Loading

Aktualności

M. Arokkh. Missouri State University.

The Chairman may constitute various Specialists Group / Working Groups / Sub- groups/task forces etc cheap cialis professional 40 mg without a prescription erectile dysfunction icd 10. Working Group will keep in focus the Approach paper to the 12 Five Year Plan and monitorable goals purchase generic cialis professional line erectile dysfunction due to diabetes icd 9, while making recommendations. The Working group would submit its draft report by 31 July, 2011 and final report st by 31 August, 2011. Prevention & Control of Neurological Disorders (Epilepsy, Autism, Dementia) 240 20. Since the majority of deaths are premature there is a substantial loss of lives during the productive years as compared to other countries. Heart diseases, stroke and diabetes are projected to increase cumulatively, and India stands to lose 237 billion dollars during the decade 2005-2015. Road traffic injuries are increasing precipitously, and are estimated to account for as much as 25% of all health care expenditures in developing nations. Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to primary care. More than 20% of the population has at least one chronic disease and more than 10% have more than one. Chronic diseases are widespread in people who are younger than 45 years and in poorer populations. Whereas socioeconomic development tends to be associated with healthy behaviours, rapidly improving socioeconomic status in India is associated with a reduction of physical activity and increased rates of obesity and diabetes. The emerging pattern in India is therefore characterized by an initial uptake of harmful health behaviours in the early phase of socioeconomic development. Such behaviours include increased consumption of energy-dense foods and reduced physical activity and increased exposure to risk factors. Health-damaging behaviours such as smoking, drinking, consuming unhealthy diets (rich in salt, sugar and fats, and low in vegetables and fruits) are also found to be common among the low socioeconomic group. However, personal behaviours are not only a matter of personal choice, but may be driven by factors such as higher levels of urbanization, technological change, market integration and foreign direct investment. National Health Pogrammes for Cancer and Blindness were started as early as 1975 and 1976 respectively, followed by programme on Mental Health in 1982. Some of the programmes were within the framework of National Rural Health Mission. These programmes have given insights of problems and experiences in implementation that would be useful in upscaling and expanding programmes across the country. Broadly, across programmes, following experiences were observed and lessons learnt in th implementation of programmes, which need to be addressed during the 12 Plan: 1. Convergence and integration would be critical in implementation of large number of interventions which would require unified management structure at various levels. Integration of cross cutting components like health promotion, prevention, screening of population, training, referral services, emergency medical services, public awareness programme management, monitoring & evaluation etc. Costs borne by the affected individuals and families may be catastrophic as treatment is long term and expensive. Investments during the 11 Plan and earlier plans have been more on provision of medical services which have not been adequate in the public sector. Private sector has grown particularly in urban settings but is beyond the reach of the poor and middle sections of the society. While Government of India’s role will be policy formulation, population based multi-setoral interventions, technical and financial th support, the onus of implementation will be with the States. To ensure convergence and integration with public health services, a decentralized approach is proposed with District as the management unit for programs. Oro-dental disorders (b) Programmes for Disability Prevention and Rehabilitation 10. Tertiary Care for advanced management of complicated cases including radiotherapy for cancer, cardiac emergency including cardiac surgery, neurosurgery, organ transplantation etc. Health Promotion & Prevention: Legislation, Population based interventions, Behaviour Change Communication using mass media, mid-media and interpersonal counselling and public awareness programmes in different settings (Schools, Colleges, Work Places and Industry). To ensure convergence, common districts will be selected for all three major programmes. The schemes would be flexible to meet local requirements as there would be 13 variation in prevalence and availability of existing health infrastructure. Airports, Ports and Land Borders covered 19 Neurological Disorders New All districts Thalassemia, Sickle Cell 20 New Pilot in selected endemic districts Disease and Hemophilia Estimated Budget It is envisaged that for comprehensive and sustainable programmes to prevent, control and manage important non-communicable diseases and key risk factors across the country, a large th investment would be required during the 12 Plan. Trauma, Disasters, Emergency Medical Services, Diseases of Bones &Joints, Mental Health and Health Care of the Elderly are disabling diseases and requiring investment for not only treatment but also rehabilitation. It is also important to invest on preventive programmes and health promotion to check occurrence of new cases and reduce at risk population. Nearly one-third of the budget would be required for primary health care in the rural areas. Secondary and tertiary level care is important to manage these chronic and fatal diseases and injuries and large share of the budget would be required to upgrade and strengthen District Hospitals, Medical Colleges and other Tertiary level institutions. About 80% of the burden occurs in low / middle-income countries, and 25% is in individuals younger than 60 years. This 4 goal had been presented as a formal action plan to the 61st World Health Assembly in 2008. Since the majority of deaths are premature there is a substantial loss of lives during the productive years as compared to other countries. The overall non-communicable diseases are the leading causes of death in the country, constituting 42% of all deaths. However, majority of ill-defined causes are at older ages (70 or higher years) and most of ill- defined deaths are likely to be from non-communicable diseases. Urban areas have a lower number of deaths from communicable, maternal, perinatal and nutritional conditions but a higher proportion from non-communicable diseases (56%). Notable differences by gender are seen in the case of diarrhoeal diseases with 10% of women deaths against 7% of men deaths, tuberculosis with 5% of women deaths vis-à-vis 7% men deaths, and cardiovascular diseases with 17% women deaths versus 20% men deaths. Diabetes: Prevalence, increasing in both urban and rural areas, is in the range of 5–15 percent among urban populations, 4–6 percent in semi-urban populations, and 2–5 percent in rural populations. Hypertension: Present in 25 percent of the urban and 10 percent of the rural population. Cancer: Over 70 percent of cases are diagnosed during the advanced stages of the disease, resulting in poor survival and high case mortality rates. Smoking: Prevalence is similar to other South Asian countries (men 33 percent, women 4 percent) while smoking prevalence among youth is higher (boys 17 percent, girls 9 percent). Smoking accounts for 1 in 5 deaths among men and 1 in 20 deaths among women, accounting for an estimated 930,000 deaths in 2010. Injuries: Road traffic injuries and deaths are on the increase along with the rapid economic growth. Annually, they result in more than 100,000 deaths, 2 million hospitalizations, and 7.

In patients with severe acne purchase cialis professional cheap xyzal erectile dysfunction, it is quite common for other areas to be affected cheap cialis professional 20mg amex erectile dysfunction treatment without side effects, including the outer aspects of the upper arms, the buttocks and thighs. For the unfortunate few, the condition is a disaster, as it is disfiguring, disabling and persistent, with wave after wave of new lesions. Although the natural tendency is for resolution, it is difficult to know in any indi- vidual patient when the condition will improve. The majority have lost their acne by the age of 25 years, but some tend to have the occasional lesion for very much longer. In some women there is a pronounced premenstrual flare of their acne some 7–10 days before the menses begin. Acne improves in the summertime and sun exposure seems to improve the condition of many patients. However, the heat does not produce improvement and, indeed, can make it much worse. Soldiers with acne in hot, humid climates often become disabled by it suddenly worsening, with large areas of skin covered by inflamed and exuding acne lesions, and have to be evacuated home or to a cooler climate. This proportion varies in different parts of the world, depending on the racial mixture, the affluence and the sophis- tication of medical services. The variations in incidence in different ethnic groups have not been well char- acterized, although it does appear that Eskimos and Japanese suffer less from acne than do Western Caucasians. Onset is usually at puberty or a little later, although many patients do not appear troubled until the age of 16 or 17 years. Older age groups are not immune and it certainly is not rare to develop acne in the sixth, seventh or even eighth decade. Acne lesions sometimes appear on the cheeks and chin of infants a few weeks or months of age and even a little later than that (Fig. This infantile acne is usually trivial and short lived, but can occasionally be troublesome. It is the increased secretion of these hormones that is responsible for the increased sebum secretion at puberty. When given therapeutically for any reason, they can also cause an eruption of acne spots. Glucocorticoids, such as prednisolone, when given to suppress the signs of rheumatoid arthritis or some other chronic inflammation, can also induce troublesome acne (Fig. Glucocorticoids do not seem to increase the rate of sebum secre- tion, and the acne that results is curiously monomorphic in that sheets of acne lesions appear (unlike ordinary acne) all at the same stage of development. Interestingly, corticosteroid creams can, uncommonly, also cause acne spots at the site of application. Oil acne Workers who come into contact with lubricating and cutting oils develop an acne- like eruption at the sites of contact, consisting of small papules, pustules and comedones. This is often observed on the fronts of the thighs and forearms, where oil-soaked overalls come in contact with the skin. A similar ‘acneiform folliculitis’ sometimes arises at sites of application of tar-containing ointments during the treatment of skin diseases (Fig. This is because they sometimes contain comedo-inducing (comedogenic) agents, such as cocoa butter and derivatives and some mineral oils, that can induce acne. This cosmetic acne is less of a problem now that cosmetic manufacturers are aware of it (Fig. Chloracne Chloracne is an extremely severe form of industrial acne due to exposure to complex chlorinated naphthalenic compounds and dioxin. Epidemics have occurred after 155 Acne, rosacea and similar disorders industrial accidents such as occurred in Serveso in Italy, in which the population around the factory was affected. The compounds responsible are extremely potent, and lesions continue to develop for months after exposure. Typically, numerous large, cystic-type lesions occur in this form of industrial acne. Small acne spots around the chin, forehead and on the jaw line are picked, squeezed and otherwise altered by manual interference. Often, the patients have little true acne and the main cos- metic problem is the results of the labour of their fingers! The exact histological picture depends on the stage reached at the time of biopsy. Later, fragments of horn appear to have provoked a violent mixed inflammatory reaction with many polymorphs and, in places, a granulomatous reaction with many giant cells and histiocytes (Fig. Acne first appears at puberty, at which time there is a sudden increase in the level of circulating androgens. Eunuchs do not get acne, and the administration of testosterone provokes the appearance of acne lesions. Sebaceous glands are pre- dominantly ‘androgen driven’ and few other influences are as important. Comedones are early lesions and microscopically it is commonplace to find horny plugs in the follicular canals. Changes have been described in the follicular epithelium suggesting that there is abnormal keratinization at the mouth of the hair follicle. Pathogenic bacteria are not found in acne lesions and are not involved in Table 10. It is possible, nonetheless, that the normal flora has a role constituents of sebum and to play. The flora consists of Gram-positive cocci – the micrococci (also known skin surface lipid as Staphylococcus epidermidis) – and Gram-positive bacteria – Propionibacterium acnes. In addition, there are also yeast-like micro-organisms known as Pityrosporum Sebum ovale. The Propionibacteria are microaerophilic and lipophilic, so that they are Triglycerides ideally suited to living in the depths of the hair follicle in an oily milieu, and it is Cholesterol ester not surprising that they increase in numbers during puberty when their food Squalene supply, in the form of sebum, increases. The normal follicular flora may be Wax esters responsible for hydrolysing the lipid esters of sebum, liberating potentially irritat- Skin surface lipid ing fatty acids. The constituents of sebum and of skin surface lipid (after bacter- Sebum lipids ial hydrolysis) are given in Table 10. Consequently, many forms of familial or folk treatments seem to be more in the nature of punishments than anything else. Dietetic and social restrictions are typical, as is more frequent washing, which is another tactic adopted by well-meaning but misguided family and friends. Those who do not, find their way to the pharmacist and purchase preparations containing benzoyl peroxide or other antimicrobial compounds, or sulphur or salicylic acid. It is only those with resistant, recalcitrant and more severe types of acne who reach the physician. Basic principles Treatment may be aimed at: ● reducing the bacterial population of the hair follicles to cut down the hydro- lysis of lipids (antimicrobial agents) ● encouraging the shedding of the follicular horny plugs to free the obstruction (comedolytic agents) ● reducing the rate of sebum production, either directly by acting on the sebace- ous glands or indirectly by inhibiting the effects of androgens on the sebaceous glands (anti-androgens) ● reducing the damaging effects of acne inflammation on the skin with anti- inflammatory agents (Table 10.

Even in these other kinds of chronic diseases buy cialis professional 40mg mastercard leading causes erectile dysfunction, its disciples purchase cialis professional discount erectile dysfunction over 40, by following the teachings presented in my former writings and my former oral lectures, accomplished far more than all the afore-mentioned methods of curing; i. Using the more natural treatment, Homoeopathic physicians have frequently been able in a short time to remove the chronic disease which they had before them, after examining it according to all the symptoms perceptibly to the senses; and the means of cure were the most suitable among the Homoeopathic remedies, used in their smallest doses which had been so far proved as to their pure, true effects. And all this was done without robbing the patient of his fluids and strength, as is done by the allopathy of the common physicians; so that the patient, fully healed, could again enjoy gladsome days. These cures indeed have far excelled all that allopathists had ever - in rare cases - been able to effect by a lucky grab into their medicine chests. The complaints yielded for the most part to very small doses of that remedy which had proved its ability to produce the same series of morbid symptoms in the healthy body; and, if the disease was not altogether too inveterate and had not been too much and in too great a degree mismanaged by allopathy, it often yielded for a considerable time, so that mankind had good reason to deem itself fortunate even for that much help, and, indeed, it often proclaimed its thankfulness. A patient thus treated might and often did consider himself in pretty good health, when he fairly judged of his present improved state and compared it with his far more painful condition before Homoeopathy had afforded him its help. They had been merely treated with such medicines as Homoeopathically best covered and temporarily removed the then apparent moderate symptoms, thus causing a kind of a cure which brought back the manifest psora into a latent condition and thus produced a kind of healthy condition, especially with young, vigorous persons, such as would appear as real health to every observer who did not examine accurately; and this state often lasted for many years. But with chronic diseases caused by a psora already fully developed, the medicines which were then known never sufficed for a complete cure, any more than these same medicines suffice at the present time. This would be especially the case whenever the seemingly cured disease had for its foundation a psora which had been more fully developed. When such a relapse would take place the Homoeopathic physician would give the remedy most fitting among the medicines then known, as if directed against a new disease, and this would again be attended by a pretty good success, which for the time would again bring the patient into a better state. In the former case, however, in which merely the troubles which seemed to have been removed were renewed, the remedy which had been serviceable the first time would prove less useful, and when repeated again it would help still less. Then perhaps, even under the operation of the Homoeopathic remedy which seemed best adapted, and even where the mode of living had been quite correct new symptoms of disease would be added which could be removed only inadequately and imperfectly; yea, these new symptoms were at times not at all improved, especially when some of the obstacles above mentioned hindered the recovery. Some joyous occurrence, or an external condition of circumstances improved by fortune, a pleasant journey, a favorable season or a dry, uniform temperature, might occasionally produce a remarkable pause of shorter or longer duration in the disease of the patient, during which the Homoeopath might consider him as fairly recovered; and the patient himself, if he good-naturedly overlooked some passable moderate ailments, might consider himself as healthy. Still such a favorable pause would never be of long duration, and the return and repeated returns of the complaints in the end left even the best selected Homoeopathic remedies then known, and given in the most appropriate doses, the less effective the oftener they were repeated. But usually, after repeated attempts to conquer the disease which appeared in a form always somewhat changed, residual complaints appeared which the Homoeopathic medicines hitherto proved, though not few, had to leave uneradicated, yea, often undiminished. Thus there ever followed varying complaints ever more troublesome, and, as time proceeded, more threatening, and this even while the mode of living was correct and with a punctual observance of directions. The chronic disease could, despite all efforts, be but little delayed in its progress by the Homoeopathic physician and grew worse from year to year. Their beginning was promising, the continuation less favorable, the outcome hopeless. Nevertheless this teaching was founded upon the steadfast pillar of truth and will evermore be so. The attestation of its excellence, yea, of its infallibility (so far as this can be predicated of human affairs), it has laid before the eyes of the world through facts. Homoeopathy alone taught first of all how to heal the well- defined idiopathic diseases, the old, smooth scarlet fever of Sydenham, the more recent purples, whooping cough, croup, sycosis, and autumnal dysenteries, by means of the specifically aiding Homoeopathic remedies. Even acute pleurisy, and typhous contagious epidemics must now allow themselves to be speedily turned into health by a few small doses of rightly-selected Homoeopathic medicine. Whence then this less favorable, this unfavorable, result of the continued treatment of the non-venereal chronic diseases even by Homoeopathy? What was the reason of the thousands of unsuccessful endeavors to heal the other diseases of a chronic nature so that lasting health might result? Might this be caused, perhaps, by the still too small number of Homoeopathic remedial means that have so far been proved as to their pure action? The followers of Homoeopathy have hitherto thus consoled themselves; but this excuse, or so-called consolation, never satisfied the founder of Homoeopathy - particularly because even the new additions of proved valuable medicines, increasing from year to year, have not advanced the healing of chronic (non- venereal) diseases by a single step, while acute diseases (unless these, at their commencement, threaten unavoidable death) are not only passably removed, by means of a correct; application of homoeopathic remedies, but with the assistance of the never-resting, preservative vital force in our organism, find a speedy and complete cure. The answer to this question, which is so natural, inevitably led me to the discovery of the nature of these chronic diseases. To find out then the reason why all the medicines known to Homoeopathy failed to bring a real cure in the above- mentioned diseases, and to gain an insight more nearly correct and, if possible, quite correct, into the true nature of the thousands of chronic diseases which still remain uncured, despite the incontestable truth of the Homoeopathic Law of Cure, this very serious task has occupied me since the years 1816 and 1817, night and day; and behold! No, I left it unmentioned because it is improper, yea, hurtful to speak or write of things still immature. Not until the year I827 did I communicate the essentials of the discovery to two of my pupils, who had been of the greatest service to the art of Homoeopathy, for their own benefit and that of their patients, so that the whole discovery might not be lost to the world if perchance a higher call to eternity had called me away before the completion of the book - an event not so very improbable in my seventy- third year. This fact gave me the first clew that the Homoeopathic physician with such a chronic (non- venereal) case, yea in all cases of (non-venereal) chronic disease, has not only to combat the disease presented before his eyes, and must not view and treat it as if it were a well-defined disease, to be speedily and permanently destroyed and healed by ordinary homoeopathic remedies but that he has always to encounter only some separate fragment of a more deep-seated original disease. The great extent of this is shown in the new symptoms appearing from time to time; so that the Homoeopathic physician must not hope to permanently heal the separate manifestations of this kind in the presumption, hitherto entertained, that they are well-defined, separately existing diseases which can be healed permanently and completely. He, therefore, must first find out as far as possible the whole extent of all the accidents and symptoms belonging, to the unknown Primitive malady before he can hope to discover one or more medicines which may homoeopathically cover the whole of the original disease by means of its peculiar symptoms. By this method he may then be able victoriously to heal and wipe out the malady in its whole extent, consequently also its separate members; that is, all the fragments of a disease appearing in so many various forms. But that the original malady sought for must be also of a miasmatic, chronic nature clearly appeared to me from this circumstance, that after it has once advanced and developed to a certain degree it can never be removed by the strength of any robust constitution, it can never be overcome by the most wholesome diet and order of life, nor will it die out of itself. But it is evermore aggravated, from year to year, through a transition into other and more serious symptoms,* even till the end of manÕs life, like every other chronic, miasmatic sickness; e. This latter, also never passes away of itself, but, even with the most correct mode of life and with the most robust bodily constitution, increases every year and unfolds evermore into new and worse symptoms, and this, also, to the end of manÕs life. So also with similar chronic patients who did not confess such an infection, or, what was probably more frequent, who had, from inattention, not perceived it,. After a careful inquiry it usually turned out that little traces of it (small pustules of itch, herpes, etc. It then became manifest to me, through the aid afforded when using these medicines in similar chronic diseases, in which the patient was unable to show a like cause, that also these cases in which the patient remembered no infection of this kind were of necessity caused by a Psora with which he had been infected, perhaps, even in his cradle, or in some other way that had escaped his memory; and this often received corroboration on a more careful inquiry with the parents or aged relatives. Most painstaking observations as to the aid afforded by the anti-psoric remedies which were added in the first of these eleven years have taught me evermore, how frequently not only the moderate, but also the more severe and the most severe, chronic diseases are of this origin. This observation taught me that not only most of the many cutaneous eruptions which Willan distinguishes with such extreme care from one another, and which have received separate names, but also almost all adventitious formations, from the common wart on the finger up to the largest sarcomatous tumor, from the malformations of the finger-nails up to the swellings of the bones and the curvature of the spine, and many other softenings and deformities of the bones, both at an early and at a more advanced age, are caused by the Psora. So, also, frequent epistaxis, the accumulation of blood in the veins of the rectum and the anus, discharges of blood from the same (blind or flowing piles), haemoptysis, hematemesis, hematuria, and deficient as well as too frequent menstrual discharges, night-sweats of several yearsÕ duration, parchment-like dryness of the skin, diarrhoea of many years, standing, as well as permanent constipation and difficult evacuation of the bowels, long-continued erratic pains, convulsions occurring repeatedly for a number of years, chronic ulcers and inflammations, sarcomatous enlargements and tumors, emaciation, excessive sensitiveness as well as deficiencies in the senses of seeing, hearing, smelling, tasting and feeling; excessive as well as extinguished sexual desire; diseases of the mind and of the soul, from imbecility up to ecstasy, from melancholy up to raging insanity; swoons and vertigo; the so-called diseases of the heart; abdominal complaints and all that is comprehended under hysteria and hypochondria - in short, thousands of tedious ailments of humanity called by pathology with various names, are, with few exceptions, true descendants of this many-formed Psora alone. I was thus instructed by my continued observations, comparisons and experiments in the last years, that the ailments and infirmities of body and soul which, in their manifest complaints, differ, so radically and which, with different patients, appear so very unlike (if they do not belong to the two venereal diseases, syphilis and sycosis), are but partial manifestations of the ancient miasma of leprosy and itch; i. Thus in the year 1813 one patient would be prostrated with only a few symptoms of this plague, a second patient showed only a few but different ailments, while a third, fourth, etc. Then the one or two remedies,* found to be Homoeopathic, healed the whole epidemy, and therefore showed themselves specifically helpful with every patient, though the one might be suffering from symptoms differing from those of others, and almost all seemed to be suffering from different diseases. Thus they never pass away of themselves, but increase and are aggravated even till death. They must therefore all have for their origin and foundation constant chronic miasms, whereby their parasitical existence in the human organism is enabled to continually rise and grow. And, if we except those diseases which have, been created by a perverse medical practice or by deleterious labors in quicksilver, lead, arsenic, etc. At that time and later on among the Israelites the disease seems to have mostly kept the external parts of the body for its chief seat. This was also true of the malady as it prevailed in uncultivated Greece, later in Arabia and, lastly in Europe during the Middle Ages.