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Large gram-positive spore-forming rods growing Answers to Questions 1–2 on blood agar as large generic cleocin gel 20gm with amex acne getting worse, raised buy 20gm cleocin gel skin care lounge, β-hemolytic colonies that spread and appear as frosted green-gray glass 1. Bacillus anthracis and Bacillus cereus can best be positive and produce acid from glucose. Lecithinase and catalase Microbiology/Select methods/Reagents/Media/Bacteria/ Identification/2 β Hemolysis Motility Oxidase Catalase Lecithinase Glucose B. Which is the specimen of choice for proof of food Answers to Questions 3–6 poisoning by Bacillus cereus? Penicillin (10-unit) susceptibility test performed in a biological safety hood, and personnel B. Which of the following tests should be performed appears on the Gram stain smear as gram-positive for initial differentiation of Listeria monocytogenes short, thin, diphtheroidal shapes, whereas from group B streptococci? Culture of a finger wound specimen from a meat streptococci packer produced short gram-positive bacilli on a blood agar plate with no hemolysis. Colonies Motility (wet prep) = Neg growing on blood agar are small and transparent, Motility (media) = Neg (bottle-brush growth in stab may be either smooth or rough, and are often culture) surrounded by a green tinge. Bacillus subtilis Microbiology/Evaluate laboratory data to make identifications/Bacteria/3 7. A non–spore-forming, slender gram-positive rod Answers to Questions 7–11 forming palisades and chains was recovered from a vaginal culture and grew well on tomato juice agar. D Corynebacterium species recovered from a throat Microbiology/Evaluate laboratory data to make culture are usually considered part of the normal identifications/Bacteria/2 throat flora. In this event, direct inoculation on Loeffler culture is considered a pathogen when it produces: serum medium or tellurite medium and the following A. A pseudomembrane of the oropharynx biochemical tests should be performed to confirm B. Gray-black colonies with a brown halo on Tinsdale’s agar Gelatin hydrolysis = Neg Catalase = + D. D A Gram stain smear from a vaginal secretion showing can be made using which of the following many squamous epithelial cells loaded with findings? A gram-positive branching filamentous organism Kinyoun stain and 1% sulfuric acid as the decolorizing recovered from a sputum specimen was found to agent. The other organisms listed are negative for be positive with a modified acid-fast stain method. Darkfield microscopy for direct identifications/Bacteria/2 visualization or indirect immunofluorescence using 11. Routine laboratory testing for Treponema fluorescein-conjugated antihuman globulin (the pallidum involves: fluorescent treponemal antibody-absorption test, A. Gram staining including chemiluminescence and point-of-care Microbiology/Select methods/Reagents/Media/ immunochromatography. Spirochetes often detected in the hematology Answers to Questions 12–17 laboratory, even before the physician suspects the infection, are: 12. D Lyme disease may result in acute arthritis and Microbiology/Apply knowledge of fundamental meningitis and is caused by B. This biological characteristics/Spirochetes/1 spirochete is carried by the deer tick belonging to the Ixodes genus (I. Which of the following organisms is the cause of North-central United States and I. A Serological analysis using immunofluorescence or Microbiology/Apply knowledge of fundamental an enzyme immunoassay is the method of choice biological characteristics/Spirochetes/1 for diagnosis of Lyme disease. Te diagnostic method most commonly used for be cultured directly from lesions, and darkfield the identification of Lyme disease is: microscopy can be used for detection of spirochetes A. Primary atypical pneumonia is caused by: from the upper and lower respiratory tracts onto A. Which organism typically produces “fried-egg” is grown on “M” agar containing arginine and colonies on agar within 1–5 days of culture from a phenol red.

The overall composition of saliva varies according to the degree of activity of each of the major gland types effective cleocin gel 20 gm acne prone skin. The surface coating of mucus also serves to protect the epithelium from potentially harmful substances cheap cleocin gel 20gm with visa skin care bandung. However, this protective role means that the oral epithelium also presents a considerable barrier to systemic drug delivery. Physiological factors which affect oral transmucosal bioavailability are discussed below. When applied to the outer surface of the epithelium, these tracers are seen to penetrate only through the outermost layers of cells. Thus the compacted, flattened cells of the lower superficial layer and intermediate layer present a major physical barrier to transport. The intercellular lipids also play an important role, since extraction of these lipids results in more permeable tissue. Generally, keratinized epithelium appears to be more impermeable than non-keratinized epithelium. The permeability of the oral mucosal epithelium is intermediate between that of the skin epithelium, which is highly specialized for a barrier function (see Section 8. Within the oral cavity, the buccal mucosa is less permeable than the sublingual mucosa. The thin epithelium of the sublingual mucosa means that extremely rapid absorption is possible via this route. Thus oral mucosal delivery may be particularly attractive for the delivery of enzymatically labile drugs such as therapeutic peptides and proteins. Depending on the animal species and substrates used, buccal homogenates have shown enzyme activites between a few and several hundred percent of the activities of intestinal homogenates. In general, it can be said that enzyme levels are generally lower in the mouth than, for example, levels present in the gastrointestinal tract. Again, this lower metabolic activity makes the oral mucosa an attractive route for the delivery of enzymatically labile biopharmaceuticals. The sublingual area, in particular, is exposed to a lot of saliva which can enhance drug dissolution and therefore increase bioavailability. However, there are also negative aspects for drug delivery associated with salivary flow, including: • a drug moiety may be diluted by the saliva; • excessive salivary flow may cause too rapid dissolution and absorption; • a drug delivery system (e. The mucous secretions may also limit drug delivery via the oral cavity, via a number of mechanisms: • clearance of the drug prior to drug absorption; • forming a physical barrier through which the drug must diffuse, prior to reaching the absorbing surface; • binding drugs specifically, or non-specifically (via electrostatic, hydrophobic- and hydrogen-bonding interactions). In contrast, the sublingual mucosa is unsuitable for adhesive dosage forms for a number of reasons, including: • the mucosa is exposed to a lot of saliva; • the mucosa is highly flexible and moving constantly; • an adhesive dosage form in this region would be uncomfortable and rather disturbing for the patient. Suitable animal models for studying oral mucosal drug delivery include pigs and 174 dogs, as their oral mucosa is quite similar to the human counterpart, both in morphology and permeability characteristics. The major junctional attachment between the epithelial cells is the desmosome, which displays minimal impedence to intercellular diffusion. Thus in the majority of cases, drug absorption for small hydrophilic moieties is thought to occur via paracellular penetration, moving between the cells, as claimed for drug transport through the epidermis of the skin. However, it should also be remembered that the intercellular space of the epithelial cells of the oral cavity contains lipidic material, deposited from the membrane coating granules. Lipidic moieties (depending, as always, on their physicochemical properties) may be able to permeate through this lipidic environment between the cells, thereby being absorbed via the paracellular route. Again, movement occurs down a concentration gradient, according to Fick’s Law (see Section 1. The stratified nature of the epithelium means that lipophilic moieties must permeate across several layers of cells to reach the underlying blood capillaries (Figure 7. Carrier-mediated processes It has also been suggested that the oral mucosa contains active or carrier-mediated systems for small molecules such as mono-saccharides and amino acids. However, these processes have not been fully characterized in terms of location, transport capacity or specificity. However, as the oral cavity becomes increasingly important as a potential site of systemic absorption, particularly for high molecular weight 175 drugs which are generally thought to cross epithelial cells endocytically, future studies will tend to focus on attempting to better understand these processes.

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Endoscopic findings include mucosal edema and erythema cheap 20 gm cleocin gel amex acne disease, aphthous or linear ulcerations buy generic cleocin gel 20 gm online acne toner, and fibrotic strictures. Many patients with colonic disease also have small-bowel findings, which distinguishes Crohn’s from ulcerative colitis. Multiple subcutaneous nodules that are tender, red, raised, and microscopically composed of lymphocytes and histio- cytes characterize erythematous lesions that may form a tender necro- tizing ulcer. Most of these occur in the pretibial area, but they also can occur anywhere on the body. Ocular manifestations include uveitis, iritis, episcleritis, vasculitis, and conjunctivitis. These findings are asso- ciated more commonly with colonic disease and infrequently precede any intestinal symptoms. The incidence of carcinoma is increased in the setting of Crohn’s disease and should be suspected in patients with a severe or chronic stricture. Colon and Rectum 451 Sulfasalazine and mesalamine are the two aminosalicylates used for Crohn’s disease. For patients with exacerbations leading to moderate or severe Crohn’s disease, steroids are the primary therapy. As increasing evidence points to an immunologic etiology of inflam- matory bowel disease, efforts have been made to utilize various immunotherapies. Methotrexate is a folate analogue that inhibits purine and pyrimidine synthesis and has been shown in a number of trials to be effective in treating Crohn’s disease. However, this drug has significant side effects including hepatotoxic- ity and bone marrow suppression and thus is reserved for patients with severe Crohn’s that is refractory to other therapies. Surgical Therapy: As previously noted, the primary treatment of Crohn’s disease is medical, and surgery is considered for patients with specific complications of the disease. Crohn’s disease cannot be cured by an operation, but surgery can help ameliorate certain situations (Table 25. Small intestinal or ileocolic stenotic disease is treated by resection with primary anastomosis. Only grossly involved intestine should be resected, because wide resection or microscopically negative margins of resection have no impact on the recurrence rate of the Resection Small-bowel Bypass disease Stricturoplasty Indications for surgery Total proctocolectomy with ileostomy • Failed medical therapy • Obstruction • Complicated fistulas Abdominal colectomy with Colonic • Perforation ileorectal anastomosis disease • Cancer • Hemorrhage • Abscess Subtotal colectomy with ileostomy Segmental resection Abscess drainage Anal Fistulotomy disease Seton Algorithm 25. Failure of medical treatment Persistence of symptoms despite corticosteroid therapy for longer than 6 months Recurrence of symptoms when high-dose corticosteroids tapered Worsening symptoms or new onset of complications with maximal medical therapy Occurrence of steroid-induced complications (cushingoid features, cataracts, glaucoma, systemic hypertension, aseptic necrosis of the head of the femur, myopathy, or vertebral body fractures) Obstruction Intestinal obstruction (partial or complete) Septic complications Inflammatory mass or abscess (intraabdominal, pelvic, perineal) Fistula if Drainage causes personal embarrassment (e. Patients who present with fistulizing disease with either estab- lished fistulas or undrained sepsis require the greatest amount of judgment and caution. However, percutaneous drainage, parenteral nutrition, and bowel rest usually control sepsis and allow the inflammation of the uninvolved bowel and surrounding structures to resolve. For isolated Crohn’s colitis, a total proctocolectomy with ileostomy or total abdominal colectomy with ileorectal anastomosis or ileostomy and rectal stump are the primary therapies. The manifestations of perianal Crohn’s disease are multiple, includ- ing abscesses, fistulas, fissures, ulcers, strictures, and incontinence. Estimates of the number of Crohn’s patients who develop peri- anal manifestations at some time range from 10% to 80%. As with Crohn’s disease proximally, palliation of symptoms and preservation of functional bowel are the priorities guiding surgical intervention. Likewise, the aim of therapy is the treatment of complications of disease rather than the disease itself. Two mandates clarify these prin- ciples with respect to perianal disease: (1) the management of a septic focus is an indication for surgery, and (2) the sphincter should be pre- served as long as the patient is coping well. Colon and Rectum 453 ineal lesions often appear, they surprisingly are well tolerated. In fact, the complaint of pain is indicative of an abscess, and surgical consul- tation should be arranged promptly. Although the medical therapy is similar for Crohn’s disease and ulcerative colitis, the surgical therapies for each differ greatly, and it is imperative that a clear diagnosis is made whenever possible. The clinical manifestations of ulcerative colitis vary with the sever- ity of the disease.

Brilliant Green Lactose Bile Broth Peptone 10 g Lactose 10 g Oxgall 20 g Brilliant green 0 generic cleocin gel 20 gm without a prescription skin care urdu. Dispense into 391 fermentation tubes trusted cleocin gel 20 gm acne 2015 heels, making certain that fluid level covers inverted vials. Bromcresol Purple Broth Base Peptone 10 g Beef extract 3 g NaCl 5 g Bromcresol purple 0. Sterilize stock solutions of carbohydrates (50% w/v) separately by autoclaving or, preferably, by filtration (0. Place yolks in sterile container and mix aseptically with equal volume of sterile 0. For heart infusion agar, add 15 g agar/L and boil to dissolve before dispensing and sterilizing. Kligler Iron Agar Polypeptone peptone 20 g Lactose 20 g Dextrose 1 g NaCl 5 g Ferric ammonium citrate 0. Lysine Decarboxylase Broth (Falkow) (for Salmonella) Gelysate or peptone 5 g Yeast extract 3 g Glucose 1 g L-Lysine 5 g Bromcresol purple 0. Lysine Iron Agar (Edwards and Fife) Gelysate or peptone 5 g Yeast extract 3 g Glucose 1 g L-Lysine hydrochloride 10 g Ferric ammonium citrate 0. MacConkey Agar Proteose peptone or polypeptone 3 g Peptone or gelysate17 g Lactose 10 g 395 Bile salts No. Autoclave 15 min at 121°C, cool to 45-50°C, and pour 20 ml portions into sterile 15 x 100 mm petri dishes. Motility Test Medium (Semisolid) Beef extract 3 g Peptone or gelysate10 g NaCl 5 g Agar 4 g Distilled water 1 liter Heat with agitation and boil 1-2 min to dissolve agar. For Salmonella: Dispense 20 ml portions into 20 x 150 mm screw- cap tubes, replacing caps loosely. Agar and blood should both be at 45-46°C before blood is added and plates are poured. Suspend ingredients of Medium 1 in distilled water, mix thoroughly, and heat with occasional agitation. Prepare Medium 2 in the same manner as Medium 1, except autoclave 15 min at 121°C. Prepare stock solution of novobiocin by adding 20 mg monosodium novobiocin per ml of distilled water. Make fresh stock each time of use, or store frozen at - 10°C in the dark (compound is light-sensitive) for not more than 1 month (half-life is several months at 4°C). Trypticase (Tryptic) Soy Agar Trypticase peptone 15 g Phytone peptone 5 g NaCl 5 g Agar 15 g Distilled water 1 liter Heat with agitation to dissolve agar. Tryptone (Tryptophane) Broth, 1% Tryptone or trypticase 10 g Distilled water 1 liter Dissolve and dispense 5 ml portions into 16 x 125 or 16 x 150 mm test tubes. Tryptone Yeast Extract Agar Tryptone 10 g Yeast extract 1 g *Carbohydrate 10 g Bromcresol purple 0. Before use, test all batches of dye for toxicity with known positive and negative test microorganisms. If colony is taken from blood agar plate, any carry-over of red blood cells can give false-positive reaction. Stain is stable l month at 4°C or may be stored frozen indefinitely (50 ml portions). To determine staining time (after 2-3 days refrigeration at 4°C), stain a known flagellated organism on 3 or more cleaned slides for various times (e. Staining Procedure 411 To prepare suspension, pick small amount of growth from 18-24 h plate (equivalent to 1 mm colony). To prepare slide, pass cleaned slide through blue part of burner flame several times to remove residual dirt. Crystal violet in dilute alcohol Crystal violet (90% dye content) 2 g Ethanol (95%) 20 ml Distilled water 80 ml 2. Alcoholic solution of iodine Potassium iodide 10 g Iodine 10 g Ethanol (70%) 500 ml 2.

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If a new biomaterial is proposed to fabricate an implant quality cleocin gel 20 gm acne jawline, its safety and biocompatibility must be thoroughly evaluated to secure the approval of regulatory authorities discount cleocin gel 20 gm with visa acne 80 10 10. These issues can attribute to significant delay in the development, marketing and cost of a new implant. Adverse effects may be caused by: • The intact polymer: this may be due to the chemical reactivity of end or side groups in a polymer, organometallics used as polymerization initiators, or extractable polymeric fragments. In the case of a bioerodible poly(vinylpyrrolidone), the accumulation of the dissolved polymer in the liver raises a longterm toxicity issue. If the surface of an implant has an affinity towards specific chemicals, an abnormal boundary layer will develop. The subsequent intra-layer rearrangement or reactions with other species then trigger tissue reactions. The defence reactions of the host tissue often lead to encapsulation of an 77 implant by layers of fibrous tissues. Since the encapsulation frequently impedes drug release, in vitro drug release data may not permit the prediction of in vivo drug release patterns. High local drug concentrations at the site of implantation over extended periods of time can also cause severe local irritation or adverse tissue reactions. The performance and response of the host toward an implanted material is indicated in terms of biocompatibility. Major initial evaluation tests used to assess the biocompatibility of an implant are listed in Table 4. These tests include: • observation of the implant/tissue interactions at the site of implantation; Table 4. The choice of whether to select a reservoir-type, or a matrix-type, implantable system depends on a number of factors, including: • the drug’s physicochemical properties; • the desired drug release rate; • desired delivery duration; • availability of a manufacturing facility. For example, it is generally easier to fabricate a matrix-type implant than a reservoir system, so this may determine the selection of a matrix system. However, if drug release is the overriding concern, a reservoir system may be chosen in preference to a matrix system. This is because reservoir systems can provide zero- order controlled release, whereas drug release generally decreases with time if a matrix system is used. They vary in molecular weight, filler content, R and R, and1 2 1 2 the type of reactive silicone ligands for cross-linking. Variations in these parameters permit the synthesis of a wide range of material types such as fluids, foams, soft and solid elastomers (Figure 4. These copolymers have the advantages of: • Ease of fabrication: the copolymers are thermoplastic in nature, thus an implantable device is easily fabricated by extrusion, film casting or injection molding. As the ethylene domain is crystalline, an increase in the content of ethylene unit affects the crystallinity and the solubility parameter of the copolymer. Other polymeric materials commonly used as non-porous, rate-controlling membranes are given in Table 4. The penetration of a solvent, usually water, into a polymeric implant initiates drug release via a diffusion process. Diffusion of drug molecules through non-porous polymer membranes depends on the size of the drug molecules and the spaces available between the polymeric chains. Even through the space between the polymer chains may be smaller than the size of the drug molecules, drug can still diffuse through the polymer chains due to the continuous movement of polymer chains by Brownian motion. For transport through the membrane, there are three barriers to be circumvented (Figure 4. The drug molecules in the reservoir compartment initially partition into the membrane, then diffuse through it, and finally partition into the implantation site. C −C where Cr and C denote the drug concentrations in the reservoirr i i and at the site of implantation respectively. The release rate of a drug from different polymeric membranes can be compared from the corresponding P values. This is the familiar form1 of a first-order rate equation and indicates that the rate of diffusion is proportional to drug concentration. However, in this system, the drug reservoir consists of either: • solid drug particles, or • a suspension of solid drug particles in a dispersion medium so that the concentration of drug (C ) in the system always remainsr constant, so that Equation 4.

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Tey are nonspecific esterase positive Hematology/Apply knowledge of fundamental biological characteristics/Leukocytes/Auer rods/1 1 purchase cleocin gel 20gm without a prescription acne 5 pocket jeans. Acute myelomonocytic leukemia Leukocytes/Cytochemical stains/2 Hematology/Evaluate laboratory data to make identifications/Leukemia/3 Answers to Questions 10–14 11 order cleocin gel 20 gm free shipping acne and menopause. C In acute erythroid leukemia, more than 50% of with a fever, pallor, lymphadenopathy, and nucleated bone marrow cells are erythroid and more hepatosplenomegaly. Tese stain positive for both Sudan Black B are characteristically negative with these stains. C Phospholipids, neutral fats, and sterols are stained by of the following disorders is most likely? The addition of fluoride renders the monocytic cells (and blasts) negative, thus allowing for differentiation from the granulocytic cells, which remain positive. Any percentage health and disease states/Leukemia/Immunochemical Hematology/Apply knowledge of special procedures/ reactions/2 Leukemias/Classifications/2 16. A patient’s peripheral blood smear and bone prognosis than other immunologic subtypes of marrow both show 70% blasts. Hematology/Apply principles of special procedures/ Leukemia/Cytochemical stains/2 17. Acute myeloid leukemias with recurrent genetic of megakaryoblasts and atypical megakaryocytes. Acute megakaryoblastic categorized leukemia is defined as an acute leukemia in which D. Acute leukemias of ambiguous lineage greater than or equal to 50% of the blasts are of Hematology/Apply knowledge of special procedures/ megakaryocytic lineage. Hematology/Evaluate laboratory data to recognize Iron deficiency anemia is a predictable complication health and disease states/Anemia/2 of therapeutic phlebotomy because approximately 2. In essential thrombocythemia, the platelets are: 250 mg of iron is removed with each unit of blood. Decreased in number and functional function, leading to both bleeding and thrombotic D. Which of the following cells is considered It is a large, binucleated cell with a dense nucleolus pathognomonic for Hodgkin’s disease? Flame Hematology/Evaluate laboratory data to recognize cells are plasma cells with distinctive red cytoplasm. In myelofibrosis, the characteristic abnormal red blood cell morphology is that of: 4. Features of secondary polycythemia include all of Answers to Questions 6–11 the following except: A. Erythropoietin is increased and oxygen saturation is decreased in secondary Hematology/Evaluate laboratory data to recognize polycythemia. Te erythrocytosis seen in relative polycythemia plasma rather than an increase in red blood cell occurs because of: volume or mass. Decreased plasma volume of circulating blood levels are high only in secondary polycythemia. Hematology/Apply knowledge of fundamental biological characteristics/Polycythemia/1 10. All of these options Hematology/Evaluate laboratory data to recognize health and disease states/Myeloproliferative neoplasms/3 28 Chapter 1 | Hematology 12. What influence does the Philadelphia (Ph1) Answers to Questions 12–17 chromosome have on the prognosis of patients with chronic myelocytic leukemia? Te prognosis is better if Ph1 is present arm deletion of chromosome 22, but is actually C. Te prognosis is worse if Ph1 is present a translocation between the long arms of D. This results in production Hematology/Evaluate laboratory data to recognize of a chimeric protein with tyrosine kinase activity health and disease states/Genetic theory and that activates the cell cycle. An increase in basophils An increase in basophils and eosinophils is a Hematology/Evaluate laboratory data to recognize common finding. Multiple myeloma and Waldenström’s macroglobulinemia have all the following in common except: A. Osteolytic lesions Hematology/Evaluate laboratory data to recognize health and disease states/Myeloma/Characteristics/2 1.

Joffe R buy cleocin gel 20gm low price acne 2004, Swinson R: Tranylcypromine in primary obsessive-compulsive compulsive disorder: similar efficacy but superior tolerability in disorder buy discount cleocin gel 20 gm acne zap. Zohar J, Judge R: Paroxetine versus clomipramine in the treatment of meta-analysis. Am J and long-term treatment and prevention of relapse of obsessive- Psychiatry 1997, 154:396-401. Hoehn-Saric R, Ninan P, Black D, Stahl S, Greist J, Lydiard B, McElroy S, Elliott M: Pulse-loaded intravenous clomipramine in treatment-resistant Zajecka J, Chapman D, Clary C, Harrison W: Multicenter double-blind obsessive-compulsive disorder. Denys D, de Geus F, van Megen H, Westenberg H: A double blind, clomipramine versus fluoxetine plus placebo for obsessive-compulsive randomized, placebo-controlled trial of quetiapine addition in patients disorder. J Clin augmentation of serotonin reuptake inhibitors or clomipramine in Psychopharmacol 2008, 28:550-554. A double-blind, placebo-controlled study in patients with and serotonin reuptake inhibitors in treatment-resistant obsessive- without tics. Dannon P, Sasson Y, Hirschmann S, Iancu I, Grunhaus L, Zohar J: Pindolol comparison of aripiprazole and risperidone augmentation in selective augmentation in treatment-resistant obsessive compulsive disorder: a serotonin reuptake inhibitor-refractory obsessive-compulsive disorder: a double-blind placebo controlled trial. Mundo E, Guglielmo E, Bellodi L: Effect of adjuvant pindolol on the placebo-controlled study of risperidone addition in serotonin reuptake antiobsessional response to fluvoxamine: a double-blind, placebo- inhibitor-refractory obsessive-compulsive disorder. Hollander E, Baldini Rossi N, Sood E, Pallanti S: Risperidone augmentation strategies in treatment-resistant obsessive-compulsive disorder: in treatment-resistant obsessive-compulsive disorder: a double-blind, preliminary findings. Erzegovesi S, Guglielmo E, Siliprandi F, Bellodi L: Low-dose risperidone Salimi S, Tabrizi M, Ashrafi M, et al: Granisetron adjunct to fluvoxamine for augmentation of fluvoxamine treatment in obsessive-compulsive moderate to severe obsessive-compulsive disorder: a randomized, disorder: a double-blind, placebo-controlled study. Biol behavioral therapy vs risperidone for augmenting serotonin reuptake Psychiatry 2012, 72:964-970. Oulis P, Mourikis I, Konstantakopoulos G: Pregabalin augmentation in Ashrafi M, Hajiaghaee R, Akhondzadeh S: Memantine add-on in moderate treatment-resistant obsessive-compulsive disorder. Int Clin to severe obsessive-compulsive disorder: randomized double-blind Psychopharmacol 2011, 26:221-224. Pallanti S, Bernardi S, Antonini S, Singh N, Hollander E: Ondansetron improvement in obsessive-compulsive disorder? Eur Arch Psychiatry Clin augmentation in treatment-resistant obsessive-compulsive disorder: a Neurosci 2008, 258:319-323. Soltani F, Sayyah M, Feizy F, Malayeri A, Siahpoosh A, Motlagh I: A double- disorder [Letter]. Van Ameringen M, Patterson B, Simpson W, Turna J: N-acetylcysteine a double-blind placebo-controlled cross-over study. Eur augmentation in treatment resistant obsessive compulsive disorder: A Neuropsychopharmacol 2008, 18:455-461. J Clin Psychopharmacol obsessive-compulsive disorder to treatment with citalopram or 2008, 28:363-367. J Clin Pharmacotherapy augmentation strategies in treatment-resistant Psychopharmacol 1992, 12:11-18. Eur Neuropsychopharmacol Hollander E: Double-blind, placebo-controlled trial of topiramate 2007, 17:430-439. Van Ameringen M, Mancini C, Patterson B, Bennett M: Topiramate of fluoxetine versus placebo. Ruffini C, Locatelli M, Lucca A, Benedetti F, Insacco C, Smeraldi E: officinalis L. J Complement Integr Med 2011, 8, over the orbitofrontal cortex in drug-resistant obsessive-compulsive 10. Liu K, Zhang H, Liu C, Guan Y, Lang L, Cheng Y, Sun B, Wang H, Zuo C, Neugebauer R, Lantigua R, Shea S, Neria Y: Functional impairment in Pan L, et al: Stereotactic treatment of refractory obsessive compulsive adults with past posttraumatic stress disorder: findings from primary disorder by bilateral capsulotomy with 3 years follow-up. Poundja J, Fikretoglu D, Guay S, Brunet A: Validation of the French capsular/ventral striatal gamma capsulotomy: a pilot prospective study. Babson K, Feldner M, Badour C, Trainor C, Blumenthal H, Sachs-Ericsson N, anterior cingulotomy for refractory obsessive-compulsive disorder: Schmidt N: Posttraumatic stress and sleep: differential relations across Long-term follow-up results. Lagarde G, Doyon J, Brunet A: Memory and executive dysfunctions cingulotomy for refractory obsessive-compulsive disorder. Sharp S, Thomas C, Rosenberg L, Rosenberg M, Meyer W 3rd: Propranolol alexithymia in posttraumatic stress disorder.