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By using a single unit one can treat anemia with the packed cells generic 200mg viagra extra dosage, 100 platelate deficiency with platelate preparations purchase viagra extra dosage 130mg visa, clotting factor and other plasma deficiencies with plasma preparation. At the first sign of reaction, the phlebotomist should stop the phlebotomy, give initial first aid procedures and call the blood bank physician. Hemolytic reactions may be defined as the occurrence of abnormal destruction of red cells of either the donor or recipient following the transfusion of incompatible blood. Nonhemolytic reactions on the other hand are not usually associated with erythrocyte hemolysis, constitute conditions such as shortened post transfusion survival of erythrocytes, febrile reactions, allergic response, and disease transmission. Transfusion reactions can be further classified in to acute (immediate) or delayed in their manifestations. Factors such as antibody concentration, class or subclass, ability to fix complement, temperature of activitiy and concentration of red cell antigen infused also influence whether a transfusion reaction will be acute or delayed. Acute hemolytic reactions, which are the most serious and potentially lethal, occur during or immediately after blood has been transfused. Delayed hemolytic reactions, as the name implies the transfusion reaction is delayed due to weak antibody in the recipient 7 to 10 days of post transfusion. In most cases of delayed hemolytic reactions, the patient has been primarily immunized by previous transfusion or 104 pregnancy. The antibody is too weak to be detected in routine cross-match, but becomes detectable 3 to 7 days after transfusion, eg. Whenever adverse reaction experienced by a patient in association with a transfusion it should be regarded as a suspected transfusion reaction, and the following lab. List laboratory investigations to be carried out when incompatible transfused reactions are suspected? Important factors in a routine quality assurance program include evaluation of reagents, equipment, and personnel qualification. Each reagent on each day of 107 use must be inspected visually for color, cloudiness and other characteristics, and the manufactures procedure should strictly be followed to confirm its reactivity. Quality control of equipment: Instruments and equipments in blood bank laboratory such as centrifuge and water bath must be properly maintained and monitored to ensure they are working accurately. Water baths temperature should be constantly monitored by using thermometer to 0 achieve a temperature of 37 C for the detection of warm reacting antibodies. Quality control of personnel: Though it is the most difficult to control, the maintenance of high personnel standards is one of the most important functions of a quality assurance program. Evaluate person’s employment in the laboratory for competency: proper qualification, dedication, trust and ability to work in stressful conditions. It is also essential to maintain competence of personnel by participation in continuing education activities. This helps them to acquire new knowledge to practice it in the field, and to maintain their motivation as well. Adenosine An agent that improves the maintenance of red cell viability and is capable of restoring the adenosine triphosphate content of stored red cells. Alleles Alternate forms of genes that code for trains of the a B same type; for example, the genes Fy and Fy are alleles. Aminiocentesis The process of removing fluid from the amniotic sac for study, for example, chromosome analysis or biochemical studies. This secondary response occurs on 110 subsequent exposure to a previously encountered and recognized foreign antigen. Autologous donation may take the form of predeposit or autotransfusion, for example, intraoperative autotransfusion, hemodilution, or postoperative auto transfusion. Avidity (of an antiserum) A measure of the ability and speed with which an antiserum agglutinates red cells as a property of the combining constrant (K) Bombay phenotype The failure of an individual to express inherited A or B genes because of the lack of at least one H gene and the subsequent lack of the resulting H precursor substance. Compatibility test A series of procedures used to give an indication of blood group compatibility between the donor and the recipient and to detect irregular antibodies in the recipient’s serum. Cord blood Blood taken from the umbilical vein or the umbilical cord of a newborn Delayed hemolytic transfusion reaction A rapid increase in antibody concentration and destruction of transfused red cells a few days after transfusion usually due to low amount of antibody undetectable in pretransfusion tests on the recipient, which are stimulated to high titers by the transfusion of red cells possessing the offending antigen. Eluate In blood banking, the term denotes an antibody solution made by recovery into a fluid medium of antibodies that have been taken up by red cells (i. Immunoglobulin antibody containing globulins including those proteins without apparent anti body activity that have the same antigen specificity and are produced by similar cells. Incompatible transfusion Any transfusion that results in an adverse reaction in the patient (including reduced red cell survival).

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Occasionally the frontal bone may be separated which consists of two layers of compact bone separated by a layer of into two halves by a midline metopic suture quality 130mg viagra extra dosage. The anterior purchase 200 mg viagra extra dosage mastercard, middle and posterior cranial fossae are coloured green, red and blue respectively • There are a number of emissary foramina which transmit emissary • Foramen rotundum (Maxillary branch of trigeminal nerve) veins. These establish a communication between the intra- and extra- • Foramen ovale (Mandibular branch of trigeminal nerve) cranial veins. The interior of the base of the skull comprises the anterior, middle and • In the midline is the body of the sphenoid with the sella turcica on posterior cranial fossae (Fig. The remainder consists of the bones that were seen in the • Foramen ovale (already described) middle and posterior cranial fossae but many of the foramina seen on • Other features: the exterior are not visible inside the cranium. It then opens into the posterior wall • Jugular foramen (already described) of the foramen lacerum before turning upwards again to enter the • Foramen lacerum (the internal carotid through its internal opening) cranial cavity through the internal opening of the foramen. Each • Mental (Mental nerve) ramus divides into a coronoid process and the head, for articulation • Greater and lesser palatine foramina (Greater and lesser palatine with the mandibular fossa. Parasympathetic fibres are shown in orange Superior orbital Superior fissure Cavernous Trochlear oblique sinus nerve Abducent nerve Lateral Internal rectus carotid Petrous artery temporal Fig. Maxillary V The trochlear nerve arises from the dorsal surface of the brain Mandibular V Auriculotemporal Supraorbital Greater occipital Infraorbital Lesser occipital Greater auricular Mental Supraclavicular Transverse Sternomastoid cutaneous Clavicle Fig. Its anterior ramus joins the outgrowth of the embryonic brain and the nerve is therefore enveloped hypoglossal nerve but leaves it later to form the descendens hypoglossi. The cell bodies are in the retina and the axons pass back in • C2: The posterior ramus forms the greater occipital nerve which is the optic nerve to the optic chiasma where the axons from the nasal sensory to the scalp. They also front of the pons, traverses the cavernous sinus and enters the orbit supply sensory branches: the greater auricular, lesser occipital, an- through the superior orbital fissure. The superioris, superior, inferior and medial rectus muscles and the inferior greater auricular supplies the skin in the parotid region, the only sens- oblique. It also carries parasympathetic fibres to the ciliary ganglion ory supply to the face which is not derived from the trigeminal. The where the fibres synapse and then pass in the short ciliary nerves to the others supply the skin of the neck and the upper part of the thorax. The olfactory nerve: the cell bodies of the olfactory nerve are in superior orbital fissure and supplies the superior oblique. Parasympathetic fibres are shown in orange Deep temporal (to temporalis) Auriculotemporal Foramen ovale Otic ganglion Muscular branches Buccal Parotid gland Chorda tympani Lingual Inferior alveolar Submandibular ganglion Mylohyoid nerve Submandibular gland Fig. The pos- the trigeminal ganglion which consists of the cell bodies of the sensory terior superior dental nerve enters the back of the maxilla and supplies axons and lies in a depression on the petrous temporal bone. The maxillary nerve leaves the sphenopalatine fossa via the divides into ophthalmic, maxillary and mandibular divisions. The inferior orbital fissure, travels in the floor of the orbit where it gives the motor root forms part of the mandibular division. This traverses the cavernous sinus and enters the orbit via the superior orbital fissure where it divides into frontal, lacrimal and nasociliary (c) The mandibular division (Fig. The frontal nerve lies just under the roof of the orbit and This leaves the cranial cavity through the foramen ovale and immedi- divides into supraorbital and supratrochlear nerves which emerge ately breaks up into branches. The lacrimal nerve lies alveolar nerve, which enters the mandibular foramen to supply the laterally and supplies the skin of the eyelids and face. This nerve parasympathetic secretomotor fibres from the sphenopalatine ganglion does have one motor branch, the mylohyoid nerve, which supplies the to the lacrimal gland. The lingual nerve lies runs along the medial wall of the orbit to emerge onto the face as the close to the mandible just behind the third molar and then passes for- infratrochlear nerve. It is joined by the chorda tympani which sinuses and the long ciliary nerves to the eye which carry sensory fibres carries taste fibres from the anterior two-thirds of the tongue and from the cornea and sympathetic fibres to the dilator pupillae. All parasympathetic secretomotor fibres to the submandibular and sublin- branches of the ophthalmic division are sensory. It also carries parasympath- This leaves the cranial cavity through the foramen rotundum and enters etic secretomotor fibres, which have synapsed in the otic ganglion, to the pterygopalatine fossa. The mandibular nerve are the greater and lesser palatine nerves to the hard and soft division thus contains both motor and sensory branches. The nerve passes through the middle ear and the parotid gland Vagus Spinal accessory Cranial accessory Foramen magnum Internal carotid Cardiac branch External carotid To sternomastoid Pharyngeal and trapezius Superior laryngeal Internal jugular vein Internal laryngeal External laryngeal Cricothyroid Cardiac branch Subclavian artery Recurrent laryngeal (left) Fig.

It includes under nutrition purchase 130 mg viagra extra dosage otc, which results from less food intake and hard physical work and over nutrition results from excess food intake and less physical activities buy viagra extra dosage 150 mg overnight delivery. Diet: - is defined as food containing all the nutrients in a sufficient amount and in proper ratio. It prevents gastrointestinal disorders (gastritis, appendicitis, gallbladder stone and constipation) and metabolic disorders (diabetes mellitus, hypertension, ischemic heart disease and colon cancer). Dietary guidelines ƒ Eat a wide variety of foods ƒ Maintain healthy weight ƒ Choose a diet low in fat, saturated fat, and cholesterol ƒ Choose a diet with plenty of vegetable, fruits and grain products ƒ Use sugar in moderation ƒ Use salt and sodium in moderation ƒ If you drink alcoholic beverage, do so in moderation. Food groups ♦ Milk, cheese, yoghurt ♦ Meat, poultry, fish and alternates ♦ Fruits and vegetables ♦ Bread and cereals ♦ Fats, sweets and alcohols 5 Nutrition Why human beings need food? Human beings need food to provide energy for the essential physiological functions like:- ƒ Respiration ƒ Circulation ƒ Digestion ƒ Metabolism ƒ Maintaining body temperature. Health and nutrition are closely linked and to ensure proper development and life quality they must be adequate from early childhood on and most vulnerable groups are infants, young children, pregnant women and lactating mothers. It is important to make sure that any recommended ration scale is compared with acceptable standards and that its use is not likely to cause deficiency disease 6 Nutrition Major causes of malnutrition ƒ Lack of knowledge in selecting foodstuff with high nutritive value ƒ Poverty and infectious diseases ƒ Drought ƒ Uneven distribution of the available foods ƒ Social arrest and civil conflicts, ƒ Transport problems (inaccessibility) ƒ Increased populations ƒ Inadequate weaning ƒ Farming technique-insufficient ƒ Poor management of resources ƒ Topographical differences in different regions (variation in productivity) ƒ Loss of food through destruction by insects ƒ Exploited land due to planting the same type of food crop for many years, erosion because of overgrazing and moreover the farmers could not use the fertilizers due to many reasons. Harmful traditional practices with regard to nutrition ƒ During period of fasting important nutrients are not eaten, such as milk, eggs, butter, meat, fish, meal pattern, etc. Injera with wat prepared from - Cereals - Legumes - Vegetable ƒ Traditional use of dark green leaves “Hbesha Gommen. Enjory, Kega, Sholla, ƒ Honey mixed with butter is eaten in the morning ƒ Giving to children a tea-like drink made out of Abish (fenugreek) is rich in protein (27 gm/100gm) ƒ Good hospitality and sociability ƒ Eating of raw vegetables and cereals ƒ Taking care of elders. Good nutrition must meet the needs of varying ages and activities and always with individual differences. Therefore, the planning of food to meet especial needs begins with: • Pregnant women • Nursing mothers • Infants • Adolescents and • Adults A well-nourished individual:- ƒ Is alert mentally and physically fit ƒ Has optimistic outlook on life ƒ Has good resistance to infection ƒ Shows numerous other signs of good health such as an increased life span extending the active and vigorous period of life. In general feeding is dependent on the controlling centres, appetite and satiety in the brain. There are a variety of stimuli, nervous, chemical and thermal, which may affect the centres and so alter feeding behaviour. Daily calorie requirements of individuals Š Infants 1 - 3 years need 1,000 cal/day Š Children 5 years need 1,500 cal/day Š Children 5 – 8 years need 1,800 cal/day Š Children 10 – 12 years need 2,000 cal/day Š For adolescents and adults calorie requirements depend on the degree of physical activities 10 Nutrition From 13 – 20 years of age Office worker Heavy work 2, 800 cal/day 3,500 cal/day Adults 2,300-cal/day 2,700 cal/day Very heavy work up to 4,000 cal/day For pregnant woman, the daily figure must be increased by 150 calories for the first trimester and 350 for the second and third trimester. Staple foods Staple foods are foods, which form the largest part of a nation’s diet. They are of plant origin and are classified into three main groups Š The grain and cereals Š The roots and tubers Š The starchy fruits Discussion questions 1. In the diet of poor people, especially in the tropics, up to 85% of the energy may come from this source. On the other hand, in the diet of the rich people in many countries the proportion may be as low as 40%. Carbohydrates are components of body substances needed for the regulation of body processes. Nervous tissue, connective tissue, various hormones, and enzymes also contain carbohydrate. Carbohydrate is also a component of a compound in the liver that destroys toxic substances. If carbohydrate intake is low, larger than normal amounts of fats are called on to supply energy. As a result, the fat does not burn completely, and abnormal amounts of certain breakdown products accumulate in the blood, causing a condition known as ketosis. Types of carbohydrates Monosaccharides: ƒ Glucose ƒ Fructose ƒ Mannose ƒ Galactose Disaccharides: ƒ Sucrose (a disaccharide present taste sugar) ƒ Lactose (a disaccharide present in milk) ƒ Maltose (a disaccharide present in starch) Sugar alcohol: is found in nature and also prepared commercially. Mannitol and dulcitol are alcohol derived from mannose and 13 Nutrition galactose. It is a balanced diet as it contains all the nutrients in sufficient amount and proper ratio.

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