Pristiq

Gregory Dale Kirk, M.D., M.P.H., Ph.D.

• Joint Appointment in Oncology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0017371/gregory-kirk

Second Line · Inflammation is characterized by redness and swelling · Inflammation is stimulated by chemical factors released from damaged cells treatment quotes images cheap pristiq 50 mg. The increased blood flow causes puffiness shinee symptoms mp3 pristiq 100 mg discount, warmth treatment 20 initiative buy pristiq 50 mg low price, and attracts phagocytes (Neutrophils/Macrophages) · Macrophages are giant white blood cells that ingest large numbers of bacteria symptoms xylene poisoning pristiq 100 mg order visa. Pus is either brained or absorbed by the body Third Line · When the first two systems fail to stop the pathogen the immune system is the last line of defense. Viruses and microorganisms have substances on their outer surfaces that are antigens. Reaction to transplanted organs: the transplanted organ has foreign antigens (proteins from another person). To increase chances for a successful organ transplant, the person receiving the organ should be put on medications to reduce their immune response to the new organ. These drugs will reduce the risk of rejection of the donated organ by the organ transplant patient. Over the next 10-15 days there is a gradual rise in the levels of these products Secondary Immune Response If an antigen enters the body for second time the response is much more rapid. With 1 to 2 days after infection of antigen, high levels of antibodies and immune cells are present in blood. Vaccinations consist of dead or weakened bacteria or viruses that cause an immune response but do not make an individual sick. If the organisms enter the body, the antibodies will be there to attack and kill it. Shot consists of antibodies to the tetanus toxin made in the body of some animal. After 6 months, infant must rely on its immune system to "learn" and acquire immunity to series of diseases. After a pathogen (causes disease or illness) enters the body the person may not have symptoms immediately. It takes time for the pathogen to reproduce & produce enough toxins to make you sick. Antibodies & Antigens · Antigens are "foreign" substances that induce some kind of immune response. Antibody or immunoglobulin is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects like bacteria and viruses. Each antibody recognizes a specific antigen on the surface of the bacteria or virus Vaccinations consist of dead or weakened bacteria or viruses that cause an immune response but do not make an individual sick. Allergy: Immune system produces antibodies /chemicals against a usually harmless substance (antigen) · Allergy is a rapid overreaction to an antigen that is not normally harmful Allergy common symptoms: Runny nose Swollen, ichy eyes Sneezing, coughing A rash these symptoms are causes by the release of histamine which causes an inflammatory response Antihistamines are used to counter these effects Severe allergic reactions can lead to the swelling in the throat which will block the airway. Autoimmune diseases · the immune system fails to recognize some body cells as self. Skeleton muscles generate force and produce movement only by contracting or pulling on body parts. Tendons are attached in such a way that they pull on the bones and make them work like levers. Involuntary Muscles · Involuntary muscles are muscles that are not under your conscious control Involuntary muscles are responsible for activities such as breathing and digesting food Voluntary Muscles Voluntary muscles are under your control, you cause your body to move · Voluntary muscles are used when you smile, turn a page in a book, get out of your chair etc. Types of Muscles · There are three types of muscle tissue ­ skeletal muscle, smooth muscle, and cardiac muscle the skeletal muscles are voluntary muscles the smooth muscle and the cardiac muscle are involuntary 3 types of muscle under microscope Skeletal Muscle · Skeletal muscles help you move (locomotion), they are attached to the bones of your skeleton · At the end of the skeletal muscle is a tendon, which is a strong connective tissue that connects the muscle to the bone. Skeletal muscle cells appear banded, or striated One characteristic of skeletal muscles is that they react very quickly Smooth Muscle · Smooth muscles are muscles that you do not control. Smooth muscles can be found inside of many internal organs of the body, such as the walls of the stomach and blood vessels Unlike skeletal muscles, smooth muscles are not striated. The red marrow in bones produces red blood cells · movement - bones form joints which provide levers for movement such as walking, lifting, etc. Examples are the ball-and-socket, pivot, hinge, and gliding Moveable Joints Ball-and-socket joint ­ Ball-and-socket joints allow the greatest range of motion. They can be found in the shoulder where the top of the arm bone fits into the deep, bowl-like socket of the scapula (shoulder blade).

There are more than 200 enzymes that function to add medications joint pain cheap 100 mg pristiq, remove medicine 5513 pristiq 50 mg overnight delivery, or modify sugars from proteins and lipids in the Golgi apparatus medications you cant drink alcohol pristiq 50 mg otc. The Golgi apparatus is a polarized structure medications just like thorazine purchase 50 mg pristiq otc, with cis and trans sides (Figure 2­11). Membranous vesicles containing newly synthesized proteins bud off from the granular endoplasmic reticulum and fuse with the cistern on the cis side of the apparatus. The proteins are then passed via other vesicles to the middle cisterns and finally to the cistern on the trans side, from which vesicles branch off into the cytoplasm. From the trans Golgi, vesicles shuttle to the lysosomes and to the cell exterior via constitutive and nonconstitutive pathways, both involving exocytosis. Conversely, vesicles are pinched off from the cell membrane by endocytosis and pass to endosomes. Vesicular traffic in the Golgi, and between other membranous compartments in the cell, is regulated by a combination of common mechanisms along with special mechanisms that determine where inside the cell they will go. Individual vesicles also contain structural protein or lipids in their membrane that help to target them for specific membrane compartments (eg, Golgi sacs, cell membranes). The net result is a remarkable accuracy in the production of the proteins needed for normal body function. It should be distinguished from necrosis ("cell murder"), in which healthy cells are destroyed by external processes such as inflammation. In the central nervous system, large numbers of neurons are produced and then die during the remodeling that occurs during development and synapse formation. In the immune system, apoptosis gets rid of inappropriate clones of immunocytes and is responsible for the lytic effects of glucocorticoids on lymphocytes. Apoptosis is also an important factor in processes such as removal of the webs between the fingers in fetal life and regression of duct systems in the course of sexual development in the fetus. In adults, it participates in the cyclic breakdown of the endometrium that leads to menstruation. In epithelia, cells that lose their connections to the basal lamina and neighboring cells undergo apoptosis. This is responsible for the death of the enterocytes sloughed off the tips of intestinal villi. Abnormal apoptosis probably occurs in autoimmune diseases, neurodegenerative diseases, and cancer. It is interesting that apoptosis occurs in invertebrates, including nematodes and insects. One final common pathway bringing about apoptosis is activation of caspases, a group of cysteine proteases. Many of these have been characterized to date in mammals; 11 have been found in humans. The fact that these processes work as well as they do is because of mechanisms at each level that are responsible for "quality control. One early dividend was an understanding of the mechanisms by which antibiotics exert their effects. Almost all act by inhibiting protein synthesis at one or another of the steps described previously. Some of these drugs have this effect primarily in bacteria, but others inhibit protein synthesis in the cells of other animals, including mammals. This fact makes antibiotics of great value for research as well as for treatment of infections. Single genetic abnormalities that cause over 600 human diseases have now been identified. Many of the diseases are rare, but others are more common and some cause conditions that are severe and eventually fatal. Not surprisingly, genetic aspects of cancer are probably receiving the greatest current attention. Some cancers are caused by oncogenes, genes that are carried in the genomes of cancer cells and are responsible for producing their malignant properties. These genes are derived by somatic mutation from closely related proto-oncogenes, which are normal genes that control growth. Another group of genes produce proteins that suppress tumors, and more than 10 of these tumor suppressor genes have been described. Primary pathways include exocytosis, endocytosis, movement through ion channels, and primary and secondary active transport.

Movement is smoothed and coordinated by the medial and intermediate portions of the cerebellum (spinocerebellum) and its connections medications during pregnancy chart order pristiq 50 mg on line. The basal ganglia and the lateral portions of the cerebellum (cerebrocerebellum) are part of a feedback circuit to the premotor and motor cortex that is concerned with planning and organizing voluntary movement symptoms herpes discount pristiq 50 mg with visa. Movement executed by the cortex is relayed via the corticospinal tracts and corticobulbar tracts to motor neurons everlast my medicine cheap pristiq 50 mg buy on-line. A subdivision of reflex responses includes some rhythmic movements such as swallowing medicine used for uti effective pristiq 100 mg, chewing, scratching, and walking, which are largely involuntary but subject to voluntary adjustment and control. To move a limb, the brain must plan a movement, arrange appropriate motion at many different joints at the same time, and adjust the motion by comparing plan with performance. There is considerable evidence for the general motor control scheme shown in Figure 16­1. The movements are planned in the cortex as well as in the basal ganglia and the lateral portions of the cerebellar hemispheres, as indicated by increased electrical activity before the movement. The basal ganglia and cerebellum funnel information to the premotor and motor cortex by way of the thalamus. Motor commands from the motor cortex are relayed in large part via the corticospinal tracts to the spinal cord and the corresponding corticobulbar tracts to motor neurons in the brain stem. However, collaterals from these pathways and a few direct connections from the motor cortex end on brain stem nuclei, which also project to motor neurons in the brain stem and spinal cord. Movement sets up alterations in sensory input from the special senses and from muscles, tendons, joints, and the skin. This feedback information, which adjusts and smoothes movement, is relayed directly to the motor cortex and to the spinocerebellum. The main brain stem pathways that are concerned with posture and coordination are the rubrospinal, reticulospinal, tectospinal, and vestibulospinal tracts. The axial muscles are concerned with postural adjustments and gross movements, whereas the distal limb muscles mediate fine, skilled movements. Thus, for example, neurons in the medial portion of the ventral horn innervate proximal limb muscles, particularly the flexors, whereas lateral ventral horn neurons innervate distal limb muscles. Similarly, the ventral corticospinal tract and medial descending brain stem pathways (tectospinal, reticulospinal, and vestibulospinal tracts) are concerned with adjustments of proximal muscles and posture, whereas the lateral corticospinal and rubrospinal tracts are concerned with distal limb muscles and, particularly in the case of the lateral corticospinal tract, with skilled voluntary movements. About 80% of these fibers cross the midline in the medullary pyramids to form the lateral corticospinal tract (Figure 16­2). The remaining 20% make up the ventral corticospinal tract, which does not cross the midline until it reaches the level of the spinal cord at which it terminates. Lateral corticospinal tract neurons make monosynaptic connections to motor neurons, especially those concerned with skilled movements. Lower motor neurons refer to the spinal and cranial motor neurons that directly innervate skeletal muscles. Upper motor neurons are those in the cortex and brain stem that activate the lower motor neurons. The pathophysiological responses to damage to lower and upper motor neurons are very distinctive (see Clinical Box 16­1). The cortical areas from which these tracts originate were identified on the basis of electrical stimulation that produced prompt discrete movement. This region is in the precentral gyrus of the frontal lobe, extending into the central sulcus. The premotor area is anterior to the precentral gyrus, on the lateral and medial cortical surface; and the supplementary motor area is on and above the superior bank of the cingulate sulcus on the medial side of the hemisphere. This tract originates in the precentral gyrus and passes through the internal capsule. Most fibers decussate in the pyramids and descend in the lateral white matter of the spinal cord to form the lateral division of the tract which can make monosynaptic connections with spinal motor neurons. The ventral division of the tract remains uncrossed until reaching the spinal cord where axons terminate on spinal interneurons antecedent to motor neurons. The various parts of the body are represented in the precentral gyrus, with the feet at the top of the gyrus and the face at the bottom (Figure 16­5).

Calcium is never found in nature uncombined; it occurs abundantly as chalk treatment quinsy 100 mg pristiq buy with visa, granite administering medications 7th edition ebook buy pristiq 100 mg online, eggshell medicine upset stomach purchase 50 mg pristiq with amex, seashells 72210 treatment generic pristiq 100 mg buy line, "hard" water, bone, and limestone. The metal is used as a reducing agent in preparing other metals such as thorium, uranium, and zirconium, and is used as a deoxidizer, disulfurizer, or decarburizer for 190 Introduction to Human Nutrition a tightly regulated range. Only in extreme circumstances, such as severe malnutrition or hyperparathyroidism, is the serum ionized calcium concentration below or above the normal range. The secretion of these hormones is governed wholly, or in part, by the plasma concentration of ionized calcium, thus forming a negative feedback system. Calcium in food occurs as salts or associated with other dietary constituents in the form of complexes of calcium ions. Calcium must be released in a soluble, and probably ionized, form before it can be absorbed. Calcium is absorbed in the intestine by two routes, transcellular and paracellular (Figure 9. The transcellular route involves active transport of calcium by the mucosal calcium transport protein, calbindin, and is saturable and subject to physiological and nutritional regulation via vitamin D. The paracellular route involves passive calcium transport through the tight junctions between mucosal cells; it is nonsaturable, essentially independent of nutritional and physiological regulation, and concentration dependent. Most calcium absorption in humans occurs in the small intestine, but there is some evidence for a small colonic component. On average, between 10% and 30% of the calcium is absorbed from a mixed diet by healthy adults. Calcium absorption may also be influenced by a number of dietary factors (Table 9. Metabolic function and essentiality Calcium is required for normal growth and development of the skeleton. During maturity, the body, and therefore the skeleton, is more or less in calcium equilibrium. From the age of about 50 years in men and from the menopause in women, bone balance becomes negative and bone is lost from all skeletal sites. This bone loss is associated with a marked rise in fracture rates in both sexes, but particularly in women. Extraskeletal calcium (representing around 1% of total body calcium) plays a role in mediating vascular contraction and vasodilatation, muscle contraction, nerve transmission, glandular secretion, and as an important second messenger molecule. If, however, there is a continual inadequate intake or poor intestinal absorption of calcium. The cumulative effect of calcium depletion (by whatever mechanism) on the skeleton over many years contributes to the increasing frequency of osteoporotic fractures with age. Chronic inadequate intake or poor intestinal absorption of calcium may also play some role in the etiologies of hypertension, including pre-eclampsia and colon cancer. Calcium intake may also play a role in body weight regulation; however, this requires further investigation. Toxicity the available data on the adverse effects of high calcium intakes in humans are primarily from the intake of calcium from nutrient supplements. Daily vitamin D3 administration seems to be an effective therapy for both disorders. Type I familial benign hypercalcemia, a renal tubular defect in calcium reabsorption, is caused by a mutation in the gene encoding the calcium-sensing receptor. However, the gene(s) responsible for this type of hypocalciuric hypercalcemia is still being mapped. Assessing status There is, as yet, no biochemical indicator that reflects calcium nutritional status. Blood calcium concentration, for example, is not a good indicator because it is tightly regulated. There are, however, some potential indicators of nutritional calcium adequacy, which are related to content or metabolism of the skeletal calcium reserve. This is based on the concept that to maximize skeletal strength, optimum bone mass must be attained through a maximum skeletal calcium reserve. Finally, recent research suggests that biochemical markers of bone turnover that predict bone mass changes and fracture risk may be functional indicators of the adequacy of calcium intake.

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