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By: F. Giores, M.B. B.CH., M.B.B.Ch., Ph.D.
Professor, University of North Dakota School of Medicine and Health Sciences
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Many products can act as antigens: Mydriatic drugs: atropine, homatropine, tropicamide, Table 4. Non-pharmacological Allergen-avoidance Cold pads Antiviral agents: idoxuridine, tri? Topical ocular Antihistamines Antazoline Pheniramine Anesthetics: procaine, tetracaine. Emedastine Cosmetics (nail varnish, rimmel, lipstick), soaps, Vasoconstrictors Oxymetazoline detergents. Naphazoline the early stages are characterized by involvement of the Tetrahydrozoline lower conjunctiva, followed by the eyelid and? The acute phase may Mast cell Sodium show blepharitis of an acute eczematous appearance, while stabilizers cromoglycate the chronic phase is characterized by the appearance of folds, Lodoxamine crusts and? Multiple action Olopatadine Ketotifen the diagnosis of these eye conditions is initially based Nedocromil on the clinical findings, and is posteriorly supported by Azelastine epicutaneous patch tests involving the suspect substances, Epinastine with a view to identifying the causal allergen. In 1-2 drop every 12 hours this context, rupatadine has been shown to be as effective as Epinastine Age? Recently, bilastine 1-2 drop every 12 hours has been presented as a new antihistamine affording ef? Topical ocular antihistamines the most widely used first-generation topical ocular antihistamines are antazoline and pheniramine. The new generation of topical antihistamines, effect, though their action is limited in time (2-4 hours). Caution is rhinoconjunctivitis, the effect was seen to be similar to that required when administering these substances to patients of loratadine [90] and superior to that of terfenadine, in with glaucoma, hyperthyroidism and cardiovascular controlling ocular itching [91]. They are usually combined with topical Emedastine is regarded as a relatively selective H receptor 1 antihistamines [77]. Experimental studies mast cell degranulation-inhibiting drug, though it does not in animals have shown ketotifen to be more effective than act upon the type T mast cells. Compared with sodium cromoglycate, it has been the release of histamine and of other both immediate and late shown to be more potent, faster acting, and with fewer adverse phase allergic response mediators. It is faster acting than sodium with effects similar to those of levocabastine in a pediatric cromoglycate [103], but slower than lodoxamide [104]. Epinastine clearly reduces ocular itching compared they reduce prostaglandin and thromboxane synthesis. The with placebo [125], though in comparative studies with marketed topical agents (0. The second be superior to levocabastine [106], but less effective than generation oral antihistamines were initially considered to be emedastine in application to itching in ocular provocation more advisable for controlling the ocular symptoms [128]. Posteriorly, another metaanalysis reported similar cell stabilizing action results comparing intranasal corticosteroids with topical Olopatadine acts as a mast cell stabilizer and is also a antihistamines [130]. The drug acts rapidly and its demonstrated in several metaanalyses and for different effect is prolonged possibly due to its capacity to suppress corticosteroids: intranasal fluticasone propionate [131], mediator release and inhibit in?
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Dacryocystorhinography can show substantial lakes of discharge the rabbit nasolacrimal duct. Treatment of dacryocystitis in the rabbit is by cannulation of the single Blepharitis in the rabbit may be associated with Treponema nasolacrimal punctum and? The proximal end of the nasolacrimal duct can also the rabbit can be caused by viral as well as bacterial agents. Pressing of the lids and conjunctiva as well as of the mouth, anus, and on the lower eyelid will often manifest the duct as a pair of genitals (Fig. In the acute form, death may supervene before lighter pink lips pouting? through the darker red, in? When this does not have the desired effect, the exudate in the disease may be caused by Pasteurella multocida duct can be cannulated in a more permanent manner with? There are problems and potential hazards disease involves profound immunosuppression and, often, with this technique, however, especially given the tortuosity of subsequent multifocal infection with Pasteurella sp. Vaccinated rabbits will not succumb to this severe manifestation An unusual abnormality in rabbits is aberrant overgrowth but may develop the myxomas from which the virus derives of conjunctiva (Fig. Thus, the ocular signs of myxomatosis are a in the literature and may be termed precorneal membranous complex mixture of virally induced ocular signs and secondary occlusion, conjunctival centripetalisation or pseudopterygium infections because of a reduced immune response. It appears as a thin exenteration is the only option in such cases, with the additional annulus extending a few millimtres form the limbus or may cover a use of antibiotic-impregnated methacrylate beads being useful in considerable portion of the cornea. Surgical removal results only some circumstances just as they are used in dentistry for infected in reformation of the aberrant tissue, whereas suturing the fold tooth roots and orthopaedics to treatment osteomyelitis. In all back onto the sclera or using topical cyclosporine postsurgically too many cases eventual recurrence of the abscess occurs with are more effective method of preventing recurrence. The cause breakdown of the enculeation woundsite, euthanasia being the of this condition is unknown. Corneal epithelial dystrophy in the rabbit similar to that seen in Entropion, which is relatively commonly seen in rabbits, is a epithelial basement membrane dystrophy in the boxer dog or condition rarely of suf? As in the dog, treatment by debridement with lesion can be severe and is only corrected by surgery. Uveitic changes in the rabbit eye may be associated with infectious disease such as Pasteurella or Staphylococcal panophthalmitis (Fig. Congenital cataracts have been documented in rabbits with nuclear lenticular opacities with persistent pupillary membranes in some affected animals but age-related cataracts seem much less prevalent than in the guinea pig (see below). Optic disc cupping is seen in glaucoma in the rabbit although it can be corneal surface with a contact lens can resolve the persistent dif? No spontaneous diseases of the rabbit fundus have been reported but for one Hereditary glaucoma in the New Zealand white rabbit has been retinal degeneration in a strain of laboratory rabbits. Neonatal bu/bu homozygotes the guinea pig have normal intraocular pressure (15?23 mm Hg), but after 1 to 3 months of age, the pressure rises to between 25 and 50 mm There is very little work published on ocular disease in this Hg. Histopathologic features of these glaucomatous eyes involve species although they are used widely in research and regularly goniodysgenesis of the pectinate ligaments and trabecular kept as pets. Eyes enlarge (become buphthalmic, hence the bu of pet guinea pigs in a survey of over a thousand animals had gene terminology) with cloudy corneas, but whereas vision is some degree of ocular pathology, mostly involving incomplete lost at this stage, the eyes do not appear to be painful, probably lens opaci?
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These develop from small, thin walled vessels that otherwise carry only small amounts of blood. They are similar to varicose veins in the legs and are termed esophageal 22 the informed patient or fundal varices depending on location in the esopha gus or upper end of the stomach. After large meals, the perfusion of the bowel increases, result ing in increased pressure within the esophageal varices. Hence, six small meals are better than three large ones in patients with esophageal varices. Because of their reduced glycogen reserves, patients with cirrho sis have reached a stage of hunger after 16 hours of fasting that occurs in healthy persons only after 36 hours of abstinence from food. Hence, after only a short period of fasting, the body turns to its own protein for energy production. Similarly, repeated bacterial infections and bleeding serve to increase this protein catabolism. Fasting may result in the development of neurologic changes (encephalopathy) and, hence, should be strictly avoided. Because patients with cirrho sis are still able to utilize dietary protein for the produc tion of important proteins in the body, it is important to optimize protein intake and avoid protein-restricted diets. Measuring ammonia levels in the venous blood of pa tients with cirrhosis is not helpful. Ammonia levels in cir rhosis are almost always elevated as the result of collat eral circulation; these levels cannot be used as evidence for the extent of encephalopathy. Elevated ammonia lev els without symptoms of hepatic encephalopathy do not justify protein restriction. Pa tients with advanced liver cirrhosis therefore have higher blood concentrations of toxic breakdown products, such as ammonia, phenols, indoles and amines. They suffer from distur bances of concentration and coordination, which may become noticeable as writing disturbances, shaking and jerking of the hands (flapping tremor). These toxic symptoms of the brain are called hepatic en 25 cephalopathy (from hepar, liver; enkephalos, brain; pathos, disease). Diabetics must pay particular attention to carbohydrates and obey special dietary rules. This group of patients must be given thorough and compre hensive advice by dieticians. Patients with cirrhosis of the liver and diabetes should get themselves a carbohy drate exchange table in addition to a table of nutritional values. For diabetics, the high-fiber diet recommended in cirrhosis of the liver is doubly important. Roughage slows down the rise in blood sugar after consumption of high carbohydrate meals. This situation may also occur when, despite adequate remaining synthetic ability, the liver is unable to produce clotting factors due to a lack of vitamin K, a necessary nutrient.
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What to do Because only the blood is infectious, you do not need to isolate the patient. Most cases are acquired by intravenous drug use or by other forms of exposure to the blood of an infected person. The acute infection does not usually cause any illness but nearly all patients become chronically infected and have continuing liver in? Whooping cough (pertussis) Whooping cough is caused by the bacterium Bordetella pertussis. It is an important cause of illness and death in small children but also affects adults. Immunization against pertus sis in childhood does not provide life-long immunity and many adults are susceptible to infection. The incubation period of pertussis is usually one to three weeks but it can be much longer. Whooping cough is highly infectious and is spread by respiratory droplets but infection requires relatively close contact, usually at a distance of less than two metres. For this reason patients are often aware of contact with someone who has had a prolonged cough. Unfortunately, patients are most infectious at the beginning of the illness, when it is not possible to distinguish pertussis from viral bronchitis. Signs and symptoms Cough, in most cases, dry and occurring mainly at night, in paroxysms (bouts), with many coughs in rapid succession followed, in half of the cases, by vomiting. Signs and symptoms No symptoms in most cases; in some cases, itching around the anus; in some cases, adult female worms, which are white and about 10 mm long, can be seen around the anus or in faeces. They are acquired by eating food or, less often, by drinking water contaminated with the worms? eggs. The two worms are considered together here because their geographical ranges are similar and they often occur simultaneously. The larvae penetrate the bowel wall to reach the bloodstream, which they use to travel to the lungs. The larvae mature within the lungs for a few days, then pass up the airways to reach the throat, where they are swallowed. A person acquires infection by eating food contaminated by whipworm eggs, which hatch in the bowel and attach themselves to the wall of the colon. What to do If worms are visible in the faeces, give mebendazole, 100 mg orally, twice daily for three days. If the faeces reach moist soil, the eggs hatch and form larvae, which can penetrate the skin of humans walking barefoot on contami nated soil.
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