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A General Embryology (a) Definition of embryology; gestation period: definition of gamete sperm metabolic disorder journal buy 500mg actoplus met with visa, Ovum; gametogenesis type 2 diabetes mellitus leaflet actoplus met 500 mg fast delivery, migration of primordial germ cells into gonadal ridge; spermatogenesis; structure of sperm diabetes medications generic names cheap actoplus met master card, oogenesis; structure of ovum; growth of ovarian follicles, ovarian and uterine cycles. Implantation; formation of decidua, types of implantation and abnormal sites of implantation (e) Third Week of Development Appearance of primitive streak and primitive node; formation of intraembroynic mesoderm resulting in trilaminar germ disc; gastrulation formation of notochord, buccopharyngeal and cloacal membranes, paraxial, intermediate and lateral plate mesoderm, secondary yolk sac, intraembryonic coelom and allantoic diverticulum; derivatives of ectoderm, mesoderm and endoderm. Development from third month to birth (Fetal period) (g) Maturation of tissues and organs and rapid growth of body. Placenta (i) Formation of placenta and chorionic villi, decidua basalis; features and functions of placenta; placental circulation; abnormalities; placental barrier; placentome, types of placenta. Amniotic Cavity (k) Amniotic cavity and membrane; amniotic fluid – functions, expansions of amniotic cavity and fusion with chorion; chorion laeve with decidua capsularis; decidua capsularis with parietalis; obliteration of chorionic and uterine cavities; function of fused foetal membranes to dilate cervical canal. Theratology (o) Genetical and environmental factors as causative factors for congenital malformations. B Systemic Embryology (a) Development of the individual organs of digestive system, genital system, urinary system,, respiratory system, cardiovascular system. Abdomen: Dissection: Anterior abdominal wall and inguinal region, external genitalia. Lower Limb: Dissection: Gluteal region, front and back of thigh popliteal fossa, front back and lateral side of leg and dorsum of foot. Prosected Parts: Sole of the foot and joints Head & Neck: Dissection: Superficial and deep dissection of face and neck, orbit and eye ball. Submandibular region temporal and infratemporal fossa, cranial cavity, naso and oropharyngeal regions. Neuro Anatomy Gross specimen of full brain, meninges, spinal cord, prosected specimens to demonstrate visual system, auditory and vesibular pathways and major functional areas. Stained sections of brain and spinal cord at various levels to demonstrate cranial nerve nuclei, ascending and descending tracts, thalamic nuclei and important functional areas. Developmental Anatomy – Models to demonstrate various stages of early foetus and different organ development. Genetics Demonstration of normal karyotype and common abnormal conditions including banding; Pedigree chart, syndromes and their clinical phenotype. Localise important pulsation and the structures against which pressure can be applied in case of bleeding from a particular artery. Locate sites for : Lumbar puncture, sternal puncture, pericardial tapping, liver biopsy. Gross, Histology, Embryology, Genetics and Neuroanatomy are taught with the help of didactic lectures on specific topics followed by dissection / practicals. The general pattern of teaching methodology followed by all the faculty members and teaching staff in the department is : Anatomy 9 1. Dissection : is done by students on the cadavers and is being assisted/supervised by a team of teachers. Handouts are given at the end of completion of part/region to the students to recaptulate and remember the Gross anatomy, Neuroanatomy, Embryology and Histology. In embryology, the serial sections of early chick embryos and pig embryos are demonstrated to understand the sequence of events involved in development of various systems and to understand the developmental basis of occurrence of various congenital abnormalities. Computer assisted programs for understanding the normal development of organ/systems is also demonstrated. In genetics, the phenotype photographs, karyotyPes and pictures of various banding techniques are shown to understand the chromosomal abnormalities and various syndromes. In Neuroanatomy, the stained sections at various levels of brain and spinal cord are shown on slides and computers to localize the cranial nerve nuclei and trace the origin, course and termination of ascending and descending tracts in order to understand the effects produced as a result of lesions. Case studies of neural lesions are discussed to understand the location and level of lesions. Demonstrations : Mainly the bones of the entire body, few dissected specimen are taught in small groups.
He had moderate chorea blood sugar 78 cheap 500 mg actoplus met overnight delivery, moderate dysarthria diabetes test results explained actoplus met 500 mg fast delivery, motor impersistence diabetic quantum computer buy actoplus met 500 mg mastercard, and gait instability. He was referred for formal neuropsychological assessment, and met with the social worker to assist with the completion of disability forms. A speech- language pathologist evaluated his swallow function, which was minimally impaired, and the dietician discussed his caloric needs and made recommendations about high calorie foods and nutritional supplements. The man and his wife had not previously met with a genetic counselor, so a genetics consultation was arranged. The physical therapist recommended a daily exercise program to help the man maintain his mobility and balance. The man’s wife was struggling with the situation, as she was also working part-time and caring for the couple’s two children. A follow-up appointment with the doctor was scheduled for one month later, to evaluate the effects of medication changes and ensure that the recommendations of the health team had been well-received. At that time, the man’s wife reported that his irritability was improved, and that he was sleeping better, although he was still somewhat perseverative. After a variety of relationship, fnancial, and legal problems, she visited a psychiatrist, who referred her to a neurologist because of some involuntary movements. The family physician found no evidence of medical disease, despite the woman’s rapid 15 pound weight loss. The neurologist there found abnormal involuntary movements, abnormal saccadic eye movements, impersistence of tongue protrusion, inability to perform a three-step motor command, diffusely brisk refexes, and an erratic lurching gait. No new medications were needed, as the depression and anxiety were, by then, adequately controlled, but benztropine was deemed to be unnecessary and was discontinued. The social worker spoke with the family about applying for Social Security Disability Insurance benefts, as the psychometric testing showed moderate subcortical dementia. The dietician talked with the woman and her family about healthy eating and strategies to increase caloric intake. Six months later, she had successfully qualifed for Social Security Disability Insurance benefts, and had moved into an assisted living facility near her parents. She had completed her Advance Care Directives, and was an active participant in a clinical research study. Her mood had brightened substantially as she now understood the cause of her disabilities. Those who have not stopped driving ft into one of three categories: Those with no discernable problems, those who represent an obvious menace, usually because of a record of prior incidents or grossly impaired judgment, and those about whom the clinician is initially unsure. Uninsightful or desperate individuals may not always be upfront about these issues, and the family can be encouraged to examine the car for dents and scratches and to make sure the insurer has not cancelled the person’s policy. Have they noticed any irregularities such as swerving, errors of judgment, diffculty braking, or uneven pressure on the accelerator? A good rule of thumb is that if a person’s family would not allow him to pick up children from school then he does not belong on the road. Family members may fear the person’s reaction to their opinions and should be given a chance to speak to the physician alone. They may need advice and support to help them feel strong enough to take the necessary steps. Individuals and families should be encouraged to think ahead and develop a plan for driving cessation that addresses questions such as “Is the person living in an accessible area? In life and death matters such as this, the instruction to stop driving is not a recommendation. The physician must be willing to expend considerable emotional goodwill on this issue or even to lose the person from her practice entirely. A recalcitrant individual should be told that the assessment of him as an unsafe driver and the explicit instruction to stop will be entered into his permanent medical record, and that the doctor will not support him if an accident occurs.
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If intravenous administration is not possible blood glucose 210 order actoplus met with american express, diazepam can be administered intramuscularly diabetes mellitus feline purchase actoplus met visa. Further blood glucose kit for dogs cheap actoplus met 500 mg otc, seizures are often a signal of 4-6 other serious disease, and thus deserve a prompt and full medical work-up to rule out other causes such as brain tumors. Recognition and early treatment of alcohol withdrawal symptoms is key to prevention. One should talk with the patient in a calm voice and explain in simple terms what is going on. The room should be kept evenly lighted at all times because delirium usually is worse in the dark or in twilight. Rarely, restraints may be needed to prevent the patient from hurting himself or others. Restraints should be applied carefully, and only if safe procedures are known and followed. Mechanical restraints can be dangerous, tend to antagonize or irritate the patient, and should be used only when absolutely necessary. Restraining appliances should not be placed within reach of the patient’s fingers or teeth, or where they might cause pressure or discomfort. A complete written record explaining why restraints were needed, how they were applied, and the patients condition at regular intervals (about 15 minutes) is essential. The chart should be signed by each crew member providing one-on-one observation during their time “on watch”. Restraints should only be used if no other intervention will prevent danger to the patient or others; a patient in restraints requires close and continual one-on-one monitoring. Alcohol dependence may include tolerance, withdrawal, and the inability to reduce use, even when it interferes with other parts of one’s life. Alcohol abuse occurs when alcohol use interferes with work, school and home-life, and may also include alcohol-related legal problems. Some alcohol abusers go on periodic sprees or binges, but between these they drink little or no alcohol. Treatment Alcohol dependence and abuse are difficult to manage and treat aboard ship. For someone who has the determination to quit drinking, attending meetings in the various ports-of-call can be helpful. However, management of the crew member who does not want to change problem drinking behaviors is challenging. Most importantly, alcohol use must be prevented from interfering with the safe operation and management of the ship. They can be consumed as a solid or liquid; sniffed, snorted, or smoked; injected; inserted rectally; or applied to the skin. When drug dependence occurs, both tolerance (more drug is needed for the same effect) and withdrawal symptoms can be present. For example, with amphetamine use, a usually bored sleepy person may be more alert and even improve his/her performance. Conversely, a nervous, high-strung individual on barbiturates may be more cooperative and easier to manage.
Isomerases: Includes all enzymes catalyzing interconversion of optical ada definition diabetes type 2 buy actoplus met 500mg on line, geometric diabetes type 2 vitamins actoplus met 500 mg, or positional isomers diabetes high blood sugar symptoms purchase discount actoplus met. Example: Enzymes catalyzing interconversion of aldose and ketoses D - Glyceraldehyde-3- phosphate ketoisomerase (triosephosphate isomerase) D - Glyceraldehyde-3phosphate Dihydroxyacetone phosphate. Lock: Key model of enzyme action implies that the active site of the enzyme is complementary in shape to that of its substrate, i. Figure: Models of enzyme- substrate interactions Mechanism of Enzyme Action (1913) Michaels and Menten have proposed a hypothesis for enzyme action, which is most acceptable. Enzyme once dissociated from the complex is free to combine with another molecule of substrate and form product in a similar way. The transition state is the top of the energy barrier separating the reactants and products. The rate of a given reaction will vary directly as the number of reactant molecules in the transition state. The “energy of activation is the amount of energy required to bring all the molecules in 1 gram-mole of a substrate at a given temperate to the transition state A rise in temperature, by increasing thermal motion and energy, causes an increase in the number of molecules on the transition state and thus accelerates a chemical reaction. The enzyme combines transiently with the substrate to produce a transient state having c lower energy of activation than that of substrate alone. Once the products are formed, the enzyme (or catalyst) is free or regenerated to combine with another molecule of the substrate and repeat the process. Activation energy is defined as the energy required to convert all molecules in one mole of reacting substance from the ground state to the transition state. Themperature Starting from low temperature as the temperature increases to certain degree the activity of the enzyme increases because the temperature increase the total energy of the chemical system. Above this the reaction rate decreases sharply, mainly due to denaturation of the enzyme by heat. The temperature at which an enzyme shows maximum activity is known as the optimum temperature for the enzyme. For most body enzymes the optimum 0 temperature is around 37 c, which is body temperature. First, the catalytic process usually requires that the enzyme and substrate have specific chemical groups in an ionized or unionized sate in order to interact. Extreme pH can also lead to denaturation of the enzyme, because the structure of the catalytically active protein molecule depends on the ionic character of the amino acid chains. The pH at which maximum enzyme activity is achieved is different for different + enzymes, and after reflects the pH ] at which the enzyme functions in the body. For example, pepsin, a digestive enzyme in the stomach, has maximum action at pH 2, where as other enzymes, designed to work at neutral pH, are denatured by such an acidic environment. Concentration of substrate At fixed enzyme concentration pH and temperature the activity of enzymes is influenced by increase in substrate concentration. An increase in the substrate concentration increases the enzyme activity till a maximum is reached. This condition shows that as concentration of substrate is increased, the substrate molecule combine with all available enzyme molecules at their active site till not more active sites are available (The active Sites become saturated). Relationship between [S] and Km Km shows the relationship between the substrate concentration and the velocity of the enzyme catalyzed reaction. Take the point in which 50% of the active site of the enzyme will be saturated by substrate, Assume that at ½ Vmax-50% of the active site of enzyme becomes saturated. Therefore: 11 Vo = ½ Vmax, at 50% saturation ½ Vmax = Vmax[S] Km + [S] 2[S] = Km + [S] Km= [S] Figure: Relationship between [S] and Km Characteristics of Km Km- can defined as the concentration of the substrate at which a given enzyme yields one-half its max. Km- values varies from enzyme to enzyme and used to characterized different enzymes. Km- values of an enzyme helps to understand the nature and speed of the enzyme catalysis.