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Some women are at an increased risk for having a baby with an open neural tube defect arthritis knee driving buy 400mg trental with amex. There are natural sources of folic acid: green leafy veg etables arthritis in my fingers trental 400 mg on line, nuts rheumatoid arthritis early signs quality 400mg trental, beans natural arthritis relief dogs order cheap trental, and citrus fruits. While a daily vitamin supplement is no substitute for a healthy diet, most pregnant and lactating women need supplements to make sure they get adequate levels of these minerals. All rights reserved 13 Medicine Guidelines During Pregnancy Although some medicines are considered safe during pregnancy, the effects of other medicines on your unborn baby are unknown. Prescription medicine guidelines If you were taking prescription medicines before you became pregnant, please ask your health care provider about the safety of continuing these medicines as soon as you find out that you are pregnant. With some medicines, the risk of not taking them might be more serious than the potential risk associated with taking them. Be sure to discuss the risks and benefits of the newly prescribed medicine with your health care provider. Ask your health care provider about the safety of taking other vitamins, herbal remedies, and supple ments during pregnancy. The following medicines and home remedies have no known harmful effects during pregnancy when taken according to the package directions. Your decision whether to get tested and/or the test result itself will not prevent you from getting health care. Therefore, if you have a neg ative test during your pregnancy, it will likely prevent testing on your baby after birth. All rights reserved Index# 4849 20 Screening for Chromosome Abnormalities in Pregnancy Cleveland Clinic offers options for women who are interested in determining the risk for chromosome abnormalities and certain birth defects in their baby during a pregnancy. While the risk for having a baby with a chromosome abnormality increases with a women’s age at the time of delivery, the majority of these babies are born to younger women. Having this testing performed is optional and should only be done after a thorough discussion of available tests. In some instances, your provider may refer you for genetic counseling to see which, if any, test is best for you. Sequential Screening the sequential screen combines ultrasound and blood tests to determine the risk for chromosome abnormalities, including Down syndrome (Trisomy 21) and Trisomy 18. The nuchal translucency is a fiuid filled space behind the neck, which is typically increased in size in fetuses with Down syndrome, other chromosome abnormalities, and birth defects. Blood tests, which measure the levels of certain hormones in the mother, are drawn at the time of the nuchal translucency measurement and later in the second trimester between 15 and 21 weeks’ gestational age. This test detects ultrasound 75 to 80 percent of cases of Down -Previous history of a syndrome and 60 to 75 percent of chromosome abnormality cases of Trisomy 18, with a 5 to 7 percent false positive rate. The sound waves are recorded and changed into video or photographic images of your baby. The idea for ultrasonography came from sonar technology, which makes use of sound waves to detect underwater objects. Transvaginal ultrasound Most prenatal ultrasound procedures are performed on the surface of the skin, using a gel as a conductive medium to aid the quality of the image. However, a transvaginal ultrasound is performed using a probe that is in serted into the vaginal canal. It may also be used to get a clearer view of the uterus or ovaries if a problem is suspected. Be sure to tell the ultrasound doctor whether or not you want to know the gender of your baby. There is a chance that 25 the ultrasound images can be During the test misinterpreted. An ultrasound You will lie on a padded examining might be performed earlier in your table during the test. A small device, called a transducer, Later in pregnancy, ultrasound is gently applied against the skin on might be used to determine: your abdomen. The transducer • Fetal well-being sends high-frequency sound waves • Placenta location into the body, which refiect off • Amount of amniotic fiuid around internal structures, including your the baby baby. Even though ultrasound There is virtually no discomfort is safe for mother and baby, it is a during the test. If a full bladder is test that should be done only when required for the test, you might feel medically necessary. If you have an some discomfort when the probe is ultrasound that is not medically nec applied. You might be asked to hold essary (for example, to simply see the your breath briefiy several times. This will help interpreted by a board-certified the doctor view the baby better on physician. You will be allowed to go to the bathroom right after the test has ©Copyright 1995-2015 the Cleveland Clinic Foundation. Every woman’s pregnancy is unique, and some of these discomforts might not affect you. Round • Apply a hot water bottle or heating pad, or take a ligament pain is consid warm bath or shower. Irregular, Regular tightening or pain in your back or infrequent contrac lower abdomen tions are called Pressure in the pelvis or vagina Braxton Hicks Menstrual-like cramps contractions. Bleeding Fluid leakage Flu-like symptoms such as nausea, vomiting, and diarrhea Backaches • Wear low-heeled (but not flat) shoes. The increase in your • Get a dental checkup early in your pregnancy to make sure volume of circulation your teeth and mouth are healthy. Your crease in size as your milk glands enlarge bra should fit well without irritating your nipples. Close your occur and how bad they eyes and try to release the tension in your back, neck, are can vary. Or, place pillows under your shoulders to prevent to changing hormone stomach acids from rising into your chest. Leg cramps • Be sure to eat and drink foods and beverages rich in cal cium (such as milk, broccoli, and cheese). Nasal congestion • Apply a warm, wet washcloth to your cheeks, eyes, and nose to reduce congestion. Nausea is a result • Contact your health care provider if your vomiting is constant of hormonal or so severe that you can’t keep fluids or foods down. You might feel short • Avoid lying flat on your back, and try sleeping with your head of breath when walk elevated. Stretch marks are a • Apply lotion to your skin to keep it soft and reduce type of scar tissue dryness. Stretch marks affect the sur face under the skin and are usually not preventable. Swelling in the • Drink plenty of fluids (at least 10 to 12 glasses of fluids a day). Tight clothing can slow blood vessels carrying blood from the lower circulation and increase fluid retention. This might be a warning sign of preeclampsia or toxemia, a pregnancy related high blood pressure. Varicose veins Although varicose veins are usually hereditary, here are some preventive tips: An increased volume • Avoid standing or sitting in one place for long periods. All rights reserved Index# 5186 34 Vaccination During Pregnancy Why is vaccination necessaryfi Vaccines strengthen people’s immune systems so their bodies can fight off serious infectious diseases. Some people might be allergic to an ingredient in a vaccine, such as eggs in the infiuenza vaccine, and should not receive the vaccine until they have talked to their doctors. The following vaccines are consid the following vaccines can ered safe to give to women who potentially be transmitted to the might be at risk of infection: unborn child and might result in miscarriage, premature birth, or Hepatitis B — Pregnant women who birth defects: are at high risk for this disease and have tested negative for the virus can Hepatitis A —The safety of this vac receive this vaccine. You can receive Women should wait at least one the vaccine at any stage of your preg month to become pregnant after re nancy. Tetanus/Diphtheria (Tdap) — Tdap Varicella —This vaccine, used to pre should be administered during vent chicken pox, should be given at pregnancy, preferably during the least one month before pregnancy. If you are non-immune and are ex posed to active chicken pox, you need to call your doctor’s office for direction.
The most important percentage of cases may result from other causes such as cause is coronary atherosclerosis; less commonly it may be emboli arthritis treatment relief neck scapular pain purchase trental 400mg overnight delivery, coronary arteritis and myocarditis arthritis in one knee symptoms cheap trental american express. The mechanism of development of myocardial fibrosis these include: calcific aortic stenosis arthritis in back of neck symptoms order 400 mg trental amex, myocarditis of various can be explained by one of the following concepts: types arthritis diet milk order discount trental, hypertrophic cardiomyopathy, mitral valve prolapse, i) Myocardial fibrosis represents healing of minute infarcts endocarditis, and hereditary and acquired defects of the involving small scattered groups of myocardial fibres. There is patchy myocardial fibrosis, especially around small blood vessels in the interstitium. Myocardial infarction • Plaque haemorrhage Plaque haemorrhage, • Fissuring and ulceration unstable angina • Complete mural thrombosis C, Thrombosis with haemorrhage 5. The stress of pressure on the ventricular chiefly ventricular asystole or fibrillation. At autopsy, such cases Since the adult myocardial fibres do not divide, the fibres reveal most commonly critical atherosclerotic coronary are hypertrophied. However, the sarcomeres may divide to narrowing (more than 75% compromised lumen) in one increase the cell width. Grossly, the most signifi cant finding is marked hypertrophy of the heart, chiefly Hypertensive heart disease or hypertensive cardiomyopathy of the left ventricle (see Fig. The weight of the heart is the disease of the heart resulting from systemic increases to 500 gm or more (normal weight about 300 hypertension of prolonged duration and manifesting by left gm). The pressure higher than 140/90 mmHg) of sufficient duration papillary muscles and trabeculae carneae are rounded and may induce hypertensive heart disease. The changes include cerebrovascular stroke, renal failure following arteriolar enlargement and degeneration of myocardial fibres with nephrosclerosis, dissecting aneurysm of the aorta and sudden focal areas of myocardial fibrosis. Both genetic and haemodynamic factors heart disease is the disease of right side of the heart resulting 438 from disorders of the lungs. In spite of its name Following chronic lung diseases can cause chronic suggesting an acute arthritis migrating from joint to joint, it pulmonary hypertension and subsequent cor pulmonale: is well known that it is the heart rather than the joints which i) Chronic emphysema is first and major organ affected. William Boyd years ago ii) Chronic bronchitis gave the dictum ‘rheumatism licks the joint, but bites the whole iii) Pulmonary tuberculosis heart’. Chronic lung diseases as well as diseases though some investigators have noted a slight female of the pulmonary vessels cause increased pulmonary preponderance. The disease activation of coagulation pathway and obliteration of is seen more commonly in poor socioeconomic strata of the pulmonary arterial vessels. Pulmonary hypertension causes society living in damp and overcrowded places which pressure overload on the right ventricle and hence right promote interpersonal spread of the streptococcal infection. Initially, there is right ventricular Its incidence has declined in the developed countries as a hypertrophy, but as cardiac decompensation sets in and right result of improved living conditions and early use of heart failure ensues, dilatation of right ventricle occurs. But it is still common the sequence of events involved in the pathogenesis of in the developing countries of the world like in India, cor pulmonale is summarised in Fig. In a multicentric survey in school-going there is characteristic ovoid dilatation of the right ventricle, children by the Indian Council of Medical Research, an and sometimes of the right atrium. However, the mechanism of lesions in the heart, joints and other tissues is not by direct infection but by induction of hypersensitivity or autoimmunity. Cell wall polysaccharide of group A streptococcus forms outbreaks and epidemics of streptococcal infection of throat antibodies which are reactive against cardiac valves. This is in children from schools or in young men from training supported by observation of persistently elevated camps. Hyaluronate capsule of group A streptococcus is identical produced in experimental animals by induction of repeated to human hyaluronate present in joint tissues and thus these infection with fi-haemolytic streptococci of group A. The geographic distribution of the disease, as already of pancarditis, particularly the valvular lesions, are its pointed out, shows higher frequency and severity of the major manifestations. However, supportive connective disease in the developing countries of the world where the tissues at other sites like the synovial membrane, living conditions are substandard and medical facilities are periarticular tissue, skin and subcutaneous tissue, arterial insufficient. Initially, there is oedema of the connective streptococcus infection, mounts an autoimmune reaction by tissue and increase in acid mucopolysaccharide in the formation of autoantibodies against bacteria. This results in separation of the autoantibodies cause damage to human tissues due to cross collagen fibres by accumulating ground substance. Streptococcal epitopes present on the bacterial disintegrated and the affected focus takes the appearance cell wall, cell membrane and the streptococcal M protein, and staining characteristics of fibrin. This change is are immunologically identical to human molecules on referred to as fibrinoid degeneration. This is followed by the formation of characteristic, small (1 to 3 mm in diameter), multiple, warty vegetations or verrucae, chiefly along the line of closure of the leaflets and cusps. These tiny vegetations are almost continuous so that the free margin of the cusps or leaflets appears as a rough and irregular ridge. The higher change is followed by proliferation of cells that includes incidence of vegetations on left side of the heart is possibly infiltration by lymphocytes (mostly T cells), plasma cells, because of the greater mechanical stresses on the valves a few neutrophils and the characteristic cardiac histiocytes of the left heart, especially along the line of closure of the (Anitschkow cells) at the margin of the lesion. These are large mononuclear cells having central round nuclei and contain moderate amount of amphophilic cytoplasm. The nuclei are vesicular and contain prominent central chromatin mass which in longitudinal section appears serrated or caterpillar-like, while in cross-section the chromatin mass appears as a small rounded body in the centre of the vesicular nucleus, just like an owl’s eye. The stage of healing by fibrosis of the Aschoff nodule occurs in about 12 to 16 weeks after the illness. The Anitschkow cells in the nodule become spindle-shaped with diminished cytoplasm and the nuclei stain solidly rather than showing vesicular character. With passage of months and years, the Aschoff body becomes less cellular and the collagenous tissue is increased. Eventually, it is replaced by a small fibrocollagenous scar with little cellularity, frequently in perivascular location. The location of vegetations on mitral valve (left upper diagram) is shown as viewed from the left atrium, while the vegetations on aortic valve (left lower diagram) are shown as seen from the left ventricular surface. B, Opened up chambers and valves of the left heart show irregularly scarred mitral valve leaving a fish-mouth or buttonhole opening between its two cusps (black arrow). The free surface and margin of the mitral valve shows tiny firm granular vegetations (white arrow). Vegetations the mitral (in 98% cases alone or along with other valves) present at the free margins of cusps appear as eosinophilic, and aortic. The approximate frequency of deformity of tiny structures mainly consisting of fibrin with various valves is as under: superimposed platelet-thrombi and do not contain Mitral alone = 37% cases. Vascularisation of the valve cusps may still be evident in the form of thick-walled blood Mitral + aortic + tricuspid + pulmonary = less than vessels with narrowed lumina (Fig. Thickening, shortening and fusion of the appears as a map-like area of thickened, roughened and chordae tendineae further contribute to the chronic wrinkled part of the endocardium (see Fig. Microscopically, the appearance of MacCallum’s patch Microscopically, the inflammatory changes begin in the is similar to that seen in rheumatic valvulitis. The affected region of the valve rings (where the leaflets are attached area shows oedema, fibrinoid change in the collagen, and to the fibrous annulus) and then extend throughout the cellular infiltrate of lymphocytes, plasma cells and entire leaflet, whereas vegetations are usually located on macrophages with many Anitschkow cells. Grossly, in the early of capillaries and infiltration with lymphocytes, plasma (acute) stage, the myocardium, especially of the left cells, histiocytes with many Anitschkow cells and a few ventricle, is soft and flabby. A, Microscopic structure of the rheumatic valvulitis and a vegetation on the cusp of mitral valve in sagittal section. B, Section of the myocardium shows healed Aschoff nodules in the interstitium having collagen, sparse cellularity, a multinucleate giant cell and Anitschkow cells. The Microscopically, the most characteristic feature of subserosal connective tissue is infiltrated by lymphocytes, rheumatic myocarditis is the presence of distinctive plasma cells, histiocytes and a few neutrophils. These diagnostic nodules are scattered Characteristic Aschoff bodies may be seen which later throughout the interstitial tissue of the myocardium and undergo organisation and fibrosis. Organisation of the are most frequent in the interventricular septum, left exudate causes fibrous adhesions between the visceral and ventricle and left atrium. Derangements of the conduction parietal surfaces of the pericardial sac and obliterates the system may, thus, be present. Extracardiac Lesions surrounded by palisade of Anitschkow cells and Patients of the syndrome of acute rheumatism develop multinucleate Aschoff cells. There is infiltration by lesions in connective tissue elsewhere in the body, chiefly lymphocytes, plasma cells and some neutrophils. As pain and swelling subside in one joint, others tend to get involved, producing 3.
Most patients and whittling) arthritis pain on right side purchase trental cheap, and zheng jia arthritis diet chinese medicine order genuine trental line, concretions and conglomera also experience nausea and vomiting to arthritis in neck nhs buy trental with mastercard the point of dry tions arthritis diet citrus order trental 400 mg otc. Other symp internal damage by the seven affects, roundworms internally toms include diarrhea, anorexia, emaciation, jaundice, and harassing, and habitual bodily vacuity weakness abdominal lumps. If this endures, it may brew dampness addition, tests of pancreatic function assess endocrine and and transform heat. The Western medical treatment of chron food and drink may mutually bind in the center, obstructing ic pancreatitis begins with abstinence from alcohol. Episodes and stagnating the qi mechanism and causing loss of nor similar to acute pancreatitis are treated in the same way as malcy in upbearing and downbearing. If blockers are often administered as well as narcotics to relieve roundworms obstruct the intestines, there will be pain, nau pain. However, often increasing amounts of narcotics are sea, vomiting, torpid intake, diarrhea, and jaundice. Surgery is sometimes resorted to Either unfulfilled desires or anger may damage the liver, for pain relief in cases of pancreatic pseudocyst or other caus while worry and anxiety damage the spleen. If Commonly, there is a combination of both faulty diet and spleen vacuity is marked, add nine grams each of Dang Shen habitual emotional stress. In that case, there is a tendency to (Radix Codonopsitis), Bai Zhu (Rhizoma Atractylodis Macro liver repletion and spleen vacuity. In addition, if qi stagna cephalae), and Fu Ling (Poria) and replace uncooked Gan Cao tion endures, it may give rise to blood stasis, and blood sta with mix-fried Gan Cao. If there is concomitant blood stasis, sis may result in severe, fixed, boring pain and concretions add 15 grams of Dan Shen (Radix Salviae Miltiorrhizae) and and conglomerations. If depressive and/or damp heat lingers nine grams of Dang Gui (Radix Angelicae Sinensis). If heat has and endures, heat evils will damage and consume yin fluids, damaged stomach fluids, add 12 grams of Mai Men Dong thus giving rise to concomitant yin vacuity. For stomach and abdominal fullness, add nine grams each of Hou Po (Cortex Magnoliae Officinalis) and 1. If severe, the pain may radiate to the Yi Tang Jia Wei (Clear the Pancreas Decoction with Added chest, upper back, shoulder, and upper arm. There may also Flavors): Bai Shao (Radix Paeoniae Albae), 15g, Shan Zha be accompanying chest oppression, burping and belching, (Fructus Crataegi) and Shen Qu (Massa Medica Fermentata), possible dry heaves, reduced appetite, frequent sighing, etc. The Scutellariae), Mu Xiang (Radix Auklandiae), Yan Hu Suo tongue is normal or darkish in color with thin, white fur, (Rhizoma Corydalis), and Hou Po (Cortex Magnoliae while the pulse is bowstring and fine or deep and fine. If spleen vacuity is marked, add Zu San Bai Shao (Radix Paeoniae Albae) 9g Li (St 36). If there is also blood stasis, add Ge Shu (Bl 17) and Zhi Ke (Fructus Aurantii) 9g San Yin Jiao (Sp 6). If there is food stagnation, add Liang Men Chuan Xiong (Rhizoma Chuanxiong) 6g (St 21). Bai Shao nourishes distention and pain which is fixed in location and worse at the blood and emolliates the liver to prevent liver depression. Draining San Yin Jiao cools and quickens the blood and transforms stasis in the whole body. For constipation, add Zhao Hai (Ki 6) and Tian Wu Ling Zhi (Feces Trogopterori) 9g Shu (St 25). Yan Hu a yellowish body and eyes, possible nausea and vomiting, a Suo, Chuan Xiong, Xiang Fu, and Zhi Ke rectify the qi and dry mouth with a bitter taste, yellow urine, dry, bound stools stop pain. Dang Gui also nourishes the blood, while Dan Pi or diarrhea which is yellow or brown in color and foul and Chi Shao cool the blood. Gan Cao harmonizes the other smelling, possible jaundice, slimy, yellow tongue fur, and a medicinals in this formula. For marked liver depression, add 15 Huang Qin (Radix Scutellariae) 12g grams of Bai Shao (Radix Paeoniae Albae) and nine grams of Zhi Shi (Fructus Immaturus Aurantii) 9g Chai Hu (Radix Bupleuri). For severe pain, add nine grams Ban Xia (Rhizoma Pinelliae) 9g each of Chuan Lian Zi (Fructus Toosendan) and Mu Xiang Bai Shao (Radix Paeoniae Albae) 9g (Radix Auklandiae). If jaundice is severe, increase the Gou moves the qi in the three burners and especially below dosage of Yin Chen Hao (Herba Artemisiae Scopariae) up to the rib-side. If there is severe rib-side pain Fu Ling (Poria) 15g and distention, add nine grams each of Yu Jin (Tuber Dang Shen (Radix Codonopsitis) 12g Curcumae), Chuan Lian Zi (Fructus Toosendan), and Qing Hou Po (Cortex Magnoliae Officinalis) 9g Pi (Pericarpium Citri Reticulatae Viride). Hou Po moves the qi, transforms dampness, and elimi 34), Yin Ling Quan (Sp 9) nates stagnation. Draining Nei Guan rectifies the qi, quickens the (Rambling Powder): Chai Hu (Radix Bupleuri), Bai Zhu blood, and stops pain, especially in the rib-side, diaphragm, (Rhizoma Atractylodis Macrocephalae), Fu Ling (Poria), and and chest. Draining Yang Ling Quan clears heat and disin Bai Shao (Radix Paeoniae Albae), 9g each, mix-fried Gan Cao hibits dampness, especially in the liver-gallbladder. Draining (Radix Glycyrrhizae), Bo He (Herba Menthae Haplocalycis), Yin Ling Quan clears heat and disinhibits dampness, espe and Dang Gui (Radix Angelicae Sinensis), 6g each, and cially in the spleen-stomach. If there is blood sta with Gui Pi Tang Jia Jian (Return the Spleen Decoction with sis, add Ge Shu (Bl 17) and San Yin Jiao (Sp 6). If qi stagna Additions & Subtractions): Huang Qi (Radix Astragali), Bai tion has transformed heat, add Xing Jian (Liv 2). If there is concomi Zizyphi Spinosae), 12g each, Dang Shen (Radix tant spleen vacuity, add Zu San Li (St 36). If there is food Codonopsitis), Dan Shen (Radix Salviae Miltiorrhizae), stagnation, add Liang Men (St 21). For constipation, add Long Yan Rou (Arillus Longanae), Bai Zhu (Rhizoma Zhao Hai (Ki 6) and Tian Shu (St 25). Mu Xiang (Radix Auklandiae), 9g each, Dang Gui (Radix Angelicae Sinensis) and mix-fried Gan Cao (Radix 4. For concomitant food stagnation, and Xia Wan disinhibits the qi mechanism and regulates and add nine grams each of Shan Zha (Fructus Crataegi), Shen Qu rectifies upbearing and downbearing. Draining Tian Shu and (Massa Medica Fermentata), and Mai Ya (Fructus Germinatus Qi Hai regulates and rectifies the qi of the lower burner in Hordei). Supplementing Zu San Li supplements the spleen and boosts the qi on the one hand If there is spleen-kidney yang vacuity, replace Ping Wei San and regulates and rectifies the qi of the yang ming on the Jia Wei with Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi other. Draining it Pills) & Si Shen Wan (Four Spirits Pills): Shu Di (cooked courses the liver and rectifies the qi, harmonizes the stomach Radix Rehmanniae), 20-30g, Shan Yao (Radix Dioscoreae), and downbears counterflow. For a liver-spleen disharmony, subtract Zhong Wan Lateralis Praeparatus Aconiti Carmichaeli), 9g each, Wu Zhu and Xia Wan and add Zhang Men (Liv 13). For severe constipation, add nine grams of Mang Fu Ling (Poria) 9g Xiao (Natrii Sulfas). For emaciation, add 15 grams each of Zhi Shi (Fructus Immaturus Aurantii) 9g Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Huang Hou Po (Cortex Magnoliae Officinalis) 9g Jing (Rhizoma Polygonati). Lai Fu Zi and Chen Pi disperse each of Gou Qi Zi (Fructus Lycii), Wu Mei (Fructus Mume), food and move the qi. Most cases of chronic pancreatitis manifest spleen vacuity Atractylodis Macrocephalae). Another way of stating below the rib-side, add 15 grams each of Chai Hu (Radix this is a liver-spleen disharmony with blood stasis. Without these three as a basis, Chinese medicinals and Liang Men and Xuan Ji disperses food and abducts stagnation. It is divided into two types: bacterial and ing rise to difficulty urinating, painful urination, and incom nonbacterial. If damp heat and/or qi stagnation endure, ing urinary tract infection due to the same pathogen as they may give rise to blood stasis which even further inhibits found in the prostatic secretions. Hence there is more serious and low back and perineal pain, urinary urgency and frequency, enduring urinary difficulty and more severe, localized, sharp, and painful urination. Due to enduring damp heat or to senting signs and symptoms, and cultures taken from the over-taxation, faulty diet, and too much thinking and wor urethra, bladder, and prostatic secretions. Also due nonbacterial prostatitis are similar to those of bacterial pro to enduring damp heat or to aging, the kidney qi may be statitis. In either or both cases, there will be insufficient there is rarely a history of urinary tract infection. Its etiology is unknown, and it does not respond to cult urination and terminal dribbling. Hot sitz baths and anticholinergic be associated with either kidney yin or kidney yang vacuity drugs may provide some symptomatic relief, and periodic or both.
The symptoms of intoxication vary from bouts of vomiting and diarrhea to reactive arthritis in feet buy generic trental canada severely disrupted muscle function natural arthritis relief dogs discount 400 mg trental visa, as with botulism degenerative arthritis in my back order trental on line. In some cases arthritis in dogs medication uk trental 400 mg sale, the microbes infect the surface of the intestine; in others, they invade the intestine and other body structures. Food infection also can result in toxin production, causing the same disease signs. However, in food infection, microbes growing in the infected tissue release the toxins, unlike food intoxication, where the toxins are already present in the food. Some of the factors that infuence the infections include: V The immune status of the host—immunodepressed or immunocompetent. V How efcient the pathogen is at attaching to, and penetrating, the target tissues. Viruses and parasites, such as tapeworms, roundworms, and protozoa, can cause foodborne illness, but they are not capable of growing in food and do not cause spoilage. The following is a list of pathogens and infectious agents of public health concern. This list is not exhaustive, but contains most of the foodborne pathogens that afect meat, poultry, and processed egg products. Varying in length from 1/25,000 to 1/1,000 of an inch, they are among the smallest living creatures known. Tere are many diferent ways to classify and group microorganisms, such as microscopic appearance; materials they can use as foods; byproducts resulting from the breakdown of these foods; tolerance to oxygen; growth temperatures; resistance to destructive agents, such as heat and chemicals; ability to perform certain biochemical reactions in the laboratory; and possession of certain genetic sequences. Viewed with a microscope, bacteria appear in several shapes or forms, but are primarily either round in shape (called “cocci”) or rod-shaped (called “rods” or “bacilli”). Spore Forming and Non-Spore-Forming Bacteria Spores are at dormant or resting stage in the normal growth cycle of some bacteria. The primary function of most spores is to ensure the survival of the organism through periods of environmental stress. Spores have been compared to plant seeds because they will “sprout” (germinate) and grow when conditions are suitable. When a bacterial spore germinates, it is the same organism continuing its growth process. United States Department of Agriculture 9 Introduction to the Microbiology of Food Processing Bacteria can be placed into two groups based on their ability to form spores: spore formers and non-spore formers. As you may have guessed, spore formers can form spores, and non-spore formers cannot form spores. Tese bacteria are normally present everywhere in the environment, which can make them difcult to control in a food-processing facility. Cells of non-spore formers, cells of spore formers that have not formed spores, and cells that have sporulated are referred to as “vegetative cells. However, bacterial spores in general are extremely resistant to heat, cold and chemical agents. For example, some bacterial spores can survive in boiling water (212 °F or 100 °C) for more than 16 hours, but vegetative cells (same organisms in the vegetative state and the non-spore-forming bacteria) cannot. Generally, spores that resist heat also are highly resistant to destruction by chemicals. Tere are bacterial spores that can survive more than 3 hours in sanitizing solutions normally used in a food-processing plant. Because bacterial spores can survive in unfavorable conditions, they can be present in food before, during, and after lethality treatment is applied. This is why the time it takes to heat and/or cool product during food processing is so important. If the food product is not heated or cooled appropriately – that is, the product stays for too long in a temperature range that is favorable to bacterial growth—the spores will change to a vegetative state and start reproducing. Bacterial Toxins Toxins are substances produced by living cells or organisms that are capable of causing disease when they come in contact with, or are absorbed by, body tissues. They can vary greatly, both in the severity of efect (ranging from minor to fatal) and how easily they can be destroyed. One way to categorize toxins depends on where they afect the body: 10 Small Plant News Guidebook Series Introduction to the Microbiology of Food Processing V Enterotoxins Afect the gastrointestinal tract, causing vomiting, diarrhea, gastrointestinal distress and/or pain. V Neurotoxins Afect the nervous system, causing dizziness, blurred or double vision, the inability to swallow, skeletal muscle weakness, and/or faccid paralysis. Depending on the bacteria producing the toxin, it can be a byproduct of the sporulation process or a byproduct of normal cell metabolism. Toxins that are already present in the food product are often referred to as “preformed toxins. Some toxins are extremely heat resistant and may pose a hazard even if the food is properly cooked. Bacterial Cell Reproduction Bacteria reproduce by division, which is what microbiologists call fssion. When a bacterial cell is ready to divide, the cell material gradually increases until its volume is almost doubled. This constriction deepens until the cell contents are held in two distinct compartments separated by a wall. Tese two compartments fnally separate to form two new cells, which are duplicates of the former cell and each other. As the individual cells reproduce on a Petri dish, they form a group known as a colony. When we think about measuring bacteria, we usually think about colonies rather than individual bacterial cells. Since the reproduction of bacteria increases their numbers, the size of the colony grows. United States Department of Agriculture 11 Introduction to the Microbiology of Food Processing The following graph shows the four phases of bacterial growth (reproduction): V Lag phase-Occurs when a bacterial population frst enters an environment that allows growth. V Log phase or exponential phase-Occurs when the number of cells increases exponentially in a favorable environment. Pathogenic Bacteria of Importance Let’s take a closer look at signifcant bacteria that you should address in your operation. Tere are specifc regulatory requirements for reduction of Salmonella in ready-to-eat products, raw ground beef, and raw beef components that are intended for grinding. Salmonella is a rod-shaped, generally motile, non-spore forming, Gram negative bacterium. All Salmonella serotypes (strains) are considered potential human pathogens, but only a few serotypes are associated with foodborne illness (salmonellosis): Typhimurium, Enteriditis, Newport, Heidelberg, and Javiana. Pathogenic Salmonella possess factors that enhance their ability to invade and replicate in the host. Salmonella is an enteric microorganism associated with the intestinal tract of many animals and, thus, is potentially present in most raw meats. Illness is usually caused by the ingestion of a sufcient number microorganisms which survive digestion and reproduce in the human intestinal tract. Fortunately, Salmonella are heat-sensitive and easily destroyed with the mild heat treatments for cooking meat (heating to 145 fiF [63 fiC]). Salmonella also are acid sensitive and are not good at competing with other bacteria. However, it should be noted that acid resistance can be induced by exposure to mildly acidic conditions (pH 5. Salmonella has not been a problem with fermented sausages when the product is properly fermented using an appropriate starter culture. Salmonella not only survives drying, but also becomes more heat resistant with drying and is more of an issue in non-fermented dried meats, such as jerky, and whole meat cuts, such as dried hams. Control mechanisms include temperature control and sanitation prior to processing and the use of wet heat early in the heat process to avoid pre-drying. In non-heated meats, the proper use of high salt and proper curing techniques are most efective. The prevalence of Salmonella in beef, lamb, pork, and poultry carcasses varies greatly. The overall contamination of meat and poultry carcasses with these pathogens depends not only on the numbers of the pathogens on the hair, hide, feathers, skin, and in the intestinal tract of the animals, but also on the degree of cross-contamination occurring from these sources during slaughter and processing. Environmental sources of the organism include water, soil, insects, factory surfaces, kitchen surfaces, and animal feces, to name a few. Tere are strains of United States Department of Agriculture 15 Introduction to the Microbiology of Food Processing E. It is motile and can grow in cool (temperature range of 32-113 fiF [0-45 fiC]) and damp environments, at a pH range of 4.
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