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Hydroxylation at C21 takes place in the endoplasmic reticulum of hepatocytes in a non-regulating process purchase malegra fxt plus 160 mg. It crosses cell membrane bind to cytoplasmic receptor to form a complex generic malegra fxt plus 160mg amex, which is translocated to the nucleus. Ricketes is characterized by the production of soft pliable bones due to defective mineralization secondary to calcium deficiency. Vit D deficiency is also characterized by low concentration of calcium in blood in association with increased serum alkaline phosphatase. In adults the deficiency produce Osteomalacia due to decreased absorption of calcium and phosphorous, maintains a low plasma level resulting in weak mineralization of bones. Functions The main function of Vit E is as an antioxidant, in particular a membrane antioxidant associated with lipid membrane structure. It provides protection from the action of peroxides by converting them to a product that is conjugating with glucuronic acid and excreted in bile. Source: The richest source is vegetable oil, and nuts 180 Deficiency Vit E deficiency is a rare but found in complication of prolonged and severe steatorrhoea, and of prolonged parenteral nutrition. Deficiency of Vit E causes anemia in children with cystic fibrosis of pancreas are found to be tocopherol deficient as a result of stetorrhoea. It is required for post translational modifications of several proteins required in the coagulation cascade. Activation is carried out by the carboxylation of specific glutamate residues on the prothrombin by Vit K dependent enzyme. The presence of a second carboxyl group on the glutamate (γ- 181 carboxy glutamate) side chain confers phospholipids binding properties on the Prothrombin in 2+ the presence of Ca. However, it is found in patients suffering from Liver diseases (obstructive jaundice), in new born infants and in patients with malabsorption. The placenta is inefficient at passing maternal Vit K to the fetus and immediately after birth the circulation concentration drops, but recovers on absorption of foods. In addition the gut of the new born is sterile, so that the intestinal micro flora does not provide a source of vit K for several days after birth. This is the reason why adults who are on prolonged antibiotic treatment require supplementation of Vit. Warfarin, which inhibit the action of Vit K - probably via the mechanisms involved in the regeneration of the active hydroquinone. Tests to asses Vitamin K status include the prothrombin time-an important test in the investigation and management of jaundiced patients and of those on anticoagulant treatment. Sodium and Potassium: They are important in cell, muscle physiology, transmission of messages and other biological processes. Hyponatremia: It is common in patients who are in diuretics or excessive sweating, kidney disease, diarrhea and congestive heart failure. Other causes are decreased excretion by the kidney, diseases like Anuria, tissue damage or Diabetes Mellitus. Hypokalemia: Low potassium is not due to dietary deficiency but due to conditions like vomiting, diarrhea. Calcium and Phosphate: Major parts (90%) of them are found in the form of crystal lattice in the bone. People, who get enough sunlight, exercise regularly, on high protein diet, require 300- 400mgs per day. Clinical conditions: Hyper- calcemia; may be due to hyper parathyroidism, endocrine causes, renal failure and malignancies. Iron In body it is found in Haemoglobin, Myoglobin, ferritin, hemosiderin, transferrine and enzymes like cytochromes etc. Sources: cereals, legumes, raisins, nuts etc Functions: • Cofactor of enzymes like cytochrome oxidase, dopamine decarboxylase, tyrosinase, Cyt. Tyrosyl oxidase is important for collagen metabolism ++ +++ • Ceruloplasmin (serum ferroxidase) catalyses Fe to Fe , a pre requisite for the incorporation of iron into transferrin. Menke’s disease or Kinky hair syndrome: It is fatal sex linked recessive disorder in which there is cerebral and cerebellar degeneration, connective tissue abnormalities and kinky hair. Patient has normal absorption of iron but transport across the serosal aspect of mucosal membrane is defective.

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The process in which antibodies attach to antigens purchase 160mg malegra fxt plus with amex, causing the formation of masses of linked cells purchase 160mg malegra fxt plus, is called 26. A patient was admitted to the burn unit the previous what percentage of the patient’s blood is plasma? Explain what has happened during the hour scar tissue formation in the bone marrow impair that the sample was in the glass tube. Would you expect a patient with a form of cancer is a first intervention for someone who has suffered a called acute myelogenous leukemia to experience impaired thrombotic stroke. The technician collects a characterized by abnormal synthesis of globin proteins and blood sample and performs a test to determine its type. One of the more common adverse effects of cancer technician made an error, or is this a normal response? Lynch) Introduction Chapter Objectives After studying this chapter, you will be able to: • Identify and describe the interior and exterior parts of the human heart • Describe the path of blood through the cardiac circuits • Describe the size, shape, and location of the heart • Compare cardiac muscle to skeletal and smooth muscle • Explain the cardiac conduction system • Describe the process and purpose of an electrocardiogram • Explain the cardiac cycle 824 Chapter 19 | The Cardiovascular System: The Heart • Calculate cardiac output • Describe the effects of exercise on cardiac output and heart rate • Name the centers of the brain that control heart rate and describe their function • Identify other factors affecting heart rate • Describe fetal heart development In this chapter, you will explore the remarkable pump that propels the blood into the vessels. There is no single better word to describe the function of the heart other than “pump,” since its contraction develops the pressure that ejects blood into the major vessels: the aorta and pulmonary trunk. Although the connotation of the term “pump” suggests a mechanical device made of steel and plastic, the anatomical structure is a living, sophisticated muscle. Although the term “heart” is an English word, cardiac (heart-related) terminology can be traced back to the Latin term, “kardia. If one assumes an average rate of contraction of 75 contractions per minute, a human heart would contract approximately 108,000 times in one day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan. Each of the major pumping chambers of the heart ejects approximately 70 mL blood per contraction in a resting adult. In order to understand how that happens, it is necessary to understand the anatomy and physiology of the heart. Location of the Heart The human heart is located within the thoracic cavity, medially between the lungs in the space known as the mediastinum. Within the mediastinum, the heart is separated from the other mediastinal structures by a tough membrane known as the pericardium, or pericardial sac, and sits in its own space called the pericardial cavity. The dorsal surface of the heart lies near the bodies of the vertebrae, and its anterior surface sits deep to the sternum and costal cartilages. The great veins, the superior and inferior venae cavae, and the great arteries, the aorta and pulmonary trunk, are attached to the superior surface of the heart, called the base. The inferior tip of the heart, the apex, lies just to the left of the sternum between the junction of the fourth and fifth ribs near their articulation with the costal cartilages. It is important to remember the position and orientation of the heart when placing a stethoscope on the chest of a patient and listening for heart sounds, and also when looking at images taken from a midsagittal perspective. The slight deviation of the apex to the left is reflected in a depression in the medial surface of the inferior lobe of the left lung, called the cardiac notch. By applying pressure with the flat portion of one hand on the sternum in the area between the line at T4 and T9 (Figure 19. This is particularly critical for the brain, as irreversible damage and death of neurons occur within minutes of loss of blood flow. Current standards call for compression of the chest at least 5 cm deep and at a rate of 100 compressions per minute, a rate equal to the beat in “Staying Alive,” recorded in 1977 by the Bee Gees. At this stage, the emphasis is on performing high-quality chest compressions, rather than providing artificial respiration. It is also possible, if the hands are placed too low on the sternum, to manually drive the xiphoid process into the liver, a consequence that may prove fatal for the patient. This proven life-sustaining technique is so valuable that virtually all medical personnel as well as concerned members of the public should be certified and routinely recertified in its application. By applying pressure to the sternum, the blood within the heart will be squeezed out of the heart and into the circulation. There are also many other national and regional heart associations that offer the same service, depending upon the location. Shape and Size of the Heart The shape of the heart is similar to a pinecone, rather broad at the superior surface and tapering to the apex (see Figure 19. Given the size difference between most members of the sexes, the weight of a female heart is approximately 250–300 grams (9 to 11 ounces), and the weight of a male heart is approximately 300–350 grams (11 to 12 ounces). The heart of a well-trained athlete, especially one specializing in aerobic sports, can be considerably larger than this. That is, exercise results in the addition of protein myofilaments that increase the size of the individual cells without increasing their numbers, a concept called hypertrophy.

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Certain effects associated with clonidine suggests that it medications work to reduce the rewarding or only be prescribed to patients seeking to quit pleasurable effects of addictive substances buy malegra fxt plus 160mg fast delivery, over smoking if they are unwilling or unable to use time decreasing their appeal buy malegra fxt plus 160mg on-line. A double-blind placebo-controlled blocks the production of the enzyme aldehyde * study in humans found that more baclofen dehydrogenase which enables the liver to 135 patients than placebo patients achieved and metabolize alcohol. Ondansetron (brand name Zofran), an anti- Although disulfiram is one of the oldest 129 nausea drug, has been shown to be effective in pharmaceutical treatments for addiction reducing alcohol use cravings and alcohol use involving alcohol, there are few scientifically 138 among patients with addiction involving alcohol, valid studies of its efficacy. The medication particularly among those with an early onset appears to be most effective when its use is 130 139 addiction. There also suggest that the relatively limited evidence of is emerging evidence that ondansetron might be the efficacy of the drug may be linked to low effective in treating withdrawal symptoms in adherence rates: in one study only 20 percent of 132 patients with addiction involving opioids. Among patients who Gabapentin (brand names Fanatrex, Gabarone, completed the trial, those who received a Gralise, Neurontin), a medication used to treat neuropathic pain and epileptic seizures, has been ‡ Disulfiram is the most commonly-used aversion found to reduce withdrawal symptoms and the medication for the treatment of addiction involving alcohol. Another example of a medication that produces a similar aversive effect in individuals who consume alcohol is calcium carbimide (brand name * Sample size of 39. One for a monthly injection rather than a daily pill explanation for the variation in effectiveness and the need for regular contact with medical may be related to addiction severity: those with and other supporting staff in the course of a more severe addiction may drink despite the clinic visit which is required to obtain the 150 adverse reactions caused by disulfiram, or avoid medication. Naltrexone, used in the treatment of addiction involving alcohol and opioids, blocks opioid For addiction involving alcohol, the medication receptors in the brain, leading to reductions in is more effective at reducing heavy drinking 142 152 the reinforcing effects of these drugs. Several this by disrupting the transmission of dopamine- randomized, placebo-controlled trials found that -and thus the endorphin rush--caused by alcohol compared to patients taking placebos, patients 143 and opioid ingestion. Buprenorphine, when added to naltrexone, has been found to improve retention 156 Because of naltrexone’s mechanism of action— in treatment. Relapsing to the use of opioids reducing the reward or “high” associated with after beginning naltrexone treatment can substance use-- some patients may not take the increase patients’ risk of overdosing, due to 147 medication regularly. Noncompliance also naltrexone’s effect on increasing the sensitivity may be associated with experiencing of opioid receptors in the brain to the effects of † 157 uncomfortable side effects at the start of a opioids. Unless participants adhere to their treatment regimen 70 to 90 Varenicline (brand name Chantix) is an effective ‡ percent of the time, naltrexone does not therapy for smoking cessation that works by 149 produce significant outcomes. Injectable reducing the rewarding effects of nicotine among patients who smoke while on the * When injected, the pharmacological agent releases medication and by reducing the craving and its active compound in a consistent way over a long withdrawal symptoms that occur among period of time. A large-scale analysis of several anticonvulsant, has been validated by randomized controlled trials found that the randomized controlled trials to treat addiction 169 medication was significantly more effective than involving alcohol. It is believed to work by placebos or bupropion in relieving cravings and reducing the release of dopamine and thus the in increasing the likelihood of achieving rewarding effects of alcohol use and the urge to 170 continuous abstinence over a 12-month drink. Topiramate While nausea is the most commonly-reported also is a promising pharmaceutical treatment for side effect, insomnia, headaches and nightmares addiction involving cocaine, but additional 161 172 also are prevalent. Recent research in pharmacotherapy modifications in the product labeling and the for substance addiction has examined the use of 174 medication guide advising medical professionals vaccines in the treatment process. These to monitor all patients taking the medication for vaccines work by producing a sufficient quantity 163 neuropsychiatric symptoms. More recently, of antibodies that bind to the substance and medical professionals were advised to monitor prevent or significantly impede it from entering ‡ use of the medication among patients with the brain, reducing the accumulation of the cardiovascular disease since Chantix has been substance in the brain and ultimately decreasing 175 linked to adverse cardiovascular effects in these its rewarding effects. Modafinil, a stimulant medication (brand names § Provigil, Alertec and Modavigil), used to treat Vaccines for addiction involving nicotine are narcolepsy and other sleep disorders, reduces the farthest along in the development phase. At the same are proving to be safe, with limited adverse side time, it may reduce cocaine cravings and effects and have shown promise for helping 166 * 177 withdrawal symptoms. However, these vaccines still with addiction involving cocaine who received are undergoing clinical trials to test for safety daily doses of modafinil for eight weeks and efficacy. While they may be helpful in submitted nearly twice as many clean urine reducing the rewarding effects of nicotine in samples than placebo patients during the course those who already are addicted, they do not of the study and were more than twice as likely to achieve at least three weeks of prolonged 167 † abstinence. Another study found modafinil to Who did not have co-occurring addiction involving be effective in reducing cocaine use and cocaine alcohol. The nicotine patch A cocaine vaccine also has been developed and is available both over-the-counter and by 187 was found in a preliminary study to reduce prescription. Side effects of Maintenance Medications/Medication nicotine gum and lozenges include sore throat, 190 Assisted Therapies.

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