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If these are obstructed purchase cheap malegra dxt plus on line erectile dysfunction caused by surgery, a cyst may form that is usually lined with transitional epithelium proven malegra dxt plus 160 mg erectile dysfunction pills in malaysia. Chocolate cysts: These refer • Mesonephric cysts: Cysts derived from the same Wolffan duct may also be found on the lateral to cystic areas of endometriosis that include hemorrhages and aspect of the vulva and are called mesonephric cysts discount malegra dxt plus 160 mg free shipping erectile dysfunction joliet. These cysts purchase malegra dxt plus mastercard erectile dysfunction caused by nicotine, which contain white, cheesy material, are called keratinous (epithelial inclusion) cysts. Leukoplakia Several pathologic conditions are associated with the formation of white plaques on the The male counterpart of lichen vulva, which are clinically referred to as leukoplakia. The four cardinal histologic features are: • Atrophy (thinning) of the epidermis, with disappearance of the rete pegs • Hydropic degeneration of the basal cells • Replacement of the underlying dermis by dense collagenous fbrous tissue • A monoclonal bandlike lymphocytic infltrate • Loss of pigment in the epidermis (vitiligo) can also produce leukoplakia. Papillary Hidradenoma Hidradenomas consist of tubular ducts lined by a single or double layer of nonciliated columnar cells, with a layer of fattened “myoepithelial cells” underlying 556 Genital System and Breast the epithelium. These myoepithelial elements are characteristic of sweat glands and sweat gland tumors. Condyloma Acuminatum Condylomata acuminata are sexually transmitted, benign tumors that have a Koilocytotic atypia (nuclear distinctly verrucous gross appearance. Paget’s disease – It manifests grossly as pruritic, red, crusted, sharply demarcated map-like areas. Paget’s disease of the vulva – Histologically, it reveals single anaplastic tumor cells infltrating the epidermis. Malignant melanoma underlying ductal carcinoma of Malignant melanoma of the vulva may resemble Paget’s disease, however, these the breast, while vulvar lesions malignant cells stain positively with a melanin stain or S100 immunoperoxidase are most commonly confned to the skin. Adenocarcinoma • The tumors are most often located on the anterior wall of the vagina, usually in the upper third. Clear cell adenocarcinomas • These are often composed of vacuolated, glycogen-containing cells, hence the term are seen in young women clear cell carcinoma. Embryonal rhabdomyosarcoma or sarcoma botryoides • It is an uncommon vaginal tumor most frequently found in infants and in children younger than 5 years of age. Sarcoma botryoides or Em- • The tumor consists predominantly of malignant embryonal rhabdomyoblasts and is bryonal rhabdomyosarcoma thus a type of rhabdomyosarcoma. Cervicitis • Acute cervicitis is characterized by acute infammatory cells, erosion, and reactive or reparative epithelial change. Intraepithelial and Invasive Squamous Neoplasia • A male partner with multiple previous sexual partners a. Squamous Cell Carcinoma – Invasive cervical carcinoma manifests in three somewhat distinctive patterns: fungating (or exophytic), ulcerating, and infltrative cancers. The most common variant is the fungating tumor, which produces an obviously neoplastic mass that projects above the surrounding mucosa. About 95% of squamous car- cinomas are composed of rela- – On histologic examination, a small subset of tumors (less than 5%) are poorly tively large cells, either kera- differentiated small cell squamous or, more rarely, small cell undifferentiated tinizing (well-differentiated) or carcinomas (neuroendocrine or oat cell carcinomas). The latter closely resemble nonkeratinizing (moderately oat cell carcinomas of the lung and have an unusually poor prognosis owing diffe rentiated) patterns. Endometeritis • The endometrium and myometrium are relatively resistant to infections. Endometriosis and Adenomyosis out side of the uterus is called • Adenomyosis is thought to result from the abnormal down growth of the endometriosis endometrium into the myometrium. Symptoms produced by adenomyosis include menorrhagia, colicky dysmenorrhea, dyspareunia, and pelvic pain. Menstrual abnormalities With normal menstruation about 30 to 40 ml of blood is lost. Amount greater than 80 ml lost on a continued basis are considered to be abnormal. Postmenopausal bleeding occurs • Menorrhagia refers to excessive bleeding at the time of menstruation, either in the number of more than 1 year after the days or the amount of blood. Causes of metro or menometrorrhagia include cervical polyps, cervical carcinoma, endometrial carcinoma, or exogenous estrogens. Dysmenorrhea refers to pain- • Polymenorrhea refers to frequent, regular menses that are less than 22 days apart. It is associated with commonly associated with anovulatory cycles, which can occur at menarche. Anovulatory cycles consist of persistence of the Graffan follicle without ovulation. This results in continous and excess estrogen production without the normal postovulatory rise in progesterone levels. Avovulatory cycles charac- Instead, biopsies reveal proliferative endometrium with mild hyperplasia. The mucosa teristically occur at menarche becomes too thick and is sloughed off, resulting in the abnormal bleeding. Biopsies are usually performed several days after the predicted time of ovulation. If the histologic dating of the endometrium lags 4 or more days behind the chronologic date predicted by menstrual history, the diagnosis of luteal phase defect can be made. Prolonged functioning of the corpus luteum (persistent luteal phase with continued progesterone production) results in prolonged heavy bleeding at the time of menses. Histologically, there is a combination of secretory glands mixed with proliferative glands (irregular shedding). Clinically, these patients have regular periods, but the menstrual bleeding is excessive and prolonged (lasting 10 to 14 days). Endometrial hyperplasia (Endometrial Intraepithelial Neoplasia) It is related to excess estrogens and is important clinically because of its relation to the development of endometrial adenocarcinoma. The types of endometrial hyperplasia include simple hyperplasia and complex hyperplasias. N Nulliparity • Endometrial cancer not associated with pre-existing hyperplasia are generally more D Diabetes O Obesity poorly differentiated, including tumors that resemble subtypes of ovarian carcinomas M Menstrual irregularity (papillary serous carcinomas). Overall, these tumors have a poorer prognosis than E Estrogen therapy estrogen-related cancers do. In contrast to endometrioid tumors, serous subtypes T Tension (hypertension) infrequently display microsatellite instability and are linked to mutation of p53. Carcinosarcomas or malignant mixed Müllerian tumors Carcinosarcomas consist of endometrial adenocarcinomas in which malignant stromal differentiation takes place. The stroma tends to differentiate into a variety of malignant mesodermal components, including muscle, cartilage, and even osteoid. On histology, the tumors consist of adenocarcinoma mixed with the stromal (sarcoma) elements Sarcomatous components may mimic extrauterine tissues (i. Adenosarcomas It consists of malignant appearing stroma, which coexists with benign but abnormally shaped endometrial glands. Stromal Tumors The endometrial stroma occasionally gives rise to neoplasms that may resemble normal stromal cells. Tumors of Myometrium • Fibroids (Leiomyoma) of the uterus arise in the myometrium, submucosally, subserosally, and mid-wall, both singly and several at a time. They are benign smooth-muscle tumors that are sharply circumscribed, frm, gray-white, and whorled on cut section. Concept • Their malignant counterpart, leiomyosarcoma of the uterus, is quite rare in the de Mitoses are the most important novo state and arises even more rarely from an antecedent leiomyoma.

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Corticosteroids Varies from two to seven weeks (15 to 50 days) depending are best avoided in management of viral hepatitis buy cheap malegra dxt plus 160 mg on line erectile dysfunction treatment forums. Hepatitis B virus is second only to Tobacco in causing cancer as an external agent malegra dxt plus 160mg lowest price impotence after prostatectomy. Complications such as cirrhosis and liver cancer mostly occur at Confirm ed (Laboratory Tests) around 35 to 40 years age purchase malegra dxt plus 160 mg line erectile dysfunction doctors orange county, i cheap malegra dxt plus 160 mg line erectile dysfunction doctor milwaukee. More recently, a third type of antigen in addition to Asymptomatic infection is common. In certain parts play or from an adult (who is infected but looks healthy) of Asia, an antigen carrier rate as high as 10 to 15 to child by contact of body fluids through minor cuts, percent has been found. Captive chimpanzees may also act as reservoir of infection, but Through Vectors transmission to man has not been demonstrated. However, their role, if any, in the transmission of M ode of Transm ission infection is not known. Chronic antigenemia It may be mentioned that hepatitis B virus is much may occur even after asymptomatic infections. The disease is usually milder in chil- Mother to infant transmission can occur when the mother dren. In countries of infants infected by their mothers become chronic like Africa with a very high prevalence of chronic carrier carriers as their immature immunological system is not state in general population (about 15 %), the incidence able to clear the virus. Avoid all unnecessary injections, infusions Presence of e antigen greatly enhances the infectivity and venepunctures. Most common side effects are soreness at injection site, • Passive immunization by administration of fatigue, headache, irritability and fever higher than 37. The indications Complete vaccine series induces protective antibody are as follows: levels in 95 percent infants. When blood transfusion is The vaccine is to be stored and transported at +2 to given to a patient 5 ml may be given intramuscu- +8°C. Vials larly on the day of transfusion to prevent should not come in direct contact with icepack or ice development of post-transfusion hepatitis. Government of India recommends birth Onset is usually insidious, with anorexia, vague abdo- dose of hepatitis B within 24 hours for all minal discomfort, nausea and vomiting, progressing to Institutional deliveries to prevent perinatal jaundice less frequently than hepatitis B. In addition 3 doses should from inapparent cases to fulminating, fatal cases (rare). Vaccine is progress to cirrhosis, but more often improves clinically available as 10-dose vial of liquid vaccine in the after 2 to 3 years. It is reported that For immunocompetent adults, 20 µg of recombinant 85 percent of hepatic carcinoma in Japan is associated vaccine is administered at 0, 1 and 6 months as an with hepatitis C. The lipid-enveloped Onset is usually abrupt, with signs and symptoms resem- agent is between 30 and 50 nm in diameter; it is a bling those of hepatitis B. From one or more weeks before onset of the first symp- toms through the acute clinical course of the disease, and indefinitely in the chronic carrier states. The degree of immunity follow- The epidemiology and clinical course are similar to that ing infection is not known; repeated bouts of acute of hepatitis A; there is no evidence of a chronic form. Peginterferon or interferon alfa is used to treat acute hepatitis C for 6 to 24 weeks. Antiviral There is evidence that one virus or virus family is therapy is usually unnecessary in patients with acute responsible for hepatitis E. The Association of Physicians of India Evidence-Based Clinical Practice Guidelines on Adult Immunization. Global Advisory Epidemics consistent with a hepatitis E virus etiology Committee on Vaccine Safety, 12 to 13 December 2007. Nonparalytic aseptic meningitis: Occurs in Hepatitis G 1 to 2 percent of infections and is characterized by headache, neck, back and leg stiffness several days This virus was discovered in January 1996. Cases flavivirus that is percutaneously transmitted and recover within 2 to 10 days. It cannot be distin- associated with chronic viremia that lasts for at least guished from other causes of aseptic meningitis. Symptoms often occur in two phases, References minor and major and are often separated by several days without symptoms. The Association of Physicians form of paralytic muscles is asymmetrical and the of India Evidence-Based Clinical Practice Guidelines on extent of paralysis is variable. Operational guidelines for Hepatitis B vaccine in the Universal Immunization Programme. Ministry of Health develop quadriplegia and paralysis of the trunk, and Family Welfare. Pure bulbar form is rare and results from leukocytes, with lymphocytic predominance; count is a cranial nerve lesion, resulting in respiratory rarely more than 500/mcL. Often carried out to exclude insufficiency and difficulty in swallowing, eating other conditions. Encephalitic form: The child may be irritable, Throat: Not recommended for surveillance. Correct positioning of affected limbs, (iii) Passive Probable (history and clinical examination): movements and physiotherapy of the joints after the Epidemiologically linked case. It is a neurotropic virus takes place in first 6 months and slow recovery and has 3 antigenic types. Type 1 is the recovery is expected and the child is said to have ‘Post most prevalent as also the most paralytogenic. Type 1 is Traumatic neuritis, (iv) Transverse myelitis, (v) Encephalitis, Brunhilde, Type 2 is Lansing and Type 3 is Leon. Till recently, Organophosphate pesticide, raw metal (lead), (xi) epidemics of the paralytic disease occurred most Hereditary disease (Charcot-Marie-Tooth), and (xii) frequently in the highly developed countries. Moradabad district is a densely populated region 90 percent of children aged up to 5 years show the in western Uttar Pradesh that has had continuing wild presence of neutralising antibodies to all the three types polio virus transmission despite ongoing polio of polioviruses. Paralytic patients as well as sudden increase in the number of cases in two countries, mild, missed and inapparent cases discharge the virus e. It can be for the last three years, there has been change in demonstrated in feces 72 hours after infection and persists for 3 to 6 weeks or longer. There are no long-term The success of immunization with polio vaccine has carriers. Booster dose infectious one week before and two weeks after onset is recommended at 16 to 24 months of age along with of paralysis. Polio vaccine may be given simultaneously all other persons in household and close contacts, with any other childhood vaccines. Each single dose in the throat and for 3 to 6 weeks or longer in the consists of two drops (0. Each dose contains not In tropical countries, poliomyelitis is still a disease of 6. This vaccine has been stabilized Infants born to mothers with antibodies are protected with MgCl2.

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Vitamin the bioavailability of calcium because of formation of C helps in iron absorption order malegra dxt plus 160 mg overnight delivery erectile dysfunction medicine. Phytase destroys phytic acid in wheat during yeast vitamin A content of human milk order cheap malegra dxt plus on line erectile dysfunction statistics india, cow milk and eggs fermentation prior to baking of bread order malegra dxt plus in united states online impotence emedicine. Calcium varies according to the vitamin A content of food and hydroxide taken in betel as slaked lime is absorbed and fodder order malegra dxt plus master card erectile dysfunction treatment by injection. Cow ghee contains 20 to 25 units and buffalo may be an important source of calcium. Only 20 to 25% of dietary carotenes are absorbed depending upon the fat content of food. One microgram beta carotene is with iron and is required in very minute quantities, regarded as equivalent to 0. Fluorine prevents dental Recommended daily allowance is 600 mg retinol for an adult but 950 mg for a lactating mother. Vitam in D Vitamins It increases calcium and phosphate absorption from the intestine and helps in calcification of bones and teeth. Vitamins are organic compounds needed in minute amounts that are essential for health and well-being. Vitam in A • Ultraviolet light from sun irradiates a lipid substance It is essential for body growth and for the integrity of in the skin known as 7-dehydrocholesterol to form epithelial tissues. Clothes, glass Deficiency: Vitamin A deficiency is widely prevalent in and fog obstruct ultraviolet light and interfere with India. Calciferol is the most common synthetic preparation • Keratomalacia, xerophthalmia and Bitot’s spots. Margarine and vanaspati are routinely enriched • Drying and roughness of skin and drying of mucous with synthetic vitamins A and D. Fish liver oils are very situations associated with minimal exposure to sun, rich in vitamin A. Excess of vitamin (provitamin A), are converted into vitamin A in the D is toxic and causes calcification of tissues. Leafy vegetables such as spinach, cabbage, lettuce, curry and radish leaves; yellow pumpkin; and Vitam in E fruits such as mangoes, papaya, tomatoes and oranges are rich in carotene. The amount of carotene Germ of cereals, wheat germ oil, soybean, cotton seed in a fruit or vegetable is roughly proportional to the oil, corn oils, green leaves and milk are good sources deepness of its green or yellow color. Its function are not well-defined but it is Vitamin A is destroyed on exposure to ultraviolet presumed to prevent sterility and helps in the light. Frying may destroy up to 90% of One International Unit of vitamin E is the activity vitamin A but the loss is much less with other forms of contained in 1 mg of d-alpha tocopherol. As the vitamin is water-soluble and heat labile in alkaline Vitamin K is fat soluble and is widely distributed, solutions, considerable amounts (about 40-50%) are lost especially in green leafy vegetables and cauliflower. Natural vitamin K deficiency does not Hard milling causes considerable loss by damage to occur. Gut flora are capable of manufacturing vitamin pericarp and germ of cereals; parboiling of rice K and thus constitute an additional source. It substances which include thiamine (B1), riboflavin is thermostable but is destroyed on exposure to (B2), niacin (B4), pantothenic acid, pyridoxine (B6), folic sunshine. Green leafy vegetables in tropical countries contain more riboflavin than in Thiam ine (Vitam in B1) temperate regions. In absolute terms, this corresponds to Functions: Thiamine is essential for proper carbohydrate an intake of 1 to 2. Since nervous tissue is almost entirely dependent upon Deficiency symptoms may be oral (angular stomatitis carbohydrate for its energy needs, the ill-effects of and glossitis), dermal (scaly desquamation of nasolabial thiamine deficiency are particularly noticeable in the folds and scrotal dermatitis) and ocular (vascularization form of dry beriberi, peripheral neuropathy and of cornea). In body, it occurs In terms of total daily intake, the recommended in the form of niacinamide or nicotinamide. Particularly rich sources are proportion of total energy intake is derived from fats, meat (especially organs), fish, cereals and pulses. The the thiamine requirements will be correspondingly approximate niacin content of some foods (mg/100 gm decreased. Large amounts may Rice (lightly milled) 3 be lost if too much water is used for cooking rice or Rice (highly milled) 1. Thiamine Wheat flour (whole meal) 5 can withstand high temperature, nearly up to boiling Pulses 2 point, but only if the medium is slightly acidic (as while Fish 4 baking with yeast). If baking powder or soda is used Mutton 4 for cooking, almost all thiamine may be lost. Organs (liver, kidney) 12 396 Dietary sources of thiamine: Rich sources of thiamine Whole maize contains 1. Niacin is also derived from the essential amino acid ciency causes megaloblastic anemia and may also lead tryptophan. Rich sources are pulses, green leafy tryptophan is taken as equivalent to 1 mg niacin. The recom- computing dietary intake of niacin, tryptophan mended daily allowance is 200 micrograms for adults. It also acts as a coenzyme in amino seen in some parts of Maharashtra and other areas acid metabolism and maintains the nutrition of nerve where sorghum (jawar) is used as staple food. The dermatitis is symmetrical and acute combined degeneration of spinal cord or mainly affect the exposed parts of the body, such as demyelination of nerve fibers may also occur. Daily requirement is small, the recommended Pantothenic Acid (Vitam in B ) allowances being 1 mg (1. Milk, which is consumed by most vegetarians, is a Pyridoxine (Vitam in B6) moderately rich source, providing 0. Pulses contain some vitamin B12 because the root bac- pyridoxine, which are interchangeable. Contamination of food and water by bacteria, synthesis of neurotransmitters like serotonin dopamine, moulds, insects and fecal matter, etc. Its main dietary source It is the most unstable vitamin, being easily destroyed are liver, meat, wheat germ, yeast, legumes and rice by heat. Pyridoxine is essential for normal protein Dry and stale vegetables and fruits become markedly metabolism. It is also concerned with green leafy vegetables fresh fruits, germinating and metabolism of essential fatty acids. Fresh The clinical signs and symptoms of pyridoxine meat and milk also contain small amounts. Since these signs and symptoms are seen in other B- vitamin deficiencies as well, it is difficult to assess the magnitude of clinical pyridoxine deficiency in Functions population. Deficiency in infants is associated with • It is essential for formation and maintenance of neurological symptoms and abdominal distress. Delayed healing of wound, bleeding gums 397 It helps in the formation of white blood cells and in the and hemorrhages from mucous membranes are early maturation of normoblasts to red blood cells. Protective Foods Food and Food Groups Vitamins and minerals: Foods are often grouped according to their origin as • Green leafy vegetables follows: • Other vegetables and fruits • Eggs, milk and milk products and flesh foods. Its per capita consumption • Pulses, oil seeds and nuts was estimated to be 600 ml and 108 ml in England and • Vegetables: Leafy, non-leafy and starchy India respectively in early 70’s.

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Then it nonspecific sensitivity to tuberculin as also for a certain decreases again and is low in adolescents malegra dxt plus 160mg cheap erectile dysfunction 5-htp. While it is insignificant killed by heat and disinfectants such as phenol and cresol in early childhood order genuine malegra dxt plus line erectile dysfunction in young age, the male female difference becomes but are more resistant than other bacteria to chemical six fold in persons above 55 years of age order malegra dxt plus with a mastercard erectile dysfunction kamagra. Milk and meat of bovine cattle may rarely be a source of infection buy cheap malegra dxt plus 160mg on-line erectile dysfunction 55 years old, Other diseases: Silicosis, diabetes, hypothyroidism and especially for nonpulmonary tuberculosis. The immunity is Inhalation: Bacilli from lungs and bronchi of open mainly cell mediated in nature, operating largely cases come out in the form of droplets on coughing, through T lymphocytes. Small droplets are inhaled is less clear, though it is known that serum IgA is often directly (Direct droplet transmission). Droplet nuclei increased in patients with active tuberculosis and drops remain suspended until inhaled, (Directly airborne) or, as the infection is controlled by therapy. Presence of tuberculin hypersensitivity indicates uncooked meat of diseased cattle may, on ingestion, the presence of living tubercle bacilli. The larger the skin rarely initiate intestinal tuberculosis or mesenteric reaction, the higher the possibility that the infection is adenitis. Surface implantation: Very rarely, primary lesion Smoking: There is statistically significant evidence that may start in the skin or mucous membrane, e. Lupus both active and passive smoking predispose to develop- vulgaris and laryngitis. The result depends on certain infection are more when when people live in dark, ill- host and environment factors that are poorly understood. Healing takes place by fibrosis Clinical diagnosis is confirmed by direct examination and calcification. Roentgenography is often necessary but X-ray alone is not dependable as an Initial or primary lesion: Primary lesion is found indicator of etiology and/or activity. The lesion heals and calcifies completely in vogue some years ago, are its high cost and its relative in most people without producing any clinical picture. Allergy and immunity against have still to be bacteriologically examined to confirm tuberculosis are produced within six to eight weeks. Thus this method has been If healing is incomplete the disease process is acti- found to have a low benefit cost ratio. It may lead to pneu- A recent study from East Africa8c attempted to monic and bronchopneumonic forms, involvement of identify the clinical, X-ray and laboratory features on pleura, pericardium and regional lymph nodes or the basis of which tubercular patients could be identified discharge of bacilli into the blood stream. These were: Late or adult type lesion: Tuberculosis in the • Cough for more than 21 days adolescent or adult age may be a flaring up of the old, • Chest pain for more than 15 days incompletely healed or unhealed primary focus but, • Absence of expectoration more often, it is due to reinfection and is called • Absence of breathlessness. Any two of the above four diagnosed tuberculosis with The characteristic feature in adult pulmonary tuberculosis 85 percent sensitivity and 67 percent specificity. There is a strong tendency towards limitation three of four had diagnostic sensitivity and specificity of of the disease by fibrosis. First of all, we shall discuss the prevention and control of • Toxemic symptoms: They are related to the activity tuberculosis as per the standard levels of prevention. Health Prom otion (almost parallel with the skin with an angle of 10 to 15 percent). The great reduction in tuberculosis in the socioeconomically advanced coun- Local reaction: It is similar to primary smallpox vacci- tries of America, Australia and Europe and its low inci- nation reaction but progresses slowly. Nothing happens dence in upper social strata of society all over the world for two weeks. A papule then develops, reaching tuberculosis parallel to socioeconomic development was the maximum size in the 4th week. The papule cracks, noticed even before any specific treatment for tuber- discharges pus and is gradually changed into a crust during culosis became available. The scab falls off during the 7th include provision of well lighted, ventilated and open or 8th week leaving a small oozing ulcer which heals houses, congenial working conditions, good nutrition, and leaves a scar or keloid about 5 mm in diameter. It remains potent up vaccine is contraindicated irrespective of the child’s to one year in refrigerator and for one to four weeks condition or symptom, given the potential risk of at room temperature. The reason for this being more in preventing primary tuberculosis than is that their skin being too thin, intradermal infection pulmonary tuberculosis. A recent hospital based using the full dose is difficult without spill over to deeper retrospective case control study from Nagpur found only tissues. It is the cheapest and easiest navel recruits with history of exposure to tuberculosis, method for prevention and control of the disease. In the two sensitivities were 94 and 75 percent developing countries like India, where there is a high respectively. The international recommendation variable extent17a (17a-Menzies R, Vissandjee B 1992. However, in an indivi- • The risk of tuberculous infection in many developing dual patient, the test cannot accurately predict the risk countries is still high (1. Four factors need to be • Vaccination at school is feasible and, due to growing taken into consideration while interpreting tuberculin school attendance, will cover the vast majority of sensitivity. The British Thoracic Society tuberculin, a protein of the tubercle bacillus, into the considered the first three of these to be the key variables skin and observing whether or not an allergic reaction while the American Thoracic Society gives importance develops. A recent study suggest that the heat-killed culture was used but now the purified protein first two, i. The generally accepted and Chemoprophylaxis: It implies prevention of disease standard method of Mantoux test for the purpose of by giving drugs like isoniazid to two types of contacts: tuberculin surveys consists of injecting 0. The injection is given to a person, not infected so far (negative reactor), intradermally with the help of a tuberculin syringe on who has been exposed to an open case. This the anterior side of the left forearm, so as to raise a approach is totally irrational. An induration 10 mm or above in approach may be of value in high risk cases, such longitudinal diameter is considered positive. Sometimes as preschool children in contact with an open case 14 mm is also used as a cut off point in tuberculin in the family. Also, weak reactors (less than 5 mm drugs has radically changed the earlier approach induration) have more risk of developing the disease. Isolation The sensitivity of tuberculin test is relatively cons- would be logically needed only for those cases of tant in different populations as long as their cellular pulmonary tuberculosis who have cough and whose immunity is not compromised. A hospitalised tuberculosis patients in ten countries in good therapeutic regimen renders such a case sputum 1950‘s revealed that the sensitivity of tuberculin test for negative within a few weeks. Even in such cases, strict identifying tuberculosis infection was 93 percent for an isolation is neither necessary nor practical in real life. It 198 induration of 10 mm or more and 78 percent for 14 suffices to ensure that the patient covers his mouth and mm or more. These kill intracellular as well as Sputum cups should contain 50 percent carbolic lotion. Of the other bactericidal drugs, Disposal of sputum should be done by burying it into streptomycin kills only extracellular bacteria and soil or by burning.