Leukocoria - Definition, Symptoms, Causes, Treatment, diagnosis

Leukocoria means "white pupil" and is a term used for the clinical finding of white pupil reflex. Leukocoria is caused by anomalies with the retina, lens or vitreous. It is often the first manifestation of a number of intraocular and systemic diseases. Assessment of leukocoria is part of the routine study.

In the first year of life, the asymmetry of the red reflex when viewed through a direct ophthalmoscope or torch is the most common presentation of leukocoria. The presence of leukocoria should give a sense of urgency for prompt treatment.. First of all, the presence of non-accidental head injuries should be excluded. Vitreous hemorrhage is usually the result of trauma, including non-accidental head injuries in infants.

Every patient with suspected non-accidental head injuries should undergo an emergent eye examination performed by an ophthalmologist. Other conditions that cause leukocoria are fetal vasculature, retinopathy in prematurity, cataracts, toxocariasis and vitreous hemorrhage.


Leukocoria - Definition, Symptoms, Causes, Treatment, diagnosis

Leukocoria Symptoms


Some common opthalmological conditions that may represent with leukocoria include uveitis, disease envelope, optical disks abnormalities and retinal dysplasia. Major sign and symptoms include abnormal size of pupil, reduced vision, decreased visual acuity, nystagtnus, strabismus, buphthalmos, microphthalmos, anterior chamber cells and flare etc.

Because leukocoria affects mainly children, the condition is detected when a parent or guardian sees the pupil is being white. However, in some cases, the underlying disease occurs as reuslt of  secondary strabismus and he cause is found during dilated fundus examination.

Leukocoria Causes


One of the most important signs of an intraocular tumor in children is leukocoria or white pupil reflex. There are many reasons for Icukocoria in children. Most often include congenital cataracts, retinal detachment due to retinopathy in premature, persistent hyperplastic primary vitreous and retinal telangiectasia. Retinoblastoma is probably the most serious cause of leukocytes in children.  Each child diagnosed with leukocoria must be treated immediately to avoid further prorgression of disease.

PHPV is the second most common cause of leukocoria in children. Clinically, PHPV is present as a one-sided Leukocoria. The condition is caused by damage to the hyaloid vasculature regresses with the resulting resistance of the primary vitreous. Since direct visualization with ophthalmoscopy may be difficult, in some cases, CT-Scan and MRI may be useful to make proper diagnosis. Few eyes that are not associated with calcifications and normally increased vitreous density are common to CT findings. MRI demonstrated microphthalmia and marked hyperintensity of vitreous TI-W and T2-W images. Retinal detachment and sub-retinal blood can be seen. The diagnosis is made by visualizing a Cloquet CT scan or magnetic resonance imaging.

Leukocoria Treament


Patient survival is the primary goal of the treatment of Leukocoria and retinoblastoma, and is indeed a priority, saving vision is of secondary importance. Advanced treatment of tumors is enucleation, which involves surgical removal of the entire eye and the optic nerve. This is the only way to eliminate the tissue of eye cancer to prevent recurrence and metastasis in other body sites. After surgery, patients are equipped with artificial eye (dentures) that have eye movement capabilities.

All eye vision and transplants are not available. Vision conservation procedures are also available, and include an external ray beam. Brachytherapy, photocoagulation, thermotherapy, cryotherapy and chemotherapy are also used for treatment. External radiation uses high energy rays to kill and reduce tumor cells, and in brachytherapy, radioactive plaques are implanted into the sclera.  Photocoagulation uses lasers to burn blood vessels that deliver nutrients to tumors and thermotherapy directly heating tumors with lasers or ultrasound.

Cryotherapy involves freezing the tumor by placing cryoprobes on the sclera near the tumor. These therapies are often used in a chemo chemotherapy suite that uses drugs to disrupt the ability of tumor cells to grow and multiply.
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Common Health Problems in USA, Prevention, Diagnosis and Treatment

Medical science has now made it possible for a much larger proportion of men and women to live out a normal lifetime than was true a hundred or even fifty years ago. The resulting increase in the average length of life has been due primarily to the control of infectious and contagious diseases, especially those common in childhood. In this chapter we shift our attention from medical practice to the community's defenses against disease.

Immunization may protect against contracting disease even in the face of exposure. The community's defenses are designed to reduce the chances of the individual's being exposed in the first place. Modern health departments are responsible for keeping communities free from the hazards of preventable diseases, especially from communicable ones. The United States Government has several public-health agencies, the one probably most well known to the average citizen being the Food and Drug Administration.

State laws govern, for the greater part, the work done in local health departments; but any public-health problem large enough to involve more than one state or an outside country is the primary concern of the USA Federal Government. This being true, the general public health program is in many respects the same throughout the country, but it varies somewhat from state to state. Additional variation exists from community to community, because local health officers must also be governed or guided by the orders and ordinances of local governing bodies-city councils or county boards of supervisors, for instance.

Many of the variations exist also because of the need to fit laws and regulations to differing conditions. Several of the most important means by which a community's health is protected are often grouped together under the heading of sanitation. By sanitation is meant care of food and drink, disposal of excreta, and regulation of environment all focused on preservation of health and prevention of disease.

Scraps of food were thrown on the floors in eating places. People seldom took baths and knew nothing about how disease is spread from person to person. They feared disease but often thought it to be an act of God and did not know how to prevent it. During the fourteenth century a terrible epidemic of the Black Death (a good deal of it bubonic plague) swept across Europe.

It killed millions of people perhaps a third of the population of that continent. This disease thrives among rats, and the germs are readily carried to humans by ratfleas. One of the first signs that it may be threatening a community is an unusual number of dead rats lying around. The control of bubonic plague, then, centers around the control of rats-a sanitation problem.

Control of rats, a sanitation problem, aids in prevention of disease. Another disease that thrives amid unsanitary conditions is typhoid fever. It is usually transmitted by contaminated food, milk, or water and flies can spread the germs that cause it. Diseases prevalent under poor sanitary conditions have been greatly reduced in recent decades, but they are not yet entirely controlled.

Typhoid fever still occurs commonly in many parts of the world and occasionally even in the United States. Plague could still be a terrible scourge were it not for the constant vigilance of health departments and other health-guarding agencies. The effective protection of individual health, as well as of community health, calls for the active cooperation of each citizen in obeying the rules of sanitary living.

It is not enough that we pay taxes and expect the health departments to do the complete job of preventing infectious diseases. Each family needs to keep its own home and surroundings clean. Each person must be alert to the need for keeping food, milk, water, and air as free as possible from disease-producing agents.

Food Sanitation Food sanitation includes care in producing, marketing, preparing, and serving food. For the purpose of our present discussion, vegetable and animal foods will be considered separately. Vegetable foods are easily contaminated by contact with soil fertilizer, especially animal or human excreta of recent origin.

This kind of contamination carries germs that can cause serious bowel infections and diarrhea. All vegetables to be cooked should of course be clean, but if they are to be eaten raw, they must be more than merely clean. They must also have been produced and handled with proper sanitary safeguards. A comparatively recent new hazard in eating fruits and vegetables has come from the use of poisonous sprays to kill pests.

When crops are marketed too soon after the last spraying, they may carry a sufficient amount of poison from the spray to affect the health of consumers. Health officers try to avert this danger by enforcing regulations requiring that fruits or vegetables that have been sprayed be washed before being marketed. Some contaminants can be removed by washing with plain water. Others require the use of a mild acid solution or some other chemical.

Fruits and vegetables should be carefully handled while being harvested, transported, or marketed. Bruised spots on fruits cause them to decay rapidly. Fruits and vegetables are easily contaminated by germs carried by flies. Unpacked foods, therefore, should be protected against flies while being transported and marketed.

Cooked foods should be served promptly, before there is any possibility of contamination. If such foods must be kept over from one meal to another, they should be kept in a refrigerator. Foods allowed to remain at room temperature can serve as a breeding medium for germs. The kitchen and dining room should be kept clean and free from dust.

All flies and other insects should be kept out of rooms where food is handled. This is best done by screening windows and installing self-closing screen doors. Public eating places are required to comply with state laws and regulations and with the local ordinances of the city or county. Health department inspectors visit such places as frequently as time will pennit, but not on a regular schedule. Thus proprietors do not know when to expect their visits. Even so, unsanitary conditions sometimes develop in such places. If you notice what seem to be unsanitary meat. The red interior of "rare" steaks or roasts cannot be considered as safely cooked.

Most of what was noted above about the handling, preparing, and serving of vegetable foods also applies in a general way to animal foods. The usual precautions are even more important in the case of animal foods, however, because of the greater ease with which germs multiply in them.



Milk


Milk is a very important food. It contains generous amounts of carbohydrate, protein, and fat. It also contains an adequate supply of calcium and phosphorus, necessary constituents for bones and teeth. It is not only the best food for babies and small children but also a good food for teenagers and adults. nutritionists generally recommend that each child and teen ager drink about a quart (liter) of milk a day. Adults will do well to take at least half as much, either as a beverage or in combination with other foods.

Some people argue that milk is suitable only for babies and very young children. They point out that very little milk has been or is being used in certain very populous parts of the earth, notably China. They also argue that the young of lower orders of mammals thrive without milk after the first few weeks or months of life. It would no doubt be possible for humans to do likewise if we had some practical way to supply them with the amount of calcium and phosphorus which carnivorous animals get from bones, and which herbivorous animals get from herbage and whole grains. But milk is a much more convenient source and has been widely used throughout the course of human history.

Unfortunately, milk serves as a ready medium for the multiplication of germs. Germs of diarrhea, tuberculosis, food infection, scarlet fever, septic sore throat, undulant fever, diphtheria, and other diseases are easily carried in milk. In the days before modem public-health departments controlled the handling of milk,many epidemics were traced directly to the distribution of contaminated milk.

The production of safe and wholesome milk requires careful cooperation between the dairy and the health department. The first step in producing good milk is to make sure that all cows in the dairy herd are healthy. State and local health officials cooperate in making periodic tests on each cow, eliminating diseased animals.

The second step in producing good milk is to make sure that the dairy is kept clean. In most places adequate laws regulate this matter. Floors must be smooth and easily cleaned. There must be enough windows to provide abundant light and ventilation. The cows should be given only pure water to drink, and they should be washed with pure water before being milked. Flies must be kept away from the  milk during all stages of its processing.

Prior to the days when the handling of milk was so carefully guarded, many epidemics were spread by diseased dairy workers. Now dairies are required to keep a careful health check on each employee. Dairy workers must have frequent physical examinations. One who becomes sick is not allowed to work until well again. Those who work in dairies are carefully instructed on keeping their bodies and clothes clean, thus reducing the danger of germs in the milk.

As soon as milk is taken from the cow, it should be removed to a separate milk room, a screened area kept spotlessly clean. As the milk arrives in the milk room, it should be chilled and kept cold from then on except while it is being pasteurized. Keeping milk at a low temperature prevents germs, if any, from multiplying rapidly.

More than 90 percent of the milk now marketed in the United States has been pasteurized. In some areas it is close to 100 percent. Pasteurization can be accomplished in either one of two ways:


  • Heating the milk to a temperature of 145F° (63C°) for thirty minutes or
  • Heating it to 161F° (72C°) for fifteen seconds.


Most germs are killed by this amount of heat, and the kinds not thus killed seldom cause disease. After being pasteurized, milk should again be quickly cooled and kept cold until it is delivered to the customer. Some families still keep one or more cows for their own milk supply. It is not safe to continue using such milk raw. Boiling it would make it free from living disease germs, but boiling it or even heating it nearly to the boiling point spoils its taste for most people.

A good method of home pasteurization is as follows: Get an accurate thermometer of the sort used to test the temperature of hot liquids. Use a heavy kettle preferably of stainless steel. Heat the milk slowly over low heat. It is best to put a thin asbestos pad between the kettle and the heat. While the milk is heating, stir it constantly. Bring the milk to 165 F° (74 C°), and be sure it holds that temperature for about five minutes, still stirring constantly. (Extra temperature and extra time compensate for open-kettle method.) Then take the kettle from the stove and cover it.

Cool the milk quickly by setting the kettle in a large pan of cold water, preferably with ice in the water. Then put it in the refrigerator until time to serve it, keeping it covered. This procedure will make the milk as safe as pasteurized market milk, and it is not likely to give it an objectionable taste. Questions are often asked about the effect of pasteurization on the nutritional qualities of milk. Only two constituents of milk are adversely affected by pasteurization vitamin BI and vitamin C.

The loss of these vitamins is of little consequence because milk does not contain much of either one, and other foods can easily supply all that is needed. Only in cases where milk is used as the main food, as in infant feeding, does a deficiency of vitamin C constitute a problem. The lack is then made up easily by giving the baby a supple mental food rich in vitamin C, orange juice or tomato juice most often being used.

Most market milk is now homogenized. Homogenization does not take the place of pasteurization. It does not kill germs. Rather it breaks up the globules of fat into much smaller globules so that no cream line forms in the bottle or carton. It is easier to use such milk in cooking or infant feeding, since all parts of it contain the same percentage of milk fat. As a matter of fact, most market milk is both homogenized and pasteurized, as the wording printed on the containers will show.

Local health inspectors take frequent samples of milk at dairies, at processing plants, and at markets where milk is offered for sale. Laboratory tests are run on the samples to determine whether or not they show evidences of contamination by disease germs. If such evidences are seen, the milk is condemned until the cause of the trouble is located and corrected.

Water


Strangely, in the United States, generally considered to be a land of plenty, fresh water is becoming a major problem. Of the 12,000 billion gallons of water per day which flow toward the ocean through our rivers, we are now salvaging only about 325 billion gallons for domestic and commercial uses. At first this may seem like an abundant supply; but changing conditions have resulted in a continually increasing per capita demand for water.

Individual homes supplied with running water require from sixty to a hundred gallons (225 to 375 liters) per day per person. This need represents only a small part of the overall demand. Consider irrigation. We are using nearly half of our fresh-water supply to grow crops. Almost as much is required for industrial purposes. Three basic reasons for our growing need for water are:


  • Rapid increase in population,
  • Shift of population to urban areas where homes have modern plumbing
  • Increased industrialization.


When we speak of pure water, we do not mean water free from all extraneous chemical substances. Acceptable water may contain enough minerals to make it "hard." Even "soft" water may contain certain impurities. Water free from disease producing germs and from chemical substances harmful to the body is considered "pure" from the point of view of health. ow that the volume of sewage discharged into streams or lakes has so greatly increased, the problem of obtaining pure water for domestic use has become more complicated. However, most modern communities use sewage disposal plants to purify sewage before it goes into streams or lakes. Also, water purification plants are used to make sure that domestic water supplies are free from disease producing germs.

But a further complication is that many streams are now polluted by chemical substances discharged from industrial plants. Many of these substances stay in solution and are carried along by the water for many miles. Some are actually poisonous. In the notable example of the animals River, a tributary of the Colorado River, the water became temporarily polluted by radioactive substances originating in a uranium mill.

Another source of chemical pollution of water is the increasing amount of pesticides now used for the control of insects, as in crop dusting. These include poisonous chemicals, sometimes carried away from cultivated areas by runoff from rainfall. To date, the amount of these pesticides entering the usual sources of water supply.

is not measurably dangerous to humans,but this may not always remain true. Some commercial fertilizers also contain soluble substances that can pollute ground-water supplies and eventually become a health hazard. This is especially true of the nitrogen containing compounds in the fertilizers. If these are not already present in the form of nitrates, they are likely to be more or less slowly converted into nitrates by oxidation; and all nitrates are soluble and remain in the water as it percolates downward through the soil and deeper strata. In a few cases ground-water sources have already been found to contain nitrates in sufficient 'concentrations to be harmful, especially to babies.

Detergents sometimes find their way into water supplies. With the widespread use of automatic clothes washers and dish washing appliances, the amount of detergents introduced into sewage has become enormous. The usual treatment of sewage in purification plants does not remove detergents from the water, and this water may eventually be discharged into streams or lakes which supply water for domestic use. In rural areas where cesspools or septic tanks are used for sewage disposal, the detergent chemicals seep slowly into the subsoil and eventually into the underground water reservoirs.

When water is obtained from these reservoirs by the drilling of wells, traces of detergent chemicals appear in the water. Contamination with detergents may cause domestic water to produce suds when drawn from the faucet. When detergents were first marketed they contained considerable quantities of compounds of phosphorus. The phosphorus in such detergents, when it found its way into the soil, promoted the growth of algae.

More recently the amount of the compounds of phosphorus in detergents has been reduced and it may now be said that the amounts of detergent in domestic water are relatively harmless either to individuals or to the soil that absorbs such water. In most water purification plants, the incoming water is first allowed to settle in large tanks or reservoirs, and then it is run through a sand filter. Filtering the water through sand takes out most of the foreign matter, as well as most of the germs. In some plants, chemicals are added to the water to aid the settling process or for other reasons.

No chemicals harmful to human health are used which cannot be removed from the water before it is distributed into the mains. To ensure that the germs are killed, a small amount of chlorine is usually added to domestic water as it leaves the purification plant. It takes only one part of chlorine to a million parts of water to kill disease-producing germs. This amount of chlorine does not injure those who drink the water. We cannot tell whether or not water is pure simply by looking at it. Some people consider all clear running water safe to drink. This is not always true, for disease-producing germs may be found in swiftly running water as well as in stagnant pools. The water in a beautiful mountain stream may be clear and colorless and yet carry the germs of typhoid fever or dysentery, especially if people are free to roam about in the vicinity.

People living or traveling in an area where the source of the water is unknown or unprotected should employ a means of purifying their drinking water. Also, there are times following disasters, such as earthquakes or tidal waves, when a city's water supply may be contaminated by broken water mains or overflowing sewers. The usual and safest way to make questionable water safe to drink is to boil it vigorously for at least a full minute. Then it should be kept in a covered utensil while it is cooling and until it is used. Other methods approved by the United States Public Health Service for making water reasonably safe for drinking are as follows:

  • Iodine or chlorine tablets, designed for the purification of water, are available in most drug stores. When using them, follow the directions printed on the packages
  • Tincture of iodine from the medicine chest may be used to purify water. After adding three drops of the standard tincture to a quart (liter) of water and mixing well, allow to stand for half an hour before using.
  • Chlorine bleach solution from the home laundry may also be used to purify water.

After being mixed well, the water must stand at least half an hour before it can safely be used. For purifying muddy or turbid water, twice the amount of the chemicals listed above should be used.

Fluoridation of Domestic Water


Within recent years accumulated scientific evidence seems to indicate that a small amount of the element fluorine (the active form of fluorinecalled fluoride ion) is necessary in the body's tissues in order to ensure proper development and health of the teeth. The United States Public Health Service has made comparative studies of communities where the water supply naturally contains an adequate amount of fluorine and those where fluorine is wholly or nearly absent. In the communities where an adequate amount of fluorine is present, children are remarkably free from dental caries (cavities in the teeth), in contrast to the high incidence of caries in communities where fluorine is deficient.

Furthermore, careful investigation has shown that when fluorine is naturally present in much more than the desirable amount, no damage to the health of the water users is detected aside from the somewhat unsightly mottled appearance of the enamel of the teeth. These findings have prompted the practice of adding fluoride to the domestic water (one part of fluoride to one million parts of water) in areas where fluoride is naturally deficient.

Some oppose the practice, fearing possible poisoning by fluorine gas and some of its compounds. But there is no more danger in this procedure than in adding iodine to salt in areas where iodine is deficient. In both cases the compounds used are not those which are poisonous in ordinary amounts, and the amounts used arc always very small. As a result of continued studies made by national health organizations, two conclusions may now reliably be drawn with respect to the use 34 of fluoride in domestic water:

  • The presence of fluorine as fluoride ion in domestic water in concentrations of approximately one part per million is effective in reducing the incidence of dental caries as much as 60 to 70 percent
  • The addition of fluorine to domestic water has produced no harmful results in the general health of those using such water.


Sewage Disposal


The disposal of human excreta is a most important problem in sanitation. Water and sewer systems in modern cities take care of this problem for individual households. There was a time when such sewer systems discharged their waste directly into nearby rivers or lakes; but now most municipalities operate disposal plants where sewage is treated and made safe before being discharged into a
body of water used for domestic or irrigation purposes. When a house has a supply of running water piped into it, but no city sewer available, a flush toilet with a septic tank can be installed. Local building codes and health department regulations must be consulted in this case.


Swimming Pools


The water in swimming pools may become a health hazard, entirely apart from the danger of drowning. It not only comes in contact with the swimmer's skin but also gets into his eyes and ears and some of it may accidentally be swallowed. As a general rule, civic regulations govern the sanitation of public swimming pools; and inspectors make frequent checks on cleanliness and possible disease germs, taking water samples for laboratory examination. But private pools, the number of which is rapidly growing, are usually less carefully supervised, perhaps receiving no attention at all except that which the owners may give them spasmodically or on rare occasions.

Defenses Against Insects and Vermin


A hundred years ago, cities throughout the world were dirty. Garbage was not carried away quickly. Rats thrived in the litter scattered in alleys and backyards. Flies swarmed over exposed refuse and then flew into people's houses, carrying disease-producing germs. Now most modern cities provide for frequent collection of garbage and rubbish. Officers from health departments inspect streets and alleys and require that they be kept cl~an. This policy goes far in controlling flies, mice, rats, and the fleas carried by rats. Flies, fleas, and mosquitoes are the worst insects for carrying disease germs. Ticks, not true insects, are also dangerous carriers. In controlling these pests, it is important to kill those that already exist; but it is even more important to prevent the propagation of the young.

Ticks are more difficult to combat than flies, fleas, or mosquitoes. The most dangerous ones are found in the wilds or out of the way places, where they live on wild animals. Clearing and burning brush at certain seasons of the year, destroying wild rodents, and the periodic spraying of sheep and cattle will help to reduce the number of ticks. Flies will breed in filth of almost any kind, but the ordinary housefly prefers the filth of an ill-kept stable or barnyard. The control of flies, therefore, consists essentially of maintaining sanitary conditions where animals are kept and where refuse of any kind is deposited. All refuse, as well as fertilizer, should be kept in tightly covered containers. Make sure that flies have no access to the interior of buildings. Careful screening and the use of traps and sticky paper will help in this objective.

The control of disease-carrying fleas consists in large part in exterminating rats. As long as food is available to them, rats will breed freely. Even methods of trapping and poisoning them only partially succeed as long as the rats can obtain food. Rats thrive on most kinds of human food and on feed for poultry and domestic animals. All buildings should be carefully rat proofed. When in doubt as to the best means of doing this, consult building inspectors for the techniques of rat proofing, and health department representatives for methods of controlling rat breeding grounds.

Piles of lumber, plywood, or rubbish often serve as living quarters for rats. Mosquitoes can be most easily destroyed in the larval or pupal stage. Periodic oiling of standing water will suffocate the larvae. Dusting the surface of standing water with DDT will poison the immature mosquitoes, but may also poison any fish in the water. Certain varieties of small fish feed on the larval or pupal forms of mosquitoes. Stocking ponds with such fish is often effective in checking the propagation of mosquitoes.

Vegetation growing in the water of such ponds should be cleared away so the fish can find the mosquito larvae. Stagnant ponds and marshes should be drained if possible. Some species of mosquitoes breed in very small amounts of water, such as in empty cans, broken dishes, flowerpots, roof gutters, and even in knotholes in trees.

In controlling mosquitoes, both individual effort and community cooperation are necessary. Such measures as the draining or filling of swamps and ponds are of permanent value. Other measures may have to be repeated year after year, and sometimes several times a year. When people find it necessary to live in an area where community wide control of mosquitoes has not been accomplished, they will have to combat mosquitoes the best they can on their own premises. Having a house on a breezy elevation, well

away from known breeding places, will help. Vines and bushes should not be planted in the immediate vicinity of a house. Adequate screens on windows and doors, as well as the use of bed nets, will protect against mosquitoes. Remaining indoors after sunset is also a help in preventing mosquito bites. The Problem of Air Pollution Current population growth everywhere, with accompanying shift of population to urban areas, has in recent years increased the problem of  air pollution. Industries, for the most part, have cooperated in trying to prevent pollution of the atmosphere. But some, by their very nature, continue to discharge smoke and chemical fumes into the air in spite of the most modern means of prevention.

Also the exhaust fumes from an ever-increasing number of cars and trucks pollute the air and irritate eyes and air passages. Air may be polluted by soot, smoke, gases, dust, finely divided chemical particles, and offensive odors. For this reason some large cities prohibit the use of incinerators and other air polluting equipment. Also in some areas smog-control devices are required
on automobiles and trucks.

Heavily polluted air impairs health. Evidence for this generally accepted opinion comes partly from known interference of polluted air with the growth of plants and partly from statistics indicating that certain diseases are more prevalent, and death rates from them higher, in urban areas than in rural areas, especially in urban areas where the air is frequently heavily polluted. Several cases are on record where air pollution became both extreme and persistent, and a sharp increase in deaths from respiratory ailments resulted.

Every person living in areas where the air is easily polluted should do his best to promote health by curtailing those activities that pollute the atmosphere. Your Health Department It is easy to take for granted the many services of city, county, and state health departments. We reap the benefits of modem medical and scientific achievements without realizing how much governmental agencies do to secure our relative freedom from disease.
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