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But the disease is not necessarily the result of functional loss of these proteins purchase clomiphene 25 mg on-line women's health magazine uk back issues; rather order 100mg clomiphene with amex women's health center of oregon, these altered proteins start to accumulate and may become toxic buy clomiphene 100 mg otc menstrual 2 days late. For example, in Alzheimer’s, the hallmark of the disease is the accumulation of these amyloid plaques in the cerebral cortex. Creutzfeld-Jacob disease, the human variant of the prion disease known as mad cow disease in the bovine, also involves the accumulation of amyloid plaques, similar to Alzheimer’s. Diseases of other organ systems can fall into this group as well, such as cystic fibrosis or type 2 diabetes. Interfering with the accumulation of the proteins, and possibly as early as their original production within the cell, may unlock new ways to alleviate these devastating diseases. Functionally, the nervous system can be divided into those regions that are responsible for sensation, those that are responsible for integration, 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?
Theories of emotion: James theory or emotion proposes the following sequences of events in emotional state clomiphene 50mg fast delivery womens health diet pill. The major objection to James Lang theory came from Cannon who pointed out 1) That changes do not seem to differ very much from one emotional state to another cheap clomiphene 50mg free shipping menstrual nosebleeds. James Langes Theory Perception of Activation of Feed back to brain emotion Visceral and from bodily producing skeletal responses produce stimulus responses experience of emotion Canon theory Messages to cortex produce experience Perception of Stimulus processed by of emotion emotion Thalamus discount 25mg clomiphene women's health birth control article, which producing simultaneously send stimulus messages to the cortex and other parts of the body Messages from thalamus activates visceral and skeletal responses Emotion when sufficiently intense can seriously impair the process that control organized behavior. Motion pictures and recording of children’s cries indicate that the infants’ response to stimuli designated to arouse emotion are very diffuse and lacking in organization. Emotional shocks and hurts suffered by individuals at an early age can handicap them as long as they live. Children sooner or later acquire the capacity for experiencing negative emotions such as anger, fear, and also sorrow or grief to an intense degree. This capacity develops, before the child is mature enough to use language, to formulate his experience in words. These improvements in the young child’s ability to respond in specific ways to situations that arouse him, parallel the development of his mental and motor abilities. As the child’s intellectual and motor capacity matures, he acquires large variety of means and forms of expression such as overt and direct to more graded covert and indirect. If a person may mask intense feeling of anger tat occurs when someone hunts his pride very sharply and then still harboring his anger may explode on another occasions because of a very trivial affront. The most important factors in a child’s emotional development and the affection that he receives from his parents, peer group and society. The more genuine the parents love for the child, the, more the child tends to feel free to love other people. All physiological healthy nurses are likely to feel some affection for patients in their charge or with whom they have a chance to associate even though the children are not their own. Their un loved person may suffer in connection with the development of positive attitudes and concepts concern ing his own worth. This personality is not fixed state but dynamic totality, which is continuously changing due to interaction with the environment. Definition of personality: In the words of Munn, it is characteristic integration of an individual’s structure. In the words of Gorden Allport, “personality is the dynamic organization within the individual of those psychophysical systems, that determine his unique adjustment to his environment” The personality is the organization of the internal and external activities. Personality is the total quality of behavior, attitudes, interests, capacities, aptitudes and behavior patterns, which are manifested in his relation with the environment. However as a person genetic inheritance interacts with and is shaped by environmental factors, the emerges a self structure that becomes an important influence in shapijgn further development and behavior. A trait is an enduring and consistent characteristic of a person that is observed in a wide variety of situations. In fact All port and Odbert have listed 17,593 words in English, which are adjectives standing for personality traits. Norman listed 5 terms extroversion, agreeableness, consciousness, and emotional stability and culture. In situations of worry, panicking, stress and over emotionality a high level activity could affect performance adversely in academic work of pupils, resulting in learning disabilities. The type personality: It is older than the trait approach, which depends upon modern statistical procedures. The athletic and asthenic type of body build, go with what is known as schizothyme personality and the pyknic body goes with cyclothymic personality. Psychological theory of personality: Personality theories are grouped under three major heads 1) Psychodynamic theories. Psychodynamic theories of personality: Psychoanalytic theories of personality are referred to as psychodynamic theory. This theory at tempts to understand personality in terms of mental functions may be rational, irrational, conscious or unconscious. Freud’s theory of psychoanalysis emphasizes man as dynamic system of energies and main store house of such energies in unconscious. From anxiety, defense mechanism or unconscious attempts to reduce anxiety by denying or destroying realty,. The technique of Eric Berne’s transactional refers to wholesome transaction from childhood to adulthood. Then from 5 up to early adolescence sexual force is subordinated which marks the latency, period and finally the genital stage of heterosexuality. Carl Jung differs from Freud in taking a more positive and optimistic attitude towards human nature believing that people not only try to gratify their instincts but also try to develop their potential. Jung agreeing with Freudian view of unconsciousness, which represents the accumulated experi ences, and culture of the human species throughout its evolutionary development from primitive times. To Erickson, personality is the resultant from interaction between the needs of a person and the demands of a society at a particular stage of development. Ego identify crisis during adolescence and now an individual resolves such crisis determines personality characteristics. Svilan has stressed the interpersonal nature of personality and has laid on the acquisition of language as a means of normal personality development. Social learning theories of personality: These theories say that consistency of behavior, results not only from rigid personality traits but also from other factors like environmental stability. Dollard and Miller pointed fear, as an important factor in personality development as it acts as a powerful motive or drive in the promotion of learning. A person’s behavior depends upon the specific nature of the situation, how the situation is appraised by him as well as past reinforcement of behaviour in similar situations. Behaviorists theories of personality: Behavourists is such a skinner emphasize that conditioning alone is not adequate to explain human character and personality. These theories emphasize the existence of positive growth promoting forces in personality beyond more conflict resolution or tension reduction and also stresses present rather than past experiences. Maslow and Carl Roger both dealt on humanistic and psychoanalytic theories on growth and self actualization. An individual with a strong positive self – concept seek growth and have pleasant productive relation with others. Kelly’s cognitive theory of personality consists of personal constructs that is the ways a person has of evaluating himself and his circumstances. Defense mechanism: Another mode of reacting to difficulties is that of mental mechanism or defense oriented reactions to stress aims chiefly at protecting the self from hurt and disorganization. No Expression Mode of reactions 1 Withdrawal Protecting self from unpleasant, reality by refusal to perceive or face it. Nursing services are necessary for every patient seeking care of various types including primary, secondary, tertiary and restorative. As nursing is an important part of health care delivery system, the nurses need to understand the system to effectively deliver quality care within it.
It is indicated when presentation and examination suggest a diagnosis other than hernia or hydrocele 50mg clomiphene free shipping women's health clinic bendigo. Laparoscopy: Diagnostic laparoscopy may rarely be required for determining the presence of an inguinal hernia discount clomiphene 25 mg free shipping menstrual question. It is used only in the following: a) assessment of contralateral hernia when one is being operated upon buy clomiphene 50 mg visa menopause increased libido, and b) recurrent hernia after previous surgery. Inguinal hernias do not spontaneously heal and must be surgically repaired because of the ever-present risk of incarceration. Repair is usually planned as an elective procedure as soon as possible after diagnosis. If successful, the operation is performed after 24-48 hours to allow local oedema to settle down. If reduction is unsuccessful, or if there is clinical evidence of inflammation (as evidenced by pain, redness, edema of skin on hernia) emergency exploration and hernia repair is necessary. Hydroceles without hernia in neonates: This is the only exception in which surgical treatment may be delayed. Repair of hydroceles in neonates without the presence of hernia is typically delayed for 12 months because the connection with the peritoneal cavity (via the processus vaginalis) may be very small and may have already closed or be in the process of closing. If the hydorcoele persists after this observation period, operative repair is indicated and appropriate. Postpone the operation in the event of upper respiratory tract infection,otitis media, or significant rash in the groin. After that time, the patient is allowed to participate in physical activities (eg, sports, swimming, running). Children younger than 5 years are likely to recover extremely quickly from surgery; they are typically capable of returning to their normal level of activities within 24-48 hours of surgery. Inguinal hernia: Treatment is surgery -herniotomy operation that aims at ligating the patent processus vaginalis at the internal ring after reduction of contents into the abdomen nd b. Congenital hydrocoele: Treatment is deferred until the 2 birthday as there is a 80% chance of spontaneous closure. Surgery is indicated if hydrocoele persists nd beyond the 2 year and if it is rapidly growing is size. All children with comorbid problems-cardiac, respiratory or others, need inpatient care after surgery b Out Patient criteria same as above c. Doctor makes a clinical diagnosis, counsels the family and plans surgery- a pediatric surgeon performs the surgery b. Nurse: assists surgeon in care of child during pre, intra and post operative course of the baby c. Technician: assists medical and nursing teams in care of child during intra and post-operative periods. Quantity to also be specified) Situation Human Resources Drugs & Consumables Equipment 1 Pediatric I. Zameer K Both from Department of Pediatric Surgery Narayana Hrudayalaya,Bangalore I. Introduction: Neonatal cholestatis is a pathological condition in the newborn where in bile flow from the liver is reduced. Most of these disorders have linkage with insults during antenatal, natal and postnatal periods. Mothers must be informed about the need to seek medical attention if jaundice persists beyond two weeks of birth and / or baby passes pale stools and high coloured urine. If the previous sibling has had liver disease antenatal counselling and referral for further evaluation may be necessary. Clinical: Neonate with jaundice persistent beyond 2 weeks, dark colour urine and/or pale stool 2. Screening Biochemistry: Serum bilirubin direct and indirect Any child that meets with the clinical and /or biochemical criteria needs investigation, treatment and referral. Initiation of antibiotics: if there is clinical or laboratory evidence of infection or sepsis a. Out Patient : Baby who is clinically well, feeding well and has no evidence of hypoglycemia or coagulopathy can be investigated as an outpatient 50 c. None of the biochemical tests are of deciding value and at best reflect the degree of damage to liver. Role of Hida Scan Hepatobiliary scintigraphy, after a 5 day priming with phenobarbitone,is useful. However, the converse is not true and absence of gut excretion of radiotracer requires further evaluation. Carbamazepine Liver Transplantation This may remain the only option for infants with decompensated liver disease (ascites and /or encephalopathy) or failed portoenterostomy. Failure of Kasai operation Evidence of liver cirrhosis in biopsy Jaundice not cleared by 2 months after surgery 4. Considerations for liver transplant Situation 2: Referred cases from secondary centres or any newborn with evidence of cholestatis with deranged liver function tests. Treatment: Aims of treatment Within 7 days of hospitalisation treatment is mandatory. Yachha: Consensus Reoprt on Neonatal Cholestasis Syndrome, Indian Pediatircs 2000;37:845-85 2. Differential diagnosis of extrahepatic billiary atresia from neonatal hepatitis: a prospective study Pediatr Gastroenterology Nutr 1994; 18:121-217 8. Quantity to also be specified) Situatio Human Investigations Drugs & Equipment n resources consumables 1 Pediatrician Vitamin K Radiant Warmer Pediatric Nurse Antibiotics Saturation monitor Radiologist I. Vesico ureteric reflux may be primary due to short intramural course of ureters or it may be secondary to posterior urethral valves, Ureteroceles. Beyond 1-2 years, there is female preponderance with male to female ratio of 1:10. Presence of pelviureteric dilatation on antenatal scans needs evaluation soon after birth. Break through infections and fresh scars and structural abnormalities will be an indication for surgical intervention. At secondary hospital / Non metro situation – optimal standards of treatment in situations where technology and resources are limited. Appropriate antibiotics are chosen and administered for a period of 7 to 10 days intravenously. It should be followed by oral chemo prophylaxis till the reflux subsides with periodical monitoring of the urine culture especially during febrile episodes. Ultrasonogram done shows some structural abnormalities , should be investigated further with Intravenous urogram and sent to higher centres for intervention.