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By: U. Koraz, M.A.S., M.D.

Vice Chair, Liberty University College of Osteopathic Medicine (LUCOM)

Existing health and basic services like drinking water medications qid generic 200 mg atripla, housing 909 treatment proven atripla 200mg, electricity administering medications 7th edition answers quality atripla 300mg, drainage medications in canada best atripla 300mg, sewerage etc, are difficult to access for most of urban poor populations living in slum or slum-like conditions. There are a number of factors which determine the access to basic services by urban poor. These range across lack of government priorities in urban health, inadequate public health infrastructure in urban areas, varying socio-economic, environment and infrastructural conditions among vulnerable and non- Indian Journal of Public Health Research & Development. Around 21 % of the total urban populations live in slums (National Commission of Population, 2000), but many of slum populations also comprise of squatter populations, migrant colonies, pavement dwellers, families on construction sites, street. Rapid urbanization and tourism has resulted into growth of many congested and slum-like areas in different parts of Gangtok town6. According to a report of Planning Commission, rapid increase in urban population is putting greater strain on the urban infrastructure which is already overstretched 11 Since the urban areas do not have primary healthcare structure like in rural areas, there is a possibility that many vulnerable groups are left out of primary healthcare and family welfare services. The present study was undertaken to explore and understand the health seeking behavior of residents of slum like areas of urban areas of Gangtok. Identification of 12 slum like areas was done by scanning the entire city of Gangtok. These areas were identified on the basis of being run-down areas of the city characterized by sub-standard housing, congestion which had slum-like pockets of population. With 95 % confidence level and confidence interval of 8, a total of 136 households were included in the study, which were selected by stratified random sampling. The instruments used for data collection were formulated and finalized after field testing prior to conduction of the study. The data regarding health seeking behavior was recorded for the sickness which occurred in the previous two weeks. The data was analyzed using statistical methods namely measures of central tendency and frequency distribution. Table 1 Demographic Profile Total Population Of Underprivileged areas Total no of households in Underprivileged areas Total no of households Surveyed Total Population Surveyed Total No. Educational status Only 11 % of the population had educational qualification of matriculation and above. Table 2 Distribution of population according to sex and education Education Illiterate Up to 5th class 6th to 10th class >class 10 Total Male(%) 105(34. The main occupations for both male and females 222 Indian Journal of Public Health Research & Development. Very insignificant proportion of urban population studied is engaged in agriculture. This signifies that the government facilities are the main source of services related to delivery. In a study carried out by Goswami Mihir et al 7 regarding socio-demographic and morbidity profile of slum like area in Ahmedabad, the observed difference between literate and illiterate was statistically significant. In another study carried out by Marimuthu P et al at Delhi slums8, however found higher literacy rate (73. According to a study by Abdullahel Hadi et al in Afghanistan 10, the use of services among working women was higher than among non-working women, especially better educated women living in urban areas. The inequality in the use of antenatal care persists due to lack of access to health services which can be reduced by expanding outreach health facilities in the remote communities. When the findings of the present study were compared with another study of urban population carried out by Puvar Tapasvi et al at Ahmedabad,11 it was found that all deliveries were conducted in the hospital and the community depended heavily upon the private practitioner for the management of common ailments was private sector (87%). In the present study, the utilization of health facilities in private sector was very low. Due to rapid urbanization and tourism there has been a growth of pockets of population in Gangtok city. In many respects urban slums in Gangtok are different from those in other cities of India. Due to hilly terrain and abundant availability of water and electricity, these pockets of population relatively are better off.


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While it is the most reliable aid to support the clinical diagnosis but it may not be feasible to do in all cases medicine 60 best atripla 600mg. It is reserved only in those cases in which differential diagnosis includes salpingitis symptoms after embryo transfer best 600 mg atripla, appendicitis or ectopic pregnancy symptoms kidney proven atripla 600mg. Laparoscopic findings and severity of pid: x Mild: Tubes: Edema medicine 6 year in us generic atripla 300mg, erythema, no purulent Curtis syndrome) may occur in 5­10 per cent of cases of acute salpingitis. The liver is involved due to transperitoneal or vascular dissemination of either gonococcal or chlamydial infection. Vaginal examination reveals: (1) Abnormal vaginal discharge which may be of purulent. But as already emphasized, one should not wait for the report, instead treatment should be started empirically. The materials are to be subjected to Gram stain and culture (aerobic and anaerobic). Gram stain of the discharge may be positive for gram-negative intracellular diplococci of N. However, the status of the sexual partner is the single most important clue to the diagnosis of chlamydial infection. If the woman has a stable sexual relationship with asymptomatic man, the clinical manifestations are unlikely to be due to chlamydial infection. It may be employed where clinical examination is difficult or is not informative because of acute tenderness or obesity. Culdocentesis: Aspiration of peritoneal fluid and its white cell count, if exceeds 30,000 per mL. Bacterial culture from the fluid is not informative because of vaginal contamination. Investigations are also to be extended to male partner and smear and culture are made from urethral secretion. The two conditions-acute appendicitis and disturbed ectopic pregnancy must be ruled out, because both the conditions require urgent laparotomy whereas acute salpingitis is to be treated conservatively. Outpatient therapy: Apart from adequate rest and analgesic, antibiotics are to be prescribed even before the microbiological report is available. As because the infection is polymicrobial in nature, instead of single, combination of antibiotics should be prescribed. All patients treated in the outpatients are evaluated after 48 hours and if no response, are to be hospitalised. Inpatient therapy: the patients are to be hospitalized for antibiotic therapy in the conditions as mentioned in Table 10. Intravenous antibiotic therapy is recommended for at least 48 hours but may be extended to 4 days, if necessary (Table 10. Improvement of the patient is evidenced by remission of temperature, improvement of pelvic tenderness, normal white blood cell count and negative report on bacteriological study. The only unequivocal proof of successful treatment after salpingitis is an intrauterine pregnancy. Too often, multiple organisms are present and it is difficult to pinpoint a particular organism responsible for a particular type of infection. Malnutrition, unhygienic environment during delivery, dehydration and ketoacidosis during labor are the additional factors in underprivileged women. Following abortion, specially when induced criminally, exogenous infection is quite likely and potentially virulent. To prevent reinfection: the following formalities are to be rigidly followed to prevent reinfection: x Educating the patient to avoid reinfection and the potential hazards of it. The infection may spread to the myometrium producing endomyometritis which is limited by a leucocytic barrier. On occasion, the infection spreads to the parametrium, usually to one side, through lymphatics or directly through the tear of the cervix; thereby gaining access to the base of the broad ligament. The infection may also spread upwards through the tubal openings into the tubal lumen producing endosalpingitis. Thus, the fallopian tube is affected either from outside following parametritis, through lymphatics producing perisalpingitis or through endosalpingitis. The ovary may be affected through involvement of the tube or following pelvic peritonitis. Spread of infection: Depending upon the virulence of the organisms and resistance of the host, the following events may occur.

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Here medications vertigo effective atripla 200 mg, the fibers are organized so that those closest to the genu are concerned with cervical portions of the body medications 25 mg 50 mg safe 200mg atripla, while those situated more posteriorly are concerned with the lower extremity medications that interact with grapefruit safe atripla 300mg. The tract then continues through the middle three-fifths of the basis pedunculi of the midbrain medicine x 2016 proven atripla 600 mg. Here,the fibers concerned with cervical portions of the body are situated medially, while those concerned with the leg are placed laterally. On entering the pons, the tract is broken into many bundles by the transverse pontocerebellar fibers. In the medulla oblongata, the bundles become grouped together along the anterior border to form a swelling known as the pyramid (hence the alternative name, pyramidal tract). At the junction of the medulla oblongata and the spinal cord, most of the fibers cross the midline at the decussation of the pyramids. About one-third of the fibers originate from the primary motor cortex (area 4), one-third originate from the secondary motor cortex (area 6), and one-third originate from the parietal lobe (areas 3, 1, and 2); thus, two-thirds of the fibers arise from the precentral gyrus, and one-third of the fibers arise from the postcentral gyrus. The remaining fibers do not cross in the decussation but descend in the anterior white column of the spinal cord as the anterior corticospinal tract. These fibers eventually cross the midline and terminate in the anterior gray column of the spinal cord segments in the cervical and upper thoracic regions. The lateral corticospinal tract descends the length of the spinal cord; its fibers terminate in the anterior gray column of all the spinal cord segments. Most corticospinal fibers synapse with internuncial neurons, which, in turn, synapse with alpha motor neurons and some gamma motor neurons. Reticulospinal Tracts 157 the corticospinal tracts are not the sole pathway for serving voluntary movement. Rather, they form the pathway that confers speed and agility to voluntary movements and is thus used in performing rapid skilled movements. Many of the simple, basic voluntary movements are mediated by other descending tracts. Once alerted, the subcortical regions may react and send their own nervous impulses to the alpha and gamma motor neurons by other descending pathways. Branches are given off early in their descent and return to the cerebral cortex to inhibit activity in adjacent regions of the cortex. Branches pass to the caudate and lentiform nuclei, the red nuclei, and the olivary nuclei and the reticular formation. From the pons, these neurons send axons, which are mostly uncrossed, down into the spinal cord and form the pontine reticulospinal tract. From the medulla, Cerebral cortex Thalamus Red nucleus Midbrain Pons Deep cerebellar nuclei Reticular formation Cerebellum Medulla oblongata Pontine reticulospinal tract Medullary reticulospinal tract Lower motor neuron Figure 4-22 Reticulospinal tracts. The reticulospinal fibers from the pons descend through the anterior white column, while those from the medulla oblongata descend in the lateral white column. Both sets of fibers enter the anterior gray columns of the spinal cord and may facilitate or inhibit the activity of the alpha and gamma motor neurons. By these means,the reticulospinal tracts influence voluntary movements and reflex activity. The reticulospinal fibers are also now thought to include the descending autonomic fibers. The reticulospinal tracts thus provide a pathway by which the hypothalamus can control the sympathetic outflow and the sacral parasympathetic outflow. Most of the fibers cross the midline soon after their origin and descend through the brainstem close to the medial longitudinal fasciculus. The tectospinal tract descends through the anterior white column of the spinal cord close to the anterior median fissure. The majority of the fibers terminate in the anterior gray column in the upper cervical segments of the spinal cord by synapsing with internuncial neurons. These fibers are believed to be concerned with reflex postural movements in response to visual stimuli. Superior colliculus Midbrain Eye Tectospinal tract in anterior white column of spinal cord Lower motor neuron Figure 4-23 Tectospinal tract. The axons of neurons in this nucleus cross the midline at the level of the nucleus and descend as the rubrospinal tract through the pons and medulla oblongata to enter the lateral white column of the spinal cord.

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Now in the 2000s medications 4h2 safe atripla 200 mg, across the world there are government health promotion strategies and reviews medicine 0025-7974 trusted 200 mg atripla, statutory authorities and foundations medicine park ok order 600 mg atripla, consumer interest groups medications54583 quality 200mg atripla, professional associations and journals. In addition to this, there are universities and colleges offering masters and bachelor degrees in health promotion which is a great achievement in itself. Millions of dollars are now increasingly being invested in health promotion programs by governments and international organizations, including the World Bank, as well as through voluntary contributions from people themselves26. In the future, health promotion will be long term and even though government and international organizations are spending millions of dollars, health promotion continues to be surrounded by many chal- Indian Journal of Public Health Research & Development. One of the major future challenges is to create high level of professionalism among health promoters because most of the health promoters throughout the world are from another discipline which somewhat had narrow knowledge and training of health promotion. Also, modern health promoters need to acquire knowledge and training such as organizational skills, networking, advocacy, and activism. Also, only limited resources have been used to strengthen health promotion, so there is no reason to believe that it has a detrimental effect on hospital activities by reallocating resources from the core functions of the hospital. Developed and developing countries must cooperate to ensure that the discipline of health promotion is well established in order to promote conditions supportive of health improvement. Additionally, there is an uncertainty about health promotion among different settings. For example, how do we run health promotion effectively together with the health care industry and the environment movements that are now so dominant in our society? How could we make health promotion be recognized as a distinct discipline, and where we should spend our efforts? The current state and challenges for the future of health promotion in Polish older people. Health promotion hospitals: a typology of different organizational approaches to health promotion. Rekindling the flame: routine practices that promote hospital community leadership. Institute of Medical Sciences and Research Centre, Davangere, 2 Assistant professor, Department of Community Medicine, S. Institute of Medical Sciences and Research Centre, Davangere, 3Research Scholar, Department of Microbiology, Gulbarga University, Gulbarga, 4Reader, Department of Microbiology, Gulbarga University, Gulbarga 5Lecturer, Department of Microbiology, K. Institute of Medical Sciences and Research Centre, Davangere, 7Assistant professor, Department of Physiology, S. Early and effective treatment based on the knowledge of causing micro organisms and their sensitivity results in good clinical recovery and prevents from damage and complications. Methods After clinical evaluation, middle ear secretion was taken for bacteriological examination from 250 patients meeting the inclusion criteria. All children with cholesteatoma and those with tumors occluding the (ear) canal were excluded. The samples were processed as per the standard microbiological techniques Results A total of 272 bacterial agents were isolated from 250 patients aged between 8 months and 65 years. Amikacin was found to be the most suitable drug followed by ceftazidime for Pseudomonas aeruginosa. The high rate of multiple drug resistance for frequently used antibiotics raises serious concern. It occurs as a complication of acute otitis media, a common condition with an alarming propensity to be chronic infection. The aerobic microorganisms most frequently isolated are Pseudomonas sps, Staphylococcus aureus, Klebsiella sps, E. Chronic otitis media has a multi-factorial etiology with highly variable prevalence through out the world. Improved housing, hygiene, accessibility to medical care and antimicrobial therapy are probably the factors that contributed to this evolution4. Unfortunately, the socio-economic situation of the rural India has not changed much. Gulbarga district of Karnataka state is the most back ward district of this state. Institute of Medical College General Hospital, Gulbarga were included in the study. The patients were from the age 8 months to 65 years of both the genders were included.

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