text:
Conquer Low Platelets
Subacute or chronic meningitis is characterized by a gradual onset, often without any predisposing factor. These syndromes run their course over weeks, months or years. The clinical signs include headache, fever, stiff neck, and altered consciousness. Lower cranial nerve palsies may accompany basilar meningitis.
Of the treatable conditions, crytococcosis and syphilis can be easily diagnosed on the basis of serology and antigen detection. Lyme disease (Borrelia burgdorferi) with nervous system involvement usually presents as a chronic meningitis and should be suspected if a combination of facial nerve palsy (often bilateral) and aseptic meningitis is present. Later in the course of the disease it may cause an encephalomyelitis, although several patterns of peripheral neuropathies, radiculopathy, and myositis have also been described. The characteristic skin lesion erythema chronicum migrans is often accompanied by secondary annular skin lesions. Other symptoms may include myalgias, arthral-gias, dysesthesias, or abdominal pain. The causative spirochete, Borrelia burgdorferi, is transmitted by the bite of an infected Ixodes tick. Infection can spread hematogenously to, heart, nervous system, joints, and other organs (reviewed in ref. 5).
Fungal meningitis occurs primarily in individuals with immunosuppression. Crypto-coccus neoformans is the most common cause of meningitis in patients with human immunodeficiency virus (HIV) infection and in transplant patients. Other fungal infections that may occur in individuals with defects in cell-mediated immunity may include Coccidioides immites and histoplasmosis. Patients with granulocytopenia or a functional abnormality of granulocytes as is seen in diabetes mellitus are at risk of developing infections due to Candida, Aspergillus fumigatus, and Zygomycetes organisms (mucormycosis). Candida infections may also occur through central lines and in patients on broad-spectrum antibiotic therapy.
Tuberculous meningitis in HIV-infected patients is very similar to that in non-HIV-infected patients, except that the HIV-infected patients are more likely to have symptoms suggestive of extrameningeal tuberculosis. CNS tuberculosis can occur in the absence of pulmonary tuberculosis (6).
Treponema pallidum is a spirochete that causes syphilis. It is now recognized that CNS disease can occur through all stages of the infection. Although several well-characterized CNS syndromes have been described with T. pallidum they can be broadly classified into meningeal involvement (asymptomatic, subacute meningitis, meningo-vascular syphilis) that occurs early and is still common and parenchymal involvement (general paresis, tabes dorsalis, and gumma), which occurs several years after the primary infection and is rare. In contrast to the preantibiotic era, neurosyphilis today is identified in young patients most often with HIV coinfection, and early symptomatic syndromes and asymptomatic neurosyphilis are identified more frequently than late neurosyphilis syndromes (7,8).
Important noninfectious causes include sarcoidosis, systemic lupus erythematsous, vasculitides, carcinomatous meningitis, and Vogt-Koyanagi-Harada syndrome.
Fungal meningitis is commonly present in a state of immunosuppression which is also often associated with thrombocytopenia; hence platelet counts should be per formed prior to performing a lumbar puncture. If the platelet count is <50,000/mm3, platelet transfusion is necessary. Neuroimaging (CT or MRI scan), preferably with contrast, should also be performed in these patients, as fungal meningitis is often associated with intracranial mass lesions. Fungi are typically difficult to isolate and culture from the CSF, because the infection occurs primarily in the basilar cisterns, and fungi are seldom present in the lumbar thecal sac where the lumbar puncture is performed. Hence large volumes (40-50 mL) of CSF are typically necessary for fungal cultures, and to improve the chances of finding the organism, the CSF from the later tubes should be used and it should be centrifuged and the pellet used for cultures and smears. If repeated cultures are negative and it remains essential to establish a diagnosis, a cis-ternal puncture may be considered. Biopsy of the basilar meninges may also be performed, but it carries a high morbidity rate. Biopsy of the cortical meninges is typically negative and hence not useful. For cryptococcus, antigen detection by latex agglutination is the most sensitive and specific test available. However, in HIV-infected patients, cryptococci may be detected by India ink in nearly 80% patients (9).
In tuberculous meningitis, similar to other chronic meningitides, a lymphocytic pleocy-tosis is commonly seen in the CSF. However, early in the course of the illness (2-3 d) polymorphonuclear cells may be present which are replaced by lymphocytes (10). Similarly, following initiation of antituberculous therapy polymorphonuclear cells may reappear in the CSF (11). Because tuberculous meningitis is also a basilar meningitis, similar guidelines should be followed with regards to collection and processing of CSF as discussed previously. In addition, in some patients with tuberculous meningitis, owing to the large amount of protein present, a cobweb-like clot may appear on the surface of the fluid if kept undisturbed for a few hours. Tubercle bacilli get trapped in this proteinaceous material and can be identified by a acid-fast bacilli (AFB) smear. Alternatively, by adding 95% alcohol to the CSF the proteins can be precipitated and then examined. Smears are positive in approx 10-30% patients with tuberculous meningitis. Cultures require 3-6 wk and are positive in approx 75% patients. Polymerase chain reaction for M. tuberculosis may help establish the diagnosis early.
Two types of serological tests are available for diagnosing syphilis, broadly called tryponemal and nontreponemal tests. The tryponemal tests detect specific antibodies against Tryponema pallidum antigens and include the fluorescent treponemal antibody absorption test (FTA-ABS) and the microhemagglutination-T pallidum test (MHA-TP). The nontreponemal tests detect antibodies against lipid antigens on the membrane of T. pallidum and include the Veneral Disease Research Laboratory test (VDRL) and the rapid plasma reagin test (RPR). The treponemal tests become positive earlier in the course of infection and are more specific than the nontreponemal tests. A large number of conditions have been described in which false-positive syphilis serology may occur (12). Most studies use a newly reactive positive CSF VDRL as a criteria for diagnosis of asymptomatic neurosyphilis. In two large prospective studies of CNS syphilis, CSF findings of patients with and without HIV infection were compared (13). The frequency of isolation of T. pallidum was similar in both instances, the only difference being the presence of a slightly greater lympho-cytosis in the HIV-infected patients.
For diagnosis of Lyme disease, positive or equivocal results on an enzyme-linked immunosorbent assay (ELISA), immunofluorescent assay (IFA), or immunodot assay requires supplemental testing with a Western blot assay. A negative result on the West-
em blot or ELISA indicates that there is no serologic evidence of infection by B. burgdorferi (14).
Once polymerase chain reaction (PCR) techniques become available for clinical use, they will revolutionize the diagnosis of chronic meningitis, owing to their extreme sensitivity and rapidity with which the diagnosis can be established (15,16).
For all types of fungal meningitis, intravenous amphotericin B is the treatment of choice. The major side effect of amphotericin B is renal impairment; hence renal functions should be monitored every other day for the first month and then weekly for the duration of therapy. Addition of flucytosine allows a dose reduction of amphotericin B and hence decreases the chance of developing nephrotoxicity. However, at serum concentrations >100 ^g/mL bone marrow suppression may occur and therefore drug levels should be monitored regularly. The risk of bone marrow suppression should be carefully weighed in patients with acquired immunodeficiency syndrome (AIDS) who may be on other drugs with similar side effects. In patients with AIDS and fungal meningitis, maintenance therapy with fluconazole is necessary for life (17).
Treatment requires the use of intravenous and intrathecal amphotericin B administered preferably by an Ommaya reservoir. It is recommended that treatment be continued for at least 1 yr after the CSF returns to normal. Intrathecal steroids may be used to decrease drug related inflammatory reaction.
In non-AIDS patients a clinical trial that compared fluconazole to amphotericin B showed that treatment with fluconazole required 36% fewer days of hospitalization (18). In non-AIDS patients, a negative or low cryptococcal antigen titer suggests that the infection is adequately treated. However, in patients with AIDS, CSF cryptococcal antigen may remain positive despite adequate treatment owing to release of antigen from dead cells or slow clearing of the antigen from the CSF. Hence the clinical status is the best indicator for response to therapy and repeated CSF evaluations are not needed. Serum cryptococcal antigen titers are useful in patients on maintenance therapy. A rising titer indicates a relapse and requires confirmation with cultures. Prognostic factors in AIDS patients includes the titer of cryptococcal antigen in CSF, serum albumin level, and CD4 cell count, which together with dose of amphotericin B, have the strongest association with failure to achieve negative CSF cultures by d 14 (19).
Initiation of empiric chemotherapy should not await the results of CSF cultures (20). Isoniazid and pyrazinamide have excellent penetration of the blood-CSF and blood-brain barriers even under noninflamed conditions and hence form the backbone of all antituberculosis therapy. Treatment of tuberculous meningitis in non-AIDS patients should be initiated with isoniazid, rifampicin, and pyrazinamide. Pyridoxine is given to prevent isoniazid-induced peripheral neuropathy. If antimicrobial resistance is suspected, ethambutol may also be added. Once a clinical response is noted, pyrazi-namide and ethambutol may be discontinued (usually after 2 mo of treatment). Isoniazid and rifampicin should be continued for 9-12 mo. In patients with HIV infection it is recommended that treatment be initiated with four drugs: isoniazid; rifampicin; the third drug, which should be either ethambutol or pyrazinamide; to and the fourth drug, which should be streptomycin, rifabutin, or clofazimine. The recommended dosage for isoniazid is two to three times that of non-AIDS patients (i.e., 10-15 mg/kg/d). Hence these patients should be carefully monitored for the development of peripheral neuropathy. Ethambutol causes a dose-related optic neuropathy, while rifampicin, pyrazinamide, and isoniazid can be hepatotoxic. The American Academy of Pediatrics (21) recommends the use of isoniazid, rifampicin, pyrazinamide, and streptomycin for 2 mo followed by isoniazid and rifampicin for another 2 mo. They recommend that liver function be monitored for the first several months. The Academy also recommends that the use of corticosteroids be considered in this patient population. Dexamethasone (0.3-0.5 mg/kg/d) is to be given during the first week of therapy followed by prednisone staring at 2 mg/kg/d and gradually tapered over 3-4 wk. The steroids decrease cerebral edema and the inflammatory reaction (22).
Penicillin is the drug of choice for neurosyphilis treatment. However, the total dose, the most appropriate formulation, and the duration of therapy remain a subject of debate. The CDC recommends intravenous crystalline penicillin G, 12-24 million units daily in divided dosages at 4-h intervals for 10-14 d. Lower dosages do not provide adequate CSF levels of the drug. An alternative regimen is the use of procaine penicillin, 2.4 million units given intramuscularly daily, plus probenecid, 500 mg orally, four times daily for 10-14 d (23). The interactions of HIV and syphilis are still not completely understood. However, patients with syphilis and HIV infection are at increased risk for treatment failure, so that higher dosages of penicillin given for 10-14 d offer no clear advantage over standard regimens (24). Careful observation coupled with a low threshold for repeat CSF evaluation remains the recommended management strategy for these patients (25). In patients allergic to penicillin, tetracy-clines, chloramphenicol and ceftriaxone have been suggested based on case reports. Erythromycin frequently results in treatment failure.
Intravenous ceftriaxone or cefotaxime are the treatment of choice for nervous system involvement with Lyme disease due to their good CSF penetration and long halflife (26,27). However controlled trials have shown that intravenous penicillin (28) and doxycycline may be just as effective (29,30). Courses of therapy ranging from 10 to 21 d are supported by the available evidence, although the optimal duration of therapy is unknown (31). Recently a vaccine has become available for human use for individuals at high risk (32).
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If you have ever had to put up with the misery of having a yeast infection, you will undoubtedly know just how much of a 'bummer' it is.


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Life is Sweeter
At Traditions
Join our email newsletter to stay updated on all the latest news, receive event invitations, and more! Life truly is sweeter at Traditions of Braselton.
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It's never lost on us that your home will serve as the backdrop to countless memories and special milestones. Wherever you are in your stage of life – newly married, at the helm of a growing family, enjoying "empty nester" status or in search of your "forever home" – Traditions of Braselton has a home plan to fit your vision, needs and unique family structure.
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As a sprawling 1140-acre master-planned community, Traditions of Braselton has assembled some of the South's finest builders to offer a wide array of homes to fit a variety of styles, taste levels and budgets. From an expertly crafted spec home to an imaginatively designed custom home, we invite you to find the ideal builder to realize the home of your dreams.
Luxury Homes
Nestled within Turnberry, semi-custom and custom homes in Traditions of Braselton are innovatively designed and painstakingly crafted by some of the South's most visionary builders. Just imagine the luxury home of your dreams boasting all the bells and whistles – including a prime spot along the golf course.
Ranch-Style Homes
With a surge in popularity of one-level living, we'd be remiss not to include a collection of thoughtfully designed, beautifully rendered ranch style floor plans. Many plans boast private and tranquil sleeping quarters contrasted against vibrant open concept living spaces that are ideal for entertaining.
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subset: commoncrawl


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NP 11-203 Process for Exemptive Relief Applications in Multiple Jurisdictions -- exemption from National Instrument 81-106 Investment Fund Continuous Disclosure to permit investment fund that uses specified derivatives to calculate its NAV weekly and not on a daily basis, subject to certain conditions.
Applicable Legislative Provisions
National Instrument 81-106 Investment Fund Continuous Disclosure, ss. 14.2(3)(b), 17.1.
May 19, 2009
(the Jurisdiction)
(the Filer)
The principal regulator in the Jurisdiction has received an application from the Filer for a decision under the securities legislation of the Jurisdiction of the principal regulator (the Legislation) for relief from the requirement in section 14.2(3)(b) of National Instrument 81-106 Investment Fund Continuous Disclosure (NI 81-106) that the net asset value (NAV) of an investment fund must be calculated at least once every business day if the investment fund uses specified derivatives (the Exemption Sought).
Under the Process for Exemptive Relief Applications in Multiple Jurisdictions (for a passport application):
(a) the Ontario Securities Commission is the principal regulator for this application; and
(b) the Filer has provided notice that Section 4.7(1) of Multilateral Instrument 11-102 Passport System (MI 11-102) is intended to be relied upon in Alberta, British Columbia, Manitoba, Saskatchewan, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, Yukon, Northwest Territories and Nunavut.
Terms defined in National Instrument 14-101 Definitions and MI 11-102 have the same meaning if used in this decision, unless otherwise defined.
This decision is based on the following facts represented by the Filer:
1. The Filer will be an investment trust, to be established under the laws of Ontario pursuant to a trust agreement.
2. Connor, Clark & Lunn Capital Markets Inc. (the Manager) is the promoter and manager of the Filer. The Manager will be responsible for providing or arranging for the provision of administrative services required by the Filer. The head office of the Manager is located in Ontario.
3. The Filer filed a preliminary prospectus (the Preliminary Prospectus) dated April 15, 2009 on SEDAR with respect to a public offering (the Offering) of Class A Units and Class F Units (collectively, the Units, and each holder of a Unit a Unitholder) in each of the provinces and territories of Canada, a receipt for which was issued by the Ontario Securities Commission on April 16, 2009. The Offering of the Units is a one-time offering and the Filer will not continuously distribute the Units.
4. The Filer's investment objectives are (i) to provide Unitholders with attractive tax-advantaged quarterly cash distributions, and (ii) to return to Unitholders at least the original issue price of the Units upon termination of the Fund on June 30, 2014. The Filer will seek to achieve its investment objectives through exposure to an actively managed portfolio (the Portfolio) consisting primarily of securities issued by entities related to the six largest Canadian banks that hold debt securities, deposit notes of the banks, or other assets which are used to generate income to be distributed to holders of such securities.
5. The Portfolio will be held by Portfolio Trust, a trust to be established under the laws of the Province of Ontario pursuant to a trust agreement. The Manager is also the manager and promoter of Portfolio Trust.
6. Portfolio Trust will be established for the purpose of acquiring and holding the Portfolio. The Filer will seek to achieve its investment objective by entering into a forward purchase and sale agreement (the Forward Agreement) with a Canadian financial institution or one of its affiliates (the Counterparty) pursuant to which the Counterparty will agree to deliver to the Filer on the earlier of: (i) June 30, 2014; or (ii) any other date upon which the Forward Agreement is terminated in accordance with its terms (the Forward Termination Date), a portfolio consisting of Canadian public issuers that are "Canadian securities" as defined under subsection 39(6) of the Income Tax Act (Canada) (the Canadian Securities Portfolio). The aggregate value of the Canadian Securities Portfolio will be equal to the redemption proceeds of a corresponding number of units of Portfolio Trust, net of any amount owing by the Filer to the Counterparty.
7. The Class A Units have received conditional listing approval from the Toronto Stock Exchange (the TSX).
8. The Class F Units are designed for fee-based accounts and differ from the Class A Units in the following ways: (i) Class F Units will not be listed on a stock exchange; (ii) the fees payable to the syndicate of agents with respect to the Offering on the issuance of the Class F Units are lower than the Class A Units; and (iii) the service fee component of the management fee payable to the Manager, being 0.40% per annum of the net asset value attributable to the Class A Units, plus applicable taxes, is only payable with respect to the Class A Units. The Class F Units are convertible into Class A Units and it is expected that liquidity for the Class F Units will be obtained by means of conversion into Class A Units and the sale of those Class A Units through the facilities of the TSX.
9. Class A Units and Class F Units may be redeemed on the second last business day of November of any year commencing in 2010 (but must be surrendered by the Unitholder on the last business day of October in order to be redeemed), subject to certain conditions, at a redemption price per Unit equal to 100% of the net asset value per Unit of the relevant class, as applicable (less any costs associated with the redemption, including brokerage costs, and less any net realized capital gains to the Filer that are distributed to a Unitholder concurrently with the proceeds of disposition on redemption).
10. In addition to such annual redemption right, Class A Units and Class F Units may be redeemed on the second last business day of each month, other than in the month of November (but must be surrendered by the Unitholder on the last business day of the month preceding the redemption month in order to be redeemed), subject to certain conditions, at a redemption price computed by reference to the market price of the Class A Units on the applicable monthly redemption date (and less any costs associated with the redemption, including brokerage costs).
11. Class F Units may be converted in any month on the first business day of the month (the Conversion Date) by delivering a notice and surrendering such Class F Units by 5:00 p.m. (Toronto time) at least 10 business days prior to the Conversion Date. For each Class F Unit so converted, a holder will receive that number of Class A Units equal to the net asset value per Class F Unit as of the close of trading on the business day immediately preceding the Conversion Date divided by the net asset value per Class A Unit as of the close of trading on the business day immediately preceding the Conversion Date.
12. Under section 14.2(3)(b) of NI 81-106, an investment fund that is a reporting issuer that uses or holds specified derivatives, such as the Filer intends to do, must calculate its net asset value on a daily basis.
13. The Filer proposes to calculate net asset value on the Friday of each week (or if any Friday is not a business day, the immediately preceding business day) and the last business day of each month.
14. The Preliminary Prospectus discloses, and the final prospectus of the Filer will disclose, that the net asset value per Unit of each class of Units will be calculated and made available to the financial press for publication on a weekly basis. The Manager will provide to the public on request, and will post the net asset value per Unit of each class of Units on its website at www.cclcapitalmarkets.com.
The principal regulator is satisfied that the decision meets the test set out in the Legislation for the principal regulator to make the decision.
The decision of the principal regulator under the Legislation is that the Exemption Sought is granted provided that:
(a) the Class A Units are listed on the TSX; and
(b) the Filer calculates the net asset value per Unit of each class of Units at least weekly.


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StarTech.com-DisplayPort to DVI Converter Cable – 3ft – 1920×1200-DP2DVI2MM3
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Re-reason a current DVI show for use with another DisplayPort-prepared PC, or as an auxiliary presentation
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Realizzer 3D 1.6.0 Studio
Realizzer 3D 1.6.0 Studio | 523 Mb
Realizzer 3D allows you to create photo realistic designs and instantly view your light show in real-time on your PC. The software has a comprehensive library with many 3D models included such as Truss, Decorations and Stages etc.. With the Pro, Ultimate and Studio versions you have also the possibility to simulate complete laser and video installations (Lasergraph DSP & Pangolin Support). Also, custom created 3D models can be imported in over 20 formats (OBJ, 3DS, DAE, etc.). Starting with Realizzer Studio you can create highly realistic videos rendered in full HD to present your show designs.
The simulation can be controlled with any DMX capable lighting control protocol such as ArtNET and SyncroNET or directly by a separate available USB-DMX Interface.
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- 0000259: [Fixture Builder] Auto renaming annoys sometimes
- 0000306: [Main Software] Check for updates on startup
- 0000303: [Main Software] Laser hotspot on output
- 0000304: [Main Software] Advanced Hot Beams
- 0000305: [Main Software] Laser ambient light
- 0000302: [Main Software] Realizzer Basic offers 1 Laser inpuzt
- 0000300: [Main Software] Soundlight USBone Interface Support
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- 0000273: [Fixture Builder] Program crash when closing 3D preview
- 0000272: [Fixture Builder] No way to bring up closed ShiChuang again
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- 0000254: [Fixture Builder] Truss Builder measures changed to millimeter
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- 0000239: [Main Software] Error message on render video Unable to save SDK control settings
- 0000238: [Main Software] Adjustable ShadowMap Resolution in Application Settings
- 0000237: [Main Software] Sometimes shadows not working for lasers
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text:
The outer box isn even labeled year seizures jumped by 25
You may want to hold your shirt so that the contact with your nipples is limited. Then, when you get home you might see blood on your shirt and your body and find that your nipples are bleeding. That's when you panic, hit the internet and search for «bleeding nipples». But you bought an iPhone […]Read more


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Loloi Rug Nyla NY-24 Stone Blue
Free shipping
The Nyla collection by Loloi Rugs captures the casual beauty in contemporary style. Warm and subtle neutrals are fused with linear tonal designs to create an ultra-chic, sophisticated design. The shimmering viscose comes together through power-loomed construction to give you the most breathable, soothing harmony of chic comfort. Choose from our selection of Loloi Nyla Rugs to complete your peaceful abode.
- Power-loomed
- Clean spills, including water, immediately by blotting with a clean sponge or cloth
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- Professional cleaning recommended
- Appropriate rug pad is highly recommended on all surfaces to prevent slipping, add cushion, and improve durability
- Made in Egypt
|Shown In
|Stone Blue
|Material Detail
|100% Viscose
|5'-0" x 7'-6"


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MHP increases poultry sales by 21% in Q1, 2019
Myronivsky Hliboproduct (MHP) in January-March 2019 sold 164,004 tonnes of poultry, which is 21.2% more than in the same period of 2018.
According to a report by MHP on the website of the London Stock Exchange, the average selling price of this product remained at the level of the previous year at UAH 38.63 per kg. In the first quarter, export prices for poultry, as well as prices in the domestic market remained virtually unchanged in annual terms.
Export sales of MHP in the first quarter rose by 47%, to 93,050 tonnes, while sales in the domestic market decreased by 2% compared to the same period last year, to 70,960 tonnes.
"MHP exported poultry to almost 60 countries of the world. Export sales accounted for about 57% of total poultry sales in the first quarter of 2019 against 47% for the first quarter of 2018," the holding said.
The total volume of poultry production in January-March 2019 grew by 13%, to 171,272 tonnes due to the launch of new farms both in the second half of 2018 and in the first quarter of 2019 (the second phase of Vinnytsia poultry farm).