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By the time she had it filled purchase roxithromycin 150mg visa antibiotics for acne breakout, the next day roxithromycin 150mg lowest price antibiotics for sinus infection without penicillin, her lesion had stopped enlarging order 150mg roxithromycin overnight delivery antibiotic metallic taste, and she could reduce her supplements roxithromycin 150mg online antibiotics for sinus infection and pregnancy. Her ratio of segmental to lymphocyte white blood cells was low, evidence for a chronic viral condition. She stopped using tooth- paste (strontium), salt, deodorant, detergents (aluminum). She got the metal out of her mouth and eliminated her radon problem by opening crawl space vents. Fatigue Fatigue, whether minor or extreme, is always associated with blood sugar disturbances. We have three organs that do most of the sugar regu- lating: our adrenals, the liver, and the islets in the pancreas. In severe fatigue, that keeps you partly bedridden, all three organs are heavily parasitized. Killing the viruses is not as important as killing the larger parasites and getting your organs functioning for you again. The adrenals (the outer layer called the cortex) help to regulate the blood sugar in a complex way. The heart of sugar regulation is in your pancreas in the tiny islands of cells that secrete insulin, called the islets of Langer- hans. There is wood alcohol in store-bought drinking water, fruit juice, powders meant to be stirred into bev- erages, even if they are health food varieties. The only beverage you can safely buy (not safe unless you sterilize it, though) at a grocery store is milk. Your first step toward curing your fatigue syndrome is to kill the pancreatic fluke and all other living invaders of the pancreas, liver, adrenals and thyroid. Your energy can bounce back in a few weeks by attending your liver, adrenals and pancreas. Take these supplements for three weeks, then cut the dose in half, and take on alternate days only, as a hedge against possible pollution in these. Although your energy may be normal in three weeks, you are at higher risk for fatigue than the average person. Reinfection with anything will put the new parasites right back where the old ones were. Other bacteria, solvents and toxins will head for the pancreas, liver and adrenals again because these are weakened organs. It could take two years to build your health to its previous level, but is well worth it to have youth, initiative, and a beautiful appearance again. Going back to school is a good use of your time when your initiative has returned but your physical strength is still not up to housework or a job. When your energy comes back to you, it is tempting to overwork: to clean the whole house or to get into some gardening. Our test showed her body was full of bismuth (fragrance) and silver (tooth fillings) especially in the ovaries. She cleansed her kidneys and killed parasites but could not make up her mind to do the expensive dental work. Her skin, kidneys, breasts, brain, ovaries and pancreas were all loaded with mercury, platinum and other metals. Before the moving date arrived she had cleansed kidneys, killed parasites and done dental work and was feeling noticeably better. She immediately was very fatigued again and worried that the move had been in vain. This time she had a liver full of Salmonella and a return of phosphate crystals in her kidneys. But it was easy to clear up and it was a very useful lesson to her to avoid unsterilized dairy products. Her tissues were full of arsenic from pesticide; her urinalysis showed kidney crystals and her eosinophil count was high 5. She had sheep liver flukes and stages in her pancreas due to a buildup of wood alcohol there. In four months after killing parasites and doing a kidney cleanse she was much improved. She had Ascaris and pancreatic flukes in her pancreas and reacted to sugar in her diet quite strongly, so avoided it. In 6 weeks she had done everything except the mercury removal and was feeling much better. She cleaned her home and cleansed kidneys, killed parasites, and did two liver cleanses. Meanwhile, though, her infertility problem got solved (she got pregnant) and this encouraged her to continue the battle against fatigue after the baby was born. Hector Garcia, age 14, was getting gamma globulin injections every three weeks for his chronic fatigue syndrome. He had pancreatic flukes in his pancreas, sheep and human liver flukes in his liver and intestinal fluke in his intestine. He had a buildup of benzene, propanol, and carbon tetrachloride as well as aflatoxin from his granola breakfasts. He killed parasites with a frequency generator and went off the solvent polluted items in the propyl alcohol and ben- zene lists. Dana Levi, age 16, had chronic fatigue syndrome and dizziness; he was not in school. He had pancreatic fluke in his pancreas, sheep, human and intestinal flukes in his liver! As soon as the para- sites were killed (with a frequency generator) and he changed a lot of his products, he felt better but soon lost his improvement. At the next visit, our tests showed a buildup of vanadium (from burning candles in his bedroom). But getting a taste of normal energy gave him the determination to get himself well! His lungs and trachea had accumulated seven heavy metals: va- nadium, palladium, cerium, barium, tin, europium, beryllium. The gas leak was fixed (vanadium), the garage was sealed off from the house to eliminate barium and beryllium but the other toxic elements came from his dental retainer. As soon as his retainer came out, and they stopped using flea powder on their dog, his energy became normal and sinuses cleared up. Evelina Rojas, age 12, was having extreme fatigue with mood problems and sudden fevers. She killed Ascaris and sheep liver flukes with the parasite program but promptly got them back due to a benzene buildup I believe due to using products containing an herbal oil. Her high levels of Streptococcus pneumoniae (cause of fevers), Staphylococcus aureus and Nocardia could not be eliminated until her three baby teeth (with root canals) were pulled. She was toxic with arsenic, a substance that replaces en- ergy with nervous excitement and exhaustion.
Caution in the use of rodenticides is required discount roxithromycin 150mg on-line best antibiotic for sinus infection cipro, and manufacturer’s label instructions should be strictly followed discount roxithromycin 150mg fast delivery antibiotics without food. A single-dose rodenticide will kill rodents after one feeding if an adequate amount is consumed discount roxithromycin 150 mg fast delivery antibiotic 2 times a day. Most single-dose compounds are toxic to nontarget animals and should be kept out of reach of children order 150mg roxithromycin with visa treatment for uti guidelines, pets, poultry, and livestock. Only extreme situations call for the use of a single-dose rodenticide with high toxicity. Multiple-dose compounds have a cumulative effect and will kill rodents after several feedings. Some products kill within 1 hour, but most available anticoagulant rodenticides require 4 to 7 days after ingestion. Baits are available in dry or wet form, in powder mixed with grain, in pellets, micro-encapsulated, in paste, in wax, or in water. Bait should be offered at stations located in the activity zone of rodents, in the routes between the nesting site and the common food source, and at the entrance to houses and near active burrows. These include Newcastle disease, avian influenza, duck viral enteritis, chlamydiosis, salmonellosis, and pasteurellosis. The following precautions can be applied to reduce the probability of infection: • Water obtained from lakes or ponds on which waterfowl accumulate must be filtered and treated with chlorine to a level of 2 ppm. A commercial product, Avipel® (9,10-anthraquinone) can be applied as a paint suspension to roof areas, gantries and structures where resident pigeons and sparrows congregate. Avipel® will repel birds by a process of aversion to the compound, which induces an irritation of the crop as a result of ingestion of minute quantities following preening. Water containing mineral impurities can affect skeletal integrity, intestinal function and detract from optimal growth and feed conversion efficiency. Microbiological contamination including fecal coliforms and viable Newcastle disease and avian influenza viruses can result in infection of flocks. Chlorine can be added to drinking water at a level of 2 ppm using either sodium hypochloride or a gas chlorine installation. Water lines can be flushed and decontaminated with solutions as indicated in Table 4. Backyard poultry and gamefowl serve as reservoirs for a wide range of infections which can impact the health and profitability of commercial poultry. Inadequate change room facilities may contribute to the introduction of infection to farms and hatcheries. Wet markets are a source of infection and special precautions should be taken to avoid introduction of disease onto farms by live bird traders. Bulk delivery of grain reduces manual handling, is cost efficient and consistent with accepted standards of biosecurity. Manual handling of feed bags by workers may result in introduction of infection onto farms. Vaccination programs should be based on the following considerations: • Diseases prevalent in the area of operation. Passively acquired maternal antibody may protect progeny against post-hatch exposure to certain pathogens for up to 2 weeks. Circulating antibodies derived from the hen increase from day 1 to day 3 as yolk is absorbed. A waning in titer occurs over the succeeding 1-3 weeks, according to a decay rate characteristic for the antibody. High maternal antibody is reflected in uniform and proportionally elevated antibody levels (titers) in progeny. Low and variable immunity in parent flocks is associated with early susceptibility of chicks. High levels of maternal immunity often inactivate mild attenuated vaccine virus administered to chicks. The dilemma facing poultry health professionals in developing vaccination programs for chicks is to specify the age of administration relative to the level of maternal immunity. If the initial vaccine is administered too early in relation to the decline in maternal 35 antibody, the chick will not be protected. If the initial vaccination is delayed, field challenge of susceptible birds will occur. For young breeder flocks, which are housed at high levels of biosecurity, the initial doses of vaccine may be delayed until 7-14 days of age to ensure active priming of the immune system. Administration of vaccines in drinking water or by spray are repeated successively during the growing period. High uniform levels of maternal antibody are attained in breeders using attenuated live vaccines as “primers” followed by inactivated subcutaneous or intramuscular oil-emulsion “boosters” prior to onset of lay. Although it is not possible to provide immunization protocols to suit specific circumstances, Tables 5. Avian health professionals are advised to consult with local specialists and suppliers of vaccines to develop appropriate programs. This program should only be considered as a general guide to the types of available vaccine, sequence, routes, and ages of administration. The principle of using a mild attenuated vaccine to establish immunity is emphasized. The administration of oil emulsion vaccines to boost immunity is required to ensure satisfactory transfer of maternal IgM antibody to progeny. It is emphasized that appropriate control over the reconstitution of live vaccines is required to ensure potency. The administration of drugs is generally a last resort to salvage the value of a flock and to reduce losses following infection. Over-reliance on medication is both expensive and has negative flock and public health implications. Medication should be used only after implementing accepted methods of prevention and control of disease. Important considerations which contribute to effective medication include: • The diagnosis should be established by isolation and identification of the pathogen by microbiological or other laboratory procedures. It is emphasized that if routine medication is required for successive flocks, deficiencies in management, biosecurity or vaccination exist. Alternatively, breeding stock may be infected with a vertically transmitted disease. Frequent or continuous administration of medication will result in emergence of drug resistant pathogens which will affect poultry, other livestock and consumers. A schedule of therapeutic drugs and appropriate dose rates is depicted in Annex 41.
Supply to the affected area was switched to a chlorinated surface water source discount roxithromycin 150mg free shipping antibacterial liquid soap, and a flushing program with hyperchlorinated water was carried out to remove possible contamination from the water distribution system purchase roxithromycin 150mg otc virus alive. One of the victims lived in Peoria and the other in the neighboring town of Glendale generic 150mg roxithromycin with mastercard virus - zippy, some four miles away buy roxithromycin 150 mg with visa infection 5 metal militia. Both boys became ill on 9 October and died a few days later on 12 and 13 October respectively. Health authorities then began investigating possible common sources of Naegleria exposure including drinking water, pools, bathtubs, spas and fountains. This supply is predominantly drawn from surface water sources but is supplemented by groundwater in times of high demand. As Arizona state law prevents counties from supplying water to areas outside the incorporated municipal zones, the remaining 20,000 residents in the rapidly growing town are served by private water companies which mainly rely on groundwater sources. The suspect water supply is drawn from a deep aquifer and is not routinely chlorinated, although periodic chlorination has been used after new connections, line breaks or incidents that might allow ingress of microbial contamination. The chlorinated well is believed unlikely to be the source of infection as chlorination is effective in killing N. Naegleria fowleri is a free living amoeba which is common in the environment and grows optimally at temperatures of 35 to 45 degrees C. Exposure to the organism is believed to 95 Bacteriological Diseases ©11/1/2017 (866) 557-1746 be relatively common but infections resulting in illness are rare. The disease was first described in 1965 by Dr Malcolm Fowler, an Australian pathologist, who identified the amoeba in a patient who had died from meningitis. Cases are often reported to be associated with jumping or falling into the water, providing conditions where water is forced into the nose at pressure. The amoeba may then penetrate the cribiform plate, a semiporous barrier, and spread to the meninges (the membrane surrounding the brain) and often to the brain tissue itself. The cribiform plate is more permeable in children, making them more susceptible to infection than adults. The incubation period is usually 2 to 5 days, and the infection cannot be transmitted from person to person. In early studies, transmission by contaminated dust was suspected as an infection route but this has since been discounted as the organism does not survive desiccation. Similar symptoms also occur in viral and bacterial forms of meningitis which are much more common than the amoebic form. Cases of disease have also been associated with swimming pools where disinfection levels were inadequate, and inhalation of tap water from surface water supplies that have been subject to high temperatures. The involvement of tap water supplies was first documented in South Australia, where a number of cases occurred in the 1960s and 70s in several towns served by unchlorinated surface water delivered through long above-ground pipelines. About half of the cases in the state did not have a recent history of freshwater swimming, but had intra-nasal exposure to tap water through inhaling or squirting water into the nose. Tap water may also have been the primary source of infections attributed to swimming pools in these towns. The incidence of disease was greatly reduced by introduction of reliable chlorination facilities along the above-ground pipelines and introduction of chloramination in the 1980s led to virtual elimination of N. Cases of disease have also been recorded in Western Australia, Queensland and New South Wales, and N. Warm water conditions and the absence of free chlorine may then allow it to proliferate in the system. Plans are also underway to install a continuous chlorination plant on the groundwater supply, and some residents have called for the municipality to purchase the private water company and take over its operations. Method: Negative-stain Transmission Electron Microscopy Rotovirus Note the wheel-like appearance of some of the rotavirus particles. Method: Negative-stain Transmission Electron Microscopy Photographs and information courtesy from the U. Almost unknown in industrialized countries, schistosomiasis infects 200 million people in 76 countries of the tropical developing world. A Flatworm that spends part of its life in a freshwater snail host causes schistosomiasis. Multiplying in the snail, a microscopic infective larval stage is released that can penetrate human skin painlessly in 30 to 60 seconds. The larvae grow to adulthood and migrate to the veins around the intestines or bladder, where mating occurs. The eggs produced may lodge in these tissues and cause disease, or they are passed out in urine or feces, where they reach fresh water and hatch to infect snails. Multiplication and Life Cycle Free-swimming larvae (cercariae) are given off by infected snails. These either penetrate the skin of the human definitive host (schistosomes) or are ingested after encysting as metacercariae in or on various edible plants or animals (all other trematodes). After entering a human the larvae develop into adult males and females (schistosomes) or hermaphrodites (other flukes), which produce eggs that pass out of the host in excreta. Cercariae 99 Bacteriological Diseases ©11/1/2017 (866) 557-1746 Pathogenesis In schistosomiasis, eggs trapped in the tissues produce granulomatous inflammatory reactions, fibrosis, and obstruction. The hermaphroditic flukes of the liver, lungs, and intestines induce inflammatory and toxic reactions. Host Defenses Host defenses against schistosomiasis include antibody or complement-dependent cellular cytotoxicity and modulation of granulomatous hypersensitivity. In a relatively small proportion of individuals, heavy infections due to repeated exposure to parasitic larvae will lead to the development of clinical manifestations. The distribution of flukes is limited by the distribution of their snail intermediate host. Larvae from snails infect a human by penetrating the skin (schistosomes) or by being eaten (encysted larvae of other trematodes). Diagnosis Diagnosis is suggested by clinical manifestations, geographic history, and exposure to infective larvae. Control As a control measure, exposure to parasite larvae in water and food should be prevented. Clinical Manifestations Signs and symptoms are related largely to the location of the adult worms. Infections with Schistosoma mansoni and S japonicum (mesenteric venules) result in eosinophilia, hepatomegaly, splenomegaly, and hematemesis. Fasciola hepatica, Clonorchis sinensis, and Opisthorchis viverrini (bile ducts) cause fever, hepatomegaly, abdominal pain, and jaundice. Infections with Paragonimus westermani (lungs, brain) result in cough, hemoptysis, chest pain, and epilepsy. Viral gastroenteritis is an infection caused by a variety of viruses that results in vomiting or diarrhea. It is often called the "stomach flu," although it is not caused by the influenza viruses. Many different viruses can cause gastroenteritis, including rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Viral gastroenteritis is not caused by bacteria (such as Salmonella or Escherichia coli) or parasites (such as Giardia), or by medications or other medical conditions, although the symptoms may be similar. Your doctor can determine if the diarrhea is caused by a virus or by something else.
Other diagnostic modalities: Magnetic resonance imaging can provide additional anatomic and hemodynamic information discount roxithromycin 150mg mastercard infection z imdb, and is particularly useful in defining vascular anatomy and volumetric assessment of the ventricles when a two ven- tricular repair is being considered cheap 150 mg roxithromycin fast delivery rubella virus. Abdominal ultrasound and hematologic smear are routinely performed to evaluate for presence of a spleen and evidence of splenic function discount 150mg roxithromycin with visa antibiotics for pneumonia. Finally cheap roxithromycin 150mg line antibiotics used for acne, all heterotaxy infants warrant diagnostic evaluation for intestinal malrotation, as they have significant risk for developing volvulus, intes- tinal obstruction and ischemia, and threatened bowel viability. Treatment For the newborn who presents with severe cyanosis and cardiovascular compro- mise, prompt medical stabilization and initiation of prostaglandin infusion are indicated, followed by urgent pediatric cardiology consultation and echocardiog- raphy evaluation. If hypoxemia and/or shock seem to worsen following prosta- glandin initiation, obstructed pulmonary veins must be considered, as the improved pulmonary blood flow may have unmasked a pulmonary venous obstruction. If obstructed pulmonary veins are suspected, urgent surgical intervention is indicated. Following medical stabilization and complete diagnostic evaluation in the intensive care unit, an individualized surgical plan can be formulated. For newborns with cyanosis and restricted pulmonary blood flow, an artificial systemic to pulmo- nary shunt is often required. While some heterotaxy infants may ultimately be good candidates for a biventricular repair, many infants, particularly those with right isomerism, will only be candidates for single ventricle palliation (the Norwood procedure). Single ventricle palliation involves utilizing the stronger ventricle to provide active systemic blood flow while relying on passive venous return to the lungs to provide pulmonary blood flow. Infective endocarditis prophylaxis is indicated for these patients, particularly for single ventricle palliation of the cyanotic lesions. The risks incurred with surgery are moderately increased for heterotaxy patients compared to other congenital heart diseases due to the complexity of the lesions. Palliated patients still have a 50% 5-year mortality rate due in large part to infection and sepsis risk from asplenia, but also due to complications from congeni- tal heart disease and intestinal malrotation. Nonoperative left isomerism patients have a much lower mortality risk in the first year – only 32% – with a 5-year mortality rate of about 50%. Furosemide is a commonly prescribed diuretic and carries with it the risk of hypokalemia, hypocalcemia, osteopenia, and hypercalciuria with calcium oxalate urinary stones. Furosemide-associated hearing loss is more commonly associated with rapid intravenous administration of the medication. Patients are also at risk for long-term complications due to their intestinal abnor-malities, including intermittent partial volvulus associated with intestinal malrotation and an increased risk of sepsis due to translocation of abdominal microorganisms. Case Scenarios Case 1 A full-term newborn infant is born precipitously in a community hospital. The responding pediatrician places an endotracheal tube and an umbilical venous line to stabilize the infant. The infant’s color improves and the vital signs stabilize: pulse 148, blood pressure 73/37, oxygen saturation 92% while ventilated with 100% oxygen. Following the first few breaths, inflation of the lungs leads to a decrease in pulmonary vascular resistance and a brisk increase in pulmonary blood flow. When pulmonary venous return is obstructed, the increase in pulmonary blood flow exacer- bates the pulmonary edema. Following initiation of prostaglandin infusion, the duct will dilate and further augment pulmonary blood flow, further potentiating pulmonary venous obstruction. There is lack of R wave progression in the precordial leads, where the R wave should become taller and taller from V1 to V6, suggesting right ventricular dominance or dextrocardia. Diffuse T wave flattening indicates a repolarization abnormality and is suggestive of ischemia Patients who are born without prenatal diagnosis can have a dramatic presenta- tion of right atrial isomerism, secondary to significantly obstructed pulmonary outflow and/or pulmonary venous obstruction. This infant underwent segmental cardiac evaluation by echocardiography, which found: • Cardiac position and direction of apex: – Dextrocardia with apex to the right • Systemic venous connections: – Bilateral superior vena cava – Absent coronary sinus – Inferior vena cava to right-sided atrium – Bilateral hepatic venous connections • Pulmonary venous connections: – Total anomalous pulmonary venous return to a systemic vein below the diaphragm • Atrial situs: – Right atrial appendage isomerism – bilateral broad-based triangular atrial appendages 268 S. He was born by spontaneous vaginal delivery at 41-5/7 weeks and had incomplete prenatal care. A soft, 2/6 systolic flow murmur is noted both at the right and left sternal border. Pulmonary vascularity is slightly increased, suggesting increased pulmonary blood flow. The gastric bubble is on the right and the liver is on the left indicating situs inversus of abdominal structures Discussion The dextrocardia, right-sided gastric bubble, and left-sided liver confirm a condi- tion of abnormal left–right positioning. The differential diagnosis includes: • Dextrocardia with situs inversus (rightward heart with mirror-image arrange- ment of the thoracic and abdominal viscera), particularly since bilateral short bronchi cannot be confirmed on chest X-ray. If this were the diagnosis and the patient subsequently developed recurrent pulmonary infections, sinusitis, and bronchiectasis, a diagnosis of Kartagener syndrome should be considered. It is the reduced systemic oxygenation, tachypnea, and growth failure which raise the concern for associated intracardiac malformation. Left isomerism more commonly presents with signs and symptoms of increased pulmonary blood flow (tachypnea), growth failure, and signs of congestive heart failure (livedo reticularis suggests increased systemic vascular resistance associated with congestive heart failure). This infant was referred to the hospital for cardiology consultation where echocardiogram confirmed left atrial isomerism (Fig. Segmental analysis demonstrated: • Cardiac position and direction of apex: – Dextrocardia with apex to the right 270 S. He then underwent single ventricle pallia- tion with a pulmonary valvectomy and placement of a systemic-to-pulmonary shunt. He presented to the office at 4 months of age with lethargy and poor feeding and was found to be responsive, but bradycardic, with a heart rate of 58. Murmurs may not be appreciated by auscultation; how- ever, the second heart sound is single. Definition Hypoplastic left heart syndrome is a cyanotic congenital heart disease presenting in the first week of life. The mitral valve is severely stenotic or atretic leading to small or hypoplastic left ven- tricle and severely stenotic or hypoplastic aortic valve. The ascending aorta tends to be hypoplastic and slightly enlarges towards the aortic arch with a normal S. Blood travels in a retrograde fashion through the aortic arch and all the way back to the ascending aorta to provide blood flow to the coronary arteries. Often, the mitral and aortic valves are not completely atretic, but severely hypoplastic. In the neonatal period, maintaining the patency of the ductus arteriosus is crucial for survival (Fig. Pathophysiology With severe hypoplasia of the left heart, there is no forward flow across the aortic valve through the ascending aorta. The blood flows in a retrograde fashion through the ascending aorta to supply the brachiocephalic branches and the coronary arteries. Blood ejected from the right ventricle supplies the pulmonary artery as well as the systemic circulation. The pulmonary circulation has a lower vascular resistance (about 3 Wood units) compared to the systemic vascular resistance (about 25 Wood units). This significant difference in resistance will favor blood flow into the pul- monary system leading to excessive pulmonary blood flow and eventual pulmonary edema. The comparatively limited blood flow to the systemic circulation will result in poor systemic cardiac output and, in extreme cases, can manifest as cardiogenic shock.
Pravesh Mehra (Head of Department buy roxithromycin 150 mg cheap antibiotics for sinus infection webmd, Department of Dentistry and Maxillofacial Surgery) 3 purchase roxithromycin 150mg with amex treatment for dogs broken toe. Ten Service Centres spread across 5 geographical regions of the country namely North buy cheap roxithromycin 150 mg line antibiotic prophylaxis for colonoscopy, South cheap roxithromycin 150mg on-line homemade antibiotics for acne, West, East and North East. This centre will also function as a base for exchange of education and research programmes with other centres in the country and abroad. The prime objectives of the R&D Department will be: • Identify the right interventional strategy for the right age from the day the child is born. North- East Meghalaya (Shillong); Manipur (Imphal) ‐ 170 ‐ Thesee States are chosen on tthe basis off high incideence of Craanio- maxilloofacial disorrders. There is very littlle support frrom the Statte Governmments to patieents/ familiees suffering from such ddisorders. The coommittee wiill convene tthrice duringg this time, ffirst after 2 yyears of projject commenncement andd then twice aat intervals oof 1. Trauma Care Facility on National Highways th th Based on analysis of the 11 Plan, the strategies proposed for the 12 plan are as follows: • The construction activity is taken 2-3 years time causing delay in release of funds for equipments which takes round about a year for procurement. In order to augment the pace of implementation of scheme it is proposed that the funds for construction & equipment may be released in first phase. The procurement of equipment may be initiated on completion of the civil structure upto terrace. Prevention & Management of Burn Injuries The program needs to continued and expanded in the 12th Plan because- Total number of burn injury cases annually in India is approximately 70 lacs (7 million) and the cases are on increase In India approx. However, to avoid duplication of services, districts where medical college is already functioning, the district hospital will not be taken up for establishing burn’s unit. The remaining states/districts would be taken up for implementation in subsequent years. Hence, approximately 150 Government Medical Colleges and 492 district hospital would be taken up for implementation in phased wise manner as follows- th 12 Plan Year Additional Additional Cumulative no. Strategies for implementation- The programme will be implemented at National level with following objectives- 2. To reduce the incidence, mortality, morbidity and disability due to Burn Injuries. To improve the awareness among the general masses and vulnerable groups especially the women, children, industrial and hazardous occupational workers. To monitor and supervise the programme at various levels of implementation and carry out Operational Research for assessing risk factors for burn injuries and its management for effective need based planning. Treatment Programme: This component will include capacity building of healthcare manpower and quality burn injury management at all the levels of Health-care delivery system. Rehabilitation Programme:Rehabilitation services to be provided at district and state level to restore functional capacity of the burn patients to optimum. Monitoring and supervision: Development of mechanism for monitoring and supervision of programme activities at central, state and district level for better implementation of the programme. M th Cost proposed for the educational and preventive component for 12 Plan would be for Rs 209. Treatment Programme: For quality management and rehabilitation of burn injuries at various levels of Health-care delivery system, certain additional requirement of physical infrastructure (construction/renovation of burn units), trained manpower, equipments & materials would be provided to the medical colleges and district hospitals. It shall be the responsibility of the states to provide for adequate land / build up structure which can be suitably modified for creating the burns unit at medical college and district hospitals levels. To implement the programme, it is imperative that additional medical, nursing and paramedical manpower would be required. This will also be utilized to transport serious burn patients from the place of injury to the district or the designated burns unit. These ambulances will be provided with multi disciplinary workers who will be running the ambulance and helping in dressing the serious burns patients to the district or at designated burns unit. Training: To improve the quality of burn management, a network of trained manpower from Medical colleges and District Hospitals will be created. Hospital or Safdarjung Hospital or any Medical College/ Selected Training hospitals in the country having such facilities. The training will be conducted by each Training centres closest to the district hospitals. If required, on-the-job training of the medical college workers will also be done at existing burn centres. Orientation training for the primary level workers will also be done at district centre by the trained Surgeon / Medical Officers. Therefore, under construction component funds may be kept either for renovation/alternation of existing structure, or for new construction as the case may be. Further, to start burn services immediately and expeditiously in the infrastructure already available in Medical Colleges / District Hospitals provision may be kept for simultaneous release of funds for construction work, procurement of equipments and recruitment of manpower. Rehabilitation Programme: To restore the burn patients back into the society to their normal functional capacity as what existed prior to the burn injury. Burn management is an unpleasant task and the district surgeon needs to be incentivized for their work in providing this service. The incentive may be either an increment in pay scale or a fixed incentive of Rs 1000/- per month, which can be disbursed to all district surgeons receiving burn management training or it could be linked to submission of a Medico-legal case record from the district, which would also help in case monitoring and surveillance. Monitoring and supervision- For strengthening monitoring & supervision of the programme at various levels and also facilitating implementation of the program following structure would be required- 1. This group will interact through frequent meetings at the centre and will be advising the Program officials for monitoring, supportive measures and other issues essential for smooth functioning of the program. Mid-term Evaluation of the programme for assessing progress of various activities is th proposed to be carried out in third year (2014-15) of the 12 five year plan. Evaluation would cover approximately 25% of the implementing medical colleges/district hospitals. Disaster Preparedness and Response in Health Sector Preamble: 48 National Disaster Management Act (2005) defines disaster as “a catastrophe, mishap, calamity or grave occurrence in any area, arising from natural or manmade causes, or by accident or negligence which results in substantial loss of life or human suffering or damage to, and destruction of, property, or damage to, or degradation of, environment, and is of such a nature or magnitude as to be beyond the coping capacity of the community of the affected area”. It results from the combination of hazards, conditions of vulnerability and insufficient capacity or measures to reduce the potential negative consequences of risk. Risk assessment and management would require a collaborative approach from all concerned stakeholders at all levels. This also underscoredthe need to adopt a multi dimensional endeavour involving diverse scientific, engineering, financial and social processes; the need to adopt multi disciplinary and multi sectoral approach and incorporation of risk reduction in the developmental plans and strategies. Disaster management occupies an important place in this country’s policy framework as it is the poor and the under-privileged who are worst affected on account of calamities/disasters. Disasters retard socio-economic development, further impoverish the impoverished and lead to diversion of scarce resources from development to rehabilitation and reconstruction. The steps taken by the Government of India have been translated into a National Disaster Framework culminating into the Disaster Management Act, 2005, encompassing institutional mechanisms, disaster prevention strategy, early warning system, disaster mitigation, preparedness and response and human resource development.
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