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Defciency of glucose 6-phosphatase is seen in i) Von Gierks disease ii) galactosemia iii) albinism iv) alkaptonuria 3 buy cheap viagra vigour 800mg on-line impotence thesaurus. Liver cells are loaded with glycogen in i) hemophilia ii) galactosemia iii) albinism iv) Von-Gierkes disease 4 viagra vigour 800mg erectile dysfunction doctor miami. Hypopigmentation in skin and sclera is observed in i) albinism ii) alkaptonuria iii) hemophilia iv) galactosemia. Hence, any biological oxidation taking place at tissue level is associated with 2 the uptake of oxygen and release of carbon dioxide and rapidly liberates energy. This biological oxidation accompanied by specifc enzymes and coenzymes in a step wise fashion involves the union between hydrogen atoms with oxygen atom to form water. Oxidation involving phosphorylation is a very vital process and it is a continuous process and any disturbance of its function is incompatible with life. The electron donor is called as reductant or reducing agent and the electron acceptor, the oxidant or oxidizing agent. The system which transfer its electron is changed into oxidant form while the system which accepts electrons gets converted to the reductant form. A direct transfer of electrons from substrate to the oxidant would liberate a sudden burst of energy and most of it will be wasted by dissipation. In biological system this oxidation reduction process takes place smoothly without increasing the temperature because the transfer of hydrogen pairs occurs in a step by step process till it reacts with oxygen. In biochemistry, the oxygen has the highest redox potential or electron affnity (E ) and therefore the 0 electron pass from the systems of hydrogen donors which have lower potentials. It is usual to compare the redox potential of a system (E ) against the potential of the 0 hydrogen electrode, which is at pH 0 designated as 0. In the biological system, the enzymes concerned with this oxidation reduction processes are designated as oxidoreductases. However, listings of standard reduction potentials are always given in the form of a reduction reaction. In the electron transport chain electron carriers and hydrogen-electron acceptors are positioned alternatively to carry the function. All the reducing equivalence that can release energy during oxidation of carbohydrates, fatty acids and proteins are available in the mitochondria. In mitochondria, a series of catalysts referred as respiratory chain that collects these reducing equivalents and direct them towards oxygen to form water. The folding of the inner membrane produces a number of partitions called cristae that extend into the matrix. The space between the inner and the outer membrane is called as Inter membrane space which is surrounded by matrix. This is an oxidation 117 reaction where 2 hydrogen atoms (or 2 hydrogen ions and 2 electrons) are removed from the organic metabolite. These dehydrogenase enzyme does not react with oxygen instead an electron carrier is interposed between the metabolite and next member in the chain. At the point of coenzyme the H+ ion dissociate and go into solution, leaving the electrons to the cytochromes. The signifcant feature is the heme structure containing the iron (Fe) ions, initially in the +3 state and changed to the +2 state by the addition of an electron. F protruding into matrix from the inner membrane 0 1 1 and F0 embedded and extend across the inner membrane. They are classifed as (a) inhibitors of respiratory chain, (b) inhibitors of oxidative phosphorylation, and (c) uncouplers of phosphorylation. The carbon monoxide and cyanide inhibit cytochrome oxidase so that it cannot transport electrons to oxygen.

General symptoms of chronich infection (tiredness buy viagra vigour 800 mg with visa food erectile dysfunction causes, poor appetite are common Indication for Adenoidectomy or /and tonsilectomy (over 3 years only) a discount viagra vigour 800 mg online erectile dysfunction treatment houston tx. Assessment of ear problem Ask Look - Does the child have ear - Look for pus draining pain? Signs - Pus drainage from Pus draining from the ear - Tender swelling behind the ear <2 weeks or 2 weeks or more the ear ear pain or red immobile ear drum Mastoiditis Acute ear infection Chronic ear infection Treatment - Give oral antibiotic - Dry the ear by wicking - Refer urgently to - Dry the ear by - Paracetamol for pain hospital wicking treat fever - Give first dose or - Reassess in five antibiotic days - Paracetamol for pain, - Treat fever if present treat fever - Paracetamol for pain 117 Pediatric Nursing and child health care Study Questions 1. What steps would you take for a child with a very severe disease or sever pneumonia before referral? If you think the mother will not take the child who need referral or if the referral will be delayed, what steps will you take? Diarrheal disease is among the leading causes of morbidity and mortality among children < 5 years of age in Ethiopia. Diarrhea is most common in children, especially those between 6 months and 2 years of age. Acute diarrhea causes death because of dehydration Dysentery causes death because of a number of severe and potentially fatal complications occurring during dysentery such as Intestinal perforation - Toxic mega colon - Convulsions - Septicemia - Prolonged hyponatremia - Diarrhea is worse in person with malnutrition. Diarrhea can also cause malnutrition and make it worse because - Nutrients are lost from the body during diarrhea - Nutrients are used to repair damaged tissue rather than for growth 120 Pediatric Nursing and child health care - A person with diarrhea may not be hungry - Mothers may not feed children during diarrhea or even for some days after diarrhea stops To prevent malnutrition, food should be given to children with diarrhea as soon as, they eat it. Less water and salts pass into the blood, and more passes from the blood into the bowel. Thus, more than the normal amount of water and salts passed in the stool results in dehydration. Dehydration also can be caused by a lot of vomiting, which often accompanies diarrhea. Treating Diarrhea: The most important measures in treating diarrhea are to: - Prevent dehydration from occurring if possible - Treat dehydration quickly and well if it does occur - Feed the child 121 Pediatric Nursing and child health care 9. Mix well with a clean spoon until the powder is dissolved - Taste the solution so that you would know its taste like salt - Then give the child frequent small sips out of a cup or spoon. If the answer to either question is ‘yes’, use the following management chart to assess, classify and treat the child Calcifying Dehydration: - There are three possible calcifications of dehydrations for a child with diarrhea. If there is Falciparum malaria in the area and the child has any fever (38 or above) or history of fever in the past 5 days give anti-malarial treatment according to malaria program recommendation in your area 128 Pediatric Nursing and child health care 9. Treatment of Diarrhea Decide on appropriate treatment: After the examination, decide how to treat the child - if the child has any of the signs in the column labeled “for other problems” specific treatment is needed in addition to treatment given for dehydration - if there is blood in the stool and diarrhea for less than 14 days, the child has dysentry and appropriate antibiotics should be given - if there is diarrhea for longer than 14 days with or without blood in the stool and/or if there is severe under nutrition, continue feeding the child and refer for treatment. Determine the degree of dehydration Look at the upper row, the assessing and classifying chart. What important measures should be taken to prevent dehydration in children with diarrhea? What important pieces of advice would you give to the mother for home treatment of diarrhea? Older children are more likely to have acquired heart diseases such as rheumatic fever, endomyocardial fibrosis. Cyanosis can best be detected under the fingernails or on the mucus membranes of the mouth (lips, under side of the tongue). One of the main causes of this is chronic under saturation of the blood with oxygen. Signs of Cardiac Failure: ƒ Tachycardia-rapid pulse ƒ Tachyponea-rapid respiration ƒ Dyspnea-shortness of breath ƒ Edema and other signs of raised venous pressure ƒ Fatigue and failure to thrive ƒ Arrhythmia-irregular heart beat ƒ Systolic and more frequently diastolic murmurs ƒ Cough ƒ Orthophea Management: Any child with congestive heart failure should be referred to hospital whenever possible. In all cases where you have to start treatment: - check weight of the child ,record the pulse and respiration carefully at 2 hours intervals and indicate the exact time of any drugs given. Digitalization is most important In order to achieve effective blood levels quickly a digitizing dose is calculated and given over 24 hours. The only known cause is damage to the fetus by rubella Virus, when the mother is one to three months pregnant, or by chromosomal abnormality in children with Down’s syndrome.

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The ventilator moves the Figure 9 Pathway of gas flow in anesthetic machine gas mixture through the common gas outlet and into the anesthetic circuit cheap viagra vigour 800 mg free shipping erectile dysfunction statin drugs, the tubing that connects to the pa- tient’s airway discount 800 mg viagra vigour mastercard erectile dysfunction latest treatment. There are several other types of circuits which are useful in specific clinical situations or are of historical interest. The origin and pathways of gas flow that applies to most anesthetic machines is de- The shaded shapes represent (from left to right): volatile anesthetic va- picted in schematic form in Figure 9. Image by Wikimedia user TwoOneTwo, available under the Creative Commons It is imperative that all anesthesia equipment undergo Attribution-Share Alike 3. It is the responsibility of the anesthesiologist to ensure that the equipment is in functioning condition prior to the administration of every anesthetic. The practice of • pulse oximeter anesthesia involves the use of some key monitors that are not commonly seen in other health care settings. Ex- • apparatus to measure blood pressure amples include the pulse oximeter, the capnograph and • electrocardiography the peripheral nerve stimulator. The Canadian Anesthe- sia Society guidelines for intra-operative monitoring • capnograph when an endotracheal tube or are listed in Table 8. There are methods of invasively monitoring the cardiovascu- lar, renal and central nervous systems in the peri- Monitors which must be exclusively available: operative period. The pharmacology of each of the important drugs used in the delivery of anesthesia can be found in the “Drug Finder” (Chapter 6). However, often it is used in • regional combination with sedation in which case monitor- ing is required. While local anesthesia is inade- • general quate for more invasive procedures such as those The findings on pre-operative assessment, the na- involving the body cavities, local infiltration is ture of the surgery and the patient’s preference often used as an adjunct in post-operative pain all factor into the choice of anesthetic technique. Care must be taken to avoid intra- Contrary to popular belief, studies have failed to vascular injection and to avoid exceeding the identify one technique as superior (lower morbid- toxic dose of the local anesthetic in use. Regardless of the technique em- ployed, the anesthesiologist must ensure patient comfort, maintenance of physiologic homeostasis and provision of adequate operating conditions. Sedation involves the delivery of agents (usually intra- venous) for the purpose of achieving a calm, relaxed pa- Many different agents have been used for sedation. The tient, able to protect his own airway and support his term “neurolept anesthesia” refers to the (now histori- own ventilation. The range of physiologic effects of se- cal) use of high doses of droperidol (a butyrophenone, dation is varied and is dependent on the depth of seda- in the same class as haloperidol) in combination with tion provided: minimal, moderate or deep. Cur- under minimal sedation will be fully responsive to ver- rently, agents are chosen with specific effects in mind. The short-acting appear calm and relaxed and would have normal car- benzodiazepine, midazolam, is a popular choice be- diorespiratory function. Propo- receiving deep sedation would be rousable only to re- fol, an anesthetic induction agent, can be infused in peated or painful stimuli. In some instances, the patient sub-anesthetic doses to produce a calm, euphoric pa- may require assistance in maintaining a patent airway. Often it is used in combination with local or regional anesthesia to provide a more palatable experience for the patient. Care must be taken to reduce the dose administered to the frail, elderly or debilitated patient, in whom depressant ef- fects may be exaggerated. While regional techniques are perceived to be “safer” than general anesthesia, they do carry risks of their own. The central neuraxial blocks have many potential complications, both early and late, which will be discussed in the next section. There are some patients in whom a regional technique offers at least short term benefits over general anesthe- sia. For example, in those undergoing total hip arthro- plasty, the use of spinal or epidural anesthesia is associ- ated with less intra-operative blood loss, less post- operative hypoxemia and a lower risk of post-operative deep venous thrombosis formation.

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Blood circulation is very important buy viagra vigour 800 mg low cost new erectile dysfunction drugs 2011, as blood is required to transport oxygen from the lungs to other tissues throughout the body 800mg viagra vigour mastercard erectile dysfunction sample pills. The pulmonary artery provides deoxygenated blood to the capillaries that form respiratory membranes with the alveoli, and the pulmonary veins return newly oxygenated blood to the heart for further transport throughout the body. The lungs are innervated by the parasympathetic and sympathetic nervous systems, which coordinate the bronchodilation and bronchoconstriction of the airways. The lungs are enclosed by the pleura, a membrane that is composed of visceral and parietal pleural layers. The mesothelial cells of the pleural membrane create pleural fluid, which serves as both a lubricant (to reduce friction during breathing) and as an adhesive to adhere the lungs to the thoracic wall (to facilitate movement of the lungs during ventilation). The force exerted by gases within the alveoli is called intra-alveolar (intrapulmonary) pressure, whereas the force exerted by gases in the pleural cavity is called intrapleural pressure. Air flows when a pressure gradient is created, from a space of higher pressure to a space of lower pressure. A gas is at lower pressure in a larger volume because the gas molecules have more space to in which to move. The same quantity of gas in a smaller volume results in gas molecules crowding together, producing increased pressure. The surface tension of the alveoli also influences pressure, as it opposes the expansion of the alveoli. However, pulmonary surfactant helps to reduce the surface tension so that the alveoli do not collapse during expiration. Pulmonary ventilation consists of the process of inspiration (or inhalation), where air enters the lungs, and expiration (or exhalation), where air leaves the lungs. During inspiration, the diaphragm and external intercostal muscles contract, causing the rib cage to expand and move outward, and expanding the thoracic cavity and lung volume. This creates a lower pressure within the lung than that of the atmosphere, causing air to be drawn into the lungs. The air pressure within the lungs increases to above the pressure of the atmosphere, causing air to be forced out of the lungs. However, during forced exhalation, the internal intercostals and abdominal muscles may be involved in forcing air out of the lungs. Respiratory volume describes the amount of air in a given space within the lungs, or which can be moved by the lung, and is dependent on a variety of factors. Tidal volume refers to the amount of air that enters the lungs during quiet breathing, whereas inspiratory reserve volume is the amount of air that enters the lungs when a person inhales past the tidal volume. Expiratory reserve volume is the extra amount of air that can leave with forceful expiration, following tidal expiration. Residual volume is the amount of air that is left in the lungs after expelling the expiratory reserve volume. Anatomical dead space refers to the air within the respiratory structures that never participates in gas exchange, because it does not reach functional alveoli. Respiratory rate is the number of breaths taken per minute, which may change during certain diseases or conditions. Both respiratory rate and depth are controlled by the respiratory centers of the brain, which are stimulated by factors such as chemical and pH changes in the blood.

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