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Which hepatitis B marker is the best indicator of Answers to Questions 28–33 early acute infection? Which is the first antibody detected in serum is the first detectable hepatitis B antibody discount floxin 400mg online. What is the most likely explanation when a of hepatitis B infection when both the surface antigen patient has clinical signs of viral hepatitis but tests and surface antibody are undetectable purchase 200mg floxin with amex. The IgM negative for hepatitis A IgM, hepatitis B surface anti-hepatitis B core and the anti-hepatitis B core total antigen, and hepatitis C Ab? Tests were performed improperly markers in the serum of a patient in the core window B. Which hepatitis antibody confers immunity against reinfection with hepatitis B virus? Given a heterophile antibody titer of 224, which consistently elevated in viral hepatitis? No titer reduction No titer reduction Immunology/Correlate laboratory data with C. Five-tube titer reduction Five-tube titer reduction physiological processes/Hepatitis/Testing/1 D. Hepatitis B virus vaccination health and disease states/Serum sickness/Testing/2 B. Highest levels occur in acute viral hepatitis, physiological processes/Hepatitis/Testing/2 reaching 20–50 times the upper limit of normal. A Antibodies to infectious mononucleosis (non- Forssman antibodies) are not neutralized or absorbed 38. A positive test is indicated by at least a Absorption with Absorption with Beef four-tube reduction in the heterophile titer after Guinea Pig Kidney Cells absorption with beef cells and no more than a A. Two-tube titer reduction Five-tube titer reduction three-tube reduction in titer after absorption with guinea pig kidney. Five-tube titer reduction No titer reduction guinea pig kidney and beef cell antigens, and at least a three-tube (eightfold) reduction in titer should Immunology/Evaluate laboratory data to recognize occur after absorption with both. Given a heterophile antibody titer of 224, which Answers to Questions 40–44 of the following results indicate an error in testing? B An individual with a 56 or higher titer in the Absorption with Absorption with Beef presumptive test (significant heterophile antibodies) Guinea Pig Kidney Cells has either Forssman antibodies, non-Forssman A. Five-tube titer reduction Five-tube titer reduction is observed after absorption because absorption D. Serial dilutions are prepared and the highest dilution showing agglutination is the Immunology/Apply principles of laboratory endpoint. Highest serum dilution that shows no significant if it is 166 Todd units or higher. Lowest serum dilution that shows agglutination demonstration of a rise in titer from acute to D. Lowest serum dilution that shows no convalescent serum is required to confirm a current agglutination streptococcal infection. Which increase in antibody titer (dilution) best was negative, even though the patient showed indicates an acute infection? Another streptozyme test using diluted serum Immunology/Correlate laboratory data with C. A A streptozyme test is used for screening and contains several of the antigens associated with 46. Because some patients obtained from nasopharyngeal swabs detect: produce an antibody response to a limited number A. IgA-influenza Ag immune complexes sensitivity is increased by performing additional tests D. How can interfering cold agglutinins be removed patients with recent streptococcal infections than from a test sample? The absorbed serum will be Immunology/Apply principles of special procedures/ free of cold agglutinins. All tubes (dilutions) except the negative control are have cold agglutinin disease, a cold autoimmune positive for cold agglutinins. A rare antibody against red cell antigens positive, except the negative control, then a high titer C. Te sample was stored at 4°C prior to separating of cold agglutinins is present in the sample. C Cold agglutinins do not remain reactive above 30°C, Immunology/Select course of action/Cold agglutinins/ and agglutination must disperse following incubation Testing/3 at 37°C.

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Quaternary ammonium compounds (Quates) It causes loss of cell membrane semi permeability leading to loss of nutrients and essential metabolites buy floxin 200mg otc. Soaps and fatty acids It causes gross disruption of cell membrane lipoprotein frame work buy 400mg floxin. Active at acidic P Phenolic compounds Phenol is highly effective in Gram positive bacteria. Currently used as a standard for measuring bactericidal potency of new chemicals i. Phenol coefficient is the ratio of the concentration of the new chemical agent being tested to the concentration of the reference standard (phenol) required to kill in a specific time. If phenol coefficient is less than one, the new chemical agent is less effective than phenol. If phenol coefficient is equal to one, the new chemical agent is equal to phenol in efficacy. If phenol coefficient is more than one, the new chemical agent is more effective than phenol. Active against Gram-positive bacteria, Gram-negative bacteria and acid-fast bacilli. Causes conformational alteration of proteins (unfolding of polypeptide chain) resulting in irregular looping and coiling of polypeptide chain. Acids like benzoic acid, citric acid and acetic acid are helpful as food preservatives: extending storage life of food products. Chemical agents that modify functional groups of proteins and nucleic acids Heavy metals 1. Hydrogen peroxide (3%) Used for cleansing of wound, disinfecting medical-surgical devices and plastic contact lenses. Formaldehydde Glutaraldehyde Ethylene oxide Formaldehyde 37% aqueous solution form is named as formalin. Dry heat : It is less efficient and requires high temperature and long period heating than moist heat. Incineration : It is an efficient method of sterilization and disposal of contaminated needles, syringes and cover slips at high temperature b. Red heat : Inoculating wires, loops and points of forceps are sterilized by holding them in the flame of a Bunsen burner until they are red hot. Flaming: Scalpels and neck of flasks, bottles and tubes are exposed for a few seconds, but it is of uncertain efficacy. Hot Air Sterilizer (Oven): it is essential that hot air should circulate between the objects being sterilized and these must be loosely packed and adequate air space to ensure optimum heat transfer. Tyndallization : Intermittent steaming (Fractional sterilization) 0 Steaming of the material is done at 100 c for 30 minutes on three consecutive days. The principle is that spores which survived the heating process would germinate before the next thermal exposure and then would be killed. It is used for sterilizing heat sensitive culture media containing materials such as carbohydrates, egg or serum. Pasteurization: It is the process of application of heat at temperature of 100 0 0 62 c for 30 minutes(Holder method) or 72 c for 15 seconds (Flash method) followed by rapid cooling to discourage bacterial growth. Autoclaving : Steam under pressure It is based on the principle that when water is boiled at increased pressure, hot saturated steam will be formed which penetrates and gives up its latent heat when it condenses on cooler objects. Hot saturated steam in autoclaving acts as an excellent agent for sterilization because of: 1. Uses: Sterilize solid and fluid culture media, gowns, medical and surgical equipment. Time –Temperature-Pressure level relationship in moist heat sterilization (autoclaving) Temperature Time Pressurelevel 0 2 121 c 15 minutes 15 lb/inch 0 2 126 c 10 minutes 20 lb/inch 0 2 134 c 3 minutes 30 lb/inch Methods of controlling sterilization 1. Color change of autoclave tape from blue to brown-black indicates completesterilization. Biological indicator : Use of paper strips impregnated with spores of Bacillus stereothermophilus. Put the paper strip in the culture medium after autoclaving and observe for germinating bacteria to check for growth. It prevents active multiplication of bacteria by decreasing the metabolic activity of bacteria. Radiation : Ioning and ultra violet radiation Ioning radiation includes χ ray, γ ray and β ray. Ultra violet radiation has less quantum energy with low penetrating power than ionic radiation.

On the other hand order 400 mg floxin amex, Black is an inclusive term that describes the shared social and political culture of people that share physical traits such as skin color purchase 400 mg floxin with mastercard, hair texture, and distinct facial features (Barksdale, Farrug, & Harkness, 2009). Thus, Blacks may not be African Americans since Blacks include people who originated from other countries that may include the Caribbean, Central America, South America, Europe, and African. Neither the term African American or Black refers to a homogeneous group, but rather includes numerous subgroups with common physical traits (Barksdale et al. The category Negro is rarely used except in a historical context and considered obsolete. Because this study does not specify the origin of descendants, the more inclusive term Blacks was used to reference the study population. Considerable legislation was passed by congress during the Civil Rights movement to legally address segregated education, voting rights, employment discrimination, access to public housing (Byrd & Clayton, 2002) and segregated public places (Civil Rights Act, n. Racial discrimination in all federally assisted programs such as Medicare and Medicaid was prohibited, and all hospitals who were recipients of federal funds were obligated to comply with civil rights legislation. While Blacks had access to hospitals throughout the nation during the 1970s and 1980s, health disparities continued to widen between Whites and racial/ethnic minorities, but the gap was more profound for Blacks (Gamble & Stone, 2006). Still, in the year 2000, laws were enacted because of minority health inequalities. Unfortunately, inequalities in healthcare persist today for Blacks and other racial/ethnic groups despite the Civil Rights movement and legislative action. Research findings confirmed the perceptions of injustices and discrimination experienced by many Blacks in various health care situations. For example, cardiac care is one area of health care that consistently demonstrates disparity in health care access and delivery. Equally perplexing is the strong link related to finances and access to cardiac care (Mayberry, Mili, & Ofili, 2002) that oftentimes result in discriminatory practices for poor people. It is also daunting to consider that discriminatory practices persist even in Blacks and other minority/ethnic groups who have the ability to pay for health care services (Kennedy, Mathis, & Woods, 2007). Recognition of disparities in health care have been the impetus for local, state, federal, and private efforts to address this issue (Betancourt, 2009). Disparate health care, coupled with fear and distrust, have continued over the course of several centuries creating a powerful motivating factor for nonadherence and result in limited use of health care services and sicker presentations requiring emergency care (Rand & Sevick, 2000). Understanding the historical context of Blacks in this country provides some clues about nonadherent behaviors. Male and female participants differed in that the majority of females stated they respond to racism by holding their anger in whereas males were more likely to express their anger. Black women reported the highest levels of perceived unfair treatment followed by Chinese women. Authors surmised that this observation may reflect cultural differences in encountering and responding to racism in the United States. In both studies, differences between men and women were not significantly different. However, the exact mechanism responsible for the negative physiological and psychological health outcomes remains unclear. There is an old myth that depression is rare for Blacks, especially Black women (Fakhruddin, Woolridge, & Khan, 1975; Jones & Shorter-Gooden, 2003). Because depression is oftentimes camouflaged in Black women, it may not be physically detected due to a confident, tough appearing exterior (Jones & Shorter-Gooden, 2003). In addition, depression may not be easily identified on standardized instruments because perceptions of depression are different in Black women who often complain of feeling tired or stressed out. Jones and Shorter-Gooden (2003) describe depression in Black women as the loss of self or loss of one‘s identity whereby self is silenced, as opposed to typical depression that is precipitated by an external loss such as death or a job. Participants described depression as a mask, oppressiveness on the inside, and as a strong Black woman on the outside and breaking down on the inside. According to Duckworth (2009), the avoidance of emotions among Black women originated during slavery as a survival technique that has now evolved into a cultural habit. Traditionally, Blacks have not sought treatment because depression is perceived as a personal weakness as opposed to a health problem. Therefore, health care providers may need 78 additional training to appropriately screen Black women for depression (Schoenthaler, Ogedegbe, & Allengrante, 2009). The study found that Blacks and Hispanics were less likely than Whites to think that antidepressant medication was acceptable treatment for depression. The odds of finding counseling acceptable as a treatment option were significantly higher for Hispanics and lower for Blacks when compared to Whites. In additions, Blacks were more likely to believe that prayer may help heal depression and stated a preference for a health care provider of the same race.

Down syndrome can also be screened by assaying maternal serum levels of a-fetoprotein 400 mg floxin free shipping, chorionic gonadotropin buy cheap floxin 200mg online, and unconjugated estriol. This so-called triple screen can detect approximately 70% of fetuses with Down syndrome. At During Metaphase 2, each the end of Meiosis 1, each chromosome aligns individually daughter cell has one homolog. In Anaphase 2, sister chromatids migrate to opposite poles and each daughter cell gets one chromatid Figure 11-3-2A. Some alterations may result in a loss or gain of genetic material and are called unbalanced alterations; balanced alterations do not result in a gain or loss of genetic material and usually have fewer clinical consequences. As with other types of mutations, structural alterations can occur either in the germ line or in somatic cells. The latter, although not transmitted to offspring, can alter genetic material such that the cell can give rise to cancer. Translocations Translocations occur when chromosomes are broken and the broken elements reattach to other chromosomes. Translocations can be classified into two major types: reciprocal and Robertsonian. Reciprocal translocation Reciprocal translocations occur when genetic material is exchanged between nonhomologous chromosomes; for example, chromosomes 2 and 8 (Figure 11-3-3). If this happens during game- togenesis, the offspring will carry the reciprocal translocation in all his or her :cells and will be called a translocation carrier. Because this individual has all of the genetic material (balanced, albeit some of it misplaced because of the translocation), there are often no clinical consequences other than during reproduction. A Reciprocal Translocation In a translocation carrier, during gametogenesis and meiosis, unbalanced genetic material can Note be transmitted to the offspring, causing partial trisomies and partial monosomies typically resulting in pregnancy loss. During meiosis 1, the translocated chromosomes may segregate as Alternate Versus Adjacent chromosome 8 or as chromosome 2, producing a variety of possible gametes with respect to Segregation these chromosomes. The diagram in the upper right is used to depict the segregation refer to diagrams possible sperm the father can produce. It acknowledges that the translocated chromosomes can (Figure 11-3-4, upper right) potentially pair with either of the two homologs (2 or 8) during meiosis. These con- quadrants (next to each ceptions are likely to result in pregnancy loss. Fertilization with Normal Egg I Normal Translocation Partial Trisomy 8 Carrier Partial Monosomy 2 Figure 11-3-4. Because these translocations involve only a single cell and the I genetic material is balanced, there is often no consequence. This translocation alters the activity of the abl proto-oncogene (proto- leukemia (retinoid :. More than 100 different chromosome rearrangements involving nearly every chromosome have been observed in more than 40 types of cancer. If alternate segregation occurs, the offspring will inherit either a nor- ~,I mal chromosome complement or will be a normal carrier like the. Consequences of a Robertsonian Translocaton in One Parent (illustrated with a male), I " f Robertsonian Translocation and Down Syndrome. Approximately 5% of Down syndrome cases are the result of a Robertsonian translocation affecting chromosome 14 and chromo- some 21. When a translocation carrier produces gametes, the translocation chromosome can, segregate with the normal 14 or with the normal 21. A diagram can be drawn to represent the six possible gametes that could be produced. The key difference is 47 versus 46 chromosomes in the individual with Note,, Down syndrome. The recurrence risk (determined empirically) for female translocation carriers is I carner: 10-15%, and that for male translocation carriers is 1-2%. The elevated recurrence risk for translocation carriers Adjacent segregation versus noncarri~rs underscores the importance of ordering a chromosom~ study when Down produces unbalanced syndrome is suspected in a newborn. Examples include: Prader-Willi syndrome Angelman syndrome If a micro deletion includes several contiguous genes, a variety of phenotypic outcomes may be part of the genetic syndrome. Inversions thatinclude the centromere are termed pericentric, paracentric) whereas those that do not include the centromere are termed paracentric. The karyotype of the inversion shown in Figure 11-3-8, extending from 3p21 to 3q13 is 46,xy,inv(3)(p21;q13)~ • Ring chromosomes Inversion carriers still retain all of their genetic material, so they are usually unaffecte • Isochromosomes (although an in~ersion may interrupt or otherwise affect a specific gene and thus cause disease) Because homologous chromosomes must line up during meiosis, inverted chromosomes. Pericentric Inversion of Chromosome 16 A male infant, the product of a full-term pregnancy, was born with hypospadias and ambiguo genitalia. His brother had two childre " " both healthy, and the father assumed that he would also have normal children. A Pericentric Inversion of Chromosome 3 l Ring Chromosome I 1: A ring chromosome can form when a deletion occurs on both tips of a chromosome and the r remaining chromosome ends fuse together. The karyotype of an isochromo- some for the long arm of the X chromosome would be 46;X,i(Xq); this karyotype results in an individual with Turner syndrome, indicating that most of the critical genes responsible for the Turner phenotype are on Xp.

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