دليل الخدمات الطبية والثقافة الصحية في اليمن - موقع تعليمي خدمي
أخر تحديث للموقع :12/10/2003
From Al-Haddad. A. M., Moharam, A., Naji, A.
Yemen Medical Journal, Vol 2, No. 1, April 1996.
Common endemic diseases play a significant in morbidity in Yemen. They constitute a high percentage (30 %) of the total cases recorded by the Ministry of Public Health. The importance of this group of ailments is clearly reflected in the five years plan drawn up by the ministry of public health for the year's 1996-2000. The top ten medical problems given high priority in the plan are as follows:-
3-Complication of pregnancy and Labor.
4-Diseases of respiratory tract.
For this review article information was obtained from the Ministry of Health and other relevant establishments in our effort to come up with a picture for the prevailing situation of these diseases all over the country
The article also mentioned the following information's:-
There are about 1182 cases of leprosy in the country
4774 cases of Cholera were seen in one year
The report also establishes the main causes for infant mortality as being:
Upper respiratory diseases
For children up to five years, The following factors are the most common causes of death, they are
- Diarrheal diseases.
Amniocentesis involves the collection and analysis of an amniotic fluid sample. Before an amniocentesis (and often during the entire procedure), a fetal ultrasound test is done to locate the fetus and placenta. A long, thin needle is inserted through the abdomen into the uterus, avoiding the fetus and placenta, and a small amount [1 to 2 Tbsp (29.57 mL)] of amniotic fluid is collected through the needle. Amniotic fluid contains cells that have been shed by the developing fetus. These can be examined for chromosomal defects that cause conditions such as Down syndrome and cystic fibrosis Amniotic fluid can also be used to identify the sex of the fetus.
Amniotic fluid can be tested for a fetus's Rh factor. If the fetus is Rh-negative, no further testing or treatment is necessary during the current pregnancy.1
Chemicals in the amniotic fluid can indicate whether an Rh-positive fetus is being harmed by maternal antibodies to the Rh factor. Bilirubin is naturally found in amniotic fluid. During a normal pregnancy, the bilirubin level increases until 23 to 25 weeks of pregnancy, and then decreases throughout the remainder of the pregnancy.
If fetal blood cells are being attacked by the mother's immune system, the bilirubin level continues to increase throughout the pregnancy. After the 27th week of pregnancy, bilirubin measurements are accurate enough to guide further testing or treatment.
Fetal lung maturity
The chemicals lecithin and sphingomyelin are produced by the fetus's lungs and found in the amniotic fluid. Their amounts are measured and their levels are compared as a ratio (L/S ratio). This number gives an indication of fetal lung maturity and ability to breathe independently if an early (preterm) delivery is necessary.
Another estimate of fetal maturity is the amount of phosphatidylglycerol (PG) in the amniotic fluid. This test is usually done prior to the L/S ratios, especially for pregnant women who have diabetes. When tested in a diabetic woman, the L/S ratio is more likely to indicate that the fetus's lungs are mature when they are not.
Why It Is Done
Amniocentesis may be done to:
Determine the fetal blood type and Rh factor. An Rh-negative fetus is not at risk, even if the mother is Rh-sensitized.
Gain an indication of fetal health when the mother is sensitized to the Rh factor.
Help determine the timing and necessity of fetal blood sampling.
Indicate whether fetal lungs are mature if the fetus needs to be delivered earlier than 37 weeks (preterm birth).
When maternal Rh antibody levels are too high, an amniocentesis is performed. The amount of bilirubin found in the amniotic fluid is used to predict the level of fetal harm that is occurring from Rh sensitization.
Amniocentesis is repeated every 2 to 4 weeks if the fetus is mildly affected. The fetus is usually delivered close to term.
Amniocentesis is repeated every 1 to 2 weeks if the fetus is being moderately affected. The fetus is usually delivered earlier than 38 weeks and may need a blood transfusion after birth.
Amniocentesis may be repeated every week if the fetus is being severely affected. The fetus may need a blood transfusion before birth and is usually delivered early.
The results of amniocentesis may guide treatment for Rh sensitization. The level of fetal lung maturity that is indicated by the L/S ratio may guide decisions about the timing of delivery.
If the bilirubin levels are very high but the fetus is less than 32 weeks' gestation, a blood transfusion before birth may be done to keep the fetus healthy until delivery is possible.
If bilirubin levels are very high, and the fetus is older than 32 weeks' gestation but the fetus's lungs are still immature, medication may be given to speed up fetal lung development. Delivery is ideally done 2 days later.
If fetal lungs appear to be mature, then delivery does not need to be delayed.
What to Think About
Amniocentesis is a more sensitive method for predicting fetal health than is ultrasound.
Amniocentesis is less sensitive than fetal blood sampling (FBS). However, because it is less risky than FBS, amniocentesis is the preferred test for detecting mild to moderate Rh disease.
Normal results from amniocentesis do not guarantee that the baby will be healthy.
Amniocentesis carries a slight risk of injuring the fetus, causing preterm labor or miscarriage, or introducing an infection into the uterus.
Amniocentesis may cause mixing of the mother's and fetus's blood. Therefore, unsensitized Rh-negative women are given Rh immune globulin after amniocentesis to prevent sensitization
CitationsCunningham FG, et al. (2001). Diseases and injuries of the fetus and newborn. In Williams Obstetrics, 21st ed., pp.1039–1091. New York: McGraw-Hill.American College of Obstetricians and Gynecologists (1999). Prevention of Rh D all immunization. ACOG Practice Bulletin, no. 4, pp. 1–7. Washington, DC: American College of Obstetricians and Gynecologists. Hartwell EA (1998). Use of Rh immune globulin: ASCP practice parameter. American Society of Clinical Pathologists, 110: 281–292.
Human blood is classified, or typed, according to the presence or absence of certain markers (called antigens) on the surface of red blood cells. Blood typing tests are done before a person receives a blood transfusion and to check a pregnant woman's blood type. Blood typing may also be done to determine whether two people are likely to be blood relatives (for instance, to help establish paternity).
The most important antigens are blood group antigens (ABO) and the Rh antigen. Therefore, the two most common blood typing tests are the ABO and Rh tests. Although there are other ways to type blood, these two tests are the most common. Both the ABO and Rh blood typing tests are done on a blood sample taken from a vein.
The ABO test classifies people's blood into one of four types: A, B, AB, or O. If your red blood cells have:
Blood received in a transfusion must contain antigens that are the same as the antigens on a person's own red blood cells (compatible blood). If you receive a transfusion that contains antigens different from your own (incompatible blood), the antibodies in your plasma will recognize the transfused (donor) blood as foreign and will attack and destroy the donor red blood cells. This is called a transfusion reaction and it happens immediately when incompatible blood is transfused. A transfusion reaction can cause serious illness and even death.
Type O-negative blood does not have any antigens. It is called the "universal donor" type because it is compatible with any blood type. Type AB-positive blood is called the "universal recipient" type because a person who has it can receive blood of any type. Although “universal donor” and “universal recipient” types are occasionally used to classify blood in an emergency, blood typing tests are almost always done to prevent transfusion reactions.
Minor antigens (other than A, B, and Rh) that occur on red blood cells can sometimes also cause problems and are also checked for a match before giving a blood transfusion.
Serious transfusion reactions are rare today because of blood typing tests.
Rh blood typing determines the presence (+) or absence (–) of the Rh antigen (also called the Rh factor). If your red blood cells:
Rh blood typing is especially important for pregnant women. A potential problem arises when a woman who has Rh-negative blood becomes pregnant with a fetus that has Rh-positive blood. This is called Rh incompatibility. If the blood of an Rh-positive fetus mixes with the blood of an Rh-negative woman during pregnancy or delivery, the mother's immune system produces antibodies. This antibody response is called Rh sensitization and, depending on when it occurs, can destroy the fetus's red blood cells.
Rh sensitization does not usually affect the health of the fetus during the pregnancy in which the sensitization occurs. However, the fetus of a subsequent pregnancy is more likely to be affected if the fetus's blood type is Rh-positive. Once sensitization has occurred, the fetus can develop mild to severe problems (called Rh disease, hemolytic disease of the newborn, or erythroblastosis fetalis). If untreated, complications from sensitization can, in rare cases, lead to the death of an Rh-positive fetus.
Rh testing is done in early pregnancy to detect a woman's blood type. If she is Rh-negative, she can receive a vaccine called Rh immune globulin (such as RhoGAM) that almost always prevents sensitization from occurring. Problems arising from Rh sensitization have become very rare since the Rh immune globulin vaccine was developed.
Why It Is Done
Blood typing is done:
The following table shows the compatibility of blood types between blood donors and recipients.
Minor antigens (other than A, B, and Rh) on the red blood cells are also checked for a match before a blood transfusion.
Since blood type is an inherited characteristic, different ethnic groups have different proportions of the basic blood types. The following table shows these percentages for different ethnic groups in the United States. Most people (about 85%) have Rh-positive blood.
What Affects the Test
What to Think About
From the CNN
Only for Doctors
CHICAGO, Illinois (AP) -- The popular pain relievers ibuprofen and acetaminophen, contained in scores of over-the-counter remedies, may increase the risk of high blood pressure, a study in women suggests.
Skeptics say the link is flimsy and needs confirmation in better-designed studies, and even the Harvard researchers who conducted the study do not recommend that people stop taking the medications. But the authors add that their findings are plausible given what's known about how the drugs affect the body.
The study, in Monday's Archives of Internal Medicine, involved 80,020 women aged 31 to 50 who participated in a nurses' health study and had not been diagnosed with high blood pressure at the outset. They were asked in 1995 about their use of painkillers; information about high blood pressure was obtained from a survey two years later.
During those two years, 1,650 participants developed high blood pressure. Women who reported taking acetaminophen 22 days a month or more were twice as likely to develop hypertension as women who did not use the drug. Those who used nonsteroidal anti-inflammatory medicines that often -- mostly ibuprofen -- were 86 percent more likely to develop hypertension than nonusers. Aspirin use did not appear to be associated with an increased risk.
Acetaminophen is contained in Tylenol and ibuprofen is in Motrin, two of the most popular over-the-counter painkillers.
While the relative risks sound high, the results suggest that the vast majority of women taking the medications will not develop high blood pressure, said Dr. William J. Elliott, an internal medicine and pharmacology specialist at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
Elliott, who was not involved in the research, also noted that the study lacks information on doses participants used, which would be needed to show a true cause and effect.
The researchers from Harvard's School of Public Health acknowledged that shortcoming and other limitations, including relying on women's own reports about hypertension rather than blood pressure measurements.
Still, the link was seen even when other possible explanations were factored in, including age and body-mass index, said researcher Dr. Gary Curhan.
Ibuprofen and similar non steroidal anti-inflammatory drugs may raise blood pressure by blocking production of prostaglandins, hormone-like substances that can widen blood vessels and improve blood flow. The drugs also can increase sodium retention.
Acetaminophen also may increase blood pressure by affecting prostaglandin production, the researchers said.
Dr. Anthony Temple of McNeil Consumer & Specialty Products -- makers of Tylenol, Motrin and St. Joseph aspirin -- said the study "does not show any cause and effect relationship."
Curhan also said the results probably did not stem from underlying conditions such as rheumatoid arthritis that might increase blood pressure risk. Factoring in that variable also did not change the results, he said.
"Given that these medications
are readily available over the counter and are used by a large proportion of the
adult population, this association merits further study," the researchers said.
Viral hepatitis is liver inflammation caused by infection with a virus. Hepatitis viral tests are done to diagnose viral hepatitis and identify the type of virus causing the infection. It is important to identify the type of hepatitis virus causing infection so that the spread of infection can be prevented and the proper treatment can be started immediately.
The following viruses cause most cases of viral hepatitis:
Hepatitis A virus (HAV)
Hepatitis A is the most common type of viral hepatitis. The infection usually goes away on its own without treatment and does not cause chronic illness. Hepatitis A is spread when people eat or drink contaminated food or water or when they come into contact with objects contaminated by feces containing HAV.
Once infected, a person develops antibodies to the hepatitis A virus. These antibodies provide lifelong protection, or immunity, against another HAV infection.
People who are infected with HAV can spread the virus to other people for at least 2 weeks before and for a few days after symptoms develop. Once HAV symptoms go away, a person with HAV does not become a "carrier"; that is, the person cannot infect others with HAV.
The anti-HAV test detects two different antibodies to the hepatitis A virus. IgM anti-HAV antibodies generally can be detected in the blood as early as 2 weeks after a person becomes infected with HAV and when symptoms of hepatitis A are present. These antibodies disappear from the blood 3 to 12 months after infection. The presence of IgM anti-HAV antibodies indicates that a person has recently been infected with HAV.
IgG anti-HAV antibodies appear about 8 to 12 weeks after a person is infected with HAV. These antibodies remain in a person's blood for life. The presence of IgG anti-HAV antibodies means that the person once had an active HAV infection and is now protected against HAV infection for life.
Hepatitis B virus (HBV)
Hepatitis B is spread when body fluids (such as blood, saliva, semen, or vaginal fluid) from an infected person enter another person's body through a break in the skin or a mucous membrane. It can be spread by sexual activity. It can also be spread from a mother to her baby during childbirth.
An acute HBV infection usually goes away on its own without treatment. Some people with acute HBV do not have symptoms.
A chronic HBV infection occurs when the hepatitis B virus continues to be present in a person's liver and blood cells for 6 months or more. Chronic infection can lead to serious liver diseases, such as cirrhosis and liver cancer. People with chronic HBV usually do not have symptoms, unless serious liver disease develops.
There are three main types of testing for hepatitis B: HBV genetic material testing (HBV DNA testing), antigen testing, and antibody testing.
If genetic material (DNA) from the hepatitis B virus is found in a person's blood sample, then doctors know that the virus is multiplying in the person's body. A person is highly contagious when HBV DNA is present. In a person who has chronic HBV infection, the presence of viral DNA means that the person is at increased risk for chronic hepatitis and may want to consider treatment with medications. Testing for HBV DNA is also an important way to monitor the effectiveness of treatment for chronic HBV infection.
Antigen teting measures the specific protein of the hepatitis B virus. The two common antigen tests measure the hepatitis B surface antigen (HBsAg) and the e antigen (HBeAg). A person with HBsAg in the blood for 6 months or longer has a chronic HBV infection and is a "carrier" of HBV, meaning the person can infect others with HBV. In a person who has a chronic HBV infection, the presence of HBeAg indicates a person has high levels of HBV in the blood and is at increased risk for liver disease.
Antibody testing measures a person's immune response to the hepatitis B virus. The three common antibody tests for hepatitis B measure surface antibody (HBsAb), core antibody (HBcAb), and e antibody (HBeAb). Acute HBV is characterized by the presence of HBsAg and IgM antibody to core (HBcAb-IgM). Resolution of acute HBV results in the loss of HBsAg and HBcAb-IgM and the development of HBsAb and HBcAb-IgG. HBcAb-IgG persists in the blood.
In chronic HBV, HBsAg persists beyond 6 months. Usually, HBeAg, HBcAb-IgG, and HBV DNA are also positive. However, variations of this are common.
Hepatitis C virus (HCV)
The hepatitis C virus is spread by coming in contact with blood infected with HCV. There are six major strains of HCV. About 50% to 80% of people infected with HCV develop a chronic infection, meaning it lasts for many years and often never goes away. Most people with chronic hepatitis C have some degree of liver inflammation all the time, but most do not have symptoms.
Once the hepatitis C virus enters the body, it takes about 2 weeks to 6 months for the infection to develop. Infection is detected by symptoms (such as jaundice, body aches, fever, or fatigue) or abnormal liver tests and a positive HCV RNA test.
One test for hepatitis C detects the antibodies (anti-HCV) produced by the body to fight the hepatitis C infection. The presence of anti-HCV antibodies in the blood indicates an HCV infection, but does not distinguish between an acute or chronic infection. The enzyme immunoassay (EIA) test may be the first test done to detect anti-HCV antibodies.
Occasionally, a supplemental test called the recombinant immunoblot assay (RIBA) may be done to confirm a positive EIA test result.
Other, more sophisticated lab tests (such as the polymerase chain reaction, PCR) are often done to detect the genetic material (RNA) of the hepatitis C virus. Hepatitis C RNA can be detected in a person's blood within 1 to 2 weeks after exposure to the virus. HCV RNA testing may be done to confirm a positive result on an HCV antibody test, to define the level of virus in the blood (called viral load), or to predict the likelihood that a person with HCV will respond to medical treatment. Another RNA test called genotyping can define the strain of hepatitis C and predict the likelihood of responding to treatment.
Hepatitis D virus (HDV)
Infection with the hepatitis D virus (HDV), or delta agent, occurs only in people who are already infected with the hepatitis B virus (HBV). Vaccination against hepatitis B will prevent hepatitis D infection. Hepatitis D infection is rare in the United States, except among people who inject recreational drugs and those who are frequently exposed to blood products. The test for hepatitis D detects the antibodies that fight the hepatitis D infection.
Hepatitis E virus (HEV)
A hepatitis E infection is spread through food or water that has been contaminated by the feces (stool) of an infected person. Like hepatitis A, hepatitis E causes acute infection, but hepatitis E does not develop into chronic infection. It is rare in the United States. Tests for hepatitis E that detect HEV antibodies (anti-HEV), antigens, or genetic material (RNA) are available only in research laboratories.
Hepatitis viral tests are done on a blood sample taken from a vein.
Why It Is Done
A test to detect viral hepatitis is done to:
Interpretation of Hepatitis Tests
When the tests done
What Affects the Test
Rough handling, contamination, or inadequate refrigeration of the blood sample can cause inaccurate test results.
What to Think About
مارس الرياضة وقل وداعاً للأمراض
الإفراط في الأكل
يؤدي إلى السمنة
البحث عن المعرفة
لا يحتاج لجهد كبير
قم بالفحص الدوري
تنبيه: المعلومات الطبية والصحية روعى فيها الدقة فى اللغة قدر الإمكان والمواضيع والأبحاث الطبية المنشورة يتحمل مسئولية صحتها المصدر لاغير وأية معلومات صحية لاتغنيك عن استشارة طبيبيك الخاص.