By B. Seruk. Franklin Pierce University. 2018.

    Guatemala buy 160mg malegra fxt plus mastercard, Mexico effective malegra fxt plus 160mg, Nicaragua, Paraguay, and Suriname, experienced Three countries (Brazil, Colombia and Guyana) had smaller reduc- a decrease in the number of cases of more than 50%, associated with tions (25%–50%) in the number of confrmed malaria cases between intense malaria programme activity. Haiti Bahamas Panama Jamaica Guyana French Guiana Nicaragua Guyana El Salvador Suriname Bolivia (Pluri. State) Colombia Dominican Republic Brazil Guatemala Nicaragua Paraguay Honduras Belize Venezuela Ecuador Ecuador Peru Paraguay Peru Honduras Bolivia Costa Rica El Salvador Venezuela (Boliv. State) Honduras Guatemala Guatemala Haiti Argentina 0% 10% 20% 30% 40% 50% 0% 20% 40% 60% 80% 100% e) Changes in numbers of confirmed cases, 2000–2009: f) Changes in numbers of confirmed cases, 2000–2009: countries with evidence of sustained decrease in cases countries with limited evidence of sustained decrease in cases 180 Colombia Guatemala Dominican Republic Suriname Honduras 500 160 El Salvador Guyana Costa Rica Ecuador Argentina Haiti 140 Belize Mexico 400 French Guiana Paraguay 120 Bolivia (Pluri. State) 150% Panama El Salvador Guyana 100% Dominican Republic 100% Mexico Haiti 50% 50% 0% 0% 2002 2003 2004 2005 2006 2007 2008 2009 2002 2003 2004 2005 2006 2007 2008 2009 Figure 6. Two malaria-endemic; there has been no indigenous transmission of countries in the pre-elimination stage actively follow up all suspected malaria in the Maldives since 1984. The population in the Region is at some risk of malaria, with 20% at high scale of preventive interventions appears to be limited in India and risk (in areas with a reported incidence of more than 1 case per 1000 Nepal, with coverage of less than 30% of the population at high risk. Three countries accounted for 94% of the reported cases Myanmar and Timor-Leste), and the scale of control activities in the Region in 2008 (India, 65%, Myanmar, 20% and Indonesia, appeared to be small in relation to the total population at risk. Reductions of more than 50% in the number of reported cases in 2000–2009 were In summary, 4 countries (Bhutan, the Democratic People’s recorded in 5 countries (Bhutan, the Democratic People’s Republic Republic of Korea, Sri Lanka and Thailand) experienced a decrease in of Korea, Nepal, Sri Lanka and Thailand; Fig. The number of the number of malaria cases of more than 50% since 2000, associated confrmed cases in India was 23% lower in 2009 than in 2000. Malaria occurs primarily in 15 districts from 210 000 in 2000 to 558 in 2009 and the proportion of cases that border India. Only 4 malaria deaths were reduce malaria cases has been the use of Malaria Mobile Clinics reported in 2009. Thus in 2009 all locally-acquired cases in the tion) endorsed the Tashkent Declaration (9), the goal of which is to Region were due to P. Overall, the number of indigenous cases interrupt malaria transmission by 2015 and eliminate the disease reported in the Region decreased from 32 385 in 2000 to 285 in 2009. Since 2008, national and inter-country strategies on All countries registered a decrease of more than 90% in the number malaria have been revised to address cross-border collaboration and of cases since 2000 except Kyrgyzstan that had a 67% reduction with other new challenges for malaria elimination. All malaria-endemic countries in the Region have active activity is evident in all of the countries – more than 80% coverage control programmes. The parties to the Joint Statement agreed to the countries with ethnic Azerbaijanis living in Georgia and ethnic ensure regular exchange of information, synchronize action Georgians living in Azerbaijan and frequent population movements plans, ensure early notification of any changes, establish a across the border. Other countries in the Region have not reported consistent (Islamic Republic of Iran, Iraq and Saudi Arabia) and 4 countries that decreases in the number of cases (Djibouti, Pakistan, Somalia, Sudan are in the phase of preventing re-introduction of malaria (Egypt, and Yemen), although Sudan has extended the coverage of malaria Morocco, Oman, and the Syrian Arab Republic). Four countries accounted for Arabia) showed evidence of a sustained decrease of more than 50% 98% of the confrmed cases: Sudan, 70%; Pakistan, 17%; Afghanistan in the number of cases since 2000, associated with widespread imple- 6%; and Yemen, 5%. Since then the malaria burden the country has recorded no locally-acquired cases of malaria, but has declined steadily in response to a combination of intensified receives an average of 109 imported cases annually, of which 88% control interventions, improved health service coverage and socio- are due to P. It is intense and widespread in the Pacifc countries interventions appears to be low in Viet Nam which may refect the (Papua New Guinea and Solomon Islands and, to a lesser extent, focal nature of malaria in the country. In both Cambodia and Papua Approximately 247 000 confrmed cases were reported from the New Guinea there was little change in confrmed cases although Region in 2009. Three countries (Papua New Guinea, 31%, Cambodia, Cambodia reported a reduction in malaria deaths from 608 in 2000 26% and Solomon Islands, 13%) accounted for the 71% of the to 279 in 2009 (54% decrease). Despite this high importation rate, Italy had only two instances of local transmission: one case in 1997 and two cases in of reintroduction 2007, all due to P. There has been continued progress towards malaria elimination The other country in this group with local mosquito-borne trans- in several countries in 2009 and 2010. Morocco and Register is the United Arab Emirates, which reported 18 240 imported Turkmenistan were certifed free of malaria in 2010 and Cape Verde malaria cases over the period 1999–2008 (range: 1322–2629 per entered the pre-elimination stage in 2010. For 2008, the importation rate amounted and prevention of reintroduction phases as of 1 December 2010. No local transmission has been reported in the has to be made that, beyond reasonable doubt, the chain of local United Arab Emirates since 1997. The team makes a recommendation on and deaths, 2000–2009 certifcation based on an assessment of the current situation and the likelihood that elimination can be maintained. If only one household survey was “malaria-free” countries in the Weekly Epidemiological Record and on available then health service use was assumed to remain constant the International travel and health web site (www. In such cases an reports such instances in the annual updates of International travel estimate of the number of cases was constructed by sampling from and health.

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    Variations in the cedures and restoration with appropriate m aterials such diet of the Ca/P ratio obtained by changes in the phosphorus content generic malegra fxt plus 160mg overnight delivery. In advanced rat in relation to the chem ical com position of the teeth and of the cases buy malegra fxt plus 160mg with amex, where the pulp of the tooth is involved, endodontic diet. Dental caries after radiotherapy of the oral • Prevention of prem ature loss of deciduous teeth regions. Dem onstration of the etiologic role of • Restoration of m issing perm anent teeth by prostheses streptococci in experim ental caries in the ham ster. Causal relation between m alocclusion and of a 6-year oral health education program m e for prim ary caries. Im pact of socio-dem ographic variables, varnishes— a review of their clinical use, cariostatic m echanism , oral hygiene practices, oral habits and diet on dental caries efficacy and safety. W orldwide, the average prevalence of m alocclusion in the • Congenital: These include cleft lip and palate, and 10–12 years’ age group is reported to be 30% –35%. Causes of dentofacial anomalies and malocclusion Direct Indirect Distant • Hereditary/congenital • Environmental factors • Poor nutritional status·deficiency of • Abnormal pressure habits and functional ·prenatal causes such as trauma, vitamin D, calcium and phosphates aberrations maternal diet and metabolism, • Endocrine imbalance such as hypothyroidism ·abnormal suckling German measles, certain drugs, • Metabolic disturbances and muscular dystrophies ·mouth breathing and position in utero • Infectious diseases such as poliomyelitis ·thumb and finger sucking ·postnatal causes such as birth injury, • Functional aberrations ·tongue thrusting and sucking cerebral palsy, temporomandibular ·psychogenic tics and bruxism ·abnormal swallowing joint injury ·posture • Trauma and accidents • Local factors ·abnormalities of number (supernumerary teeth, missing teeth) ·abnormalities of tooth size and shape ·abnormal labial frenum and mucosal barriers ·premature tooth loss ·prolonged retention of deciduous teeth ·delayed eruption of permanent teeth ·abnormal eruptive path ·untreated dental caries and improper dental restorations, especially on the proximal surfaces • Local factors: These include abnorm alities of num ber Factors responsible for causing dentofacial anom alies such as supernum erary and m issing teeth, abnorm alities and m alocclusion are sum m arized in Table 3. Strategies for the prevention and treatment of dentofacial joint injury anomalies and malocclusion Medical interventions Non-medical interventions Distant causes 26,27 • Habit-breaking appliances • Control harmful oral habits • Endocrine im balance: H ypothroidism is related to an • Serial extractions • Prenatal and perinatal care abnorm al resorption pattern, delayed eruption and • Space-maintainers and -regainers • Genetic counselling • Functional appliances in developing gingival disturbances. Etiological and predisposing factors Secondary prevention related to traum atic injuries to perm anent teeth. The N orthcroft tions, space maintainers/regainers, and functional appliances lecture, 1985 presented to the British Society for the Study of to correct jaw relations are other m odalities. Genetic and epigenetic regulation of craniofacial craniofacial growth patterns in patients with orofacial clefts: developm ent. Gingival and inadequate plaque rem oval, can also cause gingival periodontal diseases affect 90% of the population. Distant causes19–25 Aetiology 11111–66666 These include low socioeconomic and literacy level, difficult Direct causes access to an oral health care facility, poor oral health These include poor oral hygiene leading to accum ulation awareness, and lack of oral health insurance. O ral health such as puberty, pregnancy, menopause, and pathological education is required for the m aintenance of oral hygiene causes such as hyperthyroidism , hyperparathyroidism (brushing, flossing, rinsing, etc. Interventions for the prevention and • Blood disorders such as acute m onocytic leukaem ia and treatm ent of periodontal diseases are given in Table 6. Prevention and treatment of periodontal diseases Medical interventions Non-medical interventions Other interventions • Scaling and polishing of teeth • Oral health education • Make oral health care more accessible • Oral and systemic antibiotics • Nutrition and diet and affordable • Use of mouth washes • Proper methods of oral hygiene maintenance • Improve the socioeconomic and literacy • Gingival and periodontal surgery ·use of toothpaste and tooth brush level of the population ·gingivoplasty, gingivectomy, flap surgery, ·use of inter-proximal cleaning devices such as • Include oral health care in general health mucogingival surgeries, guided tissue interdental brushes, dental floss and water pik, etc. Periodontal m anifestations of system ic in com m unity settings for people with special needs: Preface. It is the m ost com m on cancer in cancers are diagnosed at a very late stage, when treatm ent m en and the fourth m ost com m on cancer in wom en, and not only becom es m ore expensive, but the m orbidity and constitutes 13% –16% of all cancers. The 5- Aetiology year survival rate is 75% for local lesions but only 17% for Direct causes those with distant m etastasis. Since the oral cavity is easily • Tobacco— M any form s of tobacco are used in India— accessible for examination and the cancer is always preceded sm oking (78% ); chewing of betel quid, paan m asala, by som e pre-cancerous lesion or condition such as a white gutka, etc. Increased incidence of • Bacterial infections such as syphilis, and fungal (candi- 8–10 m outh cavity, pharyngeal and laryngeal carcinom as. Dental factors in the genesis Table 7 lists the direct, indirect and distant causes of of squam ous cell carcinom a of the oral cavity. Prevalence of oral subm ucous fibrosis am ong the cashew workers of Kerala, Strategies for prevention and treatm ent of oral cancer are South India. Solar radiation, lip protection, and lip cancer risk in Los Angeles County wom en (California, United 1. The concentration of fluoride in drinking water to teeth, som etim es with structural defects in the enam el such give the point of m inim um caries with m axim um safety. Fluoride water, food and drugs with a high fluoride content, (ii) varnishes— a review of their clinical use, cariostatic m echanism , efficacy and safety. Causes of dental fluorosis Direct Indirect Distant • Exposure to high levels of fluorides: >1 ppm of • Tropical climate·excess ingestion of water • Poor nutritional status·deficiency of fluoride in drinking water and beverages with a high fluoride content vitamin D, calcium and phosphates • Airborne fluoride from industrial pollution (aluminium • Presence of kidney diseases affecting the • Decreased bone phosphatase activity is factories, phosphate fertilizers, glass-manufacturing excretion of fluoride linked to fluoride toxicity industries, ceramic and brick products) • Thyroid and thyrotrophic hormones have a • Fluoride-rich dietary intake·sea food, poultry, grain synergistic effect on fluoridetoxicity and cereal products (especially sorghum), tea, rock salt, green leafy vegetables, etc.

    Extending from the mesovarium itself is the suspensory ligament that contains the ovarian blood and lymph vessels generic malegra fxt plus 160 mg without prescription. The ovary comprises an outer covering of cuboidal epithelium called the ovarian surface epithelium that is superficial to a dense connective tissue covering called the tunica albuginea order malegra fxt plus 160 mg mastercard. The cortex is composed of a tissue framework called the ovarian stroma that forms the bulk of the adult ovary. Beneath the cortex lies the inner ovarian medulla, the site of blood vessels, lymph vessels, and the nerves of the ovary. You will learn more about the overall anatomy of the female reproductive system at the end of this section. During a woman’s reproductive years, it is a roughly 28-day cycle that can be correlated with, but is not the same as, the menstrual cycle (discussed shortly). The cycle includes two interrelated processes: oogenesis (the production of female gametes) and folliculogenesis (the growth and development of ovarian follicles). Oogonia are formed during fetal development, and divide via mitosis, much like spermatogonia in the testis. These primary oocytes are then arrested in this stage of meiosis I, only to resume it years later, beginning at puberty and continuing until the woman is near menopause (the cessation of a woman’s reproductive functions). The number of primary oocytes present in the ovaries declines from one to two million in an infant, to approximately 400,000 at puberty, to zero by the end of menopause. The initiation of ovulation—the release of an oocyte from the ovary—marks the transition from puberty into reproductive maturity for women. From then on, throughout a woman’s reproductive years, ovulation occurs approximately once every 28 days. Just prior to ovulation, a surge of luteinizing hormone triggers the resumption of meiosis in a primary oocyte. The smaller cell, called the first polar body, may or may not complete meiosis and produce second polar bodies; in either case, it eventually disintegrates. Thus, the ovum can be thought of as a brief, transitional, haploid stage between the diploid oocyte and diploid zygote. The larger amount of cytoplasm contained in the female gamete is used to supply the developing zygote with nutrients during the period between fertilization and implantation into the uterus. Therefore, the cytoplasm and all of the cytoplasmic organelles in the developing embryo are of maternal origin. By analyzing these mutational relationships, researchers have been able to determine that we can all trace our ancestry back to one woman who lived in Africa about 200,000 years ago. Scientists have given this woman the biblical name Eve, although she is not, of course, the first Homo sapiens female. They grow and develop in a process called folliculogenesis, which typically leads to ovulation of one follicle approximately every 28 days, along with death to multiple other follicles. The death of ovarian follicles is called atresia, and can occur at any point during follicular development. Recall that, a female infant at birth will have one to two million oocytes within her ovarian follicles, and that this number declines throughout life until menopause, when no follicles remain. As you’ll see next, follicles progress from primordial, to primary, to secondary and tertiary stages prior to ovulation—with the oocyte inside the follicle remaining as a primary oocyte until right before ovulation. These small primordial follicles are present in newborn females and are the prevailing follicle type in the adult ovary (Figure 27. Primordial follicles have only a single flat layer of support cells, called granulosa cells, that surround the oocyte, and they can stay in this resting state for years—some until right before menopause. After puberty, a few primordial follicles will respond to a recruitment signal each day, and will join a pool of immature growing follicles called primary follicles. Primary follicles start with a single layer of granulosa cells, but the granulosa cells then become active and transition from a flat or squamous shape to a rounded, cuboidal shape as they increase in size and proliferate. Within the growing secondary follicle, the primary oocyte now secretes a thin acellular membrane called the zona pellucida 1296 Chapter 27 | The Reproductive System that will play a critical role in fertilization.

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    Use the proper cleaning method • Protect mattresses with rubber sheets • Use protective pillowcases on pillows buy 160mg malegra fxt plus amex. Hot water coagulates the protein of organic material and tends to make it adhere • Wash well in hot soapy water discount malegra fxt plus 160 mg fast delivery. Use an abrasive, such as a stiff-bristled brush, to clean equipment • Rinse well under running water • Dry the article • Clean the gloves, brush and sink 3. Care of Linen and Removal of Stains • Clean linen should be folded properly and be kept neatly in the linen cupboard • Dirty linen should be put in the dirty linen bag (hamper) and never be placed on the floor • Torn linen should be mended or sent to the sewing room • Linen with blood should be soaked in cold water to which a small amount of hydrogen peroxide is added if available • Linen stained with urine and feces is first rinsed in cold water and then washed with soap • Iodine stained linen- apply ammonia, rinse and then wash with cold water • Ink stained linen – first soak in cold water or milk for at least for 24 hrs then rub a paste of salt and lemon juice on the stain and allow the article to lie in the sun • Tea or coffee stains – wash in cold water and then pour boiling water on the stain Basic Nursing Art 9 • To remove vitamin B complex stains dissolve in water or sprit • Mucus stains – soak in salty water • Rust _ soak in salt and lemon juice and then bleach in sun 4. Care of Pick Up Forceps and Jars Pick up forceps: an instrument that allows one to pick up sterile equipment. Pick up forceps should be kept inside the jar in which 2/3 of the jar should be filled with antiseptic solution • Wash pick up forceps and jars and sterilize daily • Fill jar with disinfectant solution daily • Care should be taken not to contaminate tip of the forceps • Always hold tip downward • If tip of forceps is contaminated accidentally, it should be sterilized before placing it back in the jar to avoid contamination. Rubber Bags Example: hot water bottles, ice bags should be drained and dried They should be inflated with air and closed to prevent the sides from sticking together 6. Rubber Tubing • Should be washed with warm, soapy water • The inside should be flushed and rinsed well Admission and Discharge A. Admission Basic Nursing Art 10 Admission is a process of receiving a new patient to an individual unit (ward) of the hospital. Make introduction and orient the patient • Greet the patient • Introduce self to the patient and the family • Explain what will occur during the admission process (admission routines) such as admission bath, put on hospital gowns etc. Observation and physical examination such as: • Vital signs; temperature pulse, respiration and blood pressure Basic Nursing Art 11 • Intake and output • Height and weight (if required) • General assessment b. Record keeping or maintaining records • Record all parts of the admission process • Other recording include ⇐ Notification to dietary departments ⇐ Starting kardex card and medication records ⇐ If there is specific form to the facility, complete it. Plan for continuing care of the patient • Referral as necessary Basic Nursing Art 12 • Give information for a new person involved in the patient care. Teaching the patient about • What to expect • Medications (Treatments) • Activity • Diet • Need for continued health supervision 4. Do final assessment of physical and emotional status of the patient and the ability to continue own care. Check and return all patients’ personal property (bath items in patient unit and those kept in safe area). Help the patient or family to deal with business office for customary financial matters and in obtaining supplies. Keep records o Write discharge note o Keep special forms for facility Discharge summaries usually include: • Description of client’s condition at discharge • Current medication • Treatment (e. When the patient want to leave an agency without the permission of the physician - unauthorized discharge the following activities are indicated: 2. If the client refuses to sign the form, document the fact on the form and have another health professional witness this 6. Provide the patient with the original of the signed form and place a copy in the record 7. When the patient leaves the agency, notify the physician, nurse in charge, and agency administration as appropriate • Assist the patient to leave as if this were a usual discharge from the agency (the agency is still responsible while the patient is on premises) Charting Chart: is a written record of history, examinations, tests, diagnosis, prognosis, therapy and response to therapy Purpose Basic Nursing Art 14 • To document diagnosis or treatment of a patient while in the hospital and after discharge if the patient return for treatment at a future time. Nausea, headache, numbness Basic Nursing Art 15 As part of the admission process a new chart should be opened and certain forms must be filled Orders of Assembling Patients Chart a. Cotton Rings: are small circles of cotton rolled with gauze or bandage with hole in the middle. Air Rings: • Should be filled with air and covered with pillow case • Not commonly used • Should be changed frequently • Used to relieve pressure from the buttocks (to prevent bed sore) 3. Pillow: • Placed under head, back, between knees or at the foot of the bed to prevent foot drop and keep the patient. Basic Nursing Art 16 • Are used to give comfort, support and to position a patient properly. Splints: Are rigid supports that help maintain the wrists in hyperextension as a means of Preventing palmar flexion and constructors.

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