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By: Karen Patton Alexander, MD

  • Professor of Medicine
  • Member in the Duke Clinical Research Institute

https://medicine.duke.edu/faculty/karen-patton-alexander-md

More than 50% of the population is under 25 years of age order generic isoptin from india blood pressure medication diuretic, while only 1 5% is above 60 years of age discount isoptin online american express pulse pressure medical definition. The incidence of cancer is lower than in more developed regions cheap 240mg isoptin otc blood pressure medication breastfeeding, varying from 50 to 190 cases per 100 000 population [25. Given that approximately 50% of patients need radiotherapy and 25% may need additional treatment (re-treatment), around 184 000�203 000 patients per year are estimated to need radiotherapy treatment for cancer in the region [25. European service planning benchmarks suggested 450 patients per machine per year [25. In Australia and Turkey, the target was set at 400 patients per machine per year [25. The suitable goal for the region could be 450 patients per machine per year, and this is the benchmark used here for our calculations of teletherapy machine needs (Table 25. In addition, up to 25% might receive a second course of radiotherapy in developed countries, but this proportion for developing countries is not known. Therefore, the re-treatment rate is not considered here and the calculated rate should be taken as a minimum. The teletherapy machine throughput (the number of new treatment courses per machine per year) has been estimated at 400 or 500 in India and Belgium. Bahrain, Cyprus, Israel, Jordan, Lebanon, Qatar and Turkey exceed the region�s average. The variation in the number of teletherapy machines per 1000 cancer cases per year ranged from 0. Bahrain, Kuwait, Lebanon, Qatar, Saudi Arabia and the United Arab Emirates have 2 or more machines per 1000 cancer cases. A total of 176 simulation imaging devices were also available, and 209 treatment planning systems were recorded. These are located in Saudi Arabia (planned to be operational in 2017) and in Abu Dhabi (planned to be operational in 2018). If, ideally, one radiation oncologist is available for every 250 new patients, then between 736 and 880 radiation oncologists are needed. The number of radiation medical physicists reported was 513, with the ideal level being between 460 and 550. The undersupply or deficit was most noticeable in Yemen, the Syrian Arab Republic and Iraq, with a deficit of 87%, 69% and 58% of their calculated needs, respectively. Jordan, Kuwait, Lebanon, Saudi Arabia and the United Arab Emirates showed an oversupply relative to the calculated demand. When compared with countries in the Asia�Pacific region, only Japan, Australia, New Zealand and Singapore, out of 17 countries, showed a higher ratio [25. Introduction Over the last few years, the situation with regard to the availability of radiotherapy equipment has evolved steadily in almost all North African countries, specifically: Algeria, Egypt, Libya, Morocco and Tunisia. As a result, there is no recent publication that accurately presents the current status of radiotherapy resources and/or the needs of this region. Demographic and epidemiological aspects the North African countries are quite comparable in their demographic, economic and sociocultural background [25. Hence, it is not surprising to observe large similarities in cancer epidemiology patterns across these five countries [25. Data published by nine cancer registries in the region are summarized in Table 25. The most frequent cancers are the same in all North African countries, namely lung, breast, colorectal, bladder and prostate cancer. In terms of technical level, most centres are in transition from two dimensional (2-D) to three dimensional (3-D) conformal radiotherapy planning and delivery. To estimate the need for radiotherapy units in the region, we refer to the calculation method adopted by Barton et al. We estimate that at least 60% of all cancer patients should receive radiotherapy during their life span. On the other hand, it is estimated that the capability of the treatment machines ranges from 400 to 500 patients per year [25. The estimated demand for radiation units in Tunisia, for example, becomes: 12 189 (number of new radiotherapy cases per year) 60% (the proportion of cancer patients in which radiotherapy is indicated) divided by 450 (number of patients treated per machine per year) = 16. It is worth noting that these estimates do not apply to Libya, because many of the existing machines there are not working or are being replaced. Education in radiation oncology and medical physics in North Africa the number of radiation oncologists and medical physicists is shown in Table 25.

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Amphetamines Drugs that share a particular chemical structure that cause decreased appetite buy isoptin pills in toronto heart attack playing with fire, increased attention order 40mg isoptin overnight delivery arteria tibialis posterior, decreased sleep discount isoptin 240 mg fast delivery heart attack trey songz, and behavioral activation. Amino acid A particular type of chemical that contains an amino chemical group and a carboxylic acid chemical 678 Principles of Autonomic Medicine v. Amygdala A structure of the limbic system in the brain, involved with emotional responses. Amyloidosis Any of a variety disorders in which a type of protein called amyloid is deposited within body organs. Angina pectoris An unpleasant squeezing or pressure sensation due to inadequate delivery of oxygenated blood to the heart muscle, such as from coronary artery disease. The anterior cingulate has connections with both the �emotional� limbic system and the �cognitive� prefrontal cortex. Antibody A large, Y-shaped protein produced mainly by plasma cells that is used by the immune system to identify and neutralize pathogens such as bacteria and viruses. Anticipatory control A form of predictive or anticipatory regulation, largely synonymous with feed-forward 679 Principles of Autonomic Medicine v. Arginine vasopressin (Synonymous with vasopressin) Arachnodactyly A condition in which a person has long, thin fingers. Arrestins A family of chemicals that help turn off the intra cellular cascade that activates cells when G-protein coupled receptors such as beta-adrenoceptors are occupied. Arterial baroreflex A rapid reflex that keeps arterial blood pressure within bounds. Arterial blood sampling Obtaining blood from a large blood vessel that moves blood away from the heart. Arteries (with the exception of the arteries to the lungs) carry oxygen-rich blood at high pressure. Arteriole Tiny arteries that carry blood from the heart, like �twigs� of the arterial tree. The overall amount of constriction of arterioles is the main determinant of the total resistance to blood flow in the body. Ascorbic acid (Synonymous with vitamin C) Ashkenazi Referring to people of Eastern European Jewish ethnicity. Asphyxiation Severe, sudden loss of oxygen supply due to lack of breathing, such as in suffocation. Asthma A disease of the airways that involves episodes of airway spasm, producing wheezing, coughing, and shortness of breath. Asystole A state of no electrical activity and therefore no pumping activity of the heart. Auerbach�s plexus A nerve network in the wall of the gastrointestinal tract, part of the enteric nervous system. Autocrine/paracrine A type of arrangement where a chemical messenger acts on the same or nearby cells from the site of its release. Autoimmune Referring to an abnormal immune response against substances or tissues in the body. Autoimmune autonomic neuropathy A form of autonomic failure associated with an �attack� of the immune system on a part of the autonomic nervous system. Autonomic dysreflexia A condition after a spinal cord injury in which afferent stimulation, such as from filling of the urinary bladder, evokes a large increase in blood pressure. Autonomic function testing Testing of one or more functions of the autonomic nervous system. Autonomic medicine A medical discipline that focuses on clinical disorders of the autonomic nervous system. Autonomic myasthenia Nickname for a form of chronic autonomic failure associated with an antibody to the acetylcholine receptor responsible for transmission of nerve impulses in ganglia. Autonomic nerve supply the amount of autonomic nerve fibers and terminals in a tissue or organ. Autonomically mediate syncope Syncope due to alterations in activities of the components of the autonomic nervous system. Autosomal dominant A situation where even one copy of the mutated gene is sufficient to produce the disease. Autosomal recessive A situation where copies of the mutated gene on each chromosome produce the disease. Autotoxic A characteristic of chemicals that harm the cells in 682 Principles of Autonomic Medicine v.

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The incubation period is usually 10 to order isoptin 240 mg otc blood pressure gradient 14 days order isoptin australia mrf-008 hypertension, with a range from seven to discount 240 mg isoptin amex hypertension kidney and dialysis specialists 19 days1. Early symptoms include high fever and headache, followed by maculopapular rash two to four days later which spreads from the face to all parts of the body. The skin sores sequentially become vesicular and pustular, before they turn into crusts and scab over. There is no cure for smallpox, but vaccination can effectively prevent infection if given within four days after exposure to the virus2. Since then, one smallpox outbreak involving two cases and one fatality has been reported in Birmingham, England, in 1978, which was due to accidental exposure to variola virus in a research laboratory. In the wake of this accident, it was agreed by the international community to gradually reduce the number of laboratories holding stocks of variola virus. Eradication eventually led to the global cessation of vaccination with the smallpox vaccine. Currently the majority of the global population <40 years has been neither vaccinated against, nor exposed to, smallpox and therefore remains vulnerable to the virus today. In the past 15 years, attention has shifted from the risk of a laboratory accident to the possibility of a deliberate release of the virus as an act of bioterrorism3. Monkeypox is a rare zoonosis caused by monkeypox virus which, like the variola virus causing smallpox, also belongs to the genus of orthopoxvirus. The virus was first discovered in 1958 in monkeys kept for research, hence the disease was named �monkeypox�. Infection could occur when a person comes into contact with the virus from animals, humans or contaminated materials. Humans could get infected from various wild animals, such as some species of primates, rodents and squirrels, etc. Human-to-human transmission is also possible through respiratory droplets during prolonged face-to-face contact or direct contact with body fluids. The incubation period is usually from six to 16 days, with a range from five to 21 days4. The first few days after infection with monkeypox are characterised by fever, intense headache, myalgia and lymphadenopathy. Rash appears about one to three days after onset of fever, and spreads from the face to other parts of the body. Some patients with monkeypox develop severe swollen lymph nodes before the appearance of the rash, which is a distinctive feature of monkeypox compared to other similar diseases such as chickenpox. In addition, monkeypox can only be diagnosed definitively in the laboratory through virus isolation, antigen and nucleic acid detection, etc4. While smallpox has been eradicated for more than three decades, today monkeypox still occurs in some remote parts of Central and West Africa4. In 2003, a shipment of animals from Ghana introduced monkeypox virus into the United States which caused an outbreak affecting 47 persons. More recently in October 2017, a major monkeypox outbreak was reported in Nigeria. The investigation established that the initial cluster of cases had regularly played with a captured monkey in their neighbourhood, which was killed and eaten by them about one month prior to onset of their illness. The initial confirmation of this outbreak had been challenged by long delays in the collection, referral and testing of samples7. As of December 9, 2017, there were a total of 172 cases reported from 22 states and the Federal Capital Territory across Nigeria, among them 61 were laboratory confirmed, with one fatality recorded in a Figure 1 � Distribution of Monkeypox Cases in Nigeria, as of case with immunocompromised condition8 (Figure 1). There is currently no treatment or vaccine available for monkeypox, although previously it has been shown that smallpox vaccine may also be effective in preventing monkeypox. To reduce the risk of infection during human monkeypox outbreaks, members of the public should: Avoid close physical contact with sick persons or animals; Wear protective clothing and equipment including gloves and surgical masks when taking care of ill people or handling animals, and carry out regular hand washing after these procedures; Thoroughly cook all animal products before eating; and Seek medical advice promptly for any suspicious symptoms. The baby girl presented with cough, runny nose with reduced appetite since December 1 and was admitted to a public hospital on December 10. Contact tracing revealed her 22-month-old elder sister had cough since November 28. She was then referred to the Accident and Emergency Department of a public hospital on December 12. Epidemiological investigation revealed that both children did not travel outside Hong Kong during the incubation period. She presented with progressive memory loss and right-sided numbness in late October 2017.

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A shunt is a narrow order isoptin australia arteria3d cartoon medieval pack, fexible tube used to cheap 40mg isoptin with mastercard blood pressure pediatric move fuid from the brain to buy isoptin 40mg on-line arrhythmia quiz ecg another part of the body. The tubing is then threaded under the skin, down the neck, and into the abdominal cavity. Sometimes the shunt empties near the right atrium of the heart rather than the abdomen. Small incisions in the neck, chest and/or abdominal area are made to attach the tubing securely. Sometimes a tube is placed into one of the four cavities or ventricles in the brain and connected to a collecting bag outside of the body. When these situations occur, a surgical procedure known as shunt revision may be done to correct the problem. Abruptly changing the pressure may cause the brain to shift upward or downward toward the spine. In this situation, the doctor will use other methods to reduce the pressure before a shunt is inserted. The Ommaya reservoir can be built into the catheter as part of a shunt, or as a stand-alone device. It can involve removing the bone surrounding the brain and reassembling it again without disturbing the function of the crucial nerves or blood vessels in that area. The term �trans� means through and �sphenoid� refers to the sphenoid bone located under the eyes and over the nose. The entry point for the neurosurgeon is through an incision made under the upper lip and over the teeth or directly through the nostril. The laser probe is directed into the tumor through one or more small holes using stereotactic techniques. Brain mapping during surgery helps the neurosurgeon detect critical areas and distinguish the margin of the tumor from the rest of the brain tissue. A probe is used to stimulate certain areas of the brain with a low dose of electrical current. As the probe touches an area of the brain, the electric current causes a visible movement of that related body part. If the patient is awake, this technique can also be used to locate critical areas in speech or sensation. This helps the neurosurgeon identify critical areas of the brain that must be carefully navigated. Electrodes placed on the surface of the brain record the weak electrical impulses as they travel along nerves to the brain. These impulses are called �evoked potentials� and are another tool for identifying critical areas. This helps distinguish between normal brain, which uses oxygen, and a tumor that contains dead cells and does not use oxygen. Intraoperative Ultrasound Imaging During surgery, ultrasonic waves might be used to determine the depth of the tumor and its size. The time it takes for these �echoes� to bounce back is calculated by a computer and formed into an image on a screen. These images provide the surgeon with similar information as intraoperative ultrasound, but usually produce more detailed pictures. They are particularly helpful in determining how much of the tumor has been removed, and they allow the surgeon to navigate using updated brain images. Embolization is a technique neurosurgeons use to stop the blood fow to the tumor prior to removing it. A diagnostic test, called an angiogram, is performed to determine if a signifcant amount of blood is going to the tumor. If so, the neurosurgeon or neuroradiologist can insert a small �plug� made of wire or glue-like material into the vessel.

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References:

  • https://fas.org/sgp/crs/misc/R42130.pdf
  • https://www.ohsu.edu/sites/default/files/2019-01/2018-Convocation-OHSU-Book-Final-for-web.pdf
  • https://ecommons.cornell.edu/bitstream/handle/1813/64826.2/IFUPDirectory_v30Aug19_SENT.pdf?sequence=8&isAllowed=y
  • http://www.gammaexplorer.com/wp-content/uploads/2014/03/MURRAY-R.-L.-Nuclear-Energy.-An-Introduction-to-the-Concepts-Systems-and-Applications-of-Nuclear-Processes-.pdf
  • https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf