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By: V. Ernesto, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

Professor, Midwestern University Chicago College of Osteopathic Medicine

Carrier protein that transports two different substances in the same direction is called symport or symport pump arthritis pain in back purchase plaquenil with mastercard. Carrier protein that transports two different substances in opposite directions is called antiport or antiport pump arthritis knobby fingers purchase plaquenil 200mg mastercard. Three receptor sites for sodium ions on the inner (towards cytoplasm) surface of the protein molecule ii arthritis in my cats back legs discount 200mg plaquenil fast delivery. Mechanism of action of Na+-K+ pump Three sodium ions from the cell get attached to the receptor sites of sodium ions on the inner surface of the carrier protein what does arthritis in the knee mean cheap plaquenil 200 mg with amex. Two potassium ions outside the cell bind to the receptor sites of potassium ions located on the outer surface of the carrier protein. Now, the energy liberated causes some sort of conformational change in the molecule of the carrier protein. Because of this, the outer surface of the molecule (with potassium ions) now faces the inner side of the cell. And, the inner surface of the protein molecule (with sodium ions) faces the outer side of the cell. Exact mechanisms involved in the dissociation and release of ions are not yet known. Electrogenic activity of Na+-K+ pump Na+-K+ pump moves three sodium ions outside the cell and two potassium ions inside cell. Thus, when the pump works once, there is a net loss of one positively charged ion from the cell. Continuous activity of the sodium-potassium pumps causes reduction in the number of positively charged ions inside the cell leading to increase in the negativity inside the cell. Transport of Calcium Ions Calcium is actively transported from inside to outside the cell by calcium pump. Calcium pumps are also present in some organelles of the cell such as sarcoplasmic reticulum in the muscle and the mitochondria of all the cells. Transport of Hydrogen Ions Hydrogen ion is actively transported across the cell membrane by the carrier protein called hydrogen pump. The hydrogen pumps that are present in two important organs have some functional significance. Stomach: Hydrogen pumps in parietal cells of the gastric glands are involved in the formation of hydrochloric acid (Chapter 38) 2. Kidney: Hydrogen pumps in epithelial cells of distal convoluted tubules and collecting ducts are involved in the secretion of hydrogen ions from blood into urine (Chapter 54). When sodium is transported by a carrier protein, another substance is also transported by the same protein simultaneously, either in the same direction (of sodium movement) or in the opposite direction. Chapter 3 t Transport through Cell Membrane Secondary active transport is of two types: 1. Sodium Cotransport Sodium cotransport is the process in which, along with sodium, another substance is transported by a carrier protein called symport. And the energy released by the movement of sodium is utilized for movement of another substance. Substances carried by sodium cotransport are glucose, amino acids, chloride, iodine, iron and urate. Carrier protein for sodium cotransport Carrier protein for the sodium cotransport has two receptor sites on the outer surface. Among the two sites, one is for binding of sodium and another site is for binding of other substance. It causes conformational changes in the carrier protein, so that sodium and glucose are released into the cell. Sodium cotransport of glucose occurs during absorption of glucose from the intestine and reabsorption of glucose from the renal tubule. Sodium cotransport of amino acids Carrier proteins for the transport of amino acids are different from the carrier proteins for the transport of glucose. For the transport of amino acids, there are five sets of carrier proteins in the cell membrane. Each one carries different amino acids depending upon the molecular weight of the amino acids. Sodium cotransport of amino acids also occurs during the absorption of amino acids from the intestine and reabsorption from renal tubule.

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They are lustrous arthritis medication in canada cheap generic plaquenil canada, relatively dense arthritis water exercises buy generic plaquenil 200 mg, malleable arthritis diet uk safe plaquenil 200mg, ductile arthritis medication lymphoma discount 200 mg plaquenil free shipping, cohesive and highly conductive to both electricity and heat. Metals are crystalline in structure and the individual crystals contain positive metal ions. The outer valency electrons appear to be so loosely held that they are largely interspersed amongst the positive ions forming an electron cloud which holds the positive ions together. The crystal structure also explains the hardness and mechanical strength of metals whereas the elasticity is explained by the ability of the atoms and ions to slide easily over each other. Metals can be blended with other metals to produce alloys with specific properties and applications. Indeed the ease with which the outer electron is detached from the atom explains their highly-reactive nature. Like the alkali metals they attack water to liberate hydrogen but with less vigour. The salts of the alkaline earths are generally less stable towards heat and water than those of alkali metals, and less water soluble. Zinc has some resemblance to magnesium but the other metals in the group have little in common. At room temperature mercury is unaffected by air, water or non-oxidizing agents whereas zinc is more reactive, albeit tempered by a protective hydroxide film, a property utilized in galvanizing. Aluminium is an extremely light, white metal and whilst hard is malleable and ductile. On exposure to air the metal forms a protective oxide film which reduces its reactivity. Its compounds tend to be covalent in nature: the sulphate is hydrolysed in solution and the trichloride is volatile. Bivalent tin (stannous) derivatives are covalent whereas the nitrate and sulphate of bivalent lead (plumbous) are ionic. Tin finds widespread use because of its resistance to corrosion, or as foil or to provide protective coats/plates for other metals. Properties of lead which make industrial application attractive surround its soft, plastic nature permitting it to be rolled into sheets or extruded through dies. In the finely-divided state lead powder is pyrophoric; in bulk form the rapidly-formed protective oxide layer inhibits further reaction. Chromium is a hard, malleable, white metal capable of high polish and does not tarnish in air. Its chief use is in steel to remove trace quantities of oxygen and sulphur and to produce tough steel. Iron is a white, soft, malleable, ductile magnetic metal when pure and is used mainly in steel production. Cobalt does not oxidize in air at room temperature but oxidizes slowly if heated to yield cobaltous oxide, CoO. Nickel is silver grey, hard, malleable, capable of high polish and resistant to attack by oxygen at room temperature but yields the oxide on heating. It dissolves in dilute nitric acid but is rendered passive by the concentrated acid. They possess characteristic metallic lustre, take high polish and resist attack by air. They are extremely malleable and ductile and excellent conductors of heat and electricity. It is used for cooking utensils and wires in telegraphs, telephones, power lines, and electrical machinery. It is tough, malleable, ductile and an efficient conductor of heat and electricity. Whilst resistant to attack by oxygen, on exposure to air it is slowly covered with a black film of silver sulphide. Gold is a yellow, malleable, ductile metal which does not tarnish in air and is inert to any mineral acid.

Not available for interaction Startles to loud noise Limbs extended arthritis today diet buy discount plaquenil 200 mg online, jerky movements (a) (b) Figure 10 getting rid of arthritis in the knee order plaquenil 200mg without prescription. Decreased risk Pneumothorax Patent ductus arteriosus Intraventricular haemorrhage Bronchopulmonary dysplasia Mortality 0 0 arthritis pain medication list discount plaquenil amex. Treatmentwithraisedambientoxygenis required can arthritis in neck cause tinnitus quality plaquenil 200mg, which may need to be supplemented with continuous positive airway pressure (delivered via nasal cannulae) or artificial ventilation via a tracheal tube. Surfactant therapy reduces morbidity and mortality of preterm infants with respiratory distress syndrome. Bradycardia 162 may occur either when an infant stops breathing for over20­30sorwhenbreathingcontinuesbutagainst a closed glottis. An underlying cause (hypoxia, infec tion,anaemia,electrolytedisturbance,hypoglycaemia, seizures, heart failure or aspiration due to gastro oesophagealreflux)needstobeexcluded,butinmany instances,thecauseisimmaturityofcentralrespiratory control. If these measures fail to close a symptomatic duct, surgical ligation will berequired. Preterminfants areparticularlyvulnerabletohypothermia,as: · theyhavealargesurfacearearelativetotheir mass,sothereisgreaterheatloss(relatedto surfacearea)thanheatgeneration(relatedto mass) · theirskinisthinandheatpermeable,so transepidermalwaterlossisimportantinthefirst weekoflife theyhavelittlesubcutaneousfatforinsulation · · theyareoftennursednakedandcannotconserve heatbycurlinguporgenerateheatbyshivering. In these infants, breast milk needs to be supplemented with phosphate and may need supplementation with protein and calories (in breast milk fortifier) and calcium. In some neonatal units, extremely preterm infantsareinitiallyfedondonorbreastmilkifmaternal breast milk is not available. If formula feeding is required, special infant formulas are available which aredesignedtomeettheincreasednutritionalrequire mentsofpreterminfantsbut,incontrasttobreastmilk, do not provide protection against infection or other benefits of breast milk. For this reason, parenteral nutrition may some timesbegivenviaaperipheralvein,butextravasation maycauseskindamagewithscarring. Poor bone mineralisation (osteopenia of prematu rity)waspreviouslycommonbutispreventedbyprovi sion of adequate phosphate, calcium and vitamin D. Iron supplements are started at several weeks of age and continued after discharge home. Preterm brain injury Haemorrhages in the brain occur in 25% of very low birthweightinfantsandareeasilyrecognisedoncranial ultrasoundscans(Fig. They aremorecommonfollowingperinatalasphyxiaandin infants with severe respiratory distress syndrome. Smallhaemor rhagesconfinedtothegerminalmatrixdonotincrease the risk of cerebral palsy. Infection Preterminfantsareatincreasedriskofinfection,asIgG ismostlytransferredacrosstheplacentainthelasttri mester and no IgA or IgM is transferred. In addition, infection in or around the cervix is often a reason for preterm labour and may cause infection shortly after birth. Most infections in preterm infants occur after several days of age and are nosocomial (hospital derived); they are often associated with indwelling cathetersorartificialventilation. Theinfantmayrapidly become shocked and require artificial ventilation becauseofabdominaldistensionandpain. Necrotising enterocolitis 10 Neonatal medicine Air under diaphragm from bowel perforation Air in portal tract Distended bowel loops Intramural air Figure 10. It was initially recognised that the risk is increasedbyuncontrolleduseofhighconcentrations of oxygen. The lung damage comes from pressure and volumetraumafromartificialventilation,oxygentoxic ity and infection. The chest Xray characteristically shows widespread areas of opacification, sometimes withcysticchanges(Fig. A few infants with severe disease may die of intercurrentinfectionorpulmonaryhypertension. It becomes increas inglyevidentwhentheindividualchildiscomparedto their peers at nursery or school. Asmallproportionalsohavehearingimpairment,with 1­2% requiring amplification, or visual impairment, with1%blindinbotheyes. Agreaterproportionhave refraction errors and squints and therefore require glasses. Thisisbecause: Moderate disability 31% Mild impairments 40% · thereismarkedphysiologicalreleaseof haemoglobinfromthebreakdownofredcells becauseofthehighHbconcentrationatbirth. The neurotoxic effects vary in severity from transient disturbance to severe damage and death.

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This diagnostic procedure is useful in determining retinal disorders such as cone dystrophy (degeneration of cones) and retinitis pigmentosa (hyperactivity of the pigmented retinal epithelial cells can arthritis in neck cause head pain buy plaquenil 200 mg online, leading to damage of photoreceptors and blindness) arthritis medication relafen purchase cheap plaquenil on line. Recording electrode is placed on the cornea of eye in its usual forward up looking position arthritis of the knee discount plaquenil on line. Indifferent electrode is placed over any moist surface of body xanax arthritis pain plaquenil 200 mg visa, like inside the mouth. If there is any difficulty in seeing the distant object or the near object, the defect is known as error of refraction. Distant Vision Snellen chart is used to test the acuity of vision for dis- tant vision in the diagnosis of refractive errors of the eye. Temporal part of visual field extends up to about 100° but the nasal part extends only up to 60°, because it is restricted by nose. Extent of the upper field is about 60°, as it is restricted by upper eyelid and orbital margin. In some animals like dog, rabbit and horse, the eyeballs are present at the sides of head. Thus, the visual field is restricted in all the sides, except in the temporal part. The two images developed on retina of both eyes are fused into a single sensation. The single sensation is because of the ocular muscles, which direct the axes of the eyes in such a way that the light rays from the object fall upon the corresponding points of both retinas. If the light rays do not fall on the corresponding retinal points, diplopia occurs. While looking at an object, if the eyeballs are directed in such a way that the light rays from the object do not fall upon the corresponding point on the retina of both eyes, a double vision occurs, i. In alcoholic intoxication, the imbalanced actions of ocular muscles produce temporary diplopia 3. Experimental Diplopia Diplopia can be produced experimentally, by the following methods: 1. Applying pressure from outer side of one eye and thus displacing the eye from its normal position 2. By holding an object like pen or pencil vertically in front of face, at about 5 cm from the root of nose. The light rays from the object do not fall on the corresponding retinal points and diplopia occurs. The optic disk in the retina does not have any visual receptors and if the image of any object falls on the optic disk, the object cannot be seen. Normally, the darkness in the visual field due to the blind spot does not cause any inconvenience because, the fixation of each eye is at different angles. Light rays from temporal part of visual field of an eye fall on the nasal half of retina of that eye. Similarly, the light rays from nasal part of visual field fall on the temporal half of retina of the same side. Visual field is also determined by Bjerrum (Tangent) screen or by confrontation test. Humphrey field analyzer is also used to map visual field and it is more useful to test the central portion of visual fields. In binocular vision, the light rays from temporal (outer) half of visual field fall upon the nasal part of corresponding retina. The rays from nasal (inner) half of visual field fall upon the temporal part of retina. Fibers from the visual receptors synapse with dendrites of bipolar cells of inner nuclear layer of the retina. Each bipolar cell is connected to separate ganglionic cell, namely midget ganglionic cell. This type of private pathway is responsible for visual acuity and intensity discrimination. The fibers from temporal part of retina are in lateral part of the nerve and carry the impulses from nasal half of visual field of same eye. The fibers from nasal part of retina are in medial part of the nerve and carry the impulses from temporal half of visual field of same eye.

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Results: Almost a quarter (23%) of the incident cancer patient population had abdominal symptom(s) at presentation (n53 migratory arthritis definition plaquenil 200mg on-line,661/15 treatment arthritis diet book by margaret hills discount plaquenil online mastercard,956) arthritis recipes purchase 200 mg plaquenil with amex. The relative lengths of the patient and primary care intervals varied greatly by abdominal symptom arthritis rub discount 200 mg plaquenil with visa. However, the remainder of patients were diagnosed with solid tumors of nonabdominal organ origin (7. Conclusion: Cancer symptom awareness campaigns focusing on abdominal symptoms could contribute to the earlier diagnosis of numerous common and rarer cancers. Evidence regarding the relative lengths of the patient and primary care intervals could be used as a measure of relative need for raising awareness. Main drivers identified in previous research include late-stage disease at presentation, poor adherence to treatment and sociocultural barriers. This is an evaluation of the "Show You Care, Be Aware" campaign that was done in University of Malaya, Kuala Lumpur in October 2017. Results: 72% (n5492) of our participants were Malay, 19% (n5119) Chinese and 10% (n568) Indians and others. Agba et al, 2012; American Cancer Society, 2011; Cancer Today, 2012; Ogundipe, 2011; Osain, 2011; Prevalence of Breast Cancer, 2015. However, the theoretical understanding that underpins these complex early diagnosis interventions remains underdeveloped. Aim: To propose a theoretical framework to guide the design, implementation, and evaluation of cancer symptom awareness campaigns and motivate further relevant research. Real-world examples across high-/low-income settings were used where possible to illustrate discussions of implications for practice. Results: We identified four major factors that contribute to the logic model of cancer symptom awareness campaigns beyond contextual and practical factors. Disease burden statistics (cancer site-specific incidence, survival, mortality) could be used to gauge relative need for raising awareness. This should be triangulated with symptom epidemiology (including existing levels of awareness, symptom prevalence, the associated predictive value for cancer, symptom-specific diagnostic timeliness, and whether the symptom is a sign of early stage disease) to motivate selection of individual symptoms in a campaign. Psychosocial factors (such as cancer fatalism or fear and health literacy) and their interaction with symptom awareness should also be considered as they affect symptom appraisal. Further, an understanding and awareness of system factors (availability and access to healthcare, investigation processes, and clinical capacity) will be important for assessing campaign feasibility and knock-on effects in the health system. Based on the above, campaigns should ideally target symptoms that are strongly predictive of early stage (treatable) cancer for which there is low awareness in the target population, and are associated with long intervals to help-seeking. Campaign impact should be amplified by targeting psychosocial barriers to prompt presentation. Additionally, campaigns should be accompanied by downstream capacity planning for potential cancer investigation and subsequent treatment. Conclusion: the proposed framework considers the logic model of cancer symptom awareness campaigns, acknowledging key factors that should be taken into account beyond contextual factors. This could help identify evidential gaps in early diagnosis research, and improve campaign design and evaluation. Al Hammod2 1 Ministry of Health, Dubai, United Arab Emirates; 2King Faisal Specialist Hospital and Research Centre, Riyadth, Saudi Arabia Background: A rising trend in colorectal cancer incidence has been observed in Gulf countries. In Saudi Arabia, colorectal cancer has been the most common cancer in men and 3rd most common in female since 2002. Moreover, in a recent study in Saudi Arabia, the 5-year survival for colorectal cancer patients was 45% and 28% of patents were diagnosed with distant metastases. Aim: Present the existing colorectal screening programs in Gulf countries, highlight the role of primary care professionals, national guidelines, challenges and barriers to implementation, as well as priority actions to improve implementation. To support the data, an interview with national managers and key informants, was undertaken. Conclusion: Introduction of colorectal cancer screening is feasible in Gulf countries, in a phased manner. The national guidelines for colorectal cancer screening assist in integration of screening into primary care as well as early diagnosis in symptomatic persons. To improve uptake of the screening, Gulf countries need to invest in training of primary care professional in examination, referral mechanisms and setting up multidisciplinary diagnosis and treatment facilities. Several investigators have documented the adverse impact of delays during curative chemoradiation on survival: 2%-5% decreased survival per week delay.

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