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Allan Smith MD, PhD

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https://publichealth.berkeley.edu/people/allan-smith-md-phd/

The head begins to project from the shoulders medications education plans topamax 200mg line, and the upper and lower arms from the sides symptoms pinched nerve neck order topamax in india. The nose and ears project from the flesh and become perforated; while the eyes are filled with a clear fluid medicine 3d printing quality topamax 200mg. Moreover symptoms lymphoma topamax 100 mg overnight delivery, the upper portions of the body now respire through the mouth and nostrils medicine head purchase topamax in india, with the result that the belly is inflated and the intestines medicine effects best topamax 200mg, inflated from above, cut off respiration through the umbilicus and put an end to it. A passage outside is formed from the belly and intestines through the anus, and another one through the bladder. Suppose you were to tie a bladder onto the end of a pipe, and insert through the pipe earth, sand and fine filings of lead. First of all the ingredients will be thoroughly mixed up with the water, but after you have blown for a time, the lead will move towards the lead, the sand towards the sand, and the earth towards the earth. Now the seed, or rather the flesh, is separated into members by precisely the same process, with like going to join like. This stage is reached, for the female foetus, in forty-two days at maximum, and for the male, in thirty days at maximum. And the lochial discharge too after birth is usually completed within forty two days if the child is a girl. At least this is the longest period which completes it, but it would still be safe even if it took only twenty-five days. If the child is a boy, the discharge takes thirty days again the longest period, but there is no danger even if it takes only twenty days. In young women, the discharge takes a smaller number of days; more, when women are older. It is the women who are having their first child who suffer the most pain during the birth and during the subsequent discharge, and those who have had fewer children suffer more than those who have had a greaternumber. Now then, the reason for the discharge after birth is this: during the earlier period of gestation up to forty-two days for a girl, and thirty for a boy the least amount of blood flows to cause the embryo to grow, while after this period the amount increases right up to the time the woman gives birth. We must expect then that the lochial discharge will correspond and flow out in accordance with the number of these days. If the woman is in a good state of health and is likely to remain so, the blood flows as it does from a sacrificial animal, and clots quickly. But if her health is bad, the flow is less, unhealthy in appearance, and is slow to coagulate. For if a woman is not thoroughly purged of the lochia, she becomes gravely ill with a risk of dying, unless she is treated swiftly and the purgation is eventually induced. I maintain that the flow is proportionate, because while the seed is in the womb, the amount of blood which flows into the womb from the mother who carries a female child is least during the initial period of forty-two days, the period within which the limbs are differentiated. From * Presumably the author refers to a familiar demonstration, either of air pressure or of surface tension, but nothing is known of its precise form. And again, in the case of a male child, the same thing happens, only this time the period is thirty days. Here is further evidence for the truth of these facts: in the days immediately following the receipt of seed in the womb, the quantity of blood flowing from the mother into the womb is least, and subsequently it increases. For if a large amount were to flow all at once, the embryo could not breathe, but would be choked by the large flow of blood. In the purgation, on the other hand, the proportion is inverse; for here the flow is greatest in the initial period, and it then decreases until it finishes. So too in the case of female embryos which are miscarried, the corresponding period being forty-two days, articulation is observed. This is also why purgation takes longer after a female birth than after a male birth. Once the bones are hollow, they absorb the richest part of clotted blood from the flesh. In due course the bones at their extremities branch out, just as in a tree it is the tips of the branches which are last to shoot forth twigs. But it is in the feet and hands that both the veins and nerves are thinnest and most numerous and most dense, and the bones too. Now it is because the fingers and toes have bones, veins and nerves which are small and dense that the nails, which are also thin and dense, grow out of them. Their effect is to cut short the extremities of the veins, preventing them from growing any further, or one from being longer than another. Hair grows in the following way: it grows longest and most abundandy where the epidermis is most porous and where the hair can receive the right amount of moisture for its nutridon. Where the epidermis becomes porous subsequently, there too the hair grows subsequently namely, on the chin, the pubes, and other such places. The same is true of menstruation in girls: in their case, the way is opened for menstruation and the passage of sperm at the same time. Now when the epidermis becomes porous, pubic hair begins to grow both in girls and boys, the hair now having sufficient moisture for its nutriment. For both during intercourse and during the intervening times, the hair has the proper amount of moisture for its nutriment; but this is so most of all when the fluid in its course from the head during intercourse is delayed by its arrival at the chin, which projects forward of the breast. The evidence that hair grows where the epidermis is most porous is this: if you were to burn the epidermis just enough to raise a blister, which you then healed, the epidermis on the scar would become dense and would not grow hair. Women also are hairless on their chin and over the body, because during intercourse their bodily fluid is not agitated to the same extent as in men, and therefore does not make the epidermis porous. Those who are bald are so because their constitution is phlegmatic: for during intercourse the phlegm in their heads is agitated and heated, and impinging upon the epidermis burns the roots of their hair, so that the hair falls out. For the same reason, eunuchs do not become bald, because they do not experience the violent movement of intercourse which would heat the phlegm and cause it to burn the hair-roots. The explanation of grey hair is that after fluid has been agitated in the body over a long period, its whitest part is separated off and arrives at the epidermis: the hair grows whiter because the moisture which it attracts is whiter than it was previously, while the epidermis is whiter in places where the hair is white. Those too who have a white head of hair from birth show a whiter epidermis where the hair is white; for it is there that the whitest part of the bodily fluid is. In fact, the complexion of the skin and the colour of the hair correspond to the colour of the moisture which the flesh attracts white, or red, or black. The embryo starts to move once the extremities of the body have branched and the nails and hair have taken root. The time which it takes for this to happen is three months for males, and four for females. The reason why a male embryo starts to move earlier is its greater strength; moreover, the male is compacted earlier, since the seed from which it comes is stronger and thicker. The appearance and the flow of milk occur later in those women whose flesh is of a dense texture, and earlier in those who have loose-textured flesh. The process is the same as when you smear a hide with large quantities of oil and, after giving the hide time to absorb the oil, you squeeze it, and the oil oozes out again under pressure. Now from this fatty substance, which is warmed and white in colour, that portion which is made sweet by the action of heat coming from the womb is squeezed into the breasts. A small quantity goes to the womb as well, through the same vessels: for the same vessels and others similar to them extend alike to the breasts and the womb. When it arrives in the womb it has the appearance of milk, and the embryo uses a small quantity; while the breasts are filled with it and swell. When the child is born, it is the act of suckling itself which causes the milk to flow into the breasts, once the whole process has been set going initially. It is similar to the case of a man who enjoys intercourse frequendy: the veins become more permeable, thereby inducing him to further intercourse. In just the same way, plants growing in the earth receive their nutriment from the earth and the condition of the plant depends on the condition of the earth in which it grows. Now there is a potency in the seed: when the lightest part of this potency is condensed and compressed by breath and the moisture in the seed, it turns into green shoots and breaks the seed open. This is what happens at first: the shoots sprout upwards, but once they have sprouted, then the moisture in the seed is no longer sufficient for their nutrition. Once the plant has taken firm root below and begins to derive its nutriment from the earth, then the whole seed is absorbed by the plant and disappears, excepting the husk, which is the most solid part of the seed. Now the plant, since it comes from a seed, that is, from something moist, while it remains tender and moist and strives to grow upwards and downwards, cannot put forth fruit. The reason is that its potency is not strong and rich enough to be compacted into fruit. But when time has made the plant firm and rooted it, it develops broad veins running upwards and downwards, so the substance it draws from the earth is no longer watery, but thicker and more fatty and greater in quantity. This substance is heated by the sun, and erupts into the tips of the plant, where it becomes fruit of the same kind as what it came from. It is the sun which ripens and firms the fruit, by evaporating its more watery part. When trees are grown from slips, on the other hand, what happens is this: the cutting has a fracture at its lower end (where it was broken off from the parent tree), the end which is placed in the earth. Once the plant has taken root below, it draws moisture from the root and imparts it to the portion above the ground. And so in its turn the upper portion too swells and acquires breath; and such of the potency of the plant as is light condenses and grows out in the form of shoots: thereafter the plant grows both upwards and downwards. The reason is that there is a quantity of moisture in the seed itself, and since the seed is wholly contained in the ground, it has, initially, sufficient nutriment to feed its shoots until it becomes rooted. This is not the case with the cutting, for it does not grow from something else which provides the leaves with their initial nutriment; instead, the cutting is like the tree, which has its greatest bulk above the earth, and so cannot be filled with moisture above the earth without some great potency coming from below to transmit moisture to the upper parts. So that at first the slip must necessarily sustain itself from the earth by means of its roots, and only subsequently transmit upwards the moisture which it attracts from the earth, and so blossom into leaves, and grow. Once it has drawn an excessive amount of moisture from the earth, this superabundance causes it to break out at the point where most has collected and it is here that the plant branches. The reason that it increases in size both laterally and upwards and downwards is that the earth below its surface is warm in winter and cool in summer. This is because in winter the rain falling from the sky makes the earth moist and, since moisture is heavy, compressed upon itself. Accordingly, the earth becomes more dense and, because it has no large pores, it is unventilated. Whereas if they are dry and loosely packed, they are much slower to grow warm and to rot. Corn and barley too, if they are moist and packed together, are more likely to grow warm than when they are dry and lie loosely. Leather garments also, if you tie them together and compress them very tightly, are consumed spontaneously as though by fire. In fact you only have to consider to realize that everything which is compressed upon itself grows warmer that what is loosely packed, the reason being that these substances cannot be ventilated and cooled by the wind. Now the case is the same with the earth: under its surface it is dense and compacted upon itself as a result of the weight of moisture in it, and so it is warm during winter since it has no ventilation for its heat. This is why springs during the winter are both warmer and flow more abundantly than during the summer: the air exhaled from the water goes back into the water, since the earth is dense and the air cannot penetrate it. This large quantity of water breaks out and flows where it can, and makes a broader passage for itself than if it were only a small quantity. I have mentioned all these facts to show that the earth under its surface is warmer during winter than during summer.

It also reduces the Another possible option to reduce IgE related synthesis of IgE by B plasma cells and thereby hypersensitivity reaction is to directly kill the mast January-February 2013 | Vol 2 |Issue 1 Journal of Scientific & Innovative Research 135 Ahmed Elshemy et medications you can take while breastfeeding generic topamax 100 mg. Human originated showed lower histamine release and fewer peanut apoptosis-inducing proteins can be used treatment quad tendonitis cheap topamax online mastercard, as these specific IgE antibodies treatment 8th february buy generic topamax on line, and that allergic symptoms will be less toxic or less immunogenic than the were reduced treatment 002 purchase topamax with american express. Thus treatment keloid scars discount topamax online mastercard, their results suggest that proteins produced in a different animal or plant medicine cards cheap 200mg topamax with visa. Also, these chimeric proteins do not lucidus) decreases allergic response by reducing degranulate mast cells. The same effect was reported by enzymes such as chymase and other serine using hop, Humulus lupulus, extracts on rat mast 17 20 proteases. Reducing the allergenicity of food crops chance to react with IgE and thus attenuated mast cell activation. Destruction of IgE binding epitopes Scientists are trying to develop methods to reduce of profilin with chymase could further limit pollen plant allergenicity. Immunotherapy their vitality and makes them produce various Immunotherapy (biologic therapy) is indicated for defense molecules (Thi and De Blic, 2005); these 21 people who are extremely allergic to specific defense molecules could be active allergens. Some allergy medications are beclomethasone (Qvar) and ciclesonide available over-the-counter, while others are (Alvesco). Corticosteroid eyedrops are used to treat severe eye irritation caused by hay fever Corticosteroids and allergic conjunctivitis. Prolonged use may increase your risk of eye infections, Nasal corticosteroid sprays prevent and glaucoma and cataracts. Examples are available without a prescription, but talk include fluticasone (Flonase), mometasone to your doctor before using a topical (Nasonex), budesonide (Rhinocort Aqua), corticosteroid for more than a few weeks. Side Side effects can include skin irritation and effects can include unpleasant smell or discoloration. Fexofenadine (Allegra) is Corticosteroids are available in liquid form available both over-the-counter and by that can be useful for skin conditions prescription. Older Oral corticosteroids (pills and liquids) are antihistamines such as diphenhydramine used to treat severe symptoms caused by all (Benadryl), chlorpheniramine (Chlor types of allergic reactions. Examples Trimeton) and clemastine (Tavist) are more include prednisone (Prednisone Intensol) likely to cause drowsiness and slow your and prednisolone (Prelone, others). Antihistamine nasal sprays help relieve Long-term use can cause cataracts, sneezing, itchy or runny nose, sinus osteoporosis, muscle weakness, stomach congestion, and postnasal drip. Oral antihistamine nasal sprays include corticosteroids can also worsen azelastine (Astelin, Astepro) and hypertension. Side effects of corticosteroids may be given as a shot antihistamine nasal sprays may include (injection) rather than pills. Antihistamine Oral antihistamines (pills and liquids) ease eyedrops can ease symptoms such as symptoms such as swelling, runny nose, itching, redness and swollen eyes. Desloratadine (Clarinex) and include ketotifen (Zaditor, Alaway, others) levocetirizine (Xyzal) are available by January-February 2013 | Vol 2 |Issue 1 Journal of Scientific & Innovative Research 138 Ahmed Elshemy et. Examples medications can include red eyes, watery include phenylephrine (Neo-Synephrine, eyes, mild stinging or burning and others) and oxymetazoline (Afrin, others). Taking too much of a nasal decongestant can cause irritability, Decongestants fast or irregular heartbeat, dizziness, Decongestants are used for quick, temporary relief insomnia, headaches, anxiety, tremors, and of nasal and sinus congestion. Decongestant eyedrops (or combined Oral decongestants (pills and liquids) decongestant-antihistamine eyedrops) can relieve nasal and sinus congestion caused temporarily ease symptoms such as red, by hay fever. A common examples include tetrahydrozoline (Visine example is pseudoephedrine (Sudafed, others) and naphazoline (Clear Eyes, others). Side effects include persistent eye decongestant such as pseudoephedrine redness and damage to blood vessels in the combined with other medications. In rare cases, D, for example, contains pseudoephedrine decongestant eyedrops can cause a type of and an antihistamine. It prevents the release of histamine and immunotherapy injections can cause a life other symptom-causing chemicals during an threatening allergic reaction (anaphylaxis). Some people need to use the spray three or four times a Seasonal allergy treatments come in several forms day. These prescription medications reduce allergy What seasonal allergy medication works best for symptoms such as red, itchy eyes. Examples you can often depend on your symptoms and the include cromolyn (Crolom), lodoxamide severity of those symptoms. Your doctor can help (Alomide), pemirolast (Alamast) and nedocromil January-February 2013 | Vol 2 |Issue 1 Journal of Scientific & Innovative Research 140 Ahmed Elshemy et. Allergy shots are Different Types of Seasonal Allergy Treatments given regularly over a period of years and Allergy treatments come in different forms and contain allergen extracts. Treatment may include: available in several forms; for example, Antihistamines relieve mild symptoms such as rash, pills you swallow or as nasal sprays. Some hives, and itching Bronchodilators such as albuterol antihistamines may cause drowsiness. They work by constricting skin, given by mouth, or given intravenously blood vessels in the nose. Epinephrine by injection to decongestants may sometimes lead to an treat anaphylaxis. For this reason, training and experience to properly diagnose your and others, decongestants should be used condition and prescribe an allergy treatment and with caution in people with certain common management plan to help you feel better and live medical conditions, including high blood better. January-February 2013 | Vol 2 |Issue 1 Journal of Scientific & Innovative Research 141 Ahmed Elshemy et. The American Journal of Respiratory and Critical Care diagnosis and management of rhinitis: an updated Medicine, 2001; Vol. January-February 2013 | Vol 2 |Issue 1 Journal of Scientific & Innovative Research 142 Ahmed Elshemy et. Uguz, A, Lack, G, Pumphrey, R, Ewan, P, Inducing Human Origin Fce-BaK Chimeric Warner, J, Dick, J, Briggs, D, Clarke, S, Reading, Proteins for Targeted Elimination of Mast Cells and D, Hourihane, J. The Journal of Immunology, 2002; Reduction of the crop plant allergenecity due to soil Vol. However, recent studies have found that almost 1 in 20 young children under the age of 5 years and almost 1 in 25 adults are allergic to at least one food. Other studies indicate that food allergy, especially allergy to peanut, is on the rise. As a result, more and more people are becoming aware of food allergy, making it a subject of increasing public concern. There may be day-to-day anxiety that a loved one may accidentally eat a food that could lead to anaphylaxis, a dangerous allergic reaction. This booklet will help you understand allergic reactions to foods and their possible causes, and it explains how a healthcare professional diagnoses and treats food allergy. If you suspect you or a member of your family have a food allergy, consult your healthcare professional for medical advice. The binding of IgE to specifc molecules present in a food triggers the immune response. The response may be mild or in rare cases it can be associated with the severe and life threatening reaction called anaphylaxis, which is described in a later section of this booklet. Therefore, if you have a food allergy, it is extremely important for you to work with your healthcare professional to learn what foods cause your allergic reaction. Sometimes, a reaction to food is not an allergy at all but another type of reaction called food intolerance. A food allergy occurs when the immune system responds to a harmless food as if it were a threat. The frst time a person with food allergy is exposed to the food, no symptoms occur; but the frst exposure primes the body to respond the next time. But sometimes a frst exposure or subsequent exposure can occur without your knowledge. Step 1: the frst time you are exposed to a food allergen, your immune system reacts as if the food were harmful and makes specifc IgE antibodies to that allergen. The antibodies circulate through your blood and attach to mast cells and basophils. Mast cells are found in all body tissues, especially in areas of your body that are typical sites of allergic reactions. Basophils are found in your blood and also in tissues that have become infamed due to an allergic reaction. The binding signals the cells to release massive amounts of chemicals such as histamine. Depending on the tissue in which they are released, these chemicals will cause you to have various symptoms of food allergy. A severe allergic reaction can include a potentially life-threatening reaction called anaphylaxis. Generally, you are at greater risk for developing a food allergy if you come from a family in which allergies are common. These allergies are not necessarily food allergies but perhaps other allergic diseases, such as asthma, eczema (atopic dermatitis), or allergic rhinitis (hay fever). If you have two parents who have allergies, you are more likely to develop food allergy than someone with one parent who has allergies. An allergic reaction to food usually takes place within a few minutes to several hours after exposure to the allergen. The process of eating and digesting food and the location of mast cells both affect the timing and location of the reaction. In older children and adults, it can cause more severe symptoms, such as diffculty swallowing solid food or solid food sticking in the esophagus for more than a few minutes. In some situations, avoiding certain food allergens will be an effective treatment for EoE. For example, if you have a history of allergy to shrimp, allergy testing will usually show that you are also allergic to other shellfsh, such as crab, lobster, and crayfsh. If you have a food allergy, there is a chance that you may experience a severe form of allergic reaction known as anaphylaxis. Anaphylaxis includes a wide range of symptoms that can occur in many combinations. Some symptoms are not life-threatening, but the most severe restrict breathing and blood circulation. Sometimes the symptoms go away, only to return 2 to 4 hours later or even as many as 8 hours later. When you begin to experience symptoms, you must seek immediate medical attention because anaphylaxis can be life threatening. Anaphylaxis caused by an allergic reaction to a certain food is highly unpredictable. The severity of a given attack does not predict the severity of subsequent attacks. However, medications, insect stings, and latex can also cause an allergic reaction that leads to anaphylaxis. Anaphylaxis is highly likely if at least one of the following three conditions occurs: 1. A person exposed to an allergen previously known to cause an allergic reaction in that person experiences a drop in blood pressure. For example, milk allergy tends to develop early in life, whereas shrimp allergy generally develops later in life. Children usually outgrow their egg, milk, and soy allergies, but people who develop allergies as adults usually have their allergies for life. In Japan, for example, rice allergy is more frequent than in the United States, and in Scandinavia, codfsh allergy is more common than in the United States. Eating the raw food causes an itchy, tingling sensation in the mouth, lips, and throat. It can also cause swelling of the lips, tongue, and throat; watery, itchy eyes; runny nose; and sneezing. Just handling the raw fruit or vegetable may cause a rash, itching, or swelling where the juice touches the skin. This type of reaction to milk is associated with immune responses that are not related to IgE antibody.

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Pigeons medicine 5325 cheap topamax american express, spar acterized by septicemia and rows symptoms uterine cancer generic 100 mg topamax with visa, and wild rodents have rapid death 9 treatment issues specific to prisons cheap topamax 100mg overnight delivery, with diarrhea and been shown to be reservoirs of abortion commonly observed symptoms of mono purchase discount topamax line. Bacteria are shed in the feces of carrier rab Staphylococcus aureus causes bits and clinically ill animals symptoms your having a boy order topamax on line amex. In the chronic form treatment 4 ulcer buy generic topamax online, there may be no signs of illness other Cutaneous lesions in young Figure 7. Occasionally, small, eye with sterile saline or boric for both direct contact and aero superfcial pustules or abscesses acid solution, and applying an sol transmission. Consult a veterinarian for on the lower eyelid near the the doe or when the young are current recommendations. Other Conjunctivitis is a common members of the genus include malady of young rabbits raised T. After fnding that eyes with a copious exudate are rabbits had a natural spiro characteristic of this disease. The There is a great deal of confu bacteria most often isolated are sion concerning the incidence of Staphylococcus aureus and Pasteu treponematosis in rabbits. Conjunctivitis Recent reports indicate it is is treated by opening the eye Figure 8. In fact, serological tests Spirochetes also are found in with pathogenic bacteria and have demonstrated antibodies to regional lymph nodes, and becomes very sore. Injections are given at seems to thrive in flthy condi primarily by breeding, and an weekly intervals, and all rabbits tions, enters the host through isolated case can lead to an out must be treated, regardless of the contaminated food or water. The disease is a chronic, debili Exchange of infected bucks may Penicillin, however, may cause tating condition with signs of spread the infection among fatal enterotoxemias in some poor appetite, depression, slowly colonies. The lesions are to differentiate the two diseases sanitation procedures, including irregular in shape, tan brown, without the use of a dark feld disinfecting cages, nest boxes, and either edematous or dry microscope. All lesions Tularemia wet and dirty cage foors that show many spirochetes by spe Tularemia, sometimes called come in contact with these cial microscopic (dark feld) rabbit fever or deer fy fever, is an membranes. Tularemia Sierra Nevada Mountains, and can be carried by many wild the tip of the peninsula of Baja and domestic animals, certain California. As the for a defnite diagnosis of myxo to occur naturally in commercial disease progresses, edema of the matosis. The cut sur vaccine is not approved for use tribution of the California brush face of each edematous subcuta in the United States. Mortality is highest among other insects as vectors of rabbit Naturally occurring papilloma the unweaned young and may fbroma virus has been estab tosis has been found in domestic reach 75 percent. Given the proper envi rabbits in southern California, virus rarely is a cause of epizoot ronment (such as an epizootic in but the virus produces no evi ics, but usually is very serious wild cottontail rabbits) and an dence of a generalized illness. The lower portions of the isolated from nodules beneath uli of rabbits exists as a latent growth are pinkish and feshy to the skin of wild cottontail rab infection in some stock lines of the touch. The virus does older, they increase in size, growths) were transmitted to not produce a natural disease, become more cornifed, and are domestic rabbits. Oral papilloma Wartlike growths in the mouth, especially on the lower surface of the tongue, are caused by a virus (one of the papovaviruses) different from the rabbit papilloma virus. Rotovirus, coronavirus, and adenovirus all have been incrimi nated in enteritis outbreaks. The the body organs such as the Viral hemorrhagic clinical signs and pathology of lungs, liver, heart, spleen, and disease the viral enteric diseases are very mucous membranes. The nest box material becomes Not only can rabbits serve as Lesions usually are found on contaminated with fungus reservoirs for human infection, the nose, ears, eyelids, and feet. Fungal infections must be dif ferentiated from other types of skin problems, such as mite infestations, hair pulling, fght wounds, molting, and vitamin defciencies. If ringworm is sus pected after an evaluation of the lesions and clinical history, a skin scraping should be performed. Prevention and control rabbits rarely are infested with Griseofulvin, an antifungal drug, parasites in signifcant numbers. Each Modern pens are constructed so tion is far cheaper and preferable animal should receive 12 mil that they can be kept clean and to treatment. Griseofulvin can be added to the feed at the rate of 370 mg per pound of feed and fed to all rabbits in the herd for a period of 2 weeks. While this is an extremely effective and easy way to treat ringworm, it presents a problem: the drug has never been cleared for use in rabbit feed in the United States and, therefore, cannot be added to the feed by a commercial feed com pany. The problems caused by all of these parasites are greatly infu enced by methods of feeding, handling, and housing. To Ear mites adult and potential replacement treat fur mites in a few rabbits, Psoroptes cuniculi, the com rabbits in the herd. If rabbits tions of ivermectin or dip rabbits the mites live in the ear canal are severely infected and have (wear gloves) in a 0. This dark cotton tipped applicators and Larvae of Cuterebra fies are encrustation consists of cellular tweezers before drug application. Ivermectin is given and burrow into the skin to form surface of the pinna may be two or three times at 2 week warbles. The warbles cause Treatment of ear mite infesta rabbits these mites seldom cause tions requires a plan and perse a problem and rarely are noticed. To rid the scabs may develop in the neck herd of this bothersome para or dorsal trunk areas. Treating just the hind legs and the consequent one rabbit will result in continu loss of hair and injury to the ally treating one or two rabbits a skin. Diagnosis of fur mites is best Most mineral oil based ear accomplished by scraping the mite medications containing a skin of the affected area with a Figure 13. Paint the wound with To destroy adult feas, dust rab of the reservoirs of tularemia, an antiseptic. It is caused by a microscopic cracks of nest boxes and develop the rabbit tick, Haemaphysa protozoal parasite that invades into larvae in a short time. At least four species or types of coccidia live in the intestine, and one species grows in the liver. In some cases, patches of epithelium die and slough away from the intestinal wall. However, er coccidiosis is acquired treatment is not suggested unless Liv brush wire foors daily with a in the same manner as intes clinical disease appears. Design feeders so that controlled more easily by proper breakdown of antimicrobial resi fecal contamination is held to a management. An automatic water does occur, feed containing Eimeria stiedae, the one spe system is recommended. Like late and become infective it only until management con the other forms, it enters the (Figure 14). Infections lasting more Oocytes persist in the environ Encephalitozoon cuniculi (a than 16 days can be recognized ment and are diffcult to kill protozoan parasite) is the cause by white circular nodules on the with most common sanitizing of a mild but long standing dis liver (Figure 15). Then appetite decreases, sulfaquinoxaline may be fed for but current studies indicate that a potbelly develops, and death 2 to 3 weeks to reduce the num many apparently healthy ani sometimes follows. The histologically, but grossly the mon protozoal disease of rabbits organisms are passed in the urine organs may be swollen, and caused by Toxoplasma gondii. The disease transmit the disease to unborn of a microscope in these necrotic probably is more common than rabbits in the uterus. Diagnosis of toxoplasmosis There are two forms of the Diagnosis of encephalito generally is accomplished at disease. In the acute form, the zoonosis in a rabbit herd is necropsy by observation of his rabbit develops anorexia, fever, diffcult. In the chronic form, zoon infection can be detected by be kept out of rabbitries or at the disease occurs over a much an indirect fuorescent antibody least away from feed storage longer period of time. Take precautions to ensure may be latent, with onset stimu immunoassay utilizing India that feed and water are not con lated by stress. Only one roundworm pres Transmission of the disease ents a problem in domestic may occur in two ways. They often are seen on the surface of freshly passed feces or through the wall of the cecum when rab bits are slaughtered. As the mature worms become inactive, they are passed out of the cecum as fecal pellets are formed. When treat ment is necessary, piperazine citrate is effective when admin istered at 100 mg/100 milliliters (ml) drinking water for 1 day. The ribbon shaped, and made up released from the eggs, penetrate adult forms are very rare in of numerous segments. When form small, fuid flled cysts (cys many tapeworms are present, ticerci), which may be attached diarrhea and emaciation might to the membranes holding the occur. Each cyst contains the larval forms of tapeworm an embryonic tapeworm that, most often found are those of when consumed by a dog, will Figure 17. Cases may not be apparent because Vitamin E defciency effects on the doe and young. Affected infants do reduction in exercise, or a ration Impaired coordination may pre not reveal any gross lesions of containing too little digestible vent animals from eating, and diagnostic signifcance. The misalignment, which also results dental formula of the rabbit is: in malocclusion. Therefore, the best the teeth ground down to proper solution is to regard all maloc length and size. The reces jaw is shorter or longer than the sive malocclusion genes can be upper jaw or teeth are damaged, eliminated from a breeding herd malocclusion of the incisors by selective breeding. The condition might Glaucoma ing against opposing teeth to be similar to the hip dysplasia Glaucoma (buphthalmia) maintain their shape. Corneal are abscessed teeth, growth of Ataxia (muscle incoordina opacity may lead to blindness. It is, however, a lethal result of an abnormal drainage Malocclusion of the incisors recessive genetic factor. The dis mechanism and the inability to can be corrected temporarily ease usually appears when the maintain normal fuid relation by cutting back the teeth so the animal is 2 to 3 months of age ships in the eye. Later the animal many types of malocclusion are Malocclusion and tooth over cannot move, and its body tem inherited. As a result, a vertebra posterior from the middle of be culled from the breeding becomes displaced, and the spi the back and may be complete population. The uri of the vertebrae by sudden Heat prostration results from nary bladder may become greatly prolonged exposure to excessive heat. Remove some bedding and fur from nest boxes to improve cir culation of air around kits. Preven Several rabbits in a hutch ground noise (such as a radio) is tion is accomplished in three may eat body fur, eyelashes, and not available and the person is a ways. Diets high in cereal grains observed in does with paresis foors daily and never allow and low in alfalfa often have a (some motor function or sensory manure to hang on cage foors. Increasing fber Sore hocks rarely are reported because the in the diet almost always elimi animals are slaughtered before nates the problem. Overcrowd Sore hocks are infamed bare they reach the age at which ing in a cage also can cause hair spots, devoid of fur, found on tumors are most apt to occur. In severely With the increasing use of Rabbits also eat small amounts affected cases, secondary infec rabbits as laboratory animals, of hair by licking or grooming tions with Staphylococcus occur. When obstruction to the front feet, adding stress to Adenocarcinomas of the uteri are occurs, the rabbit quits eating, the front feet and causing them not uncommon in does over loses weight, and may die. The breed also (tumors of cells from lymph (delicate) stomach, and, perhaps, is a factor in the development nodes) occur in mature females. Plant pigments also How to pack and affect urine color Rabbits take soft fecal pellets ship specimens from the vent and swallow them intact. By per Shipping dead animals causes for this syndrome have mitting a second passage of food been postulated, the basic prob If you cannot take your rab through the digestive tract, the lem is inadequate nutrition. Yellow fat you use a restricted feeding pro Because it is against postal reg Yellow body fat is an inher gram (rabbits are not fed all they ulations to send frozen carcasses ited condition in rabbits. For thophyll pigment to a colorless gradually the amount of feed long distance shipments, place product. Therefore, the xantho (usually to about double) or to dry ice around the carcass, then phyll is deposited in the body increase the amount of energy pack it as indicated above. Follow closely the instructions on the label (and any on a weekend; most laboratories other directions you have).

Rare occasions of mild zoster following vaccination show that the currently used vaccine strains may induce latency abro oil treatment buy genuine topamax on line, with the subsequent risk of reactivation symptoms 9f anxiety buy 200mg topamax overnight delivery, although the rate seems to be lower than after natural disease treatment effect buy generic topamax on-line. Duration of immunity is unknown symptoms you may be pregnant topamax 100mg otc, but antibodies have persisted for at least 10 years; persistence of antibody has occurred in the presence of circulating wild virus symptoms xeroderma pigmentosum buy discount topamax 200mg on line. In hospital medicine xanax discount topamax 100 mg overnight delivery, strict isolation because of the risk of varicella in susceptible immunocompromised patients. It is available in several countries for high-risk persons exposed to chickenpox and indicated for newborns of mothers who develop chickenpox within 5 days prior to or within 2 days after delivery. Antiviral drugs such as acyclovir appear useful in prevent ing or modifying varicella in exposed individuals if given within a week of exposure. A dose of 80 mg/kg/day in 4 divided doses has been used, but no regimen is as yet generally recommended for this purpose. Infectious patients should be isolated until all lesions are crusted; exposed susceptibles eligible for immunization should receive vaccine immediately to control or prevent an outbreak. Oral valacyclovir or famci clovir are effective and well-tolerated for herpes zoster, these drugs help shorten the duration of the infection and possibly that of postherpetic neuralgia; they may shorten the duration of symptoms and pain of zoster in the normal older patient, especially if administered within 24 hours of rash onset. Epidemic measures: Outbreaks of varicella are common in schools and other institutional settings; they may be protracted, disruptive and associated with complications. Infectious cases should be isolated and susceptible contacts immunized promptly (or referred to their health care provider for immunization). Disaster implications: Outbreaks of chickenpox may occur among children crowded together in emergency housing situations. Chlamydiae are obligate intracellular bacteria that differ from viruses and rickettsiae but, like the latter, are sensitive to broad-spectrum antimicrobials. Those that cause human disease are classi ed into 3 species: 1) Chlamydia psittaci, the etiologic agent of psittacosis (q. Chlamydiae are increasingly recognized as important pathogens respon sible for several sexually transmitted infections, with infant eye and lung infections consequent to maternal genital infection. Asymptomatic chronic infections of endometrium and fallopian tubes may lead to the same outcome. Less frequent manifestations include Bartholinitis, urethral syndrome with dysuria and pyuria, perihepatitis (Fitz-Hugh-Curtis syn drome) and proctitis. Chlamydial infections may be acquired concurrently with gonorrhoea and persist after gonorrhoea has been treated successfully. Preventive measures: 1) Health and sex education; same as for syphilis (see Syphilis, 9A), with emphasis on use of a condom when engaging in sexual intercourse. Screening of adult women should also be considered if they are under 25, have multiple or new sex partners, and/or use barrier contraceptives inconsistently. Erythromycin is an alternative drug of choice for newborn and for women with a known or suspected pregnancy. Clinical manifestations of urethritis are often dif cult to distin guish from gonorrhoea and include moderate or scanty mucopurulent discharges, urethral itching, and burning on urination. Possible complications or sequelae of male urethral infections include epididymitis, infertility and Reiter syndrome. In homosexual men, receptive anorectal intercourse may result in chlamydial proctitis. In the female, the clinical manifestations may be similar to those of gonorrhoea and may present as a mucopurulent endocervical discharge, with oedema, erythema and easily induced endocervical bleeding caused by in ammation of the endocervical columnar epithelium. Complications and sequelae include salpingitis with subsequent risk of infertility, ectopic pregnancy or chronic pelvic pain. Infection during pregnancy may result in premature rupture of membranes and preterm delivery, and conjunctival and pneu monic infection of the newborn. Because gonococcal and chlamydial cervicitis are often dif cult to distinguish clinically, treatment for both organisms is recommended when one is suspected. The intracellular organisms are less readily recoverable from the discharge itself. No acquired immunity has been demonstrated; cellular immunity is immunotype-speci c. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Case report is required in many industrialized countries, Class 2 (see Reporting). Appropriate antibiotherapy renders dis charges noninfectious; patients should refrain from sexual intercourse until treatment of index patient and current sexual partners is completed. As a minimum, concurrent treatment of regular sex partners is a practical approach to management. Herpesvirus simplex type 2 is rarely implicated; Trichomonas vaginalis, though rarely implicated, has been shown to be a signi cant cause of urethritis in some high prevalence settings. In untreated cases, rapid dehydration, acidosis, circulatory collapse, hypogly caemia in children, and renal failure can rapidly lead to death. In most cases infection is asymptomatic or causes mild diarrhea, especially with organisms of the El Tor biotype; asymptomatic carriers can transmit the infection. In severe dehydrated cases (cholera gravis), death may occur within a few hours, and the case-fatality rate may exceed 50%. Diagnosis is con rmed by isolating Vibrio cholerae of the serogroup O1 or O139 from feces. If laboratory facilities are not nearby or immediately available, Cary Blair transport medium can be used to transport or store a fecal or rectal swab. For epidemiological pur poses, a presumptive diagnosis can be based on the demonstration of a signi cant rise in titre of antitoxic and vibriocidal antibodies. In nonen demic areas, organisms isolated from initial suspected cases should be con rmed in a reference laboratory through appropriate biochemical and serological reactions and by testing the organisms for cholera toxin production or for the presence of cholera toxin genes. In epidemics, once laboratory con rmation and antibiotic sensitivity have been established, it becomes unnecessary to con rm all subsequent cases. In any single epidemic, one particular serogroup and biotype tends to be dominant. Prior to 1992, non-O1 strains were recognized as causing sporadic cases and rare outbreaks of diarrheal disease, but were not associated with large epidemics. However, in 1992 1993, large-scale epidemics of cholera-like disease were reported in India and Bangladesh, caused by a new organism, V. The clinical and epidemiological picture of illness caused by this organism is typical of cholera, and cases should be reported as such. Epidemics and pandemics are strongly linked to the consumption of unsafe water, poor hygiene, poor sanitation and crowded living conditions. Conditions leading to epidemics exist in many develop ing countries where cholera is either endemic or a recurring problem in a large number of areas. Typical settings for cholera are periurban slums where basic urban infrastructure is missing. Outbreaks of cholera can also occur on a seasonal basis in endemic areas of Asia and Africa. For example, KwaZulu-Natal, South Africa, experienced an outbreak in 2000 2001 that resulted in more than 125 000 cases with a low case fatality rate of less than 0. Man-made or natural disasters such as complex emergencies and oods resulting in population movements as well as overcrowded refugee camps are conducive to explosive outbreaks with high case fatality rates. Cholera is one of the 3 diseases requiring noti cation under the International Health Regulations. Low case fatality rate values were observed in several countries including South Africa. Elsewhere, case fatality rates remain high and can reach up to 30 40% among vulnerable populations in high-risk areas who are not correctly rehydrated. The actual number of cholera cases, however, is likely to be much higher because of underreporting and poor surveillance systems. During the 19th century, cholera spread repeatedly through 6 pandemic waves from the Gulf of Bengal to most of the world. During the rst half of the 20th century, the disease was con ned largely to Asia, except for a severe epidemic in Egypt in 1947. During the latter half of the 20th century, the epidemiology of cholera has been marked by: 1) the relentless global spread of the seventh pandemic of cholera caused by V. Although the clinical disease was as severe as in other regions of the world, the overall case fatality rate in Latin America was kept at a remarkably low 1%, except in highly rural areas in the Andes and Amazon region where patients were often far from medical care. The epidemic continued to spread through 1994, with cases of O139 cholera reported from 11 countries in Asia. This new strain was soon introduced into other continents by infected travel lers, but secondary spread outside of Asia has not been reported and V. Water usually is contaminated by feces of infected individuals and can itself contaminate, directly or through the contamination of food. Contamination of drinking water occurs usually at source, during transportation or during storage at home. In funeral ceremonies transmission may occur through consumption of food and beverages prepared by family members after they handled the corpse for burial. When epidemic El Tor cholera appeared in Latin America in 1991, faulty municipal water systems, contaminated surface waters, and unsafe domes tic water storage methods resulted in extensive waterborne transmission of cholera. Beverages prepared with contaminated water and sold by street vendors, ice and even commercial bottled water have been incrim inated as vehicles in cholera transmission, as have cooked grains with sauces. Outbreaks or epidemics as well as sporadic cases are often attributed to raw or undercooked seafood. In other instances, sporadic cases of cholera follow the ingestion of raw or inadequately cooked seafood from nonpolluted waters. Cases have been traced to eating shell sh from coastal and estuarine waters where a natural reservoir of V. Clinical cholera in endemic areas is usually con ned to the lowest socioeconomic groups. Rarely, chronic biliary infection lasting for years, associated with intermittent shedding of vibrios in the stool, has been observed in adults. Serum vibriocidal antibodies, which are readily detected following O1 infection (but for which comparably speci c, sensitive and reliable assays are not available for O139 infection), are the best immunological correlate of protection against O1 cholera. However, infection with O1 strains affords no protection against O139 infection and vice-versa. In experimental challenge studies in volunteers, an initial clinical infection due to V. Less severe cases can be managed on an outpatient basis with oral rehydration and an appropriate antimicrobial agent to prevent spread. Cholera wards can be operated even when crowded without hazard to staff and visitors, provided standard procedures are observed for hand wash ing and cleanliness and for the circulation of staff and visitors. In communities with a modern and adequate sewage disposal system, feces can be discharged directly into the sewers without preliminary disinfection. If there is evidence or high likelihood of secondary transmission within households, household members can be given chemoprophylaxis; in adults, tetra cycline (500 mg 4 times daily) for 3 days or doxycycline a single dose of 300 mg, unless local strains are known or believed to be resistant to tetracycline. Children may also be given tetracycline (50 mg/kg/day in 4 divided doses for 3 days or doxycycline as a single dose of 6 mg/kg). A search by stool culture for unreported cases is recommended only among household members or those exposed to a possi ble common source in a previously uninfected area. Only severely dehydrated patients need rehydration through intravenous routes to repair uid and electrolyte loss through diarrhea. As rehydration therapy becomes increasingly effective, patients who survive from hypovolaemic shock and severe dehydration may manifest certain complications, such as hypoglycaemia, that must be recognized and treated promptly. Mild and moderate volume depletion should be corrected with oral solutions, replacing over 4 6 hours a volume matching the estimated uid loss (approximately 5% of body weight for mild and 7% for moderate dehydration). Continuing losses are replaced by giving, over 4 hours, a volume of oral solution equal to 1. The initial uid replacement should be 30 mL/kg in the rst hour for infants and in the rst 30 minutes for persons over 1 year, after which the patient should be reassessed. In severe cases, appropriate antimicrobial agents can shorten the duration of diarrhea, reduce the volume of rehydration solutions required, and shorten the duration of vibrio excretion. Epidemic measures: 1) Educate the population at risk concerning the need to seek appropriate treatment without delay.