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The papilledema is usually due to an intracranial space-occupying lesion generic fluticasone 100mcg otc asthma treatment, but hypertension and benign 178 intracranial hypertension need attention in the differential cheap generic fluticasone uk asthma symptoms due to allergies. Optic neuritis requires the consideration of multiple sclerosis generic fluticasone 250mcg otc asthmatic bronchitis hospitalization, neurosyphilis purchase viagra plus without prescription, tuberculosis cheap januvia 100 mg mastercard, diabetes mellitus cheap silagra 50mg with mastercard, sinusitis, and lead poisoning. Optic atrophy should suggest syphilis, methyl alcohol poisoning, hereditary optic atrophy, Foster Kennedy syndrome (frontal lobe tumors), and various congenital anomalies. Optic chiasma: Pituitary tumors, sphenoid ridge meningiomas, colloid cysts of the third ventricle, aneurysms, and cavernous sinus thrombosis are possible causes. Syphilitic or tuberculosis meningitis may also involve the chiasma, as may the spread of a Schmincke tumor from the nasopharynx. Certain forms of acute and chronic encephalitis may also involve these areas, causing blurred vision and blindness. Cortical blindness may result from an occlusion of both posterior cerebral arteries at their origin from the basilar artery. Approach to the Diagnosis A careful eye examination with magnification and fluorescence to rule out a foreign body and ulcers is essential in the acute case of blurred vision. Ophthalmoscopic examination may reveal optic neuritis or a retinal vein thrombosis. If these test results are negative, ocular tension should be checked to rule out glaucoma. A history of migraine, the use of birth control pills, and alcohol intake must be investigated. If there is headache on the side of the lesion, a sedimentation rate is done, steroids should probably be started immediately, and referral to a neurologist made promptly in case temporal arteritis is possible, especially in an aged individual. The ophthalmologist will perform visual field examinations with perimetry and a slit lamp examination, and will look for refractive errors. Case Presentation #8 A 66-year-old white female diabetic was brought to the emergency room because of sudden onset of blurred vision in the right eye. Applying the methods discussed above, what are the possible diagnoses at this point? Neurologic examination revealed constriction of the right visual field, a left central facial palsy, weakness of the left upper and lower extremities, and a positive Babinski sign on the left. Visualizing the conduction system of the heart recalls the sick sinus syndrome, atrioventricular (A-V) 182 nodal rhythm, or A-V block, but, unfortunately, it does not help recall the many causes of these disorders. V—Vascular diseases suggest myocardial infarction, especially inferior wall and anteroseptal infarctions. I—Inflammatory disease suggests viral myocarditis, diphtheria, and Chagas disease. N—Neurologic disorders may be considered, because neoplasms of the heart are infrequent. Neurologic disorders include vasovagal syncope (common faint), cerebral concussion, and anything else that might cause an increased intracranial pressure (e.

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Rating questions: Example: On 0–10 scale order 100mcg fluticasone mastercard asthma treatment 2, measure your satisfaction level by encircling the number (0 being extremely dissatisfied and 10 being extremely satisfied) 500 mcg fluticasone fast delivery asthmatic bronchitis icd 9. It consists of several declarative statements/ items that express the view point on a topic buy fluticasone 100 mcg on-line asthma bronchiale bei kindern definition. Topics/ Strongly Agree Not Disagree Strongly Questions agree decided Disagree 1 2 3 4 h discount 100 mg extra super cialis otc. These are more sensitive for subjective experience than rating based categorical adjectives discount silvitra 120mg free shipping. It helps the investigator to efficiently quantify subtle gradations in the strength or intensity of an individual characteristics order 20 mg apcalis sx mastercard. Unbearable Advantages, Disadvantages and Measure to Improve Closed Ended Questions Advantages Disadvantages Measures to improve 1. Develop picture codes answer be exhaustive which can be used for illiterates as well as literates (e. First present the extremes analyze mutually exclusive and then the values in between so that the respondent is straight away aware of the range of answers. Ensure inclusion of follow ents, the interviewer may up questions to elaborate be tempted to read the list on reasons for choosing a of possible answers in the given rating. Comparing responses of different groups, or of the same group over time, becomes easier. Designing the Questionnaire/Interview Tool The questions should be clear, specific, simple (use simple and common words that convey the idea and avoid technical terms) and neutral (avoid jargons, loaded words and stereotypes that suggest that there is most desirable answer). Following steps may be adopted to design the questionnaire/ interview tool: • State objectives and variables of the research study. The questionnaire should be translated in order to standardize the way questions will be asked. After having it translated, it should be retranslated into the original language by a different person. One can then compare the two versions Designing Research Instruments, Interview Guides and Skills 199 for differences and make decisions concerning the final phrasing of difficult questions. Avoid Pitfalls • Double barreled questions: Each question should contain only one concept. It is important that the question matches the options provided for the answer, a task that seems simple but is often done incorrectly. When you Finalize the Questionnaire, be Sure that– A separate, introductory page is attached to each questionnaire, explaining the purpose of the study, requesting the informant’s consent to be interviewed and assuring confidentiality of the data obtained. Each questionnaire has a heading and space to insert the number, date and location of the interview, and, if required, the name of the informant.

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It can be a feature of thrombocytopenia (Jacobsen syndrome) platelets have severe Rh haemolytic disease of the fetus and newborn giant granules buy fluticasone online asthma upper respiratory infection. The great majority of cases (including May–Hegglin anomaly and Fechtner generic fluticasone 100mcg visa asthma bronchitis emphysema difference, Sebas­ occurring after 72 hours are due to necrotising entero­ tian and Epstein syndromes) generic fluticasone 100mcg without prescription asthma symptoms lung cancer. In another rare congeni­ lets is normal or slightly elevated generic 150 mg viagra extra dosage amex, whereas in autoim­ tal syndrome cheap lady era generic, the Upshaw–Schulman syndrome dapoxetine 90mg cheap, there mune thrombocytopenic purpura the percentage is is episodic thrombocytopenia associated with microan­ often considerably increased [426]. Red cells nia includes all the causes of congenital thrombocyto­ should be examined for anisocytosis, poikilocytosis and penia listed in Tables 6. In babies with Down syndrome, syndrome resulting from a drug‐induced anti‐platelet the blood flm should be examined for features of tran­ autoantibody [427]. Rarely, in other throm­ Further tests bocytopenic babies, the blood flm shows features of Whether further tests are needed and the choice of congenital leukaemia. Useful tests may include study of instrument may be an underestimate of the true count. Incidence rose with age and was Investigation of other family members may be useful. The percentage of reticulated brand disease or pseudo‐von Willebrand disease is platelets (see Chapter 2) is often considerably increased. Hepatitis C infection is with a high prevalence of this virus [437], since this common in patients who would otherwise meet the diagnosis has therapeutic implications. Italy cases often have cryoglobulinaemia and anticardi­ and Japan; however, it is uncertain to what extent olipin antibodies [435]. Post‐infection immune thrombocytopenic Further tests purpura Before any other investigations are performed the Immune thrombocytopenic purpura, in many ways blood flm must be examined to confrm thrombocy­ resembling autoimmune thrombocytopenic purpura, topenia and, unless the patient has obvious petechiae can occur following various infections (e. The enza, measles, hepatitis B, poliomyelitis, mumps and blood flm should also be examined for spherocytes, triple vaccine for diphtheria, polio and tetanus [440]. However, in adults tiple organs lead to platelet consumption and renal a bone marrow examination is considered indicated and cerebral manifestations. The thrombocytopenia if: (i) there are atypical features; (ii) the patient is may lead to haemorrhage. A minority of cases follow aged above 60 years; (iii) the patient has relapsed; or identifable infections such as Escherichia coli O157:H7 (iv) splenectomy is required [436]. The pres­ of cocaine or Ecstasy [444] or to interferon therapy ence of antiphospholipid antibodies also supports the [445]. Disorders of red cells and platelets 395 The incidence has been variously estimated at 1, familial atypical haemolytic–uraemic syndrome. How­ Familial thrombocytosis ever, since urgent treatment by plasma exchange is Familial thrombocytosis is a rare condition, usually required, it is recommended that a provisional diag­ with an autosomal dominant inheritance. Apparently recessive inheritance haemolytic anaemia (fragments and polychromasia) was reported in one family, but the genetic basis was not together with thrombocytopenia with platelet anisocy­ elucidated [451].

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Applied research areas could be operational order genuine fluticasone online asthma symptoms forum, health service cheap fluticasone 500 mcg on line asthma graph, health manpower buy fluticasone australia asthma symptoms side effects, policy and economic analysis generic 20mg levitra professional fast delivery, decision linked purchase generic levitra canada, etc purchase extra super levitra overnight delivery. Clinical Trials and Monitoring: This type of research is done before new developments have reached the clinical level, commercial institutions usually become involved as they might have major commitment to having this product used, even before its value has been unequivocally demonstrated and funds are being provided by them to researcher. Some of the essential steps in the development of a health system research are given in the following Table 1. How are we sampling, plan for data going to collect this collection, data processing information? What resources do we need Budget allocation Material support, and what do we have? How will administration and and identifcation of potential utilization of result be utilization of result users ensured? Major areas of health systeMs research • Policy (the role of health in the national development plan, priority health needs, equity in distribution of resources, respect of culture and humanitarian values) • The environment (improvement of living conditions, provision of safe water and basic sanitation, disposal of waste, preservation of natural resources) 6 Research Methodology for Health Professionals • Administration and management (agreement with policy, effectiveness and efficiency in supporting direct services, development of adequate monitoring and evaluation procedures) • The community (development of institutions and practice promoting health, community participation) • Individual and families (assessment of physical, mental and socio- economic needs, potential for addressing specific health problems) • Direct services (appropriateness, effectiveness, efficiency, accessibility, acceptability). All types of researches are multidisciplinary in nature and the researcher requires multidisciplinary skills in the following areas to understand and conduct research: • Policy (political science, policy analysis, technology assessment, behavioral sciences, economics, epidemiology). This is also one of the most difficult tasks of the researcher, especially for the beginners. Research on any topic should, ultimately, be directed to bring changes towards health of the population; it means addressing one or more determinants of health. There should be a perceived difference or discrepancy between what exists and the ideal or planned situation; 2. The reason(s) for this difference should be unclear (so that it makes sense to develop research questions); and 3. There should be more than one possible answer to a question or more than one solution to the problem. These may be personal experiences, literature sources, existing theories, and previous researches. F = Feasible: The research area should be feasible in terms of technical, financial, and administrative capabilities. It should be able to answer the following questions: Can adequate number of subjects be available? I = Interesting: The selected problem area should be of interest to health policy managers and researcher. N = Novel: It should be able to fill the gap in existing knowledge and /or able to solve the problem in an area.