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Generalized electrical afferent input to the brainstem via the tonic-clonic seizures occur in 15% of patients; left vagus nerve sarafem 20mg generic women's health letter. By adolescence cheap sarafem 10mg otc pregnancy freebies, the open label treatment of patients completing a felbamate discount 20mg sarafem with visa menstrual urban dictionary, lamotrigine cheap sarafem 20 mg on-line ritmo pregnancy, and topiramate. Mortality rates of 3%-7% is Stevens-Johnson syndrome, and toxic related to intercurrent illness or accidents. Risk factors for development of lamotrigine-induced rash 195 Epilepsy, Status Epilepticus cycle, stimulants, individual provoking factors (e. In most cases, initial to fetus), but the risks of prolonged seizures to psychiatric illness. Patients may demonstrate medications should be given after 5 minutes of both the mother and unborn ch ild usually far automatisms (lip smacking, picking at clothes) continuous seizure activity or more than 2 outweigh the risks of medications. In general, provoking factors should be ruled out, even in known epilepsy patients. Serum prolactin usually is difficult to distinguish from epileptic Decrease in neuronal electrical inhibition is seizures, and there are many case reports of elevated with epileptic seizures and normal theorized, but the exact mechanism is unnecessary intubation and medication-induced with psychogenic spells, but the sensitivity and unknown. Even experienced epilepsy specialists specificity of this test are relatively low. Usually followed by clonic phase with or physical stress, lack of sleep, menstrual rhythmic muscle contractions. The contractions often become gradually less frequent and apparent in fewer muscles. If these may become necessary, especially in regimens fail (around 15 minutes of status), a Depends primarily on the presence or absence convulsive status. Overall mortality is 104- precede the use of h igh-dose barbiturates or urgently consulted. Anticipatory intubation will 20%, with the h ighest mortality in elderly stroke benzodiazepines. Further treatment of will increase risk of status: emot ional and N/A physical stress, fatigue, sleep deprivation, nonconvulsive status is controversial. Consultation with respiratory or cardiovascular status is a neurologist i s recommended. If seizures continue after 2 minutes, administer fosphenytoin (Cerebyx) 20mg/ kg (1. Tryptophan crosses the bloodbrain Fibromyalgia is a musculoskeletal pain aches/pains and/or articular pains with possible barrier and is converted to serotonin. Inhibition amplification syndrome that includes symptoms joint tenderness, although no actual synovitis is of serotonin production is associated with a of pain, stiffness, and exhaustion; physical detected. Subjective feeling of swelling usually decrease in slow-wave sleep and an increase findings of specific areas of tenderness; and no involves the hands, usually worse in the in somatic symptoms; therefore, theories have evidence of any specific etiology for cause of morning and better by midday. An may result from an insufficient concentration similar medical conditions over the years, associated sleep disorder characterized by a of circulating tryptophan. Typically patients will be tender on the mother or the developing fetus during at other sites outside of the Clinically detectable fibromyalgia as defined by pregnancy. The actual number of Neuralgia, fibrositis, myofascial pain syndrome, term trigger point is sometimes used. Race chronic fatigue syndrome, and variant reflex cause radiating pain, paresthesias, and dystrophy are all conditions with considerable autonomic symptoms. In the pediatric population, there are documented laboratory abnormalities early precursors of this condition may include " in the majority of patients affected by growing pains" or "early migraines. Sleep cervical/lumbar syndromes, referred pa in disturbances also play an important role in the There are no specific imaging abnormalities. Intrusion of alpha waves on slow delta There are no special laboratories needed for diabetes mellituswith neuropathies. Promotion of a An explanation of the condition is the initial Medications include nonsteroidal positive outlook helps to minimize depression as approach. Onaverage, 20% of patients therapy consisting of weight loss, abdominal lidocaine steroid is indicated. Absence of autoantibodies in primary Other adjuncts used to mod ulate pain include fibromyalgia. The are helpfulto e nsure compliance with a graded immunologic profile of patients with fibromyalgia. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. A wheelchair often is needed for condition became symptomatic after age 20 mobility several years afterward. The disease Occupational therapy is needed to progresses slower in the late-onset group. A expansions were correlated with earlier age at Usually begins with gait ataxia; difficulty in dietitian or nutrit ionist advises on meals and onset and shorter times to loss of ambulation. Optic atrophy and retinitis pigmentosa result from enzymatic block and subsequent during pregnancy. Gangliosides gangliosidoses can be made by measuring rigidity and a vegetative state are frequently are present predominantly in the gray matter. The incidence of includes neurodegenerative diseases such as between 6 and 20 months. Sandhoff disease is horn cell dysfunction, the differential and seizures are rare. Further deterioration in the second year of life results in decerebrate posturing, incoordinate swallowing, and a vegetative state. Low-signal The majority of patients with Tay-Sachs abnormalities of the basal ganglia and high- Gastrostomy tube placement and Nissen disease survive to age 2-4 years. Aspirat ion signal lesions of the white matter may be fundop lication may be needed for patients pneumonia is often the cause of death. Mutations include Patients with exacerbation of epilepsy often missense, nonsense, and insertion varieties. Additionally, anemia ( may be unresp onsive to analgesics complicate 40%-50% of cases. A genetic predisposition decreased visual acuity, decreased color taken from the affected side. Some authors atrophy occurs Rheumatoid arthritis recommend bilateral temporal artery biopsies; Less common ophthalmic presentations however, biopsy of the symptomatic side are diplopia secondary to cranial usually is adequate. If large-vessel involvement is and Hornets syndrome suspected, ultrasound and/or angiography Polymyalgia rheumatica (>50 years of Diagnosis should be pursued. Unfortunately, visu al loss often is High-dose oral therapy should continue for 8 permanent, and further damage to the affected weeks with gradual taper to achieve the lowest Relapse most commonly occurs during the eye and even in the previously unaffected possible maintenance dose. Therefore, 250 mg in 6 hours)for 3 days may be patients may require corticosteroids for prompt diagnosis and immediate corticosteroid beneficial in cases presenting with visual greater than 2 years. The proper methylprednisolone should be converted to expectancy as age-matched controls. The goal of therapy is to maintain the been found to correlate with decreased extended taper schedules should be patient on the lowest dose of corticosteroid quality and duration of life. Relative relapse, and possible sequelae of long-term monitor response to therapy and disease contraindications include diabetes, steroid therapy control.

When ketoacid levels rise discount sarafem 10mg with amex journal of women's health issues and care, the blood becomes acidic discount 20mg sarafem with amex atraso menstrual 02 dias, which impairs enzymatic reactions Diabetes can cause many problems in pregnancy order 20mg sarafem pregnancy 9 weeks symptoms. This results in abdominal pain cheap sarafem 10 mg amex women's health center victoria tx, the first trimester, about 510% of fetuses develop major nausea, and vomiting. Ketones can be detected in the birth defects and 1520% of pregnancies end in miscar- urine and produce a fruity odor on the breath. Now, plications during delivery for both the mother and the about 2% of patients with this condition die. The goal of diabetic treatment in pregnancy is tight In type 2 diabetes, insulin resistance is the main control of glucose levels to reduce the chance of these problem and insulin is not as severely deficient. In gestational diabetes, if glucose levels are Therefore, ketoacidosis does not occur. Instead, glucose not controlled with diet and exercise, then insulin (or levels continue to rise to 1,000 mg/dl or more. Women with preex- duces a condition known as nonketotic hyperosmolar isting diabetes who become pregnant also need intensive state. Patients with diabetes are prone to certain infec- The elderly are more vulnerable, but overall about tions in the urinary tract or skin and soft tissue and fun- 2040% of people with this condition die. Good glucose control helps prevent infections and may also help with wound healing. Generally speaking, type 1 damage to the retina, kidney failure, and nerve damage patients need a long-acting or intermediate-acting (neuropathy). Diabetes is the leading cause of blindness insulin to cover them for a 24-hr period regardless of in people aged 2074 years. Diabetes is also the leading food intake, plus a short-acting insulin to take care of cause of kidney failure requiring dialysis, accounting for glucose swings during meals. Nerve damage affects 6070% of dia- insulins are ultralente and glargine; intermediate-acting betics and causes an inability to sense trauma. Diabetic feet especially heal An insulin pump may be used in cases involving slowly if at all, and many diabetic foot infections ulti- type 2 diabetes that does not respond to treatment or mately require amputation. Diabetes accounts for more type 1 diabetes in which a patient does not follow her than 60% of all nontraumatic lower limb amputations. The insulin pump acts as a contin- Macrovascular complications include heart disease uous insulin infusion. These complications are exacerbated by acting insulin is stored in a reservoir, and is connected high blood pressure and high cholesterol, which often by tubing to a needle inserted under the skin, usually go along with diabetes. The pump is programmed to provide cause of death in diabetes, occurring 24 times more different basal rates of insulin infusion throughout the often in diabetics than in nondiabetic individuals. Patients have to monitor their blood glu- Stroke is also 24 times more common in diabetes. Diabetes monitoring goals to make adjustments by taking extra calories for low HbA1c (%)reflects 3-month average glucose 7% sugar reading (corrections). The insulin pump can pro- Glucose before meals (mg/dl) 80120 vide smoother glucose control, but patients have to be Bedtime glucose (mg/dl) 100140 extremely motivated in order to check their glucose up Blood pressure (mm Hg) 130 systolic, to 68 times daily. Sometimes the transplanted cells annual eye exams are excellent preventive measures. The American Diabetes Association dietary recom- Treatment of type 2 diabetes includes oral medica- mendations are as follows: carbohydrates should tion and/or insulin. The medication chosen depends on comprise 50% of daily calories, fat less than 30%, and a variety of factors, such as how long the person has cholesterol should be less than 300 mg daily. Of the fat, been diabetic, whether she is overweight or lean, and less than 10% of calories should be derived from satu- how high the blood glucose rises. There are different rated fat and greater than 10% from monounsaturated classes of oral medications. Capillary blood monitoring lets It must be used with care in patients with kidney prob- patients and their care providers assess glucose control lems and congestive heart failure. With these drugs, liver function must be mon- Two major studies in both type 1 and type 2 diabetes itored with blood tests. Weight gain and edema are com- have shown that tight control of glucose reduces compli- mon side effects so these medications cannot be used in cations. It con- medication in the treatment of poorly controlled type 2 clusively showed that intensive glucose control reduces diabetes, either when oral agents have failed or at any microvascular complications. In patients with high blood pres- The most frequently used diaphragms are made of sure and type 2 diabetes, intensive control resulted in latex, but a silicone diaphragm is now on the market for 30% reduced risk of stroke and 46% reduction in death. The cost The Diabetes Prevention Program was a study of for the medical appointment will add additional persons at risk of developing type 2 diabetes. In addition, the a 58% reduction in diabetes with 30 minutes a day of over-the-counter spermicidal jelly used with the moderate physical activity along with a 510% reduction diaphragm must also be purchased at additional cost. The Diabetes The diaphragm is an excellent method of contra- Prevention Trial used insulin in subjects at risk for type 1 ception for women who do not wish to or cannot use diabetes, based on family history and other parameters, hormonal contraception. In women with polycystic diaphragm is somewhat complicated and requires fore- ovary syndrome, metformin taken before and throughout thought to have supplies on hand. It may interrupt pregnancy reduces the occurrence of gestational diabetes spontaneity if it is used at the time of intercourse, from 31% of pregnancies to 3%. Metformin appears to be though it may be inserted up to 6 hours prior to having safe to for use in pregnancy. If a woman is not comfortable touch- Suggested Reading ing her genitals or has difficulty with placing the Brotman, D. The metabolic syndrome: A tug-of- diaphragm correctly, she may wish to consider another war with no winner. Metabolic syndrome, diabetes and coronary heart following recent cervical surgery disease. Inspection of the diaphragm prior to placement ensures that it has no Diaphragm The diaphragm is a dome-shaped, holes or tears. It is left in place for 6 hours following flexible device inserted into the vagina that covers the intercourse to assure that all sperm have been immobi- cervix and prevents conception by blocking live sperm lized prior to removing the barrier. However, if the initial act of inter- reversible, prescription, barrier method of contraception. Oil-based lubricants should not be used Eating practices are influenced by taste and food with a latex diaphragm as this may weaken the latex preferences, the bodys ability or inability to process and decrease the effectiveness of the method. Diaphragms are inex- food and snacking on high-calorie snacks have replaced pensive and an immediately reversible form of the three-meal pattern of the olden days. Obesity can lead to protection from cervical infections such as gonorrhea chronic disorders such as diabetes, heart disease, arthri- and chlamydia as well as human papillomavirus. Moderate drink- Toxic shock syndrome, Urinary tract infections ing is described as no more than one drink a day for women and two drinks per day for men. A balanced diet can be achieved by planning the meals based on The Food Guide Pyramid, in Planned Parenthood Federation of America.

This figure shows an extended pedigree of an X-linked recessive disorder in which the male parents (in both generations) are normal & the female parents carriers buy cheap sarafem 20mg women's health center queens. In contrast to the vertical distribution in dominant traits (parents & children affected) & the horizontal distribution in autosomal recessive traits (sibs affected) cheap sarafem 10 mg with amex menstruation girls, the pedigree pattern in X linked recessive traits tends to be oblique buy sarafem 20mg overnight delivery menstruation vs ovulation, i buy sarafem 20 mg low cost menstruation depression. Pathogenesis of X-linked recessive disorders The genes responsible for X-linked disorders are located on the X-chromosome, & the clinical risks are different for the 2 sexes. Since a female has 2 X chromosomes, she may be either homozygous or heterozygous for a mutant gene, & the mutant allele may demonstrate either dominant or recessive expression. Therefore, in heterozygous females carrying X-linked recessive mutations, some cells have one active normal X chromosome & other cells have an active abnormal X chromosome containing the mutant allele. Therefore, the heterozygous female expresses the disorder partially & with less severity than hemizygous men. Very rarely, the mutant allele may be activated in most cells & this results in full expression of a heterozygous X-linked recessive condition in the female. The male is, therefore, said to be hemizygous (& not heterozygous) for the X-linked mutant genes. Males have only oner X-chromosome, so they will clinically show the full phenotype of X-linked recessive diseases, regardless of whether the mutation produces a recessive or dominant allele in the female. Thus, the terms X-linked dominant or X-linked recessive refer only to the expression of the mutations in women. Mitochondrial inheritance - is mediated by maternally transmitted mitochondrial genes, which are inherited exclusively by maternal transmission. Chromosomal disorders (Cytogenetic disorders) - are caused by chromosome & genome mutations ( i. They are found in 50% of early spontaneous abortuses, in 5% of stillbirths, & in 0. The normal karyotype Chromosome classification & nomenclature: Karyotype is the chromosome constitution of an individual. The term is also used for a photomicrograph of the chromosomes of an individual arranged in the standard classification (i. Karyotyping uses many types of techniques of which G-banding is the most common procedure. G-banding has the following steps:- - Arrest dividing cells in metaphase by using colchicine. About 400 -800 dark & light bands can be seen in a haploid set of chromosomes using G banding. And the first nd chromosome in such an arrangement is called chromosome 1, the 2 chromosome is called chromosome 2, etc. Metaphase chromosomes are divided longitudinally into 2 sister chromatids held together at the centromere, which delineates the chromosome into a short arm (p) & a long arm (q). In a banded karyotype, each arm of the chromosome is divided into 2 or more regions. Each region is further subdivided into bands & sub bands which are also similarly numbered. Nomenclature of a chromosome showing the division of the long arm (q) of the chromosome into regions 1 & 2. Even though not shown in this figure, the other bands of this q arm & the p arm are similarly divided & numbered. The following order is used to describe karyotypes: First the total number of chromosomes is given. Types of chromosomal anomalies - Chromosomal anomalies may be numerical or structural. Structural anomalies are rearrangements of genetic material within or between chromosomes. In balanced structural anomalies, there is no change in the amount of essential genetic material whereas in the unbalanced ones there is a gain or loss of essential chromosome segments. Trisomy is the presence of 3 copies of a particular chromosome instead of the normal 2 copies. Monosomy is the presence of only one copy of a particular chromosome instead of the normal pair. Anaphase lag - During meiosis or mitosis, one chromosome lags behind & is left out of the cell nucleus. Nondisjunction - is the failure of chromosomes to separate during meiosis or mitosis. As shown in this figure both (B) & (C) produce gametes that are disomic or nullisomic for a specific chromosome. It is responsible for disorders such as trisomy 21, the most common form of Down syndrome. Nondisjunction can also occur in a mitotic division of somatic cells after the formation of the zygote. If mitotic nondisjunction occurs at an early stage of embryonic development, then clinically significant mosaicism may result. The mitotic nondisjunction occurred in one of cells & resulted in a trisomic cell. Also note that most of the cells undergo normal mitosis resulting in normal cells. Therefore, an individual formed from such an embryo will have 2 populations of cells a trisomic cell population & a normal cell population. And the clinical appearance of such an individual depends on the proportion of trisomic cells. Anyway, the clinical feature is less severe than that of an individual in whom all the cells are trisomic. In general, monosomies & trisomies of the sex chromosomes are compatible with life & usually cause phenotypic abnormalities. And trisomies of all autosomal chromosomes except chromosomes 13, 18, & 21 cause abortion or early death. Polyploidy - is a chromosome number that is a multiple greater than 2 of the haploid number. Structural anomalies - result from breakage of chromosomes followed by loss or rearrangement of genetic material - are of the following types (See Fig. This is denoted by using the prefix del before the notation for the site of the deletion. Interstitial deletions arise from 2 breaks, loss of the interstitial acentric segment & fusion at the break sites. Ring chromosomes arise from breaks on either side of the centromere & fusion at the breakpoints on the centric segment. Segments distal to the breaks are lost so that individuals with chromosome rings have deletions from both the long arm & short arm of the chromosome involved. Isochromosome formation - results when one arm of a chromosome is lost & the remaining arm is duplicated, resulting in a chromosome consisting of 2 short arms only or 2 long arms only. Inversion - is reunion of a chromosome broken at 2 points, in which the internal segment is reinserted in an inverted position. Reciprocal (balanced translocation) - is a break in 2 chromosomes leading to an exchange of chromosomal material between the two chromosomes.

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In other words medical entomology is a medical science directly concerned with vectors that affect human and animal health order sarafem 10 mg without a prescription women's health clinic in houston. Old World:- refers to the Eastern hemispher; the world of Europe discount sarafem 20 mg visa women's health raspberry ketone diet, Asia and Africa generic sarafem 20mg fast delivery pregnancy 0-0-1-0. Rodents:- comprise a great number of mammals order sarafem 20mg amex menstruation is triggered by a drop in the levels of, ranging in size from the rats and mice to as large as the Porcupines and which belong to the order rodentia. In this course we are concerned with the domestic rats and mice, which is one of the serious health hazards in the community. Technical grade insecticides: are an insecticides that exist in its purest commercial form. Vector(s):-In communicable disease terminology, vectors are arthropods or other invertebrates which transmit infection by inoculation into or through the skin or mucous membrane by 8 biting or by deposit of infective materials on the skin or on food or other objects. Namely, Mechanical disease transmission, Biological disease transmission, and hereditary disease transmission. Mechanical disease transmission:- is a type of disease transmission in which the vector is no more than a carrier that transmit pathogens without any change either on the number or form of disease pathogens. Biological disease transmission: In this type of disease transmission certain developmental pattern exists either in the vector or host or in both cases. Propagative: In propagative type of disease transmission only the number of pathogens increases and the developmental stage remain constant. The disease plague and typhus are a good examples of propagative type of disease transmission. Cyclo-developmental: In this type of disease transmission only the developmental stage (form) of the disease pathogen changed (small to big, immature to matured stage, etc. Cyclo-propagative: This type of disease transmission is a combination of both propagative and cyclo-developmental where by the disease pathogen under take a change both in number and developmental form (stage). Transovarian(Hereditary)disease transmission:- is a type of disease transmission where by the causative agent is transmitted to the immature stage ( usually to egg ) from the adult insects and / or other arthropods who carry disease pathogens and when the infected egg complete its developmental stage, it become infective or can transmit the disease to man and other animals. Ticks are very good examples of arthropods that exhibit hereditary disease transmission. Insects of Public Health Importance Introduction Arthropod is the great phylum of invertebrate animals. They were the first animal phylum to overcome the problems of locomotion, respiration, and water conservation in a terrestrial environment. All species under phylum arthropoda have the following characteristics in common Bilaterally symmetrical body sub-divided into segments. Chitin is a tough and rigid substance made up of poly (N-acetyl)-D-glucosamine (C15H20N2O10). The phylum arthropoda from public health point of view can be sub- divided in to five important classes namely Insecta, Arachnida, Diplopoda, Chilopoda and Crustacea. Of all the animal phyla, only the arthropods and the chordates have succeeded extensively in adapting to life in dry air. Insects now inhabit virtually all land surfaces of the globe except the extreme polar regions and the highest mountain peaks. Of these, the predators kill their prey more or less immediately, while parasitoids feed externally or internally in their host for some period before finally killing it. The exoskeleton provides not only strong support and protection for the body but also a large internal area for muscle attachments. The head bears a pair of large compound eyes and as many as three simple eyes, or ocelli, a pair of sensory antennae, and the feeding appendages or mouth parts. The abdomen is composed of no more than 10 or 11 visible segments and lacks appendages except for a pair of cerci and the reproductive external genitalia that may be present near the tip of the anal opening. Adult insects belonging to the diptera have one pair of functional wings and undergo holometabolous life cycle. Generally there are more than 50,000 species of both biting and non-biting diptera and the majority of which have no medical importance, but few of them are the most important disease vectors. Most of the families (including Culcidae, Simulidae, Psycodidae, Glosinidae and Muscidae) which are discuced in the concicative chapters are included under this order. Write the three types of disease transmission and give a short description for each. Mosquitoes are notorious as proven vectors of some of the most devastating human diseases. There is little need to document the impact on human public health of malaria, yellow fever, filariasis, and several mosquito-borne diseases of arboviral etiology. Rift Valley fever and the equine encephalitis are important livestock diseases transmitted 14 by mosquitoes. The Anophelinae and the culicinae are blood feeders but the third subfamily, the toxorhynictinae, do not feed on blood and so do not concern in here. They can be easily identified from other insects by -Mouth parts possession of a mouth part which is conspicuous 15 and forwardly projected proboscis -The presence of scales on their abdomen, legs and thorax - The presence of fringe of scales at the posterior margin of wings. This sperm is enough to fertilize all the eggs that can be laid by the female through out her life time thus only one mating and insemination per female is required. After mating it is a must for a mosquito to have a blood meal for the eggs to be matured. After taking a blood meal they have to take a rest for digestion and egg maturation. The speed of digestion of the blood-meal depends on temperature and in most tropical species takes only 2-3 days, but in colder, temperate countries blood digestion may take as long as 7-14 days. Such a repeated process of blood feeding then egg maturation followed by oviposition through out the females life time is called Gonotrophic cycle. The adult is an active flying insect, while the larvae 16 and pupae are aquatic and occur only in water. Depending on the species eggs are laid either on the surface of water or are deposited on moist soil or other objects that will often be flooded. One method of classifying mosquitoes, which is important in the control of the larval stage, is by the type of habitat in which the eggs are laid. Those species that lay eggs singly on the moist soil usually near the edge of temporary pools of water are known as flood water mosquitoes. Psorophora, Aedes, and Ochlerotatus mosquitoes are floodwater mosquitoes which are most abundant shortly after spring rainfall. Those species that lay eggs on the surface of the water, either clumped in rafts or as single floating eggs, are known as permanent water mosquitoes. Floodwater mosquitoes are usually pests in April and May, with permanent water mosquitoes being problems later in the summer. The females usually mate only once but produce eggs at intervals through out their life. The Eggs - Many species lay their eggs directly on the surface of water either singly having a boat shape (Anopheles) or stuck together in rafts (culex) which allow the eggs to float on the water surface. Aedes lay their eggs just above the water line or on wet mud: these eggs hatch only when flooded with water.