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By: Jonathan Handy

  • Consultant in Intensive Care Medicine,Royal Marsden Hospital,Honorary Senior Lecturer,Imperial College London

Giving women and girls support medicine you cant take with grapefruit 30mg paroxetine with amex, information and facilities for menstrual hygiene management can empower them and enable them to treatment jalapeno skin burn purchase paroxetine 20 mg without prescription contribute more in society asthma medications 7 letters buy generic paroxetine 30mg line. Examples of good practice are available for training and awareness-raising sessions on menstrual hygiene medicine 852 discount 40mg paroxetine with visa. Educating boys (particularly from adolescence) on the challenges and struggles girls face could help reduce teasing and help them become more understanding and supportive husbands and fathers. Girls and women have been known to have been so desperate for sanitary products that they have traded sex or favours with men to be able to obtain them (refer to Module 3. By helping boys and men to better support their friends, sisters, wives and daughters in regards to menstrual hygiene, this risk can be minimised. One adult man said, "It is a taboo to talk about it and worse when women and girls are around. No special attention is paid to their wives in terms of money, food materials and workload. I come to school on a bicycle but I had to walk home pushing my bicycle because I was afraid I would hurt the bleeding area. When I got home my aunt was not there, only my uncle, so I had no choice but to tell him that I was bleeding. They have overcome additional barriers to discuss and promote solutions to the challenges facing women and girls relating to menstrual hygiene. This section introduces a few of the increasing numbers of male champions around the world working on this issue. As a member of the Teens Watch Club, he heard how girls in the group could not afford to buy sanitary towels and were therefore embarrassed to stay in school. He proposed a fundraising football tournament, attracting people from different villages. With the money, the group bought 1,000 sets of sanitary towels and over a month gave them to 500 girls in more than ten schools in slums across Nairobi. He said nothing and went to his bedroom and came out with a lot of cloth and told me that I should put them in my pants and wait for my aunt to come back. My aunt came back and told me that I had grown from a child to an adult and that I should now act responsible and be careful with boys and she taught me how to use the cloths and that I was going to bleed every month until I become too old. Consequently, community hygiene promoter Nurul Islam was uncomfortable discussing menstruation hygiene, although it was a part of his role to educate the women and girls in his village about the dangers of using dirty rags. With their advice, he came up with a plan, "After our meeting, I invited Amina Khatum from Char Bramgacha to come to my village to speak about menstrual hygiene. Because Amina is from a village that is very close to ours, some of the women knew her. Amina tries to involve men and boys in her menstrual hygiene sessions whenever possible. At school sessions in her own village, she includes the boys in some of the menstrual hygiene discussions. Om Prasad WaterAid in Nepal Om Prasad supports menstrual hygiene advocacy efforts in Nepal, engages in international debates, and trains community leaders. Syed Shah Nasir Executive Director, Integrated Regional Support Programme, Pakistan Syed Shah Nasir introduced the issue of menstrual hygiene in Pakistan after attending a workshop in Bangladesh. He supported his team to assess issues for schoolgirls, undertake training and introduce low-cost menstrual materials into schools. He also supported an assessment of menstrual hygiene needs during the 2010 flood emergency, and is planning to advocate menstrual hygiene in national and international forums in the future. Gender budgeting means showing awareness that some problems are more relevant or particular to boys/men and some to girls/women. This includes budgeting relating to improving the menstrual hygiene situation for women and girls. Budgeting for menstrual hygiene In any menstrual hygiene programme, both one-off and ongoing running costs need to be considered.

Peptide hormones and amines are stored in secretory granules by endocrine cells so that they are readily available for release treatment yellow fever cheap 20 mg paroxetine free shipping. The release treatment centers for alcoholism buy paroxetine 40 mg amex, and thus the plasma concentration treatment kennel cough 40 mg paroxetine mastercard, of most hormones is controlled by some type of negative feedback regulation medications on airline flights buy 10mg paroxetine. In this type of regulation, the rising levels of the hormone bring about a biologic response that inhibits further hormone release. For example, -cells in the pancreatic islets are directly affected by the concentration of glucose in the body fluids. An increase in glucose concentration causes the -cells to increase their release of insulin. One effect of insulin is to promote the uptake of glucose by skeletal muscle cells. As glucose is removed from the body fluids, the stimulus for insulin release is removed, and this has a negative effect on insulin release. This negative feedback regulation of insulin release is a major factor in determining a normal plasma concentration of glucose. The negative feedback regulation of insulin by changes in plasma glucose is a relatively simple and straightforward feedback loop. The plasma constituent, glucose, being regulated by the hormone, insulin, has a direct effect on the cells releasing the hormone. However, negative feedback loops can be quite complex and have multiple organs in the loop. Some of the more complex loops involve the hormones regulating Cellular Effects of Steroid and Thyroid Hormones Receptors that bind steroid and thyroid hormones are found either in the cytosol or in the nucleus. Steroid and thyroid hormones are lipid soluble and can reach these intracellular receptors by diffusing into the cell through the cell membrane. Biologic responses to steroid and thyroid hormones typically develop more slowly but last longer than responses to peptide hormones. A second type of feedback regulation, that is seen much less frequently than negative feedback, is positive feedback regulation. In this case, the hormone brings about a biologic response that produces a further increase in the release of the hormone. This type of regulation is unusual, and it is not designed to maintain a stable or homeostatic level of some activity or blood constituent. One of the few examples of this type of regulation is the relationship between oxytocin release and dilation of the uterine cervix. An increase in oxytocin release is associated with dilation of the uterine cervix during parturition (details in chapters on reproduction), and oxytocin acts on the smooth muscle of the uterus to increase uterine contractions. When the cervix dilates during parturition and oxytocin is released, the contractions of the uterus move the fetus out of the uterus through the cervix. This further dilates the cervix, providing a greater stimulus for secretion of oxytocin. Hypothalamopituitary Axis the hypothalamus is ventral to the thalamus in the diencephalon and forms the floor and part of the wall of the third ventricle (see Chapter 9). The pituitary gland, or hypophysis cerebri, is attached to its base by the infundibulum, a stalk of nervous tissue (primarily axons). Cell bodies of neurons whose axons form the infundibulum are found in the hypothalamus, and their termini abut on the capillaries in the neural part of the pituitary gland (neurohypophysis, posterior pituitary, or pars nervosa). Associated with the infundibulum is a unique system of arterioles and capillaries called the hypothalamohypophysial portal system. This system is a true vascular portal system in that blood from a capillary network in the hypothalamus flows through portal vessels (similar to veins) to the glandular portion of the pituitary (adenohypophysis, anterior pituitary, or pars distalis), where it enters a second capillary network. B) Drawing illustrates direct neural connection between hypothalamus and neurohypophysis. The neurotransmitters released by hypothalamic neurons whose termini end in the neurohypophysis enter the blood and are carried to distant sites to function as systemic hormones. These peptides are manufactured by the neuronal cell bodies within the hypothalamus, transported via axons into the neurohypophysis, and released directly into blood vessels when action potentials arrive at the telodendria.

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The receptor for noxious stimuli is the nociceptor medicine 7 order paroxetine 10 mg with mastercard, a naked (not encapsulated) nerve ending symptoms zika virus discount paroxetine 30 mg with mastercard. As a rule medications related to the lymphatic system generic paroxetine 20 mg mastercard, axons transmitting noxious information are smaller and less myelinated than those carrying tactile or body position information symptoms 7 days post iui safe 20 mg paroxetine. Activation of pain fibers of medium diameter and myelination (so-called A fibers) is associated with a sharp, pricking quality of pain as reported by human beings. Activation of the smallest diameter C fibers, which are unmyelinated, produces a dull, burning type of pain. The preponderance of C fibers in visceral sensory fibers explains the burning, aching quality of visceral pain. As indicated in Chapter 9, a number of ascending spinal cord tracts transmit information about noxious stimuli to brain structures. In addition to projecting to the cerebral cortex for conscious perception, pain pathways typically have strong connections to autonomic centers in the brainstem and parts of the brain that produce increased mental alertness and behavioral and emotional responses to painful stimuli. These connections are responsible for producing signs of sympathetic stimulation. The ability of a given noxious stimulus to produce a perception of pain is a highly mutable property that can be modified in the periphery, in the spinal cord, and in the brainstem. Importantly, many substances released by injured tissues and inflammatory cells stimulate or lower the threshold of nociceptors. Thus, in damaged or inflamed tissue, stimuli that would normally be below threshold for detection may produce activity in nociceptive afferents. These events contribute to the development of primary hyperalgesia, a phenomenon wherein the perception of pain in injured tissues is increased. A dramatic example of this is made by sunburned human skin; the inflammation of the injured skin lowers threshold of nociceptors so that even a light touch (for instance, contact with clothing) can activate them. Cerebral Cortex (Conscious Perception) Brainstem (Autonomic Centers) Nociceptor (Naked Nerve Endings) Motor Neuron (Reflex Movements) Muscle Figure 11-3. From there the information produces reflex movements and goes to the brainstem to produce autonomic and other involuntary responses and to the cerebral cortex for conscious perception. Events in the dorsal horn of the spinal cord can also affect transmission of nociceptive information. Rapid, prolonged firing of action potentials in the primary afferent neuron can produce changes in the neuron on which it synapses, making it respond more vigorously to subsequent stimulation. Activity in spinal nociceptive pathways is also strongly influenced by descending antinociceptive systems that originate in the brainstem. The midbrain and medulla both possess a series of midline nuclei that inhibit nociception via their connections with nociceptive pathways. These nuclei use multiple neurotransmitters, most notably endorphins, transmitters with powerful antinociceptive properties. High-strung individuals often exhibit exaggerated reactions to stimuli that scarcely merit attention in more "laid-back" individuals. Studies have shown, however, that the correctly applied twitch actually stimulates a release of endorphins, lowers the heart rate, and produces behavioral signs of sedation in the horse. This very old technique of restraint may actually be recruiting some of the neuroanatomic pathways postulated to be stimulated by acupuncture. Consequently, proprioceptive tracts typically have few synapses and are composed of very large diameter, highly myelinated axons (called Aa fibers). In fact, the very fastest (up to 120 m/second) axons of the entire nervous system transmit proprioceptive information. We, and presumably animals, are generally not aware of proprioception, but it is critically important in the execution of accurate, wellcoordinated movements. Injury to the proprioceptive pathways results in awkward, inaccurate, uncoordinated gait and movement. Touch Touch is the modality associated with nonnoxious mechanical contact with the body.

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Taste in the caudal third of the tongue is conveyed by fibers of the glossopharyngeal nerve medications hypothyroidism buy cheap paroxetine 10mg line. Somatic sensations (heat symptoms dengue fever order paroxetine 40mg otc, cold medicine you can take while breastfeeding buy discount paroxetine 20 mg line, touch symptoms multiple sclerosis buy cheap paroxetine 10 mg line, pain) from the tongue are conveyed by branches Referred Pain In humans and presumably in animals, most visceral sensations are ill defined and poorly localized. Noxious stimuli originating in viscera, such as might be caused excessive dilation of a viscus, are often perceived as originating instead from a somatic region (body wall or skin), a phenomenon called referred pain. This perception is thought to result from the fact that information from that region of viscera converges on spinal cord neurons and pathways that also convey information from somatic structures. Since we are much more familiar with sensations arising from our skin and body wall, the pain is interpreted to originate in these somatic structures. A well-known example of referred pain comes from human medicine; pain due to ischemia of heart muscle is usually perceived as radiating across the left shoulder and down the left arm. A veterinary example may be the high degree of sensitivity in the region of the sternum that some cows exhibit with traumatic peritonitis caused by a wire or nail perforating the wall of the forestomach. Chemical Senses Chemical senses are those that detect particular molecules in the external or internal environment. Chemical senses that detect molecules outside the body include gustation (taste) and olfaction (smell). Within the body, the chemical senses include the detection of blood pH and carbon dioxide concentration. It is likely that taste buds on areas other than the tongue are innervated by the vagus nerve. Individual taste cells have membrane receptor physiology designed to detect the chemical substances associated with these tastes. The more complex sensory experiences that we normally associate with taste (for example, the flavors that we detect when we distinguish between an apple and a carrot) are created primarily from stimulation of olfactory (smell) receptors in combination with the basic taste modalities. Dissolution of substances so that they can be tasted is an important function of saliva. In addition to the four basic tastes, a fifth taste modality with its own specific taste cell receptor has been identified. This taste, experienced when the amino acid glutamate is present, imparts a savory quality to foodstuffs. Because this taste modality was first described by Japanese researchers, it is known by the Japanese word for savory or delicious: umami. Olfactory sensory neurons are scattered among supporting cells throughout the olfactory mucosa in the dorsocaudal part of the nasal cavity. The apex of each olfactory neuron bears a single dendrite with a tuft of several fine hairlike projections, which bear the chemical receptors for the sense of smell. An axon from each olfactory neuron passes through the cribriform plate of the ethmoid bone; the mass of fine fibers thus entering the cranial vault collectively constitutes the olfactory nerve. These fibers synapse within the olfactory bulb on neurons whose central processes make up the olfactory tracts of the brain. Olfaction is the only sensory modality that is not routed through the thalamus before reaching conscious perception at a primary sensory cortex. Inset shows a microscopic view of the olfactory epithelium, which covers the ethmoid bone within the caudodorsal nasal cavity. There is a subset of olfactory sensory neurons outside the olfactory epithelium that innervate the mucosa of the vomeronasal organ, a diverticulum of the nasal cavity in the hard palate. These olfactory neurons appear to be receptors for pheromones, chemical substances that can influence the behavior of other individuals. In spite of vigorous research efforts, no human pheromones have yet been unequivocally identified. The combined secretion of these glands is called cerumen, a brown waxy substance that protects the canal. A separate annular cartilage adjacent to the funnel-shaped base of the auricular cartilage forms most of the external acoustic canal.

References:

  • https://canjurol.com/html/free-articles/V19I5S1F-03-DrKapoor.pdf
  • http://eprints.ums.ac.id/45880/20/NASKAH%20PUBLIKASI.pdf
  • https://www.spine.org/Documents/ResearchClinicalCare/Guidelines/Spondylolisthesis.pdf
  • https://www.bodytalksystem.com/member/downloads/english/member/FYP-Sinusitis.pdf