28 August 2015
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Nagaland /ˈnɑːɡəlænd/ is a state in Northeast India. It borders the state of Assam to the west, Arunachal Pradesh and part of Assam to the north, Burma to the east and Manipur to the south. The state capital is Kohima, and the largest city is Dimapur. It has an area of 16,579 square kilometres (6,401 sq mi) with a population of 1,980,602 per the 2011 Census of India, making it one of the smallest states of India.[1]

The state is inhabited by 16 major tribes - Ao, Angami, Chang, Konyak, Lotha, Sumi, Chakhesang, Khiamniungan, Bodo-Kachari, Phom, Rengma, Sangtam, Yimchunger, Thadou, Zeme-Liangmai (Zeliang) and Pochury as well as a number of sub-tribes.[2] Each tribe is unique in character with its own distinct customs, language and dress.[3] Two threads common to all, are language and religion - English is in predominant use and Nagaland is one of three states in India where the population is predominantly Christian.[4][5]

Nagaland became the 16th state of India on 1 December 1963. Agriculture is the most important economic activity and the principal crops include rice, corn, millets, pulses, tobacco, oilseeds, sugarcane, potatoes, and fibers. Other significant economic activity includes forestry, tourism, insurance, real estate, and miscellaneous cottage industries. The state has experienced insurgency as well as inter-ethnic conflict since the 1950s. The violence and insecurity have long limited Nagaland's economic development, because it had to commit its scarce resources on law, order and security.[6][7] In the last 15 years, the state has seen less violence and annual economic growth rates nearing 10% on a compounded basis, one of the fastest in the region.[8]

The state is mostly mountainous except those areas bordering Assam valley. Mount Saramati is the highest peak with a height of 3,840 metres and its range forms a natural barrier between Nagaland and Burma.[9] It lies between the parallels of 98-degrees and 96-degrees east longitude and 26.6-degrees and 27.4-degrees latitude north of the equator. The state is home to a rich variety of flora and fauna; it has been suggested as the "falcon capital of the world".[10]

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    Before any conclusions are made during a patient interview, the impact of culture on the patient's presentation should be considered. At some point curative therapies are no longer viable, but aggressive palliative care efforts should continue to the point of death. This can be a challenge in very hot climates or when participating in outdoor activities. Forced vital capacity, which represents the total amount of air that can be exhaled, can be expressed as a series of timed volumes. Random measures of plasma GH levels are not usually dependable because of the pulsatile pattern of release. After binding, antibodies are induced that destroy the cell. A reported advantage of this agent is that a limited number of plasma samples (as few as two collected at 120 and 300 minutes after injection) can be used to quantify iohexol plasma clearance. This syndrome can be characterized by fatigue, malaise, and a disorganized sleep-wake cycle that can lead to poor performance and gastrointestinal distress. A PFT is labeled abnormal when the results fall outside the range in which 95% of people of same age, height, and sex would be found (95% confidence interval). Skin testing with the major and minor determinants has been shown to facilitate the safe use of penicillin in up to 90% of patients with a history of immediate penicillin allergy. This chapter describes some examples of the spectrum of toxicity, outlines means to recognize poisoning risk, and presents principles of treatment. Serum elevations in the liver enzymes begin 40 to 50 hours after ingestion. For example, pramipexole undergoes OCT2-mediated uptake along with MATE-mediated efflux, resulting in extensive tubular secretion and renal clearance values of 500 to 800 mL/min. Significant electrolyte imbalances including hypokalemia, hyponatremia, hypocalcemia, and hypomagnesemia develop secondary to gastrointestinal losses. VHL codes for the VHL protein (VHL), which is expressed ubiquitously throughout the body, and is part of the complex that selects substances for ubiquitination and subsequent destruction by the proteasome.

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    This slowed detection and commencement of infection control protocols, recognition of the need for personal protective equipment (PPE), postexposure prophylaxis (PEP), and prompt treatment may have great local, and in some cases global, public health implications. Millions of children die because of preventable diseases, particularly in developing countries of the world. Much work remains to be done in this area but efforts are under way. Drug-induced thrombocytopenia is the most common drug-induced hematologic disorder, with reports suggesting that between 0.1% and 5% of patients who receive heparin develop heparin-induced thrombocytopenia (HIT). Bevacizumab was studied in a phase III double-blind clinical trial in which 649 treatment-naive patients with mRCC were randomized to receive bevacizumab plus IFN-О±2a or placebo plus IFN-О±2a. It is not bound to plasma proteins, is freely filtered at the glomerulus, is not secreted or reabsorbed, and is not metabolized by the kidney. Diarrhea may complicate therapy with deferasirox and recommendations for management have been published. An outpatient psychiatrist recently started the patient on an antidepressant medication for symptoms of depression. Establishment of adequate oxygenation and maintenance of adequate circulation are the highest priorities. Intestinal amebiasis is diagnosed by demonstrating E. If unbound drug leaves the bloodstream and distributes to tissue, it may become tissue-bound, it may remain unbound in the tissue, or if the tissue can metabolize or eliminate the drug, it may be rendered inactive and/or eliminated from the body. Previously, sulfites had been given "generally recognized as safe" status by the Food and Drug Administration (FDA). Knowledge of normal hematopoiesis is needed to understand the pathophysiology of MDS (see Chapter e86 for a more detailed description of hematopoiesis). This equation is an approximation of the actual new steady-state trough concentration that will be attained in the patient because, mathematically, Css,new is an exponential function of П„. The reported prevalence of latex allergy depends on the sample population. Like postexposure prophylaxis the antibiotic choices, dosing, and duration for treatment are the same. A time-concentration curve is generated, and a minicomputer calculates the cardiac output from the area of the inscribed curve.

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    Which figure(s) represent(s) resistant bacteria in the presence of an antibiotic? If the patient is comatose or lacks a gag reflex, gastric lavage should be performed only after intubation with a cuffed or well-fitting endotracheal tube. ARBs may cause repeat events through an independent mechanism or through a common pathway not yet determined. In the case of renally eliminated drugs (eg, aminoglycosides, vancomycin, and digoxin), population estimates for kinetic parameters are generated by entering the patient's age, weight, height, gender, and serum creatinine concentration into the computer program. In older children, GFR is best assessed using standard measurement techniques for GFR. To elicit information about a patient's religious or spiritual concerns, providers may ask, "I feel that I can help you better if you can tell me what religious or spiritual needs I should consider in your healthcare." Table e2-5 lists some health beliefs and practices found in common worldwide religions. The mechanism is attributed to combined inhibition of creatinine uptake (OCT2, OCT3) and efflux (MATE1). The parenteral administration of deferoxamine produces an orange-red-colored urine within 3 to 6 hours because of the presence of ferrioxamine. Patients with an isolated deletion of chromosome 5q and no excess marrow blasts are a distinct WHO category of MDS termed 5q- syndrome. The cough can begin within 3 days or have a delayed onset of up to 12 months following initiation of ACE inhibitor therapy. This roadmap highlights the importance of integrating culturally competent care across the organizational and professional structure from admission to dismissal. The recognition of chemicals responsible for acute mass emergencies resulting from industrial disasters, hazardous materials accidents, or acts of terrorism may be aided by evaluating characteristic signs and symptoms. Because the patient is at steady state, it can be assumed that Cmin,ss is identical for each dosage interval. The widespread presence of the CYP2D6*17 variant among people of African heritage suggests that native African populations would metabolize CYP2D6 substrates at a slower rate than do other ethnic groups. For the chapter in the Wells Handbook, please go to Chapter 80. There are three main syndromes that can develop from high altitude exposure: (1) acute mountain sickness (AMS), (2) high altitude cerebral edema (HACE), and (3) high altitude pulmonary edema (HAPE).

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