Rhinoplasty-Procedure and Risks

The rhinoplasty is a reconstructive or correction surgery in order to improve the function or the esthetic appearance of the nose.Can have as propuse the correction of a trauma,birth defects or breathing problems.
It is a surgical procedure wich is usually performed by the plastic surgeon but can be performed by ortolaryngologist or maxillofacial surgeon too.
The rhinoplasty surgery can be performed under general anesthetic or with local anesthetic.

Procedure:
There are two possible approches to the nose:
-close approach
-open approach.
In close rhinoplasty the incisions are made inside the nostrils (so,in this case the incisions are hidded) and in open approch the incision is made across the skin that separates the nostrils.
The surgeon first separates the skin and soft tissues of the nose and then reshape the cartilage and bone.
After the surgery the patient can return home (this in hours,or a day).After surgery restrict your activities and sleep with your head elevated,supported by pillows.
The bruises around the eyes and cheeks are apparent only the first 3 days and the swelling may last few weeks,after the paking is removed (in 7 days after surgery).The stitches are removed in 3-7 days.
Even most of the patients prefer to remain in house for the first week,is more safe to be outdoors to fast the healing.
For any case the plastic surgeon has to decide about the possibilities of correction,is not professional to complish the patient wishes (that can be exagerated and unreal) without stablish if the bone structure and the septum support are suitable to reconstruction .
Drastically corrections,exagerating demands can bring risks for minor complications until nasal obstarction.
If after surgery bleeding occurs,this is not serious,pass fast and doesn't need treatment (consult your doctor).
Other post operative complications are the scars (very rare) and nasal obstraction.
Exist an other way to reshape the nose without surgical procedure,by injection.

Don't become a victim of your illusions.
Discuss with the plastic surgeon if is possible the correction you wish.
The plastic surgery has its gratitude if reconstruct when is needed and correct when is necessary!

Choose L.M.A Plastic Surgery!We provide you Professor Doctors with Esthetic Skills,modern and discret procedures with the possibility to recover in an exotic place,sunny all seasons,confortable and accesible!

Syphilis-Modes of Transmission and stages of disease

Syphilis is one of the sexually transmitted diseases.Is an acute disease that becomes chronic and disabling if is not treated.

Modes of Transmission:
1.Contact with open lesion of infected person:common mode of infection is venereal infection by sexual contact and kissing (Atention!: the infection in the secondary stage reach the mucous of the mouth).
2.Exposure to infected blood by:
-using blood contaminated syringes and needles for inoculation of medicines or taking blood sample or by intravenous drug abuse.
-blood transfusion without precaution.
professional exposure of medical and paramedical and laboratory workers t infected blood.
3.Congenital Infection "inutero infection": transplacental infection from the 4th month of pregnancy to the end of delivery.
4.Contaminated articles and fomites::towels,clothing,drinking,cups and others are potentially infectious  but their role is minor.
Period of Infectivity: Untreated cases are infectious during the primary and secondary stages of disease of varied period,usually 2-4 years.
Exit of Infection: the organisms exit in exudate of skin and mucous membrane lesions,blood and body fluids.
Incubation period: 3 weeks on the average.

Untreated cases pass through three basic Clinical Stages over many years:

1.Primary Syphilis:  "Chancre" is the first manifestation that appears at the portal of entry usually on geniatlia and occasionally on other parts in nonveneral infection.
"Chancre" is indurated,firm,painless,highly infectious ulcer with enlarged lymph nodes and disappears spontaneously in 4-6 weeks.

2.Secondary Syphilis: this stage is characterised by:
-generalised skin rash
-patchy lesions of mucous membranes specially on mouth and genitalia.They are highly infectious.
-involvement of eyes and other pars of the body.The secondary stage syphilis disappear spontaneous after weeks or months,followed by a latent period of years before the 3rd stage appears.

3.Symptomatic Syphilis: involves different parts of the body leading to cardiovascular syphilis and neurosyphilis.

Priapism (painful erection)-Serious cause of permanent impotance

Priapism is a painful medical condition in which the erect penis does not return to the its falccid state,despite of both physical and psycological stimulation,within four hours.

Is a continuous painful erection without sexual excitation.In this case the blood vassel dilatate,increasing the blood flow into the penis giving a continuosly painful erection,this can lead to ischemia and permanent impotence and as complication the ischemia can result in gangrene,for which could necessitate penis removal.

Priapism is considered a medical emergency and an early treatment is necessary for a functional recovery.

Priapism can be also caused by reactions to medications like intra-venous injection for dysfunctional erection,antidepressants,anticoagulants,alcohol and cocaine.
Priapism is associated with leukemia and neurological disease.

The Treatment should be started as early as possible whitin the first 24 hours.
The treatment most be given by a qualified medical practitioner,and consists in:
-intracorporial injection of adrenaline or ephedrine
-evacuation of the penile blood.

Mosquitos-Transmission of disease

They are more common in worm,tropical and temperate countries.
They are small insects of 3-10 mm,the body covered with scales,one pair of compound eyes,one pair of long antenne and mouth.

Female are adapted for percing and sucking blood with the blood feeder formed of: uper lip,tongue with salivary duct running along it,one pair of mandibles and one pair of maxille with separrated tips,lower lip (this does not enter the wound of bite when mosquito feeds).The secretion of saliva causes hyperemia and prevent coagulation of blood.

The male suck only and feeds on flower juice (vegetarian) and has no role in disease transmission.

The life cycle takes 2 weeks.Fertilised female need a blood meal for development of eggs and eggs are laid on the surface of water either singly or in group cemented together.It hatches within 3-4 days at the suitable temperature.
The larva lives in water and feeds on organic matter and plants.

Transmission of disease:
By bite the female mosquito can transmit the fallowing diseases:
-human malaria
-tissue namatode (tissue worm)
-viral encephalitis
-rift valley fever virus: viral disease.
-bird malaria
-dengue fever virus: a viral disease similar to influenza characterized by fever,headache,bone aches and severe joint pains that last for about one week.
-yellow fever virus: is a qurantinable viral disease wich is endemic in Tropical africa and South America).

Outcome of Pregnancy-Delivery

Outcome means what happens to the product of conception during pregnancy,labour and neonatal,and occasionally postneonatal period.
Outcome is classified into favourable and unfavourable (that may be lethat or sublethal).

Favourable outcome is the delivery of a normal and healthy infant.
Unfavourable outcome may be:
-Lethal Outcome (foetus and infant losses) given by abortion,intrauterine death of the foetus or neonatal death.
-Sublethal Outcome: in this case exist no losses but the liveborn is affected from expusure to different risks during pregnancy and labour,resulting in: congenital anomalies,congenital disease,mental retardation,nerve palsies,organs injuries and low birth weight.

Exist many factors that influences the outcome,and they may be social,biological or environment.

Factors influencing outcome:

1.Age: exist a high risk for mothers below 16 years,more higher above 40 (the most appropriate time is considered the period of 20-30 years).
2.Health Status: the outcome is determinated by the general health and body build specially height,nutritional deficiency and infection (syphilis and toxoplasmosis for exemple).
3.Socioeconomic Circumstances: may indirect have an adverse effect on outcome.So,are important the education,the tradition,conditions of living,the medical care.
4.Smoking
5.Diabetes: the foetus begins to suffer from 28th week,with the risk of excessive growth,mental retardation or intrauterine death.
6.Parity (number of pregnancies and deliveries): exist a lower risk with 1-4 parity,a higher riskin primiparity,greatly increased risk above 4.
7.Pregnancy Spacing: insufficiently spaced pregnancies are more risky.Suitable spacing is 2-3 years.
8.Obstetric History: are important the past history and outcome of previous pregnancies.
9.Genetic Factors: may cause unfovourable outcome with abortion,intrauterine death of foetus or liveborn having congenital anomalies or congenital disease.

All this information are made to determinate a necessary care with the pregnancy stage.
The genetical factor is very important,every body  reacts different and for this every mother have to know the risks and to take all the measures for her and foetus health.
We promote a responsible attitude on decision to become mother,we promote the prevention for a healthy life!
Go to the medical examination,be consciously of your body,get treatment if is necessary and enjoy the role of mother without complications!

Alarming Signals during Pregnancy

Mothers should know about the fallowing alarming signals:
-persistent or recurrent headache
-visual disturbance
-severe epigastric or lower abdominal pain
-respiratory disconfort or dyspnoea (breathlessness symptoms)
-excessive edema (fluid retention)
-vaginal discharge or bleeding,rupture of membranes
-not feeling foetal movements.

READ ALSO:
Labour Symptoms

Maternal Health- Mother care during pregnancy stages

Mothers are a vulnerable group that need special maternal health program.maternal health is required for athe foetus health ( for a normal growth and development intrauterine) and for a favourable outcome of pregnancy.Mothers have prevent diseases that may occur during pregnancy and labour,by a regular health control for early diagnosis and management.

Maternal Health Program:
1.Preconceptional Care
2.Pregnancy Care
3.Interconceptional Care (Interpregnancy Care).

1.Preconceptional Care:
Represents the care of mother before conception:continued care from birth through stages of growth and development,until time of conception and pregnancy.
Special care forthose particulary risk in pregnancy:
-untreated rickets,complicated with bone deformity
-complicating unmanaged streptoccocal phyryngitis
-severe paralytic poliomyelitis
-giving Rh positive blood transfusion to Rh negative females.
Is necessary a regular health appraisal for early case finding and management and prevention of complications and a premarital care for both partners.
The education of young girls at school about the about woman health is important.

Premarital care involves premarital conseling,immunization and examination.
In premarital conseling partners are educated for principles of adjusted marriage and family life,health childbearing andd family planing on personal approach.
In case of immunization,adolescent or young adult female not infected or actively immunized before,can be given any of meales,mumps and rubella vaccines,according to needs.If s not premarital,active immunization can be post marital but never during pregnancy.
males can be similarly immunized when is necessary,specially for mumps.

2.Pregnancy Care:
It is care during pregnancy that must be started early and continued though pregnancy.
This starts with medical examination.On first visit it will be a comprehensive medical examination and investigations and on periodic prenatal visits it will be a medical examination and screening tests.
On each visit the pregnant is examined for:
-general health status and complaint or suffering if any.
-weight
-blood presure
-obstetric examination.

Nutritional education during pregnancy:
Adequate nutrition is a base required of pregnancy and lactation.Extra allawances of nutrients and energy are needed during the latter part of pregnanncy,foetal and child health.
A healthy lifestyle includes:
-rest (physical and mental) with sufficient hours of sleep and avoiding fatigue and stress.
- some homework and activities are allowed
-exercises are allowed and open-air recreation.
-suitable clouthing.
-bathing (not hot).

3.Natal Care:
By:
-helping the pregnant to have a normal delivery
- and providing emergency sevice when needed.All this information are made to determinate a necessary care with the pregnancy stage.


The genetical factor is very important,every body reacts different and for this every mother have to know the risks and to take all the measures for her and foetus health.
We promote a responsible attitude on decision to become mother,we promote the prevention for a healthy life!
Go to the medical examination,be consciously of your body,get treatment if is necessary and enjoy the role of mother without complications

READ ALSO:
Pregnancy Trimesters

Congenital Infection-Transmitted infection from the pregnant to foetus

Inutero infection is that infection transmitted from the pregnant to the embryo or foetus.
Infection is usually of embryo in first trimester before formation of placenta which is a barrier of infection.
Transplacental infection are pathogens and may pass through placenta and involve the foetus.

Congenital infection is an important cause of unfavourable outcome of pregnancy,that depends on nature and severity of infection and period of pregnancy when infection occurs.Can result in:
-abortion
-sillbirth (intrauterine death of foetus)
-congenital anomalies
-congenital disease (syphilis,rubella syndrom,hepatitis,AIDS).

Type of Congenital Infection and Features:

1.Syphilis:
Is transplacental transmitted from 4th month of pregnancy to time of delivery.
Causes unfavourable outcome: repeated abortion,intrauterine death of foetus,liveborn with congenital deformities and neonatal mortality,liveborn with congenital disease.

2.Viral Infections:
May occur at any time of pregnancy.
Particularly risky  during 1st trimester.

3.Rubella:
Early infection cause abortion or congenital anomalies.
Later infection: intrauterine death of foetus,liveborn with congenital disease.

4.Hepatitis B Virus:
Is a congenital infection from HBs agents positive pregnant.
Infected liveborn is exposed to sequeles.

5.HIV:
The infant is infected and become infectious.

6.Other virusus: mumps,varicella,etc.

7.Toxoplasma:
Is a recent,not past infection of the pregnant.
In utero infection causes unfavourable outcome,lethal and sublethal.
Can determinate anomalies of retina.

Important inutero infections causing congenital disease are: syphilis,rubella syndrome and AIDS.

Present your self to the doctor for tests and examination if you decide to become mother!
If you suffer of any type of disease consult the doctor in case of pregnancy!
Have a safe sexual life,protect yourself against any infectious transmitted disease!

Vitamin A as "anti-infection" vitamin and cure for eyes

Vitamin A is known for its anti-infection role.Vitamin A is needed for formation of healthy epithelial surfaces which are the first line of natural barriers of infection that resists invasion by pathogenic organisms.

Important: Once infection occurs,vitamin A has no effect against infection.The anti-infection role is preventive not therapeutic!

Vitamin A has sources in animal and plant foods.
1.Animal Food: liver,egg yolk,whole milk and cheese,butter,cream and fatty fish.
2.Plant foods: plants don't provide vitamin A,but the vitamin precursor (provitamin) carotenes are converted in the body into vitamin A.Carotenes are found in pigments of most vegetables and fruits (green,yellow,red,orange).The Beta-Carotene found in leafy vegetables is particularly important.

One other rich source of vitamin A is the cod liver oil and other fish liver oils that can be given as supplement of vitamin A.

Functions of Vitamin A:
Vitamin A is responsable with the growth of healthy ephithelial cells of skin and mucous membranes,specially of respiratory passages and urinary tract.The vitamin A has the anti-infection role in this case.
The vitamin A is responsabe with the normal secretion of lacrimal glands.Deficiency of vitamin A leads to xerosis and lack of tears whit the risk of eye infection.
Vitamin A is a component of visual purple of the retina that is needed for vision in low-intensity light.Deficiency of vitamin A leads in an early face to impaired dark adaptation or severe case of night blindness.

The importance of Carbohydrates.Choose the good ones!

All carbohydrates are of plant origin,except lactose (milk,sugar) and glicogen (animal starch).

Carbohydrates sources:
-Cereal grains and pulses-the rich source.
-Potatoes,sweet potatoes,rice,banana,dates,honey,molasses and drie fruits as good source.
-Rafinated products:sugar,flour and starch.
Sugar and flour are used to make bread,cakes,syrups,pasta.

Digestion of carbohydrates ends in glucose, one gram gives 4.1 calories and provides the greater part of energy need of the body.Carbohydrates results in cellulose too and the cellulose of food is ingestible,but gives bulk which is valuable for stimulation of intestinal peristalsis and prevention of constipation.Dietary roughage showed to be of value in prevention of caner colon.
he dietary allowance of carbohydrates varies with total energy need of the individual.
Carbohydrates from a balanced diet gives around 60% of energy requirement.

Don't eliminate totaly the carbohydrates from your daily diet.Eliminate the excess and the consumption type rafinated products (sugar,flour) that can develop obesity (the carbs are converted in fats in the body and stored in fatty tissues).
A low carbohydrate diet expose you to:
-combustion of fat as energy,causing excess formation and accumulation of ketone bodies (risk of diabetes)
-combustion of more protein for energy (when we have a fat restricted diet too)-dangerous for the vital functions.

Include "good" carbohydrates in your diet,consume fruits,vegetables and cereal grains daily to avoid constipation,colon cancer,irritated state of mind,diabetes and failure of the vital function of the body.

First choose the health!
Don't keep a restrictive diet,avoid the excess and those unhealthy carbohydrates that don't have nutritive value for your body!

The value of the PROTEIN in diet

Protein is a nitrogenous compund made of a number of amino aids linked together.
Proteins are classified into high and low biological value.

Any high biologial value in adequate amount provides the body needs of amino acids.
All animal proteins are high biologial value,exept gelatin.
All plants proteins are of low biological value,exept of soyabeans.
In this case some of the essential amino aids are either missing or of inadequate amount and so annot maintain growth or support life by itself.

Improve biologial value of plant protein:
When dietary proteins are only or largely of plant source it is necessary to take a variety of plant-protein foods every day,so that missing or inadequate essential amino aids of one food can be supplemented by the other foods.
So,they collectively provide the required essential amino acids and can dispense with animal protein foods.

Sources of protein:
Animal foods:
-milk
-eggs
-meat (muscle,poutry,fish,organ meat like liver,kidney,brain).
Plant foods:
-dried beans,peas,lentils-the main sources,the most richest.
-cereals
-nuts.

Functions of proteins:
Proteins are responsible with :
-Formation of cells (proteins are necessary to form protoplasma),building cells (during growth and pregnancy),maintenance of cells,repair of injuried cells.
-Formation of od essential biological compaunds: hormones,enzymes,immunoglobulins.
-Regulation of fluid movement between blood and tissue
-Combustion (proteins provides around 10% of energy requirement).

When the body is not provided with recommended daily protein requirement  result a protein deficiency .Thsi can lead to:
-protein energy malnutrition in infants and young children.
-undergrowth in shoolchildren
-underweight and debility in adults
-impired immune response
-general weakness and early fatigue.

Low-Protein diet is recommended for:
-pathological conditions associated with disturbed protein metabolism and impaired elimination of metabolic produts (ammonia and urea).
-hepatic failure and hepatic coma.
-kidney disease.

High Protein diet is recommanded for:
-severe hypoproteinaemia
-chronic debilitating desease:malignant disease,tuberculosis,chronic infections.
-cases of negative nitrogen balance: severe injuries and burns.

Botulism

Botulism is a rare highly fatal food intoxication.The causative agent is a neurotoxin that is very potent in minute amount.
Neurotoxin interferes with transmission of impulses from nerve to muscle.
When the food is left without refrigeration at room temperature specially in hot weather,staphylococci multiply rapidly.
Foods at risk of contamintion:
-milk
-cream
-pastries
-cakes
-meat

Incubation Period: 2-4 hours.

Symptoms:
-abrupt onsent of acute gastro-enteritis
-severe nausea
-abdominal cramps
-vomiting
-diarrhoea
-slight or no fever
-subnormal temperature
Manifestation persist for some hours fallowed by recovery.

Many cases appear in the involved group within short time if they share common food.
Manifestation appear after very short incubation period (hours).Cases show more or less similar manifestations (gastrointestinal) for short time.

Prevention:
-protection and clean hndling of food
-refrigeration of food,not left at room temperature,until consumed
-boiling of milk if is not pasteurized.

Wash your hands before getting contact with the food!
Provide food only from safe conditions!
Keep the food in sanitary conditions!

Immunization: Influenza Vaccines

For immunization are used two influenza vaccines:inactivated and attenuated.

INACTIVATED INFLUENZA VACCINE:
Application of Vaccination:

Vaccination is recommended yearly for protection of high-risk individuals and groups.
The elderly of more than 65 years old,specially when having chronic disease,or in geniatric or nursing homes or hospitalized.
Individuals exposed to increased risk of influenza complications when infected:
-chronic heart and lung disease
-kidney and metabolic disorders.
Dangerous groups who may transmit infection,though their work to high-risk group:
-helth and medical care providers
-personnel serving chronic cases in different institutes and centers.
Children having chronic disease like heart and respiratory including asthmatics.
The vaccine is not given below two years of age ,who can be immunized by a special vaccine.

Contraindication of Vaccination:
 Vaccination is contraindicated when history of allergy to egg protein is given since the virus are grown in embryonated eggs and some eggs protein is found in the vaccine,otherwise they develop manifestation of hypersensitivity after vaccination.

LIVE ATTENUATED INFLUENZA VACCINE:
Is a recombinant vaccine,made to replace the inactivated vaccine that provides moderate immunity of t most 70% only and lacks stimulating local immunity that is needed to resist respiratory infection.

Skin,Hair and Nails Contagoius Diseases- DERMATOPHYTOSES

Dermatophytoses are superficial diseases caused by a group of fungi which invade the skin,hair and nails.Exemples are Taenias.

Dermatophytoses of scalp:
Ringworm and favus (a type of taenia) are contagious diseases of scalp affecting children,specially in less developed communities.This type of dermatophytoses exist on man nd animals: dogs,cats,cattle,horses,rodents.

Modes of Transmission: contact infection.
-direct contact with infected children or animals
-using contaminated rticles and fomites of case like comb,hir brush and headwear.

Prevention:
-the mothers and the children have to know about the mode of transmition and try to avoid any of those conditions
-have clean habits and not to use ny articles and fomites in common with the other
One other important aspect is the sanitation of barbers shops.

Impetigo Contagiosa:
Is a purulent infection of skin,caused by mixed staphylococcus and staphylococcus infection of scratches.

Causes of Impetigo:
-autoinfection: the case infects other parts by cratching whit soiled fingers
-contact with affected skin
-using contaminated articles and fomites of case

Autoinfection and contacts may get infected with:
-nose or ear discharge
-respiratory droplets
contaminated hand
-soiled articles and fomites.

Symptoms:
The clinic picture is characteristic purulent lesion of skin,on exposed parts usually face,neck nd hands.

Prevention:
Any wounds and skin abrasions need aseptic management and protection from any contamination.

Types of Sleep and Characteristics

The sleep is a state of unconsciousness from which a person can be aroused by proper stimuli.
Exist 2 types of sleep that alternate with each other:

1.NON REM sleep:Slow wave sleep which is the first to occur when the person falls asleep.
2.REM sleep.

1.Non REM Sleep:
-occurs at the start of sleep
-takes 80% from the sleep time
-has a duration cycle around of 90 min
-non-rapid eye movement,eyes deviate up
-hypotonic (decreased) muscle tone
-the dreams are present nut not remembered
-talking and wlking can be present
-easy awaked

2.REM Sleep:
-occurs after 4th stage of non REM sleep
-takes 20% of the sleep time
-has a duration around of 20 min
-rapid eye movement
-marked hypotonia
-dreams are present and remembered
-the talking and walking are absent
-difficult to awaken.

Non REM sleep have 4 stages:
According to the brain waves registration during sleep:
-low amplitude-high frequency
-light sleep
-high amplitude-low frequency (moderate sleep)
-few frequency (deep sleep).

For REM Sleep:
-small rapid irregular waves like an alert person.

Types of Headache and Causes

Headache is a reffered pain of two origins:
-INTRACRANIAL
-EXTRACRANIAL

The brain is insensitive to pain.

Causes of INTRACRANIAL Headache:

-Meningeal Irritation:due to meningitis,brain tumors or opertive trauma.
-Migraine Headache: it is abnormal vascular phenomenon.
tension or emotion causes vasospasmof cerebral vessels.The vessels becomes flaccid and pulsates with blood pressure,this giving severe headache.
-Hypertension: Headache due to marked expansion of cerebral brain vessels.
-Alcohol Headache: alcohol produces toxic meningeal irritation.
-Constipation: causes headache due to absorption of toxic substances to the blood resulting irritation.

Causes of EXTRACRANIAL Headache:
-Head and neck: muscular spasm of scalp and neck muscles due to emotional tension.
-Nose: irritation of the nasal sinuses.
-Eye: error of refraction.
-Ear: otitis media.
-Teeth: tootache.
-Systemic disorders: as anaemia or carbon dioxid poisoning.

Maternal Role at Risk.Appropriate time and conditions to become Mother

It is necessry a regular prenatal visits started in early pregnancy for examination and investigation.

Pregnancy my be risky at the two extremes of childbearing period:
-pregnancy below 16 years is associated with more risk of abortion,premature labour,obstetric problems and difficult labour.
-late pregnancy over 35,nd more risky over 40 years,may be associated whit risk to mother and foetus.

Pregnancy may be at risk in case of:
-emotional maladjustment and psychological disorders
-unstisfactory living conditions:insanitary environment and poor housing,undernutrition,social disorders
-faulty lifestyle and habits:smoking (exposes the pregnant to unfavourable outcome with increased risk of abortion  and congenital anomalies),alcohol consumption,drug abuse,dietary factor (with increased salt,excess of calories,sugar and animal fat).

Chronic Disease may be a risk factor for the pregnancy:
-Uncontrolled hypertension: the pregnant is exposed to more risk to celebrovascular disease.
-Heart disease:usually rheumatic and occasionally congenital.The pregnant is exposed to heart failure.
-Kidney disease: the pregnant is exposed to more risk of abortion or premature labour,aggravation of the disease.
-Uncontrolled diabetes: the pregnant is more exposed to unfavourable outcome,abortion,premature labour,difficult labour and sequelae,baby with congenital anomalies.
-Malnutrition.

The 5th or more pregnancy can be risky.
Don't induce an abortion!In case of unwanted pregnancy,address your self to an authorized doctor in first 12 weeks of pregnancy.

Infants feeding (until 2 years old)

While milk is the exclusive food for the first four months or six months ,it is recommanded to start weaning from the 4th month and progress to the age of 24 months.
During infancy (the first two yers) tha baby takes varied numbers of meals,according to feeding pattern and feeling of hunger and desire for food.Common number,however is usually six.
We will give you a guide for foods to be introduced by month from the 4th to the 12th.Each food forms either a separate meal that replaces a milk feed or is a extra feed or is a extra feed,according to need.

On 4th month:
-orange or tomato juice for vitamin C (sometimes given earlier)
-milk pudding: for prrotein,starch and other nutrients.

On 5th month:
-vegetable soup( by bottle): for iron,iodine and vitmin C
-yolk of boiled egg: for protein,iron,B Vitamins and others.

On 6th/7th month:
-fruits for vitamins and minerls as mashed bananas or composted (cooked) fruits
-mashed vegetables given by spoon.

On 8th/9th month:
boiled pottoes or sweet potatoes
-piece of bread or biscuits.

On 10th/12th month:
-mashed liver of chicken
-minced meat of chicken,cattle or fish.
-peeled mashed stewed beans.

During the second year the mother is guided how to make  a balanced diet from selected foods plus milk feeds,until weaning is completed.

The Advantages of Breast Feeding

Lactation is a physiological function with two processes:
-milk secretion
-milk letdown.
Each of them controlled by a special hormone of the posterior pituitary.

The breast feeding must be started very early after delivery,once general condition of mother is satisfactory (usually within hours).
Putting the newborn so early to breast has this advantages:
-stimulates milk secretion and emptying the breast
-allows suckling of colostrum that has an anti-infection value
-early mother-baby bonding.
The baby must be given sufficient time for suckling.Mother must be at confort and physiologicaly relaxed to help the letdown the milk.

The advantages of bret-feeding:
Advantages exist for both baby and mother.

ADVANTAGES TO BABY: nutritional and non-nutritional:anti-infection.
Human milk composition:protein,fat,lactose,water,energy,calcium,phosphoras,iron,vitamin a,vitamin D,vitamin C,thiamine,ribolavin,niacin.

1.Nutritional advantage:
Do to better quality (composition) of breat milk.Except for deficient iron and vitamin D that can be supplemented.Breast milk is of suitable composition and properties for optimal growth and development.It is readily digestible and satisfies needs of infant in the first months.
Milk is balanced to fulfil requirements of physiological functioning and health promotion if is given in adequate quantity.

2.Non-nutritional advantages:

• Anti-infectional value:

Incidence of infection,specially the diarrhoeal and respiratory is sinificantly lower in the breast-fed rather that the bottle-fed.The breats milk have the fallowing anti-infection properties:
-immunoglobulin,specially in colostrum
-lysozyme (antibacterial).

• Convenient feeding:

The baby can be nursed at any time.Breast milk is fresh and need no preparation and is usually sterile.

• Psychological value:

Breast feeding allows intimate motehr baby contact,that is emotionally valuble for both.

ADVANTAGES TO MOTHER:

1.Postpartum value:suckeling stimulates secretion of oxytocin that causes contraction of uterus,this helps limiting the risk of postpartum bleeding,and enhances involution of uterus.
2.Lower risk of breat cancer
3.Psychological (emotional0 value.
4.Fertility regulation: exclusive breast feeding suppresses ovarian activity and postpartum ovulation and is thus associated with lactational anovulation and amenorrhoea.
Contraceptive effect of breast feeding however needs special pattern that may be partically difficult to fulfil:feeds must be frequent by day and night,for sufficient time on the two breats each feed.

Hazard of sun exposure-MALIGNANT MELANOMA

In UK have been registarted an incidence of 3500 cases of malignant melanoma/year.
Sunlight is considered the major cause ,particularly in the early years of research.
Malignant Melanoma may occur in pre-existing moles and can have the fallowing signs:

• Less helpful sign:

-asymmetry
-irregular colour
-elevation
-irregular border

• Minor signs:

-inflammation,crusting or bleeding
-sensory change
-the diameter become more than 7 mm(unless growth is in the verticl plane)

• Major:

-change in size
-change in shpe
-change in colour
If is smooth,well-demarcated and regular -is not a melanoma.

Squamous Cell Cancer:
This usually presents as an ulcerated lesion with hard,raised edges.They may begin in solar keratoses or be found on the lips of smokers or in long-standing gravitational leg ulcers.Metastases are rare,but local local distuction may be extensive.As treatment is required the total excision.

Basal Cell Carcinoma:
Typically ,pearly nodule with rolled telangiectatic edge usually on the face.If is untreatead become localy distructive epithelioma.Have as cause the UV exposure and can apper as red scaly plaques with raised smoot edges.

Avoid long and unprotected sun exposer!
Go for medical examination !

Raw Milk-source of Extrapulmonary Tuberculosis

Extrapulmonary Tuberculosis is tuberculosis that involves different parts of the body other that the lungs.

Mode of Transmission: ingestion infection:
1) Ingestion of raw or insufficiently heated milk or dairy products (cheese and yogurt) mde of this milk.

How bovine tuberculosis bacilli reach milk?
-Directly secreted in milk,from infected udder.
-Contamination of milk with discharges of tuberculous animals,whithin the animal environment.

2) Ingestion of insufficiently cooked or processed meat.
3) Ingestion of raw or insufficiently boiled eggs.

Why milk is the main vehicle of tuberculous infection than meat?
-milk is a popular,regularly consumed food.
-milk is ready food and so may be consumed without heating,while meat is usually cooked.
-milk used in many widely consumed dairy products is not necessrily boiled or pasteurized beforehand,and may be just warmed and so is not safe.
-milk may be infected or contaminated with many pathogens from two sources,animal and man.
-milk takes a long way from farm to consumer whit many handling and exposure to contamination and hot weather.
-nutrients of milk llow rapid growth of organisms,specially in hot weather without cooling.
-water used in adulteration of milk or washing utensils may be polluted.
-fulfilment of milk sanitation is practically difficult in developing countries.

Symptoms of Extrapulmonary Tuberculosis:
Extrapulmonary Tuberculosis involves he lymph nodes,bones and joints,intestine,kidney,meninges and other parts of the body.All systems of the body including the skin are at-risk in varied incidence.Clinical picture depends of parts affected.

Pulmonary Tuberculosis-Transmission,Symptoms and Diagnosis

Tuberculosis is an infection disease that may involve any part of the body,though the majority of cases re pulmonary.

Sources and Transmission:
1.MAN: open cases of active pulmonary TB are the sources of infection for the human tubercle bacillus.
The infection is exit by respiratory secretions,on coughing and expectoration..

Infectivity: persists so long the disease is active(open into the air pssages).
-proper chemotherapy of case controls infection whitin few months.
-untreated and drug-resistant case remain infective for long time.

Modes Of Transmission:
1.Direct respiratory infection:the most important favoured by repeated close association whit the case (at home,school,institute,cmp or work),specially in crowded badly ventilated places.

2.CATTLE:
Animals having respiratory TB are the reservoirs of infection,for the bovine tubercle bacillus.the orgnisms find exit in respiratory spray.

Mode of Transmission:inhalation of tubercle bcilli in cough spary of diseased animal.Infection is usually occupational in farmers and agriculture workers.

The infected individul is exposed to reinfection from the environent that he usually overcomes.Sometimes,however,reinfection is followed by active disease.This depends on the number and virulence of inhaled tubercle bacilli and the body resistance.

Symptoms:
Unmanaged cases of active tuberculosis show constitutional and local chest manifestations that vary according to stage and severity of disease.Cases are usually chronic and may show exacerbations and remissions.
Clinical picture: general and chest manifestations are not specific,but only suggestive like afternoon low-grade fever,night sweat.anorexia,mild loss of weight and hemoptysis.

Diagnosis:
-Chest X-ray:screens suspected cases.
-sputum examination: to demonstrate tubercle bacilli.It is the only evidence of conclusive diagnosis by:
direct smear microscopy and culture for particulary cses.

GONORRHOEA-Sexually Transmitted Disease

Gonorrhoea is an acute infectious sexually transmitted disease (venereal disease) that becomes chronic if neglected or improperly treated.

Source of Infection: human.
If is untreated remains infectious so long the organisms find exit in discharges of involved mucous membranes,may be for years.
Spcific chemotherapy eliminates infection whithin days.

Transmission:direct sexual contact only.
Incubation period: 3 or 4 days,usually.

Symptoms:

1.Clinical Picture: caused by involvement of the mucous membranes of genitourinary tract.
2.Acute picture:In males:acute anterior urethritis whit purulent discharge.
In female case:urethritis or cervicitis whit discharge.
And as extragenital manifestation: arthritis.
3.Chronic Picture:if case is neglected or improperly treated infection extends to other parts of genitourinary tract and becomes chronic.

Diagnosis:
Acute gonorrhoea is suspected by purulent urethral discharge and history of sexual exposure,to be confirmed by lboratory examination:
-film of pus from urethra or cervix to demonstrate intracellulr gonococci.
-culture of pus if is necessary.
For chronic cases:complement fixation test.

Atention: No aquired immunity after attack and so the same person is exposed to reinfection and repeated attacks.

Prevention:
General preventive measuress of venereal infection (avoid changing sexual partners,use the condom for protected sex).
Specific prevention: chemoprophylaxis by oral penicillin (400 000 units) just before or after exposure.

Control:
-case-finding:early diagnosis is valuable to limit spread of infection and prevent becoming chronic.
-health education of the public,specially young dults so as to seek medical care once suffering.
Some cases may be shy to consult the physician and so has to be encouraged to seek care.

Read on this blog :GONORRHEA SYMPTOMS AND TREATMENT
http://lifemedicalassistance.blogspot.com/2010/6/gonorrhea-and-treatment.html

Pork Meat- possible source of TRICHINOSIS

Trichinosis is a parasitic disease of man that gives two pathological conditions caused by:
-adult worm in small intestine.
-encycted larvae in skeletal muscles.

Trichinella spiralis worm is a round worm with male of 1.5 mm and female of 3 mm long.It inhabits small intestine attached to or buried in the mucosa.

Reservoirs of Infection:
The pig with trichinella cysts in muscles is the only intermediate host of human infection.

The pig gets infected from rats,dogs,cats,swine and other animal reservoirs which have both worms in intestine and encysted larve in muscles.
Infection spread inbetween animals when an animal feed on waster contamining infected tissues of another animal and ingests the infective encysted larve.The pig can thus be infected this way to become the only intermediate host of human infection.

Modes of Infection:
Man is infected with both worms and cysts.

Infection with adult worms occurs first by ingestion of insufficiently cooked or processed raw,meat (muscle) of infected pig:encysted larve in muscle of pig are liberated in small intestine and develop into adult worms.

Infection with encysted larve: man is then exposed to autoinfection,where fertilized female worm burrows into th eintestinal mucosa to deposit larve.Larve penetrate the intestinal wall to be carriedby the circulation to different skeletal muscle where the encyst (forming encyst larve).

Symptoms:
Adult worms in intestine cause intestinal disturbance.
Encysted larve in muscle gives different muscle manifestations.

Trichinosis is a problem in communities commonly consuming pork (meat of swine) and pork products,under insanitary conditions like:
-No clean feeding of pigs: they are fed on wastes containing tissue of infected animals (dogs,cats,rats) and so get infected with encysted larve in muscle.
Insufficient cooking and processing of infected meat,where cysts remain viable.

Prevention of Trichinosis:
1.Measures for pig: the intermediate host of human infection.
-sanitary raising and feeding to prevent being infected from contaminated wastes.
-meat sanitation: examining muscle of slaughtered pig,efficient cooking of meat,to destroy the encysted larve,efficient meat processing in factories.

2.Health Education of those consuming pork for porkborne infections and how to be avoided.

What are the infections transmitted by pork?
Parasitic and bacterian infections.

1.Parasitic Infections:
-Trichinosis : both dult worms in samll intestine and ecysted larve in skeletal muscle.
-Taeniasis solium : infection with worms in small intestine.
2.Bacterial Infections: Salmonellosis and Brucellosis.

Pork transmits two parasitic infections.In both,man is not only infected with adult worm in small intestine,but is also exposed to infection with larva stage in different parts of the body,causing cysticercosis and trichinosis that may be serious.

Parasitic Disease transmitted by ingestion-ASCARIASIS

Ascariasis is chronic intestinal parasitic disease.
Ascariasis lubricoides are nematode that lives in the lumen of small intestine,with male of 15-25 cm and female of 20-40 cm worms.
Each female worm puts thousands of eggs every day,to find exit in faeces.

Infective stage: passed eggs are not infective.They develop outside the body in 2-3 weeks to become embryonated.
Embryonated egg in polluted environment is the infective stage.It is resistant to desiccation and disinfectants and remains viable and infective under favourable environmental conditions for around three months.

Modes of Transmission:
Foodborne and hand to mouth infection (ingestion infection).
1.Foodborne infection: consuming embryonated egg in contaminated food,specially salad vegetables and pollutes water.
2.Hand to mouth infection: when the hand is contaminated with eggs-containing dust.Children are particularl affected,when hands get contaminated on playing in the road and are infected through either:
   -putting contaminated fingers in the mouth
   -taking food without handwashing.

How ascariasis eggs reach food?
-using fresh human fertilizer for vegetables
-contamination of food with eggs-containing dust (from human excreta)
-flies may have potential.

How ascariasis rech dust?
Through contaminating the soil with human excreta,by promiscuous defecation in underdeveloped areas.

Why there is no faeco-oral infection for ascariasis?
Because eggs passed in faecas are not infective,after developing in to embryonated egg in 2-3 weeks.That is also whyinfected food handlers do not spread infection .

Ascariasis cycle in the body:
Ingested infective eggs hatch in the small intestine to give larve that penetrate the intestine,to be carried by the circulation to the lungs where they reach the alveoli,then up in the airways to the pharynx,to be swallowed and backn to small intestine.
Migration cycle takes about 10 days.

Incubation period: about two months from ingestion of embryonated eggs until eggs first appear in stools.

Symptoms:
Manifest cases commonly show:
-Respiratory manifestation :spasms of coughing,usually nocturanl and pneumonitis due to petechial bleeding caused by migrating larve in the lungs.
-Intestinal disorders: abdominal discomfort and colic.
-Nutritional deficiency: du to anorexia,impaired digestion and protein absorption and loss of nutrientts consumed by parasite (proteins,vitamins).
-Others: restless sleep and griding of teeth,commonly in children.

Ascaris is diagnosed by indentifying the eggs in smear of faeces.

Predisposing Factors:
-Promiscuous defecation that contaminates the soil with ascaris eggs.
-Fertilizing vegetables with fresh human fertilizer.
-Ingestion of salad (fresh vegetables) without thorough washing.
-Neglecting care of children who play in the road and get hands contaminated with eggs carrying dust and not washed.

Prevention of Ascariasis:
1.Sanitation of environment:
-safe water supply,food sanitation.
-providing rural area with sanitary convenient latrines and sanitary disposal of wasters.
To be used for fertilization of vegetables human excreta must be stored in covered packed heaps for at least six weeks.
-fly control.

2.Health education of the public:
-using water closetof latrines and avoid promiscuous defecation.
-thorough washing of uncooked vegetables.
-handwashing on returning home and before food.
-supervision of children on playing outdoors and advise them to avoid putting fingers in the mouth and wash hands when necessary and before food.

L.M.A Travel Medical Insurance for Red Sea Tourists

You travel at the Red Sea,Egypt?Enjoy your vacations without  any medical problems.
Sharm El Sheikh,Hurghada,El Gouna,Marsa alam,Makadi Bay are well known s destination for water sports:snorkeling,diving,etc.The exotic view of all Red Sea resorts atracts every year tourists from all parts of the world,specially europeans.Russians,franch,italians,germans,hungarians choose Red Sea Resorts as locations for their vacations.
The place dedicated to water sports can bring the risk of accidents,and  even minor health problems can destroy your vacation,that's why a travel medical insurance is necessary!
The medical assistance for foreigners,outside their original country have special conditions and diferent costs.
Often medical centers requires cash paymant for their services after an untrustfull relation with Insurance Companies from the origin country of the tourist.
To avoid this to hapen choose a medical insurance that guarantes you local medical assistance.
L.M.A offers this type of insurance!
Choose the L.M.A Easy Travel,a medical insurance f 35 $ for 7 days (Insurance Policy) and avoid any surprises caused by the system.

L.M.A offers you medical assistance in any of medical centers and clinics,with high standards and professional team of doctors.

L.M.A  Simple Insurance Policy cavers:
-emergency transportation
-special transportation (if it is necessary)
-treatment at the place of the patient
-medical clinic sitting
-examination,tests and treatment
-food during hospitalization
-minor intervations
-nursering

The Simple Insurance Policy is not suitable for:
-performant sportives
-those over 55 years old
-those who are already under treatment for a disease that need supervision or is incompatible with traveling.

For more information contact us!

AIDS Symptoms,Manifestation

Cases that shows varied manifestations may be grouped into:
-AIDS related complex
Secondary pathological conditions

1.AIDS related Complex :manifestations are caused by HIV.
The case shows nonspecific symptoms,of low-grade fever,fatigue,diarrhea and loss of weight,and persistent generalized lymphadenopathy,specially in children.

2.Secondary pathological conditions:
Arise from immun dysfunction.
-Infection:cases of AIDS are susceptible to varied infections,as the respiratory,that may be life-treatening.
-Autoimmune and neurologic disorders.
-Malignancy:sarcomas.

Immune deficiency is irreversible and threatens life.Disease is fatal within years,usually from:
-secondary infection,specially the viral.
-malignancy.

Diagnosis:
Clinical manifestations are nonspecific,undiagnostic.
AIDS however may be suspected in high-risk individuals suffering for long from vague disease,not responding to given treatment,to be confirmed by laboratory diagnosis.
Laboratory Diagnosis: based on presence of viruses and formation of HIV antibodies.Blood testing of the infected becomes positive 1-3 monthafter infection.

Influenza

Influenza is acute highly disease that shows endemic,epidemic and pandemic spread.

Causative organism:
Type A:responsable for epidemics and pandemics and may show mutation changes.
Type B: may cause outbreacks in confined groups and is less lieble to mutation.
Type C: causes sporadic cases,usually of mild or inapparent disease.

Reservoirs of Infection:
Man: cases where the virus find exit in respiratory discharges,from the mouth and nose.They are infectious for few days.
Animals: pigs,horses and some avian species are reservoirs of subtypes of virus A.

Modes of Transmission:
-direct droplet infection: the most important
-airborne infection with crowded groups (schools,camps)
-freshly soiled articles and fomites.

Incubation period: 1-3 days.
Caracteristics: manifestations and severity vary,may be inapparent,mild,typical or severe fatal disease.Uncomplicated disease is self-limited,of 2-7 days.

Typical cases: abrupt onset,with high fever,chills,headache,myalgia and respiratory catarrh (sore throat,coughing).

Complications:
-secondary bacterial infection of respiratory tract,usually streptococcal or pneumococcal,causing acute sinusitis,otitis media,bronchitis and pneumonia.
-Viral pneumonia,by influenza virus (rare).
-Pericarditis,myocarditis and thrombophlebitis (uncommon).

An individual may get more than one influenza attack,due to:
-many types and subtypes of influenza virus
-continual antigenic changes of the virus.

Age incidence: age group 5-15 years shows the hight incidence.

Prevention:
Adequate ventilation and spacing in confined and public places are generally required,yet they are not significantly effective to prevent spread of outbreaks and epidemics once started.
And by active immunization principally.