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In the skirmish between the White League and state forces, over thirty-one people died and nearly eighty people suffered wounds. The White League only gave up control of city hall, the state house, and the arsenal when federal troops dispatched by the president Page 829 Page 829 Chapter Seventeen: reConStruCtion arrived. When the elections finally happened, the Democrats appeared to take control of the legislature. However, the certifying board threw out the returns in many parishes because of the intimidation. When the Democrats maneuvered to seat their representatives anyway, the governor asked the federal troops for assistance. The field commander then marched into the state house and forcibly removed the Democrats. Grant responded to the situation with force, but it only hurt the prospects of the Republican Party in Louisiana and nationally in 1874. The ongoing problems in the Author: Thomas Nast Source: Wikimedia Commons South, coupled with the Panic of 1873, caused voters to turn against the Republican Party in the midterm elections of 1874. A 110-vote Republican majority in the House turned into a sixty-vote Democratic majority after the election; the Democrats also gained ten seats in the Senate. Democratic victories made it clear that Congress would no longer support additional enforcement measures because the American people clearly indicated they wanted the government to turn its attention to more pressing issues like economic recovery. The election results caused Republican Party leaders to look for ways to repair the damage. Before they firmly committed to that policy, in his annual message to Congress in December 1874, Grant reminded members and the American people that if they accepted blacks as citizens then much of the violence would stop. Many Democrats, however, only supported the measure because they expected the federal courts to declare it unconstitutional. The Court invalidated the First Enforcement Act when it ruled that the Fifteenth Amendment did not apply to local or state elections, only to national elections. This time, the Court ruled that the Fourteenth and Fifteenth Amendment applied only to state actions, not individual actions, and thus the federal government had no right to prosecute individuals for ordinary crimes like assault and murder. The two decisions closed the door to further federal intervention should anyone at the national level have cared to do so, and few did at that point. After 1875, only Florida, Louisiana, and South Carolina still had Republican governments, and leaders in all three states needed federal support to maintain their power. Grant spoke fervently about the need to curb political terrorism and protect black rights, but he still lacked a policy to achieve both goals. Tilden, the governor of New York, built his reputation in party circles by promoting civil service reform. The platform suggested only reform could save the Union "from a corrupt centralism" which led to fraud in the central government, misrule in the Page 831 Page 831 Chapter Seventeen: reConStruCtion South, and continued economic misery. The Democrats proposed "to establish a sound currency, restore the public credit and maintain the national honor. However, allegations of impropriety for selling some railroad stock to the Union Pacific well above market value made him a poor choice in an election focused on government scandals. Hayes, the governor of Ohio, emerged as the most likely favorite son candidate to do well at the convention. Blaine led in the early balloting, but as the convention dragged on, delegates turned to Hayes as a compromise candidate because he came from the crucial state of Ohio, had a reputation for reform, and favored a moderate policy toward Reconstruction. Initially both campaigns focused on issues other than reconstruction; however, violence in South Carolina prompted the Republicans to wave the bloody shirt. Authors: Mathew Brady, Unknown Source: Library of Congress (both) Page 832 Page 832 Chapter Seventeen: reConStruCtion remainder of the statement focused on political corruption, public education, land grants, tariff revision, immigration restriction, and other issues. Moreover, Hayes did little to attempt to explain how he would do anything different from Grant when it came to preserving peace and political rights in the South, especially as South Carolina descended into violence in the months before the election. At first, Grant seemed to let South Carolina go the way of Mississippi, but then he changed his mind after the Hamburg Massacre. On July 4, 1876, the black militia in Hamburg held a parade; local authorities arrested them for blocking traffic. Outgunned, the black forces surrendered; that night white forces murdered five of them. The violence, according to Brooks Simpson, proved a blessing in disguise for the Republicans during the campaign.

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Infected pancreatic Imipenem-cilastatin Therapy to be adjusted as per necrosis, pancreatic and vancomycin the culture and sensitivity abscess results from pancreatic aspirate or necrosectomy. Antifungal cover with fluconazole, or echinocandins may be added if risk factors for disseminated candidiasis. For nosocomial infections, depending on the culture and sensitivity data, colistin/ tigecycline may be used. Cholangitis, cholecystitis As for community associated complicated intra-abdominal infections Liver Abscess CefoperazoneThe treatment should be sulbactam or changed as per culture report piperacillinand amoebic serology 48 tazobactam with metronidazole to cover for possible bacterial and amoebic etiology subsequently. For an initial diagnostic paracentesis, other tests should be performed as clinically warranted on the remaining ascitic fluid which includes albumin, total protein, glucose, lactate dehydrogenase, amylase, and bilirubin. Prior to administering antibiotics, ascitic fluid (at least 10 ml) should be obtained and then directly inoculated into a blood culture bottle at the bedside, instead of sending the fluid to the laboratory in a syringe or container. The practice of immediate inoculation in blood culture bottles improves the yield on bacterial culture from approximately 65 to 90%. For patients with a possibility of harboring multi-drug resistant organism imipenem or meropenem may be more reasonable. However these antibiotics are unlikely to be useful for prophylaxis in India as the prevalence of resistance is >20% even for community acquired isolates, and may drive further resistance. Diagnosis and management of complicated intraabdominal infection in adults and children: guidelines by the surgical Infection society and the Infectious diseases society of america. Montravers P, Dupont H, Leone M, Constantin J-M, Constantin J-M, Mertes P-M, et al. Anaesth Crit Care Pain Med 2015;34:117-30 Comments Antibiotics should be tailored as per the culture and sensitivity data. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant bacteria. Review article: spontaneous bacterial peritonitis-bacteriology, diagnosis, treatment, risk factors and prevention. The diarrheal diseases represent one of the five leading causes of death worldwide and are the second leading cause of death in children under five years of age. Acute diarrhea is defined as diarrhea of 14 days in duration, in contrast to persistent (>14 days and 30 days) or chronic (>30 days) diarrhea. Epidemic disease; Vibrio cholera Other causes include Campylobacter jejuni, enteroinvasive and enterohemorrhagic E. The patient should be evaluated for signs of dehydration, including decreased urine output, thirst, dizziness, and change in mental status. Vomiting is more suggestive of viral illness or illness caused by ingestion of a preformed bacterial toxin. Symptoms more suggestive of invasive bacterial (inflammatory) diarrhea include fever, tenesmus, and grossly bloody stool. In contrast, shigellosis is typically characterized by the frequent passage of small liquid stools that contain visible blood, with or without mucous. Infection with Entameba histolytica presents with frequent passage of small liquid stools that contain visible blood and mucous associated with tenesmus. Symptoms ascribed to Candida-associated diarrhea in the literature include prolonged secretory diarrhea with abdominal pain and cramping but without blood, mucus, fever, nausea, or vomiting. A stool culture is indicated if the patient has grossly bloody stool, severe dehydration, signs of inflammatory disease, symptoms lasting more than three to seven days, or is immunuosuppressed [6]. Routine microscopy of fresh stool is inexpensive and can identify the presence of numerous fecal leukocytes, suggesting an invasive bacterial infection. Microscopic evidence of Entamoeba trophozoites containing red blood cells provides sufficient basis for treating for amoebic dysentery instead of shigellosis. Notably, finding cysts or 52 trophozoites without red blood cells in a bloody stool does not indicate that Entamoeba is the cause of illness, since asymptomatic infection is frequent among healthy persons. Antimicrobial therapy is not typically indicated for the treatment of acute watery diarrhea in adults. An important exception is the treatment of severe cholera in outbreak settings, for which antibiotics can decrease the duration of illness and the volume of fluid losses. The use of probiotics or prebiotics for the treatment of acute diarrhea in adults is not recommended, except in cases of postantibiotic-associated illness.

However, many still harbored suspicions about the possibility of the government abusing the considerable power placed in its hands. Republicans favored a less powerful central government and sought to place restrictions on its operation. Inevitably, these two visions of the republic led to clashes between the leaders of both factions over the meaning of the French Revolution and the threat posed by the Whiskey Rebellion. Thus, the federal government needed to step in to eliminate such threats to order. The two leading candidates-John Adams and Thomas Jefferson-both had the needed revolutionary credentials to run for president. Based on the provisions of the Electoral College, Federalist John Adams became president, and Republican Thomas Jefferson became vice president. Many people hoped the outcome would lessen political divisions, but during the Adams years tensions mounted as the two parties debated how to handle problems caused by the war between Great Britain and France. In the election of 1796, the Federalist John Adams became president, and his vice president was a. He pushed for independence at a time when other delegates to the Continental Congress wavered. He felt conflict between the ordinary and the elite was inevitable, and only a strong president could effectively mediate disputes and preserve the rights of the people. His Republican critics associated his ideas with a desire to reinstate a monarchy in the United States, and members of his own party did not always trust his intentions. Thus, as he took the oath of office and gave his inaugural address, Adams sought to convey his republican simplicity, his desire for political unity, and his determination to avoid war with France or Britain. The growing crisis with France dominated his administration and, in turn, made partisan politics worse in the United States. Therefore, he had Timothy Pickering at the state department, Oliver Wolcott at the treasury department, and James McHenry at the war department. The new president thought the decision would lend greater prestige to his administration and help develop a civil service. When Jefferson and Hamilton left government service, Washington found it difficult to find qualified appointees willing to serve given the bitter political climate. Therefore, his appointments possessed less political and administrative skill than needed for their positions. On political issues, they followed his lead publically even when it countered official administration policy. To some extent, Adams also experienced problems during his presidency because he prided himself on his independent action. After the election, Jefferson wrote to Adams, both to congratulate him and to suggest his willingness to serve the new president. To accomplish this, the president-elect looked to give Jefferson a greater role in his administration-possibly having him attend cabinet meetings and having him use his diplomatic skills. According to Joseph Ellis, Adams, unlike many of his contemporaries, seemed willing to negotiate political differences. The president-elect could not in the political climate of the day directly approach the vice president-elect to discuss the situation. Adams wrote letters and told his confidants his plans, knowing those plans would become public knowledge. However, his response changed when he heard the most controversial aspect of the plan: Adams planned to send a special minister to France to help avert war and hoped that either Jefferson or James Madison would head the delegation. Jefferson seemed more inclined to accept the offer than Madison, but Madison convinced him that accepting would be politically unwise. The two men had dinner in early March with Washington at the presidential mansion in Philadelphia. Thus, Jefferson remained a viable alternative to Adams in the presidential election of 1800.

Diseases

• Halal Setton Wang syndrome
• Portal hypertension due to infrahepatic block
• Hennekam Koss de Geest syndrome
• Galactokinase deficiency
• Macrocephaly mental retardation facial dysmorphism
• Onat syndrome
• Craniomicromelic syndrome
• Sexually transmitted disease

Bulky items such as biohazard bags, discard pipette trays and vacuum collection flasks should be placed to one side of the interior of the cabinet. If placing those items in the cabinet requires opening the sash, make sure that the sash is returned to its original position before work is initiated. The correct sash position (usually 8 or 10 above the base of the opening) should be indicated on the front of the cabinet. The frequent inward/outward movement needed to place objects in these containers is disruptive to the integrity of the cabinet air barrier and can compromise both personnel and product protection. Only horizontal pipette discard trays containing an appropriate chemical disinfectant should be used within the cabinet. Furthermore, potentially contaminated materials should not be brought out of the cabinet until they have been surface decontaminated. Alternatively, contaminated materials can be placed into a closable container for transfer to an incubator, autoclave or another part of the laboratory. For example, techniques used to reduce splatter and aerosol generation will also minimize the potential for personnel exposure to infectious materials manipulated within the cabinet. Therefore, as a general rule of thumb, keeping clean materials at least one foot away from aerosol-generating activities will minimize the potential for cross-contamination. Materials and supplies should be placed in the cabinet in such a way as to limit the movement of "dirty" items over "clean" ones. Investigators working with Petri dishes and tissue culture plates should hold the lid above the open sterile surface to minimize direct impaction of downward air. Open flames are not required in the near microbe-free environment of a biological safety cabinet. On an open bench, flaming the neck of a culture vessel will create an upward air current that prevents microorganisms from falling into the tube or flask. When deemed absolutely necessary, touch-plate micro burners equipped with a pilot light to provide a flame on demand may be used. This combination will provide protection to the central building vacuum system or vacuum pump, as well as to the personnel who service this equipment. Inactivation of aspirated materials can be accomplished by placing sufficient chemical decontamination solution into the flask to inactivate the microorganisms as they are collected. Once inactivation occurs, liquid materials can be disposed of as noninfectious waste. When chemical means are appropriate, suitable liquid disinfectant should be placed into the discard pan before work begins. When a steam autoclave is used, contaminated materials should be placed into a biohazard bag or discard pan containing enough water to ensure steam generation during the autoclave cycle. It is a prudent practice to decontaminate the exterior surface of bags and pans just prior to removal from the cabinet. If necessary, the cabinet should also be monitored for radioactivity and decontaminated when necessary. Investigators should remove their gloves and gowns in a manner to prevent contamination of unprotected skin and aerosol generation and wash their hands as the final step in safe microbiological practices. The cabinet blower may be turned off after these operations are completed, or left on. Any splatter onto items within the cabinet, as well as the cabinet interior, should be immediately cleaned up with a towel dampened with an appropriate decontaminating solution. Gloves should be changed after the work surface is decontaminated and before placing clean absorbent toweling in the cabinet. Spills large enough to result in liquids flowing through the front or rear grilles require decontamination that is more extensive. After ensuring that the drain valve is closed, decontaminating solution can be poured onto the work surface and through the grille(s) into the drain pan. Twenty to 30 minutes is generally considered an appropriate contact time for decontamination, but this varies with the disinfectant and the microbiological agent. The spilled fluid and disinfectant solution on the work surface should be absorbed with paper towels and discarded into a biohazard bag.