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The prognosis in these patients is similar to those with postinfectious encephalomyelitis discount diclofenac gel 20 gm without prescription. However diclofenac gel 20gm with visa, inflammatory cells are largely lymphocytes and discrete perivenous lesions are the rule rather than the exception. This pathogenesis of acute disseminated encephalomyelitis appears to represent an immune destruction of myelin, which is not dependent upon direct invasion of the brain by virus. Experimental allergic encephalomyelitis, an autoimmune, inflammatory demyelinating disease, 118 appears to be an excellent model for this human disease. Acute hemorrhagic leukoencephalitis Acute hemorrhagic leukoencephalitis (Weston Hurst disease) is thought to be an hyperacute form of acute disseminated encephalomyelitis. This usually occurs in childhood and there may be an antecedent viral infection (influenza, chicken pox, measles) or a vaccination. The onset is dramatic and often asymmetric due to the predominance of lesions in one cerebral hemisphere. Pathologically, these lesions are characterized by necrosis of blood vessels with a marked fibrinous exudate, ring-shaped hemorrhages and neutrophilic inflammatory cells. Grossly, the lesions are variable in size, multiple, granular and usually restricted to the deep white matter. Microscopically, primary demyelination with marked, often bizarre, astrocytosis is observed. Oligodendrocytes are diminished within the lesions; their nuclei are enlarged and exhibit amphophilic viral inclusions. Viral antigens and particles have been demonstrated in these inclusions and rarely in the bizarre astrocytes. Although the reactivation of a latent virus appears to play a fundamental role, it must be emphasized that both the chronicity of its clinical course ("slow infection") and the lack of immune and inflammatory host responses set this disease apart from classical latent infections, such as varicella-zoster. This disease entity is illustrated in the infectious disease section of this syllabus. This is predominantly a disease of children, characterized by the insidious onset of behavioral changes and mental deterioration followed by myoclonus, ataxia and sometimes seizures. About half the patients are known to have had measles prior to the age of 2 years. These are mainly inherited disorders, most commonly autosomal recessive, that affect infants and children, but rare adolescent 119 and adult forms are also recognized.

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Tube Dilution Take 20µl blood with sahli pipette and mix it with 4ml diluent in a small tube to give a final dilution of 1:201 105 Hematology Counting and Calculation After the suspension is charged into the chamber and the cells allowed to settle cheap 20gm diclofenac gel mastercard, cells should be counted using the 40× objective and 10× eyepiece in 5 small squares of the central 1mm2 area of the improved Neubauer counting chamber (4 corner and 1 central squares each with an area of 0 generic diclofenac gel 20 gm mastercard. It is important to count as many cells as possible for the accuracy of the count is increased thereby; 500 cells should be considered as the absolute minimum. Platelet counts are also performed when patients are being treated with cytotoxic drugs or other drugs which may cause thrombocytopenia. Method using formal-citrate red cell diluent Diluent should be prepared using thoroughly clean glassware and fresh distilled water. To prevent drying of the fluid, place the chamber in a petri dish or plastic container on dampened tissue or blotting paper and cover with a lid. Count the number of platelets which will appear as small refractile bodies in the central 1mm2 area with the condenser racked down. Not more than 500ml should be prepared at a time using thoroughly clean glassware and fresh distilled water. The preparation is mixed, the chamber filled and the cells allowed to settle in a similar fashion as Method 1. The cells are counted in 5 small squares in the central 1mm2 of the improved Neubauer counting chamber. Rough estimation of platelet number from a stained blood film Normally there are 10-20 platelets per oil immersion field. Special care must be taken when counting platelets: • To check there are not clots in the blood sample. Platelet counts from capillary blood are usually 111 Hematology lower than from venous blood and are not as reproducible. Thrombocytosis Causes of an increase in platelet numbers include: • Chronic myeloproliferative disease e. Principle Blood is diluted with a fluid that causes lysis of erythrocytes and stains eosinophils rendering them readily visible. Diluting Fluid Hinkleman’s fluid It has the advantage of keeping well at room temperature and not needing filtering before use. Method Make dilution of blood using thomma pipette or tube dilution as described for the white cell count.

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The polar end is hydrophilic (water loving) because it can interact with water molecule which is also polar discount diclofenac gel 20 gm otc, the non- polar end is hydrophobic (water fearing) and will not mix with water diclofenac gel 20 gm without prescription. Such two-sided molecule self assemble into a lipid bilayer, a double layer of lipid molecules when in contact with water. The hydrophobic tails bury themselves in the center away from the water, while the hydrophilic heads line up on both sides in contact with water. Cholesterol provides to the fluidity as well as the stability; cholesterol lies in between the phosphate molecules, preventing the fatty acid chain from packing together and crystallizing that could decrease fluidity of the membrane. On account of fluidity of the membrane it gives flexibility to the cell to change its shape; transport process are also dependent on the fluidity of the lipid bilayer. The membrane proteins are either attached to or inserted within the lipid bilayer; some extending through the entire membrane thickness; they have polar region at both ends joined by a non-polar central portion. Other proteins are on either the outside or inner surface, anchored by interactions with proteins that spans the membrane or by attachment to the lipid bilayer. On account of membrane fluidity many proteins float freely, although the mobility of protein that have special function in a particular area of the membrane is restricted - this gives ever changing mosaic pattern of the protein embedded in the lipid layer. Only the outer surface of the plasma membrane contains a small amount of carbohydrate. Short-chain carbohydrates are bound primarily to membrane proteins and to a lesser extent to lipids, forming glycoproteins and glycolipids. The plasma membrane is actually asymmetrical; the two surfaces are not the same; carbohydrate is only on the outer surface; different amount of different proteins are on the outer and inner surfaces and even the lipid structures of the outer and inner half is 23 not the same. The plasma membrane is highly complex, dynamic, regional differentiated structure. The lipid layer forms the primary barrier to diffusion, whereas proteins perform most of the specific membrane functions. Responsible for the fluidity of the membrane Membrane Proteins Membrane proteins are variety of different proteins within the plasma membrane; serve the following special functions: (see fig. Some form water-filled passage ways or channels, across the lipid bilayer; such channels allow ions to pass through without coming in direct contact with lipid interior. The channels are highly selective; they can selectively attract or repel particular ions. Other proteins serve as carrier molecule that transport specific molecule that cannot cross on their own.