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L. Abbas, MD

Program Director, University of Texas Medical Branch School of Medicine

The name is derived from its capacity to agglutinate red blood cells at neutral pH. There are 15 hemagglutinin (H) subtypes of which only 3 (H1, H2 and H3) are associated with human illness. Hepatitis A A form of viral hepatitis that is known as infectious hepatitis because it can spread through contact with oral secretions or stool or through sexual contact. Liver disease caused by chronic hepatitis B can be fatal due to the development of cirrhosis leading to liver failure and an increased risk of hepatocellular liver cancer. These patients usually develop chronic hepatitis or become asymptomatic carriers of the virus. The surface coat is added on in the cytoplasm and, for unknown reasons, is produced in large quantities. Symptoms of hepatitis C may not manifest until the chronic stage and include jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting. Cirrhosis from hepatitis C is the major condition responsible for the majority of orthotopic liver transplants in the U. Infection with hepatitis C has also been associated with increased risk of primary hepatocellular carcinoma. The virion consists of a nucleocapsid core and two envelope proteins within the lipid bilayer. Hepatitis, Fulminant A rare syndrome usually associated with hepatitis B and, in rare cases, with hepatitis A or E. It is characterized by rapid clinical deterioration and the onset of hepatic encephalopathy. The liver parenchyma undergoes massive necrosis and the organ size decreases significantly. Functional renal failure sometimes occurs; in some cases, coma may develop within hours of onset. Herd Immunity the indirect protection of unvaccinated individuals against a given disease achieved via immunity of a sufficiently large proportion of the surrounding population against the respective pathogen. The virus is spread via sexual contact with an infected individual, exposure to contaminated blood. Examples are hyaline cartilage and hyaline hyphae present in fungus such as Aspergillosis spp. I Immune System An integrated group of various cell types and the soluble molecules they secrete. Immunization the means to produce a protective immune response in susceptible individuals by administration of a living modified agent. Immunization, Active the means by which antibody production or cell-mediated immunity is stimulated by giving the antigen in the form of a vaccine or through exposure to naturally occurring antigens such as bacteria, viruses or fungi. Immunization, Passive A means to produce a temporary immune response against an infectious agent or toxin by giving preformed antibodies actively produced in another person or animal in the form of serum or gamma globulin. Immunocompromised Used to describe persons with an underdeveloped (as in the very young) or impaired immune system. The impairment may be a natural deterioration from age, or may be caused by disease or by the administration of immunosuppressive drugs. Immunogenic See Antigenic Immunoglobulin (Ig) A subgroup of globulins that are classified as alpha, beta and gamma according to lipid or carbohydrate content and physiological function. Serum Igs belong to the gamma group and constitute a family of glycoproteins that bind antigens. Immunoglobulin A (IgA) Major class of immunoglobulins found in mammalian serum, body fluids. Of the five types of Igs (IgM, IgG, IgA, IgE and IgD) in the body, only IgE has been shown to be involved in allergic reactions. It is responsible for the symptoms seen in patients with allergic rhinitis, asthma and eczema. The Fabs include the antigen combining sites while the Fc region consists of the remaining constant sequence domains of the heavy chains and contains cell binding and complement binding sites. IgGs act on pathogens via agglutination, opsonization, activation of complement-mediated reactions against cellular pathogens and/or neutralization.

While this handbook contains important information about thyroid cancer, your individual course of testing, treatment, and follow-up may vary for many reasons. ThyCa is fortunate to have a distinguished Medical Advisory Council of more than 50 professionals, who are world recognized experts in thyroid cancer. This handbook was funded through donations from individual contributors and by unrestricted educational grants from Bayer HealthCare, Eisai, Exelixis, Inc. Please note: the information in this handbook is intended for educational purposes and is for general orientation. You are advised to consult your own medical doctor(s) for all matters involving your health and medical care. Invitation: Your suggestions for ThyCa publications- E-mail to publications@thyca. More than 9 of every 10 people with thyroid cancer have differentiated thyroid cancer. More than 53,000 people will be newly diagnosed with thyroid cancer in the United States in 2018. About 2 of every 3 people diagnosed with thyroid cancer are between ages 20 and 55. However, most people with such exposure do not get thyroid cancer, and most people with thyroid cancer did not have such exposure. Types of Thyroid Cancer There are four types of thyroid cancer: papillary, follicular, medullary, and anaplastic. Another variant is poorly differentiated thyroid carcinoma, which has also been called insular. Some variants tend to grow and spread more aggressively than typical papillary or follicular thyroid cancers. Their treatment and management are similar and are based on staging and individual risk levels. Papillary thyroid cancer generally grows very slowly, but can often spread to lymph nodes in the neck. Determining the Tg level in your blood by periodic testing will help your doctors determine how well you are doing with your treatment. Some patients produce anti-thyroglobulin anti-bodies (TgAb), which are not harmful but which mask the reliability of the Tg value. Medullary thyroid cancer is easier to treat and control if found before it spreads to other parts of the body. The specific mutation can be used to determine when the thyroid gland should be removed. Prognosis in Thyroid Cancer Although a cancer diagnosis of any kind can be scary, the most common forms of differentiated thyroid cancer (papillary and follicular) have a very high long-term survival rate (over 90%), especially when diagnosed early. While the prognosis for most people with thyroid cancer is very good, the rate of recurrence or persistence can be up to 30%, and recurrences can occur even decades after the initial treatment. Therefore, it is important that you have regular follow-up examinations to detect whether the cancer has recurred. In this situation, testing for molecular markers is often used to determine whether the nodule is probably cancer. In some situations, the tissue analysis after thyroid surgery is used to determine the diagnosis. Staging Thyroid Cancer, and Risk Levels Your doctor needs to know the stage of the disease and your risk level to plan your treatment.

Patients and carriers of diphtheria should receive appropriate treatment and not return to childcare until two (2) cultures from both the nose and throat (and from skin sores in cutaneous diptheria), are negative for the bacteria. These cultures should be taken at least 24 hours apart and no sooner than 24 hours after finishing antibiotic treatment. Where culture is impractical, isolation may be ended after 14 days of appropriate treatment. Children and staff should be excluded until bacteriological examination proves them not to be carriers. Diphtheria causes a sore throat and swollen tonsils, with a grayish covering and swollen glands in the neck. The bacteria also produce a toxin (a type of poisonous substance) that can cause severe and permanent damage to the nervous system and heart. Yes, Diphtheria is reportable by New Hampshire law to the Division of Public Health Services, Bureau of Infectious Disease Control at (603) 271-4496. Individuals who have been in contact with an infected person and are not adequately vaccinated should receive a booster. Usually symptoms disappear in a few days but the bacteria can remain in the intestinal tract for several weeks. Drinking unpasteurized milk and swimming in or drinking sewagecontaminated water can also cause infection. An infected person having diarrhea can pass the bacteria from one person to another if hand-washing habits are not adequate. Young children usually continue to shed the bacteria in their stool a week or two following their illness. Avoid drinking from unknown water sources, raw milk, and unpasteurized apple juice. Children who are infected with this bacterium will be excluded from childcare while they are symptomatic. Infected adults should be excluded from childcare centers, food handling, and direct care healthcare, until their stool cultures are free of E. If antibiotics have been given, the initial cultures should be obtained at least 48-hours after the last dose. They vary from mild diarrhea to a bloody diarrhea with severe abdominal cramps and little or no fever. This is more likely to occur in children under five years of age and the elderly, and may lead to death. The virus has a complex life cycle involving birds and a specific type of mosquito, called Culiseta melanura. Sometimes though, the virus can escape from its marsh habitat by means of other mosquitoes that feed on both birds and mammals. Antibiotics are not effective against viruses, and no effective anti-viral drugs have yet been discovered. Most people have no symptoms; others get only a mild flu-like illness with fever, headache, and sore throat. For people with infection of the central nervous system, a sudden high fever (103 to 106), severe headache, and stiff neck can be followed quickly by seizures and coma. Of those that survive, many suffer permanent brain damage and require lifetime institutional care. Although people may be asymptomatic with the illness, most children with it develop a facial rash. The rash may reappear for several weeks following exposure to non-specific stimuli such as sunlight, change in temperature or emotional stress. Except for the rash, the patient is typically otherwise well: but some give a history of mild general symptoms one to four days before rash onset.

In Uganda, the state Dairy Corporation began collecting and processing milk, developing marketing infrastructure and servicing milk-producer cooperatives in the 1960s. Some independent dairy cooperatives were also established then and at least two are still in operation today in Mukono and Fort Portal. The Dairy Corporation was privatized in 2006 and producer groups function well in the restructured industry, with much of the countries milk being processed and marketed by the private sector. However, smallholders in Uganda are still without influence on the dairy value chain after milk is collected at the primary cooperative and they are fully dependant on the private dairy industry and their pricing policy. To address this, a cooperative dairy union in the Mbarara region has started the construction of one of the first large-scale cooperative processing plants in East Africa and the private sector has also recently installed a milk drying plant in the same area. Dairying is relatively less important in western Africa than in eastern and southern Africa and milk producer organizations there are not as developed as in eastern and southern Africa. Recently, the African Development Bank has also significantly expanded its investments in the dairy sector in western Africa in response to high demand and rising food prices. However, consumption levels may not increase beyond current levels, given that some people can consume only moderate amounts of dairy products or tend to go for dairy products that are more easily digestible, such as yoghurts, probiotics, etc. About 80 percent of milk in Asia is produced by smallholders, and tens of millions of traders and entrepreneurs, small and large, work in the informal sector. In Thailand, rapid growth in milk consumption is driven by a highly successful school milk programme (see Chapter 7 for details). However, between 2000 and 2006, gross output of milk and dairy products quadrupled to 33. Over the past two decades per capita consumption of milk has grown from less than 2 kg to about 20 kg per year. Urban consumption is about five to eight times rural consumption, reflecting the widening income gap between town and country. The phenomenal growth in milk production has largely taken place in the three northern province of Hebie, Heilongiang and Inner Mongolia, which by 2006 were producing 52 percent of national milk output, up from 18 percent in 1985. As a result of huge investments in milk processing across China since the late 1990s, it is estimated that processing capacity exceeded demand by about 30 percent in 2003. This tended to sharpen competition among the three leading processors; as a result, farm gate prices were, and still are, depressed. Most of the spare capacity is now better utilized as demand continues to grow (up 22. However, it is understood that price collusion by the large dairy companies enables them to control prices. The parks, which are financed by either the processors, the local authority or the smallholders themselves, each house between 300 and more than 1 000 cows. These include the following: Smallholders must be competitive if they are to access markets, i. If they achieve this, most subsistence smallholder producers become small-scale commercial dairy farmers. A strategy of including smallholders requires a development vehicle sensitive to impacts of policies, programmes and activities on them. Smallholder dairy action plans, based on local context and people, are required to transform the regional strategy into national action. The private sector must be fully engaged in developing the regional strategy and putting the strategy into action at country level. The strategy also notes that the smallholder dairy chain business model has been less successful: where central plans are used; when governments intervene by establishing large dairy processing enterprises managed by the public sector; and where low tariffs facilitated import of cheap commodities rather than local milk.