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Causal relation between m alocclusion and of a 6-year oral health education program m e for prim ary caries cheap zyrtec 10 mg overnight delivery. Im pact of socio-dem ographic variables buy zyrtec 5mg amex, varnishes— a review of their clinical use zyrtec 5 mg with amex, 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. Strategies for the prevention of dental fluorosis Primary prevention Secondary prevention Tertiary prevention • Specific guidelines on the use and • Improve the nutritional status, especially of Treat the discoloured/disfigured dentition by appropriate dose levels of fluoride expecting mothers, newborns and children up appropriate aesthetic treatment such as bleaching, supplements, and use of fluoride to the age of 12 years. Equipment, minimum manpower required and approximate cost for medical interventions for oral and dental diseases Medical Equipment/instruments In dental In private clinics* interventions required Time required Personnel Set-up schools (in Rs) (in Rs) Dental check-up Gloves, face mask, 5 minutes Dental surgeon At all levels Nil 100–300 head light, mouth mirror, explorer, tweezers, cotton/ gauze, etc. Dental caries Though not life-threatening, these diseases are often very painful, expensive to treat and cause loss of several m an- Dental caries is a universal disease affecting all geographic days. It has now been recognized that oral and prevalence of dental caries is generally estim ated at the general health are closely interlinked. Periodontal (gum ) ages of 5, 12, 15, 35–44 and 65–74 years for global diseases are found to be closely associated with several m onitoring of trends and international com parisons. The serious system ic illnesses such as cardiovascular and prevalence is expressed in term s of point prevalence pulm onary diseases, stroke, low birth-weight babies and (percentage of population affected at any given point in preterm labour. In India, different caries, (ii) periodontal diseases, (iii) dentofacial anom alies investigators have studied various age groups, which can and m alocclusion, (iv) edentulousness (tooth loss), (v) oral be broadly classified as below 12 years, above 12 years, cancer, (vi) m axillofacial and dental injuries, and (vii) above 30 years and above 60 years (Tables 12–15). Periodontal diseases affect the supporting structures of Therefore, there is no uniform ity in data on the prevalence teeth, i. M ore advanced periodontal disease with pocket Table 17 docum ents only som e studies, and highlights form ation and bone loss, which could ultim ately lead to totally incoherent data. M oreover, m ost of the studies have tooth loss if not treated properly, m ay affect 40% –45% of been conducted on the child population, in whom periodontal the population. The major vary from m ild to severe, causing aesthetic and functional dentofacial deform ity is cleft lip and palate, which is seen problem s, and m ay also predispose to dental caries, in 1. Prevalence of dentofacial anomalies and malocclusion Author and year State Place Age group (years) Prevalence (%) Shourie 1952 Punjab Punjab 13–16 50 Guaba et al. Tooth loss (edentulousness) studies) Age group (years) Number of missing teeth Edentulousness (%) Incidence (%) 60–64 8. Tooth loss increases with advancing age (Table Data available from a field survey in Gujarat, H aryana 20). Loss of the teeth results in decreased m asticatory and Delhi are presented in Tables 22, 23 and 24, respectively.

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It is transported bound to a protein (α2-macroglobulin and transferrin) It is excreted in urine and feces buy zyrtec 10 mg otc. The body does not store Zinc to any appreciable extent in any organ buy cheap zyrtec 5 mg line, urinary excretion is fairly constant at 10 μmol/day generic zyrtec 5 mg with mastercard. Deficiency of Zinc: Patients requiring total parentral nutration, pregnancy, lactation, old age and alcoholics have been reported as being associated with increased incidence of Zinc deficiency. Deficiency of selenium: • Liver cirrhosis • Pancreatic degeneration • Myopathy, infertility • Failure of growth Toxicity: - Selenium toxicity is called Selenosis - Toxic dose is 900micro gram/day - It is present in metal polishes and anti-rust compounds 191 - The Toxicity symptoms are Hair loss,failing of nails, diarrhea,weight loss and gaslicky odour in breath(due to the presence of dimethyl selenide in expired air). Introduction Hormones are responsible for monitoring changes in the internal and external environment. Tissue production (paracrine) of hormones is also possible Hormones and Central nervous system interact to shape up development, physiology, behaviour and cognition. The actions and interactions of the endocrine and nervous system control the neurological activities as well as endocrine functions. A messenger secreted by neurons is neurotransmitter while the secretion of endocrine is called hormone. Cellular functions are regulated by hormones, neurotransmitters and growth factors through their interaction with the receptors, located at the cell surface. The basic information provides a solid foundation from which to view the existing and future developments in the rapidly moving discipline. Hormones can be classified based on their structure, mechanism of action, based on their site of production etc. Sometimes the concentration of the hormone is less, which stimulates the production of hormone by a process of feedback stimulation. Some protein hormones are synthesized as precursors, which are converted to active form by removal of certain peptide sequences. Other hormones like glucocorticoids/ minerolacorticoids from Adrenal gland are synthesized and secreted in their final active form. Pro-hormones: Some hormones are synthesized as biologically inactive or less active molecules called pro-hormones. Free Hormone concentration correlates best with the clinical status of either excess or deficit hormone. Hormone action and Signal Transduction Based on their mechanism of action, hormones are divided into two groups, steroid and peptide/protein hormones. Mechanism of action of steroid hormones • The group consists of sterol derived hormones which diffuse through cell membrane of target cells. Receptor binding to hormone involves electrostatic and hydrophobic interactions, and is usually reversible process. Prolonged exposure to high concentration of hormone leads to decreased receptors, called as desentitization. Down regulation: There is internal distribution of receptors such that few receptors are available on the cell surface. Removal of receptor to the interior or cycling of membrane components alters the responsiveness to the hormone. In another type of down regulation, H-R complex, after reaching nucleus controls the synthesis of receptor molecule. Some times Covalent modification of receptors by phosphorylation decreases binding to hormone, which diminishes signal transduction. Up regulation: Some hormones like prolactin up regulate,(increase) their own receptors which ultimately increases the biological response and sensitivity in target tissues. Bacterial Toxins: Vibrio cholerae produce entero toxin which binds to ganglioside (Gm) from the intestinal mucosa. The disease is a result of high levels of hormone/ neurotransmitters, whose actions stimulate phosphatidyl inositol cycle. Structure of Insulin C peptide=31-65, A chain=66-86, B chain=1-30 Porcine Insulin is similar to human insulin except Threonine is substituted by Alanine at 30 position of B chain. Biosynthesis of Insulin Pre-pro insulin (109 amino acids) is synthesized in the endoplasmic reticulum of B Cells of islet of Langerhans. Insulinase or Glutathione-insulin trans hydrogenase is located in liver, kidney, muscles and placenta. Regulation of Insulin Receptors High levels of insulin in blood decrease the insulin receptors on the target membrane. Regulation of Insulin secretion: Secretion of insulin is closely coordinated with the release by pancreatic α- cells. Therefore when glucose is given orally it induces more insulin secretion than when given intravenously. Metabolic Role of Insulin Carbohydrate metabolism: Insulin produces lowering of blood glucose and increases glycogen stores. Paradoxycal action of insulin * Insulin stimulates protein phosphatase-1 which dephosphorylates and activates key enzyme glycogen synthase. Lipid metabolism: Insulin causes lowering of free fatty acids level in blood and increases the stores of triacylglycerol. It also induces the synthesis of lipoprotein lipase 208 which releases more fatty acids from the circulating lipoproteins. Protein Metabolism: Insulin promotes protein synthesis by: • Increased uptake of amino acids through increased synthesis of amino acid transporters in the membrane. Diabetes mellitus β-cells of islets of Langerhans fail to secrete adequate amounts of insulin or producing absolute or relatively low amounts of insulin.

Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke cheap zyrtec 10 mg without prescription. Nitric oxide donors (nitrates) order zyrtec 5mg line, L-arginine zyrtec 5mg online, or nitric oxide synthase inhibitors for acute stroke. Effect of intravenous nimodipine on blood pressure and outcome after acute stroke. Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype. Inter- and intrajudge reliability of a clinical examination of swallowing in adults. Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables. Pneumonia in dysphagic stroke patients: effect on outcomes and identification of high risk patients. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke. Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important? Inactive and alone: physical activity within the first 14 days of acute stroke unit care. A study on additional early physiotherapy after stroke and factors affecting functional recovery. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. The effects of position on oxygen saturation in acute stroke: a systematic review. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke. A randomized control study to determine the effects of unlimited oral intake of water in patients with identified aspiration. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. Malignant middle cerebral artery territory infarction: clinical course and prognostic signs. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Prediction and prevention of stroke after transient ischemic attack in the short and long term. Canterbury, Kent: Personal Social Services Research Unit, University of Kent, 2006. Dalia Sánchez de la Guardia Especialista de I Grado en Angiología y Cirugía Vascular. Arelys Frómeta Hierrezuelo Especialista de I Grado en Angiología y Cirugía Vascular. Ha sido de manera teórico-práctica a los estudiantes de cuarto año de medicina en la asignatura de Cirugía General, en rotación de 40 horas, una semana, por Angiología y Cirugía Vascular. Ahora que se aproxima la puesta en marcha de un nuevo plan docente se hace necesario reescribir los capítulos haciéndolos no sólo más actualizados, sino también congruentes con las realidades de las enfermedades vasculares que sufre la población cubana y la de aquellas sociedades parecidas a la nuestra. De igual manera, durante los años transcurridos, hemos sido testigos de decenas de críticas al programa docente actual que resulta ya obsoleto y necesita ser modificado. Esto nos coloca en una situación privilegiada para tener en cuenta decenas de detalles que mejorarán sustancialmente la relación entre lo que enseñamos y la realidad del estado de salud o enfermedad de nuestras comunidades. En este intento, y con este propósito surgen estos capítulos revisados en detalle y sustentados por referencias bibliográficas clásicas, junto con aquellas de mayor impacto mundial, en las que podrán encontrar mediante el uso de la computación y las redes médicas de información, los detalles que motivan su lectura. La obra, que llamamos Enfermedades Vasculares Periféricas, igual que el tema del programa dentro de la asignatura Cirugía, no es por tanto enciclopédica, ni con mucho, abarca todas las enfermedades vasculares. De interés para el alumno de Cirugía a quien suministra el texto preciso de qué saber y qué conocer, en las escasas horas de rotación, pero también para el Médico General Básico y así mismo, por qué no, para el Especialista en Medicina General Integral y de otras disciplinas que encontrarán en su lectura lo que exactamente necesitan en su práctica más general. Es nuestro sueño, de igual manera, que este texto, en algún momento los acompañe, como un pequeño manual impreso en sus mochilas de médicos de cualquier país en las comunidades más humildes, más lejanas, en el llano o en empinadas montañas, en cualquier lugar del mundo. Trabajo independiente Sepsis por clostridios de tejidos blandos (gangrena gaseosa)……………………123 Capítulo 14. Clasificarlas de acuerdo con un cuadro general para su mejor estudio y comprensión. Conocer las principales enfermedades arteriales, factores de riesgo, clínica, complicaciones y tratamiento. Conocer las principales enfermedades venosas y los factores que las determinan, los cuadros clínicos que producen, las complicaciones y su terapéutica. Conocer, igualmente, las enfermedades linfáticas que afectan las extremidades, los factores que las condicionan, su clínica, complicaciones y tratamiento. Orientar la búsqueda y selección de la bibliografía más actualizada y práctica y los sitios de Internet de mayor impacto.