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Stage 2 of the Disaster The year 2003 proved to be even worse than the previous years purchase clozaril with mastercard medicine world, as 9 buy genuine clozaril on line symptoms kidney failure dogs,862 cases were reported with West Nile virus purchase duetact 17mg otc, and 264 people died of it (Lane County of Oregon, 2008). To stop the West Nile virus, the director should institute a program to spray for mosquitoes where the West Nile virus has been found. Unless the mosquitoes carrying West Nile virus are killed, the spread of the disease will continue. The direc- tor needs to coordinate any type of spraying efort to kill the mosquitoes with state and local eforts that may already be underway. Tere may be a possibil- ity to standardize the methods and chemicals used to kill the mosquitoes, which would allow an efciency gain as well as a cost savings. What resources will you need to contain the virus as well as medically treat vic- tims of the virus? The director will need spraying apparatuses available to them as well as pharmaceuticals available to treat anyone that is infected with the virus. The development of a vaccine for West Nile virus would be a long-term goal if the virus becomes more widespread. Stage 3 of the Disaster For 2004, the spread of West Nile virus through the population was decreasing, with only 2,470 cases being reported, and the number of deaths had dropped to 88 (Lane County of Oregon, 2008). To what do you attribute the decrease in West Nile virus among the population at this point? Tere may be more people using mosquito repellant, and spraying for mosquitoes may be prov- ing to be efective. Additionally, the climate may be diferent, which could Case Studies: Other Natural Disasters ◾ 115 contribute to there being less cases of West Nile virus being transmitted since there could be fewer mosquitoes. What programs should you continue based on your data that the disease is not spreading as much as it was in 2003? The programs that target spraying for mosquitoes should be continued in order for the West Nile virus cases to be kept at a low point. Key Issues Raised from the Case Study Although viruses can be spread in numerous ways, mosquitoes have been a source of infectious disease since the beginning of time (e. It is critically important to have an efective plan in place to control the mosquito population and prevent a massive outbreak of infection in densely populated areas. In this case study, health ofcials appeared to be caught of guard on the spread of West Nile virus. Tey were unable to have a plan in place that prevented a high number of infected cases from occurring. Items of Note North America West Nile virus was frst diagnosed in Uganda in 1937 (Lane County of Oregon, 2008).

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These individual that exist between the retina 100 mg clozaril with amex symptoms of flu, lateral geniculate columns are called orientation columns through nucleus purchase generic clozaril on line medicine reaction, and primary visual cortex generic 250mg ampicillin with amex, impulses from which many circular felds are converted to a the upper and lower halves of the visual feld are rectilinear receptive feld with a specifc axis of located in different parts of the optic radiation. Immediately adjacent V1 orienta- Impulses from the contralateral upper quadrant tion columns contain neurons activated by visual take a ventral course and sweep into the white stimuli to the same area of the retina but with matter of the temporal lobe before proceeding different orientations. Thus, the convergence of posteriorly into the occipital lobe where they end parallel on- and off-center inputs from the lateral in the lower wall of the calcarine sulcus, the lin- geniculate nucleus and the resultant processing gual gyrus (Fig. Impulses from the con- in the orientation columns enables objects to be tralateral lower quadrant, however, take a dorsal perceived by their shapes. Fewer and more com- course and sweep posteriorly through the white plex neurons in each orientation column respond matter of the parietal lobe to the occipital lobe, to movement of the linear shape across the recep- where they end in the upper wall of the calcarine tive feld in the retina. Binocular inputs remain segregated in the dif- Damage to the visual pathways results in the ferent layers of the lateral geniculate nucleus and loss of vision, anopsia, that is described according in ocular dominance columns in layer 4 in V1. Visual defects These alternating inputs from the right or left are homonymous when confned to the same part eye in adjacent ocular dominance columns are of the visual feld in each eye. They are heter- important for binocular interactions and depth onymous when the part of the visual feld lost perception. A homonymous defect columns of neurons in the upper layers of V1 that results from lesions in the visual pathway distal to are responsive to colors. Thus, total destruction of the umns are richly interconnected by horizontally optic tract, lateral geniculate nucleus, geniculo- oriented axonal connections that integrate activ- calcarine tract, or visual cortex results in loss of ity from across wide areas of the retina. While each of these attributes is processed in the Lesions of the optic chiasm cause several types striate cortex, the conscious interpretation of of heteronymous defects. Examples of lesions in functional divergence of the two paths continues in various parts of the visual pathway, the visual feld their termination in different parts of layer 4. From defects, and the principal causes of the lesions V1, ventral and dorsal cortical pathways emerge that result are given in Figure 14-8. The ventral pathway is the Chapter 14 The Visual System: Anopsia 189 Visual field defects Left Right Left Right A. Right optic tract: Left homonymous quadrantic anopsia (parietal or occipital hemianopsia (abscess or tumor of lobe tumor). B Macular vision may be preserved if A posterior part of the visual cortex is not involved (posterior cerebral artery C dysfunctions, tumors, trauma). D E F H G Figure 14-8 Visual feld defects resulting from lesions in various parts of the visual pathway, and chief causes of the lesions. The mixing of the signals from the dif- to the inferior temporal lobe, whereas the dorsal ferent cone receptors allows for the perception path transmits the fow of information from the of a wide spectrum of color. In V1, color perception is limited to shape and color necessary for object identifcation the regularly arranged columns in layers 2 and (the what) occurs through the ventral pathway to 3.

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Stimulation Within the cerebral cortex are several centers of this area results in aversive eye movements in associated with eye movements order clozaril medications similar to abilify. The frontal eye feld proj- known are the frontal eye feld cheap clozaril 25mg otc medications causing pancreatitis, the parietal and ects to the vertical and horizontal gaze centers temporal eye felds benzac 20gr fast delivery, and the occipital eye feld. Chapter 10 The Ocular Motor System: Gaze Disorders 127 Lesions affecting horizontal gaze and the (Fig. Lesions in the temporal eye feld or resulting abnormalities are given in Figure 10-4. Clinical The temporal eye feld is also associated Connection with optokinetic movements. An example of these movements occurs in an individual in a Due to the tonic infuence of each moving vehicle watching an object in the pass- frontal eye feld on the contralat- ing landscape. The eyes will automatically fol- eral horizontal gaze center, acute lesions of the low the particular object in the landscape until frontal eye feld result in conjugate deviation it disappears from view, at which time the eyes of the eyes toward the side of the lesion and move rapidly in the opposite direction and fx paralysis of voluntary gaze toward the contra- on a new object in the landscape. An irritative lesion such phenomenon occurs when vision is directed as occurs in a focal seizure results in devia- at alternating vertical black and white stripes tion of the eyes to the contralateral side. The eyes will fx on abnormalities are transient because of the a particular black stripe, follow it until it dis- bilateralism of these cortical connections with appears from view, and then move rapidly in the brainstem gaze centers. These slow drifting and fast return movements are referred to as optoki- Parietal and Temporal Eye Fields netic nystagmus. The superior parietal lobule affects Clinical saccadic movements through reciprocal connec- Connection tions with the frontal eye feld and projections to the superior colliculus. An absence or decrease in opto- kinetic nystagmus results from lesions of subcortical or cortical structures involved in the visual motion pathway, which Clinical includes the visual cortex and posterior tem- Connection poral areas. The absence or decrease is mani- fested only when an object is rotating toward The superior parietal lobule plays the side of the lesion. Patients with lesions in this area neglect objects on the opposite side and have diffculty in mak- Occipital Eye Field ing eye movements toward that side. The primary visual and visual association areas in the occipital cortex form the occipital eye An area in the posterior part of the lateral feld, which controls vergence movements. This phenomenon is suit movements, although the superior parietal called the near response and includes simulta- lobule and frontal eye feld may also be involved. Thus, focal lesions in the brainstem gray and white layers that are subdivided into interrupt only a small portion of the total input superfcial, intermediate, and deep layers. The fron- tal eye feld projects to the intermediate layers Clinical and sensory paths ascending through the brain- Connection stem, especially the pain and auditory paths, proj- ect to the deep layers. Output from the superior Programming of eye movements colliculus ascends to visual association areas via appears to occur not only in the pulvinar and descends into the brainstem and the cerebral cortex and brainstem but also spinal cord.

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This may be due to improper sample collection best 25 mg clozaril medicine definition, technical diffi- culties with assays buy clozaril 25mg online treatment 4 stomach virus, and immaturity of hypothalamo–pituitary–thyroid axis buy chloramphenicol 250 mg with visa. The table given below shows the incidence of various etiologies of congenital hypothyroidism and merits and demerits of screening with vari- ous approaches. Patients with hepatic hemangioma express type 3 deiodinase enzyme, which converts T4 to reverse T3. This results in reduced levels of T and T4 3 and conse- quently “consumptive” hypothyroidism. This is a rare cause of hypothyroidism and is considered as a paraneoplastic manifestation of hemangiomas. Consumptive hypothyroidism is usually seen in infants, although a few cases have also been described in adults. These patients require therapy with large doses of L-thyroxine for normalization of serum T4. The most common cause of permanent congenital hypothyroidism is thyroid dysgenesis (85%) followed by dyshormonogenesis (10–15%) and rarely, central hypothyroidism. However, thyroid dyshormonogenesis is inherited as an auto- somal recessive disorder. The classical symptoms of congenital hypothyroidism include lethargy, hoarse cry, feeding difficulty, constipation, and increased somnolence. Presence of goiter points to a clinical diagnosis of thyroid dyshormono- genesis, whereas absence of goiter suggests thyroid dysgenesis; however it does not rule out dyshormonogenesis. There is a four-fold higher prevalence of congenital malformations in newborns with congenital hypothyroidism as compared to general population (8. Congenital cardiac malformations are most common, followed by malformations of nervous system and eyes and cleft lip/palate. The most common congenital cardiac malformation is ostium secundum atrial septal defect, followed by tetralogy of Fallot and pulmonary stenosis. Thyroid hormone deficiency during intrauterine period may result in absent distal femoral and upper tibial epiphyses (in a term newborn) and wide posterior fontanelle. Epiphyseal dysgenesis, short long bones, anterior beaking of 12th thoracic, first and second lumbar vertebra, enlarged sella, and delayed bone age are other manifestations of untreated congenital hypothyroidism in a child. Kocher–Debre–Semelaigne syndrome refers to pseudohypertrophy of calf muscles as a result of long-standing untreated congenital/juvenile hypothyroid- ism. Pseudohypertrophy is a result of accumulation of glycogen, glycosamino- glycans, and connective tissue in the muscle as a result of hypothyroidism. The level of creatine phosphokinase is mildly elevated and electromyogram shows a myopathic pattern.