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By Y. Koraz. Henderson State Univerisity.

It may be compromised by pneumothorax 20 mg forzest with mastercard, hemothorax or multiple rib fractures causing flail chest forzest 20 mg amex. Look for external hemorrhage and arrest it by pressure, bandaging or tourniquet if the other methods fail. Tachycardia, hypotension, pallor may mean bleeding into the body cavities or from an obvious external wound. E- Expose (undress) the patient fully for examination not to miss serious injuries. It includes the following aspects: A- Take History: The informant may be the injured patient, relatives, police or ambulance personnel. However, never send a patient with unstable vital signs for investigation or referral before resuscitation. These include poor condition and design of roads, traffic mix (sharing of road by vehicles of different speeds and pedestrians), poor condition of the vehicles and poor traffic rule enforcement. The incidence of this serious problem can be reduced by improving the public awareness and the quality of training given to the drivers and strict enforcement of traffic rules. Moreover, improving the design and quality of the roads and regular checkup of vehicle fitness would help alleviate the problem. In many developing countries like Ethiopia, the magnitude of the problem is big due to high distribution of firearms among civilians who have little or no knowledge on safe handling and usage. It is made worse by the presence of large number of land mines, which are remnants of repeated wars and conflicts in these poor nations. Generally, missile injuries may be caused by bullets from pistols, rifles, machine guns or fragments from exploded grenades and mines. The degree of injury sustained depends on the amount of energy transferred from the missile to the patient as formulated below. The extensive tissue injury with the high degree of contamination creates a perfect medium for life threatening infection to occur. Missile injuries are classified into: I- Low- velocity missile injuries Comprise missiles fired from hand guns (<400m/s) Injury is limited to the path of the bullet. All patients with missile injuries should receive broad spectrum antibiotics and tetanus prophylaxis. It is mostly seen in developing countries where there is overcrowding, poor housing designs and wide spread usage of open fire for cooking. Types of burns, according to the mechanism, include: Flame burn Scalding Chemical burn Electrical burn, etc. The severity of a burn injury is a function of the burn depth (degree) and the extent or percentage of the body surface that is burned. Determining the percentage of burn surface is important to calculate the amount of fluid requirement while determination of burn depth is important for burn wound management. Classification of Burn according to depth (degree) 1- First degree burn: It involves the epidermis only and manifests with erythema. In children, the size of the hand may be used to estimate the burn surface, which is approximately 1%. Endotracheal intubation or tracheotomy may be needed in patients with burns involving the air way. Half of the calculated volume is given in the first 8 hours and the remaining half over the next 16 hours from the time of burn. The choice depends on the degree, size and site of the burn, and availability of facilities and expertise. Emergency escharotomy and fasciotomy should be done for deep circumferential burns of limbs, neck or trunk. Prevention of Infection: Burn patients have impaired resistance against infection. Prophylactic antibiotics (penicillin) are given for severe burns but, routine administration has no value. Nutrition: Naso-gastric tube should be inserted after admission for patients with more than 25% burn and those who have nausea and vomiting. Burn patients are in catabolic state and tend to lose weight very fast, thus special attention to their diet is important. Prophylaxis against tetanus: Tetanus prophylaxis should be supplemented as burn is potentially infected wound. Prevention of contractures and rehabilitation: Patients should constantly be urged and made to move all joints. Failure to do this results in contractures, which may be very disabling, unsightly and difficult to treat. Prevention The magnitude of burn injuries can be reduced by keeping the high risks, like children and epileptics, away from open fire or boiling pots and enforcing strict safety precautions in working places like factories etc. Investing in health research and development: Report of the ad-Hoc committee on health research relating to future intervention options. Craniocerebral trauma is consequently a source of major disability and huge financial and psychological burden. Trauma to the cranium can be either blunt or penetrating and involve the scalp, the skull or the brain.

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Moderate levels of attachment loss are seen in a higher 35 proportion of older adults: however discount forzest 20mg on line, severe loss is detected in only a small proportion 36 of older adults (Locker et al buy forzest 20mg on line. Studies have shown an increased annual rate of 37 destruction of periodontal bone support in individuals of age over 70, which shows 38 aging and its related problem on their own may marginally increase the destruction 39 process (Papapanou et al. Whether it is an age related loss of tissue or an 40 active disease or a change in the severity, the degree and type of treatment may 41 differ but all the same, treatment is essential. Factors to be considered and treatment options 02 Factors to be considered Treatment options 03 04 1. Before starting treatment in older adults, knowledge of their individual 11 past medical and dental histories is important and a careful examination of the intra 12 and extra oral structures is also essential. For patients with systemic conditions, 13 medication for the same would not only influence the treatment plan but also 14 give an idea about the priority for oral hygiene procedures and the motor skills to 15 perform the same. Perception, knowledge, socio economic status and attitude may 16 contribute to it. The Table 1 shows the 20 factors, which have to be considered for treating older adults and the different 21 treatment options. It can be postulated that with more the factors, lesser are the 22 treatment options, with treatments of least intensity predominating. In other words, 23 the factors are inversely proportional to the treatment options. Though it is meant for general anesthesia, it can also be 32 followed for out patient periodontal surgery under local anesthesia (Table 2). A patient with severe systemic disease that limits activity but is not 39 incapacitating 40 4. A patient with incapacitating systemic disease that is constant threat 41 to life 42 5. It is mandatory that the patients be 06 informed about the significance of supportive periodontal treatment. In one study, 07 it has been found that in treated cases tooth loss was found to be three times 08 more in patients who did not return for recall visits. According to Kerry (1995) there 10 are three therapeutic objectives of supportive periodontal treatment: 11 1. Also the dentist is able to carry out non-surgical 18 procedures to arrest the recurrence and progression of disease and minimize further 19 loss of tissues. But when one takes into 23 consideration all the factors by confounding effect, the treatment options become 24 restricted. So the periodontal disease starting as plaque- induced gingivitis at regular 25 intervals are aggravated by different factors till old age at which time the factors 26 become accumulated ones. In spite of this healing following treatment between 27 younger and older people do not show any difference. The incidence rate is still increasing, and despite early diagnosis 18 and improved treatment, the mortality is still high. Breast cancer is a very heterogeneous 19 disease and less than 10% of the diagnosed cases are believed to be caused by an 20 inherited factor. The information on tumor specific genomic alterations has dramatically 21 increased during the past decade, and seen in relation to the effect on survival and treatment efficiency, these genomic changes may prove to act as prognostic and predictive 22 factors. The introduction of methods to screen the entire genome for alterations has led to 23 important knowledge of tumor biology, progression and targets of therapy. The annual incidence has increased over 38 the past two decades to an estimated 1 million new cases worldwide and has not yet stagnated. Especially after the menopause, the breast cancer incidence, is 39 five to ten folds higher in Northern Europe and Northern America than in Africa, 40 South America and the Far East (Parkin et al. The mortality is presently 41 declining, due to screening programs leading to early diagnosis and improved, 42 efficient treatment (Jatoi and Miller, 2003). Still, there are 09 families with an accumulation of breast cancer incidences, in which no disease- 10 causing mutation has been identified. Due to low penetrance these genes may prove useful as diagnostic, prognostic 15 and predictive markers, also in the group of patients suffering from primary somatic 16 breast cancer. A comprehensive study of 99,500 premenopausal women 25 showed no significant effect of exercise on the risk of breast cancer, indicating that 26 the positive effect may increase by age (Margolis et al. The rapid growing amount of information about genomic variations, 31 within and between ethnic populations, correlated to known risk factors and infor- 32 mation on tumor specific genomic variations will prove a powerful tool in the 33 diagnosis and treatment of cancer patients. Prospective studies have shown that node negative patients 02 could be divided into two distinct groups based on the gene expression profile of 03 their tumor. The group with a low-risk profile had a 96% probability of survival 04 and a 87% likelihood of disease-free survival for 10 years without receiving adjuvant 05 therapy. In contrast, the group with a high-risk profile had a 50% probability of 06 overall survival and a 48% likelihood of disease-free survival for 10 years without 07 treatment (van de Vijver et al. The genetic profile of a tumor will eventually 08 become strong prognostic and predictive markers in the selection of patients who 09 will benefit from therapy, especially in the light of current international guidelines 10 recommending systemic adjuvant therapy for up to 8590% of the node negative 11 patients (Eifel et al.

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