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California encephalitis: Almost entirely affects children who usually have a history of recreational exposure in the woods prior to the onset of the disease order malegra dxt plus 160mg otc. Woodland mosquitoes are probably the vectors and small animals and birds do not appear to be involved discount 160 mg malegra dxt plus with mastercard. Although the disease may be quite severe generic 160mg malegra dxt plus, death is rare buy malegra dxt plus 160 mg low cost, and sequelae occur in only 15% of the children generic malegra dxt plus 160 mg overnight delivery. Type 1 is usually associated with primary oropharyngeal lesions and causes acute encephalitis in adults. Type 2 is associated with genital lesions and causes disseminated infection in neonates and an aseptic meningitis in adults. Clinical symptoms and signs: Starts with fever and headaches Seizures are common Nuchal rigidity may be present Progressive mental deficits, confusion and personality changes Pathological findings: Intense meningitis Necrotic, inflammatory, or hemorrhagic lesions Predilection for frontal and temporal lobes. Intranuclear inclusions, Cowdry type A Perivascular inflammation Though treatable, the mortality rate is high (around 70%). The diagnosis of Herpes can be made rapidly by brain biopsy using an immunoperoxidase test. Pathologically there is a lymphocytic infiltrate in the ganglia of the spinal cranial nerve roots. Rarely, varicella-zoster may cause an acute encephalitis, particularly after involvement of cranial nerve roots. Pathologic features: Except for the unusual case in which there may be small focal areas of necrosis in the periventricular region, the gross appearance of the brain may be deceptively normal. Rarely, a fulminating case will show necrotizing lesions with parenchymal destruction. The cerebrum is affected by a granulomatous encephalitis with extensive subependymal calcification. Hydrocephalus, hydranencephaly, microcephaly, cerebellar hypoplasia, or other developmental defects may be found. Clinical evidence of nervous system dysfunction has been reported to occur in approximately 30 - 40% of patients. The cells containing the majority of this virus appears to be of macrophage origin. However, as the disease progresses, atrophy develop as evidenced by a decrease in brain weight, prominent gaping of the cerebral sulci and dilatation of the ventricular system. There may be some attenuation of the white matter, particularly of the cerebral hemisphere. Microscopic pathology: Reactive microglial cells are present throughout the gray and white matter. Occasionally, they aggregate into cellular clusters with reactive astrocytes to form microglial nodules. These cells can be found in microglial nodules, perivascularly, or scattered through the brain parenchyma. Nonspecific white matter changes include foci of demyelination and vacuolar change. The calcification often involves the basal ganglia, but may spill into the centrum semiovale. In addition, they also may be found in the lower layers of the cortex and in the basal ganglia. These disorders are quite unusual and have been classified in the past as ‘infectious’, but more appropriately ‘transmissible’ disorders. This group of disorders is also widely classified as neurodegenerative disorders because the clinical and pathological features are more characteristic of neurodegenerative disorders rather than infectious disorders. The putative transmissible agent has been called a Prion (proteinaceous infectious particle). This agent differs radically from conventional infectious agents in that it appears to 41 be composed of protein only. It is insensitive to physical or chemical treatments that inactivate all known viruses. Formalin fixation does not destroy infectivity, but exposure to Clorox, formic acid or stringent autoclaving does.

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Cross matching to determine blood type is necessary before transfusing blood purchase malegra dxt plus 160 mg on line, unless the patient is experiencing hemorrhage − that is an immediate threat to life malegra dxt plus 160mg mastercard, in which case type O blood may be transfused purchase 160 mg malegra dxt plus visa. The one of the specimen types included cheap malegra dxt plus 160mg without a prescription, refers to a sample standard method is to use a grid best 160 mg malegra dxt plus, but this is not possible of plasma after clotting factors have been removed. Try constructing a simple table with types of measurements are given for levels of glucose in the each leukocyte type and then making a mark for each cell blood? The coagulation cascade restores hemostasis by activating coagulation factors in the presence of an injury. How does the endothelium of the blood vessel walls prevent the blood from coagulating as it flows through the blood vessels? It is a hemopoietic growth factor that prompts cancer cells lymphoid stem cells to leave the bone marrow. The process in which antibodies attach to antigens, causing the formation of masses of linked cells, is called 26. A patient was admitted to the burn unit the previous what percentage of the patient’s blood is plasma? Explain what has happened during the hour scar tissue formation in the bone marrow impair that the sample was in the glass tube. Would you expect a patient with a form of cancer is a first intervention for someone who has suffered a called acute myelogenous leukemia to experience impaired thrombotic stroke. The technician collects a characterized by abnormal synthesis of globin proteins and blood sample and performs a test to determine its type. One of the more common adverse effects of cancer technician made an error, or is this a normal response? Lynch) Introduction Chapter Objectives After studying this chapter, you will be able to: • Identify and describe the interior and exterior parts of the human heart • Describe the path of blood through the cardiac circuits • Describe the size, shape, and location of the heart • Compare cardiac muscle to skeletal and smooth muscle • Explain the cardiac conduction system • Describe the process and purpose of an electrocardiogram • Explain the cardiac cycle 824 Chapter 19 | The Cardiovascular System: The Heart • Calculate cardiac output • Describe the effects of exercise on cardiac output and heart rate • Name the centers of the brain that control heart rate and describe their function • Identify other factors affecting heart rate • Describe fetal heart development In this chapter, you will explore the remarkable pump that propels the blood into the vessels. There is no single better word to describe the function of the heart other than “pump,” since its contraction develops the pressure that ejects blood into the major vessels: the aorta and pulmonary trunk. Although the connotation of the term “pump” suggests a mechanical device made of steel and plastic, the anatomical structure is a living, sophisticated muscle. Although the term “heart” is an English word, cardiac (heart-related) terminology can be traced back to the Latin term, “kardia. If one assumes an average rate of contraction of 75 contractions per minute, a human heart would contract approximately 108,000 times in one day, more than 39 million times in one year, and nearly 3 billion times during a 75-year lifespan. Each of the major pumping chambers of the heart ejects approximately 70 mL blood per contraction in a resting adult. In order to understand how that happens, it is necessary to understand the anatomy and physiology of the heart. Location of the Heart The human heart is located within the thoracic cavity, medially between the lungs in the space known as the mediastinum. Within the mediastinum, the heart is separated from the other mediastinal structures by a tough membrane known as the pericardium, or pericardial sac, and sits in its own space called the pericardial cavity. The dorsal surface of the heart lies near the bodies of the vertebrae, and its anterior surface sits deep to the sternum and costal cartilages. The great veins, the superior and inferior venae cavae, and the great arteries, the aorta and pulmonary trunk, are attached to the superior surface of the heart, called the base. The inferior tip of the heart, the apex, lies just to the left of the sternum between the junction of the fourth and fifth ribs near their articulation with the costal cartilages. It is important to remember the position and orientation of the heart when placing a stethoscope on the chest of a patient and listening for heart sounds, and also when looking at images taken from a midsagittal perspective. The slight deviation of the apex to the left is reflected in a depression in the medial surface of the inferior lobe of the left lung, called the cardiac notch. By applying pressure with the flat portion of one hand on the sternum in the area between the line at T4 and T9 (Figure 19. This is particularly critical for the brain, as irreversible damage and death of neurons occur within minutes of loss of blood flow. Current standards call for compression of the chest at least 5 cm deep and at a rate of 100 compressions per minute, a rate equal to the beat in “Staying Alive,” recorded in 1977 by the Bee Gees. At this stage, the emphasis is on performing high-quality chest compressions, rather than providing artificial respiration.

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Wiener nomenclature Wiener’s theory states one gene instead of three closely linked ones purchase malegra dxt plus 160 mg with visa, produces one complex antigen which is made up of three factors found on the red cells order 160 mg malegra dxt plus fast delivery. According to Fisher – Race purchase malegra dxt plus 160mg line, three pairs of allelic genes on the same chromosome (haplotype) will determine the production or non- production of D with C or c malegra dxt plus 160mg with visa, E or e cheap malegra dxt plus 160mg line. They are not found in body fluids (like saliva, amniotic fluid) and not detected on leucocytes or platelets. Individuals who lack any of these antigens may be stimulated to produce the corresponding antibodies (anti-D, anti- C, ant -c, anti-E, anti-e) by transfusion or pregnancy. Antigen D, having antigen site between 110,000 and 202,000 per erythrocyte, is the most important of the rhesus antigens 53 medically, because it is highly antigenic than the other Rhesus antigens. A person is grouped as Rhesus (Rh) positive or negative based on the presence or absence of antigen D: - Rh positive: a person who inherits gene D and the red cell express antigen D. As a recipient u individuals with D + red cells regarded as Rh negative, u because of the risk of provoking the formation anti-D in a D + subject through the transfusion of D+ blood. Rh antibodies occur in individuals who lack the corresponding antigens, and as a consequence of transfusion or pregnancy (i. However, some exception, in a few percentage found to be naturally occurring, as example anti- E & anti- C are non red cell immune antibodies, and agglutinate red cells suspended in saline at room temperature. Their production is consistent with the classical immune response in that the earliest antibody to appear is IgM , followed by IgG, some IgA have also bean identified. The predominant Rh antibodies however, are immunoglobulin class IgG, which most of them are IgG1 or IgG3 subclasses. Following transfusion of one or more units of Rh positive blood, 50 to 75% of D negative recipients develop anti- D; but 25 to 30% of D negative individuals are non responders, unable to produce anti-D inspite of repeated stimulation with Rh+ blood. Secondary immunization in subjects who are primarily immunized to Rh (D) may result in maximal increase in antibody concentration in 3 weeks. Rh antibodies cause severe hemolytic transfusion reaction in a recipient if transfused with blood possessing the offending antigen. In the Rh blood group system, 56 naturally occurring Rh antibodies are not found in the serum of persons lacking the corresponding Rh antigens. In performing Rh grouping the number of drops, time and speed of centrifugation shall be determined by manufactures directions. Mix the mixtures on each slide using an applicators stick, spreading the mixture evenly over most of the slide. Gently re suspend the cell button and look for agglutination and grade the results (a reaction of any grade is interpreted as Rh positive) a smooth suspension of cells must be observed in the control. Interpretation: the positive result is agglutination in the tube containing anti–D and the control is negative. It is a sensitive technique in the detection of incomplete antibodies, anti bodies that can sensitize but which fail to agglutinate red cells suspended in saline at room temperature, mainly IgG. These antibodies are agglutinated by the anti- IgG in antiglobulin serum through the linking of the IgG molecules on neighboring red cells,as shown in Fig 5. The anti complement helps in detecting IgM antibodies, which bind complement but may elute off the red cells with increase in temperature, leaving complement components alone on the red blood cells. The anti globulin reagent is prepared by immunizing animals, often rabbits with human gamma globulin (antibody) and, or beta globulin (components of complement). There are two types of anti globulin reagents that can be used in laboratory procedure: broad spectrum (polyspecific sera) and monospecfic sera. The reagent may also contain antibodies of other specificities such as anti- IgM, anti-IgA, anti C-3, or anti C-4. Wash the red cells 3-4 times using normal saline, ensuring adequate removal of the supernatant after each wash. Gently re suspend the red cells and examine macroscopically and microscopically for agglutination or hemolysis. If a negative result is obtained, the test result is invalid if mono anti complement reagents are used complement sensitized red cells should be for substituted for IgG sensitized red cells. After washing to dilute the excess antibody in the serum, the addition anti globulin serum produces agglutination in the presence of incomplete antibodies. In the cold type the patient’s serum contains high titer cold 0 agglutinins, optimally active at 2 C but with a temperature 0 range which may go as high as 32 C. An infant having inherited an antigen from the father, which is absent in the mother, causes her to form the corresponding antibodies. These antibodies pass 68 through the placenta by active transport mechanism, coat the fetal erythrocytes and cause damage to them.

The primary motor cortex is arranged in a similar fashion to the primary somatosensory cortex malegra dxt plus 160mg free shipping, in that it has a topographical map of the body cheap malegra dxt plus 160 mg mastercard, creating a motor homunculus (see Figure 14 malegra dxt plus 160 mg sale. The neurons responsible for musculature in the feet and lower legs are in the medial wall of the precentral gyrus purchase 160mg malegra dxt plus overnight delivery, with the thighs generic malegra dxt plus 160 mg with mastercard, trunk, and shoulder at the crest of the longitudinal fissure. Also, the relative space allotted for the different regions is exaggerated in muscles that have greater enervation. The greatest amount of cortical space is given to muscles that perform fine, agile movements, such as the muscles of the fingers and the lower face. The “power muscles” that perform coarser movements, such as the buttock and back muscles, occupy much less space on the motor cortex. Descending Pathways The motor output from the cortex descends into the brain stem and to the spinal cord to control the musculature through motor neurons. Neurons located in the primary motor cortex, named Betz cells, are large cortical neurons that synapse with lower motor neurons in the brain stem or in the spinal cord. The two descending pathways travelled by the axons of Betz cells are the corticobulbar tract and the corticospinal tract, respectively. Both tracts are named for their origin in the cortex and their targets—either the brain stem (the term “bulbar” refers to the brain stem as the bulb, or enlargement, at the top of the spinal cord) or the spinal cord. These two descending pathways are responsible for the conscious or voluntary movements of skeletal muscles. Any motor command from the primary motor cortex is sent down the axons of the Betz cells to activate upper motor neurons in either the cranial motor nuclei or in the ventral horn of the spinal cord. The axons of the corticobulbar tract are ipsilateral, meaning they project from the cortex to the motor nucleus on the same side of the nervous system. Conversely, the axons of the corticospinal tract are largely contralateral, meaning that they cross the midline of the brain stem or spinal cord and synapse on the opposite side of the body. Therefore, the right motor cortex of the cerebrum controls muscles on the left side of the body, and vice versa. It then passes between the caudate nucleus and putamen of the basal nuclei as a bundle called the internal capsule. The tract then passes through the midbrain as the cerebral peduncles, after which it burrows through the pons. Upon entering the medulla, the tracts make up the large white matter tract referred to as the pyramids (Figure 14. The defining landmark of the medullary- spinal border is the pyramidal decussation, which is where most of the fibers in the corticospinal tract cross over to the opposite side of the brain. At this point, the tract separates into two parts, which have control over different domains of the musculature. The upper motor neuron has its cell body in the primary motor cortex of the frontal lobe and synapses on the lower motor neuron, which is in the ventral horn of the spinal cord and projects to the skeletal muscle in the periphery. Appendicular Control The lateral corticospinal tract is composed of the fibers that cross the midline at the pyramidal decussation (see Figure 14. The axons cross over from the anterior position of the pyramids in the medulla to the lateral column of the spinal cord. The ventral horn in both the lower cervical spinal cord and the lumbar spinal cord both have wider ventral horns, representing the greater number of muscles controlled by these motor neurons. The cervical enlargement is particularly large because there is greater control over the fine musculature of the upper limbs, particularly of the fingers. The lumbar enlargement is not as significant in appearance because there is less fine motor control of the lower limbs. Axial Control The anterior corticospinal tract is responsible for controlling the muscles of the body trunk (see Figure 14. Instead, they remain in an anterior position as they descend the brain stem and enter the spinal cord. Upon reaching the appropriate level, the axons decussate, entering the ventral horn on the opposite side of the spinal cord from which they entered. The lower motor neurons are located in the medial regions of the ventral horn, because they control the axial muscles of the trunk. Because movements of the body trunk involve both sides of the body, the anterior corticospinal tract is not entirely contralateral. Some collateral branches of the tract will project into the ipsilateral ventral horn to control synergistic muscles on that side of the body, or to inhibit antagonistic muscles through interneurons within the ventral horn. Through the influence of both sides of the body, the anterior corticospinal tract can coordinate postural muscles in broad movements of the body. These coordinating axons in the anterior corticospinal tract are often considered bilateral, as they are both ipsilateral and contralateral.

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