By X. Pyran. Augsburg College. 2018.

Findings on the association between fat intake and lung cancer have been mixed (De Stefani et al discount 100 mg labetalol free shipping. With increasing intakes of carbohydrate buy discount labetalol 100mg on-line, and there- fore decreasing fat intakes order labetalol 100 mg fast delivery, there is a trend towards reduced consumption of dietary fiber, folate, and vitamin C (Appendix K). With higher fat intakes, it is difficult to create practical high fat menus that do not contain unacceptably high amounts of saturated fatty acids (National Cholesterol Education Program, 2001). Micronutrient inadequacy can occur when sugars intake is very low (less than 4 percent of total energy) (Bolton- Smith and Woodward, 1995) because many foods that are abundant in micronutrients, such as fruits and dairy products, also contain naturally occurring sugars. A wide variety of foods from different food groups are needed to meet nutrient requirements. Because sugars are important for the palatability of foods, the complete omission of sugars from the diet could endanger overall nutrient adequacy by leading to low total energy intake, as well as low micronutrient intakes (Bolton-Smith, 1996). Although reduced nutrient intakes have been reported, adverse affects on health have not. Individuals with fructose intolerance, a condition caused by fructose-1-phosphate aldolase deficiency, strictly avoid foods containing fructose and sucrose and yet remain in good health (Burmeister et al. Conversely, many interventional studies show that when fat intake is high, many individuals consume additional energy, and therefore gain additional weight. Furthermore, these ranges allow for sufficient intakes of essential nutri- ents while keeping the intake of saturated fatty acids at moderate levels. There is no lower limit of intake and no known adverse effects with the chronic consumption of Dietary Fiber or Functional Fiber (Chapter 7). While such trends exist, it is not possible to determine a defined intake level at which inadequate micronutrient intakes occur. Fur- thermore, at very low or very high intakes, unusual eating habits most likely exist that allow for other factors to contribute to low micronutrient intakes. Based on the available data, no more than 25 energy from added sugars should be comsumed by adults. A daily intake of added sugars that individuals should aim for to achieve a healthy diet was not set. Total sugars intake can be lowered by consuming primarily sugars that are natu- rally occurring and present in micronutrient-rich foods, such as milk, dairy products, and fruits, while at the same time limiting consumption of added sugars from foods and beverages that contain minimal amounts of micro- nutrients, such as soft drinks, fruitades, and candies. Low Fat, High Carbohydrate Diets of Children Fat Oxidation Jones and colleagues (1998) reported a significantly greater fat oxidation in children (aged 5 to 10 years, n = 12) than in adults (aged 20 to 30 years, n = 6). The children also had greater fat oxidation compared with women studied previously by these investigators (0. Growth Most studies have reported no effect of the level of dietary fat on growth when energy intake is adequate (Boulton and Magarey, 1995; Fomon et al. A cohort study with a 25-month follow-up showed that there was no difference in stature or growth of children aged 3 to 4 years at baseline across quintiles (27 to 38 percent) of total fat intake (Shea et al. The Special Turku Coronary Risk Factor Intervention Project showed no difference in growth of children 7 months to 5 years of age when they consumed 21 to 38 percent fat (Lagström et al. Niinikoski and coworkers (1997a) reported that 1-year-old children who consistently con- sumed low fat diets (less than 28 percent) grew as well as children with higher fat intakes. A cohort study showed that children aged 2 years in the lower tertile of fat intake (less than 30 percent) had a height and weight similar to that of the higher fat intake groups (Boulton and Magarey, 1995). A few studies have observed impaired growth among hypercholsterolemic children who were advised to consume 30 percent or less of energy from fat. However, the energy intake was also reduced (Lifshitz and Moses, 1989) or not reported (Hansen et al. In a group of Canadian children 3 to 6 years of age, a fat intake of less than 30 percent of energy was associated with an odds ratio of 2. The dietary determinants that best explained low birth weight were energy, protein, and animal fat, suggesting that high-quality animal protein and associated nutrients are important for growth and development. Because the diets of young children are less diversified than that of adults, the risk of inadequate micronutrient intake is increased in these children. A cohort of 500 children aged 3 to 6 years showed that those who consumed less than 30 percent of energy from fat consumed less vitamin A, vitamin D, and vitamin E com- pared with those who consumed higher intakes of fat (30 to 40 percent) (Vobecky et al. Calcium intakes decreased by more than 100 mg/d for 4- and 6-year-old children who consumed less than 30 percent of energy from fat (Boulton and Magarey, 1995). Lagström and coworkers (1997, 1999), however, did not observe reduced intakes of micronutrients in chil- dren with low fat intakes (26 percent). Tonstad and Sivertsen (1997) observed no reduced intake of micronutrients with diets providing 25 percent of energy as fat. Nicklas and coworkers (1992) reported reduced intakes of certain micronutrients by 10-year-old children who consumed less than 30 per- cent of energy as fat; however, this level of fat intake was associated with marked increased intakes of candy.

As a precaution cheap labetalol 100 mg with visa, this product should not be used in humans if an alternative is available purchase labetalol 100 mg visa. Therapeutic action – Antifungal order labetalol 100 mg line, weak antiseptic, drying agent Indications – Oropharyngeal candidiasis, mammary candidiasis in nursing mothers – Certain wet skin lesions (impetigo, dermatophytosis oozing lesions) Presentation – Powder to be dissolved Preparation – Dissolve 2. Use – 2 applications/day for a few days Contra-indications, adverse effects, precautions – Do not apply to wounds or ulcerations. In the event of mammary candidiasis, clean the breast before nursing and apply cream after nursing. Remarks – For the treatment of vulvovaginal candidiasis, miconazole cream may complement, but does not replace, treatment with clotrimazole or nystatin vaginal tablets. Therapeutic action – Antibacterial Indications – localized non bullous impetigo (less than 5 lesions in a single area) Presentation – 2% ointment, tube Dosage and duration – Child and adult: 3 applications/day for 7 days, to clean and dry skin The patient should be reassessed after 3 days. Contra-indications, adverse effects, precautions – May cause: pruritus and burning sensation; allergic reactions. Contra-indications, adverse effects, precautions – Use with caution and under medical supervision in children under 6 months. Preventive treatment of non- infected persons is ineffective and increases the risk of resistance. Contra-indications, adverse effects, precautions – Do not use in children under 2 months (safety not established). In the event of secondary bacterial infection, administer an appropriate local (antiseptic) and/or systemic (antibiotic) treatment 24 to 48 hours before applying permethrin. Remarks – Close contacts should be treated at the same time regardless of whether there have symptoms or not. Decontaminate clothes and bed linen of patients and close contacts simultaneously. The treatment may be repeated if specific scabies lesions (scabious burrows) are still present after 3 weeks. Dosage – Adult: 1 drop into the conjunctival sac 4 times daily Duration – life-long treatment Contra-indications, adverse effects, precautions – Do not administer to children. Duration – 3 consecutive days per week, for a maximum of 4 weeks Contra-indications, adverse effects, precautions – Do not use to treat genital warts in children. Use – Always apply a protective layer of vaseline or zinc ointment on the surrounding skin prior to treatment. Contra-indications, adverse effects, precautions – Do not use to treat genital warts in children. Another advantage is that the patient may apply the solution to the warts himself; whereas the resin must always be applied by medical staff. The skin should be cleaned beforehand if soiled or if the procedure is invasive (lumbar puncture, epidural/spinal anaesthesia, etc. Contra-indications, adverse effects, precautions – Do not use with other antiseptics such as chlorhexidine (incompatibility) or mercury compounds (risk of necrosis). Use – Antiseptic hand wash Wet hands; pour 5 ml of solution, rub hands for 1 min; rinse thoroughly; dry with a clean towel. Spread again 5 ml of solution on hands and forearms and rub for 2 min; rinse thoroughly; dry with a sterile towel. Contra-indications, adverse effects, precautions – Do not use with others antiseptics such as chlorhexidine (incompatibility) or mercury compounds (risk of necrosis). Contra-indications, adverse effects, precautions – Do not use: • in patients with hypersensitivity to sulfonamides; • in infants less than one month. The risk is limited for good quality stainless steel instruments if concentration, contact time (20 minutes maximum) and thorough rinsing recommendations are respected. Caution: some formulations used for disinfecting floors contain additives (detergents, colouring, etc. Remarks – Tetracycline eye ointment replaces silver nitrate 1% eye drops for the prevention of neonatal conjunctivitis. When systemic treatment cannot be given immediately, apply tetracycline eye ointment to both eyes every hour until ceftriaxone is available. Remarks – Storage: below 25°C – Once the ointment has been exposed to a high temperature the active ingredients are no longer evenly distributed: the ointment must be homogenized before using. In any case, national pharmaceutical policies and regulations must be taken into account when implementing pharmaceutical activities. Selection of essential medicines Most countries have a national list of essential medicines. The list of selected drugs is drawn in accordance with pre-established standardised therapeutic regimens. This offers two major advantages: – better treatments due to more rational use of a restricted number of essential drugs; – economic and administrative improvements concerning purchasing, storage, distribution and control. In most cases, one form/strength for adults and one paediatric form/strength are sufficient. This classification presents a certain pedagogical advantage but cannot be used as the basis of a storage arrangement system (e.

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The technique is less effective on the obese as fatty tissue will absorb sound waves cheap 100 mg labetalol overnight delivery. For long bones running near the surface of the body a fracture can be localized by drawing the tuning fork along the bone slowly (>30 sec 100mg labetalol mastercard, but <60 sec) until a very localized source of pain is identified (<3 cm) cheap labetalol 100 mg on line. A cone formed from rolled paper can act as a substitute for a stethoscope but is less than ideal. Once again, the reality will be that the most useful method for diagnosing fractures will be clinical examination. This is also the case for the clinical chest examination in patients who would previously have had a chest x-ray. Treatment The trick to learn for patient care in a truly austere situation is to do what you can do extremely well. You may not have access to many medications or much equipment but do what you are able to do well and you will save lives. The classic survival cliché is a simple scratch could result in you dying from gangrene infection of the leg. While at the extreme end of the spectrum this may be true cleaning the wound with copious amounts of water and keeping it covered will prevent most infections; if there are signs of infection further good basic wound care, resting the limb, and keeping it elevated for 48-72 hours will further the chances of serious infection all without antibiotics. Now obviously sometimes antibiotics will be lifesaving but you can reduce the reliance on high tech treatment by doing low tech treatments well. Medical supplies/Instruments Bandages and Dressings: Any absorbent material may be used as a dressing and any length of material for a bandage. It would be wise to identify what you plan to use in advance and ensure you store it. This book takes a different perspective as it looks at production starting with raw materials and goes through fibre processing, spinning, weaving, bleaching, and finally - 95 - Survival and Austere Medicine: An Introduction sterilizing, and converting into medical textiles. The level of technology is that of the developing world, and the illustrations could be used by the average person to build looms, etc. Coverage of turning finished cloth into medical textiles is not as complete, but offers a different perspective from the first reference. Provided the material used for dressings is clean, in most cases this will have very little impact on the incidence of infection. If you require a higher degree of sterility boiling your dressing material and then air-drying prior to use is an option – not perfect but this will give you a degree of sterility. Haemostatic dressings: It is worth noting that TraumaDex is nothing more than purified potato starch and HemCon purified shrimp shell derivative ground up and placed in a bandage matrix. While we couldn’t condone manufacturing your own it does give you something to think about. Syringes and needles: Plastic syringes and needles are readily available and relatively cheap. While designed to be disposable plastic syringes can be reused; they should be thoroughly cleaned and resterilised by boiling. It may be possible to do this several times before the rubber and plastic degrades. Before sterilizing syringes that you are reusing, soak them in a solution of dishwashing detergent or soapy water Needles, again, can potentially be reused but it can be difficult; all blood and tissue debris needs to be removed from the inside of the needle using a fine piece of wire from the top down, they may need to be straighten at the end, and the tip resharpened. More information on reusing and sterilising syringes and needles can be found in Chapter 6. It will certainly be possible to manufacture syringes if you have access to a glass blower – they are technically not difficult to make at least in a crude form. It may be possible to manufacture larger needles and cannula but they too are likely to be very crude. The ideal situation is to try and obtain glass syringes and old-fashioned needles which can be reused and resharpened. Homemade dressing manufacture Making your own sterile dressings: Save Money by making your own dressings from old sheets or similar material. Here’s what you will need: • White material for dressing (100% cotton is most absorbent) • Colored material can be used for the bandage tails, if desired. Example: 6" Fold Lines 4" 2" 2" 2" Fold Fold 6" 2" Fold Step 1 Step 2 Step 3 Step 4 Step 5 For combination dressing and bandages: Make the tails 36-48 inches long and the width equal to the size of the dressing you are making. Place the dressing in the middle of the tail and stitch on each edge or down the middle of the square dressing. Stitch Tail (36"- 48") Cut 2",3",4",6",12" Wide Dressing For triangle bandages: Cut a triangle 55” across the base and from 36-40 inches along the sides. The following are suggestions to minimize the amount of foil you might use: For a 2” x 2” dressing, fold in half and place in a 4” x 4” piece of foil.

A few reports addressed the issue of trans fatty acid intake and blood pressure (Mensink et al cheap labetalol 100 mg with visa. The authors concluded that consumption of diets high in saturated buy generic labetalol 100 mg on-line, mono- unsaturated safe labetalol 100mg, or trans fatty acids resulted in similar diastolic and systolic blood pressures. Because trans fatty acids are unavoidable in ordinary, nonvegan diets, consuming 0 percent of energy would require significant changes in patterns of dietary intake. It is possible to consume a diet low in trans fatty acids by following the dietary guidance provided in Chapter 11. Saturated Fatty Acids • Further examination of intakes at which significant risk of chronic diseases can occur is needed. Cis-Monounsaturated Fatty Acids • Information is needed to assess energy balance in free-living indi- viduals who have implemented a diet high in monounsaturated fatty acids versus a diet lower in monounsaturated fatty acids (and higher in carbohydrate). Trans Fatty Acids •A comprehensive database needs to be developed for the trans fatty acid content of the United States food supply; this database could then be used to determine the trans fatty acid intakes in different age and socio- economic groups. The effects of dietary α-linolenic acid compared with docosahexaenoic acid on brain, retina, liver, and heart in the guinea pig. Fasting serum cholesterol and triglycerides in a ten- year prospective study in old age. Neurodevelopment quotient of healthy term infants at 4 months and feeding practice: The role of long-chain polyunsaturated fatty acids. Develop- mental quotient at 24 months and fatty acid composition of diet in early infancy: A follow up study. Effects of partially hydrogenated fish oil, partially hydrogenated soybean oil, and butter on serum lipoproteins and Lp[a] in men. Effects of partially hydrogenated fish oil, partially hydrogenated soybean oil, and butter on hemostatic variables in men. Docosahexaenoic acid is the preferred dietary n-3 fatty acid for the development of the brain and retina. Effect of n-3 fatty acid supplementation on lipid peroxidation and pro- tein aggregation in rat erythrocyte membranes. Stearic acid, trans fatty acids, and dairy fat: Effects on serum and lipoprotein lipids, apolipo- proteins, lipoprotein(a), and lipid transfer proteins in healthy subjects. Aro A, Van Amelsvoort J, Becker W, van Erp-Baart M-A, Kafatos A, Leth T, van Poppel G. Dietary fat and risk of coronary heart disease in men: Cohort follow up study in the United States. Failure to increase lipid oxidation in response to increasing dietary fat content in formerly obese women. Visual acuity, eryth- rocyte fatty acid composition, and growth in term infants fed formulas with long chain polyunsaturated fatty acids for one year. Growth and development in term infants fed long- chain polyunsaturated fatty acids: A double-masked, randomized, parallel, prospective, multivariate study. The effect of repeated stimulation of the pancreas on thes pancreatic secretion in young and aged men. Membrane fatty acids associated with the electrical response in visual excitation. In contrast with docosahexaenoic acid, eicosapentaenoic acid and hypolipidaemic derivatives decrease hepatic synthesis and secretion of triacylglycerol by decreased diacylglycerol acyltransferase activity and stimulation of fatty acid oxidation. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. A randomized con- trolled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Low plasma cortisol and hematologic abnormalities associated with essential fatty acid deficiency in man. Comparison of the lipid composition of breast milk from mothers of term and preterm infants. Alpha-linolenic acid deficiency in patients on long-term gastric-tube feeding: Estimation of linolenic acid and long-chain unsaturated n-3 fatty acid requirement in man. Alpha-linolenic acid deficiency in man: Effect of essential fatty acids on fatty acid composition. Linseed and cod liver oil induce rapid growth in a 7-year-old girl with n-3 fatty acid deficiency. Pro- and anti-inflammatory cytokines in healthy volunteers fed various doses of fish oil for 1 year. Essential fatty acid deficiency, prostaglandin synthesis and humoral immunity in Lewis rats. Intestinal absorption of stearic acid after con- sumption of high fat meals in humans. Effects of differences in dietary fat on growth, energy and nutrient intake from infancy to eight years of age.

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