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Throw rugs and electrical cords toms generic elavil 75mg line, or internal characteristics of the individual) or running across the floor should be eliminated cheap 10mg elavil mastercard. Carpet extrinsic (having to do with the environment elavil 50mg otc, or char- edges should be tacked or taped down. Elevated toilet lems and sleep disturbances, postmeal blood pressure seats can make it easier to sit and stand up again. Lighting should be bright and easily accessi- icy sidewalks, throw rugs, or poor footwear. Alcohol intake should be minimized or avoided the bathroom or when getting up to go to the toilet. Half of all patients who suffer a fall causing falls, false pride and unwillingness to use appropriate serious injury will die within 1 year. Scheduled Older people are at higher risk of falling because toileting can help avoid the urgent need to urinate and the natural process of aging reduces eyesight, balance, reduce the risk of falls. Drinking adequate fluids will and proprioception (the inner sense of the bodys posi- help avoid lowered blood pressure from mild dehydra- tion in space). People who become dizzy when arising from bed falls among middle- to late-aged women, because it can should sit on the bed for 12 minutes before walking. Injury Balancing and strengthening exercises such as water due to falls and the fear of repeat falls can cause elderly exercise, tai chi, or yoga can reduce the risk of falls. If people to avoid physical activity, leading to reduced physical conditions such as urinary urgency or dizziness strength and deconditioning, putting them at even are a persistent problem, medical treatment may be greater risk for falls. If an elderly person falls twice within 6 months, even with- Suggested Reading out significant injury, a medical evaluation should be done to look for treatable causes. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. Fecundity It is clear that womens fecundity, or Fertility and Sterility, 65, 791795. These tests do not have a high sensitivity or a high diminished ovarian reserve in infertile women. An abnormal test is associated with a poor Journal of Obstetrics and Gynecology, 179, 804812. A variety of environmental factors have been asso- Type 1: Sunna (traditional)removal of varying ciated with decreased fecundity. Smoking and heavy use of the early 1950s in response to an edict by the gov- marijuana will decrease fertility in men and women. This method includes the week) is also associated with decreased fertility as well removal of the clitoris, labia minora, and parts of as a variety of pregnancy-related complications, such as the labia majora. Menstrual and urinary the Pharonic and intermediate forms of circum- blockages are very common. Urinary dermoid cysts are cision, the left and right raw edges of the female very common and can grow to the size of a grapefruit. However, they do not threaten health except which is the technique for female circumcision during labor. It is estimated that 31% of circumcised in most parts of the world other than sub- women develop at least one, and more commonly Saharan regions of Africa. Despite the with certain ethnic groups and has no relation to polit- suffering, most women request recircumcision after ical or religious boundaries. Infibulation causes prolongation of labor and African continent in a broad, triangular eastwest band obstructed delivery, with increased risk of brain damage that stretches from Egypt in the northeast and Tanzania to the infant and stillbirth. Infibulation childbirth is the development of a passage between the occurs most frequently in the Horn of Africa, namely, bladder and the vagina (vesicovaginal fistulae). The World caused when the head of the fetus exerts friction or Health Organization estimates that between 85 and 114 pressure against the urinary bladder for a long time, million girls and women have been subjected to this which can occur for several hours as the infants head practice. There are many cultural beliefs surrounding slowly passes through the birth canal. Postpartum blood loss is another decrease the womans sexual desire, prevent promiscu- concern due to the cutting of scar tissue, often by ity, and ensure chastity before marriage; that it enhances untrained midwives. Prisoners of ritual: An odyssey into female quent complications include severe pain, blood loss, circumcision in Africa. Primary among these is that it fails to recognize that women and men do not always embody their respective archetypes, other than to label this diversity as deviant. Furthermore, it does not address individual differences in behavior in various situations. Sex-role theory also fails to articulate how characteristics become assigned to femi- nine and masculine archetypes. For example, there may be no daily activity that requires more rational thinking Femininity Femininity is defined in various than being the primary caretaker of a child, yet rational- dictionaries in either a circular manner as the quality of ity is assigned as a characteristic of the masculine arche- being feminine or indirectly as qualities associated with type. This is because femininity is typically professional sports are those who are described as hav- conceptualized as a constellation of multiple interacting ing an intuitive sense of the game, yet intuition is elements that coalesce to yield an energy, an essence, assigned as a characteristic of the feminine archetype. However, using a linguistic metaphor to and exclusive linkage of feminine worth with chastity. Consequently, in addition integrate archetypical ways of behaving that are appro- to archetypical representations of chastity, religious texts priate to their assigned sex from societys institutions. Theory of Hegemonic Masculinity proposes that an However, sex-role theory fails to account for the fact archetypical form of masculinity exists in a given cul- that cultures do not value the characteristics of each sex ture within a particular historical period, that masculin- equally.

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These are the 2 major constituents of the extracellular matrix and its abnormalities are associated with the pathogenesis and complications of dia betes buy generic elavil 25mg online. Ascorbic acid enhances the collagen and proteoglycans in fibroblast culture media order 75 mg elavil with amex. Insulin removes the inhibitory effect of glucose on the production of collagen order 10 mg elavil overnight delivery, but the mechanism is not yet known. Thus high con centrations of glucose in diabetes damage the action of ascorbic acid at the cellular level. And in many cases is "asymptomatic" or people who have it doing not give importance. However there have been great efforts to use its measurement in the detection of primary or secondary essential hypertension for decades. Virtually the observed declines in blood pressure and its control in recent years due to better control among individuals diagnosed as hypertensive. Obesity, dietary sodium and alcohol consumption are strongly associat ed with low or high blood pressure values. A high intake of polyunsaturated fatty acids and magnesium are associated with for in stance with low pressure. It has also shown an inverse association between plasma vita min C and blood pressure. These subjects have a similar difference in diastolic pressure ranging from 78 to 73 mm Hg, a difference of 6%. These results were consistent in several studies regardless of quintiles being compared. Such relationships have also been identified in Chinese-American population; both men and women aged 60-96 years without antihypertensive treatment. This study revealed a statisti cally significant difference between the values of systolic and diastolic pressure in upper and lower quintiles of 14% (21 mm Hg) and 9% (8mmHg) respectively. It appears that vita 474 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants min C has a lowering effect on systolic rather than diastolic pressure. Supplementation with vitamin C (1g/day) does not influence the diastolic pressure. Subjects with low vitamin C levels in serum have a high risk of developing stroke compared with those with high values in plasma of the vitamin. Hypertensive subjects, usually overweight, and low levels of se rum vitamin C have the same risk. The increase in the consumption of vitamin C during periods of fat restriction occurs on the one hand a reduction in blood pressure. Thus dietary antioxidants en hance the production of prostacyclin for the purification of free radicals and peroxides that inhibit prostacyclin synthase. Vitamin C and blood pressure then are related, because it has a lowering effect on blood pressure especially when fat intake is low. Ascorbic acid and cardiovascular disease Vitamin C acts as a regulator of the catabolism of cholesterol into bile acids in the guinea pig and is an important factor in the regulation of lipid in several animal species (rabbit, horse, and rat). Correlation studies in humans have shown an inverse relationship between vitamin C in take and mortality from cardiovascular disease. Experimental and observational studies in humans have been inconsistent but indicate that individuals with high cholesterol consumption, greater than or equal to 5. This effect is explained by the promotion or in hibition of degradation of prostacyclin and its implications for thrombosis and atherogene sis, in addition to its protective effect on lipid peroxidation. In patients with high cardiovascular risk, supplementation with antioxidant vitamins shows no reduction in over all mortality or incidence of any vascular disease, cancer or other adverse events. Recent findings indicate a relationship between the nutritional status of vitamin C (as meas ured by the concentration of ascorbate in serum), biological markers of infection and haemo static factors and support the hypothesis that vitamin C may protect against cardiovascular events through effects on the haemostatic factors in response to infection. This relationship is surprising given the uncertainty and potential error in the estimation of consumption of vitamin and vitamin C status assessment (determined mostly by food intake records of 24 h blood samples isolated). Add to this the wide variation between subjects is greater than within the same subject. Lower socioeconomic status and smoking are associated with low concentrations of ascor bate and high concentrations of homeostatic factors that may be confounding factors in cross-sectional studies. The inverse association between homeostatic factors and serum concentrations of ascorbate is strong and consistent, however only some markers of infection (e. C-reactive protein and 1-antichymotrypsin) are related inversely and significantly with serum ascorbate. It is possible that this low concentration of ascorbate may be the result rather than the cause, of a biological response to infection. The strong relationship between serum ascorbate and diet ary intake suggest however that their serum concentrations reflect the nutritional status of the vitamin. The various studies reported in the literature indicate that vitamin does not prevent respira tory infection but may modulate the biological response, leading to less severe disease, so it has a protective function in lung function. Effect of antioxidants in cardiovascular disease It has been suggested a protective effect of antioxidants such as vitamin C, A (-carotene) and E plus selenium in cardiovascular disease. Prospective studies so far have documented an inverse relationship between vitamin C intake and cardiovascular disease, and a strong protective effect of vitamin E supplementation on coronary patients. Finnish and Swiss studies showed that blood levels of ascorbate and therefore a diminished nutritional status of vitamin predicts myocardial infarction. Mediterranean studies showed a 70% reduction in mortality and risk of myocardial infarction independent of the effect on blood pressure and lipids. The infection may contribute to the inflammatory process observed in atherosclerosis. C-reactive protein and alpha-1 antichymotrypsin are acute phase proteins are synthesized in hepatocytes in large numbers in inflammatory processes.

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Although gender as a risk factor is clearly not subject to alteration purchase elavil 75mg without a prescription, 02 some studies suggests that post-menopausal use of estrogen may be associated with 03 reduced risk of nuclear cataract (Cumming and Mitchell buy discount elavil 75mg line, 1997) buy generic elavil 25 mg on-line. However, other 04 studies have been unable to confirm this finding (McCarty et al. Ocular surgery is also an important 09 risk factor, especially trabeculectomy (Klein et al. It 11 has been suggested that surgically created alternative pathways for the drainage of 12 aqueous from the eye may deprive the lens of aqueous-borne nutrients necessary to 13 preserve normal clarity. A dose dependent association (measured both in terms of 14 concentration and length application) between age-related cataract and mitomycin C, 15 an anti-metabolite used regularly in glaucoma surgery, has also been established in 16 a trial setting (Ramkrishnan et al. Ocular trauma can clearly be associated 17 with lens opacity in certain individuals, although studies suggest that the impact 18 on the prevalence in the population of lens opacity is probably minimal (Wong 19 et al. These smaller, well-defined subpopulations with a relatively 22 high risk of rapid-onset cataract could ultimately serve as ideal subjects for trials 23 of anti-cataract medications, although the relevance of the findings of such studies 24 to age-related cataract would be unknown. It is well known 31 that increased refractive index of the lens in advanced nuclear cataract may cause 32 a secondary myopia; pre-existing myopia may also serve as an independent risk 33 factor (Lim et al. The aggregation of lens protein into 41 randomly distributed high molecular weight clusters are thought to produce suffi- 42 cient fluctuation in protein density to account for the opacification. The 03 crystallins, which constitute approximately 90% of the total protein content of 04 the lens, accumulate and show many age-related oxidative changes. These include 05 formation of disulfide and other inter- and intramolecular cross-links and methionine 06 oxidation, all of which result in the aggregation of high molecular weight molecules. It may be possible that local or systemic conditions 09 affecting the protein redox status, such as myopia and diabetes, influence this 10 process (Altomare et al. The sulfhydryl proteins, 19 known to have structural and functional role in the crystalline lens, contain an 20 elevated number of thiol groups and, therefore are reduced as a result of oxidation. A significant proportion of lenses and 28 aqueous humor taken from cataract patients have elevated H2O2 levels. Because 29 H2O2, at concentrations found in cataract, can cause lens opacification and produces 30 a pattern of oxidation similar to that found in cataract, it is concluded that H2O2 31 is the major oxidant involved in cataract formation (Ramachandran et al. After exposure to oxidative stress, the redox 39 set point of the single layer of the lens epithelial cells (but not the remainder of the 40 lens) quickly changes, going from a strongly reducing to an oxidizing environment 41 (Ito et al. The female gender 05 has been found to display an increased incidence of cataracts, as compared with 06 age-matched men. This increased risk is seen in woman population after menopause 07 only (Gupta et al. Protective effect of Sex Steroid 08 Hormones in the perspective of cataractogenesis in females has been substantiated 09 by epidemiological information. The Beaver Dam Eye Study suggests a modest 10 protective effect of estrogen exposure on the lenses of women in the context of 11 age related opacities (Klein et al. The results indicated that the current use 12 of post-menopausal estrogens is associated with decreased risk of severe nuclear 13 sclerosis. The study also showed that from menarche to menopause the life span of 14 woman is associated with protective effect and decreased risk of nuclear sclerosis 15 and cortical opacities. Proper ionic 19 milieu and hydration of lens cells are essential to maintain transparency of crystalline 20 lens. Estrogen maintains proper ionic composition by its non-genomic action (Singh 21 and Gupta, 1997a). Further, estrogens are known for increasing water imbibitions 22 and retention of hydration in the target tissues (Singh and Gupta, 1997b). At the molecular level, a number of scavenger molecules are present that 26 protects against oxidative stress. It maintains ascorbate in the reduced state and 33 scavenges peroxides and radiation induced free radicals Vitamin C, always in high 34 concentration in the aqueous is actively transported into the lens, where it is at a 35 higher concentration. Glare is 02 another debilitating symptom of cataract for which an active individual needs to 03 be operated. This happens particularly in context of night driving or even in bright 04 sunlight. The phacoemulsification technique, which allows 10 an exquisite intraoperative control and a consistent closed-chamber removal of 11 cataract, undoubtedly reigns supreme in the developed countries. This technique has 12 brought cataract surgery results as close to anatomical perfection as possible with 13 the current technology and skills. In order to increase safety and to achieve faster 14 visual rehabilitation for their patients, many surgeons are now adopting topical 15 anesthesia with an adjunctive intracameral 1% lidocaine (Shah et al. Understanding 19 the distinctive uses of the newer dispersive and cohesive viscoelastics has helped 20 ensure better corneal endothelial protection during phacoemulsification. Of the wide 21 range of phaco techniques developed to suit different cataracts and their related 22 conditions, recommendations are for those that ensure endocapsular (posterior plane) 23 phacoemulsification, which ensurse far superior long-term outcome. Hydrodisection procedure is then performed to free the nucleus from 31 the capsule. After ensuring a freely rotating nucleus, a wide trench or crater is 32 created which is confined within the area of the capsulorhexis. After achieving 33 sufficient thinning of the nuclear plate (atleast 90% of the total central depth), the 34 phaco tip is buried at 6 oclock, using controlled U/S power, to produce a vacuum 35 seal. The entire nucleus is 38 chopped thus in a step-by-step fashion by rotating the chopped fragment clockwise 39 and repeating the same chop technique. This is followed by foldable 44 intraocular lens implantation in the capsular bag.

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The mouthparts are visible at 189 the front of the body cheap elavil 75mg overnight delivery, differentiating them from the soft ticks discount elavil 50mg with amex. In contrast to the soft ticks they have a shield like plate or scutellum behind the head on the back of the body discount elavil 75 mg amex, and there is only one nymphal stage. Most species of hard tick feed on three different hosts: one each for the larva, nymph and adult. The Argasids are a multi-host ticks and therefore, nymphs as well as adults may take several short blood meals from different hosts. Ixodidae have one eight-legged nymphal instar, however, the argasidae may have up to eight nymphal instars. The immature stages resemble the adults and each of them need a blood meal before it can proceed to the next stage. Both sexes feed on blood, the males less frequently than the females, and both can be vectors of diseases. They may cause local traumatic and inflammatory damage when they puncture the skin and suck blood. In public health ticks are important largely because of their activity 190 as vector of pathogenic organisms. Transovarian transmission has been observed to a greater or lesser extent in the case of all the major categories of ticks. The majority of ticks are essentially ectoparasites of wild animals, and humans must be regarded as an incidental host, for both the ticks and the organisms which they transmit. Tick borne relapsing fever The disease is caused by a microorganism of the genus Borrelia. It is transmitted by the bite soft ticks of the genus Ornithodoros in many countries in the tropics and sub-tropics. The ticks usually feed quickly at night in or near houses and then leave the host. Tick borne rickettsial infection This group of diseases is caused by closely related Rickettsia microorganisms transmitted by tick bites or contamination of the skin with crushed tissues or faces of the tick, such as:- Spotted fever - caused by Rickettsia rickettsii and R. The disease is transmitted mostly by Ixodes ticks, commonly, in the summer when the nymphs are abundant. Some rodents, especially mice, serve as reservoirs of infection while large mammals serve principally as hosts maintaining tick populations. Tularaemia Tularaemia is caused by the infectious agent francisella tularensis (pasteurella tularensis). Tick paralysis Hard ticks inject in to the body with their saliva certain toxins that can cause a condition in people and animals called tick paralysis. It is an acute intoxication characterized by elevation of temperature up 0 to 40 C and difficulty in swallowing and respiration. It occurs worldwide and is most common and severe in children aged up to two years. Tick borne viral encephalitides: It is a group of viral diseases causing acute inflammation of the brain, spinal cord and meninges. Severe infections may cause violent headaches, high fever, nausea, coma and death. These diseases are transmitted by biting ticks and by the consumption of milk from infected animals. Personal protection measures and animal care in fields, forests, in the shed, stable and in other places that are infested with ticks should be taken. Children or adult who walk through tick infested area should remove all clothing as soon as they return to their home, and all attached or crawling ticks should be removed to minimize danger. Some times repellents can be used to prevent ticks from 192 attaching to the body. Application of Insecticides: Spraying of appropriate chemicals over ticks directly in their natural habitats such as forests and fields may control them. Large areas may be treated by ultra-low-volume spraying of liquid acaricide concentrates. Small areas may be sprayed by means of motorized knapsack spraying or mist blowers. Larval trombiculids commmonly known as chigger or red bugs, are very small, being 0. After emerging from the egg, the larvae crawl on grasses or low laying vegetation and leaf litter to wait for an animal or human host. They attach themselves to the skin of reptiles, birds, mammals and humans walking or resting in the habitat. On humans they seek out areas where clothing is tight against the skin, the waist and ankles being the parts most commonly attacked. The larvae remain attached to the skin of the host between two days and a month, depending on the species. They then drop to the ground and enter the soil to develop in to the harmless nymphal and adult stages. Generally over 700 species have been described and about 20 of these are important either as a cause of dermatitis (scrab- itch) in man or as a vector of human pathogens. Scrab-itch in man, which is the result of an allergic reaction to the saliva of the chigger, can be caused by many trombiculid species. Biting can be prevented by avoiding infested terrain and applying repellents to skin and clothing. Chigger mites can be prevented by treating clothing, particularly socks or stockings, cuffs and collars with mite repellents. The most efficient chigger repellent is diethyl toluamide, but also dimethyl phthalate, dibutyl phthalate and benzyl benzoate are efficient.

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