"10mg norvasc, hypertension benign essential 4011".

W. Malir, M.B. B.A.O., M.B.B.Ch., Ph.D.

Medical Instructor, Marian University College of Osteopathic Medicine

Restraint Examination of the udder of a fractious suckler cow or a painful udder can be difficult. Restraint in a crush is advisable unless the patient is a docile trustworthy dairy cow. This may include an antikick bar, an udder kinch placed around the abdomen just anterior to the udder, raising of the tail or lifting the contralateral leg to the side of the udder being inspected. Rupture of the ligaments Applied anatomy the udder is composed of four mammary glands, each with its own teat. The weight of the udder is supported by the medial and superficial and deep lateral ligaments. Each gland is composed of milk producing alveolar cells, a reservoir for the milk produced called the gland cistern and a teat. The teat has an annular fold at the base which partially separates the gland cistern from the teat cistern. The teat cistern is intermittently filled with milk from the gland cistern during milking. At the apex of the teat is the streak (teat canal) and the teat orifice through which milk passes during milking. The teat canal has a muscular sphincter which opens during milking but which is sealed during the dry period. There is a specialised area at the proximal end of the streak canal called the rosette of Furstenberg which is concerned with defence against infection. The skin covering the teat is hairless and strongly adherent to the underlying tis154 Observations of the contour and the anatomical position of the udder from the lateral aspects and the rear are required to detect the changes caused by rupture of the supporting ligaments of the udder. Rupture of the medial ligaments this is the most common type of rupture and results in a lateral displacement of the right and left halves of the distal udder. The farmer may notice a sudden change in the udder confirmation, and there is a loss of the dividing curvature between the two halves of the udder. Rupture of the lateral ligaments this is most easily recognised and results in a dramatic lowering of the udder below the hocks. Clinical Examination of the Udder Pelvic symphysis Gland sinus Annular ring Medial suspensory ligaments Lateral suspensory ligaments Symphyseal tendon Teat sinus Rosette of Furstenberg Streak canal Figure 12. Conditions of the skin of the udder the skin of the udder is examined in detail by visual and olfactory inspection, and palpation. The general examination should precede the examination of the udder to identify clinical signs which may be present and related to the udder lesions. Staphylococcal impetigo this condition of the udder skin may present as numerous erythematous papules. Rupture of the anterior sections of the ligaments Sometimes this occurs and presents as a gross enlargement in front of the udder. Mange Chorioptic and, occasionally, sarcoptic mange may infest the skin of the udder causing papules, abrasions, alopecia and thickening of the skin. The condition may be first suspected by an unpleasant smell emanating from the ventral surface of the udder. Photosensitisation the skin of the udder is usually unpigmented and is often affected when an animal is photosensitised. The supernumerary teat may be attached to the main teat, but is usually entirely separate. The identification of which of the teats is (are) the supernumerary teat(s) may be more difficult. Accurate identification is important because surgical amputation is the preferred treatment. If a teat is not in the correct anatomical position, is smaller and thicker, and the teat cistern is absent on palpation, then it is likely to be a supernumerary teat. If in doubt, delaying the decision until the animal is older may assist in identifying the supernumerary teat.

With movement of the cervix on bimanual vaginal examination the patient may exhibit the "Chandelier sign" (cervical motion tenderness is so severe that the patient leaps to the chandelier). Urethritis Urethritis, an infection of the urethra, is usually con tracted sexually. Neisseria gonorrhoeae is the most famous bacterium causing urethritis, but not the most common. Symp tomatic patients develop painful urination (dysuria) along with a thin to thick, mucoid discharge from the urethra. Peni cillins treat the gonorrhea, but are ineffective against Chlamydia trachomatis. Remember that Chlamydia trachomatis has no peptidoglycan layer, which is the target for penicillin. Therefore, all patients diagnosed with urethritis are empirically treated with antibiotics to cover Neisseria gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. A commonly used treatment regimen involves a single dose of intramuscular ceftriaxone (a third-generation cephalosporin that is extremely effec tive against Neisseria gonorrhoeae) followed by a 7-day course of oral doxycycline or 1 oral dose of azithromycin (which covers both Chlamydia trachomatis and Ure aplasma urealyticum). The preferred diagnostic test for gonorrhea and chlamydia in most centers is a nucleic acid amplification test, such as polymerase chain reaction, on an endocervical swab or urine sample. The inflamed cervix appears red, swollen, and has a yellow mucopurulent endocervical discharge. This infection can spread upwards to involve the uterus, fallopian tubes, and ovaries. Fitz-Hugh-Curtis syndrome is an infection of the liver capsule with symptoms of right upper quadrant pain that can occur in men and women. The bacteria migrate to regional lymph nodes, which enlarge over the next 2 months. These nodes become increasingly tender and may break open and drain pus (see Chapter 1 1, page 97). Chlamydophila psittaci between the two classes of pneumonias based on radi ographic appearance, with atypical pathogens causing less well-defined infiltrates than typical organisms. For the most part this dogma has been debunked, but you will still hear attendings banter on about atypical versus typical presentations of pneumonia. Humans are infected by in haling Chlamydia l aden dust from feathers or dried-out feces. This infection is an occupational hazard for breeders of carrier pigeons, veterinarians, and workers in pet-shops or poultry slaughterhouses. Infection most commonly results in an atypical pneumonia called psittacosis, which occurs 1-3 weeks after exposure. However, Rickettsia differs from Chlamydia in a number of ways: 1) Rickettsia requires an arthropod vector (except for Q fever). Atypical Pneumonia Pneumonia caused by viruses, Mycoplasma pneumo niae, and Chylamydophila species have frequently been called atypical pneumonias because it was felt that they presented clinically and radiographically differ ently from a typical bacterial pneumonia such as that caused by Streptococcus pneumoniae. The classic teach ing is that patients infected with atypical organisms present more often with a dry cough, fever, and are less sick appearing than those infected with "typical organ isms. He rides a tick in Rocky Mountain spotted fever, a louse in epidemic typhus, and a flea in endemic typhus. Some Rickettsia share antigenic characteristics with certain strains of Proteus vulgaris bacteria. The Weil-Felix reaction is a classic test that uses these cross-reacting Proteus vulgaris antigens to help confirm a diagnosis of a rickettsial infection. This test is done by mixing the serum of a patient suspected of having a rickettsial disease, with antigens from specific strains of Proteus vulgaris. If the serum has antirick ettsial antibodies, latex beads coated with Proteus antigens will agglutinate, indicating a positive Weil116 Felix test. Unfortunately the Weil Felix test is neither sensitive nor specific, leading most experts to recommend against its use. Antigenic differences among the Rick Diagnosis of a rickettsial infection can also be made with specific serologic tests documenting a rise in anti Rickettsial antibody titers over time. Therapy for all rickettsial diseases consists primarily of doxycycline and chloramphenicol.

The latter has seen the application of numerous ethical approaches (eg, rights-based theories, utilitarianism, virtue ethics, contractarianism, pragmatic ethics) to assessing the moral value of animals and the nature of the human-animal relationship. Changing societal attitudes toward animal care and use have inspired scrutiny of some traditional and contemporary practices applied in the management of animals used for agriculture, research and teaching, companionship, and recreation or entertainment and of animals encountered in the wild. Attention has also been focused on conservation and the impact of human interventions on terrestrial and aquatic wildlife and the environment. Within these contexts, veterinarians provide leadership on how to care well for animals, including how to relieve unnecessary pain and suffering. As new research is conducted and more practical experience gained, recommended methods of euthanasia may change. While some euthanasia methods may be utilized in slaughter (which refers to humane killing of animals destined for human consumption) or harvest and depopulation, recommendations related to humane slaughter and depopulation fall outside the purview of the Guidelines and are addressed by separate documents. The Guidelines set criteria for euthanasia, specify appropriate euthanasia methods and agents, and are intended to assist veterinarians in their exercise of professional judgment. The Guidelines acknowledge that euthanasia is a process involving more than just what happens to an animal at the time of its death. The scope of the 1963 edition was limited to methods and recommendations applicable to dogs, cats, and other small mammals. More than 3 years of deliberation by more than 60 individuals, including veterinarians, animal scientists, behaviorists, psychologists, and an animal ethicist, resulted in robust commentary and recommendations. This material is located in the Laboratory Animals section to place them with other techniques used with these species. Updates to the application of captive bolt in several species have been made and new illustrations are available to assist veterinarians in proper usage. This recommendation should be applied across avians with consideration for species-specific differences in development and using the best available data. Species-specific sections have been expanded or added to include more guidance for terrestrial and aquatic species kept for a variety of purposes and under different conditions. Where possible, appropriate flowcharts, illustrations, tables, and appendices have been used to clarify recommendations. Appendices 1 and 2 may be useful as a quick reference guide, but should never be used in lieu of the full text of the doucment by those performing euthanasia. Specifically, animals under sedation may be aroused to a conscious state with sufficient stimulation. Recognizing this is critical when categorizing the effects of agents and distinguishing even deep states of sedation from unconsciousness. A veterinarian experienced with the species of interest should be consulted when choosing a method of euthanasia, particularly when little species-specific research on euthanasia has been conducted. Given the complexity of issues that euthanasia presents, references on anatomy, physiology, natural history, husbandry, and other disciplines may assist in understanding how various methods may impact an animal during the euthanasia process. Veterinarians performing or overseeing euthanasia must assess the potential for animal distress due to physical discomfort, abnormal social settings, novel physical surroundings, pheromones or odors from nearby or previously euthanized animals, the presence of humans, or other factors (including impact on the environment and other animals). In addition, human safety and perceptions, availability of trained personnel, potential infectious disease concerns, conservation or other animal population objectives, regulatory oversight that may be species specific, available equipment and facilities, options for disposal, potential secondary toxicity, and other factors must be considered. Human safety is of utmost importance, and appropriate safety equipment, protocols, and knowledge must be available before animals are handled. Advance preparation includes protocols and supplies for addressing personnel injury due to animal handling or exposure to drugs and equipment used during the process. For this reason, although the Guidelines may be interpreted and understood by a broad segment of the general population, a veterinarian should be consulted in their application. Euthanasia is derived from the Greek terms eu meaning good and thanatos meaning death. The term is usually used to describe ending the life of an individual animal in a way that minimizes or eliminates pain and distress. Debate exists about whether euthanasia appropriately describes the killing of some animals at the end of biological experiments11 and of unwanted shelter animals. When evaluating our responsibilities toward animals, it is important to be sensitive to the context and the practical realities of the various types of human-animal relationships.

W 3267 Potential Alternatives to Systematic Review: Evidence Maps and Scoping Reviews B. Systematic reviews, with their comprehensive, transparent, and repeatable protocols, are rapidly becoming the gold standard for using existing literature to assess environmental health questions. However, there are instances when a full systematic review may not be feasible or necessary to address particular questions or to make decisions. Alternatively, there are less labor-intensive ways, using systematic methodologies, to answer questions in environmental health that do not require (or are premature for) an exhaustive systematic review. Scoping reviews and evidence maps are systematic, transparent assessments that may be better suited for some research questions. These intermediate alternative products can be performed more quickly and are often used to inform systematic reviews (usually in the initial steps of problem formulation and development), and can also serve as publishable stand-alone products. Two major challenges of conducting systematic review for decision-making are the time and resources needed to complete the review. On average, systematic reviews can take more than 1,000 hours to complete and can cost over $100,000. Further, by the time a systematic review is published, those data can be outdated, and thus perhaps not useful for rapid decision-making. Systematic evidence maps represent a process for categorizing literature to rapidly map key concepts, types of evidence, and data gaps related to a defined research area, and can include an interactive visualization of the relevant data. These maps are useful in identifying characteristics of studies that might facilitate decision-making for a particular research question, such as evidence stream, exposure information, dose ranges, and major health effects. Systematic evidence maps can be stand-alone products, can inform other intermediate products. Scoping reports can take the information from a systematic evidence map further and can begin synthesizing results to serve as a standalone product or can inform systematic reviews, for example, by narrowing in on a specific endpoint or chemical for further review. The yolk quantity and composition deposited in oocytes can be disrupted by maternal exposures to environmental toxicants, with potentially profound impacts on the developing embryo and later-life health. The session will begin with an overview of basic systematic review principles and how they are used in environmental health. The strengths and limitations of systematic reviews will be discussed, followed by an introduction to systematic maps and scoping reports, and their utility in addressing the challenges of conducting systematic reviews. Following the introduction, there will be four case examples of a systematic review, scoping report, and evidence maps. The presentations will detail the research question(s) addressed by use of these systematic products as well as tools that could potentially facilitate the generation of the reviews/reports where applicable. The advantages and limitations for each review or report type will be discussed, as well as how the product was used for decision-making. The session concludes with a panel discussion to provide thoughts on the utility, advantages, disadvantages, and challenges of these reviews/reports within the systematic review spectrum. The panel will discuss how advances in automation and interest in publication can contribute to the uptake and usability of these products, and hopefully serve to streamline decision-making in environmental health. These include how the production of a context-neutral evidence map necessitates development and implementation of new database techniques not previously used in systematic reviews or systematic maps, but long familiar in computer science. W 3268 Brief Overview and Introduction to Systematic Review and Related Products B. Systematic review is rapidly becoming the gold standard for addressing environmental health questions. The systematic review process involves the objective and transparent method of collecting and synthesizing data for reaching hazard conclusions on specific research questions. This overview will provide a brief review of systematic review methodology and the relatively recent uptake of systematic review practices from different environmental health groups. This overview will highlight the strengths and challenges of conducting systematic review in addition to briefly introducing the intermediate products (systematic maps and scoping reviews) that can be used for decision-making for environmental health questions that will be discussed in subsequent presentations. W 3271 Illustrating Fit for Purpose in Systematic Evidence Maps: Case Study Mapping of the Evidence of Transgenerational Health Effects W 3269 Rigor and Resources for Systematic Reviews in Toxicology: Case Study Applications in Food Safety, Consumer Product Safety, and Environmental Health Risk Assessment V. Beverly Evidence maps are a new method in environmental health science used to categorize literature and rapidly map key concepts, types of evidence, and gaps in research related to a defined topic. Mapping displays the extent of literature with varying degrees of detail depending on topic and goals.

They contain micrometric and low solubility particles, consisting of toxicologically relevant elements, implying a potential for inhalation exposure in occupational settings. New proposed applications such as printable or spray-paintable batteries might also expose consumers. Inhalation large animal dosing requires the use of a facemask to deliver the aerosol to in vivo species. Exposure dosing exposure period can be up to 240 min depending on the target dose. However, the historical masks that have been used by the industry are modified from existing off the shelf clinical or veterinary masks and generic in size and as such are a compromise for their application. Envigo designed and manufactured new masks to improve animal welfare by making them specific for inhalation dosing masks by using 3d printing. Prototype masks and seals were then produced using 3d printer software that could be adhered to the animals face with the use of Velcro straps. Upon introduction of the new masks, decreased the mean in vivo dog respiration rates from a mean of 24. These decreases in the respiration rate was also accompanied by anecdotal visual dosing observations that the animals appear noticeably calmer especially primates and thus improving animal welfare. This personalised approach to mask fitting and design has been adopted for all future studies. Variability in the uniformity of particle deposition across the cell culture inserts was observed and ranged from 40% to 150% of the mean number of particles. Male and female offspring (average 16 weeks old on day 0) were sensitized intranasally. Respiratory responses to methacholine aerosol (0, 10, 20, and 40 mg/ml saline) were assessed by whole body plethysmography 2 days after challenge. Greater lung injury in male offspring due to the same maternal diets may predispose to increased susceptibility to air pollutants. Diacetyl, an -diketone, is used extensively in artificial flavorings due to its butter like aroma. Exposure to diacetyl vapors is associated with the development of bronchiolitis obliterans in workers of microwave popcorn and flavor manufacturing industries. Our study shows that diacetyl exposure results in significantly increased expression of pro-inflammatory, oxidative stress, anti-protease, and tissue injury/ repair markers. Altered expression of these markers may play a pivotal role in diacetyl mediated pulmonary toxicity. Spontaneously breathing male Wistar rats were anesthetized, intratracheally intubated, and exposed to 0. Additionally, bronchial epithelial- and mesothelial-hypertrophy/hyperplasia, interstitial fibrosis and dysregulated epithelial repair were evident. This correlated with the appearance of proteinaceous bronchiolar and alveolar exudate entrapping inflammatory cells, diffuse squamous metaplasia, aberrant bronchial epithelial repair and multifocal alveolar interstitial and peribronchial fibrosis. Systemic lupus erythematosus (lupus) is a chronic and debilitating autoimmune disease that affects approximately 1. Pulmonary exposure to crystalline silica dust (cSiO2) has been implicated as an environmental trigger of lupus. One cohort of mice (n=8/group) were sacrificed 13 weeks after the last cSiO2 instillation. To determine the survival rate, a second cohort of mice (n=8/group) remained on experimental diets and monitored for moribund criteria. Woutersen More than 5% of any population suffers from asthma, and these individuals may be more sensitive to nanoparticle aerosols than the healthy population. There is as yet a paucity of data on the molecular underpinnings and mechanisms involved.