Mark Corson

By U. Mufassa. Cleveland Chiropractic College.

Phagolysosome: Fusion ofphagosome and lysozyme (bag of hydrolytic and proteolytic enzymes found in phagocytic cells) effective cernos caps 40 mg. Specific defense mechanisms There are two main mechanisms by which the host mounts a specific immune response against bacterial infection order 40mg cernos caps visa. The cell mediated response The humoral response Antibodies are proteins produced by B-lymphocytes in response to antigens (foreign substance which induces and binds with antibody) buy cernos caps 40 mg online. Bacterial Lysis The cell mediated response It is important in killing of intracellular pathogenic bacteria. T-lymphocytes are population of lymphocytes conferring cell mediated immunity due to release of hormone-like mediators (lymphokines). Inhibition of macrophage migration: Localizes macrophage to the site of infection. Chemotactic attraction of lymphocytes, macrophages and polymorphs to the site of infection. Transient normal flora Resident normal floras are relatively fixed microorganisms regularly inhabiting the skin and mucus membrane of the normal host. Prevent colonization by pathogenic micro-organisms and possible disease through “bacterial interference”. Normal flora of the skin 4 The skin is rich in resident bacterial flora, estimated at 10 microbes per square inch. Alpha-hemolytic streptococci and non-hemolytic streptococci 301 Normal flora of the mouth and nasopharynx and upper respiratory tract The upper respiratory tract is heavily colonized by normal flora but the lower respiratory tract is sterile. Normal flora of the gastrointestinal tract The normal flora of the stomach, duodenum, jejunum and upper ileum is scanty but the large intestine is very heavily colonized with bacteria. Anaerobes like bacteroides, bifidobacteria, anaerobic lactobacilli, clostridia and peptostreptococci Feces contain enormous number of bacteria, which constitute upto one third of the fecal weight. Normal flora of the genitourinary tract For anatomical reasons the female genital tract is much more heavily colonized than that of the male. Non-hemolytic streptococci Normal flora of the external auditary meatus It is an extension of skin normal flora and often profusely colonized. Extensive tissue destruction with necrosis of muscle, foul smelling discharge and gas under the skin. Dirty wound Laboratory diagnosis: Specimen: Swab from lesion, ulcer and discharge. Culture: Blood agar medium and Mac Conkey agar medium Biochemical and sensitivity testing for microbe identification. Diagnosis: Specimen: Lavage/drainage of sinuses Procedure: Gram staining, culture, biochemical testing, serological testing and sensitivity testing Treatment: Amoxicillin/ampicillin Co-trimoxazole 2. Chronic suppurative otitis media Long standing ear disease characterized by periods of exacerbation with profuse ear discharge and pain; and remission with relatively dry ear. Risk factors: History of acute or chronic otitis media Parental history of otitis media Crowding Causative agent: P. Treatment: Little role of oral antibiotic agents in the treatment of chronic suppurative otitis media. Chronic sinusitis Painful sinusesand head ache are prominent symptoms; often associated with mucoid or purulent nasal discharge and nasal obstruction. Laboratory diagnosis: Specimen: Saline washings from the affected sinus Procedure: Gram staining, culture, biochemical and serological test for microbe identification. If antibiotic is given, it should be guided by sensitivity pattern or “best-guess” basis. Acute bronchitis It is an acute inflammation of the tracheobronchial tree generally self-limited and with eventual complete healing and return of function. Environmental irritants like indoor air pollution and tobacco smoking Clinical features: Symptoms of upper respiratory infection proceed acute infectious bronchitis. Initially dry cough followed by productive cough with mucoid or mucopurulent expectoration, low grade fever and substernal chest pain. Laboratory diagnosis: Specimen: Sputum Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Chronic bronchitis It is defined as chronic productive cough for at least three months in each of two successive years. Causative factors: Cigarette smoking Air pollution Exposure to noxious stimuli Clinical features: Chronic productive cough with mucoid expectoration, low grade fever, weakness, and occasional chest pain. It is characterized by remission and exacerbation of symptoms; the commonly exacerbating condition is superimposed bacterial infection. Bacteria that exacerbate chronic bronchitis are: Streptococcus pneumoniae Haempphilus influenzae Mycoplasma pneumoniae Branhamella catarrhalis Laboratory diagnosis: Specimen: Sputum Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Clinical features: Sudden onset of fever, chills, sweating, and productive cough of purulent or blood streaking sputum and pleuritic chest pain. Procedure: Gram staining, culture, biochemical and serological test for microbe identification. Giardia lamblia causes diarrhea by physical coverage of the normal absorptive surface. Laboratory diagnosis: Specimen: Stool, rectal swab Wet mount preparation: Pus cells, red blood cells, parasites and ova. Incubation period and severity of disease in food infection is determined by inoculum of micro-organism ingested.

The phi phenomenon looks like a moving zone or cloud of background color surrounding the flashing objects discount cernos caps 40mg on-line. The beta effect and the phi phenomenon are other examples of the importance of the gestalt—our tendency to “see more than the sum of the parts buy discount cernos caps 40mg on line. In the phi phenomenon generic cernos caps 40 mg online, the perception of motion is based on the momentary hiding of an image. The lens adjusts to focus the light on the retina, where it appears upside down and backward. Receptor cells on the retina are excited or inhibited by the light and send information to the visual cortex through the optic nerve. Color blindness occurs when people lack function in the red- or green- sensitive cones. Consider some ways that the processes of visual perception help you engage in an everyday activity, such as driving a car or riding a bicycle. Do you think you would be able to compensate for your loss of sight by using other senses? Segregation of form, color, movement, and depth: Anatomy, physiology, and perception. Distributed and overlapping representations of faces and objects in ventral temporal cortex. The development of prospective grasping control between 5 and 7 months: A longitudinal study. Draw a picture of the ear and label its key structures and functions, and describe the role they play in hearing. Sound waves that are collected by our ears are converted into neural impulses, which are sent to the brain where they are integrated with past experience and interpreted as the sounds we experience. The human ear is sensitive to a wide range of sounds, ranging from the faint tick of a clock in a nearby room to the roar of a rock band at a nightclub, and we have the ability to detect very small variations in sound. But the ear is particularly sensitive to sounds in the same frequency as the human voice. A mother can pick out her child’s voice from a host of others, and when we pick up the phone we quickly recognize a familiar voice. In a fraction of a second, our auditory system receives the sound waves, transmits them to the auditory cortex, compares them to stored knowledge of other voices, and identifies the identity of the caller. Vibrating objects (such as the human vocal chords or guitar strings) cause air molecules to bump into each other and produce sound waves, which travel from their source as peaks and valleys much like the ripples that expand outward when a stone is tossed into a pond. Unlike light waves, which can travel in a vacuum, sound waves are carried within mediums such as air, water, or metal, and it is the changes in pressure associated with these mediums that the ear detects. As with light waves, we detect both the wavelength and the amplitude of sound waves. The wavelength of the sound wave (known as frequency) is measured in terms of the number of waves that arrive per second and determines our perception of pitch, the perceived frequency of a Attributed to Charles Stangor Saylor. Longer sound waves have lower frequency and produce a lower pitch, whereas shorter waves have higher frequency and a higher pitch. The amplitude, or height of the sound wave, determines how much energy it contains and is perceived as loudness (the degree of sound volume). Zero decibels represent the absolute threshold for human hearing, below which we cannot hear a sound. Each increase in 10 decibels represents a tenfold increase in the loudness of the sound (see Figure 4. The sound of a typical conversation (about 60 decibels) is 1,000 times louder than the sound of a faint whisper (30 decibels), whereas the sound of a jackhammer (130 decibels) is 10 billion times louder than the whisper. Audition begins in the pinna, the external and visible part of the ear, which is shaped like a funnel to draw in sound waves and guide them into the auditory canal. At the end of the canal, the sound waves strike the tightly stretched, highly sensitive membrane known as thetympanic membrane (or eardrum), which vibrates with the waves. The resulting vibrations are relayed into the middle ear through three tiny bones, known as the ossicles—the hammer (or Attributed to Charles Stangor Saylor. The vibrations cause the oval window, the membrane covering the opening of the cochlea, to vibrate, disturbing the fluid inside the cochlea. The movements of the fluid in the cochlea bend the hair cells of the inner ear, much in the same way that a gust of wind bends over wheat stalks in a field. The movements of the hair cells trigger nerve impulses in the attached neurons, which are sent to the auditory nerve and then to the auditory cortex in the brain. The cochlea contains about 16,000 hair cells, each of which holds a bundle of fibers known as cilia on its tip. The cilia are so sensitive that they can detect a movement that pushes them the width of a single atom. To put things in perspective, cilia swaying at the width of an atom is equivalent to the tip of the Eiffel Tower swaying by half an [1] inch (Corey et al. The resulting vibrations are moved by the three small ossicles into the cochlea, where they are detected by hair cells and sent to the auditory nerve. Although loudness is directly determined by the number of hair cells that are vibrating, two different mechanisms are used to detect pitch. The frequency theory of hearing proposes that whatever the pitch of a sound wave, nerve impulses of a corresponding frequency will be sent to the auditory nerve.

In this chapter buy 40 mg cernos caps amex, you’ll learn about inflammation and the medications that are prescribed to reduce the redness cheap cernos caps 40 mg with visa, swelling cernos caps 40 mg without a prescription, warmth, and pain that is associated with inflammation. An Inside Look at Inflammation Inflammation is the body’s protective response to injury to tissues. Injury causes the release of three chemicals that stimulate a vascular response that force 197 Copyright © 2006 by The McGraw-Hill Companies, Inc. This chemical works to bring more blood and lymph fluid to the site of the invasion. These are blood plasma proteins that influence smooth muscle con- tractions, increase blood flow throughout the body, increase the perme- ability of small capillaries, and stimulate pain receptors. They are produced in response to the white blood cells that flow to the area of injured tissue. It is important not to confuse inflammation and infection because they are not the same. Only a small percentage of inflammation is caused by infection from micro- organisms. Trauma, surgery, extreme heat or cold, electricity, and caustic chem- icals cause most inflammation. It is dur- ing this phase that blood vessels dilate (vasodilation) and become more perme- able, enabling fluid and white blood cells to leave the plasma and flow to the injured tissue. White blood cells (also called leukocytes or immune cells) are components found in the blood. They help defend the body against infectious disease and foreign material as part of the immune system. Combating Inflammation Although inflammation is a natural response to injury, this process can be uncomfortable for a patient, especially when there is fever, pain, and swelling. Anti-inflammatory medication can be given to reduce the inflammatory process and bring comfort to the patient. Anti-inflammatory medication stops the production of prostaglandins result- ing in a decrease in the inflammatory process. Inhibits platelet aggregation (grouping to form clot) Many anti-inflammatory medications fall within all three categories. Aspirin is one of them, which is the oldest and least expensive anti-inflammatory med- ication available and, along with acetaminophen and ibuprofen, is the choice for relieving headaches. Corticosteroids, such as prednisone, are frequently used as anti-inflammatory agents. This group of drugs can control inflammation by suppressing or pre- venting many of the components of the inflammatory process at the injured site. There are other anti-inflammatory medications that are not chemically the same as corticosteroid medication. This com- mon form of arthritis is the result of deformation or mismatched joint surfaces, rather than an inflammatory disease. Symptoms include joint stiffness that usually lasts only a few minutes after initiating movement and perhaps an aching pain in weight-bearing joints. Rheumatoid arthritis usually occurs between 30 to 70 years of age and occurs more often in women than in men. Early symptoms may include feelings of fatigue and weakness, joint pain and stiffness, and, joint swelling several weeks later. Joints are inflamed (warm, red, swollen) and often are limited in range of motion. A list of drugs utilized in the treatment of arthritis is provided in the Appendix. Gout has been called the “disease of Kings” because in the past, royalty ate rich foods and drank wine and alcohol and suffered from gout. The most common site of acute gouty inflam- mation is at the joint of the big toe. It is characterized by a uric acid metabolism disorder and a defect in purine (products of certain proteins) metabolism, resulting in an increase in urates (uric acid salts) and an accumulation of uric acid (hyperuricemia) or an ineffective clearance of uric acid in the kidneys. Uric acid solubility is poor in acid urine and urate crystals may form, causing urate calculi (stones). Gout may appear as bumps or “tophi” in the subcutaneous tissue of earlobes, elbows, hands, and the base of the large toe. The complications of untreated or prolonged periods of gout include tophi, gouty arthritis, urinary calculi, and gouty nephropathy. Fluid intake should be increased while taking antigout drugs and the urine should be alkaline. Foods rich in purine, including wine, alcohol, organ meats, sardines, salmon, and gravy should be avoided. The body releases hista- mines, kinins, and prostaglandins that force fluid and white blood cells to the site of the injury to stimulate nerve endings and clean the area so it can heal. The site of the injury becomes red, swollen, and warm and loses its normal function. The vascular phase is where blood vessels dilate and become permeable so fluid and white blood cells can leave the vessel. Anti-inflammatory medication reduces the inflammatory process which may allow the patient to go about normal daily activities while the tissue heals. There are three categories of anti-inflammatory medications: analgesic, to relieve pain; antipyretic, to reduce fever; and anticoagulants, to inhibit blood clotting.

The other enantiomer is the (À)-glyceraldehyde and this was assigned as L- glyceraldehyde cheap 40 mg cernos caps with mastercard. We can easily identify the only difference in the following structures purchase 40mg cernos caps visa, which is the orientation of the hydroxyl group at the chiral centre buy 40mg cernos caps otc. In the D and L system, structures that are similar to glyceraldehyde (at chiral carbon) are compared, for example 2,3-dihydroxypropanoic acid. The D-isomer does not have to have a (þ) rotation, and similarly the L-isomer does not have to have a (À) rotation. This system is particularly used to designate various carbohydrate or sugar molecules, e. Prelog (Switzerland), devised a system of nomenclature that can describe the configuration of enantiomers more precisely. According to this system, one enantiomer of 2-hexanol should be designated (R)-2-hexanol, and the other (S)-2-hexanol. R and S came from the Latin words rectus and sinister, meaning right and left, respectively. Priority is first assigned on the basis of the atomic number of the atom that is directly attached to the chiral carbon. In this case, on the basis of the atomic number of the carbon atom alone, one cannot assign the priority of these two carbon atoms, and must consider the next set of atoms attached to these carbon atoms. When we examine the methyl group of the enantiomer, we find that the next set of atoms consists of three H atoms. On the other hand, in the propyl group, the next set of atoms consists of one C and two H atoms. For example N C C O as if it were C O C N as if it were C N O C N C (d) Having decided on the priority of the four groups, one has to arrange (rotate) the molecule in such a way that group 4, i. It is then necessary to designate all these stereoisomers using the (R) and (S) system. All four stereoisomers of 2,3,4-trihydroxybutanal (A–D) are opti- cally active, and among them there are two enantiomeric pairs, A and B, and C and D, as shown in the structures below. Other pairs of diastereomers among the stereoisomers of 2,3,4-trihydroxybutanal are A and D, and B and C. However, because one half of the tartaric acid molecule is a mirror image of the other half, we get a meso structure. Hence, we have a meso-tartaric acid and it is achiral (since it has a plane of symmetry, and it is superimposable on its mirror image). Cyclic compounds Depending on the type of substitution on a ring, the molecule can be chiral (optically active) or achiral (optically inactive). For example, 1,2-dichlorocyclohexane can exists as meso compounds (optically inactive) and enantiomers (optically active). When there are substituent groups attached to the double bond, they can bond in different ways, resulting in trans (opposite side) and cis (same side) isomers. The conversion occurs because the p bond breaks when energy is absorbed, and the two halves of the molecule can then rotate with respect to each other before the p bond forms again. G H G G C C C C H G H H trans-Isomer cis-Isomer Substituent G is on opposite sides Substituent G is on same side on the double-bonded carbons on the double-bonded carbons When there is the same substituent attached to the double bonded carbons, as in the above example, it is quite straightforward to designate trans or cis. However, if there are more than one different groups or atoms present, as in the following examples, the situation becomes a bit more complicated for assigning cis and trans. Cl H Cl Cl F H C C C C C C Br Cl Br H I Cl Alkenes with different substituents on the double-bonded carbons To simplify this situation, the E/Z system is used for naming geometrical isomers. Z stands for German zusammen, which means the same side, and E for German entgegen, meaning on the opposite side. So, once the priorities are assigned, we can easily draw the (E)- and (Z)-isomers of 1-bromo-1,2-dichloroethene in the following way. Cl H Cl Cl C C C C Br Cl Br H (Z)-1-Bromo-1,2-dichloroethene (E)-1-Bromo-1,2-dichloroethene The two higher priority groups are on the same side The two higher priority groups are on the opposite side Now, let us have a look at the cyclic compounds. We can use this (E) and (Z) system for a cyclic compound when two or more groups are attached to a ring. For example, if in the following substituted cyclopentane A and B are different groups, each C atom attached to A and B is a chiral carbon or stereocentre. H H H H H H H H B H H H H H H H * * * * A H A B (E)-form (Z)-form The two higher priority groups (A or B > H) The two higher priority groups (A or B > H) are on the opposite side are on the same side In 1-bromo-2-chlorocyclopentane, there are two chiral centres. One is an optically inactive meso isomer (cis or (Z)-isomer) and two are optically active trans or (E)-isomers. Thus, with trans structure, we obtain di-axial and di- equatorial bonds, and with cis structure we obtain axial–equatorial bonds. All drugs are chemical entities, and a great majority (30–50 per cent) of them contain stereocentres, show stereoisomerism and exist as enantiomers. Moreover, the current trend in drug markets is a rapid increase of the sales of chiral drugs at the expense of the achiral ones. In the next few years, chiral drugs, whether enantiomerically pure or sold as a racemic mixture, will dominate drug markets. It is therefore important to understand how drug chirality affects its interaction with drug targets and to be able to use proper nomenclature in describing the drugs themselves and the nature of forces responsible for those interactions. Most often only one form shows correct physiological and pharmacolo- gical action. For example, only one enantiomer of morphine is active as an analgesic, only one enantiomer of glucose is metabolized in our body to give energy and only one enantiomeric form of adrenaline is a neurotransmitter. Not only drug molecules, but also various other molecules that are essential for living organisms exist in stereoiso- meric forms, and their biological properties are often specific to one stereoisomer. Thus, it is important to understand stereochemistry for a better understanding of drug molecules, their action and toxicity. The (R)-form is completely inactive, although it is slowly converted in the body to the active (S)-form.