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Furthermore buy 100mg januvia otc diabetes type 1 side effects, a recent systematic review and meta-analysis of colorimetric redox indicator methods to detect multi- drug resistance in M. Colorimetric methods represent a good alternative for the rapid detection of drug resistance in laboratories with limited resources. Resistant strains will reduce the nitrate, which is revealed by a pink-red color in the medium, while susceptible strains will lose this capacity as they are inhibited by the antibiotic (Ängeby 2002). The assay has been evaluated in several studies for first-line drugs and ofloxacin with good results (Montoro 2005, Martin 2005a). It has the added advantage of using the same format and culture medium as the standard proportion method. Further evaluation studies are expected in target populations to assess the perform- ance of this method in different settings. Rapid and inexpensive drug susceptibility testing of Mycobacterium tuberculosis with a nitrate reductase assay. Single-nucleotide polymorphism-based differentiation and drug resistance detection in Mycobacterium tu- berculosis from isolates or directly from sputum. Epidemiology of antituberculosis drug resistance (the Global Project on Anti-tuberculosis Drug Resistance Surveillance): an updated analysis. Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes. Tetrazolium microplate assay as a rapid and inex- pensive colorimetric method for determination of antibiotic susceptibility of Mycobacte- rium tuberculosis. Rapid, efficient detection and drug susceptibility testing of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide, 2000-2004. Direct detection in clinical samples of multiple gene mutations causing resistance of Mycobacterium tuberculosis to isoniazid and rifampicin using fluorogenic probes. Rapid detection of resistance in Mycobacterium tuberculosis: a review discussing molecular approaches. Evaluation of mycobacteria growth indicator tube for direct and indirect drug susceptibility testing of Mycobacterium tuberculosis from respiratory specimens in a Siberian prison hospital. Evaluation of hybridisation on oligonucleo- tide microarrays for analysis of drug-resistant Mycobacterium tuberculosis. Recent advances in molecular methods for early diagnosis of tuberculosis and drug-resistant tuberculosis. Drug susceptibility testing of Mycobacterium tuberculosis: a neglected problem at the turn of the century. Rapid assessment of drug susceptibilities of Mycobacterium tuberculosis by means of luciferase reporter phages. Application of molecular genetic methods in macrolide, lincosamide and streptogramin resistance diagnostics and in detection of drug-resistant Mycobacte- rium tuberculosis. Rapid, auto- mated, nonradiometric susceptibility testing of Mycobacterium tuberculosis complex to four first-line antituberculous drugs used in standard short-course chemotherapy. Resazurin microtiter assay plate testing of Mycobacterium tuberculosis susceptibilities to second-line drugs: rapid, simple, and inexpensive method. Multicenter evaluation of the nitrate reductase assay for drug resistance detection of Mycobacterium tuberculosis. Rapid detection of ofloxacin resistance in Mycobac- terium tuberculosis by two low-cost colorimetric methods: resazurin and nitrate reduc- tase assays. Colorimetric redox-indicator methods for the rapid detection of multidrug resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis. A new rapid and simple colorimetric method to detect pyrazinamide resistance in Mycobacterium tuber- culosis using nicotinamide. A microplate indi- cator-based method for determining the susceptibility of multidrug-resistant Mycobacte- rium tuberculosis to antimicrobial agents.

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The fluoroquinolones are excreted mainly by tubular secretion and by glomerular filtration buy 100 mg januvia with mastercard diabetes in pug dogs. Clinical Uses: Fluoroquinolones are effective in urinary tract infections even when caused by multidrug-resistant bacteria, eg, Pseudomonas. Norfloxacin 400 mg, ciprofloxacin 500 mg, and ofloxacin 400 mg given orally twice daily and all are effective. These agents are also effective for bacterial diarrhea caused by Shigella, Salmonella, toxigenic E coli, or Campylobacter. Fluoroquinolones (except norfloxacin, which does not achieve adequate systemic concentrations) have been employed in infections of soft tissues, bones, and joints and in intra- abdominal and respiratory tract infections, including those caused by multidrug-resistant organisms such as Pseudomonas and Enterobacter. Ciprofloxacin and ofloxacin are effective for gonococcal infection, including disseminated disease, and ofloxacin is effective for chlamydial urethritis or cervicitis. Concomitant administration of theophylline and quinolones can lead to elevated levels of theophylline with the risk of toxic effects, especially seizures. Thus, they are not routinely recommended for use in patients under 18 years of age. Since fluoroquinolones are excreted in breast milk, they are contraindicated for nursing mothers. It is well absorbed after oral administration and excreted mainly through the liver into bile. It is relatively highly protein- bound, and so adequate cerebrospinal fluid concentrations are achieved only in the presence of meningeal inflammation. Occasional adverse effects include rashes, thrombocytopenia, nephritis, cholestatic jaundice and occasionally hepatitis. Rifampin induces microsomal enzymes (cytochrome P450), which increases the elimination of anticoagulants, anticonvulsants, and contraceptives. Administration of rifampin with ketoconazole, or chloramphenicol results in significantly lower serum levels of these drugs. The oral, absorbable sulfonamides can be classified as short-, medium-, or long acting on the basis of their half-lives. Sulfonamides inhibit both gram-positive and gram-negative bacteria, Nocardia, Chlamydia trachomatis, and some protozoa. Some enteric bacteria, such as E coli, Klebsiella, Salmonella, Shigella, and Enterobacter, are inhibited. Pharmacokinetics: They are absorbed from the stomach and small intestine and distributed widely to tissues and body fluids, placenta, and fetus. Absorbed sulfonamides become bound to serum proteins to an extent varying from 20% to over 90%. Sulfonamides and inactivated metabolites are then excreted into the urine, mainly by glomerular filtration. Clinical Uses Oral Absorbable Agents: Sulfisoxazole and sulfamethoxazole are short- to medium-acting agents that are used to treat urinary tract infections, respiratory tract infections, sinusitis, bronchitis, pneumonia, otitis media, and dysentery. Sulfadiazine in combination with pyrimethamine is first-line therapy for treatment of acute toxoplasmosis. Sulfadoxine, long- acting sulfonamide, in combination with pyrimethamine used as a second-line agent in treatment for malaria. Oral Nonabsorbable Agents: Sulfasalazine is widely used in ulcerative colitis, enteritis, and other inflammatory bowel disease. Sulfasalazine is split by intestinal microflora to yield sulfapyridine and 5-aminosalicylate. Salicylate released in the colon in high concentration is responsible for an antiinflammatory effect. Comparably high concentrations of salicylate cannot be achieved in the colon by oral intake of ordinary formulations of salicylates because of severe gastrointestinal toxicity. Silver sulfadiazine is a much less toxic topical sulfonamide and is preferred to mafenide for prevention of infection of burn wounds.

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Recomfort the patient • Change linen if soiled • Arrange the bed • Put pt in comfortable position • Remove the screen 6 generic 100mg januvia diabetic quarter socks. Give proper care of materials used for bathing • Document and report pertinent data • Observation of the skin condition • General appearance or reaction of the pt • Type of bath give Report any abnormal findings to the nurse in charge B. Therapeutic Baths • Are usually ordered by a physician • Are given for physical effects, such as sooth irritated skin or to treat an area (perineum) • Medications may be placed in the water • Is generally taken in a tub 1/3 or ½ full, about 114 liters (930’gal) • The client remains in the bath for a desired time, often 20-30 min • If the clients back, chest and arms are to be treated, immerse in the solution o • The bath temperature is generally included in the order, 37. Saline: 4 ml (1Tsp) NaCl to 500 ml (1 pt) water • Has a cooling effect • Cleans • Decrease skin irritation 2. Potassium permanganate (Kmno4): available in tablets, which are crushed, dissolved in a little water, and added to the bath • Cleans and disinfects • Treats infected skin areas Oatmeal (Aveeino) and cornstarch can also be used Back Care (massage): includes the area from the back and shoulder to the lower buttocks Purpose • To relieve muscle tension • To promote physical and mental relaxation • To improve muscle and skin functioning • To relieve insomnia • To relax patient • To provide a relieve from pain • To prevent pressure sores (decubitus) Procedure 1. Massaging the back • Pour small amount of lotion (oil) on your palm and rub your palms together to warm the lotion (oil) before massaging. Basic Nursing Art 35 • Complete the back rub using long, firm strokes up and sown the back. Petrissape: kneading and making large quick pinches of the skin, tissue, and muscle • Clean the back first • Warm the massage lotion or oil before use by pouring over your hands: cold lotion may startle the client and increase discomfort 1. Effleurage the entire back: has a relaxing sedative effect if slow movement and light pressure are used 2. Petrissape first up the vertebral column and them over the entire back: is stimulating if done quickly with firm p Basic Nursing Art 36 • Assess: signs of relaxation and /or decreased pain (relaxed breathing, decreased muscles tension, drowsiness, and peaceful affect) ⇒ Verbalizations of freedom from pain and tension ⇒ Areas or redness, broken skin, bruises, or other sings of skin breakdown Note • The duration of a massage ranges from 5-20 minutes • Remember the location of bony prominence to avoid direct pressure over this areas • Frequent positioning is preferable to back massage as massaging the back could possibly lead to subcutaneous tissue degeneration. Mouth Care Purpose • To remove food particles from around and between the teeth • To remove dental plaque to prevent dental caries • To increase appetite • To enhance the client’s feelings of well-being • To prevent sores and infections of the oral tissue • To prevent bad odor or halitosis • Should be done in the morning, at night and after each meal • Wait at least for 10 minutes after patient has eaten Equipments • Toothbrush (use the person’s private item. If patient has none use of cotton tipped applicator and plain water) • Tooth paste (use the person’s private item. If patient has none of use cotton tipped applicator and plain water) • Cup of water Basic Nursing Art 37 • Emesis basin • Towel • Denture bowel (if required) Procedure 1. Prepare the pt: • Explain the procedure • Assist the patient to a sitting position in bed (if the health condition permits). Brush the teeth • Moisten the tooth with water and spread small amount of tooth paste on it • Brush the teeth following the appropriate technique. Brushing technique • Hold the brush against the teeth with the bristles at up degree angle. Give pt water to rinse the mouth and let him/her to spit the water into the basin. Recomfort the pt Basic Nursing Art 38 • Remove the basin • Remove the towel • Assist the patient in wiping the mouth • Reposition the patient and adjust the bed to leave patient comfortably 5. Normal solution: a solution of common salt with water in proportion of 4 gm/500 cc of water 2. Move the floss up and down between the teeth from the tops of the crowns to the gum 3. A fracture, the slipper or low back pan Advantage ⇒ Has a thinner rim than as standard bed pan ⇒ Is designed to be easily placed under a person’s buttocks Disadvantage ⇒ Easier to spill the contents of the fracture pan Basic Nursing Art 40 ⇒ Are useful for people who are a. The pediatric bedpan • Are small sized • Usually made of a plastic Offering and Removing Bed Pan • If the individual is weak or helpless, two peoples are needed to place and remove bed pans • If a person needs the bed pan for a longer time periodically remove and replace the pan to ease pressure and prevent tissue damage • Metal bed pans should be warmed before use by: o Running warm water inside the rim of the pan or over the pan o Covering with cloth • Semi-Fowler’s position relieves strain on the client’s back and permits a more normal position for elimination Improper placement of the bedpan can cause skin abrasion to the sacral area and spillage o Place a regular bed pan under the buttocks with the narrow end towards the foot of the bed and the buttocks resting on the smooth, rounded rim o Place a slipper (fracture) pan with the flat, low end under the client’s buttocks o Covering the bed pan after use reduces offensive odors and the clients embarrassment Basic Nursing Art 41 If the client is unable to achieve regular defecation help by attending to: 1. Timing – do not ignore the urge to defecate • A patient should be encouraged to defecate when the urge to defecate is recognized • The patient and the nurse can discuss when mass peristalsis normally occurs and provide time for defecation (the same time each day) 3. Nutrition and fluids For a constipated client: increase daily fluid intake, drink hot liquids and fruit juices etc For the client with diarrhea – encourage oral intake of foods and fluids For the client who has flatulence: limit carbonated beverages; avoid gas- forming foods 4. Exercise • Regular exercise helps clients develop a regular defecation pattern and normal feces 5. Positioning • Sitting position is preferred 3 Measures to assist the person to void include: • Running water in the sink so that the client can hear it • Warming the bed pan before use • Pouring water over the perineum slowly • Having the person assume a comfortable position by raising the head of the bed (men often prefer to stand) • Providing sufficient analgesia for pain Basic Nursing Art 42 • Having the person blow through a straw into a glass of water – relaxes the urinary sphincter Perineal Care (Perineal – Genital Care) Perineal Area: • Is located between the thighs and extends from the top of the pelvic bone (anterior) to the anus (posterior) • Contains sensitive anatomic structures related to sexuality, elimination and reproduction Perineal Care (Hygiene) • Is cleaning of the external genitalia and surrounding area • Always done in conjunction with general bathing Patients in special needs of perineal care • Post partum and surgical patients (surgery of the perineal area) • Non surgical patients who unable to care for themselves • Patients with catheter (particularly indwelling catheter) Other indications for perineal care are: 1. Excessive secretions or concentrated urine, causing skin irritation or excoriation 4. Care before and after some types of perineal surgery Purpose • To remove normal perineal secretions and odors • To prevent infection (e. Patient preparation • Give adequate explanation • Provide privacy • Fold the top bedding and pajamas (given to expose perineal area and drape using the top linen. Cleaning the genital area • Put on gloves For Female • Remove dressing or pad used • Inspect the perineal area for inflammation excoriation, swelling or any discharge. In case of post partum or surgical pt • Clean by cotton swabs, first the labia majora then the skin folds between the majora and minora by retracting the majora using gauze squares, clean from anterior to posterior direction using separate swab for Basic Nursing Art 44 each strokes.

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Methods of keeping food safe and preservation include modern innovations such as vacuuming and filtration techniques buy generic januvia 100 mg online diabetes mellitus uk, pressure canning and radiation processes. The primary objective of keeping food safe is to prevent food from acquiring hazardous properties during preparation, shipment, or storage. The principal methods and the techniques used to keep food safe include temperature control (including pasteurization, cooking, canning, refrigeration, freezing and drying), fermentation and pickling, chemical treatment and irradiation (2, 3, 4, 6, 7). The greatest advance in food hygiene was inadvertently made when man discovered the advantages of boiling, roasting, cooking and other heat treatments of food. Heat renders the destruction of microorganisms / pathogens and in some forms also destroys the toxin produced, such as in the case of the toxin of clostridium botulinum. The use of low temperature Unlike high temperature, low temperature (cold) is not an effective means of destroying microorganisms and toxins in foods except retarding their multiplication and metabolic activities there by reducing toxin production. This is a suitable temperature to preserve perishable food items that may get spoiled at freezing temperature. Pickling on the other hand refers to the immersion of certain foods in concentrated natural acid solution such as vinegar. Chemicals that increase osmotic pressure with reduced water activity below the level that permits growth of most bacteria can be used as bacteriostatic. Collection and handling specimen Proper collection of specimen is essential since the final laboratory results are dependent on the initial proper quality of the sample. The cause of food borne disease may be identified in the laboratory by examining specimens such as stool, blood, vomit, rectal swab, liver and duodenal aspirate; macroscopically, microscopically, culture and immunolgicly (16). If food poisoning is suspected because of a cluster of cases are 106 related to the eating of common foodstuff a sample of the suspected food should be collected (17). Safety Some organisms are more hazardous to handle and are more likely to infect laboratory workers than others, e. Infection may be acquired through the skin, eye, mouth and respiratory tract so laboratory staff must practice the following safety precautions. It should be uncontaminated with urine and collected in to a suitable size, clean, dry and leak–proof container. This container need not to be sterile but must be free of all traces of antiseptics and disinfectants. Several specimens collected on alternative days may be required for detecting parasites that are excreted intermittently e. Dysenteric and watery specimens must reach the laboratory as soon as possible after being passed (with in 15 minutes), otherwise motile parasites; such as E. Fecal specimens like other specimens received in the laboratory, must be handled with care to avoid acquiring infection, from infectious parasites, bacteria, or virus. Whenever it is difficult to get feces, rectal swab should be obtained but rectal swab is unsatisfactory unless it is heavily charged and visibly stained with feces, which collected from the rectum, not anus. Collection of Blood Specimens The following precautions need to be followed during collection of blood sample. Amebiasis Macroscopic Examination: Amoebic dysentery contains blood and mucus Microscopic stool examination: The laboratory diagnosis of amoebic dysentery is by finding E. Specimen must be examined without delay; otherwise identification of the trophozoites becomes impossible because the amoebae lose their motility. Only one–third of infected patients are identified from a single stool specimen and it is recommended that at least three separate specimens be evaluated before excluding the diagnosis (18). Serology: Serology is an important addition to the methods used for the parasitological diagnosis of invasive amoebiasis. A circular blue – green spot in the test area indicates the presence of Giardia antigen in the specimen. Microscopic Examination ¾ Identifying the ova in the stool A concentration technique and the examination of several specimens may be necessary to detect Taenia eggs in fces. Eggs may also be present in the perianal area; thus, if proglottids or eggs are not found in the stool, the perianal region should be examined with use of a cellophane tap swab (9). Ascariasis The laboratory diagnosis of Ascaris lumbericoides is by: Macroscopic Examination ¾ Identifying A. Fertile egg has yellow – brown oval or round shell is often covered by an uneven albuminous coat; contains a central granular mass, which is the unregimented fertilized ovum.






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