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Leaves of monocotyledons have parallel veins buy zyprexa online medications ibs, whereas leaves of dicotyledons have branching veins zyprexa 20mg cheap treatment jammed finger. Pistils (one or more) are the female portion of the plant and consist of an ovary at the base zyprexa 2.5mg overnight delivery symptoms joint pain fatigue, a style projecting upward zyprexa 7.5mg low cost 4 medications at walmart, and a stigma, the sticky portion to which pollen grains adhere. Stamens, which are the male portions of the plant, are variable in number and consist of anthers borne on filaments. Sepals, the protective portion of the flower bud, are usually green and three to six in number. The phylogenetically primitive flower had numerous separate parts, as typified by the magnolia. Fusion of flower parts and reduction of their number is a characteristic of phylogenetic advancement. A perfect flower contains both male and female organs; an imperfect flower contains only stamens or only pistils. Monoecious ( one house ) plants bear both stamens and pistils; the individual flowers may be perfect or imperfect. Dioecious ( two houses ) plants have imperfect flowers, and all flowers on a particular plant are the same type (male and female). Ragweed is a monoecious plant with perfect flowers; corn is a monoecious plant with imperfect flowers; willows are dioecious plants. Like the flowering plants, gymnosperms may be either monoecious (pines) or dioecious (cypresses and ginkgoes). The gymnosperms include two orders, the Coniferales (conifers) and the Ginkgoales. Neither are of particular importance in allergy, but because of the prevalence of conifers and the incidence of their pollens in surveys, some comments are in order. The pollen grains of pines are 45 to 65 mm in diameter and have two bladders ( Fig. Spruces produce pollen grains morphologically similar to pine pollen but much larger, ranging from 70 to 90 mm exclusive of the bladders. The firs produce even larger pollen grains, ranging from 80 to 100 mm, not including the two bladders. The mountain cedar is an important cause of allergic rhinitis in certain parts of Texas and has proliferated where the ecosystem has been disturbed by overgrazing of the grasslands. Taxodiaceae (Bald Cypress and Redwood) The bald cypress may be a minor cause of allergic rhinitis in Florida. Other trees have been implicated in pollen allergy, but most of the pollinosis in the United States can be attributed to those mentioned here. Order Salicales, Family Salicaceae (Willows and Poplars) Willows are mainly insect pollinated and are not generally considered allergenic ( Fig. Poplar pollen grains are spherical, 27 to 34 m in diameter, and characterized by a thick intine ( Fig. Their seeds are borne on buoyant cotton-like tufts that may fill the air in June like a localized snowstorm. Patients often attribute their symptoms to this cottonwood, but the true cause usually is grass pollens. Order Betulales, Family Betulaceae (Birches) Betula species are widely distributed in North America and produce abundant pollen that is highly allergenic. The pollen grains are 20 to 30 m and flattened, generally with three pores, although some species have as many as seven ( Fig. They are 40 m in diameter, with an irregular exine (outer covering) and three tapering furrows (Fig. Pollens of the various species are similar, with three long furrows and a convex, bulging, granular exine. They produce large amounts of allergenic pollen and continue to be a major cause of tree pollinosis despite the almost total elimination of the American elm by Dutch elm disease. Elm pollen is 35 to 40 m in diameter with five pores and a thick, rippled exine ( Fig. Order Juglandales, Family Juglandaceae (Walnuts) Walnut trees (Juglans) are not important causes of allergy, but their pollen often is found on pollen slides. The pollen grains are 35 to 40 m in diameter, with about 12 pores predominantly localized in one area and a smooth exine ( Fig. Grains have multiple pores surrounded by thick collars arranged in a nonequatorial band. Pecan trees in particular are important in the etiology of allergic rhinitis where they grow or are cultivated. The pollen grains are 40 to 50 m in diameter and usually contain three germinal pores. Order Myricales, Family Myricaceae (Bayberries) Bayberries produce windborne pollen closely resembling the pollen of the Betulaceae. Order Urticales, Family Moraceae (Mulberries) Certain members of the genus Morus may be highly allergic. The pollen grains are small for tree pollens, about 20 m in diameter, and contain two or three germinal pores arranged with no geometric pattern (neither polar nor meridial). Order Hamamelidales, Family Platanaceae (Sycamores) These are sometimes called plane trees. Order Rutales, Family Simaroubaceae (Ailanthus) Only the tree of heaven (Ailanthus altissima) is of allergenic importance regionally. Its pollen grains have a diameter of about 25 m and are characterized by three germinal furrows and three germinal pores. The pollen grains are distinct, 28 to 36 m, with germ pores sunk in furrows in a thick, reticulate exine. Order Sapindales, Family Aceraceae (Maples) There are more than 100 species of maple, many of which are important in allergy. Order Oleales, Family Oleaceae (Ashes) This family contains about 65 species, many of which are prominent among the allergenic trees. Pollen grains have a diameter of 20 to 25 m, are somewhat flattened, and usually have four furrows (Fig. The others are wind pollinated, but of the more than 1,000 species in North America, only a few are significant in producing allergic symptoms. Those few, however, are important in terms of the numbers of patients affected and the high degree of morbidity produced. Most of the allergenic grasses are cultivated and therefore are prevalent where people live. Other species of Agrostis immunologically similar to redtop are used for golf course greens. Tribe Phalarideae Sweet vernal grass (Anthoxanthum odoratum) is an important cause of allergic rhinitis in areas where it is indigenous.
Public participation in biobanks and research projects would build trust (Levy et al discount 20mg zyprexa visa treatment definition statistics. Although a waiver of authorization to use identifiable health information may be granted under certain circumstances generic zyprexa 2.5mg on line medicine kit for babies, many health care organizations are reluctant to participate discount zyprexa 2.5mg with visa symptoms thyroid cancer. Thirdly cheap 20mg zyprexa amex treatment diffusion, requirements for accounting to patients for research uses of data are burdensome and discourage data sharing. These regulations are strong deterrents to the kinds of pilot projects envisaged in this report. A biobank might serve as a trusted intermediary for the pilot projects described above, giving researchers only data and materials without overt identifiers but retaining a key to coded samples so they could update clinical information or re-contact patients or donors when appropriate. The Committee envisages that best practices and ultimately consensus standards will emerge from the different models of consent and return of clinically significant results to participants. The research needed to build the Information Commons, which will require projects involving vast amounts of data from large numbers of patients, will proceed more efficiently if such collaborations can be developed both between academia and industry and among for-profit companies that have historically been competitors (Altshuler et al. These collaborations could include developing common standards and database formats and building infrastructure to facilitate data sharing. Consortia might be organized to share upstream research findings widely that have no immediate market potential but are critical to downstream product development. Examples of such upstream research include the identification and validation of biomarkers and predictors of adverse drug reactions. To build a flourishing culture of pre-competitive collaboration, drug companies will need to overcome their reluctance to share all data from completed clinical trials, not just the selected data relevant to regulatory proceedings. Finally, and most significantly, guidelines for intellectual property need to be clarified and concerns about loss of intellectual-property rights addressed. Precompetitive collaborations will only emerge if individuals and organizations have incentives to join them (Vargas et al. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 59 with its attendant benefits in improved health outcomes and reduced health-care costs, can become a widespread reality. Similar principles apply whether the collaborations involve commercial entities or are confined to academia. To encourage the collection of materials and data, organizations and researchers who collect them should have first access to their use for research, while still ensuring their timely availability to others. The Committee does not envision the desirability or need, in the context of the research required to populate the Information Commons with data and derive a Knowledge Network from it, for the instant-data-release model adopted during the Human Genome Project. However, it does believe that timely, unrestricted access to data sets by researchers with no connections to the investigators who created them will be essential. The cost of populating the Information Commons with data precludes extensive redundancy in publicly financed research projects. At the same time, the size and complexity of these data sets as well as the need for diverse, competitive inputs to their analysis precludes giving any one group prolonged control over them. They must be regarded as public resources available for widespread and diverse research into ways to improve health care and to increase the efficiency of health care delivery. Because the Committee is skeptical that one-size-fits-all policies can accommodate the conflicting values associated with incentivizing researchers and insuring adequate access to data, it believes that pilot projects of increasing scope and scale should put substantial emphasis on addressing the challenges associated with data-sharing, rather than focusing exclusively on data collection and analysis. On one hand, these organizations recognize the potential value and cost saving that could emerge from such an effort. One of the main impediments is cultural: many of these organizations view their data as a propriety asset to be used in efforts to generate competitive advantages relative to other organizations. For example, large health-care systems and insurance providers are interested in developing decision support tools for physicians that would cut down on the substantial waste caused by misdiagnosis or inappropriate treatment decisions. Integration of biological data, patient data, and outcomes information into Knowledge Networks that aggregate data from many sources could dramatically accelerate such efforts. However, if the data and the research results are shared, it would undermine one type of competitive advantage that large data providers might otherwise have. In this way, there is a tension between the sharing that would be good for the health-care system as a whole and the short-term competitive instincts of individual providers and payers. Apart from the culture of competition there are other impediments related to cost pressures. Cost pressures within the health-care system are such that providers and payers are unlikely to be willing to invest substantially (or in some cases, at all) in the collection of biological data for research purposes. Over the long-term, once such data have been shown to yield clinically useful information, it will become justifiable to expend health care resources on the collection of actionable data, just as is presently done for standard diagnostic tests. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 60 Commons will become populated by biological data (such as genome sequences) acquired from providers and payers. Similarly, the information technology challenges associated with integration of large data sets and new disease classification systems are substantial. While the goals of integrating data sets and changing classification systems are achievable in principle, they will be beyond the technical capacity of all but the largest and most technologically sophisticated providers and payers. Thus, the transition to non- proprietary Knowledge Networks into which all data would be deposited would have to involve strong incentives for payers and providers. This may mean that the government will ultimately need to require participation in such Knowledge Networks for reimbursement of health care expenses. At an even more fundamental level, the longstanding issue of equity in access to a sufficiently advanced level of healthcare should also be addressed if the data in the Knowledge Network is to adequately represent the diversity of our society. The Development of a Knowledge Network of Disease will require and inform the education of health-care providers at all levels Decision-making based on a Knowledge Network of Disease and the New Taxonomy, which will incorporate a multitude of parameters, will represent a significant adjustment in the practical work of the primary care physician. Given the demands on the time of physicians and other care-givers in the present health-care environment, few are likely to have the time or to feel qualified to interpret the results of omics -scale analyses of their patients. The importance of this issue will escalate over time as the Knowledge Network and its linked molecular-based taxonomy evolve into a system whose sheer complexity greatly exceeds current approaches to disease classification. One concern is that the infusion of large molecular datasets into clinical records will reinforce a tendency many perceive as already crediting genetic and other molecular findings with more weight than they deserve. In extreme cases, this cultural bias has enabled the promoting and marketing of omic tests with no clinical value whatsoever (Kolata 2011). In other cases genetic or omic tests with real value in specific contexts may be over-interpreted and thereby occlude consideration of other relevant clinical data. To develop the Knowledge Network of Disease and the New Taxonomy that will be derived from it, health-care providers will need to develop much greater literacy in the interpretation and application of molecular data. To meet these challenges, health-care providers will require both decision-support systems and new training paradigms. Whenever possible, such decision-support systems should enable shared decision-making by patients and their care-givers. In order to prepare physicians for the use of a comprehensive, dynamically changing disease- Knowledge Network, biomedical education will need to adjust. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 61 (2011) recently proposed that graduate and medical-life-sciences curricula would significantly benefit from a major shift away from the current discipline-specific model to a vertically integrated nodes-and-connections framework. It also would give future physicians a more holistic view of biological processes, which reflects what will be required to fulfill the promises of genomics and personalized medicine (Ashley et al.
Complications Aetiology Neurological and cerebrovascular complications in- The likely organism changes with age generic zyprexa 2.5 mg with visa symptoms pink eye. In adults buy discount zyprexa line acne natural treatment, the clude intracranial venous thrombosis order 10 mg zyprexa overnight delivery symptoms your dog has worms, cerebral oedema most common are Neisseria meningitidis buy zyprexa 5 mg without prescription 94 medications that can cause glaucoma, Streptococcus and hydrocephalus. Less common intravascular coagulation occur in 8 10% of patients organisms include gram-negative bacilli (particularly as with meningococcal meningitis. There may be r Nasopharyngeal clearance may be recommended for oedema, focal infarction and congested vessels in the the patient and household kissing contacts, e. Cephalosporins provide good clearance of nasal carriage in the patient, but penicillins do not. Poor givenstill demonstrates the causative organism in many prognostic markers include hypotension, confusion and cases. Abroad-spectrum antibiotic such as a cephalosporin at high doses is initially recommended due to the increasing emergence of penicillin-resistant strepto- Viral meningitis cocci. Once cultures and sensitivities are available, the course and choice of agent can be determined Denition (ceftriaxone/cefotaxime for Haemophilus inuenzae Acute viral infection of the meninges is the most com- andStreptococcuspneumoniae,penicillinforN. Aetiology Pathophysiology Mayarise as a complication of miliary tuberculosis or In viralmeningitis there is a predominantly lymphoid in primary or post primary infections. Ifatuberculous focus develops in the brain, meninges or Rash, upper respiratory symptoms and occasionally di- skull and ruptures into the subarachnoid space, a hyper- arrhoeamaybepresent. This inammation can directly involve the cranial are absent in recurrent infections. Clinical features Culture is possible, but rarely useful clinically as it The onset is usually insidious over days or weeks, al- takes up to 2 weeks. Focal neurology may develop If bacterial meningitis is suspected, broad-spectrum an- at this time including cranial nerve signs and hemi- tibiotics must be given without delay. Macroscopy/microscopy The subarachnoid space is lled with a viscous green exudate, the meninges are thickened and tubercles and Tuberculous meningitis chronic inammation may be seen in the brain and on Denition the meninges. Treatment Metastatic carcinoma and should be initiated on clinical suspicion, before conr- adenocarcinomas mation, as deterioration can occur within days, and even Auto-immune/ Systemic lupus erythematosus Inammatory Behcet s disease when treated mortality is as high as 15 40%. Sarcoid Corticosteroids have been shown to reduce vascular Drugs Particularly nonsteroidal complications, and improve survival and neurological anti-inammatory drugs function. If it is not clear whether the process is bacterial or vi- Aetiology ral, antibiotics may be given empirically whilst awaiting The differential diagnosis for these cases of aseptic further investigation. Acute viral encephalitis Investigations/management In many cases of aseptic meningitis, the diagnosis is of Denition aself-limiting, benign viral meningitis. However, it is Inammation of the brain parenchyma caused by important to consider these other causes, particularly if viruses. Around the world, arthropod- In all cases except herpes simplex encephalitis there is borne viruses cause epidemics and rabies causes an no effective treatment apart from supportive manage- almost invariably fatal encephalitis. Sus- pected cases of herpes encephalitis are treated urgently Pathophysiology with high dose i. Inammation affects the meninges and parenchyma causing oedema and hence Prognosis raised intracranial pressure, diffuse and focal neurolog- Herpes simplex encephalitis has a mortality of 20% de- ical dysfunction. Seizures (par- ticularly temporal lobe seizures) are also a presenting Tetanus feature. Denition Tetanus is a toxin mediated condition causing muscle Macroscopy/microscopy spasms following a wound infection. The meninges are hyperaemic, the brain is swollen, sometimes with evidence of petechial haemorrhage and necrosis. There is cufng of blood vessels by mononu- Aetiology clear cells and viral inclusion bodies may be seen. Clostridium tetani (the causative organism), an anaero- bic spore forming bacillus, originates from the faeces of domestic animals. Tracheostomy and ventilatory support may r Generalisedtetanusisthemostcommonpresentation, be necessary for severe laryngeal spasm. The Childrenareroutinelyvaccinatedagainsttetanusfrom facial muscles may contort to cause a typical expres- age 2 months. Any sensory stimulation such asnoiseresultsingeneralisedmusclespasmsincluding Poliomyelitis arching of the back (opisthotonos). Spasms of the lar- ynx can impede respiration, and autonomic dysfunc- Denition tion causes arrhythmias, sweating and a labile blood Infection of a susceptible individual with poliovirus type pressure. Geography Acute poliomyelitis has been eradicated in developed Complications countries, apart from rare cases due to the live, atten- Muscle spasms may lead to injury, in severe cases res- uated oral polio vaccine. Thevirusisneurotropic,withpropensityfortheanterior r A booster dose with tetanus toxoid (which is an in- horn cells of the spinal cord and cranial nerve motor activated toxin which induces active immunisation), neurones. The virus enters via the gastrointestinal tract, or course of three injections, should additionally be then migrates up peripheral nerves. Theincubationperiodis7 14days,anumberofpatterns Active tetanus:Patients should be nursed in a quiet, occur: dark area to reduce spasms. Surgical wound debride- r Subclinical infection occurs in 95% of infected indi- ment should be performed where indicated and intra- viduals. However, the immunoglobulin can only neu- r Paralytic poliomyelitis occurs in about 0. Dys- phagia and dysarthria result, with the risk of aspi- Cerebritis and cerebral abscess ration pneumonia. Denition iv Respiratory involvement may lead to the need for Afocal infection within the parenchyma of the brain ventilatory support. Complications Post-polio syndrome this is progressive, often painful Aetiology weakness in the territories originally affected by the Often the causative organism cannot be identied, or acute illness which can occur many years later (usually a mixed growth of bacteria is found. More suffer cause cerebral abscesses include various Streptococci, from pain, but without progressive weakness. Immuno- to be a failure of the compensatory mechanisms which suppressed patients are predisposed to fungal abscesses occur to bring about the original recovery those with such as Candida, Aspergillus and Toxoplasma. The organism may enter the brain by direct exten- sion from meningitis, otitis media or sinusitis, or Investigations by haematogenous spread, e. Management Clinical features r Acute treatment is supportive with bed rest, respira- The onset of symptoms is usually insidious, with tory support where indicated. In the rst 1 2 weeks, there is inammation and oedema iii Shortening: Leg length inequality of up to 3 cm (cerebritis). Later, necrosis and liquefaction lead to for- may be treated by built up shoes, larger differences mation of a cavity lled with pus. There are acute in- may require leg lengthening (or shortening of the ammatory cells (neutrophils), surrounded by gliosis opposite leg) procedures. Frequently treatment is by a combination of antimicro- bial therapy and surgical drainage. Incidence Approximately 2% have two or more seizures during Prognosis their lives.
In children with persistent diarrhoea order zyprexa 7.5 mg line 911 treatment center, more combination of infection or infestation was detected purchase zyprexa online from canada symptoms of depression. So more antimicrobial therapy was found to be given in all persistent diarrhoeal patients quality 20 mg zyprexa treatment yeast diaper rash. Also the usage of antibiotics in acute diarrhoeal cases should be minimized to actual indiacted cases buy discount zyprexa line treatment toenail fungus. Bacteria isolated from the jejunal fluid in upper small intestines of these children were incubated with lactulose at neutral pH. Anaerobes were present in all but one child, and in 15 children they were present in numbers greater than 5 log 10 organisms per ml. This study suggests that in the diagnosis of small bowel bacterial overgrowth using lactulose breath hydrogen test, it is important to consider that patients with a flat breath hydrogen response to a carbohydrate challenge during the first 60min may be infected with enteric bacteria which are not capable of producing H2. Rotavirus was detected by enzyme linked immunosorbent assay in stools of 43 children. Cases were 67 children 1-59 months old hospitalized for diarrhoea lasting >14 days and complicated by severe malnutrition; for each case, a healthy control child was selected who was age- and sex-matched from the same neighbourhood. Homes of cases and controls 92 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar were visited for interviews and for direct observation of household child-care practices. Risk factors were catalogued and calculations made for relative risk and etiologic fractions. These results indicated that persistent diarrhoea and malnutrition in Burma is caused by a complex of several interrelated socioeconomic factors, unsanitary behaviour pertaining to personal hygiene, the practice of demand breastfeeding and lack of certain weaning foods, and low education of mothers who showed less knowledge about causes of diarrhoea and prevention of malnutrition. Glycine 4g and glycyl-glycine 4g patients with clinical cholera were given tetracycline 500mg q. Rectal swabs were also taken and investigated for culture and sensitivity at the Bacteriology Research Division of the Department of Medical Research. A total of 200 children under five years of age with acute diarrhoea were included in the study. Sixteen serogroups were identified 94 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar O125 and O126 were common serotypes. The serogroups of Escherichia coli classified were O1 K51; O8K25; K+; O25K+; O27K+; 028K+; O78K+; O86 K61, K62; O114 K90; O119 K69; O125 K70; O126 K71; O127 K63; O128 K67; O136 K78; O148 K+; O157 K+ and O159 K+. It was also noted that personal hygiene still plays an important role in causing acute diarrhoea. As peptic ulcer disease is very common in Myanmar, it is of great importance to elucidate whether H. A total of fifty biopsy specimens which were obtained from forty-three male and seven female patients were included in this study. Patients of age range forty-five and above forty-five years were observed to be of highest prevalence consisting of 44 percent. These patients had undergone endoscopic examination and the respective biopsies were taken. The invasive tests used in this study were rapid urease tests, histology and culture. Among the fifty patients studied, 95 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar thirty five patients (70%) were urease positive, twenty patients (40%) were positive on histological examination and ten patients (20%) were positive on bacteriological examination. The sensitivity and specificity of urease test, histology and culture were 90% and 35% for urease test, 50% and 62. The study included fifty biopsy specimens obtained from forty three male and seven female patients. These patients were submitted to endoscopic examination and the respective biopsies were taken. The sensitivity and specificity of urease test, histology and culture in the diagnosis of H. The endoscopic study from 50 patients revealed, 18 patients with only gastritis (36%); 19 with gastritis and duodenal ulcer (38%); 6 with gastritis and gastric ulcer (12% and with gastritis, duodenal and gastric ulcer (14%). Factors associated with duration of diarrhoea were ascertained by multiple regression analysis, where as prognostic indicators were confirmed by simple logistic regression procedure. Positive association with duration of diarrhoea of diarrhoea 96 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar noted with presence of mucus/blood/both in stool, decreased weight for age, lower income group and non-use of soap in hand washing after defecation. In addition to these factors lack of exclusive breast feeding in under 2 years children had positive association with duration of diarrhoea. In a logistic regression analysis, malnutrition, lack of hand washing with soap after defecation and lack of exclusive breast feeding were found to be prognostic indicators for the development of persistent diarrhoea. Endoscopic antral biopsy tissues for urease testing and 14C urea breath test confirmed the diagnosis of H. A total of 487 children, 327 with acute and 160 with persistent diarrhoea participated in the study, intestinal pathogen was detected in 71% (114) of persistent diarrhoea cases including bacteria agent 31%, viral agent 6. Male had more diarrhoea than female and peak incidence of acute and persistent diarrhoea occurred in the 2-11 months age group. Fever and vomiting were found frequent in persistent than acute diarrhoea during second week of illness (p<0. The presence of leucocyte and reducing substances in the stool was equally frequent. A total of 487 children, 327 with acute and 160 with persistent diarrhea participated in the study. Male children who suffered from diarrhoea were more than females and peak incidence of acute and persistent diarrhoea occurred in the 2-11 month age group. Fever and vomiting were found more frequent in persistent than acute diarrhoea during second week of illness and differences were statistically significant. The presence of leucocytes and reducing substances in the stool was equally frequent. Ninety eight male children aged 4 months to 10 years presenting with watery diarrhoea of less than 72 hours prior to hospitalization were studied. Ninety eight male children aged 4 months to 10 years presenting with watery diarrhoea of less than 72 hours prior to hospitalization ware studied. Stool for routine examination was done on each children and base line assessment on lactose absorption and small bowel bacterial overgrowth status were done. The results indicate that parasitic infections hinder the lactose absorption and favour the small bowel bacterial overgrowth; thus deworming could improve the lactose absorption status in children. Intestinal mucosal integrity was assessed by measurement of permeability index using dual sugar lactulose and L-rhamnose. Significantly decreased L-rhamnose excretion was observed in all of the clinical groups, in comparison to controls reflecting decreased absorption through enterocytes and villous atrophy. Raised lactulose urinary excretion was observed in all clinical groups except in children with persistent diarrhea, suggesting increased paracellular spaces and mucosal injury. It is concluded that major changes in intestinal permeability occurred in children with persistent diarrhea. There were lesser degree of damage in acute diarrhea and recovered persistent diarrhea groups. Only minor changes was observed on those who recovered from acute diarrhoeal illness.
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