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Some common ways the bacteria can be spread from an infected person are: Living in the same household or dormi to ry room Kissing on the lips Sharing drinks from the same container (glasses, cups, water bottles) Sharing eating with utensils (forks and spoons) Sharing a to othbrush, cigarettes, or lipstick Preventive antibiotic therapy is recommended for individuals who are close contacts of or provide medical care to someone who has meningococcal disease. Symp to ms of meningococcal disease include: Fever (sudden onset) Severe headache Stiff neck Drowsiness or confusion Skin rash that appears as bruising or bleeding under the skin Nausea and vomiting Eyes that are sensitive to light In babies, the symp to ms are more difficult to identify but may include: Fever Fretfulness or irritability Poor appetite Difficulty in waking the baby How is meningococcal disease diagnosedfi Meningococcal disease is treated with several different types of antibiotics, and early treatment may reduce the risk of complications or death from the disease. Supportive care in an intensive care unit may be necessary for those with severe infection, and surgery may be needed to remove damaged tissue and s to p the spread of infection. Meningococcal vaccine is also recommended for other people at increased risk for meningococcal disease, such as: 2012-2013 Meningitis Quick Facts Reference Sheet for Parents (May 2012) Appendix A: Immunization Reference Packet College freshmen living in dormi to ries U. For information on the availability of meningococcal vaccine, contact your health care provider or local health department. La bacteria Neisseria meningitidis normalmente se encuentra en la nariz y en la garganta de entre el 10 y el 15% de los adul to s. En raras ocasiones, la bacteria puede entrar en areas del cuerpo en las que normalmente no se encuentra y causar una infeccion grave que puede ser mortal ("enfermedad invasiva") conocida como enfermedad meningococica. Ejemplos de la enfermedad meningococica incluyen meningitis (infeccion de las membranas que recubren el cerebro y la medula espinal) y septicemia (infeccion en el to rrente sanguineo). Se trata de una enfermedad muy poco comun; se informan alrededor de 30 casos por ano en el estado de Indiana. La bacteria Neisseria meningitidis se propaga de persona a persona solo a traves del contac to con gotitas de la nariz o de la garganta, incluida la saliva, de una persona infectada. Las siguientes son algunas maneras comunes de contagiarse la bacteria de una persona infectada: Vivir en el mismo hogar o habitacion de residencia estudiantil. Se recomienda la terapia preventiva con antibioticos para las personas que estan en contac to direc to con alguien que tiene enfermedad meningococica o que le brinda atencion medica a alguien con esta enfermedad. Los bebes pequenos, los estudiantes que asisten a la secundaria o a la universidad, y los reclutas son mas propensos a contraer la enfermedad. Las personas con un sistema inmunitario debilitado tambien tienen mayor riesgo de contraer la enfermedad, al igual que las que viven con muchas personas o estan expuestas en el hogar al humo de cigarrillos. Los sin to mas de la enfermedad meningococica incluyen los siguientes: Fiebre (comienzo repentino). En bebes, los sin to mas son mas dificiles de identificar, pero pueden incluir los siguientes: Fiebre. Si tiene algunos de los sin to mas que se mencionan antes, es importante buscar atencion medica de inmedia to. Una persona infectada puede enfermarse pocas horas despues de desarrollar sin to mas y es importante el diagnostico precoz. Su proveedor de atencion medica le puede extraer sangre o liquido cefalorraquideo para detectar la presencia de bacterias meningococicas. La enfermedad meningococica se trata con varios tipos distin to s de antibioticos y el tratamien to precoz puede reducir el riesgo de complicaciones o muerte a causa de la enfermedad. Es posible que las personas con infeccion severa necesiten cuidados de apoyo en una unidad de cuidados intensivos, y quizas se necesite una cirugia para extirpar el tejido danado y detener la propagacion de la enfermedad. Existen dos tipos de vacuna que protegen contra 4 de las 5 cepas mas comunes de esta enfermedad. La vacuna meningococica tambien se recomienda para personas que tienen mayor riesgo de contraer la enfermedad meningococica: Estudiantes universitarios de primer ano que viven en residencias estudiantiles. No existe una vacuna disponible para bebes menores de 9 meses ni para 1 de las cepas comunes, la enfermedad meningococica por serogrupo B. Pertussis is spread by droplets created when an infected person coughs or sneezes. Infants and young children are usually vaccinated against pertussis, but the vaccine becomes less effective as children get older, and vaccinated children can become infected. Young infants are at highest risk for developing complications from the disease like pneumonia, seizures, and death. Generalmente, se vacuna a bebes y ninos pequenos contra la to s ferina, pero la vacuna se vuelve menos eficaz a medida que los ninos crecen, y los ninos vacunados pueden contraer la infeccion. Los bebes pequenos estan en mayor riesgo de desarrollar complicaciones a causa de la enfermedad, como neumonia, convulsiones y muerte.

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Hypertension Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. Hypertension is classified as either primary (essential) hypertension or secondary hypertension. This reduction in the amount of bone mass leads to fractures after minimal trauma. Since these services are related to the visit, the appropriate items should be entered. Screening 6-Foot exam A foot exam includes visual inspection, sensory exam, and pulse exam. This is the purpose of the glycosolated hemoglobin (glycohemoglobin) tests, most commonly known as the hemoglobin A1C measurement. A sample of cells is collected from the outer opening of the cervix by scraping it with a spatula. The cells are spread on a glass slide and fixed or a specimen is suspended in a liquid solution. Colonoscopy is the endoscopic examination of the colon and the part of the small bowel with a camera on a flexible tube passed through the anus in order to detect polyps, malignant tumors, and sources of bleeding. The signals can be analyzed to detect medical abnormalities, activation level, recruitment order or to analyze the biomechanics of human or animal movement. It measures the airflow through the bronchi and thus the degree of obstruction in the airways. Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. Most to nometers are calibrated to measure pressure in millimeters of mercury (mmHg). Services may include skilled nursing care; help with bathing, using to ilet or dressing provided by home health aides; and physical therapy, speech language pathology services, and occupational therapy. X-rays, gamma rays, and charged particles are types of radiation used for cancer treatment. Systemic radiation therapy uses radioactive substances, such as radioactive iodine, that travel in the blood to kill cancer cells. Examples include information aimed at general health promotion and disease prevention and information given to the patient to treat or control a specific medical condition. Contraception is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. The major forms of artificial contraception are: barrier methods, of which the commonest is the condom; the contraceptive pill, which contains synthetic sex hormones that prevent ovulation in the female; intrauterine devices, such as the coil, which prevent the fertilized ovum from implanting in the uterus; and male or female sterilization. It includes referrals to other health professionals for the purpose of coping with stress. It includes referrals to other health professionals for the purpose of weight reduction. Other services not listed: Enter any other examinations, tests, imaging services, non 85-Other medication treatment, and health education that was ordered or provided at this visit that were not listed above. When performing arthroscopic surgery, the surgeon can see inside the joint with a small camera. Record the exact drug name (brand or generic) written on any prescription or on the medical record. If more than 30 drugs are listed, then record according to the following level of priority: 1. For mental health provider, include pyschologist, counselors, social workers, and therapist who provide mental health counseling.

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Strep to coccal throat infections require treatment with antibiotics in order to reduce the complications noted above. This infection does not occur in children less than 6 years because their air spaces are not well developed. Viral infections resulting in common cold (Rhinitis), sinusitis, pharyngitis and to nsillitis, influenza infections and nasopharyngitis are precursors to bacterial infections. Acute re-infection associated with fever and pain is usually related to an obstruction to drainage through the perforated drum with secondary infection by strep to cocci, pneumococci or gram negative organisms, A chronically draining ear can only heal if it is dry. Drying the ear is time consuming for both the health worker and the mother but it is the only effective measure. Pharmacological treatment (Evidence rating: C) If the ulcers look infected Amoxycillin, oral, Adults 500 mg 8 hourly for 5 days; Children 6-12 years; 250 mg 8 hourly for 5 days 1-5 years; 125 mg 8 hourly for 5 days < 1 year; 62. There are many causes of low back pain several of which can be determined with reasonable accuracy from a good clinical his to ry and physical examination. In some patients however, no cause will be found and these people are described as having non-specific back pain. In such cases management is by reassurance and treatment of depression if appropriate. Slipping forward of a vertebra upon the one below Narrowed spinal canal from spinal stenosis Psychogenic pain: the back is a common site of psychogenic pain. Weight bearing joints (hips, knees), cervical and lumbar spine and the metacarpo-phalangeal and distal interphalangeal joints of the hands are commonly affected. Instead, they should have alternatives such as paracetamol 1g 8 hourly or tramadol 50 mg 8 hourly. Also refer other complications such as lumbar spinal stenosis, cervical spondylosis and nerve compression for specialist management. Other organs such as the lungs, kidneys, eyes and the haema to poietic system may occasionally be affected. Rheuma to id fac to r is positive in older girls in whom the disease course is similar to the adult type. Occasionally single joint (proximal interphalangeal joint) and swollen knee may be the only joints affected. The majority are due to non-gonococcal bacteria whereas the remaining cases may follow gonorrhoeal infection. Good prognosis depends on early initiation of appropriate antibiotic treatment which should begin immediately diagnosis is suspected while ensuring that samples are taken for appropriate investigations. Pharmacological treatment with antibiotics should be by the parenteral route for two weeks followed by the oral route for 4 weeks. Pharmacological treatment (Evidence rating: C) Tetanus prophylaxis for all potentially contaminated wounds, followed by booster doses of tetanus to xoid as appropriate (see section on Immunization). Do not use Eusol, which is both irritant and exposes patient to unnecessary borate levels Dress infected wound as often as needed with normal saline or povidone iodine lotion. Take wound swab for culture and sensitivity test if possible and start Amoxicillin (Amoxycillin) while waiting for results of wound culture Amoxicillin (Amoxycillin), oral, Adults 500 mg 8 hourly Children 6 -12 years; 250 mg 8 hourly 1-5 years; 125 mg 8 hourly 1 year; 62. Infection is usually via the umbilical cord if it is not kept clean or if non-sterilised instruments or dressings are used. To prevent tetanus in patients with potentially contaminated wounds (tetanus prone wound), provide adequate wound to ileting (see section on Wounds) and also provide tetanus prophylaxis (see section on Immunization). All cases of snake bites (venomous/non-venomous) should be observed for at least 6 hours. Do not move the limb that has been bitten-the more it is moved, the faster the poison spreads. Detain for observation Give the patient plenty of fluids to drink In the case of bee sting remove stinger from skin by scraping. A deliberately inflicted bite on the hand or elsewhere should be considered as contaminated. Always complete the rabies vaccine moni to ring form Check availability of treatment for the next patient First dose of antirabies vaccine may be given whilst observing for presence or absence of rabies in the dog these guidelines are prepared with respect to the use of Rabies Immunoglobulin of human origin and human diploid cell rabies vaccine. Children, patients with no recall of the event leading to the injury and those vomiting should be admitted. Treating only the underlying cause may take a long time for pain relief to be achieved. Special attention must be given and precautions taken in providing pain relief in children, pregnant women and the elderly as well as those with concurrent hepatic or renal disease, cognitive or behavioural disorders and those who are opiate- to lerant or have a his to ry of substance abuse.

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In the case of extensive submucosal disease with surface ulceration with rolled edges, a malignant tumor might be considered. Mural changes include smooth muscle hypertrophy, neuronal hyperplasia and fbrosis around the foci of endometriosis. Mullerian type adenocarcinomas, most commonly endometrioid and clear cell carcinoma, may rarely arise within endometriosis of the intestine. Since the morphology of clear cell carcinoma differs signifcantly from most primary colorectal carcinomas, this diagnosis is a rather straightforward matter. Urinary Tract Endometriotic urinary tract involvement is rarely seen, with a prevalence of less than 1 % in women suffering from endometriosis. In case of endometriotic involvement of the bladder wall, this is usually seen with coexisting fbrosis and muscular proliferation resulting in thickening of the bladder wall. On the one hand, endometriotic tissue is capable of transgress ing organ barriers and infltrating in to neighboring tissues or organs (deeply infltrating endometriosis). On the other hand, it has been known for quite a long time that patients suffer Fig. However, the increased risk is not equally dis In addition, patients with endometriosis have a higher risk tributed among all types of ovarian carcinoma, but specifcally for adenosarcoma, endometrioid stromal sarcoma as well as applies to endometrioid adenocarcinoma (Fig. Endometriosis-associated carcinomas A relationship between endometriosis and clear cell carcinoma affecting younger patients are diagnosed in lower stages, with is also supported by immunohis to chemical data. Apart from that, numerous molecular fndings To date, it remains unclear what causes the various genomic suggest a causal relationship between endometriosis changes. A contributing fac to r could be the bloody content of and endometrioid carcinoma and clear cell carcinoma, the endometriotic cyst which exerts an oxidative stress on the respectively. Mutations were gynecologic diseases to subsequent risk of ovarian and uterine tumors. Mullerian adenosarcomas with unusual growth endometriosis at some distance from the tumor. Abdominal Wall Endometriosis on the Right Port Site After Laparoscopy: Case Report and Literature Review. Mutations in the beta-catenin gene adenocarcinoma of the abdominal wall: a case report. Polypoid endometriosis: a clinicopathologic analysis of 24 cases Identifcation of multiple pathways involved in the malignant and a review of the literature. Association between endometriosis and risk serous borderline tumor and endometrial stromal sarcoma of the of his to logical subtypes of ovarian cancer: a pooled analysis ovary: a report of a rare lesion in an infant. Clear cell carcinoma arising from relation to benign ovarian conditions and ovarian surgery. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Critical adjunct discussions of approach to endometriosis offers distinct advantages for endometriosis pathology (subsection 1. Superfcial endometriosis lesions are most commonly Laparoscopic Trocar Placement in the Anterior found in the posterior compartment of the pelvis and, Abdominal Wall specifcally, on the left side. Similarly, primary and recurrent Complete understanding of the major structures of the ovarian endometriomas most frequently are observed in the anterior abdominal wall is essential for safe entry in to the left ovary. The two critical considerations of laparoscopic trocar placement are vascular and nerve ana to my. The inferior epigastric artery branches from have pain symp to ms that are strongly related to that depth the external iliac artery at the level of the inguinal ligament. The right Also in the retroperi to neal space is the presacral (or superior ureter is easiest to view in the retroperi to neum overlying the hypogastric) nerve plexus, which is anterior to both the aortic pelvic brim and crosses over the right external iliac artery bifurcation and the left common iliac vein, which is most (Fig. The retroperi to neal retroperi to neal tissue and typically falls with the medial leaf of entry is accomplished in the space created by the round the broad ligament after opening the peri to neum parallel to the ligament anteriorly, the infundibulopelvic ligament medially, ovarian vasculature. The uterine artery travels laterally to the and the external iliac artery laterally.