A Global Perspective on Vaccine Safety vaccines relative to the Jeryl–Lynn vaccine purchase levitra professional 20mg mastercard erectile dysfunction treatment after surgery. There is no and Public Health: The Global Advisory Committee on known viral explanation for this difference based on Vaccine Safety buy levitra professional with a mastercard erectile dysfunction treatment homeveda. Central auditory deafness Mild eruptive fever with a measles like rash generic 20 mg levitra professional with mastercard erectile dysfunction quick fix, appearing Mental retardation, Speech defects, Autism on first or second day of illness. The rash fades by the Cardiovascular system second day and disappears by the third. Lymphadenopathy helps to Ventricular septal defects 1 Eyes Retinopathy clinch the diagnosis when the rash is atypical. The Cataracts: pearly, dense, nuclear; 50 percent bilateral sequence of events is a prodrome, a rash, then Microphthalmos lymphadenopathy followed, at times, by complications. Transient neonatal m anifestations The causative agent is a togavirus that was Thrombocytopenia, +/- purpura Hepatospenomegaly successfully cultured in 1962. Prevalence is worldwide, Meningoencephalitis with occurrence of periodic epidemics. A person is infective for two weeks- with neonatal signs; laboratory confirmation of the about one week before and one week after the diagnosis is therefore recommended. Rubella virus may appearance of skin rash, the maximum infectivity being be isolated for 6 to 12 months following birth, and at the time of appearance of rash. Rubella-specific IgM is readily detected in infects the placenta and the developing fetus. Humans the first six months of life, and among a decreasing are the only known host. Its detection subclinical infections may be one to six times as usually indicates prenatal rather than postnatal infection. However, the presence of IgG in a When a woman is infected with the rubella virus early child over six months of age may indicate either prenatal in pregnancy (first trimester), she has a 90 percent or postnatal infection; and identification of low-avidity chance of passing the virus on to her fetus that may IgG1 will indicate prenatal infection. Sensorineural deafness The differential diagnosis includes measles, dengue, may occur following maternal infection up to the 19th parvovirus B-19, human herpesvirus-6, coxsackievirus, week of pregnancy, while cataract and heart disease only echovirus, adenovirus, and Streptococcus group A (beta occur after infection prior to the ninth gestational week. However, many infants only antibody titre between acute and convalescent specimens. The occurrence of such infection may or may solid long-term immunity in 95 percent cases. Confirmation can be obtained main purpose of rubella vaccination is to prevent 7 through serological tests and through isolation of the virus. There are a number of • Serological tests rubella vaccines available, either as single antigen – Presence of rubella specific IgM indicative of vaccines or combined with either measles vaccine recent infection. When stored at 4°C, its • Isolation of virus potency is maintained for at least five years. The vaccine This can be done from the pharynx during a period should be stored at 2°C – 8°C and protected from light. The vaccines are highly protective and References without significant adverse effects. In: Principles and Practice of Infectious have demonstrated that the benefits far outweigh the Diseases, Mandell G, et al (Eds). Control of Communicable Diseases in Man is also available in combination with measles and (15th edn). They tically, even the vaccine, which is a live one, may be may be bacterial or viral in etiology. The pneumococcal pneumonia is an acute febrile infec- Droplets, air, dust and fomites, all play a part in its tion with cough, dyspnea and, often, pleural pain. Its important complications are rheumatic fever monia is usually lobar or segmental but a bronchopneu- and acute glomerulonephritis, hence it should be treated monial involvement is common in childhood and old early. The causative agent is Streptococcus pneumoniae which has more than 75 antigenic subtypes depending upon the type of capsular antigen. The that are absorbed into the blood from the site of lesion infections spreads by droplets and by direct oral contact, while the bacteria remain localized. There are four but illness among casual contacts and attendants is clinical varieties: infrequent. Faucial: It is characterized by fever ranging from The incubation period is one to three days. There may be bleeding Immunity lasts for several years after an attack, but is if the membrane is detached. Laryngeal: It may be primary or secondary to to feed, lethargy, breathing trouble (head nodding), faucial diphtheria and is characterized by hoarseness, grunting in a child with fever and cough. Preventive loss of voice, croupy cough, obstruction to breathing measures being using warm clothes to cover the children and regression of chest wall, respiratory failure and during winter, keeping newborn babies especially death. Membranous vulvovaginitis may occur in contains 25 μg each of purified capsular polysaccharide children through common towels used in the nursery. Pneumococcal typical asymmetric, grayish-white appearance and strong vaccination is recommended in patients undergoing attachment to the underlying tissue. Such pseudo- splenectomy (preferably at least two weeks prior to membranes may extend into the nasal cavity and the splenectomy). Laryngeal diphtheria, which sometimes occurs even without Reference pharyngeal involvement, is a medical emergency that often requires tracheostomy. Expert Group of the Association of Physicians of India on Adult Immunization in India. It is an acute inflammation of throat due, most • Exposure to a suspect case of diphtheria in the 186 commonly, to Streptococcus hemolyticus, group A (beta previous one week or a diphtheria epidemic in the hemolytic) which also causes scarlet fever, impetigo, area. The occurrence of diphtheria reflects An illness characterized by laryngitis or pharyngitis or inadequate coverage of the national childhood tonsillitis and an adherent membrane of the tonsils, immunization program. Confirm ed (Laboratory Tests) Probable case that is laboratory confirmed or linked Causative Agent epidemiologically to a laboratory confirmed case, i. Corynebacterium diphtheriae, the Klebs-Loeffler bacillus isolation of the corynebacterium diphtheria from throat (discovered in 1884) is a slender, club-shaped, Gram- swab or four fold or greater rise in serum antibody titer positive bacillus that exists in four biotypes (gravis, mitis, (only if both serum samples are obtained before belfanti and intermedius). The heat-stable O-antigen is common to all Myocarditis and neuropathy are the most common and corynebacteria, whereas the variable, heat-labile K- antigen permits differentiation between individual most serious complications. Also, while the K-antigen is important for block, cardiac arrhythmias and heart failure, which mucosal attachment, invasiveness is facilitated by the cord develop at the end of 2nd or beginning of 3rd week. The most important virulence The neuropathy usually involves the paralysis of cranial factor of C. Outside the host cell, the exotoxin The extent of toxin absorption depends largely on is relatively inactive, but following cellular attachment and the extent of the mucosal lesions. Diphtheria exotoxin causes both form (erythema of pharynx, no membranes), (ii) the 1 local and systemic cell destruction. Mitis type is more follicular form (patches of exudates over pharynx and common in India.
The most common lesions in the anterior mediastinum are thymomas discount 20mg levitra professional erectile dysfunction testosterone, lymphomas buy genuine levitra professional erectile dysfunction doctors in nc, teratomatous neoplasms levitra professional 20mg cheap erectile dysfunction and diabetes type 2, and thyroid masses. The most common masses in the middle mediastinum are vascular masses, lymph node enlargement from metastases or granulomatous disease, and pleuropericardial and bronchogenic cysts. In the posterior mediastinum, neurogenic tumors, meningoceles, meningomyeloceles, gastroenteric cysts, and esophageal diverticula are commonly found. If the epithelial cells of the thymus become neoplastic, the tumor that develops is a thymoma. The epithelial component of the tumor may consist primarily of round or oval cells derived mainly from the cortex or spindle-shaped cells derived mainly from the medulla or combinations thereof. In addition to myasthenia gravis, other paraneoplastic syndromes, such as acquired hypogammaglobulinemia, pure red cell aplasia, Graves disease, pernicious anemia, dermatomyositis-polymyositis, and Cushing syndrome, can be seen. Diffuse and limited scleroderma are both a systemic disease, whereas the linear/morphea form is localized to the skin. Difuse Scleroderma Diffuse scleroderma (progressive systemic sclerosis) is the most severe form. It has a rapid onset, involves more widespread skin hardening, will generally cause much internal organ damage (especifcally the lungs and gastrointestinal tract), and is generally more life- threatening. Skin hardening is usually confned to the hands and face, internal organ involvement is less severe, and a much better prognosis is expected. In typical cases of limited scleroderma, Raynaud’s phenomenon may precede scleroderma by several years. Morphea/Linear Scleroderma Morphea/linear scleroderma involves isolated patches of hardened skin. Diagnosis is by clinical suspicion, presence of autoantibodies (especifcally anti-centromere and anti-scl70/anti-topoisomerase antibodies) and occasionally by biopsy. Anti-centromere antibody is more common in the limited form (80-90%) than in the systemic form (10%), and anti-scl70 is more common in the diffuse form (30-40%). Splenic macrophages in Gaucher’s disease differ from histiocytosis is positivity for which of the following? Two biopsies take from the (d) Keratin 14 lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infltrating the sub- 3. In familial Mediterranean fever, the gene encoding the frozen section biopsy in histopathology laboratory? A 14 years old girl on exposure to cold develop pallor of (c) Neural extremities followed by pain and cyanosis. Which of the following diseases have an underlying (a) Triad of diarrhea, dementia and dermatitis mitochondrial abnormality? Most common second malignancy in patients with (a) Dermatitis, glossitis, steatorrhea familial retinoblastoma is: (Karnataka 2004) (b) Dermatitis, glossitis, alopecia (a) Teratoma (c) Mental changes, diarrhea, alopecia (b) Medullary carcinoma (d) Dermatitis, dementia, diarrhea (c) Osteosarcoma 45. Frozen section biopsy in not used for: (Bihar 2005) (c) Disarrangement of tooth (a) Enzyme (d) Dysplastic leukoplakia (b) Amyloid 43. Endothelial cells have: (Bihar 2003) (c) Pleomorphic adenoma (a) Weibel Palade bodies (d) None (b) Gamma Gandy bodies (c) Both 56. They are essential for normal colla- gen fbrillogenesis in various connective tissues like cornea. Prognostic factors in Neuroblastoma • Age and stage: Good prognosis in infants regardless of stage. Note: Most characteristic cytogenetic abnormality in neuroblastoma is 1p deletion. It is important to distinguish verrucuous carcinomas from squamous cell carcinoma as these tend to remain localized and are cured by wide excision, however they may undergo malignant transformation to invasive squamous cell carcinomas. Features of verrucuous carcinomas • Predilection for males > 50 years • Predisposed in tobacco users, poor oral hygiene • Grossly, it is a soft, large, wart like (papillomatous) lesion which may show fungation • Microscopically: – Cytological features of malignancy are absent or minimal and rare – Epithelium is thickened and thrown into papillary folds – The folds project both above and below the level of surrounding mucosa and crypt like surface grooves exhibit marked, pre-keratin plugging. Because some are too small to be detected cytogenetically, they are termed as microdeletion syndromes The important microdeletion syndromes are: 1. Miller-Dieker syndrome 17p 13 Deletions involving the long arm of chromosome 22 (22q 11) are the most common microdeletions identifed to date. A pair of connexins from adjacent cells joins to form a gap junction that bridges the 2-4 mm gap between the cells. The presentation of multiple faccid bullae and oral lesions in a young boy is suggestive of Pemphigus vulgaris. An im- portant histological fnding in pemphigus is acantholysis which is dissolution, or lysis, of the intercellular adhesion sites within a squamous epithelial surface. The suprabasal acantholytic blister that forms is characteristic of pemphigus vulgaris. The antibody in pemphigus vulgaris reacts with desmoglein 1 and 3, a component of the desmosomes that ap- pear to bind keratinocytes together. By direct immunofuorescence, lesional sites show a characteristic netlike pattern of intercellular IgG deposits. The bullae are tense and oral lesions are present in 10-15% of affected individuals. The disease results from formation of an- tibodies against gliadin and is associated with celiac disease. By direct immunofuorescence, dermatitis herpetiformis shows granular deposits of IgA selectively localized in the tips of dermal papillae. There is selective involvement of su- perfcial epidermis at the level of the stratum granulosum. It usually affects the scalp, face, chest, and back, and the mucous membranes are only rarely affected. The blanching, or pallor, represents the ischemic phase of the phenomenon and results from vasospasm of digital arteries. During the ischemic phase, capillaries and venules dilate, and cyanosis results from the deoxygenated blood that is present in these vessels. A sensation of cold or numbness or paresthesia of the digits often accompanies the phases of pallor and cyanosis. Abnormalities of the digital vessels may contribute to the development of Raynaud’s phenomenon in this disorder. Occasionally, persistent digital ischemia develops and may result in ulcers or gangrene. In most severe cases, the small vessels are occluded by a proliferative endarteritis. Raynaud’s phenomenon occurs in about 30% of patients with dermatomyositis or polymyositis. It frequently develops in patients with rheu- matoid arthritis and may be related to the intimal proliferation that occurs in the digital arteries.
W. Dimitar. Potomac College.