Famvir

Tracy L. Sprunger, PharmD, BCPS

Associate Professor of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana

http://www.usaprn.org/state-prn--school-contacts/indiana-2/tracy-l-sprunger-pharmd.html

Influenza can cause fever antiviral ganciclovir purchase cheap famvir on line, chills antiviral wipes buy famvir discount, cough hiv infection and symptoms discount generic famvir canada, sore throat hiv infection after 5 years 250 mg famvir overnight delivery, headache hiv infection symptoms mouth buy famvir 250 mg with amex, and muscle aches stages of hiv infection cdc generic famvir 250 mg line. The influenza virus is usually passed when an infected person coughs or sneezes and another person inhales droplets containing the virus. Although most people are ill for only a few days, some have much more serious illness and need to be hospitalized. Routine annual influenza vaccination is recommended for all persons aged 6 months and older. Since the influenza virus changes frequently, yearly vaccination should begin September (or as soon as vaccine is available) and continue throughout the influenza season. Any child or staff person that develops a fever (100F or higher under the arm, 101orally, or 102 rectal) with cough and/or sore throat should be sent home until 48 hours after resolution of symptoms. Note: Notify the Division of Public Health, Office of Infectious Disease Epidemiology at 1-888-295 5156 if you become aware that a child or adult in your facility has developed Influenza. They should be allowed to participate in activities appropriate for their development even though these activities may result in some minor injuries, such as scrapes and bruises. Children should be prevented from taking part in activities or using equipment that is beyond their abilities and that may result in major injuries such as broken bones. You will need to assess the injury to determine what type of medical attention, if any, is required. Unintentional Injuries Children are often injured unintentionally during the normal course of a day. Many of these injuries, such as scrapes and bruises, are minor and only need simple first aid. Physical aggression, such as biting, hitting, scratching, and kicking may result in physical injuries. Running outside, kicking balls, punching bags, and other physical play allows children to let off steam. Therefore, there are no exclusion criteria for a child or caregiver that has Lyme disease. The following information may be helpful should you have any questions regarding this tickborne, bacterial disease. Spread Lyme disease is spread by the bite of an infected deer tick or western-blacklegged tick. Ticks search for host animals from the tips of grasses and shrubs and transfer to animals or persons that brush against the vegetation. Lyme disease is not transmitted from person to person and there is no evidence that it can be transmitted directly from wild or domestic animals. Campers, hikers, outdoor workers and others who frequent wooded, brushy, or grassy places are commonly exposed to ticks. If untreated, weeks to months later, some patients may develop arthritis, including intermittent episodes of swelling and pain in the large joints; neurologic abnormalities, and rarely, cardiac problems. Treatment and Prevention Early stage Lyme disease is treated with oral antibiotics. When outdoors, frequently check your clothing and skin to detect ticks before they become attached. Tick populations may be effectively controlled with application of pesticides to vegetation along trails. Mowing grass frequently in yards and outside fences also helps to reduce tick populations. Tick Removal Guidelines Grasp the tick with tweezers or forceps as close as possible to the attachment (skin) site, pull upward, and out with firm and steady pressure. If tweezers are not available, use fingers shielded with tissue paper or rubber gloves. Be careful not to squeeze, crush, or puncture the body of the tick, which may contain infectious fluids. Symptoms include a fever, runny nose, cough, and sore and reddened eyes followed by a red-brown blotchy rash. The rash usually starts on the face and spreads down the body, and lasts three or more days. Most children with measles become quite ill and occasionally measles can lead to pneumonia or inflammation of the brain, blindness, permanent disability or death. Measles is highly contagious and is spread easily from person to person through the air when an infected person coughs or sneezes and a susceptible person inhales the organism. These particles may remain suspended in the air and persons have become infected simply by being in a room after an infected person has left. Thus, all children and any adult who did not have the disease as a child should be vaccinated. If a case of measles occurs in your facility: Exclude the infected person from the facility until 5 days after the rash appears or as directed by the Division of Public Health. Any unimmunized children and adults should be immunized or excluded from the center until two weeks after the rash appears in the last case of measles in the facility. Note: Notify the Division of Public Health, Office of Infectious Disease Epidemiology at 1-888-295 5156 if you become aware that a child or adult in your facility has developed Measles. Although mumps does not usually cause serious long-term problems, the acute symptoms, such as severe swelling of the salivary glands can be very uncomfortable. Childcare providers should be aware that exposure to the virus in the first trimester of pregnancy may increase the rate of miscarriages. Mumps is spread from person to person through direct contact with saliva, secretions from the respiratory tract and urine of an infected person. If a case of mumps occurs in your facility: Exclude the infected child from the facility until nine days after the swelling begins, or until the swelling subsides or as directed by the Division of Public Health. Note: Notify the Division of Public Health, Office of Infectious Disease Epidemiology at 1-888-295 5156 if you become aware that a child or adult in your facility has developed Mumps. Whooping cough gets its name from the whooping sound the child makes when trying to draw a breath after a coughing spell. Symptoms generally include those of a cold, such as runny nose and a cough that gradually worsens. A person who is not immune to pertussis becomes infected by inhaling air that has been contaminated with the respiratory secretions of an infected person who has coughed. Children in the United States are immunized with the pertussis vaccine beginning at 2 months of age and again at 4 months, 6 months, 15 months, and 4 to 6 years. All childcare providers should receive a one-time dose of Tdap vaccine to protect themselves and the children in their care from pertussis. If a child or adult in your facility is diagnosed with pertussis: Exclude the infected person from the facility until that person has been on antibiotics for at least 5 days and as directed by the Division of Public Health. Anyone developing a persistent cough should be referred to his or her healthcare provider. Note: Notify the Division of Public Health, Office of Infectious Disease Epidemiology at 1-888-295 5156 if you become aware that a child or adult in your facility has developed Pertussis. Bacterial and viral infections usually produce white or yellowish drainage that may cause the eyelids to stick shut in the morning. The germs that cause conjunctivitis may be present in nasal secretions, as well as in the discharge from the eyes. Persons can become infected when their hands become contaminated with these materials and they rub their eyes. Eyes can also become infected when a person uses contaminated towels or eye makeup. Children with a watery discharge generally do not need to be excluded unless there have been other children in the group with similar symptoms, but should be monitored for signs of more serious illness, such as fever or rash. Symptoms include anal itching, sleeplessness, irritability, and anal irritation due to scratching. Pinworms are spread when an uninfected person touches the anal area of an infected person. An infected person can spread pinworms by scratching the anal area, then contaminating food or other objects, which are then eaten or touched by uninfected persons. Infection of the lungs often is secondary to an infection that starts in the nose and throat area and then spreads to the lungs. The infection can start in the lungs from an infection brought there by the blood. Signs and symptoms of pneumonia are coughing, rapid, difficult breathing, fever, muscle aches, loss of appetite and lethargy. The germ that causes the pneumonia can spread if the person is still infectious at the time the pneumonia develops. Most of the germs that cause pneumonia spread by direct or close contact with mouth and nose secretions and touching contaminated objects. Additional pneumonia vaccine may be needed for those at high risk for complications. Influenza vaccine may prevent pneumonia that sometimes occurs as a complication of influenza infection. It is the most frequent cause of lower respiratory infections, including pneumonia, in infants and children under two years of age. About half of the infections result in lower respiratory tract infections and otitis media. Children with heart or lung disease and weak immune systems are at increased risk of developing severe infection and complications. Do not exclude ill children unless they are unable to participate comfortably in activities or require a level of care that would jeopardize the health and safety of the other children in your care. On other areas of the skin ringworm causes a reddish, ring-like rash that may itch or burn. The same fungi that infect humans can also infect animals such as dogs and cats, and infections may be acquired from pets as well as from infected children. Ringworm is spread by direct contact with a person or animal infected with the fungus. A child with ringworm is infectious as long as the fungus remains present in the skin lesion. Symptoms include a high fever that lasts for 3 to 5 days, runny nose, irritability, eyelid swelling, and tiredness. The high fever often ends abruptly and at about the same time a pinkish red rash appears on the trunk and spreads over the body. The rash blanches (turn white) when you touch it and individual spots may have a lighter "halo" around them. In approximately 10% to 15% of young children, the fast-rising fever that comes with roseola can trigger febrile seizures (convulsions caused by high fevers. A child with fever and rash should be excluded from childcare until seen by a healthcare provider and fever and rash have resolved. Some children have no symptoms of rotavirus infection while others may have severe vomiting, watery diarrhea, and fever. Rotavirus diarrhea usually lasts from four to six days, but may last longer and cause intermittent diarrhea in children who have compromised immune systems. Children and adults can become infected by coming in direct contact with the viruses that are in the feces of an infected child and then passing those viruses to the mouth (fecal-oral transmission). Often, another child or adult touches a surface that has been contaminated and then touches their own mouth. A child with rotavirus infection may be contagious before the onset of diarrhea and for a few days after the diarrhea has ended. Although there is no specific therapy for rotavirus diarrhea, the most effective therapy is to encourage ill children to drink plenty of fluids to avoid dehydration. The virus causes fever, swollen lymph nodes behind the ears, and a rash that starts on the face, spreads to the torso and then to the arms and legs. Rubella is no longer very common because most children are immunized beginning at 12 months of age. Rubella is not usually a serious disease in children, but can be very serious if a pregnant woman becomes infected. Infection with rubella in the first three months of pregnancy can cause serious injury to the fetus, resulting in heart damage, blindness, deafness, mental retardation, miscarriage, or stillbirth.

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Pure biodiesel contains no petroleum anti viral enzyme order 250 mg famvir overnight delivery, but it can be blended at any level with petroleum diesel to create a biodiesel blend hiv infection personal stories buy famvir 250 mg with visa. Renewable diesel (co-processed diesel) is another alternative fuel that has potential in California antiviral ointment buy famvir from india. Renewable diesel is comparable to biodiesel in that similar feedstocks are used in a traditional fractional distillation method that creates a chemically different product antiviral x anticoncepcional discount famvir 250mg with mastercard. Thermally depolymerized diesel is non petroleum feedstock-based diesel that is produced through a hydrous pyrolysis process that mimics the geological heat and pressures that naturally produces crude petroleum oil side effects of antiviral medication order famvir with american express. This Tier I report is the first step in a three tier process evaluating the cumulative health and ecological impacts from releases to air antiviral in a sentence famvir 250 mg with amex, surface water, groundwater and soil at all stages of the biodiesel life cycle: production, storage and distribution, and use. The risk posed by biodiesel is assessed as a relative risk compared to ultra low sulfur diesel currently in use. This report excludes the direct and indirect environmental, ecological, and health impacts associated with biomass production such as changes in land use and the possible net gain in carbon emissions due to feedstock cultivation. There is a scientific debate concerning the sustainability of wide scale energy conversion from fossil fuels to biofuels (Wang & Haq, 2008). Such issues have lead the European Union to propose a ban on certain biofuel sources such as palm oil from Southeast Asia due to associated deforestation and habitat loss, and due to non sustainability of palm tree monoculture (Kantor, 2008; Rosenthal, 2007). It is clear that the issue of sustainability and complete life cycle costs of biofuels are important aspects of the impacts biofuels will have. However, such evaluation is beyond the current scope that includes the risks associated with the production, transportation, storage, and use of biofuels and not the broader impacts of increased/decreased use of various raw feedstocks. History the first appearance and demonstration of an oil based diesel fuel was at the Paris Exhibition in 1900. The French Government requested the Otto Company to use Arachide (earth-nut or peanut) oil as a fuel in one of their small diesel engine cars. The demonstration went so well that few spectators were aware that the car was running on vegetable oil. It was thought that if Arachide could be used as a fuel, it would not only be economically feasible, but also result in a sustainable fuel source. The use of crude vegetable oil as a fuel was explored until 1937 when Walton discovered that the viscosity of vegetable oil was too high for use in a combustion engine and that vegetable oil required a refining process to reduce its viscosity. In this process, oil was reacted with an alcohol to transform the triglycerides to esters with glycerin as a by product. With limited oil supplies, many nations resorted to vegetable oil based fuels and used oil from locally grown plants to fuel large tankers and other war machinery (Knothe et al. Another wartime benefit of biodiesel was its byproduct, glycerin, used as a main ingredient for explosives. However, following the war, a steady supply of cheaper diesel became available again and the production of biodiesel was essentially curtailed. Early experiments on the production and use of biodiesel were conducted at the University of Idaho, University of Missouri, the National Renewable Energy Laboratory, and a handful of other institutions. In 1991, the first small-batch-process pilot plant was set up in Kansas City, Missouri to supply limited quantities of biodiesel. Today biodiesel continues to attract attention with the expectation that this renewable resource will provide environmental benefits with lower emissions (Kemp, 2006). This Act required 75% of new vehicle purchases made by federal and state governments, and alternative fuel providers to be alternative fuel vehicles. Compliance was mandatory for these agencies that operated, leased, or controlled 50 or more light-weight vehicles. This amendment significantly increased the use of B20 by government and alternative fuel provider fleets. Consumer and business federal tax credits for biodiesel were extended to 2008 and the credits were provided to small agri-biodiesel producers. In 2007, California Senator Christine Kehoe introduced Senate Bill 140 which, if passed will require all diesel sold in California to contain two percent renewable fuel. Two years after implementing this requirement, all diesel fuels will be required to contain at least five percent renewable fuels (California Senate Bill 140, 2007). Biodiesel Production Chemistry To make biodiesel, a vegetable oil or animal fat is subjected to a chemical reaction known as transesterification. In this reaction, a feedstock (either oil or fat) is reacted with alcohol in the presence of a catalyst to produce glycerin and methyl esters (known as biodiesel). Biodiesel Transesterification Reactants There are a variety of alternative reactants available for producing biodiesel. Reactants are selected based on economic considerations and on the chemical and physical properties of the feedstock. Alcohol Either methanol or ethanol can be used as a reactant alcohol in the transesterification process. Economic considerations generally dictate which one is selected because the chemical characteristics of biodiesels do not depend greatly on the particular alcohol used in this process (Van Gerpen et al. Compared with methanol, ethanol is currently more expensive and about 44% more ethanol is required for the transesterification reaction (Van Gerpen et al. But the alcohol recovery process is also an important factor in selecting between ethanol and methanol. Excess alcohol must be recovered to minimize operation costs and environmental I-12 Biodiesel Multimedia Evaluation Final Tier I Report impacts. Although the stoichiometric molar ratio for alcohol to triglycerides is 3:1, a 6:1 molar ratio is typically used to ensure a total conversion of the fat or oil to its esters, leaving residual (unreacted) alcohol. Since methanol has a low boiling point, the unreacted alcohol can be removed fairly easily through distillation. Ethanol is more difficult to recover and return to the process because ethanol in water forms an azeotrope, i. The properties of the final biodiesel product can vary greatly based on the composition of the unit. Feedstock extraction Primary biodiesel feedstocks expected to be used in California include: soybean oil, palm oil, yellow grease, animal tallow, trap (brown) grease, canola oil, safflower oil, and (perhaps in the future) algae. Once a feedstock is harvested, the oil-bearing component (such as seeds) must be crushed to extract the oil (which is then transesterified). Since the resulting product still contains between 14 and 20% oil, a second step is required. The product is sprayed with a solvent (typically hexane) and the oil, which is soluble in the solvent, is removed. While this oil extraction process is relatively simple, in California there are some additional challenges. To support large-scale biodiesel production in California, additional facilities must be built. The biggest challenge for increasing the number of oil extraction facilities in the state is obtaining the environmental permits for building them. Solvent losses to the atmosphere during several points in the production process range from 0. For example, hexane is classified under the Clean Air Act as a Hazardous air pollutant and emissions are highly restricted. It is critical to use the appropriate catalyst as it can dictate the type of reaction that occurs. I-13 Biodiesel Multimedia Evaluation Final Tier I Report Base catalysts are most commonly used to produce biodiesel. Base catalysts are typically sodium hydroxide, potassium hydroxide or other similar alkoxides with concentrations ranging from 0. When an acid catalyst is used, a byproduct of the esterification reaction is water. Biodiesel producers must take precautions that the water from the acid catalyst is removed prior to the addition of a base catalyst. Managing the Transesterification Process There are many steps involved in the production of biodiesel. For a more complete reaction with a lower alcohol requirement, the reactor step (where the reactants first enter the biodiesel production) can be divided into two steps. Both products use a substantial amount of excess methanol; the methanol is not removed in this separation process because there is concern that the transesterification process may reverse without it. The methyl esters are then neutralized with acid to remove any residual catalyst and split any soap that may have formed during the reaction. The biodiesel is then dried in a vacuum flash process; this leaves a clear amber-yellow liquid with a viscosity similar to petroleum diesel. The amount of glycerin actually leaving the separator is ~50% of the remaining product which also contains methanol, catalyst and soap. At this stage, the methanol content is so high that glycerin must be treated as a hazardous waste. The last step is to remove methanol by using a vacuum flash process (or another type of evaporator). The resulting glycerin is about 85% pure and can be sold to glycerin refiners who can increase the purity, often as high as 99. Overview of Biodiesel Feedstocks Biodiesel is produced from a variety of feedstocks including: common vegetable oils (soybean, palm, rapeseed/canola, sunflower, safflower, algae, cottonseed, peanut), animal fats (usually tallow), and waste oils (used frying oils, trap grease). The greatest difference among feedstocks is the amount of free fatty acids that are associated with triglycerides. This minimal production is due to the lack of feedstock available within the state. As of 2006, no California farmers were known to be growing feedstock for biodiesel production (Krauter, 2006). Instead, feedstock has to be transported from outside sources to California, increasing the overall costs of the fuel. The future of wide-scale biodiesel production in California may be dependent on the capacity for local feedstock production. Feedstocks such as canola, sunflower, safflower, cotton, and Chinese tallow tree show potential. However, canola and rapeseed seem to show the greatest promise for wide-scale biodiesel production, as discussed below. The four primary feedstocks-soybean, palm, yellow grease, and animal tallow-and the two alternatives (algae and trap grease) for multimedia review are described below. Additional crops that grow (or have potential to grow) in California and show promise as feedstocks with wide scale biodiesel production, are also discussed. Primary Feedstocks for Multimedia Review Soybean Oil Soybean oil is the most popular biodiesel feedstock in the United States. Approximately 75% of the virgin plant-based feedstock used in biodiesel production is soy oil (Van Gerpen, 2004). This is largely because soybeans are a major domestic crop with massive production and infrastructure and tend to be the least expensive vegetable oil available in the U. The composition of soy oil is relatively constant with few contaminants (including water) affecting biodiesel production. Since soybean oil is composed primarily of unsaturated fatty acids, it has beneficial cold flow properties. Currently, the primary challenge for the use of soy oil as a biodiesel feedstock is agricultural competition. Palm Oil Palm oil is grown primarily in tropical or subtropical areas such as Malaysia and Indonesia.

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Syndromes

Local numbness
Adolescents ages 11 - 12 and adolescents entering high school (about age 15) who have not already received the vaccination. A booster shot is given between age 16-18.
Skin irritation
Haemophilus influenza, invasive disease
Weight loss or gain without trying
Viral infections
How would you describe your breathing?
You have questions or concerns about the vaccine
Part of plant swallowed

References

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