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For any steady level of tissue activity cheap tadalis sx 20mg amex erectile dysfunction pills cape town, there is a corresponding set point for blood flow autoregulation tadalis sx 20 mg with mastercard erectile dysfunction prevalence. In this the error signal are carbon dioxide (a metabolic product) and the effector is the arteriolar smooth muscles generic 20mg tadalis sx amex erectile dysfunction treatment by yoga. Prostaglandins Prostaglandins produced from arachidonic acid are implicated in many local regulatory functions, including inflammation and blood clotting, ovulation, menstruation, labor and secretion of gastric acid. In almost all cases, intrinsic regulation is supplemented by extrinsic homeostatic processes via hormones and nerves or both. Extrinsic Regulation: Reflex Category Reflex arc or loops are circuits that link a detection system to a response system. A reflex must have: • An afferent, or sensory component that detects variation in external or internal variables, and relays information about the variable using neural or chemical signals. Neural and Endocrine Reflexes: In some reflex loop, nerves synthesize and release a substance that acts as hormone. Endocrines are a line of communication between the nervous system and effector if their hormonal secretion are controlled by nervous inputs. In some cases, endocrine gland combines the function of sensor and integrator and respond to changes in the controlled variable by increasing or decreasing their rate of secretion - such a loop is hormonal/ endocrine reflex. Autonomic reflexes that modulates the activity of smooth muscle exocrine glands, and the ` heart muscle 3. These connections are established during development, so that sensory information results in effectors that make an appropriate response. This increases the possibilities for precise control and modification of the response. Stretch reflexes are important in the maintenance of posture because their negative feedback loop tends to return limbs to their original position. Interneurons in the spinal cord connect the motor neuron of antagonist in such a way that activation of a muscle is automatically accompanied by deactivation of its antagonists. Commands are sent out over efferent neurons and may stimulate or relax vascular smooth muscle, cause glandular secretion or alter intracellular metabolism. Endocrine Reflexes: Hormones as Chemical Messengers Hormones are the major types of chemical messengers in the body. There are two important aspects about the mechanism of hormonal information transfer. Hormone binds with the receptor - this complex causes changes in the specific activities of the target cell. Same hormone may increase secretion in one cell and cause contraction of the smooth muscle. Between these two extremes there is a range of cellular responses where the cell adapts to insult. These reactions include atrophy, hypoplasia, hypertrophy, hyperplasia, metaplasia, dysplasia and the accumulation within the cell of a variety of materials that may be endogenous (lipofuscin) or exogenous in origin. Atrophy presents as: loss of cell substance, shrinkage in cell size, cells have lowered functional ability, decrease in the number and size of its organelles, decrease in cell volume, and loss of more specific functions. Hypertrophy Stimulation of the parenchymal cells of an organ by increasing functional demand or by hormones, result in an increase in the total mass of the cells. This may be by hypertrophy such as in skeletal muscle or by an increase in number - hyperplasia. It is usually more common in cardiac and 53 skeletal muscle as in athletes and laborers in which individual muscle fibers increase in thickness and not in number. An increased oxygen availability to the working muscles Physiological Atrophy Physiologic atrophy is a normal phenomenon of aging in many tissues such as involution of thymus gland after adolescence, the reduction in endometrial cellularity after the menopause. Lack of hormonal stimulation causes the atrophic changes in the ovary, uterus, vagina, and fallopian tubes during menopause. Prostate, seminal vesicles, and bulbo-urelthral glands and the brain commonly atrophy in old age. In atrophy there is accumulation of Ripofuscin, a yellowish brown pigment inside the cytosol. Endocrine Atrophy In damage to the anterior pituitary gland there is diminution of the trophic hormone resulting in involution and atrophy of adrenal cortex and gonads. In endocrine hypofuncrion there may be significant atrophy of the hormone- dependent tissues e. Though synthetic activity lasts for sometime at a normal rate but catabolism is greatly enhanced. As the workload of a cell decreases, there is decline in oxygen consumption and protein synthesis and the cell conserves energy by decreasing the number and size of organelles. In general, reduced cell activity is associated with reduced catabolism, which in turn has a negative feedback. An anaphy is observed in the muscles of extremities that have been cast in plaster or weightlessness in case of astronauts. This leads to wasting of both muscles and bones; reversible with function recovery. Emaciation of starvation is mainly due to excessive utilization of the subcutaneous fat, but there is also wasting of lean mass muscles and even some organs such as liver. The term ‘cachexia’ means the combination of muscle wasting, organ shrinking, anemia and weakness, and is found in severely sick patients in whom there is loss of appetite, general gastrointestinal dysfunction associated with terminal stage of malignant tumor. The metabolic events of starvation permit life to continue for months without calorie intake, depending on the prestarvation stage. The daily weight loss, can range from one pound to several pounds on the stage of starvation. Protein loss ensues, with substantial weight loss, the most easily recognized sign of starvation. Biochemical changes that occur in starvation: • glycogenolysis (hepatic) continues for about 16 hours 56 • hepatic gluconeogenesis takes place using amino acids (especially muscle protein, there is increased urea excretion) • as brain and other tissues use ketone bodies, glucose need is reduced. Ketone bodies also reduce glucose use by muscles, gluconeogenesis, protein catabolism and urine concentration decreases • glutamine is used by the kidney for gluconeogenesis • Proteins are spared to permit maximal starvation; survival requires of at least ½ of muscle proteins. Other Types of Atrophies Increased catabolism in prolonged fever or as result of severe trauma may cause skeletal muscle atrophy. Tumors and cysts of an organ may cause pressure atrophy due to interference with blood flow or function of the tissue, e. Hypoplasia Hypoplasia is a state of failure of the tissue to reach normal size during development. The affected individuals have short limbs, trunk relatively normal length, the head large with bulging forehead and scooped out nose. In some type of dwarfism, the cause may be the reduced production of growth hormone as in Lorain type dwarfism in which growth hormone receptors are defective in some instances cell loss may be due to infection or poisoning. Maternal rubella infection in first trimester may damage the fetal heart and a variety of embryonic defects related to development arrest involving all germ layers. Delayed and disturbed organ genesis produces structural defects of eye, brain, heart, and large arteries. In hypoxic environment with low oxygen tension, there is compensatory hyperplasia of red cells precursors and increased number of circulating red blood cells is an example of compensatory hyperplasia. Hyperplasia is usually found in tissues that have the capability for mitosis, such as epidermis.

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Belay Kassa proven tadalis sx 20 mg erectile dysfunction needle injection video, the Vice President of Academics and Research for their courageous attention and unreserved support in the production of modules suggested by the initiative cheap tadalis sx 20mg with visa erectile dysfunction medication nz. Purpose and Use of the Module A big challenge in the training of well-versed health professionals in the different higher institutions in Ethiopia has emanated from the serious shortage of adequate number of contextual reference materials tadalis sx 20 mg visa erectile dysfunction medication names. To add to this problem, even the available reference materials sometimes fail to address the most important learning issues of the Ethiopian students. However, up to this day, efforts geared towards the preparation of reference materials by instructors in the different institutions in order to reduce this problem have remained meager. This module is prepared to help students develop knowledge, attitudes and skills required in their practice areas through active learning. Technologist) to be able to recognize and manage the important food-borne diseases as well as to prevent them from occurring from the outset. Besides, it is believed that those already engaged in the service delivery working in different health facilities will benefit as well from reading this module. All individuals taking time to look at this document are reminded of the importance of consulting standard textbooks on the subject whenever possible, since this module is by no means meant to replace them. Directions for Using the Module Before starting to read this module, please follow the directions given below: 1 1. Use a separate sheet of paper to write your answers and label it “pretest answers”. Note: You may refer to the list of abbreviations and glossary shown in Unit Five for terms that are not clear. Describe the two major classifications of food-borne diseases and give one example for each. Mention some factors contributory to the widespread occurrence of food-borne diseases in Ethiopia. List the areas of emphasis in the general diagnostic approach of food-borne diseases. What are the three most important basic principles in the prevention and control of food-borne diseases? Write the most important clinical features for each of the following food-borne diseases, a. Discuss the implications of each of the following practices in relation to food- borne diseases: a. Any patient suspected to have cholera should be immediately referred to a higher center for better care. In the management of patients with cholera, fluid replacement is less important than antimicrobial therapy. One role of the use of antimicrobials is for prophylactic purpose in family members (contacts). Identify the food-borne disease not acquired through ingestion of raw or undercooked meat: A. Which one of the following can be taken as an objective data when assessing a patient with food borne diseases? During the nursing care for a patient with diarrhea secondary to food borne diseases, caffeine and carbonated beverage is limited because: A. One of the following nursing interventions is not carried out for a patient with poisoning related to the ingestion of contaminated food with chemical poisons and poisonous plants. Induction of vomiting is not recommended after ingestion of caustic substances or petroleum distillates A. Identify an incorrect statement about the nutritional management of the patient with food borne diseases that has diarrhea. Advise the patients to increase food products with a cellulose or hemi cellulose base. Which one of the following nursing interventions is used to reduce anxiety of a patient with diarrhea secondary to food borne diseases? Providing an opportunity to express fears and worry about being embarrassed by lack of control over bowel elimination. Assist to identify irritating foods and stressors that precipitate an episode of diarrhea. Identify a measure that is helpful to prevent the spread of food borne infections to others. Provision of isolation according to the general rule of body substance isolation, or individual institution adaptation of isolation. One of the following drugs is not used in the treatment of Taeniasis (T-solium) A. For Environmental Health Officers Read the following questions carefully and give the appropriate answer. Hazards at the stage of production of raw materials include the following except A. The factors that are necessary for the transmission of a food borne disease are A. Which of the following factors leads to the occurrence of food borne disease outbreaks A. List the different types of food samples collected for food-borne disease assessment. For Medical Laboratory Technologists Write the letter of your choice for the following questions on separate answer sheet. Which of the following parasites is diagnosed by finding cyst and trophozoit stage? Food- borne diseases are known to be responsible for a large proportion of adult illnesses and deaths; more importantly, as sources of acute diarrheal diseases, they are known to claim the lives of overwhelming numbers of children every day. In developing countries like Ethiopia, the problem attains great proportions due to many reasons; basic among which are poverty and lack of public health awareness. Although well-documented information is lacking regarding the extent of food-borne diseases in the country, and many cases and outbreaks are unrecognized or unreported, they are unquestionably one of the major reasons or why people of all ages seek medical help. Most food-borne diseases manifest with gastrointestinal symptoms and signs, the latter being uniformly among the top diagnoses in health facilities at all levels. Besides, they commonly lead to epidemics that result in the losses of many lives, accompanied with severe economic repercussions. In these modern days, in which food is usually not consumed immediately following and/or at the site of production, the risks of food-borne diseases are becoming increasingly important; the concern is obviously much more in areas where food storage and preparation safety measures are far below the optimum. The role of well-trained health professionals not only in the prevention and control of food- borne diseases, but also in the recognition of individual cases as well as outbreaks and their timely and proper management in order to reduce mortalities and morbidities is very crucial. Learning Objectives General Upon completion of this module, the learner will be able to recognize, prevent and manage food-borne diseases. Explain the general diagnostic and management approaches to some food born diseases. Case Study Learning Activity 1 It was during the period of drought and famine that people were getting displaced to other parts of the country. Before the resettlement, they used to wait in groups in the nearly small town for few days or weeks.

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Suppose amino acid changes in one of thefour sets consistently cor- related with the ultimate success of a lineage order tadalis sx once a day erectile dysfunction nofap. Then trusted tadalis sx 20mg erectile dysfunction caused by high blood pressure medication, at any time order 20mg tadalis sx free shipping impotence libido, one could predict which of the currently circulating isolates would be most closely related to the progenitor of future lineages. In particular, those lineages with the most amino acids that had recently changed at the key sites would be most likely to succeed. In in?uenza, success probably occurs by escaping the host’s immunological antibody memory caused by recent epidemics. Variant sites near key antibody epitopes would be good candidates to produce antibody escape. In other words, those sites with amino acid replacements favored by selection in the past also provided the best in- formation about which amino acid changes would lead to success in the future. A ret- rospective test analyzed data from 1983 to year x and predicted subse- quent evolution in the years following x,wherex varied between 1986 and 1997. At the question mark, just before 1994, the data can no longer resolve the trunk lineage because several variants cocirculated at thattimeandthetrunkcanberesolved only after one knows which of those lineages succeeded. The ?lled circles show four isolates from 1994 that represented the four classi?cations for variable amino acids. Shd5 (A/Shangdong/5/94) represented the lineagewiththegreatest number of recent amino acid changes at sites that had been positively selected in the past, as inferred from the 1983–1997 data. The Har3 (A/Harbin/3/94) lineage had variant amino acids near the receptor binding site. The Sant (A/Santiago/7198/ 94) lineage had variant amino acids at those sites that had evolved rap- idly in the past. Suc- cessful prediction means choosing the isolate closest on the tree (most alike genetically) with the lineagethatcontinues along the trunk and gives rise to the future population. It turned out that Shd5 was closest to the successful trunk lineage among the candidates. In other words, the most changes in previously positively selected sites predicted which lineage succeeded in subsequent years. In nine of those elevenyears,thelineage that contained the most changes relative to its ancestor at the eighteen positively se- lected sites identi?ed the section of the tree from which the future trunk emerged. The sites in the antibody epitopes only identi?ed seven of eleven trunk lineages, and the other amino acid sets did worse. Thus, positive selection provided the best signal for which amino acid changes correlated most closely with ?tness. The epidemic strains con- tained amino acid replacements at a small number of sites that had previously been identi?ed as crucial for escape from monoclonal anti- bodies. It would be interesting to compare these two methods in a single study of the same evolving parasite population. In the future, will these eighteen sites continue to be the primary target of selection? On the one hand, the eighteen sites may indeed be the most important for escape from protective antibodies. On the other hand, di?erent sites may dominate in the future, with little future selective change in the currently positively selected sites. A changing focus of selection may arise from evolving structural features of the viral surface that expose or hide di?erent sites or from a changed distribution in the immune memory pro?les of hosts. If episodic selection frequently occurs, then the time scale over which one studies substitution patterns plays a critical role in inference. Sim- ply measuring aggregate rates of synonymous and nonsynonymous sub- stitutions may turn out to be a rather crude tool that misses a large proportion of the changes brought about by natural selection. As more data accumulate, it will become important to match statistical methods with explicit hypotheses about the biological processes of selection and the temporal scale over which selection varies. In?uenza has certain characters that make it a particularly good model for simple analysis of positive selection. Epidemic strains often have wide distribution; thus, there is relatively less spatial varia- tion in the exposure of hosts to di?erent strains than for many other parasites. The wide and relatively uniform distribution of epidemics creates relatively uniform selective pressure on the virus. In addition, infections do not persist within hosts, so most selective pressure on the surface hemagglutinin glycoproteinarisesbyescape from antibody rec- ognition during transmission between hosts. The uniformity of selective pressure means that aggregate samples can provide clear signals. By contrast, other parasites may face multiple selective pressures that vary over relatively small spatial and temporal scales. This sampling scheme allowed them to analyze the di?erent patterns of selection within hosts and between hosts. They propose various models of selection within and be- tween hosts that could be tested by further sampling and analysis. The point here is that a simple aggregation of sequences over the entire pop- ulation may not be informative given the di?erent kinds of selection that act over various temporal and spatial scales. Imentioned in the Problems for Future Research section of chapter 11 that most population samples have been collected for reasons other than phylogenetic analysis. For example, each year epidemic surveillance teams collect thousands of in?uenza isolates from across the world. They typically use anti- genic screening to pick isolates that di?er signi?cantly from the com- mon, recently circulating strains. This biased sampling supports vaccine design but may a?ect analyses of selection and other population-level processes. Recent calls for wider and better-designed sampling should lead to great opportunities for population studies (Layne et al. Nonlinear processes of transmission and stochastic e?ects of small e?ective population sizes in epidemics strongly in?uence the patterns of evolutionary change. Random sampling may not be the best design for studying the population consequences of nonlinear transmission and stochastic ?uctuations. New theoretical work on sampling and inference would helptoguidetheadvancedscreening and analysis technologies that will be put in place in the coming years. Several parasites such as Trypano- soma brucei and Borrelia hermsii store archival libraries of antigenic variants. Strong positive selec- tion probably favored diversi?cationofthearchival variants during the initial evolution of antigenic switching. However, once a genome con- tains a large library of diverged variants, negative selection may act pri- marily to retain the existing antigenic di?erences between the variants. Their sampling did not provide multiple alleles at individual loci, so they did not report on the selective pressures re- cently acting on each individual locus.

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The definition is the same to children and infants though there are different methods for testing vision in young children until when they are at pre school age when normal visual acuity chart can be used buy cheap tadalis sx 20mg on line erectile dysfunction doctors kansas city. The common causes of blindness are Cataract purchase tadalis sx 20mg on-line impotent rage random encounter, Glaucoma cheap 20 mg tadalis sx free shipping best erectile dysfunction pump, Trachoma, and Vitamin A Deficiency, Diseases of the Retina, uncorrected Refractive Errors and Low Vision. Children should be referred immediately to a Paediatric Eye Tertiary Centre as white pupil may be a tumor in the eye. Late treatment of cataract in children may lead to permanent loss of vision, low vision or squint. Primary Open angle glaucoma Diagnosis  Present as painless loss of peripheral vision  Affects adults of 40 years of age and above  Cornea and conjunctiva are clear  Pupil in the affected eye does not react with direct light. Medical treatment is given to patients with good compliance (targeted intraocular pressure level reached). If medical treatment is given, it should be life long unless there are conditions necessitating other interventions. This is a first line treatment and it should be used with caution in patients with Asthma and cardiac diseases. This medicine causes long-standing pupil constriction so it should not be used unless a patient is prepared for glaucoma surgery or as an alternative topical treatment for patients who are contraindicated for Timolol use. Surgical Treatment  It is done in all patients with poor compliance or when prescribed topical medicines are unavailable or unaffordable. Primary Angle Closure Glaucoma This is also known as Congestive Glaucoma and commonly affect people aged 40 years and above. They are also used in emergencies to prepare patients with high intraocular pressure for surgery as they lower intraocular pressure rapidly. Diagnosis  Patients presents with bigger eyes than normal for age (buphthalmos)  Photophobia  Tearing  Cloudy cornea,  Red conjunctiva though not severe. Treatment Treatment is usually surgery, which is done by pediatric ophthalmologist. Referral Refer any child who have the above mentioned signs and you suspect that he/she is having congenital glaucoma to a specialist at a Paediatric Eye Tertiary centre. Secondary Glaucoma This presents as a complication of other eye diseases such as uveitis, hypermature cataract, trauma and retinal diseases. It may also be due to prolonged use of steroids Diagnosis  Poor vision in the affected eye  High intraocular pressure  New vessels on the iris if the cause is retinal diseases Treatment Guideline Management of these patients is retrobulbar alcohol injection 99% in the affected eye or laser photocoagulation treatment (Cyclophotocoagulation) in thrombotic glaucoma. There is a chronic inflammation of the conjunctiva leading to scarring of the upper eyelid tarsal plate, entropion and in turn of eyelashes. Note:Trachoma reservoirs are infected children and mothers in hyper endemic areas. The infection is spread by direct contact through Flies, Fomites (kanga, towels) and Fingers, in poorly hand hygienic conditions. Diagnosis  Patients presents with photophobia in early stages or re- infection  Follicles in the upper tarsal plate seen as round and white nodules in active diagnostic. This procedure can be done at a Dispensary or Health Centre at community level by a trained health worker. The regimen for children is as shown below:- Table 1: Dosage of Azithromycin in children Weight (kg) I-day Regimen < 15 20mg/kg once daily 15 – 25 400mg (10 ml) once daily 26 - 35 600 mg (15 ml) once daily 36-45 800 mg (20 ml) once daily > 45 Dose as per adults 187 | P a g e F – Face washing and total body hygiene to prevent transmission of disease from one person to the other. The age group at risk of blindness due to Vitamin A deficiency is 6 months to 6 years. Ocular Manifestations Xerophthalmia is a term used to describe the ocular symptoms and signs of Vitamin A Deficiency which are:-  Night Blindness - Patients presents/complain of poor vision during the night or in dim light  Conjunctival Xerosis - It is a dry appearance of the conjunctiva  Bitot Spots - This is an advanced stage of Conjunctival xerosis presenting as a localized white foamy appearance most often on the temporal conjunctiva  Corneal xerosis - It is a dry appearance of the cornea  Corneal ulceration with Xerosis – It is an advanced stage of corneal xerosis where you have ulceration of the cornea  Corneal Ulceration/Keratomalacia - It is a corneal melting that is of abrupt onset. It presents in severe Vitamin A Deficiency  Corneal Scarring - It is the end stage of malnutrition in children who survive. Corneal scarring often has a marked effect on vision Treatment Give Vitamin A capsules and emphasize on diet containing dark-green-leafy vegetables Table 2: Vitamin A Dosage for Children Vitamin A Dosage Age up to 1 year Age above 1 year 100,000 I. U Third dose after 4 week 188 | P a g e Ocular Treatment Give Tetracycline or Chloramphenical 1% eye ointment 8 hourly and avoid corneal exposure. Diabetic Retinopathy Diabetic retinopathy is a well recognized complication of diabetes mellitus. It is a chronic progressive sight threatening disease of the retinal blood vessels associated with the prolonged hyperglycemia and other conditions linked to diabetic mellitus such as hypertension. Diabetic Retinopathy is grouped into three: Background Diabetic Retinopathy, Diabetic maculopathy and Proliferative Diabetic Retinopathy. Diagnosis: Is reached by doing fundoscopy in a well dilated pupil, Optical Coherence Tomography and or Fluorescene Angiography. Optical Coherence Tomography and Fluorescene Angiography are done in specialized eye clinics. Treatment Laser photocoagulation, extent and type of this treatment depending on the stage of the disease. Age Related Macular Degeneration This is a disease condition, which is characterized by progressive macular changes that are associated with increase in age. It then results in the gradual deterioration of the vision and eventually loss of vision from the center of the field of vision. Age Related Macular Degeneration is associated with accumulation of abnormal materials in the inner layers of the Retina at the macula. The only symptom in this condition initially is poor central vision, later can lead to blindness. It is diagnosed by fundoscopy through a well-dilated pupil, Optical Coherence Tomography and or Fluorescene Angiography as for Diabetic Retinopathy. Treatment Intravitreal injection of Bevacizumab (Avastin) or Ranibizumab (Lucentis) in the affected eye given by vitreoretinal specialist in specialized eye clinics (dosage as in diabetic retinopathy). There are mainly 4 types of refractive errors namely presbyopia, myopia, astigmatism and hyperopia. This is a good opportunity for screening of glaucoma and diabetic retinopathy so it is very important that eyes are examined properly before testing for spectacles. Myopia (Short Sightedness): This is a condition whereby patient complains of difficulty to see far objects. Hypermetropia (Long Sightedness): This is a condition where patients have difficulty in seeing near objects. This condition is less manifested in children as they have a high accommodative power. As a person grows older, accommodation decreases and patients may complain of ocular strain. Diagnosis in children should be reached after refraction through a pupil that is dilated. Note:  Spectacles should be given to children who have only significant hypermetropia (more than +3. Astigmatism: This is a condition where the cornea and sometimes the lens have different radius of curvature in all meridians (different focus in different planes). Diagnosis is reached through refraction and treatment is with astigmatic cylindrical lenses. Low Vision A person with low vision is one with irreversible visual loss and reduced ability to perform many daily activities such as recognizing people in the streets, reading black boards, writing at the same speed as peers and playing with friends. These patients have visual impairment even with treatment and or standard refractive correction and have a visual acuity of less than 6/18 to perception of light and a reduced central visual field.