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Part 3: Preservation by Controlling of Water herbalstarcandlescom purchase hoodia 400 mg with mastercard, Structure herbs for weight loss order hoodia with a mastercard, and Atmosphere details preservation methods based on physical nature herbs used for anxiety hoodia 400 mg generic, including modified-atmosphere packaging; glass transition and state diagram; membrane technology; stickiness and caking; drying herbs pregnancy buy hoodia pills in toronto, including osmotic dehydration; water activity; sur face treatment and edible coating; encapsulation and controlled release. Part 4: Preservation Using Heat and Energy describes preservation methods based on thermal and other forms of energy, including pasteurization, canning and sterilization, cooking and frying, freezing, freezing?melting (or freeze concentration), microwave, ultrasound, ohmic heating, light, irradiation, pulsed electric field, magnetic field, and high pressure. In addition, chapters on hurdle technology (or combined methods) that uses a combination of preservation techniques are also included. Part 5: Enhancing Food Preservation by Indirect Approach presents the approaches that indirectly help food preservation by improving quality and safety. This second edition will be an invaluable resource for practicing and research food technologists, engi neers, and scientists, and a valuable text for upper-level undergraduate and graduate students in food, agriculture/biological science, and engineering. Writing a book is an endless process, so the editor would appreciate receiving new information and comments to assist in future compilations. I am confident that this edition will prove to be interesting, informative, and enlightening to readers. Mohammad Shafiur Rahman Acknowledgments I would like to thank Almighty Allah for giving me life and the opportunity to gain knowledge to write this book. I wish to express my sincere gratitude to the Sultan Qaboos University for giving me the opportunity and facilities to initiate such an exciting project, and supporting me toward my research and other intellectual activities. I sincerely acknowledge the sacrifices made by my parents, Asadullah Mondal and Saleha Khatun, during my early education. Appreciation is due to all my teachers, especially Professors Nooruddin Ahmed, Iqbal Mahmud, Khaliqur Rahman, Jasim Zaman, Ken Buckle, Drs. Habibur Rahman, for their encouragement and help in all aspects of pursuing higher education and research. Hamed Al-Oufi, Malik Mohammed Al-Wardy, and Salem Ali Al-Jabri for their support toward my teach ing, research, and extension activities at the Sultan Qaboos University. Nejib Guizani, Shyam Sablani, Bhesh Bhandari, and Mushtaque Ahmed, and my other research team members, especially Mohd Hamad Al-Ruzeiki, Rashid Hamed Al-Belushi, Mohd Khalfan Al-Khusaibi, Nasser Abdullah Al-Habsi, Insaaf Mohd Al-Marhubi, and Intisar Mohd Al-Zakwani. I am grateful to my wife, Sabina Akhter (Shilpi), for her patience and support during this work, and to my little daugh ter, Rubaba Rahman (Deya), and son, Salman Rahman (Radhin), for allowing me to work at home and for sharing their computer. He has authored or coauthored over 200 technical articles, including 70 refereed journal papers, 68 conference papers, 25 book chapters, 33 reports, 8 popular articles, and 3 books. Rahman initi ated the publication of the International Journal of Food Properties (Marcel Dekker, Inc. Rahman has served as a member in the Food Engineering Series Editorial Board of Aspen Publishers, Maryland (1999?2003). In 2003 he was invited to serve as a member of the Food Engineering Series Board, Kluwer Academic/Plenum Publishers, New York. He was also invited to serve as a section editor for the Sultan Qaboos University Journal of Agricultural Sciences (1999). Al-Jufaili Department of Marine Science and Fisheries, Sultan Qaboos University, Muscat, Sultanate of Oman Elizabeth A. Baldwin Citrus and Subtropical Products Laboratory, Agricultural Research Service, U. Driscoll Food Science and Technology Program, School of Chemical Sciences and Engineering, the University of New South Wales, Sydney, Australia T. Gorris European Chair in Food Safety Microbiology, Food Microbiology Laboratory, Wageningen University, the Netherlands Nejib Guizani Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Isam T. Kadim Department of Animal and Veterinary Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Gerard La Rooy Round Earth Business Process Improvement, Havelock North, New Zealand Theodore P. Mahapatra Agricultural Research Station, Fort Valley State University, Fort Valley, Georgia Osman Mahgoub Department of Animal and Veterinary Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Vijay Kumar Mishra Institute of Sustainability and Innovations and School of Molecular Sciences, Victoria University, Melbourne, Victoria, Australia Ann Mothershaw Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Sultanate of Oman Linus U. Opara Agricultural Engineering and Postharvest Technology Program, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Enrique Palou Chemical and Food Engineering Department, Universidad de las Americas-Puebla, Sta. Pegg Department of Food Science and Technology, the University of Georgia, Athens, Georgia Herman W. Peppelenbos Agrotechnology and Food Sciences Group, Wageningen University and Research, the Netherlands Anne Perera Fresh Direct Ltd. Perera Department of Chemistry, the University of Auckland, Auckland, New Zealand Jan Pokorny Department of Food Chemistry and Analysis, Faculty of Food and Biochemical Technology, Prague Institute of Chemical Technology, Prague, Czech Republic Mohammad Shafiur Rahman Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Hosahalli S. Ramaswamy Department of Food Science, McGill University, Ste Anne de Bellevue, Quebec, Canada M. Ramesh Department of Food Engineering, Central Food Technological Research Institute, Mysore, India Shyam S. Sablani Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman Fereidoon Shahidi Department of Biochemistry, Memorial University of Newfoundland, St. Swanson Food and Nutrition Department, Washington State University, Pullman, Washington P. Torley School of Land and Food Sciences, the University of Queensland, St Lucia, Queensland, Australia Humberto Vega-Mercado Washington State University, Pullman, Washington Jorge F. This chapter provides an overview of food preservation methods with emphasis on inactivation, inhibition, and methods of avoiding recontamination. The final section is a discussion of the factors that need to be considered to satisfy present and future demands of the consumers and law-enforcing authorities. In most countries, innovation, sustainability, and safety have become the main foci of modern indus try and economy. The United Nations World Commission on Environment and Development defined sustainable development as meeting the needs of the present generation without compromising the abil ity of future generations to meet their own needs. Food safety is now the first priority of the food production and preservation industry, incorporating innovation and sustainability. The industry can compromise with some quantities such as color to some extent, but not with safety. A number of new preservation techniques are being developed to satisfy current demands of economic preservation and consumer satisfaction in nutritional and sensory aspects, convenience, safety, absence of chemical preservatives, price, and environmental safety. Understanding the effects of each preserva tion method on food has therefore become critical in all aspects. This chapter provides overviews of the new technology, identifying the changing demands of food quality, convenience, and safety. Foods are materials, raw, processed, or formulated, that are consumed orally by humans or animals for growth, health, satisfaction, pleasure, and satisfying social needs. Generally, there is no limitation on the amount of food that may be consumed (as there is for a drug in the form of dosage) [10]. Chemically, foods are mainly composed of water, lipids, fat, and carbohydrate with small proportions of minerals and organic compounds. Minerals include salts and organic substances include vita mins, emulsifiers, acids, antioxidants, pigments, polyphenols, and flavor-producing compounds [19]. The different classes of foods are perishable, nonperishable, harvested, fresh, minimally processed, preserved, manufactured, formulated, primary, secondary derivatives, synthetic, functional, and medical foods [21]. The preservation method is mainly based on the types of food that need to be prepared or formulated. It lies at the heart of food science and technology, and it is the main purpose of food processing. First, it is important to identify the properties or characteristics that need to be pre served. This can be desirable or undesirable depending on the desired quality of the dried product, for example, crust formation is desirable for long bowl life in the case of breakfast cereal ingredients, and quick rehydration is necessary. In another instance, the consumer expects apple juice to be clear whereas orange juice could be cloudy. The main reasons for food preservation are to overcome inappropriate planning in agriculture, produce value-added products, and provide vari ation in diet [20]. Inadequate management or improper planning in agricultural production can be overcome by avoiding inappropri ate areas, times, and amounts of raw food materials as well as by increasing storage life using simple methods of preservation. Value-added food products can give better-quality foods in terms of improved nutritional, functional, convenience, and sensory properties. Consumer demand for healthier and more convenient foods also affects the way food is preserved. Variation in the diet is important, particularly in underdeveloped countries to reduce reliance on a specific type of grain. The group for whom the products are preserved After storage of a preserved food for a certain period, one or more of its quality attributes may reach an undesirable state. In general, it is defined as the degree Food Preservation: Overview 5 of fitness for use or the condition indicated by the satisfaction level of consumers. When food has dete riorated to such an extent that it is considered unsuitable for consumption, it is said to have reached the end of its shelf life.

Total blood and pathological changes described below and illustrated in cholesterol levels are also elevated in obesity worldwide herbals buy hoodia 400mg with mastercard. As a result of atherosclerosis and increased adipose stores in the subcutaneous tissues herbals discount hoodia american express, hypertension herbs montauk buy hoodia 400mg lowest price, there is increased risk of myocardial infarction skeletal muscles herbals remedies order genuine hoodia on line, internal organs such as the kidneys, and stroke in obese individuals. Many obese individuals exhibit hyper this is characterised by hypersomnolence, both at night and glycaemia or frank diabetes despite hyperinsulinaemia. This during day in obese individuals along with carbon dioxide is due to a state of insulin-resistance consequent to tissue retention, hypoxia, polycythaemia and eventually right-sided insensitivity. The term pickwickian 245 syndrome was first used by Sir William Osler for the sleep apnoea syndrome). These individuals are more prone to develop degenerative joint disease due to wear and tear following trauma to joints as a result of large body weight. Diet rich in fats, particularly derived from animal fats and meats, is associated with higher incidence of cancers of colon, breast, endometrium and prostate. Its causes may be the following: i) deliberate fasting?religious or political; ii) famine conditions in a country or community; or iii) secondary undernutrition such as due to chronic wasting Figure 9. After about one week of starvation, protein A starved individual has lax, dry skin, wasted muscles breakdown is decreased while triglycerides of adipose tissue and atrophy of internal organs. The following metabolic changes by most organs including brain in place of glucose. Starvation take place in starvation: can then continue till all the body fat stores are exhausted 1. This results in of primary dietary deficiency or conditioned deficiency may release of glycogen stores of the liver to maintain normal cause loss of body mass and adipose tissue, resulting in blood glucose level. Protein stores and the triglycerides of adipose socioeconomic factors limiting the quantity and quality of tissue have enough energy for about 3 months in an dietary intake, particularly prevalent in the developing individual. Proteins breakdown to release amino acids which countries of Africa, Asia and South America. The impact of are used as fuel for hepatic gluconeogenesis so as to maintain deficiency is marked in infants and children. Feature Kwashiorkor Marasmus Definition Protein deficiency with sufficient calorie intake Starvation in infants with overall lack of calories Clinical features Occurs in children between 6 months and 3 years Common in infants under 1 year of age (Fig. Marasmus is starvation in infants occurring due to overall nutrients are common due to generalised malnutrition of lack of calories. In the developed countries, individual vitamin the salient features of the two conditions are contrasted deficiencies are noted more often, particularly in children, in Table 9. However, it must be remembered that mixed adolescent, pregnant and lactating women, and in some due forms of kwashiorkor-marasmus syndrome may also occur. General secondary causes of conditioned nutritional deficiencies listed already above. Chronic alcoholism is a within the body and are essential for maintenance of normal common denominator in many of vitamin deficiencies. Thus, these substances must be other noteworthy features about vitamins are as under: provided in the human diet. While both vitamin deficiency and excess may occur from or animal origin so that they normally enter the body as another disease, the states of excess and deficiency constituents of ingested plant food or animal food. Vitamins are conven rod cells, and iodopsins sensitive in bright light and formed tionally divided into 2 groups: fat-soluble and water-soluble. Maintenance of structure and function of specialised epithe presence of bile salts and intact pancreatic function. Retinol plays an important role in the synthesis of deficiencies occur more readily due to conditioning factors glycoproteins of the cell membrane of specialised epithelium (secondary deficiency). Beside the deficiency syndromes of such as mucus-secreting columnar epithelium in glands and these vitamins, a state of hypervitaminosis due to excess of mucosal surfaces, respiratory epithelium and urothelium. Water-soluble vitamins are more readily absor skin diseases, premalignant conditions and certain cancers. Being water soluble, ciency of vitamin A is common in countries of South-East these vitamins are more easily lost due to cooking or Asia, Africa, Central and South America whereas mal processing of food. Night blindness is usually the first sign of vitamin A It is available in diet in 2 forms: deficiency. As a result of replacement metaplasia of mucus-secreting cells by squamous cells, there is dry and As preformed retinol, the dietary sources of which are scaly scleral conjunctiva (xerophthalmia). The lacrimal duct animal-derived foods such as yolk of eggs, butter, whole also shows hyperkeratosis. The skin develops papular lesions Retinol is stored in the liver cells and released for trans giving toad-like appearance (xeroderma). This is due to port to peripheral tissues after binding to retinol-binding follicular hyperkeratosis and keratin plugging in the protein found in blood. This invol i) Squamous metaplasia of respiratory epithelium of bronchus ves formation of 2 pigments by oxidation of retinol: rhodopsin, and trachea may predispose to respiratory infections. Very large doses of vitamin A can produce toxic manifestations in children as well as in adults. The clinical manifestations of chronic the liver and kidney for being functionally active (Fig. The main physiologic functions of the most active the effects of toxicity usually disappear on stopping metabolite of vitamin D, calcitriol, are mediated by its binding excess of vitamin A intake. The major essential function of vitamin D is to Vitamin D or calciferol; and promote mineralisation of bone. Vitamin D is normally required for minerali they are therefore referred to as vitamin D. However, There are 2 main sources of vitamin D: in hypocalcaemia, vitamin D collaborates with parathyroid i) Endogenous synthesis. Vitamin D stimulates reabsorption of calcium enters the body directly through the skin. Pigmentation of at distal renal tubular level, though this function is also the skin reduces the beneficial effects of ultraviolet light. Vitamin D receptor is expressed such as deep sea fish, fish oil, eggs, butter, milk, some plants on the parathyroid gland cells by which active form of and grains. Besides, vitamin D ted to its active metabolites (25-hydroxy vitamin D and 1,25 receptor is also expressed on cells of organs which do not have any role in mineral ion homeostasis and has 249 antiproliferative effects on them. Deficiency of vitamin D may result from: i) reduced endogenous synthesis due to inadequate exposure to sunlight; ii) dietary deficiency of vitamin D; iii) malabsorption of lipids due to lack of bile salts such as in intrahepatic biliary obstruction, pancreatic insufficiency and malabsorption syndrome; iv) derangements of vitamin D metabolism as occur in kidney disorders (chronic renal failure, nephrotic syndrome, uraemia), liver disorders (diffuse liver disease) and genetic disorders; and v) resistance of end-organ to respond to vitamin D. Deficiency of vitamin D from any of the above mechanisms results in 3 types of lesions: 1. The disease has v) Bow legs occur in ambulatory children due to weak the following lesions and clinical characteristics (Fig. Proliferation of cartilage cells at the epiphyses followed by provisional mineralisation followed by inadequate provisional mineralisation ii. Persistence and overgrowth of epiphyseal cartilage; matrix deposition of osteoid matrix on inadequately mineralised cartilage resulting in enlarged and expanded costochondral junctions iii. It is stored in fat depots, liver i) Lowered levels of active metabolites of vitamin D (25 and muscle. The main physiologic functions of vitamin E are as ii) Plasma calcium levels are normal or slightly low. Active form of Vitamin E acts as an iv) Plasma alkaline phosphatase is usually raised due to antioxidant and prevents the oxidative degradation of cell osteoblastic activity. The disease responds rapidly to formed by redox reaction in the body (Chapter 3) and thus administration of 1,25-dihydroxy vitamin D. The deficiency of poor endogenous synthesis of vitamin D, or as a result of vitamin E is mainly by conditioning disorders affecting its conditioned deficiency. Low birth weight vitamin D, osteoid matrix laid down fails to get minera neonates, due to physiologic immaturity of the liver and lised. In H and E stained microscopic sections, this is bowel, may also develop vitamin E deficiency. Lesions of identified by widened and thickened osteoid seams vitamin E deficiency are as follows: (stained pink) and decreased mineralisation at the borders 1. Neurons with long axons develop degeneration in the between osteoid and bone (stained basophilic).

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Anoxia herbs nutrition cheap 400 mg hoodia fast delivery, hypoxia gayatri herbals proven hoodia 400mg, perinatal trauma until 9 years of age); large difference in refrac 4 herbals used for pain order hoodia 400 mg line. Early detection herbs pool order 400 mg hoodia otc, prompt intervention, referral shield over injured eye to ophthalmologist 3. Effective vision screening before 3 years of age be considered with presence of lid ecchymo 3. Therapy forcing stimulation of amblyopic eye; retinal hemorrhages; ideally injuries should be patching or use of atropine in good eye photographed when possible 5. Rabies prophylaxis if trauma from animal bite General information regarding corneal abrasion, 8. Refer to ophthalmologist for further foreign body, hyphema, ecchymosis, and assessment chemical injuries Corneal Abrasion. Use caution?severe intraocular injury may be concealed behind minimal external trauma. Topical anesthetic for evaluation only and conjunctiva for lacerations, foreign body, 2. Topical anesthetic recommended for examina medications can be used for pain control tion only; slows healing of cornea 5. Remove foreign body via irrigation with infection or foreign body exists normal saline or a moistened cotton-tipped 6. Most abrasions heal within 24 to 48 hours; applicator follow up in 24 hours and restain to evaluate 6. After removal, examine for corneal abrasion, abrasion and refer to ophthalmologist if abra treat appropriately sion is not healed within 3 days Hyphema Foreign Body Eye Injury. Reduce activity for several days, bed rest in abrasion present supine position with head of bed elevated 3. Possible visual acuity abnormality blood; hospitalization often necessary; no reading or activities. Visual acuity?to determine any deviation injured eye (to protect from reinjury); patch from normal must have holes or clear plastic so patients can 2. Fluorescein test?to determine presence of assess their vision because worsening of vision corneal abrasion? Topical ophthalmic anesthetic drops for exam is most common complication, usually 2 ination unless perforating wound suspected to 5 days after the injury (50% chance in 3. If persistent corneal abrasion after 24 hours patients with sickle cell trait or anemia) (Boar, with treatment, penetrating or perforation 2008); glaucoma, cataracts, and sympathetic wound, refer to ophthalmologist ophthalmia (in? Ophthalmic examination?determine other aureus, Streptococcus pyogenes, Enterobacter orbital/ocular injuries aerogenes, Proteus mirabilis, Klebsiella pneu 2. Uncomplicated?cold compresses for 24 to 48 irritation hours, then warm compresses until swelling 4. Trauma disrupting lining of auditory canal, resolves; elevate head; inform parents/patient. Excessive dryness (eczema, psoriasis); contact damage to skull, facial bone fracture dermatitis. Steam, intense heat, and common household of otoscopic examination agents; deployment of air bags can release 3. Pressure/fullness in ear, possible hearing loss chemicals potentially causing alkaline chemi cal damage. Possible pre or postauricular age of middle ear space; without this, an lymphadenopathy effusion develops in the middle ear space 6. Observe for signs of mastoiditis or cellulitis with subsequent bacterial contamination beyond external canal b. Less common pathogens?Staphylo to 48 hours coccus aureus, group A beta hemolytic 4. Systemic analgesic often required for severe streptococcus, and Pseudomonas aerugi pain. Prevention?instillation of white vinegar and strains highest in past 15 years rubbing alcohol (50/50) in both ear canals g. Increase in drug resistant bacteria, espe after swimming; avoid water in canals, vigor cially in children younger than 24 months; ous cleaning, scratching, or prolonged use of those who recently were treated with cerumenolytic agents -lactamase antibiotics and children 8. Bottle-feeding in supine position and/or specify 3 criteria that must be present: (1) acute no breastfeeding onset of signs/symptoms, (2) evidence of middle. Consider allergy evaluation and possibly higher risk than those in home care immunologic evaluation for children with 4. Judicious use of antimicrobials due to lower socioeconomic groups increased bacterial resistance; consider no 6. Complaints of ear fullness, pain, or discomfort better, change antibiotic to 2nd line therapy 50% of the time 4. Poor appetite/feeding, irritable with sleep dis 10 days, however in older children turbances (especially in infants) (2 years) and with milder cases, may con 4. Mobility decreased or absent via tympanom episodes in 12 months etry or pneumatic otoscopy. Pneumatic otoscopy?visualize degree of to 5 episodes in one year, 6 episodes by 6 mobility impairment years of age 2. Sometimes none or mild discomfort, crackling If rash (not anaphylaxis), may use cefuroxime, or full sensation in ear cefpodoxime, and cefdinir 2. Mobility?decreased; tympanometry reveals tympanocentesis to determine pathogen (Hay, high negative pressure or? Limit use of antibiotic prophylaxis due to mar Observation without use of antibiotics is an option ginal bene? Limit passive smoking exposure, treat other to follow-up infections, control allergies 4. Decongestants and antihistamines not recom without signs and symptoms of ear infection; also mended except if allergy symptoms present referred to as serous, secretory, mucoid, and aller 7. Caused by Eustachian tube dysfunction (nega tive pressure in the middle ear produces an Tympanostomy Tubes effusion in the middle ear); also occurs as a. Oral antibiotics (see Table 4-1) for 14 days plus antibiotic eardrops (3 to 4 drops four times a. Hospitalization may be necessary if complica those allergic to penicillin or sulfonamides, tions or underlying disorder those with associated hearing loss of 20 dB, or 4. Cotton plugs with petroleum jelly (on outer with neomycin and hydrocortisone surface) when bathing and hair washing 2. Central?relatively safe from cholestea middle ear infection; a suppurative complication toma formation of otitis media b. Conductive hearing loss dependent on size of mastoiditis), Mycobacterium tuberculosis perforation (rare), Moraxella catarrhalis, enteropathic 4. Narrowing of ear canal in posterior superior membrane wall due to pressure from mastoid abscess 2. Complications?meningitis, brain abscess, as conductive, sensorineural, or mixed; can range cavernous sinus thrombosis, acute suppura from mild to severe, may be congenital or acquired; tive labyrinthitis, facial palsy quanti? Conductive loss?normal bone conduction discharge and reduced air conduction due to obstruction of transmission of sound waves through exter Cholesteatoma nal auditory canal and middle ear to the inner ear; usual range of 15 to 40 dB loss. Congenital abnormalities?external canal (4) Anoxia abnormalities, craniofacial malformations, (5) Birth trauma structural abnormalities of external ear (6) Birth weight 1500 g (7) Exposure to ototoxic drugs. Conductive?congenital atresia, deformi hearing loss ties, or stenosis of ossicles 2. Psychosocial considerations?rehabilitation, brane; severe head trauma hearing aids, educational programs (4) Cholesteatoma, otosclerosis 5. Substitution of gestures for words, espe ear disease cially after 15 months Nose 103 c. Environmental controls?removal of carpets, drapes, and stuffed animals; plastic covers for. Fexofenadine hydrochloride? exposure/sensitization to allergen (1) 6 mo 2 yr: 15 mg po bid; a. Perennial?house dust mites, mold spores, (4) nonsedating animal dander; may occur in children b. Loratadine? under age of 6, uncommonly seen under (1) 2?5 yr: 5 mg qd; 24 months (2) 6 years: 10 mg daily; 2. Most common pediatric allergic disease; com (3) nonsedating monly associated with conjunctivitis, sinusitis, c. Chronic, intermittent, or daily nasal conges (3) 6 yr: 5?10 mg qd tion, and clear rhinorrhea d. Episodes of sneezing with itching of eyes, ears, (1) 6 mo?5 yr: 4 mg oral granules or chew nose, palate, pharynx able tab qhs; 3.

Skin: Examine the skin over the front of the chest and abdomen planetary herbals quality cheap 400 mg hoodia otc, and also look at the limbs herbals dario bottineau discount hoodia 400mg on line. Except for very immature infants that have no lanugo herbs n more buy hoodia 400mg line, preterm infants have a lot of lanugo and this decreases with maturity herbs like weed buy discount hoodia 400 mg line. Measuring weight and head circumference 2-f Weighing an infant The naked infant is weighed, to the nearest 10 g, on a scale. However, the measurement of head circumference should be postponed for 24 hours if marked moulding or severe caput are present at birth as they may result in an incorrect reading. The crown-heel length is usually not measured routinely as this is very inaccurate unless a special measuring box is used. Remember that the centile lines mark the outer limit of the normal (or appropriate) weight for gestational age. On physical examination the infant appears healthy with no congenital abnormalities or abnormal clinical signs. Normal infants are at low risk of developing problems in the newborn period and, therefore, require primary care only. Normal newborn infants are at low risk of developing problems and, therefore, require only primary care. Dry the infant in a warm towel then transfer the infant to a second warm, dry towel. The normal infant will have an Apgar score of 7 or more and, therefore, does not need any resuscitation. If the infant has a lot of secretions, turn the infant onto the side for a few minutes. Gloves must be worn by the nurse or doctor who delivers the infant and assesses the infant immediately afer birth. If the infant appears to be normal and healthy, the infant can be given to the mother afer the 1 minute Apgar score has been assessed, the umbilical cord clamped and the initial examination made. Where possible, it is important that the father be present at the delivery so that he can also be part of this important phase of the bonding process. If possible the mother should put the infant to her breast as soon as the infant has been dried and assessed at 1 minute because: 1. Studies have shown that the sooner the infant is put to the breast, the greater is the chance that the mother will successfully breastfeed. Nipple stimulation by suckling may speed up the third stage of labour by stimulating the release of maternal oxytocin which causes the uterus to contract. During a complicated third stage or during the repair of an episiotomy some mothers would rather not hold their infants. It is essential that all infants be given 1 mg of vitamin K1 (Konakion) by intramuscular injection into the anterolateral aspect (side) of the mid-thigh afer delivery. Never give the vitamin K into the butock as it may damage nerves or blood vessels that are very superfcial in infants. Yes, it is advisable to place tetracycline, chloromycetin or erythromycin ointment or drops routinely into both eyes to prevent Gonococcal conjunctivitis. The use of erythromycin or tetracycline will also decrease the risk of conjunctivitis due to Chlamydia. If the infant is cared for by the mother, the staf will be relieved of this additional duty. The mother can be close to her infant all the time and get used to caring for her infant. It encourages demand feeding and avoids all the complications of schedule feeding. In practice this can be avoided by removing an occasional infant for a short while. The only indication for an infant to be washed or bathed soon afer birth is severe meconium staining or contamination with blood or maternal stool. It is, however, important that all primiparous mothers learn how to bath an infant before they are sent home. Some infants will pass a stool afer every feed while others may not pass a stool for a number of days. The umbilical cord stump is sof and wet afer delivery and this dead tissue is an ideal site for bacteria to grow. The cord should, therefore, be dehydrated as soon as possible by 6 hourly applications of surgical spirits. The infant must be examined in front of the mother so that she is reassured that the infant is normal. The normal infant should be weighed at delivery and again on days 3 and 5 if still in hospital. All newborn infants must be given a road to health? card as this is one of the most important advances in improving the health care of children. The schedule of immunisations varies slightly in diferent areas of southern Africa but most newborn infants are given B. Both are normal and caused by the secretion of oestrogen by the infant before and afer delivery. Breast enlargement is normal and the breasts may remain enlarged for a few months afer delivery. It is very important that these breasts are not squeezed as this may introduce infection resulting in mastitis or a breast abscess. Tese signs are due to the secretion of male hormones by the fetus and usually disappear within a few months. Sometimes similar patches are seen over the back, arms and legs and may look like bruises. Many infants also have pink areas on the upper eyelid, the bridge of the nose and back of the neck that become more obvious when the infant cries. A tooth that is very loose, and is only atached by a thread of tissue, should be pulled out. Many infants have a web of mucous membrane under the tongue that continues to the tip. As a result the infant is not able to stick the tongue out and, therefore, is said to have tongue tie. If the hernia is still present at 5 years the child should be referred for possible surgical correction. Many normal infants have a small dimple or sinus in the skin at the top of the clef between the 2 butocks. If you put your fnger on the dimple or sinus you will feel the ridge of the coccyx underneath. Usually a blocked nose does not need treatment provided the infant appears generally well and can still breathe and feed normally. Nose drops containing drugs can be dangerous as they are absorbed into the blood stream. This is particularly common in preterm and underweight for gestational age infants. If the fontanelle feels full and the head circumference is above the 90th centile, the infant must be referred to a level 2 or 3 hospital as hydrocephaly is probably present. Tese infants have a high risk of other abnormalities and, therefore, should be referred to a level 2 or 3 hospital. Long nails should, therefore, be cut straight across with a sharp pair of scissors. Discharging a normal infant 3-40 When can a normal infant be discharged from the hospital or clinic? Before discharging an infant from either a hospital or clinic, you should ask yourself the following questions: 1. Reporting immediately if the infant appears ill or behaves abnormally (danger signs) 5. If the infant is discharged before 7 days of age, the infant should be seen at home or at a clinic on days 2 and 5 to assess whether: 1. As soon as the infant is dried, the cord cut, the Apgar score determined and a brief examination indicates that the infant is a normal, healthy term infant. She should be encouraged to use the kangaroo mother care position of nursing her infant, skin to skin, between her breasts. Why is it important to assess whether an infant sucks well if the weight gain afer birth is poor? If an infant sucks poorly and loses weight, it suggests that the infant is not normal.