The rise of international travel has given previously region-specific diseases a global presence. The book is aimed at students, interns, fellows and health care providers.It contains chapters devoted to clinical examination and an outline of how to approach common problems encountered at the bedside. The format and style of the book allows common clinical problems to be identified and recognised within the framework of a global perspective.
More info: http://www.mcgraw-hill.com.au/html/9780070285576.html
This scientific paper summarizes a study on the factors associated with the incidence of gastritis in RSU MHAT Kerinci, Indonesia in 2015. The study found that most respondents had a poor diet, moderate knowledge of gastritis, and moderate family support. There were significant relationships between diet, knowledge, and family support with the incidence of gastritis. The paper concludes with recommendations to provide dietary counseling to patients, increase family support, and further study differences between chronic and acute gastritis patients.
Crimson Publishers: The Impact of Chronic Diseases on Patients and Their Fami...CrimsonGastroenterology
The Impact of Chronic Diseases on Patients and Their Families: Case of Ulceratice Colitis and Crohn’s Disease by Maria Tsoukka in Gastroenterology Medicine & Research: Bowel Disease
Background: The purpose of the study is to identify the potential psychological effects of ulcerative colitis and Crohn’s disease on patients and their family environment.Aim: The objective aims of this current research are to identify the causal factors creating psychological problems among patients and their family members, exploring ways to eliminate them and create a general picture for their psychological condition in relation to the diseases at a Pancyprian level.Methods: The Greek translation of the Hospital Anxiety and Depression Scale (HADS) and the Greek translation of the Health Survey (SF-12) will be used for evaluating the psychological effects of ulcerative colitis and Crohn disease on patients and their families. In addition, the Greek translation of the inflammatory Bowel Disease Questionnaire will be used only on the patients. The questionnaires will be handed out to the patients and their attendants in Gastroenterology dispensaries all over Cyprus. Conclusion: In the context of improving health care quality, it was indicated that multifaceted interventions are more effective than simpler interventions and that the insistence on change requires a multi-layered approach. A major focus of health policy is the effective management of long term diseases both for reducing the burden on patients and professionals as well as of the health services also. Studying the Group of patients with IBD could be an important example of study as the patients themselves are chronic patients with 20 years being the peak age onset of the diseases and life expectancy of healthy individuals.
This document presents the national consensus on the management of dyspepsia and Helicobacter pylori infection in Indonesia. It summarizes the epidemiology, pathophysiology, diagnosis, and management of dyspepsia and H. pylori infection. The consensus was developed using evidence-based medicine principles to guide physicians in Indonesia. Dyspepsia is a common complaint that can be organic or functional in nature. H. pylori infection is an important factor in the management of dyspepsia. The consensus provides guidelines on the diagnosis and treatment of dyspepsia and H. pylori infection to improve patient care.
This case report describes a 66-year-old obese woman admitted to the hospital for abdominal pain, nausea, vomiting and acute diverticulitis with a suspected colorectal bladder fistula. Over her 8 day hospital stay she received IV antibiotics and underwent diagnostic testing confirming diverticulitis and a colovaginal fistula. Her medical history included multiple conditions related to her obesity. She was seen by a dietitian who provided nutrition counseling and advanced her diet from clear liquids to regular foods before discharge.
Helicobacter pylori infection is associated with increased risk of gastric cancer development. A prospective study of 1526 Japanese patients found:
1) Gastric cancer developed in 36 (2.9%) of infected patients but none of 280 uninfected patients over 7.8 years of follow up.
2) Infected patients with severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia were at highest risk.
3) Gastric cancer risk was highest in infected patients with nonulcer dyspepsia (4.7%), gastric ulcers (3.4%), or gastric polyps (2.2%) but none in those with duodenal ulcers.
This document provides information about impaired gastric accommodation (IGA), a condition associated with functional dyspepsia where the stomach fails to properly relax and expand after eating. It defines key terms like gastric accommodation, compliance, and tone. IGA is diagnosed using tests like barostatic evaluation, where a balloon is placed in the stomach to measure pressure and volume changes. Around 40% of functional dyspepsia patients have impaired accommodation. The document aims to educate other patients about IGA since information is sparse, and summarizes diagnostic techniques and treatment options available or in development.
Dengue fever has assumed epidemic proportions in India. Abdominal symptoms may mimic acute surgical diseases of the abdomen. The article reviews the various abdominal manifestations of the disease.
A 43-year-old Mexican woman presented with 1 week of abdominal pain, fevers, and headache. Over the course of her hospitalization, she was found to have hepatosplenomegaly, elevated liver enzymes, thrombocytopenia, and multiple splenic lesions. A liver biopsy showed granulomatous hepatitis. Blood cultures eventually grew Brucella melitensis, and she reported recent exposure to cows in rural Mexico. The final diagnosis was brucellosis.
This scientific paper summarizes a study on the factors associated with the incidence of gastritis in RSU MHAT Kerinci, Indonesia in 2015. The study found that most respondents had a poor diet, moderate knowledge of gastritis, and moderate family support. There were significant relationships between diet, knowledge, and family support with the incidence of gastritis. The paper concludes with recommendations to provide dietary counseling to patients, increase family support, and further study differences between chronic and acute gastritis patients.
Crimson Publishers: The Impact of Chronic Diseases on Patients and Their Fami...CrimsonGastroenterology
The Impact of Chronic Diseases on Patients and Their Families: Case of Ulceratice Colitis and Crohn’s Disease by Maria Tsoukka in Gastroenterology Medicine & Research: Bowel Disease
Background: The purpose of the study is to identify the potential psychological effects of ulcerative colitis and Crohn’s disease on patients and their family environment.Aim: The objective aims of this current research are to identify the causal factors creating psychological problems among patients and their family members, exploring ways to eliminate them and create a general picture for their psychological condition in relation to the diseases at a Pancyprian level.Methods: The Greek translation of the Hospital Anxiety and Depression Scale (HADS) and the Greek translation of the Health Survey (SF-12) will be used for evaluating the psychological effects of ulcerative colitis and Crohn disease on patients and their families. In addition, the Greek translation of the inflammatory Bowel Disease Questionnaire will be used only on the patients. The questionnaires will be handed out to the patients and their attendants in Gastroenterology dispensaries all over Cyprus. Conclusion: In the context of improving health care quality, it was indicated that multifaceted interventions are more effective than simpler interventions and that the insistence on change requires a multi-layered approach. A major focus of health policy is the effective management of long term diseases both for reducing the burden on patients and professionals as well as of the health services also. Studying the Group of patients with IBD could be an important example of study as the patients themselves are chronic patients with 20 years being the peak age onset of the diseases and life expectancy of healthy individuals.
This document presents the national consensus on the management of dyspepsia and Helicobacter pylori infection in Indonesia. It summarizes the epidemiology, pathophysiology, diagnosis, and management of dyspepsia and H. pylori infection. The consensus was developed using evidence-based medicine principles to guide physicians in Indonesia. Dyspepsia is a common complaint that can be organic or functional in nature. H. pylori infection is an important factor in the management of dyspepsia. The consensus provides guidelines on the diagnosis and treatment of dyspepsia and H. pylori infection to improve patient care.
This case report describes a 66-year-old obese woman admitted to the hospital for abdominal pain, nausea, vomiting and acute diverticulitis with a suspected colorectal bladder fistula. Over her 8 day hospital stay she received IV antibiotics and underwent diagnostic testing confirming diverticulitis and a colovaginal fistula. Her medical history included multiple conditions related to her obesity. She was seen by a dietitian who provided nutrition counseling and advanced her diet from clear liquids to regular foods before discharge.
Helicobacter pylori infection is associated with increased risk of gastric cancer development. A prospective study of 1526 Japanese patients found:
1) Gastric cancer developed in 36 (2.9%) of infected patients but none of 280 uninfected patients over 7.8 years of follow up.
2) Infected patients with severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia were at highest risk.
3) Gastric cancer risk was highest in infected patients with nonulcer dyspepsia (4.7%), gastric ulcers (3.4%), or gastric polyps (2.2%) but none in those with duodenal ulcers.
This document provides information about impaired gastric accommodation (IGA), a condition associated with functional dyspepsia where the stomach fails to properly relax and expand after eating. It defines key terms like gastric accommodation, compliance, and tone. IGA is diagnosed using tests like barostatic evaluation, where a balloon is placed in the stomach to measure pressure and volume changes. Around 40% of functional dyspepsia patients have impaired accommodation. The document aims to educate other patients about IGA since information is sparse, and summarizes diagnostic techniques and treatment options available or in development.
Dengue fever has assumed epidemic proportions in India. Abdominal symptoms may mimic acute surgical diseases of the abdomen. The article reviews the various abdominal manifestations of the disease.
A 43-year-old Mexican woman presented with 1 week of abdominal pain, fevers, and headache. Over the course of her hospitalization, she was found to have hepatosplenomegaly, elevated liver enzymes, thrombocytopenia, and multiple splenic lesions. A liver biopsy showed granulomatous hepatitis. Blood cultures eventually grew Brucella melitensis, and she reported recent exposure to cows in rural Mexico. The final diagnosis was brucellosis.
This document provides an overview of epidemiology. It begins by defining epidemiology as the study of how diseases are distributed and spread in populations. It then discusses the history of epidemiology, highlighting figures like Hippocrates and John Snow. The document outlines the scope, aims, approaches and methods of epidemiology. It describes observational methods like descriptive studies and analytical studies including case-control and cohort designs. It also discusses experimental methods like randomized controlled trials. In summary, the document provides a high-level introduction to the key concepts, techniques and historical development of epidemiology as a scientific field of study.
This case study summarizes the medical details of 75-year-old male patient Sergio Abbago who was admitted to the hospital due to difficulty breathing and leg swelling. He was diagnosed with atrial septal defect, hospital-acquired pneumonia, and acute urinary retention. The case study provides background on the patient's medical history, presents results from diagnostic testing, discusses the conditions diagnosed and their pathophysiology, outlines the medical and nursing management of the patient, and establishes goals for his care and discharge plan. The objectives are to comprehensively present the case and develop knowledge and skills for delivering quality healthcare to patients.
This summary covers a set of lecture notes for internal medicine created for medical students at Weill Bugando School of Medicine. The notes were created to teach the basic concepts of internal medicine and cover major topic areas. They are focused on teaching clinical management algorithms and are intended to be used alongside textbooks. The notes include sections on history taking, physical examination, cardiology, renal medicine, gastroenterology, infectious diseases and other areas. The goal is to provide a useful guide for both students and faculty in teaching internal medicine essentials.
The guidelines provide new diagnostic criteria for coeliac disease (CD) based on recent scientific and technical developments. Two groups of patients are defined with different diagnostic approaches: 1) children with symptoms suggestive of CD and 2) asymptomatic children at increased risk.
For group 1, the diagnosis is based on symptoms, positive serology, and compatible histology. If anti-tissue transglutaminase antibody titers are >10 times the upper limit of normal, CD can be diagnosed without biopsies by applying further testing.
For group 2, the diagnosis is based on positive serology and histology. HLA testing for HLA-DQ2 and HLA-DQ8 is valuable to exclude CD if both haplotypes
The University of Virginia Department of Medicine is hosting the 38th Annual Recent Advances in Clinical Medicine Conference from October 26-28, 2011 at the Omni Charlottesville Hotel. The conference will feature lectures on current issues in both outpatient and inpatient care, as well as interdisciplinary sessions on topics such as sleep disorders, joint replacement, and caring for pregnant patients. Attendees will have opportunities to ask questions and discuss cases with speakers. The conference aims to provide practical information that physicians can apply in their practices. It is designed for generalists but also specialists staying updated in their fields.
This document provides an overview of internal medicine and discusses key aspects of studying it. It outlines internal medicine subspecialties and the origins and history of medicine. It emphasizes establishing high aims, combining theory with practice, and developing skills through problem-based learning and doctoring skills rotations. The document stresses taking a biopsychosocial approach and using evidence-based medicine to integrate experience with best research evidence for patient care.
This document presents consensus guidelines from an expert panel on the medical management of pediatric Crohn's disease. It aims to provide evidence-based guidance for treating children and adolescents based on a review of existing literature. The guidelines discuss several key points:
- Children with Crohn's disease often have a more complicated disease course than adults, impacting growth, development, and long-term outcomes.
- Exclusive enteral nutrition is the preferred induction therapy for children who have not finished growing, due to its safety profile over corticosteroids.
- Most pediatric Crohn's patients require long-term immunomodulator therapy to maintain remission.
- Certain high-risk factors may warrant an early "top-
This document provides an overview of common digestive concerns and their management from a naturopathic perspective. It begins with evaluating factors that contribute to digestive conditions like IBS, IBD, GERD and celiac disease. Next, it evaluates a case of diarrhea and abdominal pain in a 47-year-old female. It then reviews the epidemiology, pathophysiology and risk factors for GERD, IBS, IBD and celiac disease. Diagnostic guidelines, signs and symptoms, and assessment tools for each condition are outlined. Finally, management strategies are discussed, including lifestyle changes, natural therapies, pharmaceutical interventions, behavioral therapies and other modalities.
Through the Eyes of Taiwanese Palliative Care Providers: End-of-life Treatmen...inventionjournals
The growth of medical knowledge and enhanced technology has increasingly blurred the line between life and death. Resuscitation procedures and life-sustaining devices such as mechanical ventilators, defibrillators, hemodialysis, and parenteral nutrition were introduced just a few decades ago, but have brought significant changes to the treatment of EOL patients. These treatments have given physicians the ability to prolong the process of dying; yet, the decision of when and how to use them has become complicated. An understanding of these controversial life-sustaining procedures and knowledge of current legal guidelines in the American EOL treatment context is necessary when palliative care in Taiwan seems to follow the Western experience in legislation regarding life-sustaining treatment. In this article, how EOL decisions made in the United States is summarized through the eyes of Taiwanese palliative care providers.
This document discusses epidemiological methods used to study disease distribution and determinants in human populations. It describes epidemiology as the study of disease distribution, dynamics and determinants in a population. Observational studies are classified as descriptive or analytical. Descriptive epidemiology organizes and analyzes data to understand disease variation, while analytical epidemiology quantifies associations between exposures and outcomes to test causal hypotheses. Case-control and cohort studies are described as the main analytical epidemiological methods. Key features and procedures of case-control and cohort studies are defined, including advantages and disadvantages of each.
This study analyzed differences in health parameters between dietary groups using data from the Austrian Health Interview Survey. Over 1,300 participants were matched by age, sex, and socioeconomic status into four dietary groups: vegetarian, carnivorous with high fruit/vegetable intake, carnivorous with low meat intake, and carnivorous with high meat intake. The study found that vegetarians had a lower BMI but poorer overall health, with higher rates of cancer, allergies, and mental health issues. They also had greater healthcare needs and lower quality of life compared to the other dietary groups. The results suggest public health programs are needed to address health risks related to nutrition.
This document provides an introduction to epidemiology. It defines epidemiology as the study of disease occurrence and distribution in populations as well as the determinants that influence health states. Descriptive epidemiology involves characterizing disease distribution according to person, place, and time, while analytical epidemiology aims to identify risk factors and causes of disease. Common study designs in epidemiology include observational studies like cohort and case-control studies as well as experimental designs like randomized controlled trials.
This document discusses screening and the "iceberg phenomenon of disease". It defines screening as testing apparently healthy individuals to detect unrecognized disease. Much disease exists below the surface, including subclinical cases, carriers, and undiagnosed cases, constituting a large reservoir of undiagnosed disease in the community. Effective screening aims to sort healthy from diseased individuals to provide early treatment and control disease prevalence. Screening tests should be accurate, cost-effective, and acceptable while balancing risks and benefits.
Long case presentation in clinical exams.Imad Hassan
This 61-year-old Hispanic male presented with a 2-week history of dry cough, chest pain, fever, chills, nausea and vomiting. On examination, he was febrile and tachycardic with respiratory distress, rhonchi, and crackles. Chest X-ray showed bilateral pneumonia. The patient's symptoms were not improving with prior antibiotic treatment.
GERD can manifest in extraesophageal symptoms beyond heartburn, including noncardiac chest pain, asthma, posterior laryngitis, chronic cough, recurrent pneumonitis, dental erosions, and disordered sleep. While some patients experience classic reflux symptoms, many are "silent refluxers" which makes diagnosis challenging. GERD-related chest pain can mimic angina and is often worse after meals and with stress. Reflux may also be associated with asthma, laryngeal inflammation, chronic cough, dental erosions, sleep disturbances, and an exacerbation of obstructive sleep apnea symptoms through mechanisms like acid aspiration and reflex activation. Treatment with acid suppressing proton pump inhibitors provides relief for reflux-related
Rare Disease Day 2017 March 30 - 31, 2017 Day 1:
Precision medicine for Childhood Arthritis: Marinka Twilt Section of Rheumatology Alberta Children’s Hospital University of Calgary
This document discusses guidelines for managing Crohn's disease in adults. It provides background on Crohn's disease and summarizes the process used to develop the guidelines. Literature on Crohn's disease was reviewed from 1946 to 2018 using several medical databases. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate evidence and assign strengths to recommendations. Key clinical features of Crohn's disease are summarized, including common symptoms, diagnosis, and extraintestinal manifestations. The natural history of Crohn's disease is described as typically chronic and progressive, with potential for intestinal complications over time.
This document discusses genetics and genetic counseling. It begins by defining genetics as the study of inheritance and transmission of traits between generations. It then discusses how genetics relates to human health conditions like cancer, heart disease, and diabetes. The document outlines methods for screening and prevention of genetic disorders, including prenatal screening using ultrasound and amniocentesis. Genetic counseling is defined as a process that provides families information about inherited disorders and options for managing risks. The goals of counseling are promoting informed decisions, explaining treatment options, and decreasing incidence of genetic disorders.
The Journal of Gastroenterology provides a platform for researchers, clinicians, and scientists to share their findings and advancements in the field. Some of the key areas covered by the journal include
This document discusses two case studies that demonstrate how humanities research contributes to addressing societal challenges. The first case study shows how archaeologists and biologists collaborating in Finland found that northern Europeans may not have always been heavy milk drinkers as traditionally believed. This rethinking of lactose tolerance in northern Europeans could help improve understanding of food intolerance. The second case study examined video recordings of doctor-patient interactions to identify linguistic patterns that can help distinguish between epileptic and non-epileptic seizures. A method derived from conversation analysis was able to correctly predict diagnoses 85% of the time, improving on traditional focus only on what patients say. These cases illustrate how humanities research provides new perspectives that can address health challenges.
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https://www.facebook.com/thuvienluanvan01
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
This document provides an overview of epidemiology. It begins by defining epidemiology as the study of how diseases are distributed and spread in populations. It then discusses the history of epidemiology, highlighting figures like Hippocrates and John Snow. The document outlines the scope, aims, approaches and methods of epidemiology. It describes observational methods like descriptive studies and analytical studies including case-control and cohort designs. It also discusses experimental methods like randomized controlled trials. In summary, the document provides a high-level introduction to the key concepts, techniques and historical development of epidemiology as a scientific field of study.
This case study summarizes the medical details of 75-year-old male patient Sergio Abbago who was admitted to the hospital due to difficulty breathing and leg swelling. He was diagnosed with atrial septal defect, hospital-acquired pneumonia, and acute urinary retention. The case study provides background on the patient's medical history, presents results from diagnostic testing, discusses the conditions diagnosed and their pathophysiology, outlines the medical and nursing management of the patient, and establishes goals for his care and discharge plan. The objectives are to comprehensively present the case and develop knowledge and skills for delivering quality healthcare to patients.
This summary covers a set of lecture notes for internal medicine created for medical students at Weill Bugando School of Medicine. The notes were created to teach the basic concepts of internal medicine and cover major topic areas. They are focused on teaching clinical management algorithms and are intended to be used alongside textbooks. The notes include sections on history taking, physical examination, cardiology, renal medicine, gastroenterology, infectious diseases and other areas. The goal is to provide a useful guide for both students and faculty in teaching internal medicine essentials.
The guidelines provide new diagnostic criteria for coeliac disease (CD) based on recent scientific and technical developments. Two groups of patients are defined with different diagnostic approaches: 1) children with symptoms suggestive of CD and 2) asymptomatic children at increased risk.
For group 1, the diagnosis is based on symptoms, positive serology, and compatible histology. If anti-tissue transglutaminase antibody titers are >10 times the upper limit of normal, CD can be diagnosed without biopsies by applying further testing.
For group 2, the diagnosis is based on positive serology and histology. HLA testing for HLA-DQ2 and HLA-DQ8 is valuable to exclude CD if both haplotypes
The University of Virginia Department of Medicine is hosting the 38th Annual Recent Advances in Clinical Medicine Conference from October 26-28, 2011 at the Omni Charlottesville Hotel. The conference will feature lectures on current issues in both outpatient and inpatient care, as well as interdisciplinary sessions on topics such as sleep disorders, joint replacement, and caring for pregnant patients. Attendees will have opportunities to ask questions and discuss cases with speakers. The conference aims to provide practical information that physicians can apply in their practices. It is designed for generalists but also specialists staying updated in their fields.
This document provides an overview of internal medicine and discusses key aspects of studying it. It outlines internal medicine subspecialties and the origins and history of medicine. It emphasizes establishing high aims, combining theory with practice, and developing skills through problem-based learning and doctoring skills rotations. The document stresses taking a biopsychosocial approach and using evidence-based medicine to integrate experience with best research evidence for patient care.
This document presents consensus guidelines from an expert panel on the medical management of pediatric Crohn's disease. It aims to provide evidence-based guidance for treating children and adolescents based on a review of existing literature. The guidelines discuss several key points:
- Children with Crohn's disease often have a more complicated disease course than adults, impacting growth, development, and long-term outcomes.
- Exclusive enteral nutrition is the preferred induction therapy for children who have not finished growing, due to its safety profile over corticosteroids.
- Most pediatric Crohn's patients require long-term immunomodulator therapy to maintain remission.
- Certain high-risk factors may warrant an early "top-
This document provides an overview of common digestive concerns and their management from a naturopathic perspective. It begins with evaluating factors that contribute to digestive conditions like IBS, IBD, GERD and celiac disease. Next, it evaluates a case of diarrhea and abdominal pain in a 47-year-old female. It then reviews the epidemiology, pathophysiology and risk factors for GERD, IBS, IBD and celiac disease. Diagnostic guidelines, signs and symptoms, and assessment tools for each condition are outlined. Finally, management strategies are discussed, including lifestyle changes, natural therapies, pharmaceutical interventions, behavioral therapies and other modalities.
Through the Eyes of Taiwanese Palliative Care Providers: End-of-life Treatmen...inventionjournals
The growth of medical knowledge and enhanced technology has increasingly blurred the line between life and death. Resuscitation procedures and life-sustaining devices such as mechanical ventilators, defibrillators, hemodialysis, and parenteral nutrition were introduced just a few decades ago, but have brought significant changes to the treatment of EOL patients. These treatments have given physicians the ability to prolong the process of dying; yet, the decision of when and how to use them has become complicated. An understanding of these controversial life-sustaining procedures and knowledge of current legal guidelines in the American EOL treatment context is necessary when palliative care in Taiwan seems to follow the Western experience in legislation regarding life-sustaining treatment. In this article, how EOL decisions made in the United States is summarized through the eyes of Taiwanese palliative care providers.
This document discusses epidemiological methods used to study disease distribution and determinants in human populations. It describes epidemiology as the study of disease distribution, dynamics and determinants in a population. Observational studies are classified as descriptive or analytical. Descriptive epidemiology organizes and analyzes data to understand disease variation, while analytical epidemiology quantifies associations between exposures and outcomes to test causal hypotheses. Case-control and cohort studies are described as the main analytical epidemiological methods. Key features and procedures of case-control and cohort studies are defined, including advantages and disadvantages of each.
This study analyzed differences in health parameters between dietary groups using data from the Austrian Health Interview Survey. Over 1,300 participants were matched by age, sex, and socioeconomic status into four dietary groups: vegetarian, carnivorous with high fruit/vegetable intake, carnivorous with low meat intake, and carnivorous with high meat intake. The study found that vegetarians had a lower BMI but poorer overall health, with higher rates of cancer, allergies, and mental health issues. They also had greater healthcare needs and lower quality of life compared to the other dietary groups. The results suggest public health programs are needed to address health risks related to nutrition.
This document provides an introduction to epidemiology. It defines epidemiology as the study of disease occurrence and distribution in populations as well as the determinants that influence health states. Descriptive epidemiology involves characterizing disease distribution according to person, place, and time, while analytical epidemiology aims to identify risk factors and causes of disease. Common study designs in epidemiology include observational studies like cohort and case-control studies as well as experimental designs like randomized controlled trials.
This document discusses screening and the "iceberg phenomenon of disease". It defines screening as testing apparently healthy individuals to detect unrecognized disease. Much disease exists below the surface, including subclinical cases, carriers, and undiagnosed cases, constituting a large reservoir of undiagnosed disease in the community. Effective screening aims to sort healthy from diseased individuals to provide early treatment and control disease prevalence. Screening tests should be accurate, cost-effective, and acceptable while balancing risks and benefits.
Long case presentation in clinical exams.Imad Hassan
This 61-year-old Hispanic male presented with a 2-week history of dry cough, chest pain, fever, chills, nausea and vomiting. On examination, he was febrile and tachycardic with respiratory distress, rhonchi, and crackles. Chest X-ray showed bilateral pneumonia. The patient's symptoms were not improving with prior antibiotic treatment.
GERD can manifest in extraesophageal symptoms beyond heartburn, including noncardiac chest pain, asthma, posterior laryngitis, chronic cough, recurrent pneumonitis, dental erosions, and disordered sleep. While some patients experience classic reflux symptoms, many are "silent refluxers" which makes diagnosis challenging. GERD-related chest pain can mimic angina and is often worse after meals and with stress. Reflux may also be associated with asthma, laryngeal inflammation, chronic cough, dental erosions, sleep disturbances, and an exacerbation of obstructive sleep apnea symptoms through mechanisms like acid aspiration and reflex activation. Treatment with acid suppressing proton pump inhibitors provides relief for reflux-related
Rare Disease Day 2017 March 30 - 31, 2017 Day 1:
Precision medicine for Childhood Arthritis: Marinka Twilt Section of Rheumatology Alberta Children’s Hospital University of Calgary
This document discusses guidelines for managing Crohn's disease in adults. It provides background on Crohn's disease and summarizes the process used to develop the guidelines. Literature on Crohn's disease was reviewed from 1946 to 2018 using several medical databases. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate evidence and assign strengths to recommendations. Key clinical features of Crohn's disease are summarized, including common symptoms, diagnosis, and extraintestinal manifestations. The natural history of Crohn's disease is described as typically chronic and progressive, with potential for intestinal complications over time.
This document discusses genetics and genetic counseling. It begins by defining genetics as the study of inheritance and transmission of traits between generations. It then discusses how genetics relates to human health conditions like cancer, heart disease, and diabetes. The document outlines methods for screening and prevention of genetic disorders, including prenatal screening using ultrasound and amniocentesis. Genetic counseling is defined as a process that provides families information about inherited disorders and options for managing risks. The goals of counseling are promoting informed decisions, explaining treatment options, and decreasing incidence of genetic disorders.
The Journal of Gastroenterology provides a platform for researchers, clinicians, and scientists to share their findings and advancements in the field. Some of the key areas covered by the journal include
This document discusses two case studies that demonstrate how humanities research contributes to addressing societal challenges. The first case study shows how archaeologists and biologists collaborating in Finland found that northern Europeans may not have always been heavy milk drinkers as traditionally believed. This rethinking of lactose tolerance in northern Europeans could help improve understanding of food intolerance. The second case study examined video recordings of doctor-patient interactions to identify linguistic patterns that can help distinguish between epileptic and non-epileptic seizures. A method derived from conversation analysis was able to correctly predict diagnoses 85% of the time, improving on traditional focus only on what patients say. These cases illustrate how humanities research provides new perspectives that can address health challenges.
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This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Textbook of Medical Physiology by Guyton and Hall.pdfJameel221
Known for its clear presentation style, single-author voice, and focus on content most relevant to clinical and pre-clinical students, Guyton and Hall Textbook of Medical Physiology, 14th Edition, employs a distinctive format to ensure maximum learning and retention of complex concepts.
This document is a letter from the Ancestral Health Team thanking attendees of the 2011 Ancestral Health Symposium and providing information about supporting the Ancestry nonprofit organization. It encourages donations to support future symposia and the development of the Ancestral Health Society, including an academic journal. It also provides contact information and websites to stay connected including AncestryFoundation.org, facebook.com/AncestralHealthSymposium, and the email ancestralhealth@gmail.com.
ECD III - Boehm (online) - Nutrition Science 062416Tobias Boehm
This document provides an overview of nutrition science as it relates to dentistry. It begins by discussing a historical account of sailors developing severe oral disease due to malnutrition during long voyages. It then reviews key scientific concepts like levels of evidence, study designs, and statistical terms. The main body discusses macronutrients like carbohydrates, proteins, and lipids. Carbohydrates are the primary energy source and discussed in detail. Proteins and lipids are also reviewed in terms of their purposes and health effects.
Guyton and Hall Textbook of Medical Physiology, 14th EditionDrAbuSadatMdSayem
This document provides teaching resources for instructors using the 14th edition of Guyton and Hall Textbook of Medical Physiology. It lists the authors and provides copyright information. Contact information is given for Elsevier sales representatives and for requesting supporting materials available on an Elsevier website.
This document provides information on a case study of a 10-year-old female diagnosed with acute appendicitis. It includes details on her history, symptoms, family history, tests, treatment, and nursing care both before and during her hospitalization. The objectives are to develop a case study using Orem's Self Care Deficit Nursing Theory and provide holistic nursing care to help the patient recover from her appendicitis.
This document provides a summary of the latest issue of the journal Policy and Practice. It discusses several studies and papers covered in the issue, including research on mental health and political violence in Northern Ireland, water fluoridation and health risks, socioeconomic factors and various health outcomes, and geographic variation in health services. It also summarizes some methodological papers and book reviews included in the issue. The editor provides brief high-level summaries of the key topics, findings, and discussions across multiple papers and research covered in the latest journal publication.
This document provides information about acute bronchitis and acute gastroenteritis in children. It defines acute bronchitis as a viral infection causing inflammation of the bronchi, with cough as the main symptom. Acute gastroenteritis is defined as an inflammation of the stomach and intestines causing diarrhea. The document discusses the etiology, signs and symptoms, diagnosis, and treatment of both conditions. It aims to analyze the contributing factors and nursing interventions for a pediatric patient diagnosed with acute bronchitis and acute gastroenteritis using the nursing process.
One of the books, published when I was Founding Director and General Manager at SingHealth Academy.
It chronicles stories about Blood Stem Cell Transplants at SingHealth and the excellent work of healthcare professionals, the ecosystem of support for patients and the journeys of patients.
This document is an introduction to a book titled "Embracing Hope: Chronicles of Blood Stem Cell Transplants" which contains personal accounts and testimonies from patients who underwent blood stem cell transplants, as well as from the healthcare providers who supported them. The introduction provides background on how blood stem cell transplants have progressed as a treatment for blood cancers and disorders. It explains that the purpose of the book is to share the unique experiences and challenges faced by both patients and medical staff during the transplant process, with the aim of inspiring and encouraging future patients.
Assignment #1 – This assignment should help you to organize your t.docxdavezstarr61655
Assignment #1 – This assignment should help you to organize your thoughts about your research. Take time to really think about the questions – this effort will make writing the actual paper much easier. Please complete this worksheet and submit on Bb. You need to submit only once per pair (make sure I know who you are working with!).
1. With your partner, develop a research question. Write your research question here:
*Please ensure that the question is not answered by the book’s author.
Question is. "How has the development in human society led to the increased frequency of obesity?"
2. Why do you have this question? Please write a paragraph or two explaining your interest in this question. Give specific information from the book that leads you to ask this question (include page numbers). Explain how this information relates to your question.
Obesity in the whole world has become a public health problem in that it has raised concern. About 700 million people aged 15 years and above in the entire world are obese. The prevalence rate of based on years past shows a rapid increase of obesity in developed countries mainly Pacific region. Various cancers, cardiovascular diseases-morbidities, type II diabetes are some of the factors which lead to morbidity and mortality; this is based on literature on body exhaustive.
A public health strategy is, therefore, to be developed based on prevention of obesity rate of increase. The development and also the process of policies on preventing obesity should target factors which tend to contribute to obesity. Moreover, it should target barriers to lifestyle changes which are personal and also environmental and levels socioeconomic.
There are etiologies which contribute to obesity in which this etiologies are multifactorial,some if these factors include sedentary lifestyle, adverse socio-economic conditions which are there in developed countries, high rate of energy dense food, rigid restraint, alcohol, large portion sizes and food ratio which are prepared outside home (mostly in developed countries) page 70 (International journal of environmental research and public health).
There is a proposed framework by sacks (2009) where a suggestion is made that there should be policy actions and implementation of health strategies to preventing obesity. These factors target environments, behaviors directly influencing people, physical activity settings, food environments and also the socioeconomic environments.
3. What do you need to learn as a biologist to understand your question in the context of human evolution?
Obesity, diabetes and also metabolic syndrome has become a worldwide health concern due to that they are growing rapidly, and their causes are not fully understood. Therefore a research into the obesity epidemic etiology is highly appreciated depending on the evolutionary roots of metabolic control. Thrifty gene hypothesis argues that obesity is an evolutionary roots of metabolic control .
Assignment 1 Gastrointestinal Tract Disorders of MotilityJ.docxfelicitytaft14745
Assignment 1: Gastrointestinal Tract: Disorders of Motility
Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.
Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.
To Prepare
· Review this week’s media presentation on the gastrointestinal system.
· Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
· Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
· Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
· Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentat.
This document summarizes and reviews several books and publications related to rheumatology and orthopedics. It discusses the following key points in 3 sentences:
The first section summarizes a book on neurology in orthopedics, praising it as a practical guide to the essential neurology knowledge needed for those working with musculoskeletal disorders. The second section summarizes a symposium on autoimmunity and genetics, noting that it gathered existing literature on genetic factors in autoimmune diseases. The third section summarizes a book on gout that established clinical criteria for diagnosing gout and described the authors' observations of 380 gout cases, analyzing etiological factors and various clinical presentations.
This document provides guidelines for training in pediatric gastroenterology fellowship programs. It summarizes the key changes and considerations in the field that necessitated updating training guidelines, including advances in medical knowledge, emphasis on competencies and outcomes-based education, lifestyle and duty hour changes, and the evolving healthcare system. The document reviews existing guidelines that were consulted in developing the new NASPGHAN guidelines. It describes the unique characteristics of pediatric gastroenterology and outlines the core competencies that fellowship training must address according to accrediting bodies like ACGME and RCPSC.
Polygenic mutations are caused by multiple mutations across several genes that interact with environmental factors. A study identified the CHD8 gene in mice, finding its mutation causes autism-like behaviors and brain abnormalities also seen in humans. Another study analyzed DNA from Siberian populations, finding genetic adaptations related to fat metabolism that helped with surviving cold climates and fat-rich diets. It is important for doctors to understand polygenic disorders and environmental influences to properly diagnose and treat patients.
Application Gastrointestinal Tract Disorders of MotilityJamie is.docxalfredai53p
Application: Gastrointestinal Tract: Disorders of Motility
Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.
Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.
To prepare:
·
Review this week’s media presentation on the gastrointestinal system.
·
Review Chapter 33 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
·
Review Chapter 35 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
·
Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
·
Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation.
Similar to New Book: Gastroenterology and Hepatology A Manual, Isidor Segal (20)
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Pharmacology of 5-hydroxytryptamine and Antagonist
New Book: Gastroenterology and Hepatology A Manual, Isidor Segal
1. Gastroenterology
and Hepatology
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A Clinician’s Guide
to a Global Phenomenon
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3. ii CONTENTS
Dedication
Professor Segal
To my wife Arlene for her unstinting devotion and
to my dear children Rosh, Perry, Hadass and their families
for their continuing understanding and support.
Professor Pitchumoni
To my wife Prema Pitchumoni and to all my students
Professor Sung
To members of the GI team at Prince of Wales Hospital
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4. Gastroenterology and
Hepatology Manual
A Clinician’s Guide
to a Global Phenomenon
Isidor Segal
C.S. Pitchumoni
Joseph Sung
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6. Foreword
Rapid globalisation is affecting all aspects of life, and the practice of medicine
is no exception. Gastroenterology and Hepatology: a Clinician’s Guide to a
Global Phenomenon is a thoughtful attempt to address the issues related to
the teaching and clinical practice of gastroenterology and hepatology in the
current climate. The book is creatively organised and the chapters have been
written by a team of international experts in the field.
Gastroenterology and Hepatology contains carefully selected topics
that are of particular importance to the practice of gastroenterology and
hepatology throughout the world. Chapter 1, for example, provides a
scholarly, coherent discussion of the underlying factors that are propelling
the development of diseases that are similar worldwide, and of the evolution
from regional to global medicine, particularly in the field of gastroenterology
and hepatology.
The popularity of international travel has resulted in travellers being
exposed to new gastrointestinal and liver disorders that are not present in
their homelands. The chapters devoted to international travel medicine
provide useful information on the diagnosis and management of
gastrointestinal and liver disorders both for travellers from different parts of
the world to a common destination and for travellers from one region to
varied regions.
The editors have cleverly divided clinical gastrointestinal and liver
disorders into groups, such as diseases that are common in West but seem
to spreading to the East, diseases that are common in emerging countries
and spreading globally, and diseases that represent the melting pot. Other
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chapters discuss diseases—including gastrointestinal and liver cancers—that
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have different epidemiology, pathophysiology and clinical behaviour in
different parts of the world.
Chapters discussing gastrointestinal and hepatic disorders of global
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importance include: one on the differences in the diagnostic tools that are
used by practitioners for diagnosis and management of the same disorders in
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different parts of the globe; chapters dealing with important liver disorders
of international interest because of the diversity of their epidemiology and
clinical presentation; and chapters on biliary and pancreatic disorders that
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discuss global diversity in epidemiology, aetiology, clinical manifestations and
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management of these disorders.
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Finally, the book includes a chapter on Chinese traditional medicine and
another on Indian traditional medicine, both focused on gastrointestinal and
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7. vi FOREWORD
liver diseases. Throughout the world, the vast majority of these diseases are
being treated with alternatives to conventional medicine practised in the
West. Moreover, many of the practitioners of alternative forms of medicine
are now also formally trained in Western medicine. This understanding of
different types of therapies will no doubt be beneficial for patients.
This unique compilation, written by talented, scholarly contributors
with expertise in international medicine, is a pioneering work in global
gastroenterology and hepatology. Students and practitioners who care for
patients in the global environment will find this book very useful.
Raj K. Goyal, MD
Mallinckrodt Professor of Medicine
Harvard Medical School
VA Boston Health Care
Boston, Massachusetts 02132
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8. Contents
Foreword v
About the editors x
About the contributors xi
Acknowledgments xvi
Section 1: An overview 1
Chapter 01 • Introduction 2
Chapter 02 • A global phenomenon: medicine without 4
frontiers
Section 2: Gastrointestinal diseases 13
Part A: Clinical assessments 14
Chapter 03 • Acute and chronic abdominal pain 14
Part B: Western diseases spreading their wings 26
Chapter 04 • Gastro-oesophageal reflux disease (GERD) 26
Chapter 05 • Irritable bowel syndrome 39
Chapter 06 • Changing patterns of inflammatory bowel disease 48
in a global context (ulcerative colitis)
Chapter 07 • Changing patterns of inflammatory bowel disease 66
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in a global context (Crohn’s disease)
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Chapter 08 • Constipation 77
Chapter 09 • Colorectal cancer 92
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Part C: Diseases of emerging countries making inroads globally 100
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Chapter 10 • Gastrointestinal tuberculosis versus Crohn’s 100
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disease
Chapter 11 • Traveller’s diarrhoea 114
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Chapter 12 • Cholera 126
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Chapter 13 • Malaria 139
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Chapter 14 • Leptospirosis 156
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9. viii CONTENTS
Chapter 15 • Listeriosis 163
Chapter 16 • Amoebiasis 171
Chapter 17 • Schistosomiasis: global impact 181
Part D: Diseases in the melting pot 191
Chapter 18 • Giardiasis, cryptosporidiosis and cyclosporiasis 191
Chapter 19 • Gastrointestinal disorders in HIV infection 197
and other sexually transmitted infections
Par t E: Cancers of the gastrointestinal tract 207
Chapter 20 • Cancer of the oesophagus: intercontinental 207
variations
Chapter 21 • Global trends in gastric cancer: association with 217
Helicobacter pylori and other factors
Chapter 22 • Clinical aspects of gastric cancer 223
Part F: Preventative gastroenterology 227
Chapter 23 • Preventative gastroenterology 227
Part G: Nutrition 242
Chapter 24 • Nutritional evaluation: a paradigm shift in the 242
twenty-first century
Chapter 25 • Impact on children of global nutritional 257
breakdown
Part H: Gastrointestinal tools 270
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Chapter 26 • Gastrointestinal bleeding 270
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Chapter 27 • Gastrointestinal endoscopy: an overview 280
Chapter 28 • Alimentary tract imaging 292
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Section 3: Pancreatic diseases 303
Chapter 29 • Acute pancreatitis 304
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Chapter 30 • Chronic pancreatitis 316
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Chapter 31 • Pancreatic cancer 328
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Chapter 32 • Imaging of the pancreas 335
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10. CONTENTS ix
Section 4: Hepatology 347
Part A: Diseases evoking a global impact 348
Chapter 33 • Cirrhosis and complications 348
Chapter 34 • Acute liver failure 369
Chapter 35 • Acute hepatitis 381
Chapter 36 • Hepatitis B infection 394
Chapter 37 • Hepatitis C infection 409
Chapter 38 • Non-alcoholic fatty liver disease 422
Chapter 39 • Alcoholic liver disease 437
Chapter 40 • Hepatocellular carcinoma 444
Chapter 41 • Hepatic imaging 453
Part B: Biliary diseases 465
Chapter 42 • Gallstones and their sequelae 465
Chapter 43 • Neoplasms of the gall bladder and biliary tracts 475
Chapter 44 • Imaging of biliary tracts 489
Section 5: Traditional cultural medicine 499
Chapter 45 • Traditional Chinese medicine 500
Chapter 46 • Traditional Indian medicine 514
Index 526
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11. About the editors
Isidor Segal FRACP, FRCP (UK), AGAF, Master World
Gastroenterology Organisation (WGO)
Professor Segal established the African Institute of Digestive Diseases in
1999. The model of this institute has been used by the WGO to establish
13 training centres in countries such as Morocco, Pakistan, Bangkok, Egypt,
Chile, Bolivia and Argentina.
Professor Segal has held many positions in the WGO, including: member
of the Education and Training Committee and Vice Chairman African and
Middle East Zone. He has published more than 200 papers and has recently
co-edited two books and is a visiting lecturer at universities around the world.
He is currently working in the Gastroenterology Division at Prince of Wales
Hospital, Sydney.
C.S. Pitchumoni MD, MACP, MACG, AGAF, MPH
Professor Pitchumoni is the Adjunct Professor of Medicine at New York
Medical College, Clinical Professor of Medicine at both Robert Wood
Johnson School of Medicine at New Brunswick, New Jersey, and at
Drexel University in Philadelphia, USA. Currently he is also Chief of
Gastroenterology, Hepatology and Clinical Nutrition at Saint Peter’s
University Hospital in New Brunswick.
Professor Pitchumoni has more than 40 years of teaching and research
experience as a clinical gastroenterologist.
Joseph Sung MD, PhD
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Professor Sung is the President of the Chinese University of Hong Kong
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(CUHK) and Mok Hing Yiu Professor of Medicine. Before this appointment,
he was Director of the Institute of Digestive Disease, Chairman of the
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Department of Medicine and Therapeutics, and Associate Dean of Medicine
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at CUHK. He is a gastroenterologist with special interest in gastrointestinal
bleeding, digestive cancer and hepatitis infection. He has published more
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than 650 full papers in scientific journals and edited or co-edited seven
books.
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12. About the contributors
M. Abdullah, Indonesia
Division of Gastroenterology, Department of Internal Medicine, Faculty of
Medicine, University of Indonesia, Jakarta.
R.M. Agrawal, USA
Associate Professor of Medicine, Drexel University College of Medicine,
Philadelphia.
Associate Clinical Chief, Research and Education, Division of
Gastroenterology, Hepatology and Nutrition, Department of Medicine,
Allegheny General Hospital, Pittsburgh.
D.V. Alcid, USA
Professor of Medicine and Pathology, University of Medicine and Dentistry,
Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Director, Microbiology Laboratory, St. Peter’s University Hospital,
New Brunswick, New Jersey.
D. Amarapurkar, India
Bombay Hospital and Medical Research Centre; Mumbai and Jagjivanram
Western Railway Hospital, Mumbai.
T.L. Ang, Singapore
Department of Gastroenterology, Changi General Hospital.
R. Banerjee, India
Consultant Gastroenterologist, Asian Institute of Gastroenterology,
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Hyderabad, Andhra Pradesh.
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Z. Bian, Hong Kong, China
School of Chinese Medicine, Hong Kong Baptist University.
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M. Bilal, USA
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University of Tennessee Health Science Center, Memphis.
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P. Chang, Australia
Gastroenterology Division, Prince of Wales Hospital, Sydney.
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J. Chaganti, Australia
Senior Lecturer in Radiology, University of New South Wales, Sydney.
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Senior Consultant, Radiology, St Vincent’s Hospital, Sydney.
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13. XII ABOUT THE CONTRIBUTORS
G.M. Dusheiko, England
Professor of Medicine, Centre for Hepatology, Royal Free Hospital and
University College London Medical School.
S.S. Fedail, Sudan
Consultant Physician and Gastroenterologist, Chairman, Fedail Hospital,
Khartown.
K.M. Fock, Singapore
Department of Gastroenterology, Changi General Hospital.
A.Y. Garcia, Cuba
Department of Gastroenterology, National Institute of Gastroenterology,
Havana.
K.L. Goh, Malaysia
Professor of Medicine, Head of Gastroenterology and Hepatology, University
of Malaya, Kuala Lumpur.
E.V. Gomez, Cuba
Director of Research, National Institute of Gastroenterology, Havana.
R. Jackson, Australia
Paediatric Gastroenterologist, Prince Of Wales Private Hospital, Sydney.
S.S. Jhangiani, USA
Attending, Departments of Internal Medicine, Gastroenterology and Clinical
Nutrition, Montefiore Medical Center, New York.
Assistant Professor of Medicine, New York Medical College, Valhalla, New York.
Founder and Chairman, www.NutritionVista.com.
Founder and Chairman, Doctors for a Healthier Bronx.
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J.C. Joshi, India
Consulting Gastroenterologist and Hepatologist, Samvedana Clinic, Jolly
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Centre, Mumbai.
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A. Karstaedt, South Africa
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Division of Infectious Diseases, Department of Medicine, Chris Hani
Baragwanath Hospital and the University of the Witwatersrand,
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Johannesburg.
S.R. Lin, China
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Peking University Third Hospital, Peking.
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S. Nair, USA
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Professor of Medicine, Medical Director of Liver Transplantation, University
of Tennessee Health Science Center, Memphis.
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14. ABOUT THE CONTRIBUTORS XIII
C.J. Ooi, Singapore
Head and Senior Consultant, Department of Gastroenterology and
Hepatology, Director, Inflammatory Bowel Disease Centre, Singapore
General Hospital.
Associate Professor, Duke-NUS Graduate Medical School.
Clinical Associate Professor, Yong Loo Lin School of Medicine, NUS.
H. Paradwala, India
Consulting Physician, Saifee Hospital and Prince Aly Khan Hospital, Mumbai.
N.Y. Pathak, India
Senior Research Fellow, Medical Research Centre, Kasturba Health Society,
Mumbai.
C.S. Pitchumoni, USA
Clinical Professor of Medicine, Robert Wood Johnson School of Medicine,
New Brunswick, New Jersey.
Chief of Gastroenterology, Hepatology and Clinical Nutrition, Saint Peter’s
University Hospital, New Brunswick, New Jersey.
A.A. Rani, Indonesia
Head, Division of Gastroenterology, Department of Internal Medicine,
Faculty of Medicine, University of Indonesia, Jakarta.
D.N. Reddy, India
Chairman, Chief Gastroenterologist, Asian Institute of Gastroenterology,
Hyderabad, Andhra Pradesh.
S. Riordan, Australia
Professor of Medicine, Head of Department of Gastroenterology and
Hepatology, Prince of Wales Hospital and the University of New South
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Wales, Sydney.
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S.K. Sarin, India
Professor and Head of Department of Hepatology, Institute of Liver and
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Biliary Sciences, New Delhi.
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I. Segal, Australia
Gastroenterology Division, Prince of Wales Hospital, Sydney.
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S. Shah, India
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Previous Head of Department of Gastroenterology, Sir J.J. Hospital, and
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Grant Medical College Honorary Gastroenterologist at Jaslok, Saifee and
Breach Candy Hospital, Mumbai.
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15. XIV ABOUT THE CONTRIBUTORS
P. Sharma, India
Assistant Professor, Department of Hepatology, Institute of Liver and Biliary
Sciences, New Delhi.
O. Shrivsatav, India
Consultant, Infectious Diseases and HIV Medicine, Sir H.N. Hospital, Jaslok
Hospital, Saifee Hospital, Specialty Clinics, Breach Candy Hospital, Unit
Head, Kasturba Hospital for Communicable Diseases, Mumbai.
D. Singhal, India
Department of Gastroenterology and Gastrointestinal Surgery, Pushpawati
Singhania Research Unit for Liver, Renal and Digestive Diseases, New Delhi.
E.A. Soler, Cuba
General Director, National Institute of Gastroenterology, Havana.
J.D. Sollano, Philippines
Professor of Medicine, University of Santo Tomas, Manilla.
J. Sung, Hong Kong, China
President of the Chinese University of Hong Kong (CUHK) and Mok Hing Yiu
Professor of Medicine.
R.K. Tandon, India
Department of Gastroenterology and Gastrointestinal Surgery, Pushpawati
Singhania Research Unit for Liver, Renal and Digestive Diseases, New Delhi.
S. Tejavanija, Thailand
Medical Staff, Department of Endocrinology and Clinical Nutrition,
Phramongkutklao Hospital, Bangkok.
K.T. Thia, Singapore
Consultant, Gastroenterology and Hepatology, Inflammatory Bowel Disease
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Centre, Singapore General Hospital.
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R. Toney, USA
Senior Gastroenterology Fellow, Allegheny General Hospital, Drexel
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University College, Division of Gastroenterology, Hepatology and Nutrition,
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Department of Medicine, Pittsburgh.
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J. Tu, Australia
Clinical Research Fellow, Gastrointestinal and Liver unit, Prince of Wales
Hospital, Sydney.
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A.D.B. Vaidya, India
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Research Director, ICMR Advanced Centre of Reverse Pharmacology in
Traditional Medicine, Medical Research Centre, Kasturba Health Society,
Mumbai.
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16. ABOUT THE CONTRIBUTORS XV
S.W. Wong, Australia
Senior Lecturer, Colorectal Surgeon, Prince of Wales Hospital, University of
New South Wales, Sydney.
J.C.Y. Wu, Hong Kong, China
Professor, Institute of Digestive Disease, Chinese University of Hong Kong.
S.D. Xiao, China
Shanghai Renji Hospital, Shanghai Jiaotong, University School of Medicine,
Shanghai Institute of Digestive Diseases, Shanghai.
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17. Acknowledgments
Gastroenterology and hepatology continue to progress at an accelerating
pace. Exciting new advances in techniques, treatments, diagnostic strategies
and positive research outcomes have resulted in a new world for medical
practitioners.
A silent ripple has spread like a global tsunami that has made a term like
‘Western diseases’ obsolete. Obesity, inflammatory bowel disease, gastro-
oesophageal-reflux disease, colorectal cancer and other Western diseases are
now common in the burgeoning emerging populations of India, China and
other Asian and Pacific rim countries.
We have been fortunate to have the commitment of internationally
renowned experts from around the world to address the global presentation
of these diseases in their various geographic regions. These invited
contributors are at the cutting edge of both research and clinical aspects of
gastroenterology and hepatology and are able to provide an unprecedented
insight into the global phenomena of the diseases.
The editors are honoured by the excellence of the work of these
international authors, who have been partners in a sometimes difficult
process. They have generously continued to give their time and energy in
order to ensure the success of the book.
We believe the book may serve to bridge current knowledge for students,
trainees, medical practitioners and researchers in digestive diseases.
The format of the publication facilitates ease of access to the specific
information required by users. In addition to the core text, chapters also
include key points, tables, summaries and recommended reading.
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The editors are enormously indebted to the dedicated team at McGraw-
Hill for their guidance, patience and zest in getting the book to press. In
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particular we are very grateful to Fiona Richardson, who was the driving force
behind the scenes and who encouraged the enthusiastic participation of the
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other team members. We are most grateful to Lizzy Walton, Ross Blackwood
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and Yani Silvana for being part of this creative team and for their professional
interest in the provision of a distinctive book.
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Isidor Segal, C.S. Pitchumoni and Joseph Sung
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18. Chapter 2: A global
phenomenon: medicine
without frontiers
I. Segal (Australia)
Key points
Climate change.
Urbanisation.
Xenobiotics: smoking, alcohol, volatile hydrocarbons, occupational
disease, exposure to low-dose ionising radiation and air pollution.
Dietary changes: obesity and junk food.
Exercise trends.
Introduction
This is perhaps the most beautiful time in human history; it is really pregnant with
all kinds of creative possibilities made possible by science and technology which
now constitute the slave of man—if man is not enslaved by it.
Dr Jonas Salk (1914–1995), developer of the polio vaccine.
Globalisation has shifted the course of medicine. There are no longer any
sharp divisions between geographical regions in terms of the prevalence and
types of disease to be found in them: it is becoming more difficult to label
diseases in terms of their geographic location. Environmental, economic,
technological and social changes are evolving so rapidly in the twenty-first
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century that a paradigm shift is needed in order to categorise diseases that
previously were restricted by geographical location.
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The following discussion focuses on factors contributing to these
changes: climate change, urbanisation, xenobiotics, dietary changes and
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exercise trends.
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Climate change
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The dynamics of disease patterns are changing due to climate change.
In many places the Earth’s temperature is rising; some have predicted that the
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average global temperature will rise by 3 to 7 degrees by 2100.
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Warming is escalating, and significant rises have occurred in recent
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decades. Human activities enhance the natural greenhouse effect by
generating greenhouse gases that trap heat in the atmosphere. If this
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19. CHAPTER 2: A GLOBAL PHENOMENON: MEDICINE WITHOUT FRONTIERS 5
continues at or above the current rate, average global temperatures are
predicted to continue to rise, bringing significant long-term effects for people,
the environment and disease patterns.
Burning fossil fuels such as coal, natural gas and oil for powering factories,
industrial plants, home environments and cars, along with continued
tree-clearing for extended building development as populations increase, K
CK FLIC
all exacerbate greenhouse gas problems.1
Health conditions are most susceptible to changes in climate, particularly 2
in the very young, the very old or those with heart and respiratory problems.
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Change also affects microbial contamination pathways and transmission
mechanisms such that water-borne, food-borne, rodent-borne and
vector-borne diseases increase, especially malaria and diarrhoeal diseases.
If temperatures rise 2 to 3 degrees Celsius by 2030, as some predictions
maintain, the risk of malaria would increase by between 3 and 5 per cent
and diarrhoeal diseases would increase by 10 per cent. The latter would
particularly affect children, among whom mortality and morbidity from
diarrhoea is already high in some developing countries. An example of this
is seen in the spread of malaria to the previously malaria-free region of the
Eastern Highlands of Kenya, where warmer, wetter weather has resulted in
high rates of illness and death.2
McMichael et al. cite the known and probable health hazards of climate
variability and health change. They include temperature extremes, more
daily death events and disease events due mainly to very hot days and the
effects of floods, with more injuries, deaths and resultant infectious diseases,
mental health disorders, increased allergic disorders and greater risk of
diarrhoeal diseases, especially salmonellosis (poisoning by contaminated
food).3
The risk of water-borne infections such as cholera may increase, and the
incidence of mosquito-borne infections tends to increase with warming and
changes in rainfall; similarly, tick-borne infections may increase.
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Recent climate change has already contributed to altered food yields in
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some regions, causing changes in temperature, rainfall, soil moisture, pest
activity and plant disease that have reduced food production and increased
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the risk of malnutrition. It is evident that swift and aggressive international
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action is required to deal with the situation.
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Urbanisation
Asia is the most rapidly urbanising continent. Between 1970 and 1990
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the world’s urban population rose by 1038 million, of which Asian cities
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accounted for 589 million (56%). At the current rate, in China 870 million
people—more than half the projected population—will be living in cities
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within less than a decade.4
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20. 6 SECTION 1 | AN OVERVIEW
In 2008 the proportion of the world’s population living in urban areas
crossed the 50 per cent mark. Most observers believe that essentially all
population growth from now on will be in cities. The transition is happening
chaotically, resulting in unorganised urban landscapes in which many of
the poorest people are rapidly absorbed into urban slums. Urbanisation is a
health hazard for certain vulnerable populations, and this demographic shift
threatens to create a humanitarian disaster. The threat comes both in the
form of rising rates of endemic disease and a greater potential for epidemics
and even pandemics.
Most people who relocate to cities are in search of employment. Many
find that their only option is to live in dense, unplanned, illegal settlements
lacking basic public infrastructure. These slums make up an increasing
proportion of some growing cities. Increased population density in urban
areas that lack proper water supply and sanitation magnifies the risk of
communicable diseases being transmitted. Poor urban areas readily become
breeding grounds for emerging infections and potential pandemics. Although
slum residents may live close to health care providers, they generally have
little access to high-quality care. Fundamental public health-related services,
such as a safe water supply, sanitation and oral rehydration therapy, remain
important. As the world becomes increasingly urban, the health of the urban
poor may suffer and the stage could be set for devastating pandemics of
infectious disease.5
In addition to these growing problems, rapid and unplanned urbanisation
has important ramifications with regard to urban pollution and health due to
inadequate drainage and solid waste services, poor urban and industrial waste
management, air pollution (especially from particulates) and overcrowding,
as well as such factors as depletion of water and forest resources.
Asia’s economic growth is expected to continue. In order to achieve
sustainable development there will be an enormous need for waste
disposal facilities, roads, ports, power plants, water mains, airports and
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communication systems. The issue of access is important and the cost of
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infrastucture will be trillions of dollars.
The quality of education among the marginalised poor is variable and
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generally of a low standard. Access to health care is also low in poorer areas
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with overcrowded poor-quality housing, lacking potable water and with
substandard sanitation.
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In sub-Saharan Africa the traditional rural population is rapidly moving to
cities; more than half of the population of approximately 700 million already
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live in urban areas.
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UN-Habitat, the United Nations Human Settlements Program, has stated
that Africa’s chaotic urbanisation, together with the HIV/AIDS pandemic,
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was the biggest threat to the world’s poorest continent. It was estimated that,
by 2000, 51 per cent of Africans would be living in cities and towns, and
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21. CHAPTER 2: A GLOBAL PHENOMENON: MEDICINE WITHOUT FRONTIERS 7
Africa would cease to be a rural continent. In the more developed countries,
84 per cent of the inhabitants will be urban dwellers by 2030.6
In agreement with this, according to a new report issued by the United
Nations Population Division, virtually all population growth expected in the
next 30 years will be concentrated in urban areas. By 2030 the worldwide
population living in urban areas is projected to reach 60 per cent.7 K
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Xenobiotics 2
Xenobiotics are substances foreign to living systems. The term includes drugs,
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pesticides, pollutants, carcinogens, volatile petrochemicals, food additives
and polluted working environments. The following discussion focuses on
some of the important xenobiotics.
Smoking
Smoking is a risk factor for many diseases. Lung cancer is the most serious,
but other lung conditions such as chronic airways disease and emphysema
are also related to smoking, which has been identified as the second most
important risk factor for death from any cause worldwide. China, with a
population of 1.3 billion, is the world’s largest producer and consumer
of tobacco and a large proportion of deaths in China are attributable to
smoking.
It had also been predicted that smoking would cause approximately
930 000 adult deaths in India by 2010, mainly from tuberculosis and
respiratory disease in both men and women, and from heart disease and
cancer in men.
The three leading causes of death attributable to smoking in the
United States are cancer, cardiovascular disease and respiratory disease in
men and respiratory disease in women.8
Alcohol
Alcohol abuse causes 3.5 per cent of all deaths and disability in the world,
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and its impact is more than five times as significant as illegal drugs on
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human health globally.9
Alcohol consumption in South-East Asia is rising, particularly among
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youths and young adults in both rural and urban areas. This may be due to
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economic growth, increasing trade liberalisation and globalisation. Many
countries in Asia, including India, Sri Lanka, Malaysia and Thailand, cannot
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provide accurate consumption figures since local cheap illicit brews are
consumed in unknown quantities.10
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It is common knowledge that alcohol leads to health-related and social
pl
problems. In the digestive system alcohol is a leading cause of cirrhosis and
pancreatitis and is also related to cancers of the mouth, oropharyngeal,
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esophageal, liver and colorectal cancer. Diabetes is also implicated in the
disease pattern.
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22. 8 SECTION 1 | AN OVERVIEW
Volatile hydrocarbons
A 1998 study carried out in Soweto, South Africa, suggested that exposure
to volatile hydrocarbons, particularly petrochemicals, increases susceptibility
to pancreatitis.11 Braganza et al. had also earlier suggested that occupational
exposure to volatile hydrocarbons may be related to idiopathic and alcohol-
related pancreatitis.12
Chronic exposure to xenobiotics such as smoke from coal fires and
kerosene fumes from Primus stoves, along with long-term alcohol abuse
and smoking, were cited as major contributing causes of pancreatitis. Both
acute and chronic pancreatitis appear to be endemic among the Soweto
population. Case control studies all identified the same three environmental
factors in each disease: heavy alcohol consumption, marked exposure to
industrial chemicals and a low intake of fruit, which is a major source of
vitamin C.
Occupational health
People in various occupations may be exposed to xenobiotic substances that
have serious deleterious effects on health. It has been suggested that there is
an association between breast cancer and workshop exposure. The authors
believe that it is worth exploring exposure to chemicals metabolised
into reactive chemicals such as organic solvents and rubber and plastic
chemicals.13
Occupations cited as having possible links with chronic pancreatitis and
pancreatic cancer include employment in automobile engine and parts
manufacture, service and maintenance, as well as dry cleaning, catering,
cooking and serving, gasoline production, glue manufacture, oil refining,
petrochemical industries and steel manufacture.14
Exposure to low-dose ionising radiation
Imaging procedures are an important source of exposure to ionising radiation
and can result in high cumulative effective doses of radiation, which have
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been linked to the development of solid cancers and leukaemia. Thus the
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growing use of medical imaging procedures has resulted in the risks of
radiation exposure becoming relevant.15
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It has been reported that the per capita dose of radiation from medical
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imaging in the United States has increased by a factor of nearly six since
the early 1980s, the largest contributors to total effective doses being X-ray
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computed tomography (CT) scans and nuclear imaging, most of which
occurred in outpatient settings. The United States has the world’s highest per
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capita imaging rate; as many as two per cent of cancers may be attributable
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to radiation exposure during CT scanning.
Radiation-induced cancer might not appear for years. While the danger
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from individual scans may seem to be small, the effect is cumulative, so that
exposure to even moderate degrees of medical radiation is an important
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23. CHAPTER 2: A GLOBAL PHENOMENON: MEDICINE WITHOUT FRONTIERS 9
yet potentially avoidable public health threat—one should be aware of the
potential for radiation-induced carcinogenesis.16
Air pollution
Air pollution is an important cause of increased morbidity and mortality
worldwide. It has been suggested that sustained reduction of fine-particulate
air pollution exposure would result in improved life expectancy.17 K
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2
Dietary changes
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Western influences and modernisation of lifestyle in Asian populations has Q
resulted in an alarming increase in the prevalence of obesity, both in children
and adults.
Obesity
The health risks associated with increased prevalence of obesity, particularly
type 2 diabetes, have also shown a similar increase. Other diseases associated
with the obesity metabolic syndrome that have also indicated this pattern
include cardiovascular disease, hypertension, gallstones and certain cancers.
The health risks associated with obesity in Asian countries occur at a
lower body mass index (BMI) than that observed in Western populations.
This suggests that the current World Health Organization (WHO) criteria
for defining ‘overweight’ and ‘obese’ using BMI may not be appropriate for
some populations in the Western Pacific region. In addition, the pattern
of metabolic disease differs in Asians, who tend to preferentially increase
abdominal fat. Pacific Islanders tend to be prone to diabetes at greater
BMIs.
It is notable that obesity and under-nutrition occur side by side within the
same population in some developing countries. Specific populations affected
by the obesity epidemic include China, India, Japan, Korea, Malaysia,
Singapore, Taiwan, Thailand and the Philippines.18
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Junk food
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There has been a marked increase in childhood obesity both in developed
and developing countries. Parallelling this has been a great increase of
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food advertising in the media, particularly on television programs targeting
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children. Television has been singled out as the most easily modifiable
influential factor on diet. A survey carried out in six Asian nations—India,
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Indonesia, Malaysia, Pakistan, South Korea and the Philippines—showed,
for example, that 30 per cent of Malaysian children watch over eight hours
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of television daily during holidays, exposing them to more than two and a
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half hours of advertisements a day. A similar trend, although not as marked,
was observed in the other countries surveyed; of these, only South Korea
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and the Philippines have legislation regulating the advertising of fast food and
confectionery.
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24. 10 SECTION 1 | AN OVERVIEW
Child obesity has reached epidemic proportions in some countries and is
on the increase in others. Approximately 17.6 million children five years and
under are estimated to be overweight worldwide.
This trend has spread from the developed to the developing nations.
The long-term prognosis of this obesity epidemic is poor health with an
increased risk in adulthood of premature death from heart disease, and early
onset of diabetes and certain cancers. These can no longer be regarded
as Western diseases. A WHO report has emphasised that the incidence
of cardiovascular diseases has rapidly increased in India and China. The
incidence of diabetes is expected to rise 20 per cent worldwide over the next
two decades. This trend is partly due to obesity, unhealthy diets and sedentary
life styles. South-East Asia is witnessing the fastest spread of the epidemic. In
India and China the incidence is projected to rise by 50 per cent within the
next two decades, affecting younger people than in the developed countries.18
This trend is known as ‘the nutrition transition’. Interestingly, nutrition
problems in Asia cover the entire spectrum from diseases due to deficiency
to those due to excess. Global availability of cheap vegetable oils and fats has
resulted in greatly increased fat consumption among low-income nations. As the
nutrition transition has progressed, diets containing traditional root vegetables
and coarse grains are being replaced by refined rice and wheat along with other
food products containing a greater proportion of dietary fats and sweeteners.19
Television is the most powerful variable influencing child obesity,
contributing to it by two mechanisms: it reduces energy expenditure through
lowered physical activity at the same time as it increases dietary energy
intake, either during viewing or as a result of advertising. It has been observed
that the greater a child’s advertising exposure the more frequently snacking
occurs and the lower the child’s nutrient efficiency. Most food advertising
aimed at children is for foods and beverages high in sugars, fat and/or salt.
Exercise
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Many countries throughout the world are facing an increased incidence
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of chronic diseases involving the cardiovascular, pulmonary and skeletal
systems, and cancer. Obesity and Type 2 diabetes are reaching epidemic
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proportions. Regular exercise has been shown to reduce the risk for all of
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these diseases. It has been emphasised that regular physical activity has
numerous health benefits and is an essential component of a healthy lifestyle.
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Aerobic activity in particular brings about health benefits.19
The above is in the context of surveys that show that about 30 per cent
of Americans are inactive (sedentary) in their leisure time, approximately
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45 per cent are insufficiently active and only about 25 per cent are active at
recommended levels. Trends in leisure activity over time have been flat—
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although there has been a gradual decline in the percentage of individuals
who are inactive and a greater decline in older age groups.20
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25. CHAPTER 2: A GLOBAL PHENOMENON: MEDICINE WITHOUT FRONTIERS 11
The recommended levels of exercise are at least 30 minutes of
moderate-intensity physical activity on five or more days each week. This
should be integrated into a ‘lifestyle intervention’ program that integrates
physical activity into daily life.21
A study by Lorig et al. (1999) has suggested that intervention is
feasible and beneficial beyond usual care in terms of improved health K
CK FLIC
status, and can decrease hospitalisation with a substantial savings in
health care cost.22 2
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Summary
In conclusion, the breakdown of barriers to the spread of disease has
ramifications that impact on global health and may signal what one may
expect in the future. Awareness, adjustment and adaptability will be the key
to the practice of medicine worldwide.
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