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The anti- Criteria for each have been established but the criteria bodies form clumps of proteins and cause injury when are primarily for research purposes to ensure that they deposit on various tissues buy discount rhinocort 100 mcg online allergy medicine least side effects. This disease can affect virtually any diagnosed with extreme care and caution because many organ system 100 mcg rhinocort with visa allergy testing for cats. The classic symptoms are the butterfly other diseases may mimic or appear to be autoimmune rash on the face proven 100mcg rhinocort allergy symptoms to pollen, mouth sores, inflammation of the when they are not. The danger herein lies with the treat- lining of the heart and lungs, and arthritis. Since autoimmunity is a disease of almost a Rheumatoid arthritis is also a classic autoimmune hyperactive immune system, the treatment is aimed at disease and can affect organs other than joints. Many of the diseases nonjoint manifestations can involve the heart, lungs, that look like they could be autoimmune disease are skin, and eyes. The trigger for rheumatoid disease is not infections or cancer, and blocking the immune system in known. Infections must be ruled The inflammatory muscle diseases are another out through vigorous testing before treating and diag- group of diseases that have an autoimmune basis. The disease is diagnosed with certainty, the patient must be hallmark of these diseases is muscle weakness of the entirely free of infection before treatment begins. Patients have difficulty raising their arms to or system and cause changes that look like an autoim- above their heads, and difficulty getting out a chair or mune disease, there are certain classic mimics that will walking up stairs or inclines. Subacute bacterial endocarditis, may affect the neck muscles and the head may feel which is a bacterial infection of the heart valves, is fre- heavy. Respiratory muscle weakness and breathing prob- quently confused with rheumatoid arthritis and systemic lems can also occur, as well as swallowing difficulties. It is muscles, but the lungs themselves may also be affected, important to note that infections themselves cause causing an inflammatory lung disease and resulting in a surge in inflammatory chemicals and cells and can heart failure. There careful evaluation should always be done to rule out may also be joint pain without joint swelling. Often a biopsy will allow the diseases show breakdown of muscles but also signs of disease to be categorized. Specific tests can pre- Small vessel vasculitis usually involves the skin, dict lung involvement or worse prognosis. An example is hypersen- ing via electrical analysis of the muscles and nerves, and sitivity vasculitis, which is a response to something out- also muscle biopsy are critical since other muscle dis- side the body. Behcets syndrome causes eye ulcerations eases that are not autoimmune related can only be diag- and gastrointestinal problems in people of Mediterranean nosed with a biopsy. Small vessel diseases may also with both skin and muscle disease (dermatomyositis) involve the brain, causing very subtle behavioral changes have a 25% increased chance of having cancer before, or obvious neurological symptoms. Some Scleroderma is another interesting manifestation of classic syndromes are polyarteritis nodosa, allergic gran- autoimmune disease. Scleroderma causes Takayasus arteritis, temporal arteritis, and polyarteritis skin tightening and hardening. A good and detailed history usually reveals responsible for scarring and scar tissue formation classic symptoms of these disorders. The more scar tissue Autoimmunity does not only cause rheumatologic they deposit, the less able the tissues are to breathe and disorders. Diabetes, thyroid diseases, and other endo- this loss of breathability or oxygenation causes even crine diseases may also be autoimmune, as well as some more scar tissue to be deposited. Many gastroin- associated with scleroderma but it is not clear if they are testinal illnesses are associated with abnormalities of a cause or a result of the process. More than one autoimmune disease Patients with scleroderma may develop a wide vari- may be found in the same patient, or members of a ety of symptoms, ranging from Reynauds phenomenon patients family may have different autoimmune diseases. These diseases can get better or worse in cycles thickening of the skin that encases the whole body. However, it is important to be aware of open mind will help to diagnose patients who have these the diagnosis and work toward treatment. Inflammation of the blood vessels in Systemic lupus erythematosus these diseases may be due to an allergic response, or cell changes within the vessel wall, or dying off of ves- sels. Each of these diseases tends to involve only the Suggested Reading small, medium, or large arteries. Primer on the rheumatic diseases with fever, general illness, and can involve multiple (12th ed. About 6090% of is rarely if ever caused by a ruptured disk in the low people will have at least one significant episode of back. Usually, this kind of low back pain is related to low back pain during their lifetime. Trigger points the most common and the most expensive cause of are areas in the muscle that are tender, feel like a taut work-related disability in the United States. At any given time, at cause shooting pain, which may mimic a herniated least 1% of the workforce is either permanently or disk. Another cause for acute low back pain is inflam- temporarily disabled by back pain. Rarely, severe include pain that travels to the groin, and pain that trav- scoliosis (sideways curvature of the spine) can place els down the back of the leg or the side of the thigh. In these problems can cause low back pain with or with- fact, abnormalities on spine films are found in the out pain going into a leg. In addition, acute and chronic majority of adults, most of whom have no back pain at low back pain may be caused by infections, either the time. Other causes more serious causes need to be excluded by an accu- include autoimmune and inflammatory diseases such as rate history and physical examination. Cancers beginning in the spine 100 Bereavement or metastasizing from other parts of the body, especially anti-inflammatory drugs. These medications include vessel problems such as strokes in the spinal cord and antidepressant medications and antiseizure and antispas- abdominal aortic aneurysms can produce pain localized ticity drugs. Special programs that teach about pain and to a particular region of the lumbar spine. Eight-five percent of patients with acute low back pain Suggested Reading and approximately 65% of patients with chronic low back pain cannot be given a specific diagnosis. American Academy of Orthopedic Surgeons informational website: The treatment of low back pain is usually nonsur- orthoinfo. A comparison of phys- ical therapy, chiropractic manipulation, and provision of an edu- episode of low back pain will recover with simple treat- cational booklet for the treatment of patients with low back pain. Careful use of nar- cotic pain relievers and muscle relaxants can be helpful in severe, acute pain. Surgery should only be considered if there is Therapy, Psychotherapy progressive weakness, bowel or bladder incontinence, or a significant structural deformity. Despite this, the according to researchers who reviewed lots of studies majority of people handle the loss with minimum of back pain.

Hysterectomy is difficult without several long curved clamps for big vessels buy rhinocort cheap allergy-x for dogs reviews, preferably with longitudinal serrations and teeth at their tips buy rhinocort from india allergy testing johannesburg. Use these in endotracheal intubation and for removing foreign bodies in the throat (30 proven rhinocort 100 mcg allergy count chicago. One has to for holding bowel or ureter which you dont want to damage; Sponge-holding forceps for gauze swabs, or to retract the gallbladder be held by an assistant, the other holds itself. Magills are specifically for guiding an endotracheal tube, but also for extracting foreign bodies from the throat (30. Self-retaining retractors should never stretch a wound and cause ischaemia: make a bigger incision if the field is Tissue (locking) forceps have a ratchet which keeps them inadequate! When you use Allis forceps Any blacksmith should be able to make you the simpler for retracting a skin flap, apply them to the subcutaneous retractors from ordinary steel. You can use: (1) Absorbable sutures which are absorbed by the tissues so that you need not remove them. Absorbable sutures used to be solely plain catgut (from the submucosa of the bowel of sheep, not cats! Catgut can be treated with chromic acid which slows its absorption by phagocytosis and makes it keep its strength for 20days, but this remains unpredictable. Sepsis speeds the dissolution of catgut, especially plain catgut, so that it may dissolve in 2-3days. Catgut is soft and holds knots well, but not so well as a non-absorbable multifilament, such as linen or cotton. If a suture material does not hold knots too well, its knots need longer ends (>5mm). While catgut is being absorbed it makes a good culture medium and may promote sepsis. So do not use more than is necessary, do not leave the ends of ligatures unnecessarily long and avoid thick #2 or #3 catgut. Plain catgut does not hold its strength for very long, so never use it for tying larger vessels or suturing the bowel. One problem with catgut is that it may be of poor quality, and does not preserve for long, and so give way early and perhaps disastrously. This is another reason for using monofilament where you You cannot operate on a patient if the surrounding tissues get in your way. These are fairly small narrow (1);The urinary and the biliary tracts because non- deep retractors. This is a light general-purpose retractor with short shallow hooks at one (3) The mucosa of the uterus (less important). A pair of these are very useful as general sutures may work their way to the surface. This is a double ended abdominal (5);The scrotal skin, where sutures easily disappear and retractor. There are long-lasting absorbable sutures which are more These inexpensive general purpose abdominal retractors nest together, and so are easy to store. Polyglactin (Vicryl,Visyn) 60-90 days The 3 blades of this large abdominal retractor can be arranged so that they support one another, and do not have to be held. The first three come as a single (mono)filament, or as multiple filaments which are braided or twisted together. However, never hold monofilament with artery forceps or a needle holder because you will seriously weaken it at that point. Do not use it immediately under the skin, because it may work its way through to the surface, long after healing is complete. Even monofilament can come to the surface, so keep it well buried, and use absorbable close under the skin. Although attempts are Match this against surgical monofilament nylon strength for being made to replace the old system by a metric one from strength. Only very only recently qualified and had not operated on one of these cases before. He had few facilities, but he managed to find some local anaesthetic occasionally will you need sutures which are thicker or solution and some linen thread in the shops. A few instruments from the thinner than this, except for fine work such as nerve or local health centre were boiled up; he washed the wound thoroughly, and tendon repairs, and for eye and plastic surgery. When he had returned her bowel to her abdomen he was able to close it with linen The cost of sutures can significantly increase the cost of thread. Thread this through a hollow needles, the suture materials for a single operation cost sterile needle of correct size, snap off the plastic Luer lock, almost nothing. Monofilament suture material in packets is and crimp the metal of the needle tight onto the thread to 20,000% more expensive than in reels, and with needles secure it. Here are comparative suture sizes related to fishing wire breaking strengths: 59 60 Non-absorbable Diameter limits Fishing line size by breaking Improvised syringe needle gauge suture size, (mm) strength (in pounds) and Uses and inner diameter (mm) U. The thickness of fishing line is not necessarily proportional to its breaking strength! Or, if necessary, you can use ordinary linen or cotton thread almost anywhere, especially as ties. You can The narrower and deeper the space the smaller and more likewise buy this cheaply on a reel, and re-sterilize it. If necessary, you can try to Use 4/0 monofilament as your basic suture material for fine skin bend a half-curved needle into a circle. Use a cutting advantages of wire is that, unlike more massive pieces of metal, it does needle for tough fascia. You can wire tissues in the presence of sepsis; for example, when vascular pedicles and tough tissues, such as ligaments. Fasten wire by passing its ends through any convenient tube, such as that Use round-bodied or taperpoint needles for most other from a ball pen, and then grasping the ends and twisting them. If you You will want a needle-holder to hold small needles and cannot get one of these brackets, make it. Wind monofilament into these, autoclave them and cut off the length of Use big needles in big holders, and small needles in small suture material you require. Needle-holders can have plain jaws, or tungsten carbide inserts which prevent the hard steel of the needles wearing them away. Needles can be round-bodied, taper-pointed, or they can Quality counts in needle-holders, so get good ones. These small curved needles have flattened shafts, triangular points and lateral eyes. Hold these small curved needles in a needle holder, when you are working at the bottom of a narrow deep hole, such as the bottom of a burr hole. This is the only needle (not illustrated) in this list which you can use to thread wire, to close the abdomen (11. There are 2 kinds of wound to suture: A, Atraumatic suture with a needle swaged on to it especially for (1) Those caused by trauma. D, circle needle for suturing soft tissues such as the broad (2) Those which you make yourself when you operate. G, compound mostly concerned with the skin; the special sutures for curved needle.

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If you cannot make a safe anastomosis cheap rhinocort 100mcg on line allergy testing eugene oregon, bail out and fashion a colostomy and mucous fistula or perform a Hartmanns operation (12 order rhinocort 100 mcg allergy washington dc. This can only happen if they are all free to rotate as population may be infected by the parasite trypanosoma the result of a rare anomaly of the mesentery buy discount rhinocort 100mcg on line allergy forecast indiana. This is more cruzi which are deposited in insect faeces on the skin and common during pregnancy. The abdomen distends and becomes is carried by a bug, triatoma infestans, which lives in tender centrally and in the right lower quadrant. Trypanasoma may also affect the heart and oesophagus giving a picture like achalasia (30. Fix thin capillary blood films in methanol and stain both thin and thick films by Giemsa, immersing the thick films beforehand for 1sec in 05% aq. Advice on hygiene and high fibre diet is all that is needed for early cases; enemas may need saline drip irrigation in addition to soften faecalomas. When you inspect the right lower quadrant, you will find that the caecum is not in its normal If the mesenteric blood supply is compromised, patches or place. Chronic arterial insufficiency can produce long-standing If it is viable, ask your assistant to retract the right side of discomfort (intestinal angina), but there is usually a the abdominal incision. Do not If this is arterial from an embolus, the result is sudden complicate this procedure by fashioning a caecostomy, or ischaemia of the small bowel which rapidly becomes adding an appendicectomy, which may contaminate a necrotic. If the thrombosis is venous, there is infarction of bowel If it is not viable, and you are skilled, perform a right but because of the vascular arches this may be incomplete hemicolectomy (12. This may be drain the abscess: this will usually be enough to relieve the difficult to distinguish from pancreatitis and amylase obstruction. Featureless bowel gives no clue towards the diagnosis initially, but thickened bowel wall with air within the wall If you feel a solid object at the point where the develops later; occasionally you can see air in the distended loops join the collapsed ones, decompress the intrahepatic portal veins! Often you only discover the problem at solid object to another site in the bowel where the mucosa laparotomy. Remove the foreign body and repair If the bowel is suspicious, apply warm packs, and if after the bowel transversely. If it is a gallstone, it has come 5mins the bowel remains suspicious, lavage, close the through a fistula from an inflamed gallbladder. If it is a food bolus that has impacted in the small bowel If there is patchy necrosis, resect affected portions, but especially if there is a gastrojejunostomy (13. If there is an obvious embolus in a mesenteric artery, If you find a tumour in the small bowel causing try to remove it using a Fogarty embolectomy balloon obstruction, look for other such tumours (especially catheter after isolating the artery segment with bulldog purplish Kaposi sarcoma lesions). If there are many inflammatory adhesions between loops of bowel, do not try to resect bowel. You are unlikely to make the diagnosis of rarer causes of If there is atresia of the jejunum in a neonate (33. Here are some guidelines: Check for more areas of atresia distally by injecting saline into the distal bowel. If you find an inflammatory swelling in the caecum If an internal hernia is obstructing the bowel, or colorectum, it may be an amoeboma (14. You may not be able safely, but be careful with a hernia into the recess formed to make a diagnosis without histology, so take a biopsy. If you find the ileum encased in a membrane in a woman, carefully open this cocoon and free the bowel. If inflammation is peritoneal irritation (which could be due to a leaking severe or extensive, or there is evidence of perforation or anastomosis, iatrogenic bowel damage, haemorrhage or spillage (you will be able to smell it! If there is radiation damage to bowel, it will not hold Do not wait too long; if there is no improvement within sutures well. He had obstructive bowel sounds, some colicky pain, and a moderate amount of fluid was coming up the nasogastric tube. The return of normal After a messy operation with much pus, bleeding or bowel sounds is a sign that the bowel is starting to work spillage, expect ileus with absent bowel sounds. The presence of a nasogastric tube and the clean operation severe ileus is unlikely; if present, use of opioids inhibit the return of bowel action, which is it therefore points to a serious problem. Mechanical stimulated by early nutrition, mobilization out of bed, and obstruction results in increased bowel sounds. The bowel may fail to function as a result of: Examine the patient frequently, asking these questions: (1);Paralytic ileus, which is a prolongation of the normal Has he any pain? How much commonest cause, especially after an operation for nasogastric fluid is being aspirated? Persistent sepsis either inadequately dealt with, or from Is there pyrexia, tachycardia, tachypnoea? Unless frank signs of obstruction ensue, you should be able to treat him conservatively with Administer an enema if there is faecal residue in the nasogastric suction. Encourage him to chew Barium) challenge to see if there is a leak, and if contrast gum. The normal postoperative progressively more fluid, even >3l/day, suspect muscular inactivity usually starts to resolve after 72hrs, mechanical obstruction. If you have excluded enterocolitis, and ultrasound scans suggest fluid collections (38. Hypokalaemia aggravates ileus, so take care to add supplements to replace the potassium lost in the intestinal secretions. If you do decide to re-open the abdomen, do so very carefully, so as not to make more damage in the bowel and create a situation far worse than before. If you find much sepsis, wash out the abdomen thoroughly and look for a bowel leak. If this is in the proximal jejunum, introduce a feeding tube in the distal part of the bowel. Aspirate fluid and test for bile If there is minimal contamination within 48hrs of the with a urine dipstick: if present, this strongly suggests a previous operation, you will be justified in repairing the bowel leak, needing an urgent re-laparotomy. Treatment with cimetidine 400mg bd duodenum or ranitidine 150mg bd for 4wks will cure 70% of duodenal ulcers. Performing a gastrojejunostomy or pyloroplasty if the mucosal surface, allowing it to heal. Performing an elective truncal vagotomy and of ranitidine 400mg, amoxicillin 1g, and metronidazole pyloroplasty or gastrojejunostomy if there is a chronic 400mg bd will eradicate it in c. You will need to take a careful history to diagnose and manage peptic ulcer disease. For proven ulcers which recur after proper treatment with This can be difficult, so enquire how the patients cimetidine or ranitidine, it is worth trying proton-pump in your community express their ulcer symptoms. So, in spite of the limitations of the history, it may be the only way you have Alternatively misoprostol 200g bd up to qid will help of making the diagnosis. The decision to abandon medical for surgical treatment will often depend on the social circumstances; omeprazole, cimetidine and antacids may cost more than the patients salary if symptoms are chronic, so operation may be a reasonable cost-effective alternative. Do not forget that tuberculosis and burns can cause chronic gastric or duodenal ulcers, often leading to fibrosis and stricturing. Look for other signs suggesting other diagnoses: tenderness over the gallbladder (cholecystitis), Fig.

Recommendations for cancer covered the three priority fields of Cancer Plans 100mcg rhinocort mastercard allergy medicine okay while breastfeeding, Cancer Registries and Cancer Screening Programmes purchase generic rhinocort allergy shots poison ivy. Cancer screening Nation-wide screening programmes should be implemented for: breast cancer in women aged 50 and over (2- to 3 yrs intervals) buy genuine rhinocort allergy testing johnson city tn, cervical cancer in women aged 30 and over (5-year interval), colorectal cancer in persons aged 50 and over Nation-wide screening should not be implemented for other cancers unless and until 5 the evidence is strong Before implementing of a screening programme, predict the public health effects and the costs After implementation of screening maintain continuous evaluation of mortality and of screening processes (intermediate outcomes). European School of Oncology Advisory report to the European Commission for the "Europe Against Cancer Programme" European Code Against Cancer. Couffignal (Centre de Recherche Public Sant), Guy Berchem (Hmato-Cancrologie-Centre Hospitalier du Luxembourg); Malta: M. It is not actually a disease but rather a syndrome (a pattern of symptoms) which may be caused by an almost infinite number of cerebral and extracerebral diseases. Neuro-degenerative diseases and small vessel cerebro- vascular diseases account for most cases of dementia (Kurz, 2002). In this report, we will use the term dementia unless referring to a specific form of dementia such as Alzheimers disease (which is the most common form) or vascular dementia etc. A great deal of research is being carried out all over Europe into the mechanisms involved in the development of dementia, risk factors/protective factors and possible future treatments. At this moment in time, there is no curative treatment for dementia although there are a few drugs which treat the symptoms of the disease and temporarily slow down the rate of cognitive decline. It affects about one person in 20 over 65, one in five over 80 and one in three over 90. According to Alzheimer Scotland (2006), as dementia is more common in older people, delaying the onset of the disease by five years would halve the number of people with dementia. This is extremely important in the light of predicted increases in the number of elderly people in the next few decades. It is therefore not possible to provide full details of all existing information in this report. We will then briefly examine the results of a prospective analysis of risk factors carried out in Canada by Lindsay et al. This is typically rich in vegetables, fruit, cereals and unsaturated fatty acids with a low intake of saturated fatty acids and moderate fish consumption. Nevertheless, it does clearly play a role in the development of cardiovascular disease and stroke. For these risk factors, no modification of risk was found by age, sex or ApoE4 allele status. Factors which were found to increase the risk of Alzheimers disease were increasing age, few years of education and the ApoE4 allele. However, it is still unclear whether fewer years of education actually increases the risk or more years of education provide a kind of brain reserve which makes the symptoms less obvious with the result that the disease may go undetected for some time. Individual studies have reported gender differences linked to certain health determinants/risk factors. For example, Whitmer (2007) found that the increased risk of dementia associated with being overweight or obese was greater for women than for men. On the other hand, women who drank 3 or more cups of coffee per day were found to perform better on verbal and viso-spatial memory tasks than those who did not. Whilst this beneficial effect did not affect the incidence of dementia, the researchers (Ritchie et al, 2007) do not rule out the possibility that it might prolong the period of mild cognitive decline in women already in the process of developing dementia. Finally, an interesting study was carried out by Kivipelto et al (2006) which aimed to devise a simple technique to predict the risk of dementia in later life on the basis of risk factors which were present in middle age. With regard to the above-mentioned health determinants/risk factors, it is clear that there may be differences between Member States linked to different lifestyles. For example, in some countries the percentage of people who are obese, smoke, consume various amounts of alcohol or have a Mediterranean diet may differ. Nevertheless, we are unaware of any investigations regarding Member State differences in lifestyles and the incidence of dementia. However, the rates do not usually differentiate between different forms of dementia or different stages of the disease. Their work resulted in prevalence rates for men and women combined in 5 year age groups from 60 to 84 and for 85+. Their rates also differed depending on which region each country was classified as belonging to. The region Euro A covered countries in Western Europe, Euro B included countries in Eastern Europe with a low adult mortality rate and Euro C, countries in Eastern Europe with a high adult mortality rate. In terms of the actual number of new dementia cases per year for 2001, Ferri et al. However, 93 estimates vary considerably and whilst incidence seems to increase with age, actual estimates vary depending on which cases are included. Some exclude people with no diagnosis of dementia and some do not cover very mild dementia. Hospital admission is usually avoided if at all possible to provide care in another way. The reason for this is that hospital stays can be very stressful for people with dementia and can have a detrimental effect on their dementia e. Consequently, in most countries, people with dementia are not cared for in hospital. However, people with dementia may be admitted to hospital for observation, tests or other medical conditions or in the final stages of the disease. In an American study based on 21,251 patients over 60 years of age, who were discharged from a general hospital, only 3. Therefore it is complicated to obtain reliable hospital discharge data for people with dementia. Alzheimer Europe is not aware of the availability of statistics on the number of people with dementia discharged from hospital in the different Member States of the European Union. These guidelines were drawn up by the European Federation of Neurological Societies which described its aim as being to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It also investigated restrictions governing the prescription and reimbursement of such drugs. The following table shows which drugs are authorised (A) and which are reimbursed (R) in each country. Table 2 Authorisation (A) and reimbursement (R) of Alzheimer drugs Country Donepezil Rivastigmine Galantamine Memantine A R A R A R A R Austria Yes Yes Yes Yes Yes Yes Yes Yes Belgium Yes Yes Yes Yes Yes Yes Yes Yes Bulgaria Yes No Yes No Yes No Yes No Cyprus Yes Yes Yes Yes Yes Yes Yes Yes Czech Republic Yes Yes Yes Yes Yes Yes Yes Yes Denmark Yes Yes Yes Yes Yes Yes Yes Yes Estonia Yes Yes Yes Yes Yes Yes Yes Yes Finland Yes Yes Yes Yes Yes Yes Yes Yes France Yes Yes Yes Yes Yes Yes Yes Yes Germany Yes Yes Yes Yes Yes Yes Yes Yes Greece Yes Yes Yes Yes Yes Yes Yes Yes Hungary Yes Yes Yes Yes No No Yes Yes Iceland Yes Yes Yes Yes Yes Yes Yes Yes Ireland Yes Yes Yes Yes Yes Yes Yes Yes Italy Yes Yes Yes Yes Yes Yes Yes No Latvia Yes No Yes No Yes No Yes No Lithuania Yes Yes No No Yes No Yes Yes Luxembourg Yes Yes Yes Yes Yes Yes Yes Yes Malta Yes No Yes No Yes No Yes No Netherlands No No Yes Yes Yes Yes Yes Yes Norway Yes Yes Yes Yes Yes Yes Yes No Poland Yes Yes Yes Yes Yes No Yes No Portugal Yes Yes Yes Yes Yes Yes Yes Yes Romania Yes Yes Yes Yes No No Yes Yes Slovak Republic Yes Yes Yes Yes Yes Yes Yes Yes Slovenia Yes Yes Yes Yes Yes Yes Yes Yes Spain Yes Yes Yes Yes Yes Yes Yes Yes Sweden Yes Yes Yes Yes Yes Yes Yes Yes Switzerland Yes Yes Yes Yes Yes Yes Yes Yes Turkey Yes Yes Yes Yes Yes Yes Yes Yes United Kingdom Yes Yes Yes Yes Yes Yes Yes No Whilst the four drugs used in the treatment of Alzheimers disease are available in most countries, each country has its own conditions governing prescription. The following table provides brief details of some of these conditions which incidentally result in some people with Alzheimers disease not receiving the treatment they need at the time when they most need it. A few studies have investigated the number of people with Alzheimers disease being treated and have revealed that there are important differences between European countries in this respect. A survey reported by Wilkinson amongst 200 carers in 6 different countries found that whilst the majority of doctors prescribed treatment at the time of diagnosis, this varied from 51% of cases in the United Kingdom to 86% of cases in Poland and Spain. The percentage of people with dementia (diagnosed or undiagnosed) receiving treatment varied considerably from one country to another and Waldemar et al. Generally, the treatment rates were lower in Eastern European countries with only 6% of people treated in Bulgaria, 9% in the Czech Republic and 16% in Poland.