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The cause of this disease is the anaerobic, spore-forming rod Clostridium tetani The organisms are found in the feces of some humans and many animals, particularly horses, from which they readily contaminate the soil The spores may remain dormant for many months or years, but when they are introduced into a wound, especially if a foreign body or suppurative bacteria are present, they are converted into their vegetative forms, which produce the exotoxin tetanospasmin In developing countries, tetanus is still a common disease, particularly in newborns, in whom the spores are introduced via the umbilical cord (tetanus neonatorum) In the United States, the incidence rate of tetanus is about one per million per year Injection of contaminated heroin is a signi cant cause About two-thirds of all injuries leading to tetanus occur from deep scratches and puncture wounds in the home and about 20 percent in gardens and on farms Since 1903, when Morax and Marie proposed their theory of centripetal migration of the tetanus toxin, it has been taught that spread to the nervous system occurs via the peripheral nerves, the toxin ascending in the axis cylinders or the perineural sheaths Modern studies, utilizing uorescein-labeled tetanus antitoxin, have disclosed that the toxin is also widely disseminated via blood or lymphatics, probably accounting for the generalized form of the disease However, in local tetanus, the likely mode of spread to the CNS is indeed by retrograde axonal transport Mode of Action of Tetanus Toxin Like botulinum toxin, the tetanus toxin is a zinc-dependent protease It blocks neurotransmitter release by cleaving surface proteins of the synaptic vesicles, thus preventing the normal exocytosis of neurotransmitter The toxin interferes with the function of the re ex arc by the blockade of inhibitory transmitters, mainly GABA, at presynaptic sites in the spinal cord and brainstem Elicitation of the jaw jerk, for example, is normally followed by the abrupt suppression of motor neuron activity, manifested in the electromyogram (EMG) as a silent period (see further on) In the patient with tetanus, there is a failure of this inhibitory mechanism, with a resulting increase in activation of the neurons that innervate the masseter muscles (trismus or lockjaw) Of all neuromuscular systems, the masseter innervation seems to be the most sensitive to the toxin Not only do afferent stimuli produce an exaggerated effect, but they also abolish reciprocal innervation; both agonists and antagonists contract, giving rise to the characteristic muscular spasm as discussed on page 40 In addition to its generalized effects on the motor neurons of the spinal cord and brainstem, there is evidence that the toxin acts directly on skeletal muscle at the point where the axon forms the end plate (accounting perhaps for localized tetanus) and also upon the cerebral cortex and the sympathetic nervous system, in the hypothalamus. how to generate pdf in asp net mvc Asp . Net MVC how to get view to generate PDF - Stack Overflow
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2 Aug 2017 ... In this article you will learn how to create a PDF file and download it using ASP. NET MVC . ... Now let's start creating our method for pdf creation . 1268) Even with mild localized tetanus there may be a slight trismus, a useful diagnostic sign Symptoms may persist in localized form for several weeks or months Gradually the spasms become less frequent and more dif cult to evoke, and they nally disappear without residue Complete recovery is to be expected, since there are no pathologic changes in muscles, nerves, spinal cord, or brain, even in the most severe generalized forms of tetanus Cephalic Tetanus This form of tetanus follows wounds of the face and head The incubation period is short, 1 or 2 days as a rule The affected muscles (most often facial) are weak or paralyzed Nevertheless, during accessions of tetanic spasm, the palsied muscles are seen to contract Apparently the disturbance in the facial motoneurons is suf cient to prevent voluntary movement but insuf cient to prevent the strong re ex impulses that elicit facial spasm The spasms may involve the tongue and throat, with persistent dysarthria, dysphonia, and dysphagia Ophthalmoparesis is known to occur but is dif cult to verify because of severe blepharospasm In a strict sense these cephalic forms of tetanus are examples of local tetanus that frequently becomes generalized Many cases prove fatal Diagnosis This is made from the clinical features and a history of preceding injury The latter is sometimes disclosed only after careful questioning, the injury having been trivial and forgotten The organisms may or may not be recovered from the wound by the time the patient receives medical attention; other laboratory tests, apart from the EMG, are of little value Serum CK may be moderately elevated if the rigidity is generalized The EMG recorded from muscles in spasm shows continuous discharges of normal motor units like those recorded from a forceful voluntary muscle contraction Most characteristic of tetanus, as mentioned earlier, is a loss of the physiologic silent period that occurs 50 to 100 ms after re ex contraction This pause, normally effected by the recurrent inhibition of Renshaw cells, is blocked by tetanus toxin In generalized tetanus the loss of the silent period can almost always be demonstrated in the masseter, and it is found in a muscle affected by local tetanus Interestingly, the silent period is preserved in the stiff man syndrome (page 1279) Tetany due to hypocalcemia, the spasms of strychnine poisoning or black widow spider bite, trismus due to painful conditions in and around the jaw, the dysphagia of rabies, hysterical spasms, rigidity and dystonic spasms caused by neuroleptic drugs, and the spasms of the stiff-man syndrome all resemble the spasms of tetanus but should not be dif cult to distinguish when all aspects of these disorders are considered The death rate from tetanus is about 50 percent overall; it is highest in newborns, heroin addicts, and patients with the cephalic form of the disease The patient usually recovers if there are no severe generalized muscle spasms during the course of the illness or if the spasms remain localized Treatment This must be directed along several lines At the outset, a single dose of antitoxin (3000 to 6000 U of tetanus immune human globulin) should be given along with a 10-day course of penicillin (12 million U of procaine penicillin daily), metronidazole (500 mg every 6 h intravenously or 400 mg rectally), or tetracycline (2 g daily) These drugs are effective against the vegetative forms of C tetani Immediate surgical treatment of the wound (excision or debridement) is imperative, and the tissue around the wound should be in ltrated with antitoxin Survival depends on expert and constant nursing in an inten-. mvc pdf ASP.NET MVC - Export PDF Document From View Page - C# Corner
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