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Ismailis in Central Asia The term "Central Asia" will include here the mountainous regions of China, Soviet Union, including Hindukush, Pamir, Yarkand, Wakhan, Oxus, Shagnan, Gilgit, Hunza and Chitral. During the period of Imam al-Mustansir billah, Nasir Khusaro was designated as a hujjat of Khorasan and Badakhshan. He came from Khorasan and launched mass conversion in Central Asia. When public pressure against him escalated, he found refuge in Yamghan, in the court of Ali bin al-Asad, an intellectual Ismaili prince in the mountainous region of Badakhshan. Thus Yamghan became synonymous with prison, where he died. Ismaili Flag - Green Color - Its Special Features "The Ismaili flag contains rich green colour with a red strip descending from left upper corner to the bottom of right side, making a cross mark in the flag. The nature of the characteristics, which the Ismaili flag, acquired green and red colours (lawn) from the historical context will be explored briefly in the following lines. Green (akhdar) is synonymous with nature. For the Arabs, as for many other people, green is the symbol of good luck, of natural fertility, of vegetation, of youth. For Islam, the green standard of the Prophet and the green cloak of Ali bin Abu Talib have become the very emblems of the religion. As a beneficent colour, green belongs so naturally to the popular spirit of the Arabs that their colloquial language is full of expression where this colour symbolizes joy, gaiety or success. Green is mentioned six times in the Koran as an adjective (khudr, akhdar), vide 12:43, 46:18, 31, 36:80, 55:76 and 76:21, and once as a participle (22:63). Giving the description of green, the Koran also says, "Reclining on green cushions and beautiful carpets" (55:76) and "Do you not see that God sends down water from the cloud so the earth becomes green?" (22:63). In Syria, a green land is used in describing a lucky person. To wish somebody a good year, one uses the expression green year, and when one takes up residence in a new dwelling, green leaves of beet are hung there as a token of good luck. In Morocco, the expression my stirrups are green means, "I bring the rain when I travel into an area where it is awaited." The Prophet himself declared, "The sight of green is agreeable to the eyes as the sight of a beautiful woman" (al-Jahiz, Tarbi, p.137). Ismaili Flag - Alamut Period "Hasan bin Sabbah (1034-1124) took possession of the fort of Alamut in Iran in 1090. His immediate concerns were to refortify Alamut, provide for it food and water supply, irrigate the field in the valley, acquire adjacent castles, erect forts at strategic points, institute economic and social reforms and unite the Ismailis. Thus, he succeeded to establish the Nizarid Ismailis rule in Alamut. It appears from the fragments of the historical sources that, the Ismailis continued green colour as their standard, and Hasan bin Sabbah is reported to have hoisted it for the first time on the summit of the Alamut. Ismaili Constitution The word constitution is derived from the Latin constituere means an action of decreeing or ordaining. According to The Oxford English Dictionary (London, 1933, 2:876), "It is a decree, ordinance, law, regulation usually one made by a superior authority, civil or ecclesiastical." In the broad sense, a Constitution is a body of rules governing the affairs of an organized group. Ismaili Tariqah The word tariqah (pl. turuq, tara'iq) is derived from tariq meaning a space between two rows of palm-trees. It is thus simply meant the way, path or road, as it is said in Arabic qatah atariq means he interpreted the road, and howalla tariqatah means he is following his own way. Salmon suggests in his Arabic Dictionary (p, 499) the derivation of tariqah from taraqa meaning a string of camels following a difficult tract to a well." The word tariq occurs nine times in the Koran. The tariqah is not only internal perception of the hidden meaning of the law, it also purports to be a total discipline aimed towards the progressive purification of the soul. Atrial fibrillation (AF) with a rapid ventricular response A previously healthy 22-year-old woman presents to the emergency department (ED) with acute shortness of breath. Her shortness of breath became worse with exertion and was associated with pleuritic chest pain for 2 days. She has had a fever, nonproductive cough, nausea, vomiting, and arthralgia. On presentation, she is febrile with a temperature of 101.5°F (38.6°C), a blood pressure of 88/54 mm Hg, a pulse of 104 bpm, a respiratory rate of 28 breaths/min, and an oxygen saturation of 88% while breathing room air. Her oxygen saturation improved to 92% with supplemental oxygen given at 2 L/min. She is in moderate respiratory distress; however, she can speak in full sentences. Her physical examination reveals absent breath sounds throughout the right thorax, with decreased breath sounds halfway up the left thorax. Other findings include egophony, decreased fremitus, and dullness to percussion on the right thorax. She has no jugular venous distention, edema on her lower extremity, or rash. Indian Ocean Martime Museum (IOMM) The IOMM will be a part of the redevelopment of Zanzibar's Stone Town and its waterfront. It will be located in the recently restored Stone Town Cultural Centre, in direct proximity to the port. The museum programme will be constructed around the theme of the Indian Ocean as a context for the exchange of goods, ideas and myths in which diverse civilizations have coexisted, interacted and shared intrinsic common values over time. It will showcase the maritime cultures of the Indian Ocean, including the display of naval vessels and other artifacts that illustrate the history of the commercial and cultural contacts between Africa, the Middle East and the Indian sub-continent. Addressing the educational needs of the local population of all ages and functioning as an information and communication centre for foreign visitors, the museum will feature educational and training programmes geared to develop local maritime crafts. The ultimate objective is to promote traditional ship-building as a means to generate revenue and income in addition to the revitalization of a maritime culture which otherwise would be on its way to extinction. Imam Shah "Syed Imam Shah was a famous Ismaili da'i in India. His name was Imamuddin, surnamed Abdur Rahim. He was born in Uchh Sharif in 834/1430, and was the younger son of Pir Hasan Kabiruddin. The tradition has it that when Pir Hasan Kabiruddin died, his all sons were present at Uchh Sharif with exception of Syed Imam Shah. The tradition attests that he reached late during the interment of his father's body. Many traditions are recounted for his dissatisfaction, but all are legendary in character. Imam Begum Bibi Tahira, commonly known as Syeda Imam Begum was the last known member of the Kadiwal family and the composers of the ginans in India. She was born most probably on 1199/1785 in Kera, Kutchh. The tradition has it that she was the daughter of Syed Hashim bin Syed Buzrug Ali bin Syed Mashaikh II bin Syed Muhammad Fazal Shah bin Syed Sadruddin bin Syed Zain al-Abidin bin Syed Abdul Hasan bin Syed Mashaikh I bin Syed Rahmatullah Shah bin Pir Hasan Kabiruddin. Imam Al-Mubin The word Imam al-Mubin occurred twice in the Koran (36:12 and 15:79). The word Imam (pl. a'imma) means a model, an exemplar, a teacher, a guide or a path. The word mubin means manifest, apparent, present, or visible. Besides, the word mubin has a special significance. In Arabic, mubin and the root b-y-n means readily apparent. Thus, Imam al-Mubin means manifest or apparent Imam. The Christian Crusaders and their occidental chroniclers were completely ignorant of Islam. They knew Islam through the literature of the Sunnis, and translated the Koran in the same vein. Peter de Venerable (1094-1156) was Abbot of Cluny in Toledo. The circle of scholars he had commissioned produced mutilated translation of the Koran for the first time from Arabic into Latin. Infection Control From A Nursing Perspective The practice of medical asepsis helps to contain infectious organisms and to maintain an environment free from contamination. The techniques used to maintain medical asepsis include hand washing, gowning and wearing facial masks when appropriate, as well as separating clean from contaminated or potentially contaminated materials and providing information to patients about basic hygienic practices. Appropriate hand washing by the nurse and the patient remains the most important factor in preventing the spread of microorganisms. Clinical Medicine Cases Case 1: • 50 year old man presented with generalized weakness, dizziness, lethargy for 10 days. He was also having loose stools for the past 15 days. On examination was pale and thin lean emaciated man. His blood pressure was 70/40 mm of mercury, with pulse of 130 beats / minute. He had bilateral decrease air entry on chest, epigastric tenderness and pedal edema on examination. Neurological exam was non focal. He had some history of undocumented weight loss, but no history of fever. His past history was significant for episodes of loose stools, which would resolve on taking antibiotics • Hemoglobin: 8 mg/dl Abumin: 1.5 • MCV: 68 Total Bilirubin: 8.1 • WBC: 14 cmm Direct Bilurubin: 5.5 • Platelet: 176 GGT: 304 • SGPT:71 • RBS: 106 AP: 359 • BUN: 15 • Cr.:1 mg/dl ESR: 53 • Na: 126 meq Stool DR: Normal • K: 4.6 meq Calcium: 7.3 • Cl: 111 Phos:1.6 • HCO: 18 Spectrum Of Abdominal Tuberculosis (ATB) Epidemiology: Tuberculosis is one of the deadliest diseases. WHO estimates that each year more than 8 million new cases of tuberculosis occur and approximately 3 million persons die from the disease. Spectrum Of Abdominal Tuberculosis (ATB) Epidemiology: Tuberculosis is one of the deadliest diseases. WHO estimates that each year more than 8 million new cases of tuberculosis occur and approximately 3 million persons die from the disease. Spectrum Of Abdominal Tuberculosis (ATB) Epidemiology: Tuberculosis is one of the deadliest diseases. WHO estimates that each year more than 8 million new cases of tuberculosis occur and approximately 3 million persons die from the disease. Aga Khan Health Services (AKHS) The Aga Khan Health Services (AKHS) is one of the most comprehensive non-profit health care systems in the developing world. Building on the Ismaili community's health care efforts during the first half of the century, AKHS now provides primary health care and curative medical care in India, Pakistan, Kenya, Tanzania and Syria. It includes five general hospitals, the Aga Khan University Hospital in Pakistan, six maternity homes and more than 230 health centers. Organized in national service companies in Kenya, Tanzania, India and Pakistan, these health facilities are also linked in internationally through network-wide strategies in human resource development, hospital management, nursing development and primary health care. Panhypopituitarism • Hypopituitarism can present with complete or partial deficiency of anterior and/or posterior pituitary hormones. • Panhypopituitarism refers to the situation in which more than 80% of the anterior pituitary is lost. Aetiology • neoplasms in the suprasellar region: – pituitary adenoma in adults – craniopharyngioma in children – glioma – meningioma – metastatic cancer New Zealand Athletes Taking Deer Velvet at Olympics Carter, number 1 ranked triathlete in the world, has been taking New Zealand deer velvet for about two years now. He is convinced this dietary supplement adds to his own huge training efforts by assisting with his strength and endurance, and providing him faster recovery after training. Deer Velvet Boost to Strength and Recovery An Evening Out with Virginia Gift Store: Plan an evening out with your family and friends to a cinema or concert and purchase tickets to an upcoming big event. Like this you'll be able to spend time together and also give everyone a gift at one time. What is irritable bowel syndrome (IBS) Irritable bowel syndrome (IBS) is one of the most common ailments of the bowel (intestines) and affects an estimated 15% of persons in the US. The term, irritable bowel, is not a particularly good one since it implies that the bowel is responding irritably to normal stimuli, and this may or may not be the case. The several names for IBS, including spastic colon, spastic colitis, and mucous colitis, attest to the difficulty of getting a descriptive handle on the ailment. Moreover, each of the other names is itself as problematic as the term IBS. Natural IBS Treatments Irritable bowel syndrome (IBS) is a chronic disorder characterized by recurrent abdominal pain and intermittent diarrhea, which often alternates with constipation. IBS most commonly affects people between the ages of 20 and 30 and is twice as common in women as in men. IBS is known by a variety of other terms: spastic colon, spastic colitis, mucous colitis, nervous diarrhea, nervous colon and nervous or functional bowel. Worst Menopause Symptoms May Start in Brain "This is an important new concept: Menopause doesn't just originate in the ovary, but also in the brain," said Laura Goldsmith, a professor of obstetrics and gynecology and women's health at the New Jersey Medical School of the University of Medicine and Dentistry of New Jersey. Study Finds Menopause Symptoms Can Be Predicted The authors of this study measured ovarian volume with transvaginal ultrasound, then looked at the relationship between ovarian volume -- ovaries shrink as a woman ages -- and number of eggs. They then applied mathematical and computer models to predict menopause. Irritable Bowel Syndrome Symptoms In functional diseases of the gastrointestinal tract such as Irritable Bowel Syndrome Symptoms, the grinding, mixing, digestion, and absorption functions are disturbed to only a minor degree. These functions are essentially maintained, perhaps because of a built-in over-capacity of the gastrointestinal tract to perform these functions. The most commonly affected function in these diseases is transportation. In the stomach and small intestine, the symptoms of slowed transportation are nausea, vomiting, abdominal bloating, and abdominal enlargement. The symptom of rapid transportation usually is diarrhea. The interpretation of symptoms, however, may be more complicated than this. For example, let's say that a person has abnormally rapid emptying of the stomach. The sensing of this rapid emptying by the intestinal sensory nerves normally brings about a motor nerve response to slow emptying of the stomach and transportation through the small intestine. Thus, rapid emptying of the stomach may give rise to symptoms of slowed transportation. Irritable Bowel Syndrome FAQ 1a: What is Irritable Bowel Syndrome?1b: What is the prevalence of IBS?1c: What factors contribute to the onset of IBS?1d: How long does IBS last?1e: What effect does IBS have on one's lifestyle?1f: Are my symptoms just "all in my head" or psychosomatic?1g: What factors contribute to health care utilization? Menopause Symptoms and Memory Loss In the latest study that exonerates menopause as a cause of impairing the ability to recall, Taiwanese researchers compared the memory of hundreds of women before they had any menopausal symptoms to their memory as they entered menopause. They found the women who were going through the menopausal process scored as well or nearly as well on five different cognitive function tests. Results of the study are to be presented Oct. 4 at the American Neurological Association annual meeting in Toronto. Irritable bowel syndrome diet IBS symptoms of abdominal pain or discomfort, bloating and constipation are associated with impaired quality of life and are the second most common cause of work-related absenteeism, behind the common cold, Canadian researcher, of the University of Alberta, Edmonton, said in a prepared statement. IBS Treatment IBS symptoms of abdominal pain or discomfort, bloating and constipation are associated with impaired quality of life and are the second most common cause of work-related absenteeism, behind the common cold, Canadian researcher, of the University of Alberta, Edmonton, said in a prepared statement. IBS Medications Bowtrol is the only natural remedy that is clinically proven effective for Irritable Bowel Syndrome. If you are suffering from constipation, diarrhea, or both in alteration, abdominal pain, bloating, and heartburn more than once a month, you are not alone. Irritable Bowel Syndrome (also called IBS) affects about 25 million to 50 million people in US alone. Cause of irritable bowel syndrome There has been a great deal of controversy over the role that poor digestion and/or absorption of dietary sugars may play in aggravating the symptoms of IBS. Poor digestion of lactose, the sugar in milk, is very common as is poor absorption of fructose, a sweetener found in many processed foods. Poor digestion or absorption of these sugars could aggravate the symptoms of IBS since unabsorbed sugars often cause increased formation of gas. Tips to Buy Real Hoodia Gordonii There are many types of Hoodia plants, but only Hoodia Gordonii species have appetite-suppressing effects. The main point is to note that you should not buy the product with label “100% natural Hoodia.” Of course you are buying natural Hoodia but not the desired Hoodia Gordonii. • If you are buying Hoodia Gordonii online then you must see CITES certificate issued by International trade laws. Only then you can be confirmed that you are buying natural Hoodia Gordonii. Science Behind Hoodia Gordonii For thousands of years the Bushmen of South Africa having been eating Hoodia Gordonii to fight off hunger during their week long hunting trips. For the Bushmen there is no question as to the appetite suppressant power of Hoodia Gordonii - it is a simple fact of life - if you are going on a long journey you chew on hoodia to avoid hunger. Pure Hoodia In a blend test, performed by ‘Phytopharm’, “400 mg per day” of Hoodia Gordonii powder, for 15 days, reduced the calorie intake by 1,000 calorie compared to the control group. Pills, Capsules, diet gum and tincture all followed. To avoid patent violation, many companies claim that their product is a food supplement, an aid for weight loss. How is Hoodia Gordonii Related to Dieting? Though Hoodia Gordonii looks very much like a ‘cactus’, it is actually a leafless succulent with cactus like spikes. Whenever the early African tribesmen traveled on long hunting expeditions, they used to consume the Hoodia Gordonii ‘cactus’ to help stave-off hunger on their prolong trips. As its natural ability to safely curb the appetite has become well known in the recent past. Hoodia Gordonii's popularity has exploded. A certified pure Hoodia Gordonii diet pills are available now in the market. Hoodia Safety Guidelines 60 MINUTES on CBS news featured Hoodia, reporting " Hoodia is very different from other diet stimulants like Ephedra and Phenfen that are now banned because of dangerous side effects. Hoodia does not stimulate the body. In fact, scientists say it fools the brain by making you think you're full, even if you've just eaten a morsel." Hoodia review - Does hoodia work for weight loss? The South African scientists, working with a British company named Phytopharm, isolated the active ingredient in hoodia, a steroidal glycoside, which they named p57. After getting a patent in 1995, they licensed p57 to Phytopharm. Phytopharm has spent more than $20 million on hoodia research. Hoodia Press Release 60 MINUTES on CBS news featured Hoodia, reporting " Hoodia is very different from other diet stimulants like Ephedra and Phenfen that are now banned because of dangerous side effects. Hoodia does not stimulate the body. In fact, scientists say it fools the brain by making you think you're full, even if you've just eaten a morsel." Hoodia Liquid Extract Vs Hoodia Pill On the other hand, Hoodia in a liquid form can be absorbed almost immediately, and the majority of people will experience its effects in just a few minutes after swallowing it. Liquid Hoodia has a superior absorption rate as opposed to the pill/tablet while it can provide you with the same or better results than the pill or tablet even at a lower dosage. Hoodia Gordonii Helps you Lose Weight Hoodia gordonii looks like a cactus, but it's actually a succulent from the Kalahari Desert in southern Africa. Bushmen from the area have been using hoodia for centuries to help ward off hunger during long trips in the desert. Hoodia Gordonii Cactus According to the British Heart Foundation 17% of men and 21% of women are obese, while 46% of men and 32% of women are overweight. Morbidity and Mortality Meeting In Gilgit she was being treated as a case of genital Tuberculosis without any objective genitourinary complaints or symptoms, She took ATT for 2 months and then stopped b/c of drug induced Acute Hepatitis. Clinical Presentation, Demographic And Pathological Pattern Of Primary Thyroid Carcinoma Discussion Thyroid carcinoma was more common in females. Papillary carcinoma was the most common histological type of thyroid carcinoma in females as well as in males. Thyroid carcinoma was more prevalent in third and fourth decades of life and it is more common in urdu speaking followed by sindhi, Punjabi and balochi and pushto speaking (Pathan) population. The most common presentation was the mass in anterior neck and weight loss and cervical lymphadenopathy, History of Hoodia Gordonii Does Phytopharm own the patent on the whole Hoodia Gordonii plant?This is an interesting question that we are sure will be decided in court one day. Here is our take on the situation - Phytopharm clearly owns the patent on the P57 molecule. If you want to try to make a diet drug with P57 you need to work through Phytopharm. Hoodia - Some Interesting Facts Here are some facts about Hoodia that one should know: Hoodia gordonii resembles like a cactus, but actually it is a succulent from Kalahari Desert of southern Africa. Hoodia gordonii is not a drug. It is absolutely an herb. Some pharmaceuticals companies are trying to isolate "P57" appetite suppressing molecule to create a pharmaceutical drug in the near future. Does Hoodia Gordonii Have Slide Effects? Remember that while using the Hoodia Pills method, you are not going on a diet; Hoodia simply decreases your appetite. You don't feel hungry and it keeps you healthy and energetic at the same time. A pure Gordonii has no stimulants and harmful side effects. Can Hoodia Slim You Down? Know The Facts About Hoodia:i) There are a variety of Hoodia plants. Only the Hoodia Gordonii class contains an active element that helps suppress your appetite. As the demand for Hoodia Gordonii is far surpassing the supply, some Hoodia sellers are using unreliable but advertising their products as Pure Hoodia even though it might have been made from a different Hoodia plant than the Hoodia Gordonii. About the South African Hoodia Gordonii Cactus The South African Hoodia Gordonii Cactus is known by many names. It is called xshoba or xhooba by the San Bushmen who have used it to treat indigestion, minor skin infections and as an appetite and thirst suppressant during long hunts. The scientific name is Hoodia Gordonii. It is actually a succulent so the names Hoodia cactus and South African desert cactus are actually misnomers, but they are commonly used. The plant resembles a cactus when seen growing wild in the Kalahari Desert. A Guide to Hoodia Cactus Plant Extract Before choosing a Hoodia product you should know that there are many kinds of Hoodia plant, but only the Hoodia Gordonii type has an astonishing 'appetite suppressing' quality. These properties have been known about for centuries by a primitive tribe known as the 'Sans Bushmen'. During mid 1990s an institute called the C.S.I.R. 'Council for Scientific and Industrial Research' was conducting a study of native plants eaten by the 'Sans Bushmen'. Basically, the study was to see what foods, the 'Sans Bushmen' were taking that protected the toxic compounds. When the C.S.I.R. studied Hoodia Gordonii, they found it was not only non-toxic, but also it helped to suppress the appetite of animals it used to feed to. 60 Minutes Report on Hoodia Kruiper led 60 Minutes crews out into the desert. Stahl asked him if he ate hoodia. "I really like to eat them when the new rains have come," says Kruiper, speaking through the interpreter. "Then they're really quite delicious." The Miracle of Green Tea Today, scientific research in both Asia and the west is providing hard evidence for the health benefits long associated with drinking green tea. For example, in 1994 the Journal of the National Cancer Institute published the results of an epidemiological study indicating that drinking green tea reduced the risk of esophageal cancer in Chinese men and women by nearly sixty percent. University of Purdue researchers recently concluded that a compound in green tea inhibits the growth of cancer cells. There is also research indicating that drinking green tea lowers total cholesterol levels, as well as improving the ratio of good (HDL) cholesterol to bad (LDL) cholesterol. Green Tea May Prevent Type 2 Diabetes In the United States, more than 20 million people suffer from diabetes -- about 7 percent of the population -- and about 19 million people in the European Union are so afflicted -- about 4 percent of the population. The cost of treating the disease is about $132 billion, according to the American Diabetes Association. Green Tea Increases Metabolism There are two ways to lose weight -- either reduce energy intake, or increase energy expenditure. Because hypothyroidism -- even after treatment -- may reduce energy expenditure in some people, patients naturally are looking for options that can help safely help raise the metabolism. The Clinical Approach to Acid-Base Disorders Methods to Interconvert pH and [H+]:The 0.1 pH Change Rule: PH Conversion Factor [H+] nmol/L 6.90 100 / 0.8 125 7.00 100 100 7.10 100 X 0.8 80 7.20 100 X 0.8 X 0.8 64 Respiratory Disease and Lung Function Data Collection: • Questionnaire data were collected by trained interviewers who gathered information on race/ethnicity, medical history, socioeconomic status, use of medication, and smoking history. • Participants were also asked whether they had taken any of the following pain medications in the last month and, if so, how often they had used each: aspirin (including Anacin, Bufferin, Ecotrin, Ascriptin, or Midol), acetaminophen (including Tylenol, Anacin-3), and ibuprofen (including Advil, Nuprin, Medipren). Pulmonary Function Testing Pulmonary Function Issues Related to Measured Values: • Overinflation of Lungs – Emphysema - COPD - Permanently – Asthma - Acutely • ? RV + Ratio RV/TLC • FEV1/ FVC ratio falls below 80% - Also flow rates fall – With age (lungs less compliant) – Falls with obstructive diseases; e.g. asthma/bronchitis • Asthma - obstructive disease ? increased collapsing force of large airways – obstruction to expiratory flow ? lung volume – bronchodilators may return flow to normal • Early COPD - characterized by irreversible ? in small airway resistance that reduces expiratory flow – not very responsive to dilators • Severe COPD - ? small & large airway resist – severe flow limitations – bronchodilators ? little help – chronic bronchitis and emphysema • Emphysema - loss of elastic recoil ? ? small airway collapse during expiration, thereby ? resistance – Max Expiratory Flow ? – Bronchodilators have no effect – ? FRC + TLC Hyponatremia by eHealthGuide.info Hyponatremia: Plasma Na < 135meq /L • Almost always due to •ADH Secretion • Appropriate • Inappropriat • One Exception: Primary Polydipsia • supression of ADH Secretion BUT still overwhelms kidney’s diluting ability • Free water retention & Hyponatremia Epidemiology of Hyponatremia: Hyponatremia is among the most common electrolyte disorders encountered in clinical medicine, with an incidence of 0.97% and a prevalence of 2.48% in hospitalized adult patients when plasma [Na+ ] concentration below 130 mEq/L is the diagnostic criterion. Clinical Manifestations: • < 125 mEq/l • • Malaise - Muscle cramps • Nausea, Vomiting, Headache • Hypotension – Tachycardia • < 110 mEq/L • • Confusion, convulsions, coma Guillain Barre Syndrome Me score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). • The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. Drug Resistance In Tuberculosis Inadequate Prescribing Practice: • In 1995 25% of new cases of TB were initially treated with 2-3 drugs regimen • 2 Surveys by AKUH among GP & Interns • Once resistance develops, prescribing errors, usually by inexperienced physicians can exacerbate situation. • Review of patients referred to National Jewish Hospital (Denver) for management of complex MDR-TB documented an average of 3.93 prescribing errors per patient. Dexamethasone in Adults with Bacterial Meningitis Methods: • a prospective, randomized, double-blind, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis. • Dexamethasone (10 mg) or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every 6 hours for four days. • The primary outcome measure was the score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). • The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. Common Bleeding Disorders Hemophilia in Pakistan: • A relatively young country, with an ancient past, Pakistan achieved independence from Britain on August 14, 1947, after its bloody partition from India. • Pakistan's health care system has crumbled: public hospitals are in appalling condition, even basic treatment unavailable for many common disorders. • Private hospitals-modern and fully equipped-foster the only available research, and provide the most advanced and comprehensive care for people with hemophilia, but are extremely expensive and beyond the reach of most. • No infrastructure currently exists to provide public and free care to people with this lifelong bleeding disorder. • Of the estimated 12,000 people with hemophilia in Pakistan, only 3,100 have been identified. • Until early 1980, hemophilia was not even known to exist within the country, and only a few patients were alive. In 1982 the first blood bank was formed. • Currently only five major cities-Karachi, Lahore, Rawalpindi-Islamabad, Peshawar Multan, Faisalabad and Quetta-now have facilities to provide plasma or cryo. • And treatment at its best in Pakistan is still primitive by Western standards. Virally inactivated high or intermediate purity factor concentrates are available only to the minority elite, who are wealthy enough to pay out of pocket. But the majority of patients, the poor, receive plasma or cryo. They most often receive inferior plasma, which is not always screened for HBV, HCV and HIV. Chronic Obstructive Pulmonary Disease. COPD A disease state characterized by airflow limitation that is not fully reversible. Airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Symptoms, functional abnormalities, and complications of COPD can all be explained on the basis of this underlying inflammation and the resulting pathology. COPD - Chronic Obstructive Pulmonary Disease History: SOB Productive cough Recurrent acute chest illnesses Exerbation – cold air, foggy weather, atmospheric pollution etc Smoking: Previous episodes Details of previous admissions Current treatment Chronic Gastric Diseases Overview: Gastric Causes of Chronic Vomiting - Chronic gastritis – Lymphocytic/plasmacytic – Eosinophilic – Associated with GHLOs – Parasitic – Reflux gastritis - Gastric foreign body - Gastric ulceration - Gastric motility disorders - Gastric neoplasia Bronchiectasis The bronchiectatic cavities may be lined by granulation tissue, squamous epithelium or normal ciliated epithelium. There may also be inflammatory changes in the deeper layers of the bronchial wall and hypertrophy of the bronchial arteries. Chronic inflammatory and fibrotic changes are usually found in the surrounding lung tissue. Chronic Obstructive Pulmonary Disease - COPD GOLD Staging Criteria: GOLD Staging Criteria Stage O: Normal spirometry; chronic sx Stage 1 (Mild): FEV1> 80% Stage 2 (Moderate): 2A: FEV1 50-80% predicted 2B: FEV1 30-50% predicted Stage 3 (severe): FEV1/FVC < 70% AND: FEV1 < 30% predicted and clinical evidence of R heart failure Snoring & Sleep Opnea help? The treatments for sleep apnea include weight loss, avoidence of sleep depressants (alcohol, sleeping pills, etc), CPAP ( a mask used at night to keep the airway open), dental repositioning devices, and surgery. Sleep Disorder Risks and ComplicationsYou have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications. The following complications have been reported in the medical literature. Obstructive Sleep Opnea & Tonsils As noted above, most cases of obstructive sleep apnea in children is caused by enlarged tonsils and adenoids. Surgical interventions are therefore directed to what is causing the obstruction. In the case of enlarged tonsils and adenoids, tonsillectomy and adenoidectomy is usually successful in relieving the problem. If the problem is not the tonsils and adenoids, the cause of the obstruction must be determined. For example, surgery of the jaw may be required. In some cases, even a tracheostomy is necessary. Non-surgical therapies include oral prostheses (difficult in children), medications (steroids, stimulants), and weight reduction. Chronic Snoring Cures Sleep apnea is diagnosed by a sleep study. During a sleep study, the patient's breathing patterns, heart rhythim and brain waves are monitored. The Best Answer For All Acne Problems The typical lesions of acne are: small whitish or skin-colored bumps (whiteheads) or blackish elevations (blackheads). More inflamed rashes take the form of pus-filled or reddish bumps, even boil-like tender swellings. After resolution of the lesions, prominent unsightly acne scars may remain. Acnezine lightens up these scar marks and makes you feel fresh and comfortable. Acnezine Treatment for Acne in Pregnancy Plan Before You Get PregnantIf you are planning to get pregnant, it is important to discuss your acne treatments with your doctor. Many of these can harm the unborn baby. These include tetracycline antibiotics, oral isotretinoin (Roaccutane, Accutane) and topical retinoids (tretinoin, isotretinoin and adapalene). 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Immune System Problems and Thyroid The Immune system: If your immune system suffers, you will too If your immune system becomes over active or under active, you could develop diabetes, cancer, arthritis, allergies, bronchitis, tuberculosis and a host of immune system related conditions. Hypothyroidism Causes Early Menopause Thyroid treatment system i.e. thyromine, works by stimulating the body to produce normal levels of thyroxine, because the supplements are all natural this may be done without side effects such headaches and insomnia. The body is also provided with necessary nutrients that help it to function properly. Thyroid treatment supplements may also help to restore deficient iodine levels, as adequate amounts are vital to a healthy thyroid gland. Heavy Menstrual Periods? 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