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Assistant Professor, Boonshoft School of Medicine at Wright State University
People beyond the age of 40 medicine journals impact factor 2.5 mg zyprexa with amex, need regular medical examinations If any of the family member has suffered from a heart disease or a stroke medicine xl3 buy zyprexa with visa, it is necessary for the other members to take extra precautions medications xanax buy discount zyprexa 20 mg. It should also be noted that 40% of the patients of stroke have no apparent and visible risk factors worth accounting for the stroke. Feeling of weakness in one side of the body; the limbs of the affected side may stop working or become numb. Vertigo, blurring of vision, diplopia, sudden headaches, nausea or vomiting, weakness in both the legs, stumbling, sudden momentary unconsciousness or falling down. These symptoms prevail for certain period of time and if the symptoms are ignored and if no treatment is commenced, paralysis of a whole side ensues, with loss of speech and the patient may be unconscious. In order to avoid this, obesity should be prevented by taking a proper nutritious diet. Blood Pressure: Blood pressure should be regularly checked and if it is high, proper medication should be taken to keep it under control. Even if a patient has come for any other disease or ailment, according to a notification of the National Stroke Association, it is the duty of the doctor to check the patient’s blood pressure. Regular check-up of blood pressure will prevent heart disease, paralysis and kidney diseases. Ideally, systolic blood pressure should be around 130 to 140 while the diastolic blood pressure should be maintained at 80 to 90. Time and again it has been proved that by merely controlling blood pressure alone, 40 to 50% cases of paralysis and heart diseases can be prevented. There are many people who are not ready to accept that they are suffering from high blood pressure because they do not get any symptoms like headache or dizziness. But they don’t understand that all patients of high blood pressure do not have these symptoms. Some patients take medications for some time and feel that their blood pressure is cured. Whenever the blood pressure is measured while taking the medication, it is bound to be normal and therefore the patient may discontinue the medication due to a false sense of security. On discontinuing the drugs, blood pressure starts increasing again, eventually resulting in paralysis or heart attack. Along with the right treatment, the patient should be careful about his lifestyle as well as eating habits. Diet: To prevent a stroke, the fat content in the diet should be reduced to bare minimum. Instead, salads, fresh fruits and vegetables should be consumed in larger quantity. Tensions and stress should be reduced and one should learn to relax and enjoy life. Jealousy, anger, negative thinking should be avoided and everyone should live in harmony, which will always be beneficial. Use of contraceptive pills should be reduced to bare minimum and other forms of contraception should be followed. The patients who have previously suffered a stroke or a heart attack should take drugs like Aspirin, Dipyridamol, Ticlopidine, Clopidogrel, etc; to keep the blood thin, as per prescription from the doctor. With the help of these drugs the chances of a heart attack or paralysis can be reduced by about 13% to 45%. If a patient has not suffered either a heart attack ©r a brain attack, but has definite risk factors e. This recent scientific invention has revolutionized the concept of treatment of heart attacks and paralysis and has averted several angioplasties, coronary bypass surgeries and perhaps carotid surgeries.
The expected rate of cervical dilatation is at least 1cm/hour: Avoid artificial rupture of membranes unless there is a clear indication symptoms after conception order zyprexa 10 mg visa. Vaginal examination is done at least 4 hourly to assess cervical dilatation treatment 8th march order zyprexa 5 mg online, moulding medicine 6mp medication order zyprexa line, caput, position. Descent is assessed by abdominal palpation, noting the number of fifths of the head felt above the pelvic brim. Foetal condition is monitored by the foetal heart sounds and the colour of the liquor. Management – Supportive Proper management of the 1st stage ensures the woman reaches 2nd stage strong enough for safe delivery. Management – Pharmacological Oxytocin drip indicated for inadequate or incoordinate uterine action in absence of cephalopelvic disproportion or foetal distress: • Dose is 2. At crowning, perineum should be supported with the fingers to prevent perineal tear. When head is born, it is allowed to rest, the cord round neck is checked and loosened if present. Cord is clamped and cut, leaving adequate length for administration of drugs if needed. Application of tetracycline 1% eye ointment is recommended as prophylaxis against ophthalmia neonatorum. Identification tag applied; baby is wrapped in warm towels and given to the mother to introduce breastfeeding. When this happens: • the placenta should be delivered by controlled cord traction. Patients are then observed closely for 1–2 hours before being transferred to the postnatal ward. Other causes of obstructed labour are malpresentations or malpositions of the foetus, and soft tissue abnormalities of the genital tract. Obstructed labour is the commonest cause of ruptured uterus and a major cause of maternal mortality. Obstructed labour and ruptured uterus can be prevented by appropriately timed caesarean section. There is maternal distress, manifested by: • Dehydration • Fever • Tachycardia Management Give supportive management. Do laparotomy: if there is rupture of the uterus: • Repair or • Subtotal hysterectomy. Major causes are: Obstructed labour Previous operations on uterus (C/S, myomectomy) Ecbolic herbs and improper use of oxytocin Grand multiparity Perforations during evacuation of uterus or D&C are a type of ruptured uterus Clinical Features Clinical features may be insidious (“quiet”) or obvious (“classical”). Impending rupture of the uterus can be diagnosed by: • Observing rise in maternal pulse (more than 100 beats per minute). Decision to repair the tear or remove uterus (hysterectomy) depends on extent and number of tears. The following option is available: – Foley’s catheter (can only be used when the membranes are intact) inflated maximally and left for 8–12 hours will normally achieve ripening. Indications and case selection must be appropriate to avoid maternal and/or foetal injuries. Postnatal care is the care of the woman in the immediate postpartum period and within 6 weeks of delivery. The emphasis is starting early in the postpartum period, with the 1st review 24 to 48 hours after delivery, the 2nd review within 2 weeks after delivery, and the 3rd review between 4 and 6 weeks after delivery. The aim of postnatal care is to protect and promote maternal and infant health, support breastfeeding, and provide family planning counselling and services. Ensuring that the uterus is well contracted, lochia loss is normal, and urine has been passed.
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Advice to mothers should be: Well babies less than 6 months old need no other milk or food apart from breast milk treatment urticaria order zyprexa online. Adding oil medicine 19th century order zyprexa no prescription, margarine medications and pregnancy discount zyprexa 20mg, or sugar, and milk, egg, or mashed groundnuts makes uji and other foods energy rich and helps young children grow well. Feed sick children at least one extra meal per day and continue for 1–2 weeks after they recover. Mothers should know that the children are likely to have poor school performance if not fed well. Avoid over feeding and limit non nutritious snacks, especially if the child is overweight. Parents can be taught how to make simple toys with materials available in the home. Encourage parents to talk to their children often, even the babies; they won’t understand the words, but they will learn about interaction. A school going child performs poorly at school long before iron deficiency anaemia manifests. Prevention Diet should consist of iron rich foods like dark green leafy vegetable (whose iron is poor absorbed), meat, liver, and other animal sources (whose iron is easily absorbed) 30. The thyroid gland may become enlarged in an effort to produce more thyroxine, leading to goitre. Prevention Consumption of iodized salt is adequate prevention against iodine deficiency. It is important in maintaining the integrity of skin and membranes, immunity, and night vision. Deficiency of vitamin A results in increased rate of infection, as well as increased mortality. Worldwide, vitamin A supplementation has been shown to result in 23–34% reduction of all childhood mortality (6–59 months), 50% reduction in measles mortality, and 33% reduction in diarrhoeal disease mortality. Vitamin A deficiency is a major cause of illness and blindness among poor communities worldwide. Later signs include irreversible damage of cornea – rupture and scarring, Bitot’s spots (white areas on lateral parts of the sclera) and blindness also develops as a consequence of vitamin A deficiency. Prevention of Vitamin A Deficiency Encourage families to consume vitamin A rich foods, which include: • Animal products, for example liver, milk and kidneys. Give vitamin A supplementation routinely in the presence of the following conditions: • Malnutrition • Diarrhoea • Malaria • Tuberculosis • Pneumonia • Worm infestation • Fever • Measles For children aged below 5 years, it is important to ensure that they have not received vitamin A in the last 1 month. Treatment for Xerophthalmia Affected children are given vitamin A on day 1 and 2 and a third dose 1–4 weeks after second dose. Advise parents to expose their children to sunshine as a preventive measure against rickets. Prevention Children should be exposed to sunlight with minimal clothing for 30 minutes a day. In addition, there should be provision for calcium and phosphate in the diet, which is usually adequate from milk for the infant and young child. Clinical Features the clinical features of the two severe forms of malnutrition, kwashiorkor and marasmus, are itemized in Table 30. A child may have combination of features for both kwashiorkor and marasmus, and then be diagnosed to have marasmic kwashiorkor. It is known that a child who is less than 60% for their “weight for age” may be so mainly because of stunting and such a child does not need hospital treatment.
Your Herpes effects on mothers or their midwife or doctor will discuss babies internal medicine buy zyprexa 2.5mg on-line, and may be carried out the implications for your baby symptoms enlarged spleen purchase zyprexa 10 mg amex. If you symptoms neck pain safe 20mg zyprexa, or your partner, have ever for medical need at any stage For further information contact had genital herpes, or you get your of pregnancy. Although scans are which is caused by an abnormal depending on the ultrasound medical procedures, many couples number of chromosomes. There may be a small Discuss the tests and what they • Detect some abnormalities, charge for this. Screening tests can: • Show the position of your • reassure you that your baby baby and your placenta. Tests can also provide valuable information for your care during Fetal movement the pregnancy. However, no test You will usually start feeling can guarantee that your baby will some movements between 16 be born without an abnormality. Later in pregnancy No test is 100% accurate and some your baby will develop its own abnormalities may remain undetected. Deciding whether to have tests These movements will range You may not want to have a from kicks and jerks to rolls and screening test if you think that you ripples and you should feel them At the scan would continue your pregnancy every day. A full a screening test and it suggests an talk to you about the pattern of bladder pushes your uterus up and increased chance of a chromosomal movements. You then abnormality, you will be offered a reduction in movements, may lie on your back and some jelly is put diagnostic tests, which will give be a warning sign that your on your abdomen. Try to is passed backwards and forwards diagnostic tests carry a small risk become familiar with your baby’s over your skin and high-frequency of miscarriage, so you may decide typical daily pattern and contact sound is beamed through your not to have them. At the scan, the of the baby having Down’s syndrome radiographer measures the thickness is lower than the recommended Some disorders, such as of the nuchal translucency at the national cut-off, this is known as haemophilia and muscular back of your baby’s neck. A low-risk dystrophy, are only found in boys information is used to calculate your result means that you are at a (although girls may carry the individual statistical chance of having low-risk of having a baby with disorder in their chromosomes a baby with Down’s syndrome. There are different ways give you a definite answer about statistical chance of having a of carrying out screening. All women should have dating and Screening results More information nuchal translucency scans between Some maternity services give the • www. As with • an ultrasound scan detects an amniocentesis, a rapid result can be These tests will give you a definite abnormality that is associated obtained, but if all the chromosomes diagnosis of Down’s syndrome and with a genetic disorder are going to be checked the results sometimes other abnormalities. Within are faced with a painful decision the fluid are cells that contain What happens? A small sample of sure you see the appropriate health and may be a little uncomfortable. Usually, the fluid will be tested Help and support for Down’s syndrome and other serious syndromes. They can give you more information or put you in touch with parents If all the chromosomes have to who decided to continue with a pregnancy in which an abnormality be looked at, it can take up to had been detected or those who decided to have a termination. When deciding whether or not to go ahead with this test, try to balance the risk of miscarriage against the value of the result to you. Waiting times in clinics can vary, and this can be particularly difficult if you have young children with you. Make sure you get answers to your questions or the opportunity to discuss any worries. You should be asked to keep your maternity notes at home with you 1 2 3 4 5 and to bring them along to all your antenatal appointments.