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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Samie R. Jaffrey MD, PhD
http://vivo.med.cornell.edu/display/cwid-srj2003
Although the second method is no longer advocated in the developed countries impotence causes discount viagra with dapoxetine 100/60mg without prescription, as long as diazepam for rectal use is not available impotence definition generic viagra with dapoxetine 100/60mg with visa, it should be done erectile dysfunction quizlet order 50/30mg viagra with dapoxetine fast delivery, especially in areas where malaria and childhood infections are common impotence in young males generic viagra with dapoxetine 100/60mg without prescription. Phenobarbitone is very effective and can be given in one daily dose before bedtime erectile dysfunction treatment dublin 100/60 mg viagra with dapoxetine. If phenobarbitone causes side-effects in the form of behaviour disturbances erectile dysfunction 30 buy cheap viagra with dapoxetine 50/30mg, then valproate might be given wherever available and affordable. The prophylaxis should continue till the child reaches five years of age with a one-year seizure-free period. If, however, seizures still occur, the prophylaxis should be continued beyond the age of five years until a oneyear free period has been reached. If seizures have occurred without fever, then the condition has become epilepsy and the administration of phenobarbitone (or valproate) should be continued until a two-year seizure-free period has been reached. Use a glass syringe or the newest plastic syringe; ordinary plastic syringes will be spoilt. Prevent malaria attacks by use of mosquito nets, and childhood infections such as measles with vaccination. It is very difficult to predict the course of the epilepsy in any individual patient. However, it has been agreed by several authors that some factors give a poorer prognosis and some forms are more difficult to treat than others. In a follow-up of 200 children, treated with the means now generally available in Africa, after 25 years, two-thirds suffered minimal ill-effects, but one-third were difficult to treat and a number of them had to be cared for in an institution or were invalids at home. In a similar study where 20,000 patients were followed, complete control was found in 60%, seizures were reduced in frequency and/or severity in another 25%, and these patients could also lead essentially normal lives, but seizures were refractory to all therapeutic measures in the remaining 15% (Livingston, 1972). From these studies it has been found that the generalized idiopathic epilepsies and the partial idiopathic epilepsies had the best prognosis. The condition could be improved upon in the partial symptomatic epilepsies, but the generalized symptomatic epilepsies were resistant to treatment. Shorvon and Reynolds (1982) found that a prognosis could be made early in the course of the epilepsy. If treatment was started early after the onset of the seizures and good control was achieved soon, the prognosis was excellent. If, however, the seizures are still present after some years of treatment, the chances of complete remission are much less. For the patient it is of vital importance that not only are his seizures controlled, but that the quality of his life is as good as possible. In all patients, therefore, continuous medical guidance and supervision are necessary, and the assistance of an Epilepsy Aide is indispensable in overcoming the social difficulties that the epilepsy patient experiences. If working shifts, a sleeping tablet may be necessary when changing shift duties; to be treated promptly. Throughout the world and through the ages epilepsy has been regarded as a supernatural happening as it is inexplicable and unpredictable. It is often believed to be a consequence of possession, curse(s), witchcraft or punishment for some ancestral error. Epilepsy is often believed to be a contagious disease, and that anyone who touches the patient, or his excreta, will acquire the disease themselves. The frightening experience of the seizures can make people try any available means to lessen their severity. As complete cure is the real aim, various treatments are tried and/or discarded and others tried, sometimes simultaneously. The more time the doctor and the Epilepsy Aide take over this the better will be the compliance of the patient and the longer the follow-up. It is impossible for a doctor to get all these points across to the patient and his parents in five minutes during a visit to the clinic. For this reason the Kenya Association for the Welfare of Epileptics has employed people called "Epilepsy Aides" who are specially trained to deal with the problems arising from epilepsy. When the child with epilepsy is of normal intelligence he can attend a normal school. But often teachers and heads have to be reassured that the condition is not dangerous to the staff and other pupils. Teachers and parents should be given appropriate counselling so that they learn to accept that epilepsy is not a disabling condition but one that can usually be controlled and lived with. Families of people with epilepsy benefit from proper counselling and they can then help the patient feel more accepted by the family and the community. Some children, although of normal intelligence, have specific learning disabilities, which require special attention from the teacher. The Epilepsy Aide, with the help of such a centre, can determine the best available educational facility for the child. If the child has a severe or profound mental retardation (one-third of the mentally retarded group), institutional care may be necessary, especially if there is also a physical handicap. There are not yet sufficient institutions to accommodate all the children requiring such facilities in Africa, therefore, the Epilepsy Aide, with the help of a social worker and an occupational therapist, should assist the mother as much as possible with the care of the child. For adults with epilepsy counselling is as necessary as for children, and they may need special advice and help with choice of work. For example, they should not become professional drivers or do a job requiring standing on ladders, climbing trees or using heavy machinery until seizures have been controlled (no seizures at all) for at least two years. Then it is better to avoid these situations, or if they are unavoidable, to ask for an increased dosage of the anticonvulsant drug so as to enjoy as normal a life as possible. Some of the well-known precipitating factors and the possible preventive measures are given in table 26, page 75. When the seizures are not completely controlled, precautions have to be taken when swimming or bathing. Someone else should always be near at hand, and when going to the toilet the door should not be locked. Any young child may fall on such a jiko, but children with seizure disorders are even more prone to be burned. To prevent accidents with fires, a protective shield should be made around the stove or it should be raised off the ground. Similar precautions should be taken to protect children and adults with epilepsy from burning themselves on open fires or electrical appliances. But every patient with epilepsy needs attention in a different way from a patient with, for example, tonsillitis who will be cured in a few days. Therefore a clinic especially for epilepsy patients is advocated where special attention can be given more easily than in a busy general out-patients department. Explanations have to be given about the medicines and their use, as compliance with drug taking is essential in seizure control. Depending on the number of patients attending, a clinic once a week or once a month is sufficient. An interval longer than a month is not advisable as a patient has to be seen more often after initiating the treatment. In the beginning, a monthly visit is necessary to observe seizure control and reactions to the medication. Patients must be informed that if reactions such as skin rash or fever occur they must visit the medical centre before the appointed date. When good seizure control has been achieved a three-monthly visit schedule is sufficient. Not only are there the medical problems, but the social problems also have to be discussed as these are sometimes more worrying than the actual seizures. They are specially trained to deal with problems arising from epilepsy such as schooling, unemployment, social ostracism, non-compliance and so on. If, however, the community does not have a Community Health Worker, the Epilepsy Aide himself has to identify patients with epilepsy in the community. The Epilepsy Aide sees the patient before, during and after clinic hours so as to be able to answer the many questions arising from this special condition and its treatment. Moreover, the Aide keeps in contact with the patient and his/her relatives between visits to the clinic to help with any problems. To help parents, teachers and health workers, National Epilepsy Support Foundations have published booklets. If such an organization does not yet exist in the country the International Bureau for Epilepsy can be contacted (see useful addresses page 122). Records should be clear and easily accessible so that anyone can continue the treatment in the absence of the usual medical worker. Patients and the medical worker must know the present medication and what has been given before. At every visit the patient must get a date for the next appointment, so he realizes that treatment has to be continued. It may be useful to make out the registration and record-keeping cards as detailed in table 28. Epilepsy treatment record card (kept in the clinic) the history taken by the Aide should be kept, but a summary with the positive findings should be entered on this card. When the epilepsy clinic is held in an established health facility, the usual clinic cards can be adapted for use in the epilepsy clinic. Seizure record card this card is kept by the patient or by a member of the family. After every clinic the book is checked to see which patients did not attend, and the Aide can take action accordingly. Epilepsy register this register is kept at every epilepsy clinic by the medical worker running the clinic. If every clinic uses the same register uniform reporting is guaranteed and information for epidemiology studies can be collected (see sample in Appendix D). Annual report form Information from the epilepsy register is entered on this form and sent yearly to the District Medical Officer of Health (see Appendix D). Recording of drugs used this can either be done on the Epilepsy Register or on a separate sheet of paper. Irregular treatment is as bad as no treatment at all (indeed it may be worse as status epilepticus may be precipitated). Costs A disorder that requires therapy for many years or for life is, in addition to being a medical and social problem, a great financial burden to the patient, parents and other relatives. Still many poor patients can not afford the drugs and those are now being sponsored. They have tasks such as awareness creation, counselling, home-visits, helping out in the clinic and they will put in place modalities to carry together the financial burden for the poor patients. If there are problems with swallowing, all uncoated tablets (phenobarbitone, carbamazepine, clonazepam, and sometimes phenytoin) can be crushed and administered in milk, tea or porridge. Only if tablets are coated (valproate and sometimes phenytoin) might syrups be indicated. If, however, no funds are available for the medicines, cost sharing can be worked out according to the policy of the health institution where the epilepsy clinic is held. Relative cost of the daily requirement of anticonvulsants Antiepileptic drug Usually effective daily dose (mg) 100 300 800 8 1250 1500 1500 2000 300 1800 300 2000 2400 Price relative to Phenobarbitone 1,00 1,13 4,89 5,03 6,41 7,52 15,53 32,59 41,54 44,87 52,17 59,34 82,43 Phenobarbitone Phenytoin Carbamazepine Clonazepam Ethosuximide Valproate Oxcarbazepine Vigabatrin Lamotrigine Gabapentin Topiramate Levetiracetam Felbamate the relation of the costs are based on a specific set of data from one country, therefore the multiplication factor may vary in other places; however, in general this will not influence the ranking very much. Other costs the setting up of a special epilepsy clinic need not involve many other costs. The Medical or Clinical Officer has only to re-allocate his time: he works in his normal surroundings. A member of staff could be trained as an Epilepsy Aide, or someone has to be employed for this function. A national epilepsy support organization may be able to provide assistance on request. With modern investigation methods and laboratory techniques it is often possible to find the cause. Treatment of seizures in the newborn All newborns with seizures should be transferred to hospital to determine the cause (hypocalcaemia, hypoglycaemia, meningitis, jaundice, etc. If pyridoxine-dependent epilepsy, then treatment is 100 mg pyridoxine daily until dietary pyridoxine can take over. There is a frequent association with neurological signs and/or mental retardation. The seizures in this age group are characterized by the rarity of generalized tonic-clonic seizures, most probably due to incomplete maturation of the interhemispherical pathways. But this age group is more characterized by the emergence of the idiopathic epilepsies. These occur in both groups, the epilepsies with partial onset of seizures, and the group with generalized onset of seizures. Aetiology: Prognosis: Treatment: Localization-related epilepsies, symptomatic (40% of all epilepsies in children younger than 15 years: Vianni et al. It is a slow virus infection, the encephalitis occurring several years after the primary measles infection.
Care will be taken to ensure that the test article will not run off of the ear during application beer causes erectile dysfunction discount 50/30 mg viagra with dapoxetine. Approximately 24 h later (day 1) and 48 h later (day 2) best erectile dysfunction doctor in india viagra with dapoxetine 100/60 mg online, each animal will receive additional applications as described previously impotence hypothyroidism order viagra with dapoxetine 50/30 mg overnight delivery. The vehicle control animals (and positive control animals erectile dysfunction medication options generic viagra with dapoxetine 100/60 mg line, if used) are treated the same as above erectile dysfunction due to diabetes purchase viagra with dapoxetine 50/30 mg on line. Injection of 3H-thymidine for Lymphocyte Incorporation On day 5 (approximately 72 h after the final application) erectile dysfunction doctor washington dc viagra with dapoxetine 100/60 mg fast delivery, the five females per group will receive an intravenous injection of 3H-thymidine for lymphocyte incorporation. Lymph Node Collection Approximately 5 h after the 3H-thymidine injections, the animals will be euthanized with carbon dioxide and the appropriate draining (auricular) lymph nodes will be removed and pooled for each individual animal. Care will be taken to assure that the lymph nodes are removed intact and placed in a capped tissue culture tube. The lymph nodes will be mechanically passed through a nylon or stainless steel screen. Procedures A preliminary irritation screen should generally be included in this test to observe the degree of primary irritation the test substance may produce. Twenty female mice, separated into 4 dose groups (5 mice/ group), are used for this procedure. Two different concentrations may be utilized on each mouse, one concentration for each ear. Eight microliters of the test substance should be used for animals in groups 3 and 4 and 8 l of the vehicle for groups 1 and 2. After a 60-min waiting period, the ears should be wiped with gauze moistened with an appropriate vehicle. At approximately 3, 24, and 48 h postirradiation, the mice should be placed back into the restraining device and ear measurements should once again be performed and recorded. On day 0, the backs of all mice should be clipped using a small animal clipper and appropriately sized clipper blade. The first two groups are designated as test substance groups with the remaining two groups set up as vehicle control and ultraviolet control groups, respectively. Mice in groups 1 and 2 should receive 50 l of the appropriate test substance gently rubbed into the skin on the dorsal back of each animal on each of the induction days. Each mouse is then placed in an individual compartment of an irradiation box with a wire lid restraining device. Approximately 60 min after application of the appropriate material, the treated area of each animal should be gently wiped against the grain of hair growth with a gauze patch moistened with an appropriate vehicle. After the wiping procedure, animals from group 2 should be returned to their respective cages and should not receive irradiation. Challenge A challenge phase of the photosensitization study should be performed 7 days after the first induction phase. While the animal is still restrained, 8 l of the test substance will be administered to each side of one ear. Ear thickness measurements as described previously should be performed at approximately 24 and 48 h after the challenge procedure. Rechallenge If a rechallenge phase is required, the procedure should be performed 7 days after the challenge exposure. The exposure period, irradiation, and ear measurement procedures should be the same as used in the challenge procedure. Procedures Unless the irritation potential of the test substance is known, the study should begin with a topical range-finding study. The range-finding study should include eight Hartley-derived albino guinea pigs (4 males and 4 females). Up to four graded concentrations of the test substance may be used in this procedure. On the day before dose administration, the eight guinea pigs should be weighed and the hair removed from the left and right side of each animal using a small animal clipper. Immediately after application, the animals should be placed in a Buehler restrainer and the patches occluded using rubber dental dam. The dental dam should be pulled taut over the back of the animal and fastened to the bottom of the restrainer. After the exposure, the foil, dental dam, and remaining patches from the left side should be removed and any residual test substance removed with an appropriate vehicle. Induction the induction phase of the study is initiated by weighing the animals and clipping the hair from the scapular area of the 10 test and 10 challenge control animals. The center portion of the skin between the injection sites is then tape-stripped using an adhesive tape to remove the outer layers of the epidermis. A piece of rubber dental dam should be placed over the application site and secured to the bottom of the restrainer to provide an occlusive binding. After the completion of the exposure period, the aluminum foil and dental dam should be removed and the test substances removed with an appropriate vehicle. If a positive control group is necessary, Musk Ambrette is an acceptable positive control substance, and a positive control group consisting of 10 Musk Ambrette test animals and 10 Musk Ambrette control animals should be treated in the same manner as the photosensitization study test and challenge control animals throughout the study. The Musk Ambrette concentrations standardly used for induction and challenge are 15% w/v and 0. On the day before challenge dose administration, the test and challenge control animals should be weighed and the hair removed from the left and right side of the animal using a small animal clipper. Immediately after the patching procedure, the animals should once again be placed into restrainers and the test sites immediately occluded with a piece of rubber dental dam. Any heavy residual test substance is removed with dry gauze before irradiation to fully expose the test site. After the target exposure, the foil, dental dam, and patches should be removed and any residual test substance removed with an appropriate vehicle. The rechallenge phase should be similar in design to the challenge phase except that 10 naive rechallenge control animals and a naive skin site should be utilized for this phase. Erythema: Add all 24-, 48-, and 72-h erythema scores of each animal individually and divide by the number of scoring intervals. Edema: Add all 24-, 48-, and 72-h edema scores of each animal individually and divide by the number of scoring intervals. Materials other than those meeting Packing Group I criteria that cause full-thickness destruction of intact skin tissue within an observation period of up to 14 days starting after the exposure time of more than 3 min but not more than 60 min. That cause full-thickness destruction of intact skin tissue within an observation period of up to 14 days starting after the exposure time of more than 60 min but not more than 4 h; or 2. That do not cause full-thickness tissue destruction of intact skin tissue but exhibit a corrosion rate on steel or aluminum surfaces exceeding 6. Characterized by a white or pale discoloration of the exposure area due to decreased blood flow to the skin (ischemia). Challenge exposure A dermal exposure to a test substance after one or more previous induction exposures, to determine whether the subject will react in a hypersensitive manner. Contact dermatitis A delayed type of induced sensitivity (allergy) of the skin with varying degrees of erythema, edema, and vesiculation, resulting from cutaneous contact with a specific allergen. Contact urticaria Wheal-and-flare response generally elicited within 30 to 60 minutes after cutaneous exposure to a test substance. Corrosion Direct chemical action on normal living skin that results in its disintegration or irreversible alteration at the site of contact. Corrosion is generally manifested by ulceration and necrosis with subsequent scar tissue formation. Cross-sensitization An individual that is sensitized to a primary allergen acquires sensitivity to a chemically related molecule, which is called a secondary allergen. Cumulative irritation Irritation resulting from repeated exposures to materials at the same skin site. Desquamation the shedding of the cuticle in scales or the outer layer of any surface. To shred, peel, or scale off, as the casting off of the epidermis in scales or shreds, or the shedding of the outer layer of any surface. Diagnostic patch testing Utilized to confirm the existence of allergic contact dermatitis. A concentration of the test substance that is known to be nonirritating is applied to the skin in a suitable vehicle. Eczema Inflammatory condition in which the skin becomes red and small vesicles, crusts, and scales develop. Edema An excessive accumulation of serous fluid or water in cells, tissues, or serous cavities. Erythema An inflammatory redness of the skin, as caused by chemical poisoning or sunburn, usually a result of congestion of the capillaries. Eschar A dry scab, thick coagulated crust or slough formed on the skin as a result of a thermal burn or by the action of a corrosive or caustic substance. Detachment and shedding of superficial cells of an epithelium or from any tissue surface. Scaling or desquamation of the horny layer of epidermis, which varies in amount from minute quantities to shedding the entire integument. False cross-sensitivity Occurs when the same antigen is present in different products. Index of sensitivity the prevalence of sensitivity to a substance in a given population at a given time. Induction exposure An experimental exposure to a test substance with the intention of inducing a hypersensitive state. Induction period A period of at least 1 week after a dermal exposure during which a hypersensitive state is developed. Irritant A substance that causes inflammation and other evidence of irritation, particularly of the skin, on first contact or exposure; a reaction of irritation not dependent on a mechanism of sensitization. Latent sensitization Subsequent exposure of the skin of a sensitized individual to a lower concentration of a sensitizer can elicit a more intense response than the initial exposure. Nonocclusive Site of application of test substance to the skin is not covered with any material and movement of the air to the site is not restricted. Previous allergy sensitized by exposure to the chemical agent and appropriate radiation necessary. The main role of light in photoallergy seems to be in the conversion of the hapten to a complete allergen. Photoirritation Irritation resulting from light-induced molecular changes in the structure of chemicals applied to the skin. Photosensitization the processes whereby foreign substances, either absorbed locally into the skin or systemically, may be subjected to photochemical reactions within the skin, leading to either chemically induced photosensitivity reactions or altering the "normal" pathologic effects of light. Semiocclusive Site of application of test substance is covered; however, movement of air through covering is only partially restricted. Sensitization (allergic contact dermatitis) An immunologically mediated cutaneous reaction to a substance. Sensitizing potential the relative capacity of a given agent to induce sensitization in a group of humans or animals. Superficial sloughing Characterized by dead tissue separated from a living structure. Ulceration the development of an inflammatory, often suppurating lesion, on the skin or an internal mucous surface of the body caused by superficial loss of tissue, resulting in necrosis of the tissue. Japan Agricultural Chemicals Laws and Regulations, Testing Guidelines for Toxicology Studies, 25, 1985. The Commission of the European Communities, Official Journal of the European Communities, Part B: Methods for the Determination of Toxicity, No. Environmental Protection Agency, Federal Insecticide, Fungicide, Rodenticide Act, Pesticide Assessment Guidelines, Subdivision F, Hazard Evaluation: Human and Domestic Animals, Series 81-6: Dermal Sensitization Study, 59, 1984. Japan New Drugs Division Pharmaceutical Affairs Bureau, Ministry of Health and Welfare, 1990 Guidelines for Toxicity Studies of Drugs Manual, 1991, Chap.
Premises that have held Brucella-infected animals should not be re-stocked until at least four weeks have elapsed between cleaning and disinfection impotence only with wife viagra with dapoxetine 50/30 mg for sale. Buildings should be maintained in a condition which prevents ready access to vermin erectile dysfunction studies discount 100/60 mg viagra with dapoxetine mastercard. Rodent control measures should be enforced and insect infestation kept to a minimum by the use of fly screens erectile dysfunction recovery cheap viagra with dapoxetine 100/60 mg free shipping, light traps and insecticides erectile dysfunction doctor dc purchase 50/30mg viagra with dapoxetine with amex. These do not readily lend themselves to the hygienic measures indicated for farms erectile dysfunction treatment massage viagra with dapoxetine 100/60mg fast delivery. Under these circumstances it is rarely possible to follow hygienic practices to the extent required to prevent infection erectile dysfunction how young viagra with dapoxetine 100/60 mg fast delivery. However, steps can be taken to reduce the impact of the disease by educating the population in the nature of the disease and its mode of transmission. In such societies, most of the adult population will already have been exposed to brucellosis and will presumably have some degree of immunity. The disease therefore makes its greatest impact on children who should be prevented from having contact with newborn animals or those that have recently aborted or given birth. Although cultural traditions can be difficult to change, the consumption of raw milk, blood or uncooked meat or offals should be discouraged. During the bacteraemic phase of the disease, the bacteria are widespread in the tissues. Animals that have recently aborted or given birth may also have extensive external contamination. It is advisable to dry off such animals before slaughter or, if this is not practicable, to incinerate the whole carcass. If animals are known to be infected with Brucella, they should be slaughtered at abattoirs designated for that purpose, where the staff have been specially trained and equipped to deal with the risk. The slaughtermen should wear full protective clothing including waterproof overalls or aprons, boots, respirators and goggles or face shields. Rubber gloves must be worn and chainmail guards should be used to protect against accidental cuts. Adequate facilities for disinfection of protective clothing, implements and for personal washing should be provided. If specially designated abattoirs are not available, the slaughter of infected animals should take place at the end of the working day, after slaughter of healthy animals has been completed. Tissues that are likely to be heavily infected, such as udder and genitalia, should be destroyed. Animal tissues and refuse for disposal should be retained in leak-proof containers such as plastic bags. Young persons under the age of 18 and pregnant women should not be allowed access. If possible, staff should be recruited from individuals known to have serological evidence of previous exposure to Brucella. The staff should be kept under medical surveillance and antibiotic therapy implemented for any who develop symptomatic brucellosis. All employees and especially women of childbearing age must be apprised of risks associated with Brucella infection. Education in safe and hygienic working practices and containment practices should be ongoing and is especially important for new staff. Blood samples and biopsy material for either serological or bacteriological diagnosis will rarely contain Brucellae in sufficient numbers to present a significant risk to personnel handling them but should still be handled with care at Biosafety level 2. Normally these will be dealt with in general diagnostic sections along with samples that may contain other human pathogens. However, after Brucellae have grown in culture, dangerous numbers of organisms are present and strict precautions are required. At the same time Biosafety level 3 facilities, practices and procedures are required. Membranes, fetal tissues and fluids may contain up to >109 Brucella cells per gram, and similar numbers may be encountered in handling cultures grown in the laboratory. A separate room is required with only one entrance; a biohazard notice prohibiting the entry of unauthorised persons should be prominently displayed at the entrance. Ideally, the room should have a double-door entrance designed to provide an airlock. The ventilation should be arranged to maintain the pressure within the room at a slightly lower level than its surroundings. Air from the room should be discharged to the exterior, well away from air intakes and opening windows, otherwise it must be sterilized by filtration or heat treatment. The walls should be impermeable and all windows sealed to allow disinfestation and fumigation; it should be safeguarded against infestation with rodents or insects. The air exhaust from the cabinet should be so arranged as to avoid interference with the air balance in the room or within the cabinet when it is switched on. The room should have a sink, an autoclave and enough incubator space for all culture requirements. For appropriate and useful information on selection and use of biological safety cabinets. Each laboratory should have written procedures addressing use of equipment (especially equipment that may generate aerosols); disinfection of equipment and contaminated materials, handling and processing samples; spill containment and cleanup; and waste handling. These procedures should be clearly and concisely written, easily accessible and rigorously followed. As previously mentioned, Biosafety level 3 is appropriate for handling Brucella cultures or infected membranes, fetal tissues and fluids. Centrifuges may cause dangerous aerosols, especially when tubes containing virulent bacteria break. Glass tubes should not be used for virulent materials, instead polycarbonate tubes with tightly fitting screw-capped lids are recommended. If virulent material has to be centrifuged, the containers should be loaded and unloaded inside the biohazard cabinet. Electric homogenisers, stomachers, sonicators and similar appliances should be used inside the cabinet. Except for grossly contaminated materials, direct culture is the preferred method for bacteriological diagnosis rather than the inoculation of laboratory animals. If the inoculation of potentially dangerous materials is required, only needles that lock to the barrel of the syringe should be used. However, the vaccines currently available are of uncertain efficacy and some may cause unacceptable reactions. Meat may also be a significant source of infection, especially in cultures where the consumption of raw or undercooked meat products is favoured. Soft cheeses prepared from fresh milk may concentrate large numbers of Brucella organisms. The preparation of such products from untreated milk should be strongly discouraged. If local customs make this difficult to achieve, the cheese should be stored for six months before being released for consumption. Hard cheeses which may undergo propionic as well as lactic fermentation are usually much less hazardous because of the acidification. Unpasteurized whey left over from cheese making could transmit infection if fed to animals. It may also contaminate containers used to transport other materials unless these are decontaminated before use. Rennet used in cheese making can also serve as a source of infection if prepared from the stomachs of Brucella-infected animals. Butter, sour milk, sour cream and yoghurt also undergo acidification processes which will drastically reduce the Brucella content. Ice cream prepared from infected milk may be particularly hazardous, especially as milk from different sources may be blended to make the product. Ideally all milk produced in areas in which brucellosis is present should be pasteurized. This should apply to all milk for human consumption, whether to be drunk without further processing or to be used for making other food products. This practice and the consumption of fresh blood, either alone or mixed with milk, should be discouraged. The handling and preparation of infected meat and offal without proper hygienic precautions may be also lead to the contamination of other foods. Similarly, the organisms survive well under refrigeration or deep freeze conditions. It is strongly recommended that all meat products are thoroughly cooked before consumption. Two live attenuated vaccine strains have been employed extensively in heavily infected areas. The vaccine was administered as a dose of 1 x 109 cells by skin scarification (epicutaneous route). Protection was effective for up to one year but with maximum efficacy at five to six months after vaccination. Accordingly, vaccination was usually timed to anticipate the season of peak incidence of disease in animals. In general, the vaccine was well-tolerated in healthy adults when given by the epicutaneous route. Local reactions manifested as hyperaemia and induration occurred in 76% of those immunized, whereas general reactions characterized by headache, lethargy and mild pyrexia, occurred in 3 to 7% of vaccinates. The frequency of general reactions was much greater in those showing evidence of previous exposure to Brucella. Epidemiological studies showed that the vaccine was effective in reducing morbidity in high-risk areas, with a 5 to 11-fold reduction in reported cases of acute brucellosis. However, the vaccine did induce hypersensitivity, especially with repeated doses and there were numerous contra-indications to vaccination. Care must be taken to avoid vaccinating individuals who may have been sensitized by previous exposure to vaccine or natural infection. These live vaccines are not currently available from sources whose production and quality control procedures would meet international standards. More emphasis in recent years has been on the development of non-living vaccines based on sub-cellular fractions. It has been used in occupationally exposed groups, particularly laboratory workers. Two doses of 1 mg each are given subcutaneously, separated by a two-week interval. However, it is reported to result in enhanced lymphocyte proliferation responses to Brucella antigens which correlate with immunity. Although used in about 2000 individuals over nearly two decades, evidence of efficacy from controlled clinical trials is not available. The vaccine is given in doses of 1 mg by intramuscular injection and stimulates only mild local and general reactions. It does not produce severe hypersensitivity responses even in previously exposed individuals. Studies involving the use of 75 000 doses in Kazakhstan indicated an efficacy of 79. Repeated doses could be given after one year without risk of serious hypersensitivity reactions. This vaccine would appear to merit further evaluation under a wider range of conditions. Person-to-person transmission is not a significant problem except through blood or organ transfer which should be subject to proper control. Airborne or contact infection through environmental contamination may be a significant problem when infected animals pass through densely occupied areas. A key means of achieving this is through education of the population, and especially those directly involved in the animal and food industries. Close collaboration between public health and veterinary services as well as other relevant agencies is fundamental in order to meet the targets. Humans are infected by Brucella mainly through inappropriately prepared and/or preserved food of animal origin. There is no lack of scientific knowledge on the systems, technologies and procedures with which to implement safe food preparation and consumption. Conversely, there is a huge gap in knowledge among the population, especially in developing countries, on the significance of safe handling, cooking and preserving food. Furthermore, food processing plant owners are often uninterested in, or even fail to apply correctly, the known rules of food safety (see Annex 1). Foodborne diseases, including brucellosis, cause considerable morbidity in populations in many parts of the world, having a major impact principally on young children and the elderly. These include loss of income and manpower, medical care costs, loss of food due to inadequacy of processing or spoilage. Therefore, public health education should be included among the essential activities to be performed within the framework of brucellosis control programmes or even as an independent activity. It cannot be regarded as effective if specific considerations referring to the community are not taken into account. These include: culture, beliefs, traditions, educational level, social status, occupation, age, etc. These should include physicians, veterinarians and farmers who may not be fully aware of the problem. They should be directed not only at specific measures but should also emphasize the responsibility of individuals for safeguarding and improving their own health and that of the community.
Deposition Specific to air toxics icd-9-cm code for erectile dysfunction cheap viagra with dapoxetine 100/60 mg mastercard, the adsorption on the respiratory tract surface of inhaled erectile dysfunction jack3d order viagra with dapoxetine 100/60 mg online, gaseous erectile dysfunction band generic 50/30 mg viagra with dapoxetine free shipping, or particulate pollutants erectile dysfunction treatment medicine purchase 100/60mg viagra with dapoxetine visa. Also erectile dysfunction treatment history viagra with dapoxetine 100/60mg free shipping, adsorption of a gaseous or particulate air pollutant at the surface of the ground erectile dysfunction symptoms treatment order viagra with dapoxetine 50/30mg overnight delivery, vegetation, or water. Major manifestations of developmental toxicity include: death of the developing organism, induction of structural abnormalities (teratogenicity), altered growth, and functional deficiency. Dispersion model A mathematical model or computer simulation used to predict the movement of airborne or waterborne contaminants. Models take into account a variety of mixing mechanisms that dilute effluents and transport them away from the point of emission. Disposition the movement and fate of chemicals in the body, including absorption, distribution, biotransformation, and excretion. Dose the amount of substance administered to an animal or human generally expressed as the weight or volume of the substance per unit of body weight. Dose-response relationship A relationship between (1) the dose, often actually based on "administered dose". Dosimetry In general, the measurement or modeling of the amount, rate, and distribution of a drug or toxicant especially as it pertains to producing a particular biological effect. Duration of exposure Generally referred to in toxicology as acute (one-time), subacute (repeated over several weeks), subchronic (repeated for a fraction of a lifetime), and chronic (repeated for nearly a lifetime). Embryo In mammals, the stage in the developing organism at which organs and organ systems are developing. For humans, this involves the stage of development between the second through eighth weeks (inclusive) postconception. Embryotoxicity Any toxic effect on the conceptus as a result of exposure during the embryonic stages of development. These effects may include malformations and variations, altered growth, in utero death, and altered postnatal function. Endemic Present in a community or among a group of people; said of a disease prevailing continually in a region. Endpoint An observable or measurable biological or chemical event used as an index of the effect of a chemical on a cell, tissue, organ, organism, etc. Environmental fate the destiny of a chemical or biological pollutant after release into the environment. Environmental fate involves temporal and spatial considerations of transport, transfer, storage, and transformation. Epidemiology the study of the occurrence and distribution of a disease or physiological condition in human populations and of the factors that influence this distribution. Exposure is quantified as the amount of the agent available at the exchange boundaries of the organism. Exposure, direct Exposure of an organism to a chemical via the medium in which it was initially released into the environment. Exposure, indirect Exposure of an organism to a chemical involving multimedia transport from the source to the exposed organism. Exposure assessment Measurement or estimation of the magnitude, frequency, duration, and route of exposure of subjects to substances in the environment. The exposure assessment also describes the nature of exposure and the size and nature of the exposed populations, and is one of the steps in risk assessment. Extrapolation An estimate of response or quantity at a point outside the range of the experimental data. Also refers to the estimation of a measured response in a different species or by a different route than that used in the experimental study of interest. Fence line concentration Modeled or measured concentrations of pollutants found at the boundaries of a property on which a pollution source is located. Usually assumed to be the nearest location at which an exposure of the general population could occur. For litter-bearing species, the number of offspring per litter is also used as a measure of fertility. Functional developmental toxicity Alterations or delays in functional competence of an organism or organ system after exposure to an agent during critical periods of development pre- and/or postnatally. Gamma multihit model A dose-response model that can be derived under the assumption that the response is induced if the target site has undergone some number of independent biological events (hits). Gavage Experimental exposure regimen in which a substance is administered to an animal into the stomach via a tube. A mutation in one or more of the nucleotides in a gene may lead to abnormalities in the structure of the gene product or in the amount of gene product synthesized. Hazard the inherent ability of a substance to cause an adverse effect under defined conditions of exposure. Hazard identification the process of determining whether exposure to a substance is causally related to the incidence and/or severity of an adverse health effect. Hazard identification involves gathering and evaluating data on the types of health injury or disease that may be produced by a chemical and on the conditions of exposure under which injury or disease is produced. A value of less than 1 indicates the risk from the exposure is likely insignificant; a value greater than 1 indicates a potentially significant risk. Hemangiosarcoma A malignant neoplasm characterized by rapidly proliferating, extensively infiltrating, anaplastic cells derived from blood vessels and lining of blood-filled spaces. Homeostasis Maintenance of normal, internal stability in an organism by coordinated responses of the organ systems. Human equivalent dose the human dose of an agent expected to induce the same type of severity of toxic effect that an animal dose has induced. Hyperplasia the abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. Hypersensitivity Exaggerated response by the immune system to an allergen sometimes used incorrectly in a nonimmune sense to indicate increased susceptibility to the effects of a pollutant. It is frequently presented as the number of new cases per 1,000, 10,000 or 100,000. The incidence rate is a direct estimate of the probability or risk of developing a disease during a specified time period. Individual risk the increased risk for a person exposed to a specific concentration of a toxicant. Indoor/outdoor ratio the ratio of the indoor concentration of an air pollutant to the outdoor concentration of that pollutant. Inflammation A protective tissue response to injury that serves to destroy, dilute, or wall-off both the injurious agent and the injured tissue. It is characterized by symptoms such as pain, heat, redness, swelling, and loss of function. Interspecies scaling factors Numerical values used in the determination of equivalent doses between species. The guidelines for carcinogen assessment generally recommend using the surface area approach unless there is evidence to the contrary. The dose as mg/kg of body weight/day is generally used to scale between species for noncancer effects of chemicals after dermal, oral, or parenteral exposure. Intraperitoneal Within the membrane surrounding the organs of the abdominal cavity; refers to injection. In vitro Tests conducted outside the whole body in an artificially maintained environment, as in a test tube, culture dish, or bottle. Involuntary risk A risk that impinges on an individual without their awareness or consent. Latency the period of time between exposure to an injurious agent and the manifestation of a response. Refers to inhalation time exposure in the context of air toxics (may refer to water concentration for tests of aquatic organisms or systems). Refers to inhalation exposure concentration in the context of air toxics (may refer to water concentration for tests of aquatic organisms or systems). Local effect A biological response occurring at the site of first contact between the toxic substance and the organism. Logit model A dose-response model that can be derived under the assumption that the individual tolerance level is a random variable following the logit distribution. The effect is generally considered not to have an adverse effect on the health and survival of the animal. Male reproductive toxicity the occurrence of adverse effects on the male reproductive system, which may result from exposure to substances. The toxicity may be expressed as alterations to the male reproductive organs and/or the related endocrine system. The manifestation of such toxicity may include alteration in sexual behavior, fertility, pregnancy outcomes, or modifications in other functions that are dependent on the integrity of the male reproductive system. Malformation A permanent structural change in a developing organism that may adversely affect survival, development, or function. Media the air, water, soil, and biota (plants or animals that transport chemicals on or in their tissues) that make up the physical pathway between the source of a chemical and an exposed individual. Metaplasia the abnormal transformation of an adult, fully differentiated tissue of one kind into a differentiated tissue of another kind. Metastasis the transfer of a disease, or its local manifestations, from one part of the body to another. In cancer, this relates to the appearance of neoplasms in parts of the body remote from the site of the primary tumor. Model A mathematical representation of a natural system intended to mimic the behavior of the real system, allowing description of empirical data, and predictions about untested states of the system. Its magnitude depends on an assessment of the scientific uncertainties of the toxicological database not explicitly treated with standard uncertainty factor. Morphology Study of the form or structure of cells, tissues, organs, or organisms. Multistage model A mathematical function used to extrapolate the probability of incidence of disease from a bioassay in animals using high doses, to that expected to be observed at the low doses that are likely to be found in chronic human exposure. This model is commonly used in quantitative carcinogenic risk assessments where the chemical agent is assumed to be a complete carcinogen and the risk is assumed to be proportional to the dose in the low region. A "heritable mutation" is a mutation that is passed from parent to offspring and therefore was present in the germ cell of one of the parents. Necrosis Death of areas of tissue or bone, usually as individual cells, as groups of cells, or in localized areas. Necrosis can be caused by cessation of blood supply, physical agents such as radiation, or chemical agents. Neoplasia the pathological process that results in the formation and growth of a tumor, i. Noncarcinogen A substance that has been demonstrated not to increase the incidence of cancer. Nonthreshold toxicant An agent considered to produce a toxic effect from any dose; any level of exposure is deemed to involve some risk. Oncogene A naturally occurring gene that specifies the synthesis of a protein that is involved in normal cellular processes. Alterations in the structure or function of oncogenes are associated with the development of some cancers. One-hit model A mathematical model that assumes a single biological event can initiate a response. Organogenesis the development of specific body structures or organs from undifferentiated tissue. In humans, this relates primarily to weeks 2 through 8 (inclusive) postconception. Pharmacokinetics the field of study concerned with defining, through measurement or modeling, the absorption, distribution, metabolism, and excretion of drugs or chemicals in a biological system as a function of time. Population at risk A group of subjects with the opportunity for exposure to a chemical. Population variability the concept of differences in susceptibility of individuals within a population to toxicants due to variations such as genetic differences in metabolism and response of biological tissue to chemicals. Potency A comparative expression of chemical or drug activity measured in terms of the relationship between the incidence or intensity of a particular effect and the associated dose of a chemical to a given or implied standard of reference. Prevalence the percentage of a population that is affected with a particular disease at a given time. Probit model A dose-response model that can be derived assuming that individual tolerance is a random variable following log normal distribution. Promotion the second hypothesized stage in a multistage process of cancer development. Reference dose (RfD) An estimate (with uncertainty spanning perhaps an order of magnitude or more) of the daily exposure to the human population (including sensitive-subpopulations) that is likely to be without deleterious effects during a lifetime. The RfD is reported in units of mg of substance/kg body weight/day for oral exposures, or mg of substance/m3 of air breathed for inhalation exposures (RfC). Reproductive toxicity Harmful effects on fertility, gestation, or offspring, caused by exposure of either parent to a substance. Respiratory rate the frequency of a complete cycle of a breath (inhalation and exhalation).
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