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The laser spots, each of 50 micron size, are placed at the junction of the anterior and Trabecular Anterior chamber posterior trabecular mesh-work to produce blanching of the out ow tissues. This is followed by a transient rise of intraocular Iris bombe pressure which requires prophylactic treatment with topical apraclonidine or other antiglaucoma medications. Mid-dilated pupil with iri dolenticular contact allowing the lax iris to bow forwards and block the trabecular meshwork. The optic suggested mechanisms for closure are a plateau iris con disc does not have fguration and peripheral crowding of the iris. Thereafter, the intraocu lar pressure and gonioscopy are noted with mini mal illumination. There is ciliary conges browache, blurring of vision on the same side and tion, a vertically dilated pupil and glaucomflecken on the lens. Changes in the optic nerve head l Primary angle closure causes a sharp rise in intra and visual field may or may not be present. Note iris stromal atrophy clinical signs of past acute angle closure includes, with anterior chamber angle occlusion by peripheral anterior synechiae. This prevents the iris from the angle and permanent damage to the trabecu being pushed forwards onto the trabecular openings by lar meshwork. This helps to mechanically Combined mechanism glaucoma is a term used to denote push the iris away from the cornea. This is because of a high incidence of ocular infections, infammations, complicated cataract surgery and trauma. The attending ophthalmologist treats the primary cause but often an undiagnosed secondary glaucoma leads to substantial loss of vision before it is identifed and specifc therapy instituted. The infam mation consists of low-grade fare and cells, with stellate Infammatory Glaucomas keratic precipitates and fne flaments scattered over the Uveitic glaucoma is thought to result from swelling and dys entire endothelium. Infammatory material cal corticosteroids and non-steroidal anti-infammatory may be seen as precipitates on the meshwork. The glaucoma is consequent fbrosis, leading to zip-like adhesions of the characteristically out of proportion to the infammation. If not treated early, the outfow channels l the lens becomes intumescent, either by the rapid may be damaged and long term glaucoma medications or development of cataractous changes or after a even glaucoma surgery may be required to control a chron traumatic rupture of its capsule.
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D) Dobutamine as it increase cardiac contractility via its effect on B1 adrenoceptors. B) Verapamil is more selectively acting on the cardiac muscles as it blocks the L-type of 2+ Ca channels. C) Beta adrenoceptor blocking agents are effective in treatment of variant angina as they decrease cardiac contractility and heart rate. B) the unbound fraction of drugs is responsible for their pharmacokinetic and pharmacodynamic processes. C) Hypoalbuminic patients may suffer from toxic manifestations of drugs more than normoalbuminic patients. D) represents a good site for pharmacodynamic drug-drug interaction via displacement. B) Dopamine is converted into norepinephrine in the cytoplasm of adrenergic neurons. C) Presynaptic alpha-2 receptors display a negative feed back control on norepinephrine release. B) It is effectively used in anaphylactic shock and in prophylaxis of bronchial asthma. C) Its conjunction with local anesthetics prolongs the duration of anesthesia but may delay the healing of wounds. B) Each of reserpine and guanethidine reduces norepinephrine contents of the central adrenergic neurons. C) Postural hypotension, bradycardia and miosis are among the possible effects of guanethidine. D) Chronic use of reserpine reduces the activity of the subsequently administered ephedrine. C) Nitroglycerin is ineffective when given orally as it suffers extensive hepatic metabolism. D) May induce methaemoglobinaemia that can be treated by ascorbic acid or methylene blue. Write true or false corresponding each of the following statements after wri ting in your answer notebook: 1 Atropine is the drug of choice in motion sickness. B) Infiltration anesthesia involves subcutaneous administration of anesthetic in close to nerve endings. C) Spinal anesthesia involves injection of anesthetic into one of the nd th intervertebral spaces from the 2 to the 5 lumbar regions.
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Secondary prevention aims at decreasing disease severity through the early detection, diagnosis and treatment of the disease. Tertiary prevention reduces the negative impact of an already established disease by restoring function and reducing disease-related complications. Tus tertiary prevention involves treating and managing disease complications which have already occurred, in order to prevent death and reduce disability. Rehabilitation is an active process by which those afected by injury or disease William Howlett Neurology in Africa 71 Chapter 3 publiC health achieve a full or optimum recovery, in all aspects of life. It is one of the key components of health care, along with prevention and treatment. The distribution and determinants of risks in a population have major implications for which type of public health intervention is used. Decreasing a small risk in a large number of people usually results in more cases being prevented than decreasing a larger risk in a smaller number. Tus, general prevention strategies aiming at reaching the whole population are often more cost-efective than prevention targeted to high risk groups only. However, combining population-based and high risk strategies can be even more efective. In general where resources are limited it is the public health based population primary prevention interventions that have the greatest priority and potential to save lives (Table 3. However, within health delivery there needs to be a balance between prevention and care as the successful implementation of both are linked and interdependent. In neurology successful examples of primary prevention include vaccination to prevent tetanus and meningitis and bed nets to prevent cerebral malaria. Neurological service provision Adequate health systems are a prerequisite for health care. Tese are the institutions and organizations within a country that provide and deliver the health services. The basic resources needed to provide these services are staf, facilities, equipment and medications. The services which they provide are delivered at three main levels in Africa (Table 3. The most common neurological disorders encountered in primary care are headache and epilepsy. Limitations to the successful delivery of neurological service at this level include the lack of adequate education and training in neurology, cultural barriers and practical constraints both fnancial and geographic.
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Alternatively, the hematuria prior to hospitalization; weight loss and increased could be a consequence of catheterization. Specimen: Catheterized Refrigerated: No Color: Yellow Appearance: Slightly turbid Outcome Sp. This is partially a result of Bilirubin 1+ Clumped No solute diuresis due to glucosuria and ketonuria, but under Crystals None lying renal disease (as evidenced by mild azotemia) also Bacteria None may have contributed to the low urine specific gravity. Six units of regular insulin were administered intramuscu larly every hour until blood glucose concentration reached approximately 250 mg/dl. After that, the dog received 7 units of regular insulin intramuscularly every 8 hours. After centrifugation, the supernatant is presumptive identification of renal pelvic decanted by inverting the tube. The pres immersed into a well-mixed sample of urine ence of large numbers and/or clumps of tran or into urine supernatant after centrifuga sitional epithelial cells may be an artifact tion. Red to amber colored urine that is transpar theory of Addis, cellular casts undergo pro ent, and that does not clear after centrifuga gressive degeneration to granular (from tion, may be due to the presence of dissolved coarse to fine) then to waxy casts. Turbid urine that clears upon centrifugation are named for their principal component. This represent the degeneration of red cell casts urine sediment was obtained from a dog with and are characterized by the presence of systemic blastomycosis and urogenital hemoglobin and faint red cell membrane out involvement. Spermatozoa this feature sometimes leads to confusion may be observed in the urine of male dogs. Bacterial urine culture Microfilaria observed in the urine sediment yielded large numbers of Escherichia coli. Fiber artifact in urine sediment that may be (pyuria) should raise suspicion of bacterial confused with a cast. Precipitated stain in urine sediment may be small size of the cells and the presence of confused with crystals, fungi, or bacteria. These precipitated stain crystals often are Cells with similar appearance were also found at the edge of the coverslip. Clumping of cells, Chapter 4: Case Studies increased nuclear-to-cytoplasmic ratio, pres ence of nucleoli, and clumping of chromatin Fig. Several epithelial cells in urine sediment suggestive of struvite crystals also are present. Note the single squamous epithelial and large numbers of free small epithelial cell in the center of the field (arrow). Note extreme variable with minimal matrix, such structures may be in particle size and characteristic orange better termed tubular fragments. Note presence of neu several transitional epithelial cells, and one trophils and small mononuclear cells in the very large squamous epithelial cell in urine cast.
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