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Patient safety committee - Each hospital willing to participate in this program must show its commitment by forming a Patient safety committee which will among other things oversee the functioning of Hospital Infection control committee cheap atomoxetine 40mg on-line symptoms 2 weeks after conception. The hospitals must designate a trained nurse as Infection control nurse exclusively for infection control work effective 25mg atomoxetine medications contraindicated in pregnancy. The committee will also do the gap analysis in their respective institutes with the help of a checklist developed for the same or through some standardized proforma generic 10 mg atomoxetine with mastercard treatment zit. The aspects covered must 276 relate to discount 25 mg atomoxetine fast delivery treatment of hyperkalemia, among other things, infrastructure and policies and procedures being followed. Hospitals will be required to organize regular meetings of the patient safety committee to review various patient safety issues, adverse events reported, actions taken and maintain records of all the meetings of their patient safety committees Research: – Under the programme the globally accepted interventions for ensuring Patient Safety shall be implemented, however, it is appropriate to know the magnitude of the problem to know the baseline existing situation in the country so that the progress of the programme can be assessed periodically. Patient Safety surveys will also be undertaken at the level of each medical college and district hospital to identify the gaps and take appropriate corrective measures. Research shall also be undertaken to develop appropriate models for implementing various strategies. Awareness generation - it is necessary to create requisite awareness regarding the problem so as to draw the attention of all the stakeholders as well as community in general. Awareness generation shall be undertaken at all three levels; National, medical college and District Hospital. Media, both electronic as well as print, may be used to create impact among the general public. Advocacy workshops for all stakeholders shall be organized or academic forums like conferences etc. In this endeavor the services of professional medical associations and similar bodies will help in creating awareness and training programmes. Moreover, the participation of these bodies will result in "buy in" of the concept of patient safety among healthcare professionals. Patient safety day shall be celebrated to highlight its importance in the country every year. Training – Master trainers will be identified at National Level and if necessary capacity building of Nodal officers of the programme and Master trainers shall be organized. Mater trainers will impart Training of Trainers through workshops to train the identified trainers/ programme officers from States/Medical colleges regarding the concepts of patient safety to implement the steps in their institutions for providing safe patient care. These trained professionals shall act as Patient Safety Champions/Ambassadors for further training at the level of medical colleges/district Hospital level so as to percolate the practices at all levels of care including District Hospitals, Sub-district Hospitals and Community Health Centers. Regional Patient safety centers - Some of the medical colleges and hospitals can be encouraged to assume the role of Regional centers and they can adopt hospitals in their region for propagating the patient safety culture. Activities of the Programme To implement the above strategies, the activities of programme at the three levels will be as given under Central level 1. Monitoring and Evaluation Medical Colleges th All 149 medical colleges will be covered during the 12 Plan. Many of such diseases are very fatal and also have potential to spread very rapidly. The history is full of such instances where diseases prevalent in a country has spread to other countries causing severe damage to the mankind. Recent outbreak of swine flu pandemic is still poised to be threat to the world security. In order to prevent cross country spread of such infectious diseases, traffic restriction are being applied to the travelers and cargo since the time immemorial. In our country there are 2 set of rules known as “Indian Aircraft (Public Health) Rules, 1954, and “Indian Port Health Rules, 1955” to be applied at international Airports and ports respectively. Already there are 21 such health units functioning in our country since 1950s at various airports, ports and land border of the country for implementation of statutory regulations. Existing infrastructure There are 21 such health units already functioning at various airport, ports and land borders of the country established under the regulatory provision. Ministry of Civil Aviation has been requested to provide space for these organizations. Out of these 10 airports 5 (Bengaluru, Hyderabad, Lucknow, Ahmedabad, and Trivandrum) are under plan scheme. Functions: Following are the major functions of Port/Airport Health Organizations 1. Supervision of sanitation, drinking water supply, anti-mosquito and anti-rodent work. Administration of yellow fever vaccine and issue of yellow fever vaccination certificate at identified yellow-fever vaccination centres. Inspection of food stuff, catering establishments inside the premises of airport and ports under the Prevention of Food Adulteration Act. Sampling of imported food items and forwarding the lab analysis report, as and when requested by custom authorities. The Organizations use to keep constant vigil on all the factors leading to outbreak of diseases of international concern and take all preventive measures to safeguard country’s health. Most of these unit were established way back in 1950s and since then are functioning with almost same sanctioned manpower even though the workload has increased manifold during all these years due to increase in the international traffic. There is urgent need to strengthen the organizations in terms of technical manpower. Need for continuation of existing units Out of the 21 units 7 are working under plan scheme and being statutory in nature , continuation of the organization is essential till these schemes are converted in to non plan scheme. If the remaining 23 entry points to international traffic are not equipped with proper health infrastructure, the whole purpose of existing units will be diluted. Further, like custom and immigration, these are statutory organizations and every airport/port/Land border needs to be established under provision of Indian Aircraft (Public Health) Rules and Indian Port Health Rules. The list of these places is given below: List of new International Airports, Ports &Land borders Airport Port Land Border 1. Patna th Proposal for consideration of 12 Plan Continuation of existing plan scheme There are 2 plan schemes already running to operationalise 7 ( 6 +1) such units. As explained above, these are performing statutory nature of functions and hence needs to be continued. Total th expenses required for these two schemes during the 12 plan will be to the tune of Rs. These units were created way back in 1950s and since then these are working with the same manpower, although, the workload has increased tremendously due to increase in the international traffic. In view of this, there is an urgent need to strengthen the technical manpower in terms of medical officers, health inspectors and nurses of these organizations. There is a need of 39 medical officers, 38 health inspectors and 16 nurses additionally required for which an amount of Rs 20. The objective of these units is to protect the country from invasion of dangerous infectious diseases like swine flu from abroad. Most of these unit were established way back in 1950s and since then are functioning with almost same sanctioned manpower even though the workload has increased manifold during all these years due to increase in the international traffic.

Syndromes

• Pain in the bones, back, flank, or abdomen
• Change in alert level (unconsciousness)
• Skin rash or discoloration
• Scalp defects (missing skin)
• Do you feel a racing, pounding, or fluttering?
• Renin
• Severe illness, including liver failure, kidney failure, AIDS, and brain cancer
• Ischemic cardiomyopathy

Infants with the disease have symptoms including enlarged liver and spleen cheap 18 mg atomoxetine fast delivery medications similar to lyrica, lowered number red blood cells and platelets atomoxetine 25mg discount symptoms congestive heart failure, neurological problems generic 10 mg atomoxetine fast delivery 68w medications, skin abnormalities cheap 40mg atomoxetine visa treatment qt prolongation, and often distinct facial features. Cardiovascular Form As the name implies, the cardiovascular form of Gaucher disease causes symptoms involving the heart, notably a hardening of the mitral and aortic valves. This type is particularly prevalent among people of Ashkenazi Jewish descent, of whom 1 in 855 is afected by the disease and 1 in 16 is a carrier. In the general population, researchers believe that about 1 in 50,000 will be afected. A form of type 3 is most common among people in the Norrbottnian region of Sweden, where 1 in 50,000 are afected. Additional treatments for the symptoms of Gaucher disease include blood transfusions for tiredness and excessive bleeding, joint replacement to relieve pain and restore movement, and medication to treat bone pain. Because symptoms of Gaucher disease vary widely in type and severity, both among the diferent types and among people with the same type, the outlook is similarly varied. The prognosis for an individual with Gaucher disease depends on the type of Gaucher, the severity in that particular individual, and the availability and efectiveness of treatment. Some individuals with severe cases of type 1 Gaucher may have debilitating symptoms that are more difcult to manage. Those with type 2 Gaucher disease often have signifcant developmental delays and die between the ages of 2 and 4. People with type 3 Gaucher disease usually develop symptoms in childhood which slowly worsen over time. For those with the cardiovascular form of the disease, the prognosis depends upon the success of valve replacement surgery. Detection Population Rate* <10% African American 84% Ashkenazi Jewish 73% Eastern Asia 79% Finland 79% French Canadian or Cajun <10% Hispanic 65% Middle East <10% Native American 79% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia 79% Southern Europe * Detection rates shown are for genotyping. The word “nonsyndromic” refers to the fact that there are no other symptoms or systems of the body involved with the disease. The degree of hearing loss is difcult to predict based on which genetic mutation one has. They may also want to consider enrolling in an educational program for the hearing impaired. The Counsyl Family Prep Screen - Disease Reference Book Page 108 of 287 Glucose-6-Phosphate Dehydrogenase Defciency Available Methodology: targeted genotyping. Detection Population Rate 95% African American <10% Ashkenazi Jewish <10% Eastern Asia <10% Finland <10% French Canadian or Cajun <10% Hispanic 73% Middle East <10% Native American <10% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia <10% Southern Europe What is Glucose-6-Phosphate Dehydrogenase Defciency? These episodes are caused by the destruction of red blood cells (hemolytic anemia), and can be brought on by taking certain types of medication or by the physical stress of a viral or bacterial infection. It should be emphasized that many people with the mutations that cause this disease do not have any symptoms. The symptoms of hemolytic anemia include fatigue, shortness of breath, a yellow tinge to the skin and whites of the eye (jaundice), rapid heart rate, an enlarged spleen, and overall paleness. Occasionally newborns with the disease show symptoms of jaundice within the frst two weeks of life. In people with particular genetic mutations, contact with fava beans and moth balls—even simply touching them—can also provoke attacks. As the name implies, the disease is caused by a defciency in an enzyme called glucose-6-phosphate dehydrogenase. A lack of this enzyme can cause red blood cells, which carry oxygen from the lungs to the rest of the body, to be destroyed faster than the body can replace them. It is common in African populations, with 5 to 25% of males afected depending on the country. They should carefully avoid the medications that can cause bouts of hemolytic anemia. These include anti-malarial drugs, common painkillers (such as aspirin or ibuprofen), and certain antibiotics. If an episode of hemolytic anemia does occur, people with the disease often need bed rest and in severe cases, may require blood transfusions. The Counsyl Family Prep Screen - Disease Reference Book Page 110 of 287 Once the cause of the episode is resolved (i. What is the prognosis for a person with Glucose-6-Phosphate Dehydrogenase Defciency? They typically have no symptoms and can live a normal lifespan with a normal quality of life. The Counsyl Family Prep Screen - Disease Reference Book Page 111 of 287 Glutaric Acidemia Type 1 Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* 12% African American 40% Ashkenazi Jewish 12% Eastern Asia 40% Finland 40% French Canadian or Cajun 12% Hispanic 12% Middle East 12% Native American 40% Northwestern Europe 12% Oceania 12% South Asia 12% Southeast Asia 40% Southern Europe * Detection rates shown are for genotyping. When these amino acids build up in the body, a person can develop brain damage that can impair their ability to move as well as their intellectual function. A small number of people with genetic mutations that cause the disease have no symptoms at all, while others have severe movement problems and/or mental disability. Symptoms appear as a “metabolic crisis,” an episode marked by low blood sugar, vomiting, lack of energy, difculty feeding, irritability, and poor muscle tone that causes the body to seem foppy. If unrecognized and untreated with a special diet, these episodes can progress to cause spastic and jerking muscle The Counsyl Family Prep Screen - Disease Reference Book Page 112 of 287 movements, seizures, swelling and bleeding of the brain, coma, and even death. This damage can result in a severe and permanent loss of motor skills, though often intellect remains normal. Other children do not experience a metabolic crisis, but show a delay in motor and intellectual development. Children with these symptoms are more likely to have intellectual impairment later in life. Early diagnosis and strict control of the child’s diet can avert a metabolic crisis and signifcantly reduce the risk of brain damage and impaired movement ability. Often these plans include vitamins and supplements and frequent meals low in certain proteins. Diets will need to be carefully structured to both avoid problem foods and ensure proper nutrition. A specialist will also devise a “sick day plan” to use when a child shows signs of illness that could lead to a metabolic crisis. As children get older, the disease is often easier to manage and the risk of metabolic crises lessens. The Counsyl Family Prep Screen - Disease Reference Book Page 113 of 287 It is believed that those who receive treatment before their frst metabolic crisis do better in the long term. Children who are having a metabolic crisis must be promptly treated, often with intravenous fuids, certain vitamins and supplements, and in some cases, dialysis. Children who have already had a metabolic crisis are likely to develop permanent brain damage that causes severe motor difculties and involuntary spastic movement. The Counsyl Family Prep Screen - Disease Reference Book Page 114 of 287 Glycogen Storage Disease Type Ia Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* 30% African American 99% Ashkenazi Jewish 57% Eastern Asia 61% Finland 61% French Canadian or Cajun 79% Hispanic 30% Middle East 30% Native American 61% Northwestern Europe 30% Oceania 30% South Asia 57% Southeast Asia 61% Southern Europe * Detection rates shown are for genotyping.

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The immune attack on hair follicles tends to spare white fibers; likewise when hair regrowth occurs order atomoxetine 25 mg without a prescription symptoms quivering lips, fibers are frequently white before coming pigmented 18mg atomoxetine with visa treatment that works, indicating that the hair follicle pigment system is still dysfunctional (Fig 10mg atomoxetine with amex treatment xerophthalmia. It is relatively easy to diagnose alopecia areata generic 18mg atomoxetine mastercard treatment 5th metatarsal avulsion fracture, particularly when there are patches of non-scarring hair loss, skin “bare as a baby’s bottom,” and positive hair-pull tests. However, patchy disease may sometimes be mistaken for tinea capitis, traction alopecia, loose anagen syndrome, aplasia cutis congenita, or pseudopelade (3). Nail abnormalities may precede, follow, or occur concurrently with hair-loss activity. Area of involvement includes the lower occipital scalp and region above both ears. Other abnormalities include koilonychia, longitudinal ridging, brittle nails, onycholysis, onychomadesis, and periungual erythema (4). Common disease associations include atopy (allergic rhinitis, asthma, and atopic dermatitis) up to 40% in some studies, while the prevalence of atopic disease in the popula- tion is estimated to be 20% (7). Other common disease associations include thyroid disease and 94 Hordinsky and Caramori autoimmune diseases, such as thyroiditis and vitiligo. These patients have chronic hypo- parathyroidism, mucocutaeous candidiasis, and autoimmune adrenal insufficiency. Other investigators subsequently confirmed many of her conclusions, but in more recent times this classification system is not commonly used. They ascertained that 30% of patients developed alo- pecia totalis (54% of children, 24% of adults) and that the proportion of patients presenting with alopecia totalis declined with each decade of life. They concluded that although spontaneous resolution is expected in most patients, a small but significant proportion of cases, approxi- mately 7%, may evolve into severe and chronic hair loss (7). From such studies and others, the presence of severe nail abnormalities, atopy (asthma, allergic rhinitis, and atopic dermatitis), and onset of extensive disease at less than five years of age have all been implicated as negative prognostic indicators. Alopecia totalis or universalis lasting more than two years, is also believed to have a particularly low chance of spontaneous regrowth and to be less responsive to therapy. Follicles are small, fibers are dystrophic, and there is minimal perifollicular and peribulbar inflammation. In some, similar prognostic indicators have been reported, but in others different associations have been observed (14–19). The authors con- cluded that their findings were similar to those reported in the Western literature. However, an association of atopy with a younger age at onset and severe alopecia was not confirmed. In Kuwait, 10,000 consecutive new patients were surveyed; 96% of whom were children of Arab descent. A female preponderance (52%) was observed, and infants constituted the largest group (28. Further study of 215 children revealed that 97% of the children were of Arab ancestry and girls outnumbered boys by a 2. The peak age of onset was seen between 2 and 6 years of age with a mean age of onset at 5. A majority of the patients had mild disease, and extensive disease was seen in 13% of the children. The age of onset, a positive family history of alopecia areata, and associated atopic disorders were observed to have no influence on the extent and severity of the disease. In northern India, a prospective, hospital-based study, which lasted for a decade (1983– 1992), evaluated the epidemiology of alopecia areata, including noting associated diseases and risk factors for development of severe alopecia areata. The study evaluated 880 patients (532 men and 276 women) and 509 controls (307 men and 202 women). Onset in childhood was more frequent in females, but the incidence of severe alopecia was higher in males with onset at an earlier age. Atopy was found to be present in 18% of patients, but its reported association with younger age of onset and severe alopecia was not confirmed. However, in our mobile world, an understanding of these differences may be important in discussions with patients and families. The best place to take a biopsy for diagnostic purposes is the active edge of an area of hair loss. This biopsy specimen will typically show the characteristic perib- ulbar, inflammatory infiltrate, in both horizontal and vertical sections, as well as an increased percentage of follicles in telogen. In extensive alopecia areata, examination of both vertical and horizontal scalp biopsy specimens may provide useful information in advising patients about therapy (Fig. A mean follicular count in horizontal sections which is less than one follicle per square millimeter usually indicates little likelihood for good regrowth (21). Interestingly, the major locus on chromosome 18 was found to coincide with a previously reported locus for psoriasis as well as hereditary hypotrichosis simplex, suggesting this region may harbor genes involved in a number of different skin and hair disorders (23). More recently, peripheral nerve function in the C2 and V1 dermatomes, both of which innervate scalp skin, was found to be abnormal as compared to controls (70). Stressful life events and psychiatric disorders have been studied as they relate to both the onset and the progression of alopecia areata. After hypnotherapy treatment, all patients had a significantly lower score for anxiety and depression and scalp-hair growth of 75% to 100% was seen in 12 patients after three to eight sessions. Clearly more patients need to be studied, but the findings suggest hyp- notherapy may enhance the mental well-being of patients and may improve clinical outcome, perhaps through an effect on the peripheral nervous and immune systems (26). It is believed that the available treatments at best only suppress the under- lying process. To facilitate comparison of data and the sharing of patient-derived tissue alopecia areata, guidelines were published in 1999 and then updated in 2004 (28,29). These guidelines are now routinely used in clinical trials and can be adapted to direct patient care. The following repre- sent the guideline recommendations for data collection on the extent of scalp and body hair loss as well as nail abnormalities: _____ S0 = no scalp hair loss _____ S1 = <=25% hair loss _____ S2 = 26–50% hair loss _____ S3 = 51–75% hair loss _____ S4 = 76–99% hair loss _____ a = 76–95% hair loss _____ b = 96–99% hair loss _____ S5 = 100% hair loss S: scalp hair loss _____ B0 = no body hair loss _____ B1 = some body hair loss _____ B2 = 100% body (excluding scalp) hair loss B: body hair loss 98 Hordinsky and Caramori _____ N0 = no nail involvement _____ N1 = some nail involvement _____ 20 nail dystrophy/trachyonychia (must be all 20 nails) N: nail involvement Sacket defined evidence-based medicine as “the integration of individual clinical exper- tise with the best available external clinical evidence of systematic research” (30). However, there are questions and concerns regarding the use of these chemicals as neither preparations nor shelf-life are standardized. The goal is to choose a concentration capable of producing a mild allergic contact dermatitis. Sensitization, if usually performed on the scalp, and weekly applications are targeted to produce a mild eczematous reaction. Initial hair regrowth may be visible after 8–12 weeks and may be discontinued once hair regrowth occurs; likewise, treatment can be reinsti- tuted if a relapse occurs. Desired reactions include the development of a mild eczematous der- matitis and enlargement of retroauricular lymph nodes. Undesired side effects noted in 2–5% of patients include vesicular or bullous reactions, dissemination of allergic contact dermatitis, urticarial or erythema multiforme-like reactions, as well as alterations in skin pigmentation (32,33).

Diseases

• Hyperkeratosis palmoplantar with palmar crease hyperkeratosis
• Bruck syndrome
• Laryngeal neoplasm
• Non-lissencephalic cortical dysplasia
• Trisomy 14 mosaicism
• Sensory neuropathy
• Radiation related neoplasm /cancer
• Medeira Dennis Donnai syndrome