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By H. Muntasir. Anderson College. 2018.

The adjacent spinal cord loses its normal structure and becomes a mixed glial-mesenchymal scar purchase kamagra soft 100mg line, poorly demarcated from the meninges to which it had become adherent buy kamagra soft 100 mg amex. Indirect Injuries to the Spinal Cord These are blunt force or compressive injuries secondary to spinal trauma. While they occasionally result from temporary spinal deformities, they are more commonly the result of spinal fracture or subluxation. It should be borne in mind that spinal instability may result in temporary deformity that is not appreciated at the time of examination but that has already caused injury to the cord. Injury to the cervical spine is generally the result of cranial or facial injuries, commonly the result of motor vehicle accidents or falls. Motorcycle and diving accidents are particularly likely to result in such injuries. Thoracic spine fractures are more commonly the result of industrial accidents, such as mining cave-ins or collapsed roofs, in which weight falls on the victim. The immediate effects of spinal cord compression are necrosis, hemorrhage, edema, and inflammation. The edema resolves after two or three weeks, and the necrotic foci become infiltrated by phagocytes. During this period the blood becomes resorbed, which can result in the formation of a syrinx (cystic space within the spinal cord). In less severely damaged areas, the astrocytic component predominates, while in the most severely damaged areas the scar is entirely fibroblastic, the glia having been lost with the other elements of the cord. Eventually, the injured portion of the cord is reduced to scar tissue, which is adherent to, and indistinct from, the surrounding meninges. Victims become bedridden or wheelchair-bound, with all the attendant problems, and they frequently require urethral catheterization. Common long-term sequelae include infected decubitis ulcers and urinary tract infections, and such infections often result in death years after the injury. Occasionally, a syrinx that forms during the resolution of a cord injury may enlarge years after the injury. If the injury has resulted in a motor and sensory level, additional symptoms will appear if there is rostral extension of the syrinx, while caudal extension will be clinically silent. Correlation of survival time with size of axonal swellings in diffuse axonal injury. These images, contributed and reviewed by the relevant lecturers, have been arranged in the thematic order of the Syllabus. Due to the diversity of source material and the initial films, it has been difficult to provide you with flawless color reproductions of all lesions - despite numerous attempts. For example, some fresh (unfixed) brain specimens tend to have a slightly yellow tint, while the fixed specimens are more faithfully reproduced. Likewise, some hematoxylin-eosin stained sections tend to be more red than pink, while the special stains tend to display their true colors. In spite of these limitations, we believe that these images will prove to be a powerful tool in your learning process, and we encourage you to study them along with the Syllabus and refer to them throughout your clinical years. For your orientation, all gross specimens are coronal sections and have been fixed in Formalin (10% formaldehyde) unless otherwise specified, all microscopic slides have been stained with the standard hematoxylin-eosin unless otherwise specified, and all electron micrographs have been stained with uranyl acetate-lead citrate or hydroxide. As a general rule, coronal and transverse sections of the brain, brain stem, and spinal cord are presented from the posterior or caudal aspect (P-A view, like the usual chest X- ray). We have expanded the text of this guide, since your predecessors strongly recommended that this would be a significant improvement. Nonetheless, some lesions in the slides have not received comment, so that you can focus more easily on the major lesion. Additionally, there are some excellent atlases of Neuropathology available in the Health Sciences Library. Atrophic neurons (arrows) with contracted cytoplasm and pyknotic nucleus, and its normal counterpart (bottom left) Cell atrophy is the major neuronal alteration in a variety of neurodegenerative diseases (for example, amyotrophic lateral sclerosis) in which the nerve cell dies - ". Perikaryal distension with rounding of the cell contour and displacement of Nissl substance (fine bluish granules) to the periphery. If the damage occurs close to the cell body, especially proximal to the first internode, the cell will likely die. The "chromatolysis" reflects displacement of basophilic ribosomes from rough endoplasmic reticulum to the cytoplasm in an attempt to synthesize the cytoskeletal elements necessary for the reconstitution of the axon. No abnormalities elsewhere A particular "system," in this case the corticospinal projection, is affected selectively.

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Factors Influencing the Rate of Chemical Reactions If you pour vinegar into baking soda generic 100mg kamagra soft visa, the reaction is instantaneous kamagra soft 100mg overnight delivery; the concoction will bubble and fizz. Properties of the Reactants If chemical reactions are to occur quickly, the atoms in the reactants have to have easy access to one another. Among other things, chewing increases the surface area of the food so that digestive chemicals can more easily get at it. As a general rule, gases tend to react faster than liquids or solids, again because it takes energy to separate particles of a substance, and gases by definition already have space between their particles. Similarly, the larger the molecule, the greater the number of total bonds, so reactions involving smaller molecules, with fewer total bonds, would be expected to proceed faster. Reactions that involve highly reactive elements like hydrogen proceed more quickly than reactions that involve less reactive elements. The higher the temperature, the faster the particles move, and the more likely they are to come in contact and react. But as more and more people get up to dance—especially if the music is fast—collisions are likely to occur. It is the same with chemical reactions: the more particles present within a given space, the more likely those particles are to bump into one another. This means that chemists can speed up chemical reactions not only by increasing the concentration of particles—the number of particles in the space—but also by decreasing the volume of the space, which would correspondingly increase the pressure. If there were 100 dancers in that club, and the manager abruptly moved the party to a room half the size, the concentration of the dancers would double in the new space, and the likelihood of collisions would increase accordingly. Enzymes and Other Catalysts For two chemicals in nature to react with each other they first have to come into contact, and this occurs through random collisions. Because heat helps increase the kinetic energy of atoms, ions, and molecules, it promotes their collision. But in the body, extremely high heat—such as a very high fever—can damage body cells and be life-threatening. On the other hand, normal body temperature is not high enough to promote the chemical reactions that sustain life. In chemistry, a catalyst is a substance that increases the rate of a chemical reaction without itself undergoing any change. They help increase the rate and force at which atoms, ions, and molecules collide, thereby increasing the probability that their valence shell electrons will interact. Like all catalysts, enzymes work by lowering the level of energy that needs to be invested in a chemical reaction. A chemical reaction’s activation energy is the “threshold” level of energy needed to break the bonds in the reactants. Without an enzyme to act as a catalyst, a much larger investment of energy is needed to ignite a chemical reaction (Figure 2. This section of the chapter narrows the focus to the chemistry of human life; that is, the compounds important for the body’s structure and function. Organic compounds are synthesized via covalent bonds within living organisms, including the human body. You will soon discover how these two elements combine in the foods you eat, in the compounds that make up your body structure, and in the chemicals that fuel your functioning. The following section examines the three groups of inorganic compounds essential to life: water, salts, acids, and bases. Just as oil lubricates the hinge on a door, water in synovial fluid lubricates the actions of body joints, and water in pleural fluid helps the lungs expand and recoil with breathing. Watery fluids help keep food flowing through the digestive tract, and ensure that the movement of adjacent abdominal organs is friction free. Water also protects cells and organs from physical trauma, cushioning the brain within the skull, for example, and protecting the delicate nerve tissue of the eyes. Water as a Heat Sink A heat sink is a substance or object that absorbs and dissipates heat but does not experience a corresponding increase in temperature. In the body, water absorbs the heat generated by chemical reactions without greatly increasing in temperature. Moreover, when the environmental temperature soars, the water stored in the body helps keep the body cool. This cooling effect happens as warm blood from the body’s core flows to the blood vessels just under the skin and is transferred to the environment.

Patients who suffer pulmonary contusions are often victims of blunt trauma with multiple injuries (25 cheap 100 mg kamagra soft, 56) buy cheap kamagra soft 100 mg on line. The hospital mortality in patients with pulmonary contusion and extrathoracic lesions was 6/42 (19%) due to associated injuries, mostly central nervous system lesions (4/6). The nature of lung lesions (contusion with or without flail chest, lacerations, and lung hematomas) showed a tendency towards the group with extrathoracic lesions but this was not significant. Therefore, we consider the concomitant lung contusion in patients with chest trauma as a benign lesion. The diagnosis of penetrating cardiac injury should be considered in all patients with penetrating wound to the chest, neck or upper abdomen, with cardiovascular instability. Pericardial tamponade means the presence of bleeding into the pericardial sac, impairing heart function. These vital signs are cardinal in all patients with chest trauma and are usually documented, whether positive or negative. However, congested neck veins could be caused by tension pneumothorax and even in the presence of a cardiac tamponade this sign might be absent due to hypotension caused by bleeding from other injuries. Therefore, we have not relied just on muffled heart sound as a diagnostic criteria when it was the only sign found. When the patient presents with a weapon like a knife or any object penetrating the chest, this must not be disturbed since the object serves as a tamponade by sealing the cardiac wound (95, 144). This should be done only after making the appropriate incision, enabling the surgeon to perform the extraction under direct visual control. Aortic rupture is thought to occur either from traction or shear forces generated between relatively mobile portions of the vessel and points of fixation or, secondly, due to direct compression over the vertebral column or, thirdly, caused by an excessive increase of intraluminal pressure. However, our observations in patients with sternal fractures may make selection easier and avoid unnecessary angiograms (102). In a twenty-year meta-analysis study (136), the authors found only 1742 patients who reached the hospital alive. So it is useful in selected subacute patients particularly those patients subjected to delayed treatment. If treatment has to be delayed, patients are recommended to be kept on the lowest blood pressure that they can tolerate. Iatrogenic penetration of the descending thoracic aorta with a nail during a neurosurgical procedure was also reported in our material (104). However, no tracheobronchial injuries, air embolism or thoracic duct injuries have been detected in our series. Such a policy includes improvements in motor vehicle design, air bags and passive restraint devices which altogether have the greatest impact in reducing mortality (117). All penetrating injuries in this thesis were caused by different types of knives, and one would suggest and encourage the Swedish and Danish laws to mandate knife control legislation besides gun control legislation. The majority of trauma deaths take place in the prehospital phase, prior to initiation of resuscitation, and the only cure is to prevent them from occurring. Furthermore, the majority of surgeons - even those working with trauma - are not involved in injury prevention programs which are important for both the medical staff as well as the public (59). A thorough knowledge of trauma care (128, 129, 143), especially early recognition, rapid transport to hospital (20), aggressive resuscitation and expeditious surgical intervention are essential for successful management. Technology is also needed to improve the performance of chest protectors used in sports so as to decrease or prevent the incidence of cases with commotio cordis usually seen in young healthy athletes who die immediately on the scene (135). The point of maximal weakness of the thoracic cage is located at 60 degrees rotation from the sternum (134). This has significant implications for automotive design as 32% of passenger car fatalities take place in lateral impact crashes, which frequently involve the elderly and the risk for injury increases steadily with age (133). This may help in the development of chest stress wave decouplers to protect the lungs from overpressure (28). The minimally invasive nature of endovascular stents make them very attractive in accordance with the new trend in surgery to develop less invasive procedures aiming at reduction of operative risks and complications.

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Advances in techniques of testing mycobacterial drug sensitivity safe kamagra soft 100 mg, and the use of sensitivity tests in tuberculosis control programmes order 100mg kamagra soft overnight delivery. Tetrazolium microplate assay as a rapid and inex- pensive colorimetric method for determination of antibiotic susceptibility of Mycobacte- rium tuberculosis. Rapid, efficient detection and drug susceptibility testing of Mycobacterium tuberculosis in sputum by microscopic observation of broth cultures. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide, 2000-2004. Direct detection in clinical samples of multiple gene mutations causing resistance of Mycobacterium tuberculosis to isoniazid and rifampicin using fluorogenic probes. Rapid detection of resistance in Mycobacterium tuberculosis: a review discussing molecular approaches. Evaluation of mycobacteria growth indicator tube for direct and indirect drug susceptibility testing of Mycobacterium tuberculosis from respiratory specimens in a Siberian prison hospital. Evaluation of hybridisation on oligonucleo- tide microarrays for analysis of drug-resistant Mycobacterium tuberculosis. Recent advances in molecular methods for early diagnosis of tuberculosis and drug-resistant tuberculosis. Drug susceptibility testing of Mycobacterium tuberculosis: a neglected problem at the turn of the century. Rapid assessment of drug susceptibilities of Mycobacterium tuberculosis by means of luciferase reporter phages. Application of molecular genetic methods in macrolide, lincosamide and streptogramin resistance diagnostics and in detection of drug-resistant Mycobacte- rium tuberculosis. Rapid, auto- mated, nonradiometric susceptibility testing of Mycobacterium tuberculosis complex to four first-line antituberculous drugs used in standard short-course chemotherapy. Resazurin microtiter assay plate testing of Mycobacterium tuberculosis susceptibilities to second-line drugs: rapid, simple, and inexpensive method. Multicenter evaluation of the nitrate reductase assay for drug resistance detection of Mycobacterium tuberculosis. Rapid detection of ofloxacin resistance in Mycobac- terium tuberculosis by two low-cost colorimetric methods: resazurin and nitrate reduc- tase assays. Colorimetric redox-indicator methods for the rapid detection of multidrug resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis. A new rapid and simple colorimetric method to detect pyrazinamide resistance in Mycobacterium tuber- culosis using nicotinamide. A microplate indi- cator-based method for determining the susceptibility of multidrug-resistant Mycobacte- rium tuberculosis to antimicrobial agents. A low cost, home-made, reverse-line blot hy- bridisation assay for rapid detection of rifampicin resistance in Mycobacterium tubercu- losis. A commercial line probe assay for the rapid detection of rifampicin resistance in Mycobacterium tuberculosis: a systematic review and meta-analysis. Rapid colorimetric assay for cellular growth and survival: application to proliferation and cytotoxicity assays. Use of 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyl tetrazolium bromide for rapid detection of rifampin-resistant Mycobacterium tu- berculosis. Drug susceptibility testing of Mycobacte- rium tuberculosis by a nitrate reductase assay applied directly on microscopy-positive sputum samples. Susceptibility testing of Mycobacteria, Nocardia, and other aerobic actinomy- cetes; tentative standard – second edition. Investigation of the Alamar Blue (resazurin) fluorescent dye for the assessment of mammalian cell cytotoxicity. Bacteriophage-based assays for the rapid detection of rifampicin resistance in Mycobacterium tuberculosis: a meta- analysis. Nonconventional and new methods in the diagnosis of tuberculosis: feasi- bility and applicability in the field. Resazurin micro- titer assay plate: simple and inexpensive method for detection of drug resistance in My- cobacterium tuberculosis.

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Foreign body - Can be on the conjunctiva or cornea - Can be metallic or non metallic - The most common eye injury Conjunctival foreign body buy discount kamagra soft 100 mg on line. Irrigate with normal saline or tape water if foreign body can not be traced Corneal foreign body kamagra soft 100mg. Conjunctival laceration Usually self healing but if it is large(>1cm) it needs referral for suturing with special suture. Conjunctival hemorrhage Bleeding beneath the conjunctiva Causes -trauma -Spontaneously Treatment Self limiting, hemorrhage will resolve approximately within two weeks 3. Chemical burn - Irritation of the eye because of accidental entry of a chemical is a common problem among factory workers - A various types of acids and alkali are incriminated - Patients have marked pain with tearing, photophobia and blepharospasm. Cornea may be edematous and hazy or opaque Treatment - Copious irrigation with water immediately after the incident - Removal of particulate material from the Conjunctival sac - Prophylactic topical antibiotics - Cycloplegic agent to relieve pain 4. Non penetrating or blunt eye ball injuries It can be by a thrown object or a fist Associated finding in the eye lids would be bruise and /or hemorrhage 68 Complication. Hyphema – blood in the anterior chamber Treatment: patching, semi sitted position and early referral. How are you going to manage a patient who came to you having chemical injury eyes? At the end of the course, students are expected to consider one or more ophthalmic manifestation for most of systemic disease that will range from mild self limiting to sever sight threatening condition. Most systemic diseases have one or more ophthalmic manifestation that ranges from mild self limiting to sight threatening conditions. Ophthalmic manifestation of diabetes mellitus 1- Diabetic retinopathy it is a disorder of the retinal vasculature that eventually develops to some degree in nearly all patients with longstanding diabetes mellitus. It has been suggested that exposure to hyperglycemia over an extended period of time results in ultimate vascular damage which is a micro-angiopathy of retinal vessels that result in micro vascular occlusion and leakage. Micro vascular occlusion will cause hypoxia of the retina and stimulate new blood vessel formation. Risk factors Duration of diabetic mellitus Age of onset Blood glucose control Co morbid illness like pregnancy, hypertension, renal diseases smoking etc Clinical symptoms and signs - Normal or reduced vision - Retinal findings include exudates, hemorrhage, new vessel formation Management Strict blood glucose control Avoid risk factors Refer to ophthalmic center for evaluation Follow up 2-Diabetic cataract 3- Others- refractive error, cranial nerve palsy, Neovascular Glaucoma B. Hypertensive retinopathy It will have retinal vascular change with arterial thickening, leakage and hemorrhage over the fundus. Symptoms Normal or reduced vision Nausea Headache Vomiting 72 Signs Normal or reduced V/A Elevated blood pressure Vascular thickening, exudates, hemorrhages ,papilledema etc on the retina Management Control of blood pressure Refer to ophthalmic center for better evaluation C. Patients will have recurrent opportunistic infections or of unusual tumors in association with a dysfunctional cellular system. Ophthalmic herpes zoster - is caused by varicella zoster - eye is affected through ophthalmic branch of trigeminal nerve. Molluscum contagiosum - In immunocompromized patient, it is multiple, large size, bilateral, recurrent and resistant to treatment. Sign ¾ single or multiple ¾ Pale, waxy ¾ umblicated nodules ¾ If the nodule is located on the lid margin it may give rise to ipsilateral chronic follicular conjunctivitis and occasionally a superficial keratitis 74 Treatment ¾ Expression ¾ shaving and excision ¾ destruction of the lesion by cauterization, cryotherapy 3. Squamous Cell Carcinoma - a malignant neoplasm of keratinizing cells of the epidermis. Kaposi’s Sarcoma a malignant vascular tumor that develops on the skin, mucous membrane, lymph node and visceral organs. It appears like flat or raised non tender , purple red -dark reddish lesion over the eye lid or conjunctiva. Cranial nerve palsy If the third, fourth, or sixth nerves are affected, there will be diplopia. These forms are more effective for the front of the eye, the conjunctiva, cornea, anterior chamber and iris. Drops are the most convenient and common way of giving topical treatment to the eye. If high levels of the drug need to be maintained, the drops must be applied frequently.

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