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If the mucus is clear purchase cialis black 800 mg on-line erectile dysfunction ayurvedic drugs in india, a common cold or allergies are most likely order genuine cialis black on line erectile dysfunction cpt code. Your doctor will help with this by asking questions about your symptoms and examining your ears order genuine cialis black prostate cancer erectile dysfunction statistics, nose, and throat. When allergies are responsible for post-nasal drip, many people experience teary eyes, itchiness of the nose and eyes, and headaches. People who experience post-nasal drip often describe a feeling of mucus dripping at the back of the throat. Post-nasal drip happens when mucus builds up in the back of the nose and throat. Almond allergy symptoms involving the respiratory tract usually include getting a stuffy, runny nose. An itchy mouth or throat is one of the most common allergy symptoms. How can you care for a sore throat caused by post-nasal drip? Your nose and throat make mucus all the time. This way, your doctor can prescribe antibiotics for treatment, which are appropriate for bacterial illnesses such as strep, but not for viral illnesses such as a cold. Sinus pressure is bringing many patients in with complaints of congestion and sore throat from post nasal drip. Lancaster General Health Physicians Roseville Pediatrics saw an increase in seasonal allergy symptoms, despite the rain, strep throat and the "dreaded" croup. When you smoke moldy weed you also inhale mold spores, which can cause symptoms such as itching, runny nose, nasal congestion. If we get rid of the scientific jargon, we can see that these two studies helped us understand something very important: Marijuana allergy is very rare but when it does occur it has similar symptoms as some common food and plant allergies. Marijuana allergy is very rare but when it does occur it has similar symptoms as some common food and plant allergies. Marijuana allergy: Common symptoms and treatments. Seasonal allergies or ongoing allergic reactions to dust, molds or pet dander, make developing a sore throat more likely. A sore throat and other flu-like symptoms sometimes appear early after someone is infected with HIV. Allergies to pet dander, molds, dust and pollen can cause a sore throat. Viruses that cause the common cold and flu (influenza) also cause most sore throats. Other less common causes of sore throat might require more complex treatment. You may also consider taking ibuprofen (such as Advil) or acetaminophen (like Tylenol) to reduce throat pain and fever symptoms. Signs and symptoms of strep throat are very similar to an ordinary sore throat, but in general strep throat has: Strep Throat vs. Sore Throat Symptoms: How to Tell The Difference. Decongestants are available without prescription as tablets (pseudoephedrine, phenylephrine) or nasal sprays (phenylephrine, oxymetazoline) and can relieve nasal congestion but have little effect on other allergic rhinitis symptoms. Nearly everyone with allergic rhinitis complains of an itchy, stuffy, runny nose. Examples include viral rhinitis (the common cold); drug-induced rhinitis (possible culprits include Viagra and the other ED pills, the alpha blockers used for benign prostatic hyperplasia, the ACE inhibitors and beta blockers used for hypertension, and aspirin and nonsteroidal anti-inflammatory drugs); and hormonal rhinitis (including the "pregnant nose" experienced by some women). But if your symptoms occur year-round (perennial allergic rhinitis), you are probably allergic to indoor allergens such as dust mites, mold, or animal dander. Blood vessels swell, causing nasal congestion, and mucus production soars, creating a runny nose. Decongestants: May be helpful in a pill form or as a nasal spray (topical), to relieve a "blockage"; or symptoms of a runny nose. Common topical nasal steroids for the treatment of sinusitis include beclomethasone dipropionate (Beconase(r) or Vancenase (r)) and Fluticasone propionate (Flonase (r)). However, if you have sneezing, watery eyes and itching, antihistamines may prevent nasal congestion due to allergies, and decrease common symptoms of postnasal drip. Drugs that may be prescribed by your doctor to treat common cold symptoms: However, if you have developed pharyngitis, or are at risk for rheumatic fever, your doctor or healthcare provider may want to protect you against developing a strep infection. Treatment of a runny nose may include antibiotic therapy if an infection is present, decongestants, humidified air (such as a vaporizer or a steamy shower), and drinking lots of fluids. If your healthcare provider thinks that you have a strep pharyngitis in addition to your runny nose or rhinitis, you should not return to school or work unless you have been on antibiotics for at least 24 hours. If you have a runny nose, or allergic rhinitis, using decongestants (such as antihistamines) and topical nose sprays may help. Overuse of nasal sprays to clear your nasal passages, such as Afrin, can cause a "rebound" effect, with worsening symptoms of congestion, and runny nose. This will lead you to develop the common cold symptoms of rhinitis. If there is constant irritation of mucous in your nasal passages, your nose will start to "run", or drain mucus down the back of your throat (called postnasal drip), or out your nose. Or as a nasal spray (topical), to relieve a "blockage"; or symptoms of a runny nose. Even though symptoms of the common cold may be gone in 2 to 3 days, make sure you take all the prescribed medication, to get rid of the suspected infection. The first-line treatment of a sinus infection includes amoxacillin 500mg by mouth, 3 times a day, for 10-14 days. However, if you have developed pharyngitis, are at risk for rheumatic fever, your doctor or healthcare provider may want to protect you against developing a strep infection. It may seem that your have a constant runny nose, but there may be some "hidden" congestion, that could lead to a sinus infection. Avoid crowds or people with common cold symptoms, especially if chemotherapy or your disease has weakened your immune system. Avoiding what has caused the allergy symptoms is the best way to treat an allergic rhinits. Fever of 100.5° F (38° C), chills, or a worsening sore throat (possible signs of infection, especially if you are undergoing chemotherapy). These are the most commonly suggested antibiotics, which will treat the bacteria that are often present in strep and sinus infections. The first-line treatment of a sinus infection includes Amoxacillin 500mg by mouth, 3 times a day, for 10-14 days. Antibiotics: Infectious rhinitis or sinusitis has most likely caused your postnasal drip.

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Inflammation and Biomarkers more than just a biomarker buy generic cialis black on-line erectile dysfunction toys, with proposed of Atherosclerosis roles in the development and progression of atherosclerosis best cialis black 800mg diabetes and erectile dysfunction causes. McGrath Exercise purchase cheap cialis black line young living oils erectile dysfunction, Inflammation cardiovascular morbidity and mortality and Atherosclerosis (Hambrecht et al. Atherosclerotic coronary arteries exhibit a reduced ability to Lifestyle modifications including diet, exer- dilate in response to increased blood flow, cise and weight control are recommended for which can cause a critical ischaemia even with the treatment of atherosclerosis. To test for endothelial and low blood cholesterol as the primary goal function, the usual test is to measure vasocon- (Williams et al. The recommendation striction in response to acetylcholine, with more was walking briskly for 30 mins for 5 days, or constriction indicating worse endothelial func- a combination of jogging/vigorous physical tion. It was also disease patients, intensive exercise training recommended that every adult should per- for 4 weeks decreased coronary artery vaso- form activities that maintain or increase mus- constriction, in response to acetylcholine, by cular strength and endurance for a minimum 54% (Hambrecht et al. Mechanistically, 4 weeks of regu- proportional improvement in cholesterol levels lar exercise training in coronary artery disease and reduction in risk for atherosclerosis. The beneficial effects of exercise on cardiovascular risk may be due to weight loss, improved body Exercise and biomarkers fat distribution, increased insulin sensitivity, of inflammation improved lipid profile and lowering of blood pressure (Mora et al. Firstly, 6 months of exercise to aerobic exercise may also be related to training decreased systemic cytokine levels improved nitric oxide generation. Many epidemiologi- In another study, rats that were exercised by cal studies have reported strong associations swimming 1 h/day, 5 days/week for 5 weeks between saturated fat and trans fatty acid showed after acute ischaemia was induced by intake, plasma cholesterol levels and death ligation of the left coronary artery that the size rates from atherosclerosis-related disease. It of the myocardial infarction was decreased by therefore follows that nutrition is one of the 30% (McElroy et al. This was associated modifiable risk factors for atherosclerosis with an exercise-induced increase in capil- (Chiuve et al. Approximately 5000 years style inclusive of regular physical activity ago, however, it was discovered that salt could and a diet rich in vegetables and fruits, whole be used to preserve food and now our diet grain high-fibre foods, fish at least twice a contains a large amount of highly salted proc- week, low saturated fat (<7% of energy), low essed foods. This high salt intake represents a trans fat (<1% of energy), fat-free or low-fat major challenge to our kidneys that must fil- dairy products, minimal hydrogenated fats ter and excrete these large salt concentrations. Although the general popula- sure with age (Intersalt Cooperative Research tion is becoming increasingly aware of these Group, 1988; He et al. There are many different diets and panzees showed that increasing salt consump- supplements available and treating physicians tion from 0. Advice given not have a high salt intake have a lower adult about nutrition therefore remains quite varied blood pressure. For example, in an isolated with regards to timing, frequency, amount of tribe, the Yanomamo Indians, their blood certain food components and calorie intake. Intervention studies to reduce salt intake Salt consistently show an improvement in blood pressure. It is currently recommended that There is substantial evidence for a causal rela- salt intake is 5–6 g/day but a further reduc- tionship between salt intake and blood pres- tion to 3–4 g/day has a much greater effect sure. On high salt intake is directly related to left ven- the basis of the fall in blood pressure from a tricular hypertrophy, an effect independent of meta-analysis study of randomized salt reduc- blood pressure. Both raised blood pressure and tion trials, it was suggested that reducing salt left ventricular hypertrophy are risk factors for intake by 6 g/day (in a population where cur- heart failure (He et al. There have now rent salt intake is 9–12 g/day) would lead to been several studies that have shown that a reduction in the incidence of stroke by 24% a reduction in salt intake is one of the most and heart attack by 18%, which would pre- cost-effective interventions to reduce cardio- vent ~2. One of the major bioactive com- under consideration as important in the pre- ponents is hydroxytyrosol, which is a major vention of cardiovascular disease. This component has been shown to inhibit lipid peroxidation, enhance cholesterol efflux and inhibit platelet aggrega- Saturated fatty acids tion (Covas et al. In a Similar to olive oil, the major mechanism of major study, the Seven Countries Study, where protection is through improving the lipo- 11,579 men, aged 40–49 years, were followed protein profile (Mukuddem-Petersen et al. Because it was documented that men in Japan had of their increasingly recognized cardiovas- very low saturated fat intake compared with cular benefits, nutritional guidelines often Japanese immigrants in California. Associated now include nut consumption (Johnson and with this, coronary heart disease, body weight Kennedy, 2000; Krauss et al. Clinical data also support that omega-3 been shown to improve the major risk factors fatty acids protect against coronary heart dis- for coronary heart disease, including lipo- ease. Olive oil has also been shown to exert to two servings of fish per week, or equivalent anti-inflammatory and antioxidant properties in omega-3 supplement if fish intolerant, or no (Perez-Jimenez et al. Finally, it has been shown that Lipid Prevention Study showed that in 18,645 omega-3 fatty acids can inhibit the secretion of patients with hypercholesteremia, treated with metalloproteinases from macrophages, thus statins alone or statins and a high-dose highly increasing plaque stability (Thies et al. Overall, the evidence is very strong that omega-3 are cardioprotective, with Fruits and vegetables greater than 25 published trials showing that intake of fish oil is associated with decreased ‘They should build houses, and inhabit them; risk of cardiovascular events. It is without known coronary heart disease eat fish now estimated that an inadequate consump- at least twice a week. For those patients with tion of fruit and vegetables accounts for up to coronary heart disease, it is recommended 2. Following on, projections suggest that Supplementation itself poses issues because increasing consumption of fruit and vegeta- the source of supplements is very important, bles by 600 g per day could decrease the global on the basis of concerns about the method of burden of coronary heart disease and stroke by processing and potential contamination by 31% and 19%, respectively (Lock et al. Pharmaceutical Meta-analysis showed that risk decreased grade products that have undergone rigor- by 4% for every portion of fruit or vegetable ous quality control testing are recommended intake (Dauchet et al. At the cellular studies have confirmed the benefits of fruit level, omega-3 fatty acids decrease smooth and vegetable intake (Dauchet et al. Omega-3 fatty acids there are very few randomized control trials have been shown to reduce the expression of to show the protective role in coronary heart endothelial cell adhesion molecules (Collie disease, and to determine the mechanisms by et al. Cardiovascular Disease and Inflammation 253 Vegetables and fruits, as well as cocoa, tea (ii) weekly consumption of potatoes (4–5 and wine, all contain polyphenols that are sug- servings), fish (4–5 servings), olives, pulses gested to be cardioprotective (Kuhnau, 1976; and nuts (more than 4 servings) and eggs and Hertog et al. A Finland study showed sweets (1–3 servings); (iii) monthly consump- that very low intake of these polyphenols tion of red meat and meat products (4–5 serv- was associated with increased mortality from ings) (Dontas et al. Dietary patterns and atherosclerosis Summary and Conclusions A meal consists of a variety of foods with complex combinations of nutrients that could There is no question that endothelial dys- well have synergistic or interactive effects. Exercise individual components is the Mediterranean training represents a non-pharmacological diet. This diet includes: (i) daily consump- treatment that reduces inflammation, tion of unrefined cereals and cereal products, improves endothelial function and impor- vegetables (2–3 servings), fruit (4–6 serv- tantly decreases atherosclerosis and protects ings), olive oil, dairy products (1–2 servings) against myocardial ischemia. Atherosclerosis is an inflammatory disease and a number of biomarkers have been identified that can predict atherosclerosis. Exercise studies completed in cycling, running and swimming show a decrease in inflammatory markers and exercise has been shown to reduce the extent of atherosclerosis. McGrath generation, which represents a major cardio- regime, good nutrition practices are cru- protective mechanism because it decreases cial. There is now strong evidence that some cytokine production and increases antioxi- foods or food components can decrease dant defences. It is highly likely that other cardiovascular risk, and/or improve coro- mechanisms await discovery. A healthful lifestyle inclusive cardiac patients such that exercise affords of exercise and nutrition plans should there- protection if there is a cardiovascular event. Intersalt Cooperative Research Group (1988) Intersalt: an international study of electrolyte excretion and blood pressure. American Journal of Physiology Regulatory Integrative and Comparative Physiology 291, R1756–R1763. Day School of Biomedical Sciences & Pharmacy, Priority Research Centre for Brain & Mental Health Research, University of Newcastle and Hunter Institute of Medical Research, Newcastle, Australia Introduction 260 Stress: A Biological Mechanism to Meet Uncontrollable Unpredictable Threats 261 Why is stress clinically relevant?

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The tumor extends many centime- difficult to reduce and does not respond to corticos- ters beyond the apparent gross or neuroimaging teroids proven 800mg cialis black causes of erectile dysfunction in 40 year old. Both types of edema containing either a uniform cell type or extremely produce a mass effect that can contribute to shifting pleomorphic cell types cheap cialis black 800mg mastercard erectile dysfunction diabetes causes. There is extensive neovascular- ization generic 800mg cialis black otc impotence quit smoking, with marked proliferation of endothelium of small capillaries feeding the tumor. Alternately, tumor cells can Glioblastoma multiforme (high-grade astrocy- have deletions in chromosomes 9 or 10 or have toma) is the most common primary brain tumor mutations in the tumor-suppressor gene P53. In management aims at slightly prolonging survival the absence of treatment, symptoms of glioblastoma and controlling symptoms. Since steroids do the tumor characteristically has low signal inten- not affect tumor growth, the signs and symptoms sity on T1-weighted and high signal intensity on eventually return. The appear- dose corticosteroids include psychosis, hyperac- ance of gadolinium-enhanced T1-weighted images tivity, irritability, insomnia, and myopathy. The extent Since fingers of the tumor have already spread far of cerebral edema varies from tumor to tumor. Side effects of radiotherapy commonly include anorexia, nau- Introduction sea, hair loss, and fatigue and may include late radiation necrosis of normal brain. Meningiomas belong to a group of brain tumors The value of chemotherapy for glioblastoma is that are often called “benign” since they are slow controversial. The choice of agent is difficult, as growing, do not invade surrounding structures, many antineoplastic agents do not cross the and are not histologically malignant. Other com- blood–brain barrier and thus poorly penetrate the mon benign tumors include pituitary adenomas, tumor. Menin- combination have been of limited benefit in giomas account for 15% of all intracranial tumors improving mean survival time. Menin- the mean survival from diagnosis is less than 6 giomas are located outside the brain, occur twice months; adult patients rarely survive longer than as often in women as men, and may be incidental 18 months. Table 14-2 lists their most teroids and surgical tumor debulking followed by common locations. Palliative care minimizes the patient’s discom- The cause of meningiomas is unknown, but 3/4 fort and disability. Headaches can be controlled have loss of genetic material from chromosome 22 with surgical debulking, corticosteroids, and anal- that likely contains a poorly defined tumor-sup- gesics. Cognitive dysfunction can contain high-affinity, robustly expressed proges- arise from tumor progression, effects of radiother- terone receptors that may account for the tumor’s apy and chemotherapy, corticosteroids, metabolic higher predilection in women. Treatment efforts and dopamine receptors of unknown clinical sig- should be aimed at the appropriate causes. With gadolinium, T1- Location Percent weighted images show intense and homogenous Falx/parasagittal 25% enhancement. Some meningiomas show edema in the adjacent brain but rarely do they appear to Cerebral convexity 20% invade the brain. Sphenoid wing 20% Olfactory groove 10% Principles of Management and Prognosis Suprasellar 10% Posterior fossa 10% Since meningiomas are slow growing, many small asymptomatic tumors can be followed safely with Other 5% periodic neuroimaging. Total removal Meningiomas are felt to arise from arachnoid has a 10-year recurrence rate of about 10%. For par- cap cells and thus may develop at any dural site tial resection, about 40% of patients develop major and receive their blood supply from the external symptoms in the following 10 years. Grossly, the tumor is firm, round, therapy and chemotherapy show little to no benefit. Histologically the classical tumor is characterized either by a sheet- like syncytial pattern in which the nuclei appear to Pituitary Adenoma be lying in an undivided expanse and/or a fibrob- lastic pattern with fascicles of spindle cells bundled Introduction in sweeping, parallel, and gentle curves and whorls throughout the tumor. The whorls may form a The pituitary lays in the sella turcica, surrounded nidus for calcifications. The hypothalamus and optic chiasm and may be present for more than a decade before lie nearby. Their slow growth often physiologically enlarges during pregnancy and lac- allows physicians to simply follow small menin- tation. Blood supply mainly comes from portal circulation and lacks a blood–brain barrier. Major Clinical Features Tumors of the pituitary can be divided into microadenomas (<10 mm diameter) and macroade- As with other brain tumors, meningiomas may nomas (>10 mm diameter) or divided into the cell present with seizures, headaches, and focal neuro- types that secrete different hormones. Because some meningiomas arise mas expand above the sella turcica, often affecting from the base of the skull, cranial neuropathies the optic chiasm, and may enlarge laterally into the may occur. Microade- present with paraparesis due to bilateral compres- nomas are usually suspected based on hormonal sion of the leg areas of the motor cortex. The cause of this tumor formation is Multiple small calcifications are sometimes seen in unknown. On malignant, seldom metastasize, grow slowly, and T1-weighted images, the tumor is isointense or remain stable in size for years. A number of pitu- eye, which may not be apparent to the patient with itary tumors do not secrete any hormones. There may be optic disk atrophy Table 14-3 lists the most common types of hor- seen on fundoscopy, but papilledema is rare. Rarely an adenoma may hemorrhage or cirrhosis, and dopamine receptor antagonists infarct, producing pituitary apoplexy with (chlorpromazine, haldoperidol), estrogens, and headache, ophthalmoplegia, bilateral visual loss, opiates. Corticosteroid have both an elevated serum prolactin level and an replacement becomes an emergency. Except for pro- findings include upward convexity of the gland, lactinomas, surgical removal of the macroadenoma increased size of the gland, stalk deviation, floor is commonly required to preserve vision. About erosion, gland asymmetry, and focal hypodensity 75% of patients with surgery are cured (total tumor or hypointensity in the gland (Figure 14-4). How- Serum prolactin levels are elevated in prolactin- ever, if the drug is stopped, prolactin levels again omas, but prolactin levels also may be elevated by elevate and the tumor again grows. Cerebral Metastases Introduction Brain metastases are neoplasms that originate in tissues outside the brain and spread secondarily to involve the brain. Of these metastases, 80% are supratentorial, 15% are cerebellar, and 5% are located in the brainstem or spinal cord. In addition, 25% of metastases are discovered before or at the time of diagnosis of primary tumor; 60% develop in the next 1 to 6 months, and 10% in Figure 14-4 Magnetic resonance imaging scan of pitu- months 7 to 12. For unknown reasons, a few cancers, such as prostate, Sign Percent uterine, and ovarian, seldom metastasize to the Impaired Cognition 60% brain. At the time of diagnosis, 1/3 of metastases Hemiparesis 60% are single and 2/3 are multiple. However, only 1% Headache 50% of cerebral metastases that are solitary have not metastasized elsewhere in the body. In addition, it Aphasia 20% is common for a patient with an initial single Hemisensory Loss 20% metastasis subsequently to develop other cerebral Seizures 20% metastases. Papilledema 20% Visual Field Cut 10% Pathophysiology Stupor or Coma 5% Most metastases arrive via the blood stream and commonly lodge at the gray–white matter junction, particularly in watershed areas of the cerebral hemi- spheres.

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F requency (Am erican Colleg e of O bstetrics/G ynecolog yand Am erican Cancer Society):Annuallyfor sexuallyactive wom en B cialis black 800 mg lowest price impotence at 18. If vag inaldischarg e:E xam ine wetm ountfor bacterialvag inosis and Candida sp c discount cialis black generic erectile dysfunction tucson. Treatm ent Ceftriaxone 125 m g I M × 1 M etronidazole 2g po × 1 Azithrom ycin 1g po × 1or doxycycline 100m g po bid × 7 Hepatitis Bvaccination F ootnots *Q uinolones are contraindicated in persons <17yr buy generic cialis black 800mg on line causes of erectile dysfunction in 40 year old,during preg nancy,and during nursing ;theyare ineffective vs incubating syphilis;increasing resistance to fluoroquinolones has been reported. Chlam ydia tests are encourag ed even if a presum ed diag nosis is m ade to 1)ensure proper care,especiallyif sym ptom s persist;2)facilitate counseling ;3)provide better g rounds for partner notification;and 4)im prove com pliance. O floxacin is equallyeffective com pared with azithrom ycin and doxycycline butis relativelyexpensive and offers no dosing advantag e. E rythrom ycin is less efficacious than azithrom ycin or doxycycline and causes substantialg astrointestinal toxicity. The glimpses of therapeutic measures mentioned in Veda were expanded in Ayurveda with eight specialities. The knowledge expanded further with lying down of fundamentals and concepts of Ëyurveda and systematization in classical texts like Caraka SaÆhit¡, Su¿ruta SaÆhit¡ and AÀ¶¡μga Saμgraha. Present form of Ëyurveda is the outcome of continued scientific inputs that have gone in to the evolution of its principles, theories and guidelines of healthy living and disease management; this reflects the pragmatic aspect of Ëyurveda. The major preventive approaches for maintaining and improving the quality of life include individualized specific daily regimen (Dinacary¡), seasonal regimen (Îtucary¡), behavioural and ethical consideration (Sadv¤tta). Healthy lifestyle is emphasized as the determinant of longevity of life, which by and large depends on the Prak¤ti (bio-identity i. The therapeutic streams advocated in Ëyurveda Comprise Daivavyap¡¿raya Cikits¡ (Spiritual measure), Yuktivyap¡¿hraya Cikits¡ (Pharmacological therapies) and Satv¡vajaya (Non-pharmacological V Psychotherapies). The treatment plan is worked out on the basis of underlying morbidity keeping in mind the strength of the disease and the tolerability of the patient. Four - pronged treatment plan consisting of avoidance of causative and precipitating factors of disease (Nid¡na Parivarjana), bio-purification (SaÆ¿odhana), use of palliative remedies (SaÆ¿amana) and health-promoting regimen (Pathyavyavasth¡) is the hall mark of Ëyurvedic therapeutics recommended for physicians to prescribe. Specific diet and lifestyle guidelines are always prescribed along with the drugs and therapies so as to facilitate restoration of bio-humoral balance and health staThis. About 65% of population in India is reported to use Ëyurveda and medicinal plants to help meet their health care needs. Besides, synergy of ingredient in conjunction with individualized Prak¤ti-based treatment plan forms the basis of efficacy and safety of Ëyurvedic formulations. Specific guidelines are prescribed for the use of certain apparently toxic medicinal plants with certain detoxification processing in limited prescribed dose which also enhances the bioavailability and efficacy of the final product. During ancient period, the requisite drugs and prescription have been directly delivered by family physician manufactured by themselves from time to time. In the current scenario the practice of Ëyurveda is mainly based on classical as well as proprietary drugs and formulation being manufactured by numerous pharmaceutical companies across the country. Diverse prescription practices are prevalent in different corners of the country based on the leads from text, experience of the physician and practices in vogue among different communities. This hand book enriched with multiple prescription option from classical texts, which are freely available in the market being manufactured by various companies and easily adopted by general practitioners in rural and urban India. It is hoped that this document will serve as a ready reference hand book for Ëyurvedic physicians, academicians, internees for sustainable utilization of merits and wisdom of Ëyurveda to deliver better health care services. The dosage may be adjusted with little alterations according to the tolerance and desire. Decoction should be prepared by boiling crushed/ coarsely powdered drug in four parts of water and reducing to one fourth. Juice should be prepared by crushing/ grinding in mixi the fresh drug with little water if required and the juice should be expressed through a clean cloth. Paste should be prepared by crushing/ grinding the drug very finely with desired liquid if required. In general too spicy, salty, chily, sour, preserved items fried food, heavy, indigestible, too cold & hot, stale food and the food that do not suit the health should be avoided. Irregular food habit, sleep and lack of physical exercise are main cause for any diseases. The information provided aims to assist with the public health strategy, prioritization and coordination of com- municable disease control activities between all agencies working in such countries. Diseases have been included if they fulfl one or more of the following criteria: have a high burden or epidemic poten- tial, are (re) emerging diseases, important but neglected tropical diseases, or diseases subject to global elimination or eradication programmes. World Health Organization Avenue Appia 20 1211 Geneva 27 Switzerland Telephone: + 41 22 791 21 11 Fax: + 41 22 791 31 11 E-mail: [email protected] The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal staThis of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or bounda- ries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifc companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organi- zation in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The aim of these profles is to provide up-to-date information on the major threats posed by com- municable diseases among resident and displaced populations in countries afected by emergencies. Such information is designed to assist with the public health strat- egy, prioritization and coordination of communicable-disease control activities among all agencies working in such countries. The purpose of publications in this series is primarily to guide public health actions; although the profle contains clinical information, it is not designed primarily for clinical practice. Clinical decisions should not be based solely on the information contained within this document. Target audience Public health managers and professionals working for populations living in Côte d’Ivoire Document rationale The diseases presented in this profle have been included on the basis of their high burden or epidemic potential in Côte d’Ivoire, or because they are (re)emerging I diseases, important but neglected tropical diseases, or a target for global elimina- tion or eradication programmes. Communicable disease epidemiological profle 5 The quantity and quality of epidemiological data in this particular profle is compromised by the humanitarian crisis in Côte d’Ivoire, which has disrupted health and surveillance systems for many years. Background to the humanitarian crisis and its impact on health in Côte d’Ivoire Côte d’Ivoire gained independence from France in August 1960, afer 67 years of colonization. Increasing tensions culminated in rebellion during September 2002, dividing the country into the occupied north under the control of the New Forces (Forces Nouvelles) and the government-controlled south. As of late 2008, an estimated 620 000 people remain internally displaced, mainly to Abidjan. Health-delivery systems have been severely disrupted, particularly in the north and west of the country: 80% of health units in these areas are closed, 85% of the health workers have lef. Disease monitoring systems and immunization programmes have been severely interrupted with important consequences, as exemplifed by I the notifcation of 17 polio cases in 2004 (see Poliomyelitis chapter), outbreaks of yellow fever (13 confrmed cases in May–July 2008; see Yellow fever chapter) and meningitis (1020 cases as of 3 August 2008; see Meningococcal disease), and re- emergence of diseases such as onchocerciasis (see Onchoceriasis [river blindness]). Recent improve- Communicable disease epidemiological profle 6 ments in water supply in urban centres have not been matched in rural areas.