Benicar
By U. Eusebio. University of West Alabama.
Ostrich skin is charac- James Stewart terized by prominent feather follicles and is a high status product of the leather industry 10mg benicar with visa hypertension 14090. Ostriches yield a red meat that has the flavor and texture of beef cheap benicar 20mg without prescription blood pressure ranges hypotension, yet has the cholesterol and nutritional value of poultry. Ostrich feathers, still used for dusters, are also used in the manufacture of fashion and theatrical attire. The male has black and white plumage at maturity, while the fe- Characteristics males and juveniles have dull brown plumage. Rhea Ostrich Rheas are frequently referred to as South American ostriches, but are related only in superficial appear- The ostrich is the largest living bird, reaching over ance. The ostrich that the rhea is the largest bird of the western hemi- was first described (nominate race) was put in the sphere. The Common Rhea ranges throughout the central conti- bird’s dome-backed profile, desert living conditions nent, and as many as five subspecies have been and odd-shaped feet are reminiscent of the camel, described. Four subspecies are cies, is a smaller bird residing in the eastern foothills currently recognized; their range is through the of the Andes. Free-ranging rheas eat grass, leaves northern, eastern and southern savannahs of the and insects. Cassowary Struthio camelus camelus (North African ostrich) ranges from Morocco to Ethiopia and Uganda. The guished by a large bony casque on the forehead that hens of all races are indistinguishable. The eggs can is used to deflect brush as they dart through their be differentiated among subspecies, and those of the dense rain forest habitat. Three species are found on nominate species are characterized by fine stellate New Guinea; one also ranges in northern Australia. Cassowaries are solitary, the males are highly ag- gressive and these birds adapt poorly to most captive S. The neck and thighs of the male 5 nian and Kangaroo Island emus became extinct only are gray and the head is feathered. Adult emus may weigh 55 kg and in the shells of this subspecies leave the egg with a stand 1. The careful breeding of this bird since the 1870’s has Other Ratites resulted in a smaller, calmer bird that has higher quality feathers than its free-ranging relatives. Both groups are specialized Ostriches can run up to 40 mph for several miles and ground-dwelling birds that bear little resemblance can kick forward with powerful and accurate blows. This chap- Ostriches have large eyes with substantial visual ter will focus primarily on the ostrich as the model acuity, and large ear canals with a keen sense of ratite, with only occasional comment on the emu, hearing. The deviations from this model, including their size, are all adaptations to a terrestrial lifestyle. The similari- ties and differences are clinically relevant and should be familiar to the ratite veterinarian. In addition, the ostrich has a callosity distal to the pubic bone and another distal to the hock joint; both anatomic areas contact the ground in a recumbent bird. Apteria are present along the lateral body wall and provide convenient access sites for surgery and diagnostic procedures such as ultrasound. In contrast to other birds, the feathers of the ostrich function to shade the body, rather than insulate it, and an ostrich will erect the feathers when hot and flatten them when cold. Musculoskeletal System The rhea, emu and cassowary have three toes (digits 2, 3 and 4), each with four phalanges. The ostrich is the most specialized runner and has only two toes (digits 3 and 4); the metatarsal-phalangeal joint is suspended so that the standing weight is born en- tirely by the digits (Figure 48. The pubic bones of the ostrich form a solid ventral symphysis to support the weight of the abdomen (Figure 48. Because there is no need for flight, the thoracic sus 2) metatarsal phalangeal pad 3) digital cushion 4) phalangeal pad 5) toenail (modified with permission from Murray Fowler19). In the ostrich and emu, one of the tarsal bones remains unfused to the contiguous bones, which should not be misinterpreted as the knee radiographically.
For instance buy cheap benicar 20mg on-line blood pressure medication over prescribed, insulin secreta- bioactive compounds and can have multiple actions on gogues are frequently linked with weight gain benicar 10mg with mastercard blood pressure chart xls, hypoglycemia, insulin action, insulin production, or both. Acarbose usually causes gastrointestinal upset target insulin resistance, -cell function, incretin-related such as diarrhea and fatulence. Additionally, a clinical trial pathways, and glucose (re)absorption (Figures 2(a) and 2(b)). Despite Phytochemistry, antidiabetic bioactivities, and likely modes the multiple benefts of incretin-based drugs, these drugs are of action of the selected plants and compounds are discussed. Selected Medicinal Herbs and of insulin cannot match the natural precise timing and Compounds for T2D dosing of insulin secretion from the pancreas in response to hyperglycemia, resulting in severe complications. More than 400 plants and compounds have shown antidi- Moreover, in addition to lack of efcacy and undesirable abetic activities in vitro and/or in vivo. Instead of listing adverse efects, all current antidiabetic agents have a major each extract/compound, here, we select some plant chemicals shortcoming in that they are only designed to alleviate T2D and/or extracts with the ability to control blood glucose as and not to cure it. Evidence suggests that targeting one or well as to modulate at least one of the following mecha- two metabolic pathways is insufcient to cure T2D. Drugs nisms involved in insulin resistance: -cell function, incretin- with the ability to target more metabolic pathways seem related pathways, and glucose (re)absorption. But it should also models, and the results of administration of the plant extracts benotedthatdrugsthatareefectiveintargetingmetabolic and compounds to patients of T2D are discussed. To ical and biological properties of the compounds discussed in ensure patients’ welfare, there is still an obvious need to this section are summarized in Table 1. Herbal Therapy for T2D for the plants that comprise the genus Glycyrrhiza,isutilized as herbal medicine for a wide range of diseases. Te ethanol Long before the birth of orthodox Western medicine, medic- extract of G. Further, amorfrutins complicated reasons, Western medicine now prevails over isolated from the licorice, G. Cinnamon has traditionally been used for rheumatism, wounds, diarrhea, headaches, and colds 4. Recently, extensive studies have been performed on of Dioscorea is used as a traditional Chinese medicine for the action of cinnamon on diabetes and metabolic syndrome asthma, abscesses, chronic diarrhea, and ulcers [41]. Cinnamon was shown to reduce blood glucose via studies on rodent models of diabetes have reported that reduction of insulin resistance and increase of hepatic glyco- Dioscorea extract improves glycemic control and insulin genesis [135, 137]. Further, Dioscorea extract reduced blood the active compounds in modulation of insulin signaling [53, glucose in high fat diet-induced rats [41]. Tis compound from cinnamon extract is thought of pS6K and increase of the phosphorylation of Akt and glucose as a potential antidiabetic agent [139]. Another study demonstrated molecular target of cinnamon and cinnamaldehyde remains that Dioscorea polysaccharides reduced insulin resistance unclear. Te seeds of fenugreek (Trigonella foenum- graecum)areusedasafoodsupplementandalsohavea long history of medicinal use for labor induction, helping 4. Fenugreek is considered a diabetes, diabetic complications, and digestion [45, 129–132]. Notably, blueberries contain powerful antioxidants that can Te glucose-lowering action of this plant involves reduction neutralize free radicals that cause neurodegenerative disease, of insulin resistance [142]. Accordingly, pheno- trigoneosides, and 4-hydroxyisoleucine have been identifed licsandanthocyaninswereproposedasactivecompoundsfor as the active antidiabetic compounds in fenugreek. Te data confrm the benefcial efect that fenugreek exerts hypoglycemic control via increasing of blueberry on metabolic syndrome. Its seeds are used as a Chinese herbal medicine for pain, Astragalus membranaceus has long been used as a Chinese gastrointestinal diseases, and others. Recently, lychee seed medicine and shows antioxidant, antidiabetic, antihyperten- wasreportedtohaveantidiabeticactivityinrats[56]and sive, and immunomodulatory activities [133]. Moreover, treatment with Astragalus oligonol from lychee fruit showed anti-oxidative activity and, polysaccharides resulted in better glycemic control in dia- thus, protected the liver and kidney in T2D animal models beticrodentsviaanincreaseininsulinsensitivity[48–50].
High volume hemofiltration in critically ill patients – a systematic review and meta-analysis buy 40 mg benicar otc pulse pressure variation. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis order 20mg benicar mastercard blood pressure medication problems. Variability of antibiotic concentrations in critically ill patients receiving continuous renal replacement therapy: a multicentre pharmacokinetic study. Hybrids of these techniques are also available and may offer theoretical advantages, but in order to understand any potential benefts of one technique over another, the fundamental processes involved must be understood. Both convection and diffusion are intimately related in that both processes are required for the separation of molecular species and although haemodialysis, for example, is viewed as a diffusive therapy, it also relies on convection. Similarly, techniques such as haemofltration relies, in part, on diffusion as well as convection [1]. Convection describes the movement of any given molecular species within the medium in which it is embedded. The movement of any given molecule is at a speed identical to that of the components of the medium itself and thus all molecular components consequently move at the same rate (Fig. It follows, therefore, that convection per se is of little use in terms of separation of molecular species. However, convection is an essential process in that it allows transport of molecular species to a boundary where they can be separated: this may be via a semipermeable M. Joannidis Medical Intensive Care Unit, Department of General Internal Medicine, Medical University, Innsbruck, Austria L. Convection is often thought of as the process which drives ultrafltration, the removal of water from a solution. However, water removal in dialysis is actually accomplished through forced diffusion through pressure across a semi-permeable membrane. Where highly permeable membranes are used such as in haemofltration, the predominant driving force is hydrostatic promoting convec- tion through the flter. Given that convection implies that all molecular components move at the same rate then all molecular components will travel with the water (so- called solvent drag) but molecular separation will also depend on the characteristics of the membrane or flter employed (Fig. Diffusive therapies rely on several phenomena including ordinary diffusion and forced diffusion. Ordinary (or Fickian) diffusion describes the molecular movement induced by random movements coupled to the non-uniform distribution in space of the species. The fux is defned as the number of molecules that pass through a unit area in a unit time. Ordinary diffusion effec- tively scatters molecular species throughout the medium and is dependent on numerous factors including molecular size and properties of the solution. Separation, however, is determined by the introduction of a further element such as a membrane or gel. These will affect diffusion coeffcients signifcantly, allowing molecular separation to occur, which in turn is limited by the available concentra- tion gradients. Forced diffusion describes the application of an external force which acts differently on the molecular species present facilitating separation. Thus in a 14 Type of Renal Replacement Therapy 177 dialysis machine separation is enhanced not only by the membrane but by concen- tration gradients (ordinary diffusion) but also by pressure changes through the application of blood pumps (forced diffusion). The rate at which molecular species cross the membrane depends on the membrane rejection coeffcient (σ) which is effectively zero for small species such as urea but approaches 1 for larger molecules such as albumin. The sieving coeffcient (Sc) is given by: Sc =−1 σ This can be determined by measuring the concentration of a given solute in the plasma water and the ultrafltrate. Thus a simple view of solute clearance (K) in convective treatments is the product of: K = Qf. Solute clearance using diffusion-based systems may be calculated from: K = QdoC× do /Cbi with Qdo and Cdo being the dialysate effuent fow and solute concentration in the effuent dialysate (that leaving the dialyser). In summary, diffusion provides the main basis for the separation of molecular species in dialysis aided by convection, whereas in fl- tration convection is aided by diffusion, and as such the two processes often act simultaneously with any division being somewhat artifcial.
With their In comparison to catheters in peripheral vessels purchase benicar 40mg with mastercard arteria ethmoidalis anterior, intraosseous high metabolic rate cheap benicar 20 mg without a prescription hypertension 1 stage, birds rapidly become dehy- cannulas are much easier to maintain. Intraosseous cannulas placed in the tibiotarsus can also be used in critically ill patients drated. Correcting dehydration will dramatically im- for intermittent fluid, blood or drug administration. This to observe from outward signs, and depth should be balanced electrolyte solution protects renal function monitored by combining information obtained from better than sugar solutions. The rates will vary ids administered to anesthetized birds should be depending on the species (Table 39. Most avian Beats Per Minute Breaths per Minute patients, however, are unstable and cannot tolerate Budgerigar 600-750 55-75 such a high rate and volume of fluid administration. Some Parrot 120-780 10-20 newer analyzers use small volumes (10 µl) of serum, Ostriches4 60-72 2-20 providing clinicians access to actual values to use in assessing the status of their patients. If no means of Anatomic locations to evaluate the reflex response to determining the bicarbonate deficit is available and pain or touch in avian patients include palpebra, the patient is dehydrated or critically ill, the admini- cornea, cloaca, propatagium, cere, interphalangeal stration of 1 mEq/kg of bicarbonate at 15 to 30 min- area, pupils (response to light) and pectoral mus- ute intervals to a maximum of 4 mEq is suggested. Fasting In a light plane of anesthesia, the patient has a Recommendations concerning fasting of birds prior palpebral, corneal and pedal reflex but has lost vol- to anesthesia have varied from no fasting to an over- untary motion. This proc- light reflex (pupillary response to light) was delayed ess takes overnight in large birds and four to six and the nictitating membrane moved slowly over the hours in smaller birds. The loss of a corneal reflex (no gency, a patient with food in the crop should be held reflex closure of the lid after touching the peripheral upright during the induction procedure, with a finger cornea with a dry swab) was considered to indicate blocking the esophagus just below the mandible. If a gauze over the choanal slit to prevent food entering patient becomes too deep, all reflexes will be lost and the nasal cavity, turning the bird upside down and the respiratory rate will be slow and irregular. The flutter is often an early indicator that an animal is esophagus can then be packed with gauze, and the head and neck positioned on an upward slant to minimize the chances of passive regurgitation. An excellent plane of anesthesia for most procedures can be accomplished by reaching a depth of anesthesia where wing tone has just disap- peared. If injectable agents have been used, the tra- ditional planes of anesthesia may not be present, making evaluation of the patient more challenging. Body Temperature Physiologically, birds are actually less efficient ho- motherms than mammals and as a result undergo more rapid changes in body temperature during an- esthesia. Besides a loss of physiologic re- sponses to reduced core temperature, hypothermia is also induced during surgery by removal of large ar- three to five minutes to give an accurate reading. A more practical option is a tympanic scanner,d which ratory tract, by the liberal use of alcohol, by body contact with a cold conductive surface and by the gives a reading in five to six seconds. Even with supplemental are easy to use by applying the probe to the outer heat, it is not unusual to have rapid reductions in surface of the ear. Tympanic temperatures are con- sistently slightly higher than cloacal temperatures. Any degree of hypothermia compromises the patient’s ability to re- cover from anesthesia. While supplemental heat will Heart Monitoring not prevent the drop in core temperature seen with anesthesia, it does tend to reduce the speed of heat Heart rate in avian patients can be monitored in loss. Palpation at the point of maximum intensity is possible in some patients (see Table 39. All patients undergoing long surgical procedures Peripheral pulses can be used but are often difficult should be placed on water circulating heating pads. Auscultation via a Keep in mind that these devices need at least a stethoscope is possible, although the chest may be 20-minute warmup period before they reach the pre- difficult to reach once the patient is draped for sur- set temperature. Esophageal stethoscopes equipped with pediat- mize the amount of alcohol used in the surgical scrub ric tubing can be used for auscultation of the heart in and instead use chlorhexidine or povidone iodine to avian patients the size of Amazon parrots and larger. Body tem- This monitoring system allows direct auscultation of perature loss may also be minimized through the use the heart without having to go near the surgical field. Hypothermia occurs in birds despite their be- can be used, but are extremely positional in nature ing placed on water circulating pads. Some oximetry units provide pulse rates up to 250 Body temperature (normal=105 to 107°F28) can be bpm; these units are easy to use and are not posi- constantly monitored during anesthesia to properly tional like the doppler. A patient under tained in a surgical plane of anesthesia, the heart anesthesia will experience a time-related reduction rate remained above 450 bpm. As a bird gets deeper, the use in avian patients, they are less reliable for smaller T-waves become smaller and may totally disappear.
