Micardis

By Y. Georg. Cornell University.

The highest rate of mixed intestinal parasitic infection was also identified in rowers (50%) buy micardis 20mg amex. No special relationship was noted between the nature of sports discipline (either aquatic generic micardis 20 mg mastercard, racket, atheletic or contact sports) and type of parasitic infections. Decisions about new vaccine introduction will require reliable data on disease impact. The Asian Rotavirus Surveillance Network, begun in 2000 to facilitate collection of these data, is a regional collaboration of 36 hospitals in nine countries or areas that conduct surveillance for rotavirus hospitalizations using a uniform World Health Organization protocol. During this period, 45% of acute diarrheal hospitalizations among children 0-5 years were attributable to rotavirus, higher than previous estimates. Rotavirus was detected in all sites 175 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar year-round. This network is a novel, regional approach to surveillance for vaccine- preventable diseases. Such a network should provide increased visibility and advocacy, enable more efficient data collection, facilitate training, and serve as the paradigm for rotavirus surveillance activities in other regions. Although the therapeutic endoscopy is the definitive treatment for bleeding oesophageal varices, many patients respond poorly and rebleed after therapeutic endoscopy. For these patients, portal systemic shunt and transection devascularization (Sugiura and modified Sugiura) procedures are the two famous options currently available. The author modified the Sugiura procedure with a transabdominal approach and subcardial gastric transection instead of tloraco-abdominal approach and oesophageal transection. A total of 19 patients were included in the study during the study period of 4 years and 2 months. Out of 19 patients, 7 patients had hepatitis B positive, 5 patients had hepatitis C positive, one patient had both B and C positive and the remaining 6 patients were free of viral antigens. Among the study patients, there were 11 cases of post hepatitic cirrhosis, 6 cases of alcoholic cirrhosis and the remaining 2 cases were extrahepatic portal vein thrombosis without cirrhosis. The mean estimated intraoperative blood loss was 2120mls and the average blood transfusion during operation was 4. Since 7 of the 19 patients died within 30 days, the early operative mortality was 36. The major causes of death were early rebleeding, septicemia probably due to the effect of splenectomy and multiorgan failure especially liver failure. Twelve survivors were discharged from the hospital with the average hospital of 21. The duration of follow up ranged from 8 months to 51 months with the mean follow up of 27. On recheck endoscopy at follow up, residual varices were noted in 4 patients (33%) and varices were eradicated in 8 patients (67%). During the follow up period, 3 patients died following recurrent bleeding and eventually 9 patients survived. The mortality and morbidity of the study is high so that the procedure is routinely not recommended as an acceptable procedure for the patients with rebleeding after therapeutic endoscopy. Blunt injuries should be treated by resection and anastomosis and in many instances with a covering colostomy. Iatrogenic injuries recognized early may be suitable for primary repair, but those presenting late often require a colostomy. Highly destructive blunt trauma forms a relatively large proportion of colonic injuries and colostomy remains an important option. From the samples collected from January to December 2005, rotavirus was detected in 536 of 1180 stool samples tested (45. Of the 133 samples identified for G typing, 88% (117) were genotype G3, followed by 10 positive samples of G1 (7%), 4 of G4 (3%) and 2 of G2 (2%). In addition to the 2005 samples, preliminary screening of the P and G genotype combinations of 30 stool samples collected in 2006 December and 2007 January were also tested. Three unusual G and P combinations, that is G2/P[9], G3/P[9] and G3/P[10] were identified in the samples collected from 2007. The distribution of G and P genotype provides valuable information for the development of effective rotavirus vaccines. Intestinal parasitosis is a main contributor in causing diarrhea in immunocompromised patients. Collected stool samples were examined as wet-mount preparation and also cultivated. Modified acid fast staining and trichome staining were applied to detect coccidia. Number of parasite positive patients varied directly with the number of diarrhea patients. Ninety-five stool samples collected from children admitted to Yangon Children s Hospital with diarrhoea cases from Yangon proper (31 cases) and outskirts of Yangon proper (64 cases 0 were examined.

A total of 3640 cases of diarrhoea and 3279 age- and sex-matched controls were studied; about 60% of the patients were aged less than 1 year and 60% were male buy micardis 40mg line. In all the study centres discount micardis 40 mg with amex, the pathogens most strongly associated with disease were rotavirus (16% of cases, 2% of controls), Shigella spp. Rotavirus was commonest among 6-11-month-olds, accounting for 20% of all cases in this age group; 71% of all rotavirus episodes occurred during the first year of life. The proportion of cases that yielded no pathogen was inversely related to age, being highest (41%) among infants below 6 months of age and lowest (19%) among those aged 24-35 months. These results suggest that microbe-specific intervention strategies for the control of childhood diarrhoeal diseases in developing countries should focus on rotavirus, Shigella spp. Methods: The study was undertaken in Burma on 33 children aged 18 months to 12 years. Thirty three patients (55%) were found to be associated with enteropathogenic bacteria. Biopsy findings of gastric ulcers and, operative findings of all cases st th were recorded. There were 42 patients with radiologically diagnosed gastric ulcers, 26 cases had benign gastric ulcers and 16 cases had malignant gastric ulcers. Therefore a laboratory profile of acute and persistent 90 diarrhoea in children admitted to Paediatric Unit xecluding Special Care Baby Unit of Mandalay General Hospital had been done during June 1996 to October 1996 with the following objectives. Out of a total 184 stool culture, the commonest bacterial pathogen isolated was enteropathogenic E. In children with persistent diarrhoea, out of total 16 stool culture done, 50% revealed positive culture. Out of this total 200 cases with diarrhoeal diseases, 16 cases (8%) had persistent diarrhoea. Abdominal pain, tenemus and muscle cramp were more marked in persistent diarrhoea 31. In conclusion, the causal organism in children with acute and persistent diarrhoea had been isolated in about 50% of cases. The common protozoa and worm infestation were Entamoeba histylitica, Giadia lamblia, Ascaris lumbricoid and tricuris trichura. In children with persistent diarrhoea, more combination of infection or infestation was detected. So more antimicrobial therapy was found to be given in all persistent diarrhoeal patients. Also the usage of antibiotics in acute diarrhoeal cases should be minimized to actual indiacted cases. Bacteria isolated from the jejunal fluid in upper small intestines of these children were incubated with lactulose at neutral pH. Anaerobes were present in all but one child, and in 15 children they were present in numbers greater than 5 log 10 organisms per ml. This study suggests that in the diagnosis of small bowel bacterial overgrowth using lactulose breath hydrogen test, it is important to consider that patients with a flat breath hydrogen response to a carbohydrate challenge during the first 60min may be infected with enteric bacteria which are not capable of producing H2. Rotavirus was detected by enzyme linked immunosorbent assay in stools of 43 children. Cases were 67 children 1-59 months old hospitalized for diarrhoea lasting >14 days and complicated by severe malnutrition; for each case, a healthy control child was selected who was age- and sex-matched from the same neighbourhood. Homes of cases and controls 92 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar were visited for interviews and for direct observation of household child-care practices. Risk factors were catalogued and calculations made for relative risk and etiologic fractions. These results indicated that persistent diarrhoea and malnutrition in Burma is caused by a complex of several interrelated socioeconomic factors, unsanitary behaviour pertaining to personal hygiene, the practice of demand breastfeeding and lack of certain weaning foods, and low education of mothers who showed less knowledge about causes of diarrhoea and prevention of malnutrition. Glycine 4g and glycyl-glycine 4g patients with clinical cholera were given tetracycline 500mg q. Rectal swabs were also taken and investigated for culture and sensitivity at the Bacteriology Research Division of the Department of Medical Research. A total of 200 children under five years of age with acute diarrhoea were included in the study. Sixteen serogroups were identified 94 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar O125 and O126 were common serotypes. The serogroups of Escherichia coli classified were O1 K51; O8K25; K+; O25K+; O27K+; 028K+; O78K+; O86 K61, K62; O114 K90; O119 K69; O125 K70; O126 K71; O127 K63; O128 K67; O136 K78; O148 K+; O157 K+ and O159 K+. It was also noted that personal hygiene still plays an important role in causing acute diarrhoea. As peptic ulcer disease is very common in Myanmar, it is of great importance to elucidate whether H. A total of fifty biopsy specimens which were obtained from forty-three male and seven female patients were included in this study.

Infants with true asthma should be given inhaled b agonists as needed for wheezing during acute exacerbations of their disease purchase micardis 80 mg on line. Anticholinergics Ipratropium bromide is a quaternary isopropyl derivative of atropine available as a nebulizer solution purchase micardis 80mg overnight delivery. In some infants with wheezing it has been found to improve pulmonary functions (61). In a double-blind crossover placebo-controlled trial, ipratropium was considered superior by parents ( 62). A pediatric asthma consensus group suggests that ipratropium may be useful as a second- or third-line medication in severe infantile asthma ( 63). A recent metaanalysis of clinical trials of ipratropium for wheezing in children under the age of 2 concluded that there is not enough evidence to support the uncritical use of anticholinergic therapy for wheezing infants (64). Cromolyn Sodium Cromolyn sodium (sodium cromoglycate) is an antiinflammatory medication that inhibits the degranulation of mast cells and inhibits early- and late-phase asthmatic reactions to allergen. It is not a bronchodilator but a prophylactic medication that must be used on a regular basis to have an effect. Its safety and lack of toxicity make it particularly attractive as a first-line therapy for the prevention of wheezing in this age group ( 65). However, nebulized cromolyn in infants over 12 months of age is effective for treating asthma ( 67). Cromolyn is a medication that is not effective in all patients and optimally must be administered regularly three to four times per day ( 68). This daily treatment for any length of time in an uncooperative infant or toddler may become tedious for parents, adversely affecting compliance. Nevertheless, due to its high safety profile, cromolyn remains one of the most important prophylactic medications currently available for the prevention of wheezing in this age group. Leukotriene Antagonists Leukotrienes are chemical mediators that produce bronchospasm and eosinophilia, stimulate mucus secretion, and increase vascular permeability, all critical features of asthma. So far, these medications appear to have a good safety profile and are well tolerated ( 69,70). Because it can be taken as a tablet once daily, the relative ease of administration of montelukast and its high safety profile makes it particularly attractive for this age group as a first-line controller medication for infantile asthma. However, until long-term exposure data are available, use as first-line controller medications will be limited. Theophylline Despite its long use and popularity in this age group, few data are available on theophylline effectiveness in infants. Studies comparing theophylline to sodium cromolyn in children under 5 years of age ( 71) have reported that cromolyn is superior to theophylline in controlling symptoms. However, theophylline is superior to ketotifen and placebo in controlling symptoms in this age group ( 72). Concern about theophylline side effects ranging from mild nausea, insomnia, and agitation to life-threatening cardiac arrhythmias and encephalopathic seizures have limited its use now that safer medications are available ( 73). Checking serum concentrations of theophylline is necessary to achieve maximal benefits without significant side effects, and minor symptoms are not predictive of elevated levels ( 74). Most serious side effects occur when the serum concentration of theophylline exceeds 20 mg/dL. Corticosteroids Corticosteroids are potent antiinflammatory medications that have profound effects on asthma. They decrease inflammatory mediators, reduce mucus production, decrease mucosal edema, and increase b-adrenergic responsiveness. Clinically, they improve lung function, reduce airway hyperreactivity, and modify the late-phase asthmatic response. The use of oral or intravenous corticosteroids for acute exacerbations of wheezing in infants is controversial. Numerous studies clearly do not demonstrate an effect when these drugs are used for bronchiolitis ( 76,77), and some studies do not show an effect in a broad population of wheezing infants under 18 months of age ( 78). Asthmatic infants treated with steroids have a significantly reduced need for hospitalization (79) and markedly improved symptom scores when compared with placebo (80). As with all studies involving treatment of wheezing in this age group, the heterogeneity of the underlying cause of the acute wheezing is probably the reason for the wide discrepancy seen in results. It appears evident that the younger the infant, the less likely that steroids will have an effect, and that those with true bronchiolitis do not respond as well to steroid treatment. Despite these inconclusive data, infants with acute wheezing who have a history consistent with infantile asthma should be treated with systemic steroids. Intramuscular dexamethasone may be used in those infants who do not tolerate oral steroids ( 81). Inhaled steroids provide many of the beneficial antiinflammatory properties of corticosteroids without numerous unwanted side effects. However, newer inhaled steroids such as fluticasone ( 83) and budesonide are reported to be effective in this age group. Treatment of 1- to 3-year-old children with inhaled budesonide using a face mask spacer for 10 days at the first sign of a viral upper respiratory infection leads to a significant decrease in wheezing, cough, noisy breathing, and breathlessness ( 87).

Aesthetics How much the attribute makes the character repellant or upsetting to others quality 20mg micardis. Peril Perceived dangers 40 mg micardis for sale, both real and symbolic, of the stigmatizing condition to others. Sometimes coping with stigma surrounding the disorder is more difcult than living with any limitations imposed by the disorder itself. Stigmatized individuals are often rejected by neighbours and the community, and as a result suffer loneliness and depression. The psychological effect of stigma is a general feeling of unease or of not tting in, loss of condence, increasing self-doubt leading to depreciated self-esteem, and a general alienation from the society. Moreover, stigmati- zation is frequently irreversible so that, even when the behaviour or physical attributes disappear, individuals continue to be stigmatized by others and by their own self-perception. One of the most damaging results of stig- matization is that affected individuals or those responsible for their care may not seek treatment, hoping to avoid the negative social consequences of diagnosis. Underreporting of stigmatizing conditions can also reduce efforts to develop appropriate strategies for their prevention and treatment. Epilepsy carries a particularly severe stigma because of misconceptions, myths and stereo- types related to the illness. In some communities, children who do not receive treatment for this disorder are removed from school. In some African countries, people believe that saliva can spread epilepsy or that the epileptic spirit can be transferred to anyone who witnesses a seizure. These mis- conceptions cause people to retreat in fear from someone having a seizure, leaving that person unprotected from open res and other dangers they might encounter in cramped living conditions. Recent research has shown that the stigma people with epilepsy feel contributes to increased rates of psychopathology, fewer social interactions, reduced social capital, and lower quality of life in both developed and developing countries (22). Efforts are needed to reduce stigma but, more importantly, to tackle the discriminatory attitudes and prejudicial behaviour that give rise to it. Fighting stigma and discrimination requires a multilevel approach involving education of health professionals and public information campaigns to educate and inform the community about neurological disorders in order to avoid common myths and promote positive attitudes. Methods to reduce stigma related to epilepsy in an African community by a parallel operation of public education and comprehensive treatment programmes successfully changed attitudes: traditional beliefs about epilepsy were weakened, fears were diminished, and community acceptance of people with epilepsy increased (24). The provision of services in the community and the implementation of legislation to protect the rights of the patients are also important issues. Legislation represents an important means of dealing with the problems and challenges caused by stigmatization. Governments can reinforce efforts with laws that protect people with brain disorders and their families from abusive practices and prevent discrimination in education, employment, housing and other opportunities. Legislation can help, but ample evidence exists to show that this alone is not enough. The emphasis on the issue of prejudice and discrimination also links to another concept where the need is to focus less on the person who is stigmatized and more on those who do the stigma- tizing. The role of the media in perpetrating misconceptions also needs to be taken into account. Stigmatization and rejection can be reduced by providing factual information on the causes and treatment of brain disorder; by talking openly and respectfully about the disorder and its effects; and by providing and protecting access to appropriate health care. Training in neurology does not refer only to postgraduate specialization but also the component of training offered to undergraduates, general physicians and primary health-care workers. To reduce the global burden of neurological disorders, an adequate focus is needed on training, especially of primary health workers in countries where neurologists are few or nonexistent. Training of primary care providers As front line caregivers in many resource-poor countries, primary care providers need to receive basic training and regular continuing education in basic diagnostic skills and in treatment and rehabilitation protocols. Such training should cover general skills (such as interviewing the patient and recording the information), diagnosis and management of specic disorders (including the use of medications and monitoring of side-effects) and referral guidelines. Training manuals tailored to the needs of specic countries or regions must be developed. Primary care providers need to be trained to recognize the need for referral to more specialized treatment rather than trying to make a diagnosis. In low income countries, where few physi- cians exist, nurses may be involved in making diagnostic and treatment decisions. They are also an important source of advice on promoting health and preventing disease, such as providing information on diet and immunization. Training of physicians The points to be taken into consideration in relation to education in neurology for physicians include: core curricula (undergraduate, postgraduate and others); continuous medical education; accreditation of training courses; open facilities and international exchange programmes; use of innovative teaching methods; training in the public health aspects of neurology. Teaching of neurology at undergraduate level is important because 20 30% of the population are susceptible to neurological disorders (25). The postgraduate period of training is the most active and important for the development of a fully accredited neurologist. The central idea is to build both the curriculum and an examination system that ensure the achievement of professional competence and social values and not merely the retention and recall of information. This is not necessarily undesirable because the curriculum must take into account local differences in the prevalence of neurologi- cal disorders. Some standardization in the core neurological teaching and training curricula and methods of demonstrating competency is desirable, however.