Tuberculosis

Definition
Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the
body but is mainly an infection of the lungs. It is caused by a bacterial microorganism, the
tubercle bacillus or Mycobacterium tuberculosis. Although TB can be treated, cured, and can be
prevented if persons at risk take certain drugs, scientists have never come close to wiping it out.
Few diseases have caused so much distressing illness for centuries and claimed so many lives.
Diagnosis
TB is diagnosed through laboratory test results. The standard test for tuberculosis infection, the
tuberculin skin test, detects the presence of infection, not of active TB. Skin testing has been
done for more than 100 years. In this process, tuberculin is an extract prepared from cultures of
M. tuberculosis. It contains substances belonging to the bacillus (antigens) to which an infected
person has been sensitized. When tuberculin is injected into the skin of an infected person, the
area around the injection becomes hard, swollen, and red within one to three days.
Today skin tests utilize a substance called purified protein derivative (PPD) that has a standard
chemical composition and is therefore a good measure of the presence of tubercular infection.
The PPD test, also called the Mantoux test, is not always 100% accurate; it can produce false
positive as well as false negative results. The test may indicate that some people who have a skin
reaction are not infected (false positive) and that some who do not react are in fact infected (false
negative). The PPD test is, however, useful as a screener and can be used on people who have
had a suspicious chest x ray, on those who have had close contact with a TB patient, and persons
who come from a country where TB is common.
Because of the multiple and varied symptoms of TB, diagnosis on the basis of external
symptoms is not always possible. TB is often discovered by an abnormal chest x ray or other test
result rather than by a claim of physical discomfort by the patient. After an irregular x ray, a PPD
test is always done to show whether the patient has been infected. To verify the test results, the
physician obtains a sample of sputum or a tissue sample (biopsy) for culture. In cases where
other areas of the body might be infected, such as the kidney or the brain, body fluids other than
sputum (urine or spinal fluid, for example) can be used for culture.
One important new advance in the diagnosis of TB is the use of molecular techniques to speed
the diagnostic process as well as improve its accuracy. As of late 2002, four molecular
techniques are increasingly used in laboratories around the world. They include polymerase
chain reaction to detect mycobacterial DNA in patient specimens; nucleic acid probes to identify
mycobacteria in culture; restriction fragment length polymorphism analysis to compare different
strains of TB for epidemiological studies; and genetic-based susceptibility testing to identify
drug-resistant strains of mycobacteria.
Treatment
Because of the nature of tuberculosis, the disease should never be treated by alternative methods
alone. Alternative treatments can help support healing, but treatment of TB must include drugs
and will require the care of a physician. Any alternative treatments should be discussed with a
medical practitioner before they are applied.
Supportive treatments include:
 • Diet. Nutritionists recommend a whole food diet including raw foods, fluids, and
particularly pears and pear products (pear juice, pear sauce), since pears may help heal
the lungs. Other helpful foods include fenugreek, alfalfa sprouts, garlic, pomegranate, and
yogurt or kefir. Four tablespoons of pureed steamed asparagus at breakfast and dinner
taken for a few months may also be helpful.
• Nutritional therapy. Nutritionists may recommend one or many of the following vitamins
and minerals: vitamin A at 300,000 IU for the first three days, 200,000 IU for the next
two days, then 50,000 IU for several weeks; beta-carotene at 25,000-50,000 IU; vitamin
E at up to 1,000 IU daily unless the patient is a premenopausal woman with premenstrual
symptoms; lipotrophic formula (one daily); deglycerolized licorice; citrus seed extract;
vitamin C; lung glandular; essential fatty acids; vitamin B complex; multiminerals; and
zinc.
• Herb therapy may use the tinctures of echinacea, elecampane, and mullein taken three
times per day, along with three garlic capsules three times per day.
• Hydrotherapy may be used up to five times weekly. Dr. Benedict Lust, the founder of
naturopathy, supposedly cured himself of tuberculosis by using hydrotherapy.
• Juice therapy. Raw potato juice, may be taken three times daily with equal parts of carrot
juice plus one teaspoon of olive or almond oil, one teaspoon of honey, beaten until it
foams. Before using the potato juice, starch should be allowed to settle from the juice.
• Topical treatment may use eucalyptus oil packs, grape packs or grain alcohol packs.

Ectopic Pregnancy

Definition
In an ectopic pregnancy, the fertilized egg implants in a location outside the uterus and tries to
develop there. The word ectopic means "in an abnormal place or position." The most common
site is the fallopian tube, the tube that normally carries eggs from the ovary to the uterus.
However, ectopic pregnancy can also occur in the ovary, the abdomen, and the cervical canal
(the opening from the uterus to the vaginal canal). The phrases tubal pregnancy, ovarian
pregnancy, cervical pregnancy, and abdominal pregnancy refer to the specific area of an ectopic
pregnancy.
Classification
Tubal pregnancy
The vast majority of ectopic pregnancies implant in the Fallopian tube. Pregnancies can grow in
the fimbrial end (5 % of all ectopics), the ampullary section (80%), the isthmus (12 %), and the
cornual and interstitial part of the tube (2%). Mortality of a tubal pregnancy at the isthmus or
within the uterus (interstitial pregnancy) is higher as there is increased vascularity that may result
more likely in sudden major internal hemorrhage.
Nontubal ectopic pregnancy
Two percent of ectopic pregnancies occur in the ovary, cervix, or are intraabdominal.
Transvaginal ultrasound examination is usually able to detect a cervical pregnancy. An ovarian
pregnancy is differentiated from a tubal pregnancy by the Spiegelberg criteria.While a fetus of
ectopic pregnancy is typically not viable, very rarely, a live baby has been delivered from an
abdominal pregnancy. In such a situation the placenta sits on the intraabdominal organs or the
peritoneum and has found sufficient blood supply. This is generally bowel or mesentery, but
other sites, such as the renal (kidney), liver or hepatic (liver) artery or even aorta have been
described. Support to near viability has occasionally been described, but even in third world
countries, the diagnosis is most commonly made at 16 to 20 weeks gestation. Such a fetus would
have to be delivered by laparotomy. Maternal morbidity and mortality from extrauterine
pregnancy is high as attempts to remove the placenta from the organs to which it is attached
usually lead to uncontrollable bleeding from the attachment site. If the organ to which the
placenta is attached is removable, such as a section of bowel, then the placenta should be
removed together with that organ. This is such a rare occurrence that true data are unavailable
and reliance must be made on anecdotal reports.However, the vast majority of abdominal
pregnancies require intervention well before fetal viability because of the risk of hemorrhage.
Heterotopic pregnancy
In rare cases of ectopic pregnancy, there may be two fertilized eggs, one outside the uterus and
the other inside. This is called a heterotopic pregnancy. Often the intrauterine pregnancy is
discovered later than the ectopic, mainly because of the painful emergency nature of ectopic
pregnancies. Since ectopic pregnancies are normally discovered and removed very early in the
pregnancy, an ultrasound may not find the additional pregnancy inside the uterus. When hCG
levels continue to rise after the removal of the ectopic pregnancy, there is the chance that a
pregnancy inside the uterus is still viable. This is normally discovered through an ultrasound.
Although rare, heterotopic pregnancies are becoming more common. The survival rate of the
uterine fetus of an ectopic pregnancy is around 70%
Successful pregnancies have been reported from ruptured tubal pregnancy continuing by the
placenta implanting on abdominal organs or on the outside of the uterus.
Persistent ectopic pregnancy
A persistent ectopic pregnancy refers to the continuation of trophoplastic growth after a surgigal
intervention to remove an ectopic pregnancy. After a conservative procedure that attempts to
preserve the affected fallopian tube such as a salpingotomy, in about 15-20 % the major portion
of the ectopic may have been removed, but some trophoblastic tissue perhaps deeply embedded
has escaped removal and continues to growth, generating a new rise in hCG levels. After weeks
this may lead to new clinical symptoms including bleeding. For this reason hCG levels may have
to be monitored after removal of an ectopic to assure their decline, also methotrexate can be
given at the time of surgery prophyllactically.
Causes
There are a number of risk factors for ectopic pregnancies. However, in as many as one third to
one half of ectopic pregnancies, no risk factors can be identified. Risk factors include: pelvic
inflammatory disease, infertility, use of an intrauterine device (IUD), those who have been
exposed to DES, tubal surgery, smoking, previous ectopic pregnancy, and tubal ligation
Treatment
Medical
Early treatment of an ectopic pregnancy with methotrexate is a viable alternative to surgical
treatment since at least 1993. If administered early in the pregnancy, methotrexate can disrupt the
growth of the developing embryo causing the cessation of pregnancy.
Surgical
If hemorrhage has already occurred, surgical intervention may be necessary. However, whether
to pursue surgical intervention is an often difficult decision in a stable patient with minimal
evidence of blood clot on ultrasound.
Surgeons use laparoscopy or laparotomy to gain access to the pelvis and can either incise the
affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube
with the pregnancy (salpingectomy). The first successful surgery for an ectopic pregnancy was
performed by Robert Lawson Tait in 1883.
Complications
The most common complication is rupture with internal bleeding that leads to shock. Death from
rupture is rare in women who have access to modern medical facilities. Infertility occurs in 10 -
15% of women who have had an ectopic pregnancy.
Learning Derives
From what I have learned in our community exposure are helping to treat some problems
that Barangay Armenia on some of its people some of theme are those who have schizophrenia,
Tuberculosis, teenage pregnancy and those who have Hazard problems just like our patient we
help. On our community exposure our group have learned to have a unity in order to finish our
requirement and that’s one of biggest achievement that we have manage not just me but all of the
members, to communicate and be part of group 29 was one of our goal. We also learned to be
part of the community people in barangay Armenia in order to fully understand and have our
intervention more accurate in helping the barangay.