Dan Engelhard, M.D.

• Associate Professor
• Department of Pediatrics
• The Hebrew University Hadassah Medical School
• Chief
• Department of Pediatrics
• Hadassah University Hospital
• Jerusalem, Israel

A detailed discussion of the physics of surface plasmons unfortunately falls beyond the scope of this book bacteria have dna order stromectol 3 mg with visa. Surface plasmons are delocalized conductive electrons that exist at the interface of two materials where the real part of the dielectric constant changes sign across the interface [11 antibiotic amoxicillin buy stromectol with a mastercard, 12] antimicrobial 24-7 6 mg stromectol sale. Usually can antibiotics for acne delay your period purchase genuine stromectol line, it is linear within a relatively small range of refractive indices antibiotic colitis buy stromectol 12 mg amex, as predicted by the Drude model of the electronic configuration in metals [20 recommended antibiotics for sinus infection buy generic stromectol canada, 21]. The extinction of the incident light occurs due to energy dissipation by both absorption and scattering. In absorption, energy is dissipated due to inelastic processes, whereas in scattering, the energy of incident light causes oscillations of electrons in the materials and a photon is emitted-either of the same frequency as that of the incident light (Rayleigh scattering) or of a different one (Raman scattering) [24]. As a result, there is considerable broadening and flattening of the absorbance peak with increasing size of the particles. Cumulatively, this causes a red-shift and flattening of the absorbance Particle Size peak with increasing size. The least aggregated dispersion is red (right), while the highest one is pale blue (left) in color. The signal amplification was significant, and such techniques are certainly worth exploring in the future. The setup usually consists of an incident p-polarized light that strikes the conducting sensor slide at the interface between high and low refractive indices, for example, an external medium, like liquid. In reality, the electron transfer between enzyme and electrode is unfortunately often slow due to either improper orientation of the enzyme molecule or denaturation of the enzyme due to impurities. Commonly used soluble mediator molecules of a lower molecular weight to address the problem often exhibit leaching from the electrode and, hence, an appreciable amount is lost into the solution during the process. Not only gold but other metallic nanomaterials (silver and copper) also harbor similar properties, although gold enjoys an edge over others due to biocompatibility, well-known chemistry, and opportunities for functionalization. However, for successful translation of such sensing platforms, an essential criterion will be its effectiveness in dealing with real pathological samples, such as blood and urine. However, with the arrival of further knowledge and improvement in functionalization techniques, such challenges are expected to be addressed adequately in the future. The presence of little structural defects and excellent stability at high temperatures. Exohedral functionalization: Exohedral functionalization is done by both noncovalent and covalent methods. However, use of surfactants can compromise biocompatibility by inducing cytotoxicity. Hydrophobic and hydrophilic groups are denoted by blue lines and yellow stars, respectively. Covalent exohedral functionalization techniques have already been discussed in Chapter 6. Most of these sensors rely on enzymatic degradation of analytes in the working electrode to release electrons, which are then transferred to generate a current or voltage signal. The loading is usually better than that in the solution method, although standardized methods to measure loading are yet to be established. However, only molecules that can withstand high temperatures and resist thermal degradation are suitable for such processes. Similarly, the detection of transferrin, the 77 kDa glycoprotein that participates in the transport of iron in body, at very low amounts (5. Upon recognition, the captured analytes are isolated by precipitation triggered by the application of an external magnetic field. The capabilities of these sensors are predicted to keep increasing with further advancements in conjugation and better designed platforms. However, the ability of these sensing platforms needs to improve in terms of real-life samples, for example, sputum, whole blood, urine, and cerebrospinal fluid. Sun, Application of nanodiagnostics in pointof-care tests for infectious diseases, Int. Jiang, Point-of-care biochemical assays using gold nanoparticle-implemented microfluidics, Chem. Cosnier, Adamantane/cyclodextrin affinity biosensors based on single-walled carbon nanotubes, Biosens. Lezec, Surface plasmons enhance optical transmission through subwavelength holes, Phys. 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Singamaneni, Bioplasmonic paper as a platform for detection of kidney cancer biomarkers, Anal. Shi, A sensitive amperometric immunosensor for carcinoembryonic antigen detection with porous nanogold film and nano-Au/chitosan composite as immobilization matrix, J. Zhu, Horseradish peroxidasefunctionalized gold nanoparticle label for amplified immunoanalysis based on gold nanoparticles/carbon nanotubes hybrids modified biosensor, Biosens. Chen, Biomolecules/gold nanowiresdoped sol-gel film for label-free electrochemical immunoassay of testosterone, J. Sheng, Direct electrochemistry of horseradish peroxidase based on biocompatible carboxymethyl chitosan-gold nanoparticle nanocomposite, Biosens. Zeng, Glassy carbon electrode modified with gold nanoparticles and hemoglobin in a 86. Guo, Electroanalytical properties of cytochrome c with direct electron transfer on graphene/gold nanoparticles chitosan modified glass carbon electrode, Anal. 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Complex epidemiology of a zoonotic disease in a culturally diverse region: Phylogeography of rabies virus in the Middle East antibiotic for bacterial vaginosis generic stromectol 12 mg with amex. Vaccine-induced rabies in a red fox (Vulpes vulpes): Isolation of vaccine virus in brain tissue and salivary glands dosage of antibiotics for sinus infection buy 3 mg stromectol fast delivery. An aerial baiting system for the distribution of attenuated or recombinant rabies vaccines for foxes treatment for dogs ear infection discount stromectol online mastercard, raccoons infection transmission buy stromectol 3mg, and skunks antimicrobial quiz questions buy stromectol 3 mg low price. Enhanced surveillance to support effective oral rabies vaccination of raccoons in the eastern United States antibiotic resistance japan stromectol 12 mg generic. The influence of pack social structure on oral rabies vaccination coverage in captive African wild dogs (Lycaon pictus). Trapping and vaccination of endangered Ethiopian wolves to control an outbreak of rabies. Formulation and evaluation of baits for oral rabies vaccination of raccoons (Procyon lotor). A review of baits and bait delivery systems for free-ranging carnivores and ungulates. Oral rabies vaccination of red foxes and golden jackals in Israel: Preliminary bait evaluation. A new flavor-coated sachet bait for delivering oral rabies vaccine to raccoons and coyotes. Design considerations for large-scale aerial distribution of rabies vaccine-baits in Ontario. Variation in host home range size decreases rabies vaccination effectiveness by increasing the spatial spread of rabies virus. Incorporating direct rapid immunohistochemical testing into large-scale wildlife rabies surveillance. Spatio-temporal use of oral rabies u vaccines in fox rabies elimination programmes in Europe. Origins of the arctic fox variant rabies viruses responsible for recent cases of the disease in southern Ontario. Geography but not alternative host species explain the spread of raccoon rabies virus in Vermont. A molecular epidemiological analysis of the incursion of the raccoon strain of rabies virus into Canada. Persistence of genetic variants of the arctic fox strain of Rabies virus in southern Ontario. Differential impacts of vaccination on wildlife disease spread during epizootic and enzootic phases. From recognition to action: A strategic approach to foster sustainable collaborations for rabies elimination. Scientific opinion-Update on oral vaccination of foxes and raccoon dogs against rabies. First field trial of fox vaccination against rabies using a vaccinia-rabies recombinant virus. Campagne internationale de vaccination antirabique du renard par voie orale mene au grand-duch de Luxembourg, en Belgique et en France. The effect of seasonal birth pulses on pathogen persistence in wild mammal populations. A study of techniques for the distribution of oral rabies vaccine to wild raccoon populations. In-depth genome analyses of viruses from vaccine-derived rabies cases and corresponding live-attenuated oral rabies vaccines. Vital signs: Trends in human rabies deaths and exposures-United States, 1938-2018. Immunogenic and protective properties of rabies virus glycoprotein expressed by baculovirus vectors. Rabies and rabies control in striped skunks (Mephitis mephitis) in three prairie regions of western North America. Oral rabies vaccination of a northern Ohio raccoon population: Relevance of population density and prebait serology. An integrated disease management strategy for the control of rabies in Ethiopian wolves. Modelling the effect of landscape heterogeneity on the efficacy of vaccination for wildlife infectious disease control. Raccoon contact networks predict seasonal susceptibility to rabies outbreaks and limitations of vaccination. First European interlaboratory comparison of tetracycline and age determination with red fox teeth following oral rabies vaccination programs. International interlaboratory trials on rabies diagnosis: An overview of results and variation in reference diagnosis techniques (fluorescent antibody test, rabies tissue culture infection test, mouse inoculation test) and molecular biology techniques. Reconsidering oral rabies vaccine bait uptake evaluation at population level: A simple, noninvasive, and ethical method by fecal survey using a physical biomarker. Management of raccoons (Procyon lotor) in Ontario, Canada: Do human interventions and disease have significant impacts on raccoon populations The control of raccoon rabies in Ontario Canada: Proactive and reactive tactics, 1994-2007. Human-assisted movements of Raccoons, Procyon lotor, and Opossums, Didelphis virginiana, between the United States and Canada. Density, movements, and survival of raccoons in Ontario, Canada: Implications for disease spread and management. Efficacy of an oral vaccinia-rabies glycoprotein recombinant vaccine in controlling epidemic raccoon rabies in New Jersey. Ineffectiveness and comparative pathogenicity of attenuated rabies virus vaccines for the striped skunk (Mephitis mephitis). Efficacy of a vaccinia-rabies glycoprotein recombinant virus vaccine in raccoons (Procyon lotor). Controlling dog rabies in Africa: Successes, failures and prospects for the future. Influence of oral rabies vaccine bait density on rabies seroprevalence in wild raccoons. Rabies transmitted by vampire bats to humans: An emerging zoonotic disease in Latin America Cost-efficient vaccination of foxes (Vulpes vulpes) against rabies and the u need for a new baiting strategy. Cost-benefit analysis of controlling rabies: Placing economics at the heart of rabies control to focus political will. Oral rabies vaccination in North America: Opportunities, complexities, and challenges. Cost and relative value of road kill surveys for enhanced rabies surveillance in raccoon rabies management. Paper presented at the 57th North American Wildlife and Natural Resources Conference, Charlotte, North Carolina. Rabies in urban foxes (Vulpes vulpes) in Britain: the use of a spatial stochastic simulation model to examine the pattern of spread and evaluate the efficacy of different control regimes. Epidemiological analysis of street rabies viruses from enzootic areas of the United States. Assessment of the immunogenicity of rabies vaccine preserved by vaporization and delivered to the duodenal mucosa of gray foxes (Urocyon cinereoargenteus). Field evaluation of an inactivated vaccine to control raccoon rabies in Ontario, Canada. Recommended best management practices to address possession, transportation and disposition of rabies vector species. Tactics and economics of wildlife oral rabies vaccination, Canada and the United States. Preparing for and responding to recent incursions of raccoon rabies variant into Canada. Oral administration of an attenuated strain of canine adenovirus (type 2) to raccoons, foxes, skunk, and mongoose. Interplay between contact risk, conspecific density, and landscape connectivity: An individual-based modeling framework. Primary multiplication site of the vaccinia-rabies glycoprotein recombinant virus administered to foxes by the oral route. Molecular epizootiology of rabies associated with terrestrial carnivores in Mexico. Oral vaccination against rabies and the behavioural ecology of the red fox (Vulpes vulpes). Oral vaccination of wildlife against rabies: Differences among host species in vaccine uptake efficiency. Oral vaccination of captive small Indian mongoose (Herpestes auropunctatus) against rabies. Vaccine-induced rabies case in a cow (Bos taurus): Molecular characterisation of vaccine strain in brain tissue. Initial pen and field assessment of baits to use in oral rabies vaccination of Formosan ferret-badgers in response to the re-emergence of rabies in Taiwan. Oral immunization of wildlife against rabies: Concept and first field experiments. Monoclonal antibodies against rabies virus produced by somatic cell hybridization: Detection of antigenic variants. A review of the development of the oral vaccination technique for immunizing wildlife against rabies. Rabies vaccination programme for red foxes (Vulpes vulpes) and golden jackals (Canis aureus) in Israel (1999-2004). Re-emergency of wildlife rabies in golden jackals (Canis aureus), Israel (2017-2018). Paper presented at the 30th Annual Rabies in the Americas Conference, Kansas City, Kansas. Modeling can also identify counterintuitive outcomes that emerge as interventions are implemented, and challenges in the endgame when disproportionate resources are necessary to reach the last mile of elimination (Klepac, Metcalf, McLean, & Hampson, 2013). In light of the global goal to eliminate human deaths due to dog-mediated rabies by 2030, models of rabies virus transmission have potential to inform control efforts as countries progress toward elimination. In contrast, models of wildlife rabies guided early control efforts (Panjeti & Real, 2011). Elimination of fox rabies in Europe was kickstarted by modeling studies that demonstrated the feasibility of control (Anderson, Jackson, May, & Smith, 1981). Surveillance of rabies in wildlife systems in Europe and North America provided rich data sets to characterize dynamics, identifying the wave front of outbreaks to target control geographically (Murray, Stanley, & Brown, 1986), establishing that landscape features such as rivers act as barriers to disease dispersal (Smith, Lucey, Waller, Childs, & Real, 2002), and delineating how birth pulses shape seasonality in transmission (Duke-Sylvester, Bolzoni, & Real, 2011). Human populations, behavior, and culture structure dog populations (Cleaveland, Beyer, et al. In addition, canine rabies persists in low- and middle-income countries where surveillance capacity is limited and representative disease data are lacking (Scott, Coetzer, Fahrion, & Nel, 2017). Beyond capturing core infection biology, models of canine rabies must also encompass human influences and be tractable to interpretation in datasparse settings. The Susceptible population is replenished by births and depleted by mortality (both natural and disease-induced) and vaccination. The Vaccinated population is governed by the rate of vaccination, but depleted by natural mortality and waning of immunity generated by vaccines (most high quality vaccines are protective for at least 3 years, Lakshmanan et al. For canine rabies, evidence suggests that domestic dogs are the reservoir host even in areas with complex wild carnivore communities (Lembo et al. While other wildlife hosts may contribute to transmission, single-host models of rabies in the dog population are likely sufficient to understanding and predicting dynamics in most endemic areas (Cleaveland, Lankester, Townsend, Lembo, & Hampson, 2014). Rabies virus is directly transmitted in the saliva of infectious animals, typically via bites. Transmission is on average low: most infectious cases do not result in forward transmission, and on average dogs infect one or two other dogs. However, there is also substantial heterogeneity in transmission, and some dogs are capable of biting upwards of 20 other dogs during their short infectious period (Hampson et al. While most exposed dogs become infectious within 1 month, some infections manifest months after initial exposure (Foggin, 1988; Hampson et al. The infectious period, on the other hand, is predictably short, and infection results in death generally within 10 days of showing neurological signs of infection (Hampson et al. Although transmission is mostly local (<1 km), rabies can cause erratic and unpredictable behavior, with infected dogs able to run more than 15 km, beyond the typical home range of most healthy dogs (Hampson et al. As a result, secondary cases often occur from disease-mediated incursions spread from neighboring populations. In addition, long-distance humanmediated incursions of incubating dogs can result in outbreaks being seeded from otherwise unconnected populations (Brunker, Hampson, Horton, & Biek, 2012). There has been considerable debate about how to model rabies virus transmission, which echoes a larger debate within the disease ecology community (Lloyd-Smith, Cross, et al. Following vaccination campaigns, vaccination coverage (y axis, inset) first increases (vertical jumps) then wanes over time (x axis) as vaccinated individuals die, susceptible individuals are born, or as immunity conferred by vaccination wanes (in this example, campaigns reach 70% of the population annually, but coverage wanes to approximately 35% before the next annual campaign).

The species most frequently recorded as rabies positive include the big brown bat (Eptesicus fuscus) bacterial conjunctivitis treatment generic 12 mg stromectol visa, which harbors several distinct variants (Nadin-Davis antibiotics for uti diarrhea buy stromectol in india, Feng bacterial growth rate cheap stromectol 12mg without a prescription, Mousse antimicrobial antibiotic purchase stromectol once a day, Wandeler antibiotics for canine ear infection discount stromectol 6mg without prescription, & Aris-Brosou antibiotic 48 hours contagious buy stromectol 3mg without a prescription, 2010; Neubaum et al. While bats of the Myotis genus are infrequently reported with rabies, several North American species harbor distinct viral types (Nadin-Davis, Alnabelseya, & Knowles, 2017; Streicker et al. Moreover, additional viral variants for which the reservoirs are yet to be determined may be harbored by other bat species (Archiga-Ceballos et al. While control of bat rabies through human-mediated efforts remains problematic due to the aerial life style and feeding habits of these hosts, the decline in populations of certain bat species, attributable to the recent white-nose syndrome outbreak (Blehert, 2012), may have a notable impact on bat rabies epidemiology in eastern North America. As information on the viruses associated with insectivorous bats of North America grew, increased surveillance in South America has identified large numbers of rabid insectivorous bats some of which represent reservoir species (Escobar, Peterson, Favi, Yung, & MedinaVogel, 2015). In the most southern parts of the continent, in Chile and Argentina, variants associated with small numbers of specimens of the Myotis, Eptesicus, Histiotus, and Lasiurus genera have been recovered, but the Brazilian free-tailed bat, Tadarida brasiliensis, is the principal bat rabies reservoir (Escobar et al. In Brazil, viral variants associated with Eptesicus furinalis, Molossus molossus, and species of the genera Histiotus, Nyctinomops, Myotis, and Lasiurus have been identified (Albas et al. In addition, single reports of rabies in other species have appeared (Castilho et al. This becomes especially important when new lyssavirus species are identified since identification of the reservoir host can impact risk assessments following a potential exposure. In addition, beyond increased fundamental knowledge of the range and spread of a particular variant, this information is of critical importance to control programs to ensure appropriate targeting of the disease reservoir. Viral typing also provides an important means of identifying incursions of variants into new areas; for example, dogs imported from countries where rabies is enzootic have occasionally brought the disease to western countries (Hercules et al. Viral sequence analysis can also reveal unexpected complexity of outbreak situations, as for recent cases in Tibet where multiple viral lineages are responsible for reemergence of the disease, thus indicating the need for a multipronged approach to control (Tao, Li, Wang, et al. Examples of such investigations range from very localized studies in an African urban setting (Coetzer et al. It is apparent that in many parts of Africa while geopolitical boundaries often limit rabies virus spread, human-mediated dispersal of the disease occurs often and is responsible for an increasingly complex pattern of viral admixture at both national and local levels (Brunker et al. Moreover, knowledge of topographical barriers to rabies spread can be beneficial in maximizing the cost effectiveness of control campaigns (Brunker, Lemey, et al. Indeed, due to their small size and subtle morphological differences, this approach is especially useful for confirming bat reservoir species, submissions of which may not reach the laboratory in good condition (Nadin-Davis, Alnabelseya, & Knowles, 2017; Streicker et al. Distinct viral variants are associated with Brazilian free-tailed bats in the southern and northern hemispheres (Velasco-Villa, Mauldin, et al. It has been postulated that migratory species such as members of the Lasiurus genus may be central to the dispersion of viral variants to other genera followed by independent evolution of these variants into distinct types (Faria, Suchard, Rambaut, Streicker, & Lemey, 2013; Streicker, Altizer, Velasco-Villa, & Rupprecht, 2012). Host genetics and feeding habits appear to impact interspecific transmission patterns of many insectivorous bat-associated rabies viruses of North America (Streicker et al. Geographic factors have almost certainly also had an impact; for example, the Rocky Mountain range in western Canada appears to have been a significant barrier to the spread of variants associated with Eptesicus fuscus and Myotis species (Nadin-Davis et al. Sequencing of mitochondrial loci or other variable loci such as microsatellites can also be used to study the population structure of the host; correlation of the association of viral subtypes with host subpopulations can provide insight into mechanisms of disease persistence and spread. Such studies have again been especially useful in examining patterns of rabies spread in bat populations due to their aerial lifestyle (Harris et al. Genetic studies of vampire bats and their viral variants in South America suggest that viral spread occurs predominantly through dispersal of males, while climactic conditions and topographical features such as mountain ranges, which restrict host movements, can result in the establishment of regionally localized viral variants (Kobayashi et al. In Europe, studies on red fox populations have identified a correlation between distinct subpopulations of this host and the spread of two different foci of rabies into Italy (Zecchin et al. However, the molecular mechanisms associated with such host shifts remain unclear. It remains to be determined whether more subtle features of the virus such as codon usage (He et al. Another more controversial theory is that recombination plays a role in lyssavirus evolution and host adaptation. The molecular process of lyssavirus genome replication and its site in the central nervous system dictate that such events would be extremely rare, consistent with minimal evidence for recombination from the vast majority of phylogenetic studies. Finally, through an ancestral state reconstruction of the genus based on a time-scaled phylogeny, it has been suggested that the lyssavirus genus emerged in the Palearctic approximately 27,000 years ago and subsequently spread to the rest of the world in three main dispersal events (Hayman, Fooks, Marston, & Garcia-R, 2016). As global temperatures rise, the range of many of the hosts that harbor these viruses will inevitably be affected. Similarly, climatic changes that modify the distribution of insect species will likely have significant effects on the range of insectivorous bats in many parts of the world and potentially expand the range of their associated lyssaviruses. In Alaska, it is speculated that expansion of the red fox range and displacement of arctic foxes to more northern regions might reduce arctic fox populations in areas of human habitation and thereby reduce the incidence of reported rabies cases (Hueffer & Murphy, 2018). However, the red fox is well known as an efficient rabies reservoir in its own right and such predictions may not extend throughout its range. It should be recognized that such predictions about the impacts of climate change on disease distribution remain speculative at this time. Such cases have illustrated the long incubation periods sometimes observed in humans (Boland et al. It has also facilitated the identification of new disease foci in wildlife (van Thiel et al. Improved ability to fully characterize the genomes of these viruses, together with development of new tools to interrogate such sequence data, allows greater insight into their epidemiology. Despite success in the elimination of terrestrial rabies in Western Europe and its control in large parts of the Americas, the ability of the rabies virus to persist in a variety of wildlife carnivores dictates that ongoing vigilance is needed to protect human health from exposure and prevent re-introduction of the disease into dog populations. Molecular epidemiology 2011), unsustainable domestic animal vaccination programs, especially in the developing world, mass migration of humans and their domestic animals due to conflict and ongoing emergence of novel viral variants in wildlife (Favoretto et al. Indeed if we accept recorded history as accurately describing the existence of rabies in ancient times, together with estimated dates of the emergence of current rabies virus lineages, it is apparent that rabies viruses have emerged more than once and that emergence of novel lyssavirus variants is a continuing threat. Ongoing surveillance and molecular phylogenetic investigation continue to extend the known diversity of the Lyssavirus genus around the world and with this increased knowledge a better understanding of the history of the genus and the evolutionary mechanisms in play that impact viral-host interactions should be achieved. Such insight will hopefully provide us with improved capabilities to further control these important pathogens. Molecular characterization of rabies virus isolated from non-haematophagous bats in Brazil. Molecular characterization of rabies virus isolated from dogs in Tunisia: Evidence of two phylogenetic variants. Clinical review of two fatal equine cases of infection with the insectivorous bat strain of Australian bat lyssavirus. New rabies virus variant found during an epizootic in white-nosed coatis from the Yucatan Pene insula. Evidence of two Lyssavirus phylogroups with distinct pathogenicity and immunogenicity. 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Utilisation of Chimeric Lyssaviruses to assess vaccine protection against highly divergent Lyssaviruses. Simultaneously reconstructing viral cross-species transmission history and identifying the underlying constraints. A new phylogenetic lineage of Rabies virus associated with western pipistrelle bats (Pipistrellus hesperus). Molecular characterization of atypical antigenic variants of canine rabies virus reveals its reintroduction by wildlife vectors in southeastern Mexico. Population structure of two rabies hosts relative to the known distribution of rabies virus variants in Alaska. Characterisation of an Australian bat lyssavirus variant isolated from an insectivorous bat. Saptiotemporal analysis of the genetic diversity of Arctic rabies viruses and their reservoir hosts in Greenland. Experimental u screening studies on rabies virus transmission and oral rabies vaccination of the Greater Kudu (Tragelaphus strepsiceros). Phylogenetic analysis of rabies viruses isolates from animals in Tokyo in the 1950s. Assessing the potential impacts of a changing climate on the distribution of a rabies virus vector. Isolation and identification of a novel rabies virus lineage in China with natural recombinant nucleoprotein gene. Identification of European bat u lyssavirus isolates with short genomic insertions. Molecular epidemiology of rabies in Botswana: a comparison between antibody typing and nucleotide sequence phylogeny. Invasion of the raccoon dog Nyctereutes procyonoides in Europe: history of colonization, features behind its success, and threats to native fauna. Molecular and geographic analyses of vampire bat-transmitted cattle rabies in central Brazil. Arctic and Arctic-like rabies viruses: distribution, phylogeny and evolutionary history. Bat lyssaviruses (Aravan and Khujand) from Central Asia: Phylogenetic relationships according to N, P and G gene sequences. 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Rabid Fox Bites and Human Rabies in a Village Community in Southern India: Epidemiological and Laboratory Investigations, Management and Follow-Up. Imported human rabies cases in Europe, the United States, and Japan, 1990 to 2010. Molecular epidemiological study of Arctic rabies virus isolates from Greenland and comparison with isolates from throughout the Arctic and Baltic regions. The lyssavirus host-specificity conundrum-rabies virus-the exception not the rule. Genetic analysis of a rabies virus host shift event reveals within-host viral dynamics in a new host.

Though these features are consistently found in severe and deteriorating forms of the disease antibiotics for uti in male discount 12mg stromectol with mastercard, they are not found in all women consistently virus us order stromectol no prescription. But there can be complications of wound haematoma and intraoperative ooze in these women antibiotic resistance developing countries cheap stromectol 3 mg online. Most of these are known as the major manifestations of pre-eclampsia and have a known strong immunological basis antibiotics for uti webmd purchase cheap stromectol on line. Frank Wolf M antibiotics for vre uti buy stromectol 12 mg with amex, Peleg D antibiotics for sinus infection breastfeeding discount 6 mg stromectol free shipping, Kariv Silberstein N, Assy N, Djibre A, Ben-Shachar I: Correlation between changes in liver stiffness and preeclampsia as shown by transient elastography. It is known to have vicious associations including those with other obstetric vasculopathies like accidental haemorrhage. It readily complicates into renal failure, pulmonary oedema and subcapsular haemorrhage in the liver. Yet there is a small percentage of women in whom the clinical situation may worsen in the postpartum period. Vigil-de Gracia P, Montufar-Rueda C: Acute fatty liver of pregnancy: Diagnosis, treatment, and outcome based on 35 consecutive cases. They had some common features; most common being they had hardly taken any antenatal care. Also, they were invariably women with severe pre-eclampsia or impending eclampsia. Established ophthalmic entities associated with (pre)-eclampsia is cortical blindness, serous retinal detachment, Purtscher-like retinopathy, central retinal vein occlusions and retinal or vitreous haemorrhages. Ensuing visual symptoms include blurry vision, diplopia, amaurosis fugax, photopsia and scotomata, including homonymous hemianopia. There is a leucocytic aggregation as a response to the activation of the complement. In normal non-diseased situations, an image is focused on the superficial layer of the retina. This transmits an electronic impulse down the succeeding layers to the optic nerve. In severe pre-eclampsia, in susceptible women, there occurs a process of retinal oedema. This is a consequent of vasospasm locally followed by reperfusion damage and incompetence of vessel walls. In retinal oedema of severe pre-eclampsia, the image formed does send the signal to the deeper layer. In such a situation, though the image does form on the superficial layer; it is deep down the impulse just fails to reach the optic nerve. So the image formed on the superficial layer once again quickly sends the impulse to the optic nerve and the woman starts "seeing" again. Optic nerve fibres once emerging from the deep layer of the retina goes to the optic chiasma. From the optic chiasma, these fibres pass to the occipital lobe from where they are directed to the anterior brain. In subjects with the central cause of visual disturbances, the cause of visual disturbance is at the occipital lobe. This is because of the central nervous system having an inherent inability to regenerate and repair once injured or destroyed. As regards the cortical origin of unilateral visual disturbance that is seen in some women with preeclampsia, it has been found that the occipital lobe gets principally involved. Metaphorically, it has been stated that retinal vessels reflect the changes in renal and intracranial vessels. It is not uncommon to find such women reporting with first signs of visual alterations to the emergency obstetric care units seeking help. In these women, retinal vasculature has an inherent propensity to develop oedema and subsequent changes. However, visual disturbances can occur much earlier and in more severe forms with each subsequent pregnancy. One more interesting aspect of blindness in pre-eclampsia is the fact that in some women this First, it helps to differentiate between chronic hypertension in women developing superimposed pre-eclampsia over women without hypertension. Then, worsening changes a fundoscopy on serial assessment in clinical practice helps decide in favour of early intervention. Finally, the presence of papilloedema at any stage of pregnancy in a women with preeclampsia is an indication for immediate intervention. Colour Doppler is better and more versatile in decisionmaking in obstetric vasculopathies in general and pre-eclampsia in particular. Mihu D, Mihu C, Tlu S, Costin N, Ciuchin S, Mluan A: Ocular changes in preeclampsia. Gupta A, Kaliaperumal S, Setia S, Suchi S, Rao V: Retinopathy in preeclampsia: Association with birth weight and uric acid level. There can also be some long-term effects and some unfortunate women can end up with renal failure and need dialysis and renal transplant subsequently. The physiological increase in blood volume in normal pregnancy is either annulled or constricted in pre-eclampsia. The intensity and frequency with which this occurs depend on the severity of preeclampsia and the rapidity with which it progresses. It also depends on the inherent robustness of the renal system of each pregnant woman to bear the changes. This gets reflected in varied clinical manifestation of renal system involvement in pre-eclampsia and other obstetric vasculopathies. Once the precarious balance of blood supply to the renal system is understood, one can understand the grave complications of pre-eclampsia with more ease. In conditions like abruptio placenta with preeclampsia, the renal system gets further impoverished of its blood supply. With the added insult of accidental haemorrhage, the kidneys may not be able to bear it any further, and at times, renal failure occurs. In most subjects, the inherent reserve of the renal system can withstand the changes of pre-eclampsia. As a result of this, total renal shut down is not seen often in clinical practice. However, oliguria is consistently seen in pre-eclampsia, especially in pre-eclampsia of a severe type. One more challenge that the obstetrician faces while managing women with pre-eclampsia is handling the fluid and electrolyte balance. There is a consequent decrease in serum creatinine, plasma urea and blood uric acid levels in normal pregnancy. There is a concomitant rise in progesterone, which protects the pregnant woman from hypokalaemia. The threshold for thirst and antidiuretic hormone secretion are depressed, resulting in lower osmolality and serum sodium levels. Increase in blood volume and an increase in renal circulation both contribute to increased urine output. There is more blood to be filtered in pregnancy, and therefore, the renal system goes into an unstressed overdrive. It has been found that when infusions are given to women with preeclampsia, the heart goes quickly into an overdrive. It increases the cardiac output by increasing the Left Ventricular Stroke Work Index. Unluckily in such subjects, the heart is already facing strong resistance from blood vessels that are in vasospasm. Attempts to increase the renal perfusion by increasing the fluid and electrolytes by infusing externally can cause the heart pump to fail. One habit that some practitioners have is trying to combat the renal hypo-efficiency in pre-eclampsia with diuretics. This can also be dangerous because the diuretics will forcibly increase the blood supply to the kidneys. It is, therefore, desirable to put a central venous pressure line to get an idea of how much fluid to give and when not to give any fluid. The renal failure in accidental haemorrhage complicating pre-eclampsia is more a result of tubular necrosis and less of cortical necrosis. If prompt and adequate blood transfusions are given to these subjects, renal failure can be reversed or altogether prevented. It is relevant to note that accidental haemorrhage has a notorious habit to recur and also has the complication of renal shut down. Nevertheless, with better monitoring facilities available and better neonatal intensive care, obstetricians tend to intervene much earlier. If the obstetric team is not vigilant or if the woman is unable to get quality antenatal care, recurrent renal failure with a poor outcome can still occur. In 20% of the subjects in whom the cortical necrosis becomes predominant, renal failure is irreversible, warranting a renal transplant and dialysis. In women with persistent albuminuria in severe pre-eclampsia, there is an increased tendency for renal failure. However, the presence of albuminuria may not be indicative of an impending renal shut down. In actuality, it reflects the compromised renal function, the consequence of which is a renal shut down. Thus, proteinuria is not the cause of renal compromise and renal failure, but in actuality, it is a marker of the underlying pathology. A word about uric acid estimation for assessing renal function in pre-eclampsia will not be out of place here. Although many biochemical markers have been used to assess renal function in non-pregnant women, many of them as seen become incompetent in pregnancy more so in preeclampsia. Uric acid assessment in pre-eclampsia has been done at different times to assess renal function. One study concludes that monitoring of plasma creatinine level among patients with pre-eclampsia will help to predict those at risk of developing pre-eclampsia. In the same way, monitoring of plasma uric acid level in those with pre-eclampsia will help to predict those that will develop eclampsia. Here the role of uric acid gets reinforced as a good prognosticator rather than predictor as has been suggested in this study. It has, therefore, a limited role in reflecting the renal function in a woman with pre-eclampsia. When the level of uric acid is assessed, the state of oxidative stress in the pregnant women is being studied and not the renal function. No wonder, a subsequent study found uric acid to be unreliable for assessing renal function in pregnancy. In the former, the changes are the result of vasospasm and in the latter because of acute blood loss. This team diligently studied and documented renal changes in subjects who died in pregnancy on postmortem. They compared postmortem findings of 112 women without pre-eclampsia who died of hypertensive disorders of pregnancy with those who died of other obstetric causes. They performed postmortems within 2 hours of death, thereby increasing the accuracy of their results. Even after so many years, their results have been corroborated by images obtained through modern imaging technologies. No discussion and pathology of pre-eclampsia or eclampsia is complete without taking into account the description of these workers. The entire compilation of their work has been published in a book by Sheehan and Lynch. All this gives an advantage to workers in this field being able to study the kidneys extensively and easily. This is not to run down the involvement of kidneys in pre-eclampsia and its complications. But the ease of access to kidneys lends great importance to renal changes in pre-eclampsia. Also, there were suggestions that the aetiopathology of pre-eclampsia and its complications lies in the kidneys. It is well-known now that not the kidneys but the foetomaternal interface is at the core of the aetiopathology in pre-eclampsia. Changes emanating here involve other organs including the kidneys and systems in their processes secondarily. Until recently, science did not have an accurate and reliable means to know what is happening at the foetomaternal interface. With the advent of ultrasonography in general and colour Doppler in particular the picture changed. As a result, the accurate picture of aetiopathology became clear to the scientific investigators. We now have a reasonably precise idea of what all causes and what is the sequence of events in pre-eclampsia. Microscopic appearance can be further divided into light microscopic appearance and appearance under electron microscopic. As regards the gross appearance of kidneys in preeclampsia, there is an insignificant increase in the size of the kidneys.

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