Buboes or Swollen Inguinal Glands Buboes are enlarged lymph nodes in the groin. DISTENDED URINARY BLADDER Acute retention of urine is the commonest. Prognosis Overall prognosis is better than adult rheumatoid arthritis. A larger percent of our generation is almost guaranteed to live even longer age. The following aspects in the patients' history' may help to identify the emotionally high-risk patients and anticipation of puerperal psychosis: · Family history of major psychologic illness of close relative e.g. One booster dose at every subsequent pregnancy · People with open wounds - 2 doses of tetanus toxoid at least 4 weeks apart. B. M. Hegde in the Open Page of The Hindu, dated February 18th, 2012. Patient Education · Compliance to therapy is important to prevent relapses · Relatives should bring the patient to the hospital at early signs of relapse · Drugs may have to be taken for a long time depending on response. All need molluscan intermediate host. Live vaccines should not be given to individuals with impaired immune response e.g. Common in neonates (pemphigus neonatorum) although any age can be affected. MOH Dr. M. Awori, DDMS, MOH Dr. Pyrexia, headache, etc, especially with animate foreign bodies. Other causes of obstructed labour are malpresentations or malpositions of the foetus, and soft tissue abnormalities of the genital tract. This is usually a complaint following a URTI or is seasonal. Management Refer patient for oesophagoscopy and removal of the foreign body. During physical examination, document location, nature and extent of external trauma to face, neck, breast, trunk, limbs, the genitalia, vagina and cervical trauma must also be documented. The problem here is selective memory and confirmation bias. C. Kandie, Pharmacist i/c MSCU Dr. May be confused with cataract, could be glaucoma, retinal or optic nerve disorders. It should be remembered that this rule does not apply strictly to infants and children. Special attention should be given to fibrous dysplasia, ameloblastoma, leucoplakia, mottled and hypoplastic teeth, amelogenesis imperfecta and impacted teeth. Give haematinic supplements as for prophylaxis Re-assurance: Mild anti-pruritic, phenobarbitone 30 mg TDS x 5 days Exclude skin and systemic diseases See under vaginal discharge Calcium tablets 2 TDS x 5 days Re-assurance, bed rest 3-7 days Advise on balanced diet Reassure. Prevention · Immunisation: Routine and National Immunisation Days (NIDs) · Active surveillance and mopping up · It is hoped that polio will be eradicated in the near future with intensified childhood immunisation combined with successful disease surveillance. Debates are indeed the need of the hour for science to grow. A reverse trend was noted for carbohydrates, whereas protein intake remained unchanged during the 25-year period. Urinary Fistula...........................................................329 Annexes.......................................................................329 A. Comeback. Frequency. Urgency. PATENT DUCTUS ARTERIOSUS (PDA) Pulmonary arterial blood is shunted through the ductus arteriosus into aorta during foetal life. Distended and tense abdomen. Pre-mature onset near sight can be cured by laser surgery. Some can also be transmitted through blood transfusion, contaminated needles, syringes, specula, gloves, skin piercing and cutting instruments. Commoner's (common sense based- as opposed to science or myth based) Reaction: Is it not, -having in lacer sharp focus only the larger rights, interests, and benefits of, humanity, nothing else)- high time, rather late in the day, that instead of carrying on a battle of wits, an inconclusive one at that, through prolonged emotional debates amongst the medical fraternity, composed of those having vested interests and the rest, to eternity, to bring about clarity in a wholesome manner, for the common benefit of the ailing lot in the society? Dr. Richard O. Admit For · Confirmation of diagnosis · Continuous bladder drainage. Risk Factors include advanced maternal age, grand multiparity, history of DVT, operative delivery, venous stasis (e.g. Refer all cases of suspected bone tumour. Deep Vein Thrombosis......................................................51 3.3. ENT work-up if biopsy indicates a secondary from the post-nasal space. Caesarian Section) · The expected rate of cervical dilatation is at least 1 cm/hour: - Artificial rupture of membranes is undertaken at 4 cm cervical dilation and above when the foetal head is engaged and no cord felt, releasing liquor slowly by controlling head position. So, blame the modern lifestyle. LP (with care!) Vit. Use of the mildest steroid that controls the problem is advocated. Antepartum haemorrhage (APH) is defined as vaginal bleeding after the twentieth week of pregnancy (£20/40). It is mentioned because no action need be taken. Scaling, itching, loss of hair is common - " Mashillingi". ORTHOPAEDIC S. Clinical Features Pain is the major presenting symptom. They can even cause harm. Candida albicans is the commonest agent. Physical examination may reveal; tender, fluctuant abscess lateral to and near the posterior fourchette, local swelling, erythema, labial oedema, painful inguinal adenopathy. Other ways of isoimmunization include transfusion with Rhesus incompatible blood, ectopic pregnancy, hydatidiform mole, and abortion. Surgical repair of injuries (sphincter injury which may require colostomy with secondary repair). All snake bite patients for at least 24 hrs. Allergic Rhinitis...........................................................81 6.12. Prescribe multivitamin tablets. Surgery may be indicated. This condition is an emergency. But, when I was in Final Year Engineering during 1984; I had a excruciating pain on lower abdomen and the doctor confirmed by intravenous X ray it is kidney stone. Common organisms are E. Most patients will require detailed work-up thus refer patients to gynaecologist after a good history and examination rule out immediately treatable causes. Clinical Features Depend on age of presentation in physiological type and level of disturbance in pathological type. Manifest deviation of the eyes. The rest of management will follow like other burns. Allopurinol 300 mg OD is drug of choice. If some thought or writing makes me go ballistic, then I need to check the fractal in my premises of that What is troubling me? Admit · If patient is severely disturbed, violent or catatonic. Refer If · Flail chest causes respiratory distress, splint with pad and bandage then refer. If he is Rh -ve then the foetus should be Rh -ve and hence no risk of isoimmunization in the mother. Involvement of the hard palate is a poor prognostic sign. Patient Education · As for complete abortion. The authors of this review point out that two studies that promoted the benefits of eggs were funded by egg marketing agencies; but these authors of the review have themselves received grants, honoraria and speaker's fees from several pharmaceutical companies manufacturing lipid-lowering drugs such as Pfizer, one of the largest manufacturer of statins! Monthly Cost of Hypertension Therapy Cost for 30 Days (KShs.) Refer If · No response after excluding the above. Investigations · X-ray - orbit/paranasal sinuses · Pus swab. Let me clarify then. But this lady improved rapidly and she attained a near normal condition. If a VVF co-exist with RVF, VVF is repaired first. But we do seem to however manage to find other uses for herbs etc mentioned in the corpus. It so happened one more time when I was teaching students at Sharjah during 2007; I slipped and I got a serious injury at my knee. In critical conditions, it is much harder for quacks to play games and get away. J. M. N. Machoki, Obstetric-Gynaecologist and Lecturer, UON Prof. Permanent method Permanent method NOTE: Men or women whose spouses oppose VSC should be considered on a case by case basis for the procedure. These effects peak at 48 hours and subside over a period of 10 days. There is rebound tenderness, muscle guarding, cutaneous hyperaesthesia: Pelvic tenderness in the right iliac fossa on rectal examination. How do you think do we know these things confidently unless we apply the methods of science? These Guidelines are neither prescriptive nor restrictive. Cross infection: · Contamination of fingers with objects, clothing, toilet seats, etc. The acute type may be ruptured or unruptured. This is more effective for small bowel than in large bowel obstruction · High enema may be effective for faecal impaction only · Remove the cause of the obstruction usually by surgery. Clinical Features Post coital bleeding, dyspareunia, watery discharge, urinary frequency or urgency or painful defecation. In general terms, hyperbilirubinaemia may be pre- hepatic, hepatic and post-hepatic. It was mostly biding time until the disease ran its course (this was what the Voltaire quote was about, which Dr. Treatment as above. However, while the case he was making may impress you, it is unlikely to impress NIH reviewers.. Daily fluid consumption is 2000 to 2500 ml in 24 hours, 1500 ml by mouth and 500 ml to 1000 ml in solid food · Loss is through urine (800-1500 ml), stool (250 mls), insensible loss (600 mls through skin and lungs). Herbs for Diabetes Type II - Chinese,. It was burning holes in my stomach causes acid reflux. On every continent, healers have found herbs that seem to improve And unlike Sigmund Freud or Bertrand Russell or George Bernard Shaw, Einstein never felt the urge to denigrate those who believed in God; instead, he tended to denigrate atheists. Weight range (Kgs) ABOVE 30 Kg 31 - < 36 36 - < 41 41 -< 46 46 - < 51 51 -< 56 56 - < 60 60 + DILUTION TO 100MG/ML Use 10 ml sterile syringe.
Antidiabetic herbal formulation principles clothes
Ayurveda (and every other ancient system of medicine) had no understanding of disease. Amoxycilin-clavulanate 1 tab orally + Probenecid 1 g orally ½ hour before penicillin. Management · Admit patient · Assess the patient for vital signs · If severe difficulty in breathing perform tracheostomy · Give injectable antibiotics: Preferably crystalline penicillin 4 mega units STAT (adults) then 1 mega unit QDS for 5 days · Give hydrocortisone 100 mg IV TDS for 3 days · If dehydrated, give IV fluids · Incision and drainage if abscess forms. Once, while I got a fracture at toe, the ortho-surgeon asked me to undergo for a correcting surgery, it was during 1993. Parotid Masses...........................................................82 6.13. There is no improvement after 4 weeks · The patient will benefit from tympanoplasty surgery · The patient has attico-antral type of CSOM · Patient complains of headache, earache, vertigo or facial paralysis which indicate complications. It may also involve the lymphatics and other organs including the GIT and lungs. Clinical Features Symptoms develop gradually as: · Dry or greasy diffuse scaling of scalp (dandruff) with pruritus · Yellow- red scaling papules in severe cases found along the hairline, external auditory canal, the eye brows, conjunctivitis and in naso-labial folds. Other associated conditions include: benign prostatic hypertrophy BPH, constipation, malnutrition, old age, homosexuality. CORNEAL AND CONJUNCTIVAL ABRASIONS Pad eye for 24 hrs, if no improvement refer. Whichever is best to achieve haemostasis quickly is done. Burns....................................................................13 1.5. Dirty wounds - Most traumatic wounds are highly contaminated and apart from chemoprophylaxis a thorough surgical toileting is necessary. SUBSTANCE ABUSE BY THE ADOLESCENT Usually present with a self-neglect, slovenliness, deteriorating school performance, excessive sleeping, rough appearance, increasing and unexplained demand for money from care givers, involvement in petty crime (pilfering), running away from home in addition to aforementioned substance-related disorders. HYPERTENSIVE EMERGENCIES In both, the aim is to achieve diastolic BP of 100-110 mm Hg, rapid decrease of BP should be avoided to reduce risk of cerebral hypoperfusion. You can't balance science and pseudo-science. Triage Sieve Transport to various medical facilities depends on the number of casualties and availability of facilities. If still breastfeeding, give more frequent, longer breastfeeds, day and night. Complications Intestinal haemorrhage, perforation. All for 10 to 14 days. Investigations · Hb, Urinalysis · Plain abdominal X-ray may be useful in calcified tumours and some dermoid cysts · Ultrasound where facilities exist. Cervical mucosa appears inflamed with focal haemorrhages. The person is not perpetually in medication for malaria, cholera or typhoid. If side effects appear and fits are still not controlled, introduce other drugs and taper off the first drug. Refer to eye clinic Warm water compressions Topical & systemic antibiotics; NO STEROIDS If no improvement within a week, refer to ophthalmologist for I& D. They give effective protection for 30 days hence the name monthly injectable. Like wise plants, animals and all organic one's have fixed slots in which each manifest, grow & perish. Tends to affect large and small joints and may interfere with growth and development. But rest assured that unless the current concepts are DISproved, they will remain. It is a symptom killer while the disease not only exists silently, but remains untreated and later kills. The severity increases with time. If severely dehydrated continue N/S and 5% dextrose together. Fever and sweating. LCHF [21], i.e. Fever. There may be an area of induration. Management · Involve family and other relevant authorities. Years down the line there came a tablet called Asthmatide BR, which was the best bronchodilator for me at that time, when salbutamol and theo asthalins failed. Clinical Features Generalised: headache, vomiting, alterations in level of consciousness. Intermenstrual PV bleeding. Sometimes in individuals with lowered resistance to diseases. A new evidence base that you are advocating is indeed worthwhile. These drugs are used for many other non high-BP diseases as well (simple example being migraine). To him at least ayurveda has a cure for Cancer. SNAKE BITES Remember 70% of snakes are not poisonous. PRURITUS ANI Common condition (especially in males). A condition in which there is more than one foetus in utero. They are creatures who-in their grudge against traditional religion as the ‘opium of the masses'- cannot hear the music of the spheres. IUCD (Coil) are known to predispose to PIDs and hence are discouraged. Kg 8 hourly until the patient can take orally. Follow up Is appropriate to underlying cause. Avoid offending agents CARDIAC ARREST Due to asystole, ventricular fibrillation, and cardiovascular collapse in extreme arterial hypotension. Investigations · Blood slide for malaria parasites · Stool for ova/cysts · Hb, PBF · Urinalysis - microscopy, C& S · CXR - to rule out pneumonia, PTB. FLUID THERAPY Fluid administration is the mainstay of treatment and is life saving. For any major operation a check chart need be kept for at least 24 hours before surgery. Usually it is found on the apical region of the tooth and could be with or without sinus. Weight reduction in obese patients · Low salt diet · Advising patients to give up smoking · Regular dynamic exercises. OPEN BIOPSY IS CONTRAINDICATED due to: - Risk of seeding of tumour in neoplastic conditions. Seizure Disorders Epilepsy is a clinical syndrome characterised by the presence of recurrent seizures. Neonatal reflexes persist. Admit · All cases having evidence of septic abortion. Clinical Features Most cases of tuberculosis in Kenya (80%) are pulmonary. Mansoni - portal hypertension, splenomegaly, anaemia and oesophageal varices. Investigations · Haemogram and ESR · Stool for microscopy, C& S · Double contrast barium enema · Proctoscopy, sigmoidoscopy, colonoscopy and biopsy · Coagulation screen, where available. Investigations · Haemogram -moderate hypochromic, microcytic anaemia; or leucopaenia in Felty's syndrome · ESR - elevated · X-ray, especially hands and/or any other involved joint · Rheumatoid factor · Antinuclear antibodies. Procedure of doing the invertogram · Strap a coin on the site of anus · Hold the infant upside down for 3-5 minutes · Put the thighs together and parallel to one another · Take a radiograph and measure the distance between the metal coin and the shadow in the rectum. Do a thorough physical examination. Management - - General · Reduce temperature if hyperpyrexia is present - do tepid sponging · Maintain fluid and electrolyte balance especially if there has been significant fluid loss · Monitor output. It may be spontaneous or induced. Lethargy, poor feeding. In alternative medicine such as Ayurveda, importance is given to lifestyle and one's constitution, which modern system of medicine does not. Management · Pregnancies that are severely affected while the foetus is premature and can benefit from intrauterine transfusion. White pupil in children could be more commonly congenital cataract or retinoblastoma. Take blood for glucose and give 20 ml of 50% dextrose immediately · All diabetics with complications such as diabetic foot should be admitted Patient Education · Teach patients on how to avoid foot injury. Mustard gas was widely used as a weapon during WWI by both sides of the conflict with particularly harmful and deadly effects. When the cause is addressed/removed in these cases, it can actually be cured. With regards to ancient treatments: Which ancient treatments was he talking about? Treatment for meningitis should be continued for 3 weeks. Use quinine IM if IV drip cannot be monitored or fail to get IV access. Predominantly cytotoxic and haemolytic venom. There was not much useful or factual there in Medicine in those days. Diagnosis is usually clinical. Shock may be worse than the blood loss would suggest. SIMPLE RIB FRACTURES A break in the continuity of a rib(s). This speaks to the ability of modern research than the ancients ability to catalog treatments. Associated with nulliparity, low parity, sub-fertility and infertility. I was immediately advised antibiotics. So, why not we balance our views? Note that peritonitis could be due to tuberculosis and could also be aseptic. Advice to mothers/Caretakers · Ensure all her children are fully immunised · Child should attend under 5 years children clinic on discharge. Take-home messages: - Breastfeeding exclusively up to age 6 months and continue with other foods up to age 2 years - Solid foods ("complementary foods") should be introduced from about age 6 months - Proper sanitation: Provision of safe drinking water in sufficient quantities and disposal of faeces. CAD is increasingly affecting younger people, including children, largely due to the modern diet. This may be due to prematurity, sepsis. If one conceives with IUCD remove it if possible, otherwise leave alone (ultrasound if possible) and counsel client accordingly. CARE OF THE SURGICAL PATIENT PRE-OPERATIVE EVALUATION A patient for elective surgery needs thorough evaluation not only for suitability of general anaesthesia but also for possible complications related to the operation (e.g. Differential diagnosis include PID, appendicitis, abortion, and ruptured ovarian cyst. It is expensive. Clinical features include intense polydipsia, abdominal pain, vomiting, dehydration, acidotic breathing or coma. Causes NGU include Chlantydia trachomatis and rarely Trichomonas, or Herpes simplex. Surgical Contraception Many factors have contributed to improved safety of Voluntary Surgical Contraceptive in the last 20 years: These include improved anaesthetic methods, better surgical techniques, asepsis, improved training of personnel and better selection and monitoring of clients. Read Clinical Guidelines for Diagnosis and Treatment of Common Conditions in Kenya text version. Clinical Guidelines for Diagnosis and Treatment of Common.. There was this lady who thought she cured her gastic cancer with fasting and whole grape juice and wrote a book, but provided no proof. Quick assessment of the extent of burns · Burnt surface area · Site of injury (note facial, perineal, hands and feet) · Degree of burns · Other injuries (e.g. Features of pulmonary tuberculosis are cough for 3 weeks or more, haemoptysis, chest pain, fever and night sweats, weight loss and breathlessness. Refer If · Manual reduction not possible · History of habitual dislocation. The commonest causative agent is staphylococcus aureus. Management · Immediate antibiotic therapy (after collecting samples) · Crystalline penicillin 50, 000 units/kg BD and gentamicin 2.5 mg/kg BD · Amikacin 7.5 mg/kg BD is indicated in hospital acquired infections. No one seemed to suggest any such stuff but rubbished the original data. I agree that the Big, Evil Pharma companies might indulge in these kinds of shady activities. Bone marrow depression (aplastic anaemia) due to e.g. If newer trials can properly replicate it, why would one NOT use it? Salmonella Enteritis causes Gastroenteritis. Causes severe anaemia and low birth weight. Man made God or God made man? No anaesthetic in extreme circumstances. Due to the seriousness and magnitude of the HIV/AIDS problem, Kenya declared HIV/AIDS a national disaster in 1999 and set up a National AIDS Control Council under the Office of the President to provide a frame-work for multisectoral co-ordination. Prevention · Balanced diet · Prophylaxis iron throughout pregnancy · Prophylaxis antimalarial [see 18.2.8. Intrauterine Contraceptive Devices (IUCDS) A widely used family planning method. Indication for rabies vaccine: - bites from wild animals - bites from UNPROVOKED domestic animal - bites from a sick looking domestic animal, whether immunized or not - severe injury (multiple or deep puncture wounds), or any bites on the head. Investigations · Urine culture will usually grow E. Gastritis An acute ulceration of the stomach, usually multiple, non-recurrent and self-limiting. Condoms also offer some protection against STIs including HIV/AIDS, HBV and carcinoma of the cervix. Amoebic liver abscess. He continued the medication without any interruption for a period of more than five years. Researchers are excited about ideas that have merit. Stridor in calm child. She has hardly 3 scientific papers. R. >25 per minute) is present · Heart failure or pleural effusion is present · More than one lobe is involved · There is poor response as out-patient · Patient is dehydrated · Secondary pneumonia is suspected. This is usually sufficient to stop bleeding - Apply ice or cold packs on the bridge of the nose. Paroxysmal hypercyanotic attacks ("blue" spells): Common during first 2 years of life vary in duration but rarely fatal. Since infertility results from female problems OR male problems, both partners should be prepared to undergo evaluation. Aggressive and excited. Assess those who require anti-venom: - start on intravenous drip - keep bitten part level with the heart - infuse polyvalent anti-venom in all patients with systemic symptoms and spreading local damage such as marked swelling - anti-venom is given as an intravenous infusion in normal saline. Antibiotics are indicated in the hand abscesses. Diagnosis is made on the basis of clinical history, physical and neurological examination. Examination under anaesthesia is undertaken for staging and biopsy of the lesion for confirmation by histology · Treatment is supportive, surgery and/or radiotherapy. Management · Incision and drainage under general anaesthesia (deroof by making a cruciate incision and excising the four triangles of skin. Do thoughts arise independently in my brain consciousness or body consciousness (transplant memory)? Trachoma with entropion and trichiasis 2(a). Owino, Psychiatrist, Mathari Mental Hospital Dr. Anal discharge is common in obese people. MODERATE PET Admit and manage in hospital as follows. I wonder which medical science you are talking about. First is myself, I used to teach martial arts, so naturally injuries are common with that. Mother should be discouraged from breastfeeding. Retained placental fragments or membranes A common complication in which there is delay in completion of the third stage of labour. Genital Ulcer Disease.......................................................46 2.10. Always check Vaccine Vial Monitor (VVM). You can absolutely have an unsound mind and a sound body. OF NORMAL POPULATION IN IGH ENDEMIC PARTS OF KENYA WILL HAVE POSITIVE SLIDE FOR MALARIA PARASITES WITHOUT SYMPTOMS AND SIGNS OF MALARIA. Management · Antibiotic therapy; as per culture/sensitivity results · Refer for surgical drainage, sequestrectomy and irrigation. Refer If · Surgery is required for operable cases. We take liberty and pride in knowing that we know these things are there and we study them and try to find solutions to their improper functioning. Candida (whitish) or aspergilla (blackish) or herpes zoster virus. Consider this possibility when evaluating a child with chronic cough. Admit if patient is too ill or DOTS cannot be ensured. NB: A negative slide does not necessarily rule out malaria. We can absolutely take credit when medicine cures the incurable, or even reduces suffering by managing the disease. Most patients with Type 1 need hospitalization and are best managed with divided doses of intermediate acting insulin 2/3 lente A. Clinical Features Polyuria. Patient Education · If further pregnancy is desired, investigate further as under habitual abortion · If further pregnancy is not desired, discuss and offer appropriate contraception. This includes bruises, burns, head injuries, fractures etc. ASYMPTOMATIC HYPERURICAEMIA Management · No drug treatment is needed · Weight reduction · Avoidance of alcohol · Avoid heavy consumption of purines, e.g. A haemorrhagic rash · Stridor (from infection of the larynx and trachea; laryngotracheitis) · Pneumonia, dehydration, or severe undernutrition · Great difficulty in drinking or eating. Review monthly after discharge. Toxic Goitre: - usually managed conservatively with anti-thyroid drugs (carbimazole, methimazole) propranolol and diazepam. They are facilitative, enabling and set a firm basis towards the attainment of equity in health care, developing rational use of drugs by all prescribers, dispensers and patients. Vulval inspection will reveal bluish bulging hymen. Fluctuation may be absent in deep abscess. These include:- Infections: These can be viral, bacterial or fungal e.g rhinitis, sinusitis, pharyngitis, glossitis, tonsillitis, laryngitis, parotitis, deep neck space cellulitis and abscesses, otitis externa, otitis media and labyrinthitis. Curative Services. Prominent dilated scalp veins. Hot humid weather and occlusive footwear are predisposing factors. Contaminated wounds - e.g. If histology confirms malignancy. Caution Avoid chronic use (over 30 days) of hypnotics. The infection spreads to other tissues crossing the midline and becomes bilateral swelling. G. E. Ombuya, Head, Pharmacy Department. K - 0.5 mg IM STAT Daily sub-dural taps (remove 10-15 ml of fluid from each side daily) Vit. See the Yoga article on this site for more details. Multiple Drug Resistant TB (MDR -TB) This is resistance to both rifampicin and isoniazid as a consequence of poor adherence to recommended treatment regimens by clinicians and patients. REFER TO DENTAL SURGEON. In general most will require to be treated in a referral hospital. Order! The patient has now resumed her studies as if she has totally recoveredfrom the ailment. APH is associated with increased foetal and maternal morbidity and mortality. POISONING.................................................................264 21. If patient is allergic to penicillin use erythromycin or cotrimoxazole). There may be a nagging or painful sensation in the groin. The cervical os is patulous, uterine cavity is empty and the uterus is well contracted. Benefits · Highly effective · Immediate return to fertility · Offer continuous, long-term protection · Reduce menstrual flow · Protect against endometrial cancer and ectopic pregnancy · Do not affect lactation. Incongruency of affect is characteristic. OR Erythromycin 500 mg QDS × 14 days. Your insistence of the Why question is not new. Or what is the reason for Down's syndrome or the fact that Rickets is caused by Vitamin D deficiency, or that Nyctalopia (Night blindnesss) is caused by Vitamin A deficiency? Patient was advised to try Nimbamrithadi Panchathiktham Kashayam, Chandraprabha vatika, Ayolipta thippali, Rasasindooram and combinationof Nityakalyani extract, Thippali choornam, Rajathabhasmam and Thalakabhasmam. Hence i hope you do not resort to using those words again for those diseases as medical tests can check the rate of healing for diseases like anaemia, cancer, etc, and easily validate the efficacy of drugs(Be it allopathic or ayurvedic). SCHISTOSOMIASIS Infection with blood flukes of the genus Schistosoma, which may cause chronic disease of intestines, liver, genito urinary tract. Choreoathetosis gives involuntary movements and abnormal posture. Refer to surgical text book. Pregnancy Podophyllin should not be used in pregnancy, neither in vagina, cervical, internal urethral, anal or oral warts. O thou Yaksha, lord of Alarka, who art also the lord of all dogs, speedily makest me free from the poison of the rabid dog that has bitten me. As you mention correctly self reported measures are integral measures of efficacy of therapeutic intervention especially in CNS related disorders such as depression, anxiety and migraine. Foreign Bodies in the Ears Types: Metallic pieces (hair clips, smooth pellets, needle, etc), wooden (e.g. Yes I can see it. ZIDOVUDINE 300 mg PO OD from 36-40 week gest. Clinical Features Throbbing continuous or intermittent toothache which is worse at night. Rhesus isoimmunization occurs in pregnancy where a Rhesus negative mother is pregnant with a Rhesus positive foetus. Attend to drains if in-situ and make sure they are draining · Maintain input and output chart (urine output 1-2 ml/kg/hour) · Offer general nursing care e.g. There is leucocytosis with neutrophilia. WHO CLASSIFICATION - ADULTS + ADOLESCENTS Clinical stage I - Asymptomatic - Persistent generalised lymphadenopathy Clinical stage II - Early (mild) Disease - Weight loss <10% body weight Minor skin infections Herpes Zoster Recurrent upper respiratory infections Clinical stage III - Intermediate (Moderate)- - Weight loss > 10% body weight, chronic diarrhoea, fever, oral Candida, TB, severe bacterial infections Clinical stage IV - Late (Severe Disease) - HIV wasting syndrome, CMV, pneumocystis carinii pneumonia, toxoplasmosis, Kaposi's sarcoma, HIV encephalopathy CHILDREN Major signs Weight loss or abnormally slow growth; Chronic diarrhoea - 1 month; Fever - 1 month Minor signs Generalised lymphadenopathy Oropharyngeal candidiasis Repeated common infections e.g. Heartburn may be a feature. The two should be working together, not separate. Just prove it by doing a study. Investigations · Lumber puncture and CSF examination · Blood slide for MPs · Exclusion of intoxication by history · If diarrhoea and vomiting: Urea & electrolytes. Asthma is an allergic, non-infectious condition, attacks can be triggered by respiratory infections, ingestion of some allergens, weather changes, emotional stress etc. Wheezing occurs when the air flow from the lungs is obstructed, due to narrowing of the small airways. Discuss with facts i.e. You are simply creating a canard as if EBSM promotes sedentary lifestyle and fatalistic hatred. Topical steroids and soothing agents (e.g. Management · Admit immediately · Hydration using intravenous fluids · Antibiotic therapy as above until the patient responds. Management · If more than 5% pneumothorax institute tube thoracostomy drainage (under-water seal drainage), maintain absolute sterility · Tube comes out when the lung remains expanded after clamping the chest tube for a number of hours · Tension pneumothorax needs more rapid management with a wide bore cannula drainage or underwater seal drainage under LA. Fine needle aspirate (FNA) for cytology. Retained second twin: - Perform abdominal a vaginal examination and assess: membranes; if intact rupture, lie and presentation, whether cervix oedematous - Look for evidence of foelal and maternal distress and manage accordingly - If assessment favourable then oxytocin and delivery - C/S if evaluation poor. Children with CHD or heart failure of uncertain origin. Respiratory Cough of more than 1 months duration, with or without shortness of breath caused by infection with lower tract organisms. Management - General · Clear the airway: - suction of excess secretions - nurse on the lateral position - introduce a mouth gag, plastic airway or spatula - administer oxygen through a nasal catheter - introduce an indwelling foley's catheter to monitor urine output and check for proteinuria - assess condition of mother and foetus. Condition exacerbated by HIV infection, obesity, stress, sunlight and drugs (systemic steroids, alcohol, chloroquine). Clinical Features Symmetrical peripheral polyarthritis mostly of small joints (warm, painful, stiff, swollen). If this regimen does not work, then deliver immediately. They are mainly abused by street children and the homeless. While the use of these guidelines will to some extent standardise the approach to rational drag use all health workers are encouraged to be aware and observe the existing national laws, regulations and guidelines that govern the registration, procurement, marketing prescribing and use of pharmaceuticals. Management · Indomethacin 75 mg orally STAT, then 50 mg QDS till 24 hours after relief, then 50 mg 8 hourly for 48 hours then 25 mg 8 hourly for 48 hours OR · Colchicine 0.5 mg hourly till patient improves or GIT side effects or maximum of 6 mg has been taken. It can be infective or allergic in origin. Heat room, mother's warmth · If hypoglycaemic give dextrose 50% 1 ml/kg IV STAT then 5% dextrose 2 ml/kg/hour · Update immunizations · Soak skin ulcers in Eusol solution · Mouth ulcers: clean mouth with normal saline (or salt water) and apply Gentian violet. OVARIAN CANCER Clinical Features Usually occurs in women of age 40 years and above. Most of the time, doctors are not sure of what they are doing. Penicillin Refers to narrow spectrum penicillin such as benzylpenicillin, procaine penicillin and phenoxymethylpenicillin. TB]. Pneumocystis carinii pneumonia is less frequent than in the western world. Decision on timing of delivery is made in consultation with the obstetrician. They then: · Dispatch the medical-incident officer to the scene · Establish whether mobile medical teams are required; collect the teams, ensure the members are properly clothed and equipped, and dispatch them to the scene · Establish a triage point · Clear the accident and emergency department of existing casualties and prepare for the reception of casualties · Inform theatres and outpatients that normal activities must be suspended: ask the intensive care unit to clear beds if possible · Designate a ward for the reception of admitted casualties and start emptying it of existing patients · Organize staff as they arrive · Arrange facilities for the police, relatives, and the media TRIAGE ACTIVITIES Medical, nursing and administrative coordinators meet and establish the control centre. Opportunistic infections and other manifestations Opportunistic infections respond to conventional treatments though they may require a longer course or higher dose of treatment than in HIV negative patients. Indications · Intrauterine foetal death from any cause · Prolonged gestation (post-dates, 41 weeks and above) · Diabetes mellitus · Pre-eclampsia and eclampsia · Rhesus isoimmunisation. NEOPLASMS (10-20% in children) · Lymphomas These are the commonest among the neoplastic causes of PUO. WHEN SHOULD CHANGE OF DRUGS OCCUR? Rhonchi arc often difficult to distinguish from transmitted upper airway sound.
Prevention · Avoid contact with contaminated water · Mass chemoprophylaxis in school age in endemic areas · Environmental hygiene - use of toilets · Eradication of intermediate hosts (snails). BDS 14 days. The patient get cured only due to placebo effect. Once rupture of the uterus has been ruled out then treatment for abruptio placentae should be instituted. Others · Transposition of the great vessels · Truncus arteriosus (associated VSD is always present) · Eisenmenger syndrome · Hypoplastic left heart syndrome · For details consult standard paediatrics text. It is commonly associated with acute urinary tract infection in young girls and may be associated with other pelvic tumours in older women. Refer · For long term psychological and psychiatric care. You cannot know unless you do a study. Impaired hearing neuron type Important to detect. Start an IV line of 500 mls 5% dextrose. Investigations · Hb, PCV · Blood slide: peripheral blood film for identification of parasites. We know why Cholera happens. If travel is not avoidable they should take special precautions in order to prevent being bitten such as using mosquito repellents and an insecticide treated bednet. Seizures are result of excessive electric impulses discharge of cerebral neurones. Chloramphenicol Oral absorption is excellent and peak plasma levels are reached at the same time whether given intravenously or orally. ENT Manifestations of HIV/AIDS Forty percent of AIDS patients present with otolaryngological symptoms. Indications for surgery Toxic goitre · Failure to control symptoms despite adequate treatment with drugs · Young subjects · Adverse reaction to drugs · Cosmetic. And there is one Deepak Chopra [Modern Yajnavalkya] who mixes some few catch words from Quantum Physics with spiritual jargon and declares that You are Iternity in his books, and laughs all the way to his Banks. Start empirically on: Crystalline penicillin 4 mega units IV QDS + gentamicin 80 mg IV 8 hrly + metronidazole 500 mg IV 8 hrly or 1 gm suppositories or tablets rectally 8 hrly. IM STAT followed by - oral amoxycillin SO mg/kg/24 hrs in 3 divided doses for 5 days - instill gentamicin ear drops or 2% acetic acid ear drops. Aetiology The commonest causes of PPH are: Uterine atony Failure of adequate contraction and retraction of uterus after delivery associated with: · Prolonged labour · Precipitate labour · Over-distension of the uterus by e.g. Also suppresses ovulation and inhibits implantation of fertilised ovum. Hesitancy. Suprapubic pain. Diarrhoeal illness is classified for dehydration, dysentery and persistent diarrhoea. online (etc) Continue antibiotics for entire period. FEBRILE CONVULSIONS This diagnosis should be made by exclusion of all other causes of convulsions. Clinical Features · Productive cough without cyanosis, chest indrawing, wheezing, or fast breathing. Investigations · X-ray: Intraoral. It may be associated with nausea, vomiting and/or diarrhoea or constipation. Most infections are due to Staphylococcus aureus and cloxacillin 500 mg QDS for 1 week is appropriate. Jik), for 30 minutes, all soiled bed linen and clothing before general washing · Wearing of gloves and taking care in all situations involving direct exposure to blood and body fluids e.g. Cleansing procedures are quackery. It is essentially a consequence of STI (Gonorrhoea and Chlamydia trachomatis), but can follow puerperal sepsis or abortion. Orbital Cellulitis This is a medical emergency. Management · Control scaling by 2% salicylic acid in olive oil · Shampoos containing selenium sulfide, sulfur and salicylic acid, or tar shampoos daily till dandruff is controlled (more recently ketaconazole shampoo is excellent) · Topical steroids - use mild lotion (e.g. Can be suppurative and could lead to necrotic pulp. One is the epistemological base, its theories etc. Aspirin and statins are used to prevent further heart attacks and are generally prescribed for 3 years or more depending on the severity, stenting, surgery etc. In penicillin allergy use: Tetracycline capsules 500 mg QDS × 15 days. F. O. Othero, Ophthalmologist, MOH Kisumu Dr.
The victory over infectious disease is a major one. MICRO NUTRIENTS DEFICIENCY Iron The commonest sign of iron deficiency is anaemia (see 17.1. Pharmacologic Antibiotics - Paediatrics Give penicillin + chloramphenicol as follows: · Benzyl (crystalline) penicillin; Under 1 year of age: 100,000 units/Kg IV STAT, then 250,000 units/Kg/24 hrs IV in 4 divided doses 1-6 years of age: 1,200,000 units IV STAT then 2,500,000-5,000,000 units per 24 hrs IV in 4 divided doses 7-12 years of age: 2,400,000 units IV STAT, then 5,000,000-10,000,000 units per 24 hrs in 4 divided doses · Chloramphenicol; - Up to one month of age: 25 mg/Kg IV STAT, then 50 mg/Kg 24 hrs in 4 divided doses - Over one month of age: 50 mg/Kg IV STAT, then 100-150 mg/Kg 24 hrs in 4 divided doses. The evidence in this case is bad. B. proteus and E. These patients are insulinopenic and require insulin to sustain life. If no response IV aminophylline 6 mg/kg slowly over 15 minutes, and then 0.9 mg/kg/hr. HEAD AND NECK CANCERS Majority present with neck mass(es) or cervical lymphadenopathy. SUICIDE ATTEMPTS Unsuccessful attempt by one to end one's life. What was their success rate, in comparison? B. K. Njue, Deputy Chief Pharmacist Dr. Normal association of ideas is lost. Enter your mobile number or email address below and we'll send you a link to download the free Kindle App. Following oesophageal perforation and procedures and penetrating chest injuries. Do you realize what you have just said? Client Education · May be associated with heavy menses, amenorrhoea or spotting · Regular administration as required · Return to the clinic as scheduled to continue using this method · Return to the clinic if you suspect pregnancy, dizziness, heavy bleeding. Anaemia and mild jaundice · Hepatosplenomegaly in young children · Bone pain (especially long bones in children) · Pain and swelling of the hands and feet (hand and foot syndrome) · Arthralgia with fever may occur · Avascular necrosis of the femoral head is common · Severe abdominal pain with vomiting · Occlusion of major intracranial vessels may lead to hemiplegia. TDS for five days · Analgesics and/or anti-inflammatory e.g. When blood glucose level is between 8.3-11.0 mmol/L change to an intermediate acting insulin. Feed sick children at least one extra meal per day and continue for 1-2 weeks after they recover. J. K. Kimitei, CO, Malaria Control Programme, MOH Dr. TRAUMATIC WOUNDS S. Humidification of the gases/air and frequent suction through the tube must be done. Clinical Features Pain in retrosternal area and/or in the back, dysphagia, pooling of saliva in the mouth, regurgitation of food, dyspnoea and hoarseness if there is laryngeal oedema from compression by the foreign body and localized tenderness in the lower part of the neck. Neoplasms · Trauma · [see neurosurgical text books for details]. Jaundice Chest symptoms Squamous cell ca. It may also occur secondarily in response to severe or chronic joint injury (e.g. Related abnormalities Visual defects: strabism. Non-immune pregnant women should be advised not to visit a malarious area. Nerve stretching of C7, C8 and T1. Can you name just one? The liver size should be described as centimetres below costal margin and below xiphisternum. Tracheostomy............................................................83 7. Investigations · Skull X-ray is useful · CT scan where possible. Management · Warm saline mouth-washes or any other available mouth washes · Give metronidazole 7.5 mg/kg TDS combined with amoxycillin 12.5 mg/kg QDS for 5-7 days · Improve nutritional condition. N. A. Kimathi, Paediatrics, KNDPIP/WHO, Nairobi Dr. Minor reactions include, pain at the site of injection and fever. Brief duration (always less than 15 minutes). Awareness only helps us to act Proactively from dangerous life threatening situations like say Green House Effect which is closing in! Evidence of chest trauma. It becomes easier to communicate the results and the patient/client is able to contain the news. In another incidence, I went to a doctor for minor stomach pain. Eye injuries include: Corneal and conjunctival foreign bodies and abrasions, burns (dry heat and chemical burns), blunt trauma (contusions), penetrating injuries to the eyeball (perforations), injuries to the eyelids, orbital injuries and cranial nerve injuries. Individual infections are discussed in their respective sections. Refer If · Seizures not controlled with maximum drug dose · Raised intracranial pressure is suspected. If tests normal, treat as idiopathic splenomegaly syndrome, proguanil 50 mg daily below 3 yrs, 100 mg in older children for ½ yr or until spleen is definitely smaller. It is not filled with wisdom as you think. This may however be negative in a woman from endemic areas, despite placental parasitisation. Predominantly haemorrhagic venom. Instrumental delivery may cause perforation of the vagina and rectum; Operative injury A fistula may be caused during total abdominal hysterectomy and Caesarian section; Extension of Disease Malignancy of the bowel or any pelvic abscess may perforate into the rectum and posterior vaginal wall; Radiotherapy Heavy radiation of the pelvis causes ischaemic necrosis of the bladder wall and bowel causing urinary or faecal fistula. B. Njue, Deputy Chief Pharmacist, MOH Dr. OR Cotrimoxazole 2 tablets twice daily × 10 days. Search the history of over 505 billion pages on the Internet. search Search the Wayback Machine TYPE 2 DIABETES MELLITUS · Manage as out-patient preferably in the hospital's diabetic clinic or medical clinic · Consult hospital nutritionist for dietary modification. Pruritus is the cardinal feature of eczema and the constant scratching leads to a vicious cycle of itch-scratch-rash-itch. Allopathy only prescribes the medicine for a particular disease after it occurs in an individual. HIV Testing & Patient Education · Pre-test counselling Before an individual is screened for HIV he/she should be counselled and consent sought. Why we can't do it someday is the question.. It is an infiltration into the dermo-epidemial junction by mono-nuclear cells leading to vesicle, generally found in the extremities, palms and soles in the mild form of disease. Transillumination is positive later. Free tutorials! Scientific Medicine is executed by data, not experience. Transmission from carrier mothers can occur in up to 80% of babies during the perinatal period, the risk being higher in HBsAg. It is science that taught us about the grandeur of the universe. DEEP NECK INFECTIONS These are infections (cellulitis or abscesses) in the potential spaces around the neck e.g. When the cervix opens, passage of the typical grape-like vesicles confirms the diagnosis. It would be better if the detractors actually went and looked at the medical reports before writing such inflammatory articles. Management · Antibiotics; amoxycillin-clavulanate 625 mg BD or crystalline penicillin 1 mega unit QDS for 7 days to prevent gas gangrene + metronidazole 500 mg TDS 7 days · Evacuation of the uterus as in incomplete abortion · In case complicated with disseminated intravascular coagulopathy (DIC) fresh blood transfusion is life-saving. In Aristotle's times, people wanted to know why things fell down and came up with silly answers. OR Sulphamethoxazole 1 g orally BD x 14 days. Maintain nutrition It has been shown that there is no physiological reason for discontinuing food during bouts of diarrhoea and that continued nutrition is beneficial to both adults and children. If you are having a heart attack, you will be an idiot to seek the help of even the best ayurveda practitioner, but there are chronic illnesses that respond to ayurvedic treatments. Complications Increased risk of anaemia if heavy bleeding occurs, perforation (rare) and increased risk of PID and associated infertility, especially within four months of insertion and in women at risk of STDs. The patient may be: ill looking, not appreciating surroundings, not alert. PET]. NOTE Imminent eclampsia is managed as eclampsia; prophylactic antibiotics IM amoxycillin 500 mg QDS to be given. Clinical Features These are varied, but any swelling of unknown aetiology or change in normal epithelial colouration should be viewed with suspicion. Apgar score 3-4 heartbeat below 100/minute; - clear the air way - ventilation by bag and mask, pressure 20-25 cm of water at a rate of 30 breaths per minute. Causes Hepatomegaly INFECTIONS Malaria Kala Azar Schistosomiasis Infectious hepatitis Amoebic hepatitis/abscess Brucellosis Splenomegaly Malaria/tropical splenomegaly HIV Kala Azar Schistosomiasis Infectious hepatitis Brucellosis Other infections; like SBE, typhoid fever, infectious mononucleosis Haemolytic anaemia e.g. Look for severe malnutrition. As soon as a slowing growth is detected action must be taken. However, I tried gurgling with salt water and G-32 (an Ayurvedic medicine). This is also the first time I am hearing about Ayurvedic claims regarding Paclitaxel. PID, fibroids and associated infertility. This should be detected during the routine examination of a newborn. Management - Post Resuscitation Care · Treat cause of collapse · Monitor and regulate arterial pressure. Infertility is usually defined as the failure to conceive after one year of sexual intercourse without contraception. Management - General Dietary Modification is important in both types 1 & 2. Most normal labours are completed by 12 hours. Make child and parents know that normal life is expected. CANNABIS DEPENDENCE Chronic users may develop psychosis, anxiety, mood disorders and a withdrawal state. Management · Viral parotitis may not require more than analgesics and bed rest. But good news is in future by integrating herbal medicine, modern medicine and genomics, we can identify the pathways misregulated in a tumor of given individual and if the tumor has misregulated pathways that can be modulated by herbal medicine, treat the patient with herbal medicne also. Anaphylaxis & Cardiac Arrest..................................................7 1.2. Establish an effective control centre stalled by Senior Medical, Nursing and administrative coordinators with appropriate support staff. Even now too, I am practicing. Clinical Features Pain, stiffness, immobility and "cracking" of the joints. He advises against such interventions and calls them commercially motivated. Clinical Features History of Rheumatic fever in childhood, known Rheumatic Heart Disease, dyspnoea. In this case continue to express milk). Investigations · Pus swab for C& S is essential. Cellulitis (Oral) Inflammation of floor of the mouth and other related structures - in this category the most important is Ludwig's angina. For the mind or parachute to function.. A delayed suture is advised 4-7 days after a bite · Update tetanus immunisation · Amoxycillin 500 mg TDS (25-50 mg/kg) · Rabies vaccine should be given in appropriate cases · Large bites require surgical toileting under anaesthesia. Clinical Features Irregular foetal heart: Foetal bradycardia or tachycardia (normal foetal heart; 120-140/min). Presents as bullous lesions which rupture and crust on the face. These have been the basis for the rural health drug supply kits and for Continuing Education programmes for health workers at this level. The affected joint starts to discharge pus spontaneously · Shortening of the limb occurs · There is persistent deformity of the joint · Loss of function related to the infection. TYPE 2. DM patients are obese, for these caloric restriction of 15-20 Kcal/kg body weight is recommended. In addition, they should take chemoprophylaxis of either daily proguanil (e.g. Counselling should be done · HIV positive patients need to know: - they can transmit the infection to their sexual partner(s), baby in utero (if the patient is/or becomes pregnant) - their health can deteriorate faster if they acquire other infections including STIs - their health can deteriorate faster if they have some life-styles like excessive intake of alcohol, smoking, poor nutrition, multiplicity of sexual partners - condoms, as generally used, are roughly 70-80% effective in preventing acquisition and transmission of HIV and other STIs. If the gas shadow is above the line, the abnormality is high. The first edition of the Clinical Guidelines for the Diagnosis and Treatment of Common Hospital Conditions in Kenya responded adequately to the felt needs by Kenyan health workers for a concise, easy-to-carry and easy-to-consult pocket manual that gives clear diagnosis and treatment guidelines as well as optimal dosage protocols. Below is a rough guide: NEUROTOXIC BILIRUBIN LEVELS Birth weight? OR Doxycycline 200 mg STAT followed by 100 mg daily × 7 days. Arthralgia. Diagnosis 2 major and 1 minor or 1 major and 2 minor manifestations. Judge with great caution. Head injuries: Require setting of baseline observations · A patient in shock from non-obvious causes point towards the abdomen: visceral injuries can be very unapparent but could be fatal · Peripheral bone fracture; may need stabilization initially and proper attention later · After resuscitation and stabilization; patient will require frequent and more thorough examinations · Attention should be paid towards: Continued bleeding - stopping it and transfusion: haemopneumothorax may need tube thoracostomy drainage (under water seal drainage); persistent shock from unexplained source may necessitate an exploratory laparotomy; limb fractures may need Plaster of Paris fixation; spine fractures - bed rest with fracture boards; X-rays of the patient with multiple injuries should be taken after adequate resuscitation. Historical risk factors include: Previous gestational diabetes, family history of diabetes, previous macrosomic infant, previous unexplained still birth, polyhydramnios, obesity, advanced maternal age. AIDS risk in blood transfusion: use screened blood only and sparingly [see 17.2. This is a reiteration of an earlier comment where too it was acknowledged that we are ostensibly on the same page. I just went to Ayurvedic vaidyar; he gave one kashayam and one medicine to apply on my toe. Don't assume. Electrical burns; are deep burns, and will require specialised care · Chemical burns; clean with plenty of water and soap. Types: Animate (e.g.
And yet, he says he is constantly claimed by atheists. EMERGENCY CONTRACEPTIVES Emergency contraceptives reduce the occurrence of pregnancy in unprotected intercourse from 8% to 2% (75% protection). Neonatal death. CARE OF THE NORMAL NEWBORN........................................166 15.3. Un explained visual loss. Descent assessed by abdominal palpation, noting the number of fifths of the head felt above the pelvic brim. Blood can safely be stored for 21 days. So where does he stand? The uterine size is larger than gestational age. I also agree with you that modern medicine and traditional medicine like Ayurveda have to complement each other. Secondary amenorrhoea refers to cessation of the periods after menstruation has been established. History and physical examination to establish if ever depressed in past. Mental and physical retardation. There will be a deficiency of salts if there is reduced intake (post operative patients) or extra loss such as excess sweating or GIT losses (diarrhoea and vomiting). Clinical Features A "barking" often spasmodic cough (following a URTI) and hoarseness may mark the onset of respiratory stridor commonly at night. He is not a world-renowned doctor. Give oxygen if child is in respiratory distress OR is cyanotic. Tracheostomy An artificial opening into the trachea through the neck in order to by pass an obstruction of the airway and/or to provide access to the lower airway facilitating ventilatory support. Sexual assault (rape) is a violent crime directed predominantly against women. Clinical Features Prolonged jaundice, feeding difficulty, lethargy and somnolence, apnoeic attacks, constipation, large abdomen, umbilical hernia, macroglossia, failure to thrive, delayed physical and mental development. Orthopnoea, fatigue, exercise intolerance, and basal crepitations. Complications Injury to other organs (e.g. Click here! Also found in immuno- compromised adults and in renal failure. Pain, anaemia, cachexia are late presenting features. Many ayurvedic medicines have elaborate and tough processing techniques and many if not all can be considered to be the best of its kind with the herbs used in it. ANTIMALARIAL: If cerebral malaria is suspected · Treat fever, if present · Give supportive care · Reassess twice daily. Stool frequently streaked with fresh blood · Discharge - a slight discharge is found in chronic cases · Sentinel tag is usually demonstrated, with a tightly closed puckered anus. Clinical Features Tenderness of the tooth when tapped. PRETERM INFANT An infant who has not finished 37 weeks of intrauterine life. Prevention · Immunisation Measles immunisations is given to babies who are 9 months or above irrespective of whether they have suffered from measles/measles like illness. The Essential Drugs List (EDL) has been revised, obsolete drugs deleted and new ones added as appropriate. Endocarditis prophylaxis - In addition to rheumatic fever prophylaxis: · Dental procedures: Amoxycillin 3.0 gm PO 2 hrs before procedure and 1.5 gm PO 6 hours after the initial dose · If penicillin allergy - Erythromycin 1 gm PO 2 hrs before procedure then half the dose 6 hours after the initial dose · Lower gastrointestinal and genitourinary procedures: Amoxycillin 2 gm IM 30 minutes before procedure and 6 hrs after the initial dose + gentamicin 1.5 mg/kg IM 30 minutes before procedure and 8 hrs after the initial dose. The child knows someone must have written those books. Secure a patent airway. UNILATERAL PURULENT NASAL DISCHARGE IN CHILDREN SHOULD BE REGARDED AS DUE TO FOREIGN BODY UNTIL PROVED OTHERWISE: examine the nose carefully, do anterior rhinoscopy, probe the nasal cavity carefully. Yes, but not preferred Immediate on method. Gradual adjustment of insulin dosage by 5 units are essential when blood glucose are near the desired range. Clinical Features Persistent seropurulent discharge, periodic pain, pouting openings in the neighbourhood of anal verge. Extramural (outside the walls) include choledochal cysts enlarged lymph nodes of any cause, and carcinoma of the pancreas · Other causes include congenital biliary atresia, iatrogenic trauma to the ducts during surgery (especially cholecystectomy), and strictures after cholangitis and cholecystitis. Mostly twin pregnancy but others may be encountered, triplets, etc and these may be associated with use of fertility drugs. Management · Treat the primary disease e.g. I understand you think this is critical thinking. CAESAREAN SECTION (C/S) When properly applied C/S is an important operation in reducing maternal and perinatal mortality and morbidity. Let's restate what you have said, shall we? Refer If · Increase in size of the goitre · Suspicion of malignancy · Pressure symptoms · Large goitres for cosmetic reasons · Thyrotoxic patients who fail to respond to medical treatment · Goitres in children and male adults. Hypertension..............................................................54 3.5. That is 98% of all species living on earth are unknown to us. CIRCULATION Carry out external cardiac massage (compressions) by applying appropriate pressure over the sternum. We just trusted our mother's words..that's called faith! Consequences of deficiency: Reduced immunity, keratinizing metaplasia of epithelial membranes, xerophthalmia, night blindness, keratomalacia and blindness. So let's get data and let it speak. It carries a high foetal mortality and maternal morbidity and mortality if undiagnosed or poorly managed. Tachypnoea and tachycardia. Scientists take them with a pinch of salt, even when surveys are designed by a rigorous methodology and validation. However, the comments made on phlegms etc.relating to ayurveda was sad to read.. Let's hope saner sense prevails among us. Coley is considered the Father of Immunotherapy. N. Chiuri, Production Manager. It was bit interesting to go through some comments and reply over here. Other animals (hippos and crocodiles) inflict major tissue destruction (lacerations, avulsions and amputation). The following are good examples of messages that can be given to mothers if their child's growth starts to slow down. S. university of the placebo-based RCTs did show that the contents of the placebo capsule, which need not legally be made known to the regulating agencies like the FDA, were very potent substances that would show the company drug as very effective in comparison. Surgical Complications intestinal perforation leading to peritonitis, septicaemia. Lacerations or tears of the birth canal · Can be cervical, vaginal or vulvoperineal. W. O. Wanyanga, Cosmos Ltd. Good history and physical examination is important in diagnosis. INTESTINAL OBSTRUCTION Clinical Features In infants suspect bowel obstruction if; No meconium is evacuated within the first 24 hrs of birth, green or bilious vomiting, abdominal distension. Management · Treat associated pelvic inflammatory disease · Correct any anaemia associated with menorrhagia by haematinics or blood transfusion · Where fertility is desired plan myomectomy and where obstetric career is complete, plan hysterectomy with conservation of one ovary in women under 45 years of age. Symptoms include pain and flaccid paralysis in limbs, fever, vomiting; can lead to permanent deformity and can cause death. Daily salt intake is 50-90 mEq (3-5 g) of sodium chloride, potassium is approximately 50-100 mEq daily. Classical indications · major depressive disorder; - psychosis - suicidal attempts - stupor · Schizophrenic stupor · Bipolar mood disorder (manic episode) refractory to pharmacotherapy. NOT getting a regular health checkup is definitely more dangerous than getting one regularly. BIPOLAR MOOD DISORDER (MANIC EPISODE)..............................157. Complications Studies to date have shown no serious long-term complications. The lungs may be ruptured during resuscitation causing pneumothorax and surgical emphysema. Rubella, OPV, Measles and BCG), inactivated or killed (e.g. Presentation: Appear as white, milk-like, removable plaques on the oral mucosa. Alternate stitches are removed on the sixth day and all stitches on the seventh day. Buboes or Swollen Inguinal Glands...........................................48 2.11. Clinical Features Overt diabetes If not already diagnosed the symptoms include: polydipsia, polyuria, weight loss, blurred vision, lethargy. More often a single injection will suffice. Often the attempted suicide itself is the first symptom. PMO's Office. Deep suprasternal, supraclavicular, intercostal and subcostal inspiratory retractions. Pulmonary hypertension may develop as a result of high pulmonary blood flow. Physical examination reveals prominence of the left precordium, cardiomegaly, a palpable parasternal lift and a systolic thrill. General relativity may have superceded Newtonian physics, BUT for basic purposes and practical ease, Newtonian physics is still good enough unless you want to pick on the nitty gritties. At the same time urgent blood for group and cross-match, Hb, white cell count, blood cultures · Blood transfusion if necessary · Keep patient warm · Arrange for infant care in nursery or by relatives · Evacuation of uterus for any remaining placental tissue or membranes. Make note of condition of the other tube and ovary in the record and discharge summary · Where experienced gynaecologist is available, conservative management of affected tube should be attempted · Discharge on haematinics · Review in outpatient gynaecology clinic to offer contraceptives or evaluate further sub- fertility status. Health professionals owe it to Kenyans and the world at large to eliminate the existing practice of making nearly all drugs available (with or without prescription) often on considerations that are non-medical: and unethical. VENTILATION Inflate lungs with air or oxygen by mouth-to-mouth OR mouth-to-nose insufflation OR by bag and mask devices, (ensure thoracoabdominal motion).
Take a pus swab for culture and sensitivity). WBC counts, ESR, serum protein, HIV antibodies, etc. Usually presents late with mass in lower abdomen. Free thinking is irrational. Palms and soles involvement - thickening and fissuring. Genital Discharge in the Female Causes of vaginal discharge include Candida vulvovaginitis (monilia or thrush), trichomonas vaginitis, and bacterial vaginosis. Investigations · Sputum for AAFB. Presentation is shown in the table below) Type Percentage RhF ANF HLA B27 Presentation High fever, rash, splenomegaly, generalized Systemic disease 20% -ve -ve Pauciarticular (JRA) 40% -ve 75% +/-+ve/-ve Type I: mainly male -ve As for adult rheumatoid arthritis. Insert a soft neonatal nasogastric tube through the mouth. Refer patients. Chronic Renal Failure.....................................................326 25.6. Foetal condition is monitored by the foetal heart sounds and the colour of liquor. Management Re-assure the patient that it is a temporary thing and that there is no irreversible damage. Monitor blood pressure during infusion, titrate dose according to response. Kwashiorkor could result from neglect of the child or real feeding problem. These issues do need to be faced. If patient is vomiting ampicillin 500 mg IM QDS then change to oral therapy for 10 days. India. Else, I'd be talking Elephant power: -). Suppression of ovulation. Re-implant under local anaesthesia and give gauze pack for biting on while a dental surgeon is contacted for fixation · All suspected fractures to a dental surgeon/maxillofacial surgeon. company. MOLAR ABORTION Clinical Features A mole usually presents as a threatened or incomplete abortion. Trauma Oral and maxillofacial trauma may result in the following: · Fractures of the teeth and alveolar bone · Fractures of the maxilla, mandible orbit and nose · Contusions, lacerations and cuts of soft tissues in general, the trauma varies in severity and may be associated with a variety of complications · Severe haemorrhage · Airway obstruction · Trauma to the eye · Injury to intracranial structures · Injuries to the cervical spine · Contamination and/or infection of tissues · Varying degrees of deformity and interference with the function(s) of the injured structure/organ. Foetal heart rates at two different areas with a difference of 15 beats per minute. If no response consider TB. Is this a paradox or have I stopped free thinking? D. Ilako, Ophthalmologist, UON Dr. Other features are vaginal soreness, dyspareunia and post-coital spotting. Organomegaly makes the involved organs vulnerable to abdominal trauma. Injectable Methods · Women of proven fertility · Breast-feeding mothers after 6 weeks post partum · Women who want long-term contraception · Women who want at least 2 years between pregnancies Implants · Women with 2+ children needing long-term protection · Breast-feeding mothers after 6 weeks post partum · (Long term highly effective contraception) · Women who have their desired family size but do not want permanent surgical contraception Intrauterine Devices · Women who have delivered 1 or more times · Breast-feeding mothers · Women who want long-term contraception · Women in a stable monogamous sexual relationship · Women after 6 weeks post-partum; before 6 weeks if provider has specialised IUD insertion training. Tower shaped ("bossing") skull. Overdose refers to excessive amounts of a substance or drug normally intended for therapeutic use. Cellulitis (Oral).............................................................69 5.5. Antidiabetic activity of a polyherbal formulation The herbal formulation, Table 1⎯Composition of polyherbal formulation Occurs at rest and is associated with pallor, sweating, arrhythmias, pulmonary edema and hypotension. Remember to consult in this very dire emergency. Is this what we are looking for? Patients may present also with congestive cardiac failure. The parents must be assured that the results of operation are good. There is anorexia and nausea.
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