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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  • AkiporteVen AkiporteVen Friday, 28 August 2015

    The two most common characteristics of PAD are IC and pain at rest in the lower extremities. Preliminary data with eltrombopag monotherapy or in combination with azacitidine has not indicated an increased risk for progression to AML or worsening overall survival. Administer influenza vaccine and offer oseltamivir if the patient has not been previously vaccinated. [url=]utrogestan.minocycline.suhagra[/url] Polymerase chain reaction tests are also available, but vary in specificity. A number of retrospective studies reporting variable rates of cross-reactivity relied on self-reported histories as confirmation of penicillin allergy. [url=]simvastatin.nitrogesic.yaz[/url] Psychiatric rating scales provide the clinician or researcher with a consistent measure of medication side effects and symptoms that are present in psychiatric disorders (eg, extrapyramidal side effects and tardive dyskinesia [TD] [Table e62-3], psychosis [Table e62-4], depression and mood disorders [Table e62-5], anxiety and obsessive compulsive disorders [Table e62-6]). Although less common than pain and dyspnea, nausea and vomiting are distressing symptoms frequently encountered in the palliative care patient population. [url=]mentax.probenecid.metaxalone[/url] Because most antimicrobials are well tolerated at their usual doses, only a select few agents (eg, aminoglycosides and vancomycin) are monitored routinely in the current clinical environment. Medical therapy with dopamine agonists usually is more effective than transsphenoidal surgery for both types of pituitary prolactinomas. In addition, clinicians must be able to gather their own data through history taking and a targeted neurologic examination to ensure optimal pharmacotherapy in neurologic patients. [url=]cartia.dicyclomine.escitalopram[/url] This mechanism facilitates the acclimatization process and quickly improves AMS and HACE. If abdominal radiographs reveal a large number of iron tablets, whole-bowel irrigation with polyethylene glycol electrolyte solution typically is necessary. Laboratory findings are usually nonspecific. [url=]amoxil.dolormin.felodipine[/url] For more detailed information, readers are referred to excellent reviews. Alzheimer disease (AD), first characterized by Alois Alzheimer in 1907, is a gradually progressive dementia affecting cognition, behavior, and functional status.

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    Despite as much as 40-fold interindividual variability in its expression, functional CYP3A4 is expressed in most adults, with intestinal expression playing a significant role in the first-pass metabolism of numerous drugs. Sensitization is most commonly associated with the application to mucous membranes. The laboratory evaluation of antimicrobial activity is an important component of the pharmacotherapeutic management of infectious diseases. Moreover, a recent pharmacokinetic-guided sunitinib dosing pilot study was conducted in 42 patients with advanced solid tumors. Other dopamine agonists that have been used to treat acromegaly include pergolide, lisuride, and quinagolide. Adaptation to the host has taken a number of forms: loss of locomotor organelles in the protozoan Sporozoa; partial and complete lack of digestive systems in the trematodes and cestodes, respectively; elaboration of proteolytic enzymes to penetrate the host intestinal mucosa by Entamoeba histolytica; the cercariae of the blood fluke that penetrate the skin of the host by elaborate enzymes; and, finally, the ability to infect an intermediate host to increase reproductive capacity, as seen among the cestodes and trematodes. The elements of a comprehensive history include the chief complaint, current symptoms, medical history, family history, social history, and review of systems. Which of the following would be the LEAST LIKELY explanation for the failure? The basic mechanisms of pain perception in infants and children are similar to those of adults, except that pain impulse transmission in neonates occurs primarily along slow-conducting, unmyelinated C fibers rather than along myelinated A-delta fibers. After an incubation period of 4 to 10 days (range 2-21 days), illness begins with an abrupt onset of flu-like symptoms: fever, chills, headache, malaise, and myalgia as well as nonspecific symptoms such as vomiting, diarrhea, and abdominal pain. Colonoscopy represents the main screening modality for the early detection and management of colonic polyps, which, in some cases, represent the precursor lesions for colorectal cancer development. Most chemicals used in warfare or terrorist attacks act immediately upon contact with the skin, mucous membranes or respiratory tract. The risk of amiodarone pulmonary toxicity is higher during the first 12 months of therapy even at a low dosage. Commercially available automated systems can inoculate the test organism into a series of panels containing a variety of test media, sugars, and other reagents.

  • AkiporteVen AkiporteVen Friday, 28 August 2015

    Consultation with a poison control center also may identify changes in recommended therapy. However, several studies have linked PPI use to uncommon but serious adverse events, including increased risk of bone fracture, enteric infection, pneumonia, and chronic kidney disease in patients with long-term use. salmeterol.citalopram.panadol Because erythrocytic forms never reinvade the liver without developing into sporozoites in the vector, malaria infections from transfusion never result in the exoerythrocytic or "liver" form. To document the characteristic rise and fall of CK-MB concentrations, blood samples should be obtained every 4 to 8 hours. Diagnosis of plague can be confirmed by testing bodily fluids or tissue, such as lymph node aspirate, blood cultures, sputum aspirate, cerebrospinal fluid, or bronchial/tracheal washings. nizoral.ditropan.cyproheptadine The cause of CF is due to a mutation of the CFTR gene. Raynor and colleagues also found that consumer medication information handouts do not meet people's information needs. ezetrol.salbutamol.crestor In these cases, the drug changes the patient's baseline value. Putting this figure in perspective is important for understanding the costs associated with ADEs. Trimethoprim–sulfamethoxazole was associated with an adverse event rate of 26.3 per 100 person-years and hypersensitivity events at 22 per 100 person-years. azur.captopril.tulasi This chapter discusses the major parasitic diseases including protozoan disease (giardiasis, cryptosporidiosis, Chagas disease, amebiasis, and malaria), helminthic infections (strongyloidiasis, cysticercosis, and toxocariasis), and ectoparasitic infestations (lice and scabies). However, there is some evidence that this strategy may be possible with sunitinib and everolimus in the future. It is known that serum cystatin C (cysC) concentrations can be altered by many factors other than kidney function, such as age, nutritional status, gender, weight, height, cigarette smoking, serum C-reactive protein levels, steroid therapy, and rheumatoid arthritis. nitrofurantoin.proben.losec Errors can occur at any step in the medication-use process, from ordering to postadministration and monitoring. This chapter reviews the tools most commonly used for accurate, relevant, and cost-effective nutrition screening and assessment, including various methods used to determine patient-specific macro- and micronutrient requirements and potential drug–nutrient interactions. Acetaminophen may be combined with other drugs, such as antihistamines or opioid analgesics, and marketed in cough and cold preparations, menstrual remedies, and allergy products.

  • AkiporteVen AkiporteVen Friday, 28 August 2015

    Spirometry tests before each bleomycin dose are not predictive of toxicity. Despite the rapid proliferation of technology for the diagnosis of digestive diseases, the patient history and physical examination remain important for initial assessment, triage, and guidance of further diagnostic interventions. [url=]vpxl.rumalaya.menosan[/url] The liver develops large, blood-filled lacunae (space or cavity) within the parenchyma. Objective responses were observed in 29% of patients, with a median response duration of 12.9 months and OS was 22.4 months. [url=]volmax.griseofulvin.celecoxib[/url] Allergic reactions depend on inducing an immune response from the host; thus, the reaction may be systemic rather than limited to skin manifestations. An HLA-matched allogeneic HSCT is recommended if an appropriate donor is available. Bayesian pharmacokinetic dosing programs are used widely to adjust the dose of a variety of drugs. [url=]levora.finpecia.cephalexin[/url] A steady-state digoxin concentration was determined and reported by the clinical laboratory as 2.2 mcg/L (2.8 nmol/L). This diagnosis is built upon history, a detailed neurological examination, and appropriate testing. In patients with diabetes, various dyslipidemias and even hypertension, the de novo production of free fatty acids from excess circulating carbohydrates, accelerates this process of accumulation. [url=]aventyl.depo-provera.benicar[/url] Symptoms of anticholinesterase poisoning and their response to antidotal therapy depend on the action of excessive acetylcholinesterase at different receptor types (Table e9-11). Likewise, the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), and Centers for Disease Control and Prevention (CDC) have each dedicated websites to this topic and have provided funding to support studies and interventions that are specifically relevant to health literacy. [url=]famciclovir.advair.adapalene[/url] Type II allergic reactions are relatively uncommon and involve destruction of host cells (usually blood cells) through cytotoxic antibodies by one of two mechanisms. Inpatient administration, intensive monitoring and supportive care are required, and many institutions administer IL-2 in an intensive care setting.

  • AkiporteVen AkiporteVen Friday, 28 August 2015

    The Etest is a plastic strip impregnated with a known, prefixed concentration gradient of antibiotic that is placed on an agar plate streaked with a suspension of known bacterial inoculum. Despite advances in therapy, these infections continue to cause significant morbidity from residual damage and chronic or recurring infections. It should be noted that patients with P. ciplar.unisom.soloxine In the patient with an elevated serum cTn concentration, the clinician must decide if the observed abnormal serum cTn concentration is the result of CAD or another condition. Dobutamine, a synthetic catecholamine, is an inotropic agent that increases heart rate and myocardial contractility, thereby increasing myocardial oxygen demands. vasotec.dutasteride.atasol Since this drug was approved after the 2014 anthrax treatment guidance update there is no formal recommendation for its use in pregnant or nursing women. While preparing a medical kit for travel to Thailand, a traveler notes that there have been increased reports of norfloxacin-resistant Campylobacter in the region he plans to travel. serophene.nizagara.elimite Potential foods and other causes have to be thoroughly investigated, and a detailed patient interview is important, as discussed earlier. These data suggest that alternative birth control measures should be employed in women known to carry a prothrombin or factor V Leiden mutation. An important finding was 7% were classified as "smartphone-dependent" users, meaning that they have a smartphone, but do not have internet at home other than their mobile data plan, nor do they have other device options for accessing the internet such as a computer or laptop. trental.terbinafine.atacand Surgery is still used for patients with metastatic disease (stage IV) and may consist of surgical resection of the renal tumor, metastectomy (surgical removal of metastatic sites), or both. Skin testing with a panel of different radiocontrast agents may aid in the identification of a product with low reactive risk. telfast.latanoprost.oxybutynin Thrombopoietin is a hormone synthesized in the liver and secreted into the systemic circulation, where it binds to thrombopoietin receptors on stem cells, progenitor cells, and platelets, resulting in increased platelet production. One commonly used system is the BACTEC (Becton Dickinson Diagnostic Instruments, Sparks, MD) system, which uses bottles of growth medium containing a fluorescent sensor that monitors culture bottles every 10 minutes for the presence of carbon dioxide (CO2) as a by-product of microorganism growth.

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    This variability is largely explained by differences in VKORC1 genotype frequency. This is a sharp increase from 1970, when only 10% of new diagnoses were incidental. prandin.zumo.letrozol Psychological testing alone cannot establish a firm diagnosis but can be a useful diagnostic tool when coupled with clinical judgment. For the chapter in the Wells Handbook, please go to Chapter 27. keftab.aciphex.cardizem As previously mentioned, certain groups are at higher risk for limited health literacy, but even people with adequate literacy levels who are unfamiliar with the healthcare context may have difficulty navigating the healthcare system and often go undetected. This noninvasive technique is frequently used to determine the degree of stenosis as well as peak systolic velocity index. fexofenadine.butenafine.clomipramine ERPF can also be measured using the radioisotopes I-orthoiodohippurate (I-OIH) or Tc-mercaptoacetyltriglycine (Tc-MAG3). Decreases in serum prolactin concentrations occur within 2 hours of oral administration, with maximal suppression occurring after 8 hours and suppressive effects persisting for up to 24 hours. The pretravel screening appointment should include a discussion of items that should be contained in a travel medical kit based on a thorough risk-assessment that considers traveler health history, destinations, duration, and type of activities. apap.cefadroxil.losartan Thus, iron kinetics essentially represent a closed system with multiple compartments. The maximum score is 30, and a score of 23 or less is indicative of significant cognitive impairment. Second, the patient must have severe disability from IC resulting in impairment of daily activities. cafergot.neuro.januvia For the chapter in the Wells Handbook, please go to Chapter 10. The book of Ecclesiastes wisely reminds us that "[W]hat has been will be again, what has been done will be done again; there is nothing new under the sun." It is doubtful that the author of these sage words was referring to the repeating cycle of substance abuse, but when it comes to this subject there rarely is anything new under the sun, and this metaphor aptly applies.

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    Steady-state trough (Cmin,ss) and peak (Cmax,ss) values were obtained before and after the fourth dose was given (more than three to five estimated half-lives), respectively, and equaled Cmin,ss = 2.8 mg/L (2.8 mcg/mL; 5.9 μmol/L) and Cmax,ss = 8.5 mg/L (8.5 mcg/mL; 18 μmol/L). These reactions have mainly been seen in patients with egg allergies. [url=]mebeverine.endometrin.prednisone[/url] The assessment tool developed with funding from AHRQ is comprehensive and is made up of three complementary parts: (a) an "assessment tour" completed by objective auditors (here, barriers for clear communication are noted as well as the physical environment of the pharmacy and staff interaction with patients), (b) a survey completed by staff (this helps determine how "friendly" the pharmacy environment is toward individuals with limited health literacy), and (c) focus groups with pharmacy patients (here, the intent is to collect detailed feedback from patients about their experience with pharmacy services). Concurrent medications, comorbidities, and frailty also play vital roles. More than 300 distinct languages are spoken in American homes. [url=]galantamine.unisom.portal[/url] Other less commonly recognized sulfonamides include antivirals (amprenavir, fosamprenavir, and darunavir), probenecid, tamsulosin, triptans, and zonisamide. Open-ended questions allow the patient to provide descriptions and other information in his or her own words. For example, identical antihypertensive therapy in two patients of similar age, sex, race, and with similar medical histories and concomitant drug therapy may produce inadequate blood pressure reduction in one patient and symptomatic hypotension in the other. [url=]buspar.colcrys.duetact[/url] For the chapter in the Wells Handbook, please go to Chapter 36. The range of serum values is 0.13 mg/L to 8.0 mg/L (10-599 nmol/L), with normal values of 0.55 to 1.18 mg/L (41-88 nmol/L) for women and 0.60 to 1.11 mg/L (45-83 nmol/L) for men based on data from the NHANES study. Type III allergic reactions occur uncommonly and are caused by antigen–antibody complexes that are formed in blood. [url=]trandate.silenor.penegra[/url] However, several case reports of women who received cabergoline therapy during the first and second trimesters of pregnancy have not documented an increased risk of spontaneous abortion, congenital abnormalities, or tubal pregnancy. If a sustained-release formulation is involved, the onset of overt toxicity may be delayed by 6 to 18 hours from the time of ingestion. Prior to the introduction of recombinant GH, the number of individuals who received treatment for GH insufficiency was relatively small because of the limited availability of human pituitary tissue for GH extraction. [url=]glumetza.sotalol.zydis[/url] Lenalidomide is also effective for some patients with lower-risk MDS without a chromosome 5 deletion and is considered an alternative treatment approach by NCCN. Clothing can also be sprayed with repellants to increase protection.

  • AkiporteVen AkiporteVen Friday, 28 August 2015

    The clinician should document whether the patient has received medications with sedative properties because the outcome of the examination can be altered if central nervous system depressants were recently taken. Two-dimensional echocardiography employs multiple windows of the heart, and each view provides a wedge-shaped image (Figs. The most widely used indicator for the measurement of cardiac output is cold solution. [url=]actonel.anastrozole.hydra[/url] As of July 2015 public health officials in Canada are recommending that patients presenting to an emergency department with acute respiratory infection be asked if they have traveled to the Arabian Peninsula or been in a healthcare facility in the Republic of Korea in the past 14 days. These effects are similar to the adverse effects reported with bromocriptine. Three stool specimens collected on separate days for ova and parasites (O&P) will yield up to 90% of the parasites. [url=]ditropan.progestin.purim[/url] A long-acting intramuscular formulation of octreotide (Sandostatin LAR) is available for monthly administration. They are helpful in identifying organisms that may not grow on culture and which otherwise would be missed. In this framework, there are two cultures of reference, the home culture (the culture from which the individual comes) and the host culture (the culture to which the individual is introduced or is immersed). [url=]lipex.aceon.mebendazole[/url] Reports of angioedema secondary to angiotensin-receptor blockers (ARBs) exist; the weighted incidence was 0.11% in a meta-analysis of 35,000 patients treated with an ARB. The normal JVP is 1 to 2 cm above the sternal angle. Patients with MDS may be neutropenic or have functional defects in neutrophils, predisposing them to infection. [url=]atomoxetine.altace.tavor[/url] The number of patients treated with PD has decreased steadily since 2000. The decline of serum iron concentrations, however, may not account for the potential cellular action of deferoxamine irrespective of its effect on iron elimination. [url=]orlistat.antacid.imuran[/url] In particular, health literacy is an important concept to consider in efforts to improve appropriate medication use. However, these findings should be interpreted with caution since confounding by indication may play a part in this association.

  • AkiporteVen AkiporteVen Friday, 28 August 2015

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