LA RDC MON PAYS

Histoire de la République démocratique du Congo Un article de Wikipédia, l'encyclopédie libre. Aller à : navigation, rechercher Le territoire qui porte aujourd’hui le nom de République démocratique du Congo est peuplé depuis au moins 200 000 ans environ. Il y eut des grands États centralisés sur ce territoire comme les Kongo, Songye, Kuba, lunda et l'empire Luba... Les Européens ne reconnaissent la région qu'en 1482-1483 avec la découverte de l'embouchure du fleuve Congo par le marin portugais Diogo Cão. Le royaume Kongo est alors à son apogée. À partir de 1879, l'explorateur Henry Morton Stanley explore l'intérieur du futur pays pour le compte du roi des Belges Léopold II. Au cours de la conférence de Berlin (1884-1885), ce dernier parvient à faire reconnaître aux autres puissances européennes sa prise de possession du Congo. C'est le début de la colonisation. Le secteur contrôlé prend le nom d'État indépendant du Congo bien qu'il soit en fait la propriété personnelle de Léopold. En 1908, le Parlement belge reprend, par legs du roi Léopold II, la tutelle sur le territoire, nouvellement dénommé Congo belge. Le 30 juin 1960 le Congo arrache son indépendance à la Belgique. Patrice Lumumba joue un rôle capital dans cette émancipation. Chargée d'espoir, l'indépendance bascule le pays dans le chaos : le Katanga puis le Kasaï font sécession ; craignant pour leur vie, les Belges s'enfuient ; la Belgique puis les Nations Unies envoient des troupes ; les gouvernements congolais se succèdent après l'assassinat de Lumumba (janvier 1961). En 1965, Mobutu, chef d'état major de l'armée, renverse par un coup d’État le président Kasavubu. Le Congo retrouve une certaine stabilité au prix d'un régime autoritaire. Il devient le Zaïre. Mobutu se maintient au pouvoir pendant trente deux ans. En 1997, l'avance de l'AFDL, une force armée rebelle, l'oblige à fuir Kinshasa. Le régime tombe, affaibli par la crise économique, discrédité par la corruption, et abandonné par les puissances occidentales. Le porte-parole de l'AFDL, Laurent-Désiré Kabila, se proclame chef d'État en mai 1997. Le pays change encore une fois de nom devenant la République démocratique du Congo. Kabila conduit le pays d'une manière aussi autocratique que son prédécesseur et le plonge dans la guerre (Deuxième guerre du Congo). Depuis l'assassinat de Kabila (2001) et la fin du conflit, le Congo est entré dans une phase de démocratisation, marquée notamment par la tenue d'élections libres en 2006 et 2011. Le président actuel est Joseph Kabila, le fils de Laurent-Désiré. Sommaire [masquer] 1 Préhistoire, Moyen Âge et exploration par les Européens 2 Colonisation belge (1885-1960) 2.1 La propriété du roi Léopold II : l’État indépendant du Congo (1885-1908) 2.2 Le Congo belge (1908-1960) 2.3 L'accession à l'indépendance (1956-1960) 3 La première République (1960-1965) 4 La seconde République de Mobutu : Le Zaïre (1965-1997) 4.1 La mise en place de la dictature 4.2 Zaïrianisation et recours à l'authenticité 4.3 Économie 4.4 Structures politiques 4.5 Diplomatie 4.6 Chute de Mobutu (1989-1997) 4.6.1 La démocratisation du régime 4.6.2 Arrivée au pouvoir de Laurent-Désiré Kabila 5 République démocratique du Congo : vers la paix et la démocratie ? (1997 à aujourd'hui) 5.1 La guerre interafricaine 5.2 La normalisation 6 Chronologie 7 Notes et références 8 Voir aussi 8.1 Bibliographie 8.2 Filmographie Préhistoire, Moyen Âge et exploration par les Européens[modifier | modifier le code]Article détaillé : Congo précolonial.La zone qui porte aujourd’hui le nom de République démocratique du Congo est peuplée depuis au moins 200 000 ans environ d'après les découvertes de pierres taillées sur les sites de Mulundwa (Katanga), Katanda et Senga (Kivu)[1]. Des vestiges archéologiques de l'homo sapiens (os, pointes de harpons, outils en quartz) ont été découverts à Ishango dans le parc national des Virunga et datées entre 25000 et 20000 ans. Des peuples bantous venus d'une zone comprise entre l'Est du Nigeria et les Grassfields du Cameroun viennent s'installer dès 2600 ans avant J.-C. Les grands royaumes (luba, lunda, kongo) se forment entre les premiers siècles après Jésus-Christ et avant le XVe siècle, époque de l'arrivée des premiers Portugais sur le littoral atlantique. Mais de nombreuses populations vivaient alors dans des chefferies, c’est-à-dire de petites principautés plus ou moins auto-suffisantes. À partir de cette époque, on voit ces royaumes éclater sous l’impulsion de la traite et l’émergence de nouveaux rapports de force qui déboucheront sur la colonisation. Des jésuites portugais christianisent les rois et les peuples du Kongo. Les cultures du maïs et du manioc, importées d'Amérique, se répandent. La première carte européenne de la région est due à l’explorateur vénitien Alvise Cadamosto au service du Portugal (XVIe s.). Entre 1874 et 1877, Henry Morton Stanley, explorateur britannique, pénètre l'Afrique équatoriale, jusqu'alors terra incognita pour les Européens. Sur son bateau à vapeur, il descend le fleuve Congo, principale voie de pénétration, et cartographie la zone. Entre 1879 et 1884, l'explorateur effectue un deuxième voyage à travers le Congo, mais cette fois en remontant le fleuve. Sa mission est de créer des postes pour le compte de l'Association Internationale Africaine (AIA), que préside le roi des Belges Léopold II. L'Association a officiellement un objectif scientifique et philanthropique : il s'agit de continuer à cartographier la région et à lutter contre l'esclavage, en rachetant notamment les esclaves aux marchands afro-arabes. Elle s'avère surtout un moyen d'expansion pour le roi de Belges. Stanley et ses compagnons négocient avec les chefs locaux pour s'approprier les terres et exploiter les richesses du pays. Des missionnaires protestants débarquent. En 1884-1885, au cours de la Conférence de Berlin, les grandes puissances européennes reconnaissent l'Association Internationale du Congo (AIC succédant à l'AIA). Derrière celle-ci, opère en fait Léopold II qui se voit en fait reconnaître son autorité sur un gigantesque territoire en Afrique centrale. Ce territoire, découpé par Stanley, et encore en grande partie inexploré, est nommé État indépendant du Congo (1885). Derrière la façade de l'AIC, cet État est en fait la propriété personnelle du roi. Colonisation belge (1885-1960)[modifier | modifier le code]Article détaillé : Colonisation du Congo.La colonisation du Congo se réfère à la période comprise entre la prise de possession par le roi Léopold II de Belgique en 1885 et l'indépendance en 1960. La propriété du roi Léopold II : l’État indépendant du Congo (1885-1908)[modifier | modifier le code]Article détaillé : État indépendant du Congo.Le roi Léopold II prend possession du territoire en son nom propre sous le nom d’État Indépendant du Congo. Des expéditions d'exploration sont lancées, et les voies de communication développées. La maîtrise du territoire s'achève en 1894 pour l'essentiel avec la fin de la guerre contre les Arabo-Swahilis. L'exploitation intensive du territoire commence alors, où se côtoient tant les missionnaires que les aventuriers à la recherche de fortune facile par tous les moyens. La population locale doit notamment récolter par le travail forcé pour le compte du Domaine royal ou de compagnies privées du caoutchouc. Le marché de ce matériau est alors en pleine expansion en raison de la demande mondiale en pneus. À la fin du XIXe siècle, on commence à découvrir les richesses minières du Congo : le cuivre, l'or, le diamant... Après avoir servi à rembourser les emprunts, la vente du caoutchouc et des produits miniers, facilitée par la toute nouvelle ligne de chemin de fer Matadi-Léopoldville, fait la fortune de Léopold II, qui fait construire de nombreux bâtiments à Bruxelles et Ostende. Au cours de la période 1885-1908, la population eut à souffrir de cette exploitation forcée, de façon directe ou indirecte. De très nombreuses exactions (meurtres, mutilations, tortures…) furent commises, et la population décrut. Il y eut cependant des protestations contre ces traitements qui allaient à l'encontre des principes fondateurs de l'État, notamment de la part de l’écrivain Mark Twain, du diplomate britannique Roger Casement, dont le rapport de 1904 condamnait les pratiques en vigueur au Congo et surtout du journaliste anglais du West Africain mail Edmond Morel. Suite à ces dénonciations, Léopold II est contraint de laisser sa colonie à l’État belge. Le Congo belge (1908-1960)[modifier | modifier le code]Article détaillé : Congo belge.En 1908, le Parlement belge reprend la tutelle sur le territoire désormais appelé Congo belge. Une colonisation plus "classique" se met en place. Un ministre des Colonies est institué tandis qu'un gouverneur général est installé sur place, à Boma. La situation de la population s'améliore graduellement : un réseau d'établissements sanitaires permet de faire reculer les maladies et la malnutrition, l'enseignement est développé notamment par les missionnaires protestants et catholiques, et le pays est mis en exploitation, avec notamment la découverte des formidables ressources minières du Katanga. Le travail forcé, notamment dans les mines, persiste cependant sous diverses formes jusqu'à la Seconde Guerre mondiale, Les Congolais s'acculturent à l'Europe par l'intermédiaire des missions qui établissent des écoles et des chapelles à travers le pays, par l'incorporation dans l'armée (la Force publique) ou par le travail de boy (serviteur) pour les Blancs[2]. En travaillant dans les mines, sur les chantiers de chemin de fer ou dans les plantations, ils découvrent le salariat alors que l'économie domestique était principalement basé sur le troc. Le contrôle de la population se structure, ayant notamment recours au fichage ethnique et à des méthodes d'apartheid. Les Blancs ne vivent pas dans les mêmes quartiers que les Noirs. Ces derniers ne peuvent pas entrer dans la police ou dans l'enseignement. Une émancipation de la population, notamment par l'accès à des études supérieures, n'est envisagée qu'à l'aube de l'indépendance en 1960. À cette date, il n'y a aucun médecin ou juriste congolais. Toutefois, depuis la fin de la Seconde Guerre mondiale émerge la classe des évolués, des Congolais instruits, salariés, citadins, dont le mode de vie ressemble à celui d'un Européen. C'est parmi eux que se trouveront les leaders de la lutte pour l'indépendance : Patrice Lumumba, Joseph Kasavubu, Moïse Tshombe... Lors du déclenchement de la Première Guerre mondiale, la Force publique participa à la campagne victorieuse contre l'Afrique orientale allemande. La Belgique récupère par conséquent le protectorat sur le Ruanda-Urundi. Au cours de la Seconde Guerre mondiale, la Force publique remporta un certain nombre de victoires sur les troupes italiennes en Afrique du Nord. Le Congo belge fournit aussi le minerai d'uranium extrait de la mine de Shinkolobwe et employé pour les bombes nucléaires d'Hiroshima et Nagasaki. Avant l'indépendance, le pays compte 14 000 km de voies ferrées et une centaine de centrales électriques ou à charbon. Il est le troisième producteur mondial de cuivre et le premier producteur de diamant[2]. L'accession à l'indépendance (1956-1960)[modifier | modifier le code]Les Belges pensent avoir trouvé le système parfait : une présence permanente tout en gardant l'estime des Africains. L'amélioration lente mais continue du niveau de vie semble justifier les vertus de la colonisation belge. Mais sous cet ordre en surface se développent des revendications venant de sectes religieuses, des tribus et des intellectuels. Vers 1920, Simon Kimbangu prêche une forme originale de christianisme ; les autorités belges jugeant son enseignement subversif le condamne à mort puis à la détention perpétuelle. Cependant, la prise de conscience politique des Congolais se manifeste tardivement. En 1956, sont publiés trois manifestes, Conscience Africaine, la Déclaration de l'épiscopat du Congo Belge et le Contre-Manifeste. Dans le premier texte, les signataires notamment Joseph Malula (futur cardinal de Kinshasa), Joseph Ileo et d'autres élèves des Pères de Scheut, revendiquent "l'émancipation politique complète dans un délai de trente ans"[3]. Dans le second texte, l'Église prend ses distances avec l’État colonial en insistant sur le fait que les Congolais "ont le droit de prendre part à la conduite des affaires publiques"[4]. Le Contre Manifeste rédigé par l'ABAKO de Joseph Kasavubu est encore plus radical en exigeant l'émancipation immédiate[5]. En 1957, la Belgique accepte l'organisation d'élections locales. Les Congolais votent pour la première fois. L'annulation d'un meeting de l'ABAKO provoque le 4 janvier 1959 des émeutes à Léopoldville que la répression militaire noie dans le sang (quelques centaines de morts, tous Congolais)[6]. Au début de l'année 1960, au cours d'une table ronde réunissant à Bruxelles des indépendantistes congolais et des délégués du Parlement et du gouvernement belges, l'indépendance du Congo est fixée au 30 juin de la même année. La Belgique précipite l'événement car elle craint une rébellion du Congo (les Algériens se battent alors pour leur indépendance) et un isolement international dans un contexte où les grandes puissances (Royaume-Uni et France principalement) se séparent une à une leurs colonies en Afrique Noire. Enfin, la métropole sait qu'elle conservera finalement la mainmise sur son ex-colonie : les grandes entreprises et les officiers de l'armée congolais resteront belges tandis que les futurs dirigeants solliciteront l'aide de conseillers belges. La Belgique organise des élections législatives pour élire les membres du parlement à qui elle signerait et remettrait les documents signifiant l'indépendance de la république démocratique du Congo Patrice Lumumba joue un rôle crucial, mettant en avant une vision nationale du Congo et non fédérale comme le voulaient les Belges et des Congolais opportunistes. Le MNC de Lumumba et ses alliés remportent les élections nationales avec 65 % de sièges au Parlement. L'État indépendant sera sous régime parlementaire, le Premier Ministre étant le chef du gouvernement, le président n'ayant qu'un rôle symbolique. À l'occasion de la nomination du président, Lumumba convainc ses amis et alliés d'offrir ce poste à son adversaire Joseph Kasavubu car estime-t-il la victoire contre les colons est d'abord celle de tous les Congolais. La première République (1960-1965)[modifier | modifier le code]Article détaillé : Crise congolaise.Joseph Kasavubu est président de la République du Congo tandis que Patrice Lumumba occupe les postes de Premier ministre et ministre de la Défense. Très rapidement, les relations avec la Belgique se tendent. Quelques jours après l'indépendance, les soldats de la Force Publique, foyer de la ségrégation raciale, se mutinent suite à la provocation de son commandant en chef, le général belge Emile Janssens[7]. Les mutins pillent les propriétés des Européens, s'en prennent aux officiers et aux civils européens. Le gouvernement belge envoie des troupes pour protéger ses ressortissants. La révolte militaire s'éteint après le limogeage de Janssens par Lumumba et la promotion immédiate de Congolais comme officiers de la Force Publique[8]. L'ami de Lumumba, Joseph Mobutu, est nommé chef d'État major avec le grade de colonel. Dans le même temps, le 11 juillet, Moise Tshombe, d’origine lunda, déclare l'indépendance de la riche province minière du Katanga (représentant 70 % des devises) sous le nom d'État du Katanga. La Belgique semble soutenir les sécessionnistes. Le 14 juillet, Kasavubu et Lumumba rompent leur relation diplomatique avec l'ancienne métropole, l'accusant d'être intervenue militairement sans la permission express du gouvernement congolais. À son tour, la province du Sud-Kasaï fait sécession sous l’égide d’Albert Kalonji. Lumumba s'adresse à l’ONU pour être aidé à reprendre le contrôle du Katanga ; si le secrétaire général des Nations Unies Dag Hammarskjöld envoie bien des casques bleus, il ne leur donne pas l'ordre d'attaquer les sécessionnistes du Katanga. Lumumba demande alors l’aide de l’URSS qui répond favorablement en lui envoyant notamment des techniciens, des avions et véhicules militaires[9]. Pour le président des États-Unis, Dwight Eisenhower, il est évident que Lumumba est un communiste. Craignant qu'un bastion communiste se créé au centre de l’Afrique, le président américain donne l'ordre à la CIA d'éliminer Lumumba mais la tentative d’empoisonnement échoue. Voyant que son premier ministre n'arrête pas de se faire des ennemis, le président Kasavubu le démet de ses fonctions. Soutenu par le parlement, Lumumba, à son tour, démet le président de ses fonctions. Partagée entre les deux hommes, l'ONU vote finalement la confiance à Kasavubu. Celui-ci nomme Joseph Mobutu premier ministre pendant que Lumumba est placé en résidence surveillée à Kinshasa le 10 octobre 1960. Ce dernier s’enfuit et tente de rejoindre ses partisans à Stanleyville mais des soldats de Mobutu le capturent. Kasavubu et son nouveau premier ministre l'envoie par avion à son ennemi, Moise Tshombe, leader du Katanga indépendant. Le 17 juin 1961, il est exécuté par un peloton sous les yeux de ministres katangais et d'officiers belges[10]. La radio préfère annoncer que Lumumba a été victime de villageois. Les premiers ministres se succèdent jusqu'à ce que Mobutu mène le 24 novembre 1965 un deuxième coup d’État militaire qui, cette fois, renverse le président Kasavubu. La seconde République de Mobutu : Le Zaïre (1965-1997)[modifier | modifier le code]La mise en place de la dictature[modifier | modifier le code]Immédiatement après le coup d'État, Mobutu s'autoproclame président. En quelques années, Il vide de son contenu la constitution républicaine et crée une véritable dictature. Il se fait accorder ou s'octroie des pouvoirs exceptionnels : il cumule les fonctions de premier ministre, de chef de l'armée et de législateur. Il nomme les ministres. Le MPR (Mouvement populaire de la Révolution) est le parti-État auquel toute la population doit adhérer. Le régime de Mobutu est fondé sur l’autorité et le nationalisme, qui sont les secrets de sa longévité. D’entrée, Mobutu se présente comme le libérateur des Noirs, en nationalisant les mines (1966) et déboulonnant les statues coloniales dans la capitale Léopoldville rebaptisée Kinshasa la même année. Les Congolais qui viennent de sortir de l’époque coloniale sont alors très sensibles à cette propagande. La police politique recherche, intimide ou torturent les opposants politiques. Suite à des voyages en Chine et en Corée du Nord, Mobutu met en place le culte de sa personnalité. Son portrait apparait à la télévision juste avant le journal du soir. Des panneaux dans les rues vantent sa politique ; des chants célèbrent ses vertus[11]. Zaïrianisation et recours à l'authenticité[modifier | modifier le code]Article détaillé : Zaïrianisation.Dès 1971, Mobutu prend une série de mesures pour se détacher de tout ce qui peut rappeler l'Occident. Le pays est renommé « République du Zaïre ». Les Congolais doivent adopter des noms africains (suppression des prénoms occidentaux, et rajout d'un « postnom ») à l'image de Mobutu qui se fait appeler Mobutu Sese Seko Kuku Ngbendu wa Zabanga. La tenue vestimentaire abacost est imposée aux hommes en lieu et place du costume-cravate. Une nouvelle monnaie - le zaïre divisé en 100 makuta (singulier likuta) - remplace le franc congolais. De nombreuses villes sont rebaptisées : Stanleyville devient Kisangani, Elisabethville Lubumbashi. Lors du sixième anniversaire de l’indépendance, un défilé résume l’histoire du pays, montrant notamment le Belge infligeant la chicotte. En arrière-plan, les relations entre la Belgique et le président sont bonnes : en 1968, en voyage à Bruxelles, Mobutu reçoit le Grand Cordon de l'ordre de Léopold[12]. Le roi Baudouin est à son tour reçu au Zaïre en 1970 et 1985. Réalisée dans le courant de l'année 1974, la « zaïrianisation » a constitué l'un des événements des plus importants de la politique menée par le régime mobutiste, à savoir la nationalisation progressive des biens commerciaux et des propriétés foncières qui appartenaient à des ressortissants ou groupes financiers étrangers. En réalité, si cette mesure s'inscrivait officiellement dans un effort visant à la réappropriation nationale de l'économie ainsi qu'à la redistribution des richesses acquises pendant la colonisation, elle constitue surtout un échec. Économie[modifier | modifier le code]Après la première guerre du Congo, Mobutu, nouveau chef d’État s’est engagé à regagner la confiance des milieux d’affaires étrangers. En 1966, les puissantes industries minières du Kasaï et du Katanga ont été nationalisées. C'est alors l’âge d’or du Congo, maintenant indépendant : en 1967 1 franc congolais vaut alors 2 dollars américains, les écoles publiques se développent et l’exode rural s’accélère ; les prix du café, du cuivre ou d’autres minerais sont florissants. La réalisation de grands travaux (le barrage hydroélectrique d’Inga sur le Congo), le financement d'un programme spatial donnent l'impression que le Zaïre, à l'image de certains pays asiatiques émergents, est un dragon africain. Cependant l’économie du pays est encore, comme à l’époque coloniale, trop tournée vers l’exportation et donc fragile. À partir de 1973, le pays est touché par une crise économique aiguë, causée par la baisse des prix du cuivre et à l’augmentation de ceux du pétrole. La corruption se généralise et l'inflation devient galopante tandis que Mobutu privatise de nombreuses entreprises à son nom ou aux noms de ses proches (« Zaïrianisation »)[13]. Le pays produit d’importantes quantités de café pour l’exportation mais ne couvre pas ses besoins alimentaires, Mobutu fait importer des céréales et de la viande d’Afrique du Sud et de Rhodésie au lieu de moderniser l’agriculture du pays qui, vu son climat, pourrait facilement subvenir à ses besoins. Dans les années 1980, l'économie congolais tourne au marasme : le PIB croît faiblement alors que la croissance démographique explose. De manière générale, les nouveaux propriétaires de biens économiques et financiers ne sont pas suffisamment préparés pour assurer une gestion de moyen et de long terme de l'outil de production. Ceux qui n’ont pas fait faillite ont placé d’immenses investissements en Occident. Mobutu détourne les devises d’État de telle façon qu'en 1984, il est un des hommes les plus riches de la planète avec 4 milliards de dollars, l’équivalent de la dette extérieure du pays. La dette s’accroît encore plus avec la construction pharaonique du barrage hydroélectrique d’Inga, chantier légué par la Belgique coloniale et dont le Zaïre n’avait pas besoin. Si le barrage d’Inga a rapporté de l’argent aux entreprises françaises (EDF) ou italiennes, celui-ci, tout comme l'aciérie de Maluku fonctionnent à capacité réduite, faute de maintenance et de personnel compétent[14],[15]. La dictature, les persécutions et la paupérisation font fuir les cerveaux en Occident (Belgique et France en tête). Structures politiques[modifier | modifier le code]La mise à disposition de fonds commerciaux et de patrimoines économiques a également constitué un relais du clientélisme entretenu par le pouvoir. Le clan entourant le chef de l'État a ainsi pu bénéficier des fruits de la politique de nationalisation, tout comme ceux qui dans les différentes régions du pays, faisaient allégeance au régime en échange d'un commerce ou d'une propriété foncière. De nombreux pays occidentaux ont signé des conventions avec le Zaïre afin de procéder à l'indemnisation des parties spoliées, mais dans la très grande majorité des cas, ces accords n'ont jamais été appliqués. La corruption devient l'une des caractéristiques du régime. Diplomatie[modifier | modifier le code]Bien que le régime mobutiste se soit inscrit dès le départ dans le sillage de la guerre froide, en privilégiant des liens étroits avec l'ancienne puissance coloniale belge, les États-Unis et la France, on peut néanmoins parler de manière générale de schéma politique particulier. 24 novembre 1965 : Le coup d'État orchestré à Kinshasa n'aurait pas pu avoir lieu sans appuis occidentaux, qui craignent un basculement du géant africain dans la sphère de l'Union soviétique. Le colonel Mobutu représente à leurs yeux la seule alternative face à la politique prônée jadis par le panafricaniste Lumumba et à l'incapacité du président Kasa-Vubu de stabiliser son gouvernement. De 1970 à 1980, le Zaïre constitue une forme de rempart anti-communiste en Afrique, une situation d'autant plus attrayante pour les pays occidentaux que l'endiguement de la sphère soviétique (ex. Congo-Brazzaville), s'accompagne d'un accès au très important sous-sol minier (cuivre, uranium, cobalt, etc.). Ainsi, en parallèle de la coopération militaire avec des pays comme la Belgique et la France, le Zaïre a également servi de principale base arrière d'approvisionnement en armes de la rébellion du Front national de libération de l'Angola FNLA de Holden Roberto et l’UNITA de Jonas Savimbi, soutenue par les États-Unis et l'Afrique du Sud, contre le régime marxiste angolais. Un élément clé du conflit dans le Sud-Ouest africain transite ainsi par le canal du régime zaïrois et ce, en échange d'un soutien politique externe mais aussi interne. 1977 : des rebelles « katangais » venus d’Angola envahissent le Shaba, les troupes de Mobutu sont impuissantes, les rebelles sont repoussés par des troupes marocaines acheminées par l’aviation française[16] mai 1978 : à nouveau, 4 000 rebelles venus d’Angola, « les gendarmes katangais », attaquent la ville minière de Kolwezi, comme on les accuse d’avoir massacré des Européens, la Légion étrangère françaises et des soldats belges interviennent pour mater la rébellion[17]. Dans ces deux opérations, certains ont pu voir une tentative des marxistes angolais d’affaiblir Mobutu qui soutient l’UNITA et le FNLA. Les rebelles en tout cas en noyant les mines de Kolwezi, font aussi fuir pour de bon les ingénieurs, ce qui affaiblit l’économie zaïroise à long terme. Cette guerre interposée entre Luanda et Kinshasa montre aussi l’importance du Zaïre aux yeux des Occidentaux. Pour autant, en dépit des liens étroits entretenus avec les capitales occidentales, le président Mobutu ne ferme à aucun moment véritablement la porte aux pays situés dans l'orbite soviétique et à la Chine. En réalité, il s'agissait plus d'affinités du régime zaïrois pour les oripeaux des différents systèmes communistes que pour l'idéologie de base. Ainsi, le modèle de la révolution culturelle de Mao inspire le dirigeant zaïrois, qui l'adapte à son pays : naissance de l'abacost (« à bas le costume ») surmonté d'un col mao, publication du petit livre vert (1968), recueil des citations de Mobutu, équivalent du petit livre rouge de Mao retour à l'« authenticité » des patronymes individuels. Bien que largement inférieurs à l'aide occidentale, les appuis issus des pays du bloc de l'Est n'en sont pas moins existants à l'instar de la mise à disposition de coopérants dans l'enseignement ou le financement de micro-projets de développement. Chute de Mobutu (1989-1997)[modifier | modifier le code]La démocratisation du régime[modifier | modifier le code]Avec la fin de la Guerre froide, symbolisée par la chute du Mur de Berlin en novembre 1989, le régime de Mobutu perd la plupart de ses soutiens occidentaux. L'arrestation puis l'exécution de son ami Nicolae Ceaușescu en Roumanie semble avoir ébranlé le dictateur. Des manifestations, des grèves, des marches de protestation agitent Kinshasa et d'autres centres urbains. Le 24 avril 1990, dans le "Discours de la démocratisation", Mobutu annonce une série de réformes politiques pour son pays : abandon de la présidence du MPR, multipartisme, des élections d'ici deux ans[18]. Un premier ministre est nommé fin avril. Porté par ce revirement, l'épiscopat zaïrois propose l'organisation d'une Conférence Nationale pour soutenir la transition démocratique. Mobutu accepte. Pendant environ un an et demi (août 1991-décembre 1992), la Conférence, réunie à Kinshasa, discute d'une nouvelle constitution pour remplacer celle de Luluabourg (1964) mais ne débouche sur rien. Une "marche de l'espoir" organisée par les chrétiens de Kinshasa est réprimée dans le sang le 16 février 1992[19]. Contrairement au vœu de la rue, Mobutu ne compte pas abandonner le pouvoir. L'élection d’Étienne Tshisekedi, principal leader de l'opposition, comme premier ministre par les Conférenciers[20] n'apporte pas de changement. Mobutu le démet de son poste le 5 février 1993. La tentatives de libéralisation du régime ne résolvent pas la crise économique. Dans les années 1990, le PIB diminue. Le pays n'arrive plus à assumer le service de la dette. Les services publics s'effondrent, l'inflation galopante ruine le pouvoir d'achat (+ 9769 % en 1994[2]). Le 21 septembre 1991, des soldats, impayés, pillent les magasins de Kinshasa et d'autres villes. Nouvelles scènes de pillage, du 28 au 30 janvier 1993, dans la capitale, beaucoup plus violent : on compte environ un millier de morts dont l'ambassadeur de France[21]. Arrivée au pouvoir de Laurent-Désiré Kabila[modifier | modifier le code]Article détaillé : Première guerre du Congo.Le génocide au Rwanda redonne une crédibilité internationale au maréchal Mobutu. Il accepte d'accueillir en Ituri les réfugiés rwandais fuyant la zone de l’opération Turquoise. Le Zaïre accueille 1,5 millions de personnes. Au Rwanda, les tutsis ont pris le pouvoir mais s’inquiète de la présence à la frontière zaïroise de ces camps de réfugiés principalement hutus : ils craignent qu’ils ne reprennent les armes et entre au Rwanda. Déjà, ces réfugiés Hutu sont accusés de persécuter les Tutsis du Zaïre. En 1996, le président rwandais Paul Kagame excite les tensions. Physiquement, Mobutu est malade : il souffre d’un cancer de la prostate. Son premier ministre Kengo Wa Dondo exerce de plus en plus de pouvoir. L’armée du Zaïre est déliquescente. Seule la Division spéciale présidentielle maintient le régime. Le Rwanda de Paul Kagame, l’Ouganda de Yoweri Museveni et des Zaïrois se coalise dans un mouvement hétéroclite appelé AFDL (Alliance des Forces démocratiques pour la libération du Congo). Cette rébellion armée, soutenue par les États-Unis de Bill Clinton et l’Angola de Dos Santos, vise officiellement à renverser Mobutu mais sert aussi de couverture à la pénétration par le Rwanda et l'Ouganda du Zaïre pour traquer les réfugiés hutus et accéder aux richesses du sous-sol[22]. Un ancien marxiste congolais, Laurent-Désiré Kabila s'impose à sa tête. Muluba, né à Moba au Katanga, il a milité pour l’indépendance du Congo belge, a fui la guerre civile de 1960-1965 en Tanzanie, devenu là-bas trafiquant d’ivoire et d’or. L'AFDL reçoit le financement de lobbys miniers américains et canadiens. Kabila signera en effet des accords concernant l'exploitation minière avec les sociétés American mineral fields (le futur Adastra), Barrick Gold, First American Diamond, Horsham Corporation, Anglo Gold ashanti. La faible motivation des soldats zaïrois à résister, la corruption de leurs officiers, la lassitude de la population par rapport au mobutisme facilite l'avancée de l'AFLD[23]. Alors que la rébellion approche de Kinshasa, Mobutu fuit dans sa ville natale de Gbadolite, puis s'envole pour le Togo puis le Maroc. Sans combattre, les forces de l'AFDL entrent dans Kinshasa le 17 mai 1997, bientôt rejointes par Laurent-Désiré Kabila qui s'autoproclame président du pays. L'opposition, historique et non violente, d’Étienne Tshisekedi est ignorée par le nouveau pouvoir. République démocratique du Congo : vers la paix et la démocratie ? (1997 à aujourd'hui)[modifier | modifier le code]Bien que le Zaïre soit rebaptisé République démocratique du Congo, le régime de Kabila s'avère aussi autoritaire que du temps de Mobutu. Le multipartisme est supprimé, une nouvelle constitution met le président à la tête des pouvoirs exécutifs, législatifs et judiciaire. Il est aussi le chef du seul parti autorisé (l'AFLD), de l'armée, de l'administration et de la diplomatie et choisit les ministres. La guerre interafricaine[modifier | modifier le code]Article détaillé : Deuxième guerre du Congo.Le 26 juillet 1998, volte-face de Kabila qui rompt avec ces anciens alliés extérieurs : le Rwanda et l'Ouganda. Les deux pays déclarent la guerre à la RDC puis l'envahissent. C'est le début de la deuxième guerre du Congo, parfois appelée la Grande Guerre africaine[24], en raison du nombre de pays belligérants et de morts. Terminé en 2003, c'est le conflit le plus meurtrier depuis la Seconde guerre mondiale. Il est pourtant peu couvert par les médias, sûrement gênés par la complexité du conflit[25]. Ne pouvant pas faire face à l'invasion, Kabila appelle les armées angolaise, zimbabwéenne et namibienne à l’aide. A Kinshasa, Didier Mumengi, ministre de l'information et porte-parole du gouvernement, lance le mot d'ordre de résistance populaire. Il invente le slogan "la Paix se gagne" et organise des "Forces d'Auto-défense Populaire" (FAP). Les envahisseurs se divisent entre le MLC (Mouvement pour la Libération du Congo) de Jean-Pierre Bemba soutenu par l’Ouganda et le RCD soutenu par le Rwanda. Le président Laurent-Désiré Kabila est assassiné par un garde du corps le 16 janvier 2001. Son fils Joseph Kabila, 28 ans, lui succède immédiatement. La normalisation[modifier | modifier le code]Articles détaillés : Gouvernement de transition de la République démocratique du Congo et Troisième République (République démocratique du Congo).En 2003, Kabila démarre une transition démocratique. Une nouvelle constitution est adoptée par referendum en 2005. L'année suivante, les premières élections libres depuis 1966 confirment Kabila à la tête du pays. Il remporte son deuxième mandat en décembre 2011, les observateurs nationaux et internationaux des élections jugeant toutefois les élections comme manquant de crédibilité et de transparence[26]. Le pays reste troublé à l'est, dans le Kivu et en Ituri, par des bandes armées, des dissidents et des déserteurs. Chronologie[modifier | modifier le code]1482-1483 : découverte de l'embouchure du Congo par les Portugais 1506-1524 : Règne de Nzinga Mbemba, connu sous le nom d'Afonso Ier, roi du Kongo Vers 1680 : fin du royaume Kongo 1874-1877 : exploration du fleuve Congo par Henry Morton Stanley 1876 : fondation de l’Association Internationale Africaine (AIA) par Léopold II de Belgique 1879 : retour de Stanley au Congo pour coloniser des terres au travers de l’AIA 1884 novembre -1885 février : Conférence de Berlin 1886 : Léopold II de Belgique devient roi de l’État Indépendant du Congo (EIC) 1908 : Léopold II de Belgique cède l’EIC à la Belgique, naissance du Congo belge, charte coloniale pour la gestion du Congo et scandales dans la presse belge 1914-1918 : Participation à la première guerre Mondiale. Combats sur lac Tanganyika et sur ses rives (1914-1915). Invasion de l'Afrique orientale allemande par les forces belgo-congolo-britanniques en 1916. 1921 Condamnation à mort du leader religieux Simon Kimbangu 1940 : entrée en guerre du Congo du côté des Alliés 1959 : émeutes à Léopoldville pour l’indépendance 30 juin 1960 : indépendance du Congo 1961 : Exécution de l'ancien premier ministre Patrice Lumumba Novembre 1965 : second coup d’État de Mobutu. 1972 : Le pays est rebaptisée Zaïre. 1990 : début d'une libéralisation politique de la dictature 17 ami 1997 : Laurent-Désiré Kabila s'autoproclame président de la République démocratique du Congo après la fuite de Mobutu. 16 janvier 2001 : assassinat du président Laurent-Désiré Kabila. Son fils lui succède. 2006 : élections présidentielles : victoire de Kabila fils. 2011 : Nouvelles élections présidentielles : nouvelle victoire de Kabila Notes et références[modifier | modifier le code]1.↑ Bernard Clist, Découvertes archéologiques en République démocratique du Congo [archive] (pdf) 2.↑ a, b et c David Van Reybrouck, Congo. Een geschiedenis, 2010 (trad. française : Congo. Une histoire, Actes sud, 2012.) 3.↑ Isidore Ndaywel è Nziem, Théophile Obenga, Pierre Salmon, Histoire générale du Congo: de l'héritage ancien à la république démocratique, p.515 4.↑ Isidore Ndaywel è Nziem, Théophile Obenga, Pierre Salmon, Histoire générale du Congo: de l'héritage ancien à la république démocratique, p.518 5.↑ Isidore Ndaywel è Nziem, Théophile Obenga, Pierre Salmon, Histoire générale du Congo: de l'héritage ancien à la république démocratique, p.519-520 6.↑ Isidore Ndaywel è Nziem, Théophile Obenga, Pierre Salmon, Histoire générale du Congo: de l'héritage ancien à la république démocratique, p.537 7.↑ Il écrit sur un tableau noir devant ses troupes « avant indépendance = après indépendance » 8.↑ Isidore Ndaywel è Nziem, Théophile Obenga, Pierre Salmon, Histoire générale du Congo: de l'héritage ancien à la république démocratique, p.571 9.↑ Frank R. Villafana, Cold War in the Congo: The Confrontation of Cuban Military Forces, 1960-1967, Transaction Publishers, 2012, p.24 10.↑ Ludo de Witte, L'assassinat de Lumumba, Karthala éditions, 2000, p.253-258 11.↑ Mobutu roi du Zaïre, film documentaire de Thierry Michel, 1999 12.↑ Gauthier de Villers, De Mobutu à Mobutu: trente ans de relations Belgique-Zaïre, De Boeck Supérieur, 1995, p.33 13.↑ Les années Mobutu (1965-1989): l'accroissement exponentiel d'une dette odieuse [archive] 14.↑ Jean-Claude Willame, Zaïre : L’épopée d’Inga, Chronique d’une prédation industrielle, Paris, L’Harmattan, 1986 15.↑ Le barrage d’Inga, l’exemple emblématique d’un éléphant blanc pp.22-26 [archive] 16.↑ Crawford Young, Thomas Edwin Turner, The Rise and Decline of the Zairian State, 1985, p.256-257 17.↑ Crawford Young, Thomas Edwin Turner, The Rise and Decline of the Zairian State, 1985, p.257-258 18.↑ Ngimbi Kalumvueziko, Congo-Zaïre: Le destin tragique d'une nation, L'Harmattan, 2013, p.179 19.↑ Kambayi Bwatshia, L'illusion tragique du pouvoir au Congo-Zaïre, L'Harmattan, 2007, p.148-149 20.↑ Ngimbi Kalumvueziko, Congo-Zaïre: Le destin tragique d'une nation, L'Harmattan, 2013, p.181-189 21.↑ David Van Reybrouck, Congo. Een geschiedenis, 2010 (trad. française : Congo. Une histoire, Actes sud, 2012) 22.↑ Ngimbi Kalumvueziko, Congo-Zaïre: Le destin tragique d'une nation, L'Harmattan, 2013, p.195 23.↑ Ngimbi Kalumvueziko, Congo-Zaïre: Le destin tragique d'une nation, L'Harmattan, 2013, p.201 24.↑ Filip Reyntjens, The Great African War: Congo and Regional Geopolitics, 1996-2006, Cambridge University Press, 2009 25.↑ La guerre n'oppose pas deux camps bien circonscrits ; les méchants et les victimes ne se distinguent pas facilement. David Van Reybrouck, Congo. Een geschiedenis, 2010 (trad. française : Congo. Une histoire, Actes sud, 2012) 26.↑ "RD Congo : 24 morts depuis l’annonce du résultat de l’élection présidentielle", Human Rights watch, 22 décembre 2011 Voir aussi[modifier | modifier le code]Bibliographie[modifier | modifier le code]Sur les autres projets Wikimedia : Histoire de la République démocratique du Congo, sur Wikimedia CommonsColette Braeckman, L’Enjeu congolais. L’Afrique centrale après Mobutu, Paris : Fayard, 1999. Buchmann, J., L'Afrique noire indépendante, Paris, 1962. Buana Kabwe, L'Expérience zaïroise : du casque colonial à la toque de léopard, Paris, Afrique Biblio Club, 1975. Briselance, M.F., Histoire de l’Afrique, Paris, Ed. Jeune Afrique, 1988, 2 t. Breuil, H., Le Paléolithique du Congo-Belge d'après les recherches du docteur Cabu, Transactions of the Society of South Africa, 1944, 30, part. 2, p. 143-160. Braeckman, C. et alii, Congo-Zaïre : la colonisation, l'indépendance, le régime Mobutu et demain, Bruxelles, GRIP, 1990. Deward, G., Histoire du Congo, Liège-Paris, Dessain, 1962. Isidore Ndaywel è Nziem, Théophile Obenga, Pierre Salmon, Histoire générale du Congo: de l'héritage ancien à la république démocratique, De Boeck Supérieur, 1998. Kisonga Mazakala, Albert, 45 ans d'histoire congolaise : l'expérience d'un lumumbiste (préfacé par Isidore Ndaywel è Nziem), Paris : l'Harmattan, coll. « Mémoires lieux de savoir. Archive congolaise », 2005. – 301 p., 22 cm. – (ISBN 2-7475-9020-8). Van Reybrouck, David, Congo. Een geschiedenis, 2010 (trad. française : Congo. Une histoire, Actes sud, 2012, 711 p.) Bibliographie de l'archéologie de la République démocratique du Congo Malu-Malu Jean-Jacques Arthur, Le Congo Kinshasa. Clamecy : Karthala, mai 2002. 383 p. Ndaywel è Nziem Isidore, Histoire générale du Congo. Bruxelles : Duculot, 1998. 955 p. Filmographie[modifier | modifier le code]La Mémoire du Congo en péril, film documentaire de Guy Bomanyama Zandu, 2006 Mobutu roi du Zaïre, film documentaire de Thierry Michel, 1999 [afficher]v · d · m Histoire de la République démocratique du Congo Congo précolonial (avant 1867) · Colonisation du Congo (1867-1885) · État indépendant du Congo (1885-1908) · Congo belge (1908-1960) · Première République Indépendance (1960-1965) · Crise congolaise (1960-1965) · Deuxième République et zaïrianisation Zaïre (1965-1996) · Première Guerre du Congo (1996-1998) · Gouvernement de Salut public (1997-2003) · Deuxième guerre du Congo (1998-2003) · Gouvernement de transition (2003-2006) · Guerre du Kivu dont rébellion du M23 (2004-2012) · Troisième République (2006-) Histoire des divisions administratives [afficher]v · d · mHistoire de l'Afrique État souverain Afrique du Sud · Algérie · Angola · Bénin · Botswana · Burkina Faso · Burundi · Cameroun · Cap-Vert · Comores · Côte d'Ivoire · Djibouti · Égypte · Érythrée · Éthiopie · Gabon · Gambie · Ghana · Guinée · Guinée-Bissau · Guinée équatoriale · Kenya · Lesotho · Liberia · Libye · Madagascar · Malawi · Mali · Mauritanie · Maurice · Maroc · Mozambique · Namibie · Niger · Nigeria · Ouganda · République centrafricaine · République démocratique du Congo · République du Congo · Rwanda · Sao Tomé-et-Principe · Sénégal · Seychelles · Sierra Leone · Somalie · Soudan · Soudan du Sud · Swaziland · Tanzanie · Tchad · Togo · Tunisie · Zambie · Zimbabwe États non reconnus internationalement‎ République arabe sahraouie démocratique (Sahara occidental) · Somaliland Territoires à souveraineté spéciale Îles Canaries · Ceuta · Madère · Mayotte · Melilla · Plazas de soberanía · La Réunion · Sainte-Hélène, Ascension et Tristan da Cunha Portail de l’histoire Portail de la République démocratique du Congo Ce document provient de « http://fr.wikipedia.org/w/index.php?title=Histoire_de_la_République_démocratique_du_Congo&oldid=102858901 ». Catégorie : Histoire de la République démocratique du Congo | [+]

MASTURBATION

Allah Ta’âla a prêté à l’homme une enveloppe corporelle afin qu’il l’utilise à bon escient au travers du respect de Ses commandements. Ce corps est un dépôt dont l’utilisation est gérée, contrôlée et limitée par les principes divins. L’homme ne peut disposer de sa chair selon ses désirs et sa raison dans une liberté absolue et prétendre simultanément obéir à son Créateur. Dans notre société sexiste actuelle, les moyens de communication sont minés par la perversité et la nudité. Les images, les pensées, les mauvaises fréquentations, la solitude attirent facilement un individu et particulièrement les jeunes dans la fleur de l’âge vers la recherche du plaisir facile et immédiat. La masturbation en est un. Alors qu’elle était considérée jusqu’à peu comme un sujet tabou voir même une perversion, cette tendance semble de nos jours s’inverser. Notre société actuelle encourage la banalisation de cette pratique en la présentant comme un facteur déstressant, relaxant, renforçant le contrôle de la force charnelle … Cette pratique est tellement généralisée que certains ne la considèrent plus comme un péché alors que le Qour’âne et les Hadiths révèlent le caractère interdit de la masturbation pratiquée dans le seul but de la recherche du plaisir et de la détente. Les chiffres suivants sont révélateurs : * Aux Etats-Unis dans les années 1960, un sondage (le «rapport Kinsey») a montré qu’à 15 ans, la proportion de jeunes hommes s’étant masturbés était de 82,2% et de femmes 24,9%. À 18 ans, ce chiffre atteignait 95,4% pour les hommes et 46,3% pour les femmes. Cela dit, il est probable qu’aujourd’hui le nombre soit plus important. Une autre étude, beaucoup plus récente, démontre d’ailleurs que la plupart des garçons qui se masturbent commencent en moyenne vers l’âge de 14 ans. Une étude faite dans le cadre d’un cours sur la sexualité humaine dans un Cégep de la région de Montréal en 2002 relate ce qui suit : * 70 % des jeunes qui ont commencé à se masturber avant l’âge de 16 ans disent qu’ils le faisaient en moyenne tous les deux jours durant leur adolescence. La fréquence tend à diminuer passé 18-20 ans. Ce groupe de jeune mentionne qu’ils le font de 1 à 4 fois par semaine encore aujourd’hui indépendamment de leur vie intime avec leur partenaire. * La quasi-totalité des jeunes qui ont commencé entre 16 et 18 ans nous disent qu’ils l’ont fait durant cette période entre 2 et 5 fois par semaine. * 100 % des jeunes qui se masturbe affirment que lorsqu’ils ont commencé, peu importent leurs groupes d’âge, ils ont tous continué à le pratiquer par la suite. * 83 % des jeunes qui ont commencé avant l’âge de 14 ans ont été influencés par quelqu’un de proche comme un frère, un cousin ou un ami proche un peu plus vieux que lui. Près de 22 % des jeunes entre 14 et 16 ans ont été influencés lors de cours sur la sexualité. Ils affirment tous que la façon dont l’information était véhiculée par les professeurs, cela les excitait et leur donnait envie d’essayer. Notre société sexiste dénigre les méfaits de la masturbation mais il n’en est rien. Nous présenterons succinctement dans un premier temps l’interdiction de la masturbation à travers le Qour’âne et les Hadiths avant de détailler les effets physiques et psychologiques dévastateurs issus des rapports de médecins musulmans et de Hakîm (spécialiste de la médecine prophétique). L’interdiction de la masturbation à travers le Qour’âne Première preuve : Allah Ta’âla dit dans le Qour’âne : “Bienheureux sont certes les croyants… et qui préservent leurs sexes [de tout rapport], si ce n’est qu’avecleurs épouses ou les esclaves qu’ils possèdent, car là vraiment on ne peut les blâmer ; alors que ceux qui cherchent au-delà de ces limites sont des transgresseurs…” (Sourate “Les croyants”) * Imâm Qourtoûbi (rahimahoullâh) écrit dans son Tafsîr que Mâlik (rahimahoullâh) a été questionné à propos d’un homme qui se masturbe et il répliqua par le verset ci-dessus. * Imâm Baghawi (rahimahoullah) écrit dans son Tafsîr à propos de ce verset que c’est une preuve que la masturbation est Harâm et c’est là l’opinion de la majorité des Oulamahs. * Ibn Kathîr (rahimahoullâh) affirme dans son tafsîr que Imâm Shâfi’i (rahimahoullâh) et ceux qui sont de la même opinion justifient l’interdiction de la masturbation par ce verset. Imâm Shâfi’i (rahimahoullah) le mentionne également dans son livre “Al Oum”. * Imâm Nassafi (rahimahoullâh) et Allâma Âloûssi (rahimahoullâh) ainsi que bien d’autres commentateurs du Qour’âne (Ma’arifoul Qour’âne, Bayânôul Qour’âne, Mawâhibour Rahmâne…) confirment également l’interdiction de cette pratique par la majorité des érudits dans leurs commentaires de ce verset. Deuxième preuve : Allah Ta’âla dit dans le Qour’âne : “Et que ceux qui n’ont pas de quoi se marier, cherchent à rester chastes jusqu’à ce qu’Allah les enrichisse par Sa grâce”. (Sourate An-nour / Verset 33) * Allâma Âloûssi et Qourtoûbi (rahimahoumoullâh) font référence à ce verset pour l’interdiction de la masturbation à des fins de plaisir. L’interdiction de la masturbation à travers les Hadiths Il est rapporté de Anass (radhi yallâhou 'anhou) que le prophète (sallallâhou 'alayhi wa sallam) a dit : “Il y a sept catégories de gens lesquels Allah ne regardera pas avec miséricorde, ni ne pardonnera, ni ne ressuscitera avec l’humanité entière et ils seront envoyés en enfer en premier avec ceux qui y étaient destinés, sauf s’ils demandent pardon et celui qui demande pardon, Allah lui pardonnera : Celui qui fait le Zina avec ses mains (masturbation), l’homosexuel, l’alcoolique, celui qui frappe ses parents jusqu’à ce qu’ils s’en plaignent, celui qui importune ses voisins jusqu’à ce que les gens le blâment, celui qui fait l’adultère avec la femme de son voisin.” Même si ce Hadith a été qualifié de faible authenticité selon certains, il demeure quand même une preuve authentique pour des raisons que nous ne mentionnerons point dans le cadre de ce bref exposé. Il est rapporté d’une narration authentique de Ousmâne Ibn Maz’oun (radhi yallâhou 'anhou)qu’il demanda un jour au Prophète (sallallâhou 'alayhi wa sallam): “O Envoyé d’Allah ! Je suis un homme dont le célibat m’est difficile à supporter, autorise-moi donc à me castrer.” Le Prophète (sallallâhou 'alayhi wassalam) répondit : “Non ! Mais il t’incombe de faire le jeûne car certes c’est une protection.” Certains savants affirment que ce Sahâbi et bien d’autres vivaient dans le célibat. Ils étaient tiraillés par les impulsions charnelles de leur corps. Afin de se libérer du fardeau des désirs corporels ils ont demandé au Prophète (sallallâhou 'alayhi wassalam) l’autorisation de se faire émasculer. Si la masturbation avait été autorisée, le Prophète (sallallâhou 'alayhi wassalam) le leur aurait indiqué car c’est une solution bien plus raisonnable que la castration. Et pourtant, le Prophète (sallallâhou 'alayhi wassalam) les a incités au jeûne. Cela indique donc que la masturbation est interdite (As soukouto fi ma’ridil bayâne youfîdoul hasr). (Voir Al Istiqssa li adillati tahrîmi listimnaa) Les méfaits de la masturbation Les informations qui vous sont présentées dans les lignes suivantes sont issues des rapports de médecins musulmans et de Hakims (spécialistes de la médecine prophétique). Les conséquences néfastes de la masturbation sont les suivants : 1) Elle constitue un grand péché. 2) Elle entraîne l’impuissance ou la stérilité : * Il existe une veine qui amène le sang dans l’organe génital de l’homme : Une pratique fréquente de la masturbation entraîne un assèchement progressif de cette veine. Ainsi l’organe n’est plus irrigué correctement. Les petites veines collatérales prennent la relève, se gonflent et s’abîment. Ce phénomène aboutit à une absence d’érection et à l’impuissance. * L’éjaculation fréquente entraîne un appauvrissement du sperme. En effet, l’évacuation du stock de spermatozoïdes provoque une suractivité au niveau des testicules afin de reconstituer le stock. Cette reconstitution doit s’accompagner d’une suralimentation en énergie, en protéines et autres. Bien souvent ces éléments ne sont pas présents en quantité suffisante dans le corps pour pouvoir répondre à cette forte demande. Les spermatozoïdes ne sont donc par reproduits en quantité et en qualité suffisante d’où apparition de stérilité. * Une personne qui se trouve dans un tel état de faiblesse aura tendance à fuir les femmes et le Nikah et sera attiré vers l’homosexualité. 3) Elle provoque une hypersensibilité de l’organe génital : * Contrairement aux idées reçues, l’organe devient très sensible. Le sperme est évacué par de simples touchers ou quelques pensées. Il arrive même parfois que ces évacuations de sperme se produisent fréquemment de façon inconsciente et en petites quantités par les mouvements du corps de la vie quotidienne, le frottement avec les vêtements, la vision d’images sensuelles, le regard des choses harams etc. Il se produit ainsi le phénomène de suractivité mentionné plus haut. * Cette hypersensibilité peut se traduire également par des troubles dans la force de rétention ou d’évacuation de l’urine. * L’évacuation de l’urine avec force s’accompagne de sperme. * Problème de continence d’urine par exemple en riant trop fort ou en portant un objet lourd. * Problème de l’éjaculation précoce. 4) Elle peut être à l’origine d’un affaiblissement du cerveau : * Les pensées érotiques et interdites détruisent la concentration et une activité intellectuelle saine. Elles provoquent également une diminution du plaisir et de la jouissance lors des relations intimes dans le couple. * Les érections fréquentes affaiblissent encore plus les nerfs. * La masturbation peut aussi entraîner un affaiblissement de la vue et des maux de tête; un simple effort dans la marche ou un changement rapide de position (en se mettant debout ou en s’asseyant) peut causer l’apparition d’un “voile noir” devant les yeux. * Cette habitude peut aussi provoquer des pertes de mémoire, des yeux lourds après quelques efforts pour étudier. Ce qui a pour conséquence de diminuer la motivation pour l’apprentissage. 5) Elle détériore le foie : * Le foie participe à la production du sang. La sortie fréquente de sperme par la masturbation entraîne une demande plus importante de constituants sanguins pour fabriquer le sperme. Le foie est surmené. La quantité de sang ne répond pas à la demande corporelle. Ce qui entraîne : * Teint jaune du visage. * Pertes d’appétit. * Fatigue et lassitude fréquente qui suscite des pertes de motivation, de courage, pour l’effort et l’activité. * Dérèglement hormonal pouvant provoquer une acné. * Faible résistance à la maladie. * Etat colérique fréquent pour des choses insignifiantes. * Douleur des seins.… 6) Affaiblissement du coeur : * La chaleur naturelle du coeur diminue car elle n’est pas reconstituée ce qui entraîne des signes de vieillesse. Cette chaleur naturelle du coeur et sa diminution entraîne une faiblesse corporelle voir même des évanouissements chroniques. * Le pompage sanguin du coeur est insuffisant et le sang n’atteignant pas convenablement l’organe génital provoque des faiblesses d’érection. * La personne souffre d’un sentiment de culpabilité qui détruit le courage et développe la gêne. Elle éprouve de la répulsion et l’aversion du public (grande timidité et refus de se mélanger aux autres). 7) Détérioration des fonctions testiculaires : * Les testicules ont pour fonction de fabriquer le sperme. L’évacuation fréquente du sperme par la masturbation augmente excessivement l’activité testiculaire. Cette surcharge entraîne une activité défaillante qui peut se traduire par la stérilité, l’évacuation de sang au lieu de sperme, ainsi que des douleurs aux reins et aux pieds. * Le mauvais fonctionnement du foie, du coeur, des testicules, du cerveau, peut entraîner des maladies graves telles la paralysie ou des maladies nerveuses. Certains médecins ont établi un rapport de corrélation entre ses maladies et la pratique de la masturbation. Une étude statistique a révélé que sur 1000 tuberculoses, 414 étaient dues à la masturbation et 186 étaient dues à l’abondance de relations. Sur 124 malades mentaux, 24 étaient dues à la masturbation. * A cela s’ajoute également la fragilisation des os qui deviennent squelettiques. * Chez les femmes cette pratique peut se traduire par une fréquence des fausses couches et un assèchement de la matrice avec toutes les conséquences qui s’en suivent. 8) Déformation de l’organe génital (le pénis) : * L’organe se déforme et se distord. Cette déformation nuit gravement à la jouissance au moment de relations et peut s’accompagner même d’une impossibilité de relations intimes. * Grossissement de la tête et amincissement de la base. * La tête devient anormalement rouge par les mouvements du sang vers le haut. 9)Effet de drogue : Cette pratique entraîne la personne dans un cercle vicieux ascendant vers l’adultère et il est de plus en plus difficile de s’arrêter. Et lorsqu’elle décide de s’arrêter, le retour à une activité physiologique normale n’est pas immédiat. Le corps réagit à cet arrêt par une augmentation des Ihtilâms (pertes de pureté corporelle nocturnes). L’objectif de ce que vous venez de lire est de mettre en évidence les effets destructeurs de cette pratique sur la force vive de notre jeunesse, de notre corps, de notre vie seulement pour le plaisir vicieux, malsain et égoïste de quelques secondes. Il existe des divergences d’opinion sur l’autorisation exceptionnelle de cette action dans des cas extrêmes. Il n’en demeure pas moins que cette divergence n’occulte en aucun cas le caractère nuisible et dangereux de la masturbation que ce soit du point de vue spirituel que physique. L’effet le plus regrettable est l’humiliation que puisse subir le jeune marié lors des premières nuits du mariage lorsqu’il découvre qu’il est incapable d’avoir une relation normale et satisfaisante avec son épouse. Avant qu’il ne soit trop tard, il est encore temps de s’arrêter. Les dégâts physiques ne sont pas généralement irréversibles, mais leur traitement par un Hakîm peut s’avérer très long (plusieurs années). Quelques moyens pour se préserver ou s’en séparer : 1) Le recours au jeûne : Abdoullah Ibnou Massoud (radhi yallâhou 'anhou) rapporte : Jeunes et pauvres, nous accompagnions le Prophète (sallallâhou 'alayhi wassalam) et il nous disait : “Ô jeunes, celui d’entre vous qui est capable de supporter les charges du mariage doit se marier car le mariage aide à baisser le regard et est plus à même à protéger le sexe. Celui qui ne le peut pas doit pratiquer le jeûne car il est dissuasif (il le protège contre l’envie d’avoir des relations sexuelles prohibées).” (Boukhari) Le Prophète (sallallâhou 'alayhi wassalam) a conseillé aux célibataires de se marier. Celui qui ne peut pas s’engager dans le mariage et éprouve d’énormes difficultés à préserver sa chasteté et à s’écarter des pensées, des regards et des actions interdites doit pratiquer le jeûne, car le jeûne est un très bon inhibiteur des pulsions charnelles. Le Prophète (sallallâhou 'alayhi wassalam) n’a pas mentionné la masturbation qui est pourtant plus facile que le jeûne. 2) Protéger son regard : Regarder les choses interdites (photos interdites, sites pornographiques, parties du corps non recouvertes, etc) excite les passions et les désirs qui deviennent ensuite obsessionnelles. Allah le Très Haut dit : “Dis aux croyants de baisser leurs regards.” (Sourate 24, Verset 30) et le Prophète (sallallâhou 'alayhi wassalam) dit : “Ne faites pas suivre un regard par un autre.” (Rapporté par Tirmidhi) Le premier regard interdit non intentionné n’est pas un péché. Par contre le deuxième regard ou un regard prolongé est interdit. Si on ne peut protéger notre regard, on doit s’éloigner des facteurs d’incitations au désir charnel. 3) Le mariage : C’est la solution la plus efficace et il constitue la moitié du Imâne. Il libère totalement et légalement les désirs refoulés. 4) Une intention sincère et ferme : L’abandon de cette pratique ne nous apportera que des bienfaits physiques et spirituels : “Allah rend chaste quiconque cherche à l’être ; rend riche quiconque se satisfait de ce qu’il a et aide à demeurer patient quiconque cherche à s’imposer la patience. Nul n’a reçu un don meilleur et plus ample que la patience.” (Rapporté par Boukhari) Cet abandon doit s’accompagner d’une profonde détermination, d’une patience sans faille et d’une fermeté intransigeante quant à l’obéissance aux ordres de Notre Créateur et au rejet de tout ce qui engendrerait Son mécontentement et Sa colère. L’obéissance à satan ne peut que nuire à la vie d’ici-bas et de l’au-delà. 5) Filtrer ses pensées : Les mauvaises actions peuvent être commises également par des pensées interdites. Les mauvaises pensées ainsi que les insinuations perpétuelles de satan peuvent devenir obsessionnelles et peuvent même aboutir à la réalisation de l’acte : L’adultère, dont la masturbation n’en serait qu’une étape préliminaire. En gardant nos pensées occupées dans le Zikr d’Allah, satan n’aura aucun accès à nos pensées et le contrôle de nos pensées sera plus efficace. 6) Pratiquer la Sounnah : Chaque action accomplie selon les enseignements du Prophète e sera une protection contre les péchés. Par exemple, lire les douas avant le sommeil et dormir dans la position sounnah c’est-à-dire sur le côté droit et non pas sur le ventre. 7) S’occuper : La paresse et l’oisiveté sont des amis de satan. En restant occupé dans diverses activités utiles ou cultuelles, on laisse peu de temps libre pour la désobéissance. 8) Ne pas croire aux fausses idées : Certaines personnes pensent que cette pratique est permise voire même conseillée car elle permet de garder sa chasteté dans une société où la tentation du sexe est très pesante. Le Prophète e n’a jamais proposé cette solution comme moyen préventif du Zina. 9) Se rappeler des préjudices physiques : Ces préjudices ont été développés dans l’article précédent. Le rappel des méfaits physiques et psychologiques de la masturbation devrait nous décourager. De plus, elle perturberait notre propreté corporelle et nous obligerait à effectuer des bains rituels répétés. Cela risquerait de nuire gravement à l’assiduité dans la pratique religieuse telles les prières manquées, les jeûnes annulés etc. 10) Pas de médicament inhibant : On doit éviter de prendre des médicaments qui réduisent les désirs charnels. Cela est contraire à la Sounnah. 11) Demande excessive du pardon : Accomplir deux rakates de salah nafil et demander pardon sincèrement à Allah le Très Haut. Le pardon est l’arme la plus puissante du musulman et c’est une des actions les plus aimées à Allah Ta’âla. Ce pardon pour être accepté doit s’accompagner de l’abandon immédiat de la mauvaise action, du regret de l’avoir commise, et de l’intention de ne jamais recommencer. Le pardon est capable de détruire les péchés les plus vils. Il n’y a aucune raison donc de désespérer de la Clémence divine. 12) Ne pas hésiter à consulter un Hakîm (spécialiste de la médecine prophétique) afin de s’aider de solutions naturelles et efficaces et de réparer les dommages causés. Qu’Allah Ta’âla aide ceux qui ont décidé de mener une vie conforme à Sa volonté et rappelez-vous que “Sa miséricorde dépasse Sa colère” et que tout effort sera généreusement récompensé dans ce monde et dans l’au-delà. Moufti Louqman Ingar Note : article publié dans AL ISLAM n°178

SCIENTIFIC & MEDICAL ENGLISH

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Course learning objectives and schedule
I. COURSE LEARNING OBJECTIVES
 General leaning objective:
At the end of course the learner, future medical doctor, will be able to read and understand scientific & medical texts (books, articles and… other paper)
 Specific learning objectives:
A) PART ONE: MEDICAL ENGLISH I,DOCTORATE 1
1) Able to speak English and hold a useful scientific and medical conversation
2) Able to understand and describe the human body
3) Be informed on major clinical problems, diseases and symptoms within the human body
4) Be informed on important public health problem in a developing country
5) Be informed on the mission of some international and national organizations in the health care field
6) Be informed on the science methodology and medical research paper
7) Be able to understand and read a scientific and medical document
B) PART II: MEDICAL ENGLISH II,DOCTORATE II
At the end of the medical English part II, the learner will be to understand:
 The DRC Health problems and the DRC Primary health care programmer
 Selected topics of the human body physiology and biochemistry
 Relationships between the patient and the physician
 The hospital and selected service/department clinical cases:
 In surgery
 In internal Medicine
 In Pediatrics
 In OB-GYN (obstetrics and gynecology)
C) PART III: MEDICAL ENGLISH III,DOCTORATE III
At the end of the Medical English Part III, the learner will beable to understand, describe medical procedures and be informed on taking care of the sick in English
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Preface
This reading material has been designed to help whoever is interested improving his medical English knowledge, abilities and skills.
Students entering faculties of medicine or other medical institutes, health professionals working on field and visiting sometimes foreign countries will take advantage of it. In fact, most of the best scientific books and articles are written in English!
English is the language spoken in most of scientific international meetings!
The whole material is organizes into chapters. Each chapter focuses on a main idea in medicine, public health or research. Texts to be analyzed are parts of each chapter. A section of non medical and medical vocabularies is included as well.
Finally, at the end of each chapter, comprehensive questions are asked, to make sure the candidates fully understand main idea and the following texts.
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Objectives of the course:
At the end the course, the student will:
1) Be able to speak English and hold a useful scientific and medical conversation;
2) Be able to understand and describe in English the human body;
3) Be informed on major clinical problems and diseases within the human body;
4) Be informed on the most important health problems in a developing country;
5) Be able to understand the mission of some international organizations in the health care field;
6) Be informed on the “Science methodology” and the medical research paper;
7) Be able to read and understand medical and scientific texts (books, articles…).
Course units
UNIT 0: the origin of the English language
UNIT 1: glossary/ Vocabulary/Abbreviations
UNIT 2: The Human Body & common medical problems within the human body.
UNIT 3: Major Public Health Problems in developing countries
UNIT 4: Health Care Organizations
UNIT 5: The Medical Research Paper
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UNIT 0
A. Brief history of the English language
The English language evolved into five steps:
01. Proto indo European language:
Prehistoric language spoken in a region that has not yet be identified, possibly in the fifth millennium BC.
If was an unwritten language: therefore, no record of it survives. The proto Indo European language gave birth to the prehistoric common Germanic language.
02. The Germanic dialect:
The prehistoric common Germanic language subdivided into 3 Germanic dialects with geographic distribution:
 North Germanic dialect;
 East Germanic dialect;
 West Germanic dialect.
When the West Germanic language or dialect began to show significant differences forms the other Germanic dialects, the English language was cold old English.
03. The Old English
Gradually, Old English became a distinctively different language but continued to be bear marks of its Germanic ancestry.
As a Germanic language, old English had endings resembling those of modern German.
04. Middle English comprises the various dialects of late old English, modified both by evolutionary changes and by influences from norm French.
05. Modern English
A series of vowel changes from about 1350 to 1550 marks the shift middle English to modern English.
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0. 2. TEXT ANALYSIS
0.2.1. Text one: The origin of English
English, Genetically a member of Germanic branch of Indo-European, and retaining much of basic structure of its origin, has an exceptionally mixed lexicon. During the millennium of its documented history; it has borrowed very extensively from its Germanic and romance neighbors and from original Old English vocabulary. However, the inherited, remains the genuine core of the language, all of the language, all of the 100 words shows to be the most frequent in the Brown University Standard Corpus of Present-Day Edited American English (See Professor Keera’s article “Computers in Language Analysis and in Lexicography”), are native, inherited words; and of the second 100, 83 are native. Precisely because of its propensity to borrow from ancient and modern Indo-European language, especially those mentioned above but including nearly every other member of the family, English has in a way replaced much of the Indo-European lexicon it lost. Thus, while the distinction between native and borrowed vocabulary remains fundamentally important, mare than 50 per cent of the basic roots of Indo-European as represented in Julius Peony’s Indo-Germanic Etymologists Wörterbuch (Bern, 1959) are represented in modern English by one means or the other.
Indo-European therefore looms doubly large in the background of our language.
 Words to look for in a dictionary:
Lexicon lexicography Bulk Genuine
Core Propensity Native Toborrow
 Comprehension question:
1) Why do they say: « English Genetically a member of the Germanic branch of European…? »
2) What language did the English borrow words from?
3) Did the English language borrow more from outside?
4) What is the difference between native and borrowed vocabularies?
0.2.2. Text two: at the medical faculty
Every year many young people who really care for medicine enter medical faculties and become students.
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A new life begins it is the life of the adult who has the reasonability for all his actions before the society.
Some students live students’ homes, others –with their relative.
The students work much in class, at the medical faculty laboratories and libraries. As the students. As the students want to become not ordinary but good doctors they must pay attention to modern medical literature. It means that they must study not their textbooks but read many special medical articles not in English, but in French and other foreign language. They will continue to study them in class during their studies.
Already in the first and the second year some students join student’s scientific societies. There they work on those subjects which they care for. It may be Biology, Chemistry or Anatomy. In anatomy Scientific Society the subject of the students work may be the study of the heart or other organs of the body. In the second year some functions of the organs. This work in the Scientific Societies will help future doctors to understand better the character of many diseases. It will teach them to be more observant.
 Medical words to know
Medicine Scientific society Biology
Chemistry Anatomy Physiology.
Comprehensive questions
 Where do stay students entering medical faculties?
 When do work students learning medicine?
 What do read students learning medicine?
 What languages will use students learning medicine?
 What do learn students in the fist and the second year of medicine?
0.2.3. Text there: The Medical Faculty of the Patrice Lumumba University
Young people from Africa, Asia and Latin America study together with Soviet students at the Medical Faculty of the Patrice Lumumba University in Moscow. As they come from foreign countries and have no relatives in Moscow they live at a hostel.
This medical faculty is a little different from clinical faculties in other Soviet medical institutes. It prepares general practitioners who gain good knowledge of therapy, surgery or obstetrics. Epidemiology and hygiene.
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These subjects are very necessary for doctors in Africa, Asia and Latin America. The professors, teachers and lectures of this faculty pay great attention to prophylactic subjects.
When a foreign student completes his medical course he gets an appointment to work as an intern at one of the hospitals in Moscow. This helps him to gain more experience and to increase his knowledge of one of the main fields of medicine.
 Non medical words to know:
Foreign Relatives Lecturer
To pay great attention to appointment
 Medical words to know:
General practioner Therapy Surgery Obstetrics
Sanitation Epidemiology Prophylactic To specialize
Comprehensive question
1) Where is located the medical faculty of the Patrice Lumumba University?
2) What is the mission of the medical faculty of the Patrice Lumumba University?
3) What is next after a student has completed his medical studies at the medical faculty of Patrice Lumumba University?
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UNIT 1: GLOSSARY/VOCABULARY
1.1. Glossary
 Abrasion
 Allergic conditions
 Amebiasis
 Anemia
 Biopsy
 Bladder
 Bleeding
 Body weight (1kg = 2,20 pounds, 1 inch = 2, 54cm , 1 foot = 12 inches = 30, 48cm 1mille = 1,609km, 1 years = 3 feet = 91,44cm)
 Bronchitis
 Stones
 Cerebrovascular diseases
 Chest x Ray
 Cold (=froid)
 Cough
 Cyst
 Colors
 Deaf = (deafness)
 Blind = (blindness)
 Paralysis
 Diabetes
 Diarrhea
 Disease (sickness, illness)
Diet:
Balanced diet:
60% of carbohydrates
27% of lipids or fats
13 % of proteins
Plus Vitamines (A, D, E, K)
Inorganic salts
Surgery
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OB-GYN (Obstetrics-Gynecology)
Internal medicine
Pediatrics (Pediatrician)
Waste (waste disposal)
Weight (Weight loss)
1.2.Prefixes & suffixes
A = without
Ab = from
Alg = pain
Bi = twice
Endo = interior
Hema = Blood
Plasty = repair
Scopy = visual examination
Stomy = mouth opening
Body temperature (fever):
Centingrade (C) or Fahrenheit (F)
Fahrenheit = (C+9/5): 32
Centingrade = (F-32) x5
Goiter
Hypertension
Immunization
Kidney
Measles
Mortality/Mortality rate
Pelvic inflammatory diseases (PID)
Frequency
Prevalence/incidence
Reproductive system
Nervous respiratory, urinary, digestive, circulatory, reproductive systems
Rest room
Spotting
Sudden death
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1.3. Standardized abbreviations
 ABD: abdomen
 AC: before meal
 Amp: ampule
 AM: morning
 Appt: Appointment
 BP : blood pressure
 Bx: biopsy
 C: with
 CA: cardiac arrest
 Ca: cancer
 C/O: complaint of
 CXR: Chest X Ray
 DTP: Diphtheria/tetanus/pertussis
 F: Fahrenheit
 f: female
 Ft: foot
 Fx: fracture
 GT: group therapy
 H/A: headache
 HBP: High Blood Pressure
 STD: Sexual transmitted disease
 XRT: X ray therapy
 MIS: Medical information system
 ADR: adverse drug’s reaction
 RN: registered nurse
 MD: Medical Doctor
 D/C: Discharge
 Adm: admission
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TEXT ANALYSIS
Monitoring for side effects/adverse drug reactions Adverse drug reaction
Any response to a drug which is noxious unintended and occurs at doses used for prophylaxis, diagnostic or therapy, excusing failure to accomplish the intended purpose.
Types:
1. Side effects-knows pharmacologic from a drug;
2. Hypersensitivity- immunologic and unpredictable reactions to standard doses of drugs;
3. Idiosyncrasy- unpredictable and occur after unusually small doses of drugs and which are not explained on the basic of genetic factors;
4. Toxic reaction: unintended, unwanted and related to drug’s pharmacologic effects;
5. Adverse drug interaction: reactions that are due to the in vivo interaction of two or more drugs;
Reporting procedure:
1. Notify attending physician and nursing supervisor;
2. Note in patient’s medical record, allergy label and in MIS the patient’s
3. Apparentdrug reaction as appropriate. Clarify with physician as necessary;
a. All allergy information entered into MIS automatically prints each on the Allergy List for the nursing units. The allergies print on each drug order label for Pharmacy;
4. Voluntary reporting to notify Pharmacy of potential side effects/adverse drug reactions (ADR’s) via MIS. Pharmacy will review and report appropriately.
b. The RN or MD makes appropriate selections from MIS screen.
1) When drug discontinued:
a) Proceed to Current Orders D/C;
b) Select SIDE EFFECTS;
c) Select the uncommon side effects or type in;
d) Select the uncommon side effects or type in;
e) Review and enter.
2) For nursing when drug not discontinued:
a) Proceed Nursing screen;
b) Select Pharmacy Orders;
c) Select POSSIBLE SIDE EFFECCT NOTE;
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d) Select the reaction or type in;
e) Type in name of drug, review and enter.
5. Reaction that would jeopardize the patient’s safety if repeated again (i.e. allergic reaction to IV Renograffin) or a life threatening reaction should reported to the physician immediately.
a. Notify physician and nursing supervisor as above;
b. Alert Pharmacy through MIS as abos;
c. Complete an Incident report;
d. Update the patient’s Medical record, allergy label on front of chart, allergy entry via MIS.
 Non-medical words to know:
Noxious Label to jeopardize
To threaten to alert
 Medical words to know:
Side (side effects) hypersensitivity idiosyncrasy
Toxic reaction drug interaction allergy
 Abbreviation to know:
 MIS;
 ADR:
 RN;
 MD;
 D/C;
 IV.
Comprehensive questions:
What is?
1) Side effect?
2) Hypersensitivity?
3) Idiosyncrasy?
4) Toxic reaction.
5) Drug interaction?
6) An attending physician?
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 Explain in your words:
1) MIS
2) RN
3) MD
4) D/C
5) ADR’S.
UNIT II: THE HUMAN BODY & COMMON CLINICAL PROBLEMS
2. The human body is composed of
1. The bones and the muscles
2. The nervous system
3. The circulatory system
4. The respiratory system
5. The urinary system
6. The digestive system
7. The reproductive system.
The following items will be studied as well:
 Hearing and the ear
 Seeing and the eye
 Feeling and the skin
 Smelling and the nose
 Tasting and the tongue.
1.0. The bones and the muscles
1.0.1. The Skeleton
The skeleton is composed of bones. In the adult the skeleton has overs 200 bones.
The bones of the skull consist of cranial and facial parts. They are 26 bones in the skull.
The bones of the trunk are the spinal column or the spine and the chest (ribs and the breastbone). The spine consists of the cervical, thoracic, lumbar and sacral vertebrae and the coccyx.
The vertebra is a small bone, which is formed by the body and the arch. All the vertebrae compose the spinal column or the spine. They are 32 or 34 vertebrae in the spine of the adult. In the spinal column there are save cervical vertebrae, twelve thoracic vertebrae, five lumbar, five sacral vertebrae and from one to five vertebrae which from the coccyx.
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The cervical part of the spine is formed by seven cervical vertebrae. Twelve thoracic vertebrae have large bodies. The lumbar vertebrae are the largest in the spinal column. They have oval bodies.
The chest (thorax) is composed of 12 thoracic vertebrae, the breastbone and 12 pairs (nap) of ribs.
The breastbone is a long bone in the middle of the chest. It is composed of three main parts. The basic part of the chest is formed by the ribs. On each side of the chest seven ribs are connected with the breastbone by cartilages. The cartilages of three other ribs are connected with each other and with the seventh rib. But the cartilages of these ribs are not connected with the breastbone. The eleventh and the twelfth ribs are not connected with the breastbone either. They are not connected with other, ribs, they are free. Each rib composed a head, neck and body.
The lower extremity consists of the thigh, leg and foot. It is connected with the trunk by the pelvis. The upper extremity is formed by the arm, forearm and hand. It is connected with the trunk by the shoulder girdle.
The bones of the skeleton connected together by the joint or by the cartilages and ligaments. The bones consist of organic and inorganic substance.
1.0.2. The Muscles
The names of all the muscles in the body and all other anatomical terms were established at three Congresses in Basel, Jane and Paris. In 1895 the Basel Nominal Anatomical was introduced: in 1935 it was greatly changed at the Congress of Anatomists in Jena. But the anatomical terms which were established at that Congress were not used in the USSR. In established new universal anatomical, the so-called Paris Nominal Anatomical.
In his lecture Prof Smirnov said that the body was composed of about 600 skeletal muscles. The students that in the adult about 35% - 40% (per cent) of the body weight was formed by the muscles. According to the basic parts of the skeleton all the muscles were divided into the muscles of the trunk, and extremities.
When Prof. Smirnov spoke about the form of the muscles he said that all the muscles were divided into three basic groups: long, short and wide muscles; the free extremities were formed by the long muscles; wide muscles lay on the trunk; the walls of the body cavities were formed by wide muscles.
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Some muscles were called according to the structure of their fibers, for example radiated muscles; others according to their uses, for example extensors or according to their direction, for example oblique.
When Prof. Smirnov spoke about the structure of the muscles he said that the muscles were formed by a mass of muscles calls, the muscles fibers were connected together by connective tissue, the blood vessels and nerves were in the muscles.
Great research work was carried out by many scientists to determine the functions of muscles. The basic methods of study were used: experimental work on animals, the study of the muscles on a living human body and on the corpse.
Their work helped to establish that the muscles were the active agents of motion and contraction.
In one of his works written in 1892 Prof. Lesgaftdivided the muscles into two basic groups – static and dynamic. In his work they were called strong and skilled. He determined that the static muscles were connected with large surfaces of the bones far from the point of their origin; they were formed by short bands of muscular fibers; the dynamic muscles were composed of the bands of long muscular fibers.
His studies on static and dynamic muscles were continued by Professor A.K. Koveshnikove, who received many interesting finding. In 1954 it was determined by her experiment on animals that static and dynamic muscles were different in the number of nerve fibers and the form of nerve endings.
1.1.The nervous system and its clinical problems
1.2.The nervous system description
The nervous system has three components:
 The brain
 The spinal cord
 The nerves
The nerves link the brain to the body
They are 2 kings of nerves:
Cranial nerves (link the brain to the body)
- Spinal nerves (link the spinal cord to the body)
The combination of the brain and the spinal cord is called “central nervous system”= CNS
The CNS coordinates the body’s activates by the motor and sensory nerves :
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- Motor nerves : carry message from the SNS to the muscles or glands
- Sensory nerves: carry message from the surface or interior of the body to the CNS .
2.1.2. Clinical problems with the nervous system
2.1.2.1. Neurologic problems
Neurosis refers to discarded mental function ( nerves are affected )
1) Headache ( H/A)- pain in the head in most cases , it is a primary headache which is not progressive
In a minority of cases it is a progressive and life threading condition (brain tumor , meningitis)
2) Seizures ( convulsion )
Seizures result from synchronous firing of an abnormally active group of neurons
If this occurs in a localized area (local seizure)
If this occurs in deeper brain structures (local seizures generalized seizure)
3) Parkinsonism
Parkinsonism is a clinical syndrome characterized by
- Resting tremor
- Slowing of voluntary movements
- Muscle rigidity
- Gait abnormalities
4) Bell’s palsy
It is an idiopathic facial paralysis
It is a paralytic condition of the seventh cranial nerve(the facial nerve)
In this case, expression of the face is on one side
5) Dementia (in the Elderly)
It is an altered mental status in the elderberry with intellectual impairment
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2.1.2.2. Psychiatric problems
Psychosis refers to disturbance of thinking, mood and behavior (personality is affected)
1) Anxiety
Patients are complaining of being
“Shaky”,tense,irritable, uptight
2) Depression
Patients have depressed feeling with psychobiologic disorder(decreasedappetite, insomnia, agitation, feeling of worthlessness or guilt, slowed thinking decreased concentration, thought of death or suicide.
3) Insomnia :
It is the subjective perception of inadequate sleep, accompanied by disturbed day time functioning, with complaints such as irritability, difficulty concentrating,and fatigue.
Patients might suffer of transient or persistent insomnia
4) Problem patients
These patients comprise a heterogeneous group who may have no specific medical or psychiatric diagnostic but are characterized by the behavior they exhibit within the health care system and the reaction they elicit in the physicians caring for them ( bizarre description of the symptoms , persistent complaints , resistance to improvement)
5) Grief : reaction to loss= syndrome with psychological and somatic symptoms
6) Alcoholism: the continuation of drinking despite physical , social occupational problems alcohol use.
2.1.3. TEXTA ANALYSIS: THE MENTAL STATUS EXAMINATION
Mental status testing , unless made obvious by the clarity of the history , includes asking about orientation to time , place , and person orientation to person is lost only in severely obtunded , delirious or demented individuals , and its isolated absence should suggest malingering . A normally attentive grammar school graduate should be able to repeat 7 random digits forward and 4 in reverse order to spell world backwards , and to make simple
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calculations ( number of nickels in $1,35 serial sevens ) immediate recall is tested by asking the patient of remember 3 unrelated items for 3 or 5 min whether a patient can describe news events or yesterday’s breakfast yields information about recent memory . Remote memory can be checked by asking the patient what make and color of car he first purchased or the color of his suit on his wedding day. Ability toabstract ischecked with proverb interpretation and analogies insight intoillnessshould bedetermined, since is absence complicates management. Fund of knowledge will reflect the patient’s educational level, most persons should be able to name the last 5 presidents and know their own state capitals.
A patient should be able to follow a simple 3 componement command involving periphefal and central body parts and to discriminate between right and left (eg, “put your right thumb over your left ear and strict out your tongue”).
Language function: naming of simple objects and body parts, reading, writing, and repetition are assessed; if function is disturbed, further testes of aphasia are. Cortical sensory function is tested by asking the patient to identify small objects in the hand numbers written on the palm and to discriminate 2 points from one at both palm and fingers (stereo perception). Facility with facial relationship can be checked at the bedside by asking the patient to imitate simple and complex fingers construction, and to draw a clock,cube, or house. The effort expended often is as well informative as the final result and may identify impersistence if perseveration as wellas neglect of one side of space. Praxis canbe checked by asking the patient to use a toothbrush or to take a match out of a box and strike it.
Non medical words to know:
- Status
- Obtunded
- Random digit
- Wedding day
- To abstract
- Aphasia
- Impersistence
- Perseveration
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Medical words to know
- Mental status
- Demented individual
- Malingering
- Recent memory
- Remote memory
- Body part
- Disturbed function
- Palm
- Praxis
Comprehensive question
- What do you look for during the mental status examination?
- What is the difference between recent memory and remote memory?
- How can you test the language function?
- What is praxis?
2.2. THE CIRCULATORY SYSTEM
2.2.1. System description
The heart us dividend four parts:
A=left atrium C= right atrium
B= Left ventricle D= right ventricle
1. Blood pumped from the left ventricle
2. Blood goes in the arterial system ( main artery = aorta with many branches )
3. From the arterial system , blood gets to all the tissues and flows trough capillaries have two parts:
- The artery side
- The vein side
4. From the capillaries , blood gets into the vein system ( the main vein is the cava with many branches )
5. From the vena cava , blood gets to the right atrium
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6. From there , the blood flows to the right ventricle
7. From there , blood s goes to the pulmonary artery
8. From there , it goes to the lungs’ capillaries
9. From there , it goes to the pulmonary vein
10. From there , it goes the left atrium
11. And from there to the left ventricle
12.
2.2.2. Major clinical problems with the circulatory system (cardiovascular problems)
1) Hypertension
A disease in which the blood pressure is high
(Systolic blood pressure) 14 cm Hg= 140 mm Hg
(Diastolic blood pressure) 9cm Hg = 90mm Hg
2) Angina pectoris
It refers to the chest pain resulting from coronary ischemia(coronary artery which takes blood to the heart muscle is closed)
Patients with angina pectoris may die suddenly or may live for decades experiencing remissions and recrudescence in the symptoms of disease.
3) Congestive heart failure
It is a clinical syndrome in which the heart fails to deliver an adequate supply of oxygenated blood to meet the metabolic needs of tissues.
4) Other problems
- Paroxysmal supra ventricle tachycardia with rapid beats per minutes ( 140 , 220)
- Premature ventricular contractions with increased risk of death is some patients
- Peripheral vascular problems:
- Varicose veins: superficial veins are distended
- Thrombophlebitis : abstraction to vein flow by clothing
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2.2.2. Text analysis one: The Heart and the vascular System
The heart is an inner hallow muscular organ placed within the chest and included in the pericardium. The base of the heart is against the third rib . Its apex is against the interspace between the fifth and sixth costal cartilages. The weight if the heart is abouy 300Bgrams (gr) in the male and about 220 gr in the female.
The heart consists of two chambers divided by the septum. Each of the chambers has two connected parts: the atrium and the ventricle. The art ventricular valves separate the atria from the ventricles.
The right atrium is larger than the left one, but the walls of the left atrium are thicker than those of the right one. The right ventricle is triangular in from and has thick walls. The right ventricle is in the anterior part of the heart.
The left ventricle is longer and more conical the right one. The walls of the left ventricle are three times as thick as the walls of the right one. The valves are located at the entrance and exit of each ventricle.
The vascular system consists of three groups of vessels – arteries, veins and capillaries.
The vessels carrying blood to and from the tissues of the body compose the general system. They are called the systemic vessels.
The pulmonary system is formed by the vessels carrying blood to and from the lungs.
The portal system is formed by the veins passing to the liver. Most of the arteries are composed of three coats. The arteries dilate and contract simultaneously with the action of the heart.
- Non medical words to know
Inner hollow to contract triangular
Wall thick anterior
- Medical words to know
Rib apex interspaces costal
Cartilage chest pericardium
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Comprehensive questions:
- What does separate the two chambers of the heart?
- What does separate the atria from the ventricles?
- Talk about the three groups of vessels?
2.2.3. Text Analysis Two: THE BLOOD
Blood consists of red and white blood cells suspended in liquid called plasma. White blood cells play an important role by removing foreign particles from the blood cells contains hemoglobin, a protein that is very important in the transport of oxygen, carbon dioxide, and acid by the blood. Proteins that are dissolved in the plasma play an important role in blood cutting, in the exchange of fluid across capillary walls, and in antigen – antibody reactions.
Blood clots that form near a wound are made from a fibrous network of an insoluble protein called fibrin.
The blood clot forms as a result of a series of reactions initiated by the liberation of thromboplastic from injured tissue or platelets.
The fluid exchanged between the capillaries and the tissues spaces is governed by two forces: capillaries blood pressure and osmotic pressure of the plasma proteins. The blood pressure tends to force fluid out of the capillaries and into the tissue space; osmotic pressure exerted by the plasma proteins tends to move fluid in the opposite direction. Normally these two forces balance one another.
When antigens gain entry into the body, they stimulate the production ofantibodies. The antibodies react with the antigens and destroy or inactivate the antigens. This antigen –antibody reactions are responsible for immunity to many diseases. Incompatible blood transfusions result from antigen- antibody reactions in the antibodies in the plasma of the recipient react with the antigens of donor’s blood cells and cause them to agglutinate.
Non medical words
To clot To agglutinate
Medical words
Plasma Thromboplastin Hemoglobin Fibrin
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Platelets Antigens Antibodies
Comprehensive questions
1. What kinds of cells do you find in the blood and what is the role of each kind , ( red and white )?
2. Explain the way blood clots
3. Explain capillaries blood pressure and osmotic pressure
4. Explain antigen – antibody reactions
2.2.4. Text analysis three: The circulation of the blood
Now we now that the venous blood from the systematic and portal circulation is brought to the right atrium of the heart. When the pressure in the right atrium has increased the blood passes into the right ventricle from the right atrium.
During the systole of the ventricle the blood is pumped from the right ventricle into the pulmonary artery. When the right ventricle has pumped the venous blood into the pulmonary artery it enters the pulmonary circulation. The blood is brought to the lungs trough the pulmonary artery.
In the lungs the venous blood discharged out carbon dioxide. When the blood has discharged out carbon dioxide ittakes in oxygen in the lungs.
THE BLOOD which has become oxygenated passes from the venous part of the pulmonary capillary system into the venues and veins. When the oxygenated blood has passed the four pulmonary veins it is brought to the left atrium of the heart.
Under the pressure in the left atrium the arterial blood which the pulmonary veins have brought to the heart is pumped into the left ventricle. During the prolonged contraction of the left ventricle, the so called ventricularsystole, the arterial blood is pumped into the aortia the main artery of the vascular system. When the left ventricle has pumped the arterial blood into the aorta it is carried through the arteries to all the parts of the body.
Non- medical words
To increase to pump carbon dioxide
Medical words:
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Systemic circulation portal circulation
Systole contraction
Comprehensive question
1) Where does the blood get oxygen from?
2) Where does the blood discharge carbon dioxide?
3) Is the blood in the pulmonary vein oxygenated?
4) Is the blood in the pulmonary artery oxygenated?
2.3. THE RESPIRATORY SYSTEM
2.3.1. System description
Breathing is the way in which we exchange materials with the air ( breathing cycle).
- During INSPIRATION
1. 02 is taken from outside to the noseor the mouth
2. From there , it is taken the trachea and branches
Bronchi, bronchioles
3. From there it goes to the alveoli
4. The alveoli are tiny saclike structures in close proximity to capillaries (lung capillaries). It is here 02 diffuses into the blood CO2 diffuse out.
- During EXPIRATION
1. CO2 is taken from the capillaries to the alveoli
2. From there to the bronchioles , bronchi
3. From there to the mouth , nose and the cycle of breathing is completed
2.3.2. Clinical problem with the respiratory system
1) The common cold:
Is a benign viral infection of the upper respiratory tract (voies respiratoires supérieures?)
Symptoms:
1) Sneezing
2) Congestion
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3) Stuffy nose and
4) Watery nasal discharge
2) Sinusitis:
Acute or chronic inflammation of the sinus symptoms: pain, nasal discharge, fever
3) Sore throat
Infection of the throat by microbes= pharyngitis
(Streptococcal), (Viral), (Gonococcus)
4) Rhinitis
A general term with an unpleasant symptoms that tend to occur together :
- Obstruction
- Discharge
- Itching
- Sneezing
5) Lower respiratory problems
- Asthma
- Pneumonia
2.3.3. Text analysis one: the lungs
The lungs arethe mains organs of the respiratory system. The are two lungs in the human body located in the lateral cavities of the chest. The lungs are separated from each other by the mediastinum. The lungs are covered with the pleura .They are conical in shape. Each lung has the base,apex, two borders and three surfaces.
The lung has the apex extending up ward 3-4 centimeters(Cm) above the level of first rib.
The base of the lung is located in the convex surface of the diaphragm .
The posterior borders of the lungs are on each side of the spinal column. The anterior border is thin and over laps the pericardium.
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The weight of the lungs varies according to many conditions. In the adult male the weight of the lungs is about 1,350 gr. The right lung is about 15% heavier than left one. The vital capacity of the lungs is 3.5- 4 liters in the male and it is 3-3.5 liters in the female.
The right lung consisting of three lobes is heavier that, the left one because the latter consists only two lobes. The lower lobe the left lung is larger than upper one.
In infants the lungs are of a pale rose colour, but later they become darker.
The structure of the lung consists of an external serous coat, the visceral layer of the pleura, a subseries elastic tissue and the parenchyma or proper substance of the lungs.
Non- medical words to know:
Conical shape Border
Extending Anterior To overlap
Medical words to know
Chess Cavity Mediastinum Pleura
Convex Diaphragm Spinal Colum Pericardium
Comprehensive questions:
- How many lungs have a person in his chest?
- What are the parts of the lung?
- Talk about the vital capacity of the lungs
- What is the difference between the right and the left lung?
2.3.4. Text analysis two: Acute lower respiratory tract infection
The spectrum of acute,infectious lower respiratory tract disease in adults ranges from minor, self –limited trace bronchitis to sever and sometimes fatal lobar pneumonia. The usual discussion of the diseases differentiates “bronchitis” from” pneumonia”.
This differentiation, based primarily on pathologic changes in the lung, does not correlate well with pattern of clinical management. In practice, the severity of illness, specifically the height of the fever and the presence or absence ofdyspnea and tachypnea , is a better determinant of
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management strategy , less seriously ill patients can be managed in the ambulatory setting , more seriously ill patients usually require hospitalization.
Although the less seriously ill patients will usually have acute bronchitis, many have areas of “pneumonia”, often inapparent on clinical examination that can be detected only by chest x- ray.
Radio graphically these areas appear as segmental or sub segmental patchy infiltrates or peribronchial cuffing. Patients with acute bronchitis and less seriously patients, many of whom have lobar pneumonia, require hospitalization for diagnostic procedures, administration of parenteral medications fluids and oxygen therapy.
Non- medical words
Spectrum inapparent minor to range
Medical words
Tracheabronchitis pneumonia bronchitis tachypnea
Hospitalization chest x- ray patchy cuffing
Parental oxygen therapy
Comprehensive questions
- What is the difference between bronchitis and pneumonia?
- Among the patients described in the text, who need hospitalization?
2.4. DIGESTIVE SYSTEM
2.4.1. System description
The gastro – intestinal tract is a long hallow lying deep within the body. Both ends of this tube open onto the surface of the body. The digestive system is made up of the various following organs:
- The mouth , including teeth and salivary glands
- The esophagus
- The stomach where food is stored and mixed
- The small intestine into which the liver and the pancreas secrete materials
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- The large intestine and the anus, which is the terminal opening of the large intestine.
When food enters the gastro intestinal tract; it is chewed, then mixed and lubricated by salivary secretions.
Swallowing carries the food to the stomach where digestive secretions begin to attack the proteins, but the food is not yet ready for absorption by the blood stream.
When that absorption into the blood stream moved into the small intestine takes place.
Food that has not been absorbed is moved into the large intestine waste is finally eliminated through the anus
2.4.2. Common clinical problems with the digestive system
1) Dysphagia
Dysphagia is the subjective awareness that something has gone wrong with the active mechanical transport of food from pharynx to stomach. Patients complain of constant sensation of a lump () in the throat.
2) Esophagitis
Infection of the mucosa of the esophagus, usually resulting from retrograde flow of gastric contents above the gastro esophagus junction the patients complain of heartburn
3) Dyspepsia
We customarily use the term to refer to “ indigestion “ , which is an abdominal fullness or pain that can be dull , gnawing or burning with belching abdominal distension and audible borborygmus.
4) Peptic ulcer
A circumscribed ulceration of the mucous membrane penetrating trough the muscular is mucosa and occurring in area exposed to acid and pepsin.
5) Hemorrhoids:
Hemorrhoids are protrusions into the anal of stretched ( ) mucosa and underlying vascular cushions ( ) of sub mucosal tissues.
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6) Anal fissures
Are superficial, longitudinal lacerations or ulceration of the skin that lines the anal canal just below the anal line?
7) Acute diarrhea
Is defined as diarrhea of less than one week’s duration, occurring in a previously health patients, with more than 3 Watery stools a day.
8) Constipation
Constipation is the passage of fewer than three stools per week and/or the sensation of incomplete evacuation.
9) Hematochezia
Hematochezia is visible bleeding from the rectum; from lesions throughout the gastro intestinal tract.
2.4.3. Text analysis one: The alimentary tract
The alimentary tract is a musculomebraneous canal about 8 ½ m (meters) in length. It extends from the oral cavity to the anus. It consists of the mouth, pharynx, esophagus, stomach, small intestine, and large intestine. The liver with gallbladder and pancreas are the large glands of the alimentary tract.
The first division of the alimentary tract is formed by the mouth, the teeth and tongue, which is the organ of taste. The soft and hard palates and the salivary glands are also in the oral cavity.
From the mouth food passes through the pharynx to the esophagus and then to the stomach.
The stomach is a dilated portion of the alimentary canal. It is in the upper part of the abdomen under the diaphragm. It measures about 21-25 cm in length, 8- 9 cm in its greatest diameter. It has a capacity of from 2.14 to 4.28l (liters).
The small intestine is a thin-walled muscular tube about 6.5 meters long it is located in the lower and central portions of the abdominal and pelvic cavities.
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The small intestine is about 1.5 meters long. It is divided into caecum, colon and rectum.
The liver is the largest glands in the human body. It is in the right upper part of the abdominal cavity under the diaphragm. The liver is in the right side of the abdomen. The weight of the liver is 1,500g.
The gallbladder is a hollow sac lying on the lower surface of the liver.
The pancreas is a long thin gland lying under and behind the stomach.
No medical words to know
- To extend ; - taste ; - upper - lower
Medical words to know
Alimentary; tract ; canal; oral
Anus; liver; gallbladder, pancreas;
Thin – walled; lower central portion of the abdomen right upper part of the abdomen upper part of the abdomen.
Comprehensive questions
1) What is the alimentary tract consisting of?
2) Where is located the stomach
3) Where is located the small intestine?
4) Where is located the liver?
2.4.4. Text analysis two: Acute abdomen and surgical gastroenterology abdominal pain
Al tough many diseases can produce abdominal pain, acute and severe pain nearly always is a symptom of intra – abdominal pathology. It may be the sole guide to the need for an emergency or elective operation or to determine whether the treatment should be non-surgical.
The crucial decision that must make swiftly is whether or not the patient has a “surgical abdomen”.
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Precious time may be lost in useless testing. The physician must remember that gangrene and perforation of gut can occur in as little as 6h after interruption of the intestinal blood supply from either a strangulating obstruction or an embolus.
Abdominal pain can be acute, in which the question of urgent surgery always arises, or it can be chronic, in which case therapy (at latest for a protracted time) is medical. This discussion is concerned primarily with acute abdominal pain and surgical therapy; details of therapy for other disorder may be found elsewhere.
Text book descriptions if abdominal pain has severe limitations, because each individual reacts defiantly. Infants and children may be unable to localize their discomfort and they have many diseases not seen in adults. Obese or elderly patients tend to tolerate pain better than other, but find it difficult to localize the pain. On the other hand, hysterical patients tend to exaggerate symptoms.
Non- medical words to know
- A sole guild ; Emergency ; Elective
- Swiftly; Useless ; Elderly
- Medical words to know
- Acute pain Severe pain ; Pathology
- Surgical abdomen; Gangrene; Perforation
- Strangulating ; Gut ; Embolus
- Surgical treatment; Medical treatment.
Comprehensive question
1) What to do, when abdominal pain is acute?
2) What to do when abdominal pain is chronic?
3) What is the problem you have with infants and children?
4) What is the problem you have with obese and elderly patients?
2.5 THE URINARY SYSTEM
2.5.1. System description
Animals have 2kidneys
- The right kidney
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- The left kidney
Three important tubes are attached to each kidney:
- The renal which conducts bloods from the aorta to the kidney
- The renal vein which conducts blood away from the kidney to the vena cava
- The ureter conducting urine from the kidneys to the bladder.
Urethra is a membranous canal which convery from the bladder to the surface.
For the female:
1) The same canal will also convery seminal ejaculations
2) The canal is divided into 3 portions for the male :
- The prostatic portion
- The membranous portion
- The spongy portion
If we use a microscope , we find that each kidney contains about a million of tiny tubes called “ nephrons “ which are the site of urine formation.
The kidney has 3 functions:
1) Filtration
2) Reabsorption
3) Secretion
Blood comes in contact with nephrons by means of capillary beds arranged in series.
The first capillaries bed is called glomerulus. From the glomerulus, blood flows out thought the arteriole and other capillaries bled.
In the kidneys, a fluid that resembles plasma is filtered thought the glomerular capillaries into the renal tubules (glomerular filtration).
As this glomerular filtrate passes down the tubules, its volume is reduced and its composition altered by the processes of tubular reabsorption (removal of water and solutes from the tubular fluid ) and tubular secretion ( secretion of solutes into the tubular fluid ) to form urine.
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2.5.2. Clinical problem with the urinary system
1) Acute lower urinary tract infection:
Low urinary tract infections are common in female symptoms are:
- Dysuria = pain full or difficult urination
- Urinary frequency = the frequency of urination is high
3) prostatic : prostate infection with symptoms of chronic obstruction
4) benign prostatic hyperpiesia : ( BPH)= benign prostatic hypertrophy ( in case of benign adenoma)
5) renal failure : acute renal failure (ARF)
Chronic renal failure (CRF)
6) renal stone (calculs rénaux)
7) proteinuria : ( proteins in the urine)
8) urinary incontinence:
= the bladder is emptied involuntarily
=failure of voluntary control of the bladder sphincter which involves passage of urine
= loss of the control of urine
9) nephrnotic syndrome (Ns) with proteinuria , edema and fever
TEXT: ANALYSIS: CHANGES IN MICTURITION
Most people void about 4 to 6 times / day, mostly in the day time, frequency (frequent micturition), unassociated with an increase in urine volume, and are a symptom of lessened bladder effective filling capacity. Infection, foreign bodies, stones or tumor may injure the bladder mucosa or underlying structures, leading to inflammatory infiltration and edema. Mild stretching of the bladder and a loss of bladder elasticity result, producing a functional decreases, pain, and urgency (a compelling need to urinate). Involuntary urination may occur if voiding is not immediate. Voiding’s usual are small in volume, and the desire to urinate may be felt as almost constant urinary tenesmus (painful straining) until the irrigativeprocess resolves. Dysuria (painful urination) suggest irritation or inflammation in the bladder neck or urethra, usually due to bacterial infection. Persistent symptoms without such infection require careful evaluation of the bladder and urethra.
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Nocturia (voiding during the night) is an abnormal, but nonspecific, symptom, which may reflect early renal disease with a decrease in concentrating capacity but is commonly associated with cardiac and hepatic failure without evidence of intrinsic urinary system disease. Nocturia also may occur without disease; e.g. as a result of excessive fluid intake in the late evening or from urine retention secondary to bladder neck obstruction(e.g. prostatism).
Enuresis (bed wetting at night) is psychological during the first 2 or 3 years of life but becomes an increasing problem after that age. It may be produced by delayed neuromuscular maturation of the lower urinary tract, or it may indicate organic disease; e.g infection or distal urethral stenosis in girls’ posterior urethral valves in boy, or neurogenic bladder.
Hesitancy, straining, decrease in force and caliber of the urinary stream, and terminal dribbling are common symptom of obstructions distal to the bladder.
It men, these are most commonly associated with prostatic obstruction, less often with urethral stricture. Similar symptoms I a male child suggest posterior urethral stricture. Similarly symptoms in a make child suggest posterior urethral valves, congenital or acquired structure, or meatal stenosis in women, these symptoms suggest mearal stenosis.
Incontinence ( a loss of urine without wanting – see also , is associated with exstrophy of the bladder , epispadias , vesicovaginal fistula , ectopic ureteral orifices , congenital or acquired neurogenic ( peripheral neuropathy , stroke dementia dysfunction , as well as injuries sustained during prostatectomy or child birth.
In women, incontinence with mild physical stress such as coughing, laughing; running, or lifting is commonly associated with a cystocele as a result of aging or stretching of pelvic floor muscles during child birth. Loss of urine due to bladder outlet obstruction oar a flaccid bladder may produce overflow incontinence when the intravascular pressure exceeds outlet resistance. Residual urine is always present with over flow incontinence.
Pneumaturia (the passage of gas in the urine), a rare symptom, usually indicates a fistula the urinary tract and the bowel. This may be a complication of diverticulitis, with abscess formation,enterolocotis, carcimona of the colon, orvesicovaginal fistula. Rarely, pnematuria may be due to gas formation from bacteriuria alone? Chyluria is lymph in urine produced by rupture of a lymph vessel, chiefly due to obstruction from filarasis.
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NON MEDICAL WORDS
- To void to lessen - to stretch / Stretching.
Medical words
- micturition
- urgency
- enuresis
- dribbling/ to dribble
- meatal
- pneumatiria
- to injure
- Nocturiahesistancy
- Distal
- Incontinence
- Chyluria
- Edema
- Intake (Fluid°
- Straining / to strain
- Stricture
- Stroke
Comprehensive question
 What is frequency?
 What is pneumaturia
 What is urgency
 What is chyluria
 What is dysuria
 What is Nocturia
 What is enuresis
 What is incontinence
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2.4. REPRODUCTIVE SYSTEM
2.6.1. Introduction
Sexual reproduction always involves specialized cells called gametes. There are two types of gametes:
1. Sperm , produced by the female
2. Ova or eggs, produced by the female.
A new individual will develop only after a sperm cell has united with an ovum or an egg cell.
The fusion of a sperm cell with an ovum is called fertilization. A newly fertilized egg contains two sets of genes, a set from each parent.
2.6.2. Production of sperm
The organs involved in the production of sperms are:
- The testes: which are contained in the scrotum? They consist of thousands of small tubules which lead through a series of tubes to the urethra ( seminiferous tubules )
- Vas deferens :in going from the testes to the opening of the penis , the cells pass through the vas deferens
- Other organs are : Seminal vesicle,Prostate,Cowper’s glands
These glands secrete material which mixes with the sperm and is thought to provide the sperm with nourishment, to offer chemical protection and to support swimming motions.
The fluid consisting of sperm cells mixed with the glandular secretions is called semen.
- Also interstial cells of the testes secrete the male hormone called testosterone. This secretion and normal development of sperm are controlled by anterior pituitary secretion called gonadotropic hormones.
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2.6.3. Cycle of ova production
The female sex organs are:
- The ovaries ; together with fallopian tubes ( oviducts)
- The uterus ( wombs)
- The vagina ( birth canal)
The ovum begins to develop within the ovary. As itmatures, it migrates toward the surface and become surrounded by a fluid – filled cavity called a follicle. Every 28 days, on the average, one the most highly developed follicles ruptures and releases a single egg . This process is after a bout three to four days enters the uterus. Following ovulation, the ruptured follicle is transformed into a new structure called the corpus luteum which has two fates. It the egg has been fertilized, the corpus luteum persists for several months. If the egg is not fertilized, the corpus luteum degenerates.
2.6.4. Clinical problems with the reproductive system
1. Clinical problems with the female reproductive organs:
- Vaginitis : with the female reproductive
- Abnormal vaginal bleeding
 Oligomenorrhea:infrequent, irregular episode of bleeding, usually occurring at interval greater than 40 days.
 Metrorrhagia (hypomenorrhee): uterine bleeding excessive in both amount and duration of flow, occurring at intervals of 21 days a less.
 Polymenorhea: frequent but regular episodes of bleeding, usually occurring at intervals of 21 days a less.
 Hypomenorrhea: uterine bleeding that is regular bur decreased I amount.
 Intermenstrual bleeding: uterine bleeding usually not excessive, occurring between regular menstrual periods.
 Menometrorrhagia: uterine bleeding, usually excessive and prolonged occurring at frequent and irregular intervals.
 Spotting: vaginal bleeding occurring intermittently and usually not of sufficient quantity to require a pad or tampon.
 Dysmenorrhea
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Which is painful menstruationconsidered sever by the patient? The pain consists of lower abdominal cramping with nausea vomiting diarrhea, headache, breastwelling and even syncope.
Premenstrual syndrome(PMS) which is a constellation of symptoms occurring during the luteal phase of the menstrual cycle common manifestation include:headache, breast swelling and tenderness,irritability, tension
Pelvic inflammatory disease (PID) refers to an acute or sub-acute ascending genital tract infection. It may besalpingitisophoriotis acute adhexitis….
- Benign breast disease
- Femalesexual dysfunction
- Lack of interest
- Lack of arousal
- Lack of orgasm
2. Clinical problems with the male reproductive organs:
- Priapism:painful, persistent and abnormal penile an accompanied by sexual desire or excitation.
- Hydrocele : which is excessive accumulation of fluid around testes
- Impotence which is the inability to maintain erection adequate or sexual intercourse
TEXT ANALYSIS
TEXT ONE: PREGNANCY & MENOPAUSE
PREGNANCY
The uterine cycles are also stopped by pregnancy, which begins with fertilization of the ovum. At the climax of the sex act, male sperms are deposited in the upper region of the vagina. From here some of the sperms may be transported through the uterus and into the oviducts, or fallopian tubes. The sperms are carried into the oviducts BY THEIR OWN SWIMMING action and perhaps by movements of the uterus and oviducts. The sperms can probably remain in a healthy, fertile state for as long as 24 hours. The ovum probably remains fertilizable foe a shorter time, perhaps for only a few hours.
These two periods must overlap if fertilization is to take place.
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Although millions of sperms are liberated by each ejaculation (release of male sperm), only one sperm out of the million enters and fertilizes the two ovum.
Once the sperm enters the ovum.Its head expands and the hereditary material which it contains combines with the hereditary material of the ovum. Next, the egg begins to divide into a two cell stage, the into a four cell stage,eight, and so on. The process continues and forms a small/ball of cells. By this the developing mass of cells has moved through the oviduct entered the uterus.
MENOPAUSE
The menstrual cycle can be interrupted in either of two ways – by menopause or by pregnancy. When a woman reaches the age of 45 to 55 years the uterine cycles begin to change.
At first becomes irregular, then after a few months to a few years, the cycles cease. During this time FSH is still produced and ovulation ceases. During this period the woman must adjust both psychologically and psychologically to the withdrawal of estrogens.
TEXT TWO: ERECTION & EJACULATION
ERECTION
Erection is initiated by dilatation of the arterioles of the penis. As the retile tissue of the penis fills with blood, the veins are compressed, blocking out flow and adding to the furgor of the organ. The integrating centers in the lumbar segments of the spinal cord are activated by impulses in afferents from the genitalia and, in men, descending tracts that mediate erection in response to erotic psychic stimuli. The efferent fibers are in the pelvic splanchnic nerves. Sympathetic vasoconstrictor impulse to the arterioles terminates the erection.
EJACULATION
Ejaculation is a – 2part spinal reflex that involves emission, the movement of the semen into the urethra; and ejaculation proper, the propulsion of the semen out of the urethra at the time of orgasm. The afferent path ways aremostly fibers from touch receptors in the glands penis that reach the spinal cord thought the internal pudenda nerves. Emission is a sympatheticresponse integrated in the upper lumbar segments of the spinal cord and affected
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by contraction of the smooth muscle of the vasa differentia andseminal vesicles in response to stimuli in the hypo gastric nerves. The semen is propelled out of urethra by contraction of the bulb cavernous muscle, a skeletal muscle.
The spinal reflex centers for this part of the reflex are in the upper sacral and lowest lumbar segments of the spinal cord, and the motor path ways traverse the first to third sacral roots and the internal pudenda nerves.
No medical- words
- Out flow
- Propulsion
- Withdrawal
- Turgor
- To propel out
- To overlap
- To mediate
- To cease
Medical words
- Arterioles
- Sympathetic
- Climax
- Fertilizable
- Genitalia
- Splanchnic
- FSH
- Erotic
- Orgasm
- Fertile
Comprehensive questions
1) What is the pregnancy?
2) What is the menopause?
3) Explain erection
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4) Explain ejaculation
2.7.HEARING AND THE EAR
2.7.1. Ear description
The ear has three parts:
- The external ear
- The middle ear
- The inner ear
The tympanum or ear drum; a membrane that initiate a series of events leading to the way the sound is perfected trough vibrations. It separates the external from the middle ear. While the external and the middle ears are filled with air, the inner ear is filled with fluid.
The middle ear is separated from the inner ear by rigid walls consisting of membranous material which can stretch. Other parts of the ear are:
- The cochlea, with the basilar membrane which connects with nerve endings that transmit impulses from the ear to the brain.
- The Eustachian tube which lead the middle ear to the mouth. It is an opening important in preventing the development of any pressure differences across the ear drum.
2.7.2. Clinical problems of the ear
The main ear clinical problems are:
1) Deafness which is hearing loss it may be :
- A nerve deafness ; due to an interruption of nerve fibers;
- A Conductiondeafness: due to occlusion of the external auditory canal or the Eustachian tube.
2) Tinnitus or ringing in the ear
It is a subjective phenomenon described variously as “ringing”. “whistling” or” crickets in the ear”
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3) Otitis :
Is the general term referring to any inflammatory process of the external or the middle ear (Otitis external and Otitis media).
4) Earwax (Cerumen)
Is created by the secretions of the sebaceous gland (located in the skin that lines theouter, cartilaginous half of the ear canal).
Cerumen has a protective, antibacterial effect, by helping to maintain an acid pH in the ear canal and serving as barrier to infection. However, when excessive or impacted secretion result in a hearing deficit,Cerumen removal become necessary.
2.7.3. TEXT ANALYSIS :
External, middle & inner ear
The external ear funnels sound waves into the external auditory meat us. In some animals, the ears can be moved like radar antennas to seek out sound.
From the meat us, the external auditory canal passes to the tympanic membrane (eardrum).
The middle ear is an air-filled cavity in the temporal bone that pens via the auditory (Eustachian) tube into the nesopharynx and through the nesopharynx to the exterior. The tube is usually closed , but during swallowing , chewing and yawning it opens , keeping the air pressure on the 2 sides of the eardrum equalized the 3 auditory ossicles,the malleus , incur , and stapes, are located in the middle ear . The manubrium (handle of the malleus) is attached to the middle ear. The manubrium (handle of the malleus) is attached to the back of the tympanicmembrane. It’sattached to the wall of the middle ear and its short process is attached to the incur, which in turn articulates with the head of the stapes. The stapes is named for its resemblance to a stirrup its foot plate is attached by an annular ligament to the walls of the oval window. Two small skeletal muscles, the tensor tympani and the stampedes, are also located in the middle ear. Contraction of the former pulls the manubrium of the malleus medially and decreases the vibrations of the tympanic membrane, contraction of the latter pulls the foot plate of the stapes out the oval window.
The inner ear (labyrinth) is med up of 2 parts, one within the other. The bony labyrinth is a series of channels in the petrous portion of the temporal bone.
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Inside thesechannels, surrounded by a fluid called per lymph, is the membranous labyrinth. The membranous labyrinth more or less duplicates the shape of the bony channels, it is filled with a fluid calledendolymph, and there is no communication between the spaces filled with endolymph and those filled witherilymph.
HOME WORK
Make a list of essential medical and non- medical words.
Make sure you understand those words and the text.
2.8.SEEING AND THE EYE
2.8.1. Eye description
The eye is covered on the outside with a tough white tissue called sclera. Toward the front of the eye, the sclera becomes transparent and is known as the cornea. An inner layer, called the retina, contains cells sensitive to light. These cells are connected to nerve fibers that transmit impulse the brain.
Light reflected from objects is focused on the retina by the lens which divides the eye into two chambers filled with fluid.
2.8.2. Clinical problems eye:
The main eye clinical problems are:
1. Ocular foreign bodies from shattered particles in a work related accident or from explosion ( gunshot, fireworks)
2. Corneal abrasion: when a portion of the epithelial surface of the cornea happens to be destroyed.
3. Conjunctivitis: which are the inflammation and/or infection of the conjunctiva, a transparent tissue that converse the posterior surface of the lids (palpebral conjoctiva) and the anterior surface of the sclera (bulbar conjunctiva).
4. Cataracts which is the clouding of the lens with severe visual impairment.
5. Glaucoma: which is characterized by an increased ocular tension capable of producing optic serve damage?
6. Visual impairment in terms of
- Distance vision (myopia)
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- Near vision ( blindness)
- Color vision ( red, green color deficiency)
- Intra ocular pressure ( glaucoma)
2.8.3. TEXT ANALYSIS :
Anatomic considerations of the eye
The eyes are complex sense organs that have evolved from primitive light – sensitive spots on the surface of invertebrates. Within its protective casing each eye has a layer of receptor to the brain. The outer protective layer of the eyeball, the sclera, is modified interiorly to form the transparent cornea,through which light rays enter the eye. Inside the sclera is the choroid, a pigmented layer that contains many of the blood vessels which nourish the structures in the eyeball. Lining the posterior two- thirds of the choroids is the retina, the neural tissue containing the receptor cells.
The crystalline lens is a transparent structure held in place by a circular lens ligament (zonule). The zonule is attached to the thickened anterior part of the choroid the ciliary body contains circular muscle fibers and longitudinal fibers that attach near the corneoscleral junction.
In front of the lens is the pigmented and opaque iris, the colored portion of the eye. The iris contains circular muscle fibers that constrict and radial fibers that dilate the pupil. Variations in the diameter of the pupil. Variations in the diameter of the pupil can produce up to 5- fold changes in the amount of light reaching the retina.
The space between the lens and the retina is filled primarily with a clear gelatinous material called the vitreous (vitreous humor). Aqueous humor, a clear liquid, is produced in the ciliary body by diffusion and active transport and flowstrough the pupil to fill the anterior chamber of the eye. It is normally reabsorbed trough a network of trabeculae into the canal of Schlemm, a venous channel at the junction between the iris and the cornea n ( anterior chamber angle) . Obstruction of this outlet leads to increased intraocular pressure and the serious eye disease glaucoma. One cause is decreased permeability trough thetrabeculae (open (angle, angle closure glaucoma).
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HOME WORK:
Make a list of essential medical and non -medical words
Make sure you understand those words and the text.
2.9.SMELLING AND THE NOSE
2.9.1. Nose & smelling sense description
The olfactory/ smelling receptors are located in a specialized portion of the nasal mucosa , the yellowish – pigmented olfactory mucus membrane.
Filaments of the olfactory nerve, which is responsible for the smelling pass from the nasal mucous membrane trough the cribriform plate of the ethmoid bone to the olfactory bulbs.
2.9.2. Clinical problem with smelling sense:
Clinical problems with the smelling sense:
1) Hyposmia which is a partial loss of the sens of smell ( reduction of smell)
2) Anosmia : which is a total loss of the sense of smell
3) Parosmia: which is the perversion of the sense of smell
4) Hypersomnia:which is an increased sensitivity to odors.
2.9.3. TEXT ANALYSIS:
Psychology of olfaction, stimulation of receptors
Olfactory receptors respond only to substances that are in contact with the olfactory epithelium and are dissolved in the thin layer of mucus that covers it.
The olfactory thresholds for the representivesubstance shown in table 1-1 illustrate the remarkable sensitivity of the olfactory receptors o some substances. For example , methyl mercaptan, the substance that gives garlic its characteristic ador, can be smelled at a concentration of less than one – millionth of a milligram perliter of air. On the other hand, discrimination of differences in the intensity of any given ador is poor. The concentration of an ador – producing substance must be changed by about 30% before a difference can be detected. The comparable visual discrimination threshold a 1% change in light intensity.
Make a list of essential medical and non medical words
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Make sure you understand those words and the text.
Table 1: some olfactory thresholds
Substance mg/L of Air
Ethyl ether 5.83
Chloroform 3.30
Pyridine 0.03
Oil of peppermit 0.02
Iodoform 0.02
Butyric acid 0.009
Propyl mercaptan 0.006
Artificial musk 0.00004
Methyl mercaptan 0.0000004
When odoriferous molecules react with a receptor, they generate a receptor potential; but the mechanism by which the molecules generate the potential is not known. Odor – producing molecules are generally those containing from 3-4 up to 18-20 carbon atoms, and molecules with the same number of carbon atoms but different structural configurations have different odors. Relatively high water and lipid solubility are characteristic of substances with strong Odors. One theory holds that odoriferous molecules inactivate enzyme systems in the epithelium, altering its chemical reactions. Another theory holds that the molecules alter the surface of the receptor cells; thus changing their electrical state. A third theory holds that the molecules simply alter the Na+ permeability of the receptor membrane.
There is a pronounced degree of inhibitory within the olfactory pathways. The reciprocal synaptic connections between mitral and granule cell dendrites mediate inhibitory control of mitral cell out- put. In the olfactory cortex, the response to a door is excitation of pyramidal cells followed by inhibition. The pyramidal cells are then subject to self reexcitation via long axon collaterals and this may explain the propensity for rhythmic activity and seizures in the olfactory cortex.
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HOME WORK:
 Make a list of essential medical and non medical words
 Make sure you understand those words and the text.
2.10. FEELING AND THE SKIN
2.10.1. Skin description
The skin is composed of three layers:
- The epidermis with cells like melanocytes
- The dermis with nerves and vessels
- The hypodermis, which is panniculusadiposus or subcutaneous tissues that act as a cushion between epidermis & dermis and the underlying bone.
We would insist on the fact that three are four cutaneous senses:
 Touch – pressure
 Cold
 Warmth
 Pain
The skin contains various types of sensory endings.
These include naked nerve endings (expanded tips on sensory nerve terminals) and encapsulated endings.
The expanded endings include Markel’s disk and Ruffini endings, whereas the encapsulated endings include pacinian corpuscles, Meissner’scorpuscules and Krause’s end – bulbs. Where they are present, the expanded or encapsulated endings appear to function as mechano receptors that respond to tactile stimuli.
Any given ending signals one and only one kind of cutaneous sensation.
Also, touch receptor organs are most numerous in the skin of the fingers and lips and relatively scare in the skin of the trunk.
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2.10.2. Clinical problems of the skin :
Principal types of the skin lesions are:
1. Primary lesions :
- Macule : a flat discolored spot ( less than 10mm ofvaried shape)
- Patch : a spot similar to macule superior to 10mm
- Papule : a solid , elevated lesion usually inferior to 10 mm in diameter
- Nodule : a palpable solid , superior to 5 or 10 mm in diameter
- Vesicle: a circumscribed elevated lesion less than 5 mm containing serous fluid.
- Pustule: a superficial elevated lesion containing pis.
2. Secondary lesions
They result either from natural evolution of primary lesions or from the patient’s manipulation of the primary lesions.
- Crust: dried serum, blood or pus crusting occurs in a wide variety of inflammatory and infectious diseases.
- Erosion: loss of part or all of the epidermis. Erosion is offers seen in infections from herpesviruses.
- Ulcer: loss of epidemis and at least a part of the dermis.
o Excoriation: a linear or hallowed out crusted area caused by scratching ( rubbing or picking)
- Atrophy : paper – thin , wrinkled skin
- Scar: fibrous replacing normal skin structures after destruction of some of the dermis.
2.10.3. TEXT ANALYSIS
Cutaneous sense organs
The are 4 cutaneous sense: touch pressure (pressure is sustained touch),cold, warmth, and pain. The skin contains various types of sensory endings.
These include naked nerve endings, expanded tips on sensory nerve terminals, and encapsulated ending include paciniancorpsules, Meissner’s corpuscles, and Krause’s end –bulbs.
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Ruffiniendings andpaciniancorpuscles are also found in deep fibrous tissues. In addition, sensory nerves end around hair follicles. However, none of the expanded or encapsulated endings appear to be necessary for cutaneous sensation.
Their distribution varies in different regions of the body, and it has been repeatedly demonstrated that all 4 sensory modalities can be elicited from areas that on histologic examination contain only naked nerve endings. Where they are present, the expanded or encapsulated endings appear to function as mechanoreceptors that respond to tactile stimuli. The nerve endings around hair follicle mediate touch and movement of hairs initiate tactile sensations. It should be emphasized that although cutaneous sensory receptors lack histologic specificity, they are psychologically specific. Thus, any given ending signals one and only
HOMEWORK
 Make a list of essential medical and non-medical words
 Make sure you understand those words and the text.
2.11. TASTING AND TONGUE
2.11.1. Tasting sense description & disease
Taste conceptors are chemo receptors that respond to substances dissolved in the oral fluids bathing them. These substances appear to evoke generator potentials, but how molecules in the solutions interact with receptor cells to produce these potentials is not known. This is evidence that taste producing molecules act on the membrane of the receptor cells or their processes.
In human, there are from basic tastes: sweet, sour, bitter and salt.
 Bitter substances ate tasted on the back of the tongue
 Sour along the edges of the tongue
 Sweet at the tip of the tongue
 Salt on the dorsum of the tongue anteriorly.
The most frequent clinical problem with the tongue is “glossitis” which is an acute or chronic inflammation of the tongue.
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2.11.2. TEXT ANALYSIS:
Psychology of taste, receptor stimulation
Taste receptors are chemo receptors that respond to substance is dissolved in the oral fluids bathings them.
These substances appear to evoke generator potentials, but how molecules solution interacts with receptor cells to produce these potentials is not known. There is evidence that taste producing molecules act on the membranes of the receptor cells of their processes.
One theory is based on the hypothesis that the receptor hairs have a polyelectrolyte surface film. According to this theory, binding of ions to this film causes a distortion in the special arrangement of the film, with a consequent change in the distribution of change density .There is also evidence that taste –provoking molecules bind to specific proteins in taste buds. The binding of substances of the receptors must be weak, because it usually takes relative rely washing with water to abolish a taste.
HOME WORK
- Make a list of essential medical and non-medical words
- Make sure you understand those words and the text.
Overall comprehensive questions:
1) Explain the hearing process
2) Explain the seeing process
3) Explain the smelling process
4) Explain the tasting process
If you don’t find enough explanation in your hand out or syllabus, ask questions and read other books.
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UNIT THREE: MAJOR PUBLIC HEALTH PROBLEM IN DEVELOPING COUNTRIES
3.1.Definition
- Health: a state of complete physical mental and social wellbeing and not only the absence of disease or infirmity.
- Disease: anatomical and physiological alteration of the body structures due to the incapacity of the body to adjust to outside aggressions. They are mainly two types of diseases: in born (hereditary) and acquired diseases.
- Health for all: it is awho objective which state that, every citizen of the world will have to lead a socially economically acceptable life.
- Primary health care ( PHC):
It is the strategy to reach HFA objective. PHC is essential health care, scientifically and technically sound provided to all the members of the communities of the country, in the spirit of self - determination (participation); at cost that the communities and the country can afford
- Components of the PHC strategy
1. Health Education
2. Good Nutrition
3. Safe Water supply & Sanitation
4. Maternal and Child health center(CMH)& Family Planning
5. Preventable communicable diseases
6. Chronic endemic diseases
7. Treatment of current lesions and common diseases
The Democratic Republic of Congo (DRC) added:
8. mental health
9. personnel development
10. district or health zone managerial process
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3.2.The goal of public health
3.3.Methods of prevention
- Safe environment
- Immunization
- Behavior change (life style)
- Adequate nutrition
- Appropriate medical care
Environment: these is a relationship between fifth and disease (fifth = dirty waste, garbage)
Immunization: short term & long term immunization
Passive immunization is conferred by immune serum, while active immunization is conferred by vaccines.
Behavior: reduced mortality from infections and other communicable diseases is due, not only to the quality of curative care, but also to the attitude towardspersonal hygiene ( behavior change ).
Nutrition: nutrition status has influence on health. Under nutrition leads to malnutrition, over nutrition leads to obesity.
Appropriate medical care: this is related to the quality of care (qualified personnel, good facilities , modern equipment)
3.4.TEXT ANALYSIS
3.4.1. Reading
The goals of medicine are to preserve health, to restore health and to relieve suffering. To preserve and promote health requires applications of scientific disciplines and possession of skills and beliefs that are best described by the phrase ‘public Health and Preventive medicine’. Public health can be defined ova combination of sciences, skills and beliefs that are directed to the maintenance and improvement of the health of all the people. Public health in concerned with the wellbeing of mankind and of course with the wellbeing of individual members of the society.
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Preventive medicine is the branch of medicine that is primarily concerned with preventing physical, mental and emotional disease and injury, in contrast to treating the sick and injured. Of course, prevention is often inseparable from treatment and cure.
Prevention is seen at three levels: primary, secondary and tertiary prevention.
Primary prevention means preventing the occurrence of disease of injury (the disease is no there yet).
Secondary prevention means early detection and intervention before the condition is clinically apparent (the disease is there already, but you want to modify its course).
Tertiary prevention means minimizing the effects of disease and disability (preventing complications).
3.4.2. Look up the following medical words in the dictionary
- To restore :
- To relieve
- Skill
- Wellbeing
- Mankind
- Disability
3.4.3. Comprehensive questions
- What are the goals of medicine?
- What is the main difference between public health and curative medicine?
- What are the three levels of prevention? Explain then.
3.5.Public health problems in less developed countries
3.5.1. Infection & communicable diseases:
- Viral infection like small pox, chickenpox poliomyelitis, hepatitis….
- Bacterial infection like tuberculosis, typhoid, meningitis, cholera, trepanematosis….
- Parasitic infections like amibiasis, ascaridiasis ….
- Diseases transmitted by arthropods , malaria , trypanosomiasis , filariasis
- Diseases transmitted from animal to man (viral disease like rabies, parasitic disease like taeniasis…).
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3.5.2. Environmental problems :
- Water quality ( drinking water)
- Waste disposal& sanitation
- Air pollution ( pulmonary diseases)
3.5.3. Poverty
- Hunger
- Children < 5years
- Malnutrition
- Pregnant women
3.5.4. Problems related
- Pregnancies ( abortion)
- Deliveries ( accident)
- Complications of pregnancies and deliveries.
3.5.5. Road accident , injuries and other problems like
- Alcoholism – when you drink , do not drive
- When you drive , do not drink
- Youth behavior :life style
- Ignorance of rules: driver’slicense.
UNIT FOUR: HEALTH CARE ORGANIZATIONS
4.1.MULTILATERAL
Many countries are involved. Most of them are parts of the united nation (UN) system. The main organizations are:
- General Assembly
- Secretariat
- Security council
- Economic and social council ( with WHO)
- International court of justice
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4.1.1. The World Health organization WHO
The head quarter is in GENEVA
- Head quarter organization
WHO has a director general charged with (1) infections and communicable disease(2) environment (3) statistics (4) cancer (5) ; publication (6) primary care and (7) administration.
WHO objective
The attainment by all the people on the highest possible level of health
WHO provides worldwide services to promote health?
WHO cooperates with member countries in their health effort?
WHO coordinates biomedical research?
WHO mains organ are:
(1) The world Health assembly
(2) The executive Board
(3) Secretariat in Geneva and regional office
4.1.2. The United Nations Children Fund( UNICEF)
- Created after the war II to assist children in reducing morbidity & mortality
- Collaborates with other UN programs:
EPI = Expended Program of Immunization (PEV)
DDC= Diarrhea Disease Control (in Atlanta)
4.1.3. The world blank
Plays a key role in financing basic health services to improve the health of low groups:
- Water supply project
- Sewerage
- Nutrition
- Family planning
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- Training for health personal
4.2.Bilateral organizations
Two countries involved (government to government)
4.2.1. AID ( USAID)= Agency for International Development
USAID objectives:
- To develop the abilities of the people of third world countries to solve their own problems;
- To promote democratic institutions through which local communities can take responsibilities for their own development.
4.3.(PVO) Private Voluntary Organization ( no for profit)
- Religions groups like ( evangelical Foreign mission Association( EFMA)
- Secular groups like Oxfam , Rockefeller Foundation
4.4.For profit Organization like drug Manufactures (CIBA)
4.5.Text analysis
4.5.1. Reading : preamble to the constitution of the world health organization
The states parties to this constitutiondeclare, in conformity with the character of the UN, that the following principles are basic to the happiness, harmonious relations and security of all peoples:
- Health is a state of complete physician , mental and social wellbeing and not merely the absence of disease or infirmity
- The enjoyment of the highest attainable standard of the health is one of the fundamental rights of every human being without distinction of race, religions, political belief, economic or social condition.
- The health of peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and states.
- Inequality development in different countries in the promotion of health and control of disease, especially communicable diseases is a common danger.
- Health development of child is of basic importance…
The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.
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- Informed opinion and active cooperation on the part of the public are the utmost importance in the improvement of the health of the people.
- Governments have a responsibility for the health of their peoples which can be full flied only by the provision of adequate health and social measures.
4.4.2. Look up the following words in the dictionary
- Preambles;
- Charter
- Happiness
- Right
- Standards
- Responsibility
4.4.3. Comprehensivequestions
- Is health a right
- What are other values people attain trough health?
- What is the responsibility of the public (communities) with regard to health?
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UNIT FIVE: THE MEDICAL RESEARCH PAPER
A research paper might be:
- A dissertation
- A project
- A report
5.1.Definitions
- Research is designed to answer the question “why”. It is based on thinking rationally logically.
- Science is a method to solve problem or answer questions that investigations find to interesting. Researchers use scientific methods in their attempt to explain things.
Basic research: research whose primary purpose is discovering knowledge (the pratical side is considered later).
- Applied or operational research: aims to solve practical problems (the practical side comes first).
5.2. The scientific method
- Problem identification
- Problem definition
- Objectives and hypothesis formulation
- Data collection
- Conclusion and recommendations.
1. Problem Identification
A problem is a perceived discrepancy between what it is what should be.
2. Problem definition
The research problems identified must now be defined in terms of occurrence, intensity, distribution and other measures for which data are available.
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3. Objectives and hypothesis formulation
- Objective : expected contributions
- Hypothesis : statement on an expected relationship between 2 or more variables
4. Data collection : use of questionnaire
5. Data analysis : use statistics methods& tests
6. Conclusion and recommendations.
5.4. TEXT ANALYSIS
5.4.1. TEXT ONE: SCIENCE AND THEORY
The ultimate goal of scientific inquiry is to formulate theories. Theories provide a way to conceptualize, organize, integrate, and classify the facts that scientists accumulate. A theory can describe a tentativeexplanation of some phenomenons.
As scientists, when we ask the question “why” and attempt to answer it we are formulating a theory is then verified trough evidence either by observation or experimentation.
Look up the following words in the dictionary
- Theory
- Fact
- Phenomenon
- Observation
- Experimentation
Comprehensive questions:
- What is a theory,
- Is a non-verified theory valid? Why?
5.4.2. Text two: predicting the success of primary health care districts in the Democratic Republic of Congo
The democratic Republic of Congo is a developing country with a population living for the most part in rural area. Its major health problems are determined by the equatorial or tropical climate as well as the general poverty of the population. To address the problems above, the Democratic Republic of Congo government prepared is first National Development
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Plan for primary health care in 1986. This plan resulted in the creation of 306 districts called “health Zones”.
In the last five years, bilateral, multilateral and non- for- profit organizations have been providing any kind of resources to either urban or rural health zone to sustain their primary health care activities and accelerate an equitable development in the space and time horizon. Today, more than two hundred health zones are considered operational. Among those operational health zones, some have progressed more rapidly than others. They have been more successful in attaining health foe objectives. The reason for this disparity across health zones is a central question of this research.
This study investigated the way some factors contribute to the success of a health zone. Factors were identified by using a group of experts who estimated,(1) the likelihoods of success associated with each factor level or the value of the impact of new evidence (information) about the health zone to succeed , (2) the a priori probability of a health zone to succeed or the perceived chance of a health zone to succeed without new information. The two results above were used to calculate likelihood and prior odds ratios which the odds form of the Bayes ’ theorem aggregated produce the following predictive model.
P (S/F1 OR NF1…..F16 OR NF 16) = LHR ( F1 OR NF1 )….LHR ( F16 OR NF 16) X 1.27
P( NS/F1 OR NF1 , …..F 16 OR NF 16)
Where S= Success, F1. F16. F16 = factor 1 ….. Factor 16 NF…..NF16= NO Factor 1…..NO Factor 16, LHR = Likelihood ratio.
The model was validated (1) internally by comparing its predictions to the opinion of expert and, (2) externally by comparing its predictions to observe out comes and predictions of logistic regression model.
It is expected that, the Democratic Republic of Congo government and similar developing countries will use the model to evaluate their PHC programs. It is also expected that WHO, UNICEF, the WORLD BANK and other stakeholder will use the model for decision making health zones or health districts.
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HOMEWORK
1. Make a list of essential medical and non-medical words
2. Make sure you understand those words and the text.
REFERENCES
BRENDAD D. Smith, Bridging the GAP: college reading, second ed. Foreman’s and company, 1985
Christian Medical Commission, WCC, Story telling for health teaching, GENEVA
HARRISON, Principles of Internal Medicine, seven, ed R.R. Donnelley&Sons Company; Mcgraw – hill 1974
HELEN A. Introductory Nutrition, second ed. The CVMOSBY Company Saint Louis 1975.
John M. Last Public Health and Preventive Medicine, New York;
LAURNA R. Manual of clinical problem in adult, Boston, Toronto, 1985
LESTIE B, medical dictionary? WB Saunder Company, Philadelphia and London, 1959
MCEROY, Foundation of Biology, prentice – hall, Inc, New Jersey 1968
MUNYANGA MUKUNGO; Predicting the success of primary health care district in the Democratic Republic of Congo
Philip K. The Merck manual of diagnostic and therapy, Rahway NJ, 1992
Z.I. Winestein; A. M. MASLOVA.LS. Piebeyskaya, essential English for students.
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SCIENTIFIC & MEDICAL ENGLISH COURSE, PART II
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THE MEDICAL ENGLISH COURSE SECOND YEAR, 1996-1997
OBJECTIVE OF COURSE
At the end of the course, the student will be able to understand and describe in English:
- The Congo health problems and the Congo Primary health care program
- Selected topic of human body physiology and biochemistry
- Relationship between the patient and the physician
- The hospital and selected clinical cases:
In surgery (department / service)
In internal medicine (department/service)
In pediatric (department /service)
In OB- GYN (obstetrics – gynecology)
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COURSE PLAN
Section A: Congo Health Problems& Congo Primary Health care Program
Chap .I Congo Health Problems
Chap II. Congo Primary Health care Program
Section B: Human Body physiology & Biochemistry
Chap. III. Human Body physiology
Chap .IV. The chemistry of Biological compounds
Section C: The patient, the physician and medical record
Chap V: the patient, the physician, the medical record
Chap VI. The vital signs
Section D: the hospital and clinical selected cases
Chap VII. The hospital
Chap III. Clinical selected cases
8.1. The internal medicine service and an intern medicine selected case
8.2. The surgery service and a surgery selected case
8.3. The pediatric service and a pediatric selected case
8.4. The obstetric – Gynecology service and OB& GYN selected cases.
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Section A: CONGO HEALTH PROBLEMS & CONGO PRIMARY HEALTH CARE PROGRAM
CHAPITRE I: CONGO HEALTH PROBLEMS
1.1. Causes of death and disease
- Most deaths result from infections and parasitic diseases. The parasitic diseases are chronic and debilitating. They are also endemic. The common infection diseases can be prevented by immuzation.
- Diarrhea diseases are widespread in the country. They are transmitted by human foe call contamination of soil; food and water. Most of the people have no access to a safe water supply or adequate sanitary facilities.
- Diseases transmitted by insects and other vectors are also widespread in the country. Malaria remains the most prevalent in spite of the fact that it can be prevented by a routine administration of inexpensive drugsor by insecticide spraying to kill the mosquito’se and its larvae.
- Schistosomiasis, caused by a snail- born parasite is endemic in the country
- Onchocerciasis or “river blindness” causes blindness in more than 20 % of the adult population.
In developed countries, on the other hand, deaths are due to cardiovascular diseases, cancer and accidents.
In developed countries, health problems due to industrialization urbanization and chronic diseases in adult people are also important.
1.2. Congo Health problems
Health problems in Congo are determined by the nature of the tropical or equatorial environment as well as the generalized poverty of the population.
The major health problem is:
1. Infectious diseases as malaria , tuberculosis, schistomiasis, STD ( sexual transmitted disease)
2. Pregnancies , deliveries and their complications
3. Malnutrition in it from of kwashiorkor or marasmus
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Other problem of relative less importance includes:
 Hypertensive diseases
 Diabetes mellitus
 Drepanocytosis
 Cardiovascular diseases
Angina pectoris, myocardial infarction are still of negligible importance compared to their impact in highly developed countries.
TEXT ANALYSIS: CHILDHOOD INFECTIOUS DISEASE EPIDEMIOLOGY
Based on data reported from hospitals in 1975, from throughout the country, the National Health Plan of Congo lists infectious and parasitic diseases as the most important causes of overall morbidity and mortality. Malaria is described as the most important cause of morbidity from infection disease and the most important causes of infectious disease mortality during the first year of life. Measles is described as the greatest overall cause of infectious disease – related mortality. Cholera and other acute diarrhea disease are like wise listed as important causes of mortality. Malnutrition and birth defects are listed as important non – infectious causes of under – five mortality .The following supplemental information about measles, diarrhea diseases and malaria in the under – five population was developed by the pre- program assessment team from an analysis of records at Mama Yemo Hospital (Kinshasa), Kisantu Hospital (Kisantu Rural Health Zone) and Ngidinga Maternity Dispensary (Kisantu Rural Health zone). The information is presented for the years 1976, 1978 and 1980, and clearly confirms that these three diseases are serious childhood health problem in both urban and rural Congo.
Non-medical words
- Childhood
- Throughout
Medical words
- Morbidity
- Mortality
- Defect ( birth, defect)
- Assessment
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- Measles
Comprehensive questions
- In which document did they take the text from?
- What is morbidity? Mortality?
- What are the most important causes of diseases and death in children under five?
- What are the three serious childhood health problems?
CHAPII: CONGO PRIMARY HEALTH CARE
2.1. Primary health care
Is essential health care
- Based on practical scientifically sound and socially acceptable methods and technology
- Made universally accessible to individuals and families in the community and the country can afford to maintain at every stage of their development in a spirit of self- reliance and self-determination.
2.2. What are PHC components (in CONGO?)
1) Information and Education concerning health
2) promotion of food availability and proper nutrition
3) water and sanitation / adequate supply of water & basic sanitation
4) maternal and child health including family planning
5) immunization against the major infection diseases
6) prevention and control of endemic diseases
7) appropriate treatment of common diseases and injuries
8) provision of essential drugs
9) man power organization and management
10) mental status
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2.3. How is PHC organized in CONGO?
In 1986, the country prepared its first national development plan for PHC. This plan resulted in the creation of 306 districts called “health Zone”. A health zone is defined as an operational , autonomous and planning entity designed to provide all aspects of basic health care curative , preventive, primitive and rehabilitative to an average of 100.000or 150. 000 inhabitants.
Each health zone is organized around a hospital and net mark of 15 to 20 health centers. A health center is in charge of 5000 to 10. 000 inhabitants.
2.4. PHC indicator
Indicator gives an indication of a situation. (The situation of the PHC program). They are variables which help to measure changes (changes in the PHC program).
1) Valid: they should measure what they are supposed measure
2) Objective : the answer they give should be the same if measured by different people in similar circumstances
3) Sensitive : they are supposed to vary with changes
4) Specific: they should reflect changes only in the situation concerned.
What are those indications for the PHC program?
Indication used to help Congo assess the progress towards HFA is grouped into four broad categories:
1) Health policy indicators :
- Political commitment to HFA
- Resource allocation & the degree of equity of distribution of health resources : proportion of the budget given to PHC
- Community involvement in attaining HFA( the project is designed , executed and evaluated with the community
- Organizational frame work and managerial process.
2) Social and economic indicators related to health
- Rate of population increase
- Gross national product
- Income distribution
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- Work condition ( salary , allowances)
- Adult literary
- Housing
- Food availability( 240.000 cal)
3) Indicators of the provision of health care
- Coverage by PHC/ service utilization
- Coverage by the referral system
4) Health status indicators
- Nutritional status and psychosocial development of children
- Infant mortality rate ( 0-1 year)
- Child mortality rate ( ages 1-4 years inclusive)
- Life expectancy of birth or at other specificages
- Maternal mortality rate
4. TEXT ANALYSIS
5. 1 THE TEXT : CONGO’S POLICY IS” HEALTH FOR ALL”
In 1981, Congo adopted a decentralized primary health care strategy emphasizing high impact preventive interventions and affordable basic curative care. This strategy replaced a hospital centered approach that had been consuming 80 percent of the budget but reaching only 15 percent of the people. The country was divided into 306 health zones, each to serve about 100, 000people.
USAID’s Basic rural health I and II projects have been working trough both government and non- government entities since 1981 to establish services in 100 rural health zones covering one third of the population. A health zone consists of more villages. Village health workers and traditional birth attendants provide care at the local level, especially in sparsely populated areas.
Three quarters of the project zones are managed by local non – government organizations. USAID provides basic medical and laboratory equipment, health education materials, training programs, and vehicles for supervising health center personnel and transporting vital drugs and vaccines.
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A separate project, Shaba refugee health, was begin as an effort to reconstruct health facilities destroyed during the Shaba invasions of 1977 and 1978, but is now trying to integrate those facilities into the zone system.
Words to look for in a dictionary
Non- medical words
 To emphasize
 Affordable
 To staff
 Medical words
 A nurse
 An aide
 A worker
Comprehensive questions
1. What is the difference between a centralized and decentralized system in the health care field?
2. What did the USAID’S Basic Rural Health I and II projects?
3. What is a health Zone?
4. Explain :
- A nurse
- An aide
- A village health worker
- An traditional birth attendant
5. What did provide USAID to the PHC program in Congo?
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SECTION B: HUMAN BODY PHYSIOμOGY & BIOCHEMISTRY
CHAPITRE III: HUMAN PHYSIOLOGY
3.1. The internal and external environment
If you examine a piece of a living tissue of your body under a microscope, you will find that its living cells are surrounded by a watery fluid.
The fluid surrounding cells is called “internal environment “, compared to external environment, outside your body. Inside the body is the internal environment.
Outside the body is the external environment. Your survival depends on exchanges between the internal and external environment.
3.2. Homeostasis
To survive the body must have some mechanism for keeping the composition of the internal environment constant, in a steady state. This tendency to regulate internal environment, keeping it in a steady state is called “homeostasis”.
3.3. Transport
The exchange of material between the external and the internal environments is important. Substances taking part in these continual exchanges must be transported back and forth in the same ways.
Forces causing this movement arise from difference in
- Pressure
- Concentration
- Electrical charge
3.4. Motion and muscular contraction
Most of body movements are caused by contraction of muscles there are three types of muscles:
1) Skeletal muscle: responsible for moving the bones of the skeleton . This type is frequently involved in rapid and short activity.
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2) Cardiac muscle: responsible for the pumping of blood out of the heart. This type contracts and relaxes with each beat of the heat.
3) Smooth muscle: found in the walls of hollow internal organs and blood vessels.
This type is involved in slow, sustained contraction. Skeletal muscle is under voluntary control .Smooth and cardiac muscles are not.
3.6.Information transfer:
In general, there are two ways in which information is transferred from one part of the body to another.
- One way through the action of hormones which are “chemical messengers”
- Another way is through the action of nerves impulses from different parts of the body to central nervous system or the other way around.
Motor nerves carry impulses from the CNS to the muscles and glands.
The motor pathway to the internal organs is known as the autonomic nervous system (ANS) which is not under voluntary control and is divided into sympathetic and parasympathetic systems.
3.7.TEXT ANALYSIS : BLOOD TYPES
There are several types of antigens that may be present on the donor’s red blood cells. Such antigens for the basis for classification of blood types. Two of the antigens are called simply A and B. Red Blood cells may have either A or B, both, or neither antigen. If your red cells contains only the antigens; then you have AB blood. If they contains only the A antigens, then you have type A blood; if only the B antigen; type B antigen, type B. If they do not contain either of the antigens then you have type O blood.
A person whose blood types us AB does not have any antibodies for either the A or B antigen in his plasma. If they did; these antibodies would react with the antigens and cause the cells to agglutinate and he would not survive. Similarly, a person whose blood type is A cannot have the A antibody in his plasma, but the man, and usually does have the B antibody. A person whose blood type is A cannot have the A antibody. And finally, the person whose blood type is O usually has both the A and the B antibodies in his plasma.
No reaction occurs here because there is no antigen on his red blood cells.
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Suppose we want to transfuse blood into a person whose type is B.? We must assume that he has A antibodies in his plasma. This means that be cannot receive blood from anyone who has the A antigen on his red cells. In other words, he cannot receive blood cells from a donor of type A or of type AB. However , he can receive blood from a person with the same blood type ( type B) or from a donor whose blood type is O. Using the same arguments, we see that a person with type A blood can receive cells from another person whose blood type is either A or O. A person whose blood type is AB has no antibodies is his plasma so he can receive blood from any of the type A,B,AB or O. Finally a person whose blood type is O has both antibodies in his plasma. Consequently, he can receive blood only from a type O donor. The A and B antigens are not the only ones carried by red blood cells. Sometimes, although less frequently reactive that do not involve A and B antigens.
Comprehensive questions
1) In which case a person will be classified as
- Type A
- Type B
- Type AB
- Type O
2) Who can receive from any other type? Why?
3) Who can give to any other types? Why?
4) Type A (or B) can receive from A (or B) and O. Why?
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CHAPITRE IV: THE CHEMESTRY OF BIOLOGICAL COMPOUNDS
4.1. What is water?
Water is the union o two atoms:hydrogen and an oxygen atom.
Water is the only substance that is commonly present in all three states as a solid, liquid and gas in the range of the temperature found at the earth surfaces.
The water freezing temperature is 0°C
The water boiling temperature is 100° C
F=C (9/5) +32(F= Fahrenheit)
C= (F-32) x 5/9 (C= Centigrade)
4.2. What are acids?
What are bases?
Acids are substances that can donate a proton (a hydrogen ion).
The concentration of hydrogen ions determines the degree of acidity of a solution. On the Ph.Scale, 7 is the neutral.
Acid substance has less than 7
Water is neutral. It has 7
Bases have more than 7
Bases are substances that combine with hydrogen ions.
4.3. What are carbohydrates, lipids and proteins?
Carbohydrates:
The basic units in carbohydrates are carbon, hydrogen and oxygen.
They range from relatively simple molecules (called sugars) to complex molecules ( starches and cellulose).
You may have: monosaccharide, disaccharides, and polysaccharides.
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Starch amidon is the reserve of carbohydrates in most plants it is formed by green plants in the process of photosynthesis. Glycogen is the reserve of carbohydrate of animals.
LIPIDS OR FATS
They are made up fatty acids. Animal fats are in solid or semi-solid state at the room temperature.
Vegetable fat or oils are in a liquid state.
Body fat represents the primary form in which energy is stored in the body.
Deposit of fat beneath the skin serve as insulating material for the body protecting it against shock and against changes in the environment.
PROTEINS
They are made up of amino acids. They make a significant portion of animal cells. They are important parts of the structures of chromosome, nucleoplasm and nuclear membrane.
Some of them speed up chemical reactions (enzymes)
TEXT: ANALYSIS: CHEMISTRY OF BIOLOGICAL COMPOUNDS
In this chapter we have briefly reviewed most of the major chemical substances that are associated with living organism, such as carbohydrates, fats, and proteins. We also saw that the source of chemical energy preserve in the carbohydrates is photosynthesis, which is carried out by green plants. Simple sugars such as glucose can combine with one another to form complex polysaccharides, such as glycogen (in animals) or starch (in plant). One of the chief ingredients of the cell walls of plants is cellulose, a complex polysaccharide. It can be broken down by microorganism and be made available to other organism as a useful nutrient.
Proteins are also complex polymers made up of varying combination of simple amino acids. The primary structure of proteins is determined by the kind and number of amino acids linked to gather by the peptide bond.
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This polypeptide can form spirals and fold back and forth on itself , giving a secondary and tertiary structures are important for certain catalytic and functional roles for the protein , and the structures are maintained in part , by hydrogen bonds .
In order for organism to make these complex structures internally – and thus grow and reproduce - certain nutrients are required,an energy source is essential (carbohydrates), and a nitrogen source (for the synthesis of amino acids and other nitrogen - containing compounds). If an organism cannot make the vitamins it requires, then it must consume other organisms that can make the vitamins, or obtain the vitamins from other source in the diet.
Certain autotrophic organism can live and multiply on a diet that certain only CO2, ammonia, minerals, and water. They obtain energy from the oxidation of ammonia (NH3). These are called chemosynthesis autotrophic organism. The greed plants obtain their energy from sunlight and are called photosynthetic autotrophs.
Man and most mammals are complex heterotrophic organism .They must obtain essential amino acids, fatty acids, and vitamins from other organisms that are capable of making them.
Oxygen is essential for a large number of organisms; but there are some that can live and reproduce without this gas (anaerobic organism). All organisms require certain major elements, such as sodium, chlorine, potassium, calcium, phosphorous, and magnesium. In addition, trace amounts of iron, copper, manganese; and zinc are also essential. Cobalt and iodine (and possibly vanadium and selenium) are required by animals, boron, molybdenum; and vanadium are required by plants. Because these latter elements are needed in trace amounts only does not mean that the trace elements are less important than the major elements.
The trace elements function, as catalysts, thus only small amounts are required.
Non-medical words
- Briefly
- Trace
- To carry out
- Bond
- Spiral
- To hold back and forth
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Medical words
- Autotrophic
- Heterotrophic
- Nutrient
- Polymer
Comprehensive questions
1) What is photosynthesis?
2) Compare glycogen to starch
3) Describes carbohydrates , proteins and fat
4) What are anaerobia organism
5) What are anaerobic organism
6) What is chemosynthetic autotrophic organism?
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CHAPITRE V: THE PATIENT, THE PHYSICIAN AND THE MEDICAL RECORD
5.1.THE PATIENT
The same type of illness presents in a variety of ways depending on the age, personality and social situation of the patient. This is one the basic principles in psychological medicine .Relevant here is the progressive change in the social relationship , from a state of complete dependence on parent , family or teacher , who must supply much of the historical details of an illness to one of relative Independence. At the same time, there are variable degrees of maturation which involve the partial suppression of egocentric drives. Their trends and their modification during life experience are the basis of personality, and deviation in this natural development preventssatisfactory social adjustment. Another aspect of the problem is the real or implied significance of disease in the mind of the patient. Also, illnesses constitute a threat , not only to the individual’s life but also to the individual’s status in his social group.
5.2.THE PHYSICIAN
The examining physician is himself a human instrument, subject to reactions arising from events in his own biography. The problem of understanding and responding appropriately to the patient is strongly influenced by this fact. To perceive an understand the problems of the patient depend not simply on instruction but on the emotional maturity of the physician and his interest I, and concern for other human beings.
The physician has a special function is society and should be killed as a psychologist in human behavior as well as a biologist in human disease.
The physician seeks.
1) To respond to and alleviate the patient’s complaints
2) To search out signs of ill health not yet apparent to the patient or of abnormalities which may lead to ill health.
3) To maintain the patient in a state of well – being
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5.3.PATIENT – PHYSICIAN RELATIOSHIPS
Traditional “patient physician” relationships
The care of the patient begins with the development of an interpersonal relationship between the patient and his physician.
In the absence of a since of trust and confidence on the part of the patient, the effectiveness of therapeutic measures is diminished.
In case which for the time being are insusceptible of solution or for which no effective remedy is available; a feeling on the part of the patient that his physician is doing all that is possible is one of the most important therapeutic measures that the doctors can provide.
- The changing patient physician relationships
The one to one relationships is changing because of the changing setting in which medicine is increasingly being practiced. In many cases, the management of the individual patient requires the active participation of a variety of trained professional personnel (physician, psychiatrist, nurses, dietitians, biochemists, psychologists and other paramedical personnel).
5.4.INCURABILITY AND DEATH
When death is imminent and inevitable, what should the patient and his family be told?
There is no rule the patient must be told everything. How much the patient is told will depend:
- His own desires and characters
- The wishes of his family
- The state of his affairs: resources that represent the savings of lifetime may be dissipated in days or weeks.
- His religious convictions
This is the reason why opportunity has to be given to the patient to speak and ask questions. Patients find it easier to share feelings about death with their physician who should therefore provide emotional, physician and spiritual support.
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What is the death?
Traditionally, in every society, arrest of heart action has been taken as the only valid iriterium of death. Law books cite this as the only certain woof that human life has ended.
5.5.THE MEDICAL RECORD
Medical records, as kept for years have often failed the purpose of lucid communication, education, and rapid retrieval of stored information. Elements of the medical record include
- Identifying information; name , age , sexe , race , religion
- Patient profile: occupation, education, marital status, children, hobbies, worries, moods, sleep patterns, habits…
- Medical history :
a) Chief complaints
b) History of present illness
c) Past medical history
d) Family history
e) Medications
- Physical examination
- Laboratory data and physiologic tests: blood count, electrocardiogram, chest ray, etc…
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5.6.TEXT ANALYSIS : PROBLEM MEDICAL RECORD
Medical records, ask kept for years, have often failed the purpose of lucid communication, education, and rapid retrieval of stored information. Poorly supported diagnoses, incomplete progresses notes, chaotically entered laboratory results, and inadequately expressed plans of management are embarrassingly common finding in records existing at some of the most sophisticated medical institutions. In response to this, the problem-oriented medial record (POMR) has been devised with the object of providing a means whereby the medical record will better reflect the health problems of patients and the professional responses to them on the part of physicians, nurses, and other major participants in care.
Central to its formulation is the view that the patient’s record must be designed so that it expresses specifically what physicians deal with most frequently – the problems of patients. While the ultimate goal of clinical taxonomy is directed toward identification of etiology, pathology, and pathologic physiology, in view of their, importance as guides in therapy, it would be both unrealistic and dangerous to require a specific diagnosis for a severely dyspnea patient in the absence of reasonably convincing information concerning the season for this dysnea. Until the cause can be established, all diagnostic modalities and therapeutic intervention are oriented to the real and immediate problem – dyspnea. The same true of a great variety of symptoms, signs, and laboratory findings which are derived in the process of patient care. A high serum calcium reported in an SMA screening study, a suspicious pigmented skin lesion, or a sudden unexplained deterioration of intellect are examples of worrisome findings that are most appropriately expressed, initially, as problems. In each instance, a more refined diagnosis in the absence of further date can only represent guesswork; hence, it may be wrong. As date pertaining to each problem become available, the problem may than be expressed at a higher level of understanding, i.e., hyperparathyroidism, malignant melanoma, or subdural hematoma. By offering the physician a system of record keeping compatible with his most frequent focus of attention in the practice of medicine – the problem – an opportunity is provided to reduce distortion and errer.
The second and more fundamental aspect of problem orientation is the systematized display of patient care embodied in records. This is best described considering the elements of medical care and their dynamic interrelationship, as proposed by weed.
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Non-medical word Medical word
 To devise Taxonomy
 To design Dyspnea, dyspnea
 To deal with intellect
 Worrisome Hyperthyroidism
 Guess work Melanoma
 Hence Hematoma
 Embodied
Comprehensive questions
 What is POMR?
 Wow do you have to design the patient record?
 What is the ultimate goal of clinical taxonomy?
 Explain “problem”.
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CHAPITRE VI. VITAL SIGNS
(VITAL SIGNS INCLUDE: BLOOD PRESSURE, TEMPERATURE, PULSE; AND RESPIRATION)
BLOOD PRESSURE STANDARDS
A blood pressure is taken:
1. On admission and the daily unless otherwise indicated;
2. When “routine vital signs” are ordered by the physician they should be taken b.i.d. (8: A.M. and 4: P.M);
3. Pre-operatively within two hours of pre-operative medication, or with the pre-operative medication;
4. Post-operatively, upon return to the nursing unit and a 4 hours for 24 hours if minor surgery, and a 4 hours 48 hours if major surgery;
5. Patients with hypertension or anti-hypertensive therapy should have blood pressure monitored b.i.d, unless otherwise ordered by the physician (8:00 A.M. and 4:00 P.M);
6. Transfer patients when received on the new nursing unit;
7. Patients receiving blood: Observe and record blood pressure before transfusion is started, every 30 minutes during and at termination of the transfusion. This may be indicted at more frequent intervals if the patient’s condition warrants it, but never less frequently.
TEMPERATURE, PULSE, RESPIRATIONS (TPR) STANDARDS:
Monitor the patient’s temperature, pulse, and respirations as follows unless otherwise ordered by the physician. Average body temperature varies for individual patients; a sudden change outside the patient’s normal should be reported judgment should be utilized. The general temperature guidelines listed in the procedure can be used.
1. On admission, and the b.i.d. routinely (8:00 A.M. and 4:00 P.M);
2. Report oral temperatures above 99. 6°F (37.6°C) to charge nurse. Patients with an elevation of 100°F (37°3.C) orally should be monitored every 4 hours for 24 hours after each elevation.
3. Oral temperature of 11°F (38.1°) or more, or an abnormally low temperature should be reported to the physician unless otherwise indicated by the physician.
4. Pre-operatively, the morning of surgery and within two hours of pre-operative medication.
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5. Pre-operatively, upon return to the nursing unit, then monitor a 4 hours for 24 hours if minor surgery, and a 4 hours for 48 hours if major surgery.
6. The day prior and the morning of discharge, patient should be afebrile. A temperature of (37.3°) oral or 101°F (38.1°) rectal necessitates notifying the physician and documenting this in the Nursery Notes.
7. Patients with nasogastric tube, oxygen, trach, or an Endo tube should rectal or axillary temperature taken unless otherwise indicated.
8. When unable to take an oral or rectal temperature, an axillary temperature may be obtained.
9. Patient’s receiving blood: observe and record temperature, pulse, and respirations before transfusion is started, every 30 minutes during and at the termination of the transfusion. This may be indicated at more frequent intervals if the patient’s condition warrants it.
NOTE: the taking of vital signs may be indication at more frequent intervals if the patient’s condition warrants it.
TEMPERATURE USING ELECTRONIC THERMOMETERS
PURPOSE:
To accurately and safely measure body temperature.
Requisites
1. Electronic thermometer, (IVAC Temp. Plus-Model 2000)
2. Disposable proba covers (obtain from central supply)
3. Nursing Unit Worksheet
4. Alcohol wipes.
PROCEDURE
1. Wash hands (nurse)
2. Check for adequate supply of probe covers
3. Remove thermometer from the charger base and place carrying strap around your neck
4. Explain procedure to the patient
a. The barrier isolation (compromised) patient is to have temperature taken first
5. Set P-M switch, P for oral or rectal temperature, or M for axillary temperature or pulse mode
6. Set °F - °C switch to °F (Fahrenheit) position
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7. To attach a disposable probe cover, grasp probe by large ring at the top and insert firmly into the cover. Does not push top – it is the ejection button.
8. For oral Temperatures:
a. Gently slide probe under tongue and along gum line to be the sublingual pocket at the base of the base of the tongue (heat pocket). Patient’s lips should rest at the on the probe cover.
1) The thermometer must contact the area of highest temperature/ richest blood supply to obtain an accurate reading.
b. Hold the probe and maintain its position in the patient’s mouth until the audible signal notified you that the patient’s temperature has registered and is displayed. (Approximately 25-35 seconds).
c. Remove probe from patient’s mouth. Discard probe cover into wastebasket by pushing ejection button with thumb.
d. After reading and recording temperature, return probe to storage well. This automatically turns the thermometer off and resets if for the next temperature.
9. For rectal temperature
a. Red colored is used. Attach probe cover.
b. Wash perineum if necessary and position patient in Sam’s or prone position.
c. Insert probe approximately ½ inch above sphincter. The use of a lubricant is optional.
d. Hold probe in place. The patient’s temperature is reached in approximately 25 seconds.
e. Remove probe and discard cover into wastebasket
f. After automatically turns the thermometer off and resets if for the next temperature.
g. If soiled, cleanse probe with an alcohol wipe
h. Wash hands
NOTE:
1. Patients with diarrhea should preferably gave oral or axillary temperature taken
2. Gloves are to be worn when taking rectal temperatures on patients with diarrhea, rectal drainage in the rectal area, lesion in rectal area, Universal Precaution, and Isolation Precautions requiring gloves for direct care.
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10. For Axillary Temperature:
(Be sure in monitor mode “M” and “°F”
a. Attach probe cover
b. Place probe cover under axilla’s, close to axillary artery with arm held close to side
c. Leave in place for 10 minutes (no audible tone will sound)
d. Read and record temperature, discard probe cover, and return probe to storage well.
11. For pulse:
(Be sure in monitor mode “M” )
a. Compatibly insert probe intro probe storage well.
b. Grasp TEMP. PLUS case so thumb can easily press PULSE button during pulse count and other is free.
c. With free hand locate patient’s pulse.
d. Begin a 20 – beat pulse count, pressing OULSE button momentarily at the front beat (the word PULSE will appear on the display) and press PULSE button on the twentieth beat.
e. The unit will calculate pulse and flash the results in beats – per – minute for twenty seconds.
NOTE: “Error” message will display if rate is outside 20 to 200 beats – minute range. Remove probe from storage well, reinsert into well, and retake patient’s pulse as indication above.
12. After completing temperature rounds, return thermometer to charger base.
CARE OF EQUIPMENT
1. Charger base is to be plugged into electrical outlet at all times. While the thermometer is recharging a red light should appear on the display panel.
2. If soiled during use clean with alcohol wipe.
3. Wipe thermometer surface and charger base daily with alcohol wipe.
4. If equipment does not appear to be working satisfactorily, take to Central supply immediately to obtain a replacement.
5. Do not mark equipment with permanent ink. After repair by Company, equipment is returned to circulation for use by any unit.
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CHARTING:
1. Temperature registering an tenth should be rounded off to the next highest even tenth, i.e., 98.5° is charted as 98.6°, etc. record temperature on Nursing Unit Worksheet.
2. Entre into MIS; graph on Clinical Sheet.
NOTE:
1. Electronic thermometer and charger base should be kept in a secure place, i.e., clean utility room.
2. Average body temperature varies for individual patients; a sudden change outside the patient’s normal should be reported to the charge nurse or physician as appropriate. Good nursing judgment should be utilized. The general temperature guidelines listed can be used. Report any of the following to change nurse or team leader:
a. Oral temperature above 99.6°F (37.6°F) or below 96°F (35.5°F); 101°F or above to physician;
b. Rectal temperature above 100.1°F (38.1°) or below 96°C (35.5°C);
c. Axillary temperature above 98.6°F (36.9°C) or below (35.5°C);
3. Error messages that may display include:
a. Err E- the unit fails to obtain a temperature within one minute after insertion ;
b. Err L – the unit senses a loss of proper tissue contact within the mouth for more than 30 seconds;
c. Err H - the probe temperature exceeds 42.1°C/107.9°F;
d. Err O – the unit indicates electronic error – if the error persists after resetting (by removing and inserting probe into well) return unit for service;
e. Error – will display if the calculated pulse rate is outside the 20 to 200 beats per minute range. Remove probe, reinsert, and take pulse;
4. A rise in temperature is to be expected 20 – 30 minutes following a chill.
5. A drop in temperature is to be expected 30 minutes after a tepid sponge bath;
6. Appropriate protective barriers should be worn when actual or potential exposure to blood and/or body fluids exists. See the Infection Control Manual for specific policies.
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TEMPERATURE USING STANDARD GLASS THERMOMETER
PURPOSE:
1. To measure the degree of body temperature;
2. To determine changes in the condition of patient;
3. To note effectiveness of treatment;
REQUISITES:
1. Thermometer
2. Lubricant for rectal temperature
3. Bath towel for axillary temperature;
4. Gloves, when indicated.
PROCEDURE
1. Review “Vital Signs” standards if necessary;
2. Wash hands (nurse)
3. Obtain thermometer and take to patient’s bedside;
4. Explain procedure to patient.
5. FOR ORAL TEMPERATURE:
a. Assist patient to sitting or lying in comfortable position;
b. Remove thermometer from clean envelope;
c. Check thermometer for chips and/or breaks;
d. Check to see that mercury is below 94°F (35.5°C);
e. Place thermometer under patient’s tongue and leave in place for three minutes.
f. Remove thermometer;
g. Read and replace in envelope;
h. Record on Nursing unit worksheet;
i. Report any temperature above 99.6 (37.6°C) or below 96°F (35.5°C) to charge or tean leader 101°F (38.1°C) or above to physician.
6. FOR RECTAL TEMPERATURE
a. Assist patient into Sims’ or prone position;
b. Provide privacy for patient. (See note);
c. Remove thermometer from clean envelope;
d. Check thermometer for chips and/or breaks;
e. Check to see that mercury is below 94°F (34.5°C);
f. Lubricate and insert thermometer gently into rectum approximately one inch;
g. Remain with patient and hold thermometer in place for two minutes
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h. Remove thermometer. Clean entire thermometer with a tissue. Read and replace in envelope;
i. Record on Nursing Unit Worksheet;
j. Report any rectal temperature above 100.1°F (38.1°C) or below 96°F (35.5°C) to change nurse or team leader.
Note: gloves should be worn when taking rectal temperature of patient having diarrhea, rectal drainage in the rectal area, lesions in rectal area. Follow Universal Precaution as indicated.
7. FOR AXILLARY TEMPERATURE:
a. Assist patient to sitting or lying in comfortable position;
b. Provide privacy for patient while exposing axillary space;
c. Dry axilla with bath towel
d. Remove thermometer from clean envelope;
e. Check thermometer for chips and/or breaks;
f. Check to see that mercury is below 94°F (34.5°C)
g. Place thermometer well under axilla close to axillary artery and place arms across chest. (point stem towards chest);
h. Leave in place for then minutes;
i. Remove thermometer;
j. Read and replace in Worksheet;
k. Record any axillary temperature above 98.6°F (36.9°C) or below 96°F (35.5°C) to charge nurse or team leader.
CARE OR EQUIPMENT:
1. Place soiled thermometer into slot of base of weck caddy rack which contains detergent, and discard envelope. (For units solely using glass thermometers);
2. Broken or chipped thermometers are placed in envelope labeled “broken thermometer.” Place in soiled utility room to be picked up and replace by central supply;
3. Used for isolated patients:
a. Apply dispensable gloves;
b. Wash with soap and water, rinse and dry;
c. Place in paper towel and envelope. Mark envelope “Isolation Thermometer” and place in soiled utility room for central Supply to pick up.
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CHARTING:
1. Record on Nursing Unit Worksheet;
2. Graph on Clinical Sheet following procedure;
3. Enter into MIS
NOTES:
1. A rise in temperature is expected 20 – 30 minutes following a chill;
2. A drop in temperature is expected 30 minutes after a tepid sponge bath;
3. Temperature registering an odd tenth should be rounded off to the next highest even tenth, i.e., 98.5°F is charted as 98. 6°F, etc.;
4. Appropriate protective barriers should be worn when actual or potential exposure to blood and/or body fluids exists. See the Infection Control Manual for specific policies;
5. Average body temperature varies for individual patients; a sudden change outside the patient’s normal should be reported to the charge nurse or physician as appropriate. Good nursing judgment should be utilized. The general temperature guidelines listed in the procedure can be used.
RESPIRATIONS
Purpose:
To measure the rate and character of a respiration.
REQUISITES:
Watch with a second hand.
PROCEDURE
1. Note the rise and fall of patient’s chest or upper abdomen with each inspiration and expiration:
a. A complete respiration consists of one inspiration and one expiration;
b. The rate and character of the respiration: deep, shallow, regular irregular, or abdominal;
c. The rhythm and depth of breathing.
2. Count for one full minute;
3. Record on Nursing Unit Worksheet;
4. Report to charge nurse or team leader any irregular respiration, or rate below 12 or above 30.
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CHANGE:
1. Record on Nursing Unit Worksheet;
2. Chart on Clinical Sheet;
3. Enter into MIS;
4. Record any pertinent observation in the Nurses Notes.
NOTE:
Average adult respirations are 16 – 20 respiration per minute.
SECTION 4: THE HOSPITAL AND SELECTED CLINICAL CASES
Chapter VII: THE HOSPITAL
A hospital is an institution for the treatment of the sick. It is an institution suitably located, constructed, organized and personnaled to supply scientifically, economically, efficientlyall or any recognized part of the complex requirements for the prevention, diagnosis and treatment.
Hospital can be classified in a variety of different ways:
1) Type of ownership:
 Government or public,
 Private (for profit, non for profit)
2) Type of problem treated:
 General hospital;
 Specialized hospitals
3) Average length of stay:
 Short term hospital;
 Long term hospital.
4) Type of medicine:
 Regular medicine;
 Osteopathic (disease of bone).
5) Role of education:
 Teaching hospital;
 Non teaching hospital.
6) Size of hospital (number of bed)
In the USA,
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1. Federal government hospitals
 Army hospitals
 Navy hospitals
 Air Force Hospitals.
2. State government
 Lang term: Psychiatric, Chronic diseases, Tuberculosis:
 Short term: State University, Medical school Hospital, Prison Hospitals.
3. Local government: District, Country & City;
4. Voluntary or non for profit hospitals:
 Religious group hospitals;
 Industrial Hospitals;
 Health Maintenance organizations Hospitals;
 Cooperatives Hospitals/
5. Proprietary or profit hospitals:
 Individual owner;
 Partnership;
 Corporation.
General hospitals: Provide care for adult medical and surgical patients and otter but not always for pediatric and maternity patients (USA).
Specialty hospitals: provide care for specific and specialized medical problems.
Such hospitals include:
 Children’s - Psychiatric
 Maternity - Alcoholism and drug dependency
 Orthopedic - Mental retardation
 Cancer - Tuberculosis
 Eye and ear - Chronic.
(“ENT = eye, nose, throat)
Teaching hospitals: Are hospitals having an agreement with a medical school to provide clinical, experience for medical students. In these hospitals, there is an existence of approved physician residency training programs.
Community hospitals: Are those hospitals serving primarily a local population in contrast to a “referral hospital” that receives many of its patients from a wide area. Most of the time, they are non university and non teaching hospitals.
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Tertiary care hospitals: They are hospitals that have the most complex diagnostic and therapeutic procedures, often on referral from other hospitals seconding patients with complicated problems.
Medical centers: Hospitals or hospital groups ranging from single hospitals to complexes of geographically related affiliated institutions, often including a medical school. It implies complexity and special expertise.
The mission of a Hospital:
1. To deliver a comprehensive range of quality health care to residents, especially to medically indigent or anyone needing emergency care;
2. To provide services without regard to race, color, national origin or ability to pay;
3. To serve as the tertiary referral center and as a resource to other hospitals and medical care providers;
4. To serve as an educational center that fosters excellence in training, education and research;
5. To maintain an environment where patients and staff are treated with dignity, compassion and respect;
Hospital goals:
1. To provide quality health care service consistent with current standards;
2. To develop and maintain a comprehensive range if clinical services that include care, treatment and prevention of disease;
3. To develop a management framework that supports cost effective and effiscient medical care delivery system witch antipastos and responds to changes;
4. To promote a feeling of dignity and for each client, learner, and employee and or sense of pride in being a part of the hospital;
5. To take the leadership role in defining management options that will allow both autonomy and continues;
6. To integrate the activities and service of the medical schools to more fully support the hospital’s mission;
7. To obtain continuous and adequate funding needed to carry out hospital’s mission;
8. To provide opportunities for staff development, research and medical education.
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HOSPITAL’S DEPARTMENTS & SERVICES
Hospitals are organized by functional departments that cut across the patient units.
These include:
 Nursing;
 Ancillary;
 Administrative and support departments or services.
1. Nursing services (Department or Division of Nursing)
It includes a direction of nursing responsible for the whole department and nursing supervisions, responsible for several units, each of which run by a head nurse.
You also have:
 Professional nurses (RNs);
 Practical nurses (LPNs);
 Nursing aides;
 Ward clerk (with paper work).
2. Medical departments:
They are the medical specialty departments.
 Medicine: cardiology, hematology;
 Surgery: general surgery: general surgery, thoracic surgery orthopedics, urology, prasstic surgery;
 Pediatrics: Infant, Toddlers, School age;
 Gynecology & obstetrics;
 Specialties (ENT) + dermalogy an intensive care unit (ICU).
3. Ancillary medical departments:
These are medical speciality departments whose physicians and other personal provide direct parint services including diagnostic and therapeutic procedures but do not in general have primary ongoing responsibility for patients.
 Anesthesiology;
 Pathology (laboratories);
 Physical medicine or rehabilitative medicine.
4. Patient support services are:
 Pharmacy;
 Social services;
 Dietary services;
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 Chaplaincy service.
5. General administration:
 Administration;
 Financial affairs office;
 Public relation department;
 Admissions;
 Medical recordsdepartments
 Medical library (bibliothèque);
 Personal department;
 Purchasing and stores;
 Communications;
 Control supply;
 House keeping;
 Maintenance and plant;
 Security.
6. Ambulatory services
They are service where other than implements services are provided. These include:
 Out patient department (OPD) for non emergency ambulatory patients
 Emergency services for acutely ill patient.
CHAP. VIII: SELECTED CLINICAL CASE
8.1.A INTERNAL MEDICINE SELECTED CASE
INFECTION OF THE LUNG
Acute pneumonia continues to be a major cause of death and disability; it is the fifth leading cause of death in USA. A signification cause of prevalence of these infections is the large number of compromised hosts resulting from alcohol and drug abuse, an aging population.
Approximately half of the acute are of bacteria origin. The other principal causes are viruses and Mycoplasma. Early identification of the infection agent is essential for the proper treatment of pneumonia.
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A careful history will often help to differentiable bacterial from viral infections and also identify noninfectious diseases masquerading as pneumonia. A suden onset of symptoms, including fever,chills, cough, and often chest pain, suggests bacterial infection. Viral pneumonia is more often gradual inanest, with malaise and low – graver without chills, and is more likely to follow and upper respiration infection. Elderly patients, especially those chronic illnesses, may have bacterial pneumonia without typical symptoms.
Tachycardia, tachypnea, and sings of pulmonary consolidation are more common with bacterial pneumonia. There is often paucity finding viral pneumonia.
Leukocytosis may occur with either bacterial of viral infections, although significantly abnormal white counts are more common with the former. Examination of a gram – stained smear of sputum is the most useful laboratory test and often directs one to the appropriate initial antibiotic treatment. Absence of white cells or organisms in the sputum smear suggests viral infection care must be to obtain bronchial secretions, using Tran’stracheal aspiration if necessary, for culture and staining with Gram’s stain. A portion should be injected directly into a proper medium for anaerobic culture, and smear and culture for acid – fast organism should also be done. Nasotracheal aspiration into a sterile trap is an alternative procedure but the specimen is more likely to be contaminated with nasopharyngeal organisms.
Fool – smelling sputum usually indication mixed bacterial infection, including anaerobes, and is suggestive of a lung abscess. Blood culture may help identify the causative consolidation and pleural effusions are more common with bacterial pneumonia, and interstitial lesions are more likely to be of viral origin.
Medical words.
 Pneumonia;
 Chills;
 Tachypnea;
 Tachycardia;
 Smear;
 Sputum.
Comprehensive questions
1. What are the causes of pneumonia?
2. Is there any difference between bacterial and viral infection if the lungs?
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8.2.A SURGERY SELECTED CARE: ACUTE APPENDICITIS
The history of onset should be carefully obtained for the history is the only clue to a correct diagnosis of retrocecal appendicitis, when abdominal signs are absent. The first symptom in another wise well individual is acute periumbilical or epigastria pain. In young children, the abdominal pain cannot be localized is usually generalized.
Pain varies from mild or vague to quite severe and is followed by anorexia, nausea or vomiting. The sequence of these symptoms is very important. When the illness is initiated by nausea and vomiting, which is then followed by abdominal pain, ebo should suspect an infection. Pain is the first symptom of appendicitis, and due to distention of the appendicle serosa by edema.
Medical words
 Onset;
 Retrocecal;
 Periumbilical;
 Anorexia;
 Epigastric,
 Nausea;
 Edema.
Comprehensive questions
1. What are the symptoms of an acute appendicitis?
2. Why do we have pain in acute appendicitis?
8.3. A GYNECOLOGY SELECTED CASES PELVIC INFLAMMATORY DISEASE (PID)
Pelvic inflammatory disease (salpingtis), saplingoophoritis and acute adenitis and acute adenitis refer to an acute or sub cute ascending tract infection. Although, there may be associated endometritis, the hallmark of pelvic inflammatory disease is an acute infection suppuration of the fallopian tapes an ovary. PID is one of the most important transmitted diseases in the United States, for several reasons. The prevalence is high (1%) during the childbearing years (2%) in women aged 30 – 24 and has been increasing aver the past decade. The acute symptoms are disabling.
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8.4.AN OBSTETRIC SELECTED CASE: PREGNANCY AND BIRTH
Most of the time, fertilization occurs with the mother to be totally unaware of the event. If there are sperm cells thrashing around in the genital tract at any time within forty eight hours before ovulation to about twelve hours after, the adds are very good that pregnancy will accur. As soon as the egg is touched by the head of a sperm, it undergoes violent pulsating movement which the twenty-three chromosomes of the sperm with its own genetic complement. From this single cell, about 1/175 of on ion in diameter, a baby weighing severed about 266 days later.
For connience, will divide the 266, or nice mouths, into three periods of three mouths each. We can consider these trimesters separately, since each is characterized by different sorts events.
In the first trimester, the embryo begins the delicate structural differentiation that will lead to its final form. It is therefore particulary susceptible during this period to any number of factors that might influence its development. In fact, the embryo often fails to survive this stage.
In the second trimester, the fetus grows rapidly, and by the end of the sixth mouth it may be about a foot long, although it will weigh any a pound and a half. Where’s the predominant growth of the fetus during the first trimester was in the head and brain areas, during the second trimester the body grows at a much faster relative rate that brain and begins to catch up in siwe with the head.
During the third trimester, the fetus grows until it is no longer floating free in its amniotic pool; it now fills the abdominal area of the mother. The fetus is crowded so tightly into the greatly enlarged uterus that its movements are restricted. In these last three months, the mother’s abdomen becomes greatly distended and heavy, and her posture and gait may be nautically altered in response to the shift in her center of gravity.
The signal that there will be soon a new member of the earth-s most dominant is the onset of labor, a series of uterine contractions that usually about half hour intervals and gradually increase in frequency. Meanwhile, the sphincter muscle around the cervix dilates, and as the periodic contractions become stronger, the baby’s head pushes through the external cervical canal to the opening of the vagina. The infant is finally about to emerge into its new environment, one that, in time, may give it the chance to propel its own genes into the gene pool of the species.
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Medical words
 Fertilization;
 Sperm;
 To thresh (se debattre);
 The odds;
 Egg;
 Embryo;
 Fetus;
 Amniotic pool;
 Gait (demarche);
 Labor.
Comprehensive questions
1. How does happen fertilization;
2. What is the main characteristic of each of three trimester of a pregnancy;
3. What is: a pound? A foot?
ADDENDUM: MEASURES
1. Measures with prefixes:
Deca: 10 times;
Hector: 100 times
Deci: one tenth;
Centi: one hundredth;
Mille: one thousandth.
2. Linear measures
1 Millemètre =0,03937 inch 1 foot = 12 inches = 30,48 cm
1centimètre = 0,3937inch 1 mile = 1,609 km
1 mètre = 39, 37 inches 1 yard = 3 feet = 91,44cm
= 1,094 yards
1 kilomètre = 0, 6214 miles (=5/8 mile)
3. Measure of capacity
1litre = 1, 75 pints = 0, 22 gallop
4. Measure of weights
1gramme = 15, 4 gains
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1kologramme = 2, 2046 pounds
1quintal = 100 kologramme = 220, 46 pounds
1 tonne = 1. 000 kilogramme = 0, 9842 ton
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SCIENTIFIC & MEDICAL ENGLISH COURSE, PART III
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Course objective
At the end the course, the student will be able to understand, describe, medical procedures and treat (if possible) diseases using the English language.
Course units
Unit 1: Pulmonary disorders
Unit 2: Cardiovascular disorders
Unit 3: Gastrointestinal disorders
Unit 4: Nutrition and metabolic disorders
Unit 5: Neurologic and Psychiatric disorders
Unit 6: Genito – Urinary disorders
Unit 7: Gynecology and Obstetrics disorders
Unit 8: Pediatrics disorders
Unit 9: Hematology disorders and Oncology;
Unit 10: Dental and Oral disorders
Unit 11: The Hospital
Unit 12: The Patient, the Physician and the Medical Record
Unit 13: Surgical Management of Buruli Ulcer Patient
Unit 14: Caesarian Section.
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UNIT 1
PULMONARY DISORDERS
1.1. APPROACH TO THE PULMONARY PATIEN:
Diagnosis and management of pulmonary disorders require a history physical examination chest x rays and pulmonary function testing.
 Cough
A sudden explosive expiratory maneuver that tends to clear material airways ( expiratory action);
 Dyspnea:
An unpleasant sensation of difficulty in breathing.
Clinical types of dyspnea:
1. Physiologic: associated with physical exertion. Wen you get tired;
2. Pulmonary: in case of restrictive and obstructive defects;
3. Cardiac in case of heart failure (AHF CHF) Most of the time, the patient has orthopnea which is a respiratory discomfort while he is standing up impelling him to sit up;
4. Circulatory: acute dyspnea after hemorrhage;
5. Chemical: acidosis, heart failure…
6. Central: in cerebral lesions (hemorrhage);
7. Psychogenic: hysterical type;
 Chest pain:
 Pleuretic pain: pain originating from the pleura (infection of envelop of lungs)
 Originating in the chest wall;
 Pain originating the lungs: ex: lung abscess.
 Wheeze
We talk about wheezing or whistling noises associated with breathing like in asthma chest;
 Hemoptysis:
Coughing up blood as a result of bleeding from respiration tract;
 Stridor:
A musical sound audible without a stethoscope, and predominately inspiratory;
 Cyanosis:
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A bluish discoloration of the skin, seen when there is an excess of reduced HB in the:
 Peripheral cyanosis (in case of stasis);
 Central cyanosis (arterial hypoxemia).
1.2. PULMONARY FUNCTION TESTING
 Vital capacity (VC): The maximum volume of air that can be expired slowly and completely after a full inspiration effort;
 Forced vital capacity;
 Total lung capacity (TLC): The total volume of air within the chest after a maximum inspiration;
 Functional residual capacity (FRC): Is the volume of air in the lungs at the end of a normal expiration when all respiratory muscles are relaxed;
 TLC – ERC – Inspiratory capacity.
1.3. SPECIAL PROCEDURES
 Chest imaging ex chest X ray;
 Thoracentesis: taking pleural fluid;
 Thoracoscopy: examination of the pleura through a scope under general anesthesia;
 Thoracostomy tube drainage: insertion of a tube into the pleura through a small incision + thoracotomy for lung biopsy;
 Bronchoscopy: Direct visual examination of the larynx, trachea, bronchi.
1.4. MOST COMMON PULMONARY DISEASES
1) Pneumonia: an acute infection of the lung;
2) Bronchitis: acute infection of the tracheobronchial ire;
3) Bronchiectasis: Focal bronchial dilation (infection, congenital and heredity diseases);
4) Atelectasis: A shrunken, airless state of the lung;
5) Pulmonary embolism (PC): A sudden lodgment of a blood clot in a pulmonary artery;
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6) Lung abscess;
7) Occupational lung diseases (dusts coal workers);
8) Airways obstruction (Asthma).
UNIT 2
CARDIOVASCULAR DISORDERS
2.1. APPROACH TO THE CARDIAC PATIENT
The diagnostic of cardiovascular disease can be made:
 With a careful history;
 Followed a careful physical examination;
 With selected confirmation technic or tests
THE HISTORY
The symptoms of the major cardiac diseases are:
1. Pain: the are 3 types of pain:
 Ischemic pain: due to accumulation of metabolites in the myocardium (pressing, squeezing);
 Pericardial pain: due to the inflammation of the pericardium (burning, cutting);
 Atypical pain syndrome: atypical chest pain seen in a number of cardiac disorders (Mitral valve prolapse, aorta dissection, pulmonary embolism);
2. Dyspnea – respiratory discomfort (cardiac in AHF, CHF) with orthopnea;
3. Fatigability: weakness: as a result of inadequate cardiac out put (CO) for the metabolic needs of the body:
 First (initially) on exertion (a l’effort);
 Eventually at rest (au repos).
4. Palpitations: the perception of heart action by the patient;
5. Syncope: sudden brief loss of consciousness resulting:
 From decreased cardiac output (CO);
 From decreased cerebral blood flow.
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2.2. THE PHYSICAL EXAMINATION OF THE CARDIAC PATIENT
 History taking;
 Mood (eating habits?);
 Emphasis on certain symptoms;
 Complete examination:
 Systemic effect
 Peripheral
 Vital signs:
1. Blood pressure (BP);
2. Pulse;
3. Temperature;
4. Respiration.
 Auscultation of the chest (cardiac auscultation);
 Normal sounds:
 The 1st fund = SI is loud in mitral stenosis
 The 2nd sound = S2 aortic valve pulmonic valve;
 Other sounds of the is a disorders: S3, S4;
 Heart murmurs: (Systolic or diastolic)
2.3. SPECIAL DIAGNOSTIC PROCEDURES
2.3.1. Non invasive cardiovascular procedures
 Plain chest radiography;
We may examine:
The heart size;
The heart shape and chamber analysis;
The lung and the pulmonary vessels.
 Cardiac Fluoroscopy: Important in the assessment of congenital heart disease et and calcification;
 Radionuclide imaging of the heart (expensive equipment);
 Magnetic resonance imaging (MRI);
(=non invasive investigation of cardiac structure and function) many imagine are taken at any angle through the heart;
 Echography: Using ultrasonography.
Of the heart diseuse
Closure
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2.3.2. Invasive cardiovascular procedures
 Peripheral venous annulation;
 Central venous annulation;
 Arterial annulation;
 Pulmonary artery catheterization;
 Cardiac catheterization;
 Angiocardiography.
2.4.CARDIOVASCULAR DISORDERS
2.4.1. Generalized cardiovascular disorders
 Arteriosclerosis
The arterial wall became thickened and losesplasticity.
 Hypertension: Elevation of systolic and or diastolic BP, either primary ( = essential hypertension) or secondary (= secondary hypertension);
 Syphilis of the cardiovascular (treponemapalladium): the VDRL- test has to be done VDRL = Venereal disease research laboratory.
2.4.2. Diseases of the heart and pericardium
 Heart failure (HT): the cardiac out put is not able to meet the body’s needs;
 Myocardial ischemic disorders:
 Angina pectoris: coronary artery is close;
 Myocardial infarction: myocardial necrosis;
 Sudden cardiac death (SCD).
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UNIT 3
GASTRO INTESTINAL DISORDERS
3.1. APPROACH TO THE PATIENT WITH GASTRO INTESTINAL DISORDERS
Patient with gastro intestinal disorder will be diagnosed to have “function” disorder with no anatomic abnormality.
Thus, consideration of both biological and psychical features that may contribute the illness is required. Information is obtained using an interview style with direct rather than indirect questioning.
3.2. GASTRO INTESTINAL DISORDERS
3.2.1. Disorder of the esophagus
 Dysphasia: a subjective awareness of difficulty in swallowing due to the stomach;
 Achalasia: a neurogenic esophageal disorder of unknown etiology causing impairment of esophageal peristalsis and lower esophageal sphincter relaxation;
 Gastro esophageal reflux (GER): reflux of gastric contents into the esophagus;
 Hiatus hernia: protrusion of the stomach above the diaphragm;
 Functional dyspepsia: common discomfort described as indigestion, fullness or burning in the upper abdomen or chest;
 Nausea: unpleasant feeling that one is about to vomit;
 Vomiting: forceful expulsion of gastric contend produced by involuntary contraction of the abdominal musculature;
 Regurgitation: expulsion of gastric contents without associated nausea or forceful abdominal muscular contractions;
 Adult rumination: involuntary regurgitation of small mouth of food from the stomach with renewing of the material and swallowing.
3.3.2. Disorders of the stomach and duodena
 Gastritis
 Acute stress gastritis: superficial mucosal lesions of the stomach happening very rapidity in relation to a variety of stresses;
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 Chronic erosive gastritis: presence of multiple punctuality stomach ulcers;
 Non erosive gastritis: A general category of idiopathic gastritis including several manifestations based largely on histologic findings;
 Inflammation;
 Peptic ulcer.
A circumscribed ulceration of the mucous accruing in areas exposed to acid and pepsin.
3.2.2. Acute abdomen and surgical gastro – enterology
 Abdominal pain: acute, severe;
 Intestinal obstruction: a complete arrest of the passage of intestinal contents;
 Appendicitis = acute inflammation of the appendix, Mac Burney point is paintul.
N.B. con you draw the gastro intestinal tract?
What is right lower quadrant?
What is left lower quadrant?
What is right upper quadrant?
What is left upper quadrant?
 Peritonitis: inflammation of the portioned cavity;
 Pancreatitis: inflammation of the pancreas.
3.2.3. Diarrhea:
Increase volume, fluidity or frequency of fecal discharges.
3.2.4. Constipation:
Difficult or infrequent passage of feces. Constipation can also refer to:
 Hardness of stool;
 Feeling of incomplete evacuation.
3.2.5. Tumors of the bowel
 Tumors of the small intestine benign tumors (ex hamangiomas); malignant tumors (exKaposisarcoma);
 Tumor of the large bowel: benign (ex Polyps of the colon, rectum), malignant tumors (ex cancer of the colon, rectum)
3.2.6. Anorectum disorders
 Hemorrhoids: the veins complicated very often by inflammation and bleeding;
 Anal fissure: an acute longitudinal ulcer in the anal canal epithelium;
 Anorectum fistula: a tube like track with one opening in the anal canal and other openings in the perianal skin.
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3.2.7. Gastroenteritis due to bacterial enterotoxins
Vibrio cholerae infections (cholera)
Salmonella infections (Typhoid fever)
Staphylococcal food poisoning (acute syndrome of vomiting and diarrhea caused by eating food contaminated by staphylococcal enterotoxin).
3.2.8. Malabsorption syndromes:
Syndromes resulting from impaired absorption of nutrients from the small bowel (ex proteinmalabsorption).
3.2.9. Chronic inflammatory diseases of the bowel
 Crohn’s diseases (CD): a non specific inflammatory disease that affects the distal ileum and colon.
3.2.10. Other problems
 Fecalincontinence: loss of voluntary central control of defecation;
 Prutitusani: anal and perianal itching;
 Foreign bodies in the rectum (swallowed.
3.2.11. Hepatic and biliary disorders
 Jaundice: a yellowing of the skin & other tissues due to excess circulating of bilirubin;
 Ascites: free fluid in the peritoneal cavity;
 Cirrhosis: diffuse disorganization of normal hepatic structure by regenerative modules that are surrounded by fibrotic tissue;
 Biliary calculi:
Calculi in the gall bladder (cholelithiasis)
Calculi in biliary ducts (choledolithiasis).
 Cholecystitis: inflammation of the gallbladder.
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3.3. SPECIAL DIAGNOSTIC PROCEDURES
 Nasogastric or intestinal intubation;
 Small bowel and duodenal aspiration;
 Gastrointestinal endoscopy;
 Abdominal paracentesis.
UNIT 4
NUTRITIONAL & METABOLIC DISORDERS
4.0. GENERAL CONSIDERATIONS ON FOOD
Food?
Items consumed in order to nourish the normally:
 Foods is consumed by men;
 Feed or fodder is consumed by animals.
Food growing?Food origin?
 Animal origin: will animals (fish, rodents, and insects) and domestic animals.
Lives tock (domestic animals)
Cattle/ buffalo?? / Pigs / Sheep / Goats / Poultry.
Beef Pork
 Plant, vegetable origine: home garden/back garden and will plants: pools, tubers, leaves, fruits, grains…
Examples of food
 Cereals: seeds carbon hydrates!!! Rice / Maize / Wheat / Sorghum/ Millet;
 Routs & tubes: carbonhydrates !!!( in the roots, in the leaves) casseve/Sweet patato/;
 Leguminous: Fat protein!!! (Grouds nuts/soya beans);
 Vegetable: Edible leaves!!! Amaranths/ Tomato/onions;
 Fruits: carbohydrates!!! Banana/ citrus/ papaya/ mango/ guayava;
 Oil plants: oil/fat!!! Coconut/oil palm;
 Sugar plants (Ex sugar Cane).

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4.1. GENERAL CONSIDERATION ON NUTRITION
 Nutriment: the part of food which nourishes the body
 Micronutrients: vitamins: fat soluble (A, D, E, K)
Elements: ex. Calcium;
Trace elements: ex. Iron.
 Macronutrients: Carbobydrates: glucose
Fats: fatty acids, glycerol;
Proteins: amino acids, peptides.
 Dietary requirements
Depend on age, sex, height, activity: the objective of a proper diet is to maintain the recommended directory allowance (RDA). In adults, a rough indication of nutritional status allowances status is:
1) Body mass index (BMI) = W(kg)
H2 (m)
If BMI>30: obesity
If BMI Between 25 – 30: Over weight
If BMI< 25: normal
Can you calculate your own BMI? Explain.
2) Assessment of nutritional status (Nutrition depletion:
 Recent weight loss > 10%;
 Triceps skin fold thickness: < 10 mm for males, < 13 mm for females;
 Upper arm circumference: < 23 cm for males, 22 cm for females;
 Serum albumin: <35 gm/1
 Nutrition support:
 Oral supplementation (food in the mouth);
 Enteral tube alimentation (food trough a tube in the stomach);
 Parenteral nutrition (food through the vein)
 Food additives & contaminants
Food additives:
The addition of chemicals to food to facilitate their processing and enhance their analeptic properties;
Contaminants:
The use of nitrite will inhibit the growth clostridium botulin.
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But nitrites are converted into nitrosamines, known as carcinogens in animals.
4.2. UNDER NUTRITION
Awareness of hight risk is important:
Poverty;
Catastrophe;
Immigrant families;
Alcohol & drug dependent people.
Starvation & Inanition with structural and functional changes due to inadequate intake of nutrients:
 Exogenous (inadequate intake);
 Endogenous (disordered absorption).
(Signs: weight loss/ emaciation are no fatter under the skin);
Protein Energy malnutrition (PEM):
According to degree of severity
Mild (1st ), Moderate (2nd ) Sever(3rd).
Kwashiorkor: deficiency in total protein and essential amino acids
Marasmus: deficiency in the 3 macronutrients (carbohydrates, proteins, fats/lipids) Miasmic kwashiorkor.
4.3. VITAMIN DEFICIENCY
 Vit A (retinol) deficiency: xerosis&Bitot’s spot. The night vision/vision in the dark is impaired;
 Vit D Deficiency:
 Rackets in children (bones lesions);
 Osteomalacia in adult (bones demineralization).
 Vit E deficiency (tocopherol): reproduction problems in animals;
 Vit K deficiency: coagulation troubles (defective coagulation) in fact, vit K controls the formation of prothrombin. A major sign of hypo vit K is defective coagulation of the blood and resulting hemorrhage;
 Vit B1 deficiency: neurologic, cerebral, cardiovascular symptoms;
 Vit B2 deficiency (Riboflavin): with angular stomatitis and linear fissures of the lips;
 Nicotinic acid (niacin) deficiency (pellagra) where maize is a major part of the diet (cutaneous lesions, CNS lesions, GI lesions/diarrhea);
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 Vit B6 (Pyridoxine) deficiency: anorexia & vomiting during pregnancy;
 Vit C (Ascorbic acid) deficiency: scurvy with hemorrhagic manifestations.
How do people get pellagra?
4.4. ELEMENT DEFICIENCY
Iodine deficiency : Goiter;
Fluorine deficiency : Dental caries;
Iron deficiency : anemia.
4.5. METABOLIC DISCORDS
 Metabolic acidosis (excessive and production or ingestion): a primary fall in extracellular fluidbicarbonateconcentration, (blood pH and HCO3 are reduced);
 Respiratory acidosis: a primary increase in arterial carbon dioxide, ph is a low and HCO3 increases;
 Metabolic alkalosis: a primary increase in blood bicarbonate pH and HCO3 are elevated;
 Respiration alkalosis: a primary decrease in carbon dioxide pressure, blood pH and HCO3 is reduced.
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UNIT 5
NEUROLOGIC & PSYCHIATRIC DISORDERS
5.1.NEUROLOGIC DISORDERS
5.1.1. Approach to the patient
 Complaints
The patient will be complaining of the following symptoms: headache, dizziness, insomnia, back pain, weakness (intimidating complaints).
 History
Fist, the physician must distinguish between the patient’s perception and perception that others around him considered relevant. Second, the functional defect to muscle, nerve, spinal cord or brain has to be localized. Third, a complete systems review is essential (family history, social and travel story);
 The neurologic examination
The physician should appreciate the speed, symmetry, coordination needed for simple task (ex. Moving to a chair);
 The menial status examination will focus on:
- Orientation to (1) time (2) place and (3) person;
- Immediate recall, memory (remembering 3 in related for 3 or 5 minutes);
- Remote recall, memory (remembering the color of the suit on the waddling day);
- Ability to abstract (analogies interpretation);
- Fund of knowledge (name country capitals);
- Language function (repetition of body parts).
 Cranial nerve examination
The first cranial nerve (olfactory): the patient is asked to identify characteristic odors (sops, coffee) to each nostril (anosmia). The second (= optic), the third (= oculomotor), the fourth (=trochlear) and the sixth (abducens) are part of the visual system (visual acuity & visual fields are tested).
The fifth (- trigeminal) is examined by testing the comical reflex. The seventh (=facial) is examined by checking the asymmetry of the facial movements when smiling = Palsy.
The eight ( =vestibulocochlear, acoustic) is examined by checking auditory and vestibular in puts (Hearing loss). The nineth (glossopharyngial) and the tenth (= vagus) examined by touching symmetrically the palate.
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The eleventh (=spinal accessory) is examined by testing the stomoeleidomastoid and the upper trapezius muscles (ex. The patient turns head against resistance).
The twelfth (hypogossal) is examined by testing the tongues (atrophy, weakness?)
Can you explain the role of ear of the cranial nerve?
 Sensory testing (pain, paresthesia, numbness)
 Reflex testing.
5.1.2. Neurologic diagnostic procedures
- Lumber puncture (LP) (cerebrospinal fluid = CSF);
- Computed tomographic X Ray (CTS Scan) (rapid, non invasive imaging of the brain)
- Magnetic resonance imaging of the brain (MRI) (Imaging structures with magnetic field);
- Encephalography, echoencephalography;
- Radionuclide imaging (arterial & venous circulation);
- Electroencephalography (EEG);
Voltage & time recording of electrical currents in the brain to detect electrical brain alterations.
5.2.PSYCHIATRIC DISORDERS
5.2.1. Formation for recording the psychiatric history:
- Identifying characteristics: name, age, sex, race, marital status, occupation, source of referral…;
- Presenting problems: a brief verbatim statement;
- History of the present: illness:
1) Chronologic account of symptoms and behavioral changes;
2) Previous treatments.
- Personal history:
1) Birth & infancy (delivery, habits);
2) Child hood,
3) Education;
4) Work record (job, achievement);
5) Legal (criminal record);
6) Religion,
7) Sexual maturation.
- Previous medical history (physical psychiatric illnesses);
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- Personality & social patterns prior to illness (nods, ambition, aspirations, habits…);
- Family history (details of parents, familial diseases of death of family members).
 Most important neurologic disorders:
- Focal disorders of higher function:
 Aphasia: a defect or loss of language;
 Apraxia: inability to execute;
 Agnosia: inability to recognize a tactile or visible stimulus (language defect must be absent);
 Amnesia: partial or total inability to recall past experiences.
- Global diffuse disorders
 Coma: with unarguable responsiveness;
 Delirium: extreme disturbance of attention, orientation, perception intellectual function after accompanied by fear and agitation;
 Dementia: permanent or progress decline in several dimensions of intellectual function that interfere with the person’s normal social an economic activity.
5.2.2. Most important psychiatric disorders
- Personality disorders:
 Disorder patterns of behavior (fixed inflexible & stylize reactions to stress, representing the individual’s way of dealing with other people and external events regardless of existing realities.
1) Paranoid personalities: projection of the their own conflicts and hospitalities into others;
2) Schizoid personalities: introverted, emotionally distant;
3) Antisocial personalities: impulsive, irresponsible, amoral personalities.
- Drug dependence:
1) Dependence on alcohol;
2) Dependence on the opium type;
3) Dependence on anxiolytic& hypnotic drugs;
4) Dependence on the cannabis, marijuana type;
5) Dependence on the cocaine type.
- Psychosexual issues
 Gender identity disorders;
 Homosexuality: male homosexual, female homosexual (lesbians);
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 Disorders of sexual function (male & female).
UNIT 6
GENITOURINARY DISORDERS
6.1. Symptoms and signs
- Changes in micturition
Frequency = frequent micturition (>4 – 6 times/days)
Urgency = compelling need to urine
Dysuria = painful urination
Nocturne = voiding the night
Narcissi = bedwetting at night
Incontinence = a loss of urine without knowing warning
Pneumaturia = passage of gaz in the urine
Chyluria = lymp in urine
- Changes in urinary output
Polyuria: a daily urine volume > 2500 ml/day (normally 700 – 2000 ml);
Oligurial: a daily urine volume < 500 ml/100 ml/day.
6.2.GENITOR URINARY DISORDERS
1) Acute renal failure (ARF);
A clinical condition associated with rapid increasing azotemia, with or without oliguria;
2) Chronic renal failure (CRF)
A clinical condition resulting from a multitude of pathology processes that lead to derangement and insufficiency of renal excretory and regulatory function;
3) Immunologically mediated renal diseases (Immune Renal Diseases = IRD). Glomeruli and tubule intestinal renal diseases that are mediated by host immune mechanisms;
4) Nephrotic syndrome (NS)
Predictable compels diseases that follow a severe, prolonged increase in glomerular permeability for protein. The main feature is:
- Proteinuria (> 2gm/m2/day);
- Generalized edema;
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- Fever.
5) Toxic Nephropathy
Any functional a morphologic change in the kidney produced by a drua chemical or biologic agent that is ingested, injected, inhaled or absorbed;
6) Hydronephrosis:
Dilatation of the renal pelvis and usually of the infundibula and calyces beyond the normal capacity of 3 to 10 ml;
7) Urinary calculi
Stones any where in urinary tract;
8) Priapism
Painful, persistent and abnormal penile erection unaccompanied by sexual desire or excitation.
6.3. MEASUREMENT OF RENAL FUNCTION
Renal function tests are useful in evaluating the severity of kidney and in following its progress.
- The glomerular filtration rate (GFR): the GFR is estimated from the endogenous creatinin clearance (140 to 200/day for man and 70 ±14 ml for woman) ;
- The renal plasma flow;
- The proximal tubular transport;
- The distal tubular transport.
6.4.IMAGING PROCEDURES
- A plain X Ray of the abdomen;
- Intravenous urography (IVU);
- Retrograde pyelogram;
- Urethrecystography;
- Ultrasonography;
- Computed tomography (CT);
- Angiography &demography;
- Magnetic resonance imaging (MPI);
- Morphologic procedures.
Renal biopsy;
Urine cytology
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6.5. DIALYSIS & FILTRATION PROCEDURES
- Dialysis:
The process of separating elements in a solution by diffusion across a semipermeable membrane (diffuse solute transport) down a concentration (Hemodialysis and peritoneal dialysis).
a) Peritoneal dialysis: instilling into the peritoneal cavity and periodically draining and replenishing it;
b) Hemodialysis: blood is removed from the patient and cleaned in a membrane unit, and then returned to the patient.
UNIT 7
GYNECOLOGY AND OBSTETRICS DISORDERS
7.1.GYNECOLOGY PRACTICE AND APPROACH TO THE PATIENT
A young women’s first visit in the physician is often for pelvic pain, contraception or pregnancy.
Gynecology and obstetric problems account for 20 % of office visits for women.
7.1. The gynecologic history
Everything begins the physician’s courtesy, attention and friendly, unhurried manner while completing the medical history.
Care must be taken to avoid making the patient feet embarrassed and dependent. The following items are ports of the history:
- Primary complaint;
- Menstrual history: age of menarche, regularity, amount of flow; pain during the menses activity (orientation);
- Sexual activity (orientation?)
- A history of venerealdiseases (herpes);
- Pain, fever;
- A review of past illnesses (hospitalization…);
- A history of radiation therapy;
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- A history of possible, expose to diethylstilbestrol (DES) by mothers we were pregnant;
- General health, weight, bulimia, anorexia, nausea, vomiting, food intolerance;
- Drug in take;
- Gastro intestinal symptoms;
- Breast problems;
- Endocrine status (abnormal hair, growth, abnormal lactation);
- Cardiac status (hypertension, smoking);
- Family history.
7.1.2. The gynecologic examination
- The bladder must be emptied before pelvic examination;
- The general examination includes: height, weight, BP, a cheek of heart, lungs lymph nodes hair texture or distribution;
- Abdominal examination: using a flat hand, the physician should systematically probe (not poke) cash quadrant of the abdomen for messes and tenderness;
- Pelvic examination (LAST);
The patient should be put into the lithotomy position (in which the buttocks are at the age of the table and the legs supported by heel or knee stirrups).
Inspection of the genital area is fist done. What about:
 Hair distribution;
 Clitoral size;
 Vulvar lesions;
 Discoloration;
 Discharge;
 Inflammation;
 Hymeneal orifice patency.
Then, a gentle touch of genitalia can be done.
The warmed, lubricated speculum can be inserted into the upper vaginal and then be opened.
Then, the Papanicalaou test sample (pap test) can be taken (to detect lesions like dysplasia, cancer in situ).
Then, a bimanual palpation of the uterus is done, with the index and the middle finger of one hand in the vagina and fingers of other hand on the abdomen. What do you feel? The uterus, a pear shaped, smooth organ.
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You have to check for its position, size consistency, surface contour, mobility and tenderness. Any softening? (Pregnancy, myoma…);
Any softening?(Pregnancy malignancy…);
Any irregularity? (Myoma, malignancy…);
Any abnormal adnexal structures? (Ovary tumors pregnancy…).
Do you think a myma is a cancer? Explain.
7.1.3. Reproduction endocrinology
7.1.3.1. Hormones
- Gonadotropin releasing hormone (GnRH). What is its role?
- Luteinizing releasing hormone (LRH). What is its role?
- Luteinizing hormone (LH). What is its role?
- Follicle stimulating hormone (FSH). What is its role?
- Estradiol/ Estrogen. What is its role?
- Progesterone. What is its role?
7.1.3.2. Puberty, Menstrual cycle & menopause
- Puberty: the sequence of maturational events by which a child is transformed into adult;
Puberty occurs during adolescence.
- Menstrual cycle
A menstrual cycle begins with the first day of genital bleeding (day 1) and ends just before the next menstrual period.
Menarche refers to the onset of menses.
Menopause refers to the cessation of menses.
What about hormonal events during the menstrual cycle?
Different phases:
- The preovulatory or follicular phase;
- The ovulatory phase;
- Post ovulatory luteal phase.
7.1.4. Gynecologic disorders
- Infertility:
Failure by a couple to conceive after one year of unprotected intercourse.
- Common gynecologic problems:
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 Pelvic pain:
The differential diagnosis is very important (colic pain, urology pain, gastrointestinal pain, psychogenetic pain)
 Ectopic pregnancy: pelvic pain, menstrual irregularity, adnexal mass;
 Ovarian cysts;
 Vulvovagnitis;
Infection diseases and other inflammatory conditions affecting the vaginal mucosa and often secondarily involving the vulva; vaginal discharge is common;
 Salpingitis:
Infection of the fallopian tube
Pelvic inflammatory disease (PID) infection of the cervix (Cervicitis); infection of the uterus (endometritis), infection of the ovaries (ophoritis).
 Premenstrual syndrome (PMS).
A condition characterized by seriousness, irritability, emotional instability, depression headache, edema and mastalgia.
If occurs 7 to 10 days before menstruation and disappear a few hears after onset of menstrual low.
 Endometriosis:
A benign disease in which functioning endometrial tissue is present in site outside the uterine cavity,
 Breast disorders:
1. Brest self examination (BSE);
(Palpation for mass and nipple discharge checking)
It this examination important? Why?
2. Physician’s examination with the following exams
 Routine mammography;
 Ultrasonography.
3. Breast disorders
 Benign breast disorder with mastalgia;
 Breast cancer
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7.2. NORMAL PREGNANCY, LABOR AND DELIVERY
7.2.0. Pregnancy, birth
Descriptions in bus stationnivels notwithstanding, fertilization occurs with the mother to be totally unaware if the vent. If there are sperm cells thrashing around in the genital tract at any time within forty right hours before ovulation to about towels hours after, the odds are undergoes violent punting movement which unite the twenty-tree chromosomes of the sperm with awn genetic complement. Form this single cell about 1/175 of an inch in diameter, a body weighing several pound and composed of trillions of cells wills be delivered about 266 days later.
For convenience we will divide the 266 days, or nine months into three periods of three month each. We can consider these trimesters separately, since each is characterized by difference sorts of events.
The First Trimester
In the first trimester the embryo begins the delicate structural differentiation that will lead to its final form. It is therefore particularity susceptible during this period to any number of factors that might influence its development. In fact the embryo often fails to survive this stage.
The first cell divisions result in cells that look about alike and roughly the same potentials. In other words, at this stage cells are, theoretically anyway, interchangeable. Seventy two hours after fertilization, the embryo will consist of sixteen such cells. (So, how many division will have taken place?) Each cell will divide before it reached the size of the cell that has production it hence the cells will became progressively smaller with each division. By the end of the first month the embryo will have reached a length of only 1/8 but it will consist of millions of cells. in the second month the features of the embryo become recognizable. Bone begins to form throughout the body, primarily in the jaw and shoulder areas. The head and brain are developing at a much faster rate that the rest of the body so that at this point the ears appear and open, lidless eyes stare blankly into the amniotic fluid. The circulatory system is developing and blood is pumped through the umbilical cord out to the chorion, where it receives life sustaining and deposits the poisons it has removed from the developing embryo. The nitrogenous wastes and carbon dioxide filter into the mother’s bloodstream, where they will be circulated to her own kidneys and lungs for removal. At about day 46 the primordial reproductive organs begin to from, either as testes or varies, and it is now, second month fingers and toos begin …..on the flattened paddles which have formed from the limb buds. By this time embryo is about two inches long and
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…….appearance, it is now called a fetus. Growth and differentiation continue during the third month, but now the fetus begins to move. It breathes the am, iotie fluid in and out bulblike lungs and swallowing motions become distinct. At this point individual differences can be distinguished in the behavior of fetus. The clearest differences are in their facial expressions. Some frown a lot, anthers smile or grimace it would be intersecting to correlate this early behavior with the personality traits that develop after birth.
The second trimester
In the second trimester the fetus grows rapidly, and by the end of the sixth month may be about a foot long, although it will weigh only about apound a half. Whereas the predominant growth of the fetus during the first trimester was in the head and brain areas, during the second of the fetus during the first trimester was in the head and brain and begins to catch up in size with the head.
The fetus is by this time behaving more vigorously. It is able to move freely within its sea of amniotic Fluid and the delighted mother can feet it kicking and trashing about. Interestingly, the fetus must steep now, so there are periods when it is inactive. It is capable of reacting to more types of stimuli as time passes. For example, by the fifth month the eyes are sensitive to fight, although there is still no sensitivity, the lungs are developed but they cannot exchange oxygen. The digestive organs are present, but cannot digest food. Even the skin is not prepared to cope with the temperature changes in the outside world. In fact, at the and of the fifth month the is covers by a protective paste consisting of was and swanlike secretion mixed with loosened skin cells . The fetus is still incapable in nearly all instances of surviving alone. By the sixth month the fetus is kicking and turning so constantly that the mother often must time her own sleep periods to coincide with her baby’s. the distracting effect has been described similar to being continual tapped on the shoulder, but not exactly.
The fetus mover with such vigor that its movements are not only fell from the incide, but can be seen clearly from the outside. To add to the mother’s distraction, the fetus may even have periods of hiccups. By this stage it is so large and demanding that it places a tremendous drain on the mother’s reserves.
At the end of the second trimester the fetus has the unmistakable appearance of a human baby (or a very old person, since its skin is loose and wrinkled at this stage). In the event of a premature birth around the end of this trimester, the fetus may be able to survive.
The third trimester
During the third trimester the fetus grows until is no longer floating free in its amniotic pool. It now fills the abdominal area of the mother. The fetus is crowded so tightly into the greatly
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enlarged uterus that its movement is restricted. In these last months the mother’s abdomen becomes greatly distended an heavy, and her posture and gait may be noticeably altered in response to the shift in her center of gravity the mass of tissue and amniotic fluid that accompanies the fetus ordinarily weighs almost twice as much as the fetus itself. Toward the of the period, milk begins to form in the mother’s mammary glands, which in the previous trimester have undergone a sudden surge of growth.
At this time, the mother it at a great disadvantage in several ways in terms of her physical well begins. About 85 percent of the calcium she eats goes to the fetus skeleton, and about the same percentage of her iron intake goes to the fetal blood cells. Of the protein she cats, mush of the nitrogen geos to the brain and other nerve tissues of the fetus.
Some interesting question arises here. If a woman is unable to afford expensive protein rich foods during the third trimester, what is the probability of lowered I.Q. in her offspring? On the average the poorer people in this country show lower 1.Q. scores. Are they poor because their I.Q. is low or arc I. Q low because they are poor? It there a self perpetuating nature about either of these alternatives?
In the third trimester, the fetus is large. It requisition increasingly greater amounts of food, and each day it produces more poisonous wastes for the mother’s body to carry away. Her heart must work harder to provide food and oxygen for two bodies. She must breathe, now, for two individuals. Her blood pressure and heart rate rise. The fetus and the tissues maintaining it form large mass that crowds the internal organs of the mother. In fact, the crowding of the fetus against the month’s diaphragm may make breathing difficult for her in these months. Several weeks before delivery, however, the fetus will change its position, dropping lower in the pelvis (called “lightening” and the pressure against the mother’s lungs.
They are important change occurring in the fetus in these last three months, and some of three are not very well understood. The effects of these changes, however, are reflected in the survival rate of babies delivered by Caesarian section (an incision through the mother side). In the seventh month, only 10 percent survive, in the eight month, 70 percent, and in the ninth, 95 percent service.
Interestingly, there is another change in the relation in the fetus and mother at this time. Whereas measles and certain other infectious diseases would have affected the embryo during the first trimester of pregnancy, at this stage the mother’s antibodies confer an immunity to the fetus, a prediction that that may last through the first few weeks of infancy.
At some point about 255 to 265 days from the time of conception the lite sustaining placenta begins to break down. Certain parts shrink, the tissue structure begins changing and the
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capillaries begin to disintegrate. The result is a less hospitable environment for the fetus, and mature births at this time are not usual. At about this time fetus slows its growth, and drops into position with its head toward the bottom of the uterus. Meanwhile, the internal organs undergo the final changers that will enable the newborn to survive in an entirely different kind of word its home has been warn, rather is its qualities, protected, and counting. It is not likely to encounter anything quite so secure again.
Birth
The signal that there soon is a new member of the earth’s most dominant species is the onset of labor, a series of uterine contractions that usually begin at about half-hour intervals and gradually increase in frequency. Meanwhile the sphincter muscle around the cervix dilates, and as the periodic constriction become stronger, the baby’s head pushes through the extended cervical canal to the opening of the vagina. The infant is finally about to propel its own genes into the gene pool of the species.
Once the baby’s head emerges, the pattern of uterine contraction changes. The contractions become milder and more frequent. After the head gradually emerges through the vaginal opening, the smaller shoulders and the body appear. The with a rush the baby slips into a new world. As soon as soon as the baby has merged the umbilicus by which it is attached to the placenta is tied off and cut. The placenta is expelled by further contractions as the after birth . The mother recovers surprisingly rapidly. On other species which deliver their young unaided the mother immediately chews though the umbilicus and eats the afterbirth so that it will not advertise to predators the presence of a helpless newborn, fortunately, the behavior never because popular in our own species.
The cutting of umbilicus stops the only source of oxygen the infant has known. There is a resulting rapid buildup of carbon dioxide in the blood which affects a breathing center in the brain. An impulse is fired to the diaphragm, and the body gasps its first breath, exhaling cry signals that is breathing on its own.
In American hospital the newborn is the given the first of the many rests it will encounter during its lifetime. This one is called the Apgar test series, in which muscles tone, breathing relaxes, and heart rate is evaluated. The obstetrician then checks for skin lesions and evidence of hernias is a boy, it is checked to see whether the testes have properly descended into the stratum. A footprint is then recorded as a means of identification, sinee the new individual despite the protestation of proud parents, does not yet have many other distinctive features that would be apparent to the casual observer. And there have been more than a few cases of accidental baby switching.
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Comprehension question
1. The main that the author is trying to get across in this selection is
…………………………………………………………………………………………
After reading the selection, answer the following questions with a, b, c, or d.
2. All the of the following are true about fertilization except
a. The twenty tree chromosomes if the sperm unite with the egg;
b. The egg and the sperm form a single cell;
c. The mother can feel the egg and sperm touch;
d. Spearman lives for several hours in the genital tract.
3. All of the following are truck of the first trimester except:
a. The jaw bone begins to develop;
b. Changes in facial expressions occur;
c. The eyes open and close;
d. Fingers and toes begin to appear.
4. All of following are true of the second trimester:
a. The mother can feel the fetus kicking;
b. Oxygen is taken in trough the lungs;
c. The fetus sleeps;
d. The fetus can have the hiccups.
5. All the following are true of the third trimester except:
a. The fetus requires great amounts of calcium and protein;
b. The fetus floats freely with room to move in the uterus;
c. Milk forms in the mother’s mammary glands;
d. The mother’s center of gravity may shift.
6. During which of the trimesters does the author imply the mother’s body works the hardest?
a. First;
b. Second;
c. Third;
d. Equality in all.
7. According to the author during which of the following periods would the fetus be able to survive in the event of a premature birth?
a. The first trimester;
b. The beginning of the second trimester
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c. The fifth month;
d. The beginning of the third trimester.
8. According to the author the embryo is considered fetus at;
a. Conception;
b. The end of the first month;
c. The end of the second month;
d. Not until the third trimester.
9. “Lighteming” means that:
a. The baby has dripped lower in the pelvis;
b. Delivery must be Caesarian section;
c. The pressure is relieved on the baby’s hungs;
d. The heart rate of the fetus begins to rise.
10. The baby is forced to breathe when
a. The head pushes through the canal;
b. The umbilicus dilates;
c. The umbilicus is cut;
d. Labor begins.
Answer the following questions with T (true), F (false), or CT (can’t tell).
11. Abnormal pregnancy is approximately 266 days in length
12. Babies are footprints as a means of identification;
13. The fetus is most susceptible to measles during the last trimester;
14. Intelligence is determined when the egg and the sperm meet;
15. The author implies that hospitals have seldom, if ever, failed to identity babies properly.
Vocabulary
According to the way the word was used in the text, indicate a, b, c, or the word or phrase that gives the best definition.
1. “Thrashing around in the genital tract”
a. Floating
b. Tossing about
c. Punish
d. Resting
2. . “correlate this early behavior”
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a. Compare
b. Contrast
c. Repeat
d. Consider
3. “become greatly distend and heavy”
a. Crowded
b. Irritated
c. Expanded
d. Engorge
4. “gait may be noticeably altered”
a. Breathing
b. Walk
c. Posture
d. Attitude
5. “sudden surge of growth”
a. Feeling
b. Moment
c. Swell
d. Signal
6. “Confer immunity to the fetus”
a. Seize
b. Replace
c. Represent
d. Bestow
7. “Less hospitable environment”
a. varied
b. normal
c. confortable
d. complex
8. “The cervix dilates”
a. opens
b. collapses
c. becomes red
d. deepens
9. “Propel its own genes”
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a. alter
b. pushes
c. remodel
d. manage
10. “Apparent to the casual observer”
a. intriguing
b. unwelcomed
c. visible
d. Humorous.
Essay Question
Discus the major changes that occur in both the fetus and the month during each of the trimester of pregnancy.
7.2.1. Diagnosis of pregnancy
The first sign of pregnancy is the absence of an expected menstrual period. Other signs:
Breast engorgement
Nausea, vomiting, fatigue
A blood urine test is usually positive (GCH level is high).
Weight gain during pregnancy:
11, 2 to 13, 3 kg or 0, 9 to 1, 4 kg/month
25 to 30 1b 2 to 3/month
7.2.2. Management of normal delivery
The following method of anesthesia will be used
- Pudential block: injecting a local anesthesia through the vaginal well to get to the pudential nerve;
- Regional analgesia: lumber epidural injection of local anesthetic;
- General anesthesia (inhalation of agents ).
Use of forceps for delivery have been/ can she be used for delivery. An episiotomy, surgical incision of the perineum should be performed for patients in when the perineum does not stretch.
The delivery of the infant ends with delivery of the placenta. Then observation is mandatory for into make sure there are no complication (hemorrhage).
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7.2.3. Complication of pregnancy
- Abortion
Loss of the product of conception before the 20th week of pregnancy (delivery is used between 20 – 38 weeks). Preterm birth is different from abortion.
Abortion classification: early late abortion, spontaneous, induced abortion incomplete, complete abortion.
- Ectopic pregnancy:
Pregnancy in which impanation occurs outside the endometrium and endometrial cavity (like in the fallopian tubes).
- Anemia
When, during the pregnancy Gb concentration is below 10 gm. /dl
- Hyperemesis gravidarum
Malignant nausea and vomiting to the extent that the pregnant women becomes dehydrated and acidotic.
- Preeclampsia and Eclampsia
 Preeclampsia
Development of hypertension with albuminuria or edema between the 20th week and the end of the first postpartum week;
 Eclampsia
Come and/ or convulsive seizures in the same period, without other etiology.
- Placenta Previa (PP)
Implantation of the placenta over and near the internal os of the cervix with bleeding in late pregnancy.
- Abruptio Placentae (DPPNI)
Premature Separation of a normally implanted from the uterus with contracted uterus and bleeding.
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7.2.4. High Risk Pregnancy (HRP)
HRP is pregnancy in which the mother fetus or newborn is or will be at increased risk for morbidity or mortality before or after delivery.
Risks factors are:
- Maternal: age (> 35 years)
- Stature: women of(< 5 ft fall)
- Obstetric history of habitual abortion, neonatal death, previous pretermed infant, previous large infant, multiparty, previous infant with is immunization (hemolytic new born disease), previous eclampsia, genetic disorder;
- Reproductive system disorders with genital trackabnormalities, uterus myomas,;
- Medical conditions: with chronic hypertension, renal disease, diabetes mellitus, heart disease;
- Family history with mental retardation, twins, familial hereditary diseases
- Antepartum risk factors:
 Exposure to teratogens during frequency (drugs during pregnancy)
 Cigarette smoking;
 Alcohol use;
 Drug addiction and substance abuse (marijuana, cocaine).
- Medical complication
 Hypertension
 Renal diseases
 Fever
 Acute surgical problems
- Pregnancy complications
 Iso immunization, (RH)
 Third trimester bleeding
 Oligo, polyhydroamnios
 PRETERM LABOR + MULTIPLE GESTATION
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UNIT 8
PEDIATRICS AND GENETICS
8.1.INTRODUCTION
Because this section discusses medical care of the newborn, infant, child and adolescence, it is helpful to define those age groups:
(1) Neonate (newborn) = birth to one month;
(2) Infant = 1 month to 1 year;
(3) Early child hood: 1 year to 5 years;
(4) Late childhood: 6 years to 12 years;
(5) Adolescence: 13 years to years.
The term child may used in general from birth on, as in discussion of the number of children in a family. Specifically, “child” refers to ages 1 through 12.
8.2. COMPLETE EXAMINATION OF THE NEW BORN
(1) Measurements:
Body length should measured from the crown to heel.
Head circumference should be half the body length 10 cm.
(2) Skin:
The skin is usually ruddy and acroyanosis is common in the first few hours.
Dryness and feeling after occurs in a few days.
(3) Head
In a vertex delivery, the head will be molded, with overriding of the cranial bones at the sutures and some swelling and or ecchymosis of the scalp.
In breech deliveries, the head is usually unmolded with the swelling & ecchymosis occurring in the presenting (buttocks, feet).
(4) Abdomen
The liver, spleen and kidneys are palpable;
(5) Genitalia
In the full make, the testes should be present in the scripture. Hydrocele and inguinal hernia are after encountered in the new born. A rare situation is a painful testicular torsion. In females, the labia are prominent.
(6) Neuromuscular system
Limited movement of the thighs is a sign of congenital hip dislocation;
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(7) Neurologic system
Neurologic examination should include:
- Elicitation of More reflexes;
- Elicitation of sucking reflexes;
- Elicitation of rooting reflex.
In the first few days
(1) There is weight loss of to 10%
(2) The umbilical cord has to be examined
(3) Circumcision, if indicated will be performed
(4) Voiding will be checked (urination)
(5) Defecation will be cheeked (meconium, than stooling)
8.3. HEALTH SUPERVISION OF THE WELL CHILD
It is about period health supervision visits intended to promote the optimal health of infants and children.
(1) Measurements: Height, Head circumference height
(2) Sensory screening (vision, hearing)
(3) Development, behavioral assessment
(4) Hereditary, metabolic screening
(5) Immunization.
8.4. SCREENING PROCEDURE FOR INFANTS AND CHILDREN
- Metabolic diseases screening [ phenylkatonuria (PKU), hypothyroidism];
- Sickle cell diseases screening ( electrophoresis);
- Urine screening for drug (cocain and opioids used by month during pregnancy)
- New born of mothers whose blood type is O, Rh should be typed and coombs test performed (jaundice!!!);
- G6PD deficiency (with hemolytic anemia);
- Growth and development should be monitored ;
- Cardiac auscultation to identify murmurs.
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8.5. IMMUNIZATION PROCEDURES (USA)
8.5.1. Routine active immunization
- 2 month:
1) Diphtheria & tetanus toxoid with pertussis (DTP)
2) Oral poliovirus vaccine (OPV) or trivalent oral poliomyelitis vaccine (TOPV);
3) Hemophilic conjugal vaccine (HbCV).
- 4 month: (DTP, OPV, HbCV);
- 6 months (DTP, HbCV)
- 12 months;
- 15 months measles – Mumps – Rubella (MMP) and HbCV;
- 15 – 18 months: DTP, OPV;
- 4 – 6 years: DTP, OPV;
- 11 – 12 years: Measles, mumps, rubella;
- 14 – 16 years: Tol (adult tetanus toxoid).
8.5.2. Passive immunization
- Immune globule (IG);
- Other immune globulins: Hyperimune globule, IV immune globin
NB: - what are globulins and what are their roles?
- What is the difference between active immunizations?
8.6. INFANT NUTRITION
- Breast feeding
Human milk contains nutritional substance ideal in quantity and quality for optimal growth and development of the human infant.
In the weaning solid of foods are added to the infant diet gradual weaning over weeks or months is raciest. One breast feeding/day should be replaced by a bottle or cup of fit juice or fresh cow’s milk when the infant is 7 months old.
- Bottle feeding
Different commercial infant formulas are used.
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8.7. DISTURBANCE IN NEW BORN & INFANT
- Premature infant: any infant born before 37 weeks gestation
- Post mature infant: any infant whose weight is below the 10th percentile for gestational age, whether premature full term or post mature;
- Large for gestation age (LGA) infant: any infant whose weighty is above 90th percentile for gestation age, when the premature, full term or post mature;
- Meconium aspiration syndrome (MAS): aspiration of meconium that has entered the amniotic sac, leading to a chemical pneumonia and mechanical obstruction of the bronchi;
- Intracranial hemorrhage;
- Rhesus (RH) incompatibility when a Rh – mother carries an Rh + fetus (incompatibility with hemolysis);
8.8. CONGENITAL ABNORMALITIES
Usually we have defects of heart and major great vessels by abnormalities at various stages of fetal development.
- Ventricular defect (VSD);
On or more opening in the septum normally separetes the ventricles.
- Atrial septal defect (ASD)
Opening in the septum that normally separates the atria;
- Patent DuctusArterious (PDA);
(persistence du canal artériel), failure of the fetal communication between the pulmonary artery and the aorta to close.
- Pulmonic valve stenosis;
- Tetralogy of Fallop:
An anatomic abnormality with severe or total right ventricular out flow tract obstruction and a ventricular sepal allowing right ventricular unoxygeneted blood to by pass the pulmonary artery and enter the aortadirectly.
What are the 4 symptoms of the tetralogy?
- Neurologic
 Anencephaly: absence of the cerebral hemispheres;
 Spina bifida: defective closure of the vertebral coulomb with protrusion of a sac containing meninges;
- Intersex states:
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Condition in which the appearance of the external genitalia is either ambiguous or are variance with the chromosomal gonadal sex of the individual.
Behavioral problems like nocturnal enuresis (involuntary and repeated passage of urine while asleep)
8.9. Asphyxia and resuscitation
In high risk pregnancy, resuscitation will be needed.
Prenatal asphyxia may be due to placental or neonatal pulmonary dysfunction.
Asphyxia produces both hypoxemia and hyperceptia
In the clinical examination, apger scoring is evaluated (Heart rate, respiration, and reflexes response and muscle tone).
Delivery room personnel must be skilled in resuscitation which will follow 6 steps:
1. Step 1: Clearing of the airways (secretion suction);
2. Step 2: Ventilation (mask resuscitation);
3. Step 3: Circulation (cardiac massage);
4. Step 4: Fluid & glucose (rapid infusion);
5. Step 5: Depression secondary to narcotics given to the mother (give naloxone 0,1 mg/kg);
6. Step 6: temperature (radiant heating)
UNIT 9
HEMATOLOGY AND EVACUATION
This unit will discuss blood abnormalities and cancer problems
9.1. LABORATORY EVALUATION
(1) Blood specimen collection (Sampling)
Blood is collected by venipuncture, through finger tip with a sterile lancet, vacuum tubes and needles, etc…
(2) Complete blood count includes Hemoglobin (Hb), Hematocrit white blood cell count (WBC), platelet count and a description of the blood smear relative to Red Blood Cell morphology (RBC);
NB: Normal values are WBC: 4,300 – 10, 800 μ
Differential WBC:
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 Segmented neutrophils: 34 – 75 %
 Band neutrophils: 0 – 8%
 Lymphocytes: 12 – 50 %
 Monocytes: 3 – 15%
 Eosinophil’s: 0 – 5%
 Basophils: 0 – 3%
What are the French for those WBC?
RBCs: 5,4 million/μfor me
4,8 million/μ for women
Other feature of circulating RBCs help to indicate the type of anemia present. The following RBC indices will indicate the type of anemia (macro, norm or micro anemia).
- The mean corpuscular volume (MCV) = volume globulairemoyen:
Het/RBC (millions) x10,
Normal values = 80 – 94.
- The meancorpuscularHb concentration (MCHC) = teneur globulaire moyenne en HbHb/RBC (millions) x 10;
Normal values = 28 – 32.
(3) Bone marrow aspiration and biopsy provide direct observation of erythroi activity, status and character of maturation of the RBC precursors ;
(4) Other test are:
Bleeding time (temps de saignement), clot retraction (temps de coagulation) and observation, fibrin/fibrinogen degradation products, partial intromboplastin time and prothrombin time (in case of bleeding disorders).
9.2. HEMATOLOGY DISORDERS
9.2.1. Anemia
Decrease in number of RBCs or Hb content because of blood loss, implaired production, increased RBs destruction or combination of these alteration.
(1) Anemia due to bleeding
Anemia caused by rapid massive hermorrhage (post hermorrhagi) (anemia)
(2) Anemia due deficient erythropoiesis
(Hypochromic – microcytic anemia), with the following laboratory evaluation fess:
- Fe –binding capacity;
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- Serum ferritin;
- RBC ferritin;
- Feet RBC protoporphyrin (FEP).
(3) hyperplastic (aplastic) anemia:
Anemia with decrease of marrow mass, often borderline high MVC values.
(4) Anemia due to Vitamine B12 deficiency
Vit B12 is a available in meet, animal protein foods and legumes. Its absorption requires the presence the intrinsic factor, facilitating the absorption of Vit B12
How do you get anemia due to Vit B12 deficiency?
(5) Anemia due excessive hemolysis
(6) Anemia due to immunologic abnormalities, like auto immune hemolytic anemia (AHA)
(7) Anemia due to infectious agents like plasmodium
(8) Anemia due to do defective hemoglobin synthesis:
Like in the sickle cell disease (a chronic hemolytic anemia occurring almost excessively in blacks and characterized by sickle shaped RBCs due to homozygous inheritance of HbS). Hb electrophoresis has to be done.
9.2.2. Hemorrhagic disorders
Disorder due to hereditary A & B clotting factors deficiency
9.2.3. Hereditary coagulation disorders, like the hemophilia’s (common bleeding disorders due to hereditary A & B clotting factors deficiency).
9.2.4. Dissemination intravascular coagulation (DIC), with defibrination
9.3.ONCOLOGY
9.3.1. Cancer definition
A cellular malignancy whose unique trait; loss of normal controls, results in unregulated growth of differentiation and ability to invade local tissue and metastasize.
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9.3.2. Cancer epidemiology
The following factors have important on the incidence and mortality of cancer?
(1) Age (> 25 years)
(2) Geographic difference (colon & breast cancer is in Japan) ;
(3) Familial importance (malignancies in certain families).
9.3.3. Oncologytreatment and prognosis
Successful therapy must be focused on the primary cancer and its metastases. Thus, local and regional therapy, surgery or radiation must be integrated with the systemic therapy (drugs). If cure is impossible, palliation of symptoms may improve the quality and duration of life.
We have cancers curable in early stages with surgery alone (bloc resection) and cancers that are curable with radiation alone. The following are antineoplastic drugs:
(1) Alkylating agents ;
(2) Antimetabolites (methotrexate);
(3) Plant alkaloids (vincristine);
(4) Enzymes (asparaginase);
(5) Hormones (Tamoxifer).
9.4.TRANSFUSION IN MEDICINE
9.4.1. Blood & transfusion definition
Blood is living tissue. Transfusion of it or of cellular component from a donor to a recipient is a form of transplantation. The decision to transfuse is a clinical judgment that requires weighing the possible benefic and known hazards with alternative treatment.
9.4.2. Preparing of donor and recipient blood and its companies:
- Collection and storage of blood and its components
Regulation is established. They have to be Causes of disqualification are:
1) History of hepatitis;
2) History of heart disease;
3) Cancer;
4) Severe asthma;
5) Bleeding disorder;
6) Convulsion;
7) AIDS or being in a AID risk group.
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- Immunohematology:
To avoid transfusing incompatible RBCs, doners and patients must be first classified as to their ABO and Rh type.
- Compatibility testing (cross – matching)
If has to be done to ensure that the recipient’s serum does not contain clinically significant antibodies (Ab) that will react with the transfused RBCs.
- Transfusion Technique:
Transfusion of IU 450 ml of RBC should take more than 2 h close observation is important during the first 15 minutes to avoid severe reactions.
- Complication of transfusion:
(1) Hemolytic reactions (recipient’s RBC hemolysis);
(2) Febrile reaction (chills, fever);
(3) Allergic reactions (hypersensitivity).
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UNIT 10
DENTAL AND ORAL DISORDERS
10.1. EXAMINATION OF THE ORAL REGION
Examination of the oral region begins with a pertinent history to check for:
1) Inability to chew food well;
2) Slight, occasional bleeding;
3) Recurring oral infections (sores, lumps and pain);
4) Facial asymmetry or swelling;
5) Breath odor existence;
6) Lips movements, thickening;
7) Temporamandibular (TMS) smoothness, deviation of jaw movement;
8) Defects in teeth from;
9) Oral mucosa color & dryness;
10) The palate form;
11) The tongue movement and surface (normal or atrophied papillae);
12) Salivary glands and the saliva flow.
10. 2. DISORDERS OF THE LIPS, MOUTH AND TONGUE
- Stomatitis:
An inflammation of the mouth, after a symptom of systemic disease
- Glossitis
An acurte or chronic inflammation of the tongue.
- Cheiltis: infection of the angles of the mouth.
10.3. DENTAL CARIES AND ITS COMPLICATIONS
- Tooth decay:
A graduat pathologic disintegration and dissolution of tooth structure by microorganisms, with eventual involvement of the pulp.
- Pulpitis
Inflammation of the dental pulp (containing vascular, connective and nervous tissues) and of the adjacent periodontal tissues resulting in tooth ache.
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10.4. Periodontal Disease
- Gingivitis
Inflammation of the gingiva, characterized by swelling redness, change of normal.
- Acute encoringuleerative (ANUG)
- Compatibility testing (cross-matching);
It has to be done to ensure that the recipient’s serum does not contain clinically significant antibodies (Ab) that will react with the transfused RBCs.
- Transfusion technique:
Transfusion of IU 450 ml of RBC should take more than 2 h close observation is important during the first 45 minutes to avoid severe reactions.
- Complication of transfusion:
(1) Hemolytic reaction (recipient’s RBC hemolysis);
(2) Febrile reactions (chills, fever);
(3) Allergic reactions (hypersensitivity).
A non contagious infection associated with a fuss from bascillus and a spirochete, thatusally begin on the interdental papillae and can affect the marginal and attached gingiva by direct extension.
- Periodontitis
Progression of singivitis to the point that loss of supportin bone has begun (primary cause of tooth loss in adults)
10.5. DENTAL EMERGENCY
- Toothache and infection
- Post extraction problems (swelling, bleeding pain)
10.6. DENTAL RESTORATION & APPLIANCES
- Filling ( = plombage)
Are inserted removals of decay?
Silicate cement is used to fill cavities.
- Bridger:
When teeth are missing a bridge on partial to partial denture can be made (false teeth)
- Complete dentures:
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They are removable appliances that help a patient whew solid and improve his speech and appearance (denture).
Can you describe the organization of a heqth zone?
Con you describe the three levels of the organization of the heath ministry in the DRC?
UNIT 11
THE HOSPITAL
A hospital is an institution for the treatment of the sick. It is an institution suitably locatcd, construction , organization and personnaled to supply scientifically, economically all or any recognized part of the complex requirement for the prevention, diagnosis and treatment.
Hospital can be classified or group in a variety of different ways:
1) Type of ownership:
- Government or public;
- Private (for profit, non for profit)
2) Type of problem treated:
- General hospital;
- Specialized hospital;
3) Average lengnth or stay
- Regular medicine;
- Long term hospital.
4) Type of medicine:
- Regular medicine
- Osteopathic (disease of the bone)
5) Role of education
- Teaching hospital
- Non teaching hospital
6) Size of the hospital (number of bed)
in the USA
1. Federal government hospitals
- Army hospital;
- Navy hospitals
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- Air force Hospitals
2. State government
Long term: psychiatric, chronic diseases, Tuberculosis
Short term: state hospital, University hospital, Medical School Hospital, Prison Hospital.
3. Local government: District Country & City
4. Voluntary or non for profit hospitals
- Religious group hospital
- Industrial hospitals
- Health Maintenance Organizations Hospitals
- Cooperative Hospitals
5. Proprictary or for hospitals
- Individual owner
- Partnership
- Corporation
General hospitals
Provide care for adult and surgical patients and but often but not always for pediatric and maternity patients (USA)
Specialty hospitals
Provide care for specific and specialized medical problems. Such hospitals include:
- Children’s
- Maternity
- Orthopedic
- Cancer
- Eye and ear (ENT = eye, ear, throat)
- Psychiatric
- Alcoholism and drug dependency
- Mental retardation
- Tuberculosis
- Chronic
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Teaching hospitals
Are hospitals having agreement with a medical school to provide clinical; experience for medical students. In these hospitals, there is an existence of approved physician residency training programs.
Community hospitals
Are those hospitals serving primary a local population in contrast to a referral hospital that receives many of its patients from a wide are. Most of the time, they are non university and non teaching hospitals.
Tertiary care hospitals
They are hospitals that have the most complex diagnostic and therapeutic procedures, often on referral from other hospitals sending patient with complicated problems.
Medical centers
Hospitals or hospital groups ranging from single hospitals to complexes of geographically related affiliated institutions, ofter including a medical school. It implies complexity and special expertise.
The mission of a hospital:
1. To deliver a comprehensive range of quality heath care to residents, especially to medically indigent or anyone needing emergency care;
2. To provide services without regard to race, color, national origin are ability to pay;
3. To serve as the tertiary referee center and as a resource to other hospital and medical care providers;
4. To serve as an education center that fosters excellence in training education and research;
5. To maintain an environment where patients and staff are treated with dignity, compassion and respect.
Hospital goals
1. To provide quality health care services consistent with current standards,
2. To develop and maintain a comprehensive range of clinical services that include care, treatment and prevention of disease;
3. To develop a management framework that supports cost effective and efficiency medical care delivery system which anticipates and responds to changes;
4. To promote a feeling of dignity and respect for each client, learner, and employee and or sense of pride in being a part of the hospital;
5. To integrate the activates band service of the medical schools to fully support the hospital’s mission;
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6. To obtain continuous and adequate funding needed to carry out hospital’s mission;
7. To provide opportunities for staff development, research and medical education.
Hospital’s departments or services
Hospitals are organized by function department that cut across the patient units.
These include:
- Nursing;
- Ancillary;
- Administrative and support departments or service.
1. Nursing services (Department or Division of Nursing)
It includes a direction of nursing responsible for the whole department and nursing, supervisions, responsible for several units, each of with run by a head nurse.
You also have
- Professional nurse (RNs)
- Practical nurses (LPNs);
- Nursing aides
- Ward leak (with paper work).
2. Medical departments
They are the medical specialty departments.
- Medicine: cardiology, hematology…
- Surgery: general, surgery, throat surgery orthopedist, plastic surgery;
- Pediatrics: Infant, Toddlers, School age…;
- Gynecology & obstetrics;
- Specialties: ENT (Ear Nose and Trod), dermatology, an intensive care unit (ICU)…
3. Ancillary medical departments:
These are medical specialty departments whose physicians and other personal provide direct patient service inclunding diagnostic and therapeutic procedures but do not in general have primary ongoing responsibility for patient:
- Anesthesiology;
- Pathology (laboratories);
- Radiology;
- Physical medicine or rehabilitative medicine.
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4. Patient support service are:
- Pharmacy;
- Social services;
- Dietary services;
- Chaplaincy service.
5. General administration
- Administration;
- Financial affairs office;
- Public relations department;
- Admission;
- Medical records departments;
- Medical library (bibliothèque);
- Personal department;
- Purchasing and stores;
- Communications;
- Chaplaincy;
- Control supply;
- Housekeeping ;
- Maintenance and plant;
- Security.
6. Ambulatory services
They are services where other impatient services are provided. These include:
- Out patient (OPD) for non emergency ambulatory patients;
- Emergency services for acutely ill patient.
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UNIT 12
THE PATIENT, THE PHYSICIAN AND THE MEDICAL RECORD
THE PATIENT
The same type illness presents in a variety of ways depending on the age, personality and social situation of the patient. This is one of the basic Principles in psychologic medicine. Relevant here is the progressive change in social relationships, from a state of complete dependence on parent, family or teacher, who must supply much of the historical datails or an illness to one of relative independence. Al the same time, there are variable do grees of maturation which involve the partial suppression of egocentric drives. Their trends their modification during life experience are the basic of personality, and deviations in these natural development prevent satisfactory social adjustment. Another aspect of the problem is the real or implied significance of disease on the patient. Also, illness constitutes a threat, not only to the individual’s life but also to the individual’s status in his social group.
THE PHYSICIAN
The examining physician is himself a human instrument,subject arising from events in his own biography. The problem of understanding and responding appropriately to the patient is strongly influenced by this fact. To perceive and understand the problems of the patient depend not simply on instruction but one the emotional maturity of the physician and his interest in and concern for other human beings.
The physician has a special function in society and should be skilled as a psychologist in human behavior as well as a biologist in human disease.
The physician seeks:
1. To respond to and alleviate the patient’s complaints;
2. To search out sings of ill health not yet apparent to the patient or of abnormalities which may lead to ill health;
3. To maintain the patient in a state of well-being.
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THE PATIENT- PHYSICIAN RELATIONSHIPS
Traditional “patient physician” relationships
The care of the patient begins with the development of an interpersonal relationship between the patient and his physician.
In the absence of a sense of trust and confidence on the part of the patient, the effectiveness of therapeutic measures is diminished.
In cases which for the time being are insusceptible of solution or for which no affective remedy is available, a feeling on the part of the patient that his physician is doing all that is possible is one of the most important therapeutic measures that the doctors can provide.
The charging patient physician relationships
The one to one relationships are changing because of the changing in which medicine is decreasingly begun practiced. In many cases, the management of the individual patient request the active participation if a variety of trained professional personnel (physician psychiatrists, nurses, dieteticians, biochemists, psychologist and other paramedical personnel).
INCURABILITY AND DEATH
When catch is imminent and inevitable, what should the patient and his family be told?
There is no rule that the patient must be told everything.
How much the patient is told will depend upon:
- His own dares and character;
- The wisher of the family;
- The state is this affairs: resources that represent the savings of lifetime may be dissipated in days or weeks!!!
- His religious convictions.
This is the mason why opportunity has to be give to the patient to speak and ask questions. Patient find it to share feeling about death with their physician who should therefore provide emotional, physical and spiritual support.
What is death?
Traditionally, in every society arrest of heart action has been taken as the only valid criteria of death.
Law books cite this as he only certain proof that life has ended.
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THE MEDICAL RECORD
Medical records, as kept for have often failed the purpose of lucid communication education and rapid retrieval of stored information. Elements of the medical records……..:
- Identifying information: name, age, race, religion;
- Patient profile: occupation, education, marital status, children, hobbies, worries, moods, sleep patterns, habits…;
- Medical history:
a. Chief complaints;
b. History of present illness;
c. Past medical history;
d. Family history;
e. Medications.
- Physical examination;
- Laboratory date and physiologic test: blood count, electrocardiogram, chest X ray, etc…
TEXT ANALYSIS: PROBLEM ORIENTED MEDICAL RECORD
Medical records, as kept for years, have often failed the purposes of lucid communication, education, and rapid retrieval of stored information. Poorlysupported diagnostic incomplete progress notes. Notes, chaotically entered laboratory results, and inadequately expressed plans of management are embarrassingly common finding in record existing at one of the most sophisticated medical institutions. In response to this, the Problem Oriented Medical Record (POMR) has been devised with the objective of providing a means whereby the medical record will better reflect the health problems of patient and the professional responses to them on the part of physician nurses and other major patient in here.
Central to its function is the view that the patient’s record must be designed so that expresses specifically what physicians deal with most frequently, the problems of patient. While the ultimate goal of clinical taxonomy is directed towards identification of etiology, pathology, and pathologic, in view of their importance as guides in therapy, it would be both unrealistic and dangerous to require diagnosis for a severe, dyspnea patient in the absence of reasonably convincing information concerning the reason of the dyspnea. Unit the cause can be established, all diagnostic modalities and therapeutic interventions are oriented the real and immediate problem – dyspnea. The same is true of a create variety of the real and laboratory findings which are delivered in the process of patient care. A high serum reported in an SMA
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screening study, a suspicious pigmented skin lesion, or a sudden unexplained deterioration of intellect are examples of worrisome fended that are most appropriately expressed, initially, as problems. In each instance, a more refined diagnosis in the absence of further date can only represent guesswork’s hence, it may be wrong. As date pertaining to each problem become available the problem may then be expressed at a higher level of understanding i.e., hyperparathyroidism, malignant, or subdural hematoma. By offering the physician a system of record keeping compatible with his most frequent focus of attention in the practice of medicine – the problem – an opportunity is provided to reduce distortion and error.
The second and more fundamental aspect of problem oriented is the systematized display of patient care more embodied in records. This is best described by considering the elements of medical care and their dynamic interrelationship, as proposed by week.
Non medical word
To devise;
To design;
To deal with;
Worrisome;
Guess work;
Hence;
Embodied.
Medical word
Taxomony;
dyspnea;
Intellect;
Hyperpathyroidism;
Melanoma;
Hematoma.
Comprehensive questions
7. What is PPMR?
8. How do you have to design the patient record?
9. What is the ultimate good of clinical toxonomyy?
10. Explain “problem”.
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UNIT 13
SURGICAL MANAGEMENT OF BURULI ULCER PATIENT
13.1. Definition
Buruli ulcer is an endemic infection disease caused by a mycobacterium called Mycobacterium ulcerans. It occurs in a verily of forms, the most spectacular being extensive ulcerative skin lesions lesions leading to disabling sequelae.
13. 2. Epidemiology
13.2.1. Geographical distribution
The disease accours mainly in the tropics, in the zone between the Tropic of Cancer and the Tropic of Capricorn. It is found in endemic foci in endemic foci in Africa, America, Asia and Oceania.
13.3. Influence of the environment
Buruli ulcer occurs in poorly drained or marshy areas subject to flooding and irrigated areas. There is a close relationship between these land water biotopes and disease. The natural reservoir of M. Ulcerans is still not exactly known although the bacterium has found in simples of water and various insects living in association with the roots of aquatic plants in endemic areas.
13.4. Seasonal variations
Data relating to seasonal differ. Some observers note increased prevalence in the dry season. Others have noted greater prevalence in the rainy season while others have found no seasonal variation.
13. 5. Mode of transmission
This has not been elucidated. Several hypotheses have been advanced:
 Direction inoculation through contact with the infecting environment following injury or contact with vector;
 Airborne – to – person infection – only very always necessary to allow the bacterium to enter end develop in the subcutaneous tissue. A trauma (bruise or sprain) without any apparent break in develop in subcutaneous the disease (latent infection?).
13.6. Prevalence
Buruliucer is the third most common mycobacterial disease observed in humans (after tuberculosis and leprosy). The cumulative number of cases notified worldwide in 1999 was as follows:
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Australia 158 Cases
Africa 15 or 37 cases ( including 3700 in Benin) the disease is still largely understated and the number and the number of unreported cases may exceed the number of respond cases in certain villages.
13.7. Race, age , sex
Buruli ulcer is found in all races and at all ages . Prevalence in greatest among children 15 years of age . Both are equally affected if no account is taken of age . However the disease is found more often in male children and in adult women .
13.8. Site of tensions
All parts of the body may be affected ulcers tend to from in exposed areas , most commonly on the arms and the legs , Young people under 15 are more often affected in the upper part of the trunk than adult. Although is an obvious link between Buruli ulcer and parts of the body exposed to injuries , initial infection of the palms of the hands and the soles of the has never observed .
13.9. Pathogenesis
The pathogen city of M .Ulcerans is linked to the production of a lipid exotoxin .the dissemination of toxin may be limited , leading to localized lesions , or alternatively very extensive , producing larger diffuse lesions. This toxin is thought to cause necrosis of subcutaneous fat, thereby constituting an excellent culture medium for M. Ulcerans the bacterium multiples and may reach contiguous bone , and may also be disseminated by the blood or lymphatic system causing metastic coetaneous lesions or osteomvelitis.
Surgical management is divided in 3phases / Visits, pre- surgical and post – surgical.
Pre- surgical ( some days prior to surgical)
In all stage / Form / Phases of the disease , the following must be followed:
1. Exact surgical procedure plus type of anesthesia be explained to patient and / or accompanying family member(s)
2. Time to report to hospital
3. Consumable to be brought along ( these may be supplied at the health institution)
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4. Female patients advised to remove cutex( if any) from nails , rings and other jewellery before coming to hospital.
5. Laboratory investigations – full blood count , sick ling urea / creatinine , urinalysis – and x ray investigation , be done as appropriate.
6. In case of day surgery for minor cases like nodules and papules, discuses whether patient should be starved or not , patient to be changed into gowns at the world.
7. For intermediate – to – major case e.g . plaque , edematous and ulcer cases , patient is admitted , ulcer dressed daily with antiseptic agents( eusol, povidone –iodine , saline solution , phenytoin powder , nitrous oxide cream , etc) patient seen by anesthetist few days prior to surgery , anemia , other co- existing infection and / or suprainifections corrected , as demanded from laboratory findings and physical assessment , affected limb should be elevated.
8. A combined therapy of Rifampicin per os ( 10mg/ kg bw) and i.m. Streptomycin ( 15 mg/kg bw) or i.m.v. Amikacin should be given , in all cases for at least one (1) month – advised give 2 weeks prior to surgery including day of surgery and 2 weeks post surgery , under direct observation and document.
SURGICAL
1. Minor cases e.g . papules nodules may require local anesthesia general anaethesia may be necessitated especially ,in the child
2. Major cases eg. Plaques , oedematous ,and require general anesthesia
3. Principle of surgery . Wide excision – same for all cases.
Technique of excision
1. Line of incision should be paralled to any nearby joint flexion crease
2. Lesion must be removed or excised with a clear margin of healthy tissue at the lateral and deep margins ( diseased fatty tissues look less yellow , less perfused , cheesy and firmer than normal tissues)
3. Deep fascia should be preserved if not involved otherwise. Must be removed taking care not open tending sheaths or joints and not damage important nerves and blood vessels .
4. Reduces blood loss by
 Blunt dissection of affected tissue
 Use electro –cautery ( diathermy)
 Application of pneumatic tourniquet ( for not more than 2hours)
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5. Large lesions may require staged excision – one area at a time
6. Depending on location , wounds of some excised lesions may be closed primarily by suture without undue tension . Suture removed in 7-14 days depending on location and progress of healing.
7. Large surgical wounds should be dressed and , Split –Skin graft applied at a later date ( usually 1-2 weels post excision)
8. Specimen must be taken for analysis ( correct technique in specimen taking correct specimen bottle , correct storage / Transport medium , correct tabeling)
Spit skin Graft Technique
1. Instrument for harvesting skin: dermatome ( mechanical or electric ) ; razor or scapel blade
2. Preferred site for harvesting spilt skin: thigh , upper arm , fore arm buttocks , lower legs serum intended donor site and , lubricate with little sterile Vaseline or liquid paraffin to lessen friction.
3. Scrub intended donor site and , lubricate with little sterile Vaseline or liquid paraffin to lessen friction.
4. Stretch skin of donor site by means of mental plate or , medial edge of hand end at each end
5. take thin split – skin grafts , with blade at less than 45 degrees to the skin
6. keep the skin graft moist with normal saline
7. keep skin graft using skin graft expander ( mesher ) or , scapel blade if former not available
8. may secure grafts at their edges and junctions with sutures or staples
9. Vaseline gauze applied then n a further thick absorbent dressing and bandage.
POST SURGICAL
Prevention of joint stiffness post excision / Grafting
Ø Skin grafting over a flexion crease necessitates post operative splinting and subsequent physiotherapy; to minimize flexion contracture
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Ø Limbs best splinted with their joints in the following positions:
a. Knee in extension
b. Ankle in right angle
c. Elbow in extension
d. Wrist in extension
e. Metacarpo –phalangeal joints in flexion
f. Interphalangeal joints in extension
Ø suspension with slings and cords ,is an alternative for lower and upper limbs , thus maintaining joints in appropriate position during post – operative period
Ø remove surgical dressings on 3rd or 4th post – operative day, :less if presence of hematoma or infection . There after , change dressings daily or on alternate days.
Ø Commence mobilization as soon as graft has taken ( usually from 7th post – operative day)
Ø correct any inadvertent blood loss, reduce pain with analgesics , and tress on good nutrition
Ø The combined therapy of streptomycin ( orAmikacin) and Rifampicin already started 2 weeks prior to surgery must be continued for a leatest ; 2weeks post operatively under direct observation with documentation.
Ø Patient be followed up for a leatest , six (6) months
CASES NEEDING SPECIALIST’S ATTENTION
Extensive lesions e.g. extensive oedema, ; ulcer contracture
Involvement ( or loss) of face – eye , ear , nose , neck , breast genitalia involvement of bone – odtecomytilis or reactive ostcitis cases needing amputations as indicated in :
Ø septicaemia / gangrene
Ø destruction of function of a foot
Ø extensive bone destruction
Ø completion of a necrotic auto- amputation
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Wound management for Buruli ulcer patient
Wound dressing is done after complete bath or shower with clean water and soap. This is to help dressings to fall off and to prevent bleeding . The wound is then cleaned and ne w dressing applied under aseptic technique .
Cleansing lotions used
These include normal saline or savlon . Acetic acid lotion may be used to clean wounds with greenish discharge i.e. pseudomonas infection.
After adequate cleaning of the wounds , Vaseline gauze with betadine solution or wokadine ointment is applied to ensure a moist dressing and ease or removal . This is followed by several layers of sterile material for adequate absorption of exudates.
Crepe bandage is then applied to hold the dressing in position
High elevation of affected site is ensured to help reduce oedema and promote wound healing.
Dressing should be changed frequently – depending on the amount of the discharge or as advised by the surgeon. An infected wound needs to be dressed frequently than a clean wound.
Post – operative management
After excision and debridement in theatre , wound dressing is done till the wound is clean and well granulated for split skin graft to be applied.
In skin grafting two sites will be dealt with
a) Donor site
b) Recipient site
Donor site
This is the area where the skin is harvested and it is usually from the thigh . The skin can also be taken from various areas e.g. leg.armetc
Care of the Donor site
a) Observe for bleeding particularity during the firs 18 hours
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b) Reinforce donor site dressing when there is bleeding (i.e. When bandnage is soaked with
c) Adequate analgesics are given regularly to alleviate pain as ordered by the surgeon ( strictly very important)
d) To assist early healing the affected area is kept no weight bearing for some days e.g. 5 days
e) The whole dressing is removed at 10 -14 days post- operatively depending on the surgeon or earlier if there are any problems.
Technique for removal of Dressing
a) Undo crepe bandage
b) Remove sottban it applicable
c) Take of dressings layer after layer by pressing the immediate dressing down whilst removing the top layer until it comes to the Vaseline gauze.
d) Leave Vaseline gauze in place if it does not come of easily or trim edges if they are loose
e) Apply gauze and bandage in place for some days or until the Vaseline gauze can be removed without effort ; (any attempt to force the Vaseline gauze out will lead to bleeding and destruction of granulation tissue )
f) Moisturing cream e.g. sheabutter , Vaseline etc is applied to the donor site when healed to prevent dryness.
Note- which children , it is advisable to cover the area even when healed to prevent them from scractching which might lead to breakdown of scar. Where there is infection of the donor site e.g. with pseudomonas , the dressing is changed before the 10- 14 days . The top dressings are removed and the Vaseline gauze left on the sit is soaked with saline until it falls off. It is then cleaned with acetic acid solution and redressed.
Recipient site
This is the affected area where the skin from the donor site was placed the firs change of dressing takes place by 5th – 10th day depending on the surgeon
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Caution
Extreme care is necessary when removing dressing from the grafted site to prevent accidental removal of the graft from the graft bed.
Procedure
a) Remove all dressing as demonstrated above the Vaseline gauze
b) Hold the edge of the Vaseline gauze , pull gently pressing the graft down gently with the other hand or by using foceps
c) Dip cotton wool balls into gallipots containing saline
d) Using a gentle rolling motion , roll the cotton ball using foceps , from the center of the graft to the periphery of the grafted area b expressing any serous fluid or air to the outer edge of the grafty . Close contact of the graft bed is necessary to facilitate graft take .
e) Frick any remaining blister with a sterile needle or lanced to express any serous fluid or blood.
f) Apply layer of Vaseline gauze overlapping the grafted area
g) Open out gauze , fluff it up into the grated area over the Vaseline gauze
h) Cover with gauze swabs and secure dressing in position
i) Record findings especially the percentage “ take”
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UNIT 14
CAESARIAN SECTION
14.1.1. Diagnosis of labour
First stage:
- Cervix below 4cm dilated
Activate phase:
- Cervix between 4cm and 10 cm dilated
- Rate of cervical dilatation of least 1cm / hour
- Effacement is usually complete
- Fetal descent trough birth canal begins
Second stage :
- Early phase ( non – expulsive)
- Cervix fully dilated ( 10cm)
- No urge to push
Late phase
- Fetal presenting part reaches the pelvic and woman has the urge to push
- Typical last< 1 hour in primigravited and <30 minutes in multigravidae.
Carry out vaginal examinations at least once every 4 hours in the first stage of labour and plot the findings on the partograph. The partograph is very helpful in monitoring the progress of labour and in the early detection of abnormal labour patterns
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Diagnosis of vaginal bleeding in early pregnancy
Presenting symptoms and other symptoms and signs sometimes presents probable diagnosis
Symptoms and signs tropically present
Light bleeding 1 cramping / lower abdominal pain threatened abortion
Closed cervix uterus softer than normal
Uterus corresponds to dates
Light bleeding fainting ectopic pregnancy
Abdominal pain tender adnexal mass
Closed cervix amenorrhea
Uterus slightly larger than normal cervical motion tenderness
Uterus soother than normal
Heavy bleeding cramping /lower abdominal pain incomplete abortion
Diated cervix partial expulsion of products of
Uterus corresponds to dates conception
Heavy bleeding 2 cramping lawyer / lower abdominal pain inevitable abortion pain
Dilated cervix history of expulsion of products of conception
Uterus smaller than dates
Heavy bleeding cramping lawyer / lower abdominal pain inevitable abortion pain
Dilated cervix partial expulsion of products of conception
Uterus smaller than dates
1Light bleeding : take longer than 5 minutes for a clean pad or cloth to e soaked
2 Heavy bleeding : takes less than 5 minutes for ancientpad or cloth to be soaked
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Heavy bleeding nausea vomiting
Dilated cervix spontaneous abortion
Uterus larger than dates cramping / lower abdominal pain
Uterus sotter than normal ovarian cysts ( easily ruptured )
Partial expulsion or products of early onset pre-eclampsia
Conception which resemble no evidence of a letus
Grapes
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14.2. Preparation steps
1. Review indications. Check fetal presentation
2. Obtain consent from the patient after explaining the procedure and the reason for it.
3. Check patient’s hemoglobin concentration, but do not wait for the result if there is fetal or maternal distress or danger. Send the blood sample for type and screen. If the patient is severely anemic, plan to give to units of blood. Sample for type and screen
4. Start an IV infusion
5. Give sodium citrate 30 ml 0.3 molar / or ranitidine 150 mg orally or 50mg IV to reduce stomach acidity. Sodium citrate works for 20 minutes only so should be given immediately before induction of anesthesia if a general anesthetic is given.
6. Catheterize the bladder and keep a catheter in place during the operation
7. If the baby’s head is deep down into the pelvis, as in obstructed labour, prepare the vagina for assistance at caesarian delivery.
8. Roll the patient 15° to the left or place a pillow under her right hip to decrease supine hypotension syndrome
9. Listen to the fetal heart rate before beginning surgery
14.3. Before inducing anesthesia check that
1. An experienced and trained assistant is available to help you with induction
2. You have the correct patient scheduled for the correct operation on the correct side .
3. The patient has been properly prepared for the operation and has had no food or drink for the appropriate period of time.
4. The patient’s progress through the hospital up to this moment and then check that your actions will be right ones.
5. Adequate intravenous access is obtained
6. The patient is lying on a table than can be rapidly titled into a head down position in case of sudden hyptension or vomiting.
7. Your equipment before you give an anesthetic
- All the apparatus you intend to use , or might need , is available and working
- If you are using compressed gases there is enough gas and a reserve oxygen cylinder
- The anesthetic vaporizers are connected
- The breathing system that delivers gas to the patient is securely and correctly assembled
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- Breathing circuits are clean
- Resuscitation apparatus are ready and haven been decontaminated
- Needles and syringes are sterile: never use the same syring or needle for more than one patient.
- Drugs you intend to use are drawn up into labeled syringes;
- Any other drugs you might need are in room.
14. 4. Managing unexpected effects of a spinal anesthetic
To treat hypotension:
1. Increase the rate fluid infusion as fast possible, using a pressure bag, if need odd;
2. Tilt the table to the left, if already tilted;
3. Give a vasopressor: ephedrine 10 mg, repeated as necessary.
To treat the respiratory difficulty, give oxygen and IPPV, using ananaesthic face mask and self-inflating bag or bellows, or the anaesthetic machine patient circuit.
At this point, it is possible that the situation will resolve it self: the heart rate and blood pressure may rise again, the patient breathes unassisted and you continue with spinal anaesthesia.
Equally, however, the high spinal may progress further, or even became a “total spinal”. In this condition, there is no detectable cardiopulmonary activity. Start the following emergency measures without delay, as for any cardiopulmonary resuscitation:
 Intubation;
 Ventilation with oxygen;
 Intravenous epinepheine.
The question often arises: how should you intubate who is clearly unable to breathe (and when inflation by mask is insufficient) but who is still conscious? Do you need to give thiopental and suxamethonium?
In the presence of hypotension:
 Avoid thiopental give 10 mg of diazepam instead;
 Judge the need for suxamethonium to intubate on the basic of the patient’s the state of relaxation;
 Give (12 – 0,5 mg of epinephrine intravenously if the blood pressure does not respond to ephedrine.
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A high or total case should make a complete recovery. Death or cerebral damage from delayed recognition of the signs or poor management is inexcusable.
14.5. Postoperative management
If the patient is restless, something is wrong.
Look out for the following in recovery:
 Airway obstruction;
 Hypoxia;
 Hemorrhage: internal external;
 Hypotension and hypertension;
 Postoperative pain;
 Shivering hypothermia;
 Vomiting, aspiration;
 Falling on the floor;
 Residual narcotics.
The recovering patient fit for the ward when:
 Awake, opens eyes;
 Extubated;
 Blood pressure and pulse are satisfactory.
 Can lift head on command
 Not hypoxic
 Breathing quietly and comfortably
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References
1. Frederic H. Meyers: Review of medical pharmacology
2. Guedemon&Portaels: Diagnosis for Buruliuler
3. Helen Andrews: Introduction to nutrition
4. Mc Elroy: Foundations of biology
5. Philip D: Stoane: Essentials of family medicine
6. Philip Wiles: Essentials of orthopedics
7. Robert Berkow: The merck manual of diagnosis and therapy
8. Robert Collins: Dictionaire Français Anglais, Anglais Français
9. W.F Gamong: Review of medical physiology.