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The influenza virus proven 50 mg viagra professional erectile dysfunction free treatment, known to – Pneumonias be circulating as a human pathogen since at least the – Streptococcal sore throat 16th century is notable for its unique ability to cause • Specific bacterial infections recurrent epidemics and global pandemics generic 50mg viagra professional erectile dysfunction due to drug use. Genetic – Diphtheria reassortments in the influenza virus cause fast and – Whooping cough unpredictable antigenic changes in important immune – Meningococcal meningitis targets leading to recurrent epidemics of febrile – Tuberculosis order viagra professional with mastercard impotence vacuum pumps. Usual symptoms are flushed emerged strain, which can then spread to cause an face, congested conjunctivae, cough, sore throat, fever ‘Influenza pandemic’. Pandemics occur every 10 to 50 for two to three days, headache, myalgia, back pains years. Pneumonia due to secondary century and in the last 400 years; at least 31 pandemics bacterial infection is the most common complication. During the twentieth century, three Laboratory confirmation is made by recovery of virus influenza pandemics occurred (Table 16. The virus has three distinct genera (types A, B peak is reached in three to four weeks before declining. The epidemic lasts for subtypes based on two proteins on the surface of the six to eight weeks at a place. Type C influenza virus has been associated with sporadic cases New influenza virus strain may evolve due to point and minor localized outbreaks. Antigenic drift occurs in both maximally attacks those in the age group 5 to 15 years Influenza A and B viruses. Drift are highest among children, but death and serious ensures an ongoing turnover of viral strains and thus illness are common amongst persons aged 65 years, a constant renewal of susceptible hosts, which is the basis children below two years and persons of any age with for the regular occurrence of influenza epidemics. Antigenic shift is noted only with 1968 H3N2 (“Hong Kong”) Mild type A influenza virus. Antigenic shift appear to result Source: Pandemic Influenza, C D Alert, May-June 2006 Vol. An example of antigenic shift of India Immunity: The antibody to H type of antigen prevents is most frequently isolated from nasopharyngeal or initiation of the infection while that to N antigen prevents throat swabs, nasal washings or sputum obtained within virus release and spread. During an appear in about seven days after an attack and peak in outbreak of respiratory illness, however, testing can be the blood by two weeks. The level drops to preinfection very helpful in determining if influenza is the cause of level by 8 to 12 months. Following laboratory tests that can be Antibody against one influenza virus type or subtype carried out are: confers limited or no protection against another type • Detection of antigen in nasal secretions by: or subtype of influenza. Furthermore, antibody to one – Rapid test: It can be used to detect influenza antigenic variant of influenza virus might not completely viruses within 30 minutes. Transmission of viruses starts one day before the viruses that normally infects only birds and less onset of symptoms and continue up to five to seven days commonly pigs. Transmission is possible from but has on rare occasions crossed the species barrier to asymptomatic carriers. Influenza viruses can be of pathogenicity, the milder one may even go unnoticed inactivated by sunlight, disinfectants and detergents easily. This is the reason why presence of H5 and Wild birds are the primary natural reservoir for all H7 virus in poultry is always a cause of concern, even subtypes of influenza A viruses and are thought to be when the initial signs of infection are mild. The current outbreak of highly infective avian Pigs can be infected with human, avian and swine influenza which began in S E Asia in mid-2003, are the influenza viruses and there is possibility of development largest and most severe on record. Never before in the of new strain due to genetic reassortment among the histories of this disease have so many countries been viruses of different species. While it is unusual for people simultaneously affected resulting in death of so many to get influenza infections directly from animals, sporadic birds (150 million). The causative agent, H5N1 virus is human infections and outbreaks caused by certain avian now considered endemic in many parts of Asia. The incubation time for influenza ranges from one to Alarmingly most cases have occurred in the previously five days with an average of two days. A second risk of even greater concern is that the virus may change highly Diagnosis infectious form for humans and spreads easily from 172 Traditionally, the definitive diagnosis of influenza is made person to person. Such a change would mark the either on the basis of virus isolation or by serology. Currently, two subtypes of influenza A (A/H1N1 and A/H3N2) Direct contact is presently considered as the main route virus as well as influenza B virus are included in the of transmission while come in contact with infected bird vaccine. Among healthy adults, appropriate influenza (slaughter, defeathering, butchering and preparation of vaccines will in general achieve protection rates of about poultry for cooking, etc. Infections also occur from 50 to 80 percent against clinical disease, whereas virus in their feces and the environmental exposure to vaccination of the elderly reduces the risk of serious such dropping. The virus can improve its transmissibility among humans via two principal mechanisms. The first is a “re- Route and dose: Most inactivated influenza vaccines assortment” event in which the genetic material is are given via the intramuscular route in the deltoid muscle, exchanged between human and avian viruses during except in infants where the recommended site is the co-infection of a human or pig resulting in emergence antero-lateral aspect of the thigh. Other inactivated vaccine annually is appropriate, except for mechanism is the adaptive mutation increasing the previously unvaccinated preschool children pre-existing capacity of the virus to bind to human cells. Besides that with medical conditions who should receive two doses many birds are seen as “silent carriers” of the disease at least one month apart. It is important to note that, Seroprotection is usually obtained within two to three vaccine produced each for seasonal influenza will not weeks and the post-vaccination immunity lasts for about protect men from avian influenza. Antiviral drugs Cardiovascular disease, metabolic illness including can only be used as an adjunct. Resistant mutants of diabetes mellitus and renal dysfunction, various types both the classes of antiviral agents have been detected. Antibiotics for bacterial complications of antigens are carried by an oil-in-water (liposome) like influenza 2. Prevention and control strategies: People with The justification for vaccine use: During influenza respiratory infection symptoms should practice the outbreaks, appropriate vaccination may significantly following respiratory etiquette. All symptomatic people reduce respiratory illness and sick leave among healthy should: 1. Cover their nose and mouth when severe disease and premature death in the elderly and coughing or sneezing. Immediately dispose viruses undergo frequent antigenic changes, new off used tissues. A distance of at least 1 meter depression, coughing (barking), copious discharge from should be maintained between persons wherever nose and eyes. An effective vaccine is available unwell with pandemic influenza, including visitors, against highly prevalent H1N1 and H3N2 pig viruses should be avoided wherever practicable. Movement that is used in Pig Industries of people in and out of the area will be effectively restricted to prevent further spread to unaffected areas. Control of Communicable Diseases in Man killed during cooking at a temperature of 160°F. New York: After a short incubation period of two to three days, Plenum Medical, 1977. In: Principles and Practice of sore throat, coughing, respiratory distress and some Infectious Diseases. Majority of the human cases of swine influenza are mild and self limited and do not require hospitalization.

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Pleurisy may also cause dyspnea relieve the pressure on the lung discount viagra professional 50mg erectile dysfunction code red 7, allowing the and tachypnea generic viagra professional 100 mg online erectile dysfunction from smoking. In some cases order viagra professional 100 mg mastercard erectile dysfunction what kind of doctor, surgery may As the risk factors just mentioned indicate, be required to close the leak. Diagno- sis is based on signs and symptoms, physical examination, blood tests for pathogens, and atelectasis imaging tests. In some cases pleural fluid Atelectasis is a collapse of lung tissue affecting and tissue will be removed for testing. The alveoli in that part of treatment of pleurisy depends on the cause the lung no longer fill with air. As a result, they and may include antibiotics if pleurisy is can’t take part in gas exchange. The incidence of caused by a bacterial infection as well as atelectasis is not known. Risk factors for atelec- over-the-counter or prescription nonsteroidal tasis include anesthesia, prolonged bed rest with anti-inflammatory medication for pain relief. If only a small area or a early for lung infections and getting the pneu- few small areas of lung are affected, there may be monia vaccine if recommended. Auscultation Anticoagulants are the most common treat- may reveal diminished or absent breath sounds ment; if the condition is life-threatening, clot on the affected side. Preven- Atelectasis may be caused by a blockage of the tion includes actions that prevent clot formation bronchus or bronchioles or by pressure on the in the legs, including avoiding sitting for long lung. A mucus plug is the most common cause periods of time, getting mobile as soon as pos- of atelectasis. Drugs given during surgery make sible after surgery, wearing elastic compression the lungs inflate less fully than usual, so nor- stockings, and drinking plenty of fluids when mal secretions collect in the airways. Suctioning traveling to prevent dehydration, which tends to the lungs during surgery helps clear away these increase blood clot formation. Mucus plugs are also common in peo- lung Cancer ple with cystic fibrosis and during severe asthma Lung cancer is a malignant neoplasm arising in attacks. The American Cancer Society esti- tory treatments to open the airway; position- mates that in 2013 approximately 228,190 cases ing the body on the unaffected side to allow the of lung cancer will be diagnosed and 159,480 peo- affected lung to reexpand; removing obstructions ple will die from lung cancer in the United States. Risk factors percussion on the chest to loosen mucus; tilting include smoking, exposure to secondhand smoke, the body (postural drainage) so that the head is age (over 65), exposure to asbestos or radon, lower than the chest to drain mucus; and treat- genetics, and a family history of lung cancer. Lung cancer is classified into two basic types Prevention includes encouraging movement and depending on the appearance of the lung tissue deep breathing in anyone who is bedridden for under a microscope. Signs and symptoms may include cough- is not known but estimates range from 300,000 ing, chest pain, and hemoptysis. Anorexia, weight loss, and weakness Signs and symptoms may include sudden dys- accompany the disease, caused partly by poor pnea, tachypnea, chest pain, and a cough that oxygenation of the blood. Chapter Eight Diseases and Disorders of the Respiratory System L 157 maintain or improve lung capacity. The cough reflex decreases with age, enabling pathogens, irritants, and debris to reach deep into the lungs. Pneumonia is a common cause of death in older adults who suffer from other chronic diseases. On average, one square foot of the respiratory membrane is lost each year after age 30. However, the cancer probably begins earlier in life, and this incidence reflects the relatively late age at diag- nosis. Resources Figure 8–13  Chest x-ray of lung cancer; cancer is seen on the left side. Treatment includes surgery, chemotherapy, Centers for Disease Control and Prevention: www. European Respiratory Review ing respiratory muscles and arthritis in joints 2010;19(117):217–219. Clinical Interventions in Aging ing in older adults, especially if they have led 2006;1(3):253–260. Emphysema In the vast majority of people, smok- Dyspnea, coughing, cyanosis, edema of the feet and ing is the cause of emphysema. An ankles, fatigue, headache (especially in the morning), inherited form involves a genetic wheezing, barrel chest deficiency of an enzyme known as alpha-1-antitrypsin. Sheila just graduated from college and moved was in the hospital for about a week and has into an apartment with a roommate. Bill’s recovery was excited because her and her roommate decided going well until he suddenly complains of to get a cat. Sheila was never allowed to have dyspnea and chest pain and is coughing up a pet when she was growing up because her blood. A condition in which the bronchial tubes brane consisting of two layers called in the lungs react to different stimuli by ____________________. The most common cause of pharyngitis is a oxygen exchange between the air and ____________________. The bronchial challenge test is is declining because of potent used to detect and quantify airway antibiotics. The ____________________ are thin-walled sacs surrounded by blood capillaries and 4. The common cold and influenza are caused in the inherited disease called by ____________________. Chapter 9 Diseases and Disorders of the Gastrointestinal System Learning Objectives After studying this chapter, you should be able to L Describe the normal structure and function of the digestive tract L Describe the key characteristics of major diseases of the digestive tract L Name the diagnostic tests for diseases of the digestive tract L Explain the etiology of gastrointestinal diseases L Describe the treatment options for diseases of the digestive tract L Describe the normal structure and function of the liver, gallbladder, and pancreas L C. Gilda Jones, 1980) and pancreas L Explain the etiology of liver, gallbladder, and pancreas diseases L Describe the treatment options for diseases of the liver, gallbladder, and pancreas L Describe age-related diseases of the digestive system 166 Disease Chronicle Dysentery Diseases of the digestive system include common ailments familiar to nearly everyone. During the American Civil War, 81,360 soldiers died from dysentery, while 93,443 were killed in combat. Even today, 18,000 cases of bacillary dysentery occur annually in the United States. Despite modern medical diagnosis and treatment, cancer of the pancreas, colon, and liver remain deadly, and worldwide, dysentery remains a leading cause of death among children. Nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen also cause ulcers. The acces- The digestive system consists of a digestive tract sory organs include the liver, gallbladder, and and accessory organs that assist the digestive pancreas (Figure 9–1 ). The digestive tract begins at the mouth Parotid gland Tongue Parotid duct Salivary Sublingual Pharynx glands Submandibular Esophagus Fundus of stomach Spleen Left lobe of liver Right lobe of liver Body of stomach Gall bladder Left colic flexure Pylorus Pancreas Right colic flexure Transverse colon Ascending colon Descending colon Small intestines Cecum (duodenum, jejunum and ileum) Appendix Rectum Figure 9–1  The gastrointestinal system. Chapter Nine Diseases and Disorders of the Gastrointestinal System L 169 Digestion begins in the mouth with the Most digestion occurs in the first part of the mechanical breakdown of food. Intestinal secre- saliva moistens the food and provides an enzyme tions contain mucus and digestive enzymes, which for initial digestion of starch. The food is then enter by means of the pancreatic duct from the swallowed and passes through the pharynx, or pancreas (Figure 9–2 ).

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The rationale was that this would enable United Kingdom is the ambulance discount 50mg viagra professional with visa erectile dysfunction treatment south africa, which has the patient to better overcome a rapid decompensa- usually been summoned by an eye witness with a tion from further bleeding and reduce the risk of mobile phone cheap viagra professional online amex statistics of erectile dysfunction in india. Satellite locating devices now allow developing some of the complications of prolonged a rapid response to a recognized position buy cheap viagra professional 50mg new erectile dysfunction drugs 2012. The other intensive care consultants The hospital telephone exchange has the respon- sibility of contacting and requesting all the key The nurse in charge of theatres personnel to assemble at the A&E. The key contacts The blood transfusion consultants consultants in are shown in Table 6. A junior doctor The hospital manager on call should record the progress of the resuscitation and The communications department ensure that all the injuries and the clinical course of The specialist services the patient are carefully recorded. All members of plastic the team must be clearly identified by an appropri- ate tabard (a labelled overall or tunic). He/she should have the ability to contact the operating theatres, the blood bank, intensive The portering services care and the wards in order to arrange the transfer The mortuary of major casualties out of A&E as soon as they have been assessed and resuscitated. The doctor in over- all charge should undertake the initial triage of the made at the site of the accident (described above) patients into one of the following categories: and ensures that appropriate priority is given to the patients who require the most urgent treatment. It is also helpful if some surgeons go directly to the operating theatres to help staff prepare for the A sucking wound should be occluded. A chest amputations, laparotomies, fracture fixations and drain may need to be inserted. A pneumothorax should be treated by the inser- tion of a chest drain through the second anterior Initial resuscitation intercostal space or, alternatively, urgent insertion through the fifth intercostal space in the mid-axil- This follows the same system described above for lary line if it is a tension pneumothorax. A simple the scene of the accident, taking note of the valu- hollow needle or other hollow device may be used able information about the extent and cause of the as an alternative to deflate a life-threatening tension injuries provided by the transporting team. This should be repeated by the doctor in charge of Cardiac tamponade is one of the most difficult the triage to confirm initial reports and ensure that clinical diagnoses to make but should be suspected nothing has altered or been missed in the initial if there are congested neck veins, muffled heart survey. It should be treated by needle aspiration C is for catastrophic haemorrhage This must be con- of the pericardial sac using ultrasound guidance. C is for circulation The injured patients will often A is for airway Consideration is given to the cervical have had intravenous catheters inserted before they spine, which should be immobilized in a collar or by reach hospital but, if this has not occurred, two sand bags if there is any hint of a neck injury. A long mouth if this hasn’t already been done by the para- saphenous vein cut-down or bone marrow infusion medics. Endotracheal intubation of the airway is car- can be life-saving if these approaches fail. Blood should be sent for blood grouping and if B is for breathing This is assessed once a clear airway a transfusion is likely to be needed, cross-matching. If the patient is breathing sponta- All known wounds should be inspected for overt neously, has a good colour and is talking no further bleeding. All other major laboured or ineffective or if the oxygen saturation bleeding is likely to be covert rather than overt and is low poor while the patient is being given oxygen. Overloading with crystalloid is not help- systems briefly assessed, a secondary survey is care- ful. Blood and blood products should be given as fully carried out to ensure that important injuries soon as possible, especially if there is evidence of have not been missed during the early drama and continuing haemorrhage. Urine respiration, oxygen saturation, Glasgow score and output is a reliable indication of rehydration and urine output should be monitored continuously. Its value has now from the patient, if conscious, focusing on their been firmly established. Pericardiocentesis be ‘log-rolled’ by several staff to inspect their back can be life-saving. D is for disability Primarily disability can be caused The rest of the secondary survey can be per- by any associated brain injury. A alert V responding to verbal stimuli Head and neck P responding to painful stimuli The scalp should be inspected and palpated for U unresponsive. A deeply This can be used to provide a rapid assessment depressed area, especially if there is an overlying of cerebral function until, as soon as possible, a scalp wound, suggests there may be a depressed or full Glasgow Coma Scale has been calculated (see compound fracture of the skull. Battle’s sign and racoon eyes suggest the pres- ence of a fracture of the base of the skull (see E is for exposure All clothing should be removed or Symptoms and Signs). The presence of diplopia on upward gaze suggests there may be a blow-out fracture of the orbital floor. Anaesthesia over the cheek with bruising and enophthalmos suggests the presence of a fractured zygoma. The cornea and conjuctiva of both eyes should be inspected and the visual acuity checked with a Snellen’s chart. The mouth should be opened and the stability of the upper jaw checked by putting a finger and thumb inside the mouth and pulling it backwards and (A) forwards. All wounds in the neck should be carefully assessed to indicate the possibility of damage to major vessels, the airway or, rarely, the gullet. Chest (upper torso) The presence of respiratory distress should have been detected in the primary survey, but it is worthwhile rechecking that the chest movement is equal and full and that there is no evidence of any stridor. The chest wall should be carefully inspected for bruising, asymmetry and possible penetrating lacerations. Look for the presence of a flail segment, a condi- tion in which an area of chest wall is sucked inwards (B) as the chest expands during inspiration (Fig 6. The lungs should be percussed to together with the presence of pulsus paradoxus and check for dullness (a haemothorax or ruptured muffled or inaudible heart sounds is one of the diaphragm) or excessive resonance (a pneumo- main signs of cardiac tamponade. Air entry at the bases and vocal resonance The chest wall should be carefully palpated completes the examination. Plain radiographs and duplex scanning of the Abdomen and pelvis (lower torso) vessels should be carried out if a vascular injury is suspected (see below). Any wounds are documented, espe- Disposal cially if they could have breached the abdominal After completing the secondary survey the patient cavity. There may be signs of visible bruising (seat may require further imaging or may need to be belt) or distension. Local tenderness in a conscious transferred to the intensive care or high dependency patient can be helpful, especially if there is tenderness unit, the ward or the operating theatre. The bladder area should be percussed A further rapid assessment of the patient should (if a catheter has not been passed), to detect any blad- be carried out before they are transferred. The presence of normal bowel sounds All patients with major injuries should be admit- is encouraging but these may disappear in the face of ted for at least 24 hours, as a number of patients continuing intra-abdominal haemorrhage or spread- develop late symptoms and problems. It is important that the admitting teams repeat The genitalia must be checked and the exter- the secondary survey to avoid missing injuries nal urethral meatus inspected for the presence of that may have been overlooked in the resuscitation blood. The whole process should be repeated the next especially if associated with urethral bleeding, sug- day to ensure that other injuries have not been missed. In these circumstances a suprapubic be guided by the progress and further assessment rather than a urethral catheter may be a better of the injured patient. All patients who are thought to have multiple Displaced sacral fractures can be felt on rectal injuries should have a brain scan, any neck injuries examination.

By Q. Hanson. Southeastern Oklahoma State University.