By Q. Akascha. Saint Olaf College.

T-cell mediated immune response induces hypersensitivity to the organisms and controls 95% of primary infection 60pills speman with amex. This is associated with progressive fibrosis and calcification of persistent caseous debris buy generic speman 60 pills line. Moreover, most bacilli die but few remain viable for years until the persons immune response fails. However, if the infected person is immunologically immature, as in a young child or immunocompromized (eg. Such persons lack the capacity to coordinate integrated hypersensitivity and cell- mediated immune responses to the organism and thus often lack the capacity to contain the infection. Granulomas are poorly formed or not formed at all, and infection progresses at the primary site in the lung, the regional lymph nodes or at multiple sites of disseminations. Progressive primary tuberculous pneumonia: commonly seen in children less than five years of age but it ours in adults as well in those with suppressed or defective immunity. Subpleural focus may discharge bacilli or antigen into the pleural cavity resulting in the development of pleural effusion. Hilar or mediastinal groups of lymph nodes enlargement with caseous necrosis that may result in: a. Obstruction of the bronchus by the enlarged lymph nodes leading to lobar collapse. The caseous hilar lymph node may penetrate the bronchial wall and resulting in rupture of the wall with pouring of caseous materials into the bronchus hence, tuberculosis broncho-pneumonia ensues. The caseous materials may be disseminated to other parts of the body via blood streams. Miliary tuberculosis It refers to disseminated sites that produce multiple, small yellow nodular lesions in several organs. Intestinal primary infection The primary complex is similar to that of the lungs the initial site may be in the gum with lymphatic spread of bacilli to the cervical lymph nodes the commonest location for the primary lesion is the illocaecal region with local mesenteric node involvement. Lymph nodes Tuberculous lymph adenitis is the most common type of extra pulmonary tuberculosis that frequently involves the cervical groups of lymph nodes with enlargement, and subsequent periadenitis followed by matting and eventual ulcerations if left untreated. Skin is also involved in various forms of tuberculosis Post -primary (secondary) tuberculosis Conventionally the term post-primary tuberculosis is used for lung infections occurring 5 years or more after the primary infection. The commonest sites for post primary tuberculosis are the posterior or apical segment of the upper lobe and the superior segment of the lower lobe and their predilection for the anatomy location is due to good ventilation. Hypersensitivity reaction is well- developed and it thus, restricts the granulomatous reactions locally. Pulmonary and bronchial arteries around caseous cavities are occluded by endarteritis obliterans where the wall of the artery may weaken resulting in aneurysm formation (mycotic aneurism) that may occasionally rupture and cause hemoptosis. Certain tissues are relatively resistant to tuberculous infection, so it is rare to find tubercles in the heart, skeletal muscle, thyrord and pancreas. This results in less well-formed granulomas, and more frequently necrotic material that contain more abundant acid-fast organisms histologically. These infections are usually widely disseminated throughout the reticuloendothelial systems causing enlargement of involved lymph nodes, liver and 10 spleen. The organisms are present in large numbers as many as 10 organism per gram of tissue. Leprosy Definiton: Leprosy or Hansen disease is a slowly progressive infection caused by Mycobacterium leprae affecting the skin and peripheral nerves and resulting mainly in deformity, paralysis and ulceration. Pathogenesis: The bacillus is acid fast, obligate intracellular organism that does not grow in culture and 0 it grows best at 32-34 C of the temperature of human skin. The bacilli thus produce either potentially destructive granulomas or by interference with the metabolism of cells. The bacilli are taken by alveolar macrophages; disseminate through the blood but grows only in relatively cool tissues of the skin and extremities. Two forms of the disease occur depending on whether the host mounts a T-cell mediated immune response (tuberculoid leprosy) or the host is anergic (lepromatous leprosy). The polar forms are relatively stable but the borderline forms (border line-tuberculoid, borderline-borderline, and borderline-lepromatous) are unstable without treatment. Patients with tuberculoid leprosy form granuloma with few surviving bacteria (paucibacillary disease). Antibody production is not protective in lepromatous leprosy and rather the formation of antigen antibody complexes in lepromatous leprosy leads to erythema nodosum leprosum, a life threatening vasculitis, and glomerulonephrits 173 Because of the diffuse parasite filled lesions lepromatous leprosy is more infectious than those with tuberculoid leprosy. The vital organs and the central nervous system are rarely affected presumably because the core temperature is too high for the growth of M. Syphilis Definition: Syphilis is a systemic infection caused by the spirochete Treponema pallidium, which is transmitted mainly by direct sexual intercourse (venereal syphilis) and less commonly via placenta (congenital syphilis) or by accidental inoculation from the infectious materials. Pallidum spirochetes cannot be cultured but are detected by silver stains, dark field examination and immunofluorescence technique. Pathogenesis: The organism is delicate and susceptible to drying and does not survive long outside the body. Morphology: Syphilis is classified into three stages Primary syphilis (chancre): Chancre appears as a hard, erythematous, firm; painless slightly elevated papule on nodule with regional lymph nodes enlargements.

It involves gently spreading the vagina open (with a speculum) and taking a sample of cells from the cervix to look for changes that can indicate early stages of cervical cancer order speman 60pills with mastercard. This increases the risk of ovarian order 60 pills speman with amex, uterine, and cervical disease (including cancer) not being caught until it has advanced beyond the point where it can be treated. If you have had cervical cancer or high-grade abnormal Pap smears (cervical dysplasia) in the past, even after your cervix is removed you will 14 still need to get samples of the cells of the top of your vagina (vaginal cuff) to check for cancer. It is recommended that you get vaginal cuff smears done every year until you have three normal tests in a row, then they can be done every 2 years. Having them removed lowers your estrogen and therefore the amount of testosterone you need to overcome the effects of estrogen. The health risks of long-term use of relatively high doses of testosterone are not known, and some doctors and trans people believe that lower doses are lower risk. If your combined estrogen and testosterone are too low you are at risk for loss of bone density (see booklet on osteoporosis), so if you have your ovaries removed you will have to take some type of medication to protect your bones (if you have bad side effects from testosterone, there are other options). Changing the birth certificate makes it easier to change legal sex on other documents and records. Surgical techniques for hysterectomy/oophorectomy Hysterectomy In the past the only option for hysterectomy was a large cut across the abdominal muscles. Several small cuts are made in the bellybutton/abdomen and a tiny telescopic camera (laparoscope) and other surgical instruments are passed into the pelvis. The camera is used by the surgeon to see the uterus 15 and other pelvic organs, and the surgical instruments are used to snip the tissues holding the uterus and cervix in place. The uterus (and possibly cervix) is removed through a cut in the vagina (vaginal hysterectomy) or alongside the abdominal muscles (abdominal hysterectomy), and the top of the vagina is sewn shut. It is up to you and your surgeon to decide together whether to do abdominal or vaginal hysterectomy. Abdominal hysterectomy involves a larger incision than with vaginal hysterectomy, so can take longer to heal. However, a vaginal hysterectomy can be difficult to do if you have never had penetrative vaginal sex or have a small vagina (especially if your vagina has atrophied from taking testosterone over a long period of time), or if your uterus has become attached to other organs due to adhesions from endometriosis or another gynecological condition. Oophorectomy This is usually done at the same time as hysterectomy and usually involves removal of ovaries and fallopian tubes on both sides (bilateral salpingo-oophorectomy). It is usually done through laparoscopic abdominal incisions as described above for hysterectomy. If you are having hysterectomy/oophorectomy to treat pre-existing medical problems (pain, bleeding, etc. The wait for surgery depends on how much of an emergency the condition is; if its considered serious you will have surgery sooner than if it is considered a minor health problem. Mental health assessment is generally not required to have hysterectomy/oophorectomy for a physical health problem unless the surgeon has concerns about your ability to provide informed consent or doesnt think you are psychologically prepared for surgery. If you are wanting hysterectomy/oophorectomy to reduce dysphoria, to change your legal sex, or for other reasons that are considered part of gender transition, your surgeon will likely treat the surgery differently. What to expect before and after hysterectomy/ oophorectomy At the hospital You will be admitted the same day as your surgery. You may be prescribed antibiotics to help reduce the risk of infection, or laxatives to clean out your bowels. You will be monitored by hospital staff as you come out of the anesthetic and will stay in hospital for 25 days to recover (depending on the type of surgery youve had and your progress in healing). You will likely have a tube in your bladder (catheter) to collect urine for the first 48 hours after surgery, as its often difficult to urinate at first. There may also be tubes from your abdomen to help drain fluids from the operation site. As with any surgery, you will not be able to drive afterwards so you will need someone to help you get home. You will likely be given antibiotics in the hospital to help reduce the risk of infection as your wounds are healing, and also will be given pain medication. You may be given medication that 17 you put inside your anus (anal suppositories) to help with pain, constipation, bloating, and gas. After surgery The aftercare instructions are different for different types of surgery and depend on the specific technique used. Talk with your surgeon before surgery to make sure you understand what to expect and what you need to do after youve been discharged from the hospital, and to talk about pain management options. Your surgeon will give you information about wound healing and the dressings over your wounds, and a home care nurse will visit you once a day after you are discharged from hospital until the wounds have healed enough for you to take care of them yourself. If you have had surgery done by laparoscopy, the wounds will be very small; if you have had abdominal hysterectomy you will have a larger incision. Do not have a bath or otherwise soak the incisions until they have completely healed. During the first two weeks, you will need to rest and avoid lifting or other movements that cause pain.

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Insects are extremely successful animals and they affect many aspects of our lives despite their small size purchase 60 pills speman amex. All kinds of natural and modified ecosystems both terrestrial and aquatic support communities of insects that present a bewildering variety of life styles discount speman 60 pills on line, forms and functions. Their ecologies are highly diverse and often they dominate food chains and food webs in biomass and species richness. Insect life cycles are adapted to a variety of a biotic condition, including seasonal extremes of heat and cold, wet and dry, and notably to unpredictable climate. In the tropical countries the largest group of illnesses is probably insect- borne, and it is important to know the habits of the insect vectors. Similarly rodents contribute as potential reservoirs of a number of important diseases besides their attribute to economic losses. Their epidemiology is influenced by attributes of their vectors, which in turn are closely linked to environmental conditions. Over the past decades, the increased demands on the landscape for food and shelter and an increased number of by-products of mans living environment have led to unparalleled changes. Some of these changes have led to an increase in the distribution of several vector borne diseases, 6 including malaria. The key to the success of arthropod-borne disease transmission lies in the competence of vector efficiency. Whereas one vector species may be extremely efficient in the transmission of a particular pathogen, a closely related species may be totally incompetent as a vector. Even within a single vector species, individuals and populations vary dramatically in their competence to transmit a particular pathogenic agent. The expression of vector competence appears to be controlled, in part, by genetic factors involving multiple genes. Environmental factors and behavioral patterns of vector and human populations combine to provide favorable conditions for malaria transmission. While much is known about vector biology, behavior, and malaria parasites, the importance of human behavior in malaria transmission has been largely overlooked. This failure to consider community attitude and beliefs about malaria has contributed to the inability of programs to achieve sustainable control. An intimate knowledge of community attitudes, knowledge and behavior can form the basis for appropriate planning of control measures. Arbo viruses: are viruses that are transmitted from one vertebrate to the other by the help of mosquitoes and other arthropods. Biological vectors- are vectors that transmit disease pathogens after the multiplication or development of the pathogen in the 7 insect gut or muscle. Insecticide formulation:- is the addition of substances ( solvent or diluents ) which enable a given chemical insecticide to be used to greatest advantage. Mechanical vectors- are vectors that transmit pathogenic Microorganisms without undertaking any developmental change. Medical Entomology:-This is a special phase of entomology and parasitology which deals with arthropods which affect the health and well-being of man and vertebrate animals. In other words medical entomology is a medical science directly concerned with vectors that affect human and animal health. Old World:- refers to the Eastern hemispher; the world of Europe, Asia and Africa. Rodents:- comprise a great number of mammals, ranging in size from the rats and mice to as large as the Porcupines and which belong to the order rodentia. In this course we are concerned with the domestic rats and mice, which is one of the serious health hazards in the community. Technical grade insecticides: are an insecticides that exist in its purest commercial form. Vector(s):-In communicable disease terminology, vectors are arthropods or other invertebrates which transmit infection by inoculation into or through the skin or mucous membrane by 8 biting or by deposit of infective materials on the skin or on food or other objects. Namely, Mechanical disease transmission, Biological disease transmission, and hereditary disease transmission. Mechanical disease transmission:- is a type of disease transmission in which the vector is no more than a carrier that transmit pathogens without any change either on the number or form of disease pathogens. Biological disease transmission: In this type of disease transmission certain developmental pattern exists either in the vector or host or in both cases. Propagative: In propagative type of disease transmission only the number of pathogens increases and the developmental stage remain constant. The disease plague and typhus are a good examples of propagative type of disease transmission. Cyclo-developmental: In this type of disease transmission only the developmental stage (form) of the disease pathogen changed (small to big, immature to matured stage, etc. Cyclo-propagative: This type of disease transmission is a combination of both propagative and cyclo-developmental where by the disease pathogen under take a change both in number and developmental form (stage).

Freezing (cryosurgery purchase speman 60pills, see above) or cone biopsy (see below) is curative at this stage cheap speman 60 pills overnight delivery. The tumour extends out from the cervix into the upper vagina or uterus, but not into the parametrium. The tumour involves the mucosa of the bladder or the rectum, or has spread beyond the pelvis. Palliate the patient with chlorpromazine, diazepam and analgesics, as the pain increases (37. If the cervix is clinically normal, repeat the acetic acid test before you take the biopsy. Stage Ila, it extends into the upper vagina or uterus, but not into the parametrium. E, pyometra; the body of the uterus is filled with pus A cone biopsy is notorious for postoperative bleeding, above a Stage I carcinoma of the cervix. A Textbook of Gynaecology A&C Black, 5 ed 1939 a preliminary absorbable suture to prevent bleeding, Stage I. The tumour is confined to the cervix and can be exactly as with McDonalds cervical suture (20. Either, start by inserting a #0 absorbable suture (23-10B), there is an 85-90% chance of surviving 5yrs. Put it all round the cervix, as high up as you can, hysterectomy may be of some benefit, if radical and pull it tight to occlude the descending cervical vessels. Transfix the descending uterosacral, broad and cardinal ligaments) and the upper cervical vessels (23-20) on each side with #0 absorbable or of the vagina, and usually also a pelvic lymph node suture, leaving the ligatures long as stays. Schillers test (optional) helps to define the extent of the Beyond Stage I, cure is difficult to achieve by surgery atypical epithelium, but is not absolutely reliable. Endometrial carcinoma occurs mostly in post-menopausal If you have cutting diathermy, cut (with your cold knife) in women, and presents with vaginal bleeding. The older the small steps while in every stage of the procedure arresting woman, the larger the chance that vaginal blood loss is a the haemorrhage. Cut the cone open in Do this either after a hysterectomy or pre-operatively when the 12oclock position, (23-10E) and send it intact for the disease is very advanced and you note involvement of histology. If you have a vaginal ultrasound probe, measure the 2 layers of endometrium: (the basal and functional layer, the latter being shed during menstruation). For a pathologist to examine a cone biopsy: available, you dont need to take a vaginal cuff with the (1) it must be big enough, hysterectomy; otherwise this is advisable. The pathologist must be able to report whether the edges Performing inadequate surgery will not benefit the patient. The final diagnosis (pathology) will recurrence, you can stabilize the cancer by high-dose only become clear after the operation. Recurrences occur mostly in the vaginal vault and can be temporarily controlled by radiotherapy. Very large cysts, the size of term pregnancies, are usually benign and cause no pain. Many ovarian tumours are cystic, but many cysts are not The most useful diagnostic tool is ultrasound (38. If ascites is already obvious clinically, then most often the Their classification is complex; this is a simplified scheme. Malignant: A benign cyst is usually: unilateral, single, (1) Serous or mucinous cystadenocarcinomas. Completely smooth (2) Stromal cell or sex cord tumours (which can produce cysts are usually benign functional, or endometriomas. Ascites is a strong sign (in the absence of suggestions of Borderline: tumours that look benign but metastasize or tuberculosis or cirrhosis) of malignancy. Solid ovarian tumours are more likely to be malignant, and produce early metastases. Pseudocysts are post-inflammatory collections of fluid between adhesions in the pelvis (23. As a simple cyst: They metastasize in the peritoneal cavity, most commonly (1) Pregnancy. If it is bilateral (15%), try to (3) Degeneration, bleeding, or infection in a fibroid (23. As a huge cyst: If the patient is 30-55yrs and the cyst is >10cm (1) Ascites (dullness to percussion in the flanks, rather diameter, it is likely to be a cystadenoma, which may be than in the centre of the abdomen). Large cysts are more likely to (5) Haemato-colpos/-metrium from an imperforate hymen, be malignant than small ones. Try to remove a cyst without spilling the fluid, because if you do, you may spread a malignant tumour and harm the patient greatly.

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