By J. Reto. Trinity University. 2018.
For decades maxalt 10mg cheap, the Hayflick phenomenon has been con- For example purchase maxalt 10 mg line, diabetes may be caused by an autoimmune sidered to be an excellent and experimentally accessible attack or a mutation in several different genes generic maxalt 10 mg otc. Molecular and Biologic Factors in Aging 23 probably small 10 mg maxalt fast delivery, and the genes whose mutations do cause Further genetic analysis has now conclusively demon- diabetes are probably involved in a small number of spe- strated that single gene defects extending life span act cific metabolic pathways. Similarly, the molecular causes through an insulin signaling pathway remarkably similar of in vitro senescence, although not confined to a single to the mammalian insulin signaling pathway. As described Senescence in Caenorhabditis elegans: below, considerable evidence has suggested that senes- cence may arise from metabolic activity. Therefore, a Role of Genes in an Insulin-Like Signaling logical hypothesis is that an insulin-like pathway drives Pathway Acting on Neurons senescence in C. The relevance of the Hayflick phenomenon to senescence On the other hand, transgenic manipulation has now in the whole organism is not entirely clear. Certainly demonstrated that it is activity of the insulin-like pathway there are some cells that divide more or less continuously specifically in neurons, not muscle or other highly meta- throughout life (intestinal epithelia, skin fibroblast), but bolically active tissue, that regulates life span in C. Even if they did, most gerontologists agree that insulin-like pathway appear to require activity of an the cells most likely to cause functional failure during unusual cytoplasmic catalase. Furthermore, many metazoans are composed free radical damage and that, conversely, integrity of entirely of postmitotic cells, yet exhibit senescence that is neurons sensitive to this insulin-like pathway constitutes just as predictable and robust as the senescence of a limiting factor in the life span of C. One of the early dividends of this work Single gene defects have now also been shown to increase was the establishment of a group of genetic mutations maximum life span in fruit flies,70,71 yeast,72,73 and mice. Subsequent to the discovery of age-1, including insulin78 and may also enhance oxidative however, other single genes were discovered that also damage,76 also extends maximum life span in mice. Mobbs p66Shc had no apparent effect on fertility or other func- studying other aspects of biology. The specific examples tions,76 suggesting that increased life span need not entail presented in this brief review are by no means exhaus- reduced functionality in adulthood. For example, a gene for Werner’s syndrome, a prog- it appears that in mammals as well activity of an insulin- erioid syndrome in humans, has recently been cloned, and like pathway (possibly by enhancing oxidative damage) has proved to be a gene involved in DNA replication. In Drosophila, ablation of to command considerable respect, there is also reason to two genes is also known to enhance life span. The first, be optimistic that more powerful simple mechanisms may termed methuselah, appears to code for a G-coupled be elucidated in the near future. The second, termed indy, appears References to code for a dicarboxylate cotransporter. The Gompertz function: distinguishing mathe- increase in life span may be obtained with direct inter- matical from biological limitations. MacArthur Foundation Series on is that its activity is enhanced by the allosteric binding of Mental Health and Development. The free radical theory of aging with dietary restriction, reduction in glucose concentra- matures. These data suggest, consistent with results from cation hypothesis of aging from the food-restricted rodent other organisms, that metabolic activity does indeed drive model. Neurotoxic effects of estrogen, glucose, and is not entropic effects of free radical damage, but the glucocorticoids: neurohumoral hysteresis and its path- regulation of cellular processes by glucose metabolites (in ological consequences during aging. Effect of age and caloric intake on protein oxidation in different brain regions and on behavioral functions of the mouse. Mechanism of aging of rat muscle Although senescence is undoubtedly a complex phe- glyceraldehyde-3-phosphate dehydrogenase studied byse- nomenon, and there are sound reasons grounded in evo- lective enzyme-oxidation. Oxidative damage nevertheless much progress has been made using the and mitochondrial decay in aging. Epidemiology versus gentics in Parkinson’s of 8-oxo-deoxyguanosine and 8-oxo-guanine. Life and death of neurons in the sion of superoxide dismutase and catalase in Drosophila aging brain. Glau- synergistic effects of glucose deficit, oxidative stress and coma in food-restricted and ad libitum-fed DBA/2NNia advanced glycation endproducts.
Osmotic stool act on the VC and may be quite effective with fewer softeners order maxalt 10mg with amex, such as lactulose cheap maxalt 10mg amex, and milk of magnesia may be potential side effects cheap 10mg maxalt. Corticosteroids are also potent effective in maintaining bowel function for patients at antiemetics buy 10 mg maxalt with amex. A bowel regimen should be identi- Remediable causes of nausea or vomiting such as fied for all patients and followed routinely. Patients who peptic disease and obstipation should be identified and develop constipation should be treated with saline, or treated (Table 26. Doses of H2 blockers should be mineral oil retention, or tap water enemas as needed to halved in the elderly, as they may precipitate delirium. Bowel stimulants can be used once inhibitors [omeprazole (Prilosec), lansoprazole (Pre- any lower GI tract obstruction is resolved. Patients often vacid), and others] are the most potent agents respond to regularly scheduled glycerin or bisacodyl sup- for decreasing gastric acid secretion and do not alter positories (1–4 per rectum), after breakfast, daily. Bowel Management Diarrhea Constipation results in a myriad of other symptoms, Although less common than constipation, diarrhea can including urinary retention, nausea and vomiting, de- be a particularly distressing symptom in dying patients, lirium, and, if severe, intestinal perforation. When possible, the eti- mobility and bed rest predispose to constipation, so a ology of the diarrhea should be clarified, and processes bowel regimen should be initiated as patients become amenable to treatment, such as Clostridium difficile less mobile. Constipation occurs uniformly with opioid colitis, or fecal impaction, should be treated aggressively. Type of agent Medication Dose Onset Comments Stimulant/ contact agents Senna 1–3 tabs p. Care Near the End of Life 307 First-line therapy for diarrhea should be Kaolin-pectin be weighed against the discomfort of frequent move- 60 mL p. Loperamide (Imodium) is preferable to Infectious Processes diphenoxylate-atropine (Lomotil) combination, as the latter has greater potential for systemic and CNS toxicity. Fever may be suppressed by round-the-clock acetaminophen orally or per rectum, moistened swabs or artificial saliva) and lips (with petro- latum or lip balm). Even when the patient is unrespon- or with cooling techniques such as bathing with cool sive, the mouth should be cleaned and moistened at water. When a decision is made to give antibiotics, a broad-spectrum oral antibiotic or once-daily injection regular intervals for patient comfort and to lessen family distress. Other symptoms such as dyspnea associated with pneumonia, or dysuria and urinary frequency associated with urinary tract infection, Urinary Symptoms should be addressed to relieve physical distress. Urinary incontinence, dysuria, and frequency can be par- ticularly disturbing symptoms for patients, especially if Bereavement mobility is impaired. For symptoms Anticipatory grieving, or sadness about the expected of incontinence and frequency, a postvoid residual (PVR) death, should be acknowledged and support offered to volume should be documented. Communication before than 150 mL, an indwelling catheter should be left in death between the patient and friends and family is place or intermittent catheterization performed regu- important when possible. Indwelling catheters may be used for easing care- family members need to understand that death is likely, giver burden or avoiding moving patients with severe have adequate time to process that information, and pain; however, they are associated with urinary tract spend time with each other. Information about what to infections in all patients in whom they are in place for expect as disease progresses and death approaches may more than about 1 week. When retention may respond to bethanechol (Urecholine) 5 to death seems imminent, the patient and family should be 10 mg bid to tid. In the absence of elevated PVR, toltero- advised and given the opportunity to "say good-bye. Dysuria can sometimes be reduced with a caregiver team should participate in bereavement ac- bladder anesthetic, such as pyridium 100 to 200 mg p. Women with atrophic changes of the urethral meatus adequate for the family to know that the physician and external genitalia may have improved bladder func- recognizes their sense of loss. Some physicians maintain tion and reduction in irritative symptoms with small tickler files to call or to send a note to the patient’s family amounts of topical estrogen cream applied to the urethral on the anniversary of the patient’s death.
In about 1930 proven 10 mg maxalt, this Swiss surgeon asserted buy maxalt 10 mg line, on the basis of his ob- servations purchase maxalt 10 mg with amex, that he had just discovered a new technique that slows down ageing maxalt 10 mg mastercard, stimulates tissues and fires up the organs by accelerating their functions; this effect was created by injecting fresh cells taken from similar organs in a fetus or young animal — primarily sheep and bovines. He also considered placental injections to be promising, in terms of rejuvenation. Niehans proclaimed that injections of liver cells, spleen, pancreas, bone marrow or sexual organs could revitalize his pa- tients. The fresh cells must be injected within forty minutes of their hav- ing been extracted from the animal, according to Niehans, in order to avoid allergic phenomena that he ascribes to the "rejection response" to dead cells. The Niehans cure thus justified the opening of several cen- ters for specialized care; the most famous being the clinic "La Prairie", in Montreux, Switzerland. Cell-therapy claims to treat hormonal dys- functions as well as ageing and psychiatric disorders — schizophrenia, depression, and even mongolism. In spite of the absence of clinical observations that could objec- tively confirm the improvements or supposed healings that are claimed, cellular therapy quickly developed a following. However, it is being criticized more and more sharply, as healings give way to complica- tions, most frequent of which are allergic reactions, cutaneous erup- tions, joint problems and changes in diseases that are as different as tuberculosis and encephalopathy. The blame for three deaths in 1987, including that of a young German decathloner, has been laid squarely on cell-therapy. The current price of an ampoule of freeze-dried cells is close to $200, and the cure is supposed to require some 12 to 30 ampoules. However, the use of cellular extracts has benefited from the newly enforced Europe-wide jurisprudence, which has ruled that it is against the Euro- pean directives to forbid the use and marketing of these products in France. Decrees dated March 7, 1989 and April 8, 1992, from the Euro- pean Community Court of Justice, thus considered it to be "contrary to articles 30 and following, of the Treaty of Rome, the prohibition on pri- vate individuals’ importing drugs in quantities not exceeding the nor- mal personal needs of a patient". Article L601-2 of the Code of Public Health, modified on May 28, 1996 henceforth authorizes "a patient and a doctor to use, on an exceptional basis,. In the absence of serious clinical studies, and riding the wave of media-medical hype that had surrounded the Niehans method for helf a century, some none-too scrupulous doctors import (or have their pa- tients import), freeze-dried products that in fact bear little relationship to those promoted by Niehans — but which at least are bacteriologi- cally harmless. Never proven either effective or harmless, cell-therapy is very popular in Germany and gained an avid following in France, in spite of a center being closed in 1993 and its director sent to jail. Mad cow epidemics and the problems arising from genetic engi- neering have not, to date, been enough to turn off the proponents of this method, which not incidentally represents a considerable source of revenue for certain "specialized" experts, some of whom also supply steroids etc. The Aslan Cure, Gerovital Under the Ceausescu regime, Romania developed what was, at the very least, an original source of foreign currency by promoting the work of Dr. Coupled with spa treatments given at the sea- side resorts along the Adriatic coast, this method consisted in adminis- tering procaine via injection; its promoters called procaine an aid to cellular rejuvenation. Marketed under the name of Gerovital, Gerovital H3 or LD 40, procaine is at first a vasodilator (dilating the blood vessels), which briefly improves capillary circulation — an improvement quickly fol- lowed by a rebound effect in the form of increased vasoconstriction. Along with the vasoconstriction/vasodilatation phenomenon is accompanied by a modification of the rate of heartbeat, whose effect is immediately perceived by the followers of the method. However, while this braking/accelerating effect creates a kind of excitation and a euphoric effect for the patient, there are more disadvantages than ad- vantages — for it subjects the organism (generally middle-aged or older) to physiological jolts without long-term benefit. After the death of Anna Aslan and the fall of the Ceausescu re- gime, the Aslan or Gerovital cure slipped out of sight before gradually reappearing in Germany, the United States and again in Romania. These days, it is gradually taking hold in France, where it is found un- der the name of the Aslan Cure, or as an additive to rejuvenation cures recommended by spas and specialized treatment centers. There is also a kind of under-the-table market in Gerovital ampoules, and there is every reason to think that, since history suffers from chronic amnesia, the Aslan cures soon will become again a source of hard currency for seaside resorts along the Black Sea, the Dalmatian coast. Vernes’s Aqueous Solutions Variations in blood serum provide the bases of a diagnostic tech- nique and a therapeutic method perfected by Dr. Born in 1879 into a family of Protestant bankers, young Vernes had his medical studies interrupted by an attack of tuberculosis that immo- bilized him for several years. Thus, as soon as he finished boarding school, he turned toward traditional research on tuberculosis, and th syphilis, which was having a devastating impact early in the 20 cen- tury. As a hospital laboratory director, he developed a method of analy- sis extrapolated from the photometer invented by Arago for use in physics. Vernes’s diagnostic technique entailed taking blood samples from the patient and isolating the serum, then distributing it in small glass containers, and subjecting it to light rays. Adjusting the dilution rate of the serum in the containers, Vernes observed that the diffused light var- ied according to the concentration but that the variations were not lin- ear — sometimes the variations were sudden and marked.
As the prior period was based on a sense of direction and purpose 10mg maxalt for sale, this phase revolves around a sense of competency buy 10 mg maxalt visa. In a stage closely aligned with Freud’s la- tency stage (one of calm) maxalt 10 mg line, the child now receives approval purchase maxalt 10 mg visa, regard, and af- fection based on achievement, which ultimately depends on his or her competence, or conversely, suffers a continuing sense of inferiority (Lidz, 1976). Thus, the ability to complete tasks and be productive is essential for the development of ego mastery. However, if the child feels inadequate, the polarity of this stage becomes a pull toward less production and a satisfac- tion with slothful behavior. Not unlike Piaget’s stage of concrete opera- tions (logical thought about physical objects and their relationship), Er- ickson’s fourth phase sees the child applying his or her thoughts and energy to new skills and tasks. To bring a productive situation to completion is an aim which gradually supersedes the whims and wishes of play" (Erikson, 1963, p. As adolescence approaches, the child enters the fifth phase, identity versus role confusion, which could easily be defined as ‘to be or not to be. Erikson believes that phase five (identity versus role confusion) is where the prior four phases have coalesced toward an ego identity and mastery of skills. Yet, as with all of his phases, the polarity of opposites exists: If the adolescent has not gained a sense of competence, purpose, and self-control, he or she will be unable to cope with growing frustrations as peer groupings and models of leadership be- come the norm. It is at this juncture that an individual, feeling a sense of loss and isolation, may turn toward antisocial behaviors, thoughts, and at- titudes in order to secure any identity, no matter how dysfunctional. It is this growing identity that often causes parents and clinicians the most problems, for parents often do not know how to deal with the issue, and cli- nicians often overlook its importance, especially when dealing with an adult population. An individual’s sense of identity persists well into adult- hood: It knows no barriers but instead is found within. Therefore, if an identity is that of an addict, a criminal, or a dependent mentally ill frame- work, this will be brought into the therapeutic hour. It will be projected, 80 Adaptation and Integration transferred, and played out in myriad ways. Of the hospitalized patients I have worked with, very few have had a secure job, a driver’s license or photo identification, a high school diploma or college education, a viable support system, or even a home to return to: thus, their identities had be- come linked with institutionalization. Another member, in therapy for drug sales and possession, depicted himself with hoards of money in his first drawing (Figure 2. Both of these renderings, as the first drawings, are not mistakes but instead unconscious perceptions. It is commonly believed that the first drawing identifies the artist’s self-concept and identification (Machover, 1949). The identity diffusion that these gentlemen and this population experi- ence is further complicated by the continuous struggles that were not mas- tered in adolescence. Erikson’s sixth phase, intimacy versus isolation, is directly linked to the previous one, for if the adolescent fails to find a true sense of identity the shift to intimacy with another is difficult at best. One of the major ob- stacles, therefore, is retaining a sense of one’s own identity while becoming involved in a united partnership. Erikson (1963) explains the disadvantages of this phase in the following manner: The counterpoint of intimacy is distantiation: the readiness to isolate and, if necessary, to destroy those forces and people whose essence seems danger- ous to one’s own, and whose "territory" seems to encroach on the extent of one’s intimate relations.... Thedanger of this stage is that intimate, com- petitive, and combative relations are experienced with and against the self- same people. Erikson referred to his second-to-last phase as generativity versus self-absorption. It must be noted that generativity does not merely encompass procreation but also care and concern for society at large man- ifested through a promotion of values, morals, education, and charity. The difficulty of this phase lies in self-absorption, which can pull the adult away from the community with an all-encompassing focus on self-love. His final phase, integrity versus despair, revolves around the ego’s integration and the ac- ceptance of the past—a past consisting of all we have been and acknowl- edging that which we will not be. The patient was responding to the directive "Separate your paper into threes and draw in the first section where you came from, in the second where you are now, and in the last where you are going.