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By: V. Kasim, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

Clinical Director, Michigan State University College of Human Medicine

They are made up of a mass of protoplasm differentiated into cytoplasm and nucleoplasm symptoms you may be pregnant buy discount vidalista 40mg line. The cytoplasm consists of an outer layer of hyaline ectoplasm and an inner voluminous granular endoplasm medications high blood pressure purchase vidalista uk. The ectoplasm functions in protection medications 247 buy vidalista 20 mg cheap, locomotion symptoms you may be pregnant vidalista 80 mg otc, and ingestion of food, excretion, and respiration. In the cytoplasm there are different vacuoles responsible for storage of food, digestion and excretion of waste products. The protozoal parasite possesses the property of being transformed from an active (trophozoite) to an inactive stage, losing its power of motility and enclosing itself within a tough wall. The cyst is the resistant stage of the parasite and is also infective to the human host. Reproduction ­ the methods of reproduction or multiplication among the parasitic protozoa are of the following types: 1. Asexual multiplication: (a) Simple binary fission ­ in this process, after division of all the structures, the individual parasite divides either longitudinally or transversely into two more or less equal parts. Sexual reproduction: (a) Conjugation ­ in this process, a temporary union of two individuals occurs during which time interchange of nuclear material takes place. Protozoa are divided into four types classified based on their organs of locomotion. Mastigophora (Flagellates) Flagella Trypanosomes Leishmania Trichomonas Giardia 3. The helminthes of importance to human beings are divided into three main groups with the peculiarities of the different categories described in table 2. They have a hard exoskeleton, which helps enclose and protect the muscles and other organs. An open circulatory system, with or without a dorsally situated heart pumps the blood (hemolymph) via arteries to the various organs and body tissues. Arthropods affect the health of humans by being either direct agents for disease or agents for disease transmission. The arthropods of medical importance are found in Classes Insecta, Arachnida, and Crustacia which have their own distinguishing features. In Class insecta the body is divided into head, thorax, and abdomen, with one pair of antennae. Diseases like malaria, yellow fever, onchocerciasis, and trypanasomiasis are primarily transmitted by insects. There is usually some association such as mutualism, commensalisms, or parasitism between the parasite and the host. This association may produce a variety of effects and the host usually tends to react to it. Understanding the various structural and behavioral components of parasites assists classification. In general, the protozoa, helminthes and arthropods are the most commonly studied and the most important parasites in medical parasitology. Give examples of reactions that occur in the body of the host following parasitic invasion. Describe the general epidemiological aspects and transmission patterns of diseases caused by protozoa. Identify the methods and procedures of laboratory diagnosis of pathogenic protozoa in clinical specimens. They may be distinguished from other eukaryotic protists by their ability to move at some stage of their life cycle and by their lack of cell wall. Colonies of protozoa might also occur in which individual cells are joined by cytoplasmic threads and form aggregates of independent cells. However, distinct types of protozoa, include a resistant cyst (non-motile) stage to survive adverse environmental conditions, such as desiccation, low nutrient supply, and even anaerobiosis.

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Breast Reconstruction After Mastectomy Breast reconstruction is an important part of the overall care plan for women affected by breast cancer symptoms 9 dpo order discount vidalista online. It is normal for you to feel stressed treatment modality definition buy vidalista 80 mg, anxious medications for high blood pressure cheap 80mg vidalista otc, and even mournful over the loss of your breast symptoms graves disease purchase vidalista with mastercard. Many people are fearful about the effect of mastectomy on their body image, sexuality, appearance in clothes, and self-confidence. Breast reconstruction after mastectomy or lumpectomy provides women with the opportunity to restore their aesthetic appearance and improve their quality of life while simultaneously proceeding with ongoing cancer treatment such as radiation, chemotherapy, and hormonal therapy. Breast reconstruction after mastectomy can either take place at the same time as mastectomy (immediate) or after you have healed from your mastectomy (delayed). In most situations, patients are able to undergo reconstructive surgery immediately following their mastectomy. This requires coordination with your breast surgeon as well as your plastic and reconstructive surgeon who will tailor your surgeries specifically to your needs and wishes. There are many different "donor sites" for flap reconstruction, but most commonly the abdominal muscles or the latissimus muscle from the back are used to form a reconstructed breast. While these operations have the advantage of not always requiring breast implants, they do require additional scars and at times reduced strength in the donor site where the muscle was taken from. These operations can also be done immediately after mastectomy, however the surgery is longer in duration and typically requires a longer hospital stay. At the time of consultation, your plastic surgeon will discuss the many options regarding implant-based and flap reconstruction and help you to determine the best option for you. Regardless of whether you choose implantbased or flap reconstruction, it often takes several surgeries to reconstruct the breasts with an appealing aesthetic result. These operations are spread out over time and in coordination with your need for radiation or chemotherapy. Prostheses In the event that you are unable or decide not to undergo breast reconstruction, you may want to consider using an external breast prosthesis. This is an artificial breast form that you can attach to your body or place in your bra, lingerie or swimwear. Breast prostheses come in a variety of shapes and weights, which are designed to accommodate the needs and shapes of the women who wear them. A professional prosthesis fitter will help you choose the correct shape in order to distribute the weight of the prosthesis evenly against your body for anatomical fit and ideal contour. You can choose to purchase surgical support bras to hold the prosthesis or have a traditional bra or swimsuit customized to accommodate your prosthesis. Breast Reconstruction After Lumpectomy In patients who opt to undergo breastconserving therapy with lumpectomy and radiation, it is possible to have surgery to help restore symmetry and to improve the appearance of the reconstructed breast. Radiation therapy causes the affected breast skin to tighten and often sit higher on the chest compared to the unaffected breast. A mastopexy, or breast lift, or even a small breast reduction can be done to the opposite side in order to make the breasts as symmetrical as possible. It is also possible to perform fat grafting, which is injection of fat that has been removed from another part of your body by liposuction, into areas where there is dimpling of the breast from scar tissue and radiation effects on the breast where the cancer was removed. In women with large breasts who require lumpectomy, this can be completed as part of a breast reduction procedure in a collaborative effort with your breast surgeon and your plastic surgeon. You may experience pain that radiates down the arm, or you may feel as though "pins and needles" are sticking you. Pain from the incision usually takes about a week to ten days to subside, and the sensations will improve as your arm mobility is restored. There are exercises that you can do to relieve your discomfort and restore your range of arm movement. You should not lift anything heavy or begin any exercises until your doctor has given you the permission to do so. The therapist will review the exercises and let you know what symptoms to look for. In selected cases it may be recommended to treat the chest wall after total removal of the breast (mastectomy). There may be indications in certain patients to consider treatment of the lymph nodes under the arm (axilla), chest bone (internal mammary), and the collarbone (supraclavicular area).

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Checking the thermo-element · Check that the nut "A" between the thermo- element and the flame failure device is tight medicine tour vidalista 40 mg otc. If it does not treatment mastitis purchase 60 mg vidalista mastercard, loosen the fastening "C" and adjust the position of the tip of the thermo-element medicine park oklahoma vidalista 40mg line. Checking the flame failure device · Press the flame failure device button as far in as possible medicine vs nursing purchase cheap vidalista. If the flame is accidentally blown out, the flame failure device must shut off the gas supply within one minute. A thin layer of frost does not affect the cooling performance but if the frost grows thick approximately (6 to 10m (1/4 ­3/8") or more), it must be removed by defrosting. Defrosting Procedure 73 · Move the vaccine into another refrigerator or store it in a cold box with icepacks · Turn off the gas supply (or remove plug from the wall socket if on electric operation). Cleaning the flue and baffle · Turn off the gas supply · Remove the burner protection plate. Press in the replacement gasket into the groove, and ensure that the gasket has not left any gap. Remove the capillary tube end from the evaporator and carefully pull it out of the rear of the refrigerator cabinet. Two different types of connection between the gas thermostat and gas pipe are shown below. Make sure that the capillary tube makes contact with the evaporator only where it is to be fastened. Unscrew the thermo-element nut and remove the thermo-element from the flame failure device. Disconnect the gas thermostat, gas pipe and any other parts from the flame failure device. If the thermo-element must also be replaced, disconnect the other end of the thermo-element from the gas burner unit. Connect the thermo-element to the flame failure device, and tighten the nut fully. Starting on electric operation · If the refrigerator has been on gas operation, take the following action: 77 · Turn off the gas supply at the gas cylinder. Monitor the refrigerator and adjust the thermostat control knob accordingly depending on the temperatures inside the refrigerator. Usually it is located on the rear, on the lower door or on the walls inside the refrigerator. A good equipment inventory will provide the information needed to track the location, maintenance schedule, replacement and evaluation of the adequacy of the equipment. Records for each piece of equipment should include: · Technical information (brand, model, serial number, date of entry into service and date of final removal from service) · Specific location · Current condition (working, in repair, un-repairable) cold cHain emerGencieS Emergencies can interrupt immunisation services if not planned for. There should be a warning system for identifying equipment failure and make arrangements in advance for moving vaccines to the nearest health facility or location that has appropriate substitute equipment. The session should be arranged and organized in such a way that they are convenient and comfortable for the parents /guardians. For this to be realized, make sure that logistics required are available and the environment safe and comfortable for the parents/guardians. The preparations include: · Making sure that vaccines, supplies, and equipments are available · Arranging space for the convenience and comfort of health workers and parent/guardian. However where a room does not have two doors, the staff should discuss and decide how best they can improvise. The Health facilityshould have: · Waiting area where parents and guardian can sit before being immunized as they receive health talks; as the talks will be better received if people are comfortably seated in the waiting bay. Requirements for weighing are: · Weighing scales children; · Weighing pants to put the child in; · Table and chair; · Weight scale for adults. This applies to both static and mobile/outreach clinics,or put the table level for "beam balances". Note: the person who administers the immunization should record the date of the immunization. Post natal care (Pnc) Mothers report for post-natal care as early as possible after delivery. Points to remember in mcH · Keep vaccines cold in a refrigerator and maintain +2oc to + 8oc.

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It can be · Children less than 1 year · Women of child bearing age Having decided medications for schizophrenia cheap vidalista 20 mg otc, fill the appropriate space in the target setting form medicine you take at first sign of cold buy 80mg vidalista fast delivery. Having determined the population category medicine 666 purchase vidalista 60mg fast delivery, the following steps should be taken in setting targets for that particular population category medicine 7 day box discount generic vidalista canada. Obtain the total population of the division for last (outgoing) year and fill column A. Thus the new-year population will be above the outgoing year population by this number. This is done as follows: Multiplying the outgoing year population (column A) by the annual growth rate (column B). Fill column C Utopia Division Example: the population increase = (27,242 X 5) / 100 = 1,367 Estimate the total population of the division for the new-year by adding the total population for last/outgoing year (column A) to the population increase (column C). Utopia Division Example: estimated total population for new-year (2003) = 27,242 + 1,362 = 28,604 Fill column E with the proportion of the total population that make up the population category of interest. Utopia Division Example: estimate of the number of children less than 1 year for new-year (2003) = (28,604 X 4)/100 = 1,144 Determine the number of people in the selected population category to be vaccinated each month in the division by dividing the estimated total number of children under 1year for the new-year (2003) by 12 months 24 Utopia division example: the number of children to be vaccinated each month = 1,144/12 = 96 Determine the total number of children less than 1 year vaccinated in the division in the outgoing year. Get names from the summary of the divisional immunization data carried out in step 1 Utopia Division Example: See figure 3. To do this, divide the number of the people in the population category vaccinated last year in the health facility (column K) by the total number of people in the population category vaccinated last year in the division (column H) and multiply by 100. The target for each health facility should be adjusted as is necessary but the total targets for all the health facilities must not be less than the target already set for the division. Utopia Division Example · for Gituamba Health center, the target assigned is just okay. Having set the target number of children to be vaccinated in the new-year, 27 each health facility should forecast the number of doses of vaccines required to reach all the target children and childbearing age women. It helps to monitor the progress of immunization in relation to target coverage There are three methods commonly used to estimate vaccine needs: 1. Size of immunization sessions All facilities are required to estimate vaccine needs using the target population method and if the Health facilities are sharing the same population, previous consumption method would be suitable. Target Population Method Target population is the number of children under one year and women of childbearing age (1549 years old). To estimate vaccine needs on the basis of target population a number of parameter are necessary, which are: a. Wastage rate and wastage factor 28 target population After target setting and have known the target to be covered in the Health facility for the year immunisation schedule Immunisation schedule determine the age limits and the number of doses required to be fully immunized among each target group (children under one and women of childbearing age). The Immunization coverage target for each antigen is depends on the health facility and district micro plans and work plans respectively. These plans indicate the attainable percentage coverage at the end of current year. These may include: · the remainder of doses discarded with vials after the immunization session · Doses given outside the target · Doses spoilt for one reason or the other. Wastage factor Vaccine wastage rate Vaccine wastage rate should be taken into account in the estimation of vaccine needs. Knowing the wastage rates helps to determine the wastage factor, which is one of the parameters used to estimate vaccine needs. Every district and health facility must calculate its monthly vaccine wastage rates of antigens and by the end of year know their vaccine wastages, which would be used for estimation of the vaccines. Formula for Wastage rate (%) Doses Used ­ doses administered x100 Doses used Doses used include vaccines administered and wasted doses Doses administered are doses which have been received by the targeted group. To calculate the vaccine wastage rate for Rioma health facility using the formula is as follows: 200 ­ 150 200 X 100 = 50 X 100 = 25% 200 Wastage Factor Vaccines Wastage Factor is a multiplier used to order vaccines to cater for the targeted population and wastage. The total number of vaccines supplied within given period is referred to as 100% supply. Formula for calculating wastage factor 30 100% supply (100% supply ­ Wastage rate) = Wastage factor Using Rioma Health Facility example the wastage Factor is calculated as follows: 100 (100 - 25) = 100 75 = 1. Therefore the target coverage is 1 Example 1: (health facility to be formulated after target setting example to make it flow) Rioma health facility in Eldorado district has a total population of 350,000 in 2005. The children under one year comprise 4% and women of childbearing age are 24% of the total population. The district vaccine manager was to forecast and order for all the routine vaccine.

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