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By U. Marius. Anna Maria College. 2018.

In 2003 generic tetracycline 500 mg on line, the University of Lausanne agreed to renegotiate the controversial agreement generic tetracycline 500mg amex. Phytera later discontinued its research on diterpenes after negative results emerged from clinical trials tetracycline 500mg mastercard. As indicated in The World Intellectual Property Organization Traditional Knowledge 206 Documentation Toolkit (Nov. By far the most important phase of the documentation process occurs prior to documentation. This may be anything from a whole medical system, such as that practiced by traditional healers in Africa and South America, to an individual herb or natural product. This should include individuals traditionally entitled to possess or use the knowledge. This may also include persons who have non- traditionally acquired the knowledge, community members with a specific interest in the knowledge, the entire community or even other communities. On the other hand, if knowledge is restricted to an individual or a particular group within a community, the rights to that knowledge may rest with those persons rather than the entire community. Some countries, 207 such as Brazil, have laws that determine who must be included in documentation efforts. Eduardo Vlez, Brazil s Practical Experience with Access and Benefit-sharing and the Protection of Traditional Knowledge, June 2010 at 1 2. The agreement established the prior informed consent of the Krah people from an organization, Vyty-Cati, which represented the three Krah villages involved in the research. Later attempts to negotiate a new access agreeement failed, and pharmaceutical laboratories stated they were unwilling to finance the project due to concerns that new accusations of 211 bio-piracy might be raised. If documentation is expected to result in financial benefits, how will money be distributed or shared? If possible, major decisions should be by consensus, but different stakeholders may have different goals for documentation (or even oppose documentation). Carlini, Plants with Possible Psychoactive Effects Used by the Krah Indians, Brazil, 28 Rev Bras. Knowledge not already in written form should not be written down until a complete documentation strategy is in place. Depending on the knowledge in question, documentation can be costly and time-consuming. For example, traditional healers may need to be involved in documenting oral traditions or persons with language skills may be necessary to translate written texts. If documentation in electronic registries is desired, this requires computer equipment and technical expertise. For example, anthropologists from developed country universities may have valuable expertise in documenting traditional practices, but there may be concerns about transmitting knowledge outside of the community. The details of any proposed collaboration should be clearly agreed upon prior to the initiation of any substantive discussion, and should be governed by written contract rather than relying on informal agreements. However, just because information is publicly available does not mean it should not be documented. Because it is hard to know in advance what knowledge will prove useful in the future, it may be advisable to document as comprehensively as possible. A documentation plan should be created to detail exactly how data will be acquired and a timeline. If a product is being described, documentation should include all known names, variations, and both traditional and modern uses. If a process is being described, documentation should detail every step in the process, including all of the required materials and any information necessary to allow someone else to recreate the process. Documentation should also contain the name, location and contact information of stakeholders claiming ownership. Data is also significantly more accessible to researchers and patent examiners if provided in an electronic, searchable database. Finally, while full stakeholder involvement should be obtained as early as possible, it should be obtained no later than the beginning of the documentation. Written evidence of prior informed consent to documentation and future uses of traditional knowledge should be obtained. Once the documentation phase is ready to begin, the first step should be to comprehensively gather all existing sources of documentation. Based on existing documentation, stakeholders should evaluate where gaps in knowledge exist. For example, in addition to its modern role in treating peptic ulcer disease, the Chinese herbal formula Yi Wei Tang treats 43 217 yin deficiency from a traditional perspective. Terminology of this nature is useful to include in documentation, however it may not be easily comprehensible to outside parties. This includes efforts by the Indian government to document yoga practices in video. If external collaborators are involved in documentation efforts, these relationships should be carefully managed and the confidentiality of documentation maintained. A clear understanding of how documentation will be used should be in place prior to initiating documentation. It is reported that about 4,000 221 applications a year are submitted in this field domestically. An increasing number of these 222 patents are also entering the international patent system. Different ownership structures have different advantages and disadvantages, such as possible tax benefits or reduced personal liability. It is important to choose the most appropriate structure initially, for instance a corporation rather than a partnership, as changing forms of ownership later may be very difficult and costly. The specific structure of a business entity, for example how decisions will be made or how benefits will be distributed, may be shaped by contract, within the requirements of national law.

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The symptoms continue for three to nine days tetracycline 250mg with amex, while the immune system of the patient makes antibodies that attach to the bacteria and clear them from the blood discount tetracycline 250mg online, and the patient appears to recover buy 250 mg tetracycline with amex. The numbers of bacteria gradually increase, and four to seven days after recovering from the rst episode of fever, the patient relapses, i. Almost all the organs are involved and there will be pain in the abdomen and an enlarged liver and spleen, in addition to the other symptoms. Without treatment with special antibiotics, 30% to 70% of cases can die from complications such as pneumonia and infection in the brain, leading to coma (a state of deep unconsciousness) and death. Precautions should be taken by you and by health workers in the hospital or health centre, to avoid close contact with a patient with relapsing fever, to prevent acquiring the infection. Louse-borne typhus (also known as epidemic typhus, jail fever or tessibo beshita in Amharic) is similar in many ways to relapsing fever. They are extremely small bacteria called Rickettsia prowazekii (named after two doctors who died of typhus when they were researching into the disease). Louse-borne typhus has caused major epidemics over many centuries, resulting in millions of deaths during war, famine and mass displacement. The Rickettsia bacteria acquired during a blood meal from an infected person multiply in the gut of the louse and pass out of its body in the louse s faeces, which are deposited on the person s skin. The louse bites are itchy and when the person scratches them, the louse faeces are rubbed into breaks in the skin. This is how the typhus bacteria are transmitted to healthy people when an infected louse gets into their clothes or bedding. After an incubation period of about one to two weeks the symptoms begin suddenly, with severe headache and fever rising rapidly to 38. They also experience very severe muscle pain, sensitivity to light, lethargy and falling blood pressure. Refer patients suspected of having typhus to the nearest health centre or hospital, where they will be treated by doctors with special antibiotics. Typhus is an epidemic-prone disease, so search actively for other people locally with a similar illness and report all suspected cases to the District Health Ofce. In addition to the above actions, you should also educate your community about how to prevent these louse-borne diseases. As we said earlier, these diseases are associated with overcrowding and insanitary conditions in other words, they are associated with poverty. They are best prevented by addressing the underlying socioeconomic circumstances that promote louse infestation: overcrowding, poverty, homelessness and population displacement. However, you should also educate people in your community to take the following preventive actions:. Change clothes and bedding at frequent intervals to reduce the number of body lice. Treat louse-infested clothes and bedding with chemicals to kill the lice and their eggs (this is called delousing). In infested situations like those in refugee camps, clothes and bedding should be deloused by trained personnel with appropriate insecticides, such as 0. Treating clothing with liquid permethrin can provide long-term protection against louse infestation. Note that close contact with patients should be avoided and delousing of the patient s clothes and bedding should be done immediately, to prevent transmission of infected body lice from the patient to healthy people including the health workers who are caring for them. If there is an outbreak of relapsing fever or typhus, the spread of infection can be controlled by active case nding and effective treatment of infected persons and their close contacts with the correct antibiotics. Early treatment controls the spread of infection by reducing the reservoir of bacteria in the local population. In the next study session, we complete the discussion of vector-borne diseases by describing four that are of signicant public health importance in Ethiopia. They are vector-borne febrile illnesses caused by bacteria and transmitted by the human body louse. What educational messages do you give the families in that village and what is your health education aiming to prevent? A It is possible to distinguish between relapsing fever and typhus at Health Post level by identifying differences in their symptoms. C Treatment with the correct antibiotics is sufcient to control epidemics caused by relapsing fever or typhus. D The correct antibiotics can effectively treat relapsing fever and typhus if the patient is referred immediately. E Health workers should protect themselves from developing relapsing fever or typhus by avoiding close contact with patients with these diseases. A better understanding of these diseases will help you to identify patients and refer them quickly to a health centre or hospital for specialist treatment. You will also learn about the health education messages that you need to communicate to members of your community, so they can reduce their exposure to the vectors of these diseases and apply appropriate prevention measures. As you will see in this study session, prevention of all of these diseases includes controlling the vectors with chemicals and/or environmental management, using personal protective clothing or bed nets to reduce exposure to the vectors, and rapid case detection and referral for treatment. Early treatment prevents serious complications and can save lives, and it also reduces the reservoir of infectious agents in the human population. Learning Outcomes for Study Session 37 When you have studied this session, you should be able to: 37. In some described as chronic because the symptoms develop gradually, places, the disease is known by its alternative name bilharzia. Approximately 200,000 people die every year in Africa as a result of the complications caused by these parasites. Rural communities living near water bodies such as rivers, lakes and dams may be highly affected by the disease, because the worms have a complex lifecycle in which they spend part of their development living in freshwater snails.

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True breast pain may be Clinical features caused by acute mastitis tetracycline 250 mg free shipping, a breast abscess effective tetracycline 500mg, fat necrosis There may be a mass palpable proven tetracycline 250 mg, which when pressed pro- or benign breast disorders. Even if no mass is palpable, the dis- be a presentation of breast cancer therefore mammog- charge may come from one duct when one segment of raphy must be considered for women over the age of the breast is pressed. Unilateral blood-stained discharge is sugges- pressure on the costochondral junctions. However, needle core biopsy false Yellowish, green Perimenopausal negative rates are higher than ne needle aspiration and or brown Multiple/bilateral in duct ectasia ne needle aspiration allows aspiration of cystic lesions. Pus Breast abscess, periductal Fine needle aspiration may also provide cytology results mastitis on the same day (one stop clinic) helping to alleviate anxiety at a particularly stressful time for the patient. Copious bilateral milky discharge (galator- index nger and thumb and a ne needle attached to rhoea) may indicate a prolactinoma (see page 421) hence asyringe (often in a holder) is inserted into the lesion aserum prolactin level should be sent. Aspiration is performed by exerting gentle negative Management pressure through the syringe. A number of passes are If thereisnomass,anon-bloodydischargeandtheinves- made through the lesion at differing angles whilst neg- tigations have proved negative, management is conser- ative pressure is maintained. Surgical intervention is indicated if the discharge is profuse and embarrassing or if malignancy cannot be the area. One or Investigations/procedures two passes are usually sufcient to obtain diagnostic material. Imaging in breast disease Cytology from either procedure is graded into ve cate- gories (see Table 10. There are two main modalities of imaging used in as- sessment of breast disease depending on the age of the patient: r Breast reconstruction Ultrasound is the imaging method of choice for estab- lishing the nature of a breast mass in younger women Following a mastectomy breast reconstruction can be (less than 35 years). Mammograms can be difcult to performed at the same time or as a delayed procedure. Mammography alone has C2 B2 Benign a 10% false negative rate, hence it is used as part of C3 B3 Probably benign C4 B4 Probably malignant the triple assessment (clinical examination, imaging, C5 B5 Malignant breast tissue sampling). Breast development Fibroadenoma, juvenile r Previous irradiation does not rule out breast recon- hypertrophy struction but may affect the choice of surgical tech- Cyclical activity Cyclical mastalgia, cyclical niques. The mammary dysplasia) these have now been classied skin may need to be gradually stretched rst using as aberrations of normal development and involution atissue expander. A free ap requires its blood vessels to be surgically re- Aetiology anastomosed such as a latissimus dorsi ap. It may be used Some women develop generalised breast nodularity and as a pedicle or free ap. Complications of myocuta- others present with more localised nodularity (see also neous aps include necrosis of the ap and scarring section Breast Lumps, page 409). Nipple prostheses offer an alternative to ination, imaging and tissue sampling) is required for further surgical treatment. Benign breast disease Fibroadenoma Denition Denition Abnormalities that occur during the normal cycle of Previously broadenomas were considered to be benign breast proliferation and involution. Larger lesions and those with equivocal his- theyarebestconsideredasanaberrationofnormalbreast tology should be excised. Prognosis Incidence Untreated only 10% of broademonas increase in size Most common cause of a discrete breast lump in young over a 2-year period most of which occur in teenage women. Breast cysts Denition Pathophysiology Acommon uid lled epithelial lined space in the breast Fibroadenomas are usually solitary lesions that result presenting as a mass. Fibroadenomas are under hormonal Incidence control,theymayenlargeduringpregnancyandinvolute Palpable cysts occur in 7% of women in Western coun- at menopause. Clinical features Aetiology/pathophysiology Patients (normally young women) present with a Breast cysts are a very common nding in the years lead- smooth, rm, painless nodule that is well-demarcated ing up to the menopause and are thought to arise due to and freely mobile (breast mouse). Juvenile broadenoma is a rare subtype that occurs in femaleadolescentsandgrowsrapidly. Macroscopy/microscopy An encapsulated rubbery white lesion with a glisten- Investigations ing cut surface. It consists of a brous connective tissue Patients require a triple assessment consisting of clinical component and abnormally proliferated ducts and acini examination (see page 409), imaging using ultrasound (adenoma) in varying proportions. Investigations Investigation of any breast lump involves a triple assess- Management ment consisting of clinical examination (see page 409), Patients with a single cyst do not need to be reviewed fol- imaging normally by ultrasound as patients are young lowing an otherwise normal ultrasound and successful and sampling by core biopsy or ne needle aspiration neneedleaspiration. Indications for surgical biopsy in- Management clude bloody uid detected on ne needle aspiration, If conrmed as a broadenoma on triple assessment, aresidual mass following aspiration, or multiple recur- small lesions may be left unless the patient requests rence at the same site. This is Denition associated with an increased risk of developing breast Abenign breast disorder with dilation (ectasia) of the cancer. Clinical features Most patients present with a bloody or serous nipple Age discharge. It is often possible to identify the discharge Most common in women approaching the menopause. There may be a small Aetiology/Pathophysiology swelling at the areolar margin (30%), which if pressed The dilated ducts are lled with inspissated secretions may produce discharge. Macroscopy/microscopy One to two centimetres sized papilloma within a di- Clinical features lated duct with secretions collected behind it. The le- Duct ectasia may be asymptomatic or may cause nipple sion usually consists of fronds of vascular tissue covered discharge (often green) and localised tenderness around byadouble layer of cells resembling ductal epithelium. Investigations Macroscopy/microsopy Mammography and/or ductography show the dilated The ducts may be dilated as much as 1 cm in diam- duct and lling defect. Awire is often passed into the responsible duct, which is excised as a microdochectomy with the breast segment Investigations that drains into it. Although ductography or duc- toscopy are possible, they are not routine investigations. Fat necrosis Denition Management An uncommon condition in which there is death of fat Once the diagnosis is conrmed surgery may be required cellswithin the breast.

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It could be adapted buy 500mg tetracycline free shipping, however generic tetracycline 500 mg online, to be used with diabetes or smoking as entry points buy generic tetracycline 250 mg online. The package is meant to be implemented in a range of health-care facilities in low and medium resource set- tings, in both developed and developing countries. For this reason it has been designed for three scenarios that reect the commonly encountered resource availability strata in such settings (16). The minimum conditions that characterize the three scenarios, in terms of the skill level of the health worker, the diagnostic and therapeutic facilities and the health services available, are described in Table 1. It can have a number of other goals in addition to preventing illness and promoting population health. They must also consider how different types of interventions can be incor- porated into the health infrastructure available in the country, or how the infrastructure could be expanded or adapted to accommodate the desired strategies. This section discusses only health policy issues related to health promotion and disease prevention. A health policy paradox shows that preventive interventions can achieve large overall health gains for whole populations but might offer only small advantages to each individual. This leads to a misperception of the benets of preventive advice and services by people who are apparently in good health. In general, population-wide interventions have the greatest potential for prevention. For instance, in reducing risks from high blood pressure and cholesterol, shifting the mean values of whole populations will be more cost effective in avoiding future heart attacks and strokes than screening programmes that aim to identify and treat only those people with dened hypertension or raised cholesterol levels. If the goal is to increase the proportion of the population at low risk and to ensure that all groups benet, the strategy with the greatest potential is the one directed at the whole population, not just at people with high levels of risk factors or established disease. The ultimate goal of a health policy is the reduction of population risk; since most of the population in most countries is not at the optimal risk level, it follows that the majority of prevention and control resources should be directed towards the goal of reducing the entire population s risk. For example, policies for prevention of traumatic brain injuries such as wearing of helmets need to be directed at the whole population. Thus, risk reduction through primary prevention is clearly the preferred health policy approach, as it actually lowers future exposures and the incidence of new disease episodes over time. The choice may well be different, however, for different risks, depending to a large extent on how common and how widely distributed is the risk and the availability and costs of effective interventions. Large gains in health can be achieved through inexpensive treatments when primary prevention measures have not been effective. An example is the treatment of epilepsy with a cheap rst-line antiepileptic drug such as phenobarbital. One risk factor can lead to many outcomes, and one outcome can be caused by many risk factors. When two risks inuence the same disease or injury outcomes, then the net effects may be less or more than the sum of their separate effects. The size of these joint effects depends principally on the amount of prevalence overlap and the biological results of joint exposures (13). Beyond the boundaries of this denition, health systems also include activities whose primary purpose is something other than health education, for example if they have a secondary, health-enhancing benet. Hence, while general education falls outside the denition of health systems, health-related education is included. In this sense, every country has a health system, no matter how fragmented or unsystematic it may seem to be. The World Health Report 2000 outlines three overall goals of health systems: good health, responsiveness to the expectations of the population, and fairness of nancial contribution (17 ). All three goals matter in every country, and much improvement in how a health system performs with respect to these responsibilities is possible at little cost. Even if we concentrate on the narrow denition of reducing excess mortality and morbidity the major battleground the impact will be slight unless activities are undertaken to strengthen health systems for delivery of personal and public health interventions. Progress towards the above goals depends crucially on how well systems carry out four vital functions: service provision, resource generation, nancing and stewardship (17 ). The provision of public health principles and neurological disorders 15 services is the most common function of a health-care system, and in fact the entire health system is often identied and judged by its service delivery. The provision of health services should be affordable, equitable, accessible, sustainable and of good quality. Not much information is forthcoming from countries on these aspects of their health systems, however. Based on available information, serious imbalances appear to exist in many countries in terms of human and physical resources, technology and pharmaceuticals. Many countries have too few qualied health personnel, while others have too many. Staff in health systems in many low income countries are inadequately trained, poorly paid and work in obsolete facilities with chronic shortages of equipment. One result is a brain drain of demoralized health professionals who go abroad or move into private practice. The poorer sectors of society are most severely affected by any constraints in the provision of health services. Service delivery Organization of services for delivery of neurological care has an important bearing on their effec- tiveness. Because of their different social, cultural, political and economic contexts, countries have various forms of service organization and delivery strategies. The differing availability of nancial and human resources also affects the organization of services. Certain key issues, however, need to be taken into account for structuring services to provide effective care to people with neurologi- cal disorders. Depending upon the health system in the country, there is a variable mix of private and public provision of neurological care. The three traditional levels of service delivery are primary, secondary and tertiary care.

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