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The upshot is that physicians in particular best 500 mg methocarbamol, as well as other medical professionals and staff methocarbamol 500mg with amex, urgently require a basic knowledge of the pathogens involved and the genesis of infectious diseases if they are to respond effec- tively to this dynamism in the field of infectiology discount methocarbamol 500mg free shipping. Prokaryotic and Eukaryotic Microorganisms According to a proposal by Woese that has been gaining general acceptance in recent years cheap methocarbamol 500mg on line, the world of living things is classified in the three domains bac- teria purchase methocarbamol 500mg without a prescription, archaea, and eucarya. In this system, each domain is subdivided into Kayser, Medical Microbiology © 2005 Thieme All rights reserved. This domain includes the kingdom of the heterotrophic eubacteria and includes all human pathogen bacteria. The other kingdoms, for instance that of the photosynthetic cyanobacteria, are notpathogenic. It is estimated that bacterial spe- cies on Earth number in the hundreds of thousands, of which only about 5500 have been discovered and described in detail. This domain includes forms that live under extreme environmental con- ditions, including thermophilic, hyperthermophilic, halophilic, and methanogenic microorganisms. The earlier term for the archaea was archaebacteria (ancient bac- teria), and they are indeed a kind of living fossil. Thermophilic archaea thrive mainly in warm, moist biotopes such as the hot springs at the top of geothermal vents. The hyperthermophilic archaea, a more recent discovery, live near deep-sea volcanic plumes at temperatures exceeding 1008C. The plant and animal kingdoms (animales and plantales) are all eukaryotic life forms. These organisms are obligate intracellular parasites that are able to reproduce in certain human cells only and are found in two stages: the infectious, nonreproductive particles called elementary bodies (0. These organisms are obligate intracellular parasites, rod- shaped to coccoid, that reproduce by binary transverse fission. Theyare found in a wide variety of forms, the most common being the coccoid cell (0. Fungi (Mycophyta) are nonmotile eukaryotes with rigid cell walls and a classic cell nucleus. They contain no photosynthetic pigments and are carbon heterotrophic, that is, they utilize various organic nutrient substrates (in contrast to carbon autotrophic plants). Of more than 50 000 fungal spe- cies, only about 300 are known to be human pathogens. Protozoa are microorganisms in various sizes and forms that may be free-living or parasitic. They possess a nucleus containing chromo- somes and organelles such as mitochondria (lacking in some cases), an en- Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Host–Pathogen Interactions 7 doplasmic reticulum, pseudopods, flagella, cilia, kinetoplasts, etc. Many para- sitic protozoa are transmitted by arthropods, whereby multiplication and 1 transformation into the infectious stage take place in the vector. Medically signif- icant groups include the trematodes (flukes or flatworms), cestodes (tape- worms), and nematodes (roundworms). These animals are characterized by an external chitin skele- ton, segmented bodies, jointed legs, special mouthparts, and other specific features. Their role as direct causative agents of diseases is a minor one (mites, for instance, cause scabies) as compared to their role as vectors trans- mitting viruses, bacteria, protozoa, and helminths. Host–Pathogen Interactions & The factors determining the genesis, clinical picture and outcome of an infection include complex relationships between the host and invading or- ganisms that differ widely depending on the pathogen involved. Despite this variability, a number of general principles apply to the interactions be- tween the invading pathogen with its aggression factors and the host with its defenses. Since the pathogenesis of bacterial infectious diseases has been re- searched very thoroughly, the following summary is based on the host–in- vader interactions seen in this type of infection. The determinants of bacterial pathogenicity and virulence can be outlined as follows: & Adhesion to host cells (adhesins). The above bacterial pathogenicity factors are confronted by the following host defense mechanisms: & Nonspecific defenses including mechanical, humoral, and cellular sys- tems. The response of these defenses to infection thus involves the correlation of a number of different mechanisms. Primary, innate defects are rare, whereas acquired, sec- ondary immune defects occur frequently, paving the way for infections by microorganisms known as “facultative pathogens” (opportunists). The terms pathogenicity and virulence are not clearly defined in their relevance to microorganisms. It has been proposed that pathogenicity be used to characterize a particular species and that virulence be used to describe the sum of the disease-causing properties of a population (strain) of a pathogenic species (Fig. Determinants of Bacterial Pathogenicity and Virulence Relatively little is known about the factors determining the pathogenicity and virulence of microorganisms, and most of what we do know concerns the disease-causing mechanisms of bacteria.

It is usually recommended that a tube test should be performed on all negative slide tests safe methocarbamol 500mg. A tube test must always be 65 performed if the result of the slide test is not clear buy methocarbamol 500mg without prescription, or when the slide test is negative and the Staphylococcus has been isolated from a serious infection discount methocarbamol 500 mg without a prescription. Note: Occasionally citrate-utilizing organisms such as Klebsilla can cause the clotting of citrated plasma in the tube test order methocarbamol 500mg line. It is also possible for human plasma to contain inhibitory substances which can interfere with coagulase testing cheap 500mg methocarbamol with visa. Method for slide test (to detect bound coagulase) Place a drop of physiological saline on each end of a slide, or on two separate slides. Emulsiy a colony of the test organism in each of the drops to make two thick suspensions. Note: Colonies from a mannitol salt agar culture are not suitable for coagulase testing. This is used to differentiate any granular appearance of the organism form true coagulase clumping. Negative coagulase control: Escherichia coli or Staphylococcus epldermids Method for tube test (detect free coagulase) Dilute the plasma 1 in 10 in physiological saline (mix 0. Take three small test tubes and label: T = Test organism (18-24h broth culture) Pos = Positive control (18-24h staph. Aureus broth culture) Neg = Negative control (sterile broth) A suitable broth is brain heart infusion Pipette 0. It is particularly useful if plasma is not available to peform a coagulase test or when the results of a coagulase test are difficult to interpret. Observe blacking of the medium Lead acetate paper test to detect H2S When a sensitive technique for detecting H2S production is required, the lead acetate paper test is recommended. Inoculate a tube or bottle of sterile peptone water or nutrient broth with the test organism. Insert a lead acetate paper strip in the neck of the bottle or tube above the medium, and stopper well. O Incubate the inoculated medium at 35-37 C, and examine daily for a blackening of the lower part of the strip. Indole production is detected by Kovac’s or Ehrlich’s reagent which contains 4(P)-dimethylaminobenzaldehyde. A Kovac’s ragent paper strip is inserted in the neck of the tube, and indole production is indicated by a reddening of the strip. The indole test can also be performed by culturing the organism in tryptone water or peptone water containing tryptophan, and 71 detecting indole production by adding Kovac’s or Ehrlich’s reagent to an 18-24h culture. Results Reddening of strip -----------------------------Positive test Indoloe produced Noered colour ----------------------------------Negative test No Indoloe produced Note: If the reaction is weak, confirm the result by adding 1ml of Kovac’s regent to the culture. Motility Test This is shown by a spreading turbidity from the stab line or a turbidity throughout the medium (compare with an uninoculated tube). Principle A heavy inoculum of the test organism is incubated in a broth containing nitrate. After 4 hours, the broth is tested fro the reduction of nitrate to nitrite by adding sulphanilic acid reagent. If nitrite is present, the acid reagent is diazotizex and forms a pink-red compound with alpha-naphthylamine. When nitrite is not detected it 73 is necessary to test whether the organism has reduced the nitrate beyond nitrite. If no nitrite is detected when the zinc dust is added, it can be assumed that all the nitrate has been reduced beyond nitrite to nitrogen gas or ammonia by a nitrate reducing organism. Results Red colour ----------------------------- Positive test Nitrate reduced If no red colour is produced, add a very small amount (knife point) of zink dust powder. Look again for a red colour and intrpret as follows: 74 Red colour ----------------------------- Negative test No reduction of nitrate No red colour ------------------------- Positive test Nitrate reduced Controls Positive nitrate reduction control: Escherichia coli. If the organism is oxidase - producing, the phenylenediamine in the reagent will be oxidized to a deep purple colour. Occasionally the test is performed by flooding the culture plate with oxidase reagent but this technique is not recommended for routine use because the reagent rapidly kills bacteria. The oxidase positive colonies must be removed and subcultured within 30 seconds of flooding the plate. The oxidase test must not be performed, therefore, on colonies that produce fermentation on carbohydrate – containing media, such as sucrose fermenting V. Colonies tested from a medium that contains nitrate may give unreliable oxidase test results. Required − Oxidase reagent Freshly prepared This is a 10g/l solution of tetramethyl –p-phenylenediamine dihydrochloride. Method Place a piece of filter paper in a clean petri dish and add 2 or 3 drops of freshly prepared oxidase reagent.

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Prominent upper abdomen fluid collections representing the fluid-filled stomach and duodenum suggest obstruction at the level of the duodenum purchase methocarbamol 500mg without prescription, as in the case presented methocarbamol 500 mg visa. Dilated loops of bowel with increased peristal- sis may be observed in a fetus with distal intestinal obstructions discount 500 mg methocarbamol with amex, while 36 purchase methocarbamol 500 mg otc. Yes No Attempt to pass orogastric tube Obtain abdominal film Able to pass tube into stomach? Meconium peritonitis No Perforation from: Yes Volvulus Ascites Imperforate anus Atresia Intraperitoneal mass Retroperitoneal mass Obtain abdominal film Meconium ileus Choledochal cyst Hydronephrosis Renal mass Low Calcifications? No Hydrometrocolpos Obtain contrast enema Yes Ovarian cyst Pyloric atresia Duodenal atresia Meconium peritonitis Ileal atresia Malrotation with volvulus Perforation from: Meconium ileus Jejunal atresia Volvulus Meconium plug syndrome Atresia Small l colon syndrome Meconium ileus Hirschsprung’s disease Colorectal atresia Algorithm 36 quality 500mg methocarbamol. Burd Low obstruction Small bowel No polyhydramnios High obstruction Small bowel Normal-caliber polyhydramnios coion Figure 36. Calcifications can form when the peritoneal cavity is exposed to meconium, and their presence suggests an antenatal intestinal perforation. Morphologic abnormalities suggesting a chromosomal defect also may have been observed, prompting amniocentesis and chromosomal testing. Chro- mosomal defects are found in about 5% of infants with esophageal atresia (most frequently trisomy 18 and 21) and about 30% of infants with duodenal atresia (most commonly trisomy 21). Family and maternal history may provide additional insight into the cause of neonatal intestinal obstruction. Because a familial association has been reported for most causes, a family history of newborn or child- hood surgery for intestinal obstruction should be sought, and the cause should be determined, if possible. Family members with disorders and anomalies outside of the gastrointestinal tract also may suggest an eti- ology of neonatal intestinal obstruction. Almost half of neonates with small left colon syndrome are infants of diabetic mothers. Physical Examination A complete examination is mandatory for all neonates with suspected intestinal obstruction. Particular attention should be focused on the abdominal examination, on the perineal inspection, and on identifying other anomalies, including features suggesting a chromosomal disor- der. In the case presented at the beginning of the chapter, the presence of trisomy 21 provides indirect evidence supporting the diagnosis of duodenal atresia. Although difficult to observe in most cases, gastroduodenal or high jejunal obstruction may result in epigastric distention with a scaphoid lower abdomen, as described in the case presented. As discussed pre- viously, mechanically ventilated neonates with esophageal atresia and 36. Neonatal Intestinal Obstruction 651 a tracheoesophageal fistula also may exhibit abdominal distention. The abdomen should be examined for tenderness and masses, and the inguinal region should be inspected for hernia. The main features to evaluate are the general perineal appear- ance and anal position and patency. The anal canal normally is posi- tioned about halfway between the coccyx and base of the scrotum in males or the vestibule in females, and it is within a perineal depression surrounded by slightly pigmented skin. Variations from this standard suggest that a variant of imperforate anus may be present. Neonates with a short distance from the distal colon to the perineum (low imper- forate anus) may have a perineal depression with pigmentation without a patent anal canal. With observation during the first 24 hours of life, meconium eventually may pass through a rectoperineal fistula and be seen exiting on the perineum anterior to the normal anal posi- tion or at midline raphe of the scrotum or penis in males or vestibule in females. Because meconium may be seen exiting on the perineum in patients with low imperforate anus, the examination should be per- formed carefully, since a normal anal canal may be confused by inex- perienced observers with a low imperforate anus with a rectoperineal fistula. Neonates with a long distance from the distal colon to the per- ineum (high imperforate anus) have more remarkable perineal find- ings, including the absence of an anal opening, absence of a perineal depression (“flat bottom”), and lack of pigmented skin. Additional screening maneuvers may be used to supplement the physical examination. To screen for esophageal atresia, a tube gently is passed through the mouth into the esophagus. In term infants with esophageal atresia, passage of the tube usually stops at about 10cm (Fig. If the tube successfully passes into the stomach, the gastric Pass 10-Fr tube through mouth Tube 10cm Dilated esophageal pouch Fistula Trachea Figure 36. Aspiration of more than 10 to 15cc of bilious material suggests an intestinal obstruction and provides further support for pursuing additional workup for the cause. Diagnostic Studies At this point in the workup, the range of possible diagnoses may have been narrowed substantially, and minimal additional diagnostic studies may be required. When the clinical history, presentation, and examination suggest esophageal atresia, posteroanterior and lateral chest radiographs should be obtained while gently pushing an oro- gastric tube against the blind ending esophagus. The presence of a prominent esophageal air pouch containing a curled tube is observed in most cases of esophageal atresia. The chest radiograph also should be examined for an abnormal cardiac silhouette that may suggest con- comitant congenital cardiac disease and for infiltrates attributable to aspiration of oropharyngeal secretions. Posteroanterior and lateral decubitus abdominal radiographs should be obtained in all neonates with suspected intestinal obstruc- tion.

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Usage subject to terms and conditions of license Glossary 141 Fractalkine: A chemokine expressed by Hinge region: The segment of an immu- endothelial cells; has effects on inflam- noglobulin heavy chain which lies be- mation and other processe purchase methocarbamol 500mg without a prescription. Contains all five classes of immunoglo- Humoral: Any factor present within extra- bulins methocarbamol 500 mg amex. Rejection towards one another purchase methocarbamol 500mg visa, forming a stain- of transplanted cells by host tissue methocarbamol 500mg online. Mutations in the germ line purchase 500 mg methocarbamol, un- Hypervariable region: The three most like somatic mutations, are inherited variable segments present within the by progeny. Heterologous: Belonging to another spe- Immunity: Actively or passively acquired cies. High responder: Individuals (or inbred Immunofluorescence: Rendering certain strains) whichexhibit a strong immune antigens visible by binding of a specific response against a defined antigen. This gene complex codes for the Intron: The gene segment present be- most important transplantation anti- tween two exons. An in-vi- Low responder: Individuals (or inbred tro assay which measures the stimula- strains) which exhibit a weak immune tion response of lymphocytes as allor- response against a given antigen. Usage subject to terms and conditions of license Glossary 143 that are either virally infected or tu- Pseudoalleles: Tandem variants of a gene, morous. Paratope: The part of an antibody mole- Recombination: A process by which ge- cule which contacts the antigenic de- netic information is rearranged during terminant (epitope); the antigen-bind- meiosis. Secretory piece: An IgA-associated poly- Primary lymphoid tissues: Thymus, bur- peptide produced by epithelial cells, sa of Fabricius (in birds), bone marrow. Suppressor cell: A proposed antigen-spe- Thy: A cell surface antigen of mouse T cific T-cell subpopulation which acts to cells; there are several allelic variants reduce the immune responses of other of this marker. Tolerance: A state of specific immunologi- Syngeneic: Animals produced by re- cal unresponsiveness. Kayser The Morphology and Fine Structure of Bacteria 3 & Bacterial cells are between 0. The cytoplasmic membrane harbors numerous proteins such as permeases, cell wall synthesis enzymes, sensor proteins, secretion system proteins, and, in aerobic bacteria, respiratory chain enzymes. The membrane is surrounded by the cell wall, the most important element of which is the supporting murein skeleton. The cell wall of Gram-negative bac- teria features a porous outer membrane into the outer surface of which the lipopolysaccharide responsible for the pathogenesis of Gram-negative infec- tions is integrated. Its murein layer is thicker and contains teichoic acids and wall-associated proteins that contribute to the pathogenic process in Gram-positive infections. Many bacteria have capsules made of polysac- charides that protect them from phagocytosis. Foreign body infections are caused by bacteria that form a biofilm on inert surfaces. Some bacteria produce spores, dormant forms that are highly resistant to chemical and physical noxae. Magnifications of 500– 1000—close to the resolution limits of light microscopy—are required to obtain useful images of bacteria. Another problem is that the structures of objects the size of bacteria offer little visual contrast. Techniques like phase contrast and dark field microscopy, both of which allow for live cell observa- tion, are used to overcome this difficulty. Gram-positive cocci with capsules (sporulation) in cells of the (pneumococci) genera Bacillus and 4. Gram-positive, clubshaped, Clostridium (spore stain) pleomorphic rods (corynebacteria) a) Central spore, vegetative 5. Gram-negative rods with pointed cell shows no swelling ends (fusobacteria) b) Terminal spore, vegetative 6. Gram-negative curved rods cell shows no swelling (here commashaped vibrios) c) Terminal spore (“tennis 7. Gram-negative diplococci, adjacent racquet”) sides flattened (neisseria) d) Central spore, vegetative 8. Gram-negative straight rods with cell shows swelling rounded ends (coli bacteria) e) Terminal spore 9. Spiral rods (spirilla) and Gram-negative (“drumstick”) curved rods (Helicobacter) 14. Free spores (spore stain) Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Two stains with differing affinities to different bac- teria are used in differential staining techniques, the most important of which is gram staining. Gram-positive bacteria stain blue-violet, Gram-negative bacteria stain red (see p.

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Symptoms include a gradual onset of 7 to 14 days of flu like symptoms including a severe sore throat buy 500mg methocarbamol overnight delivery, fatigue buy methocarbamol 500mg overnight delivery, headache 500mg methocarbamol sale, chest pain discount methocarbamol 500mg mastercard, and myalgia purchase methocarbamol 500mg on line. Findings include enlarged lymph nodes, exudative tonsillitis, and an enlarged spleen. It is caused by antibodies to the acetylcholine receptor in the neuromuscular junction and a decrease in receptor sites for acetylcholine. Because the smallest concentration of acetylcholine receptors in the body is in the cranial nerves, weakness and fatigue of the eye muscles, muscles of mastication, and pharyngeal muscles are the most prominently affected in most patients. The disease is rare, affecting about 60 persons out of one million Mydriasis – abnormal dilatation of the pupil like fright, sudden emotion, anemia, anesthesia, drugs, coma, hysteria, botulism irritation of cervical sympathetic nerve Myelosuppressive – inhibition of bone marrow function Myelotoxicity – destroying bone marrow; pertaining to or arising from diseased bone marrow Myocardial – pertaining to the heart muscle Myocarditis – inflammation of heart muscle, usually as a consequence of infections Myoclonus – twitching or clonic spasm of a muscle or group of muscles, condition marked by persistent and continuous muscular spasms Myopia – defect in vision so that objects can only be seen distinctly when very close to the eyes, nearsightedness Myxedema – infiltration of the skin by mucopolysaccharides, giving it a waxy or coarsened appearance. The clinical 424 and metabolic manifestations of hypothyroidism in adults, adolescents and children are complaints of sluggishness, cold intolerance, apathy, fatigue and constipation. Findings may include infiltration of the subcutaneous layers of the skin by mucopolysaccharides, which coarsen the features and create nonpitting edema. If the syndrome is left untreated, hypothermia, coma, and death may result N Narcolepsy – a disorder marked by recurrent, uncontrollable attacks of daytime sleepiness, often associated with temporary muscular paralysis (cataplexy) that may occur after powerful emotional experiences. Typically, narcoleptic patients arouse from sleep relatively easily Narcotic – producing stupor or sleep, a drug which in moderate doses depress the central nervous system thus relieving pain and producing sleep, but which in excessive doses produces unconsciousness, stupor, coma, and possibly death Nasopharyngitis – inflammation of the nasopharynx (throat/part of the pharynx situated above the soft palate) Necrolysis – necrosis and dissolution of tissue – death of cells, tissues or organs Necrosis – deaths of areas of tissue surrounded by healthy parts, a gradual degeneration caused by blood supply to the area, physical agents such as trauma, radiant energy or products (toxins) of bacteria Neonates – a newborn infant up to 1 month of age Nephrolithiasis – a disorder characterized by the presence of calculi (stones) in the kidney Nephrotoxic – a specific toxin (poison), which destroys renal (kidney) cells Nerve terminal – a small nerve originating in the cerebral hemisphere in the region st of the olfactory trigone, the 1 cranial nerve. The terminal nerve courses anteriorly (in front of) along the olfactory tract and passes through the ethmoid bone. Most filaments of the nerve form a single strand, which passes to the membrane near the anterior superior border of the nasal septum and communicates in the nasal cavity with the ophthalmic division of the trigeminal nerve. The central communications of the terminal nerve end in the septal nuclei, the olfactory lobe, and the posterior commissural and supraoptic regions of the brain Neuralgia – severe pain along the course of a nerve due to pressure on nerve trunks, faulty nerve nutrition, toxins, neuritis, usually no changes can be detected 425 Neuroleptic – a condition of the nervous system, exhaustion of a nerve or nerves from prolonged stimulation, stretching of a nerve to relieve tension, loosening of adhesions surrounding a nerve, disintegration of nerve tissue Neuromuscular – concerning the nerves and muscles Neuroma – former term for any type of tumor composed of nerve cells. Classification is now made with respect to the specific portion of the nerve involved Neuron – a nerve cell, the structural and functional unit of the nervous system, consisting of a cell body and its processes, an axon and one or more dendrites, neurons function in the initiation and conduction of impulses Neurosis – also called psychoneurosis, a disorder of the thought processes not due to demonstrable disease of the structure of the central nervous system, probably due to unresolved internal conflicts which make for an uneasy adjustment in life, contact with reality is maintained which is not the case in psychosis, the neuroses are classified as fatigue, simple nervousness (anxiety), phobic, obsessive compulsive, hysteria, hypochondrial, reactive depression, the disease rarely occurs in one of these pure forms, thus most neurotic persons would be classes as having mixed psychoneuroses Neurosyphillis – an infection of the central nervous system by syphilis organisms, which may invade the meninges and cerebrovascular system. If the brain tissue is affected by the disease, general paresis may result; if the spinal cord is infected, tabes dorsalis (an abnormal condition characterized by the slow degeneration of all or part of the body and the progressive loss of peripherial reflexes) may result Neutropenia – the presence of an abnormally small number of neutrophils (a white blood cell) in the blood. Severely low levels predispose patients to infection Neurotoxicity – having the capability to be poisonous or harmful to the nerve cells Neutropenia – abnormally small number neutrophil (white blood cell) cells in the blood Neutrotransmitter – a substance (norepinephrine, acetylcholine, dopamine) that is released when the axon terminals of a presynaptic neuron is excited and acts by inhibiting or exciting a target cell. Many patients experience side effects of these medications, including upper gastrointestinal inflammation or bleeding. These side effects occur most often in elderly people, tobacco users, and people who drink alcohol. Other potential complications include acute and chronic renal failure, liver function abnormalities, and aseptic meningitis Norepinephrine – a hormone produced by the adrenal gland similar in chemical and pharmalogical, properties to epinephrine but is chiefly a vasoconstrictor and has little effect on cardiac output Nucleic acid – any one of a group of high-molecular weight chemicals that carry the genetic information crucial to the replication of cells and the manufacturing of cellular proteins. They have a complex structure formed of sugars, phorphoric acid, and nitrogen bases. The hallmarks of the disease are thickening, scaling, and discoloration of the nailbed. The treatment may cause liver dysfunction and the drugs are extremely expensive Ophthalmic – pertaining to the eye Ophthalmology – the science dealing with the eye and its diseases Opiates – a drug derived from opium, a drug inducing sleep, to deaden, to put to sleep, very habit forming Organic brain syndrome – a disease usually of the elderly associated with a gradual deterioration of the cognitive portion of the brain memory, comprehension, ideation, and orientation become defective Oropharyngeal – the central portion of the pharynx lying between the soft palate and the upper palate and the upper portion of the epiglottis Orthostatic – standing or an erect position Osmotic – the movement of a pure solvent, as water, through a semipermiable membrame from a solution that has a lower solute concentration to one that has a higher solute concentration. The rate of osmosis depends on the concentration of solute, the temperature of the solution, the electrical charge of the solute, and the difference between the osmotic pressures exerted by the solutions. Movement across the membrane continues until the concentrations of the solutions equalize Osteomalacia – a vitamin D deficiency in adults that results in a shortage or loss of calcium salts, causing bones to become increasingly soft, flexible, brittle, and deformed. An adult form of rickets, osteomalacia can also be traced to liver disease, cancer, or other ailments that inhibit normal metabolism of vitamin D Osteoporosis – softening of the bone, a disease marked by increasing softness of the bone, so that they become more flexible and brittle and cause deformities, it is attended with rheumatic pains, the limbs, spine, thorax and pelvis especially are affected, anemia and signs of deficiency disease are resent, the patient becomes weak, and finally dies from exhaustion, occurs chiefly in adults – could be a deficiency of calcium salts or Vitamin D Otitis – inflamed condition of the ear, it is differentiated as externa, media, and interna depending on the portion of the ear which is involved 428 Ototoxicity – having a detrimental effect on the eighth nerve or the organs of hearing Ovulation – the periodic ripening and rupture of the mature follicle and the discharge of an ovum from the cortex of the ovary, occurs approximately 14 days before the next menstrual period Oxidation – the process of a substance combining with oxygen, the loss of electrons with an accompanying increase in positive valence P Pallor – lack of color Palpitations – rapid, violent or throbbing pulsation, as an abnormally rapid throbbing, or fluttering of the heart Pancreatic – concerning the pancreas Pancreatitis – inflammation of the pancreas – sudden and intense pain in the epigastric region, vomiting, belching of gas, sometimes hiccups, collapse, rigidity and tenderness over the belly button, constipation, slow pulse, possible jaundice – treatment is a slow long process, eating only clear liquids for several weeks Pancytopenia – a reduction in all cellular elements of the blood Papillary – a small nipple like protuberance or elevation Papule – a small bump or pimple, that rises above the surface of the neighboring skin. Papules may appear in numerous skin diseases, including prickly heat, psoriasis, xanthomatosis, eczema, and skin cancers. Their color may range from pale to yellow, red, brown or black Paracoccidioidomycosis – a chronic granulomatous disease of the skin Paradoxical – seemingly contradictory, but demonstrably true Paralysis – a temporary suspension or permanent loss of function, especially loss of sensation or voluntary movement Paralytic ileus – pertaining to the intestinal wall with distention and symptoms of acute obstruction and prostration of the bowel Paranoid – a chronic psychotic entry characterized by fixed but ever expanding systematized delusions of persecution, general characteristics are sensitive, suspicious, jealous, brooding nature, excessive self consciousness fixed ideas, developed in well systematized, logical delusions, rare hallucinations, inability to make concessions Parasympathetic – of or pertaining to the craniosacral division of the autonomic nervous system 429 Parenteral – denoting any medication route other than the alimentary canal (stomach), such as intravenous, subcutaneous, intramuscular, or muscosal Paresis – partial or incomplete paralysis, an organic mental disease with somatic, irritative and paralytic focal symptoms and signs running a slow chronic progressive course and tending to a fatal termination, diffuse and focal involvement of the brain and spinal cord due to syphilis usually 5 - 15 years after primary infection (memory defects, expansive delusions, depression, dementia), treatment is penicillin Paresthesia – abnormal sensation without objective cause, such as numbness, prickling, and tingling, heightened sensitivity Parosmia – any disorder or perversion of the sense of smell, a false sense of odors or perception of those, which do not exit, agreeable ones are found offensive and disagreeable ones are accepted as pleasant Pathogenic – productive of disease Pellagra – a deficiency disease or syndrome seen in certain parts of the world, characterized by cutaneous (skin), gastrointestinal, mucosal, neurological and mental symptoms, due to deficiency in diet or failure of the body to absorb niacin (Vitamin B’s) and usually associated with a deficiency of proteins which one would see in high corn diets, also may be secondary to gastrointestinal diseases or alcoholism Pemoline – a central nervous system stimulating drug that is used in treating children with hyperkinesis and minimal brain damage - Cylert Perianal – around the anus or rectum Periarteritis nodosa – inflammation of the external coating of an artery Perineal – the structures occupying the pelvic outlet and constituting the pelvic floor Periodontal abscess – inflammation of a tooth with pus in an abscess form Peripheral – located or pertaining to the outer part or surface of a body, part away from the center Peripheral edema – swelling in the arms and legs, not in the heart, usually when the right side of the heart is failing not the left Peristalsis – a progressive wave-like movement which occurs in involuntary in hollow tubes of the body, it is characteristic of tubes possessing longitudinal and circular layers of smooth muscle fibers, like the bowel Peritoneal – concerning the peritoneum – which is the serous membrane lining the abdominal cavity and reflected over the viscera (any one of the large internal organs contained in the abdominal, the thoracic, or the pelvic cavities of the body 430 Peritoneal dialysis – similar to hemodialysis except this is done into the covering around all of the abdominal organs except the kidneys called the peritoneum, a tube is placed in the peritoneal space and 4 - 6 times a day the patient makes fluid exchanges to rid the body of wastes Peritonitis – inflammation of the serous membrane that lines the abdominal cavity and its viscera Permeability – the condition of the capillary wall that enables substances in the blood to pass into tissue spaces or into cells or vice versa Pernicious anemia – destructive, fatal, harmful, severe form of blood disease marked by progressive decrease in red blood cells, muscular weakness and gastrointestinal and neural disturbances, may be fatal if not treated with Vitamin B12, iron and diet Petechiae – small, purplish hemorrhage spots in the skin which appear in certain severe fevers and are indicative of extreme exhaustion, may be due to abnormal blood clotting mechanism, also applied to similar spots occurring on mucous membranes or serous surfaces, red spots from bites of a flea pH of blood – potential of hydrogen – a measure of the hydrogen ion concentration of a solution. In chemistry, the degree of acidity or alkalinity of a substance is measured in pH and normal is 7. Many drugs can be classed as being intentionally psychotropic, but many other drugs also occasionally may produce undesired psychotropic side effects 434 Psyllium – the dried ripe seed of the psyllium plant used as a mild laxative. The patient may have periods of apnea (respirations stopped) and most likely will be very ill. Ribosomes may exist singly, in clusters called polyribosomes, or on the surface of rough endoplasmic reticulum. It may result from crush injuries, the toxic effect from drugs or chemicals on skeletal muscle, extremes of exertion, sepsis, shock, and severe hyponatremia (low sodium in the blood), among other diseases and conditions. Management may include the infusion of bicarbonate containing fluids to enhance urinary secretion of myoglobin and iron or hemodialysis Rhinorrhea – a thin watery discharge from the nose Rigidity – tenseness, immovability, stiffness, inability to bend or be bent, in psychiatry refers to one who is excessively resistant to change Rigors – a sudden paroxysmal chill with high temperature, called the cold stage, followed by a sense of heat and profuse perspiration, called the hot stage, a state of harness and stiffness as in a muscle, rigor chills may be coarse, fine, diffuse, trembling Ringworm – the popular term for any skin infection caused by fungi. This common disorder is classified according to the mechanism involved with daytime sleepiness 438 Sodium – constitutes approximately 15% of elements of the body, found in fluids of the body, serum, blood, and lymph, and in the tissues, the concentration being lower in the tissues, they are necessary to preserve a balance between calcium and potassium to maintain normal heart action and the equilibrium of the body, they regulate osmotic pressure in the cells and fluids, and act as an ion balance in tissues, produce a buffer action in the blood, and guard against excessive loss of water from the tissues Sodium bicarbonate – white, odorless powder with saline taste, a buffer in the acid base system Somnolence – prolonged drowsiness of a condition, resembling trance, which may continue for a number of days, sleepiness Sphincter – circular muscle constricting an orifice or opening Status epilepticus - continuous seizure activity without a pause, that is, without an intervening period of normal brain function Steroidogenesis – production of steroids Sterols – one of a group of substances (such as cholesterol) with a cyclic nucleus and alcohol moiety (a part or portion). They are generally colorless, crystalline compounds, nonsaponifiable (unable to be turned into a soap or lather) and soluble in certain organic solvents Steven Johnson Syndrome – a side effect of sulfonamides – most serious, onset may be sudden, symptoms with lesions on the skin and mucous membranes, severe pain in muscosa are as accompanied by photophobia, fever, malaise, inability to eat or drink, lesions produce a thick hemorrhagic crusting on the lips, eyelids and genitalia may erode, temperature 102. They can also be used to form covalent bonds between proteins or peptides and plastics which is useful in a variety of assay techniques Suicidal ideation – having thoughts of committing suicide Suprachiasmatic – supra means above or over and chiasmatic means the visible point of connection between homologous chromosomes during the first meiotic division in gametogenesis.

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