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The nucleus coeruleus is pale in contrast to the usually well-pigmented pars compacta of the substantia nigra nifedipine 30mg low price. The microscopic changes are found almost throughout the brain nifedipine 20 mg cheap; however, their severity varies according to the regions. Especially involved are the areas exhibiting the most prominent atrophy including the amygdaloid nucleus, hippocampal formation, and the following regions of the cerebral cortex: temporal, prefrontal, and parietal. The pathologic changes include: 1) A decrease of neuronal density the severity of which varies according to region 2) Neurofibrillary tangles of Alzheimer (Figure 8). In advanced stages of the disease they may be found within the motor or visual cortices or both. Neuronal tangles occur within the amygdaloid nucleus, hippocampus, substantia innominata (nucleus of Meynert), hypothalamus, thalamus, raphe nuclei, nucleus coeruleus, and reticular formation. Amyloid may gradually accumulate within the walls of medium size leptomeningeal or cortical vessels (Fig. Amyloid replaced the smooth muscle fibers as inferred by the absence of their nuclei within the media (Hematoxylin and eosin). Right: Section subjected to antibodies directed against β-amyloid, which labeled the abnormal deposits present within the wall of the vessel and within the surrounding parenchyma. The frequency of this vasculopathy increases with age and occurs often in elderly people including those without cognitive impairment. The mutations lie either within the amyloid peptide region itself or adjacent to it. These genes are highly homologous and encode for a transmembrane protein that is 64 part of the γ-secretase protein complex. The highest association is seen with e4 homozygous individuals, with a lesser association with e4 heterozygotes. Senile plaques typically exhibit varying degrees of reactive cellular response by microglia and astrocytes, both of which are known to produce cytokines. In the recent past there was considerable interest in the effects of aluminum, because neurons that contain tangles also appeared to contain high levels of aluminum, and 65 because the injection of aluminum salts into brains of experimental animals produced accumulations of neurofilaments in neuronal cell bodies and axons. Many kindreds have been linked to chromosome 17, with mutations identified in the tau gene and progranulin gene. The patients are phenotypically heterogeneous even within the same kindred, although consistent features occur. The atrophy usually predominates within the frontal, or fronto-temporal, or fronto- temporal-parietal regions (Fig. Right: Microphotograph of the stratum granulosum of the dentate gyrus showing ubiquitinated cytoplasmic inclusions involving scattered granular neurons. The hallmarks of Pick disease are: - Diffuse atrophy with regional, circumscribed accentuation of the atrophy (Fig. They are found in cortical pyramidal neurons and in the hippocampal formation; and in the amygdala, and occasionally within the striatum and brainstem. Pick bodies are found in about 30 to 50 percent of brains from demented patients with discrete, circumscribed atrophy. Left: Pyramidal neurons of the Sommer sector of the hippocampus, Bielschowsky, original magnification 200X. Ballooned neurons are found in a variety of neurodegenerative diseases included Pick disease and Alzheimer disease. Left: Micrographs of two ballooned neurons or Pick cells from the cingulate gyrus of a 88-year-old woman with dementia. Right: Ballooned neurons may represent a stage of the cell body during the degenerating process of the neuron starting at the distal end of the axon (neuronal dying-back phenomenon, or “nucleo distal” atrophy, or centripetal atrophy) Spatz H. The disease is characterized by a constellation of neurological symptoms collectively termed Parkinsonism, including resting tremor, bradykinesia, rigidity and postural instability (gait disturbance). Elderly individuals are predominantly involved (the exception being the rare form of juvenile Parkinson disease). It is estimated that more than half a million Americans are affected at any one time. Recently, transplants of adrenal medullary tissue or fetal nigral tissue into the striatum has generated considerable interest and raised hopes for effective therapy; application of stem cell therapies to replace lost dopaminergic neurons are being actively researched. Lewy bodies are principally composed of α-synuclein; however there are other proteins contained within them (e. Two types of Lewy bodies can be distinguished by morphology and regional distribution: the brainstem or classical type (Fig. In addition to Lewy body- containing neurons, there is loss of neurons, which involves predominantly the following structures: -Substantia nigra (pars compacta) - Dorsal nucleus of vagus - Nucleus coeruleus - Substantia innominata including the nucleus of Meynert - Hypothalamus 69 A. B) In contrast to the control, in Parkinson disease (B), or in diffuse Lewy body disease, or in Alzheimer disease Lewy body variant, the normally expected pigment is decreased. This pigment, neuromelanin, is a byproduct of the neuronal function, the density of which gradually increases with age provided there is no pathologic, neuronal loss. A Lewy body is round, 8 – 30 µm in diameter, and consists of a hyaline core with or without concentric lamellar bands, and with a peripheral, pale halo (A, hematoxylin and eosin, original magnification 630X). Lewy bodies are labeled with antibodies directed against ubiquitinated proteins, or (as in B) with antibodies directed against α-synuclein (B, original magnification 200X).
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Upper surface has a velvette ap pearance covered by three varieties of papillae 1) Circumvallate papillae – these papillae are arranged in a “V” shape at the back of the tongue and taste buds are found numerous in the walls of the circumvallate and fungiform papillae nifedipine 20mg sale. The filaments of the nerve arise in the upper part of the nasal cavity is called olfactory portion of the nose and lined with highly specialized cells discount nifedipine 20 mg on line. The olfactory nerves and connections The olfactory bulb is an outlying portion of the brain is the slightly enlarged portion of the olfactory nerve tract which lies above the cribriform plate of the ethmoid bone form the olfactory bulb sensation is passed along the olfactory tract by several relaying stations until it reaches the final receiving area in the olfactory centre which is in the temporal lobe of the cerebral hemisphere where the sensation is interpreted. The nerve supplying this special sense is the eighth cranial or auditory nerve The ear has the following parts 1) External ear 2) Middle ear or tympanic cavity 3) Internal ear. External ear consist of 1) Pinna or auricle collects the sound waves 2) External auditory meatus conveys the vibrations of sound Middle ear consist of 1) Ear drum communicates to the mastoid process 2) Eustachian tube maintaining the pressure of air in the tympanic cavity 3) Auditory ossicles are 3 small bones. They are 58 Malleus Incus This chain of bone serves to transmit the vibrations of sound from the drum to the internal ear Stapes Mastoid process is the part of the temporal bone lying behind the ear an air space communicates in the middle ear Internal ear Consists of cavities called the bony labyrinth and membranous labyrinth. The fluid within the membranous labyrinth is endolymph and the fluid in the bony labyrinth is the perilymp. The fenestra vestbuli and the fenestra cochlea are windows directed towards the middle ear and allow the vibrations transmitted to peri and endo lymph to acti vate the nerve endings of the auditory nerve Hearing: Sound waves pass along the external auditory canal cause the tympanic membrane to vibrate. By movement of these bones, magnify the vibrations, then communicated to the vestibular fenestra to the perilymph and to the endolymph in the canal of the cochlea. This stimuli reaches the nerve endings in the organ of corti, conveyed to the brain by auditory nerve. The sensation of hearing is interpreted by the brain as a pleasant or unpleasant sound (noise or music). Balance: The change in the position of the fluid in the semicircular canals helps in order to maintain balance of the body and this canal distributed by the vestibular nerve which conveys to the brain the 59 impulse generated there by alterations in the position of the fluid in these canals which have to do with the knowledge of the sense of the position of the head in relation to the body Organs of special sense The eye and sight: Eye ball is spherical in shape situated in the anterior 2/3 of the orbital cavity and it is embedded in the fat of the cavity. The optic or second cranial nerve is the sensory nerve of the sight The eye ball composed of 3 layers 1) Outer Fibrous and supporting layer 2) Middle Vascular 3) Inner nervous layer (Retina) 1 Fig 2. It protects the delicate structure of the eye and helps to maintain the shape of the eyeball Cornea: Is a transparent front portion, avascular and continuous with the sclera. It consist of several layers and it helps to focus images on to the retina Vascular layer: Choroid: It is highly vascular and pigmented layer, supplies nutrition to the outer layer of retina, absorbs the light and prevents reflection of light Ciliiary body: It lies between the choroid and the iris and has circular muscle fibers and radiat ing fibers helps in maintaining the accommodation of the eye Iris: It is a circular, contractile and pigmented diaphragm. It is the color curtain in front of the lens and it contains 2 sets of involuntary muscle fibers, one set contract the size of the pupil & other set dilates the pupil Pupil: It is the dark central spot which is an opening in the iris through which light reaches the retina Nervous layer (retina): Composed of number of layers of fibers, nerve cells, rods and cones. At the middle side of the macula there is a circular pale area which is insensitive to light called blind spot 60 Sight When an image is perceived the rays of light from the object seen, pass through the cornea, aqueous humor, lens and vitreous body to stimulate the nerve endings in the retina. The stimuli received by the retina pass along the optic tracts to the visual areas of the brain to be interpreted. Male and female sexual reproductive organs: The sex organs in the male and female can be divided as 1. Primary sex organs in male and female: There are a pair of testes producing spermatozoa (male gametes) while in females are a pair of ovaries producing ovum (female gamete). These primary sex organs in addition to producing male and female gametes secrete male and female hormones as well. Many septate from this layer divide the testes into pyramidal lobules in which lie seminiferous tubules and interstitial cells. The interstitial cells called Ludwig cells lie between the tubules and secrete the testosterone (male sex hormone). The prostrate gland lies at the base of the urinary bladder and is covered with fibrous capsule which by a number of septa divides into many follicles. The prostrate adds another fluid to the semen, which makes the sperms more active in swimming to reach the ovum. In males the urethra is about 2022 cm in length and serves the purpose of urination as well as ejaculation of semen. Vagina: It is a muscular tube lined with membrane comprised of special type of stratified epithe lium, well supplied with blood vessels and nerves. It covers the perineal body, which is a wedgeshaped structure between the vagina and lower part of the rectum. This opening is surrounded by finger like processes called fimbriae, one of which is connected to the ovary. The fallopian tubes have walls of muscle and are lined with ciliatd epithelium and covered with peritoneum. It is sent along partly by peristaltic action of the muscles and partly by waving movements of the cilia. The narrow cavity of the uterus has three openings: one into each fallopian tube, and one through the external os of the cervix into the vagina. Ovary: The gonads of the females are called ovaries and the cells that they produce are known as ova or egg cells, each female has a pair of oval shaped structure about the size of a almond. An ovary consists of the following; 1) The germinal epithelium: it is the outer part of the ovary from which the primitive graffian follicles develop.
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Evaluation of a commercial probe assay for detection of rifampin resistance in Mycobacterium tuberculosis directly from respiratory and non respiratory clinical specimens. European Journal of Clinical Microbiology and Infectious Diseases, 1998, 17:189-192. Detection of rifampicin resistance in Mycobacterium tuberculosis isolates from diverse countries by a commercial line probe assay as an initial indicator of multidrug resistance. Rifampin- and multidrug-resistant tuberculosis in Russian civilians and prison inmates: dominance of the beijing strain family. Low levels of drug resistance amidst rapidly increasing tuberculosis and human immunodeficiency virus: co-epidemics in Botswana. Epidemiological analysis of tuberculosis treatment outcome as a tool for changing tuberculosis control policy in Israel. Drug- resistant pulmnonary tuberculosis in Israel, a society of immigrants: 1985-1994. Screening and management of tuberculosis in immigrants: the challenge beyond professional competence. The new National Tuberculosis Control Programme in Israel, a country of high immigration. Drug-resistant tuberculosis in Poland in 2000: second national survey and comparison with the 1997 survey. Drug resistance among failure and relapse cases of tuberculosis: is the standard re-treatment regimen adequate? P was established 1948 early Notification all cases (rate) /100,000 Year of Rifampicin introduction 1970s early Estimated incidence (all cases) 5. P was established 1963 Notification all cases (rate) 10 /100,000 Year of Rifampicin introduction 1982 Estimated incidence (all cases) 10. P was established 1973 Notification all cases (rate) 47 /100,000 Year of Rifampicin introduction 1983 Estimated incidence (all cases) /100,000 Year of Isoniazid introduction 1973 Notification new sputum smear + 4439 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 34. P was established 1989 Notification all cases (rate) 16 /100,000 Year of Rifampicin introduction 1980 Estimated incidence (all cases) 29 /100,000 Year of Isoniazid introduction 1970s Notification new sputum smear + 4889 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 7. P was established 1950 Notification all cases (rate) 72 /100,000 Year of Rifampicin introduction 1985 Estimated incidence (all cases) >80 /100,000 Year of Isoniazid introduction 1970 Notification new sputum smear + 2802 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 45. P was established 1962 Notification all cases (rate) 120 /100,000 Year of Rifampicin introduction 1969 Estimated incidence (all cases) 190. P was established 1998 Notification all cases (rate) /100,000 Year of Rifampicin introduction 1972 Estimated incidence (all cases) 74. P was established 1989 Notification all cases (rate) 125 /100,000 Year of Rifampicin introduction 1990 Estimated incidence (all cases) 201 /100,000 Year of Isoniazid introduction 1965 Notification new sputum smear + 13683 Use of Standardized Regimens Yes Notification new sputum smear + (rate) 58 /100,000 % Use of Short Course Chemotherapy Yes % Treatment Success 86 % Use of Directly Observed Therapy Yes 70. P was established 1963 Notification all cases (rate) 28 /100,000 Year of Rifampicin introduction 1970 Estimated incidence (all cases) 28.