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Microscopy: • Examination of cut piece of ear or swab soaked in blood of animals safe 100mg nizagara erectile dysfunction medscape, if reveals gram positive bacilli and positive M’Fadyeans reaction; presumptive diagnosis is made buy 50mg nizagara erectile dysfunction doctors in orlando. Any large Gram positive bacillus with morphology and cultural features of anthrax i buy cheap nizagara 50 mg on-line erectile dysfunction doctor dubai. Ananthnarayan 7/e, p 244, Harrison 16/e, p being: [Kar 06] 115] a) Non-capsulated 4. Malignant pustule is seen in infection: c) Sporotrichosis a) Yersinia pestis [Kar 06] d) Coccidimycosis b) Bacillus cereus [Ref. Actinomycosis caused by: [Bihar 05] d) Bacillus anthracic a) Gram+ve organism [Ref. Listeria monocytogenes can be differentiated from other Listeria by: • hemolysis on sheep blood agar. Listeria monocytogenes is divided into serotypes on the basis of somatic [O] or flagellar [H] antigen. Pathogenesis • Intracellular pathogen [so, no role of humoral immunity] hence immunity is primarily cell mediated. Harrison 17/e, p 896 • Life cycle of Listeria monocytogenes in host macrophages includes following steps: 1 Listeria has cell 2 3 4 5 the bacterial product Listeria multiplies and surface protein Listeria is A filopods extension listeriolysin O lyses assembles an actin called internalin that phagocytosed forms, facilitating the filament tail that interacts with by a epithelial cell transfer phagolysosome, pushes the E. Neonatal Listeriosis: • Early onset Before 7 days • Late onset 7 21 days A. Granulomatosis infantisepticum – Characterized by abscesses involving liver, spleen, adrenal gland and other sites. Late onset disease: • Mostly present as meningitis • Born at term by uncomplicated labor • Transmitted during passage through birth canal. A 30 year old woman with a bad obstetric history a) Ability to grow on blood agar presents with fever. The blood culture from the b) Ability to produce catalase patient grows gram-positive small to medium c) Fermentative attack on sugars coccobacilli that are pleomorphic, occurring in d) Motility at 250C short chains. A major step in the pathogenesis of listeriosis is: a) Listeria monocytogenes a) the formation of antigen-antibody complex with b) Corynebacteriumsp. All the following are true about Listeria except: c) the antiphagocytic activity of the L. In patient with Listeria meningitidis who is aller with meningitis A presumptive diagnosis of late gic penicillin the treatment of choice is: onset of perinatal infection was made. Ananthnarayan 7/e, p 403 Tumbling motility is characteristic of Listeria monocytogenes (other three are non motile). Listeria monocytogenes is: – Catalase positive, non-sporing gram positive, Cocco bacilli. Ananthnarayan 7/e, p 403 • this is a case of ‘Late onset neolnatal meningitis’ of Listeria monocytogenes as culture reveals gram positive bacillus. Forfar & Anelus text book of pedia 319, 1338 Other – Staph, other strept, Pneumococcus, Pseudomonas Hemophilus, meningococcus. Remember: • Iron is important virulence factor of Listeria • Shigella flexneri and rickettsia also use the host cell actin and contractile system to spread infection. Culture • Unique in exhibiting dopa oxidase activity and acid fastness that is pyridine extractable. Mycobacteria • Not grow in artificial media but multiply in foot pad of mice at low temperature of 200C. Clinical Features • It causes Leprosy (Hansen’s Disease) having spectrum of manifestations. Lymphocytes 3+ 2+ 1+ 1+ 0 – 1+ 127 Self Assessment & Review Microbiology & Immunology Continue. Macrophage Epithelioid Epithelioid Epithelioid Usually undifferen Foamy change the differentiation tiated; epithelioid rule; may be un foci sometimes differentiated in present; may show early lesions foamy change 6. Early reaction of Fernandez – read in 24 48 hours (analogous to tuberculin reaction). Tuberculoid Dapsone 100 mg/d Dapsone 100 mg/d + (paucibacillary) X 5 years Rifampin 600 mg/month for 6 months ii. Though cord factor itself is not a virulence factor but cord formation is coorelated with virulence. Antigenic Property • Group specificity is due to polysaccharide while type specificity is due to protein antigen. Primary focus is usually peripheral in subpleural region and is accompained by draining lymphatics, inflamed regional lymph nodes which are collectively called Primary complex/Ghon’s facus.

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Ketamine may be adminis signed for the size of fsh being euthanized proven 50mg nizagara erectile dysfunction or gay, death tered at dosages from 66 to order 25 mg nizagara visa safe erectile dysfunction pills 88 mg/kg315 (30 to cheap 50mg nizagara mastercard erectile dysfunction due to drug use 324 is nearly instantaneous. A combination euthanized by rapid chilling (2° to 4°C) until loss of ketamine, at dosages of 1 to 2 mg/kg, with of orientation and operculum movements108,110,111 medetomidine, at dosages of 0. Adult zebrafsh should be exposed followed by an injection of a lethal dose of pento for a minimum of 10 minutes and fry 4 to 7 dpf barbital. Use of a dilute sodium hypo ther an approved adjunctive euthanasia method chlorite or calcium hypochlorite solution may be an or a humane killing method. Until further re adjunctive method for early life stages of fsh, includ search is conducted, rapid chilling is acceptable ing embryos and larvae. Species-specifc thermal tolerance and body the following are unacceptable methods of eu size will determine the appropriateness and ef thanasia in any situation. Flushing of fsh into sewer, fectiveness of rapid chilling for euthanasia of septic, or other types of outfow systems is unaccept fsh. Water chemistry and quality heat loss via thermal conduction from a body is may delay time to death and result in exposure to proportional to its surface area. For systems in close proximity factors, it has been suggested that rapid chilling to and/or connected to natural waterways, pathogen in water associated with an ice slurry is a suitable release or transmission may occur from diseased or killing method for small tropical and subtropical carrier animals. Similarly death by anoxia and desiccation To ensure optimal hypothermal shock (ie, rapid after removal from the water or by anoxia in water; killing), transfer of fsh into ice water must be com any death due to exposure to caustic chemicals; and pleted as quickly as possible. This means rapid transi death including prolonged traumatic injury prior to tions from acclimatization temperature to 2° to 4°C unconsciousness are unacceptable. This can be accomplished by using While metomidate has been used for euthanasia minimal water volume to transfer fsh (ie, using a net of some fnfsh species, its listing in the Index of Le to place fsh in chilled water). Full contact with cold water ensures optimal exposure and rapid chilling of the fsh. Early stages in the lives of fsh, this method of euthanasia is not appropriate for including embryos and larvae, may require higher temperate, cool, or cold-water–tolerant fsh, such as concentrations of immersion anesthetics or a longer duration of exposure. Rapid chilling fol zard shad, as long as secondary euthanasia methods lowed by an adjunctive method such as immersion are applied after fsh are rendered nonresponsive. Tropical aquarium fsh are sold at retail ents and other pets, such as dogs and cats. Therefore, pet shops and fsh stores from systems housing 1 or it is important to consider the perception of the client more species of fsh per tank. Clients should lations of fsh may become injured or diseased and be offered the opportunity to be present during eu require euthanasia. Methods of euthanasia used in thanasia whenever feasible; however, clients also this environment need to be applicable to individual should be educated as to what method will be used fsh, to all fsh in an aquarium, to fsh held in multiple and what they may observe during euthanasia. For aquariums on a central fltration system, or for fsh example, clients may believe the excitement phase of ponds. In certain situations euthanasia may not be anesthesia, which can result in increased motor activ feasible and depopulation methods may be required. Owners exposed to this method may exhibit hyperactiv should be advised about the possibility of ket ity and appear to be in distress); immersion in a amine-induced muscle spasms during induction eugenol, isoeugenol, or clove oil solution; or im when using that agent. The following methods are acceptable with con (2) Decapitation, cervical transection, or manually ditions for use in this environment: applied blunt force trauma as step 1 of a 2-step (1) Immersion in eugenol, isoeugenol, or clove oil. Fish should be left in the solution for a minimum (3) Freezing may be used as an adjunctive method of of 10 minutes after cessation of opercular move euthanasia following anesthesia. Many facilities using fsh as Rapid chilling followed by immersion in a dilute research subjects are engaged in biomedical research. The large number of fsh, ered benzocaine, lidocaine, quinaldine sulfate, limited boat space, adverse environmental condi and 2-phenoxyethanol. Fish euthanized with tions, and personnel safety concerns may justify use these methods are not approved for use as hu of harvest techniques that may not meet the criteria man food. Because of surface animal remains should be considered when us to-volume considerations, use of this method is ing any of these drugs. Pentobarbital may also be administered intracar (3) Maceration is acceptable with conditions when dially in anesthetized animals. The process is likely to be aes a combination of ketamine and medetomidine thetically unpleasant for those observing it. Although a general concern for followed by pithing of the brain, will cause rapid all environments and situations, the potential death and unconsciousness.

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Equipment Blood components are stored at + 20-24 °C purchase 50mg nizagara erectile dysfunction doctor in phoenix, at + 2-6 °C or at diferent temperatures below 0 °C generic nizagara 50mg with mastercard erectile dysfunction drugs in philippines. Whatever type of storage device is chosen nizagara 100 mg lowest price erectile dysfunction foods to eat, the following points should be considered before purchase: • refrigerators and freezers must have surplus capacity. The space should be easy to inspect; • the operation must be reliable and temperature distribution must be uniform within the unit; • the equipment must have temperature recording and alarm devices; 107 Guide to the preparation, use and quality assurance of blood components • the equipment should be easy to clean and should withstand strong detergents. Storage at + 2 to + 6 °C The space for each of the component types should be clearly indicated. The sensor of the temperature monitoring-device can be placed within a blood bag flled with 10% glycerol solution to a volume equivalent to the smallest volume of the stored component. The alarm system should preferably have both acoustic and optical signals and should be regularly tested. Refrigerators for blood components should ideally be connected to a reserve power unit, as well as to the main supply. Tere should be a system in place to maintain and control the storage of blood components throughout their shelf-life, including any transportation that may be required. Storage of frozen plasma components Freezers with automatic defrosting should be avoided, unless it can be guaranteed that the low temperature is maintained during defrosting. Freezers should ideally be connected to a reserve power source, as well as to the main supply. If such a device is unavailable, 108 Chapter 4 Principles of blood component processing the storage location chosen should be capable of maintaining the required constant temperature. Platelets should be stored in agitators that: • enable satisfactory mixing in the bag, as well as gas exchange through the wall of the bag; • avoid folding of the bags; • have a set speed to avoid foaming. Aspects of red cell preservation The anti-coagulant solutions used in blood collection have been developed to prevent coagulation and to permit storage of red cells for a certain period of time. Designed originally for storage of whole blood, they have also been used in blood from which components are prepared. All of the solutions contain sodium citrate, citric acid and glucose, and some of them may also contain adenine, guanosine and phosphate. Citric acid is added to anti-coagulants to obtain a concentration of hydrogen ions that is suitably high at the beginning of storage at + 4 °C. When red cell concentrates are prepared, a considerable part of the glucose and 109 Guide to the preparation, use and quality assurance of blood components adenine is removed with the plasma. This also keeps the viscosity sufciently low to permit transfusion of the concentrate without pre-administrative dilution. Additive solutions An additive solution should allow maintenance of red cell viability even if more than 90 per cent of the plasma is removed. The use of glucose and adenine is necessary for the maintenance of red blood cell post-transfusion viability. Sodium chloride or di-sodium phosphate may be used to give the additive solution a suitable osmotic strength. Micro-aggregates in whole blood and red cell components Platelets and leucocytes rapidly lose their viability at + 4 °C. They form micro-aggregates that are present in considerable amounts even afer 3-4 days of storage of whole blood and, even more so, in concentrates of red cells. Micro-aggregates can cause decreased lung function by blocking lung capillaries and this may be of clinical importance in massive transfusions. Likewise, leucocyte depletion by bufy-coat removal also reduces the frequency of febrile transfusion reactions, and helps to achieve high grade depletion of leucocytes if leucocyte-removal flters are used for this purpose. Red cell preparations The maximum duration of storage (expiry date) should be noted on each container. This duration may vary with the type of preparation 110 Chapter 4 Principles of blood component processing (concentration of cells, formula of anti-coagulant, use of additive solution) and should ensure a mean 24-hour post-transfusion survival of no less than 75 per cent of transfused red cells. Frozen red cells should be prepared and reconstituted according to an approved protocol, be stored at < – 60 °C, and produce satisfactory post-transfusion survival fgures. Plastic bags intended for platelet storage should be sufciently permeable to gases to guarantee oxygen availability to platelets and difusion of carbon dioxide. Agitation of platelets during storage should be sufcient to guarantee oxygen availability but as gentle as possible to prevent induction of activation and storage lesions. Platelets undergo membrane phase transition, and cold activation (below + 20 °C) means that the discoid structure of platelets gradually converts to a sphere.

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Materials Catalog Number Provided with Purchase of Reagent Rotor Profiles VetScan Reagent Profile See “Ordering Information” on page 12-1 purchase nizagara 50 mg without prescription erectile dysfunction doctor edmonton. Optional 100 µL Pipette Tips cheap nizagara 100 mg fast delivery erectile dysfunction oral treatment, disposable Distributor Transfer pipettes (to dispense sam ples) (1 discount nizagara 100 mg erectile dysfunction drugs and heart disease. A rotor • When stored as described above, all reagents con with an opened diluent container cannot be re-used. The reagent rotor sample chamber can • Reagent beads and diluent contain sodium azide, contain up to 120 L of sample. Reagents do not • Fill specimen collection tubes at least halfway to pre come into contact with lead and copper plumbing vent an excessive concentration of anti-coagulant in when following recommended procedures. The operator does not come into men collection tubes for whole blood or plasma sam contact with the reagent beads when following the rec ples. If the operator does come into collection tubes or serum separator tubes (red or red/ contact with the beads, immediately flush eyes or skin black top) for serum samples. If swallowed, wash out • Whole blood samples obtained by venipuncture must mouth with water. To use reagent rotors, remove the rotors in • the test must be begun within 10 minutes of transfer their sealed foil pouches from the refrigerator. Glucose concentra Make sure rotors do not remain at room temperature for tions decrease approximately 5–12 mg/dL in 1 hour in 2 more than a total of 48 hours. The sample can be Do not expose rotors, in or out of the foil pouches, to separated into plasma or serum and stored in capped direct sunlight or to temperatures above 32 °C (90 °F). National Committee for Clinical Laboratory Standards the refrigerator for later use. Procedures for the Handling and Process ing of Blood Specimens; Tentative Standard. C-4 Methods Performance sample tubes at 2–8 °C (36–46 °F) if the sample can these blood constituents when the blood is allowed to not be run within 60 minutes. Normal canine and feline • Total bilirubin results can be adversely affected by 5 red blood cells do not contain significant levels of photodegradation. Analy Glucose concentrations in plasma and serum are typi sis time for all VetScan Rotors is <15 minutes. Expel any • Amylase activity can be elevated by contamination of air or air bubbles from the tip of the sample transfer the sample with human salivary amylase. Salivary device before dispensing 90–120 L of sample or amylase is found in human saliva, sweat glands, and 7 control into the rotor through the sample port. If there are air bubbles in the levels of platelets (> 1,000,000/L) or white blood chamber, add more sample (up to a total of 120 L). The analysis begins when the VetScan analyzer calculates the globulin concentra the drawer closes. Input patient and operator identification numbers as or albumin results are out of range or suppressed, the directed by the messages on the analyzer display. Print the results by an asterisk (*) next to the analyte concen results, transmit to a computer, or touch Open to tration. Remove the rotor est value of the dynamic range, or a less-than symbol from the drawer and follow standard hazardous (<) next to the lowest value of the dynamic range. Examine the • Dispense samples collected in micropipettes into the sample indices to determine if more than one interfer rotor immediately after collection. The bar code printed out of range, have it analyzed by another approved test on the bar code ring provides the analyzer with rotor method or sent to a referral laboratory. Details of the endpoint and rate reaction calcula Typically report cancellation code. The most definitive reference ranges are those established for the patient population. Test results should be interpreted in conjunction with the patient’s clinical signs.

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