Archive for the ‘Health’ Category
Posted by James
One of the major problems that one encounters during a first trip to these remote village clinics and government-run district hospitals is the variety and nature of the conditions encountered and the inability to perform a “quick fix” as Americans are accustomed to doing. For example, it is challenging to have to deal with sanitation and infectious diseases at a small district general hospital without running water if viewed from an American perspective. Therefore, you must be creative and modify best practices to what you have to work with. Working with the local officials, you can always devise a plan that works and can be sustained long after the team has departed, which should be the goal. Much of what SSA needs today is what the United States needed in the 19th century: comprehensive public health programs and policies. They are being developed, although not at the pace to which Americans are accustomed because of scarce resources. Even in some of the largest urban centers, air quality is bad for people with respiratory diseases because of the open cooking fires and the widespread use of charcoal for this purpose. Thus, problems of sanitation and water quality amidst a high prevalence of HIV/AIDS, malaria, tuberculosis and other infectious diseases require attention from both the individual countries as well as PVOs, western governments and other world health agencies.
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Posted by James
Every organization that has done missionary work on the continent quickly learns that a major problem is inoperable equipment, including clinical laboratory instruments, kitchen/laundry facilities, operating and delivery room equipment (electrocauteries, sterilizers, incubators and ventilators) and plant operations (generators, water and sewer systems). A lot of this equipment was purchased during original construction of the facility several decades ago, manuals are missing, and spare parts may no longer available. Usually they are well beyond the point of scavenging one machine to service another. Although there is no large genre of “biomedical technicians” being trained for maintenance and repair of equipment, like most people in developing countries, they are very adept at “jerry rigging” things to keep them working. However, there is some risk that this may expose delicate equipment to considerable damage—for example, if an x-ray unit is exposed to large electrical surges without proper grounding.
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Posted by James
AMTA has learned from experience to send a veteran team consisting of 3-6 individuals to make the first on-site assessment of any medical facility based upon size and complexity. Once a request has been made for our services, a standard questionnaire is forwarded for completion so that baseline data can be obtained, distributed and reviewed by the survey team and individual assignments made. This assessment determines whether AMTA can meet the needs of the country and if there is a commitment on the part of the government and local officials to support a partnership based upon mutual goals and objectives. If the initial assessment report is positive, the composition of subsequent teams is determined based on the findings in the original document and what subsequent survey teams discover. This process is greatly facilitated by having a protocol officer from the host country who is assigned to travel with the team, is familiar with local politics, can speak the local dialect and knows the local government officials and tribal/village leaders. Such a person is essential in order to minimize problems related to travel and logistics, thus, increasing the effectiveness of the team and the success of the mission.
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Posted by James
The treatment is based on the etiology of the hypernatremia and the estimated rapidity of development. Hypernatremic patients may have low, high or normal total body sodium (Drug Depakote used in the UK and U.S. for the treatment of the manic episodes of bipolar disorder). Hypovolemic hypernatremia is a much more common entity. These patients may have evidence of ECF volume depletion and have sustained water losses that are greater than the sodium (Canadian Cozaar helps the kidneys to eliminate extra sodium and fluids) losses. On the other hand, hypernatremic patients may have evidence of ECF expansion. These are invariably patients who have received excessive amounts of hypertonic NaCl or sodium bicarbonate. This variety of hypervolemic hypernatremia is rather infrequent. Most patients with hypernatremia secondary to water loss appear clinically euvolemic with near-normal total-body sodium (Fosamax tabletes is taken for the prevention or treatment of osteoporosis in postmenopausal women and men) status on physical examination. Hypernatremia usually occurs only in those who have no access to water. The renal losses of water that lead to euvolemic hypernatremia are a consequence of a defect in vasopressin production or release, or a failure of the collecting duct to respond to vasopressin.
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Posted by James
Hypernatremia is not uncommon at the extremes of age and is particularly prevalent among the elderly. A serum sodium (Canadian Coumadin is in a class of drugs known as anticoagulants) level of 150 meq/1 or greater should be considered clinically significant. The prevalence of hypernatremia in the elderly has been reported to be about 1% in both hospitalized patients and in residents of long-term care facilities. Since the percentage of body water falls with age, equal volumes of fluid loss in older individuals may represent more severe dehydration than in younger individuals. In healthy older men compared to younger controls, there are deficits in both the intensity and threshold of the thirst response, compared to younger controls. As mentioned earlier, the ability of the elderly to conserve water is also impaired. In the elderly, hypernatremia carries a high risk of morbidity and mortality ranging from 40-60%. Although mortality rate was highest in those with a rapid onset and those with serum sodium level >160 meq/L, a slow correction of serum sodium (Depakote drug affects chemicals in the body that may be involved in causing seizures) over a 72-hour period was reported to improve recovery of mental functions. Several common causes of hypernatremia in the elderly are shown (Table 4).
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Posted by James
Treatment is dependent upon the pathogenesis of the hyponatremia and the severity of symptoms. Patients with hypotension should initially be treated with normal saline to replenish the intravascular volume. Patients should then be reassessed and if symptoms of hyponatremia persist following normalization of blood pressure, hypertonic saline should be given. Furthermore, the change in serum sodium (Drug Cozaar helps the kidneys to eliminate extra sodium and fluids) concentration in response to treatment needs to be followed closely. The rate of rise of serum sodium should not exceed 0.3-0.4 mmol/hr (7-10 meq/24 hours), since correction at a rate greater than 0.5 mmol/hr has been associated with severe neurologic complications, including osmotic demyelination syndrome. Care must also be taken not to induce fluid overload and pulmonary vascular congestion. The administration of normal saline at 75 ml/hr should raise serum sodium (Fosamax medication is taken for the prevention or treatment of osteoporosis in postmenopausal women and men) by approximately 0.3-0.4 mmol/hr. If there is any concern of heart disease, a lesser rate of about 50 ml/hr is advisable. The serum sodium level should be repeated as necessary, regulated as dictated by the clinical situation with adjustment of the fluid rate as required. In sodium depletion, the quantity of sodium required to increase the serum sodium concentration by a given amount can be estimated more precisely by multiplying the desired change in serum sodium by the total body water (e.g., 8 mmol/liter change in a 60-kg person over 24 hours is 8 mmol/liter x 36 liters = 288 mmol = approximately 1.9 liter normal saline or 560 ml 3% NaCl). It should be noted that symptoms related to hyponatremia occur disproportionately throughout the population. Both aging and male gender appear to confer protection against the development of hyponatremia-associated seizures, permanent brain damage and/or mortality, although the reasons) for this is unclear. In asymptomatic patients with no evidence of volume depletion, as in SIADH, correction of the underlying problem and restriction of free water intake to 1 liter per day is usually sufficient to normalize the serum sodium (The active ingredient in Emulgel 50gm is the non-steroidal anti-inflammatory diclofenac sodium 1% w/w).
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Posted by James
Serum sodium (Florinef 0.1mg works by causing the kidneys to retain sodium in women after menopause) is usually maintained within the normal range of 135-145 mmol/1. Hyponatremia is defined as a reduction in the concentration of sodium in the aqueous portion of the serum. A reduction in serum sodium (Canadian Voltarol is one of a group of medicines called non-steroidal anti-inflammatory drugs) below 130 mmol/1 should be considered clinically significant. Hyponatremia is one of the most common electrolyte disorders in the elderly, and female gender is an important risk factor for the development of severe complications.
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