By V. Ressel. Baylor University.

The health services in many such countries purchase levamisole 150mg with amex, on which the majority of people depend buy levamisole 150mg otc, are provided by the Government entirely free of charge buy levamisole 150 mg without prescription, or at heavily subsidized rates. As a result, Government authorities have defined systems of priority for allocation of funds from limited health budgets. It is of importance therefore that relevance to national developmental activities, and this not merely in the health field, be stressed at an early stage, and in so doing the following could be emphasized to advantage: (a) Relevance to major health problems for diagnosis and treatment; (b) Applicability to other fields given high national priority such as animal husbandry and agriculture; (c) Advantages provided for research into local problems in the above fields as well as in others. In the medical sphere, recent developments in immunoassay techniques, extending their applicability to nutritional, bacterial and parasitic disorders, underscore their relevance to developing countries where these constitute the major health problems. To cite an example, if it be desired to set up assays for gonadal steroid hormones and if the only justification made is that these would be of use in the investigation of disorders of reproductive endocrinology, the response is likely to be merely lukewarm. If, however, the potential value of the techniques when established to workers in other fields where they are of equally direct relevance, such as in animal husbandry — viz. The manner of initial approach could therefore be a vital one, particularly in third-world countries — and here again some are more rigid than others - where scientists are not given a free hand and virtually nothing can be done, even when no local funds are being utilized, unless it is shown to be in conformity with governmental policies. The question of location of immunoassay centres in the third world is an im portant one to be decided, when a choice is possible, based on criteria different to those that may be applied in the developed countries. Such a centre must not exist for mere prestige value or to serve a microscopic fraction of the community, such as for patients in a hospital. A primary consideration therefore would be the degree to which its services could be extended to include a large population within a wide geographical area, and the nature and magnitude of the practical problems that would follow. A further consideration would be the extent to which the potential of immunoassays, as having a multi-disciplinary applicability and relevance in many fields, could be realized by a sharing of facilities with other workers as far as possible. On the other hand, it is often the case that even where the above requirements could be met, under existing circumstances there is failure of implementation owing to administrative problems and bureaucratic obstinacy which, although doubtless also encountered elsewhere, exerts its worst counter­ productive effects in the poorer countries. Necessary administrative arrangements that are of minor concern in some countries may present formidable difficulties in others. If obdurate customs officials, who would give no more priority to a package of isotopes than to one containing mundane materials, are encountered the problem must be dealt with at an early stage at a sufficiently high level and in a formal and definitive way so that frustrating processes do not have to be gone through on every occasion. Similarly, some forethought may be required to arrange transport of materials to user laboratories from arrival points in the country if, as is often the case, significant distances are involved. Some of the best achievements as well as great disappointments have been seen in this area. This drastic step is not recommended, nor is it likely to be generally followed, but nevertheless certain reasons may be suggested as to why well-intentioned and expensive training is sometimes wasted. Up to now, most training of personnel from developing countries has been undertaken in advanced western laboratories, many of which have little awareness of conditions in the trainee’s homeland. In itself this is not necessarily a major drawback and may be overcome should there be close and direct communication between host and recipient laboratories whenever a trainee is sent to a foreign country, so that what is learned is relevant to what is needed. Very few western laboratories run training programmes consciously designed to suit the needs of developing countries, but it must be acknowledged here that those who are aware of this problem and do attem pt to organize such programmes have made a great contribution indeed towards the progress of immunoassay in such countries. What commonly happens is that a trainee, found a placement on an ad hoc basis, finds himself involved in whatever specialized interest the training laboratory happens to be pursuing at that time. Training thus tends to be in techniques rather than in principles, resulting in the trainee being not sufficiently knowledgeable or adaptable to work in a different field under different conditions on his return. These remarks must not be misconstrued to mean that training for personnel from developing countries is required only at a most basic or elementary level. It is not possible to make blanket generalizations with regard to the level of sophistication of training, which must be decided upon in each case depending on the degree of expertise and other resources available in the home country and the extent of upgrading of these that is required. The hallmark of good training in the context of developing countries is adaptability to local situations and the better the training the more proficient the trainee would be in this respect. Attention has already been drawn to the advantages of close contact between host and recipient laboratories on the question of training, but in the final analysis those likely to benefit most by exposure to advanced western laboratories would be chiefly academic personnel with high educational levels, perhaps pursuing postgraduate degrees, or else senior technicians with some experience. At a lower level there would be many advantages in organizing as much training as possible within the region, in selected laboratories and by means of training courses organized on a regional basis. Here, trainees would encounter conditions more allied to those prevailing in the home situation, the techniques employed and the equipment used would be more similar and, as a minor but sometimes important point, they would encounter less difficulty in the way of personal problems and adaption to different cultural environments. Having drawn attention to the advantages of making the best use of facilities within a region, wherever possible, on the subject of training, it could now be stated that the principle could be applied to an even greater effect to the question of provision of suitable equipment and consumable supplies. Almost all major equipment items in developing countries are of western manufacture, though exceptions to this rule are being increasingly found with some items being locally made or assembled under licence. A reasonable and realistic standpoint on the vexed question of the sort of equipment most suitable for developing countries can only be reached if the situation is viewed in its true perspective avoiding, on the one hand, such simplistic notions as that these countries have no manpower problem because, technicians are available ‘ad lib’ from the vast reservoir of the unemployed, and on the other hand, tub-thumping pronouncements that the third world is being duped to serve as the dumping ground of unsuitable equipment for the benefit of western manufacturers. The actual situation is that in many developing countries there is at present a sufficiently high level of expertise as would allow the use of reasonably sophisticated nuclear medicine instruments such as counters, and where this is not yet so the situation is fast changing. Any degree of sophistica­ tion is acceptable within the framework of these conditions. It follows that its equipment should be such as would enable it to perform this function efficiently. With regard to the second point, inattention, lethargy, and lack of proper planning are found to be more at fault for the present situation where instruments malfunction all too frequently and are allowed to remain in that condition for long periods, rather than lack of technical expertise itself. The importance of matters such as housing instruments in suitable conditions of temperature and humidity and the provision of clean and stable power supplies is not realized, or no attention is paid to it. The fact that collaboration and co-operation between different departments or institutions is not always readily forthcoming is not a feature of developing countries alone, but the problem appears to be most acute where the need is greatest and the ivory towers may be more impregnable. An an example, a laboratory may not be able to utilize the services of an electronics engineer or technician from a different institution for no other reason than that a financial heading cannot be found under which the travelling costs involved could be accounted, not that the funds are unavailable. Although this picture may seem depressing, these problems are entirely solvable but not easily, or as a matter of course, and attention to them needs to be paid, not after the problems have occurred but well in advance, at the planning stage itself. Instances may also be related of instruments obtained by laboratories with so little forethought that the most ordinary or common sense factors have been overlooked. The voltage of a country’s power supply may be found inappropriate to that for which the instrument is designed to operate, only after its arrival in the country. Battery-operated survey meters, radiation monitors, or portable thyroid uptake measurement units are found to be fitted with special types of batteries locally unavailable when similar models using standard batteries could have been obtained.

Tension and the they personally use nylon for subcutaneous sutures resultant tearing of tissue in birds dictates the use of and stainless steel wire for skin cheap levamisole 150mg otc. It is Tissue adhesives of cyanoacrylate have many appli- important to use the smallest swaged-on atraumatic cations in avian medicine and surgery levamisole 150 mg. Many anoacrylate monomer is a liquid that polymerizes in visceral organs are very delicate and require that the the presence of the small amount of water present in surgeon develop specialized handling techniques levamisole 150mg line. The time required for the liquid to become solid and bond tissues depends on the amount of Evaluation of Suture Materials in Birds water (more water present will delay curing) and the The tissue reaction to five suture materials (poly- thickness of the acrylic applied (thicker will delay glactin 910, polydioxanone suture, monofilament ny- curing). Medical grade adhesivess are biologically in- lon, medium chromic catgut and monofilament stain- ert and cause minimal tissue reaction. Some prefer less steel) in pigeons was evaluated at 3, 7, 15, 30, 60, to use the less expensive commercial grade of glue 90 and 120 days following implantation in the body (eg, SuperGlue); however, these contain substances wall. The pigeons in this study developed a marked granulocytic inflammatory re- These materials hold tissues in approximation to sponse the the catgut that diminished during the allow healing to progress; however, cells cannot pene- period of evaluation; however, the material was still trate the adhesive. It is important not to allow the present at the end of the study indicating prolonged adhesive to run between the tissues to be apposed as absorption of the material. Polyglactin 910 is consid- the presence of the acrylic will delay healing by ered nonreactive in mammals. In some cases, especially process of hydrolysis and does not require enzyme with water birds, the acrylic may be applied in a thin degradation. In this study, polyglactin 910 caused the layer over the apposed incision to create a seal yet most intense inflammatory reaction but it was ab- allow epithelial cells to migrate under the acrylic sorbed the most quickly (completely gone by day 60). It is the limbs or digits of tiny patients to splints for considered nonreactive in mammals and is usually orthopedic problems and various other purposes. Caution should be exercised when using these mate- This material behaved similarly in the pigeons stud- rials in the presence of anesthetic gases with which ied. It caused minimal tissue reaction and absorption they are synergistic and may cause ocular irritation and vomiting in avian patients. Analgesics Postoperative Care Historically, it has been considered that birds have a remarkable capacity to deal with pain, although the assessment of what animals perceive as pain is diffi- cult. Research in the area of avian pain perception The patient should be placed in an incubator at 85°F has been minimal. Companion birds have a well with supplemental oxygen during recovery from sur- developed sense of touch and react by loud vocaliza- gery. It is best to continue maintaining the postsur- tion and withdrawal when potentially painful stim- gical patient in a small, controlled environment dur- uli are applied. Clients expect that analgesia will be ing the convalescent period (see Chapter 39). The provided for their pet, and it is the responsibility of patient’s activity level should be kept to a minimum the entire staff to relieve a patient’s postoperative to allow proper tissue healing. Food and water should be placed budgerigars3 to evaluate the effect of high doses of where they are easily accessed by the patient. Toys butorphanol tartratet and flunixin meglumine onu and extraneous objects within the enclosure should heart rate, motor control and respiratory rate. Postoperative antibiotic therapy should be instituted Butorphanol is an opioid analgesic with both agonist when there is a specific indication, such as with open, and antagonist properties, resulting in a “ceiling effect” contaminated wounds or where there has been in- such that above a maximum effective dose, neither traoperative contamination of the surgical field. The action perioperative antibiotic therapy is recommended for and potency of opiates and opioids is related to the specific receptor sites to which a given agent binds. In general, avian patients do not traumatize their There are three major types of opiate receptors. Mu surgical incisions, and they poorly tolerate bandages receptors mediate analgesia and euphoria. Elizabethan collars or neck braces also responsible for physical dependency, sedation should be reserved for the most desperate cases. Kappa receptors also Elizabethan collar is considered necessary, the pa- are involved in analgesia and, to a lesser degree, with tient’s neck should first be wrapped so the collar will sedation and respiratory depression. Using this stimulation results in cardiac and respiratory stimu- technique, a smaller, looser collar may be utilized. In some patients, the center core of cardboard from a Butorphanol exerts its effects at mu and kappa re- roll of bathroom tissue may be padded and used as a ceptors. Doses of 3 to 4 mg/kg of butorphanol given to neck brace alone or in conjunction with an Elizabe- budgerigars had no statistically significant effect on than collar. The first day, the Elizabethan collar 3 heart rate or respiratory rate; however, some treated should open rostrally in the traditional manner. This effect was considered will allow the patient time to become accustomed to minor and all birds remained alert. Return to normal the collar, and it will not damage the wings while the motor coordination occurred within two to four hours patient is struggling to escape the device. No gastrointestinal effects were day, the collar should be reversed such that the cone observed with this agent. Food and water should be placed on a pedestal to ten times this dose are safe in birds. The patient’s weight should be closely monitored to assure that an adequate amount of food Buprenorphine hydrochloridev is another opioid with and water is being consumed. The collar should be agonist/antagonist activity that appears to be effec- tive in controlling pain in avian patients. Vet Surg 18:269- Tissue reaction to five suture materi- Assoc 189:1017-1019, 1986.

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Polycyclic aromatic hydrocarbons buy levamisole 150 mg without prescription, aromatic amines 150 mg levamisole sale, and azo dyes must be metabolized by cytochrome P450–dependent mixed- function oxidases to active metabolites cheap 150 mg levamisole otc. Vinyl chloride is metabolized to an epoxide and is associated with angiosarcoma of the liver, not hepatocellu- lar carcinoma. Azo dyes, such as butter yellow and scarlet red, are metabo- lized to active compounds that have induced hepatocellular cancer in rats, but no human cases have been reported. In the past there has been an increase in bladder cancer in workers in the aniline dye and rubber industries who have been exposed to these compounds. Aflatoxin B1, a natural product of the fungus Aspergillus flavus, is metabolized to an epoxide. The fungus can grow on improperly stored peanuts and grains and is associated with the high incidence of hepatocellular carcinoma in some areas of Africa and the Far East. Bronchogenic carcinomas are associated with the development of many different types of paraneoplastic syndromes. These syndromes are usually associated with the secretion of certain substances by the tumor cells. This migratory thrombophlebitis is called Trousseau’s sign and is more classically associated with carcinoma of the pancreas. Hypertrophic osteoarthropathy is a syndrome consisting of periosteal new bone forma- tion with or without digital clubbing and joint effusion. It is most com- monly found in association with lung carcinoma, but it also occurs with other types of pulmonary disease. Erythrocytosis is associated with increased erythropoietin levels and some tumors, particularly renal cell carcinomas, hepatocellular carcinomas, and cerebellar hemangioblas- tomas. As such, this toxin can react with up to 10% of peripheral T cells, which leads to massive T cell activation and shock. Clin- ically, toxic shock syndrome is most often seen in women who use certain tampons that have been colonized with Staphylococcus. Multiple small yeasts surrounded by clear zones may be found within the cytoplasm of macrophages. The source for histoplasma is soil contaminated by the excreta of birds (starlings and chickens) and bats. The typical location for individuals to develop histoplasmosis is the Ohio and Mississippi Valley areas. Aspergillus species produce several clinical disease states, including allergic aspergillosis, systemic aspergillosis, and aspergilloma. Typically Aspergillus species are seen in tissue as acute angle–branching septate General Pathology Answers 93 hyphae; however, they may form fruiting bodies in cavities, such as within cystic cavities of the lungs. Blastomycosis is a chronic granulomatosis disease caused by a dimorphic fungus, B. In tissues this fungus is seen as a thick-walled yeast having broad-based budding. The infection, also known as Gilchrist’s disease, is seen in individuals living in the Ohio and Mississippi Valley areas and is usually confined to the lungs. Candida species, which frequently cause human infections, grow as yeasts, elongated chains of yeast without hyphae (pseudohyphae), or septate hyphae. Mucormyco- sis (zygomycosis) is a disease caused by “bread mold fungi” such as Rhizo- pus, Mucor, and Absidia species. One form of the disease, typically found in diabetics, is called rhinocerebral mucormycosis and is characterized by facial pain, headache, changing mental status, and a blood-tinged nasal discharge. Tissue sections reveal characteristic broad, nonseptate, right angle–branching hyphae. Vitamin K is required for the posttranslational conversion of glutamyl residues in some proteins into γ-carboxylates. For these four proclotting factors, this γ-carboxylation provides the calcium-binding sites necessary for the calcium-dependent interaction with a phospholipid surface. A deficiency of vitamin K, which can result from fat malabsorption, broad-spectrum antibiotics, or diffuse liver disease, produces a bleeding diathesis characterized by hematomas, ecchymoses, hematuria, melena, and bleeding from the gums. Common mediators of cell injury include chemicals, toxins, free radicals, and decreased oxygen delivery by the 94 Pathology blood. This decreases the efflux of sodium ions outside the cell and decreases the influx of potassium out of the cell, which increases the sodium ions inside the cell and increases the potassium ions outside the cell. The resultant net gain of intracellular ions causes isosmotic water accumulation and hydropic swelling (cloudy swelling) of the cell and the organelles of the cell. Decreased aerobic respiration by mitochondria also increases anaerobic glycolysis, which decreases intracellular pH by increas- ing lactic acid production (lactic acidosis). All of these changes that result from hypoxia are characteristic of reversible cellular injury, as they are reversible if blood flow and oxygen supply are restored. This type of injury is characterized by severe damage to mitochon- dria (vacuole formation), extensive damage to plasma membranes and nuclei, and rupture of lysosomes. Severe damage to mitochondria is char- acterized by the influx of calcium ions into the mitochondria and the sub- sequent formation of large, flocculent densities within the mitochondria. These flocculent densities are characteristically seen in irreversibly injured myocardial cells that undergo reperfusion soon after injury. Less severe changes in mitochondria, such as mitochondrial swelling, are seen with reversible injury. Cytochrome c released from damaged mitochondria can induce apoptosis, a process through which irreversibly injured cells can shrink and increase the eosinophilia of their cytoplasm. These shrunken apoptotic cells (apoptotic bodies) may be engulfed by adjacent cells or macrophages. Myelin figures are derived from plasma membranes and organelle membranes and can be seen with either reversible or irreversible injury. Psammoma bodies are small, laminated calcifications, while Russell bodies are round, eosinophilic aggregates of immunoglobulin.

Echocardiography in- dicated biatrial enlargement generic 150mg levamisole visa, distended hepatic vessels and ascites cheap levamisole 150mg without a prescription. Color-flow dop- pler indicated a mitral regurgitation and right sided heart failure best 150mg levamisole. Repeated echocardiography indicated a decrease in the size of the heart and liver. Congestive heart failure complicated by atrial fibrilla- tion due to mitral valve insufficiency has been reported in a Pukeko. The high incidence of cardio- vascular failure in meat-type poultry is prob- ably the result of genetic selection for rapid growth and high breast meat yield, with no attention to cardiovascular health and stress resistance. The practice of inbreeding certain species of companion birds for color or size variations could have a similar effect. Halothane described at high altitudes, but it also occurs sensitizes the heart to adrenalin-induced arrhythmias (courtesy of J. The relatively higher oxygen demand causes Clinical Findings a hypoxemia, which in turn induces a polycythemia. With polycythemia, the blood is more viscous and Heart enlargement with a thin left ventricular wall more difficult to pump through the lungs. The in- has been reported as a common occurrence in mynah 22 creased workload results in right ventricular dilata- birds. A de- crease of the heart rate can be seen due to improvement of the circula- tion and parasympathetic (vagal) stimulation. A moderate increase in dietary information is available with regard to digoxin ther- sodium for one week may cause congestive heart apy in birds. Digoxin pediatric drops, rather than Treatment digoxin tablets, should be used in birds to improve Once congestive heart failure has been diagnosed, the accuracy of dosing. The dosage adequate blood plasma levels in Quaker Conures must be adjusted for the individual bird, but 1-2 (Monk Parakeet). Vegetative Endocarditis Cardiac glycosides are indicated in congestive heart Endocarditis of the aortic and mitral valves may failure, especially when accompanied by atrial fibril- cause vascular insufficiency, lethargy and dyspnea. Ventricular tachycardia may be a contraindi- Valvular endocarditis is most common in birds with cation because digitalis may induce ventricular fibril- chronic infections (eg, salpingitis, hepatitis and bum- lation in these cases. The disease is asso- ciated with bacteremia, and thromboem- bolisms may occur throughout the vascula- ture. The initial damage to the heart valves that induces vegetative endocarditis is usually unknown. Factors that have been associated with endocardial or valvular lesions include chronic bacterial septicemia, frostbite, con- genital lesions (that alter blood flow) and degenerative myocarditis. Entero- Electrocardiographic Diagnosis: P pulmonale and P mitrale are indicative of biatrial enlargement. The dyspnea had become progressively more severe for the few days before evaluation. Total protein and protein Erysipelothrix rhusiopathiae was recovered electrophoresis were normal. Unsuccessful treatment with oxygen, gavage feed- from mitral and tricuspid valve lesions of a ing, furosemide and digoxin was attempted. Postmortem findings confirmed subclinical seven-year-old female swan that cardiohepatomegaly and severe ascites. Histologic examination of the liver 36 revealed fibrosis that was thought to have occurred secondary to right ventricu- was found dead in her enclosure. Chicken em- bryos are classic experimental animals to study tera- tologic effects of drugs on the heart. Various cardio- vascular malformations can experimentally be induced, especially intraventricular septal defects. Spontaneous cardiovascular malformations like du- plicitas cordis, multiplicatis cordis, ectopia cordis have been reported. Intraventricular septal de- fects are usually functionally closed, but in two per- cent of cases the condition is associated with conges- tive heart failure. Blood is shunted from left to right, which leads to right ventricular failure and ascites secondary to valvular insufficiency. Acquired Diseases In mammals, myocarditis can occur secondary to many common viral, bacterial, mycotic and proto- zoan infections. Cardiomyopathy has been associated with thyroid diseases, anemia, malnutrition, meta- bolic disorders, parasitic infections, pancreatitis, toxemias and neoplasia. Electrocardiography revealed a Fowl plague has been associated with myocardial heart rate = 120, P-wave = 0. Echocardiography indicated a large mass on the has been reported as a component of neuropathic aortic valve. A six-year-old curassow was presented with lethargy and a cool edematous left leg. Lesions consist generally of an enlarged Chlamydia Pasteurella and yellowish heart. A few affected birds may have Salmonella Chlamydia an excess of gelatinous fluid in the pericardial sac or Reovirus (Galliformes) Polyomavirus 69,75 Concurrent respiratory Avian serositis virus peritoneal cavity. Cardiomegaly Neuropathic gastric Polyomavirus dilatation Vitamin E and selenium deficiencies are well known Hemochromatosis Selenium and vitamin E 78 deficiencies as causes for cardiomyopathy in gallinaceous birds.

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