By S. Marik. York College, York Nebraska. 2018.
In the last couple of decades a number of diseases thought to be of unknown causes have been proven to result from food borne infections 600 mg neurontin with mastercard. In developing countries like Ethiopia in particular discount neurontin 400 mg online, the problem attains great proportions due to many reasons neurontin 100mg; basic among which are poverty 800mg neurontin mastercard, poor environmental sanitation and lack of public health awareness discount neurontin 300 mg with mastercard. In these modern day times in which food is usually not consumed immediately following and/or at the site of production purchase 600 mg neurontin, the risks of food-borne diseases are becoming increasingly important; the concern is obviously much more in areas where food storage and preparation safety measures are far from optimum. The extent of diagnostic evolution of food borne diseases can be based on history, clinical features, environmental assessment and laboratory investigations. Prevention and control of food–borne diseases, regardless of the specific cause, are based on the same principles: a. Specific modes of intervention vary from area to area depending on environmental, economic, political, technology and socio cultural factors. Place a drop of physiological saline in the center of the left half of the slide and place a drop of Dobell’s iodine solution in the center of the right half of the slide. With an applicator stick, pick up a small portion of the feces (about 2mg which is as much as the size of a match head) and put on the drop of saline. Mix the feces with the two different drops using the applicator stick to form a homogeneous suspension. Examine the saline preparations using the 10x objective for trophozoites (vegetative/motile forms) and cysts as well as oocyst of intestinal protozoa and for any ova or larva of helminthes. Examine the iodine suspension with 40 objective for better identification of the cyst stages of protozoa (iodine will stain the nuclei and the glycogen mass of the cyst. Inflammatory diarrhea The above table shows bacterial food Infections and poisonings with predominant gastrointestinal manifestations (Modified from Harrison’s Principles of Internal th Medicine, 15 Edition, 2001). Albendazole 400 mg daily for 5 days may Albendazole 200 mg po once daily for 5 be effective days for children up to 2 years of age; for children 2 years and older, similar dose as for adults 7 Ascariasis Piperazine citrate 3. Pyrantel pamoate 10 mg /kg po stat Pyrantel pamoate 10 mg /kg po stat (maximum 1 gram base) (maximum 1 gram base) May be repeated in 2-3 weeks if May be repeated in 2-3 weeks if required. These requirements should be observable and measurable, using such factors as time, temperature and sensory measures. Types of Hazards Types of Hazards Microbiological Examples Biological Bacteria Clostridium botulinum Salmonella choleraesuis Salmonella paratyphic A-C Shigella dysenteriae Vibrio cholerae Salmonella spp. Campylobacter jejuni Clostridium perfringens Staphylococcus aureus Vibrio parahemolyticus Aeromonas hydrophila Viruses Norwalk and Norwalk-like viruses Rotavirus Hepatitis A virus Parasites Anisikiasis simplex Ameba Giardia Taenia spp. Trichinella spiralis Chemical Raw materials Heavy metals Pesticide/Insecticide residues Antibiotic residues Histamine Toxins In the process Refrigerants Lubricants/Hydrocarbons from the process Pest control agents Sanitizing agents Water additive Paints From packaging materials Plasticizers Printing code inks Adhesives Lubricants Physical Natural materials Bone Skin Connective tissue Contaminating ingredients Foreign bodies Insect infestation Glass Metal Plastic Wood paper 160 C. The Center for Disease Control and Prevention, Diagnosis and Management of Food-borne Diseases, February 2004, (www. Drug Adminsitration and Control Authority of Ethiopia, Standard Treatment Guidelines for the District Hospital, 2004 25. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Nuclear family is defined as ‘’ a family consisting of a married couples and their children; the children can be born or adopted’’. For practical reasons, it may be sound to distinguish: ♦ The childbearing unit, nuclear or one parent family, where the genetic factors are prominent. It could be defined as: A quality of life, which involves social, mental and biological fitness on the part of the individual, which results from adaptations to the environment. The summary of different views conceptualises health to be multidimensional and inclusive of many components and many different aspects of one’s life.
The male sex accessory glands are the paired seminal vesicles generic 400 mg neurontin, the prostate gland buy 400mg neurontin mastercard, and the paired bulbourethral glands buy discount neurontin 800mg on line. The duct of each seminal vesicle unites with the ampulla of a ductus deferens to form a common ejaculatory duct neurontin 300 mg visa. The prostate gland surrounds the ejaculatory duct and the prostatic urethra order neurontin 600mg line, and secretes into the latter generic 400mg neurontin. The mediastinum (not visible on this slide) is the mass of acidophilic connective tissue at one 67 pole through which the major vessels enter and leave the testis. At higher magnification identify the germinal elements (spermatogonia, spermatocytes and spermatids) and Sertoli cells in the seminiferous tubules. Only the Sertoli cells and spermatogonia (usually with interphase nuclei) rest on the basement membrane. The larger primary spermatocytes lie on the luminal side of the Sertoli cells and are frequently in some stage of the prolonged prophase of the first meiotic division. Beneath the basement membrane of the tubules note the myoid cells (myoepithelium) with their pale- staining elongated nuclei. In the interstitium (between the seminiferous tubules) identify Leydig cells, which are large eosinophilic cells. It is a coiled tube lined by pseudostratified epithelium with long microvilli (non-motile stereocilia). Note: For the histological characteristics of the efferent ductules see examples in textbooks or online. Note that there are no discrete secretory alveoli in the seminal vesicle; instead the entire lining membrane of the saccular gland is thrown into a series of complex, high, thin folds. The lining epithelium is generally simple columnar or pseudostratified, and basal cells 68 are frequently seen, as in the epididymis and ductus deferens. The seminal vesicle is embryologically derived from the ductus deferens, and like the latter, it has a prominent muscularis. The acidophilic secretory material in the lumen of the gland is rich in fructose, thought to serve as an energy source for spermatozoa following ejaculation. Also evident are the elongate tubules forming the parenchyma of the gland and the dense fibrous connective tissue capsule. Compare its transitional epithelium with the epithelium lining the ducts and glands of the prostate, which can be cuboidal, columnar or pseudostratified. The tubulo-alveolar glands of the prostate are embedded in an abundant stroma of fibro-elastic connective tissue, which is interlaced with strands of smooth muscle. Fixation is much better in the H & E sections, and it should be studied for the structure of the lining epithelium of the glands. Examine the central penile urethra and the surrounding blood-filled vascular sinuses that comprise the erectile tissue of the corpus spongiosum. Note that the lining epithelium of the penile urethra has a stratified columnar or stratified cuboidal appearance. Study the erectile tissue surrounding the urethra and observe that the trabeculae between blood sinuses contain smooth muscle and connective tissue fibers. The connective tissue capsule surrounding the corpus spongiosum is not as thick as that surrounding the corpora cavernosa. At low power note the general division of the ovary into an outer cortex containing follicles in various stages of development and an inner medulla containing numerous blood vessels and dense fibrous connective tissue. Identify; Lining epithelium (classically called “germinal epithelium”) - a simple cuboidal covering the ovary, continuous with the mesothelium of the peritoneum. These are growing follicles Secondary (antral) follicles - 1 oocyte surrounded by granulosa cells among which fluid-filledo spaces are coalescing into a single space, or antrum. Outside the basal lamina of the granulosa layer, the theca has differentiated into a theca interna and a theca externa. Atresia is often first recognized in the granulosa cells as the nuclei become apoptotic and there is a loosening of the cells. Corpus luteum – Following ovulation follicular cells (both granulosa and luteal) fold into the empty follicle and undergo luteinization.
Normal Clinicians use the traditional frequency is considered to be approach of history and between four and seven voids a examination buy discount neurontin 400 mg online. This varies with the age Urgency Incontinence of the woman discount neurontin 100mg visa, with an increase Here neurontin 300 mg visa, the women describes the reported in woman above the age symptoms of urgency and she is of 70 years where normal would unable to get to the toilet in time be considered to be twice at night order neurontin 600mg with mastercard, and develops incontinence as a three times for women over 80 result cheap neurontin 300mg on line. Determining the severity of Incontinence Incontinence It is important to make a clinical Symptoms of Urinary Incontinence attempt to determine the severity are notoriously diffcult to of the incontinence symptoms proven 300mg neurontin. The International woman could be asked to quantify Continence Society defnes the symptoms on a scale of 0 to this as the “involuntary loss I0. The Urinary urgency number of incontinence episodes This is the compelling desire to per day can also be indicative of void which is diffcult to defer. It must be differentiated from urinary urge which is a normal Symptoms of voiding desire to void which can be dysfunction 4 These symptoms are not as common in women as in men Prolapse symptoms but if present, should prompt Women with prolapse have a the appropriate investigation of broad range of symptoms. Most women • Straining to void will complain of a bulge or a lump, • Incomplete Emptying whilst others will describe either • Post- Micturition dribbling discomfort or a burning sensation. Pain that is Evaluation and questioning relieved with passing urine may regarding bowel symptoms is an be associated with Interstitial essential part of the evaluation of Cystitis/ Painful Bladder Syndrome. Women with pain as a signifcant symptom should be evaluated Anal Incontinence with cystoscopy and biopsy since This is the involuntary passage of pain may also be associated with fatus. Faecal Incontinence Urethral Pain This is defned as the involuntary This may be associated with passage of liquid or solid stool. This should be quantifed by asking the women about the frequency, Haematuria severity, use of continence aids Women with urinary symptoms and impact on quality of life. Medications A note should be made of Defaecatory dysfunction medications that may be Women should be asked about worsening the symptoms, including any diffculty in completing diuretics and alpha –blockers. A record should be made of Cardiac failure can present frequency of stools and any with nocturia as a result of the symptom of constipation. Sexual History A detailed history of sexual Fluid Intake function is vital to a thorough The amount and type of fuid assessment of pelvic foor consumed on a daily basis should disorders. Obstetric History The number and type of deliveries are important as well as any history of perineal or anal sphincter injury. Other relevant parts of the history Surgical History Previous pelvic surgery, including Neurological history prolapse and incontinence surgery, Women should be questioned should be noted. Any history of multiple sclerosis, parkinsonism, spinal cord injury, stroke or spina bifda should also 6 Causes of Incontinence I. Excessive urine production Diabetes Mellitis and Insipidus Diuretics Cardiac failure Adapted from Textbook of Female Urology and Urogynaecology Eds Cardozo and Staskin. Lower Lower urinary tract symptoms are urinary tract symptoms were categorized as storage, voiding defned by the standardization sub and post micturition symptoms. Symptoms may the complaint by the patient who either be volunteered or described considers that he/she voids too during the patient interview. In general, lower urinary tract Nocturia is the complaint that the 8 individual has to wake at night Stress urinary incontinence is the one or more times to void. Urgency urinary incontinence is the complaint of involuntary leakage Urinary incontinence is the accompanied by or immediately complaint of any involuntary preceded by urgency. If it is used to denote leakage, and whether or not the incontinence during sleep, it individual seeks or desires help should always be qualifed with because of urinary incontinence. Intermittent stream or Double voiding (Intermittency) is the term Continuous urinary incontinence used when the individual describes is the complaint of continuous urine fow which stops and starts, leakage and may denote urinary on one or more occasions, during fstula. Bladder sensation can be defned, Hesitancy is the term used when during history taking, into four an individual describes diffculty categories. Straining to void describes the muscular effort used to initiate, Increased: the individual feels an maintain or improve the urinary early frst sensation of flling and stream. Terminal dribble is the term used Reduced: the individual is aware when an individual describes a of bladder flling but does not feel prolonged fnal part of micturition, a defnite desire to void. Absent: the individual reports no sensation of bladder flling or Post micturition symptoms are desire to void. Feeling of incomplete emptying is a self – explanatory term for Slow stream is reported by the a feeling experienced by the individual as the perception individual after passing urine.
There are now many thousands of chemical substances used in industry ranging from metals & inorganic compounds which risk people who work with it buy cheap neurontin 100 mg line. Heavy metal poisoning Some metals such as iron are essential for life buy neurontin 800 mg otc, while others such as lead are present in all organisms but serve no useful biologic purpose cheap 600 mg neurontin free shipping. Some of the oldest diseases of humans can be traced to heavy metal poisoning associated with metal mining purchase 100mg neurontin with amex, refining and use 100mg neurontin otc. Lead Poisoning Lead poisoning is one of the oldest occupational and environmental diseases in the world purchase neurontin 100 mg visa. Despite its recognized hazards, lead continues to have widespread commercial application (like ingested lead paints, pica, and lead pipes etc…). Environmental lead exposure, ubiquitous by virtue of the anthropogenic distribution of lead to air, water and food, has declined considerably due to diminished use of lead in gasoline and other applications. Lead is slowly but consistently absorbed via the 52 Toxicology respiratory and gastrointestinal tracts. Lead exerts multi systemic toxic effects through at least three mechanisms by; o Inhibiting enzyme activity (e. Lead interference with the biosynthesis of heme The sign and symptoms of lead poisoning may include anorexia, apathy, behavioral changes, persistent vomiting, convulsions (acute poisoning) & ataxia, wrist & ankle drop, chronic nephritis (chronic poisoning) Laboratory findings A. It is not present in iron deficiency anemia so it is valuable for differentiating the two forms of anemia. B) Serum Lead level Levels of 30-60µg/dl are regarded as significant for lead toxicity. Levels below the toxic range do not rule out toxicity because 90% of lead is stored in bone. Unexpectedly high lead levels may be due to contamination of the blood specimen with lead prior to laboratory analysis. Protoporphyrin accumulates as a result of the lead inhibition of the enzyme ferrochelases, which binds to porphyrin, forming hemoglobin. Lead inhibition of the enzyme coproporphyrinogen oxidase has been proposed as a cause for increased coproporphyrin. Spot 50 µl of acidified solution on to phase-separating filter- paper and add 50 µl of sodium rhodizonate solution. However, the test is not specific: barium salts give a brown colour and a number of other metals also give coloured complexes. Sensitivity Lead, 2 mg/l Quantitative tests Principle 56 Toxicology Whole blood that represents calibrators, controls, or victim specimens is mixed with ammonium phosphate and Triton X-100 to prepare it for graphite furnace atomic absorption analysis. The final step of analysis causes vaporization of lead, which absorbs energy at the 283. Absorbance of energy at this wavelength is specific for lead and proportional to its concentration. Add 10 µL of matrix modifier to 10µL of each sample and inject into the L’vov platform. Repeat the analysis at an appropriate dilution for any specimen with an absorbance greater than that of the high concentration calibrator Calculation 1. Perform a best-fit regression analysis of the calibrator concentrations versus the respective absorbance peak area to define the calibration curve. If the results among duplicates vary by more than 10%, sample contamination during processing is likely to have occurred. Hydrocarbons are found alone or incombination with others in a wide variety of commercial products ubiquitous around the home or work place. Lighter fluid, paint thinners, &removers, some furniture polishes, cleaning agents, solvents, various automotive products & 58 Toxicology ordinary fuels are common examples.