Homemade Skin Care Recipes

The Beauty of Food Turning Back The Clock

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Diagnostics Of Botulism And C Botulinum

The diagnosis of botulism is primarily based on the history of eating suspected foods, as well as detecting BoNT in patients and in suspected food samples. 10 The detection of C. botulinum cells in clinical and food specimens strongly supports the diagnosis. Electroneur-omyography may be used to distinguish botulism from similar neurological diseases. 10 The culture method for the detection and isolation of C. botulinum includes broth culturing in anaerobic media, such as tryptone-peptone-glucose-yeast extract medium or cooked meat medium, and subsequent culturing on plating media. Typical colonies on egg yolk agar plates show a positive lipase reaction, and a weak p-hemolysis is seen on blood agar. Proper selective media allowing the growth of all strains of C. botulinum are not available. Commercial biochemical reaction series have been developed for the identification of anaerobic bacteria, but these tests have been shown to be unreliable in the diagnosis of C. botulinum. 16

Molecular Detection of C botulinum

PCR and DNA probes provide a sensitive tool for the detection of C. botulinum. The greatest sensitivities of PCR protocols for C. botulinum in various sample materials vary from 2.5 pg of DNA 20 to 0.1 cfu (or spore) g food 21 and 10 cfu g feces. 21,22 A multiplex PCR assay that enables the simultaneous detection of all human pathogenic serotypes A, B, E, and F has provided a marked improvement in the PCR detection of C. botulinum. 21 Nested PCR involves several subsequent amplifications and provides an increased sensitivity in the detection of C. botulinum, for example, in feces. 22 The disadvantage of PCR detection directly from a sample is the possible detection of dead cells because of intact DNA after cell lysis. This problem is overcome by combining enrichment procedures with PCR. 4 Alternatively, reverse transcription polymerase chain reaction (RT-PCR) may be

Molecular Characterization of C botulinum

Molecular characterization of C. botulinum may be used to study the genetic diversity of the organism, 4,5 and in tracing the causative agents of botulism outbreaks. 9,25 Pulsed field gel electrophoresis (PFGE) provides excellent discriminatory power and reproducibility, whereas the PCR-based method (randomly amplified polymorphic DNA assay, or RAPD) is less reproducible but can be quickly performed. The application of rRNA gene restriction pattern analysis (ribotyping) has been used to identify bacterial species yielding distinct patterns for groups I and II C. botulinum. 4 The entire genome sequence of C. botulinum type A strain ATCC 3502 has been established,1-26-1 which enables the development of DNA microarrays containing the whole genome of the organism. The arrays are anticipated to provide more efficient tools for the genomic analysis of C. botulinum.

Clostridium botulinum

Background Clostridium botulinum is an anaerobic spore-forming bacterium widely distributed in soil and mud. The toxin is the most lethal substance known to man, with a LD50 of 0.00003 mg kg body weight. In one incident, an adult was paralysed for more than 6 months after eating less than two teas-poonfuls of a rice salad. Tetanus toxin from Clos-tridium tetani and ricin from the castor bean (the next most toxic substances) have LD50 values of 0.0001 and 0.02 mg kg, respectively. The seven toxin types, A-G, affect the nervous systems of vertebrates, animals, and birds more commonly than man. Birds in aquatic environments seem especially susceptible to mass die-offs caused by botulism. Invertebrates are not susceptible but can harbor the bacteria and toxins in their bodies. Types A, B, and E are the only toxins that affect man. Type E is acquired from fish. Type C is the main bird toxin, although types D and E are also important. used. The vegetative forms of C. botulinum are as...

Treatment With Botulinum Toxin Injections

Botulinum toxin (BoNT) is a food poison, produced by Clostridium botulinum. It is a protein with at least 7 antigenic types A, B, C1 C2, D, E, F, and G. Only types A, B, and F cause botulism in humans. These serotypes are different in their potency, and species difference is tremendous. BoNT produces a presynaptic neuromus-cular blockade, preventing the release of acetylcholine. It consists of a heavy chain and a light chain. The former is important in binding to the presynaptic neuro-muscular terminals, whereas the latter is released into the terminals. The light chain is a zinc metalloen-dopeptidase, which cleaves the vesicle-docking protein complex important in the process of exocytosis and acetylcholine release. The nerve terminal reacts by sprouting new extensions, which would recede once new connections are made with the motor end plates. This process takes approximately 3 months for type A toxin, which explains the duration of action. Type A toxin was the earliest to be used in...

Botulinum

Classification and the Microbial Ecology of C. botulinum C. botulinum is an anaerobic gram-positive rod-shaped bacterium that forms heat-resistant spores. 1 The taxo-nomic denominator is the production of botulinum neurotoxin (BoNT). Based on the serological properties of the BoNT they produce, C. botulinum strains are divided into types A-F, with types A, B, E, and F being human pathogens, and types C and D being animal pathogens. Based on their metabolic properties, C. botulinum strains are divided into groups I-III. 2 Groups I and II include strains that are pathogenic to humans, whereas group III includes strains causing botulism in animals. Various characteristics of the organisms belonging to different groups are presented in Table 1. Prevalence of C. botulinum C. botulinum is widely spread in the environment, with group I organisms predominating in the temperate regions of the world, and group II organisms prevailing in aquatic environments in the Northern hemisphere. C....

Elderly Skin

With aging, there is a decrease in the cellular growth rate and a degeneration of collagen and elastic fibers, resulting in a loss of both dermal and subcutaneous tissues and a thinning of the epidermis. Consequently, the skin loses its elasticity and appears transparent, wrinkled, thin, dry, fragile, and lacking in tensile strength. Normally, the epidermis attaches firmly to the dermis by projecting extensions of epidermis into the dermis in a tongue-in-groove fashion (rete pegs). With aging, this dermal-epidermal junction flattens owing to loss of capillaries, collagen fibers, and glycoproteins. There is also an increase in the fragility of the capillaries in the basement membrane zone, making the skin prone to subcutaneous hemorrhage or senile purpura. Because of all of these changes, aging skin tears with minor friction or shearing forces. These tears become an invitation to bacterial invasion and subsequent infection.

Additional Reading

Use of botulinum toxin type A in the treatment of cervical dystonia. Neurology 2000 55(12 suppl 5) S15-S21. Dutton JJ, Buckley EG. Botulinum toxin in the management of blepharospasm. Arch Neurol 1986 43 380-382. Tsui JK, Eisen A, Stoessl AJ, Calne S, Calne DB. Double-blind study of botulinum toxin in spasmodic torticollis. Lancet 1986 2 245-247.

Costeffective Treatment Options For Generalized Dystonia

Treatment of generalized dystonia in a setting in which the use of botulinum toxin, a baclofen pump, or surgical intervention are not options will rely heavily on assistive devices and oral medications. While physical and occupational therapy have not been demonstrated to alter the progression of ITD, daily range-of-motion sessions done by a caregiver will be helpful in reducing limb contracture. In some settings, the use of upper and lower limb bracing may also improve function and patient independence, but careful attention must be focused on the development of skin breakdown. Perhaps most importantly, investment in a durable, and perhaps individually designed, wheelchair is needed. Careful attention must be paid to the age of the patient, and deferring major expenditures for a long-term wheelchair is not recommended until the child has reached a growth plateau. Concurrent medical therapy most often includes treatment with levodopa, trihexyphenidyl, baclofen, or tizanidine, or a...

Specific Exercises That Can Be Done At Home

The particular exercises appropriate for a given patient will depend upon the muscles involved in that patient's particular case of ST. The treating physician should specify for the patient which muscles are acting as agonists, that is, those being injected with botulinum toxin (BoNT). The patient should practice those stretching exercises specific to the agonist muscles, along with exercises for any antagonist muscles the physician recommends for strengthening. In most cases, the antagonists will be those muscles that correspond to the agonists on the opposite side of the neck, but additional antagonists may need strengthening as well. A physical therapist can help the patient learn to perform the exercises properly.

Figure

This 70-year-old woman with a history of mild hypertension had a small, left putamen infarction. She was hospitalized for mild weakness that resolved satisfactorily. Her workup was otherwise negative. Over the next 8 months she developed right great toe extension, toe abduction, and increased plantar arch. She responded to a botulinum toxin A injection of 50 units to the extensor hallucis longus muscle and 30 units to her flexor hallucis brevis muscle.

Fumaric Acid Fumarates

Fumaric acid has been used to prevent the malolactic fermentation in wines and as an antimicrobial agent in wines (7). The compound is lethal to ascospores of Talaromyces flavus and Neosartorya fischeri (7). Esters of fumaric acid (monomethyl, dimethyl, and ethyl) at 0.15 to 0.2 have been tested as a substitute or adjunct for nitrate in bacon. Fumaric acid esters inhibit Clostridium botulinum toxin formation in bacon, and the methyl, dimethyl, ethyl, and diethyl fumarates inhibit fungal growth in tomato juice and on bread (7).

Defining the terms and scope of food and nutritional toxicology

In essence, toxicology is the science of poisons, toxicants, or toxins. A poison, toxicant, or toxin is a substance capable of causing harm when administered to an organism. Harm can be defined as seriously injuring or, ultimately, causing the death of an organism. This is a rather simplistic definition, because virtually every known chemical or substance has the potential for causing harm. The term toxicant can be a synonym for poison, or the term poison might be more appropriate for the most potent substances, i.e., substances that induce adverse effects at exposure levels of a few milligrams per kilogram of body weight (see later discussion). The term toxin usually refers to a poison derived from a protein or conjugated protein produced by some higher plant, animal, or pathogenic bacteria that is highly poisonous for other living organisms, e.g., botulinum toxins. Toxicologists study the noxious or adverse effects of substances on living organisms or on in vitro surrogate models,...

Intrinsic Product Factors

Chilled-product formulation may have a significant effect on the process applied to a particular chilled food. Several factors may be incorporated into the formulation of chilled foods that may increase the overall keeping quality of the product and subsequently decrease the amount of processing necessary to achieve a certain shelf life. One factor that reduces the amount of heat necessary to provide a particular shelf life is product pH. Microorganisms tend to be more heat sensitive in products with a lower pH, and lower pH may also enhance the keeping quality in combination with chilled storage temperatures, as the optimum pH range for the growth of most foodborne microorganisms is between 5 and 8. An example of utilizing the synergistic effect between storage temperature and product pH is in the prevention of C. botulinum type E outgrowth. A product pH of 5.5 is necessary to prevent the outgrowth of C. botulinum type E spores at 15.5 C, but if the storage temperature is maintained...

Implications for clinical practice

In individuals with mild acne whose disease is not adversely affecting their quality of life, antibacterial washes should be considered in the choice of first-line management strategies in step-up approaches. They should also be considered in the maintenance of patients who have ceased therapy following response. They should not be prescribed routinely in patients who are receiving more aggressive therapy as there is no evidence of any additional benefit. Alkaline syndet bars may be preferential to soap in skin care routines.

Characteristics of the organisms and their antigens

The Clostridia are spore-forming rod-shaped gram-positive bacteria that usually grow under anaerobic conditions. An important characteristic of these microorganisms is their ability to survive in high numbers for long periods of time in feces and soil, an ability related to the formation of spores which can be very resistant to temperature and pH extremes. Clostridia are potent pathogens in animals and humans because of their ability to release various exotoxins. Furthermore, many Clostridia species release more than one toxin and each toxin is immunologically distinct. For example, eight types of Clostridium botulinum and five types of Clostridium perfringens have been identified and each type elaborates different toxins. Many similarities exist among clostridial toxins. Amino acid homology and immunologic cross-reactivity exist between C. difficile toxins and C. sordellii lethal toxins and between tetanus toxins and botulinum B toxin, and these toxins have similar mechanisms of...

Evasive strategies by the organism

Clostridia have devised many ways to enter the host and cause disease. In the case of gas gangrene and wound infections C. perfringens enters the host through traumatic or surgical wound often taking advantage of poor blood supply in the wound area. Once Clostridia grow they release their toxins and cause disease. In C. difficile-associated colitis the bacteria multiply when the normal bowel flora is disrupted by antibiotics. C. difficile then releases its toxins which target intestinal epithelial cells and cause diarrhea and colonic inflammation. In the case of botulism, however, the organism does not grow in the host but the disease is caused by ingestion of C. botulinum toxins present in contaminated food.

Dermatological Infections

Normal skin provides an effective defense against most infectious agents. Keratinization, skin shedding, basal cell regeneration, lipid composition, low moisture content and the presence of a 'normal' cutaneous flora all contribute to making intact skin an efficient nonspecific barrier to invasion by most infectious organisms. The capacity of skin to mount a targeted immunologic response against individual invading microorganisms also makes skin an efficient specific barrier to most infectious agents. Bone marrow-derived Langerhans dendritic cells migrate throughout the epidermis, comprise 2-8 of all cells in the epithelium, sample antigen, and proceed through the dermis to regional lymph nodes via lymphatics. These cells express major histocompatibility complex (MHC) class II molecules and efficiently process and present antigens to CD4 T cells both locally (in the epidermis and dermis) and distally (in local lymph nodes). Memory effector (predominantly CD45 RA RO+) T cells, natural...

Hemodynamically Stable Symptomatic Patients

Some infants arrive at the emergency department with respiratory distress and are found on examination to have findings suggestive of congenital heart disease, usually with evidence of congestive heart failure. These infants have near normal blood pressure and usually display normal skin perfusion, but may have cyanosis. Several congenital cardiac conditions may present in this fashion.

Causes And Manifestations Of Food Deterioration

It is important to distinguish between pathogenic and nonpathogenic species. Pathogens are organisms that cause disease, and a number of human pathogens can be transmitted through food. They include Salmonella spp., Staphylococcus aureus, Clostridium botulinum, Listeria monocytogenes, and many others. Mycotoxins are fungal metabolites, some of which are potentially toxic or carcinogenic to humans, for example, aflatoxin from Aspergillus flavus. It is essential that all pathogenic species be controlled in preserved foods to eliminate foodborne disease. This is done by providing measures to eliminate what may be present in raw materials (eg, those of animal origin) through processing, and by providing measures to eliminate the entry of contaminating pathogens to the food supply through hygienic manufacturing practices. Most microorganisms, however, are not pathogenic but can cause food spoilage if allowed to grow, primarily as a result of off-flavors and odors from metabolic...

Microbial Colonization Of Humans

Your body is the mobile, warm-blooded equivalent of an ocean's coral reef, supporting a vast and highly divergent range of life. These microbes stretch from head to toe, spread across your skin, hide in the crevices of your mouth and nose, and follow your food from start to finish. Their presence is not just normal, but helpful or even necessary.

Phylum Firmicutes The low GC Grampositive bacteria

Several species of Clostridium are serious human pathogens including C. botulinum (botulism) and C. tetani (tetanus). C. perfringens causes gas gangrene, and if ingested, can also result in gastroenteritis. All these conditions are due to the production of bacterial exotoxins. The resistance of spores to heating is thus highly relevant both in medicine and in the food industry. Related to Clostridium are the heliobacteria, two genera of anaerobic photoheterotrophic rods, some of which produce endospores. They are the only known photo-synthetic Gram-positive bacteria. So-called 'Botox' injections, much in vogue in certain circles as a cosmetic treatment, involve low doses of C. botulinum exotoxin. By acting as a muscle relaxant, they are intended to reduce the facial wrinkles that develop with the passing of time The toxin is also used to treat medical conditions in which abnormal muscle contractions make it impossible for patients to open their eyes properly.

Controlled And Modified Atmospheres For Fruits And Vegetables

In considering the above described benefits, a number of potential problems associated with CA or MA storage must be recognized. Above all is the potential health hazard associated with these technologies, especially modified atmosphere packaging or MAP.317 It has been pointed out that the same principles of atmosphere modification responsible for all the benefits of CA or MA are also the main cause of controversy surrounding the potential health hazards associated with these technologies.31819 Modification of the atmosphere and, in particular, the reduction or elimination of O2 from the package head space will in many cases disturb the equilibrium of the atmosphere in favor of anaerobic microorganisms. The aerobic bacteria that normally spoil the product, and in so doing warn consumers of any potential health hazard, may find themselves at an atmospheric disadvantage and their growth inhibited. In the absence of competing aerobic organisms, anaerobic nonproteolytic toxin producers,...

Acquired Immunodeficiency Syndrome Aids

Foodborne An acute illness of varying severity, foodborne botulism is manifested by diplopia, blurred vision, bulbar weakness, or symmetric paralysis that may be of rapid onset. Laboratory confirmation of this illness consists of demonstration of botulinum toxin in serum or stool or in food the subject recently consumed. A positive

Introduction the development of thermal processing

Thermal processing is one of the conventional preservation methods which assures processed foods to be safe and shelf-stable. The origin of commercial thermal processing dates back to 1809 when the Frenchman Nicholas Appert was awarded a prize by the French government for developing a new and successful means of preserving foods, a method that eventually became known as 'canning'. Appert found a new and effective way to preserve food, but did not understand why it prevented food spoilage. In 1864, Louis Pasteur, another Frenchman, explained that the heating process killed (or inactivated) the microorganisms which limited the shelf-life of foods. This laid the foundation for advances in canning methods that eventually revolutionized the industry. In the 1890s, Prescott and Underwood established the relationship between thermophilic bacteria and the spoilage of canned corn. At about the same time, the same type of spoilage was discovered in canned peas by Russell in Wisconsin and Barlow...

How to Perform and Interpret a Virtual Colonoscopic Examination

Colonography Air Adequate Topogram

Patients often have sensitive skin at the anus due to the colonic cleansing regime. Jelly, therefore, should be used to perform the rectal exam and insert the rectal tube. Too much jelly, however, may make the catheter tip too slippery. A red rubber catheter (which is smaller and may be more comfortable than a barium enema tip), a Foley catheter, or a plain barium enema tip can be used. If using a barium enema tip, barium enema tubing can be cut into 9-in strips and one end attached to the catheter tip and the other to a hand-held bulb (blue puffer) for manual insufflation. Some investigators use a tip with a balloon cuff. The tip should be taped in place (butterfly style) to the buttock to minimize the likelihood of the tip dislodging later when the patient turns from the supine to the prone position.

Management of pure venous ulcers

Usually a simple non-adherent dressing is all that is required as a primary dressing under the compression. Chemical or larval debridement can be employed if there is excessive slough. Systemic antibiotics are only useful if there is frank cellulitus, only then should ulcers be swabbed for bacteriology as they will always share the patient's normal skin flora. Split or pinch skin grafts are often used on large ulcers and can be placed under compression bandages there is no level one evidence regarding their effect on healing rate.

Relevant outcomes

Response rate in terms of the number and size of lesions, flattening, and degree of pigmentation, is an important endpoint for systemic therapies in the treatment of cutaneous disease. One of the problems in comparing studies of systemic therapy in KS is the subjective nature of the assessment of response. Recent randomised studies of systemic therapies in AIDS-related KS have adopted the AIDS Clinical Trials Group (ACTG) criteria for assessment of response (Table 29.2).10 The overall cosmetic effect is also an important endpoint, particularly for local therapies such as radiotherapy which have long-term effects on the normal skin surrounding lesions. Consider, for example, the young homosexual man with telltale purple nodular HIV-associated KS lesions on a highly visible area such as the face. Local radiotherapy to this area, with a wide margin of normal skin, may leave him with an equally unsightly area of residual brown discoloration and a contrasting halo of depigmentation....

Transferring Heat In Foods

The processes of canning, pasteurizing, and cooking depend on transferring heat into a product to elevate the temperature to a level that will destroy microorganisms. Heat sterilization of a product (eg, pouch packaging and canning) under anaerobic conditions requires closely controlled time and temperature process conditions to ensure that spores resistant to heat (eg, Clostridium botulinum) do not survive. Pasteurization temperature and time are just as important to ensure that food-borne diseases are not spread by the food. Cooking a food not only improves sensory acceptance but reduces the microbial content.

Clinical Presentation

Clinical characteristics include unreactive mydriasis, hypo- or hypertension, absent bowel sounds, tachycardia, flushed skin, disorientation, urinary retention, hyperthermia, dry skin and mucous membranes, and auditory and visual hallucinations. Patients also can present with seizures or coma. Cardiogenic pulmonary edema may occur secondary to depression of myocardial contraction.1,34 The diagnosis of anticholinergic toxicity must be based on clinical presentation. The diagnosis may be confused with delirium tremens or an acute psychiatric disorder. Anticholinergic toxicity can be differentiated from delirium tremens and sympathomimetic toxicity by the presence of dry skin and the absence of bowel sounds. Acute psychiatric disorders may have associated tachycardia and tachypnea, but usually the physical examination is normal. Complications from anticholinergic toxicity occur secondary to hyperthermia, dysrhythmias, seizures, and circulatory collapse. 14

Current guidelines and regulation

In particular that products will be kept refrigerated. In Europe, shelf-life is based on product formulations and processing parameters for defined chill storage conditions. Such recommendations have been proposed by the UK Advisory Committee on Microbiological Safety of Foods (ACMSF, 1992), with non-proteolytic (psychrotrophic) C. botulinum as the target bacterium.

Use of microbiological risk assessment

Data published in the scientific literature and reviewed in this chapter indicate the possible presence of pathogenic bacteria, the survival of mild heat-treatment and the growth of pathogenic bacteria, in particular the spore-forming pathogens C. botulinum and B. cereus, in cooked chilled foods. In contrast cooked chilled foods have an excellent safety record in Europe. However in many cases the current safety margins are unclear and it remains to be established what the risks caused by spore-forming bacteria (SFB) in cooked chilled foods may become in the future expanding market. Microbial risk assessment consists of the following steps hazard identification, hazard characterisation, exposure assessment and risk characterisation. A formal risk assessment on cooked chilled foods made from vegetables confirmed C. botulinum and B. cereus as the main hazards, because of (for C. botulinum specifically) a high fatality rate, high number of reported cases, the ability of at least some...

Historical perspective on food processing Roman sausage to canning to space food

Early humans were hunters and gatherers. Getting food was a daily process, and food spoilage and foodborne illnesses must have been common. Agricultural production of grains and animal husbandry followed the hunting gathering stage, although hunting and gathering remained common means of obtaining food. Early forms of preservation such as salting, drying, smoking and fermenting were practiced long before people understood why they worked, and were likely discovered by accident. Although food safety was probably not at the forefront of early man's concern when they were just trying to get enough food to survive, these food preservation techniques that inhibited food spoilage microorganisms had the added benefit of inhibiting many pathogenic organisms. Early attempts at fermentation were probably especially fraught with dangers. Clostridium botulinum is derived from the Latin term botulus, meaning sausage. The 'controlled spoilage' under the specific conditions of fermentation allows...

Animal Toxins and Plant Toxicants

Blighted, solanine levels can increase sevenfold, sufficient to harm a small child. Cooked potatoes with high concentrations of solanine have a bitter taste and can cause a burning sensation in the throat. Solanine has been shown to exhibit terato-genic effects in animals. It is likely that solanine serves as a natural pesticide to the beetle and leaf hopper. Another noxious chemical, tomatine, also an alkaloid, is found in tomato and may also serve as a natural plant pesticide. Psoralen, found in parsnip, carrots, and celery, is a chemical produced by a plant under stress. Psoralen is a skin irritant, causing rash and skin problems.

Low Acid Canned Food Microbiology

While low-acid foods may be contaminated with viruses, yeast, molds, parasites, and bacteria, it is the spore-forming bacteria that are of greatest concern from the standpoint of sterilization. The bacterium most important for low-acid canned foods is Clostridium botulinum, which produces spores that survive boiling. When the vegetative cells of C. botulinum grow, they produce potent neurotoxins (Types A, B, and E are of greatest significance) that can cause death if consumed. C. botulinum Type A and proteolytic strains of Type B have decimal reduction (D) values at 250 F (121 C) of 0.10 to 0.20 minutes (5), the D value being the time in minutes at the specified temperature to destroy 1 log, or 90 , of the population. Thus, thermal processes for low-acid canned foods must be designed to destroy the spores of this organism. By convention, a process equivalent to 12D is considered adequate to protect the public health. However, there are other Clostridia important in food spoilage that...

Acid and Acidified Food Microbiology

Since C. botulinum spores cannot germinate and grow in foods at pH values below approximately 4.8 (regulations setting pH 4.6 as the cutoff between low-acid and acid acidified include a safety factor), heat treatments for acid and acidified foods need not destroy the spores of this organism. Heat treatments for products with pH values < 4.0 are designed to inactivate yeast, molds, and lactic acid bacteria that can cause spoilage. The most resistant of these organisms have D15(rF values on the order of 1.0 min. A notable exception are the ascospores of the heat-resistant molds such as Byssochlamys, Neosartorya, and Talaro-myces (6-8). These organisms may have D194oF values of 1 to 12 min, which allow them to survive commercial processes fortunately, such spoilage is rare.

Antimuscarinic Effects

TCAs frequently produce antimuscarinic symptoms. They are competitive inhibitors of acetylcholine at central and peripheral muscarinic receptors. This action is commonly referred to as being anticholinergic, but the term antimuscarinic is more precise because TCAs do not antagonize acetylcholine at nicotinic receptors. Central antimuscarinic symptoms vary from agitation to delirium, confusion, amnesia, hallucinations, slurred speech, ataxia, sedation, and coma. Peripheral antimuscarinic symptoms include dilated pupils, blurred vision, tachycardia, hyperthermia, hypertension, decreased oral and bronchial secretions, dry skin, ileus, urinary retention, increased muscle tone, and tremor. Antimuscarinic symptoms are especially common when TCAs are combined with other medications that also have antimuscarinic activity. Examples include antihistamines, antipsychotics, antiparkinsonian drugs, antispasmodics, and some muscle relaxants.

Microbial Contaminants

Consumer in recent years have expressed considerable concern over the safety of the food supply. Concern has been aimed at the presence of hormones and drugs in meats, preservatives found in food, pesticides, microbial contaminants, and food additives. Reports last year of cyanide in grapes and Alar in apples have fueled the level of concern. This issue of the public's concern over the quality of food was addressed at a conference (the International Conference on Issues in Food Safety and Toxicology) held in the spring of 1990 at Michigan State University (MSU) East Lansing, Mich. The conference was sponsored by the U.S. Department of Agriculture (USDA) and MSU's Center for Environmental Toxicology. From various presentations it became apparent that the consumers' perceptions of risks from chemical agents in food differs drastically from the experts' opinions. The experts rank the risk from chemicals below microbial risk or nutritional considerations. The general public perceives the...

Refrigeration and freezing

Modern freezing technology began with Clarence Birdseye, who, based on his experience with frozen seafood, developed rapid freezing technology that better preserved the quality of foods. A significant percentage of foods sold today are frozen (Lund, 2000). Although it was long held that refrigeration prevented growth of pathogens, we now recognize there are a number of pathogens capable of growth at refrigeration temperatures, including Listeria monocytogenes and some strains of Clostridium botulinum. Nevertheless, refrigeration significantly slows the growth even of those pathogens that can grow at low temperatures. Freezing, on the other hand, prevents growth of bacterial pathogens and sometimes kills them (Archer, 2004). Refrigeration and freezing are of key importance in the safety of foods, and are thus commonly used by the processing industry.

Jimsonweed Datura Species

Symptoms occur within 30 to 60 min and may last for up to 48 h because of delayed gastric motility. Symptoms include hyperthermia (hot as a hare), flushed skin (red as a beet), dry skin and mucus mibranes (dry as a bone), mydriasis (blind as a bat), and hallucinations or delirium (mad as a hatter). Iachycardia and urinary retention are also common.

H 1354 Phlegmasia Cerulea Dolens

Treatment follows the principles given for DVT as outlined above, with the addition of fasciotomy when the arterial component is prominent. Throm-bolysis is the primary choice when the arterial perfusion is rendered adequate - palpable pulses in the ankle arteries or good skin perfusion in the foot. If the patient lacks foot pulses, surgical thrombectomy is a better strategy because it is a quicker way to reduce clot burden and obstruction. Long-term venous function is of minor importance at this stage. When the arterial function is compromised, fasciotomy should follow the surgical thrombectomy For some patients, amputation is the only option.

Reduction of preservatives

As a result of concerns about the potential for formation of carcinogenic nitrosamines in products containing nitrite, there have been numerous studies, reports, and debates about safe levels. However, nitrite serves as a means of preventing growth of Clostridium botulinum and is thus an important safety component of these products restricting its use presents an increased risk of botulism from cured products (Marriott et al., 1981 Tompkin, 1980). The residual level of nitrite in today's cured meats is five times lower than in the 1970s (CAST, 1997), as a result in part of introducing other compounds such as ascorbates in the curing system to allow reduction of nitrites while maintaining the ability to inhibit C. botulinum (Marriott et al., 1981). Similarly, salt plays a key role in the safety of many products. Salt levels decreased considerably during the twentieth century, from levels greater than 6 in the first half of the century to around 2 today (CAST, 1997). Much emphasis has...

Concerns about refrigerated foods

While consumers focus on the convenience of prepared foods, they still want 'fresh' foods. And while they want 'fresh' foods, they want to keep the foods longer. The consumer demand for high-quality convenient meals that require minimal preparation has resulted in an increase in refrigerated foods that are lightly processed to preserve flavor, texture, nutrients, and other quality factors. This has often been combined with packaging in a vacuum or modified atmosphere to help extend shelf-life. 0ne such process is known as 'sous vide ' a food is vacuum packaged, given a minimal heat treatment, quickly chilled and then reheated just before serving. The process retains many of the flavor, nutritional and texture aspects of fresh product. Concerns have been raised about the potential for growth of psychrotrophic strains of C. botulinum, since the packaging provides an anaerobic environment, competing microflora have been destroyed by the heat treatment, and the shelf-life might provide...

Other Bacterial Pathogens

Several other bacterial pathogens are associated with food products of animal origin, but their contribution to foodborne disease has been overshadowed by the impact of the aforementioned four pathogens in recent years. They include additional pathogenic serotypes of E. coli, Yersinia enterocolitica (a psychrotroph of enteric origin), Staphylococcus aureus (a Gram-positive, heat-stable, enterotoxin-producing mesophile), Clostridium botulinum (a deadly, neurotoxin-producing spore-former), Clostridium perfringens (a common cause of gastrointestinal discomfort of short duration), and Bacillus cereus (a spore-forming mesophile or psychrotroph causing diarrheal or emetic illness). Detailed information on these and other pathogens of less current concern can be found in several publications1-1-8-1 and at www.cfsan.fda.gov.

Laser therapies Efficacy

We found one RCT34 in eight dark-skinned people (skin phototype IV-VI) with dermal melasma diagnosed by Wood's lamp. The article does not provide any detail of the demographics of participants. All participants received a 14-day course of 0-05 tretinoin cream, 4 hydroquinone cream and 1 hydrocortisone cream, applied twice daily. All participants were asked to use a sunblock of SPF15 or higher. Participants had a 1 cm2 area of the face exposed to one pass of the 950-microsecond pulsed carbon dioxide laser with a computerised pattern generation set at 300 mJ cm2. The intervention group received, in addition to the above, another pass with Q-switched alexandrite pigmented dye laser at a dose of 6 J cm2. The treated area was evaluated after 6 months. Normal skin was found in three participants of the intervention group and one of the control group. However, the sample size is too small to draw valid conclusions, and confounding factors such as the use of...

Impact of injury and stress

Archer (1996) stated that traditional food preservation systems work well to inhibit the growth of toxin-producing bacteria such as S. aureus or C. botulinum that require relatively high numbers for the toxin to cause disease. However, he expressed concern that infectious bacteria such as E. coli 0157 H7 and strains of Salmonella may increase in virulence during stressful conditions of food preservation. Stresses such as starvation and extremes of temperature, pH, and osmolarity cause adaptive responses, one of which may be to potentiate expression of virulence genes or, even worse, create unpredictable mutations in the virulence genes. To date there is little evidence that this occurs in food production, but it warrants vigilance.

Biological And Chemical Activities

Phenolic compounds are known to possess several biological and chemical properties, including antioxidant activity, the ability to scavenge active oxygen species, the ability to scavenge electrophiles, the ability to inhibit nitrosation, the ability to chelate metals, the potential for autoxidation, producing hydrogen peroxide in the presence of certain metals, and the capability to modulate certain cellular enzyme activities. Various phenolic acids and its esters are effective in the prevention of microbial growth. Phenolics such as gallic acid and p-hydroxybenzoic acid esters showed inhibitory effects against the growth and toxin production of Clostridium botulinum types A and B (50). p-Coumaric acid (> 250 ppm) and ferulic acid (250 ppm) inhibit the growth of Saccharomyces cerevisiae (51). Proanthocyanidins, flavonols, and benzoic acid extracted from cranberry showed antimicrobial effects on Saccharo-

Impact of technologies that reduce competitive microflora

An example of a new food preservation technology that presents a potential concern is the use of vacuum packaging and modified atmosphere packaging of foods to extend shelf-life. This would seem to be a very useful technology for packaging fresh fish, which is highly perishable. Greater shelf-life could increase consumption of what has become recognized as a very healthy food. However, a natural concern would be to question whether this technology would create conditions that would allow neurotoxin to be produced by non-proteolytic C. botulinum sooner than in fish stored in non-oxygen-reduced environments. In one study, not only was neurotoxin produced faster in modified atmospheres, it was produced before the fish was considered spoiled (Post et al., 1985). Therefore, a technology that provides a longer shelf-life for this very perishable food may suppress the natural warning system for consumers by suppressing the growth of the natural spoilage microorganisms.

Infections characterized by a minimal or moderate immunologic response

Tinea versicolor is another dermatological infection that elicits only minimal apparent immunologic change. The scaly hypo- or hyperpigmented macules of tinea versicolor are caused by the dimorphic, lipophilic fungus Malassezia furfur (formerly designated Pityrosporum orbiculare). Since the organism is part of the normal skin flora, it is unclear what allows the fungus to cause clinical disease. Defects or alterations in cellular immunity probably play a central role. Histopathological examination of involved skin demonstrates proliferating M. furfur organisms in stratum corneum with only minimal, if any, immunological infiltrate.

Trimetaphan Camsylate

Magnesium ions and aminoglycosides inhibit calcium entry into the synaptic terminal, and so prevent neurotransmitter release. Botulinum toxin and P-bungarotoxin bind irreversibly to nicotinic nerve terminals and prevent neurotransmitter release (a-bungarotoxin blocks post synaptic acetyl choline receptors). The main effect of these compounds is that of muscle paralysis. However, if ventilation support is instituted then the excessive parasympathetic blockade is still a serious problem.

Frankfurters and Bologna

Frankfurters and bologna are examples of finely comminuted meat products where the final product has a very homogeneous appearance. Dark muscle chunks and or mechanically deboned meat are usually emulsified with the fat. A bowl chopper or an emulsion mill are used to achieve an efficient particle size reduction. Salt is added to extract the meat proteins, which is essential in binding the small meat particles and stabilizing the small fat globules within the protein matrix (10). Nitrite is added to inhibit Clostridium botulinum growth and to provide the typical cured meat color (Fig. 2). The meat batter is then stuffed into cellulose casings and smoked and cooked in a smokehouse. Since frankfurters are such a high volume item, some processors have dedicated an entire continuous line for this product. As with other meat products, low microbial contamination and refrigerated temperature can help prolong the shelf life (Fig. 3).

Using MAP and other techniques to preserve fresh and minimally processed produce

Lactic acid bacteria (LAB) grow well under MAP packaging and storage conditions and have been credited with the inhibition of pathogens common to meats, e.g., C. botulinum and Listeria spp. Extensive research has been focused on the use of suitable strains of LAB or the bacteriocins they produce to treat fresh meats and their products in conjunction with MAP to prolong their shelf life and ensure their safety (Schillinger et al., 1996).

Recognizing when Home Treatment is No Longer Sufficient

If frank red blood is seen in the stool, or if the feces is black or contains pus, then medical consultation is recommended. Dehydration is evidence for consulting a physician and may require hospitalization. Signs and symptoms of dehydration in adults include thirst, reduced frequency of urination and or dark color of urine, dry skin that loses its elasticity and remains in a pleat when pinched, fatigue, and light-headedness. In children, dehydration is noticed from the top down. First signs are the absence of tears when a child cries, the mouth and tongue become dry, urine flow and frequency is decreased. A child is considered dehydrated if it fails to urinate for a period of three hours. Other signs of dehydration include high fever, listlessness, and pleating up of skin after pinching.

Understanding thermal inactivation

The Weibull distribution function has been a successful model of many unrelated systems, where destruction and survival are involved (Van Boekel, 2002). One would therefore expect, that a ubiquitous mortality pattern would emerge if many organisms and spores had a Weibull, or 'Weibull like', distribution of heat resistances. Consequently, we have chosen this distribution as a model for much of this chapter's discussion. It can be shown that C. botulinum spores (in the range of 101 to 1210C, and those of various bacilli, can indeed be considered as having a 'Weibull type' distribution of heat resistances

Somatopsychics Theory See OR

Three basic theories of somesthesis (i.e., the bodily sensations including the cutaneous senses, proprioception, and kinaesthesis) that have been proposed since the late 1800s are von Frey's classical or four-element theory, Head's theory of dual sensibilities, and Nafe's pattern theory of feeling. Following enunciation of the doctrine of specific nerve energies by Johannes Muller in 1838, Magnus Blix (in 1882-1883) and Alfred Goldscheider (in 1884-1885) discovered separate sensitive skin spots for warmth cold, and pressure, respectively. The German physiologist Max von Frey (1852-1932) added sensitive pain spots

Using models to improve food safety and quality

The theoretical effect of the target temperature and the initiation of the cooling on the inactivation patterns of spores are in Fig. 22.4. They were generated using survival parameters similar to those of C. botulinum spores (Campanella and Peleg, 2001) derived from the published results of Anderson et al. (1996). These were obtained in a buffered solution rather than in a real food. One could therefore expect that in any given real food, the survival parameters, especially, b(T), would be somewhat different. For the sake of this discussion, we will assume that the hypothetical food in question offers a certain degree of protection to the spores, which would be expressed by a simultaneous elevation of Tc and the lowering of k in eqn 22.5. We will therefore assign Tc 105 0C instead of 102 0C and k 0.25 C1 instead of about 0.3 C1. We shall also assume, for the sake of simplicity, that n(T) is practically unchanged and remains constant, e.g., n(T) 0.3. We can now generate survival...

Nitrates nitrites and nitrosamines

Nitrates and nitrites in preserved meats (bacon, cold cuts) can prevent growth of Clostridium botulinum, the organism that can produce the potent botulinum toxin. However, nitrates and nitrites have been shown to have adverse effects, such as methemoglobinemia and carcinogenesis, the latter resulting from the formation of nitrosamines. Coincidentally, reduction of nitrate to nitrite is a common reaction for bacteria in the GI tract. Usually, the GI effect on nitrite is preceded by nitrate being reduced to nitrite by microflora of mouth saliva. The minimum nitrate intake for a person is estimated at 75 mg d. The resulting nitrite can oxidize hemoglobin to methemoglobin, which results in the loss of oxygen-binding ability. Consequently, dietary or water sources of nitrate and nitrite can have life-threatening effects (methemoglobinemia), particularly in young children. NADH reductase is the major enzyme responsible for the reduction of methemoglobin. Because of a transient deficiency of...

Toxins that traverse cell membranes and either kill or deregulate cells

Other ADP-ribosylating toxins and their targets are Pseudomonas exotoxin S (erythrocyte proteins -not necessarily the main target) cholera and E. coli LT toxins (as subunits of G-regulator proteins) pertussis toxin (not the invasive adenylate cyclase described below - c subunit of G-regulator proteins) botulinum C2 toxin (not a neurotoxin nonmuscle actin). Shiga toxin Shigella dysenteriae) has an AB5 (B5 is a homopolymer)-type structural arrangement similar to cholera toxin. Certain bio-types of E. coli make Vero toxins (VTs or Shiga-like toxins (SLTs)) which are identical (SLT1) or near identical (SLT2) with Shiga toxin. The role of Shiga

The adaptation of spoilage and pathogenic microorganisms to physicochemical stresses

The physical stresses most often encountered in the food processing industry are heat, osmotic stress and acidification. It is remarkable that while we are working on many novel preservation technologies such as the application of high hydrostatic pressure, there are still many questions unanswered with respect to, for instance, heat stress adaptation and survival. Membrane adaptations in Clostridium botulinum cells resistant to heat have been reported but the mechanistic basis of these adaptations is not clear (Mazzotta and Montville, 1999). In B. cereus an extensive analysis of proteins involved in heat stress response has only recently been performed (Periago et al., 2002).

Chronic Vesiculoulcerative Disease

PEMPHIGUS VULGARIS Pemphigus vulgaris is a rare disease with an incidence of 0.5 to 3.2 per 100,000 persons annually. It is important, though, because without treatment, its mortality rate is high. Oral manifestations occur in up to 70 percent of patients and are frequently the first sign of disease, preceding cutaneous lesions by up to a year. Oral lesions are also the most difficult to treat. Ulceration results from autoantibodies attacking the deeper layer of the stratum spinosum of the epidermis, resulting in an intraepithelial split. Females are affected slightly more commonly, with a female-to-male ratio of 2 3. Pemphigus vulgaris most commonly affects people in their sixth decade of life. Typical lesions are superficial erosions with ragged edges found on any oral mucosal surface. Involvement of the soft palate is most common, occurring 80 percent of the time. The buccal mucosa is the next most common site of involvement (46 percent), followed by the tongue (20 percent)....

Methods of search

The following key words were used for a systematic search of the literature hyperhidrosis, focal, localised, palmar, hands, plantar, feet, therapy, treatment, topical, surgery, surgical, aluminiumchloride, anticholinergic drugs, methenamine, bornaprine, methanthelinum bromide, botulinum toxin, triethanolamine, iontophoresis, sympathectomy and sweat.

Effect Of Processing Treatments On Oxidation

Accessibility of tissues to oxygen is considered one of the most important factors contributing to oxidative instability. While filleting of fish is a common practice, it has been shown that the skin protects underlying areas from oxidation 34 . If the skin has to be removed early in the processing chain, deep skinning is an alternative to normal skinning and has been shown to improve the cold storage stability of saithe fillets 288 . Improvement is warranted since the highest rate of oxidation is observed in the under skin layer lipids 34 . Meat preservation by means of curing is typically obtained by application of mixtures containing nitrite as the key ingredient. Other ingredients in the curing mixture include sodium chloride, sugars, ascorbate, polyphosphates, and spices. Nitrite imparts multiple functional roles to cured products, inhibiting spore germination of Clostridium botulinum when added in combination with sodium chloride, producing the characteristic cured meat color,...

Principles of thermal processing

Thermal Resistance Microorganisms

The most important distinction in the pH classification, especially with reference to thermal processing, is the dividing line between acid and low-acid foods. It has been generally recognized that C. botulinum does not grow and produce toxin below a pH of 4.6. Hence, the dividing pH between the low-acid and acid groups is set at 4.5. In the low-acid foods (pH > 4.5), destruction of C. botulinum spores is the primary concern in these processes. However, there may be other microorganisms, for example, Bacillus stearothermophilus, B. thermoacidurans and C. thermosaccolyaticum, that are more heat resistant than C. botulinum. These are generally thermophilic in nature (optimal growth temperature around 50-55 C) and hence are of little concern if the processed cans are stored at temperatures below 25 C.

Microbiological Safety Of Map Foods

The major microbiological concern with MAP foods is the growth of and toxin production by C. botulinum types A, B, and E. These spore-forming microorganisms pose the greatest threat to consumer safety due to The presence of elevated levels of C02 and anaerobic packaging conditions conductive to the growth of, and toxin production by, C. botulinum. Several studies have shown that spores of C. botulinum can outgrow and produce toxin in MAP fish and in other products such as nitrogen-packed sandwiches and vacuum-packaged potatoes, especially if stored under temperature-abuse conditions. Though several challenge studies have been done with C. botulinum in MAP food, there is little conclusive evidence that MAP represents a significantly greater hazard than packaging in air, particularly under conditions of temperature abuse where C02 is less effective. Some believe that the inclusion of oxygen in the package headspace may prevent the growth of C. botulinum in products that may be...

Background And Historical Significance

The bacterium Clostridium botulinum was first isolated from food and implicated as the etiologic agent in a foodborne outbreak in 1897, although a botulism-type illness had been associated with the consumption of sausage in the early 1800s. Infant botulism was recognized in 1976 and has since become the most common form of the disease in the United States (Lund et al., 2000). Currently in the United States, it is estimated that C. botulinum is responsible for 58 foodborne disease cases annually with a case fatality rate of 0.0769 (Meadet al., 1999).

Management of Primary SCC

Retinoids are vitamin A analogues that inhibit cell proliferation and malignant transformation. Complete and partial responses have been documented for oral iso-tretinoin (1 mg kg day) in large, recurrent, or metastatic SCC (123). Responses, however, are maintained only while the patient is taking the medication, and tumors recur after stopping treatment. Isotretinoin is best indicated to prevent the development of new SCC's in susceptible individuals. An important limiting factor is toxi-city, both acute and chronic, and some side effects are severe enough to preclude further therapy. Frequent acute side effects include cheilitis, dry skin, hair loss, elevated liver enzyme levels, and hypertriglyceridemia. Chronic toxicity is manifested as skeletal changes, cheilitis, dry skin, and aggravation of underlying disorder. Etreti-nate, another oral retinoid, is also effective for chemoprevention of SCC when used in dosages of at least 30-50 mg day. Combination therapy with IFN-a (3M units...

Bullous Diseases Pemphigus Vulgaris and Bullous Pemphigoid

The primary lesions of PV are vesicles or bullae Fig. 241-12 (Plate 38) that vary in diameter from less than 1 cm to several centimeters they commonly first affect the head, trunk, and mucous membranes.202 The blisters are usually clear and tense, originating from normal skin or atop an erythematous or urticarial plaque. Within BP is characterized by the presence of tense blisters (up to 10 cm in diameter) that arise from either normal skin or from erythematous or urticarial plaques ulceration with tissue loss follows. Sites of predilection include the intertriginous and flexural areas. Pruritus, occasionally accompanied by a burning sensation, is noted with the appearance of the blistering. Lesions of the oral cavity occur in BP, but with less consistency and severity than in PV. Because the blisters in the oral cavity rupture very easily and heal without scarring, involvement in the mouth is often overlooked. Oral involvement may occur in as many as 40 percent of patients. It is...

Cultural Construction of Gender

Mardu discuss attractiveness in terms of smooth and healthy skin for both genders, and among women firm breasts are admired. Plumpness was rare, but regarded positively today, obesity is common and is sometimes remarked upon negatively. Both women and men would rub their skins with red ocher mixed with fat to beautify the skin and protect the body against illness. Love magic was used by both women and men to make themselves attractive to particular members of the opposite gender this involves the use of songs and dances as well as of material objects.

Debating danazol Danocrine

1 Skin rash Danazol may cause your skin to be more sensitive to sunlight. Even short exposure to the sun can cause a skin rash, itching, redness, or severe sunburn. When you begin taking this medicine, take precautions avoid intense sunlight wear sunglasses, a hat, and long sleeves when you do go out apply a good sun block and avoid tanning salons and tanning beds.

Preservation Principles And Applications

Canned food is typically packaged and maintained under a vacuum to eliminate oxygen and to act as an indicator for the consumer of loss of can seal integrity and hence sterility. As a result, the growth of anaerobic microorganisms, those that cannot grow in the presence of oxygen, would be favored if present. C. botulinum is an anaerobic, pathogenic, spore-forming microorganism that can cause severe illness and death hence, it is essential that all spores of C. botulinum have been destroyed during the canning operation. C. botulinum is also pH sensitive, with a minimum growth requirement of pH 4.6. Thus, foods to be sterilized are characterized as either low-acid or high-acid foods, with the latter requiring a less severe (eg, boiling water) process than the former (must be processed under pressure to achieve temperatures in excess of 121 C). As the food is thermally processed after being packaged, the heat transfer characteristics of the food itself also become of importance in...

Contact Dermatitis Of The Face

Prominent on the sensitive skin of the face. Clinically, allergic contact dermatitis resulting from an aerosolized allergen presents as erythema or scale with or without vesiculation. The involvement is diffuse with upper and lower eyelids affected. This distribution is in contrast with photosensitive eruptions in which nonsun-exposed areas, such as the upper eyelids and the upper lip, are spared. Direct allergic contact dermatitis tends to be most prominent on the most sensitive skin, such as the eyelids. Examples of aerosolized contactants include rhus (poison ivy, oak) when the plant has been burned. Examples of common contactants affecting the face include nickel, nail polishes, toothpaste, preservatives in make-up, contact lens solutions, eyeglasses, and hair care products. Chemical-splash injuries are a common cause of facial-irritant contact dermatitis. A thorough history is necessary to uncover the offending agent. Referral to a dermatologist or allergist may be necessary if...

TABLE 854 Complication Seen with Transabdominal Feeding Tubes

Foley Gastrostomy Tube Bolster

Drainage from the stomal site is a common finding and represents a foreign-body reaction due to the catheter. As long as there is no evidence of cellulitis or necrotizing fasciitis, local skin care with hydrogen peroxide and warm water will usually clear up the problem. If there is granuloma formation with localized bleeding from friable skin, local treatment with silver nitrate will usually help.

History of food irradiation

Geschichte Des Getriebes

The microbiological standard for irradiation-sterilized foods was to use a radiation dose sufficient to reduce a theoretical population of spores of Clostridium botulinum. This standard, recommended by the National Academy of Sciences and the National Research Council Advisory Committee to the army's program on food irradiation, was adopted. In the ensuing years, there was no record of any problem with possible C. botulinum survivors, although this has continued to be one of the antinuclear arguments against food irradiation.

Management of Primary BCC

Curettage and electrodesiccation (C& E) is an excellent treatment for primary, well-defined, nodular BCC in areas of low risk for recurrence such as the neck, trunk, and extremities. It is relatively contraindicated in morpheaform BCC infiltrative BCC recurrent tumors (the fibrous stroma does not allow the detection of the difference in consistency between BCC and healthy skin) and tumors extending deeply into fat, or areas with a high risk for recurrence, including the central face, periocular, and perioral regions (due to the high content of pilosebaceous units harboring tumor cells in the hair follicles). Overall cure rates are 90-98 for primary nodular tumors in low-risk areas. Recently, reports have shown similar cure rates for high-risk areas if tumors are smaller than 6 mm (76,77). Surgical excision with 4 mm margins results in 90-100 cure rates for primary BCC in low-risk locations (78). Recurrence is as low as 3.2 for primary tumors less than 6 mm in diameter, but BCCs of...

Seafood Microorganisms Of Public Health Significance

Seafood, particularly shellfish, may contain a variety of pathogenic microorganisms that impose a threat to the consumers' health. These potential pathogens include both indigenous organisms and contaminating organisms. Pathogens may contaminate the seafood after harvest or during processing. Some indigenous pathogens found are Vibrio, Clostridium botulinum type E,Aeromonas, and poisonous phytoplankton such as dinoflagellates (111,112). Extraneous pathogens include Salmonella, Shigella, Listeria, Campylobacter, Staphylococcus aureus, E. coli, Bacillus cereus, Hepatitis A, and Norwalk virus (64,112).

Microbiology Of Chilled Foods

Significant foodborne pathogens in chilled foods include both infectious and toxigenic organisms. An assessment of the ability of these organisms to grow in such products is critical for an evaluation of hazards. Organisms such as Staphylococcus aureus, Bacillus cereus, and proteolytic C. botulinum are unable to grow below 7 C, but under temperature abuse conditions they should be considered potential hazards. Spore formers such a B. cereus and C. botulinum are also likely to survive mild pasteurization treatments often given to chilled products, so the outgrowth of these pathogens is controlled by temperature alone. Organisms important to the safety of chilled foods, as well as the parameters for their growth, are listed in Table 4. Most serotypes of C. botulinum are of little significance in chilled foods with the exception of type E and nonproteolytic type B strains. Such serotypes are capable of growing at chilled temperatures and produce a neurotoxin. Incubation periods under...

Product Safety And Regulatory Issues

Regulations covering the manufacturing and sale of pressure-treated foods are under development at this date. Pressure-treated foods distributed as products labeled requires refrigeration are on the market in the United States. These types of products must be free of pathogens, must be manufactured under good manufacturing practices (GMP), and must remain free of spoilage microbes until their use by date. Naturally acidic and directly acidified products are covered by existing regulations for these products. Their safety requirements are the same as for refrigerated foods. Currently product safety and regulatory requirements for shelf-stable, low-acid foods, preserved by high pressure, and packed in hermetically sealed containers have not been developed in the United States. Good manufacturing practices (GMP) can be expected to be similar to those for heat-processed foods. It is expected that an HPP process will be required to provide the equivalent of a 12-fold decimal reduction of a...

Thermal Death Time Calculations

Where t is the heating time (corrected for the come up time) at temperature T, A is the initial number of organisms, and B is the number of survivors. Alternatively, the D value can be determined by plotting the number of survivors at several time intervals against time on semilogarithm paper. (The D value is calculated from the slope of the bestfit line.) D values determined at several temperatures are plotted on semilogarithm paper against temperature (called a phantom TDT curve), and the z value (the change in the thermal death rate with temperature) is calculated from the slope of the line. Knowing the D and z values for an organism allows the calculation of the D value at any other temperature. The F value, or the number of minutes to destroy a given number of organisms at a specific temperature, can also be calculated. The minimum health sterilizing value for a low-acid food is generally a 12D value for C. botulinum (12 times the D value determined for C. botulinum spores in the...

Spore Forming Bacteria

Clostridium species are gram-positive, anaerobic spore formers. Some are highly anaerobic and can be killed in the presence of molecular oxygen, whereas others are aero-tolerant. Important species in food spoilage include C. bu-tyricum, C. putrefaciens, and C. sporogenes. From the standpoint of food safety, C. botulinum is the most important because it produces a group of highly toxic protein toxins called botulin. These toxins are responsible for the often fatal disease called botulism. The canning industry has spent millions of dollars designing time and temperature treatments aimed specifically at killing the spores of this organism in canned goods. Fortunately, the toxin is heat sensitive. Boiling the toxin for 10 min will render it inactive. Another species of Clostridium important in food microbiology is C. perfringens. Although this organism is less toxic than C. botulinum, C. perfringens accounts for about one-fifth of all food-poisoning cases in the United States annually. It...

Spoilage Of Canned Foodsdetermination Of Cause

There are two major causes of spoilage of canned foods postprocess contamination (leakage) and insufficient thermal processing. Postprocessing contamination usually results in a mixed microbial flora of vegetative cells and spore formers, generally with little heat resistance. There is very little risk that such contamination will present a public health hazard. Underprocessing of low-acid foods usually is characterized by pure cultures of spore-forming bacteria there is the risk that C. botulinum and its toxins may be present. In addition, foods may spoil if stored at temperatures above 43 C (109 F) because of growth of thermophilic spore formers, which present no health hazard. In acid and acidified foods, underprocessing results in the growth of organisms that are not a health hazard however, improper acidification can result in the potential for spores of C. botulinum to germinate and grow.

Safety Considerations

Isms which are usually psychotrophic have a competitive advantage over most pathogens that may be present (11). Moreover, many fruits are sufficiently acidic to prevent pathogen growth. Nevertheless, foodborne disease does occur with fruits and vegetables. Some pathogens that have potential to develop in MA-packaged fresh-cut products are Escherichia coli, Aeromonas hydrophila, Clostridium botulinum, Listeria monocytogenes, Salmonella sp., and parasites including Entamoeba histolytica and Giardia lamblia can be present (11). Therefore, an intense commitment to sanitation and adherence to U.S. Food and Drug Administration (FDA) Good Manufacturing Practices (GMPs) as well as implementation of a Hazard Analysis Critical Control Point (HACCP) program should be a part of fresh-cut food processors quality assurance efforts (12).

Coryneform Bacteria Infection And Immunity

Corynebacterium spp. include many of the best speciated organisms they frequently need lipid for adequate growth in vitro and are often microaero-phils they may be called the 'small colony coryneforms'. The localized skin disease erythrasma is caused by an overgrowth of the normal skin inhabitant C. minutissimum, whilst a variety of normal axillary inhabitants are associated with pronounced

Therapeutic protocols for feline allergic skin disease

The liver, excessive fat in the kidneys, dystrophic mineralisation of the adrenal glands, degeneration of the testes and hyperkeratosis of the skin. Linoleate therefore has an important role in membrane function in that it influences growth, lipid transport, normal skin and coat condition, and maintenance of the epidermal permeability barrier. The cat is unable to synthe-sise significant quantities of AA and dietary sources are essential.

Skin and Soft Tissue Infections

Local infections of the skin and soft tissue include cellulitis, subcutaneous abscesses, septic phlebitis, necrotizing fasciitis, Fournier's gangrene, gas gangrene, and pyomyositis. Cellulitis is typically due to S. aureus and Streptococcus spp. Cultures from cutaneous abscesses are often polymicrobial, with aerobic gram-negative rods, anaerobic cocci, and bacilli.31 Quinine, which is often used to cut heroin, can increase the risk of abscess formation. The extensive interconnected abscesses produced by skin popping provide ideal growth conditions for Clostridium botulinum and C. tetani. Broken needles lodged in the skin are foreign bodies that stimulate infection.32 Groin injection has been associated with local gangrene and also the development of rapidly progressive and fatal Fournier's gangrene. Cutaneous abscesses in the neck may involve the carotid triangle and produce airway obstruction, vocal cord paralysis, and laryngeal edema.

Native Americans Early Uses of Animals

Products in medical treatment has not received the same attention. Animal products were used in a number of medical remedies in many Native American nations. Moose and bear fat were used by the Ojibwa to treat skin wounds and to ensure healthy skin in the extreme temperatures. Deer tendons were used as suture material by numerous tribes. The Yukon treated scurvy by ingestion of the animal adrenal glands. Fish oil, because of its high iodine content, was used to treat goiters in Eskimo and Aleut nations. Some South American nations treated epilepsy through shock treatment'' with electric eels. A type of injection device was used by some Native American nations well before the invention of the syringe in 1904. Such devices were constructed from the bladder of a deer or duck connected to a reed or quill of the porcupine. These syringes were used to clean wounds or to inject herbal medicine into the wound.

Candidate Genes In Tumor Progression And Metastasis

Cancer epigenetics studies cannot be fully understood if we do not appreciate the relevance of the silencing of tumor-suppressor genes associated with CpG island hypermethylation and their histone modifications and chromatin-linked changes. In such a context, the multistage mouse skin progression model is also demonstrably useful for defining the chronological inactivation pattern of tumor-suppressor genes with methylation-associated silencing that are known to be hypermethylated in human cancer (17, 18). Of these, there is information available about the DNA repair genes MLH1, BRCA1 and adhesion-related genes E-cadherin (CDH1), the transcriptional repressor Snail and the Snail Gfi-1 repressor family member (MLT1). The DNA methylation patterns of these genes during tumor progression are characterized by bisulfite genomic sequencing and by methylation-specific PCR (MSP). Four of these genes (MGMT, Snail, E-cadherin and MLT1) are methylated in the mouse skin carcinogenesis model (Figure...

Bacterial And Microbial Intoxication

Clostridium botulinum 1971 and 1985, three outbreaks were recorded with 485 cases and 55 deaths. In 1990 there were 12 outbreaks, 22 cases, and 5 deaths and in 1994 there were 42 cases of foodborne botulism, 86 cases of infant botulism, and 11 cases of wound botulism with no fatality. The general public usually have panic in the report of botulism due to its high fatality rate. The organism is a Gram-positive, anaerobic, spore-forming rod that can grow at temperatures from 3.3 C to as high as 50 C. Most strains will grow well at 30 C, with optimum temperature at 37 C. To control the growth of the organism the pH must be below 4.6, salt content of 10 and above, and a water activity of less than 0.94. The vegetative cells of this organism are easily killed by heat, but the spores formed by this cell are far more resistant to heat, cold, acid and basic chemicals, radiation, and other forms of preservation methods. Thus control of botulism is geared to the destruction of the spores. Time...

Chordates Including the Vertebrates

Reptiles show numerous evolutionary developments. Many of these developments freed reptiles from dependence on moist conditions. Their dry skin limits evaporative loss. Internal fertilization and shelled, waterproof eggs eliminates the need for water for reproduction. In turtles and crocodilians the temperature of incubation of the eggs determines the sex ratio. More efficient respiration allows greater size, up to the 115-kg Komodo dragon. Reptile jaws are capable of applying crushing force. They have higher blood pressure and more efficient circulation. Their lungs are more efficient. Whereas amphibians force air into their lungs with mouth muscles, reptiles developed the ability

Clinical Features

PILONIDAL ABSCESSES Pilonidal abscesses are located along the superior gluteal fold. It is thought that a pilonidal sinus forms along the gluteal fold possibly at the time of embryogenesis, although others believe it to be secondary to local soft tissue trauma. These sinuses are lined with squamous epithelium and hair. It is blockage of the sinus tract with hair and other keratinous material that leads to bacterial invasion and infection. The causative organisms typically are normal skin flora, with Staphylococcus species being the most common. Contamination with peritoneal and fecal organisms is also possible. Patients tend to develop symptoms in their late teens and early twenties, and without definitive surgical treatment, they tend to have recurrent infections, sometimes developing a chronic draining fistulous tract. Patients typically present to the ED with a tender, swollen, and fluctuant nodule located along the superior gluteal fold. Systemic symptoms are rare. The appropriate...

Staphylococcal Scalded Skin Syndrome

An episode of SSSS frequently begins as a clinically inapparent staphylococcal infection of the conjunctiva, nasopharynx, or umbilicus. The disease course can be divided into three phases initial erythroderma exfoliative and desquamation recovery. Initially, the patient (or parent) notes the sudden appearance of a tender erythroderma, usually diffuse, although localized disease has been described. The involved skin may have a sandpaper texture. Tender erythema is prominent in the perioral, periorbital, and groin regions, as well as in the skin creases of the neck, axilla, popliteal, and antecubital areas. The mucous membranes are spared. The exfoliative stage begins on the second day of the illness. The erythematous skin wrinkles and peels off at sites of minor trauma or with minimal lateral pressure with the examiner's fingertip, illustrating the positive Nikolsky's sign (also found in TEN). Large, flaccid, fluid-filled bullae and vesicles then appear. These lesions easily rupture...

Disorders of the Neuromuscular Junction

Botulism Ingestion of foods contaminated with Clostridium botulinum toxin causes botulism, an acute disease marked by weakness and gastrointestinal slowing. Adults whose disease is caused not by bacterial infestation but by ingestion of botulinum toxin may report exposure to foods such as home-canned vegetables in the preceding 1 to 2 days. Unlike adults, infants, whose guts are not colonized fully, are susceptible to infection with viable bacteria that elaborate toxin. Parents of infants should be questioned for possible ingestion of C. botulinum spores, commonly transmitted by feeding honey. Infants may present with poor sucking. Botulism caused by infection through a wound is rare. On examination, mentation is normal, but there may be bulbar weakness. The extraocular movements are sometimes abnormal, and an important diagnostic clue is the absence of the pupillary light reflex, which distinguishes this disorder from myasthenia gravis. There is proximal limb weakness, sensation is...

Clinical Manifestations

Clinical manifestations of hyperthyroidism reflect increased catabolism and excessive sympathetic activity caused by excess circulating thyroid hormones. Symptomatic manifestations of hyperthyroidism include weight loss despite normal or increased appetite, heat intolerance, anxiety, irritability, fatigue, muscle weakness, palpitations, and oligomenorrhea. Signs of hyperthyroidism include goiter, tremor, hyperreflexia, fine or thinning hair, thyroid bruit, muscle wasting, and cardiac arrhythmias such as sinus tachycardia or atrial fibrillation. The presentation of hyperthyroidism varies with age. Young patients typically present with hypermetabolism, while older patients may present primarily with tachyarrhythmias or cardiac failure. Rarely, elderly patients experience only muscle wasting, apathy, confusion, or a state of depression known as apathetic hyperthyroidism. Clinical features of hypothyroidism include cold intolerance weight gain constipation edema of the hands, feet, and...

Traits Sought by Both Sexes

Both sexes seek kindness in a mate, which makes sense given the strains of marriage and child rearing (Buss, 1994). They also seek a mate whom they are likely to be able to retain, that is, one of similar mate value. Likewise, they seek someone who appears to be committed to them emotionally. And of course, like other species (Andersson, 1994), people tend to prefer a sexually mature and physically attractive mate, who is likely to be healthy and fertile, and to carry high-quality genes (e.g., Shackelford & Larsen, 1999). Valid cues to genetic quality include normality and bilateral symmetry of features, and healthy skin these features are admired worldwide (Ford & Beach, 1951 Thornhill & Gangestad, 1994). Naturally, not everyone can attract someone who is above average in desirability, and so people usually wind up with mates who lack some ideal features, but the preferences that most people express are often clear and specific, and generally hold even across cultural and...

Reconstructive Surgery

Small defects can be closed by primary suturing, especially where only the pliable scrotal skin is involved. Split thickness skin grafting is most often used and yields acceptable results, even in large defects (Hessel-feldt-Nielsen et al. 1986). Healthy skin from the legs, buttocks, and arms can be used, in a single or multiple settings. Skin defects on the penile shaft should be liberally grafted so as to prevent fibrotic scar formation with future erectile problems.

Inactivation of pathogens and spoilage bacteria

The predominant Gram-positive bacterial pathogens of concern are Clostridium botulinum (and perfringens), Listeria monocytogenes and Staphylococcus aureus and Bacillus cereus. Clostridium botulinum, the causative agent in botulism, is an anaerobic, spore-forming, Gram-positive bacilli, associated with low-acid, canned and modified atmosphere packaged (MAP) meats and vegetables. In the spore form, Clostridium botulinum is highly resistant to antimicrobial processes. Clostridium botulinum produces several of the most potent and deadly neurotoxins (BoNT) known. Purified type A toxin was reported to have a 50 lethal dose (in humans) of approximately 1 ng kg of body weight (Jay, 2000). Botulism was at one time a frequent and life-threatening foodborne illness. Although less common today due to the establishment of the strict 12 D process for the inactivation of Clostridia in canned and MAP food products, occasional incidences of botulism are reported annually, due to mishandling during...

Toxic Epidermal Necrolysis

Patients with TEN often present with a one- to two-week prodrome of malaise, anorexia, arthralgias, fever, or upper respiratory infection symptoms. Skin tenderness, pruritus, tingling, or burning may be found at this time. Skin signs begin with a warm erythema, initially only involving the eyes, nose, mouth, and genitalia, but later becoming generalized. The erythematous areas become tender and confluent within hours. Flaccid, ill-defined bullae then appear within the areas of erythema. Lateral pressure with a finger on normal skin adjacent to a bullous lesion dislodges the epidermis producing denuded dermis, demonstrating Nikolsky's sign. The bullae form along the cleavage plane between the epidermis and the dermis. The epidermis is then shed in large sheets, leaving raw, denuded areas of exposed dermis. The average time of onset after exposure to the inciting agent is 2 weeks. Cutaneous extension follows an unpredictable time course, ranging from 24 h to 15 days with a minority of...

Consumers and research

PSGs can play an important role in educating patients about ways in which they can become involved in clinical research. The National Eczema Society recognised this and encouraged its members and other dermatology patient groups to volunteer to join the Cochrane Skin Group (see Chapter 4) as consumer representatives. Under the auspices of an umbrella organisation of UK skin support groups called the Skin Care Campaign (formerly a project of the National Eczema Society), a meeting was held to inform consumers about the Cochrane Collaboration and how they as consumers could contribute to its work. Some consumers subsequently contributed by hand-searching journals, commenting on protocols and reviews, translating reviews and co-authoring a review (on vitiligo). From this meeting, a focus group was set up to help identify suitable questions for eczema research.

Definition and diagnostic criteria

Atopic eczema is a chronic inflammatory skin condition characterised by an itchy red rash that favours the skin creases such as the folds of the elbows, behind the knees and around the neck. The morphology of the eczema lesions themselves varies in appearance from vesicles to gross lichenification on a background of poorly demarcated redness. Other features such as crusting, scaling, cracking and swelling of the skin can occur.1 Atopic eczema is associated with other atopic diseases such as hay fever and asthma. People with atopic eczema also have a tendency to dry skin, which makes them vulnerable to the drying effects of soaps.

Excision Of Cysts Of The Skin And Subcutaneous Tissues

Before excising a simple, uninfected epidermoid cyst, written, informed consent must be obtained and all the required materials and instruments and good light secured. If hair interferes with the procedure, it should be shaved or trimmed. The skin is cleaned. A short distance from the normal skin near the cyst, 0.5 or weaker lignocaine is injected through a fine needle, raising a wheal extending to and over the cyst. The crown of the cyst where the punctum lies should be avoided in order not to penetrate the cyst and burst it. The injection is then extended around and under the cyst. The hydrostatic pressure should separate the cyst from all its attachments except at the punctum.

Cutaneous Manifestations

Generalized cutaneous conditions, such as xerosis (dry skin), seborrheic eczema, and pruritus, are common and may be manifested prior to development of opportunistic infections. Treatment is with emollients and, if necessary, mild topical steroids. Pruritus may respond to oatmeal baths and antihistamines. Other infections, including S. aureus (manifested as bullous impetigo, ecthyma, or folliculitis), Pseudomonas aeruginosa (which may present with chronic ulcerations and macerations), and syphilis are frequently seen and should be treated with standard therapies. Several specific dermatologic conditions are discussed in more detail below.

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