By V. Kelvin. Avila College.
Psychological status of the patient This will influence the choice between regional and general anesthesia and also to give pre- medication buy tadacip 20mg low price. Special investigations should be ordered according to the condition of the patient discount 20mg tadacip free shipping. District Hospital: (Where the facilities are restricted) Hemoglobin Urine analysis Referral Hospital: Hemoglobin and full blood count Urine analysis Blood Urea Nitrogen/Creatinine Serum electrolytes Electrocardiogram (age over 40 years) Correct or improve any medical conditions before surgery (preoperative care) In case of elective surgery Fluid imbalance: The volume of circulating fluid should be corrected tadacip 20mg cheap. Smoking: Smoking should be given up at least three days preoperatively because of the increased risk of bronchial exudation and the bronchospasm buy discount tadacip 20mg line. Cardiovascular diseases: A period of 6 months should be allowed after an attack of myocardial infarction. Arrhythmias must not be too severe to interfere with patients cardiac output and hypertension should be treated properly. Respiratory disease: Acute respiratory disease is contraindication for elective general anesthesia. Asthma must be treated with appropriate bronco-dilators until the chest is clear to auscultation. After severe case of infective hepatitis, operation is best postponed for a minimum of 6 months. These include full stomach with high risk of aspiration and hypovolemia due to blood or fluid loss which has to be replaced as fast as possible. Measures which should be taken in case of full stomach include: - Postpone surgery for at least 4 hours. Crash induction: This is a procedure used to prevent aspiration when full stomach is suspected. Measures before leaving the ward to the theater - Food and drink with held for 6 hours - Lipstick removed, nails cleaned, etc. Purposes: - To alleviate anxiety and fear with sedatives (Diazepam) - To reduce secretions especially salivary and bronchial (Atropine) - To prevent undesirable reflexes, e. Assessment: Assess the patient for response by gently shaking the shoulders shouting, are you all right? If there is any suspicion of a neck injury, protect the cervical spine by manual immobilization. Provide first aid for any injuries present and carefully reassess the patient at the regular interval. Top: Airway obstruction produced by tongue and epiglottis Bottom: Relief by head tilt chin lift B. If the patient is not breathing: Turn the patient into supine position and give two breaths of expired air ventilation (mouth to mouth breathing) (Fig. Major pulses like the carotid or femoral pulses are more reliable in an emergency than peripheral pulses. Slide the fingers into the groove between the trachea and the muscles at the side of the neck where the carotid pulse can be felt (right). Drugs: Open the intravenous line and start with resuscitation fluid and at the same time one of the assistants can prepare adrenaline and give 1 mg every 3 minutes. After 20-30 minute if there is no sign of heart beat and pupilary reaction one can stop resuscitation. General Anesthesia: the method of making the patient pain free and unaware about what is going on during the surgery. Regional anesthesia: a method of blocking of nerve impulses before they reach the central nervous system using local acting drugs in order to induce analgesia and /or relaxation. To fight against the complications, one should: Keep a vein open before anesthesia Have to prepare equipments for securing air way and possible ventilation. Induction of Anesthesia Induction of anesthesia is to make the patient unconscious. Before giving the drugs to make the patient sleep you should let him/her breathe 100% oxygen, which will be used as a reserve during the time of intubation. Induction can be performed: With intravenous anesthetic agents: Ketamine + Atropine or Thiopentone With inhalation agent (e. Halothane) After the patient is induced, the anesthesia can be continued with intubation or with out (mask ventilation or spontaneous breathing). Endo tracheal intubation: It is a technique of passing an endotracheal tube into the trachea of the patient for securing the airway, and to make easier ventilation. For Intubation the patient should be adequately relaxed with inhalation agent or muscle relaxant. The relaxant used for intubation is Suxamethonium, which has fast onset of action and short effect. The carrier gas for volatile anesthetic agent can be atmospheric air or oxygen from compressed source depending on the type of Anesthesia machine in use. Because of these reasons it can be used alone for short procedures and surgery, which does not require relaxation and intubation. Dose and route of administration: Intramuscular: 5-10 mg/kg Intravenous: 1-2 mg/kg The effect of one single dose lasts for about 15 min. Treatment of systemic toxicity The best treatment of systemic toxicity is prevention by meticulous attention to technique and recognition of intravascular injection. Commonly used local anesthetic drugs 118 Lidocaine (Xylocaine) 1%, 2% or 5% with or without Adrenaline in dose of: With Adrenaline: 7 mg/kg Without Adrenaline: 3 mg/kg Bupivacaine (Carbosthesin, Marcain) 0. The level of lumbar puncture is at the rd th interspaces between the 3 and 4 lumbar vertebrae. Turn the patient to a supine position with pillow under the head in the case of heavy (hyperbaric) local anesthetic drug. Complications of spinal anesthesia and measures to take Drop in blood pressure-due to high spinal block - Give Oxygen - Make faster the drip if that does not help. Commonly performed nerve blocks: o Digital nerve block o Axillary block of the brachial plexus o Wrist-block 122 C) Field block Field block is injection of local analgesic so as to create a zone of analgesia around the operative field. It can be used for: o Repair of an inguinal hernia o Caesarean section o Circumcision D) Infiltration Infiltration is direct injection of drugs into the area to be incised and between bone ends in fractures. E) Topical anesthesia This can be performed simply by applying 4% lidocaine to the mucus membrane, for minor surgery and instrumentation of: o Nose o Mouth o Eye o Pharynx and larynx o Urethral procedures 123 Review Questions 1. After evaluation by the surgeon, it is decided to take him to the operating theater. A 17 year old girl is brought to the Emergency department with polytrauma after a car accident. L Bartholomeusz: Safe Anesthesia: A Training manual, where facilities are limited. Outline management options for thyroid carcinomas Thyroid Enlargement: Goiter Goiter refers to a generalized enlargement of the thyroid gland which is normally impalpable. Defective hormone synthesis also cause goiter and it accounts for many sporadic goiters. In endemic goiter, it usually occurs at puberty when metabolic demands are high, this is reversible if stimulations cease. As a result of fluctuating stimulation of the thyroid gland, areas of active lobule and inactive lobules will develop. Active lobules become more vascular and hyperplasic until hemorrhage occurs causing necrosis. These necrotic lobules coalesce to form nodules filled with either iodine free colloid or inactive follicles. Secondary changes like cystic degeneration, hemorrhage and calcification occur at late stages. Diagnosis Clinical presentation: Discrete swelling in one lobe with no palpable abnormality else where is called solitary (isolated) nodule. The Goiter is painless and freely moves with swallowing and usually patients are euthyroid. Complications Tracheal obstruction can occur due to gross lateral displacement or compression. Prevention and treatment Prevention In endemic areas the incidence of goiter can be significantly reduced by the introduction of iodized salt. In early stages, a hyper-plastic goiter may regress if thyroxin is given in a dose of 0. Operation might be indicated On cosmetic grounds Tracheal compression and When malignancy cannot be excluded The options of surgical treatment are Near total thyroidectomy Subtotal thyroidectomy Toxic goiters Thyrotoxicosis - is a condition in which there is increased metabolic rate due to high level of circulating thyroid hormone.
This method classifies wounds according to the likelihood or rate of wound infection buy 20 mg tadacip amex. Clean-contaminated: Minor break in technique purchase 20mg tadacip overnight delivery, oropharynx entered buy generic tadacip 20mg line, gastrointestinal or respiratory tracts entered without significant spillage purchase 20mg tadacip mastercard, genitourinary or biliary tracts entered in absence of infected urine or bile. If other serious conditions exist, which endanger the patients life, the wound should be covered with sterile gauze and priorities attended to. However, the goal in all cases is to establish a good environment to assist wound healing and prevent infection. Proper wound care includes the following measures: Adequate hemostasis locally to stop bleeding. It provides a reliable drainage and opportunity for repeated inspection and debridement as necessary. There is no specific management needed except local compress and analgesics if pain is severe. Management: - It usually gets absorbed spontaneously and should be left - Local compress to alleviate pain - Aseptic evacuation or aspiration only if very large (expanding) or over a cosmetic area or leading to compression of vital structures. Management: - Cleanse using scrubbing brushes - Use antiseptic or lean tap water and soap - Analgesic Punctures These may be compound wounds which involve deeper structures. Management: - Careful inspection - Adequate cleansing - Closure, if feasible, under appropriate anesthesia - Proper wound debridement if needed - Appropriate antibiotic prophylaxis - Tetanus Prophylaxis - Analgesics as needed Crush and avulsion wounds These are compound complicated wounds. They are usually associated with systemic involvement and have more extensive damage than may appear. Management: - Correct associated life threatening conditions - Proper wound debridement - Early skin cover if possible or late graft, wound left open if contaminated - Appropriate antibiotics - Tetanus Prophylaxis - Analgesics as needed Missile injuries These are type of wounds which are compound and complicated. They usually present with severe life threatening conditions and should be carefully managed. Human bites These are relatively rare but more heavily contaminated than those of most animalss due to polymicrobial nature including anaerobic organisms as a normal oral flora. To avoid this complication the animal must be kept for observation for at least 10 days. Management should include: First aid measures: - Local wound irrigation - Apply pressure bandage proximally to avoid or reduce venom spread with caution on the blood supply - Immobilize the limb to minimize venom absorption - Transport patient immediately to nearby hospital Hospital Measures: - Identify the species - Conduct necessary laboratory investigations like hemoglobin, renal function... Local: Local complications may manifest as one or more of the following conditions- - Hematoma - Seroma 55 - Infection - Dehiscence - Granuloma formation - Scar formation - Contracture leading to loss of joint function etc Systemic: - Death may occur if un controlled sepsis or hemorrhage - Systemic manifestations of hemorrhagic shock due to massive bleeding - Bacteremia and sepsis from a source of locally infected wound 56 Review Questions 1. A) Duration of injury B) The circumstance of wounding C) The mechanism of injury D) Local appearance of the wound E) All of the above 2. A) Bullet wound of one hour duration B) Human bite of 30 minutes duration C) Glass laceration of five hours duration D) Crush injury of the leg following car accident E) None of the above 3. A proper wound care includes all measures except A) Removing all devitalized tissue B) Removing foreign bodies impregnated to the wound C) Wound inspection following primary management D) Inadequate hemostasis of a bleeding artery E) Decision to close a wound primarily 4. A) Forearm laceration from a knife B) Dog bite to the calf of one hour duration C) Blast wound to the thigh of two hours duration D) Stick wound to the scalp of four hours E) B and C are correct 5. In a contaminated wound left open to heal without closure, healing is effected by A) First intention B) Second intention C) Third intention D) Purely by epithelialization E) All of the above 7. A) Presence of foreign body B) Systemic illness C) Sex of the patient D) Poor patient nutritional state E) Presence of infection 58 Key to the Review Questions 1. It can be defined broadly as an infection related to or complicating a surgical therapy and requiring surgical management. Many infections occupy a non-vascularized space of tissue, thus are likely to respond to non-surgical treatments. These types of infection therefore definitely require surgery as a primary or definitive therapeutic approach. On the other hand, any infection that is related to surgical therapy but that may not definitely require surgery is also categorized as a surgical infection. Examples: - Urinary tract infections after catheterization for surgical purpose - Pulmonary complications following intubation for surgery - Tracheotomy site infection All wounds that follow operative procedure or incision are also grouped as surgical infections. According to temporal relation to surgery, surgical infections are grouped into three types. Ante/pre operative infections: These infections happen before a surgical procedure. Example: - Accidents - Appendicitis - Boils - Carbuncle - Pyomyositis Operative infections: These are types of surgical infections that happen during a surgical procedure. It can occur either due to contamination of the site or poor tissue handling technique. These include: - An infectious agent - A susceptible host - Favorable external factors or local condition with closed, less or non-per fused space. An infection becomes overt only when the equilibrium between the bacterial and host factors becomes disturbed. The common organisms in decreasing order are:- 1- Aerobic bacteria - Staphylococcus aureus - Streptococci - Klebsiella - E. Host Susceptibility: Reduced immune host defense predisposes to surgical infections. Local and external factors: Closed spaces, usually with poor vascularization, are areas susceptible to infection. Favorable situations under such condition contributing to infection include:- - Poor perfusion of blood and oxygen - Presence of dead tissue 63 - Presence of foreign bodies - Closure under tension etc. External factors like a break in the sterility technique also contribute to the development of surgical infection. Post-Operative Wound Infection This is contamination of a surgical wound during or after a surgical procedure. Source of infection: The source of contamination in more than 80% cases is the patient (endogenous). In about 20% of cases, the source is from the environment, operating staff or unsterile surgical equipment (exogenous). It contains necrotic tissue and suppuration from damage by the bacteria, and white blood cells. It is surrounded by area of inflamed tissue due to the bodys response to limit the infection. Clinical features: Patients with an abscess anywhere in the body may present with the following findings. It usually involves the extremities and identifiable portal of entry is detectable. Etiology: The most common etiologic organisms are - Beta hemolytic streptococci - Staphylococci - Clostridium perfringens Clinical Features: There is usually an identifiable portal of entry which can be a surgical wound, puncture site, skin ulcer or dermatitis. Clinical Pictures: - Series of small intra epithelial abscesses, multiple - Bullous lesions - Skin erosion and - Crust formation. Poor hygiene, immune suppressive diseases and irritation are known contributing factors. Clinical feature: - There is an intense local irritation of acute onset - Painful firm, reddish, round swelling initially, which later becomes fluctuant - Suppuration and central necrosis occurs later - The condition subsides and is self-limited to recur in multiple lesions (chronicity) Treatment: It may subside spontaneously without suppuration (Blind boil) Incision /Excision if complicated Antibiotics Carbuncle Carbuncle is an infective gangrene of subcutaneous tissue which commonly occurs in patients with diabetes and other immune suppressive conditions. Clinical Feature: Formed by multiple furuncles Pain Erythema Induration Progressive suppuration of thick pus Tissue loss with shallow and deep ulcer surrounded by smaller areas of necrosis 67 Treatment: Adequate systemic antibiotics in early stages Aggressive debridement Local wound care Detect and treat predisposing factors like diabetes mellitus Pyomyositis Pyomyositis is an acute bacterial infection of skeletal muscles with accumulation of pus in the intra-muscular area. It usually occurs in the lower limbs and trunk spontaneously or following penetrating wounds, vascular insufficiency, trauma or injection. Poor nutrition, immune deficiency, hot climate and intense muscle activity are highly associated factors. Clinical Features: It usually has sub-acute onset and can present with Localized muscle pain and swelling, late tenderness Induration, erythema and heat Muscle necrosis due to pressure Fever and other systemic manifestations later after some days Treatment: Immediate intravenous antibiotics before surgery Surgical drainage of all abscess Excision of all necrotic muscles Supportive care Madura Foot This is a chronic granulomatous disease commonly affecting the foot with extensive granulation tissue formation and bone destruction. The disease is common in the tropics and occurs through a prick in barefoot walkers in 90% of cases. Etiology: The causative microorganisms for this infection are various fungi or actinomycetes found in road dust. Treatment: Sulphonamides and Dapson (prolonged course) Broad spectrum antibiotics for secondary infection Amputation if severe and disfiguring infection Necrotizing fasciitis This is an acute invasive infection of the subcutaneous tissue and fascia characterized by vascular thrombosis, which leads to tissue necrosis. It is idiopathic in origin but minor wounds, ulcers and surgical wounds are believed to be initiating factors. The condition is described as "Meleneys synergistic gangrene" if it occurs over the abdominal wall and Fourniers gangrene if in the scrotum and perineal area.
It can restore the physiological constitution of polyunsaturated fatty acid in the cell membrane  generic 20mg tadacip. Recent studies have shown that sperm and testicular Se was unaffected by the supplementation cheap tadacip 20 mg overnight delivery, suggesting that testes are protected from Se excess as well as from Se deficiency  20mg tadacip amex. Selenium in asthma Se status is decreased in patients with asthma discount 20 mg tadacip, as is activity of glutathione peroxidase in pla telets and erythrocytes. There is an associated marked oxidant/antioxidant imbalance in the blood of asthmatics, which reflects poor antioxidant status and enhanced inflammatory mediated oxidative stress . According to the University of Maryland Medical Center, a 2004 study of 24 asthmatics that were given selenium supplements for 14 weeks had signifi cant improvement in their symptoms when compared to a control group given a placebo. Selenium in cardiovascular disorders Free radicals are toxic to the myocardium and can cause tissue damage that leads to exten sive necrosis, myocytolysis and cellular edema . Selenium in rheumatoid arthritis Scientific research shows that people with rheumatoid arthritis have low levels of selenium. In reference  the au thors found lower selenium levels in patients with rheumatoid arthritis who were treated with arthritis medication compared with people without the condition. In people without 430 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants rheumatoid arthritis or a family history of the condition, low levels of the mineral may in crease the risk of developing rheumatoid arthritis . It has been con ceived that free radical mediated oxidative stress may contribute to the development of pre- eclampsia. In ad dition, selenium deficiency in women may result in infertility, miscarriages and retention of the placenta . Results from animal studies have demonstrated that Se deficiency can lead to an impairment of immune functions that result in the inability of phagocytic neutrophils and macrophages to destroy antigens. A low Se status in humans has been reported to cause a decreased immune response to poliovirus vaccination . This study also demonstrated that the subjects supplemented with Se showed fewer mutations in poliovirus than those who received a placebo. Selenium in bone impairments Osteoblasts (bone-forming cells) and osteoclasts (bone-resorption cells) are involved in bone remodeling. Studies have demonstrated that the ischemia-reper fusion processes that occur after a fracture are associated with oxidative stress development [136,138]. In  suggests that selenium is an impor tant protective element that may be used as a dietary supplement protecting against bone impairments. Vitamin E All forms of vitamin E meet the chemical definition of an antioxidant moiety: chain-break ing free radical scavenger. The free hydroxyl group on the aromatic ring is thought to be responsible for this property, and a relatively stable form of the original vitamin E is formed when hydrogen from this group is donated to a free radical. Yet, definitive proof that vitamin E possesses antioxidant properties has been hampered for a long time because of a lack of sensitive and specific analytical techniques to measure this biologic event in vivo . Apart from antioxidant properties, more recent studies have clearly demonstrated that vitamin E also possesses important non-antioxidant cellular and molecular functions. One of the first roles of -tocopherol in cell signaling was the report that it inhibits smooth muscle cell proliferation, decrease protein kinase C activity, and con trols expression of the -tropomyosin gene . The frame to pinpoint the physiological action of vitamin E is set by its chemical nature: (i) It is a redox-active compound prone to undergo 1- and 2-electron transitions and (ii) it is highly lipophilic, although this property may be modulated by phosphorylation . In  oxidative stress is a developing re search field and is being examined in female infertility. The term oxidative stress refers to the dysequilibri um between the free radicals and the antioxidants in favor of the free radicals. In actuality, free radicals are not so frightening, since they are necessary for the adequate reproductive functions within the ovary and the endometrium. Vit E administration may improve the en dometrial response in unexplained infertile women via the likely antioxidant and the antico agulant effects. It may also modulate the antiestrogenic effect of clomiphene citrate and the problem of a thin endometrium in these cycles may be adjusted. Some non-antioxidant properties of vitamin E could play a key role in neuroprotection. It has been recently shown that -tocotrienol, at nanomolar concentrations, protects mouse hippocampal and cortical neurons from cell death by modulating neurodegenerative signal ing cascades. Furthermore, it has been shown that -tocotrienol modulates 12-lipoxygenase and phospholipase A2 activities, which are implicated in glutamate-induced neuronal cell 432 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants death . Some vitamin E forms (- and -tocopherol, tocotrienols) also exhibit potent an ti-inflammatory properties [144,145]. The introduction of the free radical theory of brain ag ing has propelled a renewed interest in this vitamin. Vitamin E is a potent peroxyl radical scavenger that prevents lipid peroxidation  and is found in high concentrations in immune cells . Deficiency in vitamin E is associated with increased oxidative stress  and impaired immune function, including both humor al and cell-mediated immunity, phagocyte function, and lymphocyte proliferation . Age-related declines in immune function can be restored by vitamin E supplementation . It is thought to be a direct free radical scavenger by activating the intracellular antioxidant enzymes and saving the cell membranes from lipid peroxidation, which was demonstrated on sperm membrane components . Its antioxidant effect was concluded in cancer therapy, high-risk pregnan cy and male infertility [152-154]. Vitamin E (tocopherol acetate) is found within the phospholipid bilayer of cell mem branes where it functions as an electron donor to free radicals. Another antioxidant, Se appears to function as an antimutagenic agent, preventing the malignant transformation of normal cells. Selenium, vitamin A (retinol) and vitamin E (-tocopherol) are essential micronutrients for human health. Both selenium and vitamin E are important in host antioxidant defense and immune function. It has been reported that deficiency of selenium and vitamins may pro mote peroxidation events leading to the release of free radicals. All have free-radical-scav enging properties that allow them to function as physiologic antioxidants in protecting a number of chronic diseases, such as cancer and cardiovascular disease. In total, there are 25 identified selenoproteins (24 in rodents), many with unknown function . Selenium is important for cytotoxic T-lymphocyte and natural killer cell activity , respiratory burst , and protection against endotoxin-induced oxida tive stress . In 2010 it was again the second most common genitourinary cancer in the United States with an estab lished 70,530 new cases and 14,680 deaths . Currently it is estimated that more than 500,000 men and women in the United States have a history of bladder cancer. The etiology of most bladder urothelial carcinoma is associated with tobacco exposure, occupational ex posure to aromatic amines, and exposure to the chemical and rubber industries . Blad der cancer is the most expensive cancer in the United States, accounting for almost $3. There is substantial epidemiological and biological evidence that selenium and vitamin E may prevent bladder cancer. A recent meta-analysis of 7 published epidemiological studies, including 3 case-control, 3 nested case-control and 1 case cohort series, examined the association between selenium levels and bladder cancer . In the analysis stratified by gender only women showed a significantly decreased risk associated with selenium. An opposite gender pattern, with protective effects in men but not in women, was reported in a meta-analysis of selenium supplementation, primary cancer in cidence and mortality . Epidemiological and biological evidence suggests a preventive effect of selenium and vitamin E on bladder cancer. These researches assessed the effect of selenium and/or vitamin E on bladder cancer development. Selenium and vitamin E Selenium and vitamin E are essential components of the human diet and have been studied as antioxidants and/or potential agents for a variety of human diseases. Various formula tions of both selenium and vitamin E have been shown to possess a therapeutic and preven tive effect against prostate cancer. Sselenium an essential trace element, and vitamin E, a lipid soluble antioxidant, are impor tant mediators for protection against oxidative stress. Deficiencies in either Se or vitamin E result in increased viral pathogenicity and altered immune responses. Furthermore, defi ciencies in either Se or vitamin E results in specific viral mutations, changing relatively be nign viruses into virulent ones. Thus, host nutritional status should be considered a driving force for the emergence of new viral strains or newly pathogenic strains of known viruses .
This substance was successfully isolated from the fungus and it was named as gibberellic acid 20 mg tadacip amex. The elongation of stem is caused by the cell division and cell elongation induced by gibberellic acid buy tadacip 20 mg fast delivery. These plants exhibit excessive internodal growth when they are treated with gibberellin buy tadacip 20 mg cheap. Such plants could be made to flower without exposure to cold season in the first year itself cheap 20 mg tadacip visa, when they are treated with gibberellins. Following the discovery of kinetin many other compounds showing similar activity were discovered. Varying mixtures of auxin and cytokinin influence plant growth and differentiation. Physiological effects of cytokinin m The most important function of cytokinin is the promotion of cell division. It is synthesised in large amounts by tissues undergoing ageing and acts as a natural plant growth hormone. Physiological effects of ethylene m Ethylene prevents elongation of stem and root in longitudinal direction. Simultaneously, the tissue enlarges radially resulting in thickening of plant parts. Physiological effects of abscisic acid m Abscisic acid acts as growth inhibitor and induces bud dormancy in a variety of plants. Growth inhibitors Some organic substances produced in the plant inhibit the plant growth. Explain the experiment to measure the actual longitudinal growth of plant by lever auxonometer. Write an account on cytokinin, ethylene and abscisic acid with their physiological effects. Photoperiodism and vernalization The response of a plant to the relative lengths of light and dark periods is known as photoperiodism. In plants, most significant photoperiodic response is the initiation of flowering. It has been first observed in Maryland Mammoth variety of tobacco (Nicotiana tabacum). From the observation of Garner and Allard all the plants do not require the same length of light and dark periods for flowering. The plants requiring longer exposure to light than their critical period are known as long day plants eg. The plants requiring light for a shorter period than their critical period are known as short day plants eg. The plants in which flowering is unaffected by the photoperiod are known as day neutral plants eg. One form absorbs red with the wave length of 660 nm called Pr and the other form absorbs far red with the wave length of 730 nm called Pfr. The two forms of phytochrome are interconvertible as shown below: Light Based on the absorption spectra, Pr is 660-665 nm also called P 660 and Pfr is P 730. In short Pr Pfr day plants, Pr promotes flowering while Pfr 730-735 nm suppresses it, while it is viceversa in long day plants. Darkness Vernalization The term vernalization was first introduced by a Russian scientist T. Many species, especially biennials and perennials o o are induced to flower at low temperature range of 1 C to 10 C. Techniques of vernalization The following are the steps to be taken to induce vernalization. Seeds are allowed to germinate and subjected to cold treatment for varying period of time depending on the species. Germinated seeds after this treatment are allowed to dry for sometime and then sown. Devernalization Reversal of the effect of vernalization is called Devernalization. Subjecting the plants to higher temperature after a cold treatment brings about devernalization. Practical application of vernalization Russian scientists have used vernalization to shorten the time of crop maturity by hastening the flowering processes which are brought about by cold treatment. The response of a plant to the relative lengths of light and dark periods is known as a. This dramatic increase in population, otherwise called population explosion has created its impact not only on the environment but also on food production. Increase in population, unplanned industrialization and migration towards cities and urban areas has resulted in the degradation of the environment. The present agricultural practices have polluted cultivable land physically, chemically and biologically. These factors lead to the shrinkage of the agricultural lands and a fall in agricultural production. Food production In order to fight the menace of hunger and malnutrition, we need crops with greater yield and better nutritive value. The quantity and quality of crops can be improved by modern scientific methods through genetic manipulation called genetic engineering. However, the time old concept of breeding plants either interspecific or intraspecific to bring out the best hybrid plant in plant breeding programmes still remains in vogue even today. A plant breeder strives to get a group of plants or a variety with suitable combination of genes that gives better yield and improved quality under a particular set of environmental conditions. A single species is a group of assemblage of innumerable number of genetic types such as lines, strains, etc. The strains are tested in various climatic conditions, successful ones are named, multiplied and distributed as a variety or cultivar eg. Breeding experiments Increase in population has forced us to carry out continuous scientific experiments for the following reasons viz. By introducing specialized technology, plant breeders are now able to develop more crops, which they multiply and supply them to the growers. Aims of plant breeding The first and foremost aim in plant breeding is to create useful variation in the crop plant. Introduction of plants from nearby regions or even from other countries for improvement of the crop. Production of haploids by the application of plant tissue culture of anther and ovary. We have several wild varieties existing in nature just as in the case of salinity tolerant wild rice. Through gene manipulation, the gene for salinity tolerance could be cloned in a rice variety. In such of those areas where shortage of fresh water exists, rice can be cultivated using seawater and can even be grown in extreme saline soil. Similarly, we need many more such wild plants showing increased capacity to extremes of climatic conditions and disease resistance for plant breeding programmes. In order to safeguard the biodiversity and certain important valuable crops from going into extinction, scientists are protecting these crops by establishing gene or germplasm banks by preserving their seeds. Selection It is one of the oldest procedures in which individual plants or group of plants are sorted out from mixed population, thus eliminating undesirable ones. Mass selection In this method, plants are selected based on their desirable morphological characters (phenotype). After repeated selection for about five to six years, selected seeds are multiplied and distributed to farmers. The only disadvantage of mass selection is that it is difficult to distinguish hereditary variation from environmental variation. Pure line selection A pure line is a collection of plants obtained as a result of repeated self-pollination from a single homozygous individual. Hence, a variety formed by this method shows more homozygosity with respect to all genes.
Significant differences were also found in antioxidant capacity val 104 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants ues via the same method in different solvents purchase tadacip 20mg otc, as well as on the antioxidant capacity of each extract via different methods generic 20mg tadacip fast delivery. Nonetheless purchase tadacip 20 mg fast delivery, the broad range of activity of the extracts led to the conclusion that multiple mechanisms are responsable for the antioxidant power of the samples and clearly indicated the potential application value of the citrus fruits studied order 20mg tadacip otc. Fi nally, the study of the content of phenolic compounds and antioxidant power of tropical fruits such as guava has also been conducted. One white-fleshed and three pink-fleshed of guava were analyzed as to their content of total phenolics, in addition to ascorbic acid and total carotenoids, as well as to their antioxidant capacity . The results obtained showed that white pulp guava had more total phe nolics and ascorbic acid than pink pulp guava. In all antioxidant assays the methanol extracts showed good corre lation with the content of total phenolics and ascorbic acid, as well as between them, but showed negative correlation with total carotenoids. In addition to the aforementioned fruits, in the search for new foods rich in phenolic com pounds and high antioxidant capacity, unconventional tropical fruits have been widely researched. The antioxidant power of these fruits showed a strong correlation with their total phenolics content . Other plant-originated foods studied for their content of phenolic compounds and antioxi dant capacities are as follows. The cocoa and chocolate liquor antioxidant capacities as well as monomeric and oligomeric procyanidins were studied . However, following the changes in total and individual phenolics content as well as antioxidant capacity during the processing of cocoa beans , it can be noted that the loss of phenolic compounds and antioxidant capacity of cocoa vary according to the degree of technological processing. The roasting process and cocoa nib alkalization had the greatest influence on the content of phenolic compounds and antioxidant power. The antioxidant capacity of 107 different Spanish red wines, from different varieties of grapes, aging proc esses and vintages  was also investigated by different methods and the results showed that all samples had an important capacity of removing hydroxyl radical and were able to block the superoxide radical, but with 10 times lower intensity. The wines also showed important protective action on biomarkers of oxidative stress. However, few statistically significant correlations were found between the levels of total phenolics and antioxidant power of the wines and the values of these correlations were very low. The correlation between antioxidant capacity and content of phenolic compounds as well as between antioxidant capacity and phenolic profile of samples  was determined. However, no significant correlation was found between their antioxidant capacity and to tal phenolics content. Nevertheless, the canonical correlation and multiple regression anal ysis showed that the antioxidant capacity of the samples was highly correlated with their profile of phenolic compounds. The results obtained in this study showed the importance of analyzing the phenolic profile of the sample rather than total phenolics to help under stand the differences in the antioxidant power of wines, which should be extended to oth er food products. Among the alcoholic beverages, antioxidant power has also been reported for whiskey, sake and sherries. In addition to alcoholic beverages, the free radical- scavenging activity and total phenolic content of commercial tea  were determined, finding that green tea contained higher content of phenolic compounds than black tea. The antioxidant capacity per serving of green tea was also much higher than that of black tea. In the two methods applied, the antioxidant power of the samples per serving was found in the following descending order: cocoa, red wine, green tea and black tea. The coffee extracts with the highest antioxidant capaci ty were obtained after extraction with water neutral (pH 7. In addition, the drink degreasing and lyophilization of the extract permitted to obtain coffee extract powder with high antioxidant power, which can be used as an ingredient or additive in the food industry with potential for preservation and functional properties. It is also know that tamarind, canola, sesame, linseed and sunflower seeds are other possible sources of phenolic compounds  and have high antioxidant capacity. In the three methods applied, the aqueous extract showed higher an tioxidant capacity than the ethanolic. It was concluded in this study that the high anti oxidant power found for the aqueous extract of the studied sunflower seed suggests that the intake of this seed may prevent in vivo oxidative reactions responsible for the development of several diseases. Although some studies have shown few statistically significant correlations between the levels of total phenolics and antioxidant capacity in foods, in others the content of total phenolic compounds was highly correlated with the antioxidant power of samples. Author details Maria de Lourdes Reis Giada* Address all correspondence to: mlgiada@nutricao. Compuestos polifenlicos: estructura y classificacin: presencia en alimentos y consumo: biodisponibilidad y metabolismo. Enzymic regulation of procyanidin bisynthesis, lack of a flav-3-en-3-ol intermediate. Chemistry and biological effects of dietary phenolic compounds: relevance to cardiovascular dis ease. Phenolic compounds and related en zymes as determinants of quality in fruits and vegetables. Health effects of vegetables and fruit: assessing mechanisms of action in human experimental studies. Antioxidant properties of some commonly consumed and underutil ized tropical legumes. Ferulic and coumaric acids, total phenolic com pounds and their correlation in selected oat genotypes. Phytochemical compo sitions, and antioxidant properties, and antiproliferative activities of wheat flour. Determination of total phenolic content and antioxidant capacity of onion (Al lium cepa) and shallot (Allium oschaninii) using infrared spectroscopy. Comparative analysis of the in vitro antioxidant activity of white and black pepper. Antioxi dant capacity of some herbs/spices from Cameroon: A comparative study of two methods. Journal of the University of Chemical Technolo gy and Metallurgy, 40(3), 255-260. Evaluation of phenolic content and antioxidant capacity of blueberry cultivars (Vaccinium corymbosum L. Re lation of total antiradical activity and total polyphenol content of sweet cherries (Pru nus avium L. Targeting excessive free radicals with peels and juices of citrus fruits: grapefruit, lemon, lime and Orange. Antioxidants and other chemical and physical characteristics of two strawberry cultivars at different ripeness stages. Comparison of some in vitro and in vivo methods to assess the antioxidant capacity of Argentinean red wines. Total antioxidant capacity of plant foods, beverages and oils con sumed in Italy assessed by three different in vitro assays. Antioxidant properties of green and black tea, and their potential ability to retard the progression of eye lens cataract. In hibition of low-density lipoprotein oxidation and oxygen radical absorbance capaci ty. A comparative study on the polyphenolic content, antibacterial activity and antioxidant capacity of different sol vent extracts of Brassica oleracea vegetables. Phenolic compounds and antioxidant activity of the apple flesh and peel of eleven cultivars grown in Brazil. Comparison of antioxidant capacity and phytochemi cal properties of wild and cultivated red raspberries (RubusidaeusL. Variation in total phenolics and antioxidant capacity among European plum genotypes. Phyto chemical composition and antioxidant capacity of various botanical parts of the fruits of Prunus domestica L. Comparative study of six pear cultivars in terms of their phenolic and vitamin C contents and antioxidant ca pacity. Identification and quantification of phenolic compounds from pomegranate (Punica granatum L. Radical scavenging activi ties of Rio Red grapefruits and Sour orange fruit extracts in different in vitro model systems. Antioxidant capacity of pummelo and navel oranges: Extraction efficiency of solvents in sequence.
Perhaps most important among recent trends is the amalgamation of arthropod life history and behavior information as well as awareness of problems with environmental disruptions into the development of more holistic control schemes cheap tadacip 20 mg with mastercard. The control of insects and other pests has long been an important aspect of public health in temperate and tropical parts of the world buy tadacip 20mg overnight delivery. The arthropods involved may be causal agents themselves 20 mg tadacip fast delivery, developmental transfer hosts buy discount tadacip 20mg online, or vectors of pathogens. The study of these conditions includes broad aspects of the biology and control of the offending arthropods and recognition of the damage they do and the way that they do it. The bearing of public and individual health and on the health of domestic and wild animals is obvious. Both mental and physical health, plus general comfort and well-being are concerned. Insects are extremely successful animals and they affect many aspects of our lives despite their small size. All kinds of natural and modified ecosystems both terrestrial and aquatic support communities of insects that present a bewildering variety of life styles, forms and functions. Their ecologies are highly diverse and often they dominate food chains and food webs in biomass and species richness. Insect life cycles are adapted to a variety of a biotic condition, including seasonal extremes of heat and cold, wet and dry, and notably to unpredictable climate. In the tropical countries the largest group of illnesses is probably insect- borne, and it is important to know the habits of the insect vectors. Similarly rodents contribute as potential reservoirs of a number of important diseases besides their attribute to economic losses. Their epidemiology is influenced by attributes of their vectors, which in turn are closely linked to environmental conditions. Over the past decades, the increased demands on the landscape for food and shelter and an increased number of by-products of mans living environment have led to unparalleled changes. Some of these changes have led to an increase in the distribution of several vector borne diseases, 6 including malaria. The key to the success of arthropod-borne disease transmission lies in the competence of vector efficiency. Whereas one vector species may be extremely efficient in the transmission of a particular pathogen, a closely related species may be totally incompetent as a vector. Even within a single vector species, individuals and populations vary dramatically in their competence to transmit a particular pathogenic agent. The expression of vector competence appears to be controlled, in part, by genetic factors involving multiple genes. Environmental factors and behavioral patterns of vector and human populations combine to provide favorable conditions for malaria transmission. While much is known about vector biology, behavior, and malaria parasites, the importance of human behavior in malaria transmission has been largely overlooked. This failure to consider community attitude and beliefs about malaria has contributed to the inability of programs to achieve sustainable control. An intimate knowledge of community attitudes, knowledge and behavior can form the basis for appropriate planning of control measures. Arbo viruses: are viruses that are transmitted from one vertebrate to the other by the help of mosquitoes and other arthropods. Biological vectors- are vectors that transmit disease pathogens after the multiplication or development of the pathogen in the 7 insect gut or muscle. Insecticide formulation:- is the addition of substances ( solvent or diluents ) which enable a given chemical insecticide to be used to greatest advantage. Mechanical vectors- are vectors that transmit pathogenic Microorganisms without undertaking any developmental change. Medical Entomology:-This is a special phase of entomology and parasitology which deals with arthropods which affect the health and well-being of man and vertebrate animals. In other words medical entomology is a medical science directly concerned with vectors that affect human and animal health. Old World:- refers to the Eastern hemispher; the world of Europe, Asia and Africa. Rodents:- comprise a great number of mammals, ranging in size from the rats and mice to as large as the Porcupines and which belong to the order rodentia. In this course we are concerned with the domestic rats and mice, which is one of the serious health hazards in the community. Technical grade insecticides: are an insecticides that exist in its purest commercial form. Vector(s):-In communicable disease terminology, vectors are arthropods or other invertebrates which transmit infection by inoculation into or through the skin or mucous membrane by 8 biting or by deposit of infective materials on the skin or on food or other objects. Namely, Mechanical disease transmission, Biological disease transmission, and hereditary disease transmission. Mechanical disease transmission:- is a type of disease transmission in which the vector is no more than a carrier that transmit pathogens without any change either on the number or form of disease pathogens. Biological disease transmission: In this type of disease transmission certain developmental pattern exists either in the vector or host or in both cases. Propagative: In propagative type of disease transmission only the number of pathogens increases and the developmental stage remain constant. The disease plague and typhus are a good examples of propagative type of disease transmission. Cyclo-developmental: In this type of disease transmission only the developmental stage (form) of the disease pathogen changed (small to big, immature to matured stage, etc. Cyclo-propagative: This type of disease transmission is a combination of both propagative and cyclo-developmental where by the disease pathogen under take a change both in number and developmental form (stage). Transovarian(Hereditary)disease transmission:- is a type of disease transmission where by the causative agent is transmitted to the immature stage ( usually to egg ) from the adult insects and / or other arthropods who carry disease pathogens and when the infected egg complete its developmental stage, it become infective or can transmit the disease to man and other animals. Ticks are very good examples of arthropods that exhibit hereditary disease transmission. Insects of Public Health Importance Introduction Arthropod is the great phylum of invertebrate animals. They were the first animal phylum to overcome the problems of locomotion, respiration, and water conservation in a terrestrial environment. All species under phylum arthropoda have the following characteristics in common Bilaterally symmetrical body sub-divided into segments. Chitin is a tough and rigid substance made up of poly (N-acetyl)-D-glucosamine (C15H20N2O10). The phylum arthropoda from public health point of view can be sub- divided in to five important classes namely Insecta, Arachnida, Diplopoda, Chilopoda and Crustacea. Of all the animal phyla, only the arthropods and the chordates have succeeded extensively in adapting to life in dry air. Insects now inhabit virtually all land surfaces of the globe except the extreme polar regions and the highest mountain peaks. Of these, the predators kill their prey more or less immediately, while parasitoids feed externally or internally in their host for some period before finally killing it. The exoskeleton provides not only strong support and protection for the body but also a large internal area for muscle attachments. The head bears a pair of large compound eyes and as many as three simple eyes, or ocelli, a pair of sensory antennae, and the feeding appendages or mouth parts. The abdomen is composed of no more than 10 or 11 visible segments and lacks appendages except for a pair of cerci and the reproductive external genitalia that may be present near the tip of the anal opening. Adult insects belonging to the diptera have one pair of functional wings and undergo holometabolous life cycle. Generally there are more than 50,000 species of both biting and non-biting diptera and the majority of which have no medical importance, but few of them are the most important disease vectors. Most of the families (including Culcidae, Simulidae, Psycodidae, Glosinidae and Muscidae) which are discuced in the concicative chapters are included under this order. Write the three types of disease transmission and give a short description for each. Mosquitoes are notorious as proven vectors of some of the most devastating human diseases.
If not quality tadacip 20 mg, confirm the side Remember to complete the draping at the beginning of the with the anaesthetist and scrub nurse buy cheap tadacip 20 mg on-line. Make sure the perineum is securely on the ward and seal the bag with wide tapes onto the leg tadacip 20 mg with visa. You can cover a hand or foot by Take the amputated limb out of the theatre before putting on an extra large sterile glove and inverting it over recovering the towels cheap tadacip 20 mg overnight delivery. If important areas near the surgeon before the operation, and you may have to check this. You will also abrasions in the skin will become infected and the risk of need abdominal packs. Betadine shampoo checked at the end of each operation, and then disposed of especially of the head and groin is particularly useful after quickly in the sluice. Do this as soon as the patient is floor and clean the table and accessories after each anaesthetized. Fumigate after a septic Take a sterile swab on a holder, start in the middle of the procedure with formalin. Make sure the alcohol-based solution dries because of potential burn hazard if you use diathermy. There is no justification for using skin preparation reduce this by adding 1% glycerol to the solution. Alternatively, if it is not leave the operation site alone exposed and all other parts soiled, put on another sterile glove on top over it, covered. Place the first towel across the lower end of the in the same way as described above. Apply a towel clip at their intersection, under the folds of If you have no drapes or gowns or very few of them, the drapes. Place another towel across the opposite edge of use plastic sheets and aprons and soak them in an the site, and finally one across its upper edge. If this is impractical, immersion in boiling water for 10mins at sea level will kill all viruses and all vegetative bacteria, but not spores, particularly those of tetanus and gas gangrene. At a height of 3,000m above sea-level water boils at 90oC and is much less effective. Steam is simply the gaseous form of water; if it is to sterilize effectively, which means killing all spores: (1) It must be at an appropriate temperature (which implies an appropriate pressure). If, on the other hand, it is superheated and therefore too dry, it will be less effective as a sterilizing Fig. If air is mixed with steam: A, take hold of the inside of the glove with your right hand, and put (1) The temperature of the mixture at a given pressure will your left hand into it. If no air is discharged, the bottom of the In summary, I believe that regard for tissue is the foremost of our chamber may be much cooler than the top. Let us strive to become first class surgeons, and let us train considerate disciplined theatre staff. Let us have plenty of soap and water, As soon as the chamber of an autoclave is full of steam at or some not too corrosive detergent. We need well ventilated rooms which are light and easy to the desired temperature and pressure, it must be held there clean, and where the number of additional items is kept low. This temperature is reached at a pressure Use sharp knives, few instruments and keep things neat and clean. Do not bury undue amounts of biologically irritating material in the of about 1kg/cm (15psi). If your autoclave is rated to 13kg/cm, you can shorten the In the wounds you make yourself, bring the skin edges together carefully sterilizing time to 10mins. They have several disadvantages: (1);The air in the chamber is removed by steam rising 2. Some of the most important agents to be or rely entirely on gravity to displace the air. If no alternative is available, causes turbulence when air is admitted, so that the gravity hypochlorite is suitable for most purposes (5. Boil a tray and the Steam enters the chamber through a pipe at the top and instruments, lay a sterile towel on the tray, put the instruments on it and fold it over them. This pipe has a thermometer in it to record the temperature in the bottom of the autoclave. In some autoclaves a water pump, which works on the same principle as an ordinary laboratory water pump, sucks out some of the steam afterwards (post-vacuum). There is also a means of admitting sterile air to break the vacuum at the end of the cycle. The thermometer records the temperature in the chamber drain, which is the coolest part of the autoclave. When this reaches the operating temperature, the timing of sterilization can begin. More sophisticated autoclaves have better pumps, a recording thermometer, a thermocouple to measure the temperature of the load, and an automatic control system. Inadequate sterilization is an important cause of wound sepsis in poorly maintained theatres. You will need a standby, in case the electricity fails, so you should have an autoclave that can be heated by kerosene or gas somewhere in the hospital (see below). It is large enough for 5lof intravenous solution, or one through a tundish (open funnel) (1) and a filling valve (2). It has an air exhaust tube which same pipe there is a safety valve (3) and a pressure gauge (4) to leads from the exhaust port to the bottom of the sterilizer. A pressure switch (5) controls the you can start timing as soon as steam comes from the exhaust. Several heating elements (9) basis of time and temperature, and are reliable, provided that there is not heat it. The chamber is drained through a pipe (10) and a strainer a long drying cycle, when prolonged heat in a jacketed sterilizer could (11). A thermometer (12) and a valve (13) are fitted to the drain pipe change their colour. This brand of tape non-return valve, to prevent dirty air and some water being sucked changes colour on the basis of moisture and temperature, to indicate that up during the vacuum). Pressure and vacuum in the chamber only suitable for high pre-vacuum autoclaves, not for the downward are measured by a gauge (15). Steam is admitted fairly You may have difficulty getting drums because they are no longer used in high up the sterilizer. There is a near-to-steam trap separated from in packs, covered by two layers of towelling and preferably an outer layer the drains by a tundish, which prevents dirty water being sucked of paper. If you are sterilizing without paper, use all equipment warm back up the waste pipe into the autoclave during a vacuum phase. To test this lead a rubber tube from the 12kW, with 6 spare elements, state voltage. Never try to sterilize anything contaminated with faeces with trials you will learn how long to allow for this to happen. The safety valve will open and allow steam can of appropriate size for antiseptic fluid. It should come out with a pure hissing sound and utensils, and will also pick up small objects. Do not open the autoclave whilst the pressure is Many hospitals do not have piped steam supplies. If anything in the load has paper or cloth equipment and taking an interest in it. They must realize the Keep the jacket full of steam at 121C throughout the importance of packing the drums loosely, the need to working day. Drain the chamber to remove any water that discharge the air, and the correct holding time. When the temperature on thermometer (12) has reached the sterilizing Make sure that every article for sterilization is cleaned temperature (usually 121C), the holding time can start. Remove instruments from boiling water the temperature will not reach 121C, until it is closed. If you still do not get the temperature not wearing sterile gloves, make sure you let the you need (usually 121C), open valve (13) for a minute or instruments dry.