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By V. Fadi. Benedictine College. 2019.

Pesznyák Methodology and inaccuracies in the estimation of collective effective dose from diagnostic and interventional procedures in a university hospital E cheap cialis 10 mg on-line. Setting the Scene for the The conference was held in Bonn discount 20 mg cialis with amex, 3–7 December 2012 order cialis american express, and aimed buy cialis american express, in particular, to: Next Decade • Indicate gaps in current approaches to radiation protection in medicine; • Identify tools for improving radiation protection in medicine; • Review advances, challenges and opportunities in the field of radiation protection in medicine; Proceedings of an • Assess the impact of the International Action Plan for the International Conference Radiation Protection of Patients, in order to prepare new international recommendations, taking into account newer 3–7 December 2012 developments. It resulted in the Bonn Call for Action, which will focus efforts Bonn, Germany in radiation protection in medicine in the next decade, and maximize the positive impact of such efforts. Key: b Ref: Myocardial Infarction (591) Davidson’s Principles and Practice of Medicine. A thirty five year old man presents in a clinic with history of chronic productive cough that is worse in the morning and brought on by changes in posture. Key: b Ref: Bronchiectasis (Page 684) Davidson’s Principles and Practice of Medicine. Key: c Ref: Adverse Reaction of First Line Anti Tuberculosis Drugs (Page 702) Davidson’s Principles and Practice of Medicine. A fifteen year old boy who is diabetic presents with pain abdomen, vomiting and shortness of breath. Key: a Ref: Diabetic Ketoacidosis (Page 820) Davidson’s Principles and Practice of Medicine. A ten year old boy gives history of swelling of body starting from face and more on getting up in the morning. On examination his blood pressure is normal, pallor is absent and jugular venous pressure is not raised. Key: e Ref: Nephrotic Syndrome (Page 480) Davidson’s Principles and Practice of Medicine. A young girl comes in the cardiology ward with history of breathlessness and palpitations for last one year. After auscultation of precordium cardiology registrar makes diagnosis of mitral stenosis. The most important sign on which this diagnosis is based is: a) Ejection systolic murmur. Key: b Ref: Mitral Stenosis (Page 619) Davidson’s Principles and Practice of Medicine. Key: a Ref: Rheumatic Fever (Page 618) Davidson’s Principles and Practice of Medicine. An old lady presents with history of fever and left sided chest pain for one month. Examination of respiratory system shows decreased chest movements, stony dull percussion note and absent breath sounds on left side. Key: d Ref: Clinical Exam of Respiratory System (Page 649) Davidson’s Principles and Practice of Medicine. A forty year old woman gives history of fever for last three weeks accompanied by dry cough, night sweats and weight loss. Key: a Ref: Tuberculosis (Page 696) Davidson’s Principles and Practice of Medicine. A young girl complains of nocturnal cough and shortness of breath which disturbs her sleep. Key: c Ref: Bronchial Asthma (Page 673) Davidson’s Principles and Practice of Medicine. A fifteen year old girl presents with history of fever, bleeding from gums and pallor for last fifteen days. Key: a Ref: Acute Leukemia (Page 1040) Davidson’s Principles and Practice of Medicine. Which of the following drugs is used in the treatment of hyperkalemia in acute renal failure: a) Amiloride. Key: d Ref: Treatment of Hyperkalemia, Acute Renal Failure Davidson’s Principles and Practice of Medicine. For the patient with history of fever, headache and neck stiffness, the most important investigation is: a) Cerebrospinal fluid examination. Key: a Ref: Meningitis (Page 1224) Davidson’s Principles and Practice of Medicine. The most common risk factor for chronic obstructive pulmonary disease is: a) Air pollution. Key: e Ref: Chronic Obstructive, Pulmonary Disease (Page 678) Davidson’s Principles and Practice of Medicine. Key: a Ref: Cushing’s Syndrome (Page 779) Davidson’s Principles and Practice of Medicine. In a young boy with hypertension, examination of cardiovascular system reveals radio-femoral delay. The most likely cause of hypertension in this patient is: a) Coarctation of aorta. Key: a Ref: Coarctation of the Aorta (Page 637) Davidson’s Principles and Practice of Medicine. The gait of a patient with cog-wheel rigidity and pill rolling tremors is likely to be: a) Drunken. Key: e Ref: Parkinsonism (Page 1218) Davidson’s Principles and Practice of Medicine. An old patient presented in emergency ward with history of weakness of right side of body of rapid onset. The most helpful first line investigation for management of this patient is: a) Cerebral angiography. Key: c Ref: Cerebrovascular Disease (Page 1200) Davidson’s Principles and Practice of Medicine. In a patient of thalessemia peripheral blood film for red cell morphology shows: a) Hypochromic microcytic cells. Key: a Ref: Thalessemia (Page 1038) Davidson’s Principles and Practice of Medicine. Key: b Ref: Pyogenic Liver Abcess (Page 986) Davidson’s Principles and Practice of Medicine. Key: d Ref: Cerebrovascular Disease (Fig: 26:34, Page 1209) Davidson’s Principles and Practice of Medicine. A forty year old man gives history of high grade fever for last one week associated with cough productive of rusty sputum. The anti diabetic agent of choice for a fifty year old obese lady with mild hyperglycemia is: a) Chlorpropamide. Key: d Ref: Oral Anti-Diabetic Drugs (Page 831) Davidson’s Principles and Practice of Medicine. Which of the following characteristic suggests a benign structure of esophagus: a) Anaemia. Key: c Ref: Benign Esophageal Structure (Page 880), Carcinoma of Esophagus (Page 882) Davidson’s Principles and Practice of Medicine. A thirty five year old man presents with history of low grade fever and cough for last three months. Which of the following feature on chest X-ray suggests this diagnosis: a) Cavitation. Key: a Ref: Pulmonary tuberculosis (Page 695) Davidson’s Principles and Practice of Medicine. In a patient with history of shortness of breath, which of the following sign indicates left heart failure: a) Ascites. Key: b Ref: Heart Failure (Page 545) Davidson’s Principles and Practice of Medicine. A fifty year old man is admitted in emergency ward with acute myocardial infarction. Key: d Ref: Myocardial Infarction (Page 595) Davidson’s Principles and Practice of Medicine. A fifty year old smoker presents with history of cough productive of mucoid sputum in every winter for last three years.

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One day after undergoing cholecystectomy order 2.5mg cialis, a 37-year-old man becomes increasingly tremulous and anxious buy cialis with visa. Administration of which of the following is the most appropriate next step in management? Fourteen hours after admission to the hospital for treatment of severe hypertension generic 5mg cialis with amex, a 32-year-old woman has stridor buy cialis 20 mg with amex. Her pulse is 140/min, respirations are 32/min, and blood pressure is 140/85 mm Hg. E - 141 - Comprehensive Basic Science The Comprehensive Basic Science Examination is a general, integrated achievement test covering material typically learned during basic science education, with somewhat more emphasis on second-year courses in medical schools with traditional curricula. Systems General Principles of Foundational Science 15%–20% Biochemistry and molecular biology Biology of cells Human development and genetics Biology of tissue response to disease Pharmacodynamic and pharmacokinetic processes Microbial biology Normal age-related findings and care of the well patient Immune System 1%–5% Blood & Lymphoreticular System 5%–10% Behavioral Health 1%–5% Nervous System & Special Senses 5%–10% Skin & Subcutaneous Tissue 1%–5% Musculoskeletal System 5%–10% Cardiovascular System 5%–10% Respiratory System 5%–10% Gastrointestinal System 5%–10% Renal & Urinary System 5%–10% Pregnancy, Childbirth, & the Puerperium 1%–5% Female Reproductive System & Breast 1%–5% Male Reproductive System 1%–5% Endocrine System 5%–10% Multisystem Processes & Disorders 5%–10% Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical Lit. A 16-month-old boy is brought to the physician by his mother for a well-child examination. His mother expresses concern that he did not walk until the age of 14 months, whereas his older sister walked at the age of 10 months. A 77-year-old woman is visited by the home care nurse who notes that the patient is more lethargic than usual. An increase in the serum concentration or activity of which of the following provides the strongest indication that the patient is dehydrated? A male newborn delivered at 26 weeks’ gestation develops respiratory distress immediately after a spontaneous vaginal delivery. The most likely cause of this patient’s breathing difficulties is insufficient production of which of the following substances? A 28-year-old woman, gravida 1, para 1, comes to the physician because of progressive fatigue since delivering a male newborn 6 months ago. Pregnancy was complicated during the third trimester by severe bleeding from placenta previa. She required multiple blood transfusions during the cesarean delivery, but she did well after the delivery. A 12-year-old African American boy is brought to the physician by his mother because of a swollen right earlobe for 3 weeks. The mother developed a thick rubbery scar on her abdomen after a cesarean delivery 12 years ago. Physical examination shows a nontender, flesh-colored swelling of the right earlobe. A 5-year-old boy is brought to the physician by his parents because of an 8-month history of difficulty walking. His parents say that he limps when he walks and has a waddling gait; he also has difficulty standing. When getting up from a sitting position, he uses his hands to walk up his thighs and push his body into a standing position. His mother is an only child, but she has an uncle who became bedridden as a child and died of respiratory arrest. This patient most likely has a mutation in the gene coding for which of the following proteins? A 27-year-old man comes to the physician because of pain with urination for 3 days. Physical examination shows no abnormalities except for a clear, watery urethral discharge. A 20-year-old college student develops fever, severe pharyngitis, hepatosplenomegaly, and lymphadenopathy. A 2-year-old boy with Down syndrome is brought to the physician by his mother for a follow-up examination. His blood pressure is increased in the upper extremities and decreased in the lower extremities. The parents are both Rh-positive, but IgG isohemagglutinins are found in the mother’s blood. Which of the following parental blood types is most likely to cause this condition? A previously healthy 42-year-old woman comes to the emergency department because of progressive shortness of breath and intermittent cough productive of blood-tinged sputum for 10 days. His mother informs the physician that the family members belong to a religious denomination that does not consume meat. Her son refuses to eat dark green vegetables or to take vitamin pills, stating that they make him feel nauseated. It is most appropriate for the physician to ask the mother which of the following questions next? A 64-year-old man comes to the physician because of a 3-day history of painful rash over his right flank. Physical examination shows clustered lesions in a band-like area over the right flank. An investigator has conducted an experiment to determine whether certain environmental exposure morbidity is eliminated if a person carries a specific allele of three different genes on three separate chromosomes. The frequencies of an individual having the allele for these respective genes are 0. The probability that a randomly selected individual will have all three alleles is closest to which of the following? A health inspector confiscates chickens smuggled into Taiwan from mainland China after she discovers them in the hold of a ship. Testing shows that, although the chickens appear healthy, they are infected with the H5N1 subtype of the influenza A virus. Which of the following is the primary concern for human health from these virus-infected chickens? A 42-year-old woman comes to the physician for a routine health maintenance examination. Fasting serum studies show: Glucose 105 mg/dL Cholesterol, total 210 mg/dL Triglycerides 185 mg/dL C-reactive protein 0. A - 149 - Comprehensive Clinical Science The Comprehensive Clinical Science Examination is a general, integrated achievement test covering material typically learned during core clinical clerkships. Systems General Principles, Including Normal Age-Related Findings and Care of the Well Patient 1%–5% Immune System 1%–5% Blood & Lymphoreticular System 1%–5% Behavioral Health 5%–10% Nervous System & Special Senses 5%–10% Skin & Subcutaneous Tissue 1%–5% Musculoskeletal System 5%–10% Cardiovascular System 5%–10% Respiratory System 10%–15% Gastrointestinal System 5%–10% Renal & Urinary System 5%–10% Pregnancy, Childbirth, & the Puerperium 5%–10% Female Reproductive System & Breast 5%–10% Male Reproductive System 1%–5% Endocrine System 5%–10% Multisystem Processes & Disorders 5%–10% Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical Lit. It is unlikely that it will directly benefit the study subjects but very likely that it will benefit future patients. There is a risk for short-term minor gastric discomfort but essentially no risk for long-term adverse effects. The investigator concludes that disclosure of the risks may discourage participation in the trial. A 25-year-old man comes to the emergency department because of a 1-month history of fever, chills, nonproductive cough, and progressive shortness of breath; he now becomes short of breath after walking 20 feet. This patient is most likely to have which of the following immunologic abnormalities? A 27-year-old man is brought to the emergency department 20 minutes after his roommate found him unconscious on their bathroom floor. A 15-year-old boy has had pain in the knee since sustaining an injury in a high school football game 6 weeks ago. The high school trainer has been treating him with heat and ultrasound, without significant improvement. A 2-week-old boy is brought to the physician because of a 3-day history of persistent discharge from his eyes. Examination of the eyes shows tarsal inflammation and a thin mucopurulent discharge. Testing of scrapings from the tarsal conjunctivae is positive for Chlamydia trachomatis. Which of the following is the most likely mode of transmission of this patient’s infection? A 62-year-old man comes to the physician because of blood in his urine for 24 hours. Abstinence from which of the following is most likely to have prevented this condition? A 21-year-old nulligravid woman who is not using contraception has had irregular menstrual periods since menarche at age 13 years.

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Training in radiological protection for patients and staff should be an integral part of the education of those using interventional techniques order cialis on line amex. All interventionists should audit and review the outcomes of their procedures for radiation injury purchase cialis toronto. Risks and benefits cialis 5 mg low cost, including radiation risks buy cialis no prescription, should be taken into account when new interventional techniques are introduced. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses high enough to cause radiation injury and an increased risk of cancer. Additionally, staff in cardiac catheterization laboratories may receive high radiation doses if radiological protection tools are not used properly. There is emphasis on those imaging procedures and interventions specific to cardiology. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training and establishment of a quality assurance programme for cardiac imaging and intervention. They also provide advice on how to deal with the challenges presented by patient and staff radiological protection in cardiology. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy. Individuals who request, perform or interpret cardiology imaging procedures should be aware of the radiation risks of the procedure. Appropriate use criteria and guidelines for justification should be used in clinical practice. The informed consent process should include information on radiation risk if the risk of radiation injury is thought to be significant. Radiation dose data should be recorded in the patient’s medical record after the procedure; patient dose reports should be archived for quality assurance purposes. When the patient’s radiation dose from an interventional procedure exceeds the institution’s trigger level, clinical follow-up should be performed for early detection and management of skin injuries. Individuals who perform cardiology procedures where there is a risk of tissue reactions should be able to recognize these skin injuries, and those who perform interventional cardiology or electrophysiology procedures should be familiar with methods to reduce radiation dose to patients and staff. When there is a risk of occupational radiation exposure, staff should use appropriate personal protective shielding. In addition to the training recommended for all physicians who use ionizing radiation, interventional cardiologists and electrophysiologists should receive a second, higher level of radiological protection training. A cardiologist should have management responsibility for the quality assurance programme aspects of radiological protection for cardiology procedures, and should be assisted by a medical physicist. Radiological protection in fluoroscopically guided procedures performed outside the imaging department A serious problem of our times is that an increasing number of medical specialists are using fluoroscopy outside imaging departments. It should be noted that there has been general neglect of radiological protection coverage of this practice. Lack of radiological protection training of those working with fluoroscopy outside imaging departments can increase the radiation risk to workers and patients. Procedures such as endovascular aneurysm repair, renal angioplasty, iliac angioplasty, ureteric stent placement, therapeutic endoscopic retrograde cholangiopancreatography, and bile duct stenting and drainage have the potential to impart high skin doses, thus making fluoroscopy use outside imaging departments a potential source for serious tissue reactions and injuries. As patient dose monitoring is essential whenever fluoroscopy is used, particularly outside the imaging department, manufacturers should develop systems to indicate patient dose indices with the possibility of producing patient dose reports that can be transferred to the hospital network, and shielding screens that can be effectively used for the protection of workers using fluoroscopy machines in operating theatres without hindering the clinical task. Specific aspects are covered separately, including those for vascular surgery, urology, orthopaedic surgery, obstetrics and gynaecology, gastroenterology and the hepato-biliary system, anaesthetics and pain management. Information on the level of radiation doses to patients and staff, and dose management is presented against each specialty. It is emphasized that patient dose monitoring is essential whenever fluoroscopy is used. Recommendations for manufacturers to develop systems to indicate patient dose indices with the possibility to produce patient dose reports that can be transferred to the hospital network are provided, as are shielding screens that can be effectively used for protection of staff using fluoroscopy machines in operating theatres without hindering the clinical task. Training for health care professionals in radiation protection should be related to their specific jobs and roles. The physicians and other health professionals involved in procedures that irradiate patients should always be trained in the principles of radiation protection, including the basic principles of physics and biology. The final responsibility for radiation exposure lies with the physician providing the justification for the exposure being carried out, who should, therefore, be aware of the risks and benefits of the procedures involved. Education and training appropriate to the role of each category of physician should be given at medical schools during residency and in focused specific courses. There should be an evaluation of the training and appropriate recognition that the individual has successfully completed the training. In addition, there should be corresponding radiation protection training requirements for other clinical personnel that participate in the conduct of procedures utilizing ionizing radiation, or in the care of patients undergoing diagnosis or treatment with ionizing radiation. Scientific and professional societies should contribute to the development of the syllabuses, and to the promotion and support of the education and training. Scientific congresses should include refresher courses on radiation protection, attendance at which could be a requirement for continuing professional development for professionals using ionizing radiation. Professionals involved more directly in the use of ionizing radiation should receive education and training in radiation protection at the start of their career, and the education process should continue throughout their professional life as the collective knowledge of the subject develops. It should include specific training on related radiation protection aspects as new equipment or techniques are introduced into a centre. A major test Adequate education and training of medical staff and practitioners is considered paramount and the major route to ensuring appropriate radiological protection in medicine. In pursuit of medical, dental, radiography and other health care degrees, education and training should be part of the curriculum and for specialists, such as radiologists, nuclear medicine specialists and medical physicists, as part of the curriculum of postgraduate degrees. The term ‘education’ usually refers to imparting knowledge and understanding on the topics of radiation health effects, radiation quantities and units, principles of radiological protection, radiological protection legislation, and the factors in practice that affect patient and staff doses. The term ‘training’ refers to providing instruction with regard to radiological protection for the justified application of the specific ionizing radiation modalities (e. Education and training are officially recognized with accreditation and certification. Accreditation and certification Organizations should be established to provide ‘accreditation’ that officially recognizes education and training on the radiological protection aspects of the use of diagnostic or interventional radiation procedures in medicine. Such organizations have to be approved by an authorizing or regulatory body, and required to meet standards that have been set by that body. A system of ‘certification’ shall be established for officially stating that an individual medical or clinical professional has successfully completed the education or training provided by an accredited organization for the diagnostic or interventional procedures to be practised by the individual, demonstrating competence in the subject matter in a manner required by the accrediting body. As the number of diagnostic and interventional medical procedures using ionizing radiations is rising steadily, and procedures resulting in higher patient and staff doses are being performed more frequently, the need for education and training of medical staff (including medical students) and other health care professionals in the principles of radiation protection will be a more compelling challenge for the future. Fostering information exchange Fostering information exchange is another key general challenge for improving radiological protection in medicine. Intergovernmental organizations, national regulatory bodies, medical professional associations, and medics and patients themselves should be part of a rich network of information exchange. This brochure underlines, on the one hand, the obvious benefits to health from medical uses of radiation, in X ray diagnostics, interventional radiology, nuclear medicine and radiotherapy, and, on the other hand, the well established risks from high doses of radiation (radiotherapy, interventional radiology), particularly if improperly applied, and the possible deleterious effects from small radiation doses (such as those used in diagnostics). This brochure describes the dilemma of protection of patients in uncomplicated prose: appropriate use of large doses in radiotherapy prevents serious harm, but even low doses carry a risk that cannot be eliminated entirely. Diagnostic use of radiation, therefore, requires methodology that would secure high diagnostic gains while minimizing the possible harm. The text provides ample information on opportunities to minimize doses and, therefore, the risk from diagnostic uses of radiation, indicating that this objective may be reached by avoiding unnecessary (unjustified) examinations, and by optimizing the procedures applied both from the standpoint of diagnostic quality and in terms of reduction of excessive doses to patients. Optimization of patient protection in radiotherapy must depend on maintaining sufficiently high doses to irradiated tumours, securing a high cure rate, while protecting the healthy tissues to the largest extent possible. Problems related to special protection of the embryo and foetus in the 3 http://rpop. Strategy As described in the previous, vidi, chapter, the number of challenges still presented by radiological protection in medicine is enormous. In order to address these challenges and succeed in addressing them, a strategy is required. Altmaier, Federal Minister of Germany for the Environment, Nature Conservation and Nuclear Safety at the Bonn conference [2]. It did not only consider the protection of patients and their comforters but also the related and, many times, interrelated occupational protection of the medical staff attending the patients and the protection of members of the public who are usually casually exposed from medical sources. Notwithstanding this, the Bonn conference could well follow the pattern marked by the Malaga conference. Heinen-Esser, again comes to the rescue with a relevant suggestion by declaring: “I would be delighted if we were to adopt a new action programme by the end of this week and meet the shared objective of this conference: Setting the Scene for the Next Decade.

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The route of infection and life-cycle outside the mollusc host are unknown although the life cycle within oysters has been well documented order cialis from india. Since it has not been possible to transmit the infection experimentally in the laboratory purchase cialis with a visa, an intermediate host is suspected (possibly a copepod) 20mg cialis overnight delivery. This is reinforced by recent observations showing spores do not survive more than 7-10 days once isolated from the oyster buy cialis with visa. Spore survival within fish or birds is limited to 2 hrs, suggesting they are an unlikely mode of dispersal or transmission. Effects appear cumulative with mortalities peaking at the end of the warm water season in each hemisphere. The infective stage is a biflagellate zoospore which transforms into the feeding trophozoite stage after entering the host’s tissues where they multiply. How does the disease Transmission of the parasite directly from host to host is possible and spread between groups transmission by infective stages carried passively on currents between of animals? How is the disease The majority of agents that cause oyster disease do not pose any human transmitted to humans? However, it is recommended not to eat oysters from areas of poor sanitation because they may be infected with Vibrio spp. A decline in body condition may be seen and discolouration of the digestive glands, mantle and gills may be visible in heavily infected individuals at gross post mortem examination. A confirmative diagnosis can be obtained using histopathology and/or transmission electron microscopy. Aquaculture There is currently no available vaccine or chemical control agent for these diseases. Good farming practices can help reduce stress and thus the negative impact of disease. Sources of stress include exposure to extreme temperatures and salinity, starvation, handling and infection with other parasites. Actions should be directed firstly at prevention of the disease as subsequent control can be very difficult. A number of simple measures can minimise or prevent the spread of oyster diseases. These include: Reduction in stocking densities and/or restocking and lowering of water temperatures may suppress clinical manifestation of the disease although no eradication procedures have worked successfully to date. Early harvesting at 15-18 months of production and subtidal culture may also minimise the effects of disease on oyster production and profitability. Prevention of introduction or transfer of oysters from waters where causal agents are known to be enzootic into historically uninfected waters. The use of increased salinities which appear to suppress clinical manifestation of the disease caused by Marteilia spp. Wild oyster beds should be monitored for signs of disease as, if infected, Wildlife they may transmit disease to other beds both wild and farmed. Humans Humans must ensure that all biosecurity measures are followed to reduce the chance of spreading the infectious agents to previously uninfected sites. Direct impacts on wildlife are not clear, although indirect long-term effects may include threats to the environment and aquatic biodiversity through, for example, declining biomass and irreversible ecological disruption. Effect on Aquaculture High losses (up to 80-90% with bonamiosis) to oyster farmers through and Fisheries mortalities, and reduced growth/productivity. However, oysters could potentially pose a health concern for humans in cases where they contain high levels of Vibrio spp. Economic importance Oyster disease has the potential to financially decimate those who run oyster farming operations. Subsequently, oyster diseases can negatively affect the community and industries depending on the oyster trade. Risk assessment of Vibrio vulnificus in raw oysters: interpretative summary and technical report. Photos Oysters infected with Bonamia ostreae, illustrating classic symptoms of Bonamia ostreae infection, e. Although often characterised by high morbidity and mortality rates, pathogenicity can vary significantly, with clinical disease ranging from mild to severe. The outcome of infection may often be complicated by the involvement of pre-existing secondary pathogens. Species affected Small ruminants, predominantly sheep and goats, although many other species have been reported to be infected and develop clinical disease. The role of wildlife species in the transmission of the virus remains unclear although zoological collections in Saudi Arabia and various wildlife species across Africa have been shown to be susceptible (e. Arabian oryx Oryx leucoryx, Dorcas gazelle Gazella dorcas, Laristan sheep Ovis orientalis laristanica, gemsbok Oryx gazella, Nubian ibex Capra nubiana, Thomson’s gazelle Eudorcas thomsonii, grey duiker Sylvicapra grimmia, kobs Kobus kob and Bulbal hartebeest Alcelaphus buselaphus). Camels are also susceptible to infection and can display signs of clinical disease. However, the virus is known to be excreted in eye and nasal discharge as well as, to a lesser extent, in urine and faecal matter. Transmission via infected bedding, water, feed troughs and other inanimate objects (fomites) is possible but is thought to occur at a very low level. The variability in virulence between different isolates of the virus is currently poorly understood. However, animals can excrete and therefore spread the virus in the absence of clinical disease, often allowing the spread of virus to naïve populations when groups of animals are moved. Clinical disease is often preceded by a 4-5 day incubation period where animals must be considered to be contagious. Factors affecting the outcome of infection include breed, age, immunological competence, general health, and the presence of secondary infections. Subsequent and additional measures: quarantine affected area and restrict movement of animals avoid introduction of healthy animals collect samples (where appropriate and as directed) dispose of carcases (burning or burying as directed) disinfect in-contact fomites; most common disinfectants can be used. Diagnosis A tentative diagnosis can be made based on the clinical signs described above. The virus may survive for short periods in carcases and in refrigerated meat, and may survive for several months in salted or frozen meat. Livestock Livestock stakeholders are advised to monitor susceptible animals closely and frequently for any signs of disease or developing illness. Where possible, any newly acquired small ruminants should be quarantined for a minimum of 21 days and monitored, before being released. Infected animal carcases should be burned or buried deep, along with their contact fomites (bedding, feed etc). Disinfection and cleaning Thoroughly clean and disinfect all contaminated areas and items (including holding pens, physical perimeters, clothing and equipment) with lipid solvent solutions of high or low pH and disinfectants. Vaccination Consider and seek advice on the best use of vaccine; strategically ‘ring’ vaccinate and/or vaccinate high-risk populations. This involves vaccinating susceptible animals in a given zone, forming a buffer of immune individuals that then limit disease spread. Vaccination of high-risk populations in high-risk areas (prophylactic immunisation). However, numerous wildlife populations are susceptible and caution must be taken, by restricting interaction of livestock with wildlife species, and restricting movement of livestock where virus is known to be circulating. Effect on humans There is no evidence to suggest direct public health implications exist although outbreaks threaten food security, especially for subsistence farmers, causing a substantial reduction in the availability of animal protein, as well as essential micro-nutrients, for human consumption. Disease outbreaks are a substantial threat to livelihoods which may already be under strain due to recurrent droughts and other pressures. Global distribution of peste des petits ruminants and prospects for improved diagnosis and control. Ranavirus is a genus of iridoviruses that can infect amphibians, reptiles, and/or fish. Ranaviruses can lead to high levels of mortality in certain species and subclinical carrier status in others. Signs include swelling of the limbs or body, reddening and ulceration of the skin, and internal haemorrhage. Death in susceptible amphibians can occur within a few days following infection or may take several weeks.

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