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The role of androgens in female androgenetic alopecia is less clear-cut than it is in men buy discount cipro 1000mg on-line antibiotics quiz medical students. Scalp hair loss is undoubtedly a feature of hyperandrogenism in women (although it is much less frequent than hirsutism) buy cipro with amex antibiotics h pylori. Indeed purchase generic cipro canada antimicrobial versus antibiotic, loss of hair was reported in women with andro- gen-secreting tumors prior to Hamilton s observations in men (18,19). Several investigators have noted that women with hair loss are more likely to have elevated androgen levels or show an increased frequency of other features of androgen excess than women without hair loss. In a recent series of 89 women presenting to a trichology clinic with hair loss, 67% showed ultra- sound evidence of polycystic ovaries compared to 27% in a control group of 73 women, and 21% were signicantly hirsute compared to 4% of controls (22). The results of clinical trials of anti-androgens have also questioned whether female androgenetic alopecia is necessarily androgen-dependent and consequently the less committal term female pattern hair loss is preferred by some clinicians. Genetics Twin studies have demonstrated that the predisposition to male balding is predominantly due to genetic factors (24 26). Published concordance rates for monozygotic twins are around 80 90%, with consistently lower rates in dyzogotic twins. Several studies have shown there is a high frequency of balding in the fathers of bald men. So far, attempts to identify the relevant genes have been limited to a small number of candidate gene studies. No associations have been found with 5-reductase genes (27,30) or the insulin gene (31). This nding therefore conrms there is a mater- nal inuence on male balding but does not explain the genetic contribution from the father. Prevalence Population frequency and severity of androgenetic alopecia in both sexes increase with age. Almost all Caucasian men develop some recession of the frontal hairline at the temples during their teens. Deep frontal recession and/or vertex balding may also start shortly after puberty although in most men the onset is later. A small proportion of men (15 20%) do not show balding, apart from post-puber- tal temporal recession, even in old age. Some authorities have suggested that scalp hair loss in elderly men may develop independently of androgens (senescent alopecia) but this remains to be veried (35). Balding is less common in Asian men although there is quite a wide variation in pub- lished frequencies. Two recent studies from Thailand and Singapore found prevalence rates not far short of those in Caucasian men (36,37). In Korean men the frequency is 20 40% lower than in Caucasian men in the 40 70 age group although the difference becomes less pro- nounced with advancing age (39). Preservation of the frontal hairline was a common feature in the series reported from Korea and 11. One early study reported that balding is four times less common in African- American men than in Caucasians (40). The frequency and severity of androgenetic alopecia is lower in women than in men but it still affects a sizeable proportion of the population. Two studies in Caucasian women in the United Kingdom and the United States reported prevalence rates of 3 6% in women aged under 30, increasing to 29 42% in women aged 70 and over (41,42). As in men, androgenetic alopecia is less common and appears to start later in life in Asian women, although nearly 25% of Korean women over 70 years of age show evidence of hair loss (39). There are no published data on the prevalence of androgenetic alopecia in African women although clinical experience suggests that its frequency is similar to that in other racial groups. Under normal circumstances it has no adverse effect on physical well-being apart from increasing the risk of chronic photodamage to unpro- tected scalp skin.

Diseases

  • Familial multiple trichodiscomas
  • Crow Fukase syndrome
  • Polysyndactyly type Haas
  • Hollow visceral myopathy
  • Acute myeloblastic leukemia type 2
  • Nemaline myopathy
  • Aganglionosis
  • Succinyl-CoA acetoacetate transferase deficiency
  • Crisponi syndrome

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Severely af- Denial (for 24 hours) of milk feeding to a calf fected calves will develop a metabolic acidosis with low with viral diarrhea places the calf at signicant risk plasma bicarbonate purchase generic cipro on line antibiotics for pcos acne. Other electrolytes and glucose val- for cachexia and may lower its resistance to ues tend to be low but vary with severity and duration opportunistic disease discount cipro 500 mg with amex 6 bacteria. Chuck Diagnosis Guard order generic cipro from india klebsiella oxytoca antibiotic resistance, If a calf scours for a week, and all that the Diagnosis requires identication of rotavirus particles calf is fed is oral electrolyte replacer, then that calf in the feces of acutely infected calves. Feces should be will be well hydrated and will have absolutely per- collected within the rst 24 hours of illness and diar- fect blood electrolyte concentrations and acid-base rhea. Feces submitted to qualied diagnostic laborato- balance on the day it starves to death. Feces from more than one acute case in the and acidosis that may result from maldigestion of herd must be tested before staking an entire prevention milk nutrients can be offset by aggressive uid and program on one isolate. Obviously this comment is relative, not absolute, because generally less than 100% of the small intes- tinal villi are damaged. Therefore absorption of some proportion of the glucose, electrolytes, and water that comprise the oral uids will occur, and aggressive oral uid therapy (4 to 6 L/day) is still indicated in this disease. Isotonic electrolyte replacements may be preferable unless the calf is hypoglycemic. Electrolyte solutions containing glutamate mixed with yogurt may speed intestinal recovery, although this is not proven in the calf. Maldigestion, as well as malabsorption, will inu- A 3-week-old red and white Holstein calf with chronic ence the duration of diarrhea and digestibility of diarrhea and emaciation caused by rotavirus and Crypto- milk or milk replacers in viral enteritis patients. The calf was normally hydrated and Once diarrhea from rotavirus becomes evident, the had normal electrolytes but was deteriorating because of damage to the intestinal lining has already occurred, malabsorption/maldigestion and cachexia. This is one and only time and supportive care can allow the of the rst calves we successfully treated using parenteral intestine to heal. It also requires that management prevent acid-base and electrolyte determinations. If this is not overwhelming exposure of neonatal calves to challenge practical or available, however, the most severely af- with this or other combined infections. Guidelines for uid infection if calves are fed adequate to large amounts of therapy are available in the section on treatment of colostrum to achieve local protection. Parenteral nutrition may be life saving in calves only fed for 1 or a few days, the local protective effect with cachexia. Continued feeding of colostrum is pure rotaviral enteritis, the likelihood of mixed infec- ideal but often not practical. Initial postnatal ingestion tions and the pathologic damage to enterocytes that of very high antibody-containing colostrum may in fact fosters attachment of bacterial pathogens may be reason create high enough humoral antibody levels to create enough to treat severely affected calves with systemic secretory IgG1 antibodies into the gut. Cur- Rotavirus is ubiquitous in cattle populations; therefore rently the killed products generally are recommended, management procedures that decrease the magnitude of and the dry cow should be vaccinated 6 and 3 weeks exposure of neonatal calves to rotavirus must be the focus before freshening (or according to manufacturer s rec- of preventive efforts. Cleaning maternity pens between ommendations) and subsequently given booster shots deliveries of different cows, immediately removing the each year 4 weeks before freshening. No vaccine or an- calf from the dam (and thus exposure to feces), placing tibody can overcome massive viral challenge, and con- the calf in an individual hutch that has been cleaned and versely less concern for passive protection is necessary put on a new spot since removal of the last occupant, and when management excels at reducing risk for the new- feeding the calf from its own nipple bottle or pail rather born calf. Given the practical limitations and expense than a common feeding device all help reduce spread of of continued colostrum (or colostrum supplement) viral pathogens. Incidence of ro- of a safe pen can also be considered (see discussion in tavirus diarrhea has been decreased on some farms by section on colisepticemia).

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Morphometric and cytochemical analysis of lysosomes in rat Peyer s patch follicle epithelium: their reduction in volume fraction and acid phos- phatase content in M cells compared to adjacent enterocytes order 500mg cipro amex antibiotic resistance and livestock. Uptake and transport of copoly- mer biodegradable microspheres by rabbit Peyer s patch M cells buy generic cipro line antibiotic kills good bacteria. Conversion by Peyer s patch lym- phocytes of human enterocytes into M cells that transport bacteria purchase generic cipro canada antibiotic resistance medical journals. Surface phenotype of Peyer s patch germinal center cells: implications for the role of germinal centers in B cell differentiation. Relationship between expression of IgA by Peyer s patch cells and functional IgA memory cells. The preference for switching to IgA expression by Peyer s patch germinal center B cells is likely due to the intrinsic influence of their microenvironment. Surface lymphotoxin alpha/beta complex is required for the development of peripheral lymphoid organs. Alternate mucosal immune system: organized Peyer s patches are not required for IgA responses in the gastrointestinal tract. Immunogenicity of recombinant adenovirus- human immunodeficiency virus vaccines in chimpanzees following intranasal administra- tion. Specific secretory immune responses in the female genital tract following intranasal immunization with a recombinant adenovirus expressing glyco- protein B of herpes simplex virus. Intranasal immunization induces long-term protec- tion in mice against a Chlamydia trachomatis genital challenge. Induction of antigen-specific antibodies in vagi- nal secretions by using a nontoxic mutant of heat-labile enterotoxin as a mucosal adju- vant. Salivary, nasal, genital, and systemic antibody responses in monkeys immunized intranasally with a bacterial protein antigen and the cholera toxin B subunit. Antibod- ies and antibody-secreting cells in the female genital tract after vaginal or intranasal immunization with cholera toxin B subunit or conjugates. Intranasal vaccination of humans with recombinant cholera toxin B subunit induces systemic and local antibody responses in the upper respiratory tract and the vagina. Induction of mucosal and systemic immunity to a recombinant simian immunodeficiency viral protein. T- and B-cell functions and epitope expression in nonhuman primates immunized with simian immunodeficiency virus antigen by the rectal route. Peyer s patches: an enriched source of precursors for IgA-producing immunocytes in the rabbit. Rabbit Peyer s patches, appendix, and popliteal lymph node B lym- phocytes: a comparative analysis of their membrane immunoglobulin components and plasma cell precursor potential. Characteristics of mesenteric lymph node cells homing to gut-associated lymphoid tissue in syngeneic mice. Mesenteric lymph node B lym- phoblasts which home to the small intestine are precommitted to IgA synthesis. IgA antibody-producing cells in peripheral blood after antigen ingestion: evidence for a common mucosal immune system in humans. Specific immunoglobulin-secreting human blood cells after peroral vaccination against Salmonella typhi. Oral cholera vaccination induces strong intestinal antibody responses and interferon-gamma production and evokes local immunological memory. Expression of a protective intestinal immune response can be inhib- ited at three distinct sites by treatment with anti-alpha 4 integrin. A fundamental subdivision of circulating lymphocytes defined by adhesion to mucosal addressin cell adhesion molecule- 1.