Peter R. Kowey, MD

• Department of Medicine
• Division of Cardiology
• Jefferson Medical College
• Philadelphia, PA
• Lankenau Hospital and Main Line Health System
• Wynnewood, PA

They will also change the dressing which covers the site where the line enters your skin herbals teas safe during pregnancy buy generic himplasia 30caps on line. You may be taught how to care for your own line banjara herbals purchase discount himplasia on-line, especially if you are going home with the line still in place herbals summit 2015 himplasia 30caps free shipping. Sometimes central lines need to be taken out herbals on demand purchase himplasia uk, if for example they have become infected and the infection is not responding to antibiotics herbals detox purchase himplasia online pills. Whether or not the central line is replaced will depend on where you are in your transplant process herbals sweets purchase discount himplasia online. Like any invasive procedure carried out during your transplant, your written informed consent is required for the insertion of a central line. Conditioning therapy is used to help destroy any leftover cancer cells in your body and make space in your bone marrow for the new stem cells. It is more common to be admitted to hospital for this part of the transplant but some patients have their conditioning therapy as an outpatient, in the clinic. There are many different types of conditioning therapies used in autologous stem cell transplantation but as a general rule they involve between one and eight days of high-dose chemotherapy. Single drugs, such as Melphalan, or a combination of two or more chemotherapy drugs may be used. The kind of conditioning therapy chosen for you will depend on several factors including the type of disease you have, your age and general health and the type of transplant you are having. Transplant protocols Many patients are given a transplant protocol, a written summary of the schedule of treatment planned for the days leading up to and following the actual infusion of the stem cells. The days leading up to the transplant (pre-transplant) are called Day -6, Day -5 etc. Chemotherapy Chemotherapy may be given as an infusion through one of the lumens of your central line, or in tablet form. Some chemotherapy drugs require you to have several litres of intravenous fuid a day, on the days that you are receiving the drug. This is to ensure that the chemotherapy is quickly fushed out of your system, once it has done its job. In some cases, other drugs are also given to help reduce the toxic effects of chemotherapy on these important organs. With so much fuid going in, it is important to monitor the amount of fuid in your body and your urine output. The nurses may ask you to pass all of your urine into a bottle or a pan, so that it can be measured and tested. This is because the stem cells and other immature blood cells in your bone marrow have been damaged as a result of the conditioning therapy used. Your counts will rise when the new stem cells start to grow and produce new blood cells. Your blood counts will be monitored on a daily basis and you may need to receive some blood or platelet transfusions until your transplanted stem cells re-establish the process of blood cell formation in your bone marrow. You might like to ask the nurse or doctor for a copy of your blood count each day so that you can keep an eye on your own progress. At this stage you may be taking some medications to help prevent bacterial, viral and fungal infections while you white cell is low over the next couple of weeks. Infections and their management are discussed in more detail later in this booklet. Thanks to improvements in anti-emetic (anti-sickness) drugs, sickness is generally well controlled these days. You will receive anti-emetics on a regular basis, before and for a few days after your conditioning therapy has fnished. Be sure to tell the nurses and doctors if you think that the anti-emetics are not working for you and you still feel sick. Remember, you are not expected to simply put up with nausea and vomiting or any other side effects of treatment, at any stage of the transplant, when help is available for you. If you are unable to eat or drink suffciently you may be given some additional fuid intravenously, via your central venous catheter, to stop you becoming dehydrated if the nausea and/ or vomiting are severe. It usually starts about three to four days after your conditioning therapy has fnished. Mucositis resolves after the transplant, as soon as your new stem cells engraft and your white cell count starts to rise. Be sure to tell them if your mouth or throat is starting to feel dry or sore or if your saliva is getting thick or diffcult to swallow. Soluble paracetamol and other topical drugs (ones which can be applied to the sore area) can help. It is important to keep your mouth as clean as possible, especially when it is sore, to help prevent infection. Your nurse will advise and teach you how to best care for your mouth during this time. You should avoid commercial mouthwashes, like the ones you can buy at the supermarket. These are often too strong, or they may contain alcohol which will hurt your mouth. You may be offered ice to suck before, during and after some types of chemotherapy. Some centres may offer you the use of a humidifer, this is a special machine that moistens the air that is delivered to you via nasal prongs (small plastic tubes that sit in the base of your nostrils). This will help to keep your mouth and throat moist and therefore keep you more comfortable as well as help in the healing process. You might like to try adding a little more sugar to sweet foods and salt to savory foods during this time. Most centres have a dietician who can help you plan as nutritious and tasty a diet as possible while you are in hospital. Your appetite should start to improve once you go home, but it can take some time to return to normal. Normal taste sensation may also take several months to return to normal and contribute to a loss of appetite. You might like to ask your family to bring your favorite food to hospital, something you really fancy. Remind them, however, not to be surprised or too disappointed if you change your mind when you see it. You may need to have some intravenous fuids to make sure you don?t become dehydrated. This may be due to the effects of the conditioning therapy and the fact that they are not eating what they normally would at home. The doctors and the dietician may encourage you to have special high energy and high protein drinks during the day. Sometimes your body can hold onto too much fuid, particularly during the conditioning phase of your transplant when you may be receiving extra intravenous fuid. If you develop diarrhoea, the nurse will ask you for a specimen which will be tested in the laboratory, to rule out an infection in your bowel. After this you will be given some medication to help stop the diarrhoea and relieve any discomfort you may be feeling. Some transplant units have bidets that you can use after going to the toilet to help keep your bottom clean. If the skin is getting sore and excoriated (broken) you will need to apply a barrier cream to the area. It is important to tell your nurse or doctor if this a problem as broken or cracked skin is a route through which bacteria can get in, causing infection. It is also important to tell the nurse or doctor if you are constipated or if you are feeling any discomfort or tenderness around your bottom (anus) when you are trying to move your bowels. Hair can be lost from any place including your head, eyebrows, eyelashes, arms and legs. Many people with straight hair are surprised to fnd that their hair comes back curly. In some cases, the hair not only has a different texture but also a slightly different colour than before. Some people notice that their scalp becomes quite itchy and tender when they start to lose their hair. You may fnd that patting your hair gently with a towel to dry it, avoiding the use of heat or chemicals and using a soft brush can help to make you feel more comfortable at this time. You may wish to consider wearing a cap, wig, scarf or turban on your head, if this makes you feel more comfortable. You might like to bring a beanie to hospital with you as your head can get very cold without hair, regardless of the season. In general, you should only use non-perfumed soaps and simple moisturising creams, such as aqueous cream. These include the parotid or submandibular glands situated at the top of the jaw line, in front of the ears. It causes dryness of the mouth and jaw pain, which usually settles down within a few days, once the infammation subsides. Initially, you may fnd it diffcult to concentrate on reading, watching television or even keeping up with a conversation. You may be also feeling mentally exhausted as a result of the huge emotional and physical build up to the transplant. Ask your doctor or nurse about seeing the social worker, psychologist, occupational therapist or pastoral care worker. These people can help you through this period and advise you on practical ways to help you cope better. Some people fnd that relaxation and meditation techniques can be helpful in coping with tension and stress. The nurse or social worker may be able to provide you with audiotapes or other information on relaxation and meditation which might be useful at this time. The stem cells are infused through your central venous catheter, rather like a pink-coloured blood transfusion. This can take between 30 minutes and four hours, depending on the volume of cells being infused. Your frozen (cryopreserved) stem cells are defrosted at the bedside before being infused. Reactions to stem cell infusions are rare, but you will be carefully monitored during the infusion, just in case. Occasionally people have a reaction to the preservative used in the original freezing process, so you may be given a drug to prevent this before the infusion starts. Generally, any reactions that do occur can be quickly managed and the infusion is completed as planned. You and your visitors may notice an unusual smell resembling garlic or asparagus during and for up to 24 hours after the stem cell infusion. You may also have a strange taste in your mouth, which may be relieved by sucking mints. Here they set up home and begin to repopulate the bone marrow with families of immature white cells, platelets and red cells. This process is known as engraftment and it usually takes anywhere between 10 and 21 days. The transplant team will take great interest in your blood counts over the next few weeks. Evidence of an early engraftment is seen in a rise in the number of normal white cells in your blood. Waiting for engraftment You will be monitored very carefully in the early days following your transplant. This involves being examined by the doctor every day and having regular temperature, pulse and blood pressure measurements taken by the nurses. Each day, blood samples are taken from your central line to check your blood counts and to monitor your kidney and liver function. You may feel a mixture of emotions ranging from anxiety and frustration to boredom. Waiting for the results of blood tests, together with constant monitoring may make you feel a little vulnerable. In addition, you may be feeling quite miserable if your mouth is sore or if you have developed an infection. Your mouth should start to feel more comfortable, your fevers should settle and you should be generally feeling much better, although still quite weak. You may need them to repeatedly explain what is going on, and why certain tests or procedures might be necessary. Many people fnd that they feel more relaxed and in control if they are kept well informed of what is happening. This is because many of the complications are related to one another and the pre-transplant conditioning therapy used. This is because conditioning therapies destroy the blood stem cells in your bone marrow, which normally produce infection-fghting white blood cells. The absence of white cells, and in particular the absence of neutrophils, increases the risk of developing an infection. In general, the lower your neutrophil count and the longer it remains low, the higher your chances are of developing an infection. If you develop a temperature while you are neutropenic you are regarded as being a febrile neutropenic patient.

Syndromes

• Tumors
• Heart attack
• Chest x-ray
• If your child is missing, check the pool immediately.
• Heavy menstrual bleeding
• Remove warts, moles, sunspots, and tattoos

Such vaccines are reconstituted from the lyophilised state immediately before use with a suitable Uquid jeevan herbals hair oil generic 30caps himplasia overnight delivery. Seed management a) Characteristics Passage of a selected strain through embryonated chicken eggs establishes the master seed "X" neem himalaya herbals 60 kapsuliu 30 caps himplasia otc. In chickens herbs and uses 30caps himplasia free shipping, Uve virus vaccines should not cause mortauty or severe respiratory reaction herbs landscaping order generic himplasia pills, although sught erythema of the conjuctiva and lacrymation may occur herbs used in cooking purchase himplasia with amex. However herbals companies trusted himplasia 30caps, severe reactions may occur in certain species of pheasant foUowing routine ocular instillation of commercial Uve virus vaccines. When stored under the prescribed conditions, the lyophilised vaccine can be expected to retain its potency for not less than one year; some products specify 1. All eggs are candled prior to harvest, and only those with viable embryos are used. The resulting homogenate is pooled, tested for purity, potency, safety and virus content, mixed with a stabiliser (usually beef peptone and sucrose), lyophiUsed and stored at 4?C. Batch control a) Sterility tests Tests for sterihty and freedom from contamination of biological materials may be found in the chapter on General Information. Identification of the agent: Where clinical signs of tuberculosis are seen in the flock, or where typical lesions of tuberculosis are present in birds at autopsy, the demonstration of acid-fast bacilli in smears or sections made from affected organs is sufficient for a positive diagnosis. If acid-fast bacilli are not demonstrated, but typical signs are present in the birds, culture of the organism must be attempted. Any acid-fast organism isolated should be identified by biochemical, serological or chromatographic (thin layer chromatography of lipids) criteria. If possible, the virulence of the isolate for the species of bird affected should be demonstrated by inoculation. Tuberculin test and serological tests: these tests are normally used to determine the prevalence of disease in a flock, or to detect infected birds. When used to detect the presence of tuberculosis in a flock they should be supported by the autopsy of any birds that give positive reactions. A better test, especially for waterfowl, is the whole blood stained antigen agglutination test (Rozanska). It is more reliable and has the advantage that it will give a result in a few minutes, while the bird is still being held. An antigen preparation stained with 1% malachite green is available for the whole blood agglutination test. In most cases infected birds show no clinical signs, but they may eventually become lethargic and emaciated. Under intensive husbandry conditions sudden death may occur, often associated with severe lesions in the liver; such lesions are easily observed at post-mortem examination. All manipulations involving the handling of open hve cultures or of material from infected birds must be performed with adequate biohazard containment. Identification of the agent Where there is a characteristic history of tuberculosis in the flock and typical lesions are found in birds post-mortem, the detection of acid-fast bacilli in smears or sections from affected organs, stained by Ziehl-Neelsen method, is normally sufficient to establish the diagnosis. Occasionally a case will be encountered, presumably as a result of large infecting doses giving rise to acute overwhelming disease, in which affected organs, most obviously the liver, have a "morocco leather" appearance with fine greyish or yellowish mottling. In such cases acid-fast organisms may not be found, but careful inspection will reveal parallel bundles of brownish retractile bacilli. Prolongation of the hot carbol fuchsin stage of Ziehl-Neelsen staining to 10 minutes will usually reveal that these are indeed acid-fast bacilli, with unusually high resistance to penetration of the stain. If there is a characteristic flock history, and suggestive lesions are found at autopsy, but no acid-fast bacilli are seen in smears or sections, an attempt must be made to isolate M. Liver or spleen are usually the best organs to use, but if the carcass is decomposed bone marrow may prove more satisfactory since it could be less contaminated. It may occasionally be necessary to incorporate mycobactin, as used for the isolation of M. If the isolate is not one of these, but is stiU suspected of being the cause of the disease, pathogenicity tests must be carried out. However, it should be borne in mind that superficial tuberculosis lesions in cage birds, especiaUy psittacines, may be caused by M. Hence, if rough colonies of mycobacteria are isolated from such birds, they should be tested for growth at 42?C. For preference these should be carried out on the species of bird being investigated, but failing that domestic fowl or Japanese quail may be used. An inoculum is prepared by putting a small square of aluminium foil and some glass beads in a screw-capped container, sterilising and then weighing it. Finally, sufficient sterile normal saline solution is added to suspend the culture at 0. If the organism is virulent the bird will die in 5-6 weeks, or have extensive lesions filled with acid-fast bacilli by that time. Tuberculin and serological tests a) Tuberculin test the most widely used test in domestic fowl, and the only test for which an international standard for the reagent exists, is the tuberculin test. The test is read after 48 hours, and a positive reaction is any swelling at the site, from a small firm nodule about 5 mm in diameter to gross oedema extending into the other wattle and down the neck. It will be found that with practice even very small wattles on immature birds can be inoculated successfully. However, in immature birds the comb may be used, although results are not so reliable. Tuberculin testing of the wattle in turkeys is much less reliable than in the domestic fowl. Inoculation in the wing web has been recommended as being more efficient, but this is still not as good as for domestic fowl. Other birds may also be tested in the wing web, but results are not generally satisfactory. The bare ornamental skin areas on Muscovy ducks and some species of pheasant can be used, but reliability is doubtful and interpretation difficult. Testing of waterfowl using the foot web has also been described; the test is not very sensitive and is often complicated by infections of the inoculation site. The agglutination may be coarse, in which case it is obvious, or quite fine, in which case it may be most clearly seen as an accumulation of the malachite green-stained antigen around the edge of the drop, leaving the centre a normal blood-red. This especially useful for screening large flocks for immediate culling, and therefore has advantages over the tuberculin test for the control of the disease, even in domestic fowl. It has been claimed that in domestic fowl it is also more reliable than the tuberculin test. Tuberculosis in birds (B57) 573 Neither the tuberculin test with avian tuberculin nor the stained antigen agglutination test is likely to be of any value in cases of M. It is used by intradermal injection to reveal delayed hypersensitivity as a means of identifying animals infected with or sensitised to the same species of tubercle bacillus. An antigen stained with 1% malachite green is used for the rapid whole blood plate agglutination test. They should be shown to be free from contaminating organisms and to be capable of yielding a product that conforms to these norms. The strain used for preparation of the stained antigen must be smooth and not auto-agglutinate in saline suspension. Although at first sight it might appear that it would be best to use a strain of the serotype that is most likely to be encountered (in Europe serotype 2 for domestic fowl, serotype 1 for waterfowl), in practice it is often better to use a strain which will detect infection with any serotype. For special purposes, however, it may be preferable to use a strain which is highly specific for the serotype it detects. The specificity of strains can be determined only by testing them as antigens, although in general a serotype 2 antigen will always detect serotype 3 infection and vice versa. Consistency of results between batches will be easier with the use of pure cultures. Tuberculin: Liquid avian tuberculin should be protected from the light and held at 5?C (?3?C). Lyophilised preparations may be stored at higher temperatures (but not exceeding 25?C) protected from the light. Periods of exposure to higher temperatures or to direct sunlight should be kept to a minimum. Liquid tuberculin should retain its potency for at least 2 years, and lyophilised tuberculin for at least 8 years. Antigen: One or more batches for agglutinating antigen must be tested for efficacy in naturally or artificially infected tuberculous birds by comparison with a reference preparation of known potency. Each bottle of antigen must be tested with normal chicken serum (to detect autoagglutination) and M. This should be done, where possible, alongside a previous batch of stained antigen. Those bottles which give satisfactory agglutination reactions with the antisera can now be pooled and the antigen stained. This is done by the addition of 3 ml of 1% malachite green solution per 100 ml of suspension. If possible, the stained antigen should now be checked using whole blood just as the unstained antigen was tested with serum. The agglutinating antigen should keep for at least 6 months in the refrigerator at 4?C, and much longer if frozen at -20?C or below. If a batch has not been used for a long time it should be rechecked, especially for autoagglutination. An antimicrobial Tuberculosis in birds (B57) 575 preservative that does not give rise to false positive reactions, such as phenol (not more than 5% w/v), may be added. The product is dispensed aseptically into sterile, neutral glass containers which are sealed so as to preclude? Antigen: Antigen for agglutination tests is best grown on solid medium, such as Lowenstein-Jensen or 7H11, in Roux flasks or large bottles; again the incorporation of 1% sodium pyruvate (rather than glycerol in Lowenstein-Jensen medium) is beneficial. The use of solid medium maximises the chances of detecting any contamination, and antigens grown in some liquid media are not agglutinated by specific antibody. Liquid seed culture should be diluted (on the basis of experience) to give discrete colonies on the solid medium. This will usually give the best yield, and again increases the chance of detecting? About 10 ml of inoculum will usually be enough to allow it to wash over the whole surface, and provide sufficient moisture to keep the air in the bottle near 100% humidity. The bottles are incubated at 37?C, and good growth should be obtained in 14-21 days with most strains. The antigen is harvested by the addition of sterile glass beads and twice the volume of sterile normal saline containing 0. The bottle is then shaken gently to wash off all the growth, the washing collected into a sterile bottle and re-incubated at 37?C for 7 days. This sequence is safer than the original method, in which the washing was carried out before the incubation which kills the organisms. Finally the organisms are again centrifuged and resuspended in sterile normal saline containing 0. In-process control Tuberculin: One or more batches of tuberculin must be tested for specificity along with a reference preparation of bovine tuberculin by comparing the reactions produced in guinea pigs sensitised with M. Antigen: Cultures for antigen should be inspected for contamination daily for the first 5 days of incubation. The suspension made from the culture washings is also re-examined microscopically, likely contaminants being yeasts, and re-checked by culture to ensure that the formalin has killed the mycobacteria. Tests on tuberculin for living mycobacteria may be performed either on the tuberculin immediately before it is dispensed into final containers or on samples taken from the final containers themselves. A sample of at least 10 ml must be taken and this must be injected intraperitoneally or subcutaneously into at least two guinea pigs, dividing the volume to be tested equally between the guinea pigs. The guinea pigs are observed for at least 42 days and examined macroscopically post-mortem. Each filled container must be inspected before it is labelled and any showing abnormalities must be discarded. For antigen, the only safety test needed is the culture test of the unwashed antigen after seven days incubation, to ensure that all the bacilli are dead. Sensitise them by administering to each, by deep intramuscular injection, a suitable dose of inactivated or live M. Prepare at least 3 dilutions of the tuberculin under test and at least 3 dilutions of the reference preparation in isotonic buffer solution containing 0. Allocate the dilutions to the injection sites randomly according to a Latin square design. After 24-28 hours, the diameters of the reactions are Tuberculosis in birds (B57) 577 measured and the results calculated using standard statistical methods taking the diameters to be directly proportional to the logarithms of the concentrations of the tuberculins. The estimated potency is not less than 75% and not more than 133% of the potency stated on the label. If the batch fails a potency test, the test may be repeated one or more times provided that the final estimate of potency and of fiducial limits is based on the combined results of all the tests. It is recommended that avian tuberculin should contain the equivalent of at least 20,000 International Units/ml, giving a dose for practical use of 2,000 units/0. Diagnosis of hepatitis in ducklings is based upon a) the characteristic disease pattern in the flock, b) gross pathological changes, c) the recovery of virus from dead ducklings, and d) the reproduction of the disease in susceptible ducklings. These tests have been used for virus identification, assay of immune responses to vaccination, and epidemiological surveys. They are administered to breeder ducks to confer passive immunity to ducklings, or to susceptible day-old ducklings to actively immunise. These viruses, which cause acute infections, should not be confused with duck hepatitis B virus, a hepadnavirus classified in the same group as mammalian hepatitis B virus. The disease is an acute, rapidly spreading, often fatal virus infection of young ducklings. Ducklings lose their balance, fall on their sides and kick spasmodically prior to death.

Buy himplasia canada. Amway Persona New launch Lotus Dew Jasmine starlight Sakura Dream Soap full Information.

An indicator of human impact: gastrointestinal parasites of mountain gorillas (Gorrilla gorilla berengei) from the Virunga volcanoes region herbals and liver damage trusted himplasia 30 caps, Central Africa himalaya herbals buy 30caps himplasia with amex. In: Proceedings of the American Association of Zoo Veterinarians and the American Association of Wildlife Veterinarians joint conference herbal cheap himplasia amex. Climate extremes promote fatal co-infections during canine distemper epidemics in African lions everyuth herbals skin care products order 30 caps himplasia otc. Causal inference in disease ecology: investigating ecological drivers of disease emergence kan herbals order himplasia 30caps without a prescription. Why disease management needs to appreciate the relationship between wildlife herbals on deck discount himplasia uk, livestock and humans, and take an ecosystem approach. A summary of proactive and reactive strategies for managing animal diseases in wetlands. The dual benefits of controlling emerging infectious diseases and invasive alien species. A brief introduction to the role of communication, education, participation and awareness in disease management. However, with wetland habitats subject to substantial and widespread modification and with such a broad variety of anthropogenic uses, diseases have emerged or re-emerged in the last few decades at a far greater frequency than previously recorded. A million dead waterbirds in an outbreak of avian botulism is a clear indication of a major health problem. However, the wetland manager must understand that disease is usually a much more subtle process affecting body systems and functions, and creating energetic costs to the host. Morbidity or mortality may be the outcome but often there will be less obvious consequences on behaviour, reproductive success, the ability to compete for resources and evade predation, and so on. Disease, therefore, acts to shape and limit populations, affecting age structures and distribution of wild species. It is strange then, that wildlife disease has been rather sidelined as an issue by many ecologists for many years. Anthropogenic activities have now affected the environment to such an extent that wildlife disease has, in effect, shown itself to the ecologists, land managers and policy makers and has now become established as a cross cutting conservation issue. The real power for disease control and prevention is in the hands of the land managers and users. For wetland diseases, these key stakeholders are the wetland managers, local wetland users including farmers, hunters, fishers and people living in and around wetlands, and those making policies affecting wetland use. Therefore, this Manual focuses on the wetland managers and policy makers with the aim of influencing the activities and practices of all those using wetlands for their vital resources and services. Effective disease management practiced at a landscape or catchment scale can ensure that disease does not spread and/or become endemic and cause long term problems. The adage of prevention is better than cure is fundamental to disease management. Costs of disease management must be weighed against the benefits of preventing problems, in particular long term issues negatively impacting livelihoods, public health, domestic animal production and biodiversity. The spectrum of disease management practices is broad and may entail nothing more than routine wetland management practices through to major interventions for large scale disease control operations, depending on the issue, its scale and potential impact. Disease management practices may be focused on the environment, the hosts present in the wetland and its catchment, or, in the case of infectious disease, the parasite or pathogen, or any combination thereof. The outcome of disease is dependent on the relationship between a host and its environment, and in the case of infectious disease, the pathogen also. The figure shows some of the factors (outside the circles) which influence this relationship and thus some of the factors that can be targeted for disease control. Rinderpest eradication of a disease affecting all sectors Rinderpest, once described as the most dreaded bovine plague known, became the first disease of animals to be eradicated by human intervention. This acute viral disease has been responsible for the death of domestic cattle for millennia, adversely affecting livestock, wildlife and agricultural livelihoods, bringing starvation and famine. In its classical, virulent form, rinderpest infection can result in 80-95% mortality in domestic cattle, yaks, buffalo and many other wild ungulate species. The disease has had far reaching conservation impacts affecting the abundance, distribution and community structure of many species as well as becoming a source of conflict between agricultural and wildlife interests. Clinical signs include: fever, depression, loss of appetite, discharges from the eyes and nose, erosions throughout the digestive tract, diarrhoea and death. Weight loss and dehydration, caused by enteric lesions, can cause death within 10-12 days. Key Actions Taken to eradicate rinderpest included the development of vaccines, disease surveillance, diagnostic tools and community-based health delivery. Initially, mass livestock vaccination programmes were implemented followed by improved disease surveillance and focussed vaccination campaigns (containing any remaining reservoirs of disease). Disease surveillance and accreditation continued until 2011, when on June 28th the world was declared free from rinderpest. Outcomes: the benefits derived from the eradication of rinderpest are numerous and include: protected rural livelihoods, increased confidence in livestock-based agriculture, an opening of trade in livestock and their products and increased food security. Veterinary services worldwide have become more proficient as a consequence of the fight against rinderpest and the conservation of numerous African ungulates has also benefited. The socio-economic benefits of rinderpest eradication are said to surpass those of virtually every other agricultural development programme and will continue to do so. Rinderpest was successfully eradicated due to ongoing, concerted, international efforts that built on existing disease control programmes in affected countries. Only through international coordination can other such transboundary diseases be controlled and eliminated, as isolated national efforts often prove unsustainable. It is important to note that different stakeholders will likely have different ideas about when interventions are required and ideally these can be addressed within management and contingency plans in peacetime i. It is important to understand that disease management may be thwarted by poor understanding of disease ecology and dynamics, and thus the appropriate management practices to mitigate. Inappropriate disease management practices can even result in counter-productive consequences and novel disease problems. Hence, a good evidence base is important, appreciating that this may be difficult to attain due to complexities or limitations of diagnosis, surveillance, and other knowledge gaps. As human development and livestock have encroached into wild habitats, not surprisingly infectious diseases have spread between these populations, negatively affecting all three sectors. Movements of people and extensive trade in wild and domestic animals have resulted in the global spread of a number of pathogens, causing particular problems where infectious agents are novel and new hosts are immunologically naive. The complexities of disease dynamics in wildlife have resulted in unpredicted disease emergence. Diseases of wildlife that affect humans or their livestock have sometimes led to eradication programmes targeted at wildlife which have not necessarily resulted in reduced disease prevalence but, instead, serious long term consequences for biodiversity, public health and wellbeing, and food security, whilst failing to address causal problems. It has become common understanding that the world can no longer deal with diseases of people, domestic livestock and wildlife in isolation and, instead, an integrated One World One Health approach to health has developed. Delivering integrated approaches and responses across the medical, veterinary, agricultural and wildlife sectors can be problematic given existing organisational roles and structures but demonstrating the benefits this can bring should help promote this progressive way of working. The recent global eradication of rinderpest provides an example of how one disease with impacts across all sectors requires global coordinated efforts to bring about success and benefits for all. For wetlands, which provide the meeting place for people, livestock and wildlife, a mapping of a number of important wetland diseases, according to their hosts (Figure 2-3), illustrates clearly that more diseases are shared between these sectors than are specific to any one sector. Tackling disease in one sector is unlikely to be successful in the long term without consideration of the others. Moreover, not working at an ecosystem scale, and without integrated approaches, misses opportunities for broader positive health outcomes. A number of important wetland diseases mapped according to the hosts they affect: the majority of both infectious and non-infectious diseases are common to all three sectors. Whilst this focus is no doubt important, it distorts the health equation, and does not address what determines health (or illhealth). That failure can result in unnecessary burdens of disease for humans, domestic and wild animals. An ecosystem approach to health, instead, works further upstream closer to the driver of the problem. The approach is preventative recognising that prevention is better than cure and, for wetlands, focussing at a landscape or catchment scale ensures maintenance of social and ecosystem services. This approach then seeks to establish the societal and environmental conditions for good health, bringing long-term savings for medical and veterinary costs and overall maximising benefits and minimising costs for wetland stakeholders, particularly those most likely to be affected by specific health issues. Managing disease within one sector without consideration of the others not only misses opportunities for improved health outcomes for more sectors, but importantly may result in negative health outcomes in other sectors, and feedback unintended consequences for the original sector in the long term. Seeing health as a property of a(n eco)system, allows for more effective and widespread outcomes. The One World One Health and Ecohealth movements arose due to the appreciation of this interdependence on, and connectivity between, health of humans, domestic livestock and wildlife and their social and ecological environment, understanding disease dynamics in broader contexts of sustainable agriculture, socio-economic development, environment protection and sustainability, and complex patterns of global change. A fundamental aspect of taking an ecosystem approach to health is that it is participatory with stakeholders understanding that they can create or solve problems relating to their health and that of their livestock and wider environment. Given the complex relationships between humans and other biodiversity, the complexities of resource use, including barriers to sustainable resource use, improved health outcomes are maximised when more stakeholders are on-board and engaged. This is not an easy accomplishment and processes that allow for genuine co-operation and mutual understanding of quite different organisational sectors is required. It is worth appreciating the consequences of not taking an ecosystem approach to health in wetlands. Wetlands as settings for lifestyles and livelihoods can deteriorate, and negatively affect health in this way. Activities which negatively affect wetland functions and services can create wetlands which actively pose health risks such as exposures to toxic materials and/or water-borne, or vector-borne diseases. Whilst steps can be taken to ameliorate these risks, the risks can increase (sometimes dramatically) if disruption to ecosystems, and the services they provide, continues. Current wetland management practices focussed at maintaining wetland function and wetland benefits usually also address disease prevention and control. However, there will be strategies for disease management that are additional to traditional management practices that once integrated, provide additional gains. Wetland managers are the key stakeholders in delivering healthy wetlands and, as such, all efforts should be made to integrate disease management thoroughly within wetland site management plans and other stakeholder activities at wetlands. Invasive alien species of flora and fauna are considered the second biggest threat after habitat loss and destruction to biodiversity worldwide, the greatest threat to fragile ecosystems such as islands, and are a major cause of species extinction in freshwater systems. Climate change may also exacerbate the spread of non-native species as warmer temperatures may allow currently benign non-native species to potentially extend their ranges and become invasive. Invasive species impact native species in a wide range of ways, including competition, predation, hybridisation, poisoning, habitat alteration and disease. With respect to the latter, invasive alien species can carry novel pathogens non-symptomatically, to which native species may have no natural immunity. Crayfish plague], and amphibian chytridiomycosis carried non-symptomatically by introduced species such as American Bullfrogs Lithobates catesbeianus causes population declines and plays a role in amphibian extinctions [>Section 4. There are many parallels between prevention and control of invasive alien species, and of infectious diseases, such as the proactive measures of: Risk analysis and assessment >Section 3. Communication, education, participation and awareness Training regarding management of those species >Section 3. In general, to apply the concept of wise use and maintain biodiversity and ecological function i. Although a good understanding of disease dynamics is needed for the most effective proactive disease control strategies, there are some basic generic principles which, if implemented, are likely to reduce risks of disease emergence. For example, strategies for biosecurity (including prevention of introduction of invasive alien species), reduction of stresses on hosts and environment, and prevention of pollution, will bring obvious health benefits. Table 2-1 provides a list of proactive practices for disease prevention and control and the locations of further information in Chapter 3. Practice Section of Manual for further information Healthy wetland management Wise use of wetlands Site-specific risk assessments >Section 3. Reactive strategies may include determining an evidence base, conducting surveillance, animal movement restrictions and instigating various other control measures. Reactive strategies for complete disease eradication may involve substantial intervention. With such a wide variety of wetland stakeholders, it is important to appreciate that there is the potential for differences in opinions over reactive disease control strategies and thus cross-cutting education, awareness raising and communication about these activities is advisable, particularly where rapid responses to disease emergence are required. Practice Section of Manual for further information Utilisation of multidisciplinary advisory groups in response to >Section 3. Their application is illustrated in the case studies throughout the Manual and in the Prevention and Control in Wetlands sections of the disease factsheets in Chapter 4. Wetland users do not need to become disease experts but communication and awareness raising programmes should aim to increase motivation to become engaged and do the right thing, with respect to disease management. This will likely only come from becoming informed about the problem, understanding the issues and implications, and participating in the solutions. Developing capacity to undertake disease management may involve formal education and training of key personnel. Communication networks of key wetland stakeholders, including disease control authorities, should be established in peacetime to facilitate rapid disease control responses should the need arise. This Manual aims to provide some of the information as a foundation for communication and public awareness programmes. The concept of One World One Health has arisen due to the appreciation of the fundamental connectivity in health of humans, domestic livestock and wildlife. Embracing an ecosystem approach to health in wetlands involves recognising the dependence of health and well-being on healthy wetlands which can only be achieved through wise use, most often at a landscape and/or catchment scale. If wetland stakeholders understand both the impacts of diseases and how to prevent and control them, they will feel motivated and empowered to take action. Stakeholder understanding must be built through effective communications or training but action will also be influenced by capacity to respond. To view disease management as separate to other forms of land and wildlife management ensures that opportunities for good disease prevention will be missed. Therefore, integrating disease management into wetland management means putting disease consideration at the heart of the wetland management planning process.

Diseases

• Microphthalmia cataract
• Syndactyly ectodermal dysplasia cleft lip palate hand foot
• Polyneuritis
• Aldolase A deficiency
• Lymphomatous thyroiditis
• Mollica Pavone Antener syndrome
• Deafness epiphyseal dysplasia short stature