By N. Nafalem. Harris-Stowe State College. 2018.

Furthermore buy cytotec 200mcg without a prescription treatment 002, when descending inputs from the hypothalamus stimulate this area purchase 200 mcg cytotec visa medicine for the people, the sympathetic system can increase activity in the cardiovascular system, such as in response to anxiety or stress. The preganglionic sympathetic fibers that are responsible for increasing heart rate are referred to as the cardiac accelerator nerves, whereas the preganglionic sympathetic fibers responsible for constricting blood vessels compose the vasomotor nerves. It receives sensory input about blood pressure and cardiac function from the glossopharyngeal and vagus nerves, and its output will activate sympathetic stimulation of the heart or blood vessels through the upper thoracic lateral horn. Another brain stem nucleus important for visceral control is the dorsal motor nucleus of the vagus nerve, which is the motor nucleus for the parasympathetic functions ascribed to the vagus nerve, including decreasing the heart rate, relaxing bronchial tubes in the lungs, and activating digestive function through the enteric nervous system. The nucleus ambiguus, which is named for its ambiguous histology, also contributes to the parasympathetic output of the vagus nerve and targets muscles in the pharynx and larynx for swallowing and speech, as well as contributing to the parasympathetic tone of the heart along with the dorsal motor nucleus of the vagus. For example, it comes into play when homeostatic mechanisms dynamically change, such as the physiological changes that accompany exercise. Getting on the treadmill and putting in a good workout will cause the heart rate to increase, breathing to be stronger and deeper, sweat glands to activate, and the digestive system to suspend activity. These are the same physiological changes associated with the fight-or- flight response, but there is nothing chasing you on that treadmill. This is not a simple homeostatic mechanism at work because “maintaining the internal environment” would mean getting all those changes back to their set points. Instead, the sympathetic system has become active during exercise so that your body can cope with what is happening. A homeostatic mechanism is dealing with the conscious decision to push the body away from a resting state. Without any input from the autonomic system, the heart would beat at approximately 100 bpm, and the parasympathetic system slows that down to the resting rate of approximately 70 bpm. Homeostatic mechanisms are trying to keep blood pH in the normal range, or to keep body temperature under control, but those are in response to the choice to exercise. The autonomic system, which is important for regulating the homeostasis of the organ systems, is also responsible for our physiological responses to emotions such as fear. The video summarizes the extent of the body’s reactions and describes several effects of the autonomic system in response to fear. On the basis of what you have already studied about autonomic function, which effect would you expect to be associated with parasympathetic, rather than sympathetic, activity? These effects will primarily be based on how drugs act at the receptors of the autonomic system neurochemistry. The signaling molecules of 678 Chapter 15 | The Autonomic Nervous System the nervous system interact with proteins in the cell membranes of various target cells. In fact, no effect can be attributed to just the signaling molecules themselves without considering the receptors. A chemical that the body produces to interact with those receptors is called an endogenous chemical, whereas a chemical introduced to the system from outside is an exogenous chemical. Exogenous chemicals may be of a natural origin, such as a plant extract, or they may be synthetically produced in a pharmaceutical laboratory. Broad Autonomic Effects One important drug that affects the autonomic system broadly is not a pharmaceutical therapeutic agent associated with the system. The effects of nicotine on the autonomic nervous system are important in considering the role smoking can play in health. When the neurotransmitter released from the preganglionic fiber binds to the receptor protein, a channel opens to allow positive ions to cross the cell membrane. For example, the sympathetic system will cause sphincters in the digestive tract to contract, limiting digestive propulsion, but the parasympathetic system will cause the contraction of other muscles in the digestive tract, which will try to push the contents of the digestive system along. The end result is that the food does not really move along and the digestive system has not appreciably changed. The system in which this can be problematic is in the cardiovascular system, which is why smoking is a risk factor for cardiovascular disease. Only a limited number of blood vessels are affected by parasympathetic input, so nicotine will preferentially cause the vascular tone to become more sympathetic, which means blood pressure will be increased. Unlike skeletal or smooth muscles, cardiac muscle is intrinsically active, meaning that it generates its own action potentials. The autonomic system does not cause the heart to beat, it just speeds it up (sympathetic) or slows it down (parasympathetic). The mechanisms for this are not mutually exclusive, so the heart receives conflicting signals, and the rhythm of the heart can be affected (Figure 15. The opposing signals to the heart would both depolarize and hyperpolarize the heart cells that establish the rhythm of the heartbeat, likely causing arrhythmia.

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These drugs must be stored in a locked safe purchase cytotec 100mcg with visa atlas genius - symptoms, cabinet • Naloxone will also reverse the analgesia pro- or room cytotec 100mcg cheap symptoms high blood pressure, constructed and maintained to prevent duced by acupuncture, suggesting that this is prob- unauthorized access. A record must be kept of their ably mediated in part by the release of endogenous use in the ‘Controlled Drugs Register’ and must opioids. The regulation of opioid drugs •The class of drug must be recorded at the head of Some drugs have the potential for abuse and con- each page. The Misuse of • Entries must be made on the day of the transac- Drugs Act 1971 controls ‘dangerous or otherwise tion or the next day. The Act imposes a • No cancellation, alteration or obliteration may total prohibition on the manufacture, possession be made. The specific details required with respect to supply • The initial parenteral dose is 10mg, subsequently of Controlled Drugs (i. Only available • protect the integrity of the gastric mucosa; for parenteral use; the initial dose is 40mg, with • maintain renal blood flow, particularly during subsequent doses of 20–40mg, 6–12 hourly, maxi- shock; mum 80mg/day. The delivery of gases to the These target only the inducible form of the enzyme operating theatre at the site of inflammation. The pipelines’ outlets act patients (especially those with recurrent nasal as self-closing sockets, each specifically configured, polyps) are prone to bronchospasm precipitated by coloured and labelled for one gas. The gases (and vacu- um) reach the anaesthetic machine via flexible rein- forced hoses, colour coded throughout their length 40 Anaesthesia Chapter 2 Figure 2. Gas Body Shoulder Nitrous oxide Oxygen Black White Nitrous Oxide Blue Blue Piped nitrous oxide is supplied from large cylin- Entonox Blue Blue/white ders, several of which are joined together to form a Air Grey White/black bank, attached to a common manifold. There are Carbon dioxide Grey Grey usually two banks, one running with all cylinders turned on (duty bank), and a reserve. Cylinders, the tradi- remains the pressure within the cylinder remains tional method of supplying gases to the anaesthetic constant (440kPa, 640psi). When all the liquid has machine, are now mainly used as reserves in case of evaporated, the cylinder contains only gas and as it pipeline failure. Medical air Oxygen This is supplied either by a compressor or in cylin- Piped oxygen is supplied from a liquid oxygen re- ders. A compressor delivers air to a central reser- serve, where it is stored under pressure (10–12bar, voir, where it is dried and filtered to achieve the 1200kPa) at approximately -180°C in a vacuum- desired quality before distribution. Two pumps are connected to a system oxygen is kept adjacent in case of failure of that must be capable of generating a vacuum of at the main system. This directly to the anaesthetic machine as an emer- is delivered to the anaesthetic rooms, operating gency reserve. Safety features • The oxygen and nitrous oxide controls are linked such that less than 25% oxygen cannot be delivered. This discontinues the nitrous oxide supply and if the patient is breathing spontaneously air can be entrained. The addition of anaesthetic vapours The anaesthetic machine Vapour-specific devices are used to produce an Its main functions are to allow: accurate concentration of each inhalational • the accurate delivery of varying flows of gases to anaesthetic: an anaesthetic system; •Vaporizers produce a saturated vapour from a • an accurate concentration of an anaesthetic reservoir of liquid anaesthetic. Sevotec) to account for the loss of latent heat that causes cooling and reduces Measurement of flow vaporization of the anaesthetic. This is achieved on most anaesthetic machines by The resultant mixture of gases and vapour is the use of flowmeters (‘rotameters’; Fig. From this point, specialized the patient’s peak inspiratory demands (30– breathing systems are used to transfer the gases 40L/min) to be met with a lower constant flow and vapours to the patient. It also acts as a further Checking the anaesthetic machine safety device, being easily distended at low pres- It is the responsibility of each anaesthetist to check sure if obstruction occurs. The main danger is that the anaesthetic spontaneous ventilation, resistance to opening is machine appears to perform normally, but in fact is minimal so as not to impede expiration. In the valve allows manual ventilation by squeezing order to minimize the risk of this, the Association the reservoir bag. Its main aim is to ensure that oxygen flows through the oxygen delivery system and is The circle system unaffected by the use of any additional gas or vapour. Most modern anaesthetic machines now The traditional breathing systems relied on the po- have built-in oxygen analysers that monitor the in- sitioning of the components and the gas flow from spired oxygen concentration to minimize this risk.

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Exhalation During the processes of exhalation discount 200mcg cytotec with amex treatment 4 hiv, the diaphragm relaxes cheap 200mcg cytotec with amex symptoms 8 months pregnant, the thorax is pushed up, the volume decreases and the atmospheric pressure increases and air rushes out of the lungs. The inspired air, which contains oxygen, passes down into the billions of minute air chambers or air cells known as alveoli, which have very thin walls. It is at this point that the fresh air gives off its oxygen to the blood and takes carbon di oxide from the blood by diffusion, which is then expelled with the expired air. Physiology of Respiration: The respiratory center of the brain is located in the medulla, immediately above the spinal cord. From the neck part of the cord, these nerve fibers continue through the phrenic nerve to the diaphragm. If there is an increase in Co2 in the blood, the cells of the respiratory center are stimulated and they in term send impulses down the phrenic nerve to the diaphragm. The end products of metabolism which have to be removed from the body are called excreta, and the organs that remove them are called excretory organs. The gastro intesti­ nal tract excretes a small amount of water, bile acids, pigments, cholesterol, certain drugs (when admin­ istered into the body) salts of heavy metals (cadmium, iron, manganese) and indigestible food residues (faeces). Sweat glands excrete sweat, which contains water, salts urea, uric acid, creatinine and other compounds. The main excretory organs are the kidneys which eliminate in the urine most of the metabolites primarily those containing nitrogen. On the inner or medial border there is a notch called the hilum at which region the artery, the vein and the ureter connect with the kidney. The medulla consists of 10­18 conical or pyramidal shaped structures, known as the renal pyramids The base of a renal pyramid faces towards the cortex. Microscopic examination of mammalian kidneys reveals that each kidney consists of about million nephron, which are the functional unit of the kidney. The nephron consists of the glomerulus, the renal tubules, the collecting tubules and the associated blood vessels. The renal artery divides into innumerable branches and the ultimate divisions of the artery form a tuft of capillaries called glomerulus. The blood pressure inside the glomerulus drives out the fluid through it is opposed by the osmotic pressure. The filtrate in the capsule consists of all the constituents of blood, except the plasma proteins and the formed elements of blood. A large number of substances are reabsorbed (reabsorption) by the tubules, a few substance added (secreation) to the filtrate and the final urine is formed. For example, water, glucose, some salts and a small fraction of urea are reabsorbed from the primary urine into the blood. Usually about 200 liters of filtrate is formed per day of which one and a half liters is sent out as urine. About 80% of this re­absorption takes place in the proximal tubules and the rest is absorbed in the distal tubules, and sent back to the blood stream. Re­absorption is carried out with the help of anti ­ diuretic hormone which is secreted in the posterior pituitary gland. Thus each nephron is able to ‘clean’ or filter a very large volume of blood without causing the body to lose much of water or other essential materials. It is devoid of glu­ cose, amino acids, certain salts (phosphates and sodium) and has a very high urea concentration. When the bladder is empty, the muscular wall becomes thick and the entire organ feels firm The organ may increase from the length of 2 or 3 inches to 5 inches or more inches. It is controlled by the action of circular muscles, continu­ ous with those in the walls of the bladder and in the urethra. Normally urine is composed of Water 96% Urea 2% Salts 2% The salts consists mainly of sodium chlorides, phosphates and sulphates. Examples of exocrine glands are the sweat, lacrymal and mammary glands which pass their secre­ tion along the ducts to the external surface of the body and the glands of the mouth, stomach, and intestine which pass their secretions along ducts into the alimentary tract. A hormone is a chemical substance produced by the endocrine glands and their overall function is to regulate the activities of various body organs and their functions. The main endocrine glands in the body are 1) Thyroid 2) Parathyroid 3) Islets of Langerhans 4) Adrenal gland 5) Pituitary gland 6) Sex glands. Thyroid Gland: The largest of the endocrine glands is the thyroid which is located in the neck region. Parathyroid Gland These are two tiny oval pair (6mm x 2mm) of glands situated at upper end and lower poles of lateral lobes of thyroid gland.

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Dermatophyte isolates can usually be distinguished from contaminants by the occurrence of compact growth around the inocula and the color of the colony Dermatophytes are never green buy generic cytotec 100 mcg medicine urinary tract infection, blue or black buy cheap cytotec 100 mcg on line medicine 75 yellow. Cell culture – cytopathic effect, hemadsorption, confirmation by neutralization, interference, immunofluorescence etc. Serology; detection of antibody and convalescent stages of infection, or the detection of IgM in primary infection. Direct examination of specimen o Fluoresce in an enzyme or a radiolabel (the indicator system) is conjugated to the antibody used to detect the virus (Primary antibody) specifically. A common application of antigen capture, for which several commercial kits are available, is in the diagnosis of Herpes simplex. For rapid diagnostic purposes, virus-specific nucleic acid sequences in serum, cells or tissue extracts are detected primarily by dot- blot hybridization techniques. It is extremely sensitive and widely regarded as a research tool with limited application to the diagnostic workbench. Indirect examination o The indicator system is conjugated to a secondary antibody, which in turn directed against the primary antibody. Serologic Methods – detection of rising titers of antibody between acute & convalescent stages of infection Measurement of IgG antiviral antibodies is used to determine immunity, while quantization of IgG or IgM antibodies can diagnose current or recent infection. Laboratory Diagnosis of Cutaneous Leishmaniasis - Cutaneous leishmaniasis in Ethiopia is caused by the following Leishmania species: L. Collection and examination of slit skin smears for amastigotes Material for examination should be taken from the inflamed raised swollen edge of an ulcer or nodule. Its base or center, which usually contains only necrotic tissue should be taken to avoided because it can contaminate the specimen with blood and is low yield for amastigotes. Note: Secondary bacterial contamination makes it difficult to find parasites and therefore if bacterial infection is present, delay examination for leishmania amastigotes until antimicrobial treatment has been completed and the bacterial infection has cleared. Firmly squeeze the edge of the lesion between the finger and thumb to drain the area of blood (protective rubber glove should be worn) 3. Spread the material on a clean slide using a circular motion and working outwards to avoid damaging parasites in those parts of the smear that have started to dry. When dry, fix the smear by covering it with a few drops of absolute methanol – Fix for 2-3 minutes and stain the smear using the Giemsa technique. This solution requires minutes staining time; Preparation of 10% solution: Measure 45 ml of buffered water Ph 7. Place the slides in a shallow tray, supported on two rods, in a coplin jar, or in a staining rack for immersion in a staining trough C. C Pour the diluted stain into the shallow tray, Coplin jar, or stain thoroughly and stain for 10 minutes D. When the smear is dry, spread a drop of immersion oil on it and examine first with the 10 x and 40 x objectives to detect macrophages which may contain amastigotes (the parasites can also be found outside macrophages) use the 100-X oil immersion objective to identify the amastigotes. Morphological characteristic of amastigotes - Amastigotes are – small round to oval bodies measuring 2-4 μm 127 • Can be seen in groups inside blood monocycles (less commonly in neutrophils), in macrophages in aspirates or skin smears, or lying free between cells • The nucleus and rod-shaped kinetoplast in each amastigotes stain dark reddish mauve • The cytoplasm stains pale and is often difficult to see when amastigotes are clustered in a group. Serological diagnosis of cutaneous leshmaniasis Because of the poor antibody response in continuous leishmaniasis serological tests are of little value in diagnosis. Leishmanin test The antigen used in the leishmanin test (or Montenegro reaction), is prepared from 6 killed culture promastigotes of L. Positive reaction: The reaction is considered positive when the area of indurations is 5mm in diameter or more. A positive reaction may be found in many persons from endemic areas who show no visible skin lesions but have been exposed to infection (test remains positive for life). A positive leishmanin test in children under 10 years of age from endemic areas is highly suggestive of the disease. In persons entering an endemic area for the first time, the development of skin lesions and positive test indicates cutaneous leishmaniasis. Negative reaction: a negative reaction may be found in some 15% of patients with uncomplicated cutaneous leishmaniasis. Purpose and use of this satellite module This module is intended to be used by degree environmental health professionals to provide them with basic issues that are not discussed in the core module but essential to undertake prevention and control activities for common skin diseases. Directions for using the Module ¾ Before reading this satellite module be sure that you have completed the pre-test and studied the core module.

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