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By D. Mojok. Stanford University. 2018.

Transmission The natural reservoir of the virus is unknown buy 75mg viagra mastercard, the manner in which the virus first appears in a human at the start of an outbreak has not been determined discount viagra 25 mg overnight delivery. Researchers have hypothesized that the first patient becomes infected through contact with an infected animal cheap 25mg viagra visa. After the first case-patient in an outbreak setting is infected buy viagra 25mg amex, the virus can be transmitted in several ways: – Direct contact with blood or other secretions of an infected person (blood purchase viagra 50 mg without a prescription, secretions, organs or other bodily fluids) – Exposure to Ebola virus through contact with objects, such as needles, that has been contaminated with infected secretions. Signs and symptoms start with sudden onset of fever, intense weakness, muscle pain, Headache and Sore throat. These symptoms are followed by vomiting, diarrhea, rash, impaired kidney and liver functions. In some cases; rash, red eyes, hiccups, both internal and external bleeding can occur. Treatment There is no specific treatment, cure, or vaccine for Marburg Hemorrhagic fever. These include: o Fluid and Electrolyte balancing o Maintaining oxygen status o Blood transfusion and clotting factors o Treat for any complicating infections. It is related to Ebola virus and a parent type belongs to Viral Hemorrhagic fevers of Filoviridae family. Mode of transmission How the animal host first transmits Marburg virus to humans is unknown. However, humans who become ill with Marburg hemorrhagic fever virus may spread virus to other people. For example, persons who have handled infected monkeys and have come in direct contact with their fluids or cell cultures have become infected. Spread of the virus between humans has occurred in a setting of close contact, often in a hospital. Droplets of body fluids, or direct contact with persons, equipment, or other objects contaminated with infectious blood or tissues are all highly suspect as sources of disease. Transmission through infected semen can occur up to seven weeks after clinical recovery. Signs and symptoms are into two phases: Phase One: Sudden onset of fever, chills, headache and myalgia. Phase Two: Maculopapular rashes, Trunk rash, Nausea, Vomiting, Sore throat, Abdominal pain, Diarrhea, Jaundice, Pancreas inflammation, Severe weight loss Liver failure, Massive hemorrhage (all orifices), Multi-organ dysfunction, Delirium, Shock, and Death. These include: 353 | P a g e o Fluid and Electrolyte balancing o Maintaining oxygen status o Blood transfusion and clotting factors o Treat for any complicating infections. Transmission to human is mainly through direct or indirect contact with blood or organs of infected animals. The virus can be transmitted to human through the handling of animal tissue during slaughtering or butchering, assisting with animal births, conducting veterinary procedures. Human become viraemic; capable of infecting mosquitoes shortly before onset of fever and for the first 3–5 days of illness. Signs and symptoms are Influenza like illnesses: sudden onset of fevers, headache, myalgia, backache neck stiffness photophobia and vomiting. Most human cases are relatively mild small proportion develop a much more severe disease. Symptoms last from 4-7 days after which the immune response to infection becomes detectable with appearance of IgM and IgG. Most of human cases are relatively mild and of short duration so will not require any specific treatment. Though many cases of yellow fever are mild and self-limiting, the disease can also be a life threatening causing hemorrhagic fever and hepatitis. It is endemic in equatorial Africa and South America, with estimated 200,000 cases and 30,000 deaths annually. Overall case-fatality rate in Africa 23% Incubation period of 2-6 days and human become viremic - capable of infecting mosquitoes, shortly before onset of fever and for the first 3–5 days of illness. Once infected, mosquitoes remain so for life Treatment, prevention and control No specific anti-viral treatment, supportive therapies are recommended. Prevention and Control involve mosquito control and provision of yellow fever vaccine. Indication for Yellow fever vaccine: • persons ≥ 9 months of age – Planning travel to or residence in an endemic area – Planning travel to a country with an entry requirement • Needs to be given ≥ 10 days prior to arrival in endemic area • Revaccination at 10 year intervals 6. Table 2: The schedule for immunization for children is as follow: Age Vaccine Type of vaccine/state Disease Remarks (dose, Protection prevented site and route) Birth 1. Pentavalent Liquid Hepatitis B (Left thigh) Haemophilus influenza type b infections 3 Months 1.

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Comparison of effectiveness venereum proctocolitis: a silent endemic disease in men who have sex of 1 dose versus 3 doses of benzathine penicillin in treatment of with men in industrialised countries cheap viagra 100mg free shipping. Lymphogranuloma retreatment of serofast early syphilis patients with benzathine penicillin buy viagra 100mg overnight delivery. Recommendations for the with benzathine penicillin for the treatment of early syphilis order 100 mg viagra. Clin Infect laboratory-based detection of Chlamydia trachomatis and Neisseria Dis 2006 cheap 50mg viagra;42:e45–e9 generic 75mg viagra amex. Laboratory diagnostic response to doxycycline/tetracycline versus benzathine penicillin. Am testing for Treponema pallidum, Expert Consultation Meeting J Med 2008;121:903–8. Syphilis testing algorithms using treponemal tests for initial trial of azithromycin versus benzathine penicillin for treatment of early screening--four laboratories, New York City, 2005-2006. Discordant results from reverse sequence syphilis screening—five Treponema pallidum in the United States and Ireland. Screening for syphilis with the syphilis infection: San Francisco, California, 2000-2004. Clin Infect treponemal immunoassay: analysis of discordant serology results and Dis 2006;42:337–45. Evaluation of an point mutation and molecular subtypes in Treponema pallidum in the IgM/IgG sensitive enzyme immunoassay and the utility of index values United States, 2007 to 2009. Response of latent syphilis penicillin concentrations after single doses of benzathine and or neurosyphilis to ceftriaxone therapy in persons infected with human benethamine penicillins in young and old people. Penicillin patients with asymptomatic syphilis to intensive intramuscular concentrations in serum following weekly injections of benzathine therapy with ceftriaxone or procaine penicillin. State laws regarding prenatal blood and spinal fluid after a single intramuscular injection of penicillin syphilis screening in the United States. Global estimates of syphilis in administration of benzathine penicillin G in pregnancy. Obstet Gynecol pregnancy and associated adverse outcomes: analysis of multinational 1993;82:338–42. Treatment of syphilis and clinical abnormalities after treatment of neurosyphilis. Maternal and congenital syphilis in therapy for asymptomatic neurosyphilis: case report and Western blot Shanghai, China, 2002 to 2006. Int J Infect Dis 2010;14(Suppl analysis of serum and cerebrospinal fluid IgG response to therapy. Sex improve screening for syphilis in pregnancy: a systematic review and Transm Infect 2003;79:415–6. Fetal syphilis: clinical and cephalosporins in pediatric patients with a history of penicillin allergy. Obstet Gynecol reactions to cephalosporins in penicillin allergy patients with 1990;75(3 Pt 1):375–80. Prevalence and characteristics of reported penicillin penicillin-allergic patients: a meta-analysis. Clinical experience with penicillin syphilis in 2 patients coinfected with human immunodeficiency virus. Annals Asthma Allergy Immunol ceftriaxone and penicillin G as treatment agents for neurosyphilis in 2006;97:169–74. Recalibrating the gram stain diagnosis Institute of Allergy and Infectious Diseases Collaborative Clinical of male urethritis in the era of nucleic acid amplification testing. Sex Trial to test the predictive value of skin testing with major and Transm Dis 2012;39:18–20. Sex Transm Dis guideline for penicillin skin testing improves the appropriateness of 2005;32:630–4. Safety and effectiveness of a chlamydia and gonorrhea among females: a systematic review of the preoperative allergy clinic in decreasing vancomycin use in patients literature. A safe protocol in women with bacterial vaginosis: relation to vaginal and cervical for rapid desensitization in patients with cystic fibrosis and antibiotic infections. Mycoplasma genitalium vaginosis and leukorrhea as a predictor of cervical chlamydial or among young adults in the United States: an emerging sexually gonococcal infection.

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Because it is difcult to predict on an individual basis what the equianalgesic dose should be discount viagra 75 mg otc, any opioid conversion requires close monitoring order viagra 100 mg with mastercard. Multi-Modal Treatments Is related to cheap viagra 25 mg visa, having cheap 25 mg viagra fast delivery, or utilizing more than one mode or modality generic viagra 75 mg mastercard. For example, multi-modal pain management involves a variety of approaches including medications, behavioral and cognitive strategies. Neuropathic Pain Pain caused by a lesion or disease of the somatosensory nervous system. Neuropathic pain is divided into ‘peripheral’ (originating in the peripheral nervous system) and ‘central’ (originating in the brain or spinal cord). Neuropathic pain is often described as “burning, tingling, electrical, stabbing or pins and needles”. Glossary 3 Nociceptive Pain Arises from stimulation of pain receptors within tissue, which has been damaged or involved in an infammatory process. Nociceptive pain may be divided into: a) Somatic pain - generally well-localized pain that results from the activation of peripheral nociceptors without injury to the peripheral nerve or central nervous system, characterized by sharp, hot or stinging pain which is usually localized to the area of injury. It is felt as a poorly localized aching or cramping sensation and is often referred to cutaneous sites. Non-pharmacological methods Includes such techniques as superfcial heat and cold, massage, relaxation, imagery, prayer/spiritual practices, pressure or vibration, and therapeutic communication. Opioids Class of drugs originally derived from the opium poppy that are generally prescribed to manage pain. Opioid-Induced Neurotoxicity Is a multifactorial syndrome that causes a spectrum of symptoms from mild confusion or drowsiness to hallucinations (often visual or tactile), delirium, hyperalgesia (an increased sensitivity to pain), allodynia (pain due to a stimulus which does not normally provoke pain such as light touch or rubbing), sedation, and myoclonus (characterized by ‘muscle jerking’ that can be localized or generalized). Patients with renal impairment and patients on opioids with active metabolites appear to be at a higher risk. Physical Dependence A state of adaptation manifested by a drug class-specifc withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood levels of the drug, and/or administration of an antagonist. Pseudoaddiction Is a term that describes patient’s behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications, may “clock watch” and may otherwise seem inappropriately “drug seeking”. Even such behaviors as illicit drug use and deception can occur in the patient’s eforts to obtain relief. Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is efectively treated. Glossary 4 Referral Patient is being sent to a specialist for not only evaluation, but for ongoing care with little or no long-term involvement by the primary care (referring) physician. Sufering Is severe distress associated with events that threaten the patient’s perception of wholeness, is identifed within the spiritual dimensions of quality of life but it transcends all dimensions, often occurring when pain is not controlled. Tolerance Is a physiological state characterized by a decrease in the efects of a drug (e. This Clinical Practice Guideline should be perceived as refecting the current state of knowledge in the feld of pain assessment and management. Best practice demands that health care providers be guided by best available evidence. The grading system used in this guideline has been adapted from the Canadian and U. These types of studies include observational studies, cohort studies, prevalence studies and case control studies. Examples include clinical series, databases or registries; care reviews, case reports and expert opinion. Examples include: observational studies, cohort studies, prevalence studies and case controlled studies. In order to understand the strength of the evidence, each recommendation has been cited with a level of recommendation, as follows: Level 1 This recommendation is convincingly justifable on the available scientifc information alone. Level 2 This recommendation is reasonably justifable by scientifc evidence and strongly supported by expert opinion. Level 3 This recommendation is supported by available data but adequate scientifc evidence is lacking. This type of recommendation is useful for educational purposes and in guiding future studies.

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Quantitative review of operative and nonoperative management of achilles tendon ruptures buy generic viagra 100mg. Bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing Achilles tendon and overlying skin defect: The anatomic basis and clinical application generic viagra 25mg otc. These guidelines are a working document that refects the state of the feld at the time of publication viagra 75 mg mastercard. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances buy cheap viagra 75 mg on-line. Address correspondence to American Association of Clinical with endocrine and metabolic disorders discount viagra 75mg on-line. Many of the endocrinology training programs in the United States lack a dedicated nutrition 2. As a result, nutritional counseling and man- healthy eating for the prevention and treatment of meta- agement for our patients is often delegated to other health bolic and endocrine diseases in adults. Recommendations recently approved counseling for obesity, most overweight are assigned Grade levels based on the supporting clini- patients or patients with obesity, dyslipidemia, polycystic cal evidence and subjective factors. In addition, all primary writers are from this important component of health care. Recommendation grades are based • the relative scarcity and increased expense of on four intuitive levels: (grades A [strong], B [intermedi- healthy foods, ate], and C [weak]) or expert opinion when there is a lack • the easy accessibility, low cost, and palatability of of conclusive clinical evidence (grade D). There are also four intuitive levels quate and/or ineffective food policies, of evidence: 1 = strong, 2 = intermediate, 3 = weak, and • the perishability of foods, increased need for 4 = no evidence. Comments may be appended to recom- preservatives, and decreased awareness of food mendations regarding relevant subjective factors that may safety, have infuenced the grading process. The consensus level • the variability of nutrient-gene interactions of experts for each recommendation may also be explicitly (nutrigenomics and nutrigenetics), and provided in appropriate instances. Thus, the process lead- • transcultural factors, including religious, social, ing to a fnal recommendation and grade is not dogmatic ethnic, and economic factors, as well as individ- but rather incorporates a complex expert integration of ual food preferences, culinary styles, and belief objective and subjective factors meant to refect optimal systems. Essential macronutrients and micronutrients, (15 to 35% of calories depending on total intake) fber, and water should be provided by well-cho- can replace a portion of saturated fat and/or refned sen foods and beverages that can be enjoyed and carbohydrates in the meal plan to help improve constitute a healthy eating pattern. The weight-loss goal for overweight or obese patients with vitamin B12 defciency can gener- patients is 5 to 10% of current body weight over ally be treated with oral vitamin B12 (1,000 μg per the ensuing 6 to 12 months. When subjective factors have a strong impact, then recommendation grades may be adjusted up (“positive” impact) or down (“negative” impact). Sustained behavior modifcation must be the use of dietary supplements to meet nutrient achieved for long-term success with weight man- requirements should be implemented (Grade D, agement. When frst treating a patient with over- nutritional supplementation and medical moni- weight or obesity, emphasis should be placed on toring for complications, including electrolyte 8 Clinical Practice Guidelines for Healthy Eating, Endocr Pract. What Nutritional Recommendations are weight is recommended to prevent and treat hyper- Appropriate for Cardiovascular Health? All patients should be coun- Adiposopathy seled to adhere to the Dietary Approaches to Stop • R13. Sodium intake should be further reduced patients should also be advised to increase caloric (<1,500 mg/day; or 3,800 mg/day of table salt) expenditure to at least 150 minutes of moderate- for people age 51 years and above, all people who intensity activity every week (e. What Nutritional Recommendations are and a low-normal protein dietary reference intake Appropriate for Bone Health? A calcium intake greater Clinical Practice Guidelines for Healthy Eating, Endocr Pract. Women does not provide adequate calcium intake (Grade who are pregnant should consume 1. All individuals at risk for vitamin D defciency pregnant women should ingest a minimum of 250 (e. What Nutritional Recommendations are ing high-fber foods with lower fat content (Grade Appropriate for Pregnancy and Lactation? During breastfeeding, basal insulin 12 Clinical Practice Guidelines for Healthy Eating, Endocr Pract. What Nutritional Recommendations are micronutrients, a daily mix of nutrient-dense Appropriate for the Elderly? Older adults should consume more of the nutri- meals for institutionalized patients, correcting oral ent-dense whole-grain foods, such as brown rice, and dental problems leading to diffculties with whole-wheat breads, and whole-grain and fortifed eating, chewing or swallowing, addressing social cereals to meet carbohydrate needs. Energy and nutrient-dense and Disease Prevention foods, or manipulation of energy and nutri- Healthy eating includes the adequate provision of ent density of the meal plan, should be recom- macro- and micronutrients to sustain normal physiol- mended for the frail elderly to promote weight ogy and to avoid nutritional defciencies.

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