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Neurology, Pain Control and Mental Health in Referral Hospitals

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Neurology, Pain Control and Mental Health in Referral Hospitals IV CONSTITUTIONAL GOVERNMENT MINISTÉRIO DA SAÚDE Standard Treatment Guidelines Modules: Neurology, Pain control and Mental Health in Referral Hospitals. 1 Ref. No.MS/DG/CRSF/10/82 To : All health wokers in Timoe-Leste : All multi and bilateral organization supporting the Ministry of Health Subject : Introduction to the East Timor Standart Treatment Guidelines Along with discussions to update the Essential Medecines List (EML) which was approved January 2010, we have now also been able to finalize the second edition of the Standart Treatment Guidelines (STGs). This time, STGs have been prepared both for Primary Care level and for referral hospitals. The first draft standard treatment guideline was prepared for Primary Care in 2002 and has been lying with us since then. Unfortunately, several subjects could not be finished in that edition, due to different opinions and frequent treatment changes. The first edition was compiled with the help of consultants, Dr. Rudiger Kilian (Clinical Pharmacist) and Dr. Ali Sallami (Pharmacologist) who compiled the first guideline Edition, from drafts prepared by the Ministry and/or by specialists in national programs such as IMCI, Malaria et cetera. The first draft edition of standard treatment guidelines have now been compared with the latest literature and evidence based medicine, and also adjusted to match existing diagnostic resources available in healthcare in Timor Leste. Updating and corrections of the first draft from 2002 has now been done with advice and assistance of Dr Sam Tornquist (Clinical Pharmacologist/infectious diseases). This revision has both used input from evidence based medicine and a thorough process of consensus-building through workshops with prescribers. This process has also created a mechanism for future revision of treatment guidelines in Timor Leste. Several anomalies have now been set straight and we are confident that the information now contained in this STG is up to date and also matching the reality in Timor Leste. A standart treatment guideline is not a fixed document for ever, since medical scientific knowledge changes over time. Still, once the STG have been formally approved and agreed, this is an important tool to ensure quality of care and good clinical practice. I therefore request that all clinicians, contributors and programs shall follow these guidelines. Future updates of Standard Treatment Guidelines will be organized and coordinated by the Ministry of Health to match important changes in international evidence based medicine. The next revision will be due in the next two years. SAMES has updated its catalog and adjusted the buying program in line with the new medecines. However, since the buying procedures are taking time, the new product might not arrive in country for some time yet. There is also considerable amount of money involved in the discontinued items. You are requested to use up these supplies before changing your prescribing habits to the new medecines. Your are also requested not to use suspensions and injections where those are not really required. Do not practice polypharmacy. I take this opportunity to thank all the contributors and the editors for their excellent work, and wish that the information in this book could guide your in your daily works of practicing medecines. CC : The Minister of Health of RDTL The Vice – Minister of Health of RDTL 2 List of authors, clinical reviewers and referees: Baucau district referral hospital Family name Given name Specialty / position Dr Calvino Luis Ocana Orthopedics Dr Da Silva Nilton General Practitioner Dr De Rosa Abraham G General Practitioner Dr dos Santos Valentin Ob/Gyn Dr Estrada Delmis Doural Dermatology Dr Estrada Rene Oscare Dermatology Dr Gusmao dos Santos Celia A. Surgery Dr Hernandez Armando Anaesthetics Dr Laborde Barbara Ochra Paediatrics Dr Macaret Maria E Neonatology Dr Monsale Ancieto Internal Medicine Dr Mora Yaima General Practitioner Dr Murillo Rostico R. Ob/Gyn Dr Mwaura Phillip Surgery Dr Olivares Rene Luis E General surgery Dr Sanches M Angilberto Internal Medicine Dr Santana Jose Antonino Pediatric surgery Dr Sevilleno Edna Pediatric Dr Tornquist Sam Infectious diseases Suai, Cova Lima district referral hospital Dr Cortez L Liodemis General Practitioner Dr De Carvalho Irene Hospital Director, General Practitioner Dr Fajarda Tamayo Annie YS General Practitioner Dr Magno Julia R.C. Clinical Director, General Practitioner Dr Pupo Paiper Imaelda Paediatrician Dr Rjaboshenko Oleksiy Obstetrics & Gynecol. Dr Tornquist Sam Infectious diseases Maliana district referral hospital Dr Ajete Valdes Norgelis Mercedes Farmacology Dr Balenten Fournier Ernan Obstetrics & Gynaecology Dr Cabriales Pedroso Yaneisy General Practitioner Dr Calderon Reynoso Irene Alicia Pediatrician Dr Cid Medina Lissette General Practitioner Dr Cuellar Prieto Dagoberto General Practitioner Dr Fernandez Muniz Adilia Otilia General Practitioner Dr Hernandez Suares Odalys Harina Radiologist Dr Pineda Chacon Roberto Internal medicine Dr Vittorino Bere Talo Hospital Director, General Practitioner Dr Zaldivar Reyes Jorge General Practitioner Dr Tornquist Sam Infectious diseases Mobissi district referral hospital Dr Da Costa Dr.Horacio Sarmento General Practitioner Dr Pereira Gabriela da C.M General Practitioner Dr.Guitherez Francis Saison Obstetrics & Gynaecology Dr.Uris Hernandez Ramirez MGI Dr.Feliz Alesandro Lafiilla del Tores MGI Dr.Custadia B. Florindo General Practitioner Dr.Gonzales Amaro Matilde Maza Pediatrician Dr. Raimundo Danilo Gyaecology Dr. Quiala Alberto Surgery Dr. Hechararria Vidalina Internal medicine Dr. Ximenes Juliana Faria Internal medicine 3 Table of Contents Abbreviations and acronyms......................................................................................................... 8 Acknowledgements ....................................................................................................................... 8 Introduction .................................................................................................................................. 9 Selection of medicines in the Guidelines and Essential Medicines List…………………………………….9 Generic names…………………………………………………………………………………………………….10 Neurology in referral hospitals. .................................................................................................. 11 Orofacial conditions and pain…………………………………………………………………………………….11 Facial nerve (Bell's) palsy ............................................................................................................... 11 Trigeminal neuralgia ....................................................................................................................... 11 Headache…………………………………………………………………………………………………………..12 Migraine .......................................................................................................................................... 13 Epilepsy…………………………………………………………………………………………………………….15 Involuntary movement disorders………………………………………………………………………………..19 Parkinson's disease ........................................................................................................................ 19 Essential tremor .............................................................................................................................. 19 Chorea ............................................................................................................................................ 20 Drug-treatment-induced dystonia. ................................................................................................... 20 CNS infections……………………………………………………………………………………………………..20 Meningitis ........................................................................................................................................ 20 Bacterial meningitis - Management prior to hospitalisation ............................................................. 20 Immediate and early hospital management of meningitis ............................................................... 21 Empirical treatment of meningitis before organism is known .......................................................... 21 Directed treatment, against identified pathogens. ........................................................................... 22 Listeria monocytogenes meningitis ................................................................................................. 22 Neisseria meningitidis ..................................................................................................................... 22 Pneumococci - Streptococcus pneumoniae meningitis ................................................................... 23 Pneumococci meningitis with Strains relatively resistant to penicillin (MIC 0.125 to 1 mg/L) .......... 23 Herpes simplex encephalitis, suspected or proven ......................................................................... 24 Central nervous system infection with Herpes zoster (shingles) ..................................................... 24 Acute pain of herpes zoster ............................................................................................................ 25 Postherpetic neuralgia…………………………………………………………………………………………….25 Cerebrovascular disorders……………………………………………………………………………………….26 Stroke………………………………………………………………………………………………………………..26 Subarachnoid haemorrhage……………………………………………………………………………………..26 Prevention and management of risk-factors…………………………………………………………………..27 Primary stroke-prevention ..............................................................................................................
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