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Examples include red blood cells 7 day gastritis diet purchase motilium toronto, leukocytes and platelets disorders: Transfusion reaction; haemolytic anemia; Agranuloytosis; Thrombocytopenia; Certain drug reaction ii gastritis diet foods buy motilium 10mg with mastercard. The target cells coated with IgG antibodies are killed by a variety of nonsensitized cells that have Fc receptors gastritis diet karbo 10 mg motilium amex. Antibody-mediated cellular dysfunction In some cases gastritis diet 5 small order motilium online now, antibodies directed against cell surface receptors impair or dysregulated function without causing cell injury or inflammation. For example: In Myasthenia Gravis, antibodies reactive with acetylcholine receptors in the motor end plates of skeletal muscles impair neuromuscular transmission and cause muscle weakness. The converse is noted in Graves disease where antibodies against the thyroidstimulating hormone receptor on thyroid epithelial cells stimulate the cells to produce more thyroid hormones. Endogeneous origin Nuclear components (systemic lupus erythematosis) Immunoglobulins (rheumatoid arthritis) Tumour antigen (glomerulonephritis) Therefore, autoimmune diseases are hypersensitivity diseases in which the exaggerated immune response is directed against the self antigens as exemplified by the above three diseases. Formation of Ag-Ab complex Introduction of an antigen into the circulation, then Production of specific antibodies by immuno-competent cells and subsequent antigen antibody formation b. Deposition of immune complexes the mere formation of antigen-antibody complex in the circulation does not imply presence of disease. Other factors for immune deposition include charge of immune complexes, valence of antigen, avidity of the antibody, affinity of the antigen to various tissue components, three-dimenstional /lattice/ structure of the complex, hemodynamic factors, etc. Sites of immune complex deposition include: Renal glomeruli, joints, skin, heart, serosal surfaces, & small blood vessels 143 c. Inflammatory reaction After immune complexes are deposited in tissues acute inflammatory reactions ensues and the damage is similar despite the nature and location of tissues. Due to this inflammatory phase two mechanisms operate i) Activation of complement cascades: - C-3b, the opsonizing, and -C-5 fragments, the chemotaxins are characterized by neutrophlic aggregation, phagocytosis of complexes and release of lysosomal enzymes that result in necrosis. Neutorphiles and macrophages can be activates by immune complexes even in absence of complements. With either scenario, phagocytosis of immune complexes is effected with subsequent release of chemical mediators at site of immune deposition and subsequent tissue necrosis. Morphology of immune complex-mediated hypersensitivity reaction the morphologic consequences are dominated by acute necrotizing vasculitis with intense neutrophilic exudation permiting the entire arterial wall. Affected glomeruli are hyper cellular with proliferation of endothelial and mesengial cells accompanied by neutrophillic and mononuclear infiltration. Classification of immune complex-mediated diseases: Immune complex-mediated diseases can be categorized into systemic immune complexes diseases (e. Systemic immune-complex diseases: Acute forms: If the disease results from a single large exposure of antigen / ex: acute post-streptococal glomerulonephritis and acute serum sickness/ all lesion then tend to resolve owing to catabolism of the immune complexes. Arthus reaction: the Arthur reaction is defined as a localized area of tissue necrosis resulting from an immune complex vasculitis usually elicited in the skin. Arthus reaction occurs at site of inoculation of an antigen and depends on the presence of precipitating antibody in the 144 circulation / with antibody excess/ that resulted in immune complex deposition. Inflammatory reaction develops over 4-8 hours and may progress to tissue necrosis as described above. Chronic forms of systemic immune complex diseases result from repeated or prolonged exposure of an antigen. Continuous antigen is necessary for the development of chronic immune complex disease. Delayed type hypersensitivity: this is typically seen in tuberculin reaction, which is produced by the intra-cutaneous injection of tuberculin, a protein lipopolysaccharide component of the tubercle bacilli. Some of these activated cells so formed enter into the circulation and remain in the memory pool of T cells for long period of time. Immunologic Tolerance Immunologic tolerance is a state in which an individual is incapable of developing an immune response to specific antigens. Tolerance can be broadly classified into two groups: central and peripheral tolerance. T cells that bear receptors from self-antigens undergo apoptosis within/ during the process of T-cell maturation. The engagement of Fas by Fas ligand co-expressed on activated T-cells dampens the immune response by inducing apotosis of activated T-cells ( Fas mediated apoptosis) 2. When normal tolerance of the self antigens by the immune system fails, autoimmune diseases result.
Those children who do not develop symptoms and who survive past 5 years of age are slow progressors gastritis diet xtreme discount motilium 10 mg. Studies in Thailand gastritis healing order motilium with a visa, Rwanda gastritis diet 80% discount 10mg motilium with visa, and the United States suggest that growth failure can signal rapid disease progression chronic gastritis fever order motilium with american express. In resource-limited environments, where obtaining laboratory data is sometimes not possible, growth monitoring may be the best available tool for assessing risk of disease progression. A child is said to be failing to thrive when he or she loses weight or fails to gain weight at a normal rate for a child of that age. Growth deceleration can occur as early as the first few months of life, though some children have normal growth for many years. When people have low bone density for their age, they are said to have osteopenia. Children who fail to form bone normally are at high risk of developing early osteoporosis and suffering from fractures during adulthood. The virus also elevates levels of Puberty several cytokines (interleukin 1, interleukin 6, and tumor Delay of sexual maturation is common among children necrosis factor ) that contribute to increased activity with chronic diseases. Vitamin D delays both in the age of onset of puberty and in their deficiency also contributes to abnormal bone metabolism progression through the pubertal stages (Table 1 and and has been reported more frequently in patients with Table 2). Female pubertal (Tanner) staging later in life because of their early Normal development of osteopenia and Age Pubic Hair Other Significant Stage Range (yrs) Breast Growth Growth Changes osteoporosis. The appearance of bones on plain X rays can provide qualitative evidence for the existence of osteopenia or osteoporosis. Head circumference should also be monitored in children who are younger than 2 years. Another option is tared weighing, where the caregiver is weighed, the scale is tared (or "zeroed"), and then the undressed child is held by the caregiver, capturing the weight of the child only. Once measurements have been plotted, the resulting growth curve makes it easy to determine whether the child is experiencing growth failure. Though his weight is recovering quickly, his height will lag behind, and he is likely to remained stunted, with a lower than average adult height. Plotting Measurements on Growth Charts Once weight and height (or length) are measured, they should be plotted and interpreted using a standard growth chart. These growth charts depict age on the horizontal axis and weight, height, or head circumference on the vertical axis. Weight should be checked each visit and height checked every 3 months throughout childhood. Head circumference should be plotted at least every 3 months until 24 months of age and more frequently during the first 6 months of life. The weight-for-height ratio is a growth indicator that relates weight to length (for children <2 years) or height (for children 2 years). Health care providers should therefore aim to identify poor growth early before stunting occurs. A variety of different criteria exist to aid in the timely diagnosis of clinically significant poor growth. The nutrition chapter discusses other clinical signs of malnutrition in more detail.
Reframing is the process of reinterpreting the world in light of alternative perspectives and values gastritis diet order discount motilium on line. Because reframing can lead to critiques of current policies gastritis diet fish purchase cheapest motilium, processes gastritis chronic diarrhea discount motilium 10 mg without a prescription, or structures gastritis symptoms back order motilium 10 mg online, it can be psychologically uncomfortable and resisted by others. Nonetheless, the reframing process is an essential component of a learning organization and can be facilitated by purposefully incorporating diverse perspectives on planning teams (Yorks and Marsick 2000). Learning manifests itself in distinctive forms, including data, information, knowledge, understanding, and wisdom (Ackoff 1996). Information includes data, but provides details regarding who, what, when, and where. Knowledge concerns questions relative to "how to" and offers insight as to how a system might be managed. Understanding clarifies questions related to cause and effect; here, we begin to understand why systems act and respond as they do. Finally, wisdom, as Ackoff (1996: 16) suggested "is the ability to perceive and evaluate the long-run consequences of behavior. Learning manifests itself in distinctive forms, including data, information, knowledge, understanding, and wisdom. Given an emphasis in the adaptive management literature on the role of action informed by knowledge, it seems that appropriate indicators of learning necessarily involve both cognition and behavior. Knowledge that lacks a link to action would seem to constitute little more than facts on the shelf; conversely, action that lacks a base in improved knowledge is little more than hopeful activity. Thus, learning would seem to require both a cognitive dimension as well as an observable behavioral manifestation grounded in improved knowledge. It is also clear that significant barriers grounded in organizational processes, belief systems, or other factors act to stymie the acquisition of improved knowledge or its implementation into action. Inkpen and Crossan (1995) drew attention to how organizational norms and sanctions can operate to stymie learning or thwart behavioral change, effectively maintaining the status quo. Learning encompasses knowledge acquisition; to say we have learned implies that we know more than previously (which might include that we now know how little we knew). Michael (1995) argued that learning implies more than increasing the stock of facts: it suggests we know what needs to be done, how to do it, whether it worked, and how to apply learning to emerging consequences. In other words, learning is not an end in itself, but a means to informing subsequent action. We all have certain trained incapacities, and learning must acknowledge and accommodate these. However, to do so can evoke feelings of psychological discomfort, denial, anger, and fear (Miller 1999). For example, learning differs in terms of perception (the way in which information is taken in) as well as in the way we order that information (the way we use the information we perceive). There are differential capacities in dealing with information in a concrete versus abstract or conceptual manner. And, there are 16 Adaptive Management of Natural Resources: Theory, Concepts, and Management Institutions a variety of ways in which people best organize the information around them: as facts, as principles, in terms of relevance, or in terms of underlying reasons. A classroom teacher, for example, facilitates the learning process for his or her students. As with many of the literatures we examine in this review, this is a large, diverse area. However, for our purposes, this literature suggests that a key feature of the learning process for adults is that learning occurs not so much through incremental accumulation of understanding (e. Reflection is a key element of this process because it offers people an opportunity to determine whether previous assumptions still are relevant and applicable to the decisions that face them (Mezirow 1995). Perhaps the most controversial issue with regard to the notion of learning and the processes and structures that facilitate it links to two related questions: is learning a technical or social process (or both) and, as noted earlier, is organizational learning simply the sum of individual learning within that structure or is it an emergent product that is more than the sum of the learning of individuals within the organization? Advocates of learning as a technical process argue that it primarily involves processing information. Theory (it works, but range of applicability may be narrow) Example Laboratory experimentation Controlled observation to infer cause Enabling prediction, design, control Molecular biology and biotechnology Adaptive management (quasiexperiments in the field Trial and error Systematic monitoring to detect surprise Integrated assessment to build system knowledge Informing model-building to structure debate Strong Green inference (but Revolution learning may agriculture not produce timely prediction or control) Empirical knowledge (it works but may be inconsistent and surprising) Models of reality (test is political, not practical, feasibility) Learning by doing in mass production Problemoriented observation Extended to analogous instances To solve or mitigate particular problems To identify plausible solutions to intractable problems Unmonitored experience Casual observation Applied anecdotally Most statutory policies Source: Lee 1999: 3. Single-loop learning occurs when individuals perceive a mismatch between their intentions (i.
It should include age gastritis diet information purchase motilium once a day, marital status chronic gastritis diet plan generic motilium 10mg otc, occupation gastritis nsaids purchase motilium in united states online, education gastritis y acidez buy motilium 10mg lowest price, ethnic origin, area of residence, drinking, smoking and any substance abuse habits, past obstetric and gynaecological history. Record of each pregnancy in chronological order should include date, place, maturity, labour, delivery, weight, sex and fate of the infant and any puerperal morbidity. Patients should be told how to recognize and report promptly any deviation from normal so that prompt treatment may be initiated. Principles of management include: - Identification of high risk patient cases - Prophylaxis and prenatal counselling - to prevent some high risk patients - Early start of antenatal care - Close medical supervision during pregnancy - Special tests and examinations to evaluate foetal development and well being as well as maternal well-being - Timely intervention for therapy and delivery. Mild anaemia Hb 8-10 mg, moderate Hb 6-7 gm, severe Hb 4-5 gm, very severe below Hb 4 gm. Most cases are due to Iron deficiency: Dietary deficiency, blood loss from hookworm infestations. Folate deficiency due to inadequate intake especially in urban areas, also due to haemolysis of malaria. Iron deficiency and folk acid deficiency often occur together causing "Dimorphic Anaemia". Clinical Features General weakness, dizziness, pallor, oedema, in haemolytic anaemia; jaundice, hepatosplenomegaly occur in haemolytic anaemia. The foetal and maternal status will depend on extent of bleeding, duration and aetiology. For mothers who have been in labour recession of the foetal presenting part and disappearance of foetal heart sounds suggest rupture of the uterus. Once rupture of the uterus has been ruled out then treatment for abruptio placentae should be instituted. Placenta Praevia the management of placenta praevia depends on gestation, extent of bleeding and clinical findings. The decision follows after evaluation, complete examination of maternal and foetal status. Palpitations, body oedema, cough, easy fatigability, evidence of heart enlargement, murmurs, thrills, left parasternal heave, raised jugular venous pressure. Suitable methods include minilaparotomy, tubal ligation under local anaesthesia, vasectomy, barrier methods, progesterone only agents e. Clinical Features Overt diabetes If not already diagnosed the symptoms include: polydipsia, polyuria, weight loss, blurred vision, lethargy. Historical risk factors include: Previous gestational diabetes, family history of diabetes, previous macrosomic infant, previous unexplained still birth, polyhydramnios, obesity, advanced maternal age. Complications of diabetes include Chronic hypertension and nephropathy, pregnancy-induced hypertension, foetal macrosomia, intrauterine growth retardation, polyhydramnios, foetus distress, hypoglycaemia. The following table provides guidelines on drugs which are considered safe or relatively safe in pregnancy, drugs which should be used with caution and only when necessary, and drugs which are contraindicated.
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