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By: Y. Nasib, M.B.A., M.B.B.S., M.H.S.

Professor, Touro University California College of Osteopathic Medicine

The reason is that quit smoking 2 years ago still anxiety generic nicotinell 17.5 mg mastercard, in the absence of an adequate immune response quit smoking encouragement cheap 17.5 mg nicotinell otc, the viruses or bacteria in these normally safe vaccines are able to multiply in profusion quit smoking 5 years ago purchase nicotinell 52.5mg on-line, therebycausingseriousinfection quit smoking humor discount nicotinell online master card. Accordingly,livevaccinesshouldgenerallybe avoided in children who are severely immunosuppressed. Some parents are concerned that thimerosal, a mercury-based preservative found in some vaccines, might cause autism. First, several large, high-quality studies conducted in Denmark, Britain, and the United States have failed to show a causal link between childhoodimmunizationusingthimerosal-containingvaccinesanddevelopment ofautism. Second,thimerosalisbeingphasedoutofvaccinesmadehere(owing to concerns about mercury exposure, not concerns about autism). At this time, the amount of thimerosal in most routinely used childhood vaccines is either zeroorextremelylow(lessthan0. Theonlyexceptions are certain flu vaccines, which still contain thimerosal as a preservative. However, even if these flu vaccines are used, total mercury exposure from childhood vaccination will still be well below the limit considered safe by the U. The risk for serious adverse reactions can be minimized by observing appropriateprecautionsandcontraindications. Precautions and contraindications that apply to specific vaccines are discussed in the context of those preparations. Conditions that are often considered contraindications, althoughtheyarenot,arealsolistedinTable53. The information is used to help determinewhether(1)aparticulareventthatoccursaftervaccinationisactually caused by the vaccine and (2) what the risk factors might be. In addition to reporting events that they are required to report, practitioners should report all other seriousorunusualadverseevents,regardlessofwhether they believethe event was caused by the vaccine. The program is intended as an alternative to civil litigation in that negligence need not be proved. As a provision of the law, a table was created listing the vaccines covered by the programandtheinjuries,disabilities,illness,andconditions-includingdeath- for which compensation may be paid. Compensation may also be paid for injuriesnotlistedinthetable,providedthat(1)alistedvaccineisinvolvedand (2) causality can be demonstrated. You can find the yearly schedule recommendations and catch-up immunizationscheduleforpersonsaged4monthsthrough18years,aswellas themostrecentupdates,onlineat TargetDiseases Routinechildhoodvaccinationiscurrentlyrecommendedforprotectionagainst 16 infectious diseases: diphtheria, tetanus (lockjaw), pertussis (whooping cough), measles, mumps, rubella, invasive H. Infection is spread by inhalation of aerosolized sputum or by direct contact with nasal or throat secretions. Secondary infections can result in pneumonia and otitis media(inner-earinfection). However,ofthepotentialcomplicationsofmeasles, encephalitis is by far the most serious. Mumps Mumpsisaviraldiseasethatprimarilyaffectstheparotidglands(thelargestof the three pairs of salivary glands). Although mumps can occur in adults, it usually occurs in children aged 5 to 15 years. As a rule, the first symptom is swelling in one of the parotid glands, often accompanied by local pain and tenderness. Swellinginthe secondparotidglandoftendevelopsafterswellinginthefirstbutmayalsooccur simultaneously or not at all. Painful orchitis (inflammation of the testes) develops in about one third of adult and adolescent males. Acute aseptic meningitis develops in about 10% of all patients; symptoms, which resolve completely,includedizziness,headache,andvomiting. Rubella Rubella, also known as German measles, is a generally mild viral infection. Shortlyafter,arashdevelopsonthe face and scalp, spreads rapidly to the torso and arms, and then fades in 2 or 3 days. Inpregnantwomen,rubella cancausemiscarriage,stillbirth,andcongenitaldefects,especiallyifthedisease occurs during the first trimester. Possible birth defects include cataracts, heart disease,developmentaldelay,andhearingloss. IntheUnitedStatesrubellahas been eliminated: since 2002, all cases reported here have been traceable to foreignerswhobroughtthediseasefromabroad. Diphtheria,Tetanus,andPertussis Diphtheria Diphtheria is a potentially fatal infection caused by Corynebacterium diphtheriae, a gram-positive bacillus. The bacterium colonizes the throat and nasal passages and produces a toxin that spreads throughout the body. Colonizationofthe airwaybeginsaspatchesofgrayordirty-yellowmembranethateventuallygrow together, forming a thick coating. This coating, combined with swelling, can impede swallowing and breathing; in severe cases, a tracheostomy is needed. Tetanus(Lockjaw) Tetanus, also known as lockjaw, is a frequently fatal disease characterized by painfulspasmofallskeletalmuscles. Complications of pertussis include pneumonia, seizures, ear infections, and, rarely, permanent neurologic injury. In the United States reported cases dropped from a high of 265,269 in 1934 to 8483 in 2003.

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PhysiologicEffects EffectsDuringtheMenstrualCycle Progesterone is secreted during the second half of the menstrual cycle from a proliferative state into a secretory state quit smoking drops for cigarettes cheap nicotinell 52.5mg mastercard. If implantation does not occur quit smoking 51 order nicotinell 52.5mg on line, progesterone production by the corpus luteum declines quit smoking 26 months ago order cheap nicotinell online. In addition to affecting the endometrium quit smoking medication nicotinell 17.5 mg for sale, progesterone affects the endocervicalglands,breasts,bodytemperature,respiration,andmood. These high levels suppress contraction of uterine smooth muscle and thereby help sustain pregnancy. In the breast, progesterone promotes growth and proliferation of alveolar tubules (acini), the structures that produce milk. Lastly, progesterone may help suppress the maternal immune system, thereby preventingimmuneattackonthefetus. DysfunctionalUterineBleeding this condition, characterized by heavy irregular bleeding, occurs when progesterone levels are insufficient to balance the stimulatory influence of estrogenontheendometrium. Intheabsenceofsufficientprogesterone,estrogen puts the endometrium in a state of continuous proliferation. Because progesterone is unavailable to induce monthly endometrial breakdown, the excessively proliferative endometrium undergoes spontaneous sloughing at irregularintervals. In one regimen, oral dosing is started 10 to 14 days after the onset of each menstrual period and continued for the next 10 days. If endogenous estrogen levels are adequate, treatment with a progestin for 5 to 10 days will be followed by withdrawal bleeding when the progestin is stopped. If estrogen levels are low, it may be necessary to induce endometrialproliferationwithanestrogenbeforegivingtheprogestin. EndometrialCarcinomaandHyperplasia Progestins can provide palliation in women with metastatic endometrial carcinoma,butthesedrugsdonotprolonglife. Endometrial hyperplasia, a potentially precancerous condition, can be suppressedwithprogestins. One progestin-hydroxyprogesteroneacetate[Makena]-isapprovedforpreventing preterm birth in women with a singleton pregnancy and a history of preterm delivery. AdverseEffects Up to 20% of patients may experience breast tenderness, headache, abdominal discomfort, arthralgias, and depression. When used continuously for birth control, progestins greatly decrease production of cervical mucus and cause involutionoftheendometriallayer. Newer oral progestins-norgestimate and drospirenone-are available in fixed-dose combinations with estradiol sold as Prefest and Angeliq, respectively. Intramuscular progestins are medroxyprogesterone acetate [Depo-Provera] and progesterone (in oil). Medroxyprogesterone acetate is also available in a formulation for subQ injection [Depo-SubQ Provera 104]. Transdermal products are limited to norethindrone (formulated with estradiol under the name CombiPatch) and levonorgestrel (formulated with estradiol under the name ClimaraPro). Thepurposeofestrogeninbothregimensis to control menopausal symptoms by replacing estrogen that was lost owing to menopause. The progestin is present for one reason only: to counterbalance estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer. Hot flashes and the drenching sweats that accompany them can interfere with dailylifeandcausesleeplessnights. Notonlyaretheyuncomfortable,butthey alsomaycreateembarrassingsituations,especiallyforwomenworkingwiththe public when appearances can be important. In addition to controlling vasomotor symptoms, they report improved sleep, restoration of libido, improved cognition, and enhanced mood. Although there have been insufficient studies to quantify quality-of-life issues, the anecdotal evidencesupportsthisasanaddedbenefit. Not included in the table are results of benefits related to the vasomotor and urogenital symptoms because the benefit (90% reduction in symptoms) is firmly established. Also not included aremany ofthe previously assumedrisksthatwerenotsupportedinthedata. Conversely, the benefits of short-term therapy (less than 5 years) to treat menopausalsymptomsoftendojustifytherisks. The only indication for long-term progestin therapy is protection against endometrialcancer,whichcouldbecausedbyunopposedestrogen. TreatmentofVasomotorSymptoms Hormone therapyis themost effective treatmentfor vasomotor symptoms (hot flashes,nightsweats). Trials have shown that two antidepressants-escitalopram [Lexapro] and desvenlafaxine [Pristiq]-can produceamodestbutmeaningfulreductioninboththefrequencyandseverityof hot flashes. By contrast, controlled trials have shown that soy isoflavones do notreduce hotflashes. TreatmentofSymptomsofVulvarandVaginalAtrophy Estrogenisthemosteffectivetreatmentforreducingsymptomsofmenopauserelated vulvar and vaginal atrophy, characterized by dryness, irritation, and uncomfortable intercourse. Although long-termdataarelacking,itseemslikelythattopicalestrogenissaferthanoral estrogen because, withnearlyalltopicalformulations, blood levelsof estrogen remain low. The notable exception is the Femring, which releases enough estrogentocausesignificantsystemiceffects. PreventionofOsteoporosis Hormone therapy reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. Of course, all women (not to mention men) should practice primary prevention of bone loss by ensuring adequate intake of calcium and vitamin D, performing regular weight-bearing exercise, andavoidingsmokingandexcessivealcoholuse. To reduce risk for cardiovascular events, postmenopausal women should be counseledaboutalternativewaystopromotecardiovascularhealth.

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