if anyone needs these question papers .
they can email me...
pratyush410@yahoo.co.in
lasik stand for "laser in situ keratomileusis"
its one of the latest surgery done to correct refractory errors and improve vision.
keratomileusis means cutting the cornea into very thin flaps by the help of microkeratome.
its done in the case of 1 . myopia
2. hypermetropia
3. astigmatism
befor undergoing surgery person should fulfill certain criterias like:-
Be 18 years old and healthy Have healthy eyes - there should be no infection, glaucoma or dry eyes Refraction of the eye should be stable for at least a year Not be on prescription drugs, like oral prednisone Not be pregnant or nursing Not suffering from degenerative or autoimmune diseaseThe 9 abdominal regions take a bit more time to name. I'm sure, however, that you can find the Umbilical region . . . around the umbilicus, of course! The areas above and below are given terms relative to the stomach (or at least where people think the stomach is: Epigastric (Epi = above, gastric = stomach), and Hypogastric (Hypo = below, gastric = stomach). The six remaining regions are divided into left and right , so there are only three more names to learn. The regions on either side are named according to the area of the spine (the lumbar region is the lower back): Left Lumbar and Right Lumbar. The regions on either side of the Hypogastric are named according to the bone that makes up the crest of the pelvis (The Iliac crest): Left Iliac and Right Iliac. Lastly, the two regions on either side of the Epigastric are named according to the organs' placement below the cartilage (chondro = cartilage) attaching the ribs to the sternum (costal cartilage, costal = ribs). Since these organs are under the cartilage, their names should make sense: Left Hypochondriac and Right Hypochondriac
The US Food and Drug Administration (FDA) announced today that it has approved 4 vaccines against the 2009 influenza A (H1N1) virus, formerly known as "swine flu." The vaccine lots are expected to be available and distributed within the next 4 weeks.
The FDA said that the vaccines, based on early data, effectively elicit an immune response in most healthy adults about 8 to10 days after vaccination.
some lots of the H1N1 vaccine will contain the preservative thimerosal and others will not. The FDA has been continuing its efforts toward reducing thimerosal used in vaccines.
The FDA warns that persons with known allergies to chicken eggs or any other substance in the vaccine should probably not be vaccinated, although in the ongoing clinical trials, the vaccines have been well tolerated. The most common adverse effect is soreness at the injection site; other adverse effects can include a mild fever, body aches, and fatigue for a couple of days after vaccination. For the nasal spray delivery system, the most common adverse effects were runny nose, nasal congestion in all ages, sore throats in adults, and fever in children aged 2 to 6 years.
a change in posture alters the hydrostsatic pressure in the blood vessel affecting TRANSMURAL pressure and also on venous capacity.
hydrostatic pressure :- in supine or prone posture all blood vessels are approximatelyat the level of the heart.when standing there is increase in arterial and venous pressure below the level of the heart and decrease in arterial and venous pressure above the level of heart.
there is reflex compensation due to decrease in end diastolic volume caused by sudden standing,it is detected by atrial stretch receptors and the decrease in mean arterial blood pressure is detcted by carotid baroreceptors.
so it leads to:-
1 increse in heart rate and myocardial contractility
2 vasoconstriction in the skeletal musculature,skin ,kidneys and gut increasing total peripheral resistance
3 venocostriction in all veins , but in particular in those of skin and gut.
Burning feet is a condition where feet feel painfully hot.
its a very common complaint seen in various conditions
age over 50,diabetese
conditions are:-
mechanical,
neuropathy,
chronic alcoholics ,
vitamin deficiency,
thrombocytopenia,
pernicious anemia,
The patients have been categorised as follows: Category A: Patients with mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor. No testing of the patient for H1N1 is required. Patients should confine themselves at home and avoid mixing up with public and high risk members in the family. Category B: (i) In addition to all the signs and symptoms of Category A, if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir; (ii) In addition to all the signs and symptoms of Category A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir: children under five, pregnant women, those above 65 years, those with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS; Patients on long term cortisone therapy. No H1N1 tests are required for Category-B (i) and (ii). Such patients should confine themselves at home and avoid mixing with public and high-risk members in the family. Category C: In addition to the symptoms of Categories A and B, if the patient has one or more of the following: –Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails; – Irritability among small children, refusal to accept feed; – Worsening of underlying chronic conditions. Such patients require testing, immediate hospitalisation and treatment.
Every facility providing maternity services and care for newborn infants should:Ten Steps to Successful Breastfeeding
GIVEN BELOW ARE THE OLDER CHANGES, FOR LATEST CHANGES READ
*The number of specimen required for diagnosis of smear positive pulmonary TB is two,
RNTCP LATEST CHANGES
*The number of specimen required for diagnosis of smear positive pulmonary TB is two,
with one of them being a morning sputum specimen.
*earlier 3 weeks of cough was necessary, now its of only 2 weeks..
*One specimen positive out of the two is enough to declare a patient as smear positive
TB.
*RNTCP Launches Cat IV (DOTS Plus) treatment for Multi-Drug
Resistant TB {link http://www.tbcindia.org/pdfs/RNTCP%20Launches%20DOTS%20Plus%20treatment.pdf}
* Cat V is for XDR-TB.
*Switched to Category V treatment: A Category IV patient who during treatment is identified as an
“XDR-TB suspect” and who is found to have XDR-TB on testing by an NRL, who subsequently has had
their Category IV treatment stopped and RNTCP Category V treatment initiated.
Definition:-
Multi-drug resistant tuberculosis (MDR-TB) is defined as an isolate of M. tuberculosis resistant to at least isoniazid and rifampicin.
with or without other
anti-tubercular drugs based on DST results from an RNTCP accredited Culture & DST Laboratory.
All patients that are identified with MDR-TB and are to be treated with an RNTCP Category IV regimen,
Extensively drug-resistant tuberculosis (XDR-TB) is TB showing resistance to at least rifampicin, isoniazid, and any fluoroquinolone, and to at least 1of the 3 following injectable drugs used in anti-TB treatment: capreomycin, kanamycin and amikacin
• Mono-resistance: A patient whose TB is due to tubercle bacilli that are resistant in vitro to exactly one
anti-TB drug in an RNTCP accredited laboratory.
• Poly-resistance: A patient whose TB is due to tubercle bacilli that are resistant in-vitro to more than
one anti-TB drug, except not both isoniazid and rifampicin in an RNTCP accredited laboratory.
• Poly-resistance: A patient whose TB is due to tubercle bacilli that are resistant in-vitro to more than
one anti-TB drug, except not both isoniazid and rifampicin in an RNTCP accredited laboratory.
· * Drug-resistant case: A patient whose TB is due to tubercle bacilli that are resistant in vitro to at least to one anti-TB drug according to accepted laboratory methods in an RNTCP accredited laboratory.
*its available in downloadable format .
RECOMMENDATIONS FOR PUBLIC HEALTH PERSONNEL For interviews of an ill, suspected or confirmed SIV case, the following is recommended: For collecting respiratory specimens from an ill confirmed or suspected SIV case, the following is recommended: Infection Control Recommended Infection Control for a hospitalized patient: Recommended PPE for personnel providing clinical care to ill individuals: Antiviral Treatment Initiate treatment as soon as possible after the onset of symptoms. Oseltamivir: Zanamivir is an alternative for treatment of influenza in patients aged 7 years and older; dosage varies by age. This drug is not approved for treatment of influenza in children aged <7> Antiviral Chemoprophylaxis Close contact is defined as: within about 6 feet of an ill person who is a confirmed case of swine influenza A virus infection (e.g. post-exposure chemoprophylaxis following unprotected close exposure). Duration of antiviral chemoprophylaxis is 7 days after the last known exposure Oseltamivir: Administered by mouth once a day for seven days following the last known exposure; dosage varies by age and weight for children aged 1 year to 12 years (available in suspension, 30mg, 45mg, 75mg capsules) Zanamivir is an alternative for chemoprophylaxis for patients aged 5 years and older; dosage varies by age. It is an orally inhaled drug that is administered using a disk inhaler device. Follow-up Monitoring of Exposed Close Contacts
For interviews of healthy individuals (i.e. without a current respiratory illness), including close contacts of cases of confirmed swine influenza virus infection, no personal protective equipment or antiviral chemoprophylaxis is needed. See section on antiviral chemoprophylaxis for further guidance.
Recommended Infection Control for a non-hospitalized patient (ER, clinic or home visit):
Antiviral treatment for confirmed or suspected ill case of swine influenza virus infection may include either oseltamivir or zanamavir, with no preference given at this time. Recommendations for use of antivirals may change as data on antiviral susceptibilities become available.
Antiviral chemoprophylaxis (pre-exposure or post-exposure) can be considered for close contacts of a confirmed or highly suspected case of swine influenza virus infection.
Close contacts are defined as persons who were within about 6 feet of the confirmed swine influenza case while the case was ill up to 7 days after the case’s illness onset. Examples include household members, social contacts, public health care workers, medical health care workers, and others.
download this powerpoint presentaton from below link
http://www.unicef.org/nutrition/files/BFHI_Revised_Section2.4.a_Slides.ppt
This is a new influenza A(H1N1) virus that has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses. The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces. To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible. There are no known instances of people getting infected by exposure to pigs or other animals. The place of origin of the virus is unknown. Signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea. Seasonal influenza occurs every year and the viruses change each year - but many people have some immunity to the circulating virus which helps limit infections. Some countries also use seasonal influenza vaccines to reduce illness and deaths. But influenza A(H1N1) is a new virus and one to which most people have no or little immunity and, therefore, this virus could cause more infections than are seen with seasonal flu. WHO is working closely with manufacturers to expedite the development of a safe and effective vaccine but it will be some months before it is available. The new influenza A(H1N1) appears to be as contagious as seasonal influenza, and is spreading fast particularly among young people (from ages 10 to 45). The severity of the disease ranges from very mild symptoms to severe illnesses that can result in death. The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems. A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures). Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.) Up-to-date as of 23 July 2009 (Originally posted on 2 May 2009 and revised on 27 May and 12 July 2009) Inactivated influenza vaccine can be given at the same time as other injectable non-influenza vaccines, but the vaccines should be administered at different injection sites. Advice is being developed at present by regulatory authorities on co-administration of pandemic and seasonal influenza vaccines and will be provided when available. Once the first doses of pandemic influenza A(H1N1) vaccine become available, national health authorities will decide how to implement national vaccination campaigns.What is the new influenza A(H1N1)?
How do people become infected with the virus?
What are the signs and symptoms of infection?
Why are we so worried about this flu when hundreds of thousands die every year from seasonal epidemics?
Most people experience mild illness and recover at home. When should someone seek medical care?
Use of pandemic influenza A (H1N1) vaccines
Will it be possible to deliver influenza A (H1N1) vaccine simultaneously with other vaccines?
How can a person who wishes to be vaccinated against influenza A (H1N1) receive the vaccine?
diabetes are prone to many infections.like malignant otitis externa,pyelonephritis,cholecystitis,acute necrotising fascitis..its multi factorial. The main effect f hyperglycemia and additional immune disturbance in type I diabetics do play role. The impairment of wide range of functions in neutrophils and macrocytes (Macrophages) including chemotaxis and adherence phagocytosis and intracellular killing of microorganisms is brought by hyperglycemia. In diabetes the movement of phagocytic cells may be generally impaired.[The W.H.O. has included diabetes in its classification of secondary immunodeficiency diseases].
The development of secondary immunodeficiency seems to be determined by alterations involving at generally including polymorphonuclear granulocytes and/or lymphocytic subsets activity.
Polymorph nuclear granulocytes represent the host’s first defense barrier against bacterial agents. Alternation in chemo taxis, phagocytosis, immunoglobulin production and complement functions do occur in diabetic patients. Polymorph nuclear granulocytes, cells from diabetics have a reduced chemo taxis especially when the diabetes is poorly controlled. There are two stages of phagocytosis adhesion and ingestion of microorganisms into intracytoplasmic vacuoles. An increase in sialidase enzyme secretion together with a corresponding reduction in cell membrane sialic acid may play part along with defective lactin receptors losing their capacity to recognize target and fail to initiate phagocytosis. The critical step of intracellular killing is mediated by the intracellular release of toxic free radicals, super oxides and hydrogen peroxide. This respiratory burst which is impaired in diabetics correlates with intracellular killing. This whole process is dependent on nicotinamide adenine dinucleotide phosphate (NADPH).
The NADPH is normally generated by the metabolism of glucose through the hexose monophosphate shunt and in diabetes more glucose enters the phatogocytes and is metabolized by the polyol Pathway. Aldose reductase, the rate limiting enzyme of this process requires NADPH and this is consumed when flux through polyol pathway increase. This competition for NADPH is thought to account for the reductions in the respiratory burst and in intracellular killing.
The metabolic disturbances associated with diabetes are probably important in impairing the function of polymorphonuclear cells. Once phagosome and lysosome fusion has taken place. Killing is carried out by lysosomal enzymes. A decrease in the killing capacity of polymorph nuclear granulocytes associated with high blood sugar may come to normalization within 48 hours after correction of blood sugar levels.
Several immunoglobulin levels IgG and IgA have been reported to be reduced in diabetics as compared to normal. As well as a significant reduction in the quantity and functional activity of complement components may occur in diabetic patients. Above all these local factors like underlying susceptibility to infection, vascular disease, nerve damage and increase in blood sugar may aggravate the process. This may call upon decrease circulation, hypoxia and reduction in absorption of antibiotics and proliferation of bacteria.
In type I or IDDM, genetics predisposition to infections also plays part. Along with all above factors which are abnormalities of aspects of phagocyte functions – mobilization and chemo taxis, adherence phagocytosis and intracellular killing with bactericidal activities, micro vascular circulations abnormality may result in decreased tissue perfusion. Hyperglycemia per say reduces oxidative killing capacity because of increased glucose Metabolism through polyol pathway depleting NADPH which is necessary for generation of super oxide free radicals.
In type I or IDDM, there is alteration in some lymphocyte subpopulations, a reduction in ‘T’ lymphocytes and under specifically in the number of CD4 phenotype. (‘C’ helper ‘T’ Lymphocytes) and reduction in CD4/CD8 ration serum immunoglobulin levels IgG and IgA have been reported to be reduced in diabetics compared to normal. As well as significant reduction in the quantity and functional activity of complements may occur in Diabetic patients. An underlying susceptibility of target tissues due to hyperglycemia, vascular disease and nerve damage is proved with the relative tissue hypoxia may cause proneness to infections. A reduction in antibiotic absorption due to microangiopathy may lead to persistence of infections. A reduction in antibiotic absorption due to microangiopathy may lead to persistence of infection. About 25% of IDDM subjects have this.
Polymorph nuclear granulocytes represent the host’s first defense barrier against bacterial agents. Alternation in chemo taxis, phagocytosis, immunoglobulin production and complement functions do occur in diabetic patients. Polymorph nuclear granulocytes, cells from diabetics have a reduced chemo taxis especially when the diabetes is poorly controlled. There are two stages of phagocytosis adhesion and ingestion of microorganisms into intracytoplasmic vacuoles. An increase in sialidase enzyme secretion together with a corresponding reduction in cell membrane sialic acid may play part along with defective lactin receptors losing their capacity to recognize target and fail to initiate phagocytosis. The critical step of intracellular killing is mediated by the intracellular release of toxic free radicals, super oxides and hydrogen peroxide. This respiratory burst which is impaired in diabetics correlates with intracellular killing. This whole process is dependent on nicotinamide adenine dinucleotide phosphate (NADPH).
The NADPH is normally generated by the metabolism of glucose through the hexose monophosphate shunt and in diabetes more glucose enters the phatogocytes and is metabolized by the polyol Pathway. Aldose reductase, the rate limiting enzyme of this process requires NADPH and this is consumed when flux through polyol pathway increase. This competition for NADPH is thought to account for the reductions in the respiratory burst and in intracellular killing.
The metabolic disturbances associated with diabetes are probably important in impairing the function of polymorphonuclear cells. Once phagosome and lysosome fusion has taken place. Killing is carried out by lysosomal enzymes. A decrease in the killing capacity of polymorph nuclear granulocytes associated with high blood sugar may come to normalization within 48 hours after correction of blood sugar levels.
Several immunoglobulin levels IgG and IgA have been reported to be reduced in diabetics as compared to normal. As well as a significant reduction in the quantity and functional activity of complement components may occur in diabetic patients. Above all these local factors like underlying susceptibility to infection, vascular disease, nerve damage and increase in blood sugar may aggravate the process. This may call upon decrease circulation, hypoxia and reduction in absorption of antibiotics and proliferation of bacteria.
In type I or IDDM, genetics predisposition to infections also plays part. Along with all above factors which are abnormalities of aspects of phagocyte functions – mobilization and chemo taxis, adherence phagocytosis and intracellular killing with bactericidal activities, micro vascular circulations abnormality may result in decreased tissue perfusion. Hyperglycemia per say reduces oxidative killing capacity because of increased glucose Metabolism through polyol pathway depleting NADPH which is necessary for generation of super oxide free radicals.
In type I or IDDM, there is alteration in some lymphocyte subpopulations, a reduction in ‘T’ lymphocytes and under specifically in the number of CD4 phenotype. (‘C’ helper ‘T’ Lymphocytes) and reduction in CD4/CD8 ration serum immunoglobulin levels IgG and IgA have been reported to be reduced in diabetics compared to normal. As well as significant reduction in the quantity and functional activity of complements may occur in Diabetic patients. An underlying susceptibility of target tissues due to hyperglycemia, vascular disease and nerve damage is proved with the relative tissue hypoxia may cause proneness to infections. A reduction in antibiotic absorption due to microangiopathy may lead to persistence of infections. A reduction in antibiotic absorption due to microangiopathy may lead to persistence of infection. About 25% of IDDM subjects have this.
Nelson Textbook of Pediatrics 18th Edition
Nelson Textbook of Pediatrics e-dition, 18th Edition & Atlas of Pediatric Physical Diagnosis, 5th Edition Package
by Robert M. Kliegman, Richard E. Behrman, Hal B. Jenson, Bonita F. Stanton, Basil J. Zitelli, Holly W.
Publisher: Saunders
Publication Date: 2007-08-29
1- The Field of Pediatrics
http://mihd.net/148lw5s
2-Growth, Development
http://mihd.net/0wo38kc
3-Psychologic Disorders
http://mihd.net/lv265zg
4-Children with Special Needs
http://mihd.net/qwzjoge
5-Nutrition
http://mihd.net/24c1zd3
6-Pathophysiology of Body Fluids
http://mihd.net/7rdnofc
7-Pediatric - Drug Therapy
http://mihd.net/hjgzu80
8-The Acutely Ill Child
http://mihd.net/bxng38y
9-Human Genetics
http://mihd.net/vnpl068
10-The Fetus and the Neonatal Infant
http://mihd.net/c4mxuki
11-Adolescent Medicine
http://mihd.net/kytp4a1
12-Immunology
http://mihd.net/a6bqxi2
13-Allergic Disorders
http://mihd.net/gsyvi76
14-Rheumatic Diseases
http://mihd.net/ic5xfmn
15-Infectious Diseases
http://mihd.net/2ocwequ
16-The Digestive System
http://mihd.net/ixunp2z
17-The Respiratory System
http://mihd.net/4sfprjk
18-The Cardiovascular System
http://mihd.net/qudapx8
19-The Diseases Of Blood
http://mihd.net/sdn5341
20-Cancer and Benign Tumors
http://mihd.net/qwb8mla
21-Nephrology
http://mihd.net/mq1dl9o
22-Urologic Disorders
http://mihd.net/so93ql6
23-Gynecologic Problems
http://mihd.net/qva0xgw
24-Endocrine System
http://mihd.net/va2tdkx
25-The Nervous System
http://mihd.net/sx28ha6
26-THe Neuromuscular Disorders
http://mihd.net/ickty1h
27-Eye
http://mihd.net/4vi0c6y
28-Ear
http://mihd.net/jfa2yuh
29-Skin
http://mihd.net/riwd768
30-Bone And Joint Disorders
http://mihd.net/rc6mq0z
31-Environmental health Hazards
http://mihd.net/jmo9lvi
32-Laboratory medicine
http://mihd.net/dc5jx34
or
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pass:
http://www.medishared.com
hi friends......
1 more link 4 downloading ebooks....
its quite good ........
u can download davidson harrison nelsons n more....
hope it will be useful 4 u
hi friends........
here r some sites from where u can download
some very good medical e books and ppt presentations
hi friends.....
last week i had seminar on anatomy of pns.
so i hav uploaded my ppt presentation on slideshare
u can use this linkhttp://www.slideshare.net/pratyush410/anatomy-of-paranasal-sinuses
thanx......
ur feedbacks plz.
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