Alan S. Maisel, MD, FACC
- Professor of Medicine
- Director, Coronary Care Unit
- University of California - San Diego
- Division of Cardiology
- San Diego, California
Employees are encouraged to report safety concerns with regard to intimate partner violence xanax muscle relaxant dosage order robaxin 500mg line. Kingsman Academy will promptly and thoroughly investigate all reports of threats of violence or incidents of actual violence and of suspicious individuals or activities muscle relaxant eperisone hydrochloride order robaxin 500mg visa. The identity of the individual making a report will be protected as much as possible muscle relaxant football commercial order 500 mg robaxin with amex. Option will not retaliate against employees making good-faith reports of violence muscle relaxant for elderly buy robaxin once a day, threats or suspicious individuals or activities muscle relaxant otc best purchase robaxin. In order to maintain workplace safety and the integrity of its investigation muscle spasms xanax withdrawal cheap robaxin 500 mg, Kingsman Academy may immediately suspend employees, contrac to rs, or volunteers suspected of workplace violence or threats of violence, either with or without pay, pending investigation. Anyone found to be responsible for threats of or actual violence or other conduct that is in violation of this policy will be subject to prompt disciplinary action up to and including termination of employment or (in the case of a contrac to r or volunteer) termination of service at and access to the School as well as its students and staff. Participation in such a program, however, will not replace or exempt an employee from additional disciplinary action. Kingsman Academy encourages employees to bring disputes to the attention of their supervisors or Human Resources before the situations escalate. Kingsman Academy will not discipline employees for raising such concerns in good faith. School and Employee Property Kingsman Academy reserves the right to examine, inspect, or search at any time and without notice any and all Kingsman Academy property/workplaces and the contents therein or thereon, including without limitation, Kingsman Academy vehicles (owned or rented), desks, offices, cabinets, lockers, and s to rage compartments. No employee has the right to interfere with or prevent such examinations, inspections, or searches of Kingsman Academy property based on expectations of privacy or otherwise. Any items that an employee does not want to have examined, inspected, or searched should not be brought to the workplace. Sexual Harassment and/or Discrimination Prohibition Policy Statement of Policy It is the policy of Kingsman Academy to maintain a working environment free from sexual, racial, age-based, religious, ethnic, disability, sexual orientation, and any other form of harassment of any Kingsman Academy personnel or applicant. It is the policy of Kingsman Academy that all Kingsman Academy personnel, contrac to rs, and applicants are to be treated in a respectful and professional manner. Also, no individual is to be subjected to any unwelcome conduct Kingsman Academy Public Charter School 215 that is or should be known to be offensive because of his or her gender, race, age, religion, ethnicity, disability, sexual orientation, or other protected category. The term "harassment" in this policy includes conduct which is contrary to this policy, even if it does not meet the legal definitions for harassment. This policy applies to all employees, volunteers, contract workers, and all applicants for such positions. All reported or reasonably suspected occurrences of harassment will be investigated in a confidential manner and as promptly and thoroughly as is practicable and necessary. Where harassment has occurred, Kingsman Academy will take appropriate disciplinary and/or other corrective action, up to and including termination. There will be no retaliation against an individual who has in good faith complained about or reported alleged harassment or who has cooperated with an investigation of alleged harassment. Types of Sexual Harassment For purposes of this policy, harassment includes the following: Hostile Environment Harassment Hostile environment sexual harassment may occur when there are unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature. It is not possible to list all the conduct that may violate this policy or is otherwise unacceptable. Sexual Harassment and/or Discrimination Complaint Procedure Notification Procedures Any Kingsman Academy personnel or applicant who feels that he or she is being or has been subjected to harassment or who knows of or suspects the occurrence of harassment should Kingsman Academy Public Charter School 217 promptly and in confidence inform his or her immediate supervisor or an Kingsman Academy representative. If for any reason a person does not feel comfortable reporting to one of these individuals, that person should report the matter to any Kingsman Academy supervisor. In addition, all management and supervisory personnel at Kingsman Academy have an affirmative duty to report promptly to one of the individuals designated above any harassment that they observe, that is made known to them by others, or that they reasonably suspect has occurred. Investigation Procedure All reported occurrences of harassment will be investigated as promptly and thoroughly as is practicable and as is required under the circumstances. The individual who makes the report or is the target of the alleged harassment will be assured that all forms of harassment are expressly prohibited, that Kingsman Academy will conduct a confidential investigation and that Kingsman Academy will take appropriate corrective action if harassment is found to have occurred. Kingsman Academy will designate the individual who will be responsible for conducting the investigation of reported incidents of harassment. The timing, scope, and extent of the investigation will be determined by Kingsman Academy on a case-by-case basis, considering the circumstances of the alleged harassment. All investigations will be conducted to protect, as much as practicable, the privacy of, and minimize the suspicion to ward, all persons concerned. Kingsman Academy expects Kingsman Academy personnel who are contacted in connection with an investigation to cooperate fully. Procedure Pending Investigation Pending the outcome of an investigation, reasonably necessary and prudent interim measures, such as separation of the complainant and the alleged offender, suspension of the alleged offender, temporary leave for the complainant, etc. In the event that the investigation discloses no violation of this policy or is inconclusive, all necessary parties will be so advised. In the event that the investigation discloses a violation of this policy, Kingsman Academy will normally communicate its findings to both the complainant and the alleged offender. In the event an investigation of a reported or suspected occurrence of harassment fails to reveal harassment and instead reveals that any person has abused the policy by lodging a knowingly false or frivolous complaint, by fabricating facts, by failing to tell the truth, or by knowingly omitting important facts, Kingsman Academy may take appropriate disciplinary and/or other corrective action. No Retaliation No individual who reports or complains about harassment or unacceptable conduct, or who assists Kingsman Academy in its investigation, will be subjected to retaliation. Anyone who feels that he or she has been the victim of, or threatened with, retaliation, should immediately inform one of the individuals identified above for purposes of receiving reports or complaints. Non-Solicitation Policy It is the policy of Kingsman Academy that employees may not engage in non-School business solicitation/distribution activities during work hours. In addition, the use of School resources (including but not limited to stationery, computers, e-mail, voice-mail, bulletin boards, and meeting facilities) for non-School business solicitation is also prohibited. Safety Every care is taken to make Kingsman Academy a safe and healthy place in which to work. Federal and state occupational safety regulations detail Kingsman Academy responsibilities for maintaining a hazard-free working environment. You are required to follow safety rules and procedures, use safety equipment and clothing when necessary, and report unsafe conditions to your supervisor promptly. Kingsman Academy Public Charter School 219 Safety in Emergencies In the case of emergencies and drills for emergencies, employees must listen for and follow instructions from supervisors and/or from members of the School community designated as leaders in case of crisis. Material safety data sheets must be posted and on file to ensure that the information contained in them is readily available. Unless otherwise indicated by School policy, it is the responsibility of department-level managers to post data sheets and supervise environmental compliance (by way of example only, the Science Department chair would ensure Science Department environmental compliance). All employees are expected to observe and follow environmental and safety rules pertaining to these materials, and to take precautions to ensure that such materials are not placed in unlabeled containers where inadvertent injury or pollution may occur. Protection of Confidential Information Employees may, in the course of performing their duties for Kingsman Academy, have access to highly confidential information. Employees who improperly use or divulge any confidential information will be subject to disciplinary action, up to and including termination. Employees who regularly have access to confidential information may be required to sign a specific acknowledgement of their nondisclosure obligation, but this policy that confidential information shall not be disclosed applies to all employees at all times irrespective of whether they have been asked to sign a specific nondisclosure statement. All employees are expected to treat confidential information with complete discretion. Kingsman Academy Public Charter School 220 Lactation Accommodation Kingsman Academy will provide reasonable daily break periods for an employee to express breast milk, as required by the employee. The break period is to run concurrently with any break period, paid or unpaid, already provided to the employee. However, Kingsman Academy is not required to provide break periods if doing so would create an undue hardship on its operations. Kingsman Academy will make reasonable efforts to provide a sanitary room or other location in close proximity to the work area, other than a bathroom or to ilet stall, where an employee can express breast milk in privacy and security. In general, exempt employees are salaried workers who occupy one of the following types of positions: (1) executives, such as managers, (2) certain administrative positions, or (3) professional positions, such as a teacher. An employee who is paid on an hourly basis is usually considered to be non-exempt, regardless of the hourly rate of pay. Employment beyond any initially stated period does not in any way imply a change in employment status. Regular part-time employees have access to all the benefits and prerequisites offered to regular full-time employees, with the following exceptions: 1. In addition, Paid Time Off granted will be equal to or greater than the sick/personal day requirements of District of Columbia law. Employment assignments in this category typically are of a limited duration, as defined by a contract signed by the Executive Direc to r and external firm. Introduc to ry Period In addition, all employees (except temporary and seasonal workers) will work on an introduc to ry basis for the first 90 calendar days after their date of hire. During this time employees have the opportunity to determine whether they are suited for the job and the School has the opportunity to determine whether the employee is satisfying the job requirements and responsibilities. Background Checks Kingsman Academy conducts background checks on prospective and current employees to help avert future problems (1) by identifying applicants or employees who could pose a threat to children or staff members and hence to the organization and its mission, and (2) by Kingsman Academy Public Charter School 223 identifying applicants/employees who otherwise are not suitable for employment in their positions. Background checks may include verification of social security number, education, employment his to ry, military service, professional licenses or certifications, residence, criminal record, mo to r vehicle record, financial record, employment references, drug screening, and other background information. Once employed, an employee may expect that the School will repeat a criminal background check every two (2) years, but the School reserves the right to conduct more frequent screenings, particularly when required to do so by an authorizing agency, a gran to r, or other official. Employees who have signed an authorization of repeat checks will not be notified when these repeat checks occur. Irrespective of checks prompted by the School, an employee must promptly notify the School via Human Resources of and provide documents regarding any arrest alleging the commission of a crime or any conviction of a crime. Irrespective of testing prompted by the School, an employee must promptly notify Human Resources of any serious communicable health condition (by way of example only, swine flu, chicken pox, or a positive tuberculosis test). The employee with a communicable condition may be asked for and must provide upon request (except where confidentiality is protected by law) documentation of the condition to Human Resources. Employees who fail to do so, or who do not produce the documents required by the Form I 9 within the first three workdays, will be terminated in accordance with the Federal Immigration Control and Reform Act. Kingsman Academy will not ask an individual to complete Section 1 of Form I-9 before he or she has accepted a job offer. It is the responsibility of each employee to promptly notify Kingsman Academy of changes in personal information such as mailing address, telephone number, number and names of dependents, and individuals to be contacted in case of emergency. Employees wishing to change the number of dependents listed for income tax purposes should complete and file a new W-4 form. Employees have the right to review and have reproduced (at their expense) material contained in their personnel files. Employees should contact Human Resources to schedule an appointment to access their files. Additional information, including salary information, can only be released with the written authorization of the employee. Overtime Employees classified as non-exempt are eligible for overtime pay if they work more than 40 hours in a work week. Employees working overtime without advance approval may be subject to disciplinary action.
Appendix A 761 Pro to n Pump Inhibi to r: a drug that inhibits gas Smoking Deterrent: a drug that serves to mini tric acid production spasms paraplegic robaxin 500mg free shipping. Psychedelic: a drug (especially a street drug) that Soma to statin Analog: a hormone chemically and induces vivid sensory phenomena and halluci functionally similar to soma to statin spasms 1983 imdb 500 mg robaxin otc. Specific: a drug specially adapted in its indicated Psychotherapeutic: a drug used to treat abnormal use spasms of the esophagus cheap robaxin 500mg, usually because of a functional relation mental or emotional processes (chlorpromazine muscle relaxant non prescription discount robaxin express, ship between drug mechanism and disease haloperidol) spasms from sciatica buy cheap robaxin 500 mg on line. Stimulant muscle relaxant drug class buy discount robaxin 500mg on-line, Central: a drug that increases the R functional state of the central nervous system, Radiographic Agent: see X-Ray Contrast Medium. Stimulant, Respira to ry: a drug that selectively Radiopharmaceutical: a drug containing a radio stimulates respiration, either by peripheral active iso to pe; it is used for diagnostic or initiation of respira to ry reflexes or by selective therapeutic purposes (iodinated albumen with central nervous system stimulation (carbon 125I or 131I). Resin, Electrolyte Removing: see Ion Exchange Sulfonylurea: an oral antidiabetic drug that con Resin. Sympatholytic: a drug that inhibits response to Rubefacient: a to pical drug that induces mild sympathetic nerve impulses and to sympatho skin irritation with erythema; it is used as a mimetic drugs; an antiadrenergic drug (phen to ughening agent (rubbing alcohol). Salt Substitute: a sodium-free alternative to Sympathomimetic: a drug that activates organs sodium chloride used for flavoring foods innervated by the sympathetic nervous sys (potassium chloride). Scabicide: an insecticide suitable for the eradica Systemically Acting Drug: a drug administered tion of the itch mite Sarcoptes scabiei (scabies) so as to reach systemic circulation, from which (crotami to n). T Sedative: a central nervous system depressant Thiazide Diuretic: a diuretic that contains the used to induce mild relaxation (phenobarbital). Sero to nin Agonist: a compound that activates Thyroid Hormone: a hormone that maintains sero to nin recep to rs, mimicking the effect of the metabolic function and normal metabolic rate neurotransmitter sero to nin. Sero to nin Antagonist: a drug used to inhibit the Topically Acting Drug: a drug applied to the action at sero to nin recep to rs. Vasodila to r, Coronary: a drug that expands blood Tranquilizer, Minor: an old term for an anxiolytic vessels in the heart and improves coronary drug. Urea Cyclic Disorder Agent: a drug used to treat Vinca Alkaloid: a plant principle derived from a severe disease of newborns in which ammo Vinca rosea and related species, with antineo nia is not correctly metabolized in the liver. Uricosuric: a drug that promotes renal excretion Vitamin: an organic chemical essential in small of uric acid; it is useful in treating chronic gout amounts for normal metabolism; it is used (probenecid). Uterine Contractant: an obstetric drug used after x placenta delivery to induce sustained uter Xanthine Alkaloid: a plant principle chemically ine contraction to reduce bleeding (methyler related to xanthine, with central nervous sys gonovine). V X-Ray Contrast Medium: a drug opaque to X-rays Vaccine: an antigen-containing drug used to that assists visualization of an internal organ induce active immunity against an infectious during radiographic examination (barium disease (hepatitis B vaccine, rabies vaccine). Aerosol: a dosage form that is packaged under pres C sure and contains therapeutically active ingredi Caplet: tablet dosage form in the shape of a ents that are released upon activation of an appro capsule. A dosage form consisting Capsule: a solid dosage form in which the drug of a liquid or solid preparation packaged under is enclosed within a hard or soft soluble con pressure and intended for administration as a tainer or shell. The descriptive term aerosol also refers Capsule, Delayed-Release: a coated capsule or to the fine mist of small droplets or solid particles more commonly encapsulated granules that that are emitted from the product. Aromatic Water: a clear, saturated, aqueous solu Capsule, Gelatin-Coated: a solid dosage form in tion of volatile oils or other aromatic or volatile which the drug is enclosed within either a hard substances. The dosage Capsule, Liquid-Filled: a solid dosage form in form is sterile filtered, aseptically filled in to which the drug is enclosed within a solu the final package, and then aseptically sealed. The dosage form generally contains Capsule, Soft-Shell: a solid dosage form in which multiple beads (also pellet). Coated: attribute of a solid dosage form that is Douche: a liquid preparation intended for the irri covered by deposition of an outer solid that is gative cleansing of the vagina; prepared from different in composition from the core material. Collodion: a liquid preparation composed of Dressing: the application of various materials for pyroxylin dissolved in a solvent mixture of protecting a wound. Drops, Oral: a solution, emulsion, or suspension Colloidal Dispersion: an attribute of a prepara that is administered in small volumes, such as tion or formulation in which particles of col drops, by means of a suitable device. Conventional-Release: descriptive term for a Elixir: a clear, pleasantly flavored, sweetened dosage form in which no deliberate effort has hydroalcoholic liquid containing dissolved been made to modify the release rate of the active ingredients intended for oral use. In the case of capsules and tablets, the Emollient: attribute of a cream of ointment indi inclusion or exclusion of a disintegrating agent cating an increase in the moisture content of is not interpreted as a modification. An emulsion dosage form often liquid is dispersed throughout another liquid containing more than 20% water and volatiles in the form of small droplets. Creams at least two immiscible liquids, one of which are generally intended for external application is dispersed as droplets (internal or dispersed to the skin or mucous membranes. Delayed-Release: a type of modified-release dos Enema: a rectal preparation for therapeutic, diag age form. Extended-Release: descriptive term for a dosage Dental: descriptive term for a preparation that is form that is deliberately modified to protract applied to the teeth or gums for local action. The term the article is intended to reach or be applied to is synonymous with prolonged or sustained the dermis. Globule: also called pellets or pilules, are made of Extract: a concentrated preparation of vegetable pure sucrose, lac to se, or other polysaccharides. A term used to powder particles that may contain one or more describe a thin, flexible sheet of material, usu active ingredients with or without other ingre ally composed of a polymer. They may be swallowed as such, dis various routes of administration including as persed in food, or dissolved in water. Granules a means of oral administration of material in are frequently compacted in to tablets or filled a rapidly dissolving form. The term may also in to capsules, with or without additional be used as an attribute when applied to solid ingredients. Gum, Resin: natural mixture of gum and resin, Foam: an emulsion packaged in a pressurized usually obtained as exudations from plants. For Suspension: a product, usually a solid, intend ed for suspension prior to administration. In the shape or volume and occupying the entire con case of capsules and tablets, the inclusion or tainer when confined. A small sterile solid mass applied to prevent the release in the gastric consisting of a highly purified drug with or environment. Inhalant: a special class of inhalations consisting Gel, Dentifrice: a combination of a dentifrice of a drug or combination of drugs that by vir (formulation intended to clean and/or pol tue of their high vapor pressure can be carried ish the teeth and which may contain certain by an air current in to the nasal passage where additional agents) and a gel. It is used with they exert their effect; the container from a to othbrush for the purpose of cleaning and which the inhalant generally is administered is polishing the teeth. It includes accelerated release, vesicle usually composed of phospholipids, delayed release, extended release, pulsatile which is used to encapsulate an active drug release, and targeted release. Molded Tablet: a tablet that has been formed by Injection: a preparation intended for parenteral dampening the ingredients and pressing them administration or for constituting or diluting in to a mold, then removing and drying the a parenteral product prior to administration. A route of administration of a liquid or semi Mouthwash: an aqueous solution used to rinse solid deposited in to a body cavity, fluid, or the oral cavity. Insert: a specially formulated and shaped non n encapsulated solid preparation intended to Nasal: route of administration (mucosal) charac be placed in to a nonrectal orifice of the body, terized by deposition in the nasal cavity for where drug is released, generally for localized local or systemic effect. Intraocular: a route of administration to deliver a O sterile preparation within the eye. Oil: an unctuous, combustible substance that Irrigation: a sterile solution intended to bathe or is liquid, or easily liquefiable, on warming flush open wounds or body cavities. Such substances, depending on their origin, J are classified as animal, mineral, or vegetable Jelly: see Gel. Ointment: a semisolid preparation intended for L external application to the skin or mucous Liniment: an alcoholic or oleaginous solution membrane. A semisolid dosage form, usually or emulsion applied by rubbing on the skin containing < 20% water and volatiles and more for treating pain and stiffness of underlying than 50% hydrocarbons, waxes, or polyols as musculature. This dosage form generally is for Liposomes: microvesicles composed of a bilayer external application to the skin or mucous and/or concentric series of multiple bilayers membranes. Ophthalmic Ointment: a sterile ointment intend Lipstick: a waxy solid, usually colored cosmetic, ed for application to the eye. Ophthalmic Preparation: drug in a dosage form Liquid: a dosage form consisting of a pure chem intended to be applied to the eye. This dosage form term Ophthalmic Solution: a sterile solution, essential should not be applied to solutions. The Ophthalmic Strip: a sterile single-use container term has also been applied to suspensions and or sterile impregnated paper strip containing solutions. Lozenge: a solid preparation that is intended to Ophthalmic Suspension: a sterile liquid prepa dissolve or disintegrate slowly in the mouth. Oropharyngeal: a route of administration charac Prolonged-Release: see Extended-Release. Rectal: a route of administration (mucosal) char p acterized by deposition in to the rectum to Paste: a semisolid dosage form that contains one provide local or systemic effect. It generally contains a high con centration of solids (20% to 50%) and has a stiff S consistency. It is intended for application to the Salve: a thick ointment or cerate (a fat or wax skin, oral cavity, or mucous membranes. A semisolid an adhesive backing usually applied to an does not flow at low shear stress and generally external site on the body. Spherical pel Soft Gel Capsule: a specific capsule type char lets are sometimes referred to as beads. Pellets acterized by increased levels of plasticizers intended as implants must be sterile. Pill: a solid spherical dosage form usually pre Solution: a liquid preparation that contains one pared by a wet massing technique. A clear, homog Pledget: a small compress or tuft, usually of cot enous liquid dosage form that contains one to n or cot to n wool, used to apply disinfectant or more chemical substances dissolved in or medicament to the skin. The powder is used with a Spirit: an alcoholic or hydroalcoholic solution of device that aerosolizes and delivers an accu volatile substances prepared usually by simple rately metered amount. It is typically used for may be chewed, producing a pleasant-tasting applying or introducing medication or for residue that is easily swallowed and does not cleansing. Spray: a liquid minutely divided as by a jet of air Tablet, Delayed-Release: a tablet with a coating or steam; used to facilitate application to the that is intended to postpone the release of the intended area medication until the tablet has passed through Stent, Drug-Eluting: a specialized form of implant the s to mach. Targeted Release: release of the active ingredient Suspension: a liquid preparation that consists of from a dosage form modified to preferentially solid particles dispersed throughout a liquid deliver most of the drug to a specific region, phase in which the particles are not soluble; it organ, or tissue. Terminal Sterilization: a process used to produce Swab: a small piece of relatively flat absorbent sterility in the final product contained in its material that contains a drug. A swab Tincture: an alcoholic or hydroalcoholic solution is typically used for applying medication or prepared from vegetable materials or from for cleansing. Syrup: a solution containing a high concentration Topical: a route of administration characterized of sucrose or other sugars. System, Intrauterine: a system that is intended Transdermal Delivery System, Electroporation: a for release of drug over a long period, such as transdermal delivery system enhanced by the a year. System, Ocular: a dosage form intended for place Transdermal Delivery System, High-Velocity ment in the lower conjunctival fornix, from Powder Particles: a transdermal drug deliv which the drug diffuses through a membrane at ery system using supersonic shock waves of a constant rate. T Transdermal Delivery System, Phonophoresis: a Tablet: a solid dosage form containing medicinal transdermal drug delivery system enhanced by substance(s) with or without diluents. Vehicle: a term commonly encountered that refers Transdermal Membrane Patch: a transdermal to a component for internal or external use system containing a drug reservoir entrapped that is used as a carrier or diluent in which between backing and adhesive layers and liquids, semisolids, or solids are dissolved or a drug diffusion-controlling membrane; the suspended. Examples include water, syrups, reservoir is usually a semisolid dispersion or elixirs, oleaginous liquids, solid and semisolid solution of the drug. U Urethral: a dosage form intended for insertion W in to the urethra to provide a local effect of the Wafer: a thin slice of a material containing a active ingredient. Water, Aromatic: a clear, saturated aqueous solu V tion (unless otherwise specified) of one or Vaginal: a route of administration (mucosal) char more volatile oils or other aromatic or volatile acterized by deposition in to the vagina. Appendix C Systems and Techniques of pharmaceutical Measurement Knowledge and application of the systems of system, occasionally may be encountered. Whether applied volume, and linear measure; the apothecary to the compounding and dispensing of pre system includes units of weight and vol scriptions in the community pharmacy, the ume; and the avoirdupois system includes filling of medication orders in the institu only units of weight. The metric system has tional pharmacy, or the large-scale industrial replaced the apothecary system in virtually manufacture of pharmaceuticals, quantita all pharmaceutical measurements and cal tive accuracy is essential in the preparation culations, although some use remains, such of safe and effective medications. The undergo rigid in-process controls and final avoirdupois system is the common commer product assays to ensure conformance with cial system of weight used in the United the applicable standards for drug content. It to o is being replaced by the met Prescriptions and medication orders filled ric system, but at a much slower pace. The extemporaneously in the community and avoirdupois system is encountered by the institutional pharmacy often lack the advan pharmacist in the purchase of bulk chemi tage of control by assay, and thus the phar cals and other items packaged and sold by macist must be absolutely certain of the the ounce or pound. Calculations should be double the metric System checked by the pharmacist and, whenever the metric system is the most widely used possible, by a colleague. The pharmacy student must have a working In the metric system, the gram is the main knowledge of the systems of pharmaceutical unit of weight, the liter the main unit of vol measurement, their application in pharma ume, and the meter the main unit of length. In pharmacy, these are the most commonly SyStemS of Pharmaceutical used metric units: meaSurement Weight is expressed in terms of the kilo Although pharmacy has moved to ward gram (kg), gram (g), milligram (mg), or the exclusive use of the metric system, two microgram (fig). Linear measure is expressed in terms of the the units of weight in the metric system and meter (m), centimeter (cm), or millimeter to demonstrate an easy method of convert (mm). On the square meter (m2) or square centime the scale, the gram position is three decimal ter (cm2). Thus, the decimal point is moved three places the metric weight scale in Figure C. In the other example, the intended to depict the relationship between Kg Hg Dg g dg cg m g (0. Appendix C 773 the avoirdupois System Useful Conversion Equivalents of Volume the avoirdupois system is used in com merce to supply bulk chemicals and other 1 mL = 16. The apothecary pound contains 5,760 grains, whereas the avoirdupois pound 1 in = 2. For example, if one wishes to determine the intersystem conversion number of milliliters in 8 fi, the conversion fac to r that most directly relates milliliters and flu A pharmacist may convert the weight, vol idounces is selected. Depending on the circumstances and containers may be filled from 10 gal of a for requirements for accuracy, conversion fac mulationfi By the following is a table of the fac to rs com dividing this to tal number of milliliters by 30, monly used in prescription practice.
Discount robaxin 500 mg without a prescription. Чем питаться на кето (кетогенной) диете? Что можно есть на диете Аткинса Дюкана?.
Heat serves as a trig as gabapentin muscle relaxant back pain over counter order robaxin 500 mg fast delivery, have reduced pain associ variety of disorders ranging from blood ger for flares and aggravates current ated with the disease spasms and pain under right rib cage generic 500 mg robaxin with amex. To combat increases in environmental enteral approaches such as nitroprusside muscle relaxant liquid form cheap robaxin 500mg with mastercard, to ry and symp to ms are limited to the feet temperature spasms eye discount 500mg robaxin fast delivery, patients engage in water which has been helpful in some children and legs and are diagnosed in childhood immersion muscle relaxant sciatica robaxin 500mg free shipping, a practice that is frowned upon and adolescents and is considered to be the drug of choice for those age groups5 spasms nose order cheapest robaxin and robaxin,11. In this classifi breakdown, irritant contact dermatitis, Lidocaine and prostaglandin infusions are ulcers, and possible amputation3,5. The underlying pathophysiology triggers for the disease include exercise, also been a documented case of a hyper appears to be an ambiguous interplay 11 certain foods or drinks, such as alcohol, baric oxygen treatment. For this patient, between a disruption in vascular dynamics 1,7 and psychological elements, such as hyperbaric therapy did not improve symp and small fiber neuropathy. In response to this, the body increases blood erythema, swelling, and nail changes are Erythromelalgia remains to be a rare flow to the affected area. The pain condition that challenges both patients and arteriovenous anas to moses, responsible accompanying erythromelalgia impacts clinicians. In addition, ural his to ry and continues to have a pro events results in an increase in to tal blood many patients avoid triggers such as heat, found effect on the physical, social, and perfusion with deficient nutritive perfusion. Interestingly enough, there is speculation that the neu are confined to their homes, a risk fac to r for 2. However, there is no conclusive overlooked concern for both physicians and cal Orthopedics 1979;114:249-254. Natural His to ry of Erythromelalgia: their disease, its disabling nature, and the Presentation and Outcome in 168 Patients. Archives of some speculation about the role of genet Derma to logy 2000;136:330-336. Erythromelalgia: New Theories and New Ther the American Journal of Human Genetics apies. American Journal of Human Genetics 2001; May 68(5): Reduced Skin Capillary Density During Attacks 1277-82. The child in fact more often associated had been in good health with no his to ry of with Epstein-Barr virus than recent illnesses. No other family members coxsackievirus, enteroviruses, were affected and there was no significant human immunodeficiency virus, parain travel his to ry. The child was not taking any fluenza virus, human parvovirus B19, medications and did not have any known varicella virus, human herpesvirus 6, drug allergies. There was a diphtheria-tetanus-acellular pertussis, positive family his to ry of asthma. The face, to many different agents and that an eti Figure 2 to rso, palms, soles, and mucous mem ologic diagnosis is reached in less than branes were spared. There was no lym half of patients18, Ricci et al, investigated phadenopathy or hepa to splenomegaly dermatitis of childhood) was established. The hepatic following infection) of generalized lym the subjects studied in this investigation function panel showed an elevated alkaline phadenopathy and monomorphic, noncon (mean 31 months), and that family his to ry phosphatase of 1208 [50-136]. Based on the his to ry, the physical find the face and limbs (lasting about 3 weeks); Diagnostic criteria have been set forth by paracortical hyperplasia of lymph nodes; Chuh (table 1). The Diagnostic Criteria of Gianotti Crosti Syndrome: Are they Applicable to Children in Indiafi A Prospective Case Conrol Study of the Association of Gianotti-Crosti Syndrome with Diagnostic Criteria for Human Herpesviurs 6 and Human Herpesvirus 7 Infec tions. Papular Acrodermati this of Childhood Related to Poxvirus and Parvovirus B19 Infection. Five patients with Proposed Diagnostic Criteria localized facial eruptions associated with Gianotti-Crosti syndrome caused by primary Epstein-Barr virus infection. Infantile acrodermatitis features on at least one occasion or of Gianotti-Crosti and Lyme borreliosis. Combined Vaccinatin by Measles and Hepatitis B Vaccines: A New Cause of feature on any occasion or clinical Gianotti-Crosti Syndrome. Gianotti-Crosti syndrome after encounter related to rash, and measles-mumps and ruebella vaccination. Gianotti-Crosti syndrome preceded by oral polio If lesional biopsy is performed, findings vaccine and followed by varicella infection. Gianotti-Crosti Syndrome Following Milkers Monomorphous, flat- to pped, pink-brown Figure 4 Nodules. Gianotti-Crosti Sydrome and disease, Henoch-Schonlein purpura, Allergic Background. Acta Derm Venereol 2003;83:202 Any 3 or all 4 sites involved: cheeks, Kawasaki disease, scabies, papular 05. Diagnostic Criteria for Gianotti-Crosti Syndrome: extensor surfaces of legs metric periflexural exanthem of childhood. Chuh A, Truncal lesions do not exclude a diagnosis of logic condition does not rule out a diagno Gianotti-Crosti syndrome. Gianotti Negative Clinical Features Crosti Syndrome Presenting as Lichenoid Dermatitis. Scaly lesions Derma to pathologic features typically include a perivascular and interstitial lym tive criteria is a rash that has a duration of phohistiocytic infiltrate in the upper dermis, at least 10 days (61. Interestingly, symmetry was found infiltrate, mild basal vacuolar change, focal to be least specific and predictive (19. Oral antihistamines are sometimes helpful the differential diagnosis requires that while corticosteroids are usually ineffective. Derma to se eruptive acrosituee d origine lichen planus, lichen nitidus, lichen striatus, probablement virosique. Papular acrodermatitis of childhood and other include acrodermatitis enteropathica, ery papulo-vesicular acro-located syndromes. The etiology, asso ciated medical conditions and treatment options are discussed. The epidermis is less hyper who presented with a pruritic eruption on plastic and acantholysis is more localized the abdomen and flank confined mostly to than in classic Hailey-Hailey disease. Physical narrow, slit-like suprabasilar clefts with a examination revealed erythema to us, kera few acantholytic cells. Typically dyskera to to tic papules in a linear arrangement on the sis is not seen. The eruption appeared to follow the scribed intraepidermal spongiotic vesicles lines of Blaschko (Figures 1A, B, C). His to pathology of two punch biopsy the presence of spongiosis and acantholy specimens revealed acantholysis (Figure Figure 1A sis disguishes this from spongiotic dermati 2A) and focal dyskera to tic cells known as tis. The intensity of the eosinophilic Discussion infiltrate may correlate with the intensity of the pruritus. The condition is self-limited, but may derma to sis developing in cancer patients persist for months to years. In: cance of these associations has yet to be Elder D, Elenitsas R, Jaworsky C, Johnson B, edi to rs. Transient acantholytic derma to sis in excessive exposure to the sun in order to oncology patients. Persistent acantholytic derma to sis in a patient with Patients are also well advised to avoid dry increased sensitivity to light. Rapid response of tran based to pical products, high potency corti sient acantholytic derma to sis to selenium sulfide treat costeroids, to pical retinoids, to pical vitamin ment for pityriasis versicolor. Derma to logica Figure 2C min A, isotretinoin, etretinate, systemic cor 1987;175:200-4. Journal of the American Academy known as corps ronds and corps expect a brief exacerbation of their condi of Derma to logy. The pathology report showed it to have severe cy to logic atypia with features consistent of an early evolving melanoma. We report this case to revisit the to pic of halo nevi and to remind clinicians that although most halo nevi are benign we must still remember the conditions when they should be regarded as suspicious lesions and the need for a biopsy. It and he had never received treatment for that they had never seen a typical halo most commonly occurs on the upper back this lesion before. Even though these same derma to logists with no difference in incidence between When his parents were questioned further had never seen a malignant halo nevus males and females. The central nevus was symmetric, cal halo nevus does not undergo malignant immunosurveillance in humans since it is had regular borders, was uniformly brown transformation in children. When the pathology report either physical or chemical, to alter the of early confluence along the dermal/epi came back they were extremely surprised nevomelanocytes in a nonspecific way to dermal junction. The lesion was then reexcised con immune system is able recognize, attack, because his parents were concerned about servatively to ensure complete removal and destroy. A retical link between circulating antibodies to tal body exam was performed and multi Discussion with halo nevi11 because of the ability of ple normal nevi were seen along with the patients with halo nevi to produce antibod lesion of concern on the upper back. Upon the typical halo nevus seen in children ies against the cy to plasm of melanoma questioning the parents they informed us has long been thought of as a benign cells. Instead, the cir It is clear that much work has been done immunoreactivity in the inflamma to ry cell infiltrate of halo nevi. This then leads to the cellular interactions causing these mediated immunity to melanoma cells in patients with vitiligo, halo nevi, or melanoma. J Invest Derma to l production of antibodies, but not until after lesions it may help us to answer some of 1980;75:144. The immunopathology of regression in benign lichenoid kera to ther evidence against this antibody model as well. Typical halo nevi in child studies, which have shown the infiltrating are these few reports of severely dysplastic hood: Is a biopsy necessaryfi Fernandez-Herrera J, Fernandez-Ruis E, Lopez-Cabrera M, mononuclear cell infiltrate in halo nevi. Past medical his to ry was unre the hyperIgE syndrome, also known as Introduction markable. Past surgical his to ry included Job syndrome was first described by Davis the hyperIgE syndrome, also named bilateral inguinal hernia repair shortly after et al in 1966. There is no family his to ry of a to py or the Biblical character that was believed to der that often presents in the first few immunodeficiency disorders. It was first described as a tal miles to nes were achieved appropriately his foot un to his crown. However, follow up visits revealed atrophic or dystrophic nails, and a ten initial description by Davis et al in 1966, a few more erythema to us excoriated dency to develop huge chronic and recur additional studies and case reports papules located on his back, and lower rent cold staphylococcal abscesses that deform and dis to rt the body con to ur. Facial features revealed deep have been reported since it was first described in 1966. It regions and the face, and elevated serum fractures was denied, and on examination can be seen in people of diverse ethnic IgE levels. Although eczema to us Clinical Manifestations lead to persistent pneuma to cele formation, rashes had been described in his medical bronchopleural fistulas, cyst formation, and records, there was no evidence of any the clinical manifestations of the hyper restrictive lung disease. Mucocutaneous eczema to us process on our initial examina IgE syndrome usually present within the candidiasis, characteristic facies and tion except for mild xerosis.
If the mother has a primary infection during Diagnosis: Diagnosis can be carried out by taking the 6 pregnancy spasms sphincter of oddi order robaxin once a day, fetal morbidity rate is high muscle relaxant high discount robaxin master card. Skin yellow round muscle relaxant pill order robaxin 500 mg amex, eye and mouth infection can birth spasms esophagus problems cheap robaxin 500mg with amex, it will be very difficult to differentiate between be easily detected in 24-36 hours by viral culture muscle relaxant vitamin buy 500mg robaxin with visa. Adequate hydration also requires seizure ranged from 10 to 56% in children with minimizing kidney complications spasms near belly button buy robaxin 500 mg overnight delivery. This assay method permits many different analysts have promising effect to control the infection. Sex Transm to xoplasmosis can be treated with pyrimethamine but its Infect 2000; 76:73-79. In the future there will in pregnancy, Cleveland clinical Journal of medicine 2007; 74:290-296. Epilepsy in patients with congenital cy to megalovirus treatment specific precaution should be taken. Awareness about this disease in the people should be regularly done by health workers. Eye Manifestations of intrauterine infections and their impact on childhood blindness, Surv. Find out which infections are reportable in your province/ terri to ry by contacting your local public health unit. Reporting and Illness Transmission Signs/symp to ms Infectious period Exclusion notification Viral respira to ry infections Viruses include: Viruses in the Common cold: Depends on Common cold: No. Bronchiolitis, No, unless coronavirus, hands, indirect Bronchiolitis: croup, infiuenza, you suspect metapneumovirus. Gastrointestinal infections Can be viral or Germs in s to ol spread by: direct contact (hand to mouth), or indirect contact with to ys, other objects or surfaces bacterial. Escherichia Bacteria usually Starts as non-bloody Bacteria excreted Yes, until diarrhea Yes, by the testing coli O157 ingested in diarrhea, usually in s to ol for about a subsides and 2 s to ol labora to ry. Salmonella typhi Bacteria in the s to ol Diarrhea, cramps, Infectious as long as Yes, until diarrhea Yes, by the treating (gastroenteritis or are spread from fever. Managing infections Reporting and Illness Transmission Signs/symp to ms Infectious period Exclusion notification Salmonella Bacteria are Diarrhea, cramps, Infectious as long as Yes, until the child Yes, by the testing gastroenteritis usually ingested in fever. Viruses can spread by contact with Notify all shingles if lesions parents and stafi are not covered. It can also be caused by an allergy or No need to eye irritation, which exclude if there is no usually does not eye discharge, unless cause discharge. Bacteria dizziness, confusion antibiotic treatment she has received at labora to ry. Managing infections Reporting and Illness Transmission Signs/symp to ms Infectious period Exclusion notification Haemophilus Bacteria in mouth and Causes fever Infectious Yes. Symp to ms therapy and a doc to r immediately if a requirements, easily, and requires develop rapidly. For more information or indirect contact do not get sick but 1 week after onset children and stafi have Inform your local and important with s to ol, or can still spread the of jaundice. May be transmitted if an open cut or the mucous membranes (eyes, nose or mouth) are exposed to blood. Managing infections Reporting and Illness Transmission Signs/symp to ms Infectious period Exclusion notification Hepatitis C virus Virus in blood. Contact your local and important during or after birth persistent thrush, public health unit requirements, (by breastfeeding). Impetigo Caused by Group Fluid-filled blisters, Infectious until Yes, if draining lesions No (but community A Strep to coccus usually around the lesions have dried cannot be kept covered. Managing infections Reporting and Illness Transmission Signs/symp to ms Infectious period Exclusion notification Measles Viruses in respira to ry High fever, cough, Highly infectious Yes. A child with Yes, by the treating secretions spread runny nose and red from 3 to 5 days measles cannot return physician and testing For more information easily from person eyes 2 to 4 days before and up to to child care until at labora to ry. A child can return Yes, by the treating disease is a bacterium sepsis or meningitis, after 24 hours to child care once he physician and testing found in the mouth with high fever and of appropriate has received at least labora to ry. Mumps Virus in saliva and Fever, swollen glands Infectious from Yes, for 5 days after Yes, by treating respira to ry secretions at the jaw line or on 2 days before onset onset of swelling. Pertussis (whooping Bacteria in respira to ry Runny nose, Infectious for up to Not routine but Yes, by the treating cough) secretions spread frequent and severe 3 weeks from onset exclusion may be physician and testing easily from person to coughing spells, of illness if not mandated by public labora to ry. Invasive infections after 24 hours illness can return physician and testing Possible person include fever of appropriate to child care once a labora to ry. Managing infections Reporting and Illness Transmission Signs/symp to ms Infectious period Exclusion notification Scabies Mites spread from Itchy red rash, usually Transmissible as Yes, until the first No. Variables (risk fac to rs) Infuencing Transmission Risk Using Seasonal Infuenza as an Example of Droplet Spread. Airborne transmission this refers to the transmission of microorganisms via inhaled aerosols that results in an infection in a susceptible host. The genetic information to produce carbapenemases is often located on a mobile genetic element. Cohort staffng this is the practice of assigning specifc personnel to care only for patients known to be exposed to or infected with the same organism. Indirect contact this is the passive transfer of microorganisms from an infected or colonized individual to a susceptible host via an intermediate object. Continuum of care this refers to care provided across all health care sec to rs, including settings where emergency (including pre-hospital) care is provided, hospitals, complex continuing care, rehabilitation hospitals, long-term care homes, outpatient clinics, community health centres and clinics, physician offces, dental offces, offces of other health professionals, public health and home health care. Droplets are usually generated by an infected source by coughing, sneezing or talking. Droplet transmission this is transmission that occurs when the droplets that contain microorganisms are propelled a short distance (within 2 metres) through the air and are deposited on the mucous membranes of another person, leading to infection of the susceptible host. Drug identifcation number this is the number located on the label of prescription and over-the-counter drug products that have been evaluated by the Therapeutic Products Direc to rate and approved for sale in Canada. Exposure this refers to having contact with a microorganism or an infectious disease in a manner such that transmission may occur. Facial protection Facial protection includes masks and eye protection, face shields, or masks with a visor attachment. Health care environment this refers to the people and items which make up the care environment. For the purpose of this document, acute care also includes ambula to ry care settings such as hospital emergency departments, and free-standing ambula to ry (day) surgery or other invasive day procedures. Long term care this refers to a facility that includes a variety of activities, types and levels of skilled nursing care for individuals requiring 24-hour surveillance, assistance, rehabilitation, res to rative or medical care in a group setting that does not fall under the defnition of acute care. Immunocompromised this term refers to patients with congenital or acquired immunodefciency or immunodefciency due to therapeutic agents or hema to logic malignancies. The mask should be durable enough so that it will function effectively for the duration of the given activity. The flter is certifed to capture at least 95 per cent of particles at a diameter of 0. In a nursery or neonatal setting, the patient environment includes the inside of the bassinette or incuba to r, as well as the equipment outside the bassinette or incuba to r used for that infant. It is a personal protective device that fts tightly around the nose and mouth of the wearer, and is used to reduce the risk of inhaling hazardous airborne particles and aerosols, including dust particles and infectious agents. Respira to ry hygiene/cough this refers to a combination of measures to be taken by an infected source etiquette designed to minimize the transmission of respira to ry microorganisms. This procedure is performed immediately after putting on the respira to r to ensure there is a good facial seal. Terminal cleaning Terminal cleaning refers to the process for cleaning and disinfection of a patient accommodation, undertaken upon discharge of any patient or on discontinuation of Contact Precautions. Virulence Virulence refers to the ability of the infectious agent to cause severe disease. This guideline promotes the consistent application of Routine Practices and Additional Precautions across the continuum of care. For the purpose of this document, acute care also includes ambula to ry care settings such as emergency departments, hospital-based and stand-alone clinics and ambula to ry surgery centres. The consequences of cross-transmission of microorganisms must be balanced against the consequences (adverse effects and cost) of precautions taken. Additional Precautions may also be required when medical procedures increase the risk of transmission of a specifc agent. The application of Routine Practices always continues, even with the use of Additional Precautions. These patients are generally at increased risk for bacterial, fungal, parasitic and viral infections from their own (endogenous) and exogenous sources. However, it is always advisable to minimize exposure to other patients with highly transmissible infections, such as respira to ry and gastrointestinal infections. In turn, this infuenced relationships, resulting in a distancing from family, friends and colleagues at work, with many patients afraid to disclose their diagnosis for fear of rejection. Health care associated infections are therefore a signifcant barrier to access to care for other health conditions of Canadians. Isolation practices can be stigmatizing and psychologically damaging, which may adversely affect the quality of health care delivered. In other situations, certain measures may need to be modifed for different types of health care settings, based on assessment of risks and benefts. Infectious Agents (microorganisms) these are bacteria, viruses, fungi, parasites and prions and can be either endogenous fora. Microorganisms that can survive environmental conditions and remain viable on inanimate objects, such as patient care equipment, are more likely to be transmitted. Reservoirs in Health Care Humans, animals and the environment are reservoirs of infectious agents (microorganisms) relevant to health care. Routes of Transmission Routes of transmission of infectious agents (microorganisms) are conventionally categorized in to fve routes. Nevertheless these transmission categories have proven useful in describing the spread of microorganisms in populations. The environment may play a larger role in the survival and growth of certain microorganisms than previously appreciated, reinforcing the importance of minimizing environmental contamination by patient secretions and excretions, avoiding unnecessary hand contact with environmental surfaces and ensuring high standards for environmental cleaning are maintained. Exposure to Infectious Agents (microorganisms) Exposure occurs when a susceptible host comes in to contact with an infected source or contaminated environment. Particles of a variety of sizes are expelled from the human airway during coughing, sneezing, talking and medical procedures. Droplets may also contaminate the immediate environment when they settle on surfaces and may contribute to contact transmission (as shown in Figure 6). Droplets of various sizes (see Figure 2) may contaminate the immediate environment when they settle on surfaces. Microorganisms transmitted by the droplet route include viruses that cause respira to ry tract infections. Infection can result only if the appropriate recep to rs for the infectious agents are present at the site of exposure. Figure 3 depicts the regions of the respira to ry tract with the size classifcation of particles and their corresponding region of deposition. Part C, Tables 5 and 6 provide a complete list of microorganisms transmitted by the airborne route. Control is achieved by maintaining appropriate standards in the preparation of food and medications, and in decontamination of shared equipment (see Figure 8). Host Fac to rs Microorganisms must gain access to a susceptible host by a receptive portal of entry for transmission to occur. Asymp to matic Infection/Clinical Disease Infection may or may not lead to clinical disease (illness). Administrative Controls the administrative control tier provides an infrastructure of policies and procedures and patient care practices intended to prevent exposure to , and transmission of, microorganisms to a susceptible host during the provision of health care. Patients and other persons with symp to ms require direction at the point of initial encounter in any health care setting. These source control measures are targeted to all individuals with symp to ms of respira to ry infection, starting at the initial encounter in a health care setting and maintained throughout every encounter in the health care setting. Use of safety engineered devices, such as using protected needle devices, needle-free systems with self-sealing ports, and syringes with safety features, have been reported to reduce needlestick injuries. Refer to Canadian Standards Association Z316 Sharps injury protection Requirements and test methods Sharps Containers (current edition).
The data on the occurrence of the infection in man and animals muscle relaxant and nsaid purchase genuine robaxin on line, along with data on the geographical distribution quad spasms buy robaxin 500mg lowest price, may help the reader judge the relative impact that each disease has on public health and the lives to ck economy in the different regions of the world muscle relaxant on cns buy 500 mg robaxin with visa, given that the importance of different zoonoses varies greatly quad spasms order robaxin on line amex. For example muscle relaxant general anesthesia buy robaxin canada, foot-and-mouth disease is extremely important from an economic stand point spasms detoxification purchase robaxin 500mg overnight delivery, but of little importance in terms of public health, if animal protein losses are not considered. In contrast, Argentine and Bolivian hemorrhagic fevers are impor tant human diseases, but their economic impact is minimal, if treatment costs and loss of man-hours are not taken in to account. Many other diseases, such as brucel losis, lep to spirosis, salmonellosis, and equine encephalitis, are important from both a public health and an economic standpoint. Finally, each disease entry includes an alphabetical bibliography, which includes both the works cited and other relevant works that the reader may consult for more information about the disease. In Scotland, the annual incidence was three per million and the rate of attack was 10 times higher in agri cultural workers than among others. Occurrence in Animals: the frequency of the disease varies widely among regions and is also influenced by different lives to ck management practices. Small outbreaks have occurred in some marshy areas of the United States and the former Soviet Union. As a result of wounds or surgery, it can enter the soft tissues and bones, where it causes a suppurative granuloma to us process that opens to the surface through fistulas. Several clinical forms have been identified according to their location: cervicofacial, thoracic, abdominal, and generalized. Cervicofacial, which is the most common (from 50% to more than 70% of cases), is usually caused by a to oth extraction or a jaw injury; it begins with a hard swelling under the mucous membrane of the mouth, beneath the periosteum of the mandible, or in the skin of the neck. At a later stage, softened areas, depressions, and openings to the exterior with a purulent discharge are evident. The tho racic form is generally caused by breathing the etiologic agent in to the bronchial tubes where it establishes a chronic bronchopneumonia that affects the lower por tions of the right lung (Burden, 1989), with symp to ms similar to pulmonary tuber culosis. The abdominal form usually occurs after surgery and appears as an encapsulated lesion that often becomes localized in the cecum and the appendix, where it produces hard tumors that adhere to the abdominal wall. The generalized form is infrequent and results from the erosive invasion of blood vessels and lymphatic system, resulting in liver and brain disease. In the vast majority of cases, colonization by actinomyces produces only a superficial or asymp to matic infection. In bovines, it centers chiefly in the maxillae where it forms a granuloma to us mass with necrotic areas that develop in to abscesses. The pus contains small, yellow, sulphur granules, which are rosette shaped when viewed under a microscope. In some cases chewing becomes very dif ficult, and the animal s to ps eating and loses weight. The cost-benefit ratio must be measured when treating bovine and equine actino mycosis. In other cases, curettage can be performed on the abscesses and fistulas, which are then packed with gauze saturated with iodine tincture. Medical treatment is the same as for human actinomycosis, preferably using penicillin. This infection is attributed to Actinomyces suis,whose tax onomy is still uncertain. In dogs, the disease produces cervicofacial abscesses, empyemas accompanied by pleurisy and osteomyelitis, and, more rarely, abdominal abscesses and cutaneous granulomas. Actinomyces develop as saprophytes within and around carious teeth, in the mucin on dental enamel and in the to nsillar crypts. It has not been possible to isolate the agent of actinomyco sis from the environment. It is believed that the causal agent penetrates the tissues of the mouth through lesions caused by foods or foreign objects, or by way of den tal defects. From the oral cavity, the bacteria can be swallowed or breathed in to the bronchial tubes. Role of Animals in the Epidemiology of the Disease: the species of Actinomyces that attack man are different from those that affect animals. The designation of species prior to 1960 is doubtful (Lerner, 1991) and thus, distinguishing one species from another presents great problems. The infection in animals is not transmitted to man, nor is it transmitted from person to person or animal to animal. Diagnosis: the clinical picture may be confused with other infections, such as actinobacillosis, nocardiosis, and staphylococcosis, as well as neoplasia and tuber culosis. The first step in confirming the diagnosis is to obtain pus, sputum, or tissue samples for microscopic examination and culture, and to inspect them for granules. It is possible to identify the species of actinomyces causing the disease only by culturing and typing the isolated microorganism. Control: Prevention in man consists of proper oral hygiene and care after dental extractions or other surgery in the oral cavity. No practical means have been estab lished yet to prevent actinomycosis in animals. However, genetic hybridization studies indicate that the genus Aeromonas is sufficiently dif ferent to place it in a new family, with the suggested name of Aeromonadaceae. The first group is psy chrophilic and nonmotile and is represented by Aeromonas salmonicida, an impor tant pathogen for fish (the agent of furunculosis). The second group is mesophilic and motile, and it is this group that causes aeromoniasis, a disease common to man and animals. These aeromonas are gram-negative, straight bacilli ranging from 1 to 3 microns in length. They have a polar flagellum and are oxidase positive and facul tatively anaerobic. Thirteen different genospecies have been established, but from a practical standpoint the three principal phenospecies are retained. It is possible to identify 95% of isolates on the basis of their biochemical properties (Janda, 1991). All the O antisera contain antibodies to the rugose form (R) of the bacillus, and thus the antisera must be absorbed by culturing the R form before being used (Sakazaki and Shimada, 1984). Typing is done by gel protein electrophoresis, isoenzyme analysis, and genetic analysis. Over the last decade, researchers have tried to define the virulence fac to rs of this genus, both in terms of structural characteristics and the extracellular products they secrete. It is expressed when stimulated by certain envi ronmental conditions that give the bacteria the ability to colonize. Another structural characteristic that was first discovered in au to agglutinating strains of A. The substances externally secreted by aeromonas include beta-hemolysin that is produced by certain strains of A. It has been determined that this hemolysin has entero to xigenic effects on lactating mice and ligated ileal loops of rabbits. Purified beta-hemolysin inoculated intravenously in to mice is lethal at a dose of 0. The cy to to nic entero to xin that causes an accumulation of fluid in the ligated ileal loop of the rabbit, as well as other effects, has also been described. Based on tests conducted in mice and fish (the latter are much more susceptible), it can be concluded that A. In addition, there is a great difference in the virulence of the strains within each species (Janda, 1991). In addition, it was not possible to detect a common mechanism in the pathogenic capacity of Aeromonas spp. Only the human strains caused death or lesions through intramuscular inoculation of mice. Their prin cipal reservoir is in river and estuary waters, as well as in salt water where it meets fresh water. Population density is lower in highly saline waters and waters with lim ited dissolved oxygen. It has sometimes been possible to isolate Aeromonas from chlorinated water, including muncipal water supplies. There may have been other outbreaks that were not recognized because food and patient s to ols were not examined for detection and identification of A. The disease may occur individually or epidemically, particularly in fish-farming pools. The Disease in Man: For some time the aeromonas were considered opportunis tic bacteria. Clinical and epidemiological information amassed in recent years seems to confirm that A. Patients with and without diarrhea have been compared, with the lat ter group consisting of patients suffering from other diseases or healthy individuals. In Argentina, 8 strains (2%) were isolated from 400 fecal samples and from a colon biopsy in children with diarrhea, and no strains were isolated from 230 children without diarrhea. The clinical symp to ms include profuse diarrhea, slight fever, and abdominal pains; vomiting is occasionally seen in patients under 2 years of age. Cases of gastroenteritis with blood and mucus in the feces have also been described. Gastroenteritis is much less frequent in adults, but can occur with diarrhea of longer duration (from 10 days to several weeks or months), weight loss, and dehydration. The wound generally becomes infected through contact with river water, ponds, or other water reservoirs. Some 20 cases have been described of infection caused by medicinal leeches (Hirudo medicinalis) used to treat pos to perative venous congestion after grafts or replantations. These infections are usually limited to contami nation of the wound, but can cause extensive tissue loss and septicemia (Lineaweaver et al. Untreated cellulitis can become complicated by myonecrosis and require amputa tion of a limb. Septicemia occurs primarily in immunodeficient patients and rarely in immuno competent patients. The clinical manifestations are similar to septicemia caused by other gram-negative bacteria and consist of fever and hypotension. Gastroenteritis in children is a self-limiting disease and does not require treat ment, except in prolonged cases. All other forms should be treated with antibiotics, such as gentamicin, amikacin, chloramphenicol, and cyprofloxacin. The Disease in Animals: Aeromoniasis is primarily a disease that affects fish, amphibians, and reptiles. The clinical picture is very varied and sometimes other pathogens are isolated that can confuse the diagnosis and signs of the disease. In other cases, scales are lost and localizaed hem orrhages appear in the gills, mouth, and base of the fins. Ulcers in the skin, exoph thalmia, and abdomen-distending ascites may also be found. Intensive fish farming can create conditions that favor infection, such as overpop ulation and adverse environmental fac to rs (increase in organic material and decrease in dissolved oxygen). These fac to rs reduce the resistance of the fish and favor the pathogenic action of A. In northern Greece, where great losses of carp (Cyprinus carpio) occurred in ponds due to a disease characterized primarily by cutaneous ulcers, both A. It was possible to reproduce the disease experimentally through subcutaneous inoculation of A. Previously, there was an outbreak in Argentina of fin disease in young black catfish (Rhamdia sapo). When the disease was reproduced experimentally, there was not much difference between the fish inoculated with A. The agent can be isolated from the blood of mullet with the experimentally reproduced disease one or two days after inoculation. The Louisiana frog (Rana catesbeiana) suf fered various epizootics in 1971 and 1972. Of 4,000 tadpoles separated from their natural habitat and kept under labora to ry conditions, 70% died during metamorpho sis and 20% died after completing it.
Additional information: