There is a high prevalence of oral disease in the Alaska Native population, much of which goes untreated, creating a large discrepancy between the level of their oral health and that of the general population. The causes of this discrepancy are multiple--a major cause being the lack of access to care, especially in remote Alaska Native villages. Improving the oral health status of Alaska Natives will require treatment of current disease and initiation of an effective program to prevent oral disease. Cooperation between the Alaska Native organizations, dental health aides, the dental profession, and the government will be important. A strategy that combines addressing the disease currently present and preventing the occurrence of disease in the long run is the only strategy that offers a sustainable solution.
Introduction: Drug utilization research is an important tool to facilitate rational use of drugs. In low income countries irrational use of drugs is a common problem like overuse of drugs and inappropriate use of antibiotics, leading to poor treatment outcome and increased burden of treatment. This study was conducted to provide understanding of drug utilization pattern by using WHO Core Prescribing Indicator. Methods: This study was conducted in Orthopedics and Obstetrics / Gynecology departments. Patients visiting these Out Patient Departments with at least one drug on prescription form were included in the study. Further, information related to WHO Core Prescribing Indicators were collected in pre-designed proforma. Results: Average number of drugs prescribed per prescription was 2.6. Means of number of drugs prescribed in Orthopedics and Obstetrics / Gynecology departments were 2.9 and 2.3 respectively (p < 0.001). Drugs prescribed in generic name and from essential drug list was 41.4% and 34.3% respectively. Prescription forms with generic name in Orthopedics department were significantly more compared to Obstetrics / Gynecology department (p = 0.00002). However, there was an increased tendency to prescribe drugs from essential drug list in Obstetrics / Gynecology department compared to Orthopedics department (p < 0.001). Conclusion: Drugs were prescribed by generic name and from essential drug list, but this was not sufficient to meet the ideal values of WHO Core Prescribing Indicator. Therefore, prioritization on prescribing drugs by generic name and from essential drug list by respective departments to achieve the standards of WHO needs to be encouraged.
Introduction: When more than two fetuses simultaneously develop in the uterus, it is called higher order multiple pregnancy. The incidence of such pregnancies ranges from 0.01% to 0.07%. Case report: We report a case of 26-year-old G2P1L0D2 with previous history of preterm vaginal twin delivery, diagnosed to have quadruplet pregnancy. She was admitted at 28 weeks of gestation for safe confinement. At 33 weeks of gestation, emergency cesarean section was conducted with outcome of two female and two male babies with quadriamniotic and quadrichorionic placenta, without any intra and post-operative complications. Conclusion: A multidisciplinary approach with good neonatal care facilities is warranted for a better outcome in higher order multiple pregnancies.
A 250‐km‐long first‐order leveling line linking the geodetic surveys of Tibet and India through the Kingdom of Nepal has been measured twice in the past 15 years. Changes in relative bench mark elevation projected along a 200 km line orthogonal to the mean structural trend in the Himalaya indicate a pattern of uplift with wavelengths of 30–50 km not related to earthquake occurrence. Relative vertical velocities of bench marks of up to 4 mm/year show no evident correlation with level line slope. An absence of microearthquake data prevents localized uplift from being attributed to slip on mapped or buried faults, although circumstantial evidence suggests this is likely. In the North, in line with the high Himalayan peaks, relative uplift rates of 4 ± 1 mm/yr and a wavelength of 50 km are coincident with a steepening in the Main Boundary Thrust and the Moho proposed by Lyon‐Caen and Molnar [1985]. In the South, uplift rates of 2 ± 0.3 mm/yr with a wavelength of 30 km correspond to active folding of an anticline on the southern flank of the Lesser Himalaya. Observed tilt rates of 0.06 μrad/year are similar to the long term tilt rates needed to produce the 40–70° flanks of the anticline. A range of detachment geometries and slip velocities can generate the observed deformation field, but geologically realistic models fall into a group of horizontal to shallow dipping, sub‐horizontal faults between 12 and 6 km in depth. No unique solution exists, although the wavelength of the observed deformation field permits models with significant slip closer than 4 km to the surface to be excluded.
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