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Design appropriate methods of prevention and control of cestodes Cestodes or tapeworms are segmented worms treatment zinc deficiency order oxytrol 2.5 mg online. As each proglottid matures symptoms urinary tract infection buy generic oxytrol 2.5 mg line, it is displaced further back from the neck by the formation of new treatment 247 cheap 5mg oxytrol, less mature segments symptoms after conception purchase 5mg oxytrol. Eggs deposited on vegetation can persist for months or years, until ingested by cattle. Ethiopia is one of the Internal Medicine from cattle intestine migrates to the muscle and transform into cysticercus. Diagnosis: the diagnosis is reached by demonstrating the eggs or proglottids in the stool. Etiology: the adult tapeworm resides in the upper jejunum, similar to taenia saginata. Its scolex attaches to intestinal wall by both sucking disk and two rows of hooklets. Clinical features: Mostly patients are asymptomatic; but they could have epigastric discomfort, nausea and weight loss. When infected with cysticerica (cysticercosis), they are distributed all over the body. Diagnosis is difficult in cysticercosis, which is done by different clinical and laboratory criteria. Hatching of eggs occurs in the small intestine where they penetrate the villus and become cysticercoid. But patients could have abdominal pain, loss of appetite, anorexia, nausea, diarrhea or loss of weight. Since this tapeworm consumes a lot of vitamin B12 and interferes with its absorption, it can cause vitamin B12 deficiency; and some patients develop megaloblastic anemia. Diagnosis: Diagnosis is reached by demonstration of characteristic eggs in the stool. B further reading Module on intestinal parasitosis, by Health Science College, Hawassa University 55 Internal Medicine 3. List the etiologies & animal reservoirs of the different types of leishmaniasis 4. Refer suspected cases of leishmaniasis to hospitals for investigation & treatment 12. Design appropriate methods of prevention andcontrol of leishmaniasis Definition: is an infectious disease caused by the protozoa called Leishmania Classification of leishmaniasis There are three major clinical forms of leishmaniasis: · · · Visceral leishmaniasis Cutaneous leishmaniasis Mucocutaneous leishmaniasis Etiologic Agents the different clinical forms of leishmaniasis (listed above) are caused by different species of leishmanial parasites which are listed under each of these diseases. The parasites are seen in two forms · · Leishmanial form:- (amastogote) this is non flagellate form seen in man and extra human vertebrate reservoir Leptomonad forms (also called promastigotes) are flagellated forms the parasite is transmitted by the bite of vectors of the species phlebotomus, Sand flies 56 Internal Medicine Life Cycle of Leshimaniasis · Transmitted by the bite of an infected female phlebotomine Sand fly, the leishmaniases are globally widespread diseases. Sand flies are primarily infected by animal reservoir hosts, but humans are also a reservoir for some forms. Animal Reservoirs: include Rodents - Commonly in East Africa, Ethiopia, the Sudan and Kenya and Canines Mediterranean and Asia. As the sandfly feeds, promastigote forms of the leishmanial parasite enter the human host via the proboscis. Within the human host, the promastigote forms of the parasite are ingested by macrophage where they metamorphose into amastigote forms and reproduce by binary fission. They increase in number until the cell eventually bursts, then infect other phagocyctic cells and continue the cycle. The parasites are transformed inside the fly and delivered to a new host, and the life-cycle continues Fig 3. It is characterized by chronic irregular fever, profound wasting, debility and hepatosplenomegally. Epidemiology Visceral leishmaniasis affects many countries in Africa, mainly Ethiopia and the Sudan the Middle East, Southern soviet union, India and S. It is endemic in low land Ethiopia mainly North Western Ethiopia (Metema, Humera), Gikawo (Gambella), lower Omo river basin and in the south Woito and Segan river basin, Moyale and lower Genale river.

The physical exam should assess for pitting edema because this may be a sign of severe malnutrition medicine 1700s cheap oxytrol 2.5mg line, often without low weight or visible wasting treatment for sciatica purchase oxytrol 2.5 mg. Dietary intake and feeding history are important aspects of a nutrition assessment medications prescribed for migraines purchase 5 mg oxytrol mastercard. The adequacy of nutrient intake can be assessed based on a 24-h patient diet recall (a list of what the patient normally eats and/or ate in the past 24 h) or a 3-day food intake record (kept in writing by the patient or a caretaker) medicine used to stop contractions order oxytrol 5 mg overnight delivery. One must interview the patient/caretaker to find out the types and estimated amounts of foods, formula, fluids, and breast milk consumed. For those giving infant formula, determine how they are mixing the formula: over- and underdilution are common and potentially serious problems. If the patient is a child, know who provides the food for the child, who feeds the child, and whether there is an adequate supply of food daily or intermittently. Body weight is one of the most fundamental ways to assess nutritional status in infants and children, especially when evaluated over time, and weight alone is adequate to assess growth when no other measurements are available. One must take the time and effort to measure these values accurately (see chapter on growth). This is probably an advantage during the acute management of wasting in these children but may result in the maintenance of therapies longer than necessary. Other, more specialized, objective measures of determining body composition, such as the triceps skin fold, can be useful in a nutritional assessment but are outside the scope of this chapter. However, pinching the skin as part of the physical exam is an easy way to estimate the amount of subcutaneous fat and can help in determining the degree of acute malnutrition. Laboratory Assessment the laboratory component of a nutrition assessment in both children and adults when available should include evaluation of the complete/full blood count, total protein, albumin (dehydration can lead to falsely elevated serum levels), and prealbumin (which has a half-life of several days versus about 2 weeks for albumin). Albumin and prealbumin assess visceral protein status (muscle mass), with prealbumin, because of its shorter half-life, reflecting more recent protein intake. Classification of Malnutrition After having done an in-depth nutritional assessment, one must know how to interpret the results. Professionals often use z scores to define the presence and severity of malnutrition. The z score is the measure of distance in standard deviations that a value is from the mean. For completeness, this chapter also includes other well-accepted methods of defining malnutrition. The Waterlow criteria use the percentage of expected length/height for age and the percentage of expected weight for height to define malnutrition. Using standard growth charts, one can calculate the percentage of expected height for age and weight for length/height. Though used as a measure of chronic malnutrition, stunting has other causes, including chronic disease, genetic abnormalities, and endocrine disorders. The length/height-for-age z score is one way to determine the presence and severity of stunting. Stunting is considered to be moderate when the length/height-for-age z score is between ­2 and ­3, and severe when the z score is less than ­3. The presence Expected wt for age (kg) at 50%ile of nutritional edema of any grade indicates 1st degree (mild) 75%­85% severe acute malnutrition. One can define 2nd degree (moderate) 64%­74% the presence and severity of wasting by 3rd degree (severe) <64% the weight-for-height z score. Wasting is considered to be mild when the weightEstimating ideal body wt for adults for-height z score is between ­1 and ­2, Male: 48 kg + 1. One may use the Gomez criteria when more than 1 month or a height measurement is unavailable, though they might · reports of fever or night sweats for more than 1 be less accurate because they do not account for length/ month without other cause and lack of response to height (Table 2). For an adult, malnutrition can be inadequate feeding or other infections; and/or defined as involuntary weight loss greater than 10% · visible wasting of muscles, with or without edema or weight less than 90% of ideal weight. Causes of malnutrition and risk factors for the development of worsening nutritional status should be comprehensively addressed. Patients with moderate or severe acute malnutrition need aggressive inpatient or outpatient management depending on available resources and country-specific guidelines. When a patient has developmental delay or neurological deterioration, conduct a feeding and swallowing evaluation if possible.

For this group symptoms 16 dpo discount oxytrol 2.5 mg on line, the transition from pediatric or adolescent to adult care is often a matter of acute concern to the young people themselves medications such as seasonale are designed to purchase oxytrol 2.5 mg mastercard, their families medications causing thrombocytopenia 2.5mg oxytrol amex, and the professionals who care for them treatment models cheap oxytrol 2.5mg overnight delivery. Table 2-3 highlights characteristics of child and adolescent health that may affect the transition from pediatric to adult care for children with serious chronic conditions. Medicaid covers a range of special services for children that are not usually covered for adults and that may be particularly important for children with severely debilitating rare conditions. Treatment of serious, chronic, rare conditions often involves multiple specialties such as medical genetics, neurology, gastroenterology, psychiatry, endocrinology, and physical therapy. In principle, the implementation of this concept would support smooth transitions from pediatric to adult care for children with rare conditions. Hollaway, 2007 Rare diseases take their toll on all involved, from affected individuals and their families and friends, to the health professionals who care for them, to their communities, and the larger society. Many rare diseases result in premature death of infants and young children or are fatal in early adulthood. Such premature deaths can have lifelong effects on parents, siblings, grandparents, and others close to a family. Even for rare conditions that are less severe, the isolation, the uncertainty about the course of the disease, and the frequent lack of effective treatments can have a significant impact. Just as rare conditions vary, individual and family experiences with debilitating or life-threatening illness clearly vary-as do their responses. The effects of rare conditions on patients and families and their responses are often shaped by socioeconomic status, including differences in income and education. Better outcomes may be linked to medical and nonmedical actions that take such differences in financial and nonfinancial resources into account. Advocacy groups and educators encourage health care professionals to respect these values as they help patients and families understand what they are facing and make decisions about care and treatment. High and burdensome costs are not unique to rare diseases, but a number of factors can push patient, family, and societal costs higher for rare conditions than for more common ones. Medications developed specifically for rare conditions can be extraordinarily expensive, costing tens or even hundreds of thousands of dollars per year. Many individuals require extensive, long-term supportive care that is not covered by Medicare or private health plans, although Medicaid may cover such services for those who qualify. Even for relatively well-off individuals and families, the expenses associated with life with a rare disease can be a significant burden. For both individuals and family members, the economic impact of rare diseases extends to lost productivity, lost wages, or the inability to find manageable work with flexible leave, health insurance, and other key benefits. Notwithstanding laws against discrimination based on disability or genetic information (notably the Genetic Information Nondiscrimination Act of 2008, P. For small employers, a single health plan member with extraordinary medical costs can lead to unaffordable premiums for the entire group of employees. As described in Chapter 6, if it survives calls for its repeal, the Patient Protection and Affordable Care Act of 2010 (P. I did not choose this work as my career; the vocation was bestowed on me more than 14 years ago when my two children were diagnosed with a genetic disease called pseudoxanthoma elasticum. Terry, 2009 the physical, emotional, and financial impact of a rare disease on individuals and families has motivated many of them to try, in turn, to have an impact on the disease and others affected by it. Although not focused solely on rare conditions, the Genetic Alliance convenes a range of activities to help rare disease and other groups develop, function effectively, and collaborate. Such movement reflects both the biological reality that knowledge about one condition may be more generally relevant and the organizational reality that consolidation can bring operational efficiencies and greater public recognition (see. Many advocacy organizations take on multiple roles, including providing information, supporting patients and families in obtaining needed clinical and other services, offering emotional support, educating clinicians, shaping public policy, and promoting research. Patients, families, and advocacy groups have been a driving force in public policy. They likewise were active in working for passage of the Genetic Information Nondiscrimination Act and creation of the compassionate allowances program that allows people with a number of rare conditions to qualify quickly for Social Security Disability Insurance (see Chapter 6). Some rare disease groups and their umbrella organizations argue that efforts to influence public policy should take this broad approach rather than focus on funding or other policies aimed at individual rare diseases (see. As is true for organizations associated with common diseases such as breast cancer or cancer generally, rare disease groups often aim to engage and have an impact on the broader community through public awareness and fundraising efforts.

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Diseases

• Intercellular cholesterol esterification disease
• Oculocutaneous albinism, tyrosinase negative
• Pseudoxanthoma elasticum, recessive form
• Galactokinase deficiency
• Wohlwill Andrade syndrome
• Bathophobia
• Lymphangiomatosis, pulmonary
• Double tachycardia induced by catecholamines
• Ulnar hypoplasia lobster claw deformity of feet