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Under pharmacists were encouraged to hiv infection rates by ethnicity generic vermox 100mg with mastercard organize this format infection cycle of hiv cheap vermox 100 mg online, all pharmacists in the states their departments to antiviral y antibiotico discount 100 mg vermox otc recognize and utilize where this has been implemented can be these emerging “specialties” and proposed called doc to hiv infection statistics worldwide vermox 100 mg rs as are those who have earned that the medical model of service organi the PharmD degree; one is a professional zation might be applicable to pharmacy. Pharmacy (syn the Millis commission) was Most pharmacists practice within an ambu commissioned by the American Association la to ry care or community pharmacy setting. The practice areas, the commission suggested pharmacist develops and maintains individual that a structure be established to oversee all patient medication profiles, compounds drug pharmacist credentialing. To date, there are six cal, biological, and pharmaceutical sciences, specialty areas as follows: nuclear pharmacy, along with technical knowledge of product nutrition support pharmacy, pharmacother formulation, dosage form design, and clini apy, psychiatric pharmacy, ambula to ry care, cal use meshes well with the requirements and oncology pharmacy. Pharmacists In recent years, managed health care pro with advanced degrees (Master of Science grams have grown extraordinarily. In these functions, managed care level include positions in the military service, pharmacists apply administrative, epidemio in the U. The chief purpose is Schools of pharmacy enlist pharmacists, to train pharmacists in professional practice some with and some without advanced and management skills. A fellowship to develop skill in cific courses and/or labora to ries within research is a directed, highly individualized the academic institution, to participate in postgraduate program designed to prepare extramural research, and to contribute to 28 seCtIon I • drugs, drug dosage Forms, and drug delIvery systems the service and continuing education mis Pharmacists are essential for optimizing medication use sion of the school. Since then, the A number of pharmacists serve their pro term has been redefined by many authors, fession in volunteer or professional positions including Strand and others who in 1992 with local, state, and national pharmaceuti stated (19): cal associations. Together with applicable health care professionals; organizes and/ federal laws, they constitute the basis for the or participates in in-pharmacy education legal practice of pharmacy. Many states used the prevention, and health systems management model regulations for the practice of phar (39). The developed classification is intended maceutical care developed by the National to provide the common language to be used Association of Boards of Pharmacy. By definition, a profession is founded on an the regulations required patient medica art, built on specialized intellectual training, tion moni to ring for therapeutic appropri and has as its primary objective the perform ateness, therapeutic duplication, overuse, ing of a service. This Code, prepared and supported by pharmacists, is drug therapy, proper s to rage, refill informa intended to state publicly the principles that form tion, and action to be taken in the event of the fundamental basis of the roles and responsibili a missed dose. These principles, based on moral patient medication profiles and therapeutic obligations and virtues, are established to guide pharmacists in relationships with patients, health counseling records. A pharmacist respects the covenantal relation ship between the patient and pharmacist. A pharmacist seeks justice in the distribution efit from their medications, to be committed to their of health resources. With a caring attitude and Like pharmacy practitioners, pharmaceutical a compassionate spirit, a pharmacist focuses on scientists recognize their special obligation to serving the patient in a private and confidential society and to the public welfare. A pharmacist promotes the right of self-determina In their scientific pursuits, they tion and recognizes individual self-worth by encour aging patients to participate in decisions about their Conduct their work in a manner that adheres to the health. A pharmacist communicates with patients in highest principles of scientific research so as to merit terms that are understandable. In all cases, a pharma the confidence and trust of peers and the public in cist respects personal and cultural differences among particular regarding the rights of human subjects and patients. Avoid scientific misconduct and expose it when A pharmacist has a duty to tell the truth and to act encountered. Recognize latitude for differences of scientific opinion in the interpretation of scientific data and v. Report results accurately, stating explicitly any When appropriate, a pharmacist asks for the consul known or suspected bias, opposing efforts to im tation of colleagues or other health professionals or properly modify data or conclusions and offering refers the patient. A pharmacist acknowledges that col professional advice only on those subjects concerning leagues and other health professionals may differ in the which they regard themselves competent through beliefs and values they apply to the care of the patient. A pharmacist serves individual, community, scientific research and seek prior authorization from and societal needs. In these situations, the ers the participation and employment of all qualified pharmacist recognizes the responsibilities that ac persons regardless of race, gender, creed or national company these obligations and acts accordingly. Are there any new aspects regulations and control laws described in in the practice of pharmacy that may need this chapter. Include when the law was to be incorporated in the future version of initiated, why the law was created, what the Code of Ethicsfi Discuss, present, and the law entails, and how the law affects defend your conclusions. Research and present a pharmacy practice individual activities area you are not familiar with and would desire to learn more about. With a partner, role play a provider–pa ments for Pharmacy Practice, evaluate tient dialogue example of pharmaceutical how well the college/school of pharmacy care. Be sure the example encompasses all you attend will prepare you to practice the aspects of the definition. Medicaid Ten City Challenge: Interim clinical and humanistic program: Drug use review program and electronic outcomes of a multisite community pharmacy claims management system for outpatient drug diabetes care program. Define a package insert and the information contained therein the federal Food, Drug, and Cosmetic Act, the pharmaceutical industry. The regulations apply to the drug prod drugs), similar developmental schemes are fol ucts manufactured domestically and those lowed for new biological entities, as described imported in to the United States. The initiated to define the physical and chemical sponsor must also demonstrate that the vari properties of the agent. Formulation studies ous processes and controls used in producing follow to develop the initial features of the pro the drug substance and in manufacturing, posed pharmaceutical product or dosage form. The posed use, a carefully designed and progres process and time course from drug discovery sive sequence of preclinical. A variation of this process is followed for the discovery and development of new biological entities, as described later in this chapter. The basic underpinning for sought for orphan drugs, which are targeted this effort is the cumulative body of scien for small numbers of patients who have rare tific and biomedical information generated conditions or diseases for which there are no worldwide in research institutes, academic satisfac to ry alternative treatments. Medical devices, such as the unavailability of drugs from previous catheters and cardiac pacemakers, follow a sources, and the increased need for drugs of separate approval process (7). These regula all kinds, but especially those with lifesaving tions and others governing foods and drugs capabilities. Nowadays, new drugs are and therapies that have enhanced the lives the chemical or engineered biologic mate of countless millions worldwide. Today, the rial resulting from research that is more tar scientific exploration of disease mechanisms geted; that is, directed specifically to ward is leading to the discovery and develop the identified physiologic/metabolic process ment of agents that specifically impact these or biomolecular target of a disease. Current mechanisms, resulting in new therapeutic methods of drug discovery are discussed modalities. Certain ment within the new prescription drug mar major contributions to modern drug therapy ket and is expected to continue as such in the may be attributed to the successful conver years ahead. In addition, many new dosage a tranquilizer and a hypotensive agent, is an strengths and dosage forms of previously example of a medicinal chemical isolated by approved drugs, new generic products, and design from the folklore remedy Rauwolfia new biologics are approved each year. Another plant drug, periwinkle, Not all drugs are discovered, developed, or Vinca rosea, was first scientifically investi and first approved in the United States. Many gated as a result of its reputation in folklore pharmaceutical companies do drug R&D as an agent useful in the treatment of diabe in other countries, and many drugs are first tes mellitus. Many of the world’s largest two potent drugs that, when screened for pharmaceutical companies are multinational pharmacologic activity, surprisingly exhib firms with facilities for R&D, manufacturing, ited antitumor capabilities. Another do not occur simultaneously, as they are sub example, paclitaxel (Taxol), prepared from an ject to the laws, regulations, and requirements extract of the Pacific yew tree, is used in the peculiar to each country’s governing author treatment of ovarian cancer. Common For example, the various species of Dioscorea, to each technique is the ability to manipulate popularly known as Mexican yams, are rich and produce proteins, the building blocks of in the chemical steroid structure from which living matter. Proteins are an almost infinite cortisone and estrogens are semisynthetically source of drugs. It has the poten substances, such as thyroid extract, insulin, tial to produce almost any protein. Genetic and pituitary hormone obtained from the material can be transplanted from higher endocrine glands of cattle, sheep, and swine, species, such as humans, in to a lowly bacte are lifesaving drugs used daily as replace rium. The urine the lower organism to make proteins it of pregnant mares is a rich source of estro would not otherwise have made. Knowledge of the structural architec products as human insulin, human growth ture of the individual hormonal substances hormone, hepatitis B vaccine, epoetin alfa, has produced a variety of synthetic and semi and interferon are being produced in this synthetic compounds with hormone-like manner. The synthetic chemicals used as oral binant biopharmaceutical approved in the contraceptives are notable examples. Today the poliomyelitis exploits the ability of cells with the potential vaccine is prepared in cultures of renal mon to produce a desired antibody and stimulates key tissue, the mumps and influenza vac an unending stream of pure antibody pro cines in fluids of chick embryo, the rubella duction.

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In domestic animals hiv infection elisa discount vermox 100mg amex, the digestive route of infection seems to antiviral zovirax order vermox 100 mg with mastercard be more important than inhalation hiv infection rate swaziland buy discount vermox 100mg on-line. Role of Animals in the Epidemiology of the Disease: Humans and animals con tract the infection from a common source in the environment antiviral masks buy cheap vermox 100 mg. Diagnosis: Diagnosis is based on confirmation of the agent’s presence in scrapings or biopsies of lesions by means of direct microscopic examination or by culture. The species of fungus can only be determined by culture and spore identification (Ader, 1979). It can not determine the genus or the species of the causal agent (Kaufman et al. Control: Human zygomycosis can be prevented in many cases by proper treat ment of metabolic disorders, especially diabetes mellitus. Prolonged treatment with antibiotics and corticosteroids should be limited to those cases in which it is absolutely necessary. Subcutaneous zygomycosis caused by Basidiobolus hapthoporus:Presentation of a case mimicking Burkitt’s lymphoma. In vitro susceptibilities of human and wild-type isolates of Basidiobolus and Conidiobolus species. For better or worse, residency programs place a great deal of importance on Step 1 scores when assessing applicants. Step 1 has therefore become the one objective measure common to all residency program applicants that program direc to rs feel they can rely on to help them compare and assess applicants. A very good performance on Step 1 can definitely help when it comes to securing a to p-rate residency, and a poor score can hurt by limiting your options. A failure on Step 1 can likewise all but eliminate the possibility of some residencies al to gether. Bot to m line although Step 1 is only one of many criteria that will be used in evaluating your residency application, it is definitely in your best interest to do all you can to maximize your chances of doing well, regardless of what type of specialty training you may choose to pursue. The number of test items you answer correctly is converted to a three-digit score scale. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 215 to 235 with a standard deviation of approximately 20. Your score report will include the mean and standard deviation for recent administrations of the Step exam. Blocks of items on Step 1 are constructed to meet specific content specifications. As a result, the combination of blocks of items on any given Step 1 exam creates a form that is comparable in content to all other forms. The percentage of correctly answered items required to pass Step 1 varies slightly from form to form; however, examinees typically must answer 60 to 70% of items correctly to achieve a passing score. The earlier your application is submitted, the sooner you can schedule your test date. People who wait until mid-spring will have difficulty getting their first choice of test dates. When applying for Step 1, you must select a three-month period, such as June-July-August, during which you prefer to take Step 1. A Scheduling Permit with instructions for making an appointment at a Prometric Test Center will be issued to you after your registration application is processed and you are determined to be eligible to take the exam. The Scheduling Permit specifies the three-month eligibility period during which you must take Step 1. During peak periods (May – July), allow up to approximately four weeks for processing of your application. After obtaining your Scheduling Permit, you are able to contact Prometric immediately to schedule a test date. If your application is submitted more than six months in advance of your requested eligibility period, it will be processed, but your Scheduling Permit will be issued no more than six months before your assigned eligibility period begins. You should verify the information on your Scheduling Permit before scheduling your appointment. You will not be able to take the test if you do not bring your Scheduling Permit to the test center. Note: Your Scheduling Number is needed when you contact Prometric to schedule test dates. Scheduling Test Dates Once you’ve gotten your permit, you may schedule your test online at Please keep the following in mind: fi You must have your Scheduling Permit before you contact Prometric to schedule a testing appointment. If you must reschedule outside the approved eligibility period, you will need to reapply and pay an additional fee. In Texas there are centers in: fi Abilene fi Amarillo fi Austin (2) fi Beaumont fi Bedford (2) fi Corpus Christi fi Dallas (2) fi El Paso fi Hous to n (3) fi Lubbock fi McAllen fi Midland fi San An to nio (2) fi Tyler fi Waco fi Wichita Falls What is the format of the testfi Practice time is not available on the test day, and test center staff are not authorized to provide instruction on use of the software. A brief tu to rial on the test day provides a review of the test software, including navigation to ols and examination format, prior to beginning the test. This link also has more information about the test content and the question format. You may take only one session per exam registration and must take it in the same testing region as your Step exam. Upon receipt of your Practice Session Scheduling Permit, you may contact Prometric to schedule an appointment and pay the Practice Session fee via credit card ($52). You are strongly encouraged to take one of these self-assessments before you begin your intense Step 1 preparation and another about one week prior to your scheduled Step 1 test date. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. Step 1 is constructed from an integrated content outline that organizes basic science content according to general principles and individual organ systems. Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems. Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally defined disciplines of ana to my, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology. While not all to pics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees. The Step 1 content outline describes the scope of the examination in detail but is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new to pics, emerging content domains, and shifts in emphasis. Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination. Test items commonly require you to perform one or more of the following tasks: fi interpret graphic and tabular material, fi identify gross and microscopic pathologic and normal specimens, fi apply basic science knowledge to clinical problems. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system specific. Use this as an outline to make sure you are covering all of these to pics in your study plan. Several things have been proven to help students prepare to do their best of Step 1: 1. Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. It is the purpose of the testing agency to see how adept you are at taking partial information and, based on that, figuring out an answer you consider to be a high probability response. Some people seem to instinctively know how to answer multiple choice questions correctly, others of us not so much. There are test-taking skills that you can learn to help you answer these kinds of exam questions. If you always feel that your performance on multiple choice tests doesn’t equate with your mastery of the material, you might think about having your test taking analyzed. Jolley Test Prep (formerly Blanc Education Services) offers online diagnostic testing of your ability to take multiple choice tests and measures variables such: as the amount of time spent on different types of questions; correlations between the length of a question and the likelihood of answering it successfully; performance on questions which rely on strict definitions or precise interpretation of technical vocabulary; and the extent to which you are able to narrow down your choices to two good answers; and the extent to which your second choices are correct. Although you will have approximately 8 weeks from the time Year 2 ends to the deadline for taking Step 1, the vast majority of our students throughout the years reported that they spent between four to six weeks of intense study following the end of Year 2 preparing for Step 1. Please note, however, there is no hard and fast rule regarding amount of study time and everyone works at a different pace.

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Repeat uterine palpation through the abdominal wall frequently during the immediate postpartum period to antiviral in spanish discount vermox 100 mg fast delivery ascertain uterine to hiv infection flu symptoms buy generic vermox 100mg online ne hiv infection rates bangkok vermox 100mg on line. Moni to hiv infection greece buy 100 mg vermox mastercard r pulse, blood pressure and the amount of vaginal bleeding every 15 minutes for the first hour, then every 30 min. Apply ice to the perineum for 20-30 minutes every 4-6 hrs to decreasing swelling after the delivery. Preterm labor is defined as regular uterine contractions occurring with a frequency of 10 minutes or less between 20 and 36 weeks gestation, with each contraction lasting at least 30 seconds. When contractions are accompanied by cervical effacement (thinning), dilation (opening), and/or descent of the fetus in to the pelvis, it becomes increasingly difficult to s to p labor. The cause of preterm labor is unknown but many fac to rs have been associated with it and some include: dehydration, rupture of membranes, infections, uterine enlargement (twins), uterine dis to rtion (fibroids), and placental abnormalities (previa and abruption), smoking and substance abuse. Approximately 10-15% of women will rupture the amniotic membrane around the fetus >1 hour prior to the onset of labor. Subjective: Symp to ms Menstrual-like cramps, low back pain, abdominal or pelvic pressure, painless uterine contractions, and 3-93 3-94 increase or change in vaginal discharge (mucus, watery, light bloody discharge). Objective: Signs Using Basic Tools: Palpable uterine contractions; palpable cervical dilation and effacement Using Advanced Tools: Lab: Urinalysis and a saline wet preparation to evaluate for bacterial vaginosis. Differential Diagnosis Low back pain/spasm palpate for back spasm; evaluate for associated neurological symp to ms (leg tingling, radiation, etc. Ureter/kidney s to ne evaluate flank pain, fever; perform urinalysis True labor verify dates of last menstrual period. Fetal: Gestational age > 37 wks, fetal death, chorioamnionitis (intrauterine infection) 2. For those patients who are penicillin allergic, clindamycin 600 mg q 6 h or 900 mg q 8 h or erythromycin 1-2 g q 6 h or vancomycin 500 mg q 6 h or 1000 mg q 12 h. Help fetus mature: After postponing delivery, many fetuses less than 34 weeks gestation will benefit from administering steroids to the mother. The effect of the steroids on the fetus is to accelerate fetal lung maturity, lessening the risk of respira to ry distress syndrome at birth. Consider to colytic therapy in all mothers being transported unless contraindications exist or greater than 37 weeks gestation. Although this is more common among women with gestational diabetes and those with very large fetuses, it can occur with babies of any size. Improperly relieving the dys to cia can result in unilateral or bilateral clavicular fractures. When: After delivery of the head, the fetus seems to try to withdraw back in to the birth canal (the “Turtle Sign”). Further expulsion of the infant is prevented by impaction of the fetal shoulders within the maternal pelvis. Digital exam reveals that the anterior shoulder is stuck behind the pubic symphysis. In more severe cases, the posterior shoulder may be stuck at the level of the sacral promon to ry. Suction the infant’s mouth to clear the airway of amniotic fluid and other debris. This action can injure the nerves in the neck and shoulder (brachial plexus palsy) and must be avoided. While most of these nerve injuries heal spontaneously and completely, some do not. Otherwise cut a generous episio to my following proper technique (see Episio to my Procedure in this chapter) unless a spontaneous perineal laceration has occurred, or if the perineum is very stretchy and offers no obstruction. Initially apply gentle downward traction on the chest and back initially to try to free the shoulder. Place the mother in the MacRobert’s position, and apply gentle downward traction on the baby again. By performing this maneuver, the axis of the birth canal is straightened, allowing a little more room for the shoulders to slip through. If the MacRobert’s maneuver fails have an assistant apply downward, suprapubic (above the bony pubic arch) pressure to drive the fetal shoulder downward, to clear the pubic bone. If pressure straight down is ineffective, have the assistant apply it in a more lateral direction. This tends to nudge the shoulder in to a more oblique orientation, which usually provides more room for the shoulder. Reach in posteriorly, identify the posterior shoulder, follow the humerus down to the elbow and identify the forearm. Grasping the fetal wrist, draw the arm gently across the chest and then sweep the arm up and out of the birth canal, freeing additional space and allowing the anterior shoulder to clear the pubic bone. An electric light bulb cannot be removed by simply pulling it out it must be unscrewed. Rotate the posterior shoulder, allowing it to come up outside of the subpubic arch. At the same time, bring the stuck anterior shoulder in to the hollow of the sacrum. Continue rotating the baby a full 360 degrees to rotate (unscrew) both shoulders out of the birth canal. Two variations on the unscrewing maneuver include: · Rotating/shoving the shoulder to wards the fetal chest (“shoving scapulas saves shoulders”), which compresses the shoulder- to -shoulder diameter, and · Rotating the anterior shoulder first rather than the posterior shoulder. The anterior shoulder may be 3-95 3-96 easier to reach and simply moving it to an oblique position rather than the straight up and down position may relieve the obstruction. Applying fundal pressure in coordination with the other maneuvers may, at times, be helpful. Applied alone, it may aggravate the problem by further impacting the shoulder against the pubic symphysis. If these measures fail, return to number 4 above and consider cutting or extending the episio to my, then progress through these maneuvers again. There are several breech variations, including but to cks first, one leg first or both legs first. In any breech birth there are increased risks of umbilical cord prolapse and delivery of the feet through an incompletely dilated cervix, leading to arm or head entrapment. When: Because of the risks of breech delivery, many breech babies are born by cesarean section (see Cesarean section template) in developed countries. In operational settings, cesarean section may not be available or may be more dangerous than performing a vaginal breech delivery. It is up to the care team to decide which option will be the safest mode of delivery for both mother and infant. The mother pushes the baby out with normal bearing down efforts and the baby is simply supported until it is completely free of the birth canal. This works best with smaller babies, mothers who have delivered in the past or frank breech presentation. If a breech baby gets stuck halfway out or if you need to speed the delivery, perform an “assisted breech” delivery. A generous episio to my will give you more room to work, but may be unnecessary if the vulva is very stretchy and compliant. Have your assistant apply suprapubic pressure to keep the fetal head flexed, expedite delivery and reduce the risk of spinal injury. Exert gentle outward traction on the baby while rotating the baby clockwise and then counterclockwise a few degrees to free up the arms. If the arms are trapped in the birth canal you may need to reach up along the side of the baby and sweep them one at a time, across the chest and out of the vagina. Grasping the baby above the hips could easily cause soft tissue injury to the abdominal organs including the kidneys. During the delivery, always keep the baby at or below the horizontal plane or axis of the birth canal. If you bring the baby’s body above the horizontal axis, you risk injuring the baby’s spine. Only when the baby’s nose and mouth are visible at the introitus is it wise to bring the body up.

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It is more common in tropical and subtropical zones latest hiv infection rates vermox 100 mg overnight delivery, particularly where people go barefoot hiv infection rate in puerto rico cheap 100 mg vermox with visa. In Sudan antiviral us release date cheap vermox 100 mg fast delivery, 1 antiviral state purchase vermox 100mg visa,231 patients required hospitalization in a two-and-a-half-year period. In the Americas, it occurs most frequently in Mexico and Central America (due primarily to Nocardia brasiliensis) (Manson-Bahr and Apted, 1982). The Disease in Man: Myce to ma is a slow-developing, chronic infection that usu ally localizes on the foot, the lower leg, sometimes the hand, and rarely on some other part of the body. The myce to ma spreads to deep tissue and the foot (or hand) swells to two or three times its normal size. Numerous small abscesses form, as well as fistulous tracks in the subcutaneous tissue that branch out to the tendons and may reach the bones. Pus discharged to the surface contains characteristic granules (microcolonies) that may be white or another color depending on the causal agent. Actinomyce to mas almost always respond to treatment with antibacterial antibiotics (strep to mycin, co-trimoxazole), but eumyce to mas are quite resistant (ke to conazole, myconazole) and often lead to amputation. The same treatment is recommended for patients affected by Strep to myces somaliensis but should be changed to trimethoprim/sulfamethoxazole tablets if no improvement is seen after one month. The Disease in Animals: Almost all confirmed cases have occurred in the United States. In animals (dogs, cats, horses), eumyce to mas are localized in the feet, lymph nodes, abdominal cavity, and other areas of the body. The most com mon agents of eumyce to ma in animals are Curvularia geniculata and Pseudallescheria boydii. Intra abdominal infections have been described in dogs in association with ovariohys terec to mies or a surgical incision that had opened up, with surgery occurring two years prior to the appearance of clinical symp to ms. They generally start with a small subcutaneous nodule that grows gradually for months or years. Cases of kera to mycosis and other ophthalmic conditions due to Pseudallescheria boydii have been described in humans as well as horses and dogs (Friedman et al. Source of Infection and Mode of Transmission: the etiologic agents of this dis ease are saprophytes in soil and vegetation. The fungus is introduced in to subcuta neous tissue of humans and animals through wounds. The agent is identified through isolation in culture media such as Lowenstein-Jensen medium for actinomyce to ma granules and blood agar for eumyce to ma granules. It is rec ommended that biopsy material, rather than material from the fistulae, be used to obtain the granules aseptically (Mahgoub, 1990). It is advisable to determine the agent’s sensitivity to different medications in order to ensure correct treatment. In a study conducted in Sudan, specific diagnosis was achieved for 78% of the specimens by using his to logic methods, and for 82% of the cases by immunodiffu sion (Mahgoub, 1975). Eumycotic myce to ma: Review and report of a cutaneous lesion caused by Pseudallescheria boydii in a horse. Etiology: In recent years, mycologists have called attention to infections in humans and animals caused by microorganisms of the genus Pro to theca, the nature and taxonomy of which have not yet been clearly defined. Most authors believe they are unicellular algae, but others describe them as algae-like fungi. Hyaline cells, called sporangia when mature, produce from 2 to 20 endospores in their interior that increase in volume and repeat the reproductive cycle when they reach maturity. Occurrence in Man: Slightly more than 30 cases of pro to thecosis have been described, 60% of them in men. Occurrence in Animals: Pro to thecosis occurs in many animal species, but above all in cattle and dogs. In the United States, there were 400 reported cases in 1982 in New York State alone (Mayberry, 1984, cited in Pore et al. There were 10 cases in a herd of 192 cows in Denmark and 5 cases in a herd of 130 cows in Great Britain (Pore et al. One is progressive ulcerative or verrucous lesions of the cutaneous and subcutaneous tissue on exposed skin. The Disease in Animals: the predominant form of pro to thecosis in cattle is mas titis, which at times may affect all four quarters of the udder. Inflammation of the udder is mild in comparison with bacterial mastitis, but it is invasive and chronic. The etiological agent causes pyo granulomas in the mammary gland and the regional lymph nodes (Pore et al. Milk production in the affected quarter diminishes, and small clots may be found in the milk. Pro to thecosis in dogs is usually a systemic disease, with dissemination of the infection to many internal organs. Weakness and weight loss were observed in all cases of dissemina tion (Kaplan, 1978). Other animal species in which pro to thecosis has been diagnosed are Atlantic salmon and cats. The clinical man ifestation of pro to thecosis in cats more closely resembles the cutaneous disease in humans and does not tend to disseminate as it does in dogs. Humans acquire the infection, possibly through skin lesions, when they come in to contact with contaminated water or other habitats of these agents. The profusion of these agents in the environment, as well as the few cases described in humans, indi cate that they are not very virulent and that lowered host resistance is required for them to act as pathogens. In fact, five of nine patients with cutaneous or subcuta neous pro to thecosis had a preexisting or intercurrent disease. Similarly, seven of eight patients with the olecranon bursitis form had previously sustained a trauma to the elbow (Kaplan, 1978). A study conducted on various dairy cows, some with mastitis caused by Pro to theca and others without any his to ry of the disease, isolated the agent (94% P. Little is known of the pre disposing conditions in dogs, which almost always manifest systemic pro to thecosis. In cattle, the retropharyngeal and mandibular lymph nodes affected by green algae indicate that the infection is possibly contracted by ingestion of contaminated water. The few cases described in cattle and sheep suggest that these species are not very susceptible to green algal infection. To determine the species, cultures or the immunofluorescence test with species-specific reagents must be used. The immuno fluorescence technique can be used for cultures as well as for his to logical sections stained with hema to xylin-eosin, but not for those stained with the methods men tioned above. Geographic Distribution: the disease has been confirmed in the Americas, Asia (endemic zones in India and Sri Lanka), Africa, Europe, Australia, and New Zealand. According to more recent data, more than 50 cases have occurred in Venezuela, mainly in the states of Barinas and Portuguesa. In addition to the Latin American countries already cited, the disease has been confirmed in Argentina and Cuba. Five cases have been reported in Trinidad (Raju and Jamalabadi, 1983), four of them affecting the conjunctiva. A retrospective study (1948–1986) of 91,000 biopsies was conducted at the Central Hospital of Mapu to, Mozambique; rhinosporidiosis was diagnosed in 33 (0. Some 1,000 cases have occurred in India and Sri Lanka, and 72 occurred in Iran over a 30-year period. An unusual case occurred in a province in northern Argentina where an outbreak was described in a herd of cattle that was kept in a flooded field for two years. Twenty-four percent of the animals examined had polyps (Luciani and Toledo, 1989). The Disease in Man and Animals: Rhinosporidiosis is characterized by pedun culated or sessile polyps on the mucous membranes, particularly of the nose and eyes. The polyps are soft, lobular, and reddish with small white spots (the sporan gia). In humans, these granuloma to us formations can also be found in the pharynx, larynx, ear, vagina, penis, rectum, and on the skin. The clinical picture in animals consists of a chronic polypoid inflammation that may cause respira to ry difficulty and sneezing if the disease lodges in the nasal mucosa and if the lesion is sufficiently large. Successful treatment with dapsone has been described in three patients (Job et al. Source of Infection and Mode of Transmission: the natural habitat of the agent is unknown.


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