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Basic maths 21 For example: 259 pristiq 50 mg discount symptoms non hodgkins lymphoma,812 The last two digits are 12 which is divisible by 4 pristiq 50mg line medicine 852; so 259,812 is divisible by 4 as well. Dividing by 6 • If the number is divisible by 3 and by 2, then it will be divisible by 6 as well. For example: 378 It is an even number so it is divisible by 2; 3 + 7 + 8 = 18, which is divisible by 3; so 378 will be divisible by 6: 378 ÷ 6 = 63. Dividing by 7 • Take the last digit, double it, then subtract the answer from the remaining numbers; if that number is divisible by 7, then the original number is too. Dividing by 9 • If the sum of all the digits is divisible by 9, then the number will be too. For example: 270 Add up the digits: 2 + 7 + 0 = 9; 9 can be divided by 9, so it follows that 270 can too: 270 ÷ 9 = 30. Dividing by 10 • Numbers ending in a 0 are always divisible by 10 (simply remove the zero at the end). Consider the sum: 3 + 4 × 6 • Do we add 3 and 4 together, and then multiply by 6, to give 42? There are two possible answers depending upon how you solve the above sum – which one is right? Rules for the order of operations The processes of adding (+), subtracting (–), multiplying (×) and dividing (/ or ÷) numbers are known as operations. When you have complicated sums to do, you have to follow simple rules known as the order of operations. Initially (a long time ago) people agreed on an order in which mathematical operations should be performed, and this has been universally adopted. E Next, any exponentiation (or powers) must be done – see later for a fuller explanation of exponentiation or powers. It is important to know how to multiply and divide fractions and decimals, as well as to be able to convert from a fraction to a decimal and vice versa. Fractions Before we look at fractions, a few points need to be defined to make explanations easier. Definition of a fraction A fraction is part of a whole number or one number divided by another. Thus in the above example, the whole has been divided into 5 equal parts and you are dealing with 2 parts of the whole. To reduce a fraction, choose any number that divides exactly into the numerator (number on the top) and the denominator (number on the bottom). A fraction is said to have been reduced to its lowest terms when it is no longer possible to divide the numerator and denominator by the same number. This process of converting or reducing fractions to their simplest form is called cancellation. Remember – reducing or simplifying a fraction to its lowest terms does not change the value of the fraction. If you have a calculator, then there is no need to reduce fractions to their lowest terms: the calculator does all the hard work for you! Equivalent fractions Consider the following fractions: 1 3 4 12 2 6 8 24 Each of the above fractions has the same value: they are called equivalent fractions. If you reduce them to their simplest forms, you will notice that each is exactly a half. Now consider the following fractions: 1 1 1 3 4 6 If you want to convert them to equivalent fractions with the same denominator, you have to find a common number that is divisible by all the individual denominators. For each fraction, multiply the numbers above and below the line by the common multiple. So for Fractions and decimals 27 the first fraction, multiply the numbers above and below the line by 4; for the second multiply them by 3; and the third multiply them by 2. So the fractions become: 1 4 4 1 3 3 1 2 2 × and and 3 4 12 3 4 12 6 2 12 1 1 1 4 3 2 , and equal , and , respectively. For example: 14 7 4 14 +7 – 4 17 + – = 32 32 32 32 32 To add (or subtract) fractions with the different denominators, first convert them to equivalent fractions with the same denominator, then add (or subtract) the numerators and place the result over the common denominator as before. For example: 1 1 1 3 2 4 3– 2 + 5 – += – + = = 4 6 3 12 12 12 12 12 Multiplying fractions It is quite easy to multiply fractions. You simply multiply all the numbers ‘above the line’ (the numerators) together and then the numbers ‘below the line’ (the denominators).

In one naturalistic follow-up study (based on chart review) cheap 50 mg pristiq overnight delivery symptoms dust mites, there was no significant dif- ference in recovery rates for 10 patients with major depressive disorder and a personality dis- order (40% recovery) compared with 41 patients with major depressive disorder alone (65 order pristiq 50mg without prescription medicine 666. In another study, involving 1,471 depressed inpatients, depressed patients with a personality disorder were 50% less likely to be recovered at hospital discharge than de- pressed patients without a personality disorder (193). Several uncontrolled studies found that outcome was dependent on the time of assessment. Conversely, in another uncontrolled study of inpatients with major depression (195), compared with depressed patients without a personality disorder, those with a personality disorder had a poorer outcome in terms of depression and social functioning immediately follow- ing treatment. However, after 6 and 12 weeks of follow-up, there were no differences between the two groups in terms of depression and social functioning. The number of rehospitalizations did not differ between groups at the 6-month and 12-month follow-up evaluations. Improvements were noted in passive-aggressive and borderline personality traits that did not reach statistical significance. These symptoms should ideally be confirmed by out- side observers, as they provide an objective way to assess treatment response. Knowledge of the patient’s personality functioning before the onset of major depression is critical to knowing when the “baseline” has been achieved. Notable progress has been made in our understanding of borderline personality disorder and its treatment. However, there are many remaining questions regarding treatments with demonstrated efficacy, including how to optimally use them to achieve the best health outcomes for patients with borderline personality disorder. In addition, many therapeutic modalities have received little empirical investigation for borderline personality disorder and require further study. The efficacy of various treatments also needs to be studied in populations such as adolescents, the elderly, forensic populations, and patients in long-term institutional settings. The following is a sample of the types of research questions that require further study. For example, further controlled treatment studies of psychodynamic psychothera- py, dialectical behavior therapy, and other forms of cognitive behavior therapy are needed, partic- ularly in outpatient settings. In addition, psychotherapeutic interventions that have received less investigation, such as group therapy, couples therapy, and family interventions, require study. The following are some specific questions that need to be addressed by future research: • What is the relative efficacy of different psychotherapeutic approaches? Treatment of Patients With Borderline Personality Disorder 67 Copyright 2010, American Psychiatric Association. Further controlled treatment studies of medications—in particular, those that have received relatively little investigation (for example, atypical neuroleptics)—are need- ed. Studies of continuation and maintenance treatment as well as treatment discontinuation are especially needed, as are systematic studies of treatment sequences and algorithms. The fol- lowing are some specific questions that need to be addressed by future research: • What is the relative efficacy of different pharmacological approaches for the behavioral dimensions of borderline personality disorder? Recommendations may not be applicable to all patients or take individual needs into account. Treatment of Patients With Borderline Personality Disorder 69 Copyright 2010, American Psychiatric Association. Patient exhibits impulsive aggression, self-mutilation, or self-damaging binge behavior (e. Patient exhibits suspiciousness, referential thinking, paranoid ideation, illusions, derealization, depersonalization, or hallucination-like symptoms Initial Treatment: Low-Dose Neuroleptic (e. The first step in the algorithm is gener- ally supported by the best empirical evidence. The empirical research studies on which these recommendations are based may be “first trials” involving previously untreated patients and may not take into account previous patient nonresponse to one, two, or even three levels of the algorithm (i. Treatment of Patients With Borderline Personality Disorder 71 Copyright 2010, American Psychiatric Association. A study of an intervention in which subjects are prospectively followed over time; there are treatment and control groups; subjects are randomly as- signed to the two groups; both the subjects and the investigators are blind to the assign- ments. A prospective study in which an intervention is made and the results of that intervention are tracked longitudinally; study does not meet standards for a randomized clinical trial. A study in which subjects are prospectively followed over time without any specific intervention.

V infusion) 3 litres/day with 2g (26mmol) potassium chloride added to every litre bag (if renal function is satisfatory) cheap 100mg pristiq with visa treatment bipolar disorder. V) 10mg Plus S: Fresh Frozen Plasma initially Add Platelets if count <20 x 10g/l and patient is still bleeding If ethanol etiology is suspected give: C: Thiamine (I cheap pristiq 100 mg on-line medications kosher for passover. Note: Hepatic encephalopathy is a medical emergency and requires referral to specialized and equipped centers for proper evaluation and management. Pneumonia can either be primary (to the causing organism) or secondary to pathological damage in the respiratory system. The common causative organisms for pneumonia are bacterial (for example Streptococcus pneumoniae, Hemophilus influenza, and Staphylococcus aureus, and Mycoplasma pneumoiae, viral or parasitic e. The important clinical features are high fever 39C, dry or productive cough, central cyanosis, respiratory distress, chest pain and tachypnea. Classification of pneumonia in children is based on respiratory rate whichis fast breathing and chest in-drawing. Fast breathing is defined as Respiratory rate>60 age less than 3 months Respiratory rate > 50 age between 3 months and 5 years Chest indrawing is when the lower part of the chest moves in when the child breaths in. Table 1: Important clinical features of pneumonia in underfives Age Signs Classification Infants less than 2 Severe chest in-drawing Severe pneumonia (all young months Or infants with pneumonia are classified as severe) 60 breaths per minute or more No severe chest in-drawing No pneumonia: Less than 60 breaths per-minute Cough or cold Children from 2 Chest in-drawing Severe pneumonia months to 1 year No chest in-drawing Pneumonia 50 breaths per minute or more No chest in-drawing No pneumonia Less than 50 breaths per minute Cough or cold Children from 1 year to Chest in-drawing Severe pneumonia 71 | P a g e 5 year No chest in-drawing Pneumonia 40 breaths per minute or more No chest in-drawing No pneumonia Less than 40 breaths per minute Cough or cold General management Oxygen therapy if available Supportive care o - Lower the temperature if ≥38. M once a day) for 5 days; If child responds well, complete treatment at home or in hospital with A: Amoxicillin (15 mg/kg three times a day) Plus A: Gentamicin 7. If there are no apparent complications, switch to 72 | P a g e B: Chloramphenical (25 mg/kg every 6 hours I. Non-severe pneumonia A: Amoxicillin 25 mg/kg 12 hourly for 5 days Give the first dose at the clinic and teach the mother how to give the other doses at home. General management o If the child has fever (>39 C) give Paracetamol Give Oxygen to all children with wheezing and severe respiratory distress Give daily maintenance fluids appropriate for the child’s age Encourage breast-feeding & oral fluids Encourage the child to eat as soon as food can be eaten Treatment Bronchodialator in Children 1-5 years If a rapid acting bronchodilator is required drugs of choice: Adrenaline (1:1000) 0. The symptoms are caused by constriction of bronchial smooth muscle (bronchospasm), oedema of bronchial mucous membrane and blockage of the smaller bronchi with plug of mucus. Infants under 18 months, however, may not respond well to bronchodilator Asthma attack/ acute asthma Acute asthma is a substantial worsening of asthma symptoms. If conventional spacer not available, take a 500ml plastic bottle, insert the mouth piece of the inhaler into a hole on the bottom of the bottle (the seal should be as tight as possible). The child breathes from the mouth of the bottle in the same way as he would with a spacer 76 | P a g e Silent chest Salbutamol nebulizer 2. Nocturnal Asthma Patients who get night attacks should be advised to take their medication on going to bed. Chronic Asthma in Adults The assessment of the frequency of daytime and nighttime symptoms and limitation of physical activity determines whether asthma is intermittent or persistent. Therapy is step-wise (Step 1-4) based on the category of asthma and consists of: Preventing the inflammation leading to bronchospasm (controllers) Relieving bronchospasm (relievers) Controller medicines in asthma Inhaled corticosteroids e. Acute bronchitis is one of the most common conditions associated with antibiotic misuse. Pertussis is the only indication for antibacterial agents in the treatment of acute bronchitis. Diagnosis Patients with acute bronchitis present with a cough lasting more than five days (typically one to three weeks), which may be associated with sputum production. Patients may get secondary bacterial infection with development of fever and production of thick smelly sputum. Non Pharmaceutical Treatment Stop smoking and/or remove from hazardous environment Prompt treatment of infective exacerbations 78 | P a g e Controlled oxygen therapy Physiotherapy Bronchodilator may give some benefit Pharmaceutical Treatment Give β-agonist e. Additionally, a generalized sub classification of exacerbations based on health-care utilization is proposed. The major diseases included in this category are: Chronic bronchitis - a chronic, inflammatory condition of the bronchi characterized by coughing and expectoration (spitting-up) of sputum (mucous coughed-up from the lungs) occurring on most days and lasting 3 months or longer for at least two consecutive years. Surgical treatment options for the treatment of patients with advanced emphysema, which include: Bullectomy Lung-volume reduction surgery Lung transplantation 80 | P a g e 5.

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9 of 10 - Review by D. Gunock

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9 of 10 - Review by D. Gunock

Votes: 227 votes

Total customer reviews: 227