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Due to the small size of most of the premises involved, and the limited wildlife habitat present at most of these premises, wildlife trapping success has not been high. Ticks collected thus far from wildlife have been Dermacentor variabilis and Ixodes scapularis. All ticks collected are being submitted to the National Veterinary Services Laboratories for identification and testing. Committee Business: the Committee passed one resolution on Tropical Bont Tick, which was forwarded to the Committee on Nominations and Resolutions. This tick is the principal vector of heartwater and is also associated with dermatophilosis, which have resulted in major losses in animal production and mortality, mainly in cattle. The tick is endemic in this region and constitutes a threat to the American mainland. This objective was partially achieved: in some islands the tick was eliminated, while in others tick hotspots persisted. The surveillance level (numbers of animals examined and farms visited per quarter), and animal and farm infestation rates (by host species, year, quarter, parish) were analysed from four islands (Nevis, St Kitts, St Lucia, Barbados) with R software. The study pointed out 1) an adequate level of surveillance (for detection of 1 percent prevalence) in Nevis, St Lucia, and Barbados. In St Kitts, inadequate surveillance in some quarters could have contributed to the late detection of the recent reinvasion and spread; ) a decrease in tick populations following treatment programmes; ) adult tick seasonality on livestock during the rd quarter of the year in Nevis and St Kitts; and ) a higher infestation level in cattle than in small ruminants. Geographical information analysis will be used to clarify risk factors related to tick ecology. Tick population modelling will be performed for the Caribbean region and validated against the results of this analysis. There were several other enhancements that should allow for a more efficient work process. This includes volume sold reporting by molecule unless there is only a single company producing a specific drug in which case volumes are reported by class. Both should result in speedier approval processes for animal drugs to producers and veterinarians. More than 50 drugs have been designated for this process and there has been one approval. Both scientific and political progress is being made, but progress is slow and maximum residue levels are weapons used in global trade. Lastly, Vaughn discussed the Proposed Final Order to ban the extra- 56 label use of cephalosporin antibiotics in animals destined for food.

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Topical amphotericin lozenges or suspension are used for oral or pharyngeal candidiasis. Nystatin works in the same way as amphotericin B, but its greater toxicity precludes systemic use. Its indications are limited to cutaneous/mucocutaneous and intestinal infections, especially those caused by Candida species. Little or no nystatin is absorbed systemically from the oropharynx or gastrointestinal tract, and resistance does not develop during therapy. Cutaneous infections are treated with ointment and vaginitis is treated by suppositories. Adverse effects Nystatin can cause nausea and diarrhoea when large doses are administered orally. Available for topical (nystatin and amphotericin) treatment of common mucocutaneous fungal infections. Amphotericin is used intravenously for deep-seated and severe fungal infections (e. Intravenous amphotericin is toxic, causing fever, chills, hypotension during infusion, nephrotoxicity, electrolyte abnormalities and transient bone marrow suppression. Systemic toxicity (especially nephrotoxicity) of amphotericin is reduced by using the liposomal/ lipid/micellar formulations. Amphotericin combined with 5-flucytosine may be used in severe infections and immunosuppressed patients. Mechanism of action Amphotericin is a polyene macrolide with a hydroxylated hydrophilic surface on one side of the molecule and an unsaturated conjugated lipophilic surface on the other. Some imidazoles are also used systemically, although they have limited efficacy and significant toxicity. It results from vasoconstriction and tubular damage leading to acute renal impairment and sometimes renal tubular acidosis. Mechanism of action of azoles (imidazoles and triazoles) Imidazoles competitively inhibit lanosterol 14-demethylase (a fungal cytochrome-haem P450 enzyme), which is a major enzyme in the pathway that synthesizes ergosterol from squalene. This disrupts the acyl chains of fungal membrane phospholipids, increasing membrane fluidity and causing membrane leakage and dysfunction of membrane-bound enzymes. The imidazoles have considerable specificity/affinity for fungal cytochrome-haem P450 enzymes.

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The electrocardiogram is likely to show asystole, severe bradycardia or ventricular fibrillation. During the course of an arrest, other rhythm disturbances are frequently encountered (e. If intravenous access cannot be established, the administration of double doses of adrenaline (or other drugs as appropriate) via an endotracheal tube can be life-saving. Once the diagnosis is definite, administer adrenaline (otherwise known as epinephrine), 1 mg intravenously, followed by atropine, 3 mg intravenously. If P-waves (or other electrical activity) are present, but the intrinsic rate is slow or there is high grade heart block, consider pacing. Consider varying the paddle positions and also consider amiodarone 300 mg, if ventricular fibrillation persists. A further dose of 150 mg may be required in refractory cases, followed by an infusion of 1 mg/min for six hours and then 0. Lidocaine and procainamide are alternatives if amiodarone is not available, but should not be given in addition to amiodarone. It may be the result of severe global damage to the left ventricle, in which case the outlook is bleak. If it is caused by some potentially reversible pathology such as hypovolaemia, pneumothorax, pericardial tamponade or pulmonary embolus, volume replacement or other specific measures may be dramatically effective. If pulseless electrical activity is associated with a bradycardia, atropine, 3 mg intravenously or 6 mg via the endotracheal tube, should be given. Indeed, trials have demonstrated no difference in prognosis between patients with atrial fibrillation treated with a rate control vs. The main hazard of cardioversion is embolization of cerebral or peripheral arteries from thrombus that may have accumulated in the left atrial appendage. Patients should therefore be anticoagulated before elective cardioversion (usually for four to six weeks) to prevent new and friable thrombus from accumulating and to permit any existing thrombus to organize, thereby reducing the risk of embolization. An alternative is to perform early cardioversion provided that transoesophageal echocardiography can be performed and shows no evidence of thrombus in the left atrial appendage. Anticoagulation is continued for one month if the patient remains in sinus rhythm. Anticoagulation should be continued long term if fibrillation persists or intermittent episodes of dysrhythmia recur. Atrial flutter Atrial flutter is treated with the same drugs as are effective in atrial fibrillation, but tends to be more resistant to drug treatment. As with atrial fibrillation, atrial flutter carries a risk of systemic embolization. Criteria exist for distinguishing broad complex supraventricular and ventricular tachycardias, but these are beyond the scope of this book, and in practice are often difficult to apply precisely. Catheter ablation therapy is now possible for supraventricular tachycardias, atrial flutter and fibrillation.

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Migratory thrombophlebitis Obstructive jaundice and a dilated gallbladder Obstructive jaundice and a nonpalpable gallbladder Steatorrhea and a nontender gallbladder Steatorrhea and a tender gallbladder 322 Pathology 322. A 55-year-old female with painful chronic diarrhea, multiple recurrent duodenal ulcers, and increased basal gastric acid output is most likely to have a. A gastrin-secreting tumor of the pancreas A serotonin-secreting tumor of the ileum A somatostatin-secreting tumor of the duodenum An epinephrine-secreting tumor of the adrenal medulla An erythropoietin-secreting tumor of the liver 323. Hypercalcemia, signs of hypercalcemia, and signs of hypercalcemia relieved by hyperventilation c. Hypoglycemia, signs of hypoglycemia, and signs of hypoglycemia relieved by glucose d. An 11-year-old male presents with weight loss and dehydration despite excessive eating (polyphagia) and drinking of fluids (polydipsia). He has also had to go to the bathroom more often recently, and he has even had to wake up during the night to urinate. Laboratory examination reveals fasting hyperglycemia, while urinary examination reveals 4+ glucose (on a scale of 0 to 4+) and trace ketones. Which one of the listed findings is more characteristic of juvenile diabetes mellitus (type 1 diabetes mellitus) than of adult onset diabetes mellitus (type 2 diabetes mellitus)? A laboratory test that measures serum levels of Hb A1c (glycosylated hemoglobin) can be used to measure long-term control of an individual with a. Autoimmune hemolytic anemia Cystic fibrosis Diabetes insipidus Diabetes mellitus Megaloblastic anemia 327. Which one of the listed statements best characterizes the renal abnormality described as Kimmelstiel-Wilson disease? Amyloid nephrosis Capsular drops Glycogen nephrosis Hyaline arteriolosclerosis Nodular glomerulosclerosis Gastrointestinal System Answers 270. Congenital anomalies of the esophagus are classified into five types, but only four types are associated with esophageal atresia. Type A abnormalities consist of atresia of the esophagus without a connection to the trachea (no fistula). Type B consists of atresia of the esophagus with a fistula between the trachea and the blind upper segment, while type C (the most common type) is characterized by atresia of the esophagus with a fistula between the trachea and the distal esophageal segment. Type D involves esophageal atresia with a fistula between both segments and the trachea, while type E is characterized by a fistula between a normal esophagus and the trachea. To summarize, type A has no fistula, type B connects to the upper segment, type C to the lower segment, and type D to both segments. These defects are dangerous because material that is swallowed may pass into the trachea (aspiration) either directly (types B, D, and E) or indirectly through reflux in that there is a blind upper pouch present (types A and C). Additionally, gastric dilation can occur due to "swallowed" air in those anomalies in which the trachea communicates with the lower esophagus (types C, D, and E). Also important is the fact that any defect that interferes with fetal swallowing in utero will produce polyhydramnios during pregnancy.

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Which of the following types of anemia is clinically diagnosed by the presence of hemoglobin S in red blood cells? Auscultation of the chest reveals mid-diastolic murmur, accentuated S1, and an opening snap following S2 without radiation. Based on the presentation and physical examination, which of the following is the proper diagnosis? Which of the following laboratory values is clinically diagnostic for the onset of menopause? A 67-year-old female with a family history of pancreatic cancer presents with abdominal pain, jaundice, and a palpable gallbladder. Which of the following diagnostic studies would you perform to rule out or confirm the presence of pancreatic cancer? Physical exam reveals superficial dilated, tortuous veins in the distribution of the long saphenous vein. A 48-year-old female presents with pain in the throat area radiating to the ears with difficulty eating. A 70-year-old female presents with headache, scalp tenderness, jaw pain, throat pain, and visual disturbances. Bloodwork reveals a markedly elevated erythrocyte sedimentation rate and C-reactive protein level. A 50-year-old obese diabetic male presents with a deep lesion in the area of the lateral malleolus of the right ankle. Which of the following treatment options would you initially perform to give this lesion the best chance of healing? A 38-year-old women experiencing her first pregnancy presents in her 25th week of gestation with swelling of the face and hands, sudden weight gain, headache, visual disturbances, nausea, and decreased urine output. A 31-year-old female presents with persistent mild depression with symptoms including loss of interest, social withdrawal, overeating, oversleeping, and lack of self-esteem for over 2 years. A 55-year-old diabetic male with history of shoulder injuries presents with pain in the left shoulder. Arthrography reveals decreased volume of the joint capsule and capsular contraction. A 44-year-old man presents with shortness of breath on exertion and occasional heart palpitations. Auscultation of the chest reveals a soft systolic and diastolic decrescendo murmur with radiation to the right sternal border and arterial pulses that are large and bounding. An 18-year-old female presents with right upper quadrant pain that primarily occurs after she eats a fatty meal. Which of the following would be the most appropriate medication to treat the presence of gallstones? Which of the following types of thyroiditis is caused by a bacterial, fungal, or parasitic agent?

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Salmeterol is long acting, with a duration of action of at least 12 hours, allowing twice daily administration. The lipophilic side-chain of salmeterol binds firmly to an exo-site that is adjacent to, but distinct from, the 2-agonist binding site. The degree and rate of onset of bronchodilatation are less than those of salbutamol, but the duration of response is longer. Ipratropium has a place in maintenance therapy and the treatment of acute severe attacks of asthma and chronic bronchitis. Side effects include gastro-intestinal disturbances, vasodilatation, dysrhythmias, seizures and sleep disturbance. Mechanism of action There is increased parasympathetic activity in patients with reversible airways obstruction, resulting in bronchoconstriction through the effects of acetylcholine on the muscarinic (M2, M3) receptors in the bronchi. Oral theophylline may be used for less severe symptoms or to reduce nocturnal asthma symptoms. Recently, the use of theophylline has markedly declined, but it is still sometimes used in refractory cases. Oral theophylline sustained-release preparations can provide effective therapeutic concentrations for up to 12 hours following a single dose. Because of their slow release rate they have a reduced incidence of gastro-intestinal side effects. Mechanism of action and pharmacological effects It is not clear exactly how theophylline produces bronchodilation. Pharmacokinetics When administered by aerosol, it is poorly absorbed systemically. Plasma t1/2 is three to four hours and inactive metabolites are excreted in the urine. Several formulations of 2-agonist combined with muscarinic antagonist bronchodilators are available to simplify treatment regimens. They are used both in maintenance therapy (prophylaxis) and in the treatment of the acute severe attack.

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The outer aspects of cell membranes contain fixed negative charges that influence the electric field in the membrane, and hence the state of activation of voltage-dependent ion channels (Na and Ca2 ) in the membrane. Divalent cations bind to the outer membrane, neutralizing the negative charges and in effect hyperpolarizing the membrane. Conversely, if the extracellular concentration of Ca2 falls, Ca2 dissociates from the membrane, rendering it more unstable. Mechanism of action Adrenaline is a potent and non-selective agonist at both - and -adrenoceptors. It causes an increased rate of depolarization of cardiac pacemaker potential, thereby increasing heart rate, in addition to increasing the force of contraction of the heart and intense 1-mediated peripheral vasoconstriction (thereby producing a very marked pressor response), which is partly offset by 2-mediated arterial vasodilation. Adverse effects and contraindications Calcium phosphate can precipitate in the kidneys of patients with hyperphosphataemia, worsening renal function. However, this consideration is irrelevant when one is faced with a hyperkalaemic patient with broad complex tachycardia. Adverse effects Adrenaline is powerfully pro-dysrhythmogenic and increases the work of the heart (and hence its oxygen requirement). Therefore, these should not be given through the same line, or consecutively without an intervening saline flush. Intravenous magnesium sulphate is sometimes effective in treating dysrhythmias caused by digoxin and in drug-induced torsades de pointes. It is invaluable in eclampsia in prevention of further convulsions (see Chapter 28). Magnesium chloride may be particularly useful in settings where magnesium deficiency is common. These include prior chronic diuretic treatment, hypocalcaemia, hypokalaemia, alcoholism, diarrhoea, vomiting, drainage from a fistula, pancreatitis, hyperaldosteronism or prolonged infusion of intravenous fluid without magnesium supplementation. There is no simple test currently available to detect total body magnesium Drug interactions Tricyclic antidepressants block uptake 1 and so may potentiate the action of adrenaline. However, serial plasma magnesium determinations may be useful in preventing excessive dosing with accumulation and toxicity. Decide whether initial management might reasonably include each of the following: (a) (b) (c) (d) i. Mechanism of action Mg2 is a divalent cation and at least some of its beneficial effects are probably due to the consequent neutralization of fixed negative charges on the outer aspect of the cardiac cell membranes (as for Ca2 ). In addition, Mg2 is a vasodilator and releases prostacyclin from damaged vascular tissue in vitro.

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Current principles emphasize combination therapy, regime convenience, tolerability and lifelong therapy. The major metabolite (80%) is the glucuronide and approximately 20% of a dose appears unchanged in the urine. Occasional cases of renal failure and Fanconi syndrome have been reported, so it should be used with caution in patients with pre-existing renal dysfunction. Drug interactions these are numerous and clinically important; the following list is not comprehensive: 1. Renal excretion (unchanged), requires dose reduction in renal impairment Intracellular triphosphate has t1/2 of 12 h. Efavirenz is administered orally and causes a marked ( 50%) reduction in viral load during eight weeks of therapy. Thus they act as competitive inhibitors of the viral protease and inhibit maturation of viral particles to form an infectious virion. The majority of lopinavir is excreted as metabolites in the faeces, with only about 4% appearing in urine. This leads to reduced clearance and increased toxicity of a number of drugs often causing severe adverse effects (e. Protease inhibitors inhibit the metabolism of rifabutin increasing the risk of rifabutin toxicity. The same principle applies if saquinavir/ low-dose ritonavir or amprenavir/low-dose ritonavir are combined. It is a 36 amino acid peptide analogue of part of the transmembrane region of gp41 that is involved in the fusion of the virus particle with the host cell membranes. Future prospects include more potent protease inhibitors, novel entry inhibitors e.

References:

  • https://midnottspathways.nhs.uk/media/1278/general-guidance-hse-legionnaires-disease-code-of-practice.pdf
  • http://cdn.intechopen.com/pdfs/44135/InTech-Acute_lymphoblastic_leukemia_in_children.pdf
  • https://www.wsh.nhs.uk/CMS-Documents/Services/Urology/Recurrent-UTI-Booklet.pdf