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By E. Lester. Winona State University. 2018.

This will enable the baby to get an adequate supply of vitamin A for the first six months buy 50mg viagra soft. During the first six months the best way of feeding the baby is for the mother to breastfeed exclusively cheap 50mg viagra soft otc. In addition to extra meals and one high dose of vitamin A cheap 100 mg viagra soft, a breastfeeding womanalsoneeds: cheap viagra soft 100mg online. Vitamin A rich foods (such as papaya buy 100 mg viagra soft visa, mango, tomato, carrot and green leafy vegetables) and animal foods (such as fish and liver). You have learnt what pregnant and lactating women require to be healthy and well for themselves and their babies. Now you are going to look at the nutritional requirements of infants, children and adolescents. Small children and infants do not have a well developed body nutrient store, and therefore are more vulnerable to infection. During the pubertal growth spurt, they increase rapidly both in weight and height. Therefore, they need a nutrient intake that is proportional with their rate of growth. At about 15–16 years (the pubertal period) there is a sharp rise in growth rate/velocity. Requirements for macronutrients (proteins, carbohydrates and fats) and micronutrients are higher on a per kilogram basis during infancy and childhood than at any other developmental stage. These needs are influenced by the rapid cell division occurring during growth, which requires protein, energy and fat. Increased needs for these nutrients are reflected in daily requirements for these age groups, some of which are brieflydiscussedbelow. Infants of four to six months who weigh 6 kg require roughly 82 kilocalories per kg (490 calories/day). Children of one to three years require approximately 83 kilocalories per kg (990 calories/day). Energy requirements decline thereafter and are based on weight, height, and physical activity. As an energy source, breastmilk offers significant advantages over manufactured formula milk. Breastfeeding is associated with reduced risk for obesity, a wide range of allergies, hypertension, and type 1 diabetes. It is also linked with improved cognitive development; and with decreased incidence and severity of infections. Evidence is clear that bone calcium accretion increases as a result of exercise rather than from increases in calcium intake. Since weight gain often begins during adolescence and young adulthood, young people must establish healthy eating and lifestyle habits that reduce the risk for chronic disease later in life. Children have a larger body surface area per unit of water to drink, particularly when ill, or exposed to extreme of body weight and a reduced capacity for sweating when compared with temperatures. Parents may underestimate these fluid needs, especially if infants and children are experiencing fever, diarrhoea or exposure to very cold or very hot temperatures. Essential fatty acids Requirements for fatty acids or fats on a per kilogram basis are higher in infants than adults (see Box 3. However infants and children should not ingest large amounts of foods that contain predominantly fats, so it is important to get the balance right. Adolescence Increased requirements of energy, protein, calcium, phosphorus and zinc. You have already seen that pregnant women and lactating mothers have particular nutrient requirements that are necessary for their own health as well as the health of their baby. Suggested iron intakes reduce however from 18 mg per day in women aged 19–50 to 8 mg/ day after age 50, due to better iron conservation and decreased losses in postmenopausal women compared with younger women. Some elderly people have difficulty getting adequate nutrition because of age or disease related impairments in chewing, swallowing, digesting and absorbing nutrients. Their nutrient status may also be affected by decreased production of chemicals to digest food (digestive enzymes), changes in the cells of the bowel surface and drug–nutrient interactions. Some elderly people demonstrate selenium deficiency, a mineral important for immune function. Impaired immune function affects susceptibility to infections and tumours (malignancies). Vitamin B6 helps to boost selenium levels, so a higher intake for people aged 51–70 is recommended.

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X Ray - Particularly standing xrays for knees in which eccentric joint space reduction is the diagnostic crieterion as compared to inflammatory where there is concentric space reduction generic viagra soft 100mg otc. Referral criteria: For further evaluation and management of cases not responding to conventional therapy purchase viagra soft 50mg line. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial cheap viagra soft 50 mg without a prescription. Wandel - Effects of glucosamine purchase 50 mg viagra soft visa, chondroitin discount viagra soft 100mg mastercard, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis -- Wandel et al. Introduction: Osteomalacia is a generalized bone condition in which there is inadequate mineralization of the bone. Many of the effects of the disease overlap with the more common osteoporosis, but the two diseases are significantly different. There are two main causes of osteomalacia: (1) insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of or resistance to the action of vitamin D; and (2) Phosphate deficiency caused by increased renal losses b. Case Definition: Osteomalacia is the softening of the bones due to defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium. It may show signs as diffuse body pains, muscle weakness, and fragility of the bones. In the Middle East, a high prevalence of rickets and osteomalacia has been described in Muslim women and their infants, perhaps due to increased clothing coverage of the skin. Clinical diagnosis: Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower back) region and thighs, spreading later to the arms and ribs. The pain is symmetrical, non-radiating and is accompanied by sensitivity in the involved bones. Proximal muscles are weak, and there is difficulty in climbing up stairs and getting up from a squatting position. However, those physical signs may derive from a previous osteomalacial state, since bones do not regain their original shape after they become deformed. Investigations: Serum Calcium Serum Phosphate Alkaline Phosphatase Serum urea creatinine 24 Hr urinary calcium X rays of the deformed part c. Osteomalacia due to malabsorption may require treatment by injection or daily oral dosing of significant amounts of vitamin D Standard Operating Procedure i. Referral criteria: For evaluation and management of cases not responding to conventional therapy. Introduction: Osteoporosis is a disease of bones that leads to an increased risk of fracture. The form of osteoporosis most common in women after menopause is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1. Finally, secondary osteoporosis may arise at any age and affects men and women equally. Amongst the various risk factors for osteoporosis modifiable risk factors can be modified to prevent development of osteoporosis. Referral criteria: For further evaluation and management of cases not responding to conventional therapy. Biochemical markers of bone resorption (increased urinary excretion of C- telopeptides) 4. Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. Consensus development conference: Diagnosis, prophylaxis and treatment of osteoporosis. Biochemical markers of bone resorption (increased urinary excretion of C- telopeptides) 4. The process produces an inflammatory response of the synovium (synovitis) secondary to hyperplasia of synovial cells, excess synovial fluid, and the development of pannus in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, pericardium, pleura, and sclera, and also nodular lesions, most common in subcutaneous tissue. It can be a disabling and painful condition, which can lead to substantial loss of function and mobility if not adequately treated. Involvement of 1-3 small joints (with or without involvement of large joints) gives 2 points d. Involvement of4-10 small joints (with or without involvement of large joints) gives 3 points e.

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Polysaccharides are called complex carbohydrates and they need to be broken down into simple sugars to be used by our body viagra soft 100 mg low price. Proteins are needed in our diets for growth (especially important for children cheap viagra soft 50mg overnight delivery, teens and pregnant women) and to improve immune functions generic viagra soft 100 mg otc. They also play an important role in making essential hormones and enzymes order viagra soft 100 mg, in tissue repair 50 mg viagra soft with amex, preserving lean muscle mass, and supplying energy in times when carbohydrates are not available. Pregnant women need protein to build their bodies and that of the babies and placentas, to make extra blood and for fat storage. All animal foods contain more protein than plants and are therefore usually better sources of body building foods. Fat is found in meat, chicken, milk products, butters, creams, avocado, cooking oils and fats, cheese, fish and ground nuts. The classification is important to enable you to advise your community about which fats can be consumed with less risk to people’s health. Eating too much saturated fat is not good for a person’s health, as it can cause heart and blood vessel problems. Examples include fats from fish, oil seeds (sesame and sunflower), maize oil and ground nut oil and breastmilk. As a general rule, plant sources of fats are better for a person’s health than the animal sources, because animal fats contain more saturated fats. Butter, meat fats and oils from animal sources are not good fats, because they have a high amount of saturated fats. People can live without solid food for a few weeks, but we cannot live without water for more than a few days. That is why giving drinks are so important when people lose a lot of water, such as when they have diarrhoea. For the body to make cells and fluids such as tears, digestive juices and breastmilk. For keeping the lining of the mouth, intestine, eyelids and lungs wet and healthy. Foods rich in fibre are ‘kocho’; vegetables like cabbage, ‘kosta’, carrots, cassava; fruits like banana and avocado; peas and beans; whole-grain cereals like wheat flour and refined maize or sorghum. Fibre makes food bulky or bigger — thiscanhelpapersonwhois overweight to eat less food. Fibre slows the absorption of nutrients, so it helps nutrients to enter the blood stream slowly. In this section you have learned about the macronutrients: carbohydrates, fats, proteins, water and fibre, and how they nourish the body. You are now going to learn more about vitamins and minerals, the important micronutrients. They are grouped together because, as their name implies, they are a vital factor in the diet. Classifications of vitamins Vitamins are classified into two groups: Fat soluble vitamins (vitamins A, D, E and K) are soluble in fats and fat solvents. Water soluble vitamins (vitamins B and C, and folic acid) are soluble in water and so they cannot be stored in the body. However, an adequate micronutrient intake can only be achieved through sufficient intake of a balanced diet that includes plenty of fruits and vegetables. Vitamins Function Food sources Vitamin A Night vision Breastmilk, tomatoes, cabbage, Epithelial cells form the thin layer Healing epithelial cells lettuce, pumpkins of tissue lining the gut, Normal development of teeth Mangoes, papaya, carrots respiratory and genitourinary and bones Liver, kidney, egg yolk, milk, systems. Vitamin K For blood clotting Green leafy vegetables Fruits, cereals, meat, dairy products B complex Metabolism of carbohydrates, Milk, egg yolk, liver, kidney proteins and fats and heart Whole grain cereals, meat, whole bread, fish, bananas Scurvy is a disease caused by Vitamin C Prevention of scurvy Fresh fruits (oranges, banana, vitamin C deficiency which leads mango, grapefruits, lemons, Aiding wound healing to sore skin, bleeding gums and potatoes) and vegetables internal bleeding. Examples of minerals include calcium, iron, iodine, fluorine, phosphorus, potassium, zinc, selenium, and sodium. Minerals Function Food sources Calcium Gives bones and teeth rigidity and Milk, cheese and dairy products strength Foods fortified with calcium, e. The vitamins and minerals that make up micronutrients have a crucial role in enabling the body to function properly.

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A second potential vaccine target is streptococcal pyrogenic exotoxin B (SpeB) discount 50 mg viagra soft fast delivery, a cysteine protease that is present in virtually all group A streptococci buy generic viagra soft 50mg line. Mice passively or actively immunized with the cysteine protease lived longer than non-immunized animals after infection with group A streptococci (26) purchase viagra soft 50 mg visa. Epidemiological considerations Once a safe and effective streptococcal vaccine is available many practical issues would need to be addressed cheap viagra soft 100 mg online. Other issues purchase 50mg viagra soft otc, such as cost, route of administration, number and frequency of required doses, potential side-effects, stability of the material under field conditions, and dura- bility of immunity, would all influence the usefulness of any vaccine. The most promising approaches are M-protein-based, including those using multivalent type-specific vaccines, and those directed at non-type-specific, highly conserved portions of the molecule. Success in developing vaccines may be achieved in the next 5–10 years, but this success would have to contend with important questions about the safest, most economical and most efficacious way in which to employ them, as well as their cost-effectiveness in a variety of epidemilogic and socio-economic conditions. A review of past attempts and present concepts of producing streptococcal immunity in humans. Intravenous vaccination with hemolytic streptococci: its influence on the incidence of rheumatic fever in children. Persistence of type-specific antibodies in man following infection with group A streptococci. Epitopes of group A streptococcal M protein shared with antigens of articular cartilage and synovium. Rheumatic fever: a model for the pathological consequences of microbial-host mimicry. Streptococcal M protein: alpha-helical coiled-coil structure and arrangement on the cell surface. Alternate complement pathway activation by group A streptococci: role of M-protein. Inhibition of alternative complement pathway opsonization by group A streptococcal M protein. Streptococcal infections: clinical aspects, microbiology, and molecular pathogenesis. Type-specific immunogenicity of a chemically synthesized peptide fragment of type 5 streptococcal M protein. Multivalent group A streptococcal vaccine designed to optimize the immunogenicity of six tandem M protein fragments. Protection against streptococcal pharyngeal colonization with a vaccinia:M protein recombinant. Intranasal immunization with C5a peptidase prevents nasopharyngeal colonization of mice by the group A Streptococcus. Vaccination with streptococcal extracellular cysteine protease (interleukin-1 beta convertase) protects mice against challenge with heterologous group A streptococci. Acute rheumatic fever in Auckland, New Zealand: spectrum of associated group A streptococci different from expected. Adding to the burden on health systems of developing countries are the costs of outside referrals that are often required during the course of treatment. The socioeconomic costs were also borne by the parents of the patients, with 22% exhibiting absenteeism from work, and about 5% losing their jobs. As a programme design strategy, it is advisable to attempt small-scale pilot programmes before initiating large-scale national control programmes, as the lessons learnt from pilot schemes can, in addition to many other benefits, prevent the waste of scarce resources (2, 7). These studies emphasize that national prevention programmes based on secondary prophylaxis have the potential for considerable cost savings, which could be used to improve the spread and gains of a programme. Evidence has been presented from a simulation study suggested that the most cost-effective strat- egy was to treat all pharyngitis patients with penicillin (particularly those within an at-risk group), without a strict policy of waiting for the disease to be confirmed by bacterial culture (7, 11). However, this approach has not been confirmed and cannot be advocated until more thorough studies are carried out. In hospital settings where facilities are available, the “culture and treat” strategy has been shown to be cost-effective (12). Analysis of costs of acute rheumatic fever and rheumatic heart disease in Auckland. Analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention.

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