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It was difficult, however, to distinguish whether pH paper had any incremental benefit over the dilutional effects of simply flushing the exposed area with adequate amounts of fluid during a sufficient amount of time after exposure because patient outcome was not directly compared with and without pH monitoring. A review of chemical eye injuries by Burns and Paterson (17) further indicated, "It is generally accepted that the pH of the external eye should return to normal before discontinuing irrigation. If prolonged irrigation does not return the pH to within the normal range, particulate matter possibly remains. However, these recommendations are based on clinical experience rather than direct comparison of the effects of pH testing in different groups of patients. Additionally, much of the published research on treatment of chemical exposure has been conducted on animals, and animal-based conclusions may not be capable of being directly extrapolated to human patients (15, 8, 10, 11). The type of chemical may also be a consideration when using pH paper for monitoring exposure and ingestions. Some chemicals may not alter pH (organic chemicals) or may be so Ar ch iv ed 120 pH Testing acidic or basic that standard pH paper cannot adequately measure the agent. Krenzelok and Clinton (13) recommend that "a sample of the ingested agent and its original container. The information obtained from [pH testing] provides objective data regarding the alkalinity of the product and strongly influences the decision to perform endoscopy on each victim. Others, however, have noted that pH paper is inaccurate in the assessment of strong acids and strong bases, and biases of 1. Of further consideration is the ability to obtain a reliable result from pH paper. Storage conditions and operator technique should therefore be monitored to ensure adequate response and interpretation of results. Accurate paper readings are dependent on sufficient color vision and adequate lighting to discriminate a color change in the presence of interfering paper staining by components such as blood, antacids, and bile (18, 19). The burden and expense of documenting operator training, competency, and quality control of pH paper are not insignificant, yet the cost of the pH paper itself is minimal, and pH testing poses virtually no risk to the patient, provided proper technique is used to collect the sample and perform the test. The pH paper should not be placed in the eye or directly in contact with an exposed area of skin but should test the tears and irrigation fluid flushing the exposed area. Direct contact can lead to further irritation because of the chemicals in the paper, and pH paper is not a sterile medium. Our literature search also found 2 other emergent or acute applications of pH testing: prevention of aspiration pneumonia in surgical patients and the differential diagnosis of diarrhea. Aspiration of stomach contents can lead to pulmonary damage because of its acidity, and unconscious or anesthetized patients are at higher aspiration risk. Administration of preoperative cimetidine can block the secretion of acid and provide protection at intubation or extubation. Wynn and Modell (20) noted that the critical pH below which severe lung damage occurs varies from species to species; for example, 1. Nevertheless, gastric aspirates have commonly been termed "acidic" at pH values 2. In a separate application, the American Gastroenterological Association suggests that a low fecal pH 5. Fecal pH testing may therefore be 121 useful in distinguishing the causes of diarrhea. The use of pH paper is not directly recommended in either of these applications, and a pH meter may be better suited and more capable of distinguishing narrow pH differences, such as 5. Does continuous gastric pH monitoring, compared to random gastric pH determinations, improve patient symptoms and severity in the management of achlorhydria and gastric reflux in inpatient and endoscopy patients? We recommend against the intermittent use of pH paper on gastric aspirates in the diagnosis of gastric reflux disease in favor of continuous monitoring. Although the use of pH testing is common on critical care units, there is a lack of evidence that pH monitoring to adjust drug dosage improves either morbidity or mortality in these patients. The test involves tiny pH electrodes that are swallowed or passed transesophageally to the depth of the gastric sphincter or into the stomach to sense pH changes at those sites.
After a surgical abortion, women may experience light menstrual-like bleeding or spotting for several days. Women should be informed that bleeding similar to or heavier than a menstrual period might be expected with medical methods of abortion. To avoid delays in recognition and management of post-abortion complications, women should be advised to seek prompt health care in the event of excessive bleeding, pelvic pain, fever lasting more than one day or other symptoms of infection. Providing contraceptive services can help women avoid unintended pregnancies in the future and reduce repeat abortions (148). Family planning counselling needs to take place either before or soon after the abortion, since ovulation typically occurs within two to four weeks of terminating pregnancy. The third edition of Medical eligibility criteria for contraceptive use (35) provides additional guidance on the contraceptive use of post-abortion women. Counselling about the option of terminating pregnancy to the extent allowedbylawshouldbeprovidedbyatrainedpersonandbenon-directive, nonjudgementalandconfidential. The woman should make the final decision to terminate pregnancy; being pressuredorcoercedtoundergoanabortionisaviolationofhumanrights. Manual or electric vacuum aspiration should be used in preference to dilatation and curettage for pregnancies up to 12 weeks anddilatationandevacuationafter12weeks. Sixmonthly serological screening for syphilis may be considered in areas with high syphilis prevalence. These actions, however, must be carried out with sensitivity and considering social and cultural factors to reduce the risk of violent or stigmatizing reactions following partner notification, especially against women. This approach is based on identifying consistent groups of symptoms and easily recognizable signs and on providing treatment that will deal with most of, or the most serious, organisms responsible for each syndrome. After they are adapted to local epidemiological and antimicrobial sensitivity patterns, countries can use these tools as standardized treatment protocols. Vaginal discharge algorithms are not designed to detect the more serious but usually asymptomatic cervical infections caused by Neisseria gonorrhoeae or Chlamydia trachomatis. However, prolonged treatment of candidiasis is generally required, and chronic suppressive or intermittent prophylactic therapy may be necessary (155). S exual and reproductive health of women living with hiv/aidS As endogenous infection (infection with organisms normally present in the reproductive tract) is the most likely cause of vaginal discharge, the partner does not need to be treated unless relapses occur. Genital ulcer disease patterns vary in different parts of the world, although genital herpes, syphilis and chancroid remain the most common causes. The frequency and severity of episodes of genital herpes ulcers correlate with the level of immunosuppression. Women with advanced immunosuppression may have severe mucocutaneous ulcerations involving large areas of the perineum. Routine cerebrospinal fluid examination is not indicated for people with early syphilis unless there are nervous system or ocular symptoms. Although there is no cure, treating genital herpes with antiviral agents, such as acyclovir, can shorten the duration of active disease and may help reduce the transmission of genital herpes (160). Most lesions of herpes simplex virus respond to acyclovir, but prolonged treatment may be needed. Adequate information and counselling are needed to explain the nature and purpose of treatment and to avoid false expectations of cure. However, women who receive chronic therapy may develop thymidine kinasedeficient mutants of herpes simplex virus for which standard therapy is ineffective. Surveillance systems for viral resistance are important in programmes using chronic therapy. For treatment of granuloma inguinale, adding a parenteral aminoglycoside such as gentamicin to the standard treatment regimens could be considered. The syndromic approach to lower abdominal pain is designed to offer effective treatment to women with symptoms suggesting pelvic inflammatory disease. Although some women managed with this algorithm may S exual and reproductive health of women living with hiv/aidS not actually have pelvic inflammatory disease, treatment is justified because of the severe consequences including infertility and ectopic pregnancy that often follow when pelvic inflammatory disease is untreated or treatment is delayed. Treatment should be started as soon as the presumptive diagnosis is made, because long-term complications are more successfully prevented if appropriate antibiotics are administered immediately. Special care is required in notifying the partners of women who are treated for pelvic inflammatory disease.
Significant ¶Data suppressed because the total number of cancers for 2008-2012 was <16. Data Sources: Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Georgia Comprehensive Cancer Registry (2008-2012) Updated: January 2016 Visit: dph. Males living in metro counties (250,000 to 1 million) had the highest oropharyngeal incidence rate compared to the state incidence rate; males living in rural counties had a significantly lower rate. Female and male anal cancers do not equal the total number of anal cancers because of rounding. Females living in smaller urban counties had a significantly higher cervical cancer incidence rate than females living in metro counties (1 million or more) and females living in metro counties (1 million or more) had the lowest rate. Metro 250,000-1million includes counties in metro areas of 250,000 to 1 million population. Smaller Urban includes urban population of 20,000 or more, adjacent to a metro area; Urban population of 20,000 or more, not adjacent to a metro area; Urban population of 2,500 to 19,999, adjacent to a metro area; and Urban population of 2,500 to 19,999, not adjacent to a metro area. Rural includes completely rural or less than 2,500 urban population, adjacent to a metro area, and completely rural or less than 2,500 urban population, not adjacent to a metro area. Vaginal and penile cancer incidence rates were slightly higher than those for the U. Of 2,408 cases among males, more than half were from oropharyngeal cancer (1,876, 77. High cervical cancer screening rates could indicate a targeted effort in reaching and screening this population and may indicate a reduced access to screening services among this group and/or to a lack of follow up (Shavers & Brown, 2002; Fiscella et al. Further, improving cervical cancer screening should prevent the development of invasive cervical cancer. Parents disagree on the age to vaccinate; some believed it would be easier to vaccinate at a younger age; some worry about encouraging unsafe sexual activity; and others want their child to take part in the decision to be vaccinated. When making health decisions for their adolescents, parents generally trust what their health providers recommend. The study assessed perceptions and communication in administering vaccines to 11-12 year old patients. Differences in the incidence rate of oropharyngeal cancers may be due to tobacco use and alcohol use. Differing risk factors, such as age and sexual behaviors may also be responsible for the varying incidence rates (Smith et al. Geographically, no apparent trend was seen as related to the Rural-Urban classification. Parents of adolescents take physician recommendations into consideration when making health decisions. Further, there should be a continued effort to promote cervical cancer screening, especially to minority groups where disparities remain. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute. Eliminating disparities in cancer screening and follow-up of abnormal results: what will it take. Physician communication about adolescent vaccination: How is human papillomavirus vaccine different. Preventive Medicine: An International Journal Devoted To Practice And Theory, 77181-185. Using population-based cancer registry data to assess the burden of human papillomavirus-associated cancers in the United States: overview of methods. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivatives License creativecommons. The complete bibliographic information, a link to the original publication on. Abstract Cervical polyps are most commonly seen in the female with uterine bleeding. On the other hand, giant cervical polyps with a size greater than 4 cm are rare and until now only several cases have been described in literature. The management is surgical and can be conservative regarding to the benign pathological feature of this entity.
Oocysts rupture and sporozoites are liberated in the body cavity and migrate everywhere particularly to the salivary glands. Now the mosquito is infective the sporogonous cycle in the mosquito takes 8-12 days depending on temperature 65 Figure 15; Life cycle of Plasmodium species 4. Plasmodium falciparum Plasmodium falciparum demonstrates no selectivity in host erythrocytes, i. The trophozoite is often seen in the host cells at the very edge or periphery of cell membrane at accole position. The infected red blood cells also do not 66 · Peripheral blood smears characteristically contain only young ring forms and occasionally crescent shaped gametocytes. Weather (rainfall, temperature & humidity) is the most obvious cause of seasonality in malaria transmission. To date, abnormal weather conditions are also important causes of significant and widespread epidemics. In Ethiopia, even though all the four species of plasmodium infecting man have been recorded, P. The periodicity of the attacks then becomes tertian (36 to 48 hours), and fulminating disease develops. Capillary plugging from an adhesion of infected red blood cells with each other and endothelial linings of capillaries causes hypoxic injury to the brain that can result in coma and death. Intravascular hemolysis with rapid destruction of red blood cells produces a marked hemoglobinuria and can result in acute renal failure, tubular necrosis, nephrotic syndrome, and death. Liver involvement is characterized by 67 abdominal pain, vomiting of bile, hepatosplenomegally, severe diarrhea, and rapid dehydration. More mature trophozoites and erythrocytic schizonts containing up to 24 merozoites are present. Vivax is the most prevalent of the human plasmodia with the widest geographic distribution, including the tropics, subtropics, and temperate regions. As the infection progresses, increased numbers of rupturing erythrocytes liberate merozoites as well as toxic cellular debris and hemoglobin in to circulation. In combination, these substances produce the typical pattern chills, fever and malarial rigors. These paroxysms usually reappear periodically (generally every 48 hours) as the cycle of infection, replication, and cell lyses progresses. The paroxysms may remain relatively mild or may progress to severe attacks, with hours of sweating, chills, shaking persistently, high temperatures (1030F to 1060F) and exhaustion. This requirement produces no red cell enlargement or distortion, but it results in distinctive shapes of the parasite seen in the host cell, "band and bar forms" as well as very compact dark staining forms. The early symptoms are flu-like with fever patterns of 72 hours (quartan or malarial) in periodicity. As a consequence the classical characteristics include: · the host cell becomes enlarged and distorted, usually in an oval form. The infected cell border is commonly fimbriated or ragged Mature schizonts contain about 10 merozoites. Clinically, ovale malaria resembles vivax malaria with attacks recurring every 48-50 hours. Laboratory diagnosis Microscopic examination of thick and thin films of blood is the method of choice for confirming the clinical diagnosis of malaria and identifying the specific species responsible for disease. The thick film is a concentration method that may be used to detect the presence of organisms. Serologic procedures are available but they are used primarily for epidemiological surveys or for screening blood donors. Immunity There is evidence that antibodies can confer hormonal immunity against malaria infection. Control of mosquito breeding Protection of insect bite by screening, netting and protective clothing Use of insect repellents. Humantohuman transmission, other than transplacental transmission, does not occur.