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Adenoviruses also produce characteristic smudge cells in infected respiratory epithelial cells discount generic tofranil uk anxiety 4 hereford bull. Histologic 144 Pathology examination reveals enlarged squamous epithelial cells that have shrunken nuclei (“raisinoid”) within large cytoplasmic vacuoles buy discount tofranil online anxiety symptoms red blotches. Candidiasis is the most common fungal infection of the vagina and is especially common in patients who have diabetes or take oral contraceptives generic 50 mg tofranil fast delivery anxiety symptoms ringing in ears. Microscopic exami- nation of the vaginal discharge reveals yeast and pseudohyphae. The characteristic features of this syndrome are hemato- logic abnormalities, renal involvement, and increased vascular permeabil- ity. Although several species of rodents in the United States are known to be infected with Hantavirus, no human cases were reported until an outbreak of severe, often fatal respiratory illness occurred in the United States in May 1993 in the Four Corners area of New Mexico, Arizona, Colorado, and Utah. This illness resulted from a new member of the genus Hantavirus that caused a severe disease characterized by a prodromal fever, myalgia, pul- monary edema, and hypotension. The main distinguishing feature of this illness, which is called Hantavirus pulmonary syndrome, is noncardiogenic pulmonary edema resulting from increased permeability of the pulmonary capillaries. Laboratory features common to both Hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome include leukocyto- sis, atypical lymphocytes, thrombocytopenia, coagulopathy, and decreased serum protein concentrations. Abdominal pain, which can mimic an acute abdomen, may be found in both Hantavirus pulmonary syndrome and hemorrhagic fever with renal syndrome. Dengue fever virus is a type of flavivirus; flaviviruses which are similar to alphaviruses. Dengue fever (breakbone fever) is initially similar to influenza but then progresses to a rash, muscle pain, joint pain, and bone pain. It is spread by a mos- quito and produces characteristic coagulative necrosis of liver acinar zone 2 (midzonal necrosis). The necrotic hepatocytes produced by the process General Pathology Answers 145 of apoptosis in the absence of inflammation result in Councilman bodies. Because of liver failure, patients become jaundiced (hence the term yellow fever) and may vomit clotted blood (“black vomit”). Ebola virus is a member of the Filoviridae family that causes a severe hemorrhagic fever. In children, infection with parvovirus produces a characteristic rash, called erythema infectiosum or fifth disease, which first appears on the face and is described as a “slapped- cheek” appearance. Human parvovirus infection in adults produces a non- specific syndrome of fever, malaise, headache, myalgia, vomiting, and a transient rash. In contrast to parvovirus, rhinoviruses are the causative agents of the com- mon cold (coryza). This infection is characterized by rhinorrhea, pharyngi- tis, cough, and low-grade fever. After an incubation period of 10 to 21 days, measles is character- ized by fever, rhinorrhea, cough, skin lesions, and mucosal lesions (Koplik spots). Streptococcal or pneumococcal pneumonia involves one or more lobes and is often seen in alcoholics or debilitated persons. Legionella species cause a fibrinopurulent lobular pneumonia that tends to be confluent, almost appearing lobar. Two forms of disease produced by Actinomyces are cervicofacial actinomyces and pelvic actinomyces. The former consists of an indurated (lumpy) jaw with multiple draining fistulas or abscesses. Small yellow colonies called sulfur granules may be seen in the draining material. Histologic section reveals tangled masses of gram-positive fila- mentous bacteria. Cultures of Actinomyces grow as white masses with a domed surface, which is called a “molar tooth” appearance. A characteristic that helps to differentiate these two is the fact that Nocardia is partially acid-fast. Nocardiae are aerobic and acid-fast, in contrast to Actinomyces species, which are strict anaerobes and not acid-fast. Progressive pneumonia with purulent sputum and abscesses is suggestive of nocardiosis, especially if dissemination to the brain or subcutaneous tissue occurs. Nocardia is also one cause of myce- toma, a form of chronic inflammation of the skin that causes indurated abscesses with multiple draining sinuses. These rods tend to arrange themselves at right angles, producing characteristic V or Y configurations described as “Chinese characters. This toxin can produce a pseudomembrane covering the larynx, which is difficult to peel away without causing bleeding, and heart General Pathology Answers 147 damage with fatty change. Characteristics that are unique to Listeria include a tumbling motility on hanging drop and an umbrella-shaped motility pattern when a specimen is stabbed into a test tube agar slant. Since the organisms grow slowly on enrichment media, they may be overgrown by other coliforms at 37°C. Infection results in a chronic disease that is characterized by superficial ulcers of the genital region. Regional lymph node involvement produces large nodular masses that develop extensive scarring. Instead, histologic examination is used to demonstrate Donovan bodies, which are organisms within the cytoplasm of macro- phages. Chancroid is an acute venereal disease that is characterized by painful genital ulcers with lymphadenopathy. Gram stains of the suppurative lesions or cultures on spe- cialized media may be used to make the diagnosis. Neisseria gonorrheae, a gram-negative diplococcus, causes gonor- rhea, an acute suppurative infection of the genital tract. In women, it may be asymptomatic (50%), or it may produce infection of the cervix with accom- panying vaginal discharge, dysuria, and abdominal pain. In newborns, infection acquired during birth can produce a purulent conjunctivitis (ophthalmia neonatorum). A Gram stain of the urethral or cervical exudate may reveal the intracytoplasmic gram- negative diplococci, or the exudate can be cultured on special media. Dark-field or immunofluorescence examination may be used to detect organisms in the genital ulcers of primary syphilis. Antibodies to cardi- olipin, a substance in beef heart that is similar to a lipoid released by T. Chlamydia species are obligate intracellular parasites that form elementary bodies and reticulate bodies.

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Although all parts of this plant are used in Indian traditional medicine for the treatment of various ailments cheap 75 mg tofranil overnight delivery anxiety 1-10 rating scale, antidiarrhoeal activity of the leaves of Ficus hispida Linn discount tofranil 25mg fast delivery anxiety blood pressure. Therefore buy tofranil no prescription anxiety hives, this study is to confirm the antidiarrhoeal activity of Ficus hispida Linn. The albino mice were used for in vivo antidiarrhoeal effect and isolated rabbits intestine were used for in vitro activity to explore the possible mechanism of action of Ficus hispida Linn. General pharmacological screening test of the extract had shown no abnormal changes. Dose dependent decrease in frequency, enteropooling and percent intestinal transit of castor oil-induced diarrhoea in all 3 tested groups (i. Anti-diarrhoeal efficacy of some Burmese Indigenous Drug Formulations in experimental diarrhoeal test models. Since their raw ingredients are available locally and cheaply, both drugs are appropriate for clinical evaluation. Three chemical compounds namely wedelolactone, demethyl wedelolactone and luteolin which had been reported to possess hepatoprotective activity were detected from Kyeik-hman (E. Before screening of blood sugar lowering effect in rabbit model, the morphological and diagnostic characters of Gynura procumbens (Lour. Then phytochemical constituents, physicochemical properties, determination of heavy metals, determination of aflatoxins and pesticide residues, elemental analysis, microbial contamination and acute toxicity of G. Then, the observation was continued to at least two weeks for any toxic and harmful effects due to the dried leaves of G. It was observed that the dried leaves powder was free from harmful effect and the powder had not toxic effect during the observation period of two weeks with permission dose of 6g/kg. In the study of antihyperglycemic activity, the different doses of dried leaves powder (0. All the three doses showed significantly antihyperglycemic activity at 1hour (p<0. The administration of 3g/kg of dried leaves powder similarly lowered sugar level in blood as glibenclamide B. In comparison of percent inhibition of hyperglycemic between two different test agents, 1. The aim of the present study was to investigate the antihyperglycemic effect of aqueous extract of Piper betle Linn. Diabetes was induced in overnight fasted wistar strain albino rats by single intraperitoneal injection of freshly prepared solution of alloxan (100mg/kg) in distilled water. The characteristicts of diabetes such as polydipsia, polyuria, hyperglycemia and unexplained weight loss were reported in alloxan induced diabetic rats during the study. Significant reduction of blood glucose level was observed at 2hr , 3hr and 4hr after administration when compared with that of control group (p<0. Central nervous system depression, muscle paralysis, cyanosis around mouth and nose, pulmonary congestion and gastric erosions were observed in acute toxicity study with lethal dose. Concurrent histological studies of the pancreatic islets showed beta cells were necrotic and pyknotic nuclei with a homogenous cytoplasm and alpha cells were unaffected in alloxan induced diabetic rats. It was concluded that the present study clearly showed that aqueous extract of Piper betle Linn. Tin May Nyunt; Ohnmar May Tin Hlaing; Zaw Htet; Ohnmar; Thaw Zin; Khin Chit; Aye Than. While herbal medicine is the oldest form of medicine extensively practiced in Myanmar, it is still a very young science. It has also been claimed to be devoid of hazardous side effects which are often experienced by western anti-hypertensive agents during long-term use. With the aim to establish the therapeutic status of Plantago major in actual clinical practice, a clinical trial was carried out on 10 mild to moderate hypertensive patients who are attending an outpatient department of Thingangyun Sanpya Hospital, Yangon. The initial blood pressure between 140/90mmHg and 160/90mmHg was controlled with the trial dose 5 tablets (1. Comparative study with other standard drugs and long is conducted in future research. Tin May Nyunt; Khine Khine Lwin; Than Than Aye; May Aye Than; Khin Chit; Thein Kyaw; Ohnmar May Tin Hlaing; Min Wun; Nu Nu Win. A clinical trial to determine the antihypertensive effect of medicinal plant, Plantago major Linn. After washout period of 3 days of stopping anti-hypertensive drugs, patients were treated orally with Plantago major Linn. Monitoring of blood pressure and vital signs were done on day 1, day 2, and day 3 and weekly up to 12 weeks. The results showed that reduction of blood pressure from baseline level was found at (0. After 12 weeks of treatment with this trial drug, it was observed that significant reduction of mean blood pressure was from 150±2. This trial drug decreased the mean systolic blood pressure and diastolic blood pressure from baseline level by 21mmHg (p<0. Anti-inflammatory activity of essential oil from some plant ingredients of traditional medicine formulations. May Aye Than; Mu Mu Sein Myint; Khin Myo Naung; Aye Than; Myint Myint Khine; San San Myint; Mya Thet Lwin. Anti-inflammatory activities of all essential oils of these three plants were observed to be 75. There were no significant differences in anti- inflammatory activity of essential oil of all plants and between the standard drug, aspirin. In Myanmar, 80% of school children had gingivitis and 18% of then had periodonated destruction. Bacterial plague in oral cavity is regarded as the primary local etiological factor in inflammatory disease. Preventing and controlling of periodonated disease would prevent the microbial colonization of plague on the teeth and gingival. There are varieties of antiseptic mouthwashes in modern dental practice, but chlorhexidine gluconate is the most effective anti-plague mouthwash, which is not cheap and easily available. This study with the aim to evaluate the efficacy of Ponna-yeik mouthwash, which was easily available at low cost, was conducted at the Institute of Dental Medicine, Yangon. The study design was randomized controlled clinical trail and chlorhexidine gluconate was used as positive standard drug. Twenty patients with typical chronic gingivitis who participate this study were randomly divided into two groups, 10 patients for 0. The plaque score, bleeding on probing supra-gingival plaque formation, staining effect and severity of gingivitis were examined prior to the clinical trail, as baseline and 4 weeks after trial.

Sexual Assualt Examination 85 The hymen is the tissue that partially or completely surrounds the open- ing of the vagina buy tofranil pills in toronto anxiety 4 months postpartum. The hymen may be annular (encircling the vaginal opening) cheap tofranil online american express anxiety children, cres- centic (present at the lateral and posterior margins) buy tofranil with american express anxiety 8 weeks postpartum, fimbriated (frilly edged), or, usually after childbirth, present only as interrupted tags or remnants. It is important that the reader refer to atlases that illustrate these variations (2,92). Uncommon congenital vari- ants include two or more hymenal openings, referred to as septate or cribri- form, respectively, and, rarely, complete absence of an opening (imperforate hymen). Indentations or splits in the hymenal rim have been variously described as deficits, concavities, transections, clefts, notches, and, when clearly of recent origin, tears or lacerations (fresh and healed). In this text, the term notch will be used to describe divisions or splits in the hymenal rim. Super- ficial notches have been defined as notches that are less than or equal to half the width of the hymenal rim at the location of the notch, and deep notches have been defined as notches that are more than half the width of the hyme- nal rim at the location of the notch (93). Superficial notches of all aspects of the hymen have been described in both prepubertal (0–8 years) and postpu- bertal females (9. Deep notches of the anterior and lateral aspects of the hymen have been found in 14 of 200 postpubertal females (9. Deep notches of the posterior hymenal margin have not been described in prepubertal females screened for abuse. Deep notches of the hymenal mar- gin have been described among postpubertal females who deny having sexual activity, although because these females were not screened for abuse, it is not possible to state whether these were the result of unreported sexual abuse. The other pertinent anatomic landmarks in this area are the posterior fourchette (where the labia minora unite posteriorly), the fossa navicularis (a relatively concave area of the vestibule bounded anteriorly by the vaginal open- ing, posteriorly by the posterior fourchette, and laterally by the labia minora), and the anterior fourchette (where the labia minora meet anteriorly and form the clitoral hood). The skin of the labia majora and the outer aspects of the labia minora is keratinized squamous epithelium, but only the outer aspects of the labia majora are hair bearing. The skin of the inner aspects of the labia minora and the vesti- bule (including the hymen) is nonkeratinized. This area is usually pink, but in 86 Rogers and Newton the nonestrogenized child, it may appear red because the skin is thinner and consequently the blood vessels beneath its surface are more apparent (97). The forensically relevant areas of the internal female genitalia are the vagina and the cervix. The pertinent landmarks are the vaginal fornices (ante- rior, posterior, right, and left) and the cervical os (opening of the cervical canal). The vagina and cervix are covered by nonkeratinized squamous epithe- lium that normally appears pink in the estrogenized female. Occasionally, the columnar endocervical epithelium, which appears red, may be visible around the cervical os because of physiological or iatrogenic (e. Development The female hypothalamic–pituitary–gonadal axis is developed at the time of birth. The estrogen causes prominence of the labia and clitoris and thickening and redundancy of the hymen. During this period, the external genitalia gradually become less prominent; eventually, the hymen becomes thin and translucent and the tissues appear atrophic; occasionally, the hymen remains thick and fimbriated throughout childhood. The hypothalamic–pituitary–gonadal axis is reactivated in late childhood, and the breasts and external genitalia alter accordingly. This endogenous lubrication is enhanced with ovulation and with sexual stimu- lation (102). When the endogenous estrogen levels fall resulting from meno- pause, the vulva and vagina atrophy. Forensic Evidence Although legally it is not necessary to have evidence of ejaculation to prove that vaginal intercourse has occurred, forensic science laboratories are frequently requested to determine whether semen is present on the swabs taken Sexual Assualt Examination 87 from the female genitalia because semen evidence can play a central role in identification of the assailant. The female genitalia should also be sampled if a condom was used during the sexual act (see Heading 11) and if cunnilingus is alleged to have occurred (see Heading 7). It is also important to sample the vagina, vulva, and perineum separately when only anal intercourse is alleged to exclude the possibility of leakage from the vagina to account for semen in the anal canal (see Heading 10). Method of Sampling The scientist is able to provide objective evidence in terms of the quan- tity (determined crudely) and quality of the spermatozoa present and may be asked to interpret the results in the context of the case. When providing expert evidence regarding whether vaginal penetration has occurred, the scientist must be able to rely on the forensic practitioner to obtain the samples in a manner that will refute any later suggestions by the defense that significant quantities of spermatozoa, which were only deposited on the outside of the vulva, could have been accidentally transferred to the high vaginal area during the medical examination (7). It is worth noting that there has been no research to support or refute this hypothesis. Currently, there is no internationally agreed method for obtaining the samples from the female genital area. The following method has (October 2003) been formulated by experienced forensic practitioners and forensic scientists in England to maximize the recovery of spermatozoa while considering these po- tential problems: 1. Any external (sanitary napkins or pads) or internal (tampons) sanitary wear is collected and submitted for analysis with a note about whether the item was in place during the sexual act and whether other sanitary wear has been in place but discarded since the incident. Even though traditionally these swabs have been labeled “external vaginal swab,” they should be labeled as “vulval swab” to clearly indicate the site of sampling. However, if the vulval area or any visible staining appears dry, the double-swab technique should be used (28) (see Subheading 4. The labia are then separated, and two sequential dry swabs are used to compre- hensively sample the lower vagina. An appropriately sized transparent speculum is then gently passed approximately two-thirds of the way into the vagina; the speculum is opened, and any foreign bodies (e. Then, 88 Rogers and Newton two dry swabs are used to comprehensively sample the vagina beyond the end of the speculum (particularly the posterior fornix where any fluid may collect). At this point, the speculum may be manipulated within the vagina to locate the cervix. If doctors decide for clinical reasons to use a lubricant, then they should take care to apply the lubricant (from a single use sachet or tube) sparingly and must note its use on the forms returned to the forensic scientist. In the process of sampling the vagina, the speculum may accumulate body fluids and trace evidence. Therefore, the used speculum should be retained, pack- aged separately, and stored in accordance with local policy. If the speculum is visibly wet on removal, swabbing may be undertaken to retrieve visible material. In some centers, additional methods of semen collection are employed (5,63,103) in the form of aspiration of any pools of fluid in the high vagina and/or placing 2–10 mL of saline or sterile water in the vagina and then aspi- rating the vaginal washings. However, vaginal aspirates should not be neces- sary if dry swabs are used to sample the vagina in the manner described. Furthermore, there are no data to confirm that vaginal washings retrieve sper- matozoa more effectively than vaginal swabs. On these occasions, two dry swabs should be inserted sequentially into the vagina under direct vision, avoiding contact with the ves- tibule and hymen. An attempt should then be made to comprehensively sample the vagina by gently rotating and moving each swab backward and forward. Unfortunately, in such cir- cumstances, it is impossible to be certain that the high vaginal swab was not contaminated from semen in the low vagina, which could be there because of drainage from external ejaculation.