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Prevalence of Irritable a self-reported bowel Syndrome cheapest generic levitra professional uk erectile dysfunction drugs with the least side effects, influence of lifestyle questionnaire factors and bowel habits in Korean college Students order levitra professional toronto erectile dysfunction estrogen. Prevalence of race stratified random irritable bowel syndrome in a multi-ethnic sample of population Asian population. Mexico 20%(patients that 2004 Multicentric study Data from Asociacin Mexicana de goes to a Gastroenterologa Gastroenterologist office) Netherlands 6,20% 2003 A community survey using Hungin, A. What general practitioners know General Practitioners about irritable bowel syndrome. The prevalence, symptom characteristics, and impact of irritable bowel syndrome in an Asian community. Mearin et al, Scand J Gastroenterol 2001 Switzerland 8,40% 2003 A community survey using Hungin, A. Irritable bowel syndrome in the 21st century: perspectives from Asia or South-east Asia. Irritable people in a city centre bowel syndrome prevalence in city center of Sivas. Prevalence face interviews and Consultation Behavior of Self-Reported Rectal Bleeding by Face-to-Face Interview in an Asian Community. J Gastroenterol Hepatol 2004; 19: 1217-24 Turkey 2,70% 2008 Countrywide unpublished Data from Ege University School of study Medicine, Sect Gastroenterology (Turkish Gastroenterology Association). Irritable and random-digit bowel syndrome in the United States: telephone dialing prevalence, symptom patterns and (screening interview) impact. The effect of sex- and age-stratified new diagnosic criteria for irritable bowel sample of the population syndrome on community prevalence estimates. Overlap of gastro- questionnaire oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Even if the defining criteria have been changing over the past few years, dispersion of the data are not too wide when compared to other functional disorders. Half of the countries in this survey reported prevalence rates between 10 and 20%. Another interesting point is the absence of gradient between Western and Eastern societies. Discussion Aim of this project was to collect epidemiological data worldwide with the contribution of the National Societies Members of The World Gastroenterology Organization, and to review the literature in order to provide new awareness of the prevalence of digestive disorders and diseases. For this purpose, a total of 142 National Societies were contacted and literature searches with appropriate key terms were conducted using the main scientific and medical databases. Herein, this report gives the definition and prevalence of the most frequent functional disorders and diseases of the gastrointestinal system. Obtained data from a considerable number of countries are presented in the tables. Infection by Helicobacter pylori is the most prevalent digestive disease in the adult population, with median prevalence around 50% of the World population. As pointed out by previous surveys, differences between countries appear to be associated with socio-economic development. A highly interesting observation of our survey is the reduced prevalence found in children and young adults due to a reduced infection rate in the last decades, thanks to improved hygienic and environemental conditions. Among the gastrointestinal diseases of highest severity, colorectal cancer remains the most frequent disease, and it is still associated with high mortality. Age-standardized data demonstrates that incidence of colorectal cancer is 10 to 20 times higher in countries in the top quartile (Western Europe and North America) as compared to those in the lowest quartile (Africa, India). Median prevalence rates for these conditions are around 15% of the population with quartiles ranging from 8% up to 30% in different countries. It is important to remark that functional constipation is highly prevalent among children of the industrialized societies with prevalence rates ranging from 20 to 34%. Finally, dyspepsia is a functional disorder that requires further epidemiological investigation. Prevalence rates seem to be around 10 to 20% of the population, but data are scarce and widely dispersed because of the wide diversity of the definitions used in epidemiological studies. To summarize, this report provides for the first time a valuable tool to assess the prevalence of some of the main gastrointestinal disorders and diseases worldwide. Many of current data point out consistenly to high prevalence of functional digestive disorders and diseases on the world population. A major limitation is the limited availability of data from African and some Asian countries. Further surveys coordinated by the National Societies, including prospective studies, will provide further insights into this interesting topic. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Recent developments in the pathophysiology and therapy of gastroesophageal reflux disease and nonerosive reflux disease. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of Gastroesophageal Reflux Disease study. Fruit and vegetable intake and prevalence of colorectal adenoma in a cancer screening trial. Viruses are Kam L Hon1 responsible for approximately 70% of episodes of acute gastroenteritis in children and rotavirus 1 is one of the best studied of these viruses. Oral rehydration therapy is as effective as intravenous Department of Paediatrics, The Chinese University of therapy in treating mild to moderate dehydration in acute gastroenteritis and is strongly Hong Kong, Hong Kong Special recommended as the frst line therapy. Vomiting is one of the main reasons to explain the underuse of oral Department of Pediatrics, The University of Calgary, Calgary, rehydration therapy. Antiemetics are not routinely recommended in treating acute gastroenteritis, Alberta, Canada though they are still commonly prescribed. Ondansetron is one of the best studied antiemetics and its role in enhancing the compliance of oral rehydration therapy and decreasing the rate of hospitalization has been proved recently. The guidelines regarding the recommendation on antiemetics have been changed according to the evidence of these recent studies. Children in developing countries are particular at risk of both morbidity and mortality. Worldwide, gastroenteritis affects 3 to 5 billion children each year, and accounts for 1. In the United States, the admission rate is 9 per 1000, per annum, for children younger than 5 years old. The difference can also be Tel +852 26322861 explained by the fact that, the incidence of acute gastroenteritis is signifcantly higher Fax +852 26360020 Email ccm250@ha. This is an Open Access article 6554 which permits unrestricted noncommercial use, provided the original work is properly cited. Chow et al Dovepress is a developed city, and yet the admission rate is even higher the cause of 205,000 to 272,000 emergency department than many of the developing countries.

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Initial Assessment and maintenance of vital functions/stabilizing the patient Stroke should be considered as medical emergency generic 20 mg levitra professional with visa erectile dysfunction doctor cape town, as it affects vital functions of an individual buy cheap levitra professional medical erectile dysfunction pump. For this reason the initial step in management of patients with acute stroke should be rapid assessment and maintenance of vital functions. This includes: 508 Internal Medicine a) Maintenance of air way and ventilation b) Control of blood pressure Acute stroke alters autoregulation of cerebral blood flow, compromising the blood supply to an already damaged brain. Close monitoring of blood pressure and correction of both hypotension and hypertension reduces this risk. Because fever worsens the prognosis of stroke body temperature should be controlled appropriately. Glucose is said to be neurotoxic and it is better avoided in patients with stroke. B Exclude causes of brain dysfunction, which mimic stroke like states like syncope, migraine, hysteria and trauma. Determine Presumptive Diagnosis of Stroke Subtype Numbers of clinical features are useful in determining the type of stroke. A good history taking, and proper physical examination may suggest the possible cause of the stroke. Important historical information includes: Mode of onset and pattern of progression o Embolisms usually occur suddenly when the patient is awake, most often early in the morning, giving maximum deficit at onset. Very severe headache with altered consciousness without major neurologic deficit may suggest subarachnoid hemorrhage. Physical Examination Physical Findings may give clue to the type of stroke the patient is suffering from. Confirmation of Diagnosis: different investigations are needed to confirm the diagnosis. Management of specific stroke Goal of Treatment Interruption of further brain damage Prevention and management of complication A. General Measures Admit the patients where close follow up can be given Continue follow up and maintenance of vital functions. Anticoagulation with heparin should be initiated when the acute phase of stroke is over. Rehabilitation: is a very important part of management, and it shall be started early and include:- Physiotherapy Occupational and speech therapy. Impairment of consciousness and Coma Learning objectives: at the end of this lesson the student will be able to: 1. Introduction Maintenance of conscious state requires proper functioning of the cerebral hemispheres, reticular activating system found in brain stem and corticothalmic connections. If there is structural, metabolic or toxic insult of diffuse nature to these structures results in alteration of conscious level of different degree. Autonomic functions are relatively well maintained, and a sleep-wake cycle exists. The loss of consciousness in such patients is diffuse bilateral hemispheric impairment, and such patients have normal brainstem function. Some of the causes include :- 515 Internal Medicine Metabolic disturbances such as : hepatic encephalopathy,uremic encephalopathy,hypoglycemia, diabetic ketoacidosis. Diseases that cause focal neurologic deficit: these disorders cause coma by affecting the reticular activating system. Establishment of cause of coma: is done by taking a careful history, doing rapid but through physical examination and investigations. Level of consciousness: can be assessed semi quantitatively using the Glasgow coma Scale. Brain stem reflexes Assessment of brainstem functions helps to localize the cause of coma. This can be done using brain stem reflexes including, pupillary light response, ocular movements, corneal reflex and the respiratory pattern. If the brainstem functions are normal, coma must be ascribed to bilateral hemispherical disease. During examination size, shape, symmetry and reaction to light should be noted on both eyes. Occulocephalic reflex Oculocephalic reflex is elicited by moving the head from side to side or vertically with eyes held open. In comatose patient with intact brainstem o If the eyeballs move to the opposite direction of the head movementintact brainstem function (dolls eyes movement is positive. Caloric (occulovestibular) reflex o This test is performed by irrigating the ear with ice (cold) to stimulate the vestibular apparatus. It is lost if the reflex connections between the fifth (afferent) and the seventh (efferent) cranial nerves within the pons are damaged. Motor function /response Posture of the patient: o Quadriparesis and flaccidity: suggest pontine or medullary damage o Decorticate posturing: flexion of the elbows and the wrists with supination of the arms, and extension of the legs, suggests severe bilateral or unilateral hemispheric or diencephalic lesion (damage above the midbrain. Differential Diagnosis: Psychogenic Coma (hysteric coma): patient often has history of psychiatric illness, and non physiologic response on physical examination. Management Ideally the, care of comatose patient is started together with the initial assessment to identify the etiology. This treatment is given if hypoglycemia is even remote possibility, and thiamine is given with glucose in order to avoid eliciting Wernicke disease in malnourished o Naloxone(0. Seizure and Epilepsy Learning objectives: at the end of this lesson the student will be able to: 1. Definition: Seizure is a paroxysmal event due to abnormal excessive discharge of cerebral neurons. Depending on the distribution of the discharge, the manifestations may be: Motor Sensory Autonomic or Psychiatric manifestation. Epilepsy is a syndrome characterized by recurrent (two or more) unprovoked seizure attacks, due to a chronic, underlying process in the brain. This definition implies that a person with a single seizure, or recurrent seizures due to correctable or avoidable circumstances, does not necessarily have epilepsy. International classification of seizures: Epileptic seizures can be classified in many different ways. Commonly used classification is the one developed by International League against Epilepsy. This classification is useful in understanding underlying etiology, selecting appropriate treatment and understanding the prognosis of seizure type. Analysis of 468 epileptics seen in neurology clinics of Addis Ababa showed highest incidence in males aged 11-20 years. The commonest type of seizure was found to be grand mal seizure accounting for 60% of all cases. Etiology of seizure or risk factors: The causes of epilepsy/seizure are vary greatly in different age groups and across different regions of the world Idiopathic or cryptogenic: in which the cause is unknown, accounts for the majority. Partial Seizures: these are seizures, which arise from localized region of the brain. This seizure activity may spread over one side of the body (Jacksonian march) to involve larger body part.

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Chromium picolinate supplementation effect of coenzyme Q10 supplementation on metabolic status of type 2 dia- attenuates body weight gain and increases insulin sensitivity in subjects with betic patients order levitra professional online now doctor for erectile dysfunction in ahmedabad. Chromium treatment has no tion on metabolic prole in diabetes: A systematic review and meta-analysis order levitra professional online from canada erectile dysfunction and diabetes type 2. Potential antioxidant effects of zinc analysis of the ecacy and safety of chromium supplementation in diabetes. Elevated intakes of supplemental chro- coenzyme Q10 on oxidative stress, glycemic control and inammation in dia- mium improve glucose and insulin variables in individuals with type 2 dia- betic neuropathy: A double blind randomized clinical trial. Effect of coenzyme Q10 supple- in patients with type 2 diabetes in a Western population: A randomized, double- mentation on diabetes biomarkers: A systematic review and meta-analysis of blind, placebo-controlled trial. Ecacy of Ipomoea batatas (Caiapo) on diabe- tion on glucose metabolism and lipids: A systematic review of randomized con- tes control in type 2 diabetic subjects treated with diet. Improved metabolic control by Ipomoea batatas bination improves glucose metabolism in treated, uncontrolled overweight to (Caiapo) is associated with increased adiponectin and decreased brinogen obese patients with type 2 diabetes. The effect of L-carnitine on plasma improves coronary risk factors in hypercholesterolemic type 2 diabetes mel- lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mel- litus: A placebo-controlled, double-blind randomized clinical trial. Eur mium combined with vitamin C and e supplementation for type 2 diabetes J Clin Nutr 2005;59:5926. Circ Cardiovasc Qual Outcomes proles in patients with type 2 diabetes; a meta-analysis review of random- 2014;7:1524. Benecial effects of oral chromium Chinese herbal medicine for diabetic retinopathy: A randomized, double-blind, picolinate supplementation on glycemic control in patients with type 2 dia- placebo-controlled multicenter clinical trial. A meta-analysis of randomized controlled trials bin and fasting plasma glucose in patients with diabetes mellitus. Additive effect of qidan dihuang grain, a tradi- D(3) on markers of vascular health in patients with type 2 diabetes: tional Chinese medicine, and angiotensin receptor blockers on albuminuria levels A randomised controlled trial. Lack of effect of subtherapeutic vitamin D treat- Evid Based Complement Alternat Med 2016;2016:1064924. Jiangzhuo traditional Chinese medicine for the treatment of patients with dia- 125. Effect of Huangshukuihua (Flos Abelmoschi betes mellitus; a randomized double blind clinical trial. Ecacy and safety of tangshen formula on patients mentation on glycaemic control and cardiometabolic risk among people at risk with type 2 diabetic kidney disease: A multicenter double-blinded random- of type 2 diabetes: Results of a randomized double-blind placebo-controlled ized placebo-controlled trial. The effect of vitamin D supplemen- with diabetic nephropathy: A meta-analysis of randomized controlled trials. The effects of vitamin D supplementation on hepatic (bitter apple) extract oil in painful diabetic neuropathy: A double-blind ran- dysfunction, vitamin D status, and glycemic control in children and adoles- domized placebo-controlled clinical trial. A comprehensive review of oral glu- glycaemic control and calcium/phosphate metabolism in patients with stable cosamine use and effects on glucose metabolism in normal and diabetic indi- type 2 diabetes mellitus: A randomised, placebo-controlled, prospective pilot viduals. Comple- of vitamin D supplementation on long-term glycemic control in type 2 dia- ment Ther Med 2016;25:10412. The benets of yoga for adults with type 2 diabe- blind, randomized clinical trial. Effect of high doses of vitamin D on arte- activities on long-term glycemic control in people with type 2 diabetes: A sys- rial properties, adiponectin, leptin and glucose homeostasis in type 2 dia- tematic review and meta-analysis. Clinical review: Effect of vitamin D3 supple- tive therapy for diabetes mellitus: A randomized controlled trial. Med Acupunct mentation on improving glucose homeostasis and preventing diabetes: 2014;26:3415. Lack of evidence on Tai Chi-related effects in patients with type 2 diabetes: A meta-analysis of randomized controlled trials. Effects of tactile massage on on lipid prole and oxidative stress in hyperlipidemic patients with type 2 dia- metabolic biomarkers in patients with type 2 diabetes. Tactile massage improves glycaemic control stasis in adults with type 2 diabetes: A double-blind, placebo-controlled clini- in women with type 2 diabetes: A pilot study. Effects of vitamin D on blood pressure in patients with type 2 exercises do not improve the metabolic control of type 2 diabetics. Can J Diabetes 42 (2018) S162S169 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: www. Your physician/ nurse practitioner may advise you to start cholesterol-lowering cular age is a primary determinant in both proximate (<10 years) medication. As a powerful catalyst of vascular inammation, diabetes is the S = Stop smoking and manage stress. These models discrimi- each of the healthy behaviour interventions discussed below can nate poorly between higher- and lower-risk populations, particu- be attributed to their signicant anti-inammatory, antithrombotic larly for younger individuals (912). In a meta-analysis of 115 trials (of at least 6 months dura- lium, also promoting the development and progression of athero- tion) comparing sulfonylureas with an active comparator in people sclerosis (3539). Additional vascular-protective medications in the majority of adults a 31% reduction of coronary revascularization and a 48% reduc- with diabetes (see recommendations below) [Grade A, Level 1 (3,4) tion of stroke. Regular physical activity [Grade D, Consensus] (see Physical Activ- statement: The debate about whether all patients with type 2 dia- ity chapter, p. Age <40 years and 1 of the following: benet of lipid lowering in people with diabetes, the current guide- i. Microvascular complications [Grade D, Consensus] people with diabetes 40 years of age. Mortality from coronary heart disease betes with any of the following: in subjects with type 2 diabetes and in nondiabetic subjects with and without a. Multifactorial intervention and cardiovascu- lar disease in patients with type 2 diabetes. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: 6. Diabet are not achieved with existing antihyperglycemic medication(s) and with Med 2005;22:55462. Healthy behavior change and cardiovascularoutcomes innewly diagnosed type 2 diabetic patients: A cohort analysis of the addition-cambridge study. Chronic exercise leads to antiaggregant, antioxidant and anti-inammatory effects in heart failure patients. Association between smoking and chronic Pharmacologic Glycemic Management of Type 2 Diabetes in kidney disease: A case control study. Effects of exercise on cardiovascular risk factors in type 2 Treatment of Hypertension, p. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with Dr. Lin reports personal fees from AstraZeneca, Boehringer Ingelheim, non-insulin-dependent diabetes mellitus: A randomized prospective 6-year study. Verma also reports personal fees from Abbott and diovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353:2643 grants and personal fees from Bristol Myers Squibb-Pzer. N Engl J Med cardiovascular events in people with diabetes: Meta-analysis of randomised con- 2008;358:254559. Aspirin for primary prevention of cardiovascular control and vascular outcomes in patients with type 2 diabetes.

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The total energy absorbed by the bones of one leg at the point of compressive fracture is quality 20 mg levitra professional erectile dysfunction age graph, from Eq purchase 20 mg levitra professional visa erectile dysfunction just before intercourse. This is the amount of energy in the impact of a 70-kg person jumping from a height of 56 cm (1. It is certainly possible to jump safely from a height considerably greater than 56 cm if, on landing, the joints of the body bend and the energy of the fall is redistributed to reduce the chance of fracture. The calculation does however point out the possibility of injury in a fall from even a small height. The general characteristic of such a collision force as a function of time is shown in Fig. The force starts at zero, increases to some maximum value, and then decreases to zero again. The time interval t2 t1 t during which the force acts on the body is the duration of the collision. Because the collision takes place in a short period of time, it is usually dicult to determine the exact magnitude of the force during the collision. However, it is relatively easy to calculate the average value of the impulsive force Fav. It can be obtained simply from the relationship between force and momentum given in Appendix A; that is, mvf mvi Fav (5. The change in momentum due to the collision is usually easy to calculate, but the duration of the collision t is dicult to determine precisely. If the colliding objects are hard, the collision time is very short, a few milliseconds. If one of the objects is soft and yields during the collision, the duration of the collision is lengthened, and as a result the impulsive force is reduced. Thus, falling into soft sand is less damaging than falling on a hard concrete surface. When a person falls from a height h, his/her velocity on impact with the ground, neglecting air friction (see Eq. If the impact surface is hard, such as concrete, and if the person falls with his/her joints rigidly locked, the collision time is estimated to be about 102 sec. The collision time is considerably longer if the person bends his/her knees or falls on a soft surface. Note, however, that the assumption of a 2-cm2 impact area is reasonable but some- what arbitrary. The area may be smaller or larger depending on the nature of the landing; furthermore, we have assumed that the person lands with legs rigidly straight. Exercises 5-2 and 5-3 provide further examples of calculating the injurious eect of impulsive forces. This is illustrated by examining the inatable safety device used in automobiles (see Fig. In a collision, the bag expands suddenly and cushions the impact of the passenger. The forward motion of the passenger must be stopped in about 30 cm of motion if contact with the hard surfaces of the car is to be avoided. For a 70-kg person with a 30-cm allowed stopping distance, the average force is 70 103v2 3 2 F 1. If this force is uniformly distributed over a 1000-cm2 area of the passengers body, the applied force per cm2 is 4. At a 105-km impact speed, the average stopping force is 1010 dyn and the force per cm2 is 107 dyn. In the design of this safety system, the possibility has been considered that the bag may be triggered during normal driving. If the bag were to remain expanded, it would impede the ability of the driver to control the vehicle; therefore, the bag is designed to remain expanded for only the short time necessary to cushion the collision. Here the muscles do not respond fast enough and all the energy is absorbed by the neck bones, causing the well-known whiplash injury (see Fig. It was found in these cases that the body made about a 1-m-deep depression in the surface of the snow on impact. The credibility of these reports can be veried by calculating the impact force that acts on the body during the landing. It is shown in Exercise 5-6 that if the decelerating impact force acts over a distance of about 1 m, the average value of this force remains below the magnitude for serious injury even at the terminal falling velocity of 62. In the normal course of daily activities our bodies are subject mostly to smaller repetitive forces such as the impact of feet with the ground in walking and running. A still not fully resolved question is to what extent are such smaller repetitive forces particularly those encountered in exercise and sport, damaging. Osteoarthritis is the commonly suspected damage resulting from such repetitive impact. As a result of such wear and tear the joint loses exibility and strength accompanied by pain and stiness. After the age of 65, about 60% of men and 75% of women are to some extent aected by this condition. Over the past several years a number of studies have been conducted to determine the link between exercise and osteoarthritis. The emerging conclu- sion is that joint injury is most strongly correlated with subsequent develop- ment of osteoarthritis. Most likely this is the reason why people engaged in high impact injury-prone sports are at a signicantly greater risk of osteo- arthritis. Further, there appears to be little risk associated with recreational running 20 to 40 km a week (13 to 25 miles). It is not surprising that an injured joint is more likely to be subsequently subject to wear and tear. A joint injury usually com- promises to some extent the lubricating ability of the joint leading to increased frictional wear and osteoarthritis. This simple picture would lead one to expect that the progress of osteoarthritis would be more rapidly in the joints of peo- ple who are regular runners than in a control group of non-runners. Osteoarthritis seems to progress at about the same rate in both groups, indicating that the joints possess some ability to self- repair. If the bones of one arm absorb all the kinetic energy (neglecting the energy of the fall), what is the minimum speed of the runner that will cause a fracture of the arm bone? Assume that the object is hard, that the area of contact with the skull is 1cm2, and that the duration of impact is 103 sec. Calculate the duration of the collision between the passenger and the inated bag of the collision protection device discussed in this chapter.