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Identify the most common causes and types of cataract (eg 10 antimicrobial agents purchase 300mg tinidazole, anterior polar antibiotics for uti levaquin tinidazole 500 mg free shipping, cortical antibiotics for uti that are safe during pregnancy cheap tinidazole 1000mg otc, nuclear sclerotic, posterior subcapsular, posterior polar, mature lenses such as the Morgagnian cataract). Describe the relationship between the lens and systemic disease (eg, diabetes, myotonic dystrophy). List ocular conditions that are associated with cataract (eg, uveitis, Wilson disease, ocular ischemia, ocular tumors, including treatment for tumors such as radiotherapy). List systemic and topical medicine that can cause pathologic changes in the lens (eg, oral and topical corticosteroid use). List the basic history and examination steps for preoperative cataract and posterior capsular opacification evaluation. Identify and describe the principles and mechanisms of the following instruments in the evaluation of cataract: a. Define the elementary refraction techniques to obtain best-corrected vision prior to considering cataract extraction. Describe the major etiologies of dislocated or subluxated lens (eg, pseudoexfoliation syndrome, trauma, Marfan syndrome, homocystinuria, Weill-Marchesani syndrome, syphilis). Describe methods to decrease postoperative infection, including presurgical preparation, intraoperative antibiotics, and postoperative antibiotic techniques. Describe postoperative medications used for cataract surgery, including antibiotics, nonsteroidal anti-inflammatory drugs, and corticosteroid therapy. Describe the special considerations when dealing with a unilateral cataract (trauma, history of uveitis, history of topical steroid use, past surgeries) B. Perform subjective refraction techniques and retinoscopy in patients with cataract. Perform and document laser capsulotomy on routine cases of posterior capsule opacification. Perform direct and indirect ophthalmoscopy prior to and following cataract surgery. Perform the basic steps of cataract surgery (eg, incision, wound closure) in the practice lab, if available. Assist with cataract surgery and perform patient preparation, sterile draping, and anesthesia. Implement the basic preparatory procedures for cataract surgery (eg, obtaining informed consent, identification of instruments, sterile technique, gloving and gowning, prep and drape, and other preoperative preparation). Perform some of the steps of cataract surgery under direct supervision, including any or all of the following: a. Describe the less common causes of lens abnormalities (eg, spherophakia, lenticonus, ectopia lentis, coloboma). Systemic medication of relevance to cataract surgery (eg, alpha 1 adrenergic blocking agent, blood thinning agents, corticosteroids)** c. Relationship of external and corneal diseases of relevance to cataract and cataract surgery (eg, lid abnormalities, dry eye)** d. Describe the use of A-scan and B-scan contact and immersion ultrasonography and optical coherence techniques in cataract surgery to measure axial eye length. Describe the instruments and techniques of cataract extraction, including extracapsular surgery and phacoemulsification. Describe the important parameters of the phacoemulsification machine and how to alter them for particular conditions of surgery. Describe the types, indications, and techniques of anesthesia for cataract surgery (eg, topical,** local,** general). Describe the pathogenesis and strategies for prevention of posterior capsular opacification. Describe the fluid dynamics in phacoemulsification, including the difference between peristaltic and venture pump types. Define the more complex indications for cataract surgery (eg, better view of posterior segment, lens-induced glaucoma). Describe the techniques to manage a small pupil, including mechanical manipulation, management of iris membrane, iris hooks, viscoelastic, and phaco techniques.

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These medications have beneficial effects on scalp hair loss antibiotics for dogs gums order tinidazole with american express, body hair growth antibiotic resistance evolution cheap tinidazole on line, sebaceous glands antibiotic quizzes buy tinidazole master card, and skin consistency. Progestins With the exception of cyproterone, the inclusion of progestins in feminizing hormone therapy is controversial (Oriel,). Because progestins play a role in mammary development on a cellular level, some clinicians believe that these agents are necessary for full breast development (Basson & Prior,; Oriel,). However, a clinical comparison of feminization regimens with and without progestins found that the addition of progestins neither enhanced breast growth nor lowered serum levels of free testosterone (Meyer et al. There are concerns regarding potential adverse effects of progestins, including depression, weight gain, and lipid changes (Meyer et al. Progestins (especially medroxyprogesterone) are also suspected to increase breast cancer risk and cardiovascular risk in women (Rossouw et al. Micronized progesterone may be better tolerated and have a more favorable impact on the lipid profile than medroxyprogesterone does (de Ligniиres,; Fitzpatrick, Pace, & Wiita,). Oral testosterone undecanoate, available outside the United States, results in lower serum testosterone levels than nonoral preparations and has limited efficacy in suppressing menses (Feldman, April; Moore et al. Because intramuscular testosterone cypionate or enanthate are often administered every ­ weeks, some patients may notice cyclic variation in effects. This may be mitigated by using a lower but more frequent dosage schedule or by using a daily transdermal preparation (Dobs et al. Intramuscular testosterone undecanoate (not currently available in the United States) maintains stable, physiologic testosterone levels over approximately weeks and has been effective in both the setting of hypogonadism and in FtM individuals (Mueller, Kiesewetter, Binder, Beckmann, & Dittrich,; Zitzmann, Saad, & Nieschlag,). There is evidence that transdermal and intramuscular testosterone achieve similar masculinizing results, although the timeframe may be somewhat slower with transdermal preparations (Feldman, April). Especially as patients age, the goal is to use the lowest dose needed to maintain the desired clinical result, with appropriate precautions being made to maintain bone density. Bioidentical and Compounded Hormones As discussion surrounding the use of bioidentical hormones in postmenopausal hormone replacement has heightened, interest has also increased in the use of similar compounds in feminizing/masculinizing hormone therapy. There is no evidence that custom compounded bioidentical hormones are safer or more effective than government agency-approved bioidentical hormones (Sood, Shuster, Smith, Vincent, & Jatoi,). Therefore, it has been advised by the North American Menopause Society () and others to assume that, whether the hormone is from a compounding pharmacy or not, if the active ingredients are similar, it should have a similar side-effect profile. Because feminizing/masculinizing hormone therapy limits fertility (Darney,; Zhang, Gu, Wang, Cui, & Bremner,), it is desirable for patients to make decisions concerning fertility before starting hormone therapy or undergoing surgery to remove/alter their reproductive organs. Cases are known of people who received hormone therapy and genital surgery and later regretted their inability to parent genetically related children (De Sutter, Kira, Verschoor, & Hotimsky,). Health care professionals-including mental health professionals recommending hormone therapy or surgery, hormone-prescribing physicians, and surgeons-should discuss reproductive options with patients prior to initiation of these medical treatments for gender dysphoria. These discussions should occur even if patients are not interested in these issues at the time of treatment, which may be more common for younger patients (De Sutter,). Another group who faces the need to preserve reproductive function in light of loss or damage to their gonads are people with malignancies that require removal of reproductive organs or use of damaging radiation or chemotherapy. Lessons learned from that group can be applied to people treated for gender dysphoria. MtF patients, especially those who have not already reproduced, should be informed about spermpreservation options and encouraged to consider banking their sperm prior to hormone therapy. In an article reporting on the opinions of MtF individuals towards sperm freezing (De Sutter et al. Sperm should be collected before hormone therapy or after stopping the therapy until the sperm count rises again. In adults with azoospermia, a testicular biopsy with subsequent cryopreservation of biopsied material for sperm is possible, but may not be successful. Reproductive options for FtM patients might include oocyte (egg) or embryo freezing. The frozen gametes and embryo could later be used with a surrogate woman to carry to pregnancy. Studies of women with polycystic ovarian disease suggest that the ovary can recover in part from the effects of high testosterone levels (Hunter & Sterrett,).

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In rabbits herpes simplex virus discount tinidazole generic, Pasteurellosis antibiotics for urinary retention order tinidazole with american express, a common clinical finding antibiotic resistance world map purchase tinidazole 300 mg amex, can lead to many of the causes mentioned. In addition, Pasteurellosis of the inner ear can initiate nausea associated with the head tilt, and can contribute to anorexia. Lastly, pseudoanorexia, which is a physical inability to eat, rather than the lack of desire to eat, must always be considered with the clinically anorectic patient. Dental disease, more specifically malocclusion of either the incisors or the molars, is a frequent contributing factor in rabbits. A thorough physical examination is warranted for every case, including cases with apparent obvious explanations for the anorexia. Radiographs, laboratory analysis (including complete blood counts, serum chemistry analysis and urinalysis) should be a part of every minimum data base. Anorexia and food deprivation has serious consequences on a patient, especially to those which are convalescing. Rabbits are prone to developing fatty livers if the anorexia is not corrected quickly. Vegetable gruels can be administered via syringe feeding, and when necessary, nasogastric tubes. Pasteurellosis Pasteurella multocida is one of the more common bacteria isolated from rabbit pathology. The bacterium can be found in all organ systems, and can be responsible for several different disease symptoms. As a result, most house rabbits should be considered to at least have been exposed to or are carriers of the organism. It is believed that the organism cannot be eliminated from the host, thus resulting in a permanent carrier state. Symptoms can include "Snuffles" (ocular/nasal discharge, mild respiratory signs), dermatitis, dental disease (tooth abscesses), severe respiratory infections (pneumonia), torticollis and abscesses. These abscesses are usually dermal, and can occur anywhere on the body, or can be internal, commonly arising in organs such as the kidneys, the liver and the lungs. Dermal abscesses can literally arise in a short period of time, with owners often reporting their presence in as little as a couple of days. Although the abscesses can be found anywhere on the body, I have seen them between the mandibles, below or between the ears, and attached to the mandibular or maxillary bone, associated with dental abscesses. In pasteurella conjunctivitis, the periorbital tissue is oftentimes so inflamed as to make the entire orbit/globe appear enlarged. It is not uncommon for the lacrimal glands to be occluded with inflammatory debris, thus exacerbating the pasteurella conjunctivitis. It is a benefit to the patient to gently flush the lacrimal glands prior to initiating ophthalmic antibiotics. Simple draining of the caseous material within the abscess, even with the aid of a penrose drain, will not suffice as it does in feline abscesses. This necessitates anesthesia, and because of the propensity for pasteurella abscessation in the lungs, it is prudent to radiograph the thorax prior to administering any anesthetics. Lesser cases, those involving the As mentioned, it may not be possible to completely eradicate the pasteurellosis from a rabbit. Culture, surgical debulking and appropriate antimicrobial therapy should always be considered. In some instances, animals may require prolonged administration of antimicrobials, sometimes lasting as long as one year. Either drug should be administered for at least 14 to 21 days, or as long as is necessary to control the infection. Tooth Root Abscess It is not uncommon for rabbits to present with abscesses of dental roots. These manifest as simple anorexia, or present with large, firm swellings adhered to the adjacent maxillary or mandibular bone. There may be an associated fluid or purulent pocket associated with the abscess, over the lesion.