug resistance in M. Phage-based methods that rely on the biological amplification of mycobacterio- phages have gained wider application in the last years.

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Secondary peritonitis: caused during perforation or rupture of abdominal organ allowing access of bacteria and irritant digestive Juices to the peritoneum buy cheap coreg 6.25 mg on line blood pressure chart pdf uk. Acute peritonitis: rapid onset or brief duration with several symptoms Chronic peritonitis: long duration since the onset involving very slow changes 6.25 mg coreg amex arrhythmia consultants of greater washington. Bacteria or other pathogenic agents can gain access to the peritoneum by the above mentioned routes. The infection can remain limited to a local area of the peritoneum or become generalized. Factors which favor localization of the infection include: ƒ Anatomical factors (e. Plain film of the abdomen can also be diagnostic with findings related to underlying pathology e. Early diagnosis &referral when indicated Introduction Hepatobiliary structures have significant surgical importance not only in abdominal surgery but also in general outcome of surgical management on any other sites of human body. They are common sites of different surgical diseases due to their big size and very large and double blood supply. The right lobe is the larger, and gall bladder is attached to its inferior surface. Hepatic artery, portal vein, and the hepatic duct together with lymphatic vessels and nerves enters and leave the liver at the area called porta hepatis ,which is found at the interior and posterior aspect of right lobe. Incidence The disease occurs approximately in 3% of patients with intestinal amoebiasis. Hepatic lesion usually occurs in the right lobe and has the following characters: - Is large, single abscess - Contains characteristic liquid material which is reddish brown anchovy paste fluid - Has thin wall with little or no fibrosis Clinical manifestation History: Chief complaints are fever, chills, right upper quadrant pain which may radiate to right shoulder area. There could also be a history of: - Cough, pleuritic chest pain or dyspnea - Painful epigastric swelling if left lobe is involved - History of antecedent diarrhea - Weight loss Physical examination: Physical examination can reveal the following findings: - Tender hepatomegaly : almost constant feature - Tenderness over lower intercostal spaces with /without swelling and skin edema. Rupture: direction of rupture can be into plural cavity, lung, pericardium or peritoneum. The hepatic hydatid cyst is usually superficial and composed of two layers laminated wall. Clinical manifestation - Usually asymptomatic - Symptom of pressure on adjacent organs - Upper abdominal pain and tenderness - Palpable mass or diffuse liver enlargement - weight loss - Jaundice and ascites: uncommon - With secondary infection: fever, chills and tender hepatomegaly - Urticaria and erythema Complications 1. Broncho-pleural and hepato-bronchial fistulas Investigations - U/S of the abdomen :- cyst and daughter cysts - Casoni skin test: if reagents are available. Treatment Expectant: small/dead calcified cyst Medical: Albendazol/mebendazol for 2- 4 weeks for multilocular disease or patients unfit for surgery. Mixed stone (90%): cholesterol is the major component with others like calcium bilirubinate. Pathogenesis: Three important factors implicated in pathogenesis of cholelithiasis are: 1. When bile salt is deficient or when the cholesterol level is in excess in relation to the bile salt, the bile formed is supersaturated or lithogenic 2. Infection: causes increased mucus plug formation and scarring which form a nidus for stone formation. Also many bacteria deconjugate billirubin which will combine with calcium to form insoluble calcium bilirubinate. Clinical Presentation Most (90%) patients with gall stone diseases are asymptomatic. Symptomatic patients present with: History: - Right upper quadrant colicky pain (biliary colicky) - Dyspepsia, fatty food intolerance, flatulence, abnormal post prandial bloating - Symptoms of acute cholecystitis or other complications Physical examination: • right upper quadrant tenderness • Risk factors can be identified 190 Complications of Gall bladder stone 1. In the gall bladder: • chronic cholecystitis • acute cholecystitis • gangrene • perforation • empyema • mucocele • carcinoma 2. The main stay of treatment 2) cholecystostomy for bad risk patients with severe infection (Severe Acute cholecystitis or gall bladder empyema) 191 Acute Cholecystitis Definition Acute cholecystitis is an acute inflammation of gall bladder due to obstruction of neck of gall bladder or cystic duct stone. Another rare form of acute cholecystitis which occurs in absence of stone is called acalculous cholecystitis. Pathogenesis Direct pressure of calculus on the mucosa results in ischemia, necrosis, and ulceration with swelling edema and impairment of venous return. This process increases and extends the extent of inflammation and favors bacterial multiplication. The end result may be:- - Pericholecystic abscess - Fistula formation between gall bladder and bowel - Gall bladder empyema/mucocele - Rarely, perforation of gall bladder and bile peritonitis Commonly involved bacterial species in acute cholecystitis include E. Clinical features History: • History of chronic cholecystitis or Cholelithiasis • Women more affected than men • Moderate to severe right upper quadrant and epigastric pain which may radiate to the back. Differential diagnosis • Perforated or penetrated peptic ulcer disease • Biliary colic • Pneumonia • Pancreatitis 192 • Hepatitis • Pleurisy • Appendicitis • Myocardial ischemia or infarction. Type of the test Pre hepatic hepatic Post hepatic Serum billirubin:- Total + +++ +++ Direct N ++ +++ Indirect +++ ++ N Serum Alkaline N + +++ phos Liver Enzymes N +++ + Urine : billirubin 0 N +++ urobilinogen +++ N 0 Causes of extra hepatic biliary obstruction Obstruction in the lumen • Gall stone(the most common) • Parasitic occlusion e. To emphasize the importance of early diagnosis & intervention Introduction Abdominal wall hernias are common surgical problems encountered in all levels of health care facilities.

With oral aminoglucoside number of ammonia- most common toxicities aminoglycosides is anticoagulant therapy cheap 25mg coreg blood pressure medication beta blockers side effects, antibiotic buy coreg 25mg free shipping blood pressure solution scam. Kills bacteria forming bacteria in the with completed to determin bleeding may increase cell, treat gram- bacteria bowel. It dehydration, preexisting next dose to assure that (Erythromycin) may be given via renal disease, and therapeutic levels of endotracheal toute coadministration of other drugs are maintained nephrotoxic drug. Creatinin therapy begins to ensure is more specific for renal appropriate drug function. This level rises employed, monitor peak 3-4 days into tretment and traugh, monitor for nephrotoxocity and ototoxicity by auditometry testing. Taken with enteric coated capsules steatorrhea, Lab uric acid meals or before meals to dissolve in the malabsorption with plenty of H2O. Phenobartial (Luminal) Inhibit spread of seizure Drowsiness, dizziness, Nurse Do not give with For Seizure. Use in grand (abnormal sensation) because it inhibits uptake mal, partial seizure and Nystagmus, diplopia, of protein by binding status epilepticus. Adverse/toxicity orthostatic hypotension, peofound Hypotension, stop smoking and avoid shock and arrhythmias. As Anticipatory nausea and anticholinergic effects testing; discontinue 4 prostatic hyperplasia, a rule, management of vomiting should be hypotension, and days prior to testing, asthma, cardiac, active emesis is usually treted one hour before sedation. Promethazine Treat motion sickness Resp depression, Nurse Keep pt in bed Narrow angle glaucoma, (Phenergan) and nausea drowsiness, confusion with half side rails up stenosing peptic ulcer Antihistamine that agranulocytosis, blurred until the effects of the duodenal obstruction causes drowsiness vision dry mouth. An Use for heparin calcium Hemorrhage, not induce antidote for Heparin or heparin sodium by heparin doverdose. Short term Somnolence, diaphoresis, with meals, as a single impaired renal of Histamine H2 treatment for duodenal rash headache dose or two time daily hepatic function. V, diarrhea salt substitute they are chronic renal diuretic nephritic syndrome, constipation, impotence, high in K avoid insufficiency, diabetic cirrhosis; prevention muscle cramps, breast excessive ingestion of nephropathy, and treatment of soreness, dry mouth foods high in hypersensivity, impaired hypokalemia. Seizure may occur seizure disorder unless smooth muscle and Tremor dizziness, with drug level over 40 bronchospasm is release of hallucinations, mcg/ml. Avoid contact with the allergen that tends to cause allergic response avoids contact with smoke and other resp irritant. Toxic/adverse glycosylated hemoglobin insulin release and delay Alcohol may cause and electrolyte and response to disulfiram like reaction arterial blood gas levels hypoglycemia (flushing, palpation and when appropriate nausea, flushing of Teach with cultural skin). Signs and related to drug overdose, symptoms of drug interactions altered hypoglycemia and notify drug metabolism, or prescriber if they occur. Do not stop taking abruptly Trihexyphenidyl Block or compete an Decrease urine output Monitor I& O increase In pt with narrow angle hydrochloride (Artane) central acetylcholine Dry mouth, constipation, fluids, bulk and exercise, glaucoma, myasthenia Antichologenic. Use to decrease hesitancy doses of anicholinergic involuntary movements Adverse/toxicity to reduce retention of and rigidity in Paralytic ileus urine, avoid driving or parkinsonism. Vincristine sulfate Use in breast, lung and Major toxicities occur in Assess for leucopenia, Obstructive jaundice, (Oncovin) cervical cancer multiple the hematopoietic, which occurs in demylinating ) Plant alkaloids mitotic myeloma, sarcoma, integumentary, significant number of neurological disease; inhabitor lymphoma, Hodgkin’s neurologic and clients. Toxicity/side effect the achilles reflex is the occur in pt previously Give Hyaluronidase is Neurotoxicity, loss of earliest sign of treated with mitomucin;; the Antidote. Avoid calcium and phosphorus Hypercalcemia which magnesium containing and stimulates its may lead to dysrhythmia antacids. Vit E damage readily destroyed by heat Vitamin K1 (Aqua- Given as antidote for , Deficiency causes Nurse drug may be In pt who have mephyton) Plays role in coumadin toxicity. Has narrow Bleeding is the major Teach length of therapy, Green tea, ginseng an therapeutic range. Also use orally thrombocytopenia activated bty stress, in varicella zoster purpura hemolytic trauma, fever exposure (chicken pox). May and fibrinogen; it rash, may cause apotting medication and not cause miscarriage absorbs pepsin cramping dysmenorrheal, within 2 hours of antacid decreasing its activity. Report investigational use for loaryngospasm, seizure immediately if there is gastric ulcer. It is oral antibiotic because renal function Bun to disease, concurrent antibodies including poorly absorbed. It is amino glycoside decrease Creat ratio 20-1 or 15-1 order ror renal toxic gentamcin and only use for bowel prep vit K synthesis in the agent tobamycin some of prior to surgery to intestine. It means others are produced ammonia in hepatic Adverse/Toxicity renal damage has synthetically. Nephrotoxicity; Effect negative infetion the damage to normal and ototoxicity; Pseudomembranous All aminoglycodside floral. Traugh 30 min before White plaque; red, others are produced dose scaley, popular skin synthetically.

Coreg
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