By B. Yugul. Framingham State College.

Measurement of serum creatine phosphokinase activity is of value in the diagnosis of disorders affecting skeletal and cardiac muscle buy proscar 5 mg low cost. Carbohydrates in general are polyhydroxy aldehydes or ketones or compounds which give these substances on hydrolysis purchase 5 mg proscar visa. Chemistry of Carbohydrates Classification and Structure Classification There are three major classes of carbohydrates • Monosaccharides (Greek, mono = one) • Oligosaccharides (Greek, oligo= few) 2-10 monosaccharide units. Structure of Glucose Open chain D-glucose α-D –glucose α-D –glucose (Fisher formula) (Haworth formula) Fig. Monosaccharides having aldehyde groups are called Aldoses and monosaccharides with Ketone group are Ketoses. Depending on the number of carbon atoms, the monosaccharides are named trioses (C3), tetroses (C4), pentoses (C5), hexoses (C6), heptoses (C7). Asymmetric Center and Stereoisomerism Asymmetric carbon is a carbon that has four different groups or atoms attached to it and having optically activity in solution. All the monosaccharides except dihydroxyacetone contain one or more asymmetric or chiral carbon atoms and thus occur in optically active isomeric forms. The designation of a sugar isomer as the D- form or of its mirror images the L- form is determined by the spatial relationship to the parent compound of the carbohydrate family. When a beam of plane- polarized light is passed through a solution of carbohydrate it will rotate the light either to right or to left. When equal amounts of D 25 and L isomers are present, the resulting mixture has no optical activity, since the activities of each isomer cancel one another. Epimers When sugars are different from one another, only in configuration with regard to a single carbon atom (around one carbon atom) they are called epimers of each other. The resulting six membered ring is called pyranose because of its similarity to organic molecule Pyran. Glycosidic bond is formed when the hydroxyl group on one of the sugars reacts with the anomeric carbon on the second sugar. Maltose is hydrolyzed to two molecules of D- glucose by the intestinal enzyme maltase, which is specific for the α- (1, 4) glycosidic bond. Structure of Maltose Lactose Lactose is a disaccharide of β-D galactose and β-D- glucose which are linked by β-(1,4) glycosidic linkage. Structure of sucrose α-(1, 2) β-Glycosidic bond Polysaccharides Most of the carbohydrates found in nature occur in the form of high molecular polymers called polysaccharides. Starch consists of two polymeric units made of glucose called Amylose and Amylopectin but they differ in molecular architecture. Amylose is unbranched with 250 to 300 D-Glucose units linked by α-(1, 4) linkages Amylopectin consists of long branched glucose residue (units) with higher molecular weight. The branch points repeat about every 20 to 30 (1-4) linkages Glycogen - Glycogen is the main storage polysaccharide of animal cells (Animal starch). Cellulose is a linear unbranched homopolysaccharide of 10,000 or more D- glucose units connected by β-(1, 4) glycosidic bonds. Humans cannot use cellulose because they lack of enzyme (cellulase) to hydrolyze the β-( 1-4) linkages. Figure: Structure of Cellulose 30 Dextrins These are highly branched homopolymers of glucose units with α-(1, 6), α-(1, 4) and α-(1, 3) linkages. Since they do not easily go out of vascular compartment they are used for intravenous infusion as plasma volume expander in the treatment of hypovolumic shock. They have the special ability to bind large amounts of water, there by producing the gel-like matrix that forms the basis of the body’s ground substance. Since they are negatively charged, for example, in bone, glycosaminoglycans attract and ++ + + tightly bind cattions like ca , they also take-up Na and K 3. An example of specialized ground substance is the synovial fluid, which serves as a lubricant in joints, and tendon sheaths. Heparin: • contains a repeating unit of D-glucuronic and D-gluconsamine, with sulfate groups on some of the hydroxyl and aminx-groups • It is an important anticoagualtn, prevents the clotting of blood by inhiginting the conversion of prothrombin to throbin. Glycoproteins (Mucoproteins) Glycoprotiens are proteins to which oligosaccharides are covalently attached. They differ from the glycosaminoglycans in that the length of the glycoproteins carbohydrate chain is relatively short (usually two to ten sugar residues in length, although they can be longer), whereas it can be very long in the glycosaminoglycans. The glycoprotein carbohydrate chains are often branched instead of linear and may or may not be negatively charged.

The three countries that that second-line injectable agents (amikacin order proscar 5mg without a prescription, capreomycin or have never conducted a drug resistance survey are Angola proven 5mg proscar, kanamycin). Surveys Cambodia, Ethiopia, Malawi, Sri Lanka, Swaziland, Thailand conducted about every 5 years represent the most common and the United Republic of Tanzania). Belarus Kazakhstan Myanmar 1000 1000 1000 5% per year -6% per year 100 -8% per year 100 100 10 10 10 -2% per year -6% per year 8% per year 1 1 1 0. Between 2007 and the end of 2016, a total of b These surveys have started or feld operations are scheduled to start in 2017. This included 13 surveys pre-survey uncertainty interval, whereas for the other seven in Asian countries (of which two were in the Philippines) and countries the survey found a burden that was either signif- 12 in African countries. In 2016, surveys were completed in cantly above (six countries) or below (one country) the burden Bangladesh, the Democratic People’s Republic of Korea, Kenya that had been estimated in the absence of survey data. Post-survey prevalence estimates Sudan, Uganda and Zambia), prevalence per 100 000 were almost always more precise (i. For further details, see World Health Organization Global Task Force on variation in these gaps by sex (Fig. Report of the sixth meeting of the full Task Force; surveys implemented in 2007–2016 suggest that women are 19–21 April 2016, Glion-sur-Montreux, Switzerland. Among the in the Philippines was conducted from March to December 18 597 participants eligible for sputum collection, 16 242 2016, following surveys in 1981–1983, 1997 and 2007. All survey Of the 466 bacteriologically confrmed cases, 150 (32%) participants were screened for symptoms by interview reported screening symptoms, and 430 (92%) screened and by digital chest X-ray examination. Prevalence was highest in the 45−54 defned as having spent at least the past 2 weeks in the year age group (Fig. There was no statistically cluster or having slept in the household more than 50% of signifcant variation between the four geographical strata. Female 90 A total of 2815 (6%) survey participants reported the presence of screening symptoms at the time of interview. Based on these adjustments, the prevalence of culture- out-of-pocket expenditures on health care (34% in 2014). Notwithstanding the limitation of a 76% participation rate, survey results are of high quality and have provided a robust and up-to- 4. Network with other government agencies and other key comprehensive and sustained poverty alleviation eforts, linked to stakeholders to address social determinants. Other details are provided in the online technical at national and subnational levels, increased domestic funding, appendix, which is available at a presidential executive order for drug regulation, establishment http://www. Results for the 0–14 age group (0–4 and Mongolia 5–14 years) in each country were then further disaggregated Philippinesc 2 using outputs from an established deterministic model, Thailand followed by disaggregation by sex using results from a meta- Philippinesd analysis of the M:F notifcation ratio. Nigeria Country-specifc distributions were used for countries that Cambodia had implemented a survey, whereas for other countries the Sudan age distribution was predicted using prevalence survey data. Zambia Disaggregation by sex was based on actual M:F ratios for Malawi countries that had implemented surveys. For other countries, Pakistan this disaggregation was based on regional M:F ratios from a 3 Ghana systematic review and meta-analysis. Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates. Report of the sixth meeting of the full task force; 19–21 April 2016, Glion-sur-Montreux, Switzerland. Prevalence estimates are from a cross-sectional survey, and therefore only represent one point in time. These numbers correspond to 65% of cases 15–24 being males and 35% females, and 90% of cases being adults 1 5–14 and 10% children. Ten countries n have both been increasing since 2013, mostly accounted for 75% of the gap between enrolments explained by a 37% increase in notifcations in India. Variation among 2012 and the rollout (also since 2012) of a nationwide web- countries in the child:adult and M:F ratios of cases may refect based and case-based reporting system (called “Nikshay”) real diferences in epidemiology, diferential access to or use that facilitates reporting of detected cases by care providers of health-care services, or diferential reporting practices. The percentage of cases prevalence surveys of adults in African and Asian countries with bacteriological confrmation worldwide has declined implemented in 2007–2016 approximated 2. It excludes cases that have been re-registered as treatment after failure, as treatment after lost to follow up or as other previously treated (whose outcome after the most recent course of treatment is unknown or undocumented).

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Repetitive use of the upper limb cheap proscar 5mg fast delivery, particularly in abduction such as during throwing generic proscar 5 mg free shipping, swimming, or racquet sports, may lead to acute or chronic inflammation of the bursa or muscle tendons, a tear of the glenoid labrum, or degeneration or tears of the rotator cuff. Because the humeral head is strongly supported by muscles and ligaments around its anterior, superior, and posterior aspects, most dislocations of the humerus occur in an inferior direction. This can occur when force is applied to the humerus when the upper limb is fully abducted, as when diving to catch a baseball and landing on your hand or elbow. Inflammatory responses to any shoulder injury can lead to the formation of scar tissue between the articular capsule and surrounding structures, thus reducing shoulder mobility, a condition called adhesive capsulitis (“frozen shoulder”). Elbow Joint The elbow joint is a uniaxial hinge joint formed by the humeroulnar joint, the articulation between the trochlea of the humerus and the trochlear notch of the ulna. The articular capsule of the elbow is thin on its anterior and posterior aspects, but is thickened along its outside margins by strong intrinsic ligaments. This arises from the medial epicondyle of the humerus and attaches to the medial side of the proximal ulna. The strongest part of this ligament is the anterior portion, which resists hyperextension of the elbow. The ulnar collateral ligament may be injured by frequent, forceful extensions of the forearm, as is seen in baseball pitchers. Reconstructive surgical repair of this ligament is referred to as Tommy John surgery, named for the former major league pitcher who was the first person to have this treatment. This arises from the lateral epicondyle of the humerus and then blends into the lateral side of the annular ligament. This ligament supports the head of the radius as it articulates with the radial notch of the ulna at the proximal radioulnar joint. This is a pivot joint that allows for rotation of the radius during supination and pronation of the forearm. Hip Joint The hip joint is a multiaxial ball-and-socket joint between the head of the femur and the acetabulum of the hip bone (Figure 9. The hip carries the weight of the body and thus requires strength and stability during standing and walking. This space is deep and has a large articulation area for the femoral head, thus giving stability and weight bearing ability to the joint. The acetabulum is further deepened by the acetabular labrum, a fibrocartilage lip attached to the outer margin of the acetabulum. The surrounding articular capsule is strong, with several thickened areas forming intrinsic ligaments. These ligaments arise from the hip bone, at the margins of the acetabulum, and attach to the femur at the base of the neck. The ligaments are the iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament, all of which spiral around the head and neck of the femur. The ligaments are tightened by extension at the hip, thus pulling the head of the femur tightly into the acetabulum when in the upright, standing position. These ligaments thus stabilize the hip joint and allow you to maintain an upright standing position with only minimal muscle contraction. Inside of the articular capsule, the ligament of the head of the femur (ligamentum teres) spans between the acetabulum and femoral head. This intracapsular ligament is normally slack and does not provide any significant joint support, but it does provide a pathway for an important artery that supplies the head of the femur. The hip is prone to osteoarthritis, and thus was the first joint for which a replacement prosthesis was developed. A common injury in elderly individuals, particularly those with weakened bones due to osteoporosis, is a “broken hip,” which is actually a fracture of the femoral neck. This can happen as one lower limb is taking a step and all of the body weight is placed on the other limb, causing the femoral neck to break and producing a fall. Any accompanying disruption of the blood supply to the femoral neck or head can lead to necrosis of these areas, resulting in bone and cartilage death. Femoral fractures usually require surgical treatment, after which the patient will need mobility assistance for a prolonged period, either from family members or in a long-term care facility. In addition, hip fractures are associated with increased rates of morbidity (incidences of disease) and mortality (death). Surgery for a hip fracture followed by prolonged bed rest may lead to life-threatening complications, including pneumonia, infection of pressure ulcers (bedsores), and thrombophlebitis (deep vein thrombosis; blood clot formation) that can result in a pulmonary embolism (blood clot within the lung). What is a possible consequence following a fracture of the femoral neck within the capsule of the hip joint?

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It is located on the floor of the pelvic cavity and 346 Human Anatomy and Physiology like the kidneys and ureters buy proscar 5mg cheap. The opening of ureters and urethra in the cavity of the bladder outline triangular area called the trigone 5mg proscar with amex. At the site where the urethra leaves the bladder, the smooth muscle in the wall of the bladder forms spiral, longitudinal and circular bundles which contract to prevent the bladder from emptying prematurely. Far there along the urethra in the middle membranous portion a circular sphincter of voluntary skeletal muscle form the external urethral sphincter. In male it pass through prostate, membranous portion (pelvic diaphragm muscle), spongy portion (that pass through corpus spongosus) and open at the tip of penis. However, it is composed of mainly water, urea, chloride, potassium, sodium, cretinin, phosphate, sulfates and uric acid. Proteins, glucose, casts (decomposed blood) and calculi from minerals are abnormal if present in urine. To maintain the proper osmotic concentration of the extra cellular fluid to excrete wastes and to maintain proper kidney function the body must excrete at least 450ml of urine per day. The volume and concentration of urine is controlled by: - Antidiuretic hormone - Aldestrone - The Renin – angiotensin mechanism 349 Human Anatomy and Physiology 12. Steps of urination are: Conscious desire to urinate Pelvic diaphram muscle relax Smooth muscle of Urinary bladder neck Moves Urinary bladder down, outlet Opens, wall Contracts & urine stretch, and wall stretch ejects Receptors are stimulated 350 Human Anatomy and Physiology Study Questions 1. The apex of each renal pyramid end in the a) Cortical region b) Papilla c) Juxta medullary region d) Capsule e) Tubule 2. The inner most layer of the ureters is the a) Mucosa b) Muscularis c) Adventitia d) Longitudinal layer e) Circular layer 3. The kidney function in all of the following except a) Acid – base balance b) An endocrine organ c) By removing metabolic waste d) By removing excess carbon dioxide e) By maintaining osmotic concentration 4. An increased volume of urine formation would follow:- a) Inhibition of tubular sodium re-absorption b) A fall in plasma osmolarity c) A fall in plasma volume d) a and b e) a, b and c 5. The volume or chemical makeup of these fluids whenever deviates even slightly from normal, disease results. The correct proportion of water and electrolytes in the water and proper acid base balance are necessary for life to exist. Loss of 10% of total body water usually produce lethargy, fever and dryness on mucous membrane and a 20% loss is fatal. Extra cellular fluids found as interstitial fluid (the immediate environment of body cells), blood plasma and lymph, cerebrospinal, synovial, fluids of the eye & ear, pleural, pericardial, peritoneal, gastrointestinal and glomerular filtrate of the kidney. The concentration of water in the interstitial fluid is slightly higher than the concentration of water in plasma. The plasma proteins are responsible for this difference 354 Human Anatomy and Physiology A B Figure: 13. Hydrostatic pressure: it is the force exerted by a fluid against the surface of the compartment containing fluid. Osmotic pressure: Is the pressure that must be applied to a solution on one side of a selectively permeable membrane to prevent the Osmotic flow of water across the membrane from a compartment of pure water. When there is shift in the pressure of water to wards the interstitial space, accumulation of fluid in the space occur. Such accumulation of water produces distention of the tissue which appears as puffiness on the surface of the body. Causes of edema may be plasma protean leakage decreased protein synthesis, increased capillary or venous hydrostatic pressure, obstructed lymphatic vessels and inflammatory reaction. Under normal condition water is taken in to and excreted from the body, so it matches to maintain homeostasis. Drinking of water is regulated by nervous mechanism (thirst center in the brain) together with hormonal mechanism (Antidiuretic hormone). Kidneys are the organs regulated by homeostatic feed back response they are responsible for excreting most of the water from the body. These three electrolytes are particularly important in maintaining body function and normal water distribution among the fluid compartment. Enzymes, hormones and the distribution 360 Human Anatomy and Physiology of ions can all be affected by the concentration of hydrogen H ion. H Homeostatic maintenance of an acceptable P range in the extra cellular fluid is accomplished by three mechanisms: 1. This task is accomplished in renal tubules, where + hydrogen & ammonium ions are secreted in to urine, when H is excreted sodium is exchanged.

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