1 Schistosoma clinical aspects and treatment ESCMID Postgraduate Technical Workshop for Basic and Clinical Parasitology. June 2013 Ana Cláudia Carvalho Infectious Diseases Department Centro Hospitalar São João, Porto Department of Clinical Epidemiology, Predictive Medicine and Public Health University of Porto Medical School Institute of Public Health - University of Porto
5 1 Adult schistosomes are macroscopically visible worms, with a white-grayish, cylindrical body approximately 1 to 1.5 cm in length.
6 1 The worms live in the bloodstream of the human host, where they can survive for up to 30 years with an average of 3 to 5 years. Bee ( queen) Lion
7 1 Schistosomes have separate genders, with the male holding the female in a continuous, monogamous embrace. Wolves Swans Love birds schistosomes
8 2 Transmission cycle
9 2 BMJ 2011;342
10 3 Acute Pathology
11 3 Cercarial dermatitis : swimmers itch Minutes after the cercarial infection, local urticaria may appear. Usually last for a few hours but sometimes persist for days.
12 3 Bird schistosomes as causative agents of swimmer s itch in Europe.Although schistosomes of the genus Trichobilharzia may infect humans, they are not able to complete their life cycle within these accidental hosts, and most die soon after penetration. Trends in Parasitology February 2013, Vol. 29, No. 2
13 3 Systemic hypersensitivity reaction: Katayama fever Occurs one to eight weeks after infection by the migrating and maturing schistosomula. Symptoms are mediated by the immune complex. Symptoms last for a few weeks to 2-3 months and gradually abate without therapeutic intervention. Katayama fever A flulike syndrome with protracted fever, fatigue, myalgia, headache and dry cough. Differential diagnosis: gastroenteritis, pneumonia, viral hepatitis HIV, salmonellosis Lambertucci., Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 105(4), July 2010
14 3 Systemic hypersensitivity reaction : Katayama fever The liver or spleen may be swollen and tender, and thorax radiography may reveal patchy infiltrates. Lambertucci., Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 105(4), July 2010
15 3 Systemic hypersensitivity reaction : Katayama fever Diagnosis: Leukocytosis with 10-75% eosinophils is common (>80% of patients) and aids diagnosis. Immunoglobulins are elevated in the serum, especially IgE, IgG and IgM. Serum alkaline phosphatase may be increased. Positive serologic tests. A history of tropical water contact: lakes Malawi, Victoria, Volta; the Zambesi and Niger deltas Remember! Stool or urine examinations are still negative.
16 3 Acute Pathology affects mainly tourists/travellers! Cercarial dermatitis and acute schistosomiasis are rarely seen in local people, probably because they have been desensitized at an early age but probably also because of underdiagnosis. High-risk groups for acute schistosomiasis: soldiers during military manoeuvres, religious organisations that baptise their followers in stream waters, fishermen, canoers and rural tourists.
17 4 Chronic Pathology
18 4 Morbidity is caused by years of chronic infection in wich the eggs and not the worms are the main culprit. The female produce hundreds (300) to thousands ( 3000) of eggs per day. Eggs migrate from blood vessels trough the tissues into the lumen of the bladder or intestine but: Some are carried away with the bloodstream Most are trapped in tissues Excreted with urine /faeces (1/3)
19 Granuloma The eggs forms the foci of a classical type 2 granulomatous inflammation, characterized by an eosinophil-rich, CD4C T helper (Th) 2 cell dominated infiltrate with additional infiltration of alternatively activated macrophages (M2). Sequela : marked fibroblast infiltration and development of fibrosis. The Schistosoma granuloma: friend or foe FrontiersinImmunology Inflammation April 2013 Volume4 Large necrotic-exudative granuloma in the liver of a patient with acute schistosomiasis mansoni. Note the isolated central egg surrounded by extensive necrosis. Lambertucci., Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 105(4), July 2010
20 4 S.haematobium Vesical/ureteral walls Hematúria Dysuria Hidronephrosis Renal failure Bladder cancer (?) Eggs trapped in tissues Inflammatory and granulomatous reactions Ulcerations/micropolyps/macropolyps Fibrosis/calcification S. mansoni/japonicum Large bowel/rectum walls Abdominal pain; Diarrhoea Stricture/ Stenosis
22 4 Schistosomiasis and urinary bladder cancer in North Western Tanzania: a retrospective review of 185 patients. Rambau et al. Infectious Agents and Cancer 2013,
23 Invasive bladder cancer : Courtesy of Carlos Bras-Silva, MD. Mozambique
24 Vesical polyps associated with schistosomiasis : Courtesy of Carlos Bras-Silva, MD. Mozambique
26 4 Hepatic schistosomiasis Early hepatic schistosomiasis : an early inflammatory reaction to eggs trapped in presinusoidal periportal spaces of the liver. Hepatomegaly is typical. Chronic hepatic schistosomiasis: irreversible fibrosis which develops in longstanding intense infections and presumably, some form of immunogenetic predisposition. Portal HT; splenomegaly; portocaval shunting, gastrointestinal varices. In S.mansoni the fibrotic process takes 5-15y ( the infection might no longer be present). In S.japonicum the progression is often rapid. Important: S. haematobium only rarely reaches the portal circulation! It is not a cause of hepatic disease!
28 4 Ectopic schistosomiasis Potencial complication of acute or chronic schistosomiasis.
29 4 Ectopic schistosomiasis Pulmonary In advanced hepatic disease ( S.mansoni/S.japonicum) complicated by portocaval shunting, eggs may leak into the perialveolar capillary beds. In S.haematobium infection embolization to lungs also occurs. Granulomas»» fibrosis»» pulmonary HT»» cor pulmonale
30 4 Ectopic schistosomiasis Genital Ulcerative lesions of the vulva, vagina, cervix, ovaries, fallopian tubes Epididymis, testicles, spermatic cord,prostate Infertility Increased risk of sexual transmitted infections?
31 4 Schistosomiasis and HIV Both empiric data and mathematical models support the hypothesis that schistosome infections lead to increased susceptibility to infection with HIV-1, a more rapid progression to disease through more vigorous viral replication and immunosuppression, and a higher likelihood of transmitting the infection to others through both vertical and horizontal routes. Different species of schistosome infection vary in the magnitude of their effects on these mechanisms with Schistosoma haematobium playing a greater role for increased susceptibility and transmission because of its association with urogenital disease. Current Opinion in HIV & AIDS: May Volume 7 - Issue 3 - p
32 4 Ectopic schistosomiasis Central Nervous System Neuroschistosomiasis is arguably the most severe clinical outcome associated with schistosome infection. Myelopathy (acute transverse myelitis and subacute myeloradiculopathy) of the lumbosacral region is the most commonly reported neurological manifestation of both S mansoni and S haematobium infection, whereas acute encephalitis of the cortex, subcortical white matter, basal ganglia, or internal capsule is reportedly typical of S japonicum.
33 Lancet Neurol 2011; 10:
34 4 Cerebellar pseudotumoral schistosomiasis mansoni Sagittal (A) and coronal (B) T2-weighted MRI of the brain revealing confluent high signal in the cerebellum, especially in the right hemisphere. (C) Coronal gadolinium-enhanced T1- weighted sequence shows areas of nodular enhancement in the cerebellum, especially in the right hemisphere. Lancet Neurol 2011; 10:
35 Fig. 19: magnetic resonance of the spinal cord shows thickening of the connus medullaris (arrows: a sagittal section on the left and an axial on the right) with enhancement after contrast injection in a patient with acute schistosomiasis mansoni. Lambertucci., Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 105(4), July 2010
37 4 Schistosomiasis and other infections Pyogenic liver abscesses - Lambertucci et al. (1990) described the cases of two children with skin pustules and acute schistosomiasis who also developed multiple pyogenic liver abscesses caused by Staphylococcus aureus. Mechanisms have been proposed as probable explanations for the association of schistosomiasis with pyogenic abscesses: (i) liver necrosis caused by S. mansoni eggs or dead worms colonised by bacteria (ii) transient impairment of cell-mediated immunity in the acute phase of schistosomiasis
38 4 Schistosomiasis and other infections Animal studies: Prior infection with Schistosoma decreased the severity of the subsequent infection as with Helicobacter pylori, Fasciola hepatica, Echinostoma or Plasmodium More often, however, a prior infection with Schistosoma increased the severity of the second infection as with Leishmania, Toxoplasma gondii, Entamoeba histolytica, Staphylococcus aureus or Salmonella. Additional research is needed, particularly on Schistosoma coinfections which currently have a small body of research and are current problems in human populations. Adv Parasitol. 2011;77:1-85
39 5 Diagnosis
40 5 Diagnosis Microscopic detection of eggs in stools or urine Urine collection (10ml): Antibody-based serologic assays Detection of circulating antigen PCR Between 10h-14h After exercise Terminal urine Schistosomiasis in areas of low endemicity: a new era in diagnosis. Cavalcanti et al. Trends in Parasitology February 2013, Vol. 29, No. 2
43 Fifty-two trials enrolling 10,269 participants were included. The evidence was of moderate or low quality due to the trial methods and small numbers of included participants.
44 6 Praziquantel PZQ was synthesized by Bayer and Merck in Germany in 1972 and introduced for clinical use in the People s Republic of China since PZQ exhibits stage-specific functions in killing adult worms ( of all Schisto sp). Safe ( children and pregnant women also) Well tolerated A single oral dose of mg/kg PZQ or 40/60 mg/kg divided in two doses during RCTs resulted in protection rates of 73% (95% CI: 67%- 78%). S.Mansoni Higher doses, up to 60 mg/kg, do not appear to show any advantage (four trials, 783 participants, moderate quality evidence).
45 6 Oxamniquine (its effect is restricted to S. mansoni!) Compared to placebo, oxamniquine 40 mg/kg probably reduces parasitological treatment failure at three months (RR 8.74, 95% CI 3.74 to 20.43, two trials, 82 participants, moderate quality evidence). These trials are now over 20 years old Praziquantel versus oxamniquine Only one small study directly compared praziquantel 40 mg/kg with oxamniquine 40 mg/kg and we are uncertain which treatment is more effective in reducing parasitological failure (one trial, 33 participants, very low quality evidence). A further 10 trials compared oxamniquine at 20, 30 and 60 mg/kg with praziquantel 40 mg/kg and did not show any marked differences in failure rate or percent egg reduction. Combination treatments Two trials also compared combinations of praziquantel and oxamniquine in different doses, but did not find statistically significant differences in failure (two trials, 87 participants).
46 6 Artemisinin derivatives They are active against S. japonicum, S. mansoni and S. haematobium, mainly targeting the immature, pre-adult stage, the schistosomulum. Have been used for prevention (alone) or treatment (combined with praziquantel). PZQ and AM or AS in combination for treatment resulted in higher protection rates (84% [95% CI: 64%-91%]) than PZQ alone (73% [95% CI: 67%-78%]), respectively. Liu et al. Parasites & Vectors 2011, 4:201
47 6 Combination treatment (artemisinins and praziquantel) Attention to Artemisin and Plasmodium! Using ARTs for schistosomiasis control is not advisable in areas where schistosomiasis and malaria are co-endemic!
48 6 Treatment Individual case management ( eg tourist) vs Community morbidity control ( endemic areas)
49 6 Treatment - Acute schistosomiasis Association of steroids and schistosomicides - Clinical and experimental evidence indicate that steroids act synergistically with schistosomicides in the treatment of acute schistosomiasis. Prednisone first (1 mg/kg, body weight, for 7 days, 0.5 mg/kg for 7 days and 0.25 mg/kg for 7 days) + Praziquantel (60 mg/kg, body weight, single oral dose) The association of steroids and schistosomicides in the treatment of symptomatic patients augments the cure rate, speeds the recovery time, prevents the recurrence of symptoms and improves the quality of medical care.! Before starting steroids, however, it is good medical practice to treat patients for strongyloidiasis with ivermectin or albendazole to prevent the development of fatal strongyloides sepsis triggered by prednisone.
50 6 Treatment Individual case management/ individual who have left endemic area: Praziquantel: 60mg/kg ( may split doses); repeat 2-3days (?) Consider repeat treatment 6-12 weeks later to cure prepatent infections. Practical note: Eggs can be excreted for several weeks after treatment: the preferred time for follow up is 4-6 weeks after treatment!
51 6 Treatment Community morbidity control (endemic areas) WHO For morbidity control, mass treatment is targeted at high risk groups. The high risk group targeted and the frequency of treatment depends on the prevalence of infection. In 2012 more than 35 million people, 83% of them in sub-saharan Africa, were treated for schistosomiasis. Experience from China and Egypt shows that preventive chemotherapy, mass treatment without individual diagnosis, with high coverage can result on significant impacts on indices of infection and also reduced requirements for praziquantel. Treatment several times during childhood is likely to prevent disease in adulthood. Praziquantel is now available free of charge to high-disease burden countries in sub-saharan Africa, through a donation from Merck Serono to the World Health Organization.
52 6 Treatment
53 September 2011 Volume 5 Issue 9 e1321
54 7 Prevention
55 7 Prevention Individual: multiple doses of Artemether or Artesunate at 6 mg/kg given in 1- or 2-week intervals for prevention against schistosome infection during exposure to infected water. ( experience with S. japonicum by short term exposure during fighting against floods)
56 7 SCHISTOSOME VACCINE DEVELOPMENT Despite the discovery and testing of many vaccine candidates, and advances in understanding protective immunity, none is currently available. Novel immunomic technologies for schistosome vaccine Development. MCWILLIAM et al. Parasite Immunology, 2012, 34,
57 7 Prevention Water supply and sanitation Mozambique, 2010.
58 7 Prevention Education Mozambique, 2010.
59 7 Prevention Mass treatment Mozambique, 2010.
60 7 Prevention Fight poverty Mozambique, 2010.
61 7 Take Home Messages Schistosomiasis is a tropical parasitic disease, caused by macroscopic worms of Schistosoma. Schistosoma mansoni and S japonicum live in the mesenteric venules, S haematobium in the perivesical venules. Swimmers itch can occur shortly after cercarial infection. Search for history of exposure! Acute schistosomiasis is an allergic reaction occurring in the weeks after primary infection and present as a flulike syndrome. High index of suspicion! Steroids are the mainstay of therapy. Eggs that are trapped in the tissues provoke immunogenic inflammatory, granulomatous and fibrotic reactions that cause intestinal, hepatosplenic or urinary disease which develops over many years. Most infected people show no, limited or non-specific symptoms. Severe disease develops in people with heavy, long-standing infections and probably unbalanced immune responses.
62 7 Take Home Messages Schistosomiasis can be complicated by ectopic lesions especially in the central nervous system, the pulmonary system or in the genital area. The diagnosis of schistosomiasis relies on microscopic examination of stools or urine, serologic tests, PCR and imaging. Praziquantel is the drug of choice, active against all species. In some cases adjunct therapies may be useful. Current control strategies consist mainly of preventive therapy in communities or groups at risk. There is as yet no vaccine against schistosomiasis. On the long-term, only sanitation, water supply, education and socioeconomic development can reduce and eliminate the transmission of schistosomiasis. Gryseels B. Schistosomiasis. Infect Dis Clin North Am Jun;26(2):
63 References Gryseels B. Schistosomiasis. Infect Dis Clin North Am Jun;26(2): Gray DJ et al. Diagnosis and management of schistosomiasis. BMJ May 17;342:d2651. Lambertucci JR. Acute schistosomiasis mansoni: revisited and reconsidered. Mem Inst Oswaldo Cruz Jul;105(4): Soldánová M et al. Swimmer's itch: etiology, impact, and risk factors in Europe. Trends Parasitol Feb;29(2): Pavlin BI et al. Acute pulmonary schistosomiasis in travelers: case report and review of the literature. Travel Med Infect Dis Sep;10(5-6): Secor WE. The effects of schistosomiasis on HIV/AIDS infection, progression and transmission. Curr Opin HIV AIDS May;7(3): Danso-Appiah A et al. Drugs for treating Schistosoma mansoni infection (Review). The Cochrane Library.2013, Issue 2 Cavalcanti MG et al. Schistosomiasis in areas of low endemicity: a new era in diagnosis. Trends Parasitol Feb;29(2): Wilson RA. Virulence factors of schistosomes. Microbes Infect Dec;14(15): Liu et al. Efficacy of praziquantel and artemisinin derivatives for the treatment and prevention of human schistosomiasis: a systematic review and meta-analysis. Parasites & Vectors 2011, 4:201 Ferrari TC, Moreira PR. Neuroschistosomiasis: clinical symptoms and pathogenesis. Lancet Neurol Sep;10(9): King CH et al. Utility of repeated praziquantel dosing in the treatment of schistosomiasis in high-risk communities in Africa: a systematic review. PLoS Negl Trop Dis Sep;5(9):e1321 McWilliam HE et al. Novel immunomic technologies for schistosome vaccine development. Parasite Immunol May;34(5): Siddiqui AA et al. Schistosomiasis vaccines. Hum Vaccin Nov;7(11):
Schistosomiasis WRAIR- GEIS 'Operational Clinical Infectious Disease' Course The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or
Schistosomiasis Introduction Epidemiology Risk for Travellers Transmission Signs and Symptoms Treatment Prevention References Reading List Introduction Schistosomiasis, or bilharzia, is caused by worms
Schistosomiasis / Bilharzia An update for registered healthcare practitioners April 2017 Aims of resource:- To raise awareness of Schistosomiasis/Bilharzia infection with registered healthcare practitioners
Human schistosomiasis Bruno Gryseels, Katja Polman, Jan Clerinx, Luc Kestens Lancet 2006; 368: 1106 18 Institute for Tropical Medicine Antwerp, Nationalestraat 155 B-2000, Antwerp, Belgium (Prof B Gryseels
Travel Medicine and Infectious Disease (2011) 9, 6e24 available at www.sciencedirect.com journal homepage: www.elsevierhealth.com/journals/tmid REVIEW Schistosomiasis in travellers and migrants Jan Clerinx
DEVELOPING NEW BEHAVIOURAL CHANGE INTERVENTIONS FOR SCHISTOSOMIASIS CONTROL Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria SCHISTOSOMIASIS Disease of poverty
Heterophyiasis Heterophyes heterophyes Samar N. El-Beshbishi Prof. of Medical Parasitology Mansoura Faculty of Medicine 2 Objectives 1. Overview on heterophyiasis. 2. Geographical distribution. 3. Morphology
EUROPEAN ACADEMIC RESEARCH Vol. II, Issue 9/ December 2014 ISSN 2286-4822 www.euacademic.org Impact Factor: 3.1 (UIF) DRJI Value: 5.9 (B+) Health Education as Intervention in Promotion of Knowledge, Attitudes
Natural Hair Transplant Medical Center, Inc. 1000 Dove Street, Suite #250, Newport Beach, CA 92660 Phone-949-622-6969 Finasteride (PROPECIA ) Acknowledgement Finasteride is an oral medication, manufactured
Schistosomiasis in Travelers and Expatriates Tomasjelinek, Hans-Dieter Nothduft, and Thomas Loscher Background: Several outbreaks of schistosomiasis among travelers, expatriates, and military serviceman
PRODUCT INFORMATION PRIMOTESTON DEPOT (testosterone enantate) NAME OF THE MEDICINE Testosterone enantate is designated chemically as 17 beta-heptanoyloxy-4-androstene-3- one. The empirical formula of testosterone
Report: PAHO/WHO Preparatory Meeting on Epidemiological Data Needed to Plan Elimination of Schistosomiasis in the Caribbean (Grenada, 13 14 December 2007) 1 Table of Contents Preface...1 Background...1
Testosterone Hormone Replacement Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective date: April 1, 2018 This policy has been developed through
1001 West Broadway, Vancouver, BC V6H 4B1 Topical Finasteride 1 Topical finasteride is a solution containing the drug finasteride typically sold under the brand names Propecia and Proscar. The Finasteride
What the $*!# is Lung Protective Ventilation and Why Should I be Using it in the OR? Disclosures KATHERINE PALMIERI, MD, MBA 64 TH ANNUAL POSTGRADUATE SYMPOSIUM UNIVERSITY OF KANSAS MEDICAL CENTER DEPARTMENT
Self-declaration by New Zealand of its status of freedom from Equine Viral Arteritis Self-declaration submitted to the OIE on xxxx2014, by Dr Matthew Stone, Chief Veterinary Officer, Ministry for Primary
HGH for Sale Natural Anti-Aging Human Growth Hormone Human growth hormone is one of the hottest supplement trends on the market, and now you can purchase top-quality HGH to be delivered right to your home!
750 West Broadway Street Suite 905 Vancouver, BC M5Z 1K1 FAX: (604) 648-9003 email@example.com FINASTERIDE (PROPECIA, PROSCAR) SIDE EFFECT & CONSENT FORM What is finasteride? Finasteride
fñxv tä TÜà väx Challenges in prevention and control of schistosomiasis in the Sudan Mutamad A.Amin* and Durria Mansour Elhussin* Background The World Health Organization (WHO) estimated that 200 million
1 NAME OF THE VETERINARY MEDICINAL PRODUCT Myodine 25 mg/ml solution for injection for dogs and cats 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each ml contains: Active substance: Nandrodine laurate 25
Most organisms on Earth are aerobic. Meaning, they require oxygen to survive. The basic function of the respiratory system is to take in oxygen and release carbon dioxide A system that provides a large
The Spatial-Demographic Association Between Water Contact and Schistosomiasis Reinfection Eunice Yujung Lee Abstract Despite the progress in controlling and eradicating schistosomiasis in disease prevalent
Male Hypogonadism Jauch Symposium Waterloo, IA May 17, 2013 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any proprietary entity producing
Rio Grande County Births and Deaths 2015 Selected birth characteristics: County residents, 2015... 2 Selected birth characteristics by age group of mother: County residents, 2015... 3 Selected birth characteristics
Treatment of Schistosomiasis in Africa Junyi Mei Junyi is finishing her B.Sc. in Anatomy and Cell Biology and looks forward to working at a medical research lab this summer. She is interested in global
Line of business: Medi-Cal Effective Date: August 16, 2017 Revision Date: August 16, 2017 Testosterone Hormone Replacement Drug Class Prior Authorization Protocol This policy has been developed through
STEWARDSHIP FOR RESEARCH ON INFECTIOUS DISEASES OF POVERTY: SOCIAL RESEARCH social context of schistosomiasis and its control An introduction and annotated bibliography Birgitte Bruun Jens Aagaard-Hansen
Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 101(Suppl. I): 199-203, 2006 199 Changes induced in Biomphalaria glabrata (Say, 1818) following trials for artificial stimulation of its internal defense system
SCUBA - self contained underwater breathing apparatus 5 million sport scuba divers in US 250,000-400,000 new certifications annually in US Diving occurs in oceans, freshwater lakes, rivers and quarries
What do these athletes have in common? Drugs in Sport Why do athletes cheat? 1988 Olympics 100m Final Why is this photo so iconic? 1988 Olympics 100m Final First time ever 4 of the 8 finalists run under
IOSR Journal of Pharmacy and Biological Sciences (IOSR-JPBS) e-issn: 2278-3008, p-issn:2319-7676. Volume 9, Issue 4 Ver. II (Jul -Aug. 2014), PP 112-117 Assay of Some Biological Attributes Of Schistosome
PLANNING FOR TREATMENT AN EDUCATIONAL SERIES BROUGHT TO YOU BY GILEAD SCIENCES ADVANCES IN HEP C TREATMENT LEARN MORE ABOUT HEP C There s never been a better time to treat Hep C. Recent scientific advances
Pop Quiz What produces mucus, HCl and pepsinogen in the stomach? List a water soluable vitamin What is a ruminant stomach? Respiratory System Review Cellular respiration: obtain glucose and oxygen, get
PHYSICIANS CIRCULAR FINASTERIDE PROSCAR Tablet 5-Alpha Reductase Inhibitor FINASTERIDE (PROSCAR) a synthetic 4-azasteroid compound, is a specific inhibitor of Type II 5α-reductase, an intracellular enzyme
C A N C E R C A R E Alberta Cancer Registry 2007 Annual Report of Cancer Statistics ISSN: 1705-0251 June 2010 1 Alberta Cancer Registry 2007 Annual Report of Cancer Statistics Contents About The Alberta
Welcome to Alpharetta Wellness Clinic Mild Hyperbaric Oxygen Therapy! Below you will find many answers to your questions about Mild Hyperbaric Oxygen Therapy. If you do not find the answers please feel
The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002 2008 1719 A. FENWICK 1 *, J. P. WEBSTER 1, E. BOSQUE-OLIVA 1,L.BLAIR 1,F.M.FLEMING 1, Y. ZHANG 1,A.GARBA
Mechanical Ventilation Eric A. Libré, MD VCU School of Medicine Inova Fairfax Hospital and VHC Indications for Mechanical Ventilation Inadequate ventilatory effort Rising pco2 with resp acidosis (7.25)
Study No: ARIA3002 Year 4 Title: A Randomized, Double-Blind, Placebo-Controlled, Two Year Parallel Group Study of the Efficacy and Safety of GI198745 0.5mg in the Treatment and Prevention of Progression
Insight into male menopause' Dr Mark Vanderpump MD FRCP Consultant Endocrinologist Clinics: Tuesday PM Mark Vanderpump Consultant Physician and Endocrinologist Introduction Serum total and free testosterone
Anavar For Sale Oxandrolone Anavar (oxandrolone C 19 H 30 O 3 ) is an anabolic steroid that provides outstanding results. The Anavar steroid is a synthesized version of testosterone that boosts lean muscle
ISSN 2249 622X Asian Journal of Biomedical and Pharmaceutical Sciences The Incidence of Urinary Schistosomiasis in Ohaukwu Local Government Area of Ebonyi Anorue CO 1, Nwoke BEB 2, Ukaga CN 2 1 Department
Respiration Chapter 33 Learning Objectives: Understand the basis of gas exchange and factors that influence diffusion of gases in and out of tissues Compare and contrast different respiratory systems among
Created as a free resource by Clinical Edge Based on Physio Edge podcast 59 with Greg Lehman, Tom Goom and Dr Christian Barton Get your free trial of online Physio education at Why do runners get injured?
1 THE NATURE OF WAVES Chapter 10 Mr. Davis, M.Ed. Physical Science - 2017 2 Amplitude THE HEIGHT OF A WAVE. THE AMPLITUDE OF A WAVE IS THE MAXIMUM DISTANCE THAT THE PARTICLES OF A MEDIUM VIBRATE FROM THEIR
Updated December 2017 CHRONIC WASTING DISEASE FAQs What is CWD? Chronic wasting disease affects the central nervous system of elk, deer and moose. Most scientists believe CWD is caused by an infectious
Horse Internal parasites There are a number of worms that infest horses; the most important are the large red worms (also known as large strongyles), the small red worms (also known as small strongyles),
Transmissible Spongiform Encephalopathies (TSE) D. Heim What are TSE? Family of diseases Neurological disease accumulation of abnormal prion protein spongiform degeneration of the brain progressive and
Diving Medicine USN Diver/SEAL Submarine Overview / Tom Kersch, CAPT, MC Diving Medicine USN Diver/SEAL Submarine Overview Tom Kersch CAPT, MC SEAL Deliver Vehicle Team 1 Pearl City, HI 1 Content Attestation
Parkland College Natural Sciences Poster Sessions Student Works 2013 Testosterone Use and Effects Brandon Mills Parkland College Recommended Citation Mills, Brandon, "Testosterone Use and Effects" (2013).
Bull Vet Inst Pulawy 49, 35-39, 2005 OCCURRENCE OF MYXOBOLUS ENCEPHALICUS (MUSLOW 1911) IN POLAND: POSSIBLE RELATIONSHIP BETWEEN THE PARASITE INFECTION AND CLINICAL SYMPTOMS IN COMMON CARP (CYPRINUS CARPIO)
RECONSTITUTION AND ADMINISTRATION INSTRUCTIONS FOR HEALTHCARE PROFESSIONALS Hereditary Angioedema TRUST PROVEN PREVENTION WITH CINRYZE Whether your patients are new to treatment or are continuing their
Lead and Wildlife Julie A. Blanchong Department of Natural Resource Ecology and Management Iowa State University Lead Negative impacts of lead on human health have become well-known through: Food contamination
Schistosomiasis in the Philippines REVIEW SCHISTOSOMIASIS IN THE PHILIPPINES: CHALLENGES AND SOME SUCCESSES IN CONTROL Lydia Leonardo 1, Yuichi Chigusa 2, Mihoko Kikuchi 3, Naoko Kato-Hayashi 2, Shin-ichiro
CARBON MONOXIDE POISONING Matthew Valento, MD Assistant Professor, UW Department of Emergency Medicine Washington Poison Center Carbon monoxide (CO) Incomplete combustion of carbon-containing compounds
PCR detection of Schistosoma japonicum cercariae: a potential tool for the field Amanda Driscoll Abstract Despite decades of prevention and control efforts, the water-borne parasitic disease schistosomiasis
MR Advance Techniques Functional MRI Class IV 1 Functional MRI Functional imaging techniques allow MRI to be use to assess the functionality and physiology of the tissues. The contrast of the image depends
Georgia Annual Health Status Measures 2018 with comparisons to the U.S. and Healthy People 2000, 2010 & 2020 objectives Prepared by the Office of Health Indicators for Planning (OHIP), Georgia Department
RECONSTITUTION AND ADMINISTRATION INSTRUCTIONS FOR HEALTHCARE PROFESSIONALS TRUST THE POWER OF PREVENTION WITH CINRYZE Whether your patients are new to treatment or are continuing their journey, remind
BTL-6000 LYMPHASTIM BTL PRESSO-THERAPY SYSTEM FOR MEDICAL AND AESTHETIC PRACTICES TECHNOLOGY The human lymphatic system is responsible for removing interstitial fluid from tissues. It absorbs and transports
Lung Volumes and Capacities Normally the volume of air entering the lungs during a single inspiration is approximately equal to the volume leaving on the subsequent expiration and is called the tidal volume.
Mechanical Ventilation Jeffrey L. Wilt, MD, FACP, FCCP Associate Professor of Medicine Michigan State University Associate Program Director MSU-Grand Rapids Internal Medicine Residency Which of the following
Burn Transfer Guidelines Transfer Indicated When There Is: Partial thickness and full-thickness burns of greater than 10% of the BSA in patients less than 10 years or over 50 years of age. Partial-thickness
OHIO DEPARTMENT OF HEALTH ANNUAL SUMMARY OF INFECTIOUS DISEASES OHIO 2014 REPORTED INCIDENCE OF SELECTED NOTIFIABLE DISEASES PREPARED AND DISTRIBUTED BY: BUREAU OF INFECTIOUS DISEASES TABLE OF CONTENTS
Dihydrotestosterone (DHT) Male pattern baldness is the most common type of balding among males. It affects roughly, 30% of men by the age of 30, 50% of men by the age of 50, 57% of men by the age of 60.
Immersion pulmonary oedema: is it confused with drowning? Dr Peter Wilmshurst Consultant Cardiologist Royal Stoke University Hospital & UK Diving Medical Committee Drowning and pulmonary oedema Drowning
IJRRAS 13 (1) October 12 www.arpapress.com/volumes/vol13issue1/ijrras_13_1_17.pdf CORRELATION ANALYSIS BETWEEN THE PREVALENCE OF SCHISTOSOMA HAEMATOBUIM AND WATER CONDITIONS: A Case Study among the School
Package Leaflet: Information for the patient Sustanon 250, 250 mg/ml, solution for injection (testosterone esters) Read all of this leaflet carefully before you start using this medicine because it contains
extricare NPWT Foam Kit Instruction for Use www.devonmedicalinc.com 1.866.446.0092 Manufactured For: Devon Medical, Inc. 1100 1st Avenue, Suite 202 King of Prussia PA 19406, USA www.devonmedicalinc.com
IT S FOALING SEASON AGAIN!!! There is no doubt that foaling season is one of the most exciting and most stressful times for those Friesian owners whose mares are preparing to deliver. While we are happy
Hospital Admissions in the Northern Territory 1976-28 www.healthynt.nt.gov.au Hospital Admissions in the Northern Territory, 1976 to 28 Shu Qin Li Sabine Pircher Steve Guthridge John Condon Jo Wright Acknowledgements
32 December, 2011 The Science of 33 NUTRICULA Longevity Journal As men age, there is often a decline in libido and sexual function. This decline frequently interferes in intimacy within romantic relationships,
Dead Perch Parts Fish Anatomy Adapted from: An original Creek Connections activity created from the Fish Anatomy model. Grade Level: Intermediate or advanced Duration: 30 minutes Setting: classroom Summary:
598 Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 105(4): 598-603, July 2010 Specific schistosomiasis treatment as a strategy for disease control José Rodrigues Coura 1 / +, Maria José Conceição 2 1 Laboratório
VENTILATION AND PERFUSION IN HEALTH AND DISEASE Dr.HARIPRASAD VS Ventilation Total ventilation - total rate of air flow in and out of the lung during normal tidal breathing. Alveolar ventilation -represents
ACUTE TEMPERATURE TOLERANCE OF JUVENILE CHINOOK SALMON FROM THE MOKELUMNE RIVER Charles H. Hanson, Ph.D. Hanson Environmental, Inc. SUMMARY A series of static acute tests were performed to determine the
Reproductive DHT Analyte Information - 1 - DHT Introduction Dihydrotestosterone (DHT) together with other important steroid hormones such as testosterone, androstenedione (ASD) and dehydroepiandrosterone
BBS Fall Conference, 16 September 211 Use of modeling & simulation to support the design and analysis of a new dose and regimen finding study Didier Renard Background (1) Small molecule delivered by lung