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Regular screening camps have been conducted by the states of Tamil Nadu buy genuine lasix on-line arrhythmia khan academy, Karnataka order lasix 40mg fast delivery blood pressure chart 13 year old, Chandigarh order 40 mg lasix fast delivery artery dorsalis pedis, Sikkim and Andhra Pradesh. States namely Sikkim, Uttarakhand, Karnataka, Tamilnadu , Assam, Gujarat and Chandigarh have procured the equipments specified within the Programme. However, there is delay in procurement by other states due to problems in procedural formalities at state level and cost considerations. Process of procurement has been completed in 40 districts of 9 states and is under process in the remaining 136 districts of other states. Recruitment is low due to non availability of local candidates and low honorarium. The state of Uttar Pradesh and Manipur could not distribute the Hearing aids due to poor implementation of the programme in these states. However, the quarterly progress reports are not been submitted by the states on regular basis due to lack of dedicated manpower under the programme. Trauma Care Facility on National Highways Road Safety Initiatives by the Government of India The Department of Road Transport is also contemplating to set up national and State level Road Safety and Traffic Management Boards by enacting the National Road Safety and Traffic Management Act. These Road Safety Boards are to be set up for the establishment of National and State level Road Safety and Traffic Management Boards for the purpose of orderly development, regulation, promotion and optimization of modern and effective road safety and traffic management systems and practices including improved safety standards in road design, construction, operation and maintenance, and production and maintenance of mechanically propelled vehicles and matters connected therewith or incidental thereto. The safety of road users is primarily the responsibility of the concerned State Government. Prevention and control of road traffic injuries requires an integrated and coordinated approach between all concerned ministries and departments. The new understanding of road traffic injuries reveal that if systematic programmes can be put in place, it is possible to prevent road crashes. A road safety management authority is crucial to guide, coordinate, integrate, monitor and evaluate several activities, without which road safety cannot improve. Since Road Traffic Injuries happen due to several causes, the solution are also several. Different types of interventions need to be implemented in an integrated manner to obtain maximum results It is an accepted strategy of Trauma Care that if basic life support, first aid and replacement of fluids can be arranged within first hour of the injury (the golden hour), lives of many of the accident victims can be saved. The critical factor for this strategy is to provide initial stabilization to the injured within the golden hour. The time between injury and initial stabilization is the most critical period for the patient’s survival. Thus disability and death following road accidents are preventable to some extent. Strategic activities to achieve this objective include: • Initial stabilization by trained manpower available within a defined period of time, • Rapid transportation and • Medical facilities to treat such cases. Review status of ongoing programme “The Government will strive to achieve its target that all persons involved in road accidents benefit from speedy and effective trauma care and health management. The essential functions of such a service would include the provision of rescue operation and administration of first aid at the site of an accident, the transport of the victim from accident site to an appropriate nearby hospital. To improve communication system available with police and other emergency services as a means to reduce response times and to assist in planning and implementation of Traffic Aid Post Scheme. To train police, fire and other emergency service personnel such as those on ambulances and paramedics in basic first aid for road crash victims. To develop local and regional trauma plans based on study of post-accident assistance and consequences for road traffic accident casualties. In the light of the feedback received and the general consensus that emerged during consultations with various stakeholders, it is proposed to design and develop a network of Trauma Care Centres that would in the first phase cover the entire Golden Quadrilateral connecting Delhi- Kolkata-Chennai-Mumbai-Delhi and North-South-East-West Corridors. This project would be a major stepping stone in moving towards the desired objective of bringing down preventable deaths in road accidents to around 10%. Subsequently, after evaluation of the project, other National Highways with substantial traffic density would be taken up. Out of 113, in 16 Government hospitals trauma center are partial operational for Trauma Care facilities. Recently, Ministry of Road Transport & Highways one Advance Life support Ambulance to be deployed in 70 identified hospitals in various states. National Program for Prevention and Control of Fluorosis (2007-08) National Programme for Prevention and Control of Fluorosis was approved in the year 2007-08 for 100 districts with an amount of Rs. The following strategies are adopted for implementing the programme::- • Training:- Impart training to health personnel for prevention, health promotion, early diagnosis and prompt intervention, deformity correction and rehabilitation. The objectives of the pilot project were to model the impact of providing preventive, promotive and treatment services at peripheral centres to reduce therisk of developing these chronic diseases and appropriate management. It was started in 10 states with one district each namely, Assam (Kamrup), Punjab (Jalandhar), Rajasthan (Bhilwara), Madhya Pradesh (Jabalpur), Karnataka (Shimoga), Tamilnadu (Kancheepruam), Kerala (Thiruvananthapuram), Andhra Pradesh (Nellore), Madhya Pradesh (Jabalpur), Sikkim (East Sikkim). Opportunistic Screening for diabetes and high blood pressure will be provided to all persons above 30 years including pregnant women of all age groups at the point of primary contact with any health care facility. Funds have been released to 30 districts taken up during 2010-11 and will be released to 70 districts taken up during 2011-12. National Program for Health Care of the Elderly (2010-11) The existing health care facilities for older people in our country in terms of infrastructure, skilled manpower are almost none existing. Dedicated and separate health infrastructure is available only in a few medical colleges/institution. Major components of the programme are to establish geriatric department in 8 regional medical institutions of the country and strengthening health care facilities for elderly at various levels of 100 identified districts of the country. Funds have been released to 30 districts during 2010-11 and will be released to 70 districts during 2011-12. Assam, Haryana and Himachal Pradesh covering one Medical College and 2 district hospitals each as below. Components- ƒ Preventive Programme:This component is being implemented through Central Health Education Bureau and Awareness Programme in School for generating awareness. In Medical College, Rohtak and District Hospital, Panipat, construction plan has been finalized and construction work taken up. However in Rohtak, the Trauma Centre building where burn unit was to be located temporarily is not yet ready and will take some more time. In District nd Hospital, Gurgaon, the agreed space on 2 floor terrace could not be used. Hence, inspection visit needs to be conducted for alternative site in the hospital campus. Medical College, Tanda, District Hospital, Mandi and District Hospital, Hamirpur the Construction work has been taken up on the identified land/space. Pending construction, space has also been earmarked for burns unit & beds have been provided to the patients. However, as the District Hospital, Dhubri has been declared as a Medical College by the State govt.

The Faulty Concept of Demon Possession To say a person is demon possessed is to create a concept that is not biblical 40mg lasix overnight delivery pulse pressure of 78. It would have been much more accurate to consistently translate daimonizoma as “to have a demon purchase 100 mg lasix visa heart attack the alias radio remix demi lovato heart attack remixes 20. Fortunately discount lasix 40mg fast delivery blood pressure chart mayo, there are several excellent full- length books on deliverance that do a fine job of 4 correcting this discrepancy. Although the unfortunate use of the word “possession” is frequent, there are other places in the Bible where there are better translations. It’s extremely important for us to understand the difference between having a demon and being possessed of a demon. Having a demon is a biblical concept; possession by a demon is a concept created by a bad translation of a couple of key words. It’s the one ministry that graphically shows the world how completely defeated he really is. He, therefore, uses this mistranslation to prejudice Christians—especially leaders—against this powerful ministry. He does so by seducing them into believing that the only candidates for this ministry of power are those who are totally controlled by Satan. And, of course, the logical conclusion to this reasoning is if you are totally controlled by Satan, you certainly can’t belong to God. How could a person be possessed of God and possessed of the devil at the same time? The devil has succeeded at getting many to equate having a demon with being possessed of a demon. What Christian would submit to deliverance ministry, if by doing so it’s seen as a confession of having never been saved? So multitudes of Christians who have demons don’t get help because they don’t understand what it means to have a demon. What It Means to Have a Demon A person who has a demon is simply a person whose spiritual, mental, or physical self has been accessed by a demon. Satan now inflicts greater damage from the inside than he could’ve done from the outside. Below you’ll see how a natural or bad situation is worsened when a demon finds access. Before Demonic Access After Demonic Access Has doubts of God and spiritual matters that can Doubts grow larger no matter what the be erased by Bible person does. It becomes impossible or study, prayer, fellowship, nearly impossible to believe the Bible. Can pray, worship, and Attempts to pray, worship, and read the read the Bible with Bible causes a rush of evil thoughts, pain, natural, moderate sleepiness, or shaking of a body part. Person can’t give or unwanted, but not receive love; can’t trust; expects the allowed to control life. Has bad problems with anger, rage, Emotions sometimes hatred, sorrow, self-pity, jealousy, causes problems. Serious mental problems such as severe Mild mental weaknesses indecision, forgetfulness, confusion, common to humanity. It’s important to notice that the above table can apply to Christians and non-Christians. Can we truthfully accuse every Christian with such problems as hypocrites or carnal? Can we accuse the pastor, who has consistently proven his love for Christ, of not loving Christ simply because he has never found victory over pornography? If we will be brutally honest, we’d have to admit that we may be listed in this column. Unless we have successfully hidden our weakness or sin, others already know about it anyway. Delivered from a Demon of Pain About a year after I repented of my sins and believed the gospel, something happened to me that many Christians believe can’t happen to a servant of God. Unfortunately, these ferocious headaches had been part of my life since about nine years of age. They would come upon me suddenly and beat me down with pain that is impossible to describe. It felt as though someone was inside of my skull with a jackhammer banging every nerve. Yet this was the first time I could recall having felt a force literally enter my head. As I lay on the floor in agonizing pain, wondering what had happened, Minister Edley rebuked the devil several times. For once that headache subsided, it was the second to the last time I received a headache of that sort. As I stated above, only those who suffer these types of migraine headaches understand the misery they cause. Many of them are suffering a direct attack of a spirit of sickness and don’t know it. Unfortunately, because the ministry of casting out demons has been largely neglected or rejected by the church, most of them will never be healed as I was. For those who deny that Christians can have demons, my own experience is proof enough for me that we certainly can. I can truly say that if I was not a true Christian when that demon of sickness entered me that early Sunday morning in 1980, then I certainly am not a Christian now. I still believe that He is the eternal Creator, and that He was born of a virgin and lived a sinless life. We’ll shortly establish from the scriptures and real life experiences that Christians can have demons. But I will limit our discussion to their activities in the area of sickness, disease, emotional problems, and spiritual oppression. The Bible graphically shows us that Satan, through his demons, is intimately involved in the affairs of people. Paul said in Ephesians 6:12 that “we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places. And, behold, there was a woman which had a spirit of infirmity eighteen years, and was bowed together, and could in no wise lift up herself. And when Jesus saw her, he called her to him, and said unto her, Woman, thou art loosed from thine infirmity. And he laid his hands on her: and immediately she was made straight, and glorified God. And the ruler of the synagogue answered with indignation, because that Jesus had healed on the sabbath day, and said unto the people, There are six days in which men ought to work: in them therefore come and be healed, and not on the sabbath day. The Lord then answered him, and said, Thou hypocrite, doth not each one of you on the sabbath loose his ox or his ass from the stall, and lead him away to watering? And ought not this woman, being a daughter of Abraham, whom Satan hath bound, lo, these eighteen years, be loosed from this bond on the sabbath day. There were no doubt medical names for various diseases that could cause this kind of thing.

The second and third groups of bugs are microorganisms known as the free-swimming and stalked ciliates buy generic lasix 100mg blood pressure medication nausea. The fourth group is a microorganism cheap lasix american express blood pressure pills kidney failure, known as Suctoria discount 40mg lasix with amex arteria carotida externa, which feed on the larger bugs and assist with settling. The interesting thing about the bacteria that eat the dissolved organics is that they have no mouth. The bacteria have an interesting property; their “fat reserve” is stored on the outside of their body. A chemical enzyme is sent out through the cell wall to break up the organic compounds. This enzyme, known as hydrolytic enzyme, breaks the organic molecules into small units which are able to pass through the cell wall of the bacteria. In wastewater treatment, this process of using bacteria-eating-bugs in the presence of oxygen to reduce the organics in water is called activated sludge. The first step in the process, the contact of the bacteria with the organic compounds, takes about 20 minutes. The second step is the breaking up, ingestion and digestion processes, which takes four (4) to 24 hours. As the bugs “bump” into each other, the fat on each of them sticks together and causes flocculation of the non-organic solids and biomass. From the aeration tank, the wastewater, now called mixed liquor, flows to a secondary clarification basin to allow the flocculated biomass of solids to settle out of the water. The solids biomass, which is the activated sludge, contains millions of bacteria and other microorganisms, is used again by returning it to the influent of the aeration tank for mixing with the primary effluent and ample amounts of air. Urostyla or Euplotes Waterborne Diseases ©6/1/2018 51 (866) 557-1746 Wastewater Treatment Microlife Euglypha sp. Shelled amoebas have a rigid covering which is either secreted or built from sand grains or other extraneous materials. The shell has an opening surrounded by 8-11 plates that resemble shark teeth under very high magnification. The shell of Euglypha is often transparent, allowing the hyaline (watery) body to be seen inside the shell. Indicator: Shelled amoebas are common in soil, treatment plants, and stream bottoms where decaying organic matter is present. They adapt to a wide range of conditions and therefore are not good indicator organisms. In common with other rotifers, it has a head rimmed with cilia, a transparent body, and a foot with two strong swimming toes. The head area, called the "corona," has cilia that beat rhythmically, producing a strong current for feeding or swimming. Euchlanis is an omnivore, meaning that its varied diet includes detritus, bacteria, and small protozoa. The transparent body reveals the brain, stomach, intestines, bladder, and reproductive organs. A characteristic of rotifers is their mastax, which is a jaw-like device that grinds food as it enters the stomach. Indicator: Euchlanis is commonly found in activated sludge when effluent quality is good. It requires a continual supply of dissolved oxygen, evidence that aerobic conditions have been sustained. Waterborne Diseases ©6/1/2018 52 (866) 557-1746 Protozoan Diseases Protozoan pathogens are larger than bacteria and viruses but still microscopic. Some parasites enter the environment in a dormant form, with a protective cell wall, called a “cyst. Effective filtration treatment is therefore critical to removing these organisms from water sources. It has also been referred to as “backpacker’s disease” and “beaver fever” because of the many cases reported among hikers and others who consume untreated surface water. Symptoms include chronic diarrhea, abdominal cramps, bloating, frequent loose and pale greasy stools, fatigue and weight loss. Waterborne outbreaks in the United States occur most often in communities receiving their drinking water from streams or rivers without adequate disinfection or a filtration system. The organism, Giardia lamblia, has been responsible for more community-wide outbreaks of disease in the U. Cryptosporidiosis Cryptosporidiosis is an example of a protozoan disease that is common worldwide, but was only recently recognized as causing human disease. Cryptosporidium organisms have been identified in human fecal specimens from more than 50 countries on six continents. The mode of transmission is fecal-oral, either by person-to-person or animal-to-person. All of these diseases, with the exception of hepatitis A, have one symptom in common: diarrhea. They also have the same mode of transmission, fecal-oral, whether through person-to-person or animal-to-person contact, and the same routes of transmission, being either foodborne or waterborne. Although most pathogens cause mild, self-limiting disease, on occasion, they can cause serious, even life threatening illness. By understanding the nature of waterborne diseases, the importance of properly constructed, operated and maintained public water systems becomes obvious. While water treatment cannot achieve sterile water (no microorganisms), the goal of treatment must clearly be to produce drinking water that is as pathogen-free as possible at all times. For those who operate water systems with inadequate source protection or treatment facilities, the potential risk of a waterborne disease outbreak is real. For those operating systems that currently provide adequate source protection and treatment, operating and maintaining the system at a high level on a continuing basis is critical to prevent disease. Waterborne Diseases ©6/1/2018 53 (866) 557-1746 Summary of Common Waterborne Diseases Name Causative organism Source of organism Disease Viral gastroenteritis Rotavirus mostly in young children; Human feces; Diarrhea or vomiting. Norwalk-like viruses Human feces; also, shellfish; lives in polluted waters; Diarrhea and vomiting. Human feces; Symptoms vary with type caused; gastroenteritis Typhoid Salmonella typhi (bacterium) Human feces, urine Inflamed intestine, enlarged spleen, high temperature— sometimes fatal. Cholera Vibrio cholerae (bacterium) Human feces; also, shellfish; lives in many coastal waters; Vomiting, severe diarrhea, rapid dehydration, mineral loss —high mortality. Hepatitis A virus Human feces; shellfish grown in polluted waters; Yellowed skin, enlarged liver, fever, vomiting, weight loss, abdominal pain — low mortality, lasts up to four months. Amebiasis Entamoeba histolytica Human feces; Mild diarrhea, dysentery, (protozoan) extra intestinal infection. Giardiasis Giardia lamblia (protozoan) Animal or human feces; Diarrhea, cramps, nausea, and general weakness — lasts one week to months.

There is a relatively high incidence of congenital heart disease in Down syndrome order lasix 100mg amex blood pressure test. The pulmonary valve stenosis may protect the lung from pulmonary overcirculation and symptoms of congestive heart failure; the patient will be asymptomatic order 40 mg lasix visa pulse pressure 76. But if the stenosis is severe order on line lasix blood pressure medication pregnancy, the patient will be cyanotic with further exacerbation of cyanosis with crying or increasing effort. Management Surgical repair is indicated in this child, the timing of this is determined by sympto- motalogy. If the extent of pulmonary stenosis is significant, but not severe, it will prevent excessive pulmonary blood flow and surgical repair can be delayed to 6–10 months of age when morbidity and mortality for surgical repair plateaus. In the rare cases when pulmonary stenosis is critical with extremely depressed pulmonary blood flow, a systemic to pulmonary arterial shunt may be needed in the neonatal period to provide adequate pulmonary blood flow until more definitive repair can be preformed. Buckvold Key Facts • Noonan syndrome is associated with valvular pulmonary stenosis, Williams syndrome is associated with supravalvular pulmonary (and aor- tic) stenosis, while Allagile and congenital Rubella are associated with peripheral pulmonary stenosis. Definition Congenital obstruction to right ventricular outflow can occur at the level of pulmonary valve leaflets (valvular, 90%), in the muscular region below the valve (subvalvular, infundibular), or above the valve in the pulmonary artery (supravalvular) (Fig. Branch pulmonary artery stenosis affecting the branch and peripheral pulmonary arteries may be present with or without valvular pulmonary stenosis. Pulmonary stenosis at some level, whether valvular, sub- valvular, or supravalvular, occurs in 30–50% of other congenital heart diseases. Pulmonary stenosis also occurs with greater frequency in certain genetic disorders: • In Noonan syndrome, pulmonary stenosis occurs in 39% of patients, and can be associated with stenosis of the peripheral pulmonary arteries as well as with hypertrophic cardiomyopathy. Supravalvular pulmonary stenosis also occurs as a result of intrauterine (congenital) rubella infection. This includes the collar of muscle (the infundibulum) below the pulmonary valve, which causes subpulmonary (infundibular) stenosis. The hypertrophied right ventricle often exhibits a small chamber size, and the thick myocardium may be ischemic, particularly in the subendocardial region. On the other side of the stenotic pulmonary valve, post- stenotic dilation of the main pulmonary artery commonly occurs. Subpulmonary steno- sis without valvular stenosis is unusual, except when there is an associated ventricular septal defect. Supravalvular pulmonary stenosis, branch pulmonary artery stenosis, and periph- eral pulmonary artery stenosis may occur in isolation, multiples, or diffusely through- out the pulmonary vasculature. The lesions are characterized by fibrous intimal proliferation, medial hypoplasia, and elastic fiber degeneration and disorganization. These ultrastructural changes within the pulmonary vasculature make the vessels small and stiff. In some cases, these changes can be progressive and severe, and when diffuse, are frequently associated with a genetic disorder. The peripheral pulmonary stenosis described in this chapter should be distinguished from normal small branch pulmonary arteries noted during the first 6 weeks of life producing an innocent heart murmur and eventually resolves spontaneously at about 6–8 weeks of life. The severity of the stenosis results in a proportional rise in right ventricular pressure so as to maintain cardiac output. A sustained increase in right ventricular pressure causes a progressive increase in right ventricular wall thickness, myocardial oxygen demand, and myo- cardial ischemia. In the absence of an associated atrial septal defect, right ventricular failure occurs in infancy. Left ventricular failure also ensues from leftward shift of the interventricular septum, reduced preload, outflow obstruction, increased myocardial oxygen demand, and myocardial ischemia. On the other hand, the presence of a patent foramen ovale or atrial septal defect facilitates decompression of the right atrium though a right-to-left shunt across the atrial septum, with resulting cyanosis. Cyanosis will be intensified by any increase in oxygen demand, such as with crying in a neonate or exercise in an older child, since increased tissue oxygen demands are met by increased tissue oxygen extraction. The resulting lower saturation of hemoglobin in blood that returns to the heart and is shunted across the atrial septum contributes to the appearance of frank cyanosis. Critical pulmonary stenosis produces cyanosis secondary to increased right-to-left shunt at the atrial level, which occurs as a consequence of severe fetal pulmonary stenosis and a severely hypertensive, hypoplastic, noncompliant right ventricle. In this case, neonatal pulmonary blood flow is provided by the ductus arteriosus, so that when the ductus constricts, cyanosis is intensified. Branch and peripheral pulmonary stenoses lead to the redistribution of blood flow to normal or less affected lung segments. As a result, some lung segments are under- perfused and subject to ischemic injury, while others are overperfused, and subject to injury from flow-related shear forces. Right ventricular hypertension and hyper- trophy occurs when branch and peripheral pulmonary stenosis is diffuse and severe. Clinical Manifestations As with all other obstructive lesions, the severity of obstruction predicts the clinical manifestations. Infants and children exhibit normal growth and development, even when stenosis is severe. Cardiac examination is significant for a normoactive precordium, without a right ventricular heave or thrill. An ejection click at the upper left sternal border can often be detected, and corresponds to the opening of the doming pulmonary valve. The murmur is of an ejection quality and of medium intensity, usually grade 3 or less, and is best appreciated at the left upper sternal border, with radiation to the back (Fig. S1 first heart sound, S2 second heart sound, A aortic valve closure, P pulmonary valve closure. Obstruction to blood flow across the pulmonary valve results in the elevation of right ventricular pressure over pulmonary arterial pressure. This pressure gradient causes blood flow across the pulmonary valve to be turbulent and consequently noisy (murmur). The murmur starts with a systolic click as a result of opening of thickened valve cusps and followed by systolic ejection murmur as blood crosses the stenotic valve. The murmur’s harshness increases with severity of stenosis, although in extreme cases due to resulting heart failure, the murmur may become softer. A systolic ejection murmur not preceded by a systolic click may suggest diagnosis other than pulmonary valve stenosis. Stenosis of the right ventricular outflow tract, below or above the valve with a normal valve present with a murmur similar to pulmonary stenosis, however, without the click. Pulmonary stenosis murmur is best heard over the left upper sternal border 10 Pulmonary Stenosis 137 either slightly diminished, secondary to decreased pulmonary artery pressure, or slightly increased, secondary to poststenotic pulmonary artery dilation. Moderate valvular stenosis is often well toler- ated in children, but produces clinical symptoms with advancing age. Severe valvular stenosis can lead to exercise-related chest pain, syncope, or sudden death. Cardiac examination is often significant for increased precordial activity, with a right ventricular heave and a palpable thrill in the area of the pulmonary valve at the left upper sternal border.

K. Anktos. Harris-Stowe State College.