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By: J. Eduardo Calonje, MD, DipRCPath, Director of Diagnostic Dermatopathology, Department of Dermato-Histopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK

Chatterjee 13th /p19 – Option b- Correct- Amoebiasis occurs most frequently in adult males order zenegra with american express impotence quad hoc, children buy zenegra 100 mg low cost erectile dysfunction garlic, people with low socioeconomic status purchase zenegra 100mg without a prescription erectile dysfunction treatment pune. This may be due to poor living conditions purchase extra super levitra 100mg amex, over crowding and unhygienic practices which leads to faecal contamination of food and drinks which help in transmission of amoeba discount levitra super active 40mg. Ref: Journal of Teachers Association June 2008; Vol21 N1 – Option d- Correct- The subspecies of E. Harrison18/e p1684-85, 17/e p1275 – Option c- Incorrect- Relation between low iron content and invasive amoebiasis is not documented any where, probably is the wrong statement. Chatterjee 13/e p22, Apurba Sastry’s Essentials of Medical Parasitology,p/28-31 – Option a, c and d- correct- Already explained – Option b- Incorrect- Each mature cyst contains 4 nuclei (tetranucleate amoeba) – Option e- Amoebic colitis leading to carcinoma of colon not documented. Morphology- 2 forms • Trophozoites – Front view- Tear-drop shaped/racket shaped/piriform shaped, Lateral view- sickle/spoon shaped – Shows falling leaf like motility, 15-20µm size – It has 2 nuclei, 4 pairs of fagella, 2 Axostyles, 2 parabasal body and two Ventral sucking disk • Cyst- Mature cyst is oval, 10-14µm size, consists of 4 nuclei and an axostyle. I Pathogenesis Pathogenesis • It causes abnormalities of villous structure and causes malabsorption (lipids and Malabsorption of fat lipid soluble vitamins (steatorrhea) - leads to • Malabsorption - There could be various types which include – foul smelling profuse frothy – Malabsorption of fat (steatorrhea) - leads to foul smelling profuse frothy diarrhoea. Life Cycle • Mode of transmission - Sexual route • Reservoir of infection – woman • Infective stage & diagnostic stage– Trophozoites • Trophozoites divide by longitudinal binary fssion I Clinical Disease Trichomoniasis- • Incubation period- 4-28 days Strawberry appearance of • In men- Asymptomatic or Urethritis, Prostatitis and Cystitis vaginal mucosa (Colpitis • In women- Asymptomatic or vulvo-vaginitis - Characterized by- macularis)- seen in 2% of cases – Profuse vaginal discharge with offensive smell, high pH (>4. Chatterjee 13/e p47-48, Apurba Sastry’s Essentials of Medical Parasitology,p/50-52 – Giardia has two stages- cyst and trophozoite. Chatterjee 13/e p47-48, Apurba Sastry’s Essentials of Medical Parasitology,p/50-52 Option a - Incorrect-Disease manifestations of Giardiasis range from asymptomatic carriage (most common form) to fulminant diarrhea and malabsorption (rarely seen). Option b - Correct- Trophozoite of Giardia has 2 axostyles, 2 nuclei and 4 pairs of fagella. Option c - Correct- Common symptoms- diarrhea, abdominal pain, bloating, belching, fatus & vomiting. Option d - Incorrect-For diagnosis of Giardiasis- Duodenal aspirate/ wash fuid is diagnostic and not jejunal. Chatterjee 13/e p47-48, Apurba Sastry’s Essentials of Medical Parasitology,p/52 Refer earlier explanation. Chatterjee 13/e p47-48; Apurba Sastry’s Essentials of Medical Parasitology,p/52 The clues provided in the given history: – Affected patient- child- 4 years – History- Diarrhea - loose bulky stools for the past 20 days and associated with pain in abdomen – Suggest that probably child is suffering from Giardiasis. About Other Options: – Entamoeba histolytica causes dysentery commonly than diarrhea. Chatterjee 13/e p61, Apurba Sastry’s Essentials of Medical Parasitology,p/82 – Chaga’s disease is caused by Trypanosoma cruzi 8. Chatterjee 13/e p61; Apurba Sastry’s Essentials of Medical Parasitology,p/80 – Reduvid bug/ triatomid bug is the vector for Trypanosoma cruzi (agent of Chagas’disease) 9. Chatterjee 13/e p55; Apurba Sastry’s Essentials of Medical Parasitology,p/85 Trypanosoma brucei, the causative agent of Sleeping sickness is transmitted by tsetse fy – Trypanosoma brucei gambiense (West Africa) - Bite of Glossina (tsetse fy) – Trypanosoma brucei rhodesiense (Eastern and Central Africa )- Bite of Glossina (tsetse fy) Leishmania 11.

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Elimination of all forms of gical age may thus differ in persons of same ischemic heart disease would add another 3 buy discount zenegra 100 mg line erectile dysfunction and icd 9. Eliminating cancer buy zenegra online now vasculogenic erectile dysfunction causes, heart disease and diabetes together The number of aged people is gradually increasing will increase life expectancy at birth by only 15 discount zenegra 100 mg with amex erectile dysfunction diabetes reversible. The life expectancy in India at Aging has become an important issue because of the 60 years age is 14 order accutane 40 mg without prescription. Italy and Japan had highest people aged over 100 years-By 2031 cheap zudena online master card, it will have proportions of older persons (about 16. Their proportion will increase • Old persons should absorb themselves in social to 80 percent by 2050. They can inspire people to come to them health problems and disabilities that impact on the because they are experienced, learned, helpful and quality of life of the elderly. They win the affection of family, friends and done to relieve the hardships of old age. Such people grow old and do so, we must understand the problems of the elderly pass their time gracefully till the end. These are of four types: economic, social, social pattern of life is different from the West. True happiness depends ultimately on being able to identify Economic Problems oneself, until, death with the continuing stream of life. It bank balance and provident fund are spent up in may be precipitated by psychosocial factors like making a house or in the marriages of grown up retirement, economic deprivation, bereavement and children. Besides, drug induced affairs or to purchase amenities or comforts, which are depression from antihypertensive drugs, steroids and needed all the more in old age. Organic depression may with continued low standard of living, affect the body also occur after a stroke, heart attack or other serious and the mind. In order to avoid poverty in old age, the state • Religious pursuits may provide a satisfying avenue should provide social security in the form of welfare to old persons. An aging man should plan ahead to adapt him, self to adjust to the new environments. The sons, Mental changes are an inevitable accompaniment of old daughters and young friends get busy in their own affairs. A certain degree of cerebral atrophy is universal There is a painful feeling of futility and genuine loneliness, in the elderly and is associated with loss of memory and which becomes all the more acute because of the slowing of reflexes. Sexual changes, such as menopause increasing number of small nuclear families nowadays. According to an Apart from appropriate psychiatric management old saying, the panacea for old age is “Satat Udyog, when indicated, mental problems of the elderly can be Shant Man” (Be busy, be calm). Raising the age of mitigated to a large extent through sympathetic under- retirement would help people to be active and busy standing and sincere affection rather than through pity.

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It from handling food and should be given appropriate is a 22 page document consisting of 12 pages in text treatment zenegra 100 mg without prescription doctor's guide to erectile dysfunction. Salmonella and staphylococci do not grow the paras and subparas has been retained as in the at temperature below 5° to 6°C buy zenegra discount generic erectile dysfunction drugs in canada. The time Widespread poverty resulting in chronic and persistent dimension is also important buy cheap zenegra 100 mg on line erectile dysfunction treatment acupuncture. A policy having a mere hunger is the single biggest scourge of the developing long-term effect order kamagra from india, even if beneficial for the nutritionally world today discount cialis extra dosage 40mg on-line. After all, this group continuously reenacted tragedy is the condition of has too little to live on in the long run and has too much undernutrition which manifests itself among large to die of in the short run. Therefore, both short as well sections of the poor, particularly amongst the women as long-term strategies are called for, comprising both and children. This condition of undernutrition, therefore, direct as well as indirect interventions. Such reduced productivity translates into The Nutrition Status of India reduced earning capacity, leading to further poverty, and the vicious cycle goes on. Even in rural areas, between 1975 and 1989, The need for a National Nutrition Policy is implicit in aggregate consumption levels of all groups taken both the paramountcy of nutrition in development as together were higher than the recommended levels. This general fact, time trends show that the average intake of calories problem of undernutrition should be seen as a part of at the lowest income group had a definite increasing a larger set of processes that produces and consumes trend during the seventies. However, there has not agricultural commodities on farms, transforms them into been a commensurate increase in consumption of food in the marketing sector and sells the food to proteins and protective foods like fats and oils. In fact, the third subset, vitamin A, however, deficiencies existed among all viz. There is, however, no doubt that the adequacy of food at household levels, are no the impressive gains of the Green Revolution in terms guarantees for a stable and satisfactory nutritional status. This is the crux of the nutrition situation states was the average intake comparable to the in India. The major nutritional problems of India can be • Prevalence of low birth weight children: The preva- discussed under the following headings: lence of low birth weight children is still unacceptably high for India. In India, 30% of all • Protein energy malnutrition: It is the most widespread the infants born are low birth weight babies (Weight form of malnutrition among preschool children of our less than 2500 g) and this pattern is almost constant country. The child population In the duality of the Indian situation, where high- of urban slums had the lowest proportion of children yielding modern agriculture co-exists with rain-fed with normal body weight and recorded the highest subsistence farming, there are serious seasonal proportion of severely malnourished children. In large parts of • Iron deficiency nutritional anaemia: Nutritional India, the rainy months are the worst months for the anaemia among the preschool children and rural, landless poor. This is when cultivation, deweeding, expectant and nursing mothers is one of the major ploughing and other works demand maximum energy preventable health problems in India. It has been from them, while food stocks at home dwindle and estimated in various studies, particularly those market prices rise.

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The association areas draw on sensory information from sensory areas of the cortex and on emotional feelings transmitted via the limbic system buy genuine zenegra line erectile dysfunction in young men. This information is integrated with previously learned skills and stored memory order 100mg zenegra with amex erectile dysfunction pump manufacturers, which presumably also reside in the association areas effective zenegra 100mg viagra causes erectile dysfunction. The learning process itself is poorly understood buy proscar 5mg free shipping, but it can be studied experimentally at the synaptic level in isolated slices of mammalian brain or in more simple invertebrate nervous systems purchase discount zoloft on-line. Synapses subjected to repeated presynaptic neuronal stimulation show changes in the excitability of postsynaptic neurons. These changes include the facilitation of neuronal firing, altered patterns of neurotransmitter release, second messenger formation, and, in intact organisms, evidence that learning occurred. The phenomenon of increased excitability and altered chemical state on repeated synaptic stimulation is known as long-term potentiation, a persistence beyond the cessation of electrical stimulation, as is 2+ expected of learning and memory. An early event in long-term potentiation is a series of protein phosphorylations induced by receptor-activated second messengers leading to activation of a host of intracellular proteins and altered excitability. In addition to biochemical changes in synaptic efficacy associated with learning at the cellular level, structural alterations occur. The number of connections between sets of neurons increases as a result of experience. The cellular and structural changes that accompany the formation of long-term memories reflect changes in gene expression within the neuron. Inhibition of transcription or translation blocks the formation of long-term, but not short-term, memories in model systems. Much of our knowledge about human memory formation and retrieval is based on studies of patients in whom stroke, brain injury, or surgery resulted in memory disorders. From these combined approaches, we know that memories are not stored in a single place in the brain but are distributed across many areas. The prefrontal cortex is essential for coordinating the formation of memory, starting from a learning experience in the cerebral cortex, then processing the information, and communicating it to the subcortical limbic structures. The prefrontal cortex receives sensory input from the parietal, occipital, and temporal lobes and emotional input from the limbic system. Drawing on skills such as language and mathematical ability, the prefrontal cortex integrates these inputs in light of previously acquired learning. The prefrontal cortex can thus be considered the site of working memory, where new experiences are processed, as opposed to sites that consolidate the memory and store it. The processed information is then transmitted to the hippocampus, where it is consolidated over several hours into a more permanent form that is stored in, and can be retrieved from, the association cortices. Memory can be divided into that which can be recalled for only a brief period (seconds to minutes) and that which can be recalled for weeks to years. Newly acquired learning experiences can be readily recalled for only a few minutes or more using short-term memory. An example of short-term memory is looking up a telephone number, repeating it mentally until you finish dialing the number, then promptly forgetting it as you focus your attention on starting the conversation.