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M. Angar. University of the South.

During this rotation the dishes are simply rinsed in a bowel of water before they are given to the next user in the queue buy 16 mg betahistine with amex. However generic betahistine 16 mg with amex, after a session of service the utensils are finally washed for the next session in a three-compartment manual dish washing system filled with cold water and at the first compartment having detergents order 16 mg betahistine free shipping. Despite this fact the management of the boarding school is not prepared to train them on proper food handling assuming that they have the experience and the training requires additional cost. The wastes including garbage from the kitchen and the cafeteria are given to pigs that scavenge around these facilities. The sewage drains to underground sewers but there is frequent blockage that leads at times to overflow. This is not given much attention by the school management as they consider it to be normal to kitchens and cafeterias. The clinic head reports that mass diarrhea complaints are commonly observed but are usually not serious. In addition, the head of the clinic believes that giving proper care to the sick is easier and better than wasting time assessing the cafeteria. Do you think training of food handlers can address any problem related to food hygiene in the cafeteria? Do you believe medical certification of food handlers that will be renewed every 6 months plays an important role in reducing food borne diseases? Applied to the food industry, sanitation is “the creation and maintenance of hygienic and healthful conditions”. Sanitation is the application of a science: to provide wholesome food handled in a clean environment by healthy food handlers, to prevent contamination with microorganisms or toxic chemicals that cause food borne illness, and to minimize the proliferation of food spoilage microorganisms. However, unsanitary operations frequently result from a lack of understanding of the principles of sanitation and the benefits that effective sanitation will provide (7). Because of lack of awareness on issues of sanitation food borne diseases are among the major health problems in Ethiopia. Food borne diseases can also be caused by a variety of chemicals that may lead to illness and deaths of people who may have consume foods contaminated by these chemicals. Food sanitation is an applied sanitary science related to the production, harvesting, storage, distribution/ transport, processing, preparation, and handling of food. Sanitation applications refer to hygienic practices designed to maintain a clean and wholesome environment for food production, preparation, and storage. This applied science relates to the physical, chemical, and biological factors that constitute the environment. The basic principles for food sanitation to control food borne illnesses and outbreaks can be summarized to three essential activities: ¾ Prevention of contamination of the food from microorganisms, their toxins or other chemicals of health hazard. Biological agents in food that are of concern to public health include pathogenic strains of bacteria, viruses, parasites, helminthes, protozoa, algae, and certain toxic products they may produce. An example of path ways to food for selected chemical contaminants of food (19) Food can be contaminated in the chain of its production and distribution, i. Disposing of human waste in unsanitary manner may contaminate the food with pathogenic organisms, similarly different chemicals, such as pesticides, herbicides, and fungicides may be deposited on to and absorbed by various crops and vegetables (6,19). Harvest: Harvesting food into contaminated receptacles can spread causative agents of disease, or may also lead to its contamination by poisonous chemicals if the receptacle was used to store such chemicals (6). Transporting: During transportation, food can be contaminated by people, storage containers and so on (6). Processing and storage: Food is liable for contamination during its processing and storage if stringent sanitation measures are not in place. Food preparation and consumption areas: Restaurants cafeterias, mess halls, kitchens, bars, dining rooms, service tables, and utensils etc. In principle the same flow scheme applies to both the food industry and to locally produced foods for private consumption (19) Hazards: Production of • Nutrients Raw Materials • Natural toxins • Microbial toxins • Environmental contaminants Food Processing Hazards: • Reaction products • Contaminants • Additives Storage and Transport Hazards: • Chemical contamination • Microbial contamination Hazards: Food Consumption • Chemical contamination • Microbial contamination Risks: • Intoxication by chemical contaminates Food Preparation • Food-borne infections • Food poisoning Fig. Major contamination sources are (7, 19,4): ¾ Water: water serves as a cleaning medium during sanitation operation and is an ingredient added in the formulation of various foods. If a safe water supply is not used it then becomes a source of contamination of the food (chemical or biological agents). Examples are microorganisms causing typhoid and paratyphoid fevers, dysentery, and infectious hepatitis. If raw sewage drains or flows into potable water lines, wells, rivers, lakes, and ocean bays the water and living organisms such as seafood are contaminated. This contamination can result from unclean air surrounding the food or from contamination through improper sanitary practices. The hands, hair, nose, and mouth harbor microorganisms that can be transferred to food during processing, packaging, preparation, and service by touching, breathing, coughing, or sneezing.

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The trigger for this is not accurately known cheap 16mg betahistine free shipping, but a series of nervous and hormonal stimuli dilates the cervix that guards the opening into the womb generic betahistine 16mg, and starts the rhythmic contractions of the womb buy betahistine 16 mg on line, which will bring another human being out into the world. Usually the internal foetus is deformed, incapable of independent existence and very small but may appear as a non- cancerous mass that causes symptoms at birth or later in life. This failure of foetus to achieve its full growth potential may be due to problems with the foetus, mother or placenta. Factors due to the mother include high blood pressure (maternal hypertension), german measles (rubella), toxoplasmosis, Herpes infection, cytomegalovirus, cytotoxic medications, irradiation, diabetes, chronic renal disease, malnutrition, anaemia, family history, drug abuse, alcoholism, heavy smoker and high altitude. Factors due to the foetus include congenital, genetic or chromosomal abnormalities, cerebral palsy, foetal infections and twins. The usual factor due to the placenta is abruptio placentae (separation of the placenta from the uterus). It is essential for the basic functioning of the nucleus in cells, and extra amounts may be needed during pregnancy, breast feeding, and in the treatment of anaemia and alcoholism. It is found naturally in liver, dark green leafy vegetables, peanuts, beans, whole grain wheat and yeast. The amount in red blood cells can also be measured (normal range is a level greater than 318 nmol/L or 140 ng/mL), which gives a longer term picture than the normal folic acid level in blood which may be affected by recent changes in diet. Low levels can be due to long-term alcoholism, oral contraceptive use, anticonvulsant medications, malnutrition, sprue (poor food absorption), sickle cell anaemia, cytotoxic drugs (used to treat cancer), pregnancy and food malabsorption syndromes. They can be used not just to help pull out the child, but to turn the head into a more appropriate position if the head is coming out at the wrong angle. Once placed carefully in position, the doctor, in time with the contractions, will apply traction (and sometimes rotation) to deliver the head. The baby may be born with some red marks on its face and head from the forceps, but they disappear after a few weeks. During this time, routine tests and checks are performed, and the anaesthetist will check the heart, lungs and other vital systems. About an hour before an operation, the patient is changed into an easily removable gown and given an injection to dry up the saliva and induce relaxation. While breathing oxygen through a mask a needle is placed in a vein and a medication is injected to induce sleep and relax the muscles (eg. The drugs used last only a short time, and the anaesthesia is maintained by gases that are given through a mask or by a tube down the throat (endotracheal tube). The anaesthetist regularly checks the pulse, blood pressure, breathing and heart during the operation to ensure there is no variation from the normal. When the operation is finished, the anaesthetist turns off the gases and gives another injection to wake up the patient. The first memory after the operation is of the recovery room where the patient stays under the care of specially trained nurses and the anaesthetist until fully awake. Side effects of a general anaesthetic can include a sore throat (from the tube that was placed down the throat), headache, nausea, vomiting and excessive drowsiness (all side effects of the medication). General anaesthetics are now extremely safe, and the risk of dying from the effects of a general anaesthetic are now no greater than one in 250,000. Humans have a gestation period of about 38 weeks (although pregnancy is calculated as lasting 40 weeks from the last menstrual period). The abbreviation G4P2M1 in medical notes would indicate a pregnancy history of a woman in her fourth pregnancy who had delivered two live babies and had one miscarriage (gravida four, parturition two, miscarriage one). Symptoms may be reduced by eating small, frequent meals so that there is never too much food present but always enough to absorb the stomach acid. Antacids can usually be taken safely at most stages of pregnancy, and may be used to relieve more severe symptoms. If a doctor examines the uterus through the vagina with one hand, while the other feels the uterus by pressure on the belly, an empty softened area can be felt between the firmer cervix and the globular uterus in a pregnant woman between the 6th and 10th weeks. It occurs in less than one in ten thousand pregnancies, and is an autoimmune reaction that may be aggravated by oestrogen. Patients develop extremely itchy, fluid filled, scattered small lumps on the body, particularly the belly, sides of the trunk, palms and soles. The prognosis is good and the condition usually does not affect the baby, but it tends to recur in subsequent pregnancies. Labour can be induced in a number of ways, including rupturing the membranes that surround the baby through the vagina, stimulating the cervix, by tablets, vaginal gel (eg. Using these methods, doctors can control the rate of labour quite accurately to ensure that there are no problems for either mother or baby. There is some evidence that labour can be induced in the last week or two of pregnancy by an orgasm after sexual intercourse or by the constant stimulation of the nipples. Iron is used as a medication in tablet, capsule, mixture or injection forms to treat or prevent iron deficiency and some types of anaemia. Pregnant women are at risk of iron deficiency because the developing baby to build muscle and blood cells. In medication, it is not pure iron that is used, but various salts (compounds) of iron such as ferrous gluconate, ferrous phosphate, ferrous sulfate, ferric ammonium citrate, ferric pyrophosphate, ferrous fumarate and iron amino acid chelate.

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Pharmacodynamics Adrenaline directly stimulates all the adrenergic receptors both and brings about effects of sympathetic nerve stimulation cheap 16 mg betahistine. Its action may be divided in to two buy betahistine 16 mg line, depending on the type of receptor stimulated generic 16 mg betahistine with visa. The α effects consist of vasoconstriction in skin and viscera, mydriasis, platelet aggregation and some increase in blood glucose. The ß effects consists of increased contractility and rate of heart with a decreased refractory period (ß1), vasodilatation in muscles and coronary vessels (ß2), bronchial relaxation (ß2) uterine relaxation (ß2), hyperglycemia, lactic acidemia and increased circulating free fatty acids. Pharmacokinetics Like adrenaline, noradrenaline is ineffective orally so it has to be given intravenously with caution. It is not given subcutaneous or intramuscularly because of its strong vasoconstrictor effect producing necrosis and sloughing. The metabolism is similar to adrenaline; only a little is excreted unchanged in urine. Pharmacodynamics Nor adrenaline is a predominantly α receptor agonist with relatively less β agonist action when compared to adrenaline. Adverse effects include: - Anxiety, headache, bradycardia are common side effects - Severe Hypertension in sensitive individuals - Extravasation of the drug causes necrosis and sloughing. These are the other catecholamines which have similar properties to adrenaline and noradrenaline. These drugs have advantage over the others because they are 45 more selective in their action so that they have fewer side effects than adrenaline and nor adrenaline. It has a good distribution through out the body and is resistant to hydrolysis by the liver enzymes. Because of its stability to metabolism it has long duration of action than the catecholamines. This effect is partly by a direct action on the receptors and partly indirectly by releasing noradrenaline from its tissue stores the effect of the drug to various organs and systems is similar to that of adrenaline. Nocturnal enuresis Side effects The side effects are similar to those of adrenaline; but in addition it may produce insomnia and retention of urine. Based on their selectivity to specific receptors the rest of the catecholamines, are classified but it is very difficult to exhaust all the drugs. More over their effect and pharmacology is discussed where they are clinically indicated. Drugs blocking theβ Adrenergic receptor These drugs prevent the response of effectors organs to adrenaline, noradrenaline and other sympathomimetic amines whether released in the body or injected. Circulating catecholamines are antagonized more readily than are the effects of sympathetic nerve stimulation. The drugs act by competing with the catechoamines for α or β receptors on the effectors organs. Irreversible antagonists tightly bind to the receptor so that their effects may persist long after the drug has been cleared from the plasma e. Hence, postural hypotension and reflex tachycardia are common during the use of these drugs. It has high affinity for alpha1 receptor and relatively low affinity for the alpha2 receptor. Prazosin leads to relaxation of both arterial and venous smooth muscles due to the blockage of alpha1 receptors. Drugs blocking all the β receptor effects of adrenaline (non-selective beta blockers) e. Drugs blocking mainly the β1 effects (those on the heart) with less effect on the bronchi and blood vessels (beta1-selective blockers), e. Pharmacokinetics Propranolol is almost completely absorbed following oral administration. How ever, the liver, leaving only 1/3 rd of the dose to reach the systemic circulations, metabolizes most of the administered dose. Cardiovascular system • Bradycardia • Reduces force of contraction • Reduces blood pressure 2. However, the problem of cardiovascular disorders is also increasing in developing countries including Ethiopia. The most commonly encountered cardiovascular disorders include hypertension, congestive heart failure, angina pectoris and cardiac arrhythmias. Most drugs available currently are able to reduce the morbidity and mortality due to these disorders, and therefore, this chapter discusses the pharmacology of these drugs. General consideration:- Hypertension is defined as an elevation of arterial blood pressure above an arbitrarily defined normal value. The American Heart Association defines hypertension as arterial blood pressure higher than 140/90mmHg (based on three measurements at different times).

The availability of effective treatments also can have a profound impact on The average person in the U cheap betahistine 16mg fast delivery. They realize that example of a disease where public attitudes have not all users of alcohol or other addictive drugs will become addicted cheap betahistine 16mg with amex. They know that some yet to catch up with the science 16 mg betahistine amex, although 196 users will become addicted but that others will attitudes are shifting. In contrast, only 11 adults ages 18 and older underscores the percent of individuals who are managing the tremendous stigma still associated with disease (i. This survey also found that 43 percent of physicians consider addiction involving * alcohol to be a personal or moral weakness (nine Differences also were found between providers who percent see it primarily as a personal or moral were members of a group of addiction professionals, had been treating addiction for longer, had stronger weakness and 34 percent see it equally as a spiritual beliefs, had a past addiction problem and personal or moral weakness and as a disease or were older (tending to endorse the belief that health problem); 56 percent see it primarily as a 197 addiction is a disease) versus those who were not disease or health problem. Another 2009 nationally percent) cited “a predisposition to addiction, due representative survey of adults ages 18 and older to genetics or family history” as a primary also found that the majority of the respondents causal factor when given a list of potential believe that addiction is a health condition that causes of addiction involving tobacco/nicotine. A) afflicted with the disease and hindered progress not only in understanding it, but also in Figure 2. A developing and providing effective treatments Perceived Causes of Addiction 205 Involving Tobacco/Nicotine for it. Genetics account experience with addiction--either that of a for 48 to 66 percent of the risk that someone 209 family member or friend or their own--did not who drinks alcohol will become addicted and differ much from the general public in these nearly half (47. Co-occurring mental health disorders do appear to play a significant role in the risk that 213 drug use will progress to addiction. Note 2: Other research finds that genetics account for up to 78% of the risk for the development of addiction involving prescription and other drugs. An additional but unknown number of people have the disease but are managing it effectively and so do not meet these behavioral ‡ 3 criteria. Risky substance use and addiction are the largest preventable and most costly public health and 5 medical problems in the U. Together they are the leading causes of preventable death and cause or contribute to more than 70 other 6 conditions requiring medical care. Existing national survey data indicate that 10 percent of adults ages 18 and older report that they “once had a problem with drugs or alcohol but no longer do” (sometimes referred to as “sustained recovery”), but it is not clear what proportion of this group ever was diagnosed with addiction as distinguished from “having a problem. Percent of Population Age 12+  Risky users of addictive substances are by Level of Sustance Use* defined in this report as those who currently use tobacco products, exceed the U. Department of Agriculture Dietary Guidelines for safe alcohol use are no more than one drink a day for women, no more than two drinks a Most people (87. There are some individuals with the where impaired judgment could cause injury or death disease of addiction who do not currently use any (e. Due to data limitations, we were addictive substances and others who currently may fit unable to include categories 4-6 in our calculation of into other use categories along the continuum. Risky use can result in vulnerability to addictive substances while the § 10 devastating and costly health and social brain is still developing, we present data for consequences, including the disease of the following age groups: 12- to 17-year olds; addiction. Our and safety--including increasing the risk of definition of addiction in this report is consistent addiction--or the health and safety of others, but with the parameters used in the national survey do not meet clinical criteria for addiction. In where an adult must be present, reported prevalence this analysis, illicit drugs include marijuana/hashish, rates for teens are significantly lower than reported cocaine/crack, heroin, hallucinogens, Ecstasy, rates in school-based surveys where greater methamphetamine and inhalants. B Prevalence of Current Risky Use of Current* Risky Substance Use Addictive Substances in Among Individuals Ages 12+, 2010 U. N T Young adults, ages 18- to 25- years old, are more likely to engage in risky substance use White Black Hispanic Other than any other age group. The proportion of the population engaging in risky substance use has remained stable over the Whites, Hispanics and blacks are likelier to past decade; in 2002, 31. These races/ethnicities were combined for purposes of analysis because there are too few respondents in each category to calculate meaningful prevalence data for each category separately. The “other races/ethnicities” category is reported as a group vary between each racial/ethnic group in this despite the fact that substance use prevalence rates category. E Current* Risky Tobacco Use Among all age groups, 18- to 25- year Among Individuals Ages 12+ by Race/Ethnicity, olds have the highest rate of risky 2010 18 Percent (Number in Millions) tobacco use. Excluded from the category of risky drinkers are those who meet diagnostic criteria for addiction involving alcohol in the past year. This difference becomes more Prevalence of Current Risky, Heavy, Binge and pronounced at higher levels of drinking: men * Heavy Binge Drinking, by Race/Ethnicity, 2010 are almost twice as likely as women to be heavy Percent (Number in Millions) drinkers (23. H Current* Risky Illicit Drug Use Risky use of illicit drugs is highest among 18- to Among Individuals Ages 12+ by Race/Ethnicity, 25-year olds; adolescents ages 12 to 17 are more 2010 likely to be risky users of illicit drugs than adults Percent (Number in Millions) ages 26 and older. I Current* Risky Use of The rate of risky use of illicit drugs has Controlled Prescription Drugs increased slightly between 2002 (5. Controlled Prescription Drugs Among Individuals Ages 12+ by Race/Ethnicity, Addiction involving nicotine and alcohol are the 2010 most prevalent manifestations of addiction, Percent (Number in Millions) followed by addiction involving illicit drugs and 51 P controlled prescription drugs.