note1 harshit jain

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H.pylori new regimen..

Regimen (Duration) Drug 1 Drug 2 Drug 3 Drug 4

Regimen 1: OCM (714 days)a Omeprazoleb (20 mg bid) Clarithromycin (500 mg bid) Metronidazole

(500 mg bid)

Regimen 2: OCA (714 days)a Omeprazoleb (20 mg bid) Clarithromycin (500 mg bid) Amoxicillin (1

g bid)

Regimen 3: OBTM (14 days)c Omeprazoleb (20 mg bid) Bismuth subsalicylate (2 tabs qid)

Tetracycline HCl (500 mg qid) Metronidazole (500 mg tid)

Regimen 4d: sequential (5 days + 5 days) Omeprazoleb (20 mg bid) Amoxicillin 1 g bid

Omeprazoleb (20 mg bid) Clarithromycin (500 mg bid) Tinidazole (500 mg bid)

Regimen 5e: OAL (10 days) Omeprazoleb (20 mg bid) Amoxicillin (1 g bid) Levofloxacin (500 mg

qid)noroviur at all ages

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(II)Some more useful data@ for PGMEE

SN Particulars Figure

1 Crude Birth rate 22.5

2 Crude Death rate 7.33 Total fertility Rate 2.6

4 Maternal Mortality ratio 212

5 Infant Mortality Rate 50

6 Contraceptive prevalence rate 54.1

7 Neonatal mortality rate 35

8 Percent unmet need of family planning 21.3%

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Syphilis

Essentials of Diagnosis

Primary SyphilisPainless genital sore (chancre) on labia, vulva, vagina, cervix, anus, lips, or nipples.

Painless, rubbery, regional lymphadenopathy followed by generalized

lymphadenopathy in the third to sixth weeks.Dark-field microscopic findings.

Positive serologic test in 70% of cases.

Secondary Syphilis


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Bilaterally symmetric extragenital papulosquamous eruption.

Condyloma latum, mucous patches.

Dark-field findings positive in moist lesions.

Positive serologic test for syphilis.

Lymphadenopathy.

Tertiary Syphilis

Cardiac, neurologic, ophthalmic, and auditory lesions.

Gummas.

Congenital SyphilisHistory of maternal syphilis.

Positive serologic test for syphilis.

Stigmata of congenital syphilis (eg, x-ray changes of bone, hepatosplenomegaly,

jaundice, anemia).

Normal examination or signs of intrauterine infection.

Often stillborn or premature.

Enlarged, waxy placenta.

Latent Syphilis

History or serologic evidence of previous infection.

Absence of lesions.

Serologic test usually reactive; titer may be low

=========================================

Bounced Home Test

Steps

Patient lies supine on the table

Examiner cups the patient's heel in his/her hand

Examiner flexes the patient's knee & allows the knee to passively extend

Positive TestKnee extension is not complete or has a rubbery ("springy block") end feel; pain & guarding

Positive Test Implications

Possible meniscus tear (pain & springy block)

Possible posterior capsular sprain (pain & guarding but no springy block

======================================================================

Lachman's Test

Steps

Patient is supine with his/her knee passively flexed to approximately 20 degrees & hands crossed

across his/her chest

Examiner's thumb of the sameside hand as the knee to be examined is placed at the anterior

medial tibial plateau/joint line, while digits 25 are positioned posterior, slighty distal to the popliteal

fossa

Examiner's contralateral hand is placed laterally around the distal femur, just proximal to the patella

with the thumb anterior & the digits 25 are positioned posteriorly

Examiner sets the tibia by pushing posterior (to make sure the PCL is in tact)

Examiner provides an anterior force to the tibia while applying posterior pressure to the femur;

repeats the process 23 times


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Positive Test

Increased anterior tibial translation, pain


ACL tear (primary posterolateral bundle but also the anteromedial bundle)

=====================================

Brush/Sweep/Wipe TestSteps

Patient is supine with his/her legs extended & relaxed

Examiner uses one hand just below the joint line on the medial side & strokes proximally toward the

patient's hip 23 times

Examiner uses the other hand to stroke down the lateral side of the patella

Examiner observes for a fluid wave bulge just below the medial distal portion or patellar border

Positive Test

Fluid wave bulge just below the medial distal portion or patellar border


Intracapsular effusion/swelling

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1.b.melitiens is the commonest cause of symptomatic disease in human,for which main source are

sheep,goat and camel.

2.b.aortus.cattle and buffalo

3.b.canis ..dog

4.b.ovis.reproductive disease in sheep

5.b.neotomaedesert rodent

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Ortho-phthalaldehyde (OPA) is chemically related to glutaraldehyde. According to the Michigan

Health and Hospital Association (MHA), the disinfecting mechanism of OPA is thought to be similar

to glutaraldehyde and is based on the powerful binding of the aldehyde to the outer cell wall ofcontaminant organisms. A notable difference between the two commercial disinfectants is the

percent of active ingredient in each product. Commercial OPA-based disinfecting products contain

only 0.55% of the active ingredient, while most glutaraldehyde-based disinfecting products contain

2.4 to 3.2% active ingredient 5 to 7 times that of OPA products. is a widely used glutaraldehyde

alternative. Its potential benefits include:

lower inhalation exposure risk,

reduced disinfecting time (12 minutes vs. APIC-approved 20 minute disinfection time and FDA-

approved 45 minute disinfecting time for Cidex),

solution is approved for use in almost all of their equipment without negating the warranty, and

cost is significantly less than installing a more substantial ventilation system to minimize respiratory

irritation from using glutaraldehyde.

Ortho-phthalaldehyde is a clear blue solution with little odor. It is a potential irritant of eyes, skin,

nose and other tissues resulting in symptoms such as stinging, excessive tearing, coughing and

sneezing. It is a potential skin and respiratory sensitizer that may cause dermatitis with prolonged or

repeated contact and may aggravate pre-existing bronchitis or asthma. In addition, the product

stains proteins on surfaces to gray/black. Although OPA may pose similar occupational hazards to


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glutaraldehyde, the risk is significantly reduced due to the low percentage of OPA and relatively low

vapor pressure of OPA-based commercial products. OPA does not currently have a recommended

exposure limit; however, vendors recommend that similar protective equipment be used, including

gloves and goggles.

==============================

Occupational Safety and Health Administration (OSHA) regulations relate to sterilants anddisinfectants:

OSHA has established a permissible exposure limit (PEL) standard for ethylene oxide of 1 ppm in air

as an 8 hour time weighted average, and 5 ppm over any 15 minute sampling period.

OSHA's Hazard Communication Standard (HazCom), requires that information concerning any

associated health or physical hazards be transmitted to employees via comprehensive hazard

communication programs (Go to HERC HazCom page). The programs must include:

Written Program. A written that meets the requirements of the Hazard Communication Standard

(HazCom).

Labels. In-plant containers of hazardous chemicals must be labeled, tagged, or marked with the

identity of the material and appropriate hazard warnings.

Material Safety Data Sheets. Employers must have an MSDS for each hazardous chemical which they

use and MSDSs must be readily accessible to employees when they are in their work areas during

their workshifts.

Employee Information and Training. Each employee who may be exposed to hazardous chemicals

when working must be provided information and be trained prior to initial assignment to work with a

hazardous chemical, and whenever the hazard changes.

Depending on the ingredients contained in a sterilant or disinfectant and its manner of use,

employee protection may be required, including:

ventilation controls

personal protective equipmentclothing or gloves

and other applicable precautions. This assessment should be made by the employer, again, based

on the unique conditions of use of the product at that establishment.

Where the eyes or body of any person may be exposed to injurious corrosive materials, employers

must provide suitable mechanisms for quick drenching or flushing of the eyes and body within the

work area for immediate emergency use

=====================

Critical: contact directly with internal fluids, such as with circulating blood though blood vessel walls,

or contact directly with tissues through broken skin

Semi-critical: contact with mucous membranes, or contact with broken skin

Noncritical: contact with intact skin

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