By D. Olivier. Virginia Military Institute. 2018.
Less blood circulating means reduced blood pressure and reduced perfusion (penetration of blood) to the brain and other vital organs order proventil 100mcg without prescription. The body responds to this potential catastrophe by releasing substances in the injured blood vessel wall that begin the process of blood clotting generic proventil 100mcg. Clotting is contained in a local area based on the tightly controlled availability of clotting proteins purchase proventil 100 mcg fast delivery. However purchase 100 mcg proventil fast delivery, the purpose of this language is not to confuse, but rather to increase precision and reduce medical errors. For example, is a scar “above the wrist” located on the forearm two or three inches away from the hand? Because these languages are no longer used in everyday conversation, the meaning of their words does not change. The root of a term often refers to an organ, tissue, or condition, whereas the prefix or suffix often describes the root. For example, in the disorder hypertension, the prefix “hyper- ” means “high” or “over,” and the root word “tension” refers to pressure, so the word “hypertension” refers to abnormally high blood pressure. Anatomical Position To further increase precision, anatomists standardize the way in which they view the body. Just as maps are normally oriented with north at the top, the standard body “map,” or anatomical position, is that of the body standing upright, with the feet at shoulder width and parallel, toes forward. The upper limbs are held out to each side, and the palms of the hands face forward as illustrated in Figure 1. It does not matter how the body being described is oriented, the terms are used as if it is in anatomical position. For example, a scar in the “anterior (front) carpal (wrist) region” would be present on the palm side of the wrist. These terms are sometimes used in describing the position of the body during specific physical examinations or surgical procedures. Regional Terms The human body’s numerous regions have specific terms to help increase precision (see Figure 1. Notice that the term “brachium” or “arm” is reserved for the “upper arm” and “antebrachium” or “forearm” is used rather than “lower arm. Directional Terms Certain directional anatomical terms appear throughout this and any other anatomy textbook (Figure 1. For instance, an anatomist might describe one band of tissue as “inferior to” another or a physician might describe a tumor as “superficial to” a deeper body structure. Commit these terms to memory to avoid confusion when you are studying or describing the locations of particular body parts. Body Planes A section is a two-dimensional surface of a three-dimensional structure that has been cut. Body sections and scans can be correctly interpreted, however, only if the viewer understands the plane along which the section was made. If this vertical plane runs directly down the middle of the body, it is called the midsagittal or median plane. If it divides the body into 26 Chapter 1 | An Introduction to the Human Body unequal right and left sides, it is called a parasagittal plane or less commonly a longitudinal section. Body Cavities and Serous Membranes The body maintains its internal organization by means of membranes, sheaths, and other structures that separate compartments. The dorsal (posterior) cavity and the ventral (anterior) cavity are the largest body compartments (Figure 1. These cavities contain and protect delicate internal organs, and the ventral cavity allows for significant changes in the size and shape of the organs as they perform their functions. The lungs, heart, stomach, and intestines, for example, can expand and contract without distorting other tissues or disrupting the activity of nearby organs. Subdivisions of the Posterior (Dorsal) and Anterior (Ventral) Cavities The posterior (dorsal) and anterior (ventral) cavities are each subdivided into smaller cavities.
Several patients devel- oped nosocomial sepsis during this phase of end-organ damage and severe lymphopenia generic 100mcg proventil with visa. The two retrospective cohorts from Canada and Hong Kong demon- strated a comparable outcome (Booth cheap 100 mcg proventil fast delivery, Lee) generic proventil 100mcg fast delivery. Within both cohorts cheap proventil 100 mcg free shipping, 20- 23% of the patients were admitted to the intensive care unit, and 59- 69% of these received mechanical ventilation. In most studies, multivariate analysis revealed an older age and co-morbid conditions as being independent predictors (Table 4). In a small percentage of patients, various degrees of pulmonary fibro- sis have been reported following recovery. The increasing viral load at the end of the first week of the disease suggests that the symptoms and signs (recurrent fever, diarrhea, wors- ening of radiographic findings) could be related to the effect of viral replication and cytolysis (Peiris 2003b). However, further deterioration at the end of week 2, when some pa- tients had severe clinical worsening, may not be related to uncon- trolled viral replication, but may rather be caused by immunopa- thological damage (Peiris 2003b). If viral-induced damage was the primary pathological mechanism, such a flitting pattern of radiological change is difficult to explain (Peiris 2003b). Taken together, these findings suggest that the lung damage at this phase is related to immunopathological damage as a result of an over- exuberant host response, rather than uncontrolled viral replication (Peiris 2003b). The changes included hyaline membrane formation, interstitial mono- nuclear inflammatory infiltrates, and desquamation of pneumocytes in alveolar spaces (Ksiazek, Nicholls). There were also scattered foci of alveolar myxoid fibroblastic tissue, a finding consistent with the early organizational phase of progressive pneumonia. Bronchial epithelial denudation, loss of cilia, and squamous metapla- sia were early features (Nicholls). Examination of the liver revealed microvesicular fatty change, focal hemorrhages, and hepatocyte necrosis with scattered acidophilic bod- ies. The spleen showed large areas of probable ischemic necrosis and some atypical lymphocytes in the periarteriolar sheaths (Poutanen). In one series, autopsy of hemato-lymphoid organs from four patients showed neither enlarged lymph nodes in the peripheral soft tissues or other body parts, nor reactive lymphoid hyperplasia or T zone reac- tion. Some animals can shed infectious coronavirus persistently from the enteric tract for weeks or months without signs of disease, transmitting the infectious virus to neonates and other susceptible animals (Holmes). In a small study of 14 patients, none reported secondary cases in their household following their discharge home (Avendano). At a follow-up visit one week after discharge, all 14 patients in one series still felt weak and complained of dyspnea on exertion. Two weeks later, the patients were no longer as weak, but still complained of easy fatiguability and dyspnea on climbing stairs. Psychosocial Issues Most patients express complaints consistent with depression and anxi- ety regarding various aspects of their disease, hospitalization, and personal and family impact (Maunder). The psychosocial aspects associated with this illness should not be underestimated and warrant further investigation. In addition to the effect on the patients, the psychological impact on staff and their families was also noted to be significant (Avendano). Cluster of severe acute respiratory syndrome cases among protected health care workers – Toronto, April 2003. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report. Epidemiological determinants of spread of causal agent of severe acute respira- tory syndrome in Hong Kong. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. It has been proposed that a coordinated multicentre approach to estab- lish the effectiveness of ribavirin therapy and other proposed in- terventions be examined. Informa- tion to date suggests that risky exposures include having cared for, lived with, or having had direct contact with the respiratory secretions, body fluids and/or excretion (e. This chapter re- views the diverse treatment experience and controversies to date, and aims to consolidate our current knowledge and prepare for a possible resurgence of the disease.
The development of chronic complications correlates with the duration of diabetes and glycemic control Ophthalmologic Complications of Diabetes Mellitus Diabetes mellitus is a leading cause of blindness in the working population in the developed world Blindness is primarily the result of progressive diabetic retinopathy and clinically significant macular edema discount proventil 100 mcg. Intensive glycemic control will delay the development or slow the progression of diabetic retinopathy 100 mcg proventil for sale. There may be a transient proventil 100 mcg fast delivery, paradoxical worsening of established diabetic retinopathy discount proventil 100 mcg on line, during the first 6 to 12 months of improved glycemic control. Regular, comprehensive eye examinations for all individuals with diabetes mellitus are required, and these should be performed by an experienced ophthalmologist. Other Ocular Problems Cataract Develop early and progress rapidly in diabetic subjects Glaucoma Ocular palsies Sudden visual loss Renal Complications of Diabetes Mellitus Diabetic Nephropathy • One of the commonest causes of end stage renal failure Nephropathy progresses through the following stages. The most common form of diabetic neuropathy is distal symmetric polyneuropathy often described as having a glove and stocking distribution. Diabetic polyradiculopathy is a syndrome characterized by severe disabling pain in the distribution of one or more nerve roots. Peripheral mononeuropathies or simultaneous involvement of more than one nerve (mononeuropathy multiplex) may also occur. Autonomic Neuropathy in diabetes can involve multiple systems, including: the cardiovascular, gastrointestinal, genitourinary, sudomotor, and metabolic systems. Autonomic neuropathies affecting the cardiovascular system cause a resting 32 tachycardia and orthostatic hypotension. Hyperhidrosis of the upper extremities and anhidrosis of the lower extremities result from sympathetic nervous system dysfunction. Anhidrosis of the feet can promote dry skin with cracking, which increases the risk of skin ulceration. Autonomic neuropathy may reduce counterregulatory hormone release, leading to an inability to sense hypoglycemia appropriately (hypoglycemia unawareness, thereby subjecting the patient to the risk of severe hypoglycemia and complicating efforts to improve glycemic control. One should consider other possible causes of neuropathy before ascribing signs and symptoms to be due to diabetic neuropathy as other causes of neuropathy may present in a similar manner. Diabetic foot disease Different types of diabetic tissue damage interact and combine in the feet, giving a wide variety of lesions ranging from relatively harmless dysaesthesiae to fulminating infections and widespread ulceration and gangrene. Factors that play important roles in the pathogenesis of diabetic foot ulcers include, • Neuropathy o Predisposes patient to repetitive trauma to the feet • Reduction in blood flow o Delays wound healing o Serves as a good medium for bacterial multiplication • Deformity in the feet o This leads to abnormal foot mechanics with misdistribution of pressure over parts of the feet. If the diabetic cannot see his feet properly, someone else must look at them at least weekly or, if there is marked loss of pinprick sensation, thrice weekly. The principles of treatment of diabetic foot ulcers involve the elimination of infection by draining pus or removing infected bone, by removing dead tissue likely to provide a focus for infection, and by using antibiotics if necessary. Healing is speeded by encouraging the greatest possible blood flow, and protecting the foot from trauma. Amputation may be required in case of life threatening infections by gas forming organisms or in cases where there is of dead tissue. Antibiotics choice should be guided by culture of either the local lesion or blood when infection is widespread. The control of glucose levels should be as strict as possible, as hyperglycemia is bound to bring about dysfunction of the leucocytes. These include • Abnormalities in plasma lipids • Increased liability to hypertension in diabetics • Structural narrowing of the lumina of vessels • The presence of a state that favors coagulation Patients may present with either clinical features of ischeamic heart disease or congestive heart failure in the absence of ischeamia (diabetic cardiomyopathy). Heart disease is the major cause of death among both type 1 and type 2 diabetics, and ultimately is likely to affect about 60 per cent of patients. The management of ischaemic heart disease among diabetics differs little from that generally employed. It is common in people older than 40yrs and results from variable combinations of insulin resistance and defects in insulin secretion. In the hypothetical case already mentioned the health officer requested the following laboratory investigations with the results shown below. Clinical features The presentation of patients depends on the type of diabetes and the stage of pathologic process.
However best proventil 100mcg, as tuberculin skin test conversion is still occurring (Blackwood proventil 100mcg with visa, 2005) order proventil 100 mcg without a prescription, other practices and causes should be analyzed order proventil 100 mcg amex. These recommended measures are implemented by healthcare facilities in high- income countries, but given their high cost, few facilities in low-income countries can afford to implement them (Pai 2006). Several simple interventions can ameliorate working conditions, such as training and supervising laboratory workers in good techniques and biosafety practices to provide the necessary organization (DeRiemer 2000, Joshi 2006). Labo- ratory exposure may cause serious infection, but effective treatment and preventive measures are available and the risk of spread of infection is limited. Biosafety Level designations: are based on a combination of the design features, construction, containment facilities, equipment, practices and operational proce- dures required for working with agents belonging to the various risk groups (World Health Organization 2004). Laboratory facilities are designated as: • Biosafety Level 1 – basic laboratory • Biosafety Level 2 – basic laboratory • Biosafety Level 3 – laboratory with containment conditions • Biosafety Level 4 – laboratory with maximum containment 11. Biosafety in the laboratory 377 A national classification of microorganisms, by risk group, may be determined taking into account regional characteristics: • Organism: pathogenicity, mode of transmission • Host: immunity, density vectors, environment • Preventive measures • Treatment 11. Risk assessment Any laboratory work should be done under appropriate biosafety conditions based on risk assessment. Such an assessment will take into considerations the agent risk group as well as other factors to establish the biosafety level (World Health Or- ganization 2004). Organism Factors that should be considered concerning the organism include: • Pathogenicity of the agent and infectious dose • Potential outcome of exposure • Natural route of infection • Other routes of infection, resulting from laboratory manipulations (paren- teral, airborne, ingestion) • Stability of the agent in the environment • Concentration of the agent to be manipulated • Presence of a suitable host (human or animal) • Information available from animal studies and reports of laboratory- acquired infections or clinical reports • Laboratory activity planned (sonication, aerosolization, centrifugation, etc. General laboratory practices There are different types of laboratory hazards, such as biological, chemical, radia- tion and physical, as well as electrical hazards, slips, trips, and falls. The main causes of laboratory accidents are: lack of training, knowledge or experi- ence; excessive self-confidence, negligence, fatigue, taking shortcuts, work load, working too fast, deciding not to follow safe practices, and skepticism about bio- hazard. Unsafe workers are those who have a low opinion of safety programs, take excessive risks, work too fast and are less aware of the risk of agents. Safe workers are those who adhere to safety guidelines, practice defensive work habits and recognize potentially hazard- ous situations (Phillips 1986, Harding 1995). The manager needs to have an attitude of support towards the safety program, should provide adequate resources and training, should supply a safe work environment, monitor work practices, and assess and assign risk level for hazardous materials (biologicals, chemicals, animals). The employees, on the other hand, have to comply with occupational safety and health standards, rules, regulations and orders, use personal protective equipment and safety equipment when needed, and report all work-related accidents and ill- ness to the supervisor. The types of regulations that support working safely in laboratories are government regulations, institutional regulations, and laboratory regulations or guidelines. Biosafety in the laboratory 379 • Eating, drinking or smoking are not permitted in laboratories or offices • Wear personal protective equipment when needed • Practice good personal hygiene • Children are not allowed into laboratory areas • Good housekeeping - clean up after each manipulation - do not store materials on work surfaces - keep aisles clear - keep chemicals in storage cabinets - purge work areas of unnecessary or unused equipment, supplies or chemicals • Minimize all exposure • Never underestimate the risks • Become familiar with: - emergency exits - emergency procedures - first-aid - fire responses • Report all accidents and injuries • Ask questions when in doubt Personal safety guidelines Take pride in your workplace and practice accident prevention by banning negative attitudes and bad habits such as: • Overconfidence • Showing off • Stubbornness • Laziness • Carelessness • Impatience • Ignorance 380 Biosafety and Hospital Control Safety guidelines – slips, trips and falls • Clean up spills • Watch out for loose carpet, polished floors, or objects on floor • Keep all chair legs on the floor • Use step stools and ladders when reaching for top shelves • Never lay cords across walkways • Use as much light as possible • Do not carry loads which block your vision Safety guidelines – storage • Avoid overloading file cabinets • Close file cabinet drawers when finished • Store heavy items on lower shelves • Keep pointed and sharp objects in a box in your desk drawer Safety guidelines – personal protective equipments Appropriate personal protective equipment must be worn whenever working with hazardous materials. Biosafety in the laboratory 381 • Gloves - should be selected based on the chemicals being used - should be inspected for tears or holes before use - should be replaced or discarded when dirty or contaminated - should not be removed from the laboratory • Respiratory protection - must be worn in the laboratory where there is an inhalation haz- ard - should not be worn if not trained in their use - should be cleaned and inspected after each use and allowed to dry completely - should be selected based upon the chemicals used or agents han- dled - should not be taken out of the laboratory Safety guidelines - controlling aerosols • Avoid splattering and spilling solutions • Use plastic-backed absorbent paper on work surfaces • Place caps or tops on bottles and tubes • Place balances in ventilated enclosures • Use safety cups when centrifuging • Work under containment - biological safety cabinet - chemical fume hood - ventilated enclosures - directional airflow Risk assessment • Identify all hazardous materials and processes • Consider possible routes of entry • Consult information resources • Evaluate biosafety level or toxicity of material • Evaluate quantitative information on toxicity 382 Biosafety and Hospital Control • Select procedures to minimize exposure • Prepare for contingencies Safety guidelines – Laboratory security • Prevent unauthorized entry into laboratory areas • Prevent unauthorized removal of hazardous materials • Recognize that laboratory safety and security are different • Control access • Know who is in the laboratory • Know what materials are being brought into the laboratory • Know what materials are being removed from the laboratory • Have an emergency plan • Have a protocol for reporting incidents 11. Decontamination Mycobacteria are generally more resistant to chemical disinfection than other vegetative bacteria (Russel 1986). The subject of disinfectants, which are really effective against mycobacteria, is very controversial and can generate confusion. The most common disinfectants used in the mycobacteria laboratory are: phenol 5 %, ethanol 70 % and sodium hypochlorite 2%. Biosafety in the laboratory 383 Table 11-1: Disinfectants active against Mycobacteria Disinfectant Final concentration Phenol 5 % Sodium hypochlorite 10,000 ppm of Av Cl/mL Sodium dichloroisocyanurate 6,000 ppm of Av Cl/mL Ethanol 70 % Glutaraldehyde-phenate 2 % Av Cl = available chlorine 11. Handling of biological waste It is strongly recommended that residues be segregated, packaged and properly labeled at the point of origin. They should then be immediately placed in distinctive containers according to their species and group, in order to reduce the amount of contaminated residues, as well as accidental risks, and to adopt the best conduction for the treatment of infectious or contaminant residues (Coelho 2000). Potentially infectious: should be disposed of in plastic bags, made of polypropyl- ene, resistant to autoclaving. Bags should be filled up to 2/3 of their capacity and totally closed to prevent leak- ing of the content, even if turned upside down. In the laboratory, bags should be stored in garbage containers made of material that permits chemical or physical decontamination, identified with the label of hazard- ous biological waste having hinged-foot-activated mechanisms for opening and closing the lid, with rounded corners and edges.
The frontal lobe is responsible for motor functions purchase 100mcg proventil otc, from planning movements through executing commands to be sent to the spinal cord and periphery buy proventil 100 mcg. The most anterior portion of the frontal lobe is the prefrontal cortex generic 100 mcg proventil amex, which is associated with aspects of personality through its influence on motor responses in decision-making order proventil 100mcg without a prescription. The occipital lobe is where visual processing begins, although the other parts of the brain can contribute to visual function. The temporal lobe contains the cortical area for auditory processing, but also has regions crucial for memory formation. Nuclei beneath the cerebral cortex, known as the subcortical nuclei, are responsible for augmenting cortical functions. The basal nuclei receive input from cortical areas and compare it with the general state of the individual through the activity of a dopamine-releasing nucleus. The output influences the activity of part of the thalamus that can then increase or decrease cortical activity that often results in changes to motor commands. The cerebellum is connected to the brain stem, primarily at the pons, where it receives a copy of the descending input from the cerebrum to the spinal cord. It can compare this with sensory feedback input through the medulla and send output through the midbrain that can correct motor commands for coordination. The arterial blood to the brain comes from the internal carotid and vertebral arteries, which both contribute to the unique circle of Willis that provides constant perfusion of the brain even if one of the blood vessels is blocked or narrowed. The blood that nourishes the brain and spinal cord is behind the glial-cell–enforced blood-brain barrier, which limits the exchange of material from blood vessels with the interstitial fluid of the nervous tissue. This fluid is produced by filtering blood at the choroid plexuses in the four ventricles of the brain. It then circulates through the ventricles and into the subarachnoid space, between the pia mater and the arachnoid mater. It surrounds the venous space known as the dural sinuses, which connect to the jugular veins, where blood drains from the head and neck. Sensory ganglia contain unipolar sensory neurons and are found on the dorsal root of all spinal nerves as well as associated with many of the cranial nerves. Autonomic ganglia are in the sympathetic chain, the associated paravertebral or prevertebral ganglia, or in terminal ganglia near or within the organs controlled by the autonomic nervous system. Nerves are classified as cranial nerves or spinal nerves on the basis of their connection to the brain or spinal cord, respectively. The twelve cranial nerves can be strictly sensory in function, strictly motor in function, or a combination of the two functions. Sensory fibers are axons of sensory ganglia that carry sensory information into the brain and target sensory nuclei. Motor fibers are axons of motor neurons in motor nuclei of the brain stem and target skeletal muscles of the head and neck. Spinal nerves emerge from the spinal cord and reorganize through plexuses, which then give rise to systemic nerves. As the anterior end of the as the basal ganglia), which have two pathways that process neural tube develops, it enlarges into the primary vesicles information within the cerebrum. Those the indirect pathway is the longer pathway through the structures continue to develop throughout the rest of system that results in decreased activity in the cerebral embryonic development and into adolescence. What is the end of the three regions of the brain when comparing the early result on the thalamus, and therefore on movement initiated (25th embryonic day) brain and the adult brain? The caption for the video describes it as “less The cervical and lumbar spinal cords have enlargements as gray matter,” which is another way of saying “more white a result of larger populations of neurons. That evolutionary history is as the basal ganglia), which have two pathways that process long and is still an area of intense study. As shown in this video, happened to increase the size of the human brain relative the direct pathway is the shorter pathway through the to the chimpanzee. The direct pathway is author explores the current understanding of why this described as resulting in “disinhibition” of the thalamus. What are the two neurons According to one hypothesis about the expansion of brain doing individually to cause this?