• ARTICLE_TITLE


    By G. Killian. Newberry College. 2018.

    Data from a separate surveillance network with roughly the same population coverage are showing similar proportions of resistance in the population order cialis black 800 mg overnight delivery; however purchase cialis black 800mg without prescription, data from border regions with Myanmar are showing higher proportions of resistance32. Unlike the other countries in the region, Thailand has an extensive and well-developed laboratory network. Although survey data are not included in this report for Bangladesh, the Damien Foundation has been monitoring drug resistance in a rural population of the country for the past 10 years, and levels of drug resistance appear to be low[40]. The primary obstacle to achieving this goal is the lack of sustainable funding for the development and operation of the laboratory. Several other provincial surveys are under way, as well as a nationwide drug-resistance survey that is due to be completed in 2008. Data from surveys in Heilongjiang Province, Inner Mongolia Autonomous Region, and Beijing and Shanghai municipalities are included in this report. These proportions are similar to those reported from Liaoning province, also in North Eastern China. This is one of the first reports of lower proportions of drug resistance in urban settings. A nationwide survey, based on a random selection of 70 clusters representing counties or districts, is scheduled to complete in 2008. Despite reaching the global targets for case detection and cure, China has proportions of resistance that are among the highest in the world, only second to rates found in countries of the former Soviet Union. The last two drug-resistance surveys were carried out one year apart, so future surveys will be needed to better understand if this is a true increase in population prevalence. China, Viet Nam and the Republic of Korea have extensive culture networks in the public sector, but only China has a significant number of laboratories able to conduct drug- susceptibility testing. World Health Organization, Global tuberculosis control: surveillance, planning, financing. World Health Organization, Guidelines for the surveillance of drug resistance in tuberculosis. Use of thiacetazone, thiophen-2-carboxylic acid hydrazide, and triphenyltetrazolium chloride. Chou, Modeling the emergence of the “hot zones’” tuberculosis and the amplification dynamics of drug resistance. Yip, Surveillance of Mycobacterium tuberculosis drug resistance in Hong Kong, 1986–1999, after the implementation of directly observed treatment. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs--worldwide, 2000–2004. Ethiopia Countrywide 2005 Survey 804 588 73,1 216 26,9 62 7,7 22 2,7 19 2,4 187 23,3 165 20,5 16 2,0 8 1,0 Gambia Countrywide 2000 Survey 210 201 95,7 9 4,3 5 2,4 2 1,0 0 0,0 3 1,4 8 3,8 4 1,9 1 0,5 Guinea Sentinel sites 1998 Survey 539 460 85,3 79 14,7 50 9,3 4 0,7 3 0,6 51 9,5 53 9,8 24 4,5 1 0,2 Kenya Nearly Countrywide 1995 Survey 445 417 93,7 28 6,3 28 6,3 0 0,0 0 0,0 4 0,9 24 5,4 24 5,4 0 0,0 Lesotho Countrywide 1995 Survey 330 301 91,2 29 8,8 26 7,9 3 0,9 0 0,0 10 3,0 20 6,1 17 5,2 0 0,0 Madagascar (2) Countrywide 2007 Survey 810 759 93,7 51 6,3 37 4,6 4 0,5 4 0,5 26 3,2 42 5,2 28 3,5 0 0,0 Mozambique Countrywide 1999 Survey 1028 814 79,2 214 20,8 170 16,5 54 5,3 5 0,5 108 10,5 125 12,2 81 7,9 18 1,8 Rwanda Countrywide 2005 Survey 616 552 89,6 64 10,4 38 6,2 24 3,9 32 5,2 46 7,5 33 5,4 7 1,1 0 0,0 Senegal Countrywide 2006 Survey 237 212 89,5 25 10,5 10 4,2 5 2,1 8 3,4 18 7,6 18 7,6 3 1,3 0 0,0 Sierra Leone Nearly Countrywide 1997 Survey 117 88 75,2 29 24,8 12 10,3 1 0,9 0 0,0 25 21,4 21 17,9 4 3,4 0 0,0 South Africa Countrywide 2002 Survey 4243 3. H R E S H R Iceland Countrywide 2005 Surveillance 7 7 100 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 Ireland Countrywide 2005 Surveillance 200 194 97,0 6 3,0 6 3,0 1 0,5 1 0,5 1 0,5 5 2,5 5 2,5 0 0,0 Israel Countrywide 2005 Surveillance 211 165 78,2 46 21,8 32 15,2 12 5,7 13 6,2 41 19,4 15 7,1 2 0,9 0 0,0 Italy Half of the country 2005 Surveillance 485 438 90,3 47 9,7 30 6,2 11 2,3 4 0,8 29 6,0 30 6,2 15 3,1 1 0,2 Kazakhstan Countrywide 2001 Survey 359 154 42,9 205 57,1 153 42,6 56 15,6 89 24,8 185 51,5 50 13,9 11 3,1 1 0,3 Latvia Countrywide 2005 Surveillance 873 560 64,1 313 35,9 270 30,9 94 10,8 92 10,5 273 31,3 80 9,2 37 4,2 0 0,0 Lithuania Countrywide 2005 Surveillance 1293 980 75,8 313 24,2 262 20,3 128 9,9 234 18,1 62 4,8 109 8,4 60 4,6 0 0,0 Luxembourg Countrywide 2005 Surveillance 36 32 88,9 4 11,1 3 8,3 0 0,0 0 0,0 2 5,6 3 8,3 2 5,6 0 0,0 Malta Countrywide 2005 Surveillance 11 9 81,8 2 18,2 0 0,0 0 0,0 0 0,0 2 18,2 2 18,2 0 0,0 0 0,0 Netherlands Countrywide 2005 Surveillance 709 650 91,7 59 8,3 46 6,5 10 1,4 3 0,4 26 3,7 39 5,5 26 3,7 5 0,7 Norway Countrywide 2005 Surveillance 193 150 77,7 43 22,3 20 10,4 3 1,6 4 2,1 31 16,1 32 16,6 9 4,7 0 0,0 Poland Countrywide 2004 Surveillance 2716 2. Sweden Countrywide 2005 Surveillance 425 373 87,8 52 12,2 42 9,9 3 0,7 2 0,5 9 2,1 50 11,8 40 9,4 1 0,2 Switzerland Countrywide 2005 Surveillance 326 311 95,4 15 4,6 14 4,3 3 0,9 0 0,0 0 0,0 13 4,0 12 3,7 1 0,3 Turkmenistan Dashoguz Velayat 2002 Survey 105 73 69,5 32 30,5 16 15,2 4 3,8 2 1,9 26 24,8 22 21,0 6 5,7 0 0,0 (Aral Sea Region) Ukraine Donetsk 2006 Survey 1003 604 60,2 399 39,8 311 31,0 180 17,9 30 3,0 284 28,3 148 14,8 69 6,9 12 1,2 United Kingdom Countrywide 2005 Surveillance 3428 3. India Raichur District, 1999 Survey 278 217 78,1 61 21,9 52 18,7 7 2,5 9 3,2 20 7,2 43 15,5 34 12,2 0 0,0 Karnataka State India North Arcot District, 1999 Survey 282 204 72,3 78 27,7 66 23,4 8 2,8 13 4,6 35 12,4 47 16,7 36 12,8 0 0,0 Tamil Nadu State India Ernakulam district, 2004 Survey 305 220 72,1 85 27,9 27 8,9 11 3,6 8 2,6 72 23,6 64 21,0 8 2,6 3 1,0 Kerala State India Gujarat State 2006 Survey 1571 1. Cambodia Countrywide 2001 Survey 638 572 89,7 66 10,3 41 6,4 4 0,6 1 0,2 32 5,0 54 8,5 30 4,7 3 0,5 China Guandong Province 1999 Survey 461 401 87,0 60 13,0 43 9,3 16 3,5 11 2,4 28 6,1 37 8,0 22 4,8 2 0,4 China Beijing Municipality 2004 Survey 1043 856 82,1 187 17,9 91 8,7 44 4,2 43 4,1 95 9,1 113 10,8 35 3,4 11 1,1 China Shandong Province 1997 Survey 1009 831 82,4 178 17,6 114 11,3 38 3,8 17 1,7 123 12,2 99 9,8 38 3,8 6 0,6 China Henan Province 2001 Survey 1222 858 70,2 364 29,8 208 17,0 117 9,6 53 4,3 271 22,2 190 15,5 40 3,3 17 1,4 China (3) Liaoning Province 1999 Survey 818 474 57,9 344 42,1 207 25,3 93 11,4 31 3,8 279 34,1 177 21,6 44 5,4 4 0,5 China Heilongjiang 2005 Survey 1574 1. H R E S H R New Zealand Countrywide 2006 Surveillance 250 224 89,6 26 10,4 17 6,8 1 0,4 1 0,4 18 7,2 17 6,8 8 3,2 0 0,0 Northern Mariana Is Countrywide 2006 Surveillance 18 4 22,2 4 22,2 3 16,7 2 11,1 0 0,0 2 11,1 1 5,6 0 0,0 0 0,0 Philippines Countrywide 2004 Survey 965 767 79,5 198 20,5 130 13,5 44 4,6 41 4,2 115 11,9 122 12,6 57 5,9 4 0,4 Rep. Vanuatu Countrywide 2006 Surveillance 29 28 96,6 1 3,4 1 3,4 0 0,0 0 0,0 0 0,0 1 3,4 1 3,4 0 0,0 Viet Nam Countrywide 2006 Survey 1619 1. The reduction would be 106 Mono % Mono % Mdr % Hr % Hre % Hrs % Hres % Poly % He % Hs % Hes % Re % Rs % Res % Es % E S 0 0,0 9 3,6 1 0,4 0 0,0 0 0,0 0 0,0 1 0,4 8 3,2 0 0,0 8 3,2 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 1 5,6 2 11,1 2 11,1 0 0,0 0 0,0 0 0,0 1 5,6 0 0,0 1 5,6 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 1 0,1 60 6,2 39 4,0 10 1,0 5 0,5 5 0,5 19 2,0 37 3,8 5 0,5 21 2,2 8 0,8 1 0,1 0 0,0 0 0,0 2 0,2 7 0,3 26 1,0 71 2,7 24 0,9 33 1,3 4 0,2 10 0,4 47 1,8 16 0,6 26 1,0 3 0,1 1 0,0 1 0,0 0 0,0 0 0,0 2 0,2 23 2,6 2 0,2 0 0,0 0 0,0 0 0,0 2 0,2 12 1,3 2 0,2 9 1,0 1 0,1 0 0,0 0 0,0 0 0,0 0 0,0. Ethiopia Countrywide 2005 Survey 76 39 51,3 37 48,7 19 25,0 11 14,5 11 14,5 29 38,2 21 27,6 4 5,3 1 1,3 Gambia Countrywide 2000 Survey 15 15 100,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 Guinea Sentinel sites 1998 Survey 32 16 50,0 16 50,0 16 50,0 9 28,1 6 18,8 11 34,4 3 9,4 3 9,4 0 0,0 Kenya Nearly Countrywide 1995 Survey 46 29 63,0 17 37,0 17 37,0 0 0,0 0 0,0 3 6,5 14 30,4 14 30,4 0 0,0 Lesotho Countrywide 1995 Survey 53 35 66,0 18 34,0 16 30,2 3 5,7 2 3,8 9 17,0 11 20,8 9 17,0 0 0,0 Madagascar (2) Countrywide 2007 Survey 51 45 88,2 6 11,8 5 9,8 3 5,9 0 0,0 2 3,9 2 3,9 2 3,9 0 0,0 Mozambique Countrywide 1999 Survey 122 67 54,9 55 45,1 50 41,0 5 4,1 1 0,8 30 24,6 27 22,1 22 18,0 1 0,8 Rwanda Countrywide 2005 Survey 85 66 77,6 19 22,4 9 10,6 9 10,6 10 11,8 16 18,8 10 11,8 0 0,0 1 1,2 Senegal Countrywide 2006 Survey 42 29 69,0 13 31,0 10 23,8 7 16,7 7 16,7 12 28,6 4 9,5 1 2,4 0 0,0 Sierra Leone Nearly Countrywide 1997 Survey 13 5 38,5 8 61,5 8 61,5 3 23,1 1 7,7 3 23,1 4 30,8 4 30,8 0 0,0 South Africa Countrywide 2002 Survey 1465 1. Costa Rica Countrywide 2006 Survey 21 20 95,2 1 4,8 1 4,8 1 4,8 1 4,8 0 0,0 0 0,0 0 0,0 0 0,0 Cuba Countrywide 2005 Sentinel 19 12 63,2 7 36,8 2 10,5 1 5,3 0 0,0 6 31,6 6 31,6 1 5,3 0 0,0 Dominican Republic Countrywide 1995 Survey 117 56 47,9 61 52,1 43 36,8 37 31,6 15 12,8 30 25,6 26 22,2 12 10,3 10 8,5 Ecuador Countrywide 2002 Survey 185 104 56,2 81 43,8 56 30,3 62 33,5 10 5,4 38 20,5 24 13,0 5 2,7 11 5,9 El Salvador Countrywide 2001 Survey 100 78 78,0 22 22,0 12 12,0 13 13,0 3 3,0 9 9,0 12 12,0 3 3,0 5 5,0 Guatemala Countrywide 2002 Survey 155 70 45,2 85 54,8 56 36,1 45 29,0 31 20,0 67 43,2 34 21,9 6 3,9 3 1,9 Honduras Countrywide 2004 Survey 73 45 61,6 28 38,4 18 24,7 15 20,5 5 6,8 11 15,1 16 21,9 7 9,6 5 6,8 Mexico Baja California, 1997 Survey 107 63 58,9 44 41,1 35 32,7 30 28,0 15 14,0 20 18,7 16 15,0 11 10,3 2 1,9 Sinaloa, Oaxaca Nicaragua Countrywide 2006 Survey 103 66 64,1 37 35,9 30 29,1 9 8,7 9 8,7 21 20,4 18 17,5 11 10,7 1 1,0 Paraguay Countrywide 2001 Survey 51 41 80,4 10 19,6 6 11,8 6 11,8 1 2,0 2 3,9 7 13,7 3 5,9 4 7,8 Peru Countrywide 2006 Survey 360 210 58,3 150 41,7 109 30,3 95 26,4 33 9,2 107 29,7 52 14,4 13 3,6 8 2,2 Puerto Rico Countrywide 2005 Surveillance combined only. H R E S H R Iceland Countrywide 2005 Surveillance 1 1 100,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 Ireland Countrywide 2005 Surveillance 10 8 80,0 2 20,0 2 20,0 1 10,0 0 0,0 0 0,0 1 10,0 1 10,0 0 0,0 Israel Countrywide 2005 Surveillance 3 3 100,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 Italy Half of the country 2005 Surveillance 79 50 63,3 29 36,7 24 30,4 14 17,7 8 10,1 23 29,1 9 11,4 4 5,1 0 0,0 Kazakhstan Countrywide 2001 Survey 319 57 17,9 262 82,1 216 67,7 196 61,4 173 54,2 246 77,1 26 8,2 3 0,9 1 0,3 Latvia Countrywide 2005 Surveillance 182 86 47,3 96 52,7 90 49,5 66 36,3 63 34,6 93 51,1 9 4,9 3 1,6 0 0,0 Lithuania Countrywide 2005 Surveillance 440 176 40,0 264 60,0 250 56,8 212 48,2 239 54,3 141 32,0 27 6,1 14 3,2 2 0,5 Luxembourg Countrywide 2005 Surveillance 0 0 0 0 0 0 0 0 0 0 Malta Countrywide 2005 Surveillance 0 0 0 0 0 0 0 0 0 0 Netherlands Countrywide 2005 Surveillance 30 25 83,3 5 16,7 3 10,0 2 6,7 0 0,0 2 6,7 3 10,0 1 3,3 1 3,3 Norway Countrywide 2005 Surveillance 8 8 100,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 0 0,0 Poland Countrywide 2004 Surveillance 522 428 82,0 94 18,0 71 13,6 51 9,8 12 2,3 55 10,5 39 7,5 17 3,3 7 1,3 Portugal Countrywide 2005 Surveillance 172 127 73,8 35 20,3 26 15,1 19 11,0 10 5,8 18 10,5 14 8,1 6 3,5 2 1,2 Republic of Moldova Countrywide 2006 Surveillance 2054 605 29,5 1. Serbia Countrywide 2005 Surveillance 121 107 88,4 14 11,6 7 5,8 8 6,6 6 5,0 6 5,0 7 5,8 2 1,7 1 0,8 Slovakia Countrywide 2005 Surveillance 56 46 82,1 10 17,9 10 17,9 4 7,1 1 1,8 3 5,4 3 5,4 3 5,4 0 0,0 Slovenia Countrywide 2005 Surveillance 28 24 85,7 4 14,3 3 10,7 1 3,6 1 3,6 3 10,7 2 7,1 1 3,6 0 0,0 Spain Galicia 2005 Surveillance 68 59 86,8 9 13,2 5 7,4 1 1,5 1 1,5 6 8,8 6 8,8 2 2,9 0 0,0 Spain Aragon 2005 Surveillance 26 21 80,8 5 19,2 5 19,2 4 15,4 2 7,7 2 7,7 1 3,8 1 3,8 0 0,0 Spain Barcelona 2005 Surveillance combined only. Kerala State India Gujarat State 2006 Survey 1047 562 53,7 485 46,3 385 36,8 190 18,1 105 10,0 274 26,2 220 21,0 122 11,7 10 1,0 India Tamil Nadu State 1997 Survey new only.

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    It can be tors supplement clinical observation cialis black 800mg on line; there is no monitored using three leads applied to the right substitute for the presence of a trained and experi- shoulder (red) generic 800mg cialis black visa, the left shoulder (yellow) and the enced anaesthetist throughout the entire operative left lower chest (green), to give a tracing equivalent procedure. The pulse oximeter therefore This is the most common method of obtaining the gives information about both the circulatory and patient’s blood pressure during anaesthesia and respiratory systems and has the advantages of: surgery. A pneumatic cuff with a width that is 40% • providing continuous monitoring of oxygena- of the arm circumference must be used and the inter- tion at tissue level; nal inflatable bladder should encircle at least half • being unaffected by skin pigmentation; the arm. If the cuff is too small, the blood pressure • portability (mains or battery powered); will be overestimated, and if it is too large it will be • being non-invasive. Auscultation of the Korotkoff Despite this, there a number of important limita- sounds is difficult in the operating theatre and au- tions of this device: tomated devices (Fig. An • There is failure to realize the severity of hypoxia; electrical pump inflates the cuff, which then un- dergoes controlled deflation. A microprocessor- controlled pressure transducer detects variations in cuff pressure resulting from transmitted arterial pulsations. Initial pulsations represent systolic blood pressure and peak amplitude of the pulsa- tions equates to mean arterial pressure. The frequency at which blood pressure is estimated can be set along with values for blood pressure, outside which an alarm sounds. Such devices cannot measure pressure continually and become increasingly inaccurate at extremes of pressure and in patients with an arrhythmia. Hypoventilation can be compensated for by increasing the inspired oxygen concentration to maintain oxygen saturation. A single device embolus), the gap between arterial and end-tidal can be calibrated for all of the commonly used carbon dioxide increases (end-tidal falls), mainly inhalational anaesthetics. The gap also increases monitors are integrated and displayed on a single in patients with chest disease due to poor mixing screen (Fig. Urine Temperature output needs to be measured at least hourly, aim- During anaesthesia the patient’s temperature is ing for a flow of approximately 1mL/kg/h. The most com- to produce urine indicates that renal blood flow is monly used device is a thermistor, the resistance of inadequate, as well as the flow to the other vital which is temperature dependent. Catheterization also placed in the oesophagus (cardiac temperature) or eliminates bladder distension or incontinence. An infrared tympanic membrane thermome- This is measured by inserting a catheter via a cen- ter can be used intermittently, but the external tral vein, usually the internal jugular or subclavian, auditory canal must be clear. Most patients’ core so that its tip lies at the junction of the superior temperature falls during anaesthesia as a result of vena cava and right atrium. It is then connected via exposure to a cold environment, evaporation of a fluid-filled tube to a transducer that converts the fluids from body cavities, the administration of pressure signal to an electrical signal. This is then cold intravenous fluids and breathing dry, cold amplified and displayed as both a waveform and anaesthetic gases. It is nula is inserted into a peripheral artery and con- affected by a variety of other factors apart from fluid nected to a transducer that converts the pressure balance (Table 2. This is usually achieved using a fuel cell • coughing oxygen analyser that produces a current propor- • straining tional to the oxygen concentration, displayed as a • Pulmonary embolism numeric value of oxygen concentration. It must be • Pulmonary hypertension remembered that the inspired oxygen concentration •Tricuspid valve disease does not guarantee adequate arterial oxygen saturation • Pericardial effusion, tamponade as it may be insufficient to compensate for the • Superior vena cava obstruction effects of hypoventilation and ventilation/perfu- sion mismatch (see page 72). Irrespective of whether the patient is breathing spontaneously or being ventilated, capnography Pulmonary artery catheter and cardiac will detect most of the common problems, for output example disconnection (loss of reading), inade- See page 126. In addition, when a patient is venti- Blood loss lated, airway pressures must be monitored to avoid Simple estimates of blood loss during surgery are excessive pressures being generated within the easily performed. Airway pressure monitoring can also be used wet, the increase in weight giving an indication of as a secondary indicator of inadequate ventilation the amount of blood they have absorbed. The vol- in ventilated patients; high pressures may be the ume of blood in the suction apparatus can be meas- result of obstruction (e. Such bronchospasm), and loss of pressure the result of a methods are only estimates, as blood may remain disconnection. The latter function may be specifi- in body cavities, be spilt on the floor and absorbed cally used as a ‘disconnection alarm’. In paediatric practice, where small volumes of blood loss are relatively more Many other physiological parameters can be, and important, all absorbent materials are washed to are, monitored during anaesthesia when appropri- remove the blood and the resultant solvent as- ate.

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