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By F. Baldar. Fielding Graduate University. 2018.

A small amount of oxygen does dissolve in the blood and is transported in the bloodstream purchase nizagara 25 mg erectile dysfunction and diabetes pdf, but it is only about 1 generic 100mg nizagara fast delivery erectile dysfunction drugs lloyds. The majority of oxygen molecules are carried from the lungs to the body’s tissues by a specialized transport system, which relies on the erythrocyte—the red blood cell. Erythrocytes contain a metalloprotein, hemoglobin, which serves to bind oxygen molecules to the erythrocyte (Figure 22. One hemoglobin molecule contains iron-containing Heme molecules, and because of this, each hemoglobin molecule is capable of carrying up to four molecules of oxygen. As oxygen diffuses across the respiratory membrane from the alveolus to the capillary, it also diffuses into the red blood cell and is bound by hemoglobin. The following reversible chemical reaction describes the production of the final product, oxyhemoglobin (Hb–O ), which is formed when oxygen2 binds to hemoglobin. Oxyhemoglobin is a bright red-colored molecule that contributes to the bright red color of oxygenated blood. Hb + O2 ↔ Hb − O2 In this formula, Hb represents reduced hemoglobin, that is, hemoglobin that does not have oxygen bound to it. There are multiple factors involved in how readily heme binds to and dissociates from oxygen, which will be discussed in the subsequent sections. Function of Hemoglobin Hemoglobin is composed of subunits, a protein structure that is referred to as a quaternary structure. Each of the four subunits that make up hemoglobin is arranged in a ring-like fashion, with an iron atom covalently bound to the heme in the center of each subunit. Binding of the first oxygen molecule causes a conformational change in hemoglobin that allows the second molecule of oxygen to bind more readily. As each molecule of oxygen is bound, it further facilitates the binding of the next molecule, until all four heme sites are occupied by oxygen. The opposite occurs as well: After the first oxygen molecule dissociates and is “dropped off” at the tissues, the next oxygen molecule dissociates more readily. Therefore, when considering the blood as a whole, the percent of the available heme units that are bound to oxygen at a given time is called hemoglobin saturation. Hemoglobin saturation of 100 percent means that every heme unit in all of the erythrocytes of the body is bound to oxygen. In a healthy individual with normal hemoglobin levels, hemoglobin saturation generally ranges from 95 percent to 99 percent. Oxygen Dissociation from Hemoglobin Partial pressure is an important aspect of the binding of oxygen to and disassociation from heme. An oxygen–hemoglobin dissociation curve is a graph that describes the relationship of partial pressure to the binding of oxygen to heme and its subsequent dissociation from heme (Figure 22. Remember that gases travel from an area of higher partial pressure to an area of lower partial pressure. In addition, the affinity of an oxygen molecule for heme increases as more oxygen molecules are bound. Therefore, in the oxygen–hemoglobin saturation curve, as the partial pressure of oxygen increases, a proportionately greater number of oxygen molecules are bound by heme. Not surprisingly, the oxygen–hemoglobin saturation/dissociation curve also shows that the lower the partial pressure of oxygen, the fewer oxygen molecules are bound to heme. As a result, the partial pressure of oxygen plays a major role in determining the degree of binding of oxygen to heme at the site of the respiratory membrane, as well as the degree of dissociation of oxygen from heme at the site of body tissues. The mechanisms behind the oxygen–hemoglobin saturation/dissociation curve also serve as automatic control mechanisms that regulate how much oxygen is delivered to different tissues throughout the body. The partial pressure of oxygen inside capillaries is about 100 mm Hg, so the difference between the two becomes quite high, about 80 mm Hg.

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The overall purpose of this session is to teach you some of the basics about nutrition that you will be able to use in your work and will inform your learning throughout the whole of the Module nizagara 50 mg with visa erectile dysfunction drugs ayurveda. Learning Outcomes for Study Session 1 When you have studied this session nizagara 25 mg on-line erectile dysfunction va disability compensation, you should be able to: 1. To have adequate and regular weight gain, children need enough good-quality food to meet their nutritional requirements, they need to stay healthy and they need sufficient care from their families and communities. Your role as a Health Extension Practitioner is, therefore, key in attaining these goals. An undernourished child struggles to withstand an attack of pneumonia, diarrhoea or other illness — and illness often prevails. The children who survive may become locked in a cycle of recurring illness and slow growth, diminishing their physical health, irreversibly damaging their development and their cognitive abilities, and impairing their capacities as adults. If a child suffers from diarrhoea — due to a lack of clean water or adequate sanitation, or because of poor hygiene practices — it will drain nutrients from his or her body. Chronic undernutrition (meaning low height for age, also known as stunting) in early childhood also results in diminished mental and physical development, which puts children at a disadvantage for the rest of their lives. They may perform poorly in school, and as adults they may be less productive, earn less and face a higher risk of disease than adults who were not undernourished as children. For girls, chronic undernutrition in early life, either before birth or during early childhood, can later lead to their babies being born with low birth weight, which can again lead to undernutrition as these babies grow older. Thus a vicious cycle of undernutrition repeats itself, generation after generation. Based on the latest available data, in the developing world, the number of children under five years old who are stunted is close to 200 million, while the number of children under five who are underweight is about 130 million. Like other undernourished children, they may be susceptible to infectious disease and death, and as adults they may face a higher risk of chronic illness such as heart disease and diabetes. In turn, the health of the mother is linked to the status a woman has in the society in which she lives. In many developing countries, the low status of women is considered to be one of the primary reasons for undernutrition across the life cycle. There is a marked decrease in the number of Ethiopian households that consume iodised salt compared with a decade ago, leading to increased iodine deficiency disorder. The greatest functional consequences of malnutrition for children are increased risk of illness, and death; and for those who survive, mental impairment and reduced capacity to produce and contribute to the economy of the country. These consequences of malnutrition are often not fully appreciated because they are hidden. Beyond the individual human suffering, malnutrition reduces mental Malnutrition impacts on health, development and, thus, will mean slower learning throughout life. Malnutrition also reduces work productivity, as stunted, less educated and mentally impaired adults are less productive. It has been estimated that the annual value of the loss in productivity that can be attributed to child stunting is 2. Moreover, iodine deficiency, which results in irreversible 3 impairment of intellectual capacities, has been estimated to cost the Ethiopian economy 1. When aggregated, the effects on illness, education and productivity have an enormous impact on the economic growth and poverty reduction effort of the country.

Rates whose denominators are the total population are commonly calculated using either the mid - interval population or the average population cheap nizagara 25 mg without a prescription erectile dysfunction which doctor to consult. Population count at the beginning + Population count Average population = at the end of the time interval considered 2 38 Below are given some formulas for the commonly used mortality rates and ratios purchase 100mg nizagara fast delivery impotence 10. Thus, it is high among people who have little health care, chiefly because infections, such as pneumonia, diarrhea and malaria, are common among their infants. Exercise: 43 The following information is about kebele X which was collected for the year 1999: – Total average population = 40,000 – Total number of live births = 4000 – Total number of deaths = 400 – Total number of deaths before the age of 28 days = 50 – Total number of infant deaths = 200 – Number of women who died from pregnancy related causes = 160 – New cases of tuberculosis = 100 – All cases of tuberculosis = 300 – Deaths from tuberculosis = 60 Based on the above information calculate the following. Sources of Data There are different sources of data on health and health related conditions in the community. The information obtained from these sources is used for health planning, programming and evaluation of health services. Census data are necessary for accurate description of population’s health status and are principal source of denominator for rates of disease & death. It provides information on: Size and composition of a population The trends anticipated in the future. Data was collected on: Age, sex and size of the population Mortality, fertility Language, ethnicity Housing From these data different health indices could be calculated. Crude birth rate, crude death rate, age specific mortality rate and sex specific mortality rate are some of the examples of the indicators that could be calculated. Vital statistics: This is a system by which all births and deaths occurring nationnwide are registered, reported and compiled centrally. There is no nationwide birth and death registration system in Ethiopia but the system should be established in the future. The main characteristics of vital statistics are: Comprehensive – all births and deaths should be registered. Health Service Records All health institutions report their activities to the Ministry of Health through the regional health bureaus. Advantages: Easily obtainable Available at low cost Continuous system of reporting Causes of illness and death available. The major problems related to this source (health service records) are low compliance and delays in reporting. Health Surveys Health surveys are studies conducted on a representative sample population to obtain more comprehensive data for monitoring the health status of a population. Advantages of surveys based on interview: They are more representative of the health condition of the community. Documentary sources - Clinical records and other personal records, death certificates, publications etc. If you want to know the number of people in your kebele who are properly using latrines, which method of data collection would be appropriate? When the disease occur as epidemic, outbreak, and pandemic it is considered as excess of what is expected. Epidemic: The occurrence of disease or other health related condition in excess of the usual frequency in a given area or among a specific group of people over a particular period of time. There is no general rule about the number of cases that must exist for a disease to be considered an epidemic. If the number of cases exceeds the expected level on the basis of the past experience of the particular population, then it is an epidemic. An epidemic may cover a small area within a city, or an entire nation or may have a worldwide distribution. Common Source Epidemics:- Disease occurs as a result of exposure of a group of susceptible persons to a common source of a pathogen, often at the same time or within a brief time period.

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Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis discount 100 mg nizagara mastercard erectile dysfunction test video. Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder discount nizagara 100mg without a prescription erectile dysfunction guide; significance for staging and prognosis. Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. Radical cystectomy with or without prior irradiation in the treatment of bladder cancer. Radical radiotherapy for muscle invasive transitional cell carcinoma of the bladder: failure analysis. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. An update of selective bladder preservation by combined modality therapy for invasive bladder cancer. An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. Carboplatinbased versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma. Gemcitabine and carboplatin in advanced transitional cell carcinoma of the urinary tract: an alternative therapy. Stage Ta-T1 bladder cancer: the relationship between findings at first followup cystoscopy and subsequent recurrence and progression. A surveillance schedule for G1Ta bladder cancer allowing efficient use of check cystoscopy and safe discharge at 5 years based on a 25-year prospective database. A stage specific approach to tumour surveillance after radical cystectomy for transitional cell carcinoma of the bladder. Affects 4% of men in undeveloped countries & 15% of men in developed countries  Risk factors  Increasing age  Ethnical origin  Heredity  Risk is doubled when one first line relative has prostate cancer. It usually takes place as part of a trial or study and is initiated by the screener. In contrast, early detection or opportunistic screening comprises individual case findings, which are initiated by the person being screened (patient) and/or his physician. Rather, early detection (opportunistic screening) should be offered to the well-informed man. It is therefore not useful to replace systematic biopsies with targeted biopsies of suspect areas. The Gleason score is the sum of the most dominant and second most dominant (in terms of volume) Gleason grade. A diagnosis of Gleason score 4 or lower should not be given on prostate biopsies iii. Gleason score system is the single strongest prognostic factor for clinical behaviour and treatment response. Lymph node status (N-staging) is only important when potentially curative treatment is planned. Transurethral resection of prostate- In those men who come with bladder outflow obstruction in an unsuspected fashion and biopsy report may reveal carcinoma of prostate. When neither is available prognostic grouping is not possible, use stage grouping) 75 Treatment: Treatment of prostate cancer depends on the stage of the disease and prognostic information available. However, the survival benefit is at best marginal and not related to cancer-specific survival. These should be performed at 3, 6 & 12 months after treatment, then every 6 months until 3 years, and then annually.

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