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Using the virus affect the reproductive tract and some strains can neutralization test buy malegra fxt 140mg free shipping erectile dysfunction doctors in navi mumbai, he found that antisera against the cause nephritis discount malegra fxt 140 mg overnight delivery erectile dysfunction caffeine. Different serotypes and genetic types Mass type virus did not neutralize this new virus of the virus have been identified worldwide and for designated Conn purchase malegra fxt 140mg amex erectile dysfunction gene therapy. Since that finding types of the virus continue to arise due to mutations many different serotypes (defined by neutralizing and recombination events in the viral genome making antibodies) discount malegra fxt 140 mg mastercard erectile dysfunction guidelines 2014, and genetic types (based on the sequence this virus difficult to identify and extremely difficult of the spike gene), have been described worldwide. The S glycoprotein contains Newcastle disease, infectious laryngotracheitis, avian epitopes for neutralizing and serotype specific mycoplasma and infectious bronchitis. Spike is the most variable protein in (infectious laryngotracheitis virus and Newcastle the virus. This variability is what contributes to the disease virus) and different strains (avian emergence of new virus types and allows the virus to mycoplasmas) making them extremely difficult to continue to be maintained in poultry. This presentation will different viruses in the host, and there is sound th 116 65 Western Poultry Disease Conference 2016 evidence that these genetically different to compare the relatedness of different virus types subpopulations of the virus exist even in vaccine from all over the world allowing for a more informed strains (3, 5). Infection, Genetics and type causing disease followed by vaccination with an Evolution 12:1305-1311. Livestock Sanitary Association:203- countless different types and variants of the virus 209. Genetic diversity and selection regulates gene or the hypervariable 5 end of the spike gene evolution of infectious bronchitis virus. The structure of the virus particles and the efficacious but the same amount of virus delivered by average number of spikes associated with each virion spray cabinet is not. In addition, we measured the titer of the amount of vaccine virus delivered using a hatchery vaccines before and after spray and there was a half spray cabinet. We found that using a 100x dose, Redesign of primer and application of the reverse approximately 88% (Ct= 32. Rapid emergence of a Administration Does Not Damage Avian Coronavirus vaccine virus subpopulation in vaccinated birds with Infectious Bronchitis Virus Vaccine Based on specific changes in the S1 gene is evidence of a Analysis by Electron Microscopy and Virus Titration. Genetic diversity and selection regulates This data indicates that a critical amount of the minor evolution of infectious bronchitis virus. In: A laboratory manual for the th Thus, a new Ark vaccine or alternative vaccine isolation and identification of avian pathogens, 5 ed. The study measurements analyzed with repeated measures to was conducted at the Iowa State University research determine treatment, week, and treatment x week farm during the first half of 2014. If significant, Tukeys test was used to Line W-36 laying hens, with an initial age of 69 separate means of repeated measures. Birds were kept 2 Laying performance was summarized in Table in cage batteries at a density of 438 cm /bird. Birds fed a diet with GalliPro Max had the highest controlled feeding and offered 100-105 g/bird/day. Feed conversion ratio calculated as 2 amount of feed consumed per unit of egg produced. Live Both GalliPro Max and GalliPro Tect resulted in body weight- individual weights were measured. Energy or calorie Feed consumption was measured weekly, and feed conversion is expressed as amount of kilo calorie efficiency was calculated (egg mas/kg feed). Egg required to produce per kg eggs, GalliPro Max and production was recorded every day. Eggs Control for each kg eggs produced, which were of different treatments were collected separately. Both GalliPro Max Bacillus Subtilis (GalliPro Max) on energy and GalliPro Tect resulted in heavier eggs (1. Treatment Control GalliPro Tect GalliPro Max Ingredients -------------------------- % ----------------------- Corn 60. Treatment Ingredients Control GalliPro Tect GalliPro Max ------------------------Analyzed ------------------- Crude protein, % 17. Malladi A College of Veterinary Medicine, University of Minnesota, 1365 Gortner Avenue, St. An additional welfare issues, economic consequences, and food six premises were designated as dangerous contacts supply impacts. Established state staff during the response period, which is science and risk based approaches were used as the equivalent to more than 41 hours per day (4). All control cleaning and disinfection procedures, surveillance areas were released on July 28, 2015 (2). Taken together, these differences have representatives also were in attendance, primarily as th 124 65 Western Poultry Disease Conference 2016 observers. On the Both work groups already have convened and have day of the event, an overview of continuity of made significant progress to date. Available with respect to who should have responsibility for from: various aspects of the process. Wrinkled, salpingitis, peritonitis, and respiratory tract infections soft and thin egg shells were also observed and may (2). Genome sequencing and phylogenetic locations in the body were highly similar; indicating relatedness were also examined. Control efforts that isolates residing in their natural habitat (upper focusing on environmental and water sanitation, G. In a disease control were considered effective in reducing recent publication, it was shown that nasal the severity of the problem. Fresh mortality was selected from th 126 65 Western Poultry Disease Conference 2016 representative flocks for necropsy exam. Strains were assessed for of Gallibacterium anatis were observed in all motility, biofilm formation and general biochemical isolates. The isolates broke out into varying clades sequencing libraries, constructed according to with a variation of 0. Libraries were inspissated secretory material within the glandular quantified and pooled prior to being loaded into an parenchyma and ducts. Sequences were aligned and a colonies of bacteria, of the same morphology of that phylogenetic tree was constructed using the ClustalW identified in the oviduct. Spleen had acute diffuse necrotizing splenitis Draft assemblies for each strain were generated using with necrosis of the white pulp. Single nucleotide The zones of necrosis were circumscribed by polymorphisms were identified between the 41 multinucleated giant cell macrophages. Large blood genomes examined, and a phylogenetic tree was vessels within the zones of necrosis had cellular constructed from these data using Maximum thrombosis. In vivo studies though some differences were observed in biofilm of Gallibacterium anatis infection in chickens. A 5-year retrospective report The lesion pattern of lesions in the oviduct and of Gallibacterium anatis and Pasteurella multo- the occurrence of bacteria of similar morphology in cida isolates from chickens in Mississippi. This has been the state of the contagious upper-respiratory tract disease of technology for the past 30 years. There are many parameters predisposition to secondary infections and that can affect spray application efficacy, including condemnation at the processing plant. The turbulence and shearing regional in distribution; the Arkansas (Ark) serotype, forces created by the depression and pulling back of for example, is found almost exclusively in the the syringe plunger can destroy over a log of virus United States. Why some serotypes spread rapidly titer, depending on application volume and number of and with high efficiency while others remain syringes. Administering them to individual changed to accommodate larger volumes of vaccine chickens by eye-drop would be the gold standard for per chick basket. Increasing nozzle flow rate will also efficacy, but is logistically not possible considering increase droplet size, while increasing the number of the scale of poultry production. Therefore, mass nozzles and decreasing the flow rate of each nozzle application by spray is the only realistic method of will decrease droplet size.

Item Scleroderma The Committee is aware that scleroderma buy malegra fxt 140 mg on-line erectile dysfunction icd 9 code, an over-production of collagen resulting in the hardening of skin and joints purchase 140 mg malegra fxt visa erectile dysfunction at age of 20, affects an estimated 300 discount malegra fxt 140 mg online impotence at 70,000 people in the U generic malegra fxt 140mg otc impotence natural treatments. Further, these data serve as a population-based case series of children from which to conduct future epidemiologic research examining potential risk and causative factors of cerebral palsy. The vast majority of these limb losses are attributed to diabetic infection resulting in limb amputation and current military/war events and practices. A registry will estimate the incidence and prevalence of limb loss, promote a better understanding of limb loss, and provide data that will be useful for research on improving limb loss management and developing standards of care. Item Marfan Syndrome The Committee continues to be interested in Marfan syndrome. Many individuals affected by Marfan syndrome are undiagnosed or misdiagnosed until they experience a cardiac complication. Increasing awareness of this genetic condition is vital to ensuring timely diagnosis and appropriate management and treatment. The Partnership group, facilitated by the National Center for Birth Defects and Developmental Disabilities, encourages collaboration with other groups interested in disabling conditions. The conference will provide an opportunity for increasing awareness and knowledge of Marfan to health care providers, affected families, and the public. These Centers have gathered information from more than 32,000 families and are using this information to look at key questions about birth defects. Researchers have identified significant findings on environmental factors such as nutrition and smoking. Item Thalassemia The Committee believes that the thalassemia program, which provides blood safety surveillance to patients with this fatal genetic blood disease, has benefitted those patients by assuring that they are monitored closely by major research centers, while at the same time benefitting the general population by providing an early warning system of potential problems in the blood supply. Data collected will contribute to the scientific knowledge base on thalassemia and will play a significant role in the development of research ideas and methods to optimize health outcomes of individuals with thalassemia. Item National Health Interview Survey The Committee is concerned over the lack of health care data about the lesbian, gay, bi-sexual and transgendered community. Initial research indicates that the concept is complex and that question improvements are needed. These surveys provide unique insights into the health status of the American people and are an important resource to policymakers at the Federal, State, and local levels of government. Further cuts to the sample sizes of these surveys could compromise our ability to monitor health disparities at a time when our society becomes increasingly diverse. This effort is complicated by the fact that revisions to the standard birth and death certificates in 2003 have not been adopted by all states, creating challenges to producing national level data. States will examine chemical exposures in communities or vulnerable populations, substantially improving exposure assessments compared to current environmental modeling. These pilot grants will inform future development of state, territorial, city, and county climate change programs. The purpose of this paper is to identify research needs for all aspects of the researchtodecision making pathway that will help us understand and mitigate the health effects of climate change, as well as ensure that we choose the healthiest and most efficient approaches to climate change adaptation. This agenda is currently under inter-agency clearance and will serve as a roadmap for federal climate change research. Item National Environmental and Health Outcome Tracking Network The Committee supports the continued development of the National Environmental and Health Outcome Tracking Network. With the increased resources provided in fiscal year 2009, five new grantees will be funded taking the total number of grants to 22. In fiscal year 2010, the Committee provides increased funding to enable at least one additional State to integrate environmental and health outcome data and participate in National Environmental and Health Outcome Tracking Network. Funding was awarded through a competitive process open to previous grantees and all other non-funded states, locales, territories, and tribal nations. The 2009 application process indicates strong interest among states to participate in the National Environmental Public Health Tracking Program. Item Newborn Screening for Severe Combined Immune Deficiency The Committee is pleased that this newborn screening program has supported pilot projects in the States, which have led to the identification, treatment, and cure of patients with this fatal disease. Item Fostering Public Health Responses Program Nearly one third of American women report being physically or sexually abused by a husband or boyfriend at some point in their lives. The problem has immense financial considerations, with the health-related costs of intimate partner violence in the U. Early detection and treatment of victims and potential victims not only addresses the victims needs, but can financially benefit health care systems in the long run. Therefore, the Committee urges the development of the Fostering Public Health Responses Program to coordinate the public health response to domestic violence. Item Gun Control Advocacy The Committee maintains bill language prohibiting funds in this bill from being used to lobby for or against the passage of specific Federal, State, or local legislation intended to advocate or promote gun control. Such a program would support cross-training to enhance community responses to families where there is both child abuse and domestic violence. As the two problems often occur together, dealing with one problem and not the other is at the peril of our children. The demonstration sites joined battered womens organizations, child protection agencies, the courts, and other partners in implementing the recommendations from Effective Interventions in Domestic Violence and Child Maltreatment Cases: Guidelines for Policy and Practice. Every local site was evaluated individually, and a comprehensive national evaluation was conducted at the completion of the initiative. Many lessons were learned and products such as training curriculums, community assessment tools and multimedia materials were developed and collected to assist others in doing this work. The system should also include real-time three dimensional immersive surveillance tracking capabilities. The network infrastructure should be self-healing, redundant, and survivable during day-to-day operations and in emergency situations. An underground coal mine in Kentucky has been identified as a strong candidate for such a test bed. Item Pandemic Influenza The experience with the 2009 outbreak of the novel H1N1 virus has identified significant deficiencies in efforts to protect health care workers in the event of a pandemic influenza. Controlled studies to address the efficacy of surgical masks and filtering facepiece respirator use in preventing transmission of influenza are underway. This research will assess the rate at which respirator fit changes as a function of time and will also assess factors that effect change in respirator fit. The collaboration addressed respirator characteristics particularly germane to health care workers. Continuation of these efforts are leading to the development of standards for improving respirators used in health care settings and ultimately a respirator for the health care worker which meets the use criteria identified by health practitioners. Advances produced from this research will be incorporated into the standards development process as they occur. Implementation/operations research should be conducted in collaboration with a variety of federal agencies, including research agencies (e. The Committee is pleased that the report provides an overview of public health preparedness activities and details accomplishments and challenges. The Committee expects the Department to collect and review State by State data on benchmarks and performance measures developed pursuant to the provisions of the Pandemic and All-Hazards Preparedness Act and to detail how preparedness funding is spent in each State. These data should be made available to the Congress, State and local health departments, State and local governments, and to the public. The Committee further expects that as the Department collects and evaluates State pandemic response plans, the results of these evaluations will be made available to the Congress and to the public. These state pandemic plans currently are in operation with the 2009 H1N1 influenza response. Ongoing evaluation of pandemic operations plans will be conducted on a regular basis. The justification should include a breakdown of intramural and extramural spending and should reflect funding mechanisms used for extramural support, such as contracts, cooperative agreements and grants. All other activities, including the Early Diagnosis and Screening program have been included at the 2009 level.

A supplement check was ordered generic malegra fxt 140 mg with amex erectile dysfunction protocol food lists, to make sure she had them all and was taking them all 140 mg malegra fxt overnight delivery erectile dysfunction viagra free trials. I decided to search through my entire bacteria collection (the slides) for any clues to the responsible varie- ties discount 140 mg malegra fxt mastercard erectile dysfunction ed natural treatment. Five clostridium species generic 140 mg malegra fxt mastercard impotence postage stamp test, Lactobacillus acidophilus, and Staphylococcus aureus were all still present at the breast. The dentist had pointed out to her that three out of four wisdom teeth pulled a long time ago appeared to have cavitations left behind. She had acquired an enlarged lymph node under her chin just recently, testimony to the streams of bacteria and toxins flowing from the mouth. Her first task was to see the special dentist for plastic removal by air abrasion. When she returned from the dental visit, the breast still had all the ma- lonates accumulated as before. Unless the malonates and metals were removed from the teeth with meticulous care, the bacteria could not be eradicated. She could schedule her follow-up ultrasound of the breast in ten days if this continued. She was instructed to floss once a day with nylon thread and brush with white iodine. If it had, would this persuade her and her husband to be patient and keep the fillings open at least till the baby was born? But while on these errands panic struck and anxi- ety sent her directly to a dentist to put fourteen temporary fillings in her mouth. The next day, January 15, only one day after the temporary fillings were put in, clostridium and lactobacillus bacteria were back in her teeth! It would be a certain mastectomy and a certain death at a young age when motherhood, I felt, was her birthright. Two days later, January 17, depressed and anxious instead of happy and dancing, she still had done nothing. But a single swipe to coat the nerve with any special desensitizer and sealer was probably the true cause. It had taken our diagnostic team two years to find the extreme sensitivity of the cancer patient to even the tiniest dose of tumorigen permanently placed in the teeth. No dentist could guess it or be blamed for applying the state-of-the-art details that make dentistry so- phisticated and enjoyable. Our resolve had to be to tighten our hold on the unsuspecting patient to prevent misguided dentist visits. Only a special den- tist, aware of the pitfalls of using adjunctive materials could ever be patron- ized in the future. She would have to go back to the specialist who could do air abrasion for the third time! With the newly cancer-free breast all but a certainty, she did not want to spend another $100. She tested Positive for nickel and formaldehyde when she arrived, two serious lung toxins. Now she was started on interleukin at the National Cancer Institute of Bethesda, Marylandan immune therapy. The doctors said the cancer was advancing too rapidly, the interleukin was doing no good; she was on their high dosage already. She took the news with the stoicism of a Roman gladiator: she was given two months. Dec 31 about 200 closely packed small tumors (small white areas) in the lungs We must avoid massive infection at her lungs. Would there be bleeding on a grand scale when the tumors pulled away from the thin pleura, as we had seen so often for large tumors? Initial electronic testing at the lung showed 5 clostridium species, Lac- tobacillus acidophilus, E. Maybe Shigella flexneri was taking its toll on her mood; it is a depression-causing bacterium. When so many bacteria are present, I expect a lot of growth factors to be abnormally present also. Lactoferrin was Negative at breast, liver, and bone marrow; it should have been Positive. Her good health and youthfulness would now be called upon to make success possible. The low creatinine implied there was not enough arginine or methyl groups or glycine. She had been on iron tablets daily when she arrived, no doubt responsi- ble for the excellent iron level. She was started on a daily enema using black walnut tincture extra strength to reduce the bacterial levels in the bowel, thereby reducing them overall. She was told to drink raw milk, boiled 10 seconds and vitamin C-ed, to provide lactoferrin. She thought she was allergic to iodine, so peroxide was tried for dental sterilization instead of Lugols. Later she was given homemade colloidal silver to take during dental-work days; it was definitely superior to peroxide. She also had maleic anhydride there, starting liquid effusion and water accumulation. Three clostridium bacteria were still Positive at the lung and one clos- tridium (septicum), was still Positive at the tooth location. Evidently phenyla- lanine could convert to tyrosine, but not the other way around. She was taken off dairy and meat products entirely to reduce phenylalanine in her diet. By now, Clostridium was eliminated from the tooth location, though it was still present at the colon. Her uric acid level had fallen, revealing throngs of clostridium bacteria remaining. Four days later, January 22, she had bacteria back in her lungs; it was a setback. The situation would be hopeless un- less the benzene source was found and cleared. She got impressions triglycerides 219 150 142 84 cholesterol 145 154 148 152 made for her new partials. Summary: At this rate, only one more week would surely have dis- solved the remaining six. This scientific bent, no doubt, ex- plained her organized approach to all problems including her own health. She had returned to the clinic full of hope that something could be done for her creaky, painful knee and hip. She had believed from the age of twenty, when it was diagnosed, that she would go blind eventually. For 40 years the idea that an alternative approach was possible was branded quackery by her fellow workers, and she absorbed this disdaining attitude.

We could observe maleic anhydride being formed from maleic acid by the body if vitamin C was present buy malegra fxt 140 mg amex viagra causes erectile dysfunction. And maleic anhydride could be further detoxified to D-malic acid trusted 140 mg malegra fxt erectile dysfunction drugs sales, again malegra fxt 140mg on-line male erectile dysfunction pills review, if vitamin C was present buy 140 mg malegra fxt amex erectile dysfunction garlic. Nor did we know that acrylic plastic is detoxified to malonic acid by the body, which then could be turned into maleic acid. Her chest X-ray showed a pear shaped mass, pronounced lymphatic nodules, and fluid at the base that obliterated the lung margin. The total protein was also very slightly elevated; the globulin just a bit too high. She got off to a slow start by not getting into the copper-free housing immediately. In spite of perfect adherence to the malonate-free diet, it was still present at the parathyroids. The rise in serum iron could only mean there was less copper toxicity due to amalgam removal. She was no longer huffing and puffing; her voice sounded strong; her personality sparkled. We needed her continued optimism and compliance if we should do an early follow-up. The new X-ray showed almost double her former air ca- pacitytwice as much white area on the print. June 26 air capacity doubled, tumor dis- solving The water-logging of her lungs had stopped, the base of the lung was now fully expanded where water had accumulated before (see arrow drawn by radiologist on earlier X-ray). The large tumor had lost its top half; it was evidently pulling apart and dissolving. By June 28, a blood test showed her iron level up to normal, and other improvements. It had been about ten days since her amalgam had been removed and plastic installed. We could attribute the gain to amalgam removal, should we blame the plastic for the deterioration? The pain was actually under the left breast, no doubt where the large lung tumor had its remains. We started her on Lung Tea, mullein and comfrey, cooked together to make a strong tea. She pulled out a personal air purifier with a shiny metal case that you hang around your neck; it blows purified air at you. But she still had pain in the lung near the breast bone in the morning when awakening. When she arrived in the morning totally fasted, a saliva sample was still Positive for malonic acid derivatives. She had received three crowns (against directions), one bridge, eight fillings, and two porcelain fillings (against directions). With a bacterial problem like hers, it was ill advised to invite them into a new hiding place under a crown. We explained it was not a moral issue, as she carefully brushed the tiny bit of plastic that was covering her tooth stub. The body would detoxify it to maleic anhydride and then not be able to detoxify it further in the lung. Her mouth looked beautiful again, her tumor was gone (last X-ray not shown), her lungs worked, and her departure date was just days away. And we had learned a mighty les- son: that malonic acid could come not only from tapeworm stages and food, but from a totally unrelated, inanimate sourceplastic. And it was a pre- cious discovery made by electronic testing of dental plastic directly. Would we now be able to clear up the mystery-source of malonates that had plagued us for so long? There were nine hemangioma-like cysts in the liver, which were the cause of her anxiety. She felt the brain tumor was not bothering her, although she had some facial paralysis. Our testing, though, showed there was malignancy (ortho-phospho- tyrosine) in the brain, not in the liver. If it rained and a main water pipe broke, water would be brought in by tankers; this always contained copper and all clinic patients did a hasty exodus to other quarters. Her metal glasses frames needed to be changed to plastic, too, to eliminate copper. Wendy was a forward looking person, though, ever practical; she scheduled it all for re- moval regardless of obstacles. She should eat high fat food, such as avoca- Aug 12 inner white spot with square is dos, butter, and cream. For the first eight days she continued to test Positive for copper and malonic acid. The tumor triglycerides 72 was about half its earlier size of a year cholesterol 232 ago. A liver scan was done, too (not shown), revealing the nine heman- giomasnot tumors. In her haste and anxiety over unfilled teeth, she accepted unsafe plastic dental ma- terial for restorations. Cancer Suzanne Codding was a beautiful twenty month-old girl, but there was quite a lump on the right side of her neck, It might have started with strep throat for which she had been given Augmentin and Amoxicillin (antibiotics). It was surgically removed and clinically tested for everything: malignancy, fungus, and bacteria. It was only six weeks since the surgery and the lump had already returned; in fact, it was 1 x 1 inches in size. Taking the tuberculosis hint, I searched for resonance with my three My- cobacterium slides. Ortho- phospho-tyrosine was Positive, indicating a malignancy, despite the earlier clinical tests. It can be found in the dental area, possibly under tooth fillings or in tooth infections, Of course, Suzanne had neither. Suzannes parents both tested Positive to Mycobacterium phlei, although there was no family dog. Perhaps she had been licked on the face: The parents were ad- vised not to let the child near a dog. They had done everything else, including daily zapping and once-a- week parasite herbs, scaled down to her age. But she was still Positive for copper and malonic acid although they had finished the plumbing job. They had been visiting relatives with her and her milk had been boiled, but no vitamin C had been added (this allows ma- lonic acid to persist). She had picked up some aflatoxin while visiting relatives, but the parents prom- ised to be more watchful. August 12 was their last visit, nothing could be seen or felt at the site of the former tumor. If the six- teen nodules were benign, then surgery to remove the prostate seemed wise to one of his doctors. But if the 16 nodules were malignant, then he was in a late stage of disease, with very little hope and prostate surgery useless. He started the parasite program at home, cor- rected his life style to shut out isopropyl alcohol and zapped a lot. He had successfully stopped his can- cer, but the task was now to shrink his tumors.

S Israel; General Pathology cheap 140 mg malegra fxt fast delivery erectile dysfunction treatment in uae, Churchill Livingston Edinburgh and th London cheap 140mg malegra fxt with amex erectile dysfunction foods that help, 4 edition generic malegra fxt 140 mg fast delivery impotence legal definition, 1974 th 5 discount 140mg malegra fxt amex erectile dysfunction vitamin e. Define hyperplasia, hypertrophy, atrophy, & Metaplasia & list some of their causes. Which of these outcomes occur depends on both the injurious agent & on cellular factors. In other words, the result depends on the type, severity, & duration of the injury & on the type of the cell. This chapter covers the types of cellular adaptation, reversible cell injury, & cell death in that order. Types of cellular adaptation The types of cellular adaptation include hypertrophy, atrophy, hyperplasia, & metaplasia. Increased workload leads to increased protein synthesis & increased size & number of intracellular organelles which, in turn, leads to increased cell size. Examples: the enlargement of the left ventricle in hypertensive heart disease & the increase in skeletal muscle during sternous exercise. It can be physiological as in enlargement of the breast during pregnancy or it can pathological as in endometrial hyperplasia. The atrophic cell shows autophagic vacuoles which contain cellular debris from degraded organelles. Metaplasia Metaplasia is the replacement of one differentiated tissue by another differentiated tissue. Squamous metaplasia This is replacement of another type of epithelium by squamous epithelium. For example, the columnar epithelium of the bronchus can be replaced by squamous epithelium in cigarette smokers 2. Osseous metaplasia This replacement of a connective tissue by bone, for example at sites of injury. Reversible cellular changes & accumulations Even though there are many different kinds of reversible cellular changes & accumulations, here we will only mention fatty change & accumulation of pigments. These etiologies cause accumulation of fat in the hepatocytes by the following mechanisms: a. Melanin Melanin is a brownish-black pigment produced by the melanocytes found in the skin. Bilirubin Bilirubin is a yellowish pigment, mainly produced during the degradation of hemoglobin. Excess accumulation of bilirubin causes yellowish discoloration of the sclerae, mucosae, & internal organs. Hemolytic anemia Hemolytic anemia is characterized by increased destruction of red blood cells. Biliary obstruction This is obstruction of intrahepatic or extrahepatic bile ducts. Hepatocellular disease This is associated with failure of conjugation of bilirubin. It appears in tissues as golden brown amorphous aggregates & is identified by its staining reaction (blue 17 color) with the Prussian blue dye. Hemosiderin exists normally in small amounts within tissue macrophages of the bone marrow, liver, & spleen as physiologic iron stores. Hemosiderosis When accumulation of hemosiderin is primarily within tissue macrophages & is not associated with tissue damage, it is called hemosiderosis. Necrosis In necrosis, excess fluid enters the cell, swells it, & ruptures its membrane which kills it. After the cell has died, intracellular degradative reactions occur within a living organism. Ischemia can be caused by obstruction of arterial blood flow the most common cause, or by decreased perfusion of tissues by oxygen-carrying blood as occurs in cardiac failure, hypotension, & shock. The cell injury that results following hypoxia can be divided into early & late stages: 1. Failure of the cell membrane Na K pump, which leads to increased intracellular Na & water, which cause cellular & organelle swelling. Cellular swelling (hydropic change) is characterized by the presence of large vacuoles in the cytoplasm. It is caused by massive calcium influx & very low pH, which lead to activation of enzymes, which damage the cell membrane& organelle membranes. Free radical-induced injury Free radical is any molecule with a single unpaired electron in the outer orbital. Cell membrane damage Direct cell membrane damage as in extremes of temprature, toxins, or viruses, or indirect cell membrane damage as in the case of hypoxia can lead to cell death by disrupting the homeostasis of the cell. Increased intracellular calcium level Increased intracellular calcium level is a common pathway via which different causes of cell injury operate. For example, the cell membrane damage leads to increased intracellular calcium level. The increased cytosolic calcium, in turn, activates enzymes in the presence of low pH. Coagulative necrosis Cogulative necrosis most often results from sudden interruption of blood supply to an organ, especially to the heart. It is, in early stages, characterized by general preservation of tissue architecture. It is marked by the following nuclear changes: Pyknosis (which is chromatin clumping & shrinking with increased basophilia), karyorrhexis (fragmentation of chromatin), & karyolysis (fading of the chromatin material). Liquefactive necrosis Liquefactive necrosis is characterized by digestion of tissue. Fat necrosis Fat necrosis can be caused by trauma to tissue with high fat content, such as the breast or it can also be caused by acute hemorrhagic pancreatitis in which pancreatic enzymes diffuse into the inflamed pancreatic tissue & digest it. The fatty acids released from the digestion form calcium salts (soap formation or dystrophic calcification). In addition, the elastase enzyme digests the blood vessels & cause the hemorrhage inside the pancreas, hence the name hemorrhagic pancreatitis. Caseous necrosis Caseous necrosis has a cheese-like (caseous, white) appearance to the naked eye. Gangrenous necrosis This is due to vascular occlusion & most often affects the lower extremities & the bowel. It is called wet gangrene if it is complicated by bacterial infection which leads to superimposed liquefactive necrosis. Whereas it is called dry gangrene if there is only coagulative necrosis without liquefactive necrosis. Apoptosis usually occurs as a physiologic process for removal of cells during embryogenesis, menstruation, etc It can also be seen in pathological conditions caused by mild injurious agents. Metastatic calcification This is caused by hypercalcemia, resulting from hyperparathyroidism, milk-alkali syndrome, sarcoidosis etc 2. Inflammation is fundamentally destined to localize and eliminate the causative agent and to limit tissue injury. Thus, inflammation is a physiologic (protective) response to injury, an observation made by Sir John Hunter in 1794 concluded: inflammation is itself not to be considered as a disease but as a salutary operation consequent either to some violence or to some diseases. Causes: Causes of inflammation are apparently causes of diseases such as physical agents - mechanical injuries, alteration in temperatures and pressure, radiation injuries. Thus, inflammation of the appendix is called appendicitis and that of meninges as meningitis, etc. Classification: Inflammation is classified crudely based on duration of the lesion and histologic appearances into acute and chronic inflammation. The five cardinal signs of acute inflammation are Redness (rubor) which is due to dilation of small blood vessels within damaged tissue as it occurs in cellulitis. Some chemicals of acute inflammation, including bradykinins, prostaglandins and serotonin are also known to induce pain.

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