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Helen Drewski
I am newbie to python and learning it from books, forums and developers. Recently, I tried to implement various hand-ranking categories in the poker program. The goal is to calculate probabilities and see if it agrees with theoretical poker hand probabilities?
Please find below the code and logic I've used so far to build it. The code contains Card and Deck classes which together implement a deck of standard playing cards used, as well as a sample PyTest test function test_xxx().
The condition for a flush is simply that all cards are the same suit. This is easy to verify, by simply making a set of all unique suits in the hand, and returning true if that set has only one element (thus all the suits must be the same):
Large intestinal diarrhea is a common complaint in young cats presenting to primary care veterinary practices, and Tritrichomonas foetus is an important differential diagnosis for this condition, as Dan Thompson describes.
The highest prevalence of T. foetus appears to be in purebred cats and animals kept in colonies. An increased risk of infection has also been associated with the use of shared litter trays and with social grooming.
Diarrhea is a common reason for young cats to be presented to their primary care veterinarian. Practitioners are generally acutely aware of intestinal parasitic disease as a differential diagnosis for diarrhea, and many such patients will be treated empirically with anti-parasitic medications without further investigation. In many cases this appears to be effective, with relatively rapid improvement and cessation of clinical signs. Whilst the likes of Giardia and various helminths are likely to respond completely to such medications, the less-often considered Tritrichomonas foetus, a protozoan similar in appearance to Giardia species, cannot be cleared by such empirical treatments. This parasite can be a source of profound frustration for both cat owners and their veterinary surgeons, as clinical signs may initially appear to respond to therapy with standard anti-parasitic medications, but often return quickly after treatment is discontinued. Furthermore, the parasite can be challenging to diagnose unless sought specifically. It is therefore likely that increased awareness of this pathogen could lead to faster recognition and more effective treatment in young cats with apparently unresponsive or recurrent diarrhea.
Tritrichomonas foetus (T. foetus) has a worldwide distribution, with an estimated prevalence of between 10-59% 1. Relatively limited data exists on specific geographic prevalences; however one study in a population of UK cats estimated that roughly 20% of healthy cats may be carriers of the protozoa, and a separate study looking at the prevalence of T. foetus in diarrheic fecal samples submitted to a UK lab identified the parasite in 14.4% of samples 2. In the USA, on the other hand, a population of show cats was found to have a higher prevalence of T. foetus, at 31% 3.
The highest prevalence of T. foetus appears to be in purebred cats and cats kept as part of colonies. It has been demonstrated that individuals housed with a smaller number of square feet of housing space per cat were also more likely to be carriers of the disease, suggesting that population density plays a significant part in infection risk. Similarly, an increased risk of infection has been associated with the use of shared litter trays and with social grooming 2 3.
Diarrhea caused by T. foetus is most commonly a disease of young cats, with a mean age of 8 months, and with greater than 75% of affected individuals being less than one year of age. However, cats of any age have the potential to carry the disease, and a proportion of these may develop clinical signs 1 4.
In cats, T. foetus is primarily a parasite of the gastrointestinal tract, and localizes predominantly to the large intestine and, to a lesser extent, the distal ileum 6. This causes a mucosal inflammation manifesting as lymphoplasmacytic or neutrophilic colitis 7. Other clinical signs that have been documented repeatedly include anal irritation and occasional fecal incontinence. When present within the large intestine, the protozoa exist in close proximity to the intestinal mucosal surface and can often be found in association with colonic epithelial cells and crypts. Once in contact with the colonic wall, the organisms bind by specific receptor-ligand interactions, for which the binding is both competitive and saturable. Binding is to various cell surface molecules, including sialic acid lectins, lipophosphoglycans, cysteine proteases and adhesion proteins. Once bound, the organisms appear capable of breaking down both immunoglobulins and lactoferrins, allowing evasion of the immune system 8.
Transmission of the parasite is almost exclusively by the fecal-oral route. Trophozoites are shed in the feces of colonized cats, and are infectious in this form if consumed by another cat. There are currently no proven intermediate hosts, however it has been demonstrated that T. foetus trophozoites can survive ingestion and transit by terrestrial gastropod mollusks such as slugs, remaining infectious if subsequently eaten by a susceptible cat (Figure 2) 9. In the environment, the trophozoites can survive for several days if they remain in moist feces, however desiccation and death occurs in dry and aerobic environments 10.
Aside from the diarrhea and inflammation of the perineal region, most affected patients otherwise appear generally healthy. Some have been reported to be a little unthrifty, and occasionally patients are seen who have dropped below an ideal body condition score. Other described abnormalities include general non-specific findings such as poor coat quality, but no other specific clinical abnormalities are to be expected 1 5.
A compatible signalment and history should raise suspicion for Tritrichomonas foetus. Differential diagnoses are presented in Table 1, and a thorough clinical work-up should be performed with a view to differentiating T. foetus from these other conditions.
Findings on routine blood testing in cases of T. foetus are generally non-specific, and parameters are often all within the reference intervals. However, bearing in mind the young nature of the patient population most at risk for T. foetus, it is important not to overinterpret parameters that are altered in young animals (for example, increased alkaline phosphatase and phosphate) when abnormalities on blood testing are present. Some changes may also be seen secondary to chronic clinical signs. The most common examples of this are alterations in electrolyte levels as a result of ongoing diarrhea, especially hypokalemia, hyponatremia and hypochloremia. These are generally mild and subclinical in nature, however more profound changes can occur in more severe disease 1 5.
While there are no changes on blood samples specific to T. foetus, it still remains a valuable part of the diagnostic work-up to exclude differential diagnoses, identify co-morbidities and assess for electrolyte changes that need to be addressed as part of the treatment plan.
As with blood testing, there is still good reason to perform diagnostic imaging in these cases. The absence of other clinical findings is indirectly supportive of T. foetus being the causal agent, and the imaging is a valuable tool for investigation of differential diagnoses.
Definitive diagnosis of T. foetus can be achieved either by direct visualization of the organism or by polymerase chain reaction (PCR) testing of the feces. Fecal culture can also be performed prior to smear preparation or PCR to increase the number of organisms present, and therefore increase the sensitivity of the tests.
Direct visualization is achieved using light microscopy to assess a fecal smear. This is a relatively simple examination and requires only a light microscope and slides, and is an ideal first-line test for T. foetus. It should therefore be performed in all cases of feline large-intestinal diarrhea at first presentation. It is important to note when performing a fecal smear assessment that both Giardia and Pentatrichomonas hominis can look very similar to T. foetus on light microscopy, and therefore care should be taken to accurately identify any parasites that are visualized 3 11. The importance of this relates mainly to treatment decisions, as P. hominis is a non-pathological protozoan requiring no treatment 1, whilst giardiasis is generally substantially more responsive than T. foetus to treatment and typically can be cleared using routine anti-parasitic drugs (e.g., fenbendazole), unlike T. foetus.
Smears can be prepared from multiple sample types. Collection of samples from voluntarily passed fecal material is the simplest method, however if the patient is refusing to defecate within the hospital environment then alternative methods are reported to be successful. It is important to note that samples acquired from normal, non-diarrheic stools will rarely produce positive results, and therefore testing of such samples is not recommended 1.
Use of a rectal loop to acquire fecal material from within the colon has been found to be an adequate means by which to retrieve a sample, as has colonic flushing 1. Colonic flushing is a technique similar to that of a tracheal wash, whereby fluid is instilled into the rectum and colon with the cat under sedation. After instillation, gentle trans-abdominal palpation of the large intestine can be performed to facilitate mixing, before withdrawal of the fluid. This mechanism can generate two sample types: the first being a suspension that can be dripped onto a slide to create a wet preparation for direct light microscopy; the second being a larger sample for centrifugation to create a pellet on which PCR can be later performed.
A fecal smear for analysis is produced using the wet preparation. From colonic flush samples, a drop of the suspended material can be placed immediately on a slide and allowed to air dry. For samples collected from voided diarrhea or rectal loop, the sample should first be suspended in sterile saline before following the sample procedure. Once dry, the sample can be fixed and stained in-house using a Romanowsky stain to assist visualization. After application of a cover slip the sample can then be viewed under a light microscope using 20x or 40x magnification. Lowering the condenser can help improve identification.
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