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Stubbs ea (2004) found that smokers and nurses in an English psychiatric hospital were more permissive toward smoking on wards than were non-smokers and psychiatrists purchase accupril 10mg free shipping. A short- 756 Requirements of a national tobacco control policy are shown in the box discount 10mg accupril overnight delivery. Components of a national tobacco control policy2497 Increase price of and taxes on tobacco at rate above inflation Ban all advertising and sponsorship by tobacco industry Restrict smoking to designated areas (public places and work sites) Reduce passive tobacco exposure accupril 10 mg with mastercard, including in utero Target people at-risk for starting to smoke “Proof of age” cards required when purchasing tobacco; retailers to be banned from selling tobacco (or worse order 10mg accupril mastercard, e. However, despite calls for weaker cigarettes, smokers may compensate for low nicotine yield by puffing more often and deeper, and by smoking more cigarettes. From January 2001 all cigarette packets in Canada carried health warnings that occupy 50% of the front of the pack, although attempts to ban sponsorship of public events by tobacco companies was watered down by the Quebec Court of Appeal in 2005. Changing to cigarettes with a lower tar yield may not reduce the chances of myocardial infarction if one continues to smoke. Young Irish children could until recently readily buy cigarettes from retail outlets and retailers are obliged to ensure that prospective customers are at least 18 years of age. Iran and Uruguay have total bans on smoking in public places, Syria following them in 2009. Some American insurance firms owned by tobacco companies have charged smokers almost double for term life insurance! Tobacco companies pressurised companies producing nicotine replacement products to tone down anti-smoking messages. Tobacco dependence is a chronic disorder requiring repeated attempts aimed at eventual abstinence. Practical counselling and social support are important ingredients in management, as are sustained-release bupropion hydrochloride (e. The present author agrees with Howell (2002) that smoking cessation products should be free to all who wish to stop smoking, not just to those who qualify for medical cards. Further research is needed to determine the efficacy of pharmacological interventions. Many adult smokers started by buying three cigarettes from shopkeepers whilst underage, a failure of the state to protect them. Methyl alcohol (methanol) Mortality from methanol2503 (wood alcohol) poisoning is about 20% because of a metabolic acidosis from toxic metabolites (formaldehyde and formic acid2504). Treatment strategies include gastric lavage, ethanol or fomepizole (competes for alcohol dehydrogenase so inhibiting formic acid production), folate, bicarbonate, and haemodialysis. Isopropyl alcohol (isopropanol, rubbing alcohol) This is found in a number of products, e. It is converted to acetone, which can be detected in breath (odour), blood and urine. It can cause euphoria, ataxia, dizziness, headache, nausea, vomiting, haematemesis, nystagmus, confusion, coma, hypotension, and respiratory depression. Most cases respond to supportive measures; gastric lavage and haemodialysis are options. Ethylene glycol This is found in antifreeze, windshield washer fluid, and radiator coolants. There can be tachycardia, hypertension, pulmonary oedema, metabolic acidosis, hypocalcaemia, myositis, coma, and convulsions. Severe poisoning is an indication for haemodialysis (which means ethanol or fomepizole dose should be increased) or haemodiafiltration. Absinthe This is a green, distilled, highly alcoholic, anise-flavoured spirit derived from herbs (e. Opinion varies on its psychoactivity but it has been blamed for such phenomena as delirium and hallucinations. Rizvi ea (2010) have reported a case of acute suicidality that emerged during absinthe consumption. Vincent Van Gogh (1853-1890) 2507 Epidemiology: Not everyone who drinks (ethyl) alcohol will develop significant problems from its use. For a discussion on whether and how to collaborate with the tobacco industry see Gray. Absinthe is sometimes known as Green Fairy due to its colour and is said to have been a favourite of Oscar Wilde. Also, it is a mistake to view alcohol dependence as an all or none phenomenon – it comes in all grades. Alcohol limits for drivers in the Republic of Ireland, 2009 (from December 1994) 2511 80 mgs/100 mls of blood 35 micrograms/100 mls of breath 2512 107 mgs/100 mls of urine Alcohol limits for drivers in the Republic of Ireland from September 2011 Road Traffic Bill 2009 passed by Dáil in June 2010 20 mgs/100 mls of blood for learner and professional drivers 50 mg/100 mls of blood for other drivers European blood alcohol limits for drivers, 2009 (mgs/100 mls of blood) 0. The proportion of a population drinking excessively is largely determined by the average consumption of 2513 that population. The latter is determined by price,(Kendell ea, 1983; Purshouse ea, 2010) licensing laws , and customs and moral beliefs. Islamic countries, especially Saudi Arabia, do not officially allow alcoholic consumption. People whose jobs carry a high risk of alcoholism include those who have ready assess to alcohol (chefs, barmen, brewery workers, kitchen porters - even some laboratory workers), those on expense accounts (salesmen, executives), seamen, printers, vagrants, printers, ex-convicts, doctors, and patients in general. In England, 38% of men and 23% of women drank more 2515 than the upper recommended levels for the heaviest drinking day of the week. A fifth of British adults drank in excess of double the safe limit on their heaviest day of the week in 2007. The social stigma associated with the presence of women in pubs has largely disappeared and they have more money to spend. Barriers that may reduce likelihood of women seeking help for substance abuse/dependence Social stigma Too busy with offspring or elder care Fear of loss of children Fear of drug-using partner Lack of child care services Lack of transport Poverty/lack of health insurance Perception that drug services are not geared toward women Heavy, regular drinking occurs at a later age in women than in men but there is a shorter length of time before women develop problems: this ‘telescoping’ effect in women has been described for other drugs as well as alcohol. Over 4% of British government revenue derived from alcohol taxes in the mid-1980s during which 750,000 people worked in the British drink trade. The total annual economic, health and social costs associated with alcohol misuse in England is somewhere between £20-30 bn. Rates of first admission per 1000,000 for England for both sexes rose from 4 in 1970 to 9 in 1986. Both problems were more prevalent among young adults, especially males aged 16-24 years. Alcohol dissolves better in fat and women have a greater amount of fat and less body water relative men. In both Britain and Ireland national alcohol advisory and monitoring groups had to disband because of lack of central support. Follow up to 2005 confirmed that alcoholic disorders are a common reason for re-admission. Hospital-bed days due to alcohol-related disorders in Ireland increased from 55,805 in 1995 to 117,373 in 2004. Ireland topped the European list for binge drinking (> 5 pints or its equivalent/sitting) at 32 binges/year, Britain coming second with 28 binges. Also, Ireland spent more per household on alcohol (> 2521 €1,600/household/year) than anyone one else in Europe. According to the Office of Tobacco Control, Irish 16 and 17 year olds spend €145m on alcohol/year, i. The risk of accidental death in Taiwan is significantly associated with alcohol use disorder and with other common psychiatric disorders, especially when the two are combined. Aetiology of alcoholism: early findings and suggestions Danish adoption studies - increase in alcoholism among the sons of alcoholics Swedish studies - in some cases transmission is through the male line only but in others it affects both sexes Social factors/culture may account for some of the sex differences, e. However, not all studies support a relationship between life-long anxiety and alcoholism. In their review of the literature on the P300 in alcoholism, Gamma & Liechti 2524 (2002) conclude that a small/reduced P300 amplitude is an endophenotype in children and adolescents marking the risk for alcoholism/other substance abuse/various externalising (and perhaps internalising) disorders. However, they also admit that the similarity of P3 findings in smokers (nicotine) and alcohol- dependent people suggests that ‘a substantial part of the P3 amplitude reduction seen in alcoholics or other substance-dependent individuals’ might be explained by ‘uncontrolled nicotine co-dependence’! Somewhere between 40-60% of the variance in alcohol abuse/dependence is accounted for by genes. Alcoholism, sociopathy and depression may run in families but their interrelationship is complex – there may be a tendency for a greater incidence of the first two diagnoses in males and the last diagnosis in females, although social changes may modify this observation. Hasin and Grant (2002) found that past alcohol dependence increased the current risk of having major depression more than fourfold. Alcoholics have been shown to have a significantly reduced frontal blood flow (largely associated with duration of drinking) which is more marked if there is associated dissociality.

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Richard Westcott Apple- Beetham Memorial Scholarship Fund was ton purchase 10 mg accupril with mastercard, the income of which is to be awarded to established by Miss Martha E buy 10mg accupril with visa. Beetham to “a medical student of moral worth and intel- perpetuate the memories of Thomas and Ida lectual promise buy generic accupril 10 mg line. Aurin Scholarship Fund ed that the monies in this endowment fund be Established in 1998 by Fred B discount accupril 10 mg with visa. Belknap Family Scholarship Fund to those from the University of Oklahoma or The Elston L. Its Art Buchwald Scholarship Fund Estab- purpose is to provide assistance to deserving lished by Mr. Art Buchwald in 1989 in honor students in the School of Medicine, either in of the Centennial of Johns Hopkins Medicine. Memorial Schol- arships for students in the School of Medicine arship Fund Established in 1995 by John J. Burbage Fund Established in 1989 vide scholarship aid to medical students with by the Ernest E. Scholarship Fund ships to pre-medical and medical students Established in 1999 anonymously by a former who, due to fnancial need, could not other- student, in recognition of Dr. Berman was an associate professor arship in Medical Education This fund was of medicine at Hopkins. Bermann Memorial Fellowship Burkholder to provide scholarships for quali- Established in honor of her husband by the fed medical students. Alfred Blalock Scholarship Fund This endowed scholarship was established in scholarship, established by Dr. Carver for students in Thomas Harrold, commemorates the great the School of Medicine. Chinese students service to human kind and the many contri- are to have preference insofar as there may butions of one of Johns Hopkins’ most distin- be qualifed applicants; second preference is guished surgeons, Alfred Blalock, who devel- for students of other Asian nationalities; third oped the blue baby operation designed to preference is for American students. The fund is to be used to aid deserv- Bongiovanni was a member of the faculty in ing students in the School of Medicine. The income from the fund is to provide This fund was established in 2003 by Helena fnancial aid to needy students in the School Chang Chui, M. The fund was established by given to students that are pursuing an Mas- his estate in 1998. Turner Scholarship Fund Established by cal students pursuing a degree in one of the friends and admirers of Dr. Scholarship Fund Established in 1999 by Class of 1915 Memorial Fund A fund estab- Dr. Brookhouser to provide scholar- lished through gifts and bequests from and ships to needy medical students. Grafton ing student or students at the Johns Hopkins Brown died in 1973, leaving a Trust to provide University School of Medicine. D’Agostino, Class of 1978, to honor his in 1950 by members of the School of Medi- devotion to medicine and his lifetime affli- cine Class of 1926 to provide income for a ation with the School of Medicine. Wells Davies Fund was established by Vir- Class of 1937 Philip Bard Scholarship ginia Wells Davies in November of 1981. Its Established as an endowed fund by the purpose is to provide scholarship assistance Class of 1937 in 1987 in honor of their 50th to fnancially needy students pursuing the Reunion. Doane established an Class of 1956 Memorial Fund Endowed in endowment fund in 1952 to provide tuition aid 1971 by members of the Class of 1956, the to certain students with fnancial need. Income from the by the members of the Class of 1965 in honor principal will be used to provide fnancial sup- of their 25th Reunion, the income to provide port for medical students in the School of scholarships to needy medical students. The fund is a tribute to in honor of their 25th Reunion, the income his wife, Victoria. Memorial Fund Estab- lished in 1990 by the family, friends, and col- Class of 1976 Scholarship Fund Endowed leagues of Dr. Marcia Thomas Duncan Memorial Schol- arship This scholarship, established in 1980 Class of 1978 Scholarship Fund Endowed in memory of Marcia Thomas Duncan, is by the Class of 1978 to commemorate their awarded annually to a frst year medical stu- 25th Reunion; the income will provide schol- dent. In addition to a four-year scholarship arships to needy medical students in the covering tuition and fees, the Duncan Scholar School of Medicine. Eggleston Memorial Fund An of Medicine alumni established the Class of endowed fund established in 1989 by family, 1980 Scholarship Fund in 1995 to provide friends and colleagues of Dr. The income is to provide scholarship was created by members of the Class of 1983 assistance to needy medical students in the upon their 15th Reunion to provide assis- School of Medicine. Robert Biggs Ehrman Scholarship Fund Class of 1986 Scholarship Fund Endowed Established in 1970 at the death of Mr. Engle Endowed Scholarship Fund Established previously served as his class representative. Sharon Fox Scholarship Fund in Memory Jean Epstein Memorial Fund This endow- of Henrietta B. The income from this income from which is to be used for student fund provides a scholarship to deserving aid in the School of Medicine. Ettinger Scholarship Fund lished as a bequest from the estate of Sallye Established by Mrs. Ettinger to provide schol- Lipscomb French as a memorial to her hus- arship assistance for students in the School band, Bernard S. Scholarship ship Fund This fund is in memory of Larry Established in 2000 by a gift from Dr. Scholar- arship Fund This fund was established in ship Fund This fund was established in 1999 1998 by Stuart L. Finesilver Memorial Schol- arship Fund This fund was established in arship Fund This fund was established in 1996 by Dr. Frances Blumenthal in memory vide scholarship support to students in the of her father, an alumnus of the Class of 1924. Firor Fund An endowed schol- able candidate applying for admission to the arship established in 1989 by the estate of Johns Hopkins University School of Medi- Mrs. Abraham Genecin Memorial Fischer Family Scholarship for Medical Fund This fund was established in 1999 by Education This scholarship fund recognizes Mrs. Rita Genecin and other donors to pro- the Hopkins family legacy of Janet Fischer, vide assistance to needy medical students. Givens to provide Fonkalsrud Endowed Scholarship Fund scholarships for students in the School of This fund was established in 2002 by Eric W. The couple has a life-long Emil Goetsch Fund for Medical Students affliation with the Johns Hopkins School of The income from this endowment, estab- Medicine. Fonkalsrud served on the fac- lished in 1963, is used for scholarships for ulty in the School of Medicine’s Department medical students. Preference in award of the scholarship is 1975) leadership at the Wilmer Eye Institute. Income from this fund will be used to provide Louis Hamman Memorial Scholarship assistance to deserving medical students. This is an endowed scholarship in memory David Goldfarb Family Endowment Estab- of the late Dr. The income is avail- Established in 1986 as a bequest from the able for a scholarship for a medical student estate of Lillian Ruth Goldman to provide whose fnancial need and developmental scholarship assistance to needy and deserv- promise justify such an award. Gordon for Medical Education This fund was Memorial Fund The fund was established in established in 1999 by Dr. It is to be used for the education of medical students be awarded to female students interested in specializing in the study of arthritic diseases, surgery. Hartsock Memorial Scholar- Scholarship Fund in Memory of Leonard ship Fund This scholarship was established L. Hartsock, an endowment, with income to be allocated Class of 1920, by members of his family and to aid deserving students in the School of friends to provide aid to needy and worthy Medicine. Gross Scholar- Morrison Leroy Haviland Scholarship Fund ship Fund This fund was established in 2002 Established in 1988 by Dr. Gross were well known for their honor of their father, Morrison Leroy Havi- care and compassion for others. This income is to be used for needy Fund provides fnancially needy students the medical students.

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Source control essential when possible for cure and preventing recurrent infection buy accupril 10 mg. Test goes from S Booster effect but does not represent true conversion due to recent infection generic accupril 10 mg with amex. Due to breakdown of granuloma w/ spilling of contents into pleural cavity and local inflammation quality 10mg accupril. Pulmonary effusion pericardial and peritoneal effusions (tuberculous polyserositis) buy cheap accupril 10mg line. Reinfection (includ- ing w/ drug-resistant strains) is clinically significant,particularly in hyperendemic areas. Types: exudative (curdlike patches that reveal raw surface when scraped off), erythematous (erythema without exudates), atrophic • Oral hairy leukoplakia:painless proliferation of papillae. Bone marrow aspirate & bx (esp if signs of marrow infiltration) or liver bx (espec. Suspicious features: size 4 cm or c size on repeat scan; irregular margins, heterogeneous, dense, or vascular appearance; h/o malignancy or young age (incidentaloma less common). Serum Ca reflects total calcium (bound unbound) and ∴ influenced by albumin (main Ca-binding protein) • Corrected Ca (mg/dL) measured Ca (mg/dL) {0. Inhibit osteoclasts,useful in malignancy;caution in renal failure;risk of jaw osteonecrosis Calcitonin h 2–3 d Quickly develop tachyphylaxis Glucocorticoids days days? Ezetimibe 15–20% — — Well tolerated;typically w/ statin Fibrates 5–15% 5–15% 35–50% Myopathy risk c w/ statin. Associated with c risk of cardiovascular death com- pared with that of general population (Rheum 2009;48:1309). Endocrine Amenorrhea and infertility common; thyroid fibrosis hypothyroidism Systemic Sclerosis Limited Diffuse General Fatigue, weight loss Skin Thickening on distal extremities Thickening on extremities and face only (incl. Criteria Other Features Constitutional Fever,malaise,anorexia, (84%) weight loss Cutaneous 1. Discoid rash(erythematous Vasculitis papules w/ keratosis & plugging) Subacute cutaneous lupus 3. Nonerosive arthritis: Arthralgias and myalgias (85–95%) episodic,oligoarticular, Avascular necrosis of bone symmetrical,migratory Cardiopulmonary 6. Pt needs to be off sedation for adequate time to evaluate (depends on doses used,duration of Rx,metabolic processes in the individual Pt). Clinical evaluation • Seizure:patient usually w/o recollection,must talk to witnesses unusual behavior before seizure (ie,an aura) type & pattern of abnl movements,incl. The convex right cardiac border is formed by the right atrium (straight arrows),and the curved arrows indicated the location of the superior vena cava. The left cardiac and great vessels border what might be considered as four skiing moguls. From cephalad to caudad,the moguls are the aortic arch,the main and left pulmonary arter- ies,the left atrial appendage,and the left ventricle. Two-dimensional real-time ultrasonic imaging of the heart and great vessels:Technique,image orientation,structure identification,and validation. Two-dimensional real-time ultrasonic imaging of the heart and great vessels:Technique,image orientation,structure identification,and validation. Two-dimensional real-time ultrasonic imaging of the heart and great vessels:Technique,image orientation,structure identification,and validation. Two-dimensional real-time ultrasonic imaging of the heart and great vessels:Technique,image orientation,structure identification,and validation. Profound analyze of problems connected with Pubic health level in Bulgaria and other world regions with an accent to Health promotion and prevention, epidemiology and health services management. Having knowledge of contemporary public health legislation, of different types of epidemiological studies and their daily practice implementation. Making adequate medi- cal and ethical decisions concerning problem situations of the clinical practice. Incidence, basic terminology of incidence, International classification of diseases, medico- social aspects of incidence. Types of epidemiological studies – cross-sectional studies, follow-up studies, case-reference studies, clinical studies. Social medicine as a science – foundation, development, object, tasks and methods. Nature and importance of social etiology, social prophylaxis, social therapy and social rehabilitation of the diseases. Family and health – basic ways and mechanisms for health and disease influencing over the family. Physician’s role in problem families (unequal, mixed and dissolved marriag- es, living together without marriage, families with chronic or terminal patients). Particularities of hospitalized patients as social group; family and discharged patient; opinion of patients and their relatives for hospital services. Medico – social problems of motherhood and childhood – abortions, sterility, lonely mother, not wished children, children with chronic diseases, adopted children and treatment of children without physician prescription. Medico – social problems of adolescence – acceleration problems, alcoholism and drugs. Social medicine as a science – foundation, development, object, tasks and methods. Nature and importance of social etiology, social prophylaxis, social therapy and social re- habilitation of the diseases. Problem families (unequal, mixed and dissolved marriages, families with patients with chronic diseases). Moral and social – legal aspects of donation and transplantation of tissues and organs. Forms of evaluation: Current control - tests, 2 colloquiums during winter and summer semesters. Hygiene investigates the positive effects of some environmental and social factors, which lead to health promotion too. Ecology is the science of interrelationships of the natural environment: the dependency of one organism to another, and the ultimate dependency of all, including man, on various components of the physical environment. The hygiene is a medical science that studies a relationship of the environment to humans from the point of view of the correct development, preservation, strengthening and improving of the human health and to ensure active longevity. The aim of this teaching program for medical students is to give them theoretical knowledge and practical ability in the field of the hygienic science and prevention against the negative effects of different environmental factors and working conditions. Hygienic assessment of the environmental factors and living conditions ( physical factors, such as barometric pressure,air temperature, noise,vibrations et al. Increasing of adaptation processes and health promotion by means of: adequate nutrition, regulation of school adjustment, physical fitness, work satisfaction. NutritionalN prevention of some non-communicable diseases with social importance 9. Analysis of drinking water parameters with indicative significance (organoleptic indices, hardness of water) 2h. Hygienic evaluation of the heating, lightning and ventilation in housing, public, including hospital buildings. Test examination and written examination on 2 questions from conspectus of Community Hygiene 2h. Filtration- slow and rapid sand filters –advantages and disadvantages of these filters. Oxygen - health effects in conditions of oxygen deficiency or in condition of oxygen pressure increase 2. Hygienic characteristics of clinics and medical centres - common hygienic requirements. Fat soluble vitamins- functions, sources, daily requirements, deficiency and toxicity as a result of excess intake 1. Brief historical view of the industrial development and its influence on the working conditions and work 4. Crèches and kindergartens - main hygienic requirements in construction of kindergartens.

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