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An aortic disease patient is typically an older male with a history of atherosclerosis and hypertension. He might have Marfanoid characteristics, a history of cocaine or methamphetamine abuse or history of syphilis. Alternatively, suspect dissection in a pregnant female with complaints consistent with possible aortic problems. During your assessment, zero in on the patient's anatomy. Include aortic phenomena in your differential for chest and back pain. Take blood pressures in both arms. Search the abdomen for pulsatile masses, and be wary of hoarseness and Horner's syndrome.
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PMID:If the bubble bursts.... EMS response to aortic aneurysms & dissections. 1184 62

Appropriate preconception health care improves pregnancy outcomes. When started at least one month before conception, folic acid supplements can prevent neural tube defects. Targeted genetic screening and counseling should be offered on the basis of age, ethnic background, or family history. Before conception, women should be screened for human immunodeficiency virus and syphilis infection and begin treatment to prevent the transmission of disease to the fetus. Immunizations against hepatitis B, rubella, and varicella should be completed, if needed. Women should be counseled on ways to prevent infection with toxoplasmosis, cytomegalovirus, and parvovirus B19. Environmental toxins such as cigarette smoke, alcohol, and street drugs, and chemicals such as solvents and pesticides should be avoided. In women with diabetes, it is important to optimize disease control through intensive management before pregnancy. Medications for hypertension, epilepsy, thromboembolism, depression, and anxiety should be reviewed and changed, if necessary, before the patient becomes pregnant. Counseling about exercise, obesity, nutritional deficiencies, and the overuse of vitamins A and D is beneficial. Physicians may also choose to discuss occupational and financial issues related to pregnancy and to screen patients for domestic violence.
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PMID:Preconception health care. 1261 25

Two cases of Herpes zoster ophthalmicus complicated by motor nerve palsies are being reported. The investigations ruled out other diseases which can affect ocular motor nerves, e.g., diabetes, hypertension, syphilis and malignancy. The cases are being reported because of the rare presentations of Herpes zoster ophthalmicus like isolated internal ophthalmoplegia and VI nerve palsy in Case-1 and absence of iritis with third nerve involvement in Case-2. The probable etiology for occurrence of these uncommon phenomena has been postulated.
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PMID:Presentations of cranial nerve involvement in two patients with Herpes zoster ophthalmicus. 1217 Sep 33

High rates of infant and perinatal mortality in Guyana compared to France led to implementation of a regional maternal and child health policy in Guyana beginning in 1981. Additional personnel, improved equipment, administrative changes, and training activities were designed to reduce the perinatal mortality rate from 36 to 26/1000 and the infant mortality rate from 35 to 25/1000 over 2 years. Each death certificate was analyzed according to a systematic protocol to determine whether the mortality objective was being met and to identify epidemiological factors involved in each death. Rates of perinatal and infant mortality respectively declined from 37.6 and 36.3 in 1978 and 36.3 and 38.0 in 1982 to 27.3 and 25.3 in 1983. Half of the deaths occurred in 2 regions which accounted for only 1/4 of all births. The socioeconomic environment was considered good in 30% of cases, bad in 30%, and not known in 40%. Age did not play an important role in the deaths. 59% of the mothers had had at least 4 prenatal consultations. During pregnancy, 62% of cases had hypertension and toxemia, threatened premature labor, urinary infection, or anemia. Fetomaternal infections or syphilis were found in 16 of 62 deaths, maternal hypertensive disease in 15, acute fetal distress in 14, congenital malformations and placental pathology in 6, other causes in 8, and unknown causes in 3. 39 of the 62 infants were premature. Most of the term babies died from acute fetal distress or fetomaternal infection, causes directly related to labor, while the premature babies succumbed to uteroplacental pathology, syphilis, or indeterminate causes. Among 32 neonatal deaths and 26 postneonatal deaths respectively, 11 and 1 were caused by maternofetal infection, 8 and 0 by pathologies of pregnancy, 8 and 4 by pathologies of labor and delivery, 4 and 4 by congenital malformations, 1 and 11 by infections, 0 and 5 by nutritional problems, and 0 and 1 by accidents. The results appear to indicate that the maternal and child health policy initiated in 1981 has succeeded in improving perinatal surveillance and health care. Efforts should be continued to improve management of labor and delivery to avoid acute fetal distress and to improve health care in the regions with disproportionately high rates of perinatal and infant mortality.
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PMID:[Perinatal and infant mortality in French Guyana. Evaluation of a regional maternal and child health care policy]. 1226 49

This report examines the case of a 32 year-old man suffering from gangrene of the toes, a condition whose cause appeared to be syphilis. The man had initially developed a painful ulcer with blackish discoloration on the little toe. In 3 weeks time, the ulcer had spread to the 4th toe. The man had no history of local trauma, of ingestion of drugs, of tobacco smoking, and no one in his family suffered from diabetes of hypertension. 8 years back, however, the individual had developed an ulcer at the glans penis following sexual intercourse with a prostitute. The ulcer disappeared within 4 weeks. An examination revealed that the toes were gangrenous. While routine laboratory tests on blood, urine, and stool were normal, angiography revealed partial obstruction to the flow of dye at the levels of external iliac, femoral and popliteal arteries on the left side. Treatment with vasodilators did not succeed, and the gangrene continued to spread. He was then treated with benzathine penicillin. After 8 days of treatment, a "line of demarcation" developed between the dead and living tissues at the base of the gangrenous toes. At that point, the 2 toes were amputated. The gangrene did not progress any farther, and he had complete relief of symptoms. 2 years after there had been no recurrence of gangrene or of the peripheral vascular occlusive disease. While the exact pathological nature of these obstructive vascular lesions is not known, a reactive blood VDRL test and the therapeutic response to penicillin in the form of improvement in blood flow and the prevention of the spread of gangrene suggests that the vascular disease was due to syphilis.
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PMID:Syphilitic peripheral vascular disease: a case report. 1228 37

Prenatal care aims to preserve the health of the fetus and mother. It screens for indications of illness or pregnancy-related complications and tries to prevent them from becoming emergencies. Sufficient referral services are needed for prenatal screening to be effective. Women and their families must be motivated to go to them promptly. Often prenatal care is the first time women receive any medical care. Thus, quality care is imperative so women will again request medical care when necessary. Prenatal care providers must ask women about signs and symptoms of placenta previa and placental abruptio. They should also tell them about the gravity of hemorrhaging in late pregnancy. Referral facilities must have operative capabilities and be able to provide adequate transfusion to treat severe hemorrhage. Health workers must prevent and treat anemia in pregnant women to improve their chances of recovery from blood loss; they must also measure blood pressure and periodically test for proteinuria and edema to diagnose preeclampsia, eclampsia, and hypertension. Health workers must screen women at high risk for cephalopelvic disproportion (e.g. by assessing, height, foot size, and age) and for a malpositioned fetus and multiple pregnancies (e.g. via abdominal examination). They must also educate mothers about the importance of hygienic delivery and provide sanitary delivery kits. Unhygienic delivery conditions and untreated sexually transmitted diseases (STDs) can cause puerperal sepsis. STDs can also have other adverse effects such as ectopic pregnancy and blindness, death, or retardation of the fetus/ infant. STD screening could prevent needless suffering in many women; 5-15% of pregnant women in some developing countries have syphilis. Prenatal care should include screening for urinary tract infections which can cause preterm delivery and low birth weight. Antibiotics can treat these infections. Some pregnant women have infectious diseases which may undetected without prenatal care.
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PMID:How prenatal care can improve maternal health. 1228 37

The 1994 International Conference on Population and Development (ICPD) was the first where thousands of women contributed to the agenda. The previous emphasis of population policies on the simple provision of family planning (FP) services has led to abuses such as coercion to have only one child in China or financial incentives for undergoing sterilization in India. The 1994 ICPD Program of Action provides a more humane basis for population programs by emphasizing the fact that women have fewer children when they are educated and gainfully employed. Thus, improving women's reproductive health and social status has become a central issue, and widening access to contraception remains an important objective. In addition to the 500,000 women who die of pregnancy-related causes each year, half a billion suffer infections of the reproductive tract. By failing to address these problems, many FP services actually exacerbate them. In Giza, for example, although 39% of 500 women studied used contraception (45% of those married and living with their husbands), only 1 in 7 was free of gynecological problems, urinary tract infections, and syphilis (50% had at least 2 of these conditions). The women who used contraceptives were no healthier than their neighbors who did not. Once FP clinics attempt to tend to reproductive health issues, they encounter cultural and religious constraints. For example, a woman may obtain an IUD and then suffer from severe side effects rather than return to the clinic for attention. Another woman may become infected from an illegal abortion obtained at her husband's insistence. The infection may preclude an IUD for months, so the woman may obtain oral contraceptives from a pharmacy although she knows her high blood pressure should preclude their use. Full implementation of the ICPD Program of Action would improve the status of women such as these, fostering their self-esteem, their access to education and employment, and their participation in the political process; eliminating violence against them; and making them aware of their legal rights. The success of the readjustments in FP programs, government resource allocation, and family structures which will accomplish this task will depend largely on the women who helped put reproductive health on the ICPD agenda.
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PMID:Out of Cairo: forging a new population policy. 1228 78

Morbidity from pregnancy complications was 19.6% of inpatients in 1990 in Bangkok Metropolis. This study examines the impact of local customs on prenatal, delivery, and postpartum care; the factors affecting use of health services for prenatal care and delivery; and the nature of women's involvement in IEC for maternal health. Data was obtained from a community survey in May 1992 among 526 ever married women, 15-40 years old, from low-income communities in Bangkok Metropolis. In-depth interviews with hospital personnel were conducted at two general hospitals and three health centers, and focus groups were conducted in two communities. Findings show that Hospital A received 220 old and 80 new prenatal patients daily; Hospital B accommodated 130 old and 50 new ones. According to nurses, the major hospital problem was doctors' attitudes toward nurses. Comprehensive services were available at both hospitals. Hospital B encountered patient health problems of minor malnutrition, syphilis, and hepatitis, while Hospital A treated diarrhea and high blood pressure problems. A lack of medical personnel was reported in both settings. Low level of education was reported as related to noncompliance. Incorrect practices were identified as adherence to food taboos that led to deficiencies, consumption of whiskey with traditional medicine, which contaminated breast milk, and discarding mother's first milk. At health centers, which included family planning, doctors only saw high risk patients; complications generally were for swelling, high blood pressure, and vaginal bleeding. Not all centers had a prenatal care diagnostic manual or licensed nurses. Obstacles to delivery of health care included a lack of nurses, refusals at referral centers by low level personnel, and a poor rapport between nurses and patients, which improved with bribes. Poorly educated patients had trouble understanding their health condition. Nurses and focus groups reported that services were not convenient for patients. Migration interfered with keeping appointments. Male doctors were preferred to female doctors as nicer to patients.
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PMID:Health services providers and users' opinions on maternal health services in Bangkok metropolis. 1231 92

The study examined health conditions among an aging cohort of male narcotics addicts. This prospective cohort study (1964-1998) included interviews and medical testing for 108 surviving subjects who had been admitted to the California Civil Addict Program during the years 1962 through 1964. Medical testing results were: 51.9% had high blood pressure, 22.4% showed hyperlipidemia, 13.3% had elevated levels of blood glucose, 33.6% had abnormal pulmonary function, half of the sample had abnormal liver function, and 94.2% tested positive for hepatitis C, 85.6% for hepatitis B, 3.8% for syphilis, and 27.3% for TB. The study empirically demonstrated poor health conditions and high morbidity among surviving narcotics addicts.
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PMID:Health conditions among aging narcotics addicts: medical examination results. 1566 46

The authors of the review discuss etiological factors, pathogenesis, and diagnostic peculiarities of ischemic stroke in young patients (less than 45). Special attention is paid to the role of arterial hypertension, heart diseases, and blood pathology in ischemic stroke pathogenesis. The frequency of brain infarction grows due to meningovascular syphilis and drug abuse. Genetic aspects of ischemic stroke are discussed in detail. Brain infarction diagnostics is shown to require interdisciplinary approach, which provides early diagnosis, timely and appropriate therapy, favorable outcome, and prevention of recurrent ischemic strokes in young patients.
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PMID:[Ischemic cerebral stroke in the young]. 1675 47


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