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The initial episode of rheumatic fever can usually be prevented by early treatment of streptococcal pharyngitis (See 33) Prevention of recurrent episodes is critical Recurrences of rheumatic fever are most common in patients who have had carditis during their initial episode and in children, 20% of whom will have a second episode within 5 years Recurrences are uncommon after 5 years following the first episode, and in patients over 25 years of age Prophylaxis is usually discontinued after these times except in groups with a high risk of streptococcal infection parents or teachers of young children, nurses, military recruits, etc Secondary prevention of rheumatic fever depends on whether carditis has occurred If there is no evidence for carditis, preventive therapy can be stopped at age 21 years If carditis has occurred but there is no

tion can initiate a fibrinous and fibrotic process in the pericardium, presenting as subacute pericarditis or constriction Radiation pericarditis usually follows treatments of more than 4000 cGy delivered to ports including more than 30% of the heart Other causes of pericarditis include connective tissue diseases, such as lupus erythematosus and rheumatoid arthritis, drug-induced pericarditis (minoxidil, penicillins), and myxedema

McDonald M et al Acute rheumatic fever: a chink in the chain that links the heart to the throat Lancet Infect Dis 2004 Apr; 4(4):240 5 [PMID: 15050943]

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The quantity contract does not transfer requirements This means that: It does not create a requirement for stock within the plant and subsequently there is no confirmation of stock within the plant for the contract It does not require production to make the stock to satisfy the contract It does not require material management to purchase the stock to satisfy the contract (if it is a trading good) The requirement is placed on the plant when the release order is created with reference to the quantity contract The contract itself has no schedule lines It does have a validity date The contract allows the customer to have a special price per material for a limited quantity This quantity decreases each time an order is made by the stock ordered Once the contract validity date expires or the customer has purchased the full quota of stock, the contract expires, and a new one must be created Quantity contracts have no schedule lines or specific delivery dates, as they are not delivered An order from a contract is called a release order; the delivery is done from the release order For example, a contract is made with a quantity of 1,000 items Then each order the customer places with reference to this contract will decrease the available quantity of this contract So if the customer places an order for 100 units, the open contract quantity becomes 900 units Note that this only applies if you have set the Update Document Flow checkbox as enabled on the item category in the copy control rules If this is not set, the customer can order as much as he would like, without regard to the contract quantity being updated Quantity contracts can be used to limit the customer s purchasing; you can block the standard order type for a customer and so force him to use an order type that must be created with reference to a quantity contract Thus, this customer is limited to only ordering 1,000 items A quantity contract has validity periods and can have cancellation rules To create a contract, use the following menu path.

Anterior pleuritic chest pain that is worse supine than upright Pericardial rub Fever common Erythrocyte sedimentation rate usually elevated ECG reveals diffuse ST segment elevation with associated PR depression

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