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It can occur in acute intoxication either because of myocardial dysfunction or as a result of a massive increase in the afterload due to virus wars order 3 mg ivermectin with visa vasoconstriction antibiotic resistant std purchase ivermectin 3mg on-line. Pneumomediastinum and pneumothorax have been described in patients who snort or smoke cocaine, presumably due to increased airway pressure during a Valsalva maneuver. Metabolic complications: Severe hyperthermia has been described in patients with acute cocaine intoxication; the mechanism probably is muscular hyperactivity due to agitation or seizures and increased metabolic rate. Hyperthermia is also part of the "agitated delirium" syndrome, where it accompanies extremely violent and agitated behavior, in sometimes fatal cocaine intoxications. Rhabdomyolysis in acute cocaine intoxication is most often the result of muscular hyperactivity and hyperthermia, but can also be due to muscular ischemia due to vasoconstriction. It presents as muscular pains, which can also occur in the chest wall, and must be distinguished from the pain of myocardial ischemia. Reproductive/Neonatal: Cocaine use during pregnancy can result in an increased incidence of spontaneous abortion, placenta previa, and abruption of the placenta. Neonates born to cocaine-addicted mothers have various neurologic abnormalities, including irritability, tremulousness, poor feeding, hypotonia or hypertonia, and hyperreflexia. The symptoms can last for several weeks to several months after the cessation of use. Ephedrine is found in a variety of plants, as well as in many Chinese medicines and is part of many non-prescription decongestants. Khat shrub grows in Ethiopia, and khat leaves are chewed in East African countries, particularly in Yemen and Somalia. Pseudoephedrine is a dextro isomer of ephedrine, and has similar alpha-, but less beta-, adrenergic activity. Both drugs are marketed as a non-prescription medications for nasal decongestion, and are ingredients in many cold medications and bronchodilators. The main manifestations of ephedrine intoxication are cardiovascular, with elevation of blood pressure and heart rate. Fatalities may result from myocardial infarction, arrhythmia, seizures, or stroke. Social use of khat causes increase in energy level and alertness, but also mood lability, anxiety, and insomnia. In most cases of khat-induced psychosis, heavy khat consumption preceded the episodes. No specific physical withdrawal syndrome is recognized, but there is a psychological withdrawal characterized by depression, hypersomnia, and loss of energy. Long-term chewing of khat (for more than 25 years) was found to be strongly associated with oral cancer. Clinically, amphetamine effects are very similar to those of cocaine, but amphetamine has a longer halflife compared to cocaine (10 to 15 h), and the duration of amphetamine-induced euphoria is four to eight times longer than for cocaine. Seizures may occur in about 3% of the patients presenting in the hospital with amphetamine intoxication. There have also been reports of cerebral vasculitis with chronic abuse of amphetamine. Movement disorders: Chronic high dose amphetamine use is associated with stereotypic behavior, dyskinesias, and also with chorea, especially in patients with preexisting basal ganglia disorders. Amphetamines exacerbate tics in patients who already have them, and may induce tics, though the causation is unclear. Myocardial ischemia has been reported; the underlying mechanisms are increased myocardial oxygen demand and/or coronary vasospasm. Metabolic and other effects: Acute amphetamine intoxication can manifest with sweating, tremor, muscle fasciculations, and rigidity. Chronic amphetamine abuse can result in weight loss of up to 20 to 30 lb and malnutrition. Stroke, both ischemic and hemorrhagic, has been reported with methamphetamine abuse, and in some cases the stroke was delayed by 10 to 12 hours since last use. It is used clinically for the treatment of attention deficit disorder and narcolepsy. Phenylpropanolamine combined with caffeine has been sold as a look-alike "amphetamine".

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There are also devices available in the form of glass tubes filled with specific detection granules which allow for the reasonable determination of airborne chemical hazards in the atmosphere bacteria that cause disease purchase 3mg ivermectin free shipping. When these devices are used properly virus yardville generic ivermectin 3mg overnight delivery, the forensic scientist entering the clandestine laboratory maximizes his chances for protecting the safety of the seizure team, including himself. Even after the atmosphere has been sampled and ventilation has progressed, once inside the clandestine laboratory, the forensic chemist should be aware of the many possibilities posing a threat. The potential chemical dangers include an explosion potential, flammable and combustible chemicals, corrosive chemicals, oxidizers, poisons, compressed gases, irritants, and booby traps. Physical hazards include but are certainly not limited to broken glass, bare electrical wiring, slippery floors, and loud noises. After the laboratory processing has been completed, the forensic scientist should be a part of the team which reduces the level of environmental contamination to a controllable level. This will usually involve prior planning for the proper disposal of hazardous chemicals and protective clothing by a waste disposal authority. There should be a standard operating procedure for the decontamination of anyone who entered the clandestine laboratory. This should include provisions for an emergency shower and an eyewash station, first aid kits, and decontamination procedures for injured workers. One of the most important factors anyone processing a clandestine laboratory must remember is the following - no matter how much protective clothing is available, no matter how much pre-planning is done, no matter how careful a person might be in collecting chemicals and assessing danger, if that person fails to recognize his limitations in knowledge or physical ability, a disaster is waiting to happen. The greatest danger facing anyone who processes a clandestine laboratory is a false sense of security. A precursor is a chemical that becomes a part of the controlled substance either as the basis of the molecular skeleton or as a substituent of the molecular skeleton. Modifications to typical synthetic routes on the parts of ingenious organic chemists are typical and cannot always be predicted. This list does not inlcude all controlled steroids or controlled substance analogues. These are classes of compounds that are controlled based on chemical and pharmacological criteria which have been discussed earlier in this chapter. However, this section will devote itself to the pathological changes resulting from the pharmacologic effects of various drugs that are abused, and from the ways that these drugs are administered. A large volume of literature on drug abuse and its pathology has amassed over the past three or four decades, much of which has been recently collected into excellent comprehensive treatises. Accordingly, emphasis is placed on death scene investigation, evaluation of the drug abuse victim (living or deceased), and cardiovascular pathology. In many instances the authors have relied on their own academic and investigative experiences to provide a practical approach to evaluating these drug abuse victims. Much of what is known about the pathology of drug abuse has been derived from thorough and carefully performed autopsies. It should therefore be expected that much of this section deals with the autopsy and is therefore of particular interest to the pathologist. However, far from this being an academic exercise, it is hoped that the reader will discern applications to clinical situations. This, in fact, has been accomplished over the years as clinicians have better appreciated the pathophysiology of diseases resulting from drug abuse. What is lacking currently, however, is the proper toxicologic evaluation of the drug abuse victim at the time of admission to a hospital. Should death occur, for whatever reason, days or weeks later, it is often impossible to adequately evaluate the victim toxicologically. Conversely, adequate analysis at the beginning may readily eliminate much needless speculation, and absolve or implicate culpability on the part of others. Although such evaluations are ideal, the goal is not likely in the immediate future with an environment of cost containment and a medical focus that best describes a patient as a problem of "here and now". This leaves little consideration for events or questions which may arise in the future regarding adequacy of patient care, or subsequent questions posed by future investigators, including medical examiners, police, and attorneys. There must also be an awareness that people with natural disease may, intentionally or not, abuse drugs which may exacerbate their underlying disease process and significantly contribute to their death. Drugs create pathological states, with or without death, by their immediate pharmacologic effects, the way in which the drug is taken, by the cumulative effects of chronic abuse, and by interaction with pre-existing pathologic conditions. The scene investigator must therefore be ever cognizant of two possibilities: (1) because a person has a disease does not necessarily mean it is the cause of death; and (2) the scene of a drug overdose is frequently cleaned before investigators are even called.


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In these settings antibiotic resistant bacteria deaths cheap ivermectin 3 mg on-line, the total plasma concentration of phenytoin may result in underestimation of the free fraction and inadvertent phenytoin toxicity xifaxan antibiotic ibs order ivermectin 3 mg without prescription. In overdose settings, saturation of the hepatic hydroxylation system occurs, and zero order kinetics Toxicokinetics Phenytoin Synonym Diphenylhydantoin. Uses Phenytoin is effective against all types of partial and tonic-clonic seizures, but not absence seizures. Phenytoin is also used in the treatment of ventricular arrhythmias (especially digitalis-induced). It may be effective in treating paroxysmal choreoathetosis, especially the kinesigenic type. It is used alone or with other anticonvulsants to control paroxysmal pain in some patients with trigeminal neuralgia (tic douloureux). As phenytoin is continually excreted, elimination changes from zero-order to first-order kinetics and drug levels decrease more rapidly. Mode of Action Neurotoxic Poisons Phenytoin acts on the motor cortex preventing the spread of seizure activity. It stabilises the threshold for hyperexcitability and reduces post-tetanic potentiation at synapses. Further, phenytoin reduces brainstem activity which is responsible for the tonic phase of tonic-clonic convulsion. The toxic cardiovascular effects of phenytoin injection are related to the diluent, propylene glycol. Chronic high blood levels may cause a "phenytoin encephalopathy" with increase in seizure frequency and the development of more tonic or opisthotonic components. Transient focal neurologic signs such as hemiparesis may be seen, especially in brain-damaged patients. Gingival hypertrophy occurs in about 20% of patients (mostly children or adolescents) (Fig 17. Toxic hepatitis may occur leading to liver necrosis and chronic inflammation along with cholangitis, with chronic phenytoin use. Renal dysfunction, possibly a hypersensitivity reaction to phenytoin, has also been reported with therapeutic use. Hypersensitivity reactions are known to occur with phenytoin and usually manifest as fever, rash, lymphadenopathy, and hepatosplenomegaly, 3 weeks to 3 months after initiation of therapy. It is a progressive development of limb oedema, discolouration, and pain after phenytoin administration (Fig 17. Necrosis necessitating amputation has also occurred from extravasation of undiluted intravenous phenytoin. Arrhythmias and hypotension are associated with rapid intravenous infusions of phenytoin, and appear to be due to the diluent, propylene glycol. Phenytoin is a known teratogen and can cause a number of defects in the newborn, together referred to as foetal hydantoin syndrome, (Table 17. Several studies have reported a possible risk of birth defects with phenytoin, when used during the first trimester of pregnancy. Increased risk of neural-tube defects, cardiovascular defects, oral clefts, and urinary tract defects have been reported. Phenytoin has also been linked with transplacental tumorigenesis of the kidney, ureter, and bladder, and neuroblastoma. Drug Interactions When valproic acid is administered with phenytoin, the concentration of free phenytoin may decrease, remain constant, or increase from pre-valproic acid levels. Disulfiram has been reported to rapidly increase serum phenytoin concentration within four hours of the administration of the first dose of disulfiram. Phenytoin serum concentration has been reported to increase to a toxic level following the addition of fluvoxamine to the treatment regimen. Sometimes, paradoxical intoxication occurs characterised by increased seizure activity. Death is rare, and if it does occur it is invariably due to cardiac arrest or ventricular fibrillation. Anticonvulsants and Antiparkinsonian Drugs Usual Fatal Dose Toxic effects are rare at plasma levels less than 20 mcg/ ml (80 mcmol/L), but are common in patients with plasma levels greater than 30 mcg/ml (120 mcmol/L). Deaths are very rare even with massive acute oral overdosage and have been reported mostly with the relatively serious hypersensitivity reactions seen with chronic use. Treat hypotension by Trendelenberg position, fluid infusion, and pressor amines (dopamine or noradrenaline).

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Other hypoglycaemics Acarbose Acarbose is an alpha-glucosidase inhibitor which reduces intestinal absorption of starch acticoat 7 antimicrobial dressing buy cheap ivermectin 3 mg online, dextrin bacteria or virus generic ivermectin 3mg mastercard, and disaccharides by inhibiting the action of intestinal brush-border alpha-glucosidase. This results in depressed absorption of carbohydrates with blunting of postprandial rise of plasma glucose. Adverse effects include flatulence, gastritis, abdominal pain, nausea, anorexia, stool discolouration, hepatitis, and dermal reactions (urticaria, exanthema). Troglitazone, Ciglitazone, Pioglitazone these drugs are thiazolidinediones and have been recently introduced in the treatment of insulin-resistant diabetes. They do not cause hypoglycaemia in diabetic or normal persons, but may produce hepatotoxicity. Section 9 Forensic Issues Most cases of toxicity are iatrogenic due to inadvertent overdoses. However there have been several cases of intentional insulin overdose among depressed patients intent on committing suicide. Surreptitious insulin administration may be a symptom of serious underlying psychiatric disorder (especially in adolescents with insulin-dependant diabetes mellitus). Other Drugs Dobutamine Dobutamine resembles dopamine in its structure, but possesses an aromatic substitute on the amino group. It is used for shortterm treatment of cardiac decompensation due to depressed contractility. Infusion of dobutamine in combination with echocardiography is useful in the non-invasive assessment of patients with coronary artery disease. Dobutamine is a beta1-adrenergic agonist, and also induces alpha1-adrenoceptor-mediated vasoconstriction, as well as beta2-adrenoceptor-mediated vasodilation. This results in an increaseincardiacoutputwithoutsignificantlychangingthe blood pressure. Adverse effects include nausea, tachycardia, palpitations, angina, dyspnoea, headache, and hypotension. Overdose results in hypotension, oliguria, supraventricular tachycardia, stuffy nose, hoarseness, flushing of skin, tachypnoea, palpitations, anginal pain, paraesthesias, and urinary i ncontinence. Beta2-selective adrenergic agonists are much more useful in the treatment of asthma than beta-adrenergic agonists, because unlike the latter, they do not stimulate beta1-adrenergic receptors in the heart that can result in serious cardiac effects. Another advantage is that these drugs have enhanced oral bioavailability, and hence can be given orally. However, inhalation of small doses in aerosol form affords best protection against adverse effects. Cromolyn sodium and Nedocromil Bronchodilators Beta-Adrenergic Agonists Beta-adrenergic agonists have an important role as cardiac stimulants owing to both chronotropic and inotropic effects on the heart, and are (relatively) rarely used as bronchodilators today, so their inclusion here may appear incongruous. Isoproterenol (Isopropylarterenol, Isoprenaline, Isopropylnoradrenaline) this drug is used to stimulate heart rate in bradycardia or heart block as an emergency measure, and occasionally for the treatment of asthma. It acts by lowering peripheral vascular resistance and mean arterial pressure, while increasing cardiac output and relaxing smooth muscles. Beta2-Selective Adrenergic Agonists 488 Examples Metaproterenol (orciprenaline), terbutaline, albuterol (salbutamol), isoetharine, isoxsuprine, pirbuterol, bitolterol, fenoterol, formoterol, procaterol, salmeterol and ritodrine. Ritodrine is more commonly used for inhibition of uterine contractions (in premature labour). Decontamination-Stomach wash may be done if the patient is seen within 4 to 6 hours. The patient can be discharged if there is normal heart rate, absence of tremor, and presence of normal blood sugar and serum potassium. For serious cases, cardiac monitoring and oxygen Beta2 agonists can be given orally, by inhalation, or by injection administration are necessary. Haemodialysis may be useful if there is evidence of (especially salbutamol and bitolterol) are well absorbed, acute renal failure. Antidote-Someinvestigatorshavesuggestedtheuseof adequate absorption however, the systemic bioavailability of beta blockers.

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The success of this endeavor will depend on continued exchange of knowledge be- tween the aviculturist and the veterinarian virus types order ivermectin 3mg fast delivery. It is hoped that this book will emphasize the importance of this liaison infection minecraft server discount ivermectin 3mg visa, even if in a consulting capacity. According to philosopher Emmet Fox, "The mere acquisition of fresh knowledge received intellectually makes no change in the soul. Readers may be encouraged to approach this book, especially some of the comprehensive "core" chapters, from a new perspective. For example, study groups may be developed to systematically examine the individual chapters and discuss their application to the care of birds. No matter how the book is approached - from group study, individual investigation or as reference for a clinical case, the challenge to the reader is to improve the health of birds by fully applying the information provided in this text. Advancement in the field of avian medicine will require all interested individuals and allied industries to provide the means necessary to advance our understanding of birds through sound, well designed, clinically relevant research. It was the intention of the authors and editors of this book to stimulate its readers to become actively involved in the advancement of avian medicine. This paradox can only be resolved by constantly investigating the unknown, and applying newly derived information to the resolution of identified problems. A conservationist is an individual who advocates for the planned preservation of natural resources. The roots of conservation can be found with early man, who lived at a time when there was ample food and land. In this way the animal could return to replenish the herds of antelope or schools of fish. The Plains Indians considered the two-legged creatures (eg, man, birds, bears) to be healers, and these creatures needed to work together to correct the imbalances of nature. To him, the best definition of a conservationist was "written not with a pen, but with an axe. It is a matter of what a man thinks about while chopping, or while deciding what to chop. A conservationist is one who is humbly aware that with each stroke he is writing his signature on the face of his land. Signatures of course differ, whether written with axe or pen, and this is as it should be. Do we demonstrate humility and respect for them such that we in our role as healers may learn from them? How can we help ourselves, each other and our clients develop an ethic "to correct the imbalances in nature" that we have created? Commercialization of trade in live birds for indoor and outdoor exhibits and bird products (eg, skins, feathers, eggs) grew during this period. In the mid-19th century, curators were hired to manage some of the largest collections of bird skins. Their studies heralded the emergence of ornithology as a separate biological science. As avian veterinarians, one of our primary responsibilities is to educate our clients about the responsibility of individual companion bird stewards and to discourage the "collection" mentality. The ornithological community is currently debating the need for collecting and killing birds for scientific study. Historical Affinity In Medieval times, falcons were symbols of authority and were used for recreation and hunting. In the 18th and 19th centuries as European cities grew, wealthy landowners wanted their estates to resemble more "natural" settings. They collected live birds, especially waterfowl, and established private mini-zoological gardens. People seek to contact their roots and appreciate the oneness of life around them. The recreational uses of birds can enhance conservation when they increase that understanding. Recreational uses of birds have the greatest value when they do not impact on free-ranging bird populations.

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If the detoxification is to antibiotic 932264 generic 3 mg ivermectin amex be undertaken at home antibiotic alternatives ivermectin 3mg lowest price, there must be confidence that any withdrawal symptoms will not be severe and that adequate support is available. The appearance of withdrawal symptoms should be carefully monitored with consideration being given to the use of assessment scales. The severity of the syndrome will influence the dosage and frequency of medication given to alleviate them. Physicians should have an awareness of which drugs will cause severe or dangerous withdrawal symptoms and may require particularly careful assessment. Increasingly, patients present with polydrug use, which requires extra vigilance and may require adaptations of usual prescribing regimes. Patients who are to be detoxified will require a thorough medical examination usually with routine blood tests. An assessment of mental state is important and this should be monitored during detoxification. Patients may present, for example, with confusion or lowering of mood with suicidal ideation. These symptoms usually do not require anything beyond symptomatic relief and resolve as withdrawal progresses; however, the appropriate level of nursing care and support must be assessed. Other therapies play an important role in detoxification and can minimize the need for medication. Relaxation training has been said to be a useful way to reduce stress particularly in benzodiazepine withdrawal and complementary therapies such as massage have also been used to reduce discomfort. Any medication prescribed will either substitute for the drug that has been withdrawn or treat the symptoms of the withdrawal syndrome. It has been said that the three most common errors in the management of withdrawal syndromes are (1) failure to diagnose, (2) prescription of too much for too long, and (3) failure to use psychological means to abate withdrawal. The syndrome described consists of craving for the drug and three or more of the following symptoms: dysphoric mood, nausea or vomiting, lachrymation and rhinnarhea, muscle aches, pupillary dilatation, piloerection, diarrhea, yawning, or insomnia. In addition to this, body temperature and blood pressure may be slightly elevated with a variable effect on pulse. As discussed earlier, the onset of a withdrawal syndrome will depend on the quantity of the drug used, the frequency of usage, and the half-life of the drug. Heroin withdrawal normally begins within 6 to 8 hours of last use, symptoms of withdrawal peak at 2 to 3 days and have usually resolved within a week. Withdrawal from other opiates is similar but will exhibit different time scales and intensities. Opioid withdrawal can also be precipitated by an antagonist such as naloxone, which will produce a severe withdrawal with peak intensity about 30 minutes from administration. The opiate withdrawal syndrome is very rarely life threatening and has been described as being simliar to having influenza. It is, however, experienced as sufficiently unpleasant for it to be avoided whenever possible by users and for its successful negotiation to be the necessary first step towards abstinence. A rapid detoxification will produce more severe withdrawal symptoms than a slower one, but it may be easier to maintain motivation. A brief review of the use of methadone, alpha-2-agonists, and buprenorphine in detoxification will be given. In clinical practice patients who are on methadone maintenance treatment will usually have their methadone dose reduced gradually, commonly at a rate of 5 mg every fortnight to a daily dose of 20 to 30 mg. Gossop and Bradley91 studied 116 opiate addicts withdrawn from methadone over a 21-day period. Withdrawal symptoms started to increase on Day 10 and reached a peak at the end of the reduction, not returning to normal until Day 40. A further study92 compared this 21-day reduction with a 10-day reduction and found that the 10-day group showed higher scores for withdrawal symptoms which peaked earlier and recovered earlier. Both groups achieved the same rates of completion and it was concluded that there was no advantage to an extended period of reduction. It is important to inform patients about what to expect during detoxification as almost everyone undergoing methadone reduction will experience withdrawal symptoms. Green and Gossop93 examined 30 patients who were detoxified in the usual way, 15 of whom were taught about their likely symptoms.

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Select the wrong statement from the following (1) the chloroplasts are generally much large than mitochondria (2) Both chloroplasts and mitochondria have an internal compartment antibiotics keflex 3mg ivermectin amex, the thylakoid space bounded by the thylakoid membrane (3) Both chloroplasts and mitochondria contain an inner and an outer membrane bacteria are the simplest single cells that buy cheap ivermectin 3 mg on-line. A major break through in the studies of cells came with the development of electron microscope. This is because (1) the electron microscope is more powerful than the light microscope as it uses a beam of electrons which has wavelength much longer than that of photons (2) the resolving power of the electron microscope is 200 ­ 350 nm as compared to 0. Cytoskeleton is made up of: (1) proteinaceous filaments (2) callose deposits (3) calcium carbonate granules (4) cellulosic microfibrils Ans: (1) ht tel tp eg s: ra //t m. Plasmodesmata are: (1) connections between adjacent cells (2) locomotary structures (3) lignified cemented layers between cells (4) membranes connecting the nucleus with plasmalemma Ans: (1) [2008] Q738. Vacuole in a plant cell (1) lacks membrane and contains air (2) is membrane-bound and contains storage proteins and lipids (3) lacks membrane and contains water and excretory substances (4) is membrane-bound and contains water and excretory substances Ans: (4) [2008] Q739. The two sub-units of ribosome remain united a critical ion level of (1) magnesium (2) copper (3) calcium (4) manganese Ans: (1) ht tel tp eg s: ra //t m. Cellulose is the major component of cell walls of (1) Pseudomonas (2) Pythium (3) Saccharomyces (4) Xanthomonas Ans: (2) [2009] Q741. The main arena of various types of activities of a cell is: (1) cytoplasm (2) plasma membrane (3) nucleus (4) mitochondrian Ans: (1) jo in [2009] Q742. Which one of the following structures between two adjacent cells is an effective transport pathway? Middle lamella is composed mainly of: (1) phosphoglycerides (2) muramic acid (3) hemicellulose (4) calcium pectate Ans: (4) [2010] Q745. What are those structures that appear as beads - on- string in the chromosomes when viewed under electron microscope? Peptide synthesis inside a cell takes place in: (1) chromoplast (2) chloroplast (3) ribosomes (4) mitochondria Ans: (3) (1) plastid (2) vacuole (3) lysosome (4) golgi apparatus Ans: (4) [2011] Q749. Important site for formation of glycoproteins and glycolipids is jo in [2011] Q750. The plasma membrane consists mainly of: (1) proteins embedded in a polymer of glucose molecules (2) phospholipids embedded in a protein bilayer (3) proteins embedded in a carbohydrate bilayer (4) proteins embedded in a phospholipid bilayer Ans: (4) [2011] Q751. Which one of the following is not considered as a part of the endomembrane system? In mitochondria, proteins accumulate in the (1) intermembrane space (2) outer membrane (3) matrix (4) inner membrane Ans: (4) jo in [2012] Q755. The Golgi complex plays a major role (1) in post translational modification of proteins and glycosidation of lipids (2) in digesting proteins and carbohydrates (3) in trapping the light and transforming it into chemical energy (4) as energy transferring organelles Ans: (1) Q765. The total number of nucleotides present in the segment is (1) 60 (2) 120 (3) 480 (4) 240 Ans: (3) [1991, 05] Q772. The basic unit of nucleic acid is (1) Nucleoside (2) Pentose sugar (3) Nucleotide (4) Nucleoid Ans: (3) Q773. Mineral associated with cytochrome is (1) Fe and Mg (2) Cu (3) Fe and Cu (4) Mg Ans: (3) (1) Nitrogen base, sugar and phosphate (2) Purine, pyrimidine and phosphate (3) Pyrimidine, sugar and phosphate (4) Purine, sugar and phosphate Ans: (1) jo Q775. Amino acids are produced from (1) Essential oils (2) Proteins (3) a-keto acids (4) Fatty acids Ans: (3) Q777. Water present in human body is (1) 75 ­ 80% (2) 60 ­ 65% (3) 65 ­ 70% (4) 50 ­ 55% Ans: (3) Q778. Adenine is (1) Nucleoside (2) Purine (3) Nucleotide (4) Pyrimidine Ans: (2) [1992] Q779. Enzymes having slightly different molecular structure but performing identical activity are (1) Apoenzymes (2) Holoenzymes (3) Coenzymes (4) Isoenzymes Ans: (4) ht tel tp eg s: ra //t m. An enzyme brings about (1) increase in activation energy (2) decrease in reaction time (3) reduction in activation energy (4) increase in reaction time Ans: (3) ht tel tp eg s: ra //t m. In which one of the following groups, all the three are examples of polysaccharides? The pyrenoids are made up of (1) core of starch surrounded by sheath of protein (2) proteinaceous centre and starchy sheath (3) core of nucleic acid surrounded by protein sheath (4) core of protein surrounded by fatty sheath Ans: (2) [1995] Q789. A polysaccharide, which is synthesized and stored in liver cells, is (1) arabinose (2) lactose (3) glycogen (4) galactose Ans: (3) ht tel tp eg s: ra //t m. Two free ribonucleotide units are interlinked with (1) hydrogen bond (2) peptide bond (3) phosphodiester bond (4) covalent bond Ans: (3) Q791. Protein synthesis in an animal cell takes place (1) in cytoplasm as well as in mitochondria (2) only in the cytoplasm (3) only on ribosomes attached to the nuclear envelope (4) in the nucleolus as well as in cytoplasm Ans: (1) [1997] Q794. Genes are packed into a bacterial chromosome by (1) acidic proteins (2) histones (3) actin (4) basic proteins Ans: (4) jo in [1997] Q795.


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Nearly one-third of these verifications occurred as a result of predose urine samples related to treatment for dogs bleeding gums buy ivermectin 3mg lowest price previous drug use by subjects infection 2 strategy buy 3 mg ivermectin with amex, rather than as a result of drugs administered during sessions. The subsets consisted of 17 variables for ethanol, 17 variables for cocaine, and 28 variables for marijuana. For all three drugs, the discriminative function model testing this subset of variables predicted the presence or absence of drug with a high degree of sensitivity and specificity. However, nearly one-third of non-ethanol impairment decisions were consistent because of drug metabolites identified in predose urine specimens, rather than because of the drug administered prior to evaluations. It is widely recognized that a positive urine drug test does not indicate behavioral impairment. With this knowledge, military personnel could attempt to compensate for, or avoid, undesirable environments or agents. A comprehensive review of many assessment batteries used by government agencies, which includes a review of evidence related to the reliability and validity of the batteries, can be found elsewhere. The purpose of many of these tests is to determine the effects of risk factors on fitness for government duty, and to assess the efficacy of countermeasures designed to offset the performance effects of these risk factors. The group set out to fabricate a standardized laboratory tool to assess cognitive performance using repeated measures in a Tri-Service chemical-defense biomedical drug screening program. This enabled researchers to utilize only those tasks which best suited the needs of each protocol or evaluation. Accuracy and response time were automatically measured and the data collection updated for any of the tasks that were selected. Numerous parameters of the individual tasks could be modified, such as stimulus duration, inter-trial interval, number of stimulus presentations, and length of the task. These tasks measure a variety of human cognitive and psychomotor functioning, including focused attention, selective attention, divided attention, memory, and a variety of additional task components. The battery was designed to measure changes in performance over time as a function of environmental perturbations. The building routine prompts the researcher to specify certain hardware and software characteristics of the computer system on which it will be presented. Response times and values, and errors are stored into working memory until the completion of each task. After completion of a task, summary statistics may be shown on the subjects screen, or downloaded to a printing source, if desired. These tasks assess focused attention, selective attention, acquisition, memory, and a variety of additional task components. Focused Attention Continuous Performance Selective Attention Stroop Other Cognitive Performance Spatial Rotation-Sequential Manikin Grammmatical/Logical Reasoning Memory Match/Nonmatch to Sample Sternberg Memory Pattern Comparison service methodology in an attempt to standardize measurement of human performance in military environments. The software controller allows the experimenter to modify certain aspects of task presentation. This would facilitate standardization and allow researchers to compare all administrations of the battery equally. Focused attention, divided attention, and memory categories of tasks are included in this battery, in addition to a variety of other tasks. A tracking test, running memory test, the Walter Reed mood scale, and the Stanford sleepiness scale were substituted. Focused attention and memory categories of tasks are included in this battery, as well as a variety of additional task components. Focused Attention Complex Reaction Time Visual-Motor Tracking Divided Attention Other Cognitive Performance Spatial Rotation-Sequential Grammmatical/Logical Reasoning Serial Add/Subtract Memory Sternberg Memory Table 4. Focused Attention Complex Reaction Time Visual-Motor Tracking Other Cognitive Performance Spatial Rotation Spatial Rotation-Sequential Grammmatical/Logical Reasoning Serial Add/Subtract Memory Sternberg Memory Character/Number Recall 4. Epidemiologic research influenced the sets of tests that were included in this battery. Many of the core tests that were chosen are adaptations of pre-existing clinical instruments that have been recognized as valuable tools in investigating neurotoxin exposure. Motor ability, focused attention, selective attention, acquisition, and memory categories of tasks are included in this battery, in addition to a variety of other tasks (Table 4.

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Labetolol which has combined alpha and beta blocking effects bacterial 16s rrna universal primers order ivermectin 3 mg with mastercard, may be preferable if tachycardia is associated with hypertension antibiotics hearing loss purchase ivermectin 3mg online. For ventricular arrhythmias: Lignocaine and amiodarone are generally first line agents for stable monomorphic ventricular tachycardia. For rhabdomyolysis: Early aggressive fluid replacement is the mainstay of therapy, and may help prevent renal insufficiency. Diazepam and chlorpromazine have been effective in treating amphetamine-induced chorea. Although peritoneal dialysis and haemodialysis have been demonstrated to enhance elimination of amphetamine, the clinical efficacy of these procedures in human overdose has not been proven and they are rarely if ever clinically indicated. Acidification of urine enhances amphetamine excretion, but may precipitate acute renal failure in patients with myoglobinuria and is therefore contraindicated. Those with moderately severe dependence can be treated on an outpatient basis without using drugs. Strategies range from residential and ambulatory detoxification to day treatment, multistep activities, and case 217 Chapter 16 Stimulants 218 management. Sometimes these drugs are labeled "entactogens" for their alleged ability to increase sensitivity to touch, or "empathicogens", for their alleged ability to create empathy, especially before sexual encounters. About Ѕ hour to 3 hours after the initial ingestion, a "plateau" phase occurs in which repetitive or trance-like movements become extremely pleasurable. The "coming down" phase occurs 3 to 6 hours after the initial ingestion, and can lead to negative feelings or emotions (depression, anxiety). Designer Amphetamines Designer drugs are congeners of active compounds that have been modified from legitimate pharmaceutical agents, and are used for recreational purposes. Apart from amphetamines, there are several other groups of designer drugs (Table 16. Designer drugs are usually stronger and cheaper than the parent compound, and can be easily synthesised in clandestine laboratories. The term "designer drug" does not include new forms or new dosing routes of old drugs. The first designer amphetamine to be developed was methylenedioxymethamphetamine, which was introduced by E Merck and Company in Germany in 1914. It was only in the 1970s and early 1980s that it made its appearance as an "underground" drug. Section 5 Neurotoxic Poisons Mode of Action While designer amphetamines share a number of properties with the original amphetamines, unlike the latter, they are potent releasers of serotonin. Fentanyl derivatives: Mecloqualone Alpha-methylfentanyl ("China Nitromethaqualone white") Methylfentanyl 2. The following have also been reported: convulsions, cerebral infarcts, hallucinations, paranoia, chest pain, hyperkalaemia, and fulminant hepatic failure. Chronic use results in anorexia, weight loss, exhaustion, jaundice, irritability, flashbacks, paranoia, depression, or psychosis. However, since frequent use diminishes the pleasurable effects of these drugs, users often taken them only at intervals of 2 to 3 weeks, and then gradually lose interest and stop intake altogether over a period of time. Medicosocial and Forensic Issues Amphetamines are the most widely used illicit drugs (second only to cannabis) in the United Kingdom, Australia, and many parts of Europe. After the introduction of amphetamines into clinical use in the early 1930s, they were available as prescription drugs for various indications (obesity, narcolepsy, attention deficit disorder, psychotherapy), and even sold over the counter in the form of nasal inhalers till the early 1970s. Japan experienced an epidemic of intravenous methamphetamine abuse in the years following the Second World War. Crystalline methamphetamine ("ice") was introduced in the 1980s in Hawaii, and quickly became popular in other countries. This fad has now gripped several metropolitan Indian cities where tablets of Ecstasy are available freely among elite circles (Fig 16. Much of this popularity has to do with the copious amount of information existing on these drugs on the Internet, and the fact that unlike certain other drugs like heroin and cannabis, designer drugs are considered "hep" and "cool". Also, unlike many other hard drugs, designer drugs can be easily consumed (ingested) without the messiness of nasal insufflations, smoking, or injection.

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The word sappism is originated from the fact that the island was ruled by Medicolegal Aspects Queen Sappho virus hunters of the cdc generic ivermectin 3mg visa. Continued lesbianism can be a valid ground for divorce or annulment of marriage under Hindu MarriageAct antibiotics for uti clindamycin buy generic ivermectin 3 mg on-line. In some countries, penetration of the vagina or anus with tongue during non-consensual cunnilingus or anilingus is considered to be legally analogous to nonconsensual penile penetration of the vagina and anus. The British Parliament has created a new offense of "assault by penetration" which is defined as non-consensual penetration of the anus or vagina by an object or a body part. By males: cows, female sheep, goat, calves, mare, · Lust murder ­ in extreme case of sadism a person may she-ass, cat21 kill his partner and killing of partner acts as stimulus 2. At rapist and murderer in Textbook of Forensic Medicine times, the act is done in mistaken belief that gonorrhea and Toxicology which reads as "sometimes when I am is cured by intercourse with she-ass. Medical Examination InAccused · Stains over clothes may be present of ­ dung, mud, secretions · Signs of injuries over penis. Similarly injuries over body may be seen due to kicking or biting by animal · Stains over penis ­ in form animal feces, secretions, blood · Animal hairs may be present · Infection transmitted from animal such as genital lesions may be present. It is cruel to animal and violates the right of animal of · Thefetishpersoncontraveneslawattimeswhilestealing sexual independence. For example a male may have desire to in response to objects, which are not a part of normal wear female dress. Voyeurism (scoptophilia) Pornographomania Sexual pleasure obtained by watching or referring porno· In this deviation, sexual pleasure is obtained by repeatgraphic material or literature. Erotographomania · Peeping Tom is the name given to male voyeurs who Sexual pleasure is obtained by obscene and vulgar writings repeatedly do such activities. At times, the husband forces Sexual pleasure obtained by using obscene and vulgar lanor induces his wife to do sexual intercourse with another guage in public. For example in a crowded city bus, a male may rub his genital organ with buttocks of female standing with him or a person may touch private parts of female. Coprophilia Sexual gratification achieved by smelling or touching fecal matter (stool) of opposite sex. Ecoutage Sexual pleasure obtained by hearing sounds of love-making or sexual intercourse. Pygmalionism24 Sexual gratification achieved by watching or handling nude statues of opposite sex. Forensic Medicine Masturbation · In this condition, sexual gratification is obtained by In this type of perversion, the female partner amputes the deliberate self-stimulation of own genital organ. Bobbit syndrome Sexual pleasure obtained by watching sexual intercourse of other person or couple. A pedophile is an adult who repeatedly engages in sexual activities with pre-pubescent children. Trafficking Trafficking means the moving, selling or buying of women and children for prostitution within and outside a country for monetary or other considerations with or without consent of person subjected to trafficking. In: Practical aspects of rape investigation: a multi-disciplinary approach, 1st edn. Clothing damage analysis in alleged sexual assaults ­ the need for a systematic approach. In sexual act, normally males are active partners and females are relatively passive. Therefore, impotence is a term generally applied to the incapacity of male partner to perform sexual intercourse. ImpotenCe Definition Impotence, in male, is defined as "persistent inability to develop or maintain a penile erection sufficient to conclude coitus to orgasm and ejaculation". Malformations and local acquired causes ­ presence of malformations or congenital anomaly or local acquired causes renders a person impotent. Functional or psychological cause ­ this is the most common cause of temporary impotence ­ Fear, timidity, anxiety, guilt sense, hypochondrias, sexual over indulgence etc. This phenomenon is quite common in newly wedded person referred as bridegroom impotence.


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