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By X. Ismael. Concordia University, Portland Oregon.

Early warning systems may depend on a comprehensive understanding of a wetland site and catchment discount singulair 5 mg line, good disease intelligence from a range of stakeholders (including crucially the wetland manager purchase 5 mg singulair with amex, as well as data from local and national disease surveillance programmes), and clear systems and networks for communication and reporting. Identifying when a disease presents a ‘problem’ is complex and requires thorough disease investigation and existing good long term surveillance information. In the event of a suspected outbreak of disease, wetland managers are not expected to be the final disease diagnostician. However, they should play a key role in an outbreak investigation team being ideally placed to provide the crucial contextual epidemiological information about timing of events, the populations at risk, the effects on these, land use and environmental conditions at the time and leading up to the outbreak, and other relevant local information. Surveillance and monitoring are terms often used interchangeably but surveillance generally refers to observing a population for signs of a disease over time. Monitoring, on the other hand, can be used to refer to measuring disease prevention or control programmes and providing the information to evaluate whether or not interventions have worked or how improvements can be made. Above all, surveillance programmes should aim to evaluate the health status of a group or population and help to prevent or limit the spread of diseases by informing disease control activities. Surveillance is a continuous and systematic process which involves the collection of relevant data for a specified population, time period and/or geographical area, meaningful analysis of the data and dissemination of the results to appropriate stakeholders. Collected data should include observed clinical signs, diagnostic test results and any associated risk factors identified. Surveillance and monitoring are vital for: establishing base-line data on the health of a population or group determining temporal and spatial variation in disease prevalence identifying the point at which there is a departure from ‘normality’ and hence the point at which action should be triggered detecting disease problems before they have adverse consequences predicting future disease outbreaks determining the potential role of wildlife in the ecology of the disease helping to plan and monitor control programmes if needed. Information obtained from disease surveillance may need to be communicated to stakeholders representing public and animal health, wildlife conservation and management and environmental management interests. Disease surveillance and monitoring should form an integral part of any disease management strategy. Importance of wildlife surveillance Surveillance for wildlife diseases is an important tool for conservation management necessary for assessing risks to wild populations. As humans and their livestock increasingly move into wildlife areas and as wildlife moves into urban areas to exploit novel resource opportunities, the likelihood of contact and spillover of infections from wildlife to humans and domestic animals has increased so enhancing the need and value of wildlife disease surveillance. Appropriate human health and biosafety precautions should be followed during surveillance and monitoring activities. Activities should focus on collecting only the information that is needed to achieve the objectives, noting that this information may differ between diseases. Surveillance may involve collecting various samples from the environment, the health screening of living and dead specimens, remote screening and/or the introduction of sentinels [►Checklist 3- 1]. Information commonly collected during surveillance activities Timing Dates of findings, sampling, results etc. Estimation of timing of any change in health status Host information Species involved Numbers affected Numbers sampled Population(s) at risk i. An accurate assessment is reliant on a thorough understanding of the disease and its lifecycle, notably, transmission [►Case study 3-5. Therefore, a multi- disciplinary approach to surveillance involving a variety of professionals (e. In some cases, reports about sick wildlife from the general public can be the first indication that a larger incident of morbidity and/or mortality is about to occur. To a large extent, the robustness of a surveillance strategy relies on sampling an appropriately sized sample of the appropriate portion of the population. Skilled animal health personnel will be needed to determine sample sizes although for wildlife the wetland manager is likely to have a relatively good understanding of structures of wild populations and thus can help in the design and practicalities of achieving this target sample size. The problem of bias in surveillance strategies is less of an issue for domestic animals where it can be relatively straightforward to sample individuals randomly and in a stratified manner e. All wildlife trapping techniques have their own biases, surveillance from carcases may introduce a range of biases, e. Selection of sampling sites will primarily be dictated by the habitat preferences of the species to be sampled and occurrence of outbreaks in poultry although other factors such as bird and researcher safety, and project logistics should also be considered. Surveillance approaches Passive or ‘scanning’ disease surveillance: this involves examination of only clinically affected individuals, with no special effort being made to ‘seek out’ infected or diseased cases. This may involve the routine gathering of information on disease incidents from the general public, medical or veterinary professionals and laboratories dealing with routine cases. Passive surveillance may lead to significant under-reporting of diseases and should, therefore, be supplemented by active disease surveillance particularly for important animal diseases. Active disease surveillance: this involves proactive examination of individuals to actively seek out infection or disease, and targeted searching for evidence of disease in populations. Programmes may be broad-scale to capture any significant disease occurrences, targeted against specific high-threat diseases (e. International trade may also guide surveillance schemes to establish national and regional disease status, especially where it relates to public health and economic initiatives. For livestock diseases which are spread by the movement of infected animals, areas where animals are moving should be targeted for surveillance (e. The speed of information flow between different components of the disease surveillance system (immediate or routine). The rapidity of response required: immediate investigation of disease incidence or routine and regular analysis of data with subsequent adjustments to control activities when required. For a disease surveillance strategy to act as an early warning system, reporting, decision-making and response must be rapid.

Yet pain patients in particular often have to undergo veritable medical odysseys as a result of uncer- tain diagnoses buy 10mg singulair with mastercard, failed treatments and ever increasing pain purchase 5 mg singulair amex. De- spite having similar symptoms, painful rheumatic diseases can be caused by very different disorders, each of which re- Terms quires a distinct treatment. Whether a treatment is suc- Biopharmaceuticals drugs manufactured using biotech- nological methods. The picture is similar with Genome the (largely unalterable) complement of all genes of cancer, where the sheer va- an organism. Genomics the science concerned with the form, function riety of causes requires a new and interaction of the genes of an organism. A tu- Genotype the variants of a given gene possessed by an mor can remain completely organism; as a rule a human can have no more than two variants of each gene – one from the father and the other from the mother. Proteomics the science that deals with the form, function origin and genetic pattern of and interactions of the proteins of a biological system. In this respect, biotechnology has devised new means for identifying the precise molecular causes of such disorders. For thousands of years experienced doctors have gathered crucial information about their patients’ health from visible wounds, bone structure, posture and the colour of the skin, eyes, blood and excrement. Other methods of conventional diagnostics include palpation, for example for muscular indurations or masses, and an in-depth exchange of information between the doctor and patient. Modern medical science has supplemented this range of methods with imaging techniques, e. These routine methods still form the basis of every successful therapy – even if they often prove inadequate for the diagnosis of many diseases. Diagnostics at the organ The next level of medical diagnostics concerns and tissue level the internal structure of the body and focuses specifically on the functions and interactions of organs and tissues. In this area as well, modern diagnostic tech- niques such as sonography, computed tomography, intestinal endoscopy and arthroscopy have added to the arsenal of con- ventional examination methods. Treatment begins with diagnosis 53 Take liver biopsy tests, for example, which involve the removal of liver cells through a long needle inserted into the abdominal wall. Examining these cells closely under a microscope is still the most reliable way to identify diseases of the liver. However, in most cases biopsy is the final link in a diagnostic chain that starts with laboratory tests. Such tests became possible only with the advent of enzymes pro- duced by biotechnological means. Thanks to such screening tests,which do not require surgical intervention and produce re- liable results quickly and easily, doctors are now able to recog- nise and treat many more functional disorders of organs and tis- sues. An added benefit is that if screening test findings are negative, patients are spared an unnecessary and relatively risky intervention. Diabetes: better quality of In the case of diabetes, the advantages of quick life, fewer complications tests go even further: such tests are actually an in- tegral part of diabetes therapy. Diabetes is due ei- ther to deficient insulin production by pancreatic cells or to an acquired insensitivity of certain body cells to insulin. In either case, the detection and treatment of the disease require regular monitoring of blood glucose levels with the help of enzymes produced by biotechnological methods. On the basis of these measurements, diabetics are able to determine when and how much insulin they should inject. Until just a few decades ago diabetics had to visit their doctor for such tests, making it all but impossible to adapt insulin doses in- dividually. Today, by contrast, modern diagnostic devices like Roche’s Accu-Chek allow diabetics to check their blood glucose levels themselves at any time and thus adapt their treatment to their individual needs. This advance has not only enhanced the quality of life of diabetics but has also led to a 54 marked reduction in complications due to inadequate diabetes therapy. The enzymesrequired for measuring such blood or urine param- eters were produced as early as 1954 by Boehringer Mannheim using conventional biotechnological methods. From the biomass thus produced enzymes such as glucose oxidase and cholesterol oxidase were obtained for measuring blood glucose and cholesterol levels, respectively. Molecular diagnosis: Modern biotechnology has recently opened up What is a ‘disease’? This line of enquiry is based mainly on the sciences of genomics, which deals with our hereditary material, and proteomics, which deals with its manifestations in individuals at the protein level. This has led in recent decades to many fresh insights, with the result that we now know far more about the development, progression and treatment of most diseases than was the case a generation ago. In fact, these profound insights into molecular relationships within our bodies allowed the term ‘disease’ to be comprehen- sively defined for the first time as a state caused by an altered flow of information in a biological system. The genotype Only if we know what proteins are present in a can make a person sus- biological system and at what concentrations ceptible or resistant to can we describe the balance between health and disease. Proteomics is a powerful tool for certain disorders, endow describing protein variety. Researchers worldwide are searching for the genes and gene segments re- sponsible for these phenomena with a view to developing tests that will enable doctors to detect such predispositions in their patients.

Antibiotic cover is the leaflet may be resected or even repaired with a piece provided using a broad spectrum antibiotic to prevent of pericardium to restore valve competence generic 4 mg singulair visa. Operative mortality depends on many fac- Valve replacement: Using cardiopulmonary bypass the tors including age and concomitant disease buy 5mg singulair with mastercard, it usually diseased valve is excised and a replacement is sutured varies from 1 to 5%. Current designs all have Approximately 90% of patients have no angina postop- some form of tilting disc such as the single disc Bjork–¨ eratively, with almost all patients experiencing a signifi- Shiley valve or the double disc St Jude valve. Over time symptoms may gradually durable, but require lifelong anticoagulation therapy return due to progression of atheroma in the arteries or to prevent thrombosis of the valve and risk of em- occlusion of vein grafts. Outcome is improved by risk factor modifi- r Biological valves may be xenografts (from animals) cation(stoppingsmoking,loweringhighbloodpressure, or homografts (cadaveric). They are treated with glutaraldehyde to possible if medication is insufficient to control symp- prevent rejection and are used to replace aortic or mi- toms; however, repeat surgery has a higher mortality. They do not require anticoagulation unless Angioplastyusingstentimplantationissuitableforgrafts the patient is in atrial fibrillation but have a durabil- or native vessels. Valve failure may result from leaflet shrinkage or weakening of the valve com- petence causing regurgitation, or calcification causing Valve surgery valve stenosis. Valvesurgery is used to treat stenosed or regurgitant Valve replacements are prone to infective endocarditis, valves, which cause compromise of cardiac function. The aortic valve is not usually amenable to conservative Valve replacement provides marked symptomatic re- surgery and usually requires replacement if significantly lief and improvement in survival. A stenosed mitral valve may be treated by fol- is approximately 2%, but this is increased in patients lowing procedures: with ischaemic heart disease (when it is usually com- r Percutaneous mitral balloon valvuloplasty in which a bined with coronary artery bypass grafting), lung dis- balloon is used to separate the mitral valve leaflets. Perioperative complications include This is now the preferred technique unless there is haemorrhage and infection. All r Closed valvotomy uses a dilator that is passed through prosthetic valves require antibiotic prophylaxis against aleft sub-mammary incision into the left atrial ap- infectiveendocarditisduringnon-sterileprocedures,e. Procedure The pacemaker is inserted under local anaesthetic nor- Permanent pacemakers mally taking 45 minutes to 1 hour. A small diagonal Cardiac pacemakers are used to maintain a regular incision is made a few centimetres below the clavicle and rhythm, by providing an electrical stimulus to the heart the electrodes are passed transvenously to the heart. The through one or more electrodes that are passed to the pacemaker box is then attached to the leads and im- rightatrium and/or ventricle. The procedure is covered with Common indications for a permanent pacemaker: antibiotics to reduce the risk of infection. The most impor- tant complications are pneumothorax due to the venous access and surgical site infection. As long as aspirin and Types of permanent pacemaker anti-coagulants are stopped prior to the procedure, sig- There are several types of pacemaker, most pacemak- nificant haematoma or bleeding is unusual. Annual follow-up is required to ensure electrode usually to the right ventricle, or dual cham- that the battery life is adequate and that there has not ber, i. If it senses a beat, the paced beat advised to avoid close proximity to strong electromag- is Inhibited. It is used in complete heart block in the absence of Echocardiography atrial fibrillation. It can also trigger an atrial beat followed at a which the heart and surrounding structures can be Table2. It requires technical expertise to obtain images Two dimensional is useful for evaluating the anatomical and clinical expertise to interpret the results appropri- features. The following features are typically assessed: r Left parasternal: With the transducer rotated appro- r Anatomical features such as cardiac chamber size, my- priately through a window in the third or fourth inter- ocardial wall thickness and valve structure or lesions. Ventricular aneurysms or defects such as atrial or ven- r Apical: This is a view upwards from the position of tricular septal defects can be seen. When generate 2-D images with simultaneous imaging of flow awaveencounters an interface of differing echogenic- direction and velocity. Any Common indications for echocardiography: reflected waves (echoes) that reach the transducer are r Suspected valvular heart disease, including infective sensed and processed into an image. Tissues or interfaces that reflect the waves look for any valve lesions or regurgitation, and any strongly such as bone/tissue or air/tissue will appear evidence of a cardiomyopathy. Fluid is anechoic, so tions, such as ventricular septal rupture or papillary appearsblack. It will also identify areas of ischaemic alise the heart because they cast acoustic shadows. A transducer probe is mounted on the tip of a flexible tube that is passed into the oesophagus. The patient needs to be nil by mouth prior to the proce- Ischaemic heart disease dure, local anaesthetic spray is used on the pharynx, and intravenous sedation may be required for the procedure Definition to be tolerated.

Construct a vegetation buffer between the adjacent land and the wetland to filter nutrients and sediments 4 mg singulair overnight delivery. Install fences to keep livestock from entering the wetland to reduce nutrient-loading and sedimentation problems purchase singulair 5mg otc. In ornamental/managed ponds: Add a waterfall, or install an aerating pump, to keep water moving and reduce mosquito larvae. Keep the surface of the water clear of free-floating vegetation and debris during times of peak mosquito activity. Chemical control It may be necessary to use alternative mosquito control measures if the above are not possible or ineffective. The environmental impact of vector control measures should be evaluated and appropriate approvals should be granted before undertaken. This method is deemed least damaging to non-target wildlife and should be used before adulticides. During periods of flooding, the number and extent of breeding sites is usually too high for larvicidal measures to be feasible. Open marsh water management Control mosquitoes by introducing their natural predators to areas of tidal marsh using a system of pools connected by radial ditches. Fish feed on mosquitoes during high tide, then retreat to sumps or reservoirs at low tide. Environmental management – adapting behaviour of people and animals People: Wear light coloured clothing which covers arms and legs. Use impregnated mosquito netting when sleeping outdoors or in an open unscreened structure. Avoid physical exertion, and use colognes and perfumes sparingly as these may attract mosquitoes. Note that some repellents cause harm to wildlife species, particularly amphibians. Use screened housing with measures to eliminate mosquitoes from inside structures. Alter flow rate and water levels to disturb snail habitats and their food sources: Include ‘v’ shaped banks in irrigation channels. Remove vegetation/silt in channels to avoid a drop in velocity which may lead to further vegetation growth and good habitat for snails. Note that personnel involved in the manual removal of vegetation are increasing their exposure to snails. Flow rate should only be addressed with knowledge of the ecology of the snail in question e. Borrow-pits, small pools and ponds serving no special purpose (for humans, wildlife or livestock) may be drained to eliminate breeding sites. Expose snail habitat: Remove littoral vegetation from the sides of canals feeding irrigation projects to expose snail habitat. Thought should be given to downstream conditions and the potential for the liberated snails to recolonise new habitat. Where possible dry out littoral zones to strand snail populations, however take into account the specific ecology and the resilience of the target species. Chemical control Use of molluscicides may cause environmental damage and should be avoided. Applications are usually restricted to places frequently used by people for swimming, bathing etc. Environmental management – adapting behaviour of people and animals People: Where possible, avoid new human settlements near infested wetlands. It is safest to consider all freshwater bodies in endemic areas as potential transmission sites if sites otherwise not identified. For agricultural workers at constant risk of infection, periodic examination and treatment may be the most feasible approach to disease control. A clean water supply and improved sanitation (including on board boats) must be provided to stop human excrement entering wetlands. This is especially important for species that parasitise animal, livestock and human hosts. Snail fever integrated control and prevention project in Tongxing Village of Wucheng Township, Yongxiu County of Jiangxi Province, P. Summary Disease issue or problem: Snail fever / Schistosomiasis interruption of cattle-parasite-cycle by means of permanent stabling of cattle (long-term); awareness raising campaign by carrying out publicity and Action taken: education activities; assessment of snail host spatial distribution; cattle examination and medical treatment. The spread of snail fever in the Tongxing Village controlled Outcomes: and prevented effectively, which saves about 30. Participatory approach – stable reconstruction according to local What went well: farmers’ needs.