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Functionally purchase cabergoline 0.25 mg with visa, the nervous system can be divided into those regions that are responsible for sensation purchase 0.5mg cabergoline amex, those that are responsible for integration cheap cabergoline 0.25 mg online, and those that are responsible for generating responses. Considering the anatomical regions of the nervous system, there are specific names for the structures within each division. Whereas nuclei and ganglia are specifically in the central or peripheral divisions, axons can cross the boundary between the two. Nervous tissue can also be described as gray matter and white matter on the basis of its appearance in unstained tissue. Any sensory or integrative functions that result in the movement of skeletal muscle would be considered somatic. The sensations that lead to autonomic functions can be the same sensations that are part of initiating somatic responses. A special division of the nervous system is the enteric nervous system, which is responsible for controlling the digestive organs. The enteric nervous system is exclusively found in the periphery because it is the nervous tissue in the organs of the digestive system. Signals are received at the dendrites, are passed along the cell body, and propagate along the axon towards the target, which may be another neuron, muscle tissue, or a gland. Several types of glial cells are found in the nervous system, and they can be categorized by the anatomical division in which they are found. Astrocytes are important for maintaining the chemical environment around the neuron and are crucial for regulating the blood-brain barrier. The sensory endings in the skin initiate an electrical signal that travels along the sensory axon within a nerve into the spinal cord, where it synapses with a neuron in the gray matter of the spinal cord. The temperature information represented in that electrical signal is passed to the next neuron by a chemical signal that diffuses across the small gap of the synapse and initiates a new electrical signal in the target cell. That signal travels through the sensory pathway to the brain, passing through the thalamus, where conscious perception of the water temperature is made possible by the cerebral cortex. Following integration of that information with other cognitive processes and sensory information, the brain sends a command back down to the spinal cord to initiate a motor response by controlling a skeletal muscle. The upper motor neuron has its cell body in the cerebral cortex and synapses on a cell in the gray matter of the spinal cord. The lower motor neuron is that cell in the gray matter of the spinal cord and its axon extends into the periphery where it synapses with a skeletal muscle in a neuromuscular junction. Transmembrane ion channels regulate when ions can move in or out of the cell, so that a precise signal is generated. This signal is the action potential which has a very characteristic shape based on voltage changes across the membrane in a given time period. A stimulus will start the depolarization of the membrane, and voltage-gated channels will result in further depolarization followed by repolarization of the membrane. Once that channel has returned to its resting state, a new action potential + is possible, but it must be started by a relatively stronger stimulus to overcome the K leaving the cell. The action potential travels down the axon as voltage-gated ion channels are opened by the spreading depolarization. In unmyelinated axons, this happens in a continuous fashion because there are voltage-gated channels throughout the membrane. In myelinated axons, propagation is described as saltatory because voltage-gated channels are only found at the nodes of Ranvier and the electrical events seem to “jump” from one node to the next. Saltatory conduction is faster than continuous conduction, meaning that myelinated axons propagate their signals faster. The diameter of the axon also makes a difference as ions diffusing within the cell have less resistance in a wider space. For a neuron to generate an action potential, it needs to receive input from another source, either another neuron or a sensory stimulus. That input will result in opening ion channels in the neuron, resulting in a graded potential based on the strength of the stimulus. Graded potentials can be depolarizing or hyperpolarizing and can summate to affect the probability of the neuron reaching threshold. If the sensory stimulus is received by the dendrites of a unipolar sensory neuron, such as the sensory neuron ending in the skin, the graded potential is called a generator potential because it can directly generate the action potential in the initial segment of the axon. If the sensory stimulus is received by a specialized sensory receptor cell, the graded potential is called a receptor potential. At a chemical synapse, neurotransmitter is released from the presynaptic element and diffuses across the synaptic cleft. The neurotransmitter must be inactivated or removed from the synaptic cleft so that the stimulus is limited in time. The particular characteristics of a synapse vary based on the neurotransmitter system produced by that neuron. The cholinergic system is found at the neuromuscular junction and in certain places within the nervous system. Other neurotransmitters are the result of amino acids being enzymatically changed, as in the biogenic amines, or being covalently bonded together, as in the neuropeptides. View this This is a tool to see the structures of the body (not just the animation (http://openstaxcollege. And what is the nervous system is that fat tissue and water appear as similar about the movement of these two ions? Visit the Nobel electrophysiological processes in the nervous system, Prize website (http://openstaxcollege. Often, the action potentials occur so technology and compares it with other types of imaging rapidly that watching a screen to see them occur is not technologies. A speaker is powered by the signals recorded from compared with images obtained from x-ray or computed a neuron and it “pops” each time the neuron fires an action tomography. These action potentials are firing so fast that it game indicate the separation of white and gray matter sounds like static on the radio. Why is the leech model used for measuring troublewstairs) to read about a woman that notices that her the electrical activity of neurons instead of using humans? To what functional division of the nervous change in the target cell, multiple signals are usually added system would these structures belong? The action potential reaches the end of are the focus of intense research as failures in physiology the axon, called the axon terminal, and a chemical signal is can lead to devastating illnesses. Why are neurons only released to tell the target cell to do something, either initiate found in animals? In a very neuron function, why wouldn’t they be helpful for plants or short space, the electrical signal of the action potential is microorganisms? The axon contains microtubules and neurofilaments, bounded by a plasma membrane known as the axolemma. Outside the plasma membrane of the axon is the myelin sheath, which is composed of the tightly wrapped plasma membrane of a Schwann cell. What aspects of the cells in this image react with the stain that makes them the deep, dark, black color, such as the multiple layers that are the myelin sheath? Which part of a neuron transmits an electrical signal to sensations, what would a chemoreceptor be sensitive to? Which functional division of the nervous system would be responsible for the physiological changes seen during 21. How much of a change in the membrane potential is necessary for the summation of postsynaptic potentials to result in an action potential being generated? Include an example of each arm voluntarily, but their muscles have tone, which motor type of tissue that is under nervous system control. When eating food, what anatomical and functional divisions of the nervous system are involved in the 40. What type of cell would be the because of the time it takes for the sensations to reach most likely target of this disease? Which type of neuron, based on its shape, is best suited for relaying information directly from one neuron to 42. Sensory fibers, or pathways, are referred to as hyperpolarizations that would result in the neuron reaching “afferent. The central and peripheral divisions coordinate control of the body using the senses of balance, body position, and touch on the soles of the feet. The structures of the nervous system must be described in detail to understand how many of these functions are possible.

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The tonsils are compressed against the margins of the foramen magnum cheap cabergoline 0.25 mg visa, causing tonsillar necrosis buy cabergoline 0.25mg with mastercard. More importantly 0.5mg cabergoline, the herniating tonsils squeeze the medulla, producing medullary paralysis and death (loss of consciousness, bradycardia, irregular respirations or apneic periods, and hypotension). Cerebellar masses may produce signs of lower midbrain and of pontine compression also. The most appropriate treatment is removal of the mass lesion, but there are many instances when, because of the location of lesions, the rapidity with which brain swelling occurs or because of the presence of hemorrhages, such intervention is not feasible. In critical situations, the use of osmotically active substances is often life saving. Brain capillaries are impermeable to most substances, the exceptions being gases (02, C02, N20, anesthetics, etc. These agents dehydrate the brain; areas of cerebral edema are less easily dehydrated than normal brain tissue, but the net effect in reducing intracranial pressure is, nevertheless, beneficial. Corticosteroids are most important in treating cerebral edema, especially the synthetic steroids prednisolone and dexamethasone. The beneficial effects of steroid therapy in patients with cerebral edema secondary to tumors and in pseudotumor cerebri are well established. There is controversy as to whether steroids are effective in ischemic edema associated with strokes, but their use in patients with stroke is widespread. Improvement becomes evident within 24 hours after initiation of treatment and can be maintained for prolonged periods of time. Steroids may exert their beneficial effects by more than one mechanism: for example, they may also affect cerebral function directly or decrease the size of the primary lesion, such as a tumor. It has been demonstrated that steroids suppress activation of lysosomal hydrolyzing enzymes. They reduce disruption of brain capillaries in areas adjacent to lesions and restrict the spread of cerebral edema from a site of injury. This is performed by insertion of a catheter into a lateral ventricle or into the subdural or epidural space; the catheter is then attached to a pressure transducer. The patient must receive artificial ventilation, of course, and be very closely monitored. About one-third are mildly impaired, another third are moderately impaired and the remainder are severely impaired. Approximately one-third of these survivors will have another stroke within 5 years. From a pathophysiologic and anatomic standpoint, it is convenient to consider cerebrovascular disease as processes that lead to infarction (encephalomalacia) or hemorrhage. The two most important predisposing conditions are atherosclerosis and systemic hypertension. Anatomic Review The right and left internal carotid and vertebral arteries supply the brain. The carotid and vertebral arteries feed, respectively, the anterior and posterior circulation systems of the 21 brain. From the circle, three pairs of branches emerge to supply the two cerebral hemispheres in toto. The vertebrobasilar arterial trunks give off branches to supply the cerebellum and the brain stem. Anterior circulation: Each internal carotid artery enters the floor of the middle cranial fossa and makes a cephalad and caudad hairpin turn as it passes through the cavernous sinus in the lateral margin of the sella turcica. The postcavernous or suprasellar segment divides into the large middle and anterior cerebral arteries that, together with the short anterior communicating artery and the two posterior communicating arteries, form the anterior portion of the circle of Willis. Its branches emerge laterally to fan out over virtually the entire convexity of the hemisphere. The anterior cerebral artery enters the interhemispheric fissure to supply all of the medial and apical convolutions of the frontal and parietal lobes, as well as the corpus callosum. The anterior cerebral artery supplies the motor cortex responsible for voluntary movement of the leg, while the middle cerebral artery feeds the arm and face. The basal ganglia are supplied by the lenticulostriate arteries, which arise from the first segment of the middle cerebral artery. Posterior circulation: The vertebral arteries enter the foramen magnum, run anteriorly on the ventral surface of the medulla, and come together at the junction with the pons to become the basilar artery. At the pontomesencephalic junction, the basilar bifurcates terminally into the right and left posterior cerebral arteries. These two arteries arch around the cerebral peduncles and pass through the incisura of the tentorium to enter the supratentorial compartment, where further branchings supply the medial aspect of the occipital lobe (visual cortex), the hippocampus, the thalamus, and most of the ventral surface of the hemispheres. As they round the peduncles, each posterior cerebral joins a posterior communicating artery, which together compose the posterior half of the circle of Willis. Regional neurologic deficits can be expected whenever occlusion of any of them is sudden and complete, as in thromboembolization from the left chambers of the heart. On the other hand, especially when the underlying obstruction develops slowly other anatomic factors – more or less variable from individual to individual – modify the consequences of the basic design outlined. Variations in the configuration of the circle of Willis and in the relative caliber of the arteries affect the amount of cross flow between the anterior and posterior circulation and between the two sides. Ten percent of individuals with total atherosclerotic occlusion of one internal carotid artery in the neck are asymptomatic. Anastomoses in the subarachnoid space between terminal branches of the major cerebral arteries provide blood flow in one territory to an adjacent arterial field. A few communications between intracranial and extracranial vessels are of little or no consequence, with the exception of connections between the ophthalmic artery and branches of the external carotid artery in the orbit. However, penetrating small arteries and a few muscular arteries that run deep into the parenchyma supply much of the central gray masses of the cerebrum as well as the brain stem. The elastic fibers of intracranial arterial walls are limited to a single layer between the endothelium and the media, the internal elastica lamina. The distal branches of the arterial tree in the brain receive no autonomic innervation. Ultrastructurally, tight junctions between the endothelial cell membranes seal the lining of brain capillaries – a major facet of the relatively impermeable blood-brain barrier. Circulatory disorders of the venous system account for a small fraction of cerebrovascular disease and time does not permit a review of the superficial and deep draining pathways of intracranial blood. Physiologic Considerations Hemodynamic as well as anatomic factors play an important role in the vulnerability of brain to disorders of the circulation. The brain comprises only two percent body weight, but it receives fifteen percent of the cardiac output. Blood flow is a function of perfusion pressure (the gradient between mean arterial pressure and venous pressure) and the resistance of the vascular bed (determined mainly at the arteriolar level). Increased intracranial pressure (see the section on Intracranial Hypertension in this syllabus) raises venous pressure and, unless compensated for, lowers the perfusion gradient and the flow of blood. Overall cerebral blood flow is relatively constant over a broad range of arterial pressure. Arteriolar tone is not mediated by the autonomic nervous system or endocrine influences. Cerebral blood flow is clearly affected by oxygen tension, pH, and carbon dioxide tension. But many observations suggest that additional factors, possible oligopeptide neurotransmitters among them, are important determinants of blood flow in the brain. Lack of information in this area is one of the impediments to major advances in cerebrovascular disease. The nerve cell is dependent on oxidative metabolism and a continuous supply of glucose and oxygen for survival. Neuronal function ceases seconds after circulatory arrest; irreversible structural damage follows a few minutes later. Recent work proposes that an excess of excitatory amino acid transmitters and an abnormal influx of calcium into the cell play a decisive role in the death of the nerve cell. Glial cells, especially astroglial and microglia, are more resistant to impaired circulation than nerve cells. The amount of damage and the survival of tissue at risk depends on a number of modifying factors, which include the duration of ischemia, availability of collateral circulation, and the magnitude and rapidity of the reduction of blood flow.

In restrictive lung diseases (such as pulmonary fibrosis) generic cabergoline 0.25mg line, the vital capacity is reduced to below normal levels buy cheap cabergoline 0.5mg on-line. In obstructive lung disease (such as asthma cabergoline 0.5mg with mastercard, emphysema, bronchitis) the vital capacity is normal because lung tissue is not damage and its compliance is unchanged. In asthma the small airways (bronchioles) constrict, bronchoconstriction increases the resistance to airflow. Although the vital capacity is normal, the increased airway resistance makes expiration more difficult and takes longer time. Fick’s law of diffusion determines the amount of gas moves across the tissue is proportional to the area of the tissue but inversely proportional to its thickness. This is achieved by wrapping the pulmonary capillaries around an enormous number of small air sacs, alveoli, and each about 1/3 mm in diameter. There are about 300 million alveoli in the human 2 lung, creating 85 m surface area but having a volume of only 4 L. Calculations of Oxygen and Carbon Dioxide Partial Pressures: Dalton’s Law: Total pressure of a gas mixture (in our case air) is equal to the sum of the pressures that each gas in the mixture would have independently (Partial Pressure of each gas). However when the inspired air arrived the alveoli it is normally saturated with water vapour. The other extreme example is nitrous oxide: Nitrous oxide diffuses across the barrier but forms no combination with Hb. The amount of nitrous oxide taken up by blood depends on the amount of blood available: perfusion limited. During exercise the pulmonary blood flow is increased and the average travel time of a red blood cell in the capillary is shortened. It begins at the main pulmonary artery, which receives the mixed venous blood pumped by the right ventricle. Each time the airway branches, the arterial tree branches that the two parallel each other. The oxygenated blood is collected from the capillary bed by the pulmonary vein, which drains into the left atrium. In addition, pulmonary vessels protect the body from obstruction of important vessels in other organs such as renal or cerebral vessels. The pulmonary circulation serves as a blood reservoir and the volume in the lung capillaries is approximately equal to the stroke volume of the right heart. The pressures in the pulmonary circulation are remarkably low: The pressure in the main pulmonary artery is 25 mm Hg (systolic) and 8 mm Hg (diastolic), in average 15 mm Hg. Another striking property of the pulmonary arteries is their exceedingly thin walls. This anatomical adaptation of the lung is critically important for its function: The lung is required to receive the 24 whole of the cardiac output at all times. Keeping the pulmonary pressure as low as possible allows the right heart answer this demand with a minimum work. Unlike the systemic capillaries, which are organised as tubular network with some interconnections, the pulmonary capillaries mesh together in the alveolar wall so the blood flows as a thin sheet (capillary bed). Another unique property of the pulmonary circulation is its ability to decrease resistance as cardiac output increases. Capillary recruitment: opening of initially closed capillaries when cardiac output increases. Capillary distension: The decrease in pulmonary pressure with increased cardiac output has several beneficial effects: It (1) minimise the load on the right heart, (2) prevents pulmonary oedema, (3) maintains the adequate flow rate of the blood in the capillary and (4) increases the capillary surface area. Dissolved Oxygen: The amount of oxygen dissolved in the blood is proportional to its partial pressure (Henry’s Law). Taking 25 in to account that the tissue requirements are about 3000 ml Oxygen/min, it is obvious that this way of transporting oxygen is not adequate for human. Differences in the amino acid sequence of these chains give rise to various types of Hb. Hb-A: Normal adult Hb Hb-F: Foetal Hb, which makes part of the total Hb at birth and is gradually, replaced by Hb-A. Deoxygenated form of this Hb is poorly soluble and crystallises in the erythrocytes which results in changes in red cell shape (crescent or sickle shaped red cells are seen in the blood stream). The fragility of the red cells is increased and there is a tendency to thrombus formation. In the centre of each heme group there is one atom of iron, which can combine with one oxygen molecule. O2 + Hb £ HbO2 (oxyhemoglobin) 26 When oxyhemoglobin dissociates to release oxygen to the tissues (the heme iron is still in ferrous form) and the Hb is called deoxyhemoglobin (reduced Hb). Oxyhemoglobin is not same with oxidised +++ Hb (or methemoglobin) in which iron is in the oxidised (Fe , ferric) form. Because methemoglobin lacks the electron necessary to bind oxygen, it does not participate in oxygen transport. When the Hb concentration is high, polycythemia, the oxygen carrying capacity of the blood is increased. The Hb and red blood cell production in the body is under control of erythropoietin, which is produced by the kidneys. Its production is stimulated when the amount of oxygen delivered to the kidneys is lower than normal. Normally Hb concentration in men is higher then women, because the red cell production is also stimulated by androgen. The oxygen saturation of Hb O2 combined with Hb / O2 capacity One gram of Hb can combine with 1. Because the reduced Hb is purple a low arterial oxygen saturation causes cyanosis. When the concentrations of the products of the carbonic acid dissociation reaction bicarbonate diffuses into the blood but not hydrogen ion because the red cell membrane is relatively impermeable to the positively charged ions. In order to maintain - electrical neutrality Cl ions diffuse into the red cells according to the Gibbs-Donnan equilibrium + (chloride shift). Common reasons are excessive ingestion of alkalis and loss of gastric acid due to vomiting. This increase in ventilation (hyperpnea) matches the simultaneous increase in oxygen consumption and carbon dioxide production that the arterial blood carbon dioxide and oxygen partial pressures and pH do not change dramatically (Please note that hyperpnea is different from hyperventilation. The mechanism underlying the exercise-induced changes in ventilation is not clear. Neurogenic mechanisms: (1) stimulation of respiratory system muscles by sensory nerve activity from exercising limbs, probably via activating brain stem respiratory centres and/or via spinal reflexes. Chemical mechanisms: Because partial pressures of carbon dioxide and oxygen do not change during exercise it is difficult to explain possible chemical factors. However, the focal changes in these parameters near chemoreceptor area may contribute to the exercise-induced changes in ventilation. Anaerobic threshold: The maximum rate of oxygen consumption than can be attained before blood lactic acid levels rise as a result of anaerobic respiration. Lactic acid concentration is increased due to anaerobic limitations in the muscle cells during heavy exercise. Hypoxic ventilatory response: Hyperventilation induced by the decreased partial oxygen pressure. This lowers the arterial partial carbon dioxide pressure and causes respiratory alkalosis. The rise in blood pH in turn set the ventilation to a more stable but still slightly higher levels. Hyperventilation increases the tidal volume and reduces the proportion of the anatomical death space in the inspired air. However, in spite of all these adaptation mechanisms, the partial oxygen pressure in the arterial blood can not be increased more than the partial oxygen pressure in the inspired air. As a result partial pressure of oxygen in the arterial blood decreases with increasing altitude. At sea levels arterial blood loses 22% of its oxygen load in tissues: The oxygen saturation of the arterial and venous blood is 97% and 75%, respectively.

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W/t Tinebeb order cabergoline 0.5 mg with mastercard, W/t Hiwot and W/t Bruktawit who unwearyingly typed and retyped the document also receive our heart-felt appreciations generic cabergoline 0.5mg without prescription. Our gratitude also goes to Ato Haji Kedir order cabergoline 0.5mg on-line, Ato Jemal Seid, W/t Eriteria Tadesse and Ato Lakemariam Kassa from the Faculty of Health Sciences, Alemaya University who reviewed the whole document and suggested valuable comments which lifted the document to its present level. Moreover, the authors would like to express their appreciation to the following National and International reviewers whose comments helped to bring the module to its present shape: Dr. Last but not least the authors are also grateful to the Alemaya University in general and particularly to Professor Desta Hamito , the President and Dr. Belay Kassa, the Vice President of Academics and Research for their courageous attention and unreserved support in the production of modules suggested by the initiative. 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. 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. Note: You may refer to the list of abbreviations and glossary shown in Unit Five for terms that are not clear. What are the three most important basic principles in the prevention and control of food-borne diseases? 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. 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. 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. Provision of isolation according to the general rule of body substance isolation, or individual institution adaptation of isolation. For Environmental Health Officers Read the following questions carefully and give the appropriate answer. For Medical Laboratory Technologists Write the letter of your choice for the following questions on separate answer sheet. 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. 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. Among them, Fatuma, a 25 years old lady came to the nearby health center with one day history of nausea, vomiting and watery diarrhea. Staffs from the Health Center supervised their temporary residence and come up with the following report: There were about 50 individuals living in four rooms within one compound. There was no toilet in the compound and it was observed that there were indiscriminate human excreta in the compound. Pipe water supply was available in the compound; but the people fetched the water using wide mouthed buckets for storage. Finally the staffs conducted appropriate intervention measures and no similar cases were seen subsequently. Definition of Food borne diseases The term “food borne disease” is defined as a disease usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food (1). Epidemiology Although food is a basic human need it can sometimes cause a number of illness arising from pathogenic and toxic substances, which find their way in to food through contamination or spoilage (2). New and re-emerging food-borne illnesses have resulted from recent changes in human demographics, international travel and commerce, microbial adaptations, economic development, technology and industry, eating behavior and land use (5). For example, hemolytic uremic syndrome which is a very important cause of acute renal failure in children is caused by infection with E. But it can be evidenced that these are very common in Ethiopia because of many reasons including poverty, lack of awareness, poor water supply, poor personal hygiene and environmental sanitation, etc. According to the 2002-2003 “Health and Health-related Indicators” published by the Planning and Programming Department of the Federal Ministry of Health of Ethiopia, Helminthic infections were the second leading cause of outpatient visits Dysentery and different parasitic infections were also among the ten top causes of outpatient visits Dysentery was among the leading causes of hospital admissions and deaths The national average access to safe water was 28. Classification and Etiology of Some Food Borne Diseases Food borne diseases are classified into two major categories depending on the causative agent: food-borne poisonings/intoxications and food-borne infections. Food borne infections: are diseases whose etiologic agents are viable pathogenic organisms ingested with foods and that can establish infection. B acterial Typh oid fever Salmonella typh iand parath yph i R aw vegetables and fruits, salads, pastries, un- pasteuriz ed Paratyph oid fever Salmonella paratyph i milk and milk products,meat Sh igellosis Sh igella species A llfoods h andled by unh ygenic workers, potato oregg salad, lettuce,raw vegetables C h olera Vibrio ch olerae F ruits and vegetables wash ed with contaminated water N ontyph oid Salmonella species, e. Salmonella Eggs, poultry, undercooked meals, un-pasteuriz ed dairy Salmonellosis typh imurium products,sea foods,sausages Brucellosis Brucella species, mostly Brucella M ilk and dairy products from infected animals. Viral ViralG E R ota virus, N orwalk virus, calici virus, A ny food ofdaily use with poorh ygiene astro virus Viralh epatitis H epatitis A & E R aw sh ellfish from polluted water,sandwich ,salad, and desserts. Parasitic Taeniasis Taenia species R aw beef,raw pork A moebiasis Entameba h istolytica A ny food soiled with feces Trich inosis Trich nella spiralis Insufficiently cooked pork and pork products A scariasis A scaris lumbricoides F oods contaminated with soil,specially foods th at are eatenraw such as salads,vegetables G iardiasis G iardia lamblia A ny contaminated food item Toxoplasmosis Toxoplasma gondii R aw orundercooked meatand any food contaminated with catfeces? C ryptosporidiosis C ryptosporidium parvum A pple juice,A ny contaminated food item H ydatid disease Ech inococcus granulosus A ny food contaminated with dogfeces Diph yloboth riasis Diph yloboth rium latum R aw orundercooked fish Trich uriasis Trich uris trich uria A ny food contaminated with soil 4. F ungal F ungalInfections A spergillus C ereal,grains,flour,bread,cornmeal,popcorn,peanutbutter, Penicillium apples and apple products,moldy supermarketfoods,ch eese, Y easts dried meats,refrigerated and froz enpasteries 19 Table 2. M ush room poisoning Ph alloidine and alkaloids found Poisonous mush rooms such as species of insome poisonous mush rooms. Staph ylococcalfood Entero-toxinfrom M ilk and milk products, sliced meat, poultry, poisoning staph ylococcus aureus potato salad,cream pastries,eggsalad 2. Perfringens food Strains of C lostridium welch ii/ Inadequately h eated orreh eated meat,poultry, poisoning C. Botulism food poisoning ToxinofC lostridium botlinum H ome-canned foods,low acid vegetables,corn and peas.

Side effect: Oxytocin may cause over stimulation and leads to rupture of the uterus in the presence of cephalo-pelvic disproportion buy generic cabergoline 0.25mg line. Prostaglandins They induce labor at anytime during pregnancy but most effective at the third trimester cabergoline 0.5mg with amex. In female reproductive system prostaglandin E & F are found in ovaries purchase cabergoline 0.5mg with mastercard, endometrium and menstrual fluid which is responsible for initiating and maintaining normal birth process. They are contraindicated in the presence of cardiac, renal, pulmonary or hepatic disease Ergometrine It is one of the ergot alkaloids with the ability to cause contraction of the uterine smooth muscle. Use: after delivery of placenta if bleeding is severe (Prevent postpartum bleeding) Adverse effect: Nausa, vomiting but serious toxic effects are rare. Female Sex Hormones and Hormonal Contraception Oestrogens These drugs can be classified into three groups. Synthetic: Diethylstibosterol Natural Estradiol: Estradiol is most potent, major secretory product of ovary. It is oxidized into esterone by liver; estrone is hydrated to estriol and synthesized by ovarian follicle, adrenal cortex, fetoplacental unit, and testis. Cervix: it makes cervical mucus thin and alkaline Vagina: Stratification, cornification and glycogen deposit is affected by estrogen. It is less effective orally due to complete metabolism by liver so it’s given through intramuscular route. Metabolic actions: (a) Thermogenic action (b) Competes with aldosterone at renal tubule so inhibits sodium reabsorption. They can also be classified as fixed dose combination (monophasic), biphasic and triphasic pills. Fixed dose combination: the commonest procedure is to administer one pill containing both an estrogen and progestin daily at bed time for 21 days. In biphasic and triphasic pills: these are combined oral contraceptive pills containing varying proportion of an estrogen and a progesterone designed to stimulate the normal pattern of menustral cycle. Medroxyprogestrone acetate (Depoprovera ) iii) Subcutanous implant L – norgestril (Norplant®) Mechanism: It makes cervical mucus thick, though & hostile and also alter endometrial wall B. Post coital “morning after” pill Oestrogen like Diethyl stilbosterol used within 72 hrs Combined oral contraceptive pills can also be used. Side effects of oral contraceptive: Thromboembolic complication, Weight gain & fluid retention, Menstrual disorder, Breast tenderness & fullness, Skin changes, Nausea & vomiting, Depressed mood, Reduced lactation Beneficial effects of estrogen /progesterone oral contraceptive 1) Reduced risk of endometrial Carcinoma, ovarian cyst 2) regular Menses, No excessive blood loss 3) Less premenustrual tension and dysmennorrhea 4) Relief of endometriosis Contraindication: In patients withcardiovascular diseases (hypertension, coronary heart disease) Thromboemolic disease, breast Cancer, diabetes mellitus, liver disease, women > 35 years (esp. Effect reduced when taken with enzyme inducers like Rifampicin, Phenytoin, Phenobarbitone etc. Oral contraceptive antagonize the effect of Coumarin anticoagulant and some antihypertensives Ovulation inducing drug These are drugs used in the treatment of infertility due to ovulatory failure. Therapeutic activity in inflammatory disorder is proportional to the glucocorticoid activity. They are not widely used in therapeutics rather its antagonists are of value in cases of edema. Thyroid and Antithyroid Drugs They inhibit the function of the thyroid gland and used in hyperthyroidism. Radioactive iodine ( I) Thiourea Compounds Inhibit the formation of throid hormone through inhibiting the oxidation of iodide to iodine by peroxidase enzyme and blocking the coupling of iodothryosines to form iodothyronines. Toxicities include drug fever, skin rashes, increased size and vascularity of the thyroid gland, and agranulocytosis. Ionic Inhibitors Potassium percholate prevents the synthesis of thyroid hormones through inhibition of uptake and concentration of iodide by the gland. It has the risk of aplastic anemia, therefore no longer used in the treatment of hyperthyroidism. Iodides: Improve manifestations of hyperthyroidism by decreasing the size and vascularity of the gland so they are required for preoperative preparation of the patient for partial thyroidectomy. Iodides act through inhibition of the “protease” enzyme which releases T3 and T4 from thyroglobulin, and organification. It is trapped and concentrated as ordinary iodine, which emits beta rays that act on parenchymal cells of the gland. It is contraindicated in pregnancy and lactation as it affects thyroid gland in the fetus and the infant. Propranolol This is an important drug which controls the peripheral manifestations of hyperthyroidism (tachycardia, tremor). Manifestations include hyperpyrexia, gastrointestinal symptoms, dehydration, tachycardia, arrhythmia, restlessness, etc. Management: It consists of infusion of intravenous fluids, supportive management, and also administration of propylthiouracil, sodium iodide, hydrocortisone, and propranolol. Discuss the mechanism and beneficial effects of combined oral contraceptive pills. Describe the mechanims of action and the adverse effects of antituberculois drugs. Discuss the use, mechanism of action and problems associated with anthelminthic drugs. Antimicrrobials: are chemical agents (synthetic/natural) used to treat bacterial, fungal and viral infections. Antibiotics: are substances produced by various species of microorganisms (bacteria, fungi, actinomycetes) that suppress the growth of other microorganisms. Bactericidal versus bacteriostatic action: When antimicrobial agents lead to the death of the susceptible microbe (e. Antiprotozoals: are drugs used to treat malaria, amoebiasis, gardiasis, trichomoniasis, toxoplasmosis, pneumocystis carinii pneumonia, trypanosomiasis and leshmaniasis. The classificastion, pharmacokinetics, pharmacodynamics, clinical uses, adverse effects of commonly used antimicrobias, antiprotozoals, antihelimenthics are disscused. Alteration of the drug-binding site: this occurs with penicillins, aminoglycosides and erythromycin. Anibacterial agents Cell wall synthesis inhibitors Members the group: Beta-lactam antibiotics, vancomycin, bacitracine, and cycloserine Beta-lactam antibiotics: Penicillins, cephalosporins, carbapenems, and monobactams are members of the family. All members of the family have a beta-lactam ring and a carboxyl group resulting in similarities in the pharmacokinetics and mechanism of action of the group members. They are water-soluble, elimination is primary renal and organic anion transport system is used. Penicillins Penicillins have similar structure, pharmacological and toxicological properties. The prototype of penicillins is penicillin G and is naturally derived from a genus of moulds called penicillium. Classification: Penicillins can be classified into three groups: Natural Penicillins, Antistaphylococcal penicillins, and Extended-spectrum penicillins. Mechanism of Action: Penicillins inhibit bacterial growth by interfering with a specific step in bacterial cell wall synthesis (block the transpeptidation reaction). Pharmacokinetics: Penicillin G is unstable in acid media, hence destroyed by gastric juice. Ampicillin, amoxicillin, and dicloxacillin are acid-stable and relatively well absorbed after oral adminstraion. Oral penicillins should be given 1-2 hours before or after meals to minimize binding to food proteins and acid inactivation (except ampicilin). Blood levels of all penicillins can be raised by simultaneous administration of probenecid orally, which impairs tubular secretion of weak acids. Penicillin G is the drug of choice for infections caused by streptococci, meningococci, enterococci, penicillin-susceptible pneumococci, non-beta-lactamase-producing staphylococci, Treponema pallidum and many other spirochetes, Bacillus anthracis, Clostridium species, Actinomyces, and other gram- positive rods and non-beta-lactamase-producing gram-negative anaerobic organisms. Antistaphylococcal Penicillins: [Methicillin, Nafcillin, isoxazolyl penicillins (Oxacillin, cloxacillin, and dicloxacillin)]. The only indication is infections caused by beta-lactamase-producing staphylococci. Oral isoxazolyl penicillin is suitable for treatment of mild localized staphylococcal infections, for serious systemic staphylococcal infections, oxacillin or nafcillin, is given by intermittent intravenous infusion. Extended Spectrum Penicillins: Aminopenicillins (ampicillin, amoxicillin), Carboxypenicillins (Carbenicillin, ticarcillin, effective at lower doses), and Ureidopenicillins (piperacillin, mezlocillin, and azlocillin): Spectrum of activity similar to penicillin G, though having greater activity against gram-negative bacteria due to their enhanced ability to penetrate the gram-negative outer membrane. The aminopenicillins have the same spectrum and activity, but amoxicillin is better absorbed from the gut. These drugs are given orally to treat urinary tract infections, sinusitis, otitis, and lower respiratory tract infections. Carboxypenicillins extend the ampicillin spectrum of activity to include Pseudomonas aeruginosa and Enterobacter species.

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A systematic review of the best available evidence and the strength of that evidence effective cabergoline 0.5mg. If necessary relevant focused questions can be framed in order to exactly define the purview of the exercise discount cabergoline 0.5mg mastercard. The authors should be clearly mentioned in the published version ( we understand this is not desirable in a document for peer review) generic 0.25mg cabergoline with mastercard. Introduction Line 17 – 20 : ”However, a significant proportion, particularly in rural areas tend to disregard symptoms till complications develop and this segment requires a more proactive and individualized approach. The lack of access to effective health care in rural areas will make a proactive and individualized approach difficult. It is important for guidelines to be applicable to the entire populations of the country. Metaanalysis of the recent evidence showed screening to have no significant impact on either overall mortality or death from prostate cancer with significant overdiagnosis and overtreatment and is unlikely to save lives. Ultrasound evaluation should be restricted to the bladder and post void residual urine as an optional test. Blood urea – Blood urea estimation is superfluous when creatinine is being measured. Urethrography – An uroflowmerty is a non invasive test which can indicate a possible urethral stricture. An urethrography is invasive and will require prior urine culture sensitivity before its performance. Indications for surgery “Patients presenting with chronic low pressure require catheterization and urodynamic evaluation” – Catheterization is not required unless the patient has acute on chronic retention, overflow incontinence or obstructive uropathy with raised creatinine. Surgical (endoscopic and open) procedures • “Open prostatectomy is still an acceptable procedure for glands exceeding 100 gms in wt. Screening for prostate cancer: systematic review and meta-analysis of randomised controlled trials. A meta-analysis of the vascular-related safety profile and efficacyof a-adrenergic blockers for symptoms related to benign prostatic hyperplasia. In 2010, an estimated 58,240 Americans were diagnosed with renal malignancies and 3 13,040 deaths were estimated. Surgical excision remains the only curative treatment as this tumor is remarkably resistant to radiotherapy and chemotherapy. Currently, it may be considered in case of equivocal findings on conventional imaging, where detection of metastatic disease will influence management decision. Acceptable in the following indications: h) Considering inflammatory mass / lymphoma / metastasis, vague Radiology, multiple masses, associated significant lymphadenopathy i) Considering non-surgical therapy (e. Stage I Preferred – nephron-sparing surgery if technically feasible Optional – radical nephrectomy* Others 51 9. Ablative therapies (cryotherapy, radiofrequency ablation, microwave thermotherapy, high frequency focussed ultrasound, etc. A mere sampling of the renal hilar lymph nodes is insufficient for pathologic staging. For right sided tumor, paracaval and interaortocaval lymph nodes and for left sided tumor para-aortic and interaortocaval lymph nodes should be removed from the crus of the diaphragm to the common iliac artery. Socio-economic and facility issues – Advanced – • staging tools • surgical facility • follow up facility • socio-economic support may not be available everywhere. A substantial improvement in progression-free survival and overall survival has been 54 achieved in large randomized controlled trials, when compared to Interferon-α. Sarcomatoid variant is associated with poor prognosis, and a modest response with doxorubicin & gemcitabine is observed. Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. Lymph Node Dissection at the Time of Radical Nephrectomy for High-Risk Clear Cell Renal Cell Carcinoma: Indications and Recommendations for Surgical Templates. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. Invasive bladder cancer: Bladder cancer that histologically invades the muscularis propria. This may be partially attributed due to better detection and improved health care. Detailed evaluation of all patients with gross hematuria and elderly patients (>40 years) with microscopic hematuria and associated risk factors like smoking 15. Prompt referral of men with advanced bladder cancer to higher centers for further evaluation V. Diagnosis –The diagnosis mainly depends on the cystoscopic examination of the bladder, biopsy, and urine cytology. The management algorithm is based on the diagnosis of invasion of muscularis propria or not. Biopsy of the apical prostatic urethra when there is a bladder neck tumour or when abnormalities of prostatic urethra are visible. Pelvic examination (Bimanual examination) under anaesthesia: Helpful in assessment of local staging in muscle invasive bladder cancer and advanced cases. Bone scan –Indicated in patients with raised alkaline phosphatase and with bone pain. Stage T1 tumours originate from the urothelium but penetrate the basement membrane which separates the urothelium from the deeper layers. T1 tumours invade into the lamina propria, but are not so deep that they reach the detrusor muscle. Carcinoma in situ (Tis) is a high-grade (anaplastic) carcinoma confined to the urothelium, but with a flat non-papillary configuration. Unlike a papillary tumour, Tis appears as reddened and velvety mucosa and is slightly elevated but sometimes not visible. Three types of Tis are distinguishable;  Primary Tis (no previous or concurrent papillary tumours);  Secondary Tis (with a history of papillary tumours);  Concurrent Tis (in the presence of papillary tumours). Predicting recurrence and progression of tumours [15,16]: TaT1 tumours The pattern of recurrence and progression depends on the following clinical and pathological factors: 1. Larger tumours should be resected in fractions, which include the exophytic part, the underlying bladder wall and the edges of resection area. An immediate single post-operative instillation with a chemotherapeutic agent (drug optional – Mitomycin C preferred). Maintenance therapy for at least 1 year (monthly once) is necessary [22,23] although the optimal maintenance scheme has not yet been determined. The major issue in the management of intermediate risk tumours is to prevent recurrence and progression, of which recurrence is clinically the most frequent. Adjuvant intravesical chemotherapy (drug optional), schedule: optional although the duration of treatment should not exceed 1 year. Maintenance therapy for at least 1 year (monthly once) is necessary although the optimal maintenance schedule has not yet been determined. Early radical cystectomy at the time of diagnosis provides excellent disease-free survival, but over-treatment occurs in up to 50% of patients. Muscle invasive bladder cancer: Neo-adjuvant chemotherapy: Neo-adjuvant cisplatin-containing combination chemotherapy improves overall survival by 5-7% at 5 years. Radical Surgery and Urinary Diversion Cystectomy is the preferred curative treatment for localized muscle invasive bladder cancer. Radical cystectomy includes removal of regional lymph nodes, the extent of which has not been sufficiently defined. A delay in cystectomy increases the risk of progression and cancer-specific death. Radical cystectomy in both sexes must not include the removal of the entire urethra in all cases, which may then serve as outlet for an orthotopic bladder substitution. Terminal ileum and colon are the intestinal segments of choice for urinary diversion. Positive margins anywhere on the bladder specimen (in both sexes), if the primary tumour is located at the bladder neck or in the urethra (in women), or if tumour extensively infiltrates the prostate. Before cystectomy, the patient should be counselled adequately regarding all possible alternatives, and the final decision should be based on a consensus between patient and surgeon.

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