Palmer In the knee purchase glimepiride 2mg without prescription, chondral injuries mimic meniscal tears label any area of marrow edema as a “bone bruise generic 4 mg glimepiride with amex. Arthrographic images show The focal bone-marrow edema pattern is nonspecific generic 1mg glimepiride, and contrast filling a defect in the articular cartilage. Most of is seen in a variety of other conditions – from ischemic, the traumatic cartilage injuries are full-thickness and to reactive (subjacent to areas of degenerative chondro- have sharp, vertically oriented walls (unlike degenerative sis), to neoplastic and infectious. A frequent associat- in the femoral condyles [49], sometimes precipitated by ed finding is focal subchondral edema overlying the de- a meniscal tear or meniscectomy. Often the appears as sclerosis of the subchondral trabeculae, even- subchondral abnormality will be more conspicuous than tually leading to formation of a subchondral crescent and the chondral defect [41]. In the diaphyses, established Stress fractures – whether of the fatigue or insuffi- infarcts have a serpiginous, sclerotic margin. At this radiographs show a band of sclerosis perpendicular to the stage, bone scintigraphy will be positive (albeit non- long axis of the main trabeculae, with or without focal specifically) in the reactive margin surrounding the in- periosteal reaction. Initially, however, stress fractures are radiographical- may show decreased tracer activity. The imaging ap- signal, either in the medullary shaft of a long bone or in pearance is similar to that of traumatic fractures. The signal intensity of scans show a nonspecific, often linear, focus of intense the subchondral fragment and of the reactive surrounding uptake, with associated increased blood flow (on three- bone vary based on the age of the lesion and other fac- phase studies). As the infarction evolves, a typical serpiginous re- sity fracture line surrounded by a larger region of marrow active margin becomes visible, often with a pathogno- edema. The proximal tibia is a common location for in- monic double-line sign on T2-weighted images: a periph- sufficiency fractures, especially in elderly, osteoporotic eral low signal intensity line of demarcation surrounded patients. Marrow edema without a fracture line in a patient with a history of chronic repeti- Replacement tive injury represents a “stress reaction. Processes that alter marrow composition are typical- contusion” describes trabecular microfracture due to im- ly occult on all imaging modalities, except for specific paction of the bone. Normally, areas of yellow two bones striking each other after ligament injuries, sub- marrow are approximately isointense to subcutaneous fat luxations, or dislocation-reduction injuries. Bone bruises on all pulse sequences, while red marrow is approxi- appear as reticulated, ill-defined regions in the marrow mately isointense compared to muscle. This pattern of signal abnormality is com- countered around the knee is hyperplastic red marrow. Unlike the case bruises is an important clue to the mechanism of injury, for pathologic marrow replacement, the signal intensity and it can account for elements of the patient’s pain and of red marrow expansion is isointense to muscle, islands may predict eventual cartilage degeneration [46, 47, 48]. Irradiated and aplastic marrow is typically fatty Chondrosis refers to degeneration of articular cartilage. Fibrotic marrow is low in signal intensity on all With progressive cartilage erosion, radiographs show the pulse sequences, and marrow in patients with hemo- typical findings of osteoarthritis, namely, nonuniform siderosis shows nearly a complete absence of signal [55]. Before these findings are apparent, bone scintigraphy may show Destruction increased uptake in the subchondral bone adjacent to arthritic cartilage. The activity represents increased bone Tumors and infections destroy trabecular and/or cortical turnover associated with cartilage turnover. Subacute and chronic osteomyelitis produce pre- ization of the cartilage requires a technique that can vi- dictable radiographic changes: cortical destruction, pe- sualize the contour of the articular surface. In patients with known chronic ization of joint fluid (or injected contrast) within chon- osteomyelitis, uptake by an inflammation-sensitive nu- dral defects at the joint surface [65]. The most although neither study is sufficiently specific enough to commonly used ones are T2-weighted fast spin-echo and preclude biopsy, especially in cases in which the causative fat-suppressed spoiled gradient recalled-echo sequences. T1-weighted spin-echo sequences are used in knees that Bones with acute osetomyelitis may be radiographical- have undergone arthrography with a dilute gadolinium ly normal for the first 2 weeks of infection [58]. Magnetic resonance imaging, with or without intraartic- Both benign and malignant bone tumors occur com- ular or intravenous contrast, is the imaging study of monly around the knee. Radiographs should be the initial choice for most soft-tissue conditions in and around the study in these patients, and are essential for predicting the knee. Ultrasound can also be used in selected circum- biologic behavior of the tumor (by analysis of the zone of stances for relatively superficial structures. For staging beyond the The fibrocartilagenous menisci distribute the load of the bone (to the surrounding soft tissues, skip lesions in oth- femur on the tibia, and function as shock absorbers. Intrameniscal signal that only possibly sitive as radiography in patients with multiple myeloma, touches the meniscal surface is no more likely torn than 30 D. In ance is that of high-signal intensity amorphous material cross-section, the normal meniscus is triangular or bow- between the intact ligament fibers on T2-weighted im- tie shaped, with a sharp inner margin. The ligament may appear enlarged in cross- the normal shape – other than a discoid meniscus or one section, and often there are associated intraosseous cysts that has undergone partial meniscectomy – represents a formed near the ligament attachment points. These properties include the lo- cation of the tear (medial or lateral, horns or body, pe- Muscles and Tendons riphery or inner margin), the shape of the tear (longitudi- nal, horizontal, radial, or complex), the approximate The muscles around the knee are susceptible to direct and length of the tear, the completeness of the tear (whether indirect injuries. Blunt trauma to a muscle results in a it extends partly or completely through the meniscus), contusion. The radiologist should also note the presence of dis- out from the point of contact in the muscle belly. Around the knee, muscle trauma affects the distal When the abnormality is also present on a T2-weighted hamstrings, distal quadriceps, proximal gastrocnemius, image, when there is a displaced fragment, or when a tear soleus, popliteus, and plantaris muscles. The patellar, examination, the presence of injected contrast within the quadriceps, and semimembranosus tendons are most fre- substance of a repaired meniscus is diagnostic of a quently involved around the knee. Sonographically, a degen- a partial meniscectomy; in these cases both the meniscal erated tendon appears enlarged, with loss of the normal shape and internal signal are unreliable signs of recurrent parallel fiber architecture, and often with focal hypoe- meniscal tear. A gap between the tendon noninvasive test for recurrent meniscal tears following fibers indicates that the process has progressed to partial partial meniscectomy [75]. In those cases in which T2-weighted images show a focus of high signal intensi- T2-weighted images demonstrate ruptures of the cruciate, ty, surgical excision of the abnormal focus can hasten collateral, and patellar ligaments. When macroscopic tearing is present, the radiolo- tion of the ligament fibers [76]. While edema surround- gist should also examine the corresponding muscle belly ing a ligament is typically seen in acute tears, edema sur- for fatty atrophy (which indicates chronicity) or edema rounding an intact ligament is a nonspecific finding, (suggesting a more acute rupture). If the tear is complete, which can be seen in bursitis or other soft tissue injuries, the retracted stump should be located on the images as in addition to ligament tears [77]. Synovium Secondary findings of ligament tears, such as bone con- tusions or subluxations, are useful when present, but do While radiographs can show medium and large knee ef- not supplant the primary findings, and do not reliably dis- fusions, other modalities better demonstrate specific syn- tinguish acute from chronic injuries, nor partial from ovial processes. In the knee, the anterior cruciate liga- hanced through-transmission on ultrasound images. At least 11 other named bursae occur around will be placed on the detection of clinically suspected or the knee. The most commonly diseased ones are proba- occult soft-tissue and bone abnormalities that could be bly the prepatellar, superficial infrapatellar, medial col- exacerbated by repeat trauma or could lead to chronic in- lateral ligament, and semimembranosus-tibial collateral stability and joint degeneration unless treated. Power Doppler ultrasound or the use of ultrasound contrast agent may in- Kinematic laws dictate normal joint motion and the bio- crease sensitivity for active synovitis [86]. Although the knee moves pri- amination, thickening of the usually imperceptibly thin marily as a hinge joint in the sagittal plane, it is also de- synovial membrane and enhancement of the synovium signed for internal-external rotation and abduction-ad- following intravenous contrast administration indicates duction. The signal intensities of the bodies logical, but the menisci must shift with the contact points vary depending on their composition.

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Because they are situated so close together 2 mg glimepiride otc, they share their parasites and pollution effective 4mg glimepiride. When the kidneys form kidney crystals the flow through the kidney tubes is hindered cheap glimepiride 4mg overnight delivery, and less water and salt can leave the body. You may need to cleanse the liver several times, too, before all the pain and edema are gone. You may have to choose a pain killer, get specially built “orthopedic” shoes, or stop your daily walks to get relief from the piercing pains. These will not cure the problem but may “buy you some time” while you make basic changes in your lifestyle. Stop drinking coffee, decafs, fruit juice and soda pop because they are contaminated with solvents. We should spare the kidneys these extra tasks when we wish them to clean up heel spur deposits. Drink a pint of water upon rising in the morning, and a pint of water between meals. Your own tap water is not pure (indeed it may have 500 toxic elements), but it never contains solvents in amounts I can detect. They trap the pollutants and then allow a tiny amount to enter the water on a daily basis. Chronic toxin consumption is much worse for your health than periodic surges of toxins. The pitcher variety (it should be made of hard, inflexible plastic) and the faucet variety are listed in Sources. Bottled water is popular, and tasty, and has appealing advertising, but it is just not safe. Why is it easier for everyone to spend dollars per day, for the rest of their life, buying water instead of insisting that their water pipes are metal-free? Another reason not to drink water from bottles, however convenient, is that it is stagnant and is soon contaminated with our own bacteria from contact with mouth or hands. The solution is not to add still more chemical disinfectants, the solution is to drink from a flowing source, such as our faucets. By drinking a total of four pints of water in a day, the kidneys will notice the assistance. This is especially important while you are dissolving the heel deposits since your body is now carrying these in the circulation. Killing bacteria with a zapper may give you instant pain re- lief and is, of course, beneficial to your body. Even the amount put on cereal in the morning or used in scrambled eggs is enough to reinfect you! Our high phosphate foods are meats, carbonated beverages and grain products like rice, cereals, breads, pastas and nuts. Magnesium is often in very short supply since it comes from green vegetables in the diet and is not stored up in any special organ. So it falls on calcium to be used for this pur- pose since it is stored up (in your bones and teeth). If you catch all the urine in a 24 hour period you can measure all the calcium you have wasted. You should not lose more than 150 mg calcium 4 in a day because this is all you can absorb in a day! If you do lose more than 150 mg in a day, you are dissolving your bones at a fast clip. This also means there is too much calcium in your blood and lymph, from dissolving so much bone so quickly. Once you have dissolved your bones it is not so easy to put the calcium back into them. Your body will try to put it back as soon as possible—as soon as your acid condition is gone. Remember, though, it was the kidneys that had a problem in the first place, allowing deposits to form! It takes large amounts to put back into your bones the large amount of calcium that dissolved out during the acid state you put yourself in by over consuming phosphate food. Young persons and children, with healthy unclogged kidneys, make–that is, activate–ample vitamin D, so even if they consume too much phosphate and develop an acid condition that dissolves their teeth and bones, they can put the dissolved calcium back in its proper place. In this way we set the stage for hardened arteries, joint disease, calcified tissues that no longer have flexibility. It is true, these bones are made of calcium phosphate and one might expect, logically, to be getting a less effective calcium source. The bones of fish work nicely as a calcium source and their phosphate content is not too great. Further, I have never seen a case of mercury toxicity from eating fish; amalgam tooth fillings are our truly significant source. Eat more vegetables; always choose potato (not potato chips) instead of rice or macaroni. Nothing less than 40,000 units has any real impact by the time there are problems. This strength is available by prescription only (usually 50,000 units, which is close enough). To avoid getting a polluted product, ask your pharmacist to follow the recipe on page 560. If you overdose you will get joint and muscle pain and nausea but it is reversi- ble. Finally, toss the carbonated beverages right out of your diet or make your own (see Recipes). Evidently, the cal- cium and phosphate story must be much more complex than I am depicting here. My recommendation when de- posits have formed anywhere in the body, such as heel, toe, ar- teries, joints, is to switch to milk as a beverage. Compare the calcium level of your urine before and after the switch (allowing several weeks first). If you are monitoring the effectiveness of the kidney herb recipe in dissolving away your phosphate crystals, notice that drinking milk keeps them from reforming. With your body fluids at their proper acid level, with your kidneys able to flush out acids, with heavy metal toxins no longer settling in, with your bone-dissolving stopped, your heel deposits can shrink. Be careful not to bruise the sensitive tissue with too much walking or running immediately after the pain is gone. Names in the case histories have been changed to ones of the same sex, picked at random from a telephone directory.

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The murmur starts with a systolic click as a result of opening of thickened valve cusps and followed by systolic ejection murmur as blood crosses the stenotic valve discount 2mg glimepiride with amex. The murmur’s harshness increases with severity of stenosis generic glimepiride 4 mg online, although in extreme cases due to resulting heart failure generic glimepiride 1mg mastercard, the murmur may become softer. A systolic ejection murmur not preceded by a systolic click may suggest diagnosis other than pulmonary valve stenosis. Stenosis of the right ventricular outflow tract, below or above the valve with a normal valve present with a murmur similar to pulmonary stenosis, however, without the click. Pulmonary stenosis murmur is best heard over the left upper sternal border 10 Pulmonary Stenosis 137 either slightly diminished, secondary to decreased pulmonary artery pressure, or slightly increased, secondary to poststenotic pulmonary artery dilation. Moderate valvular stenosis is often well toler- ated in children, but produces clinical symptoms with advancing age. Severe valvular stenosis can lead to exercise-related chest pain, syncope, or sudden death. Cardiac examination is often significant for increased precordial activity, with a right ventricular heave and a palpable thrill in the area of the pulmonary valve at the left upper sternal border. The earlier the ejection click is detected at the upper left sternal border, the more severe is the stenosis. The murmur is of an ejection quality and of high intensity, usually grade 4 or more, and is best appreciated at the left upper sternal border, with radiation to the back. The P2 intensity is often diminished, secondary to decreased pulmonary artery pressure. Since the pulmonary valve in most cases does not open, an ejection click and P2 will not be present. As very little or no flow across the pulmonary valve occurs, the murmur will be quite soft. Murmurs of branch pulmonary stenoses are appreciated in the back, with radiation to the axillae. A continuous murmur in the back and axillae suggests significant bilateral branch pulmonary artery stenosis. Chest Radiography The heart size is often normal, except in critical pulmonary stenosis, when the heart size may be increased secondary to right atrial enlargement. A prominent main pulmonary artery notch from poststenotic dilation of the pulmonary artery can often be appreciated in older infants and children. Lung fields appear variably void of pulmonary vascular markings (black or anemic), reflecting reduced pulmonary blood flow from increasing stenosis. Chest radiography in children with branch and peripheral pulmonary artery stenoses is commonly normal, but there may be a difference in vascularity between the two lung fields. Right ventricular and right atrial enlargement occurs when stenosis is severe and complicated by right ventricular failure. Echocardiography Two-dimensional echocardiography demonstrates the abnormal pulmonary valve with restricted motion, and poststenotic dilation of the pulmonary artery. Measurements can be made of the pulmonary valve annulus and the branch pulmonary arteries and compared with normative data. Color Doppler demonstrates turbulent flow through the valve, and spectral Doppler produces a pulse wave from which the pressure gradient across the valve is estimated: • Mild stenosis – Doppler pressure gradient of 35 mmHg or less, or estimated right ventricular pressure less than half the left ventricular pressure. Two-dimensional echocardiography also demonstrates areas of supravalvular and branch pulmonary artery stenosis. Color and spectral Doppler can be similarly used to evaluate the flow and pressure gradients across the areas of obstruction. The entire right ventricular outflow must be sequentially examined, as multiple levels of obstruction may occur and impact the estimated pressure gradient across the pulmonary valve. Right ventricular development, hypertrophy, and systolic and diastolic function can be assessed. Right atrial size, presence of an interatrial communication, and direction of atrial septal flow can be demonstrated. In neonates with concern for critical pulmonary stenosis, patency of the ductus arteriosus can be determined. Cardiac Catheterization Cardiac catheterization is reserved for therapeutic intervention. For valvular pulmonary stenosis, hemodynamic data are recorded, and angiography is performed for func- tional assessment and annular measurement of the pulmonary valve. Balloon valvuloplasty successfully provides valve patency, and has supplanted surgical valvotomy as the choice treatment for this lesion. Varying degrees of pulmonary insufficiency result from this intervention, which is typically well tolerated by the hypertrophied right ventricle. Cardiac catheterization for supravalvular, branch, and peripheral pulmonary stenosis deserves special mention. Diagnostic cardiac catheterization is performed to provide a hemodynamic understanding of often multiple levels of obstruction, and also to provide angiographic pictures of the peripheral pulmonary vasculature. Because these lesions are characterized by ultrastructural changes such as fibrous intimal proliferation, they can be resistant to standard balloon angioplasty, and require the use of specialized equipment such as cutting balloons and stents, which provide variable results. Following successful balloon angioplasty of severely stenotic peripheral pulmo- nary arteries, reperfusion injury to the distal lung segment sometimes occurs, and is clinically characterized by cough, low-grade fever, hypoxemia, and corresponding segmental air space disease on chest radiograph. Other Diagnostic Modalities Magnetic resonance imaging can be useful in defining peripheral pulmonary vas- cular anatomy and pathology, while radionuclide lung perfusion scans can be useful for quantifying blood flow to each lung. Treatment Mild pulmonary stenosis produces no symptoms and no difference in life expectancy. Symptoms should not be attributed to mild pulmonary stenosis if stenosis is indeed mild. Moderate pulmonary stenosis is often treated with medical observation, and is typically well tolerated by infants and young children. Indications for catheter intervention include symptoms of fatigue and exercise intolerance, symptoms which often are experienced with increased age, even with stable stenosis. Severe pulmonary stenosis can be successfully treated by catheter-based balloon angioplasty. Surgical valvotomy is reserved for patients in whom balloon valvulo- plasty has been unsuccessful or for patients in whom multiple levels of obstruction are demonstrated. Critical pulmonary stenosis requires prompt initiation of prostaglandin infusion to maintain ductal patency and provide pulmonary blood flow. Following complete echocardiographic assessment, most neonates proceed to the cardiac catheterization laboratory for balloon valvuloplasty, after which the prostaglandin infusion is dis- continued. Occasionally, infundibular stenosis becomes apparent following balloon valvuloplasty, and a surgical Gore-tex shunt is required to maintain pulmonary blood flow. Though pulmonary valve patency has been established, many neonates continue to demonstrate moderate cyanosis, with SpO2 of 70–80%, which improves slowly over several months as the right ventricular compliance improves and decreases the degree of right to left atrial level shunt. An infant with a history of critical or severe pulmonary stenosis and pulmonary valvuloplasty requires pulse oximetry assessment at each visit. In the rare instance of isolated infundibular stenosis, patch widening of the right ventricular outflow tract and resection of the infundibular muscle are required. Treatment for supravalvular and branch pulmonary artery stenosis includes fre- quent medical observation.

Vehicle transmission An indirect method of disease transmission where the disease- causing organism is carried by food buy glimepiride 4 mg free shipping, water or some other object cheap glimepiride 2 mg fast delivery. Virus A group of microbes that are incapable of reproducing on their own and must invade a host cell in order to use its genetic machinery for reproduction 4mg glimepiride fast delivery. Viruses are smaller than bacteria, and are responsible for the most common human diseases, the common cold and the "flu" (influenza). Advisory Committee on Immunization Practices and the American Academy of Family Physicians. January 2007 A-71 International Association Infectious Diseases of Fire Fighters Appendices U. The composition and the terms of reference of the Working group would be as follows: Subgroup I: Communicable Diseases 1. To review the achievement of ongoing major communicable disease control programmes their target and suggests corrective measures to improve their th implementation in the 12 Plan. To suggest introduction of new programmes/ continuation of existing programmes for control of communicable diseases and modifications required, if th any, in the 12 Five Year Plan on the basis of 1& 2 above along with detailed budget for each programme. To review the current system of monitoring and evaluation of the existing communicable disease control programmes and suggest measures to make the system more effective V. To review the functioning Integrated Disease Surveillance Programme in terms of its effectiveness in strengthening surveillance for picking up early warning signals of outbreaks and institution of appropriate control measures in a timely manner, identify gaps and suggest measures to strengthen the surveillance system for th prevention and control of communicable diseases during the 12 Plan. To deliberate and give recommendations on any other matter relevant to prevention and control of communicable diseases. Jagdish Kaur, Chief Medical Officer, Ministry of Health & Family Welfare (O)23063120 Terms of Reference I. To review status of ongoing Central Sector/Centrally Sponsored Disease Control Programme for non-communicable diseases. To suggest introduction of new programmes/ continuation of existing programmes for control of non-communicable diseases and modifications th required, if any, in the 12 Five Year Plan on the basis of 1& 2 above along with detailed budget for each programme. This shall include initiating a Programme for any non-communicable disease of public health importance not yet covered under any Programme. To study and work out comparative effectiveness of interventions at different levels of health care such as health promotion, prevention, community based services, screening/ early diagnosis, treatment and rehabilitative care taking into account short term and long term needs for prevention and management of non- communicable diseases. Based on the assessment made as at 5 above, suggest proportionate expenditure on preventive, promotive, curative and rehabilitative health care for non-communicable diseases for maximizing impact of these interventions and optimizing resources available. To deliberate and give recommendations on any other matter relevant to prevention and control of non-communicable diseases. The Chairman may constitute various Specialists Group / Working Groups / Sub- groups/task forces etc. Working Group will keep in focus the Approach paper to the 12 Five Year Plan and monitorable goals, while making recommendations. The Working group would submit its draft report by 31 July, 2011 and final report st by 31 August, 2011. Prevention & Control of Neurological Disorders (Epilepsy, Autism, Dementia) 240 20. Since the majority of deaths are premature there is a substantial loss of lives during the productive years as compared to other countries. Heart diseases, stroke and diabetes are projected to increase cumulatively, and India stands to lose 237 billion dollars during the decade 2005-2015. Road traffic injuries are increasing precipitously, and are estimated to account for as much as 25% of all health care expenditures in developing nations. Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to primary care. More than 20% of the population has at least one chronic disease and more than 10% have more than one. Chronic diseases are widespread in people who are younger than 45 years and in poorer populations. Whereas socioeconomic development tends to be associated with healthy behaviours, rapidly improving socioeconomic status in India is associated with a reduction of physical activity and increased rates of obesity and diabetes. The emerging pattern in India is therefore characterized by an initial uptake of harmful health behaviours in the early phase of socioeconomic development. Such behaviours include increased consumption of energy-dense foods and reduced physical activity and increased exposure to risk factors. Health-damaging behaviours such as smoking, drinking, consuming unhealthy diets (rich in salt, sugar and fats, and low in vegetables and fruits) are also found to be common among the low socioeconomic group. However, personal behaviours are not only a matter of personal choice, but may be driven by factors such as higher levels of urbanization, technological change, market integration and foreign direct investment. National Health Pogrammes for Cancer and Blindness were started as early as 1975 and 1976 respectively, followed by programme on Mental Health in 1982. Some of the programmes were within the framework of National Rural Health Mission. These programmes have given insights of problems and experiences in implementation that would be useful in upscaling and expanding programmes across the country. Broadly, across programmes, following experiences were observed and lessons learnt in th implementation of programmes, which need to be addressed during the 12 Plan: 1. Convergence and integration would be critical in implementation of large number of interventions which would require unified management structure at various levels. Integration of cross cutting components like health promotion, prevention, screening of population, training, referral services, emergency medical services, public awareness programme management, monitoring & evaluation etc. Costs borne by the affected individuals and families may be catastrophic as treatment is long term and expensive. Investments during the 11 Plan and earlier plans have been more on provision of medical services which have not been adequate in the public sector. Private sector has grown particularly in urban settings but is beyond the reach of the poor and middle sections of the society. While Government of India’s role will be policy formulation, population based multi-setoral interventions, technical and financial th support, the onus of implementation will be with the States. To ensure convergence and integration with public health services, a decentralized approach is proposed with District as the management unit for programs. Oro-dental disorders (b) Programmes for Disability Prevention and Rehabilitation 10. Tertiary Care for advanced management of complicated cases including radiotherapy for cancer, cardiac emergency including cardiac surgery, neurosurgery, organ transplantation etc. Health Promotion & Prevention: Legislation, Population based interventions, Behaviour Change Communication using mass media, mid-media and interpersonal counselling and public awareness programmes in different settings (Schools, Colleges, Work Places and Industry). To ensure convergence, common districts will be selected for all three major programmes. The schemes would be flexible to meet local requirements as there would be 13 variation in prevalence and availability of existing health infrastructure. Airports, Ports and Land Borders covered 19 Neurological Disorders New All districts Thalassemia, Sickle Cell 20 New Pilot in selected endemic districts Disease and Hemophilia Estimated Budget It is envisaged that for comprehensive and sustainable programmes to prevent, control and manage important non-communicable diseases and key risk factors across the country, a large th investment would be required during the 12 Plan.