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As the disease progresses 30 caps npxl free shipping lotus herbals 3 in 1 review, the articular cartilage is severely damaged or destroyed buy 30caps npxl with amex bajaj herbals pvt ltd ahmedabad, resulting in joint deformation, loss of movement, and severe disability. The most commonly involved joints are the hands, feet, and cervical spine, with corresponding joints on both sides of the body usually affected, though not always to the same extent. Rheumatoid arthritis is also associated with lung fibrosis, vasculitis (inflammation of blood vessels), coronary heart disease, and premature mortality. Exercise, anti-inflammatory and pain medications, various specific disease-modifying anti-rheumatic drugs, or surgery are used to treat rheumatoid arthritis. These cause erosion and loss of the articular cartilage covering the surfaces of the bones, resulting in inflammation that causes joint stiffness and pain. Each movement at a synovial joint results from the contraction or relaxation of the muscles that are attached to the bones on either side of the articulation. While the ball-and-socket joint gives the greatest range of movement at an individual joint, in other regions of the body, several joints may work together to produce a particular movement. Overall, each type of synovial joint is necessary to provide the body with its great flexibility and mobility. Body movements are always described in relation to the anatomical position of the body: upright stance, with upper limbs to the side of body and palms facing forward. These movements take place at the shoulder, hip, elbow, knee, wrist, metacarpophalangeal, metatarsophalangeal, and interphalangeal joints. Adduction brings the limb or hand toward or across the midline of the body, or brings the fingers or toes together. Circumduction is the movement of the limb, hand, or fingers in a circular pattern, using the sequential combination of flexion, adduction, extension, and abduction motions. Adduction/abduction and circumduction take place at the shoulder, hip, wrist, metacarpophalangeal, and metatarsophalangeal joints. Medial and lateral rotation of the upper limb at the shoulder or lower limb at the hip involves turning the anterior surface of the limb toward the midline of the body (medial or internal rotation) or away from the midline (lateral or external rotation). Flexion and Extension Flexion and extension are movements that take place within the sagittal plane and involve anterior or posterior movements of the body or limbs. For the vertebral column, flexion (anterior flexion) is an anterior (forward) bending of the neck or body, while extension involves a posterior-directed motion, such as straightening from a flexed position or bending backward. These movements of the vertebral column involve both the symphysis joint formed by each intervertebral disc, as well as the plane type of synovial joint formed between the inferior articular processes of one vertebra and the superior articular processes of the next lower vertebra. In the limbs, flexion decreases the angle between the bones (bending of the joint), while extension increases the angle and straightens the joint. For the upper limb, all anterior-going motions are flexion and all posterior-going motions are extension. For the thumb, extension moves the thumb away from the palm of the hand, within the same plane as the palm, while flexion brings the thumb back against the index finger or into the palm. In the lower limb, bringing the thigh forward and upward is flexion at the hip joint, while any posterior-going motion of the thigh is extension. Note that extension of the thigh beyond the anatomical (standing) position is greatly limited by the ligaments that support the hip joint. Knee flexion is the bending of the knee to bring the foot toward the posterior thigh, and extension is the straightening of the knee. Flexion and extension movements are seen at the hinge, condyloid, saddle, and ball-and-socket joints of the limbs (see Figure 9. Hyperextension is the abnormal or excessive extension of a joint beyond its normal range of motion, thus resulting in injury. In cases of “whiplash” in which the head is suddenly moved backward and then forward, a patient may experience both hyperextension and hyperflexion of the cervical region. Abduction and Adduction Abduction and adduction motions occur within the coronal plane and involve medial-lateral motions of the limbs, fingers, toes, or thumb. Abduction moves the limb laterally away from the midline of the body, while adduction is the opposing movement that brings the limb toward the body or across the midline. For example, abduction is raising the arm at the shoulder joint, moving it laterally away from the body, while adduction brings the arm down to the side of the body. Similarly, abduction and adduction at the wrist moves the hand away from or toward the midline of the body. Spreading the fingers or toes apart is also abduction, while bringing the fingers or toes together is adduction. For the thumb, abduction is the anterior movement that brings the thumb to a 90° perpendicular position, pointing straight out from the palm.

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It has the risk of aplastic anemia buy discount npxl 30 caps line krishna herbals, therefore no longer used in the treatment of hyperthyroidism npxl 30caps low price jeevan herbals hair oil. Iodides: Improve manifestations of hyperthyroidism by decreasing the size and vascularity of the gland so they are required for preoperative preparation of the patient for partial thyroidectomy. Iodides act through inhibition of the “protease” enzyme which releases T3 and T4 from thyroglobulin, and organification. It is trapped and concentrated as ordinary iodine, which emits beta rays that act on parenchymal cells of the gland. It is contraindicated in pregnancy and lactation as it affects thyroid gland in the fetus and the infant. Propranolol This is an important drug which controls the peripheral manifestations of hyperthyroidism (tachycardia, tremor). Manifestations include hyperpyrexia, gastrointestinal symptoms, dehydration, tachycardia, arrhythmia, restlessness, etc. Management: It consists of infusion of intravenous fluids, supportive management, and also administration of propylthiouracil, sodium iodide, hydrocortisone, and propranolol. Discuss the mechanism and beneficial effects of combined oral contraceptive pills. Describe the mechanims of action and the adverse effects of antituberculois drugs. Discuss the use, mechanism of action and problems associated with anthelminthic drugs. Antimicrrobials: are chemical agents (synthetic/natural) used to treat bacterial, fungal and viral infections. Antibiotics: are substances produced by various species of microorganisms (bacteria, fungi, actinomycetes) that suppress the growth of other microorganisms. Bactericidal versus bacteriostatic action: When antimicrobial agents lead to the death of the susceptible microbe (e. Antiprotozoals: are drugs used to treat malaria, amoebiasis, gardiasis, trichomoniasis, toxoplasmosis, pneumocystis carinii pneumonia, trypanosomiasis and leshmaniasis. The classificastion, pharmacokinetics, pharmacodynamics, clinical uses, adverse effects of commonly used antimicrobias, antiprotozoals, antihelimenthics are disscused. Alteration of the drug-binding site: this occurs with penicillins, aminoglycosides and erythromycin. Anibacterial agents Cell wall synthesis inhibitors Members the group: Beta-lactam antibiotics, vancomycin, bacitracine, and cycloserine Beta-lactam antibiotics: Penicillins, cephalosporins, carbapenems, and monobactams are members of the family. All members of the family have a beta-lactam ring and a carboxyl group resulting in similarities in the pharmacokinetics and mechanism of action of the group members. They are water-soluble, elimination is primary renal and organic anion transport system is used. Penicillins Penicillins have similar structure, pharmacological and toxicological properties. The prototype of penicillins is penicillin G and is naturally derived from a genus of moulds called penicillium. Classification: Penicillins can be classified into three groups: Natural Penicillins, Antistaphylococcal penicillins, and Extended-spectrum penicillins. Mechanism of Action: Penicillins inhibit bacterial growth by interfering with a specific step in bacterial cell wall synthesis (block the transpeptidation reaction). Pharmacokinetics: Penicillin G is unstable in acid media, hence destroyed by gastric juice. Ampicillin, amoxicillin, and dicloxacillin are acid-stable and relatively well absorbed after oral adminstraion. Oral penicillins should be given 1-2 hours before or after meals to minimize binding to food proteins and acid inactivation (except ampicilin). Blood levels of all penicillins can be raised by simultaneous administration of probenecid orally, which impairs tubular secretion of weak acids. Penicillin G is the drug of choice for infections caused by streptococci, meningococci, enterococci, penicillin-susceptible pneumococci, non-beta-lactamase-producing staphylococci, Treponema pallidum and many other spirochetes, Bacillus anthracis, Clostridium species, Actinomyces, and other gram- positive rods and non-beta-lactamase-producing gram-negative anaerobic organisms. Antistaphylococcal Penicillins: [Methicillin, Nafcillin, isoxazolyl penicillins (Oxacillin, cloxacillin, and dicloxacillin)]. The only indication is infections caused by beta-lactamase-producing staphylococci. Oral isoxazolyl penicillin is suitable for treatment of mild localized staphylococcal infections, for serious systemic staphylococcal infections, oxacillin or nafcillin, is given by intermittent intravenous infusion.

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At the same time cheap npxl 30 caps with amex quantum herbals, there is about 20% decrease in blood flow to the brain during prolonged standing buy npxl 30 caps amex yavapai herbals, and in case the muscle is not kept contracting rhythmically, fainting is more likely to occur. During prolonged bed rest the entire body is affected by gravitational forces, often resulting in a temporary inability to changes in posture. Blood Volume and viscosity Blood volume normally remains constant, but decreases following hemorrhagic or traumatic shock; there is sharp drop in circulating volume, a fall in venous return, and a pronounced decrease in cardiac output and blood pressure. A rapid loss of 25% of the total blood volume in hemorrhage will reduce cardiac output to almost zero, causing circulatory shock. This results in inadequate tissue perfusion, resulting in progressive tissue damage. The damage involves the cardiovascular system as well as the other tissues of the body, so that the cardiac muscle, the blood vessels, and the vasomotor system degenerate, initiating a vicious cycle where by deterioration cardiovascular system becomes progressively incapable to supply the tissues with blood. Similar picture 183 develops if more than 40% of total blood volume is lost if the bleeding occurs more slowly from one to several hours. High altitude promotes increased red cell production and causes a mild polycythemia; people living at more than 4700 m have red cell count of 6-8 million per cu mm of blood. Acclimatization to high altitude also increases vascularity of the tissues that lowers total peripheral resistance and tries to counteract high red cell count and increased peripheral resistance. In plycythemia vera, the bone marrow becomes malignant and hematocrit may rise from a normal value of 40 – 45% to even 70 –80% blood viscosity rises sharply, peripheral resistance increases, and cardiac output falls. Anemia decreases viscosity, and together with the vasodilatation due to tissue hypoxia, causes a fall in total peripheral resistance and an increase in cardiac output, so that tissue at rest get enough oxygen, But heart has no reserve to use for the demands of exercise and severe exercise may result in heart failure. Blood Vessels The cardiovascular system is designed to provide widely varying metabolic needs under changing physiological circumstances, without overburdening the heart. These two factors: • Control blood flow and consequently regulate the cardiac output • Are influenced by such factors that control extra cellular fluid volume Microcirculation Microcirculation is the organization of the micro-size blood vessels that are present between the arterioles and venules; their number and size of these vessels vary significantly in deferent vascular beds, many of which have specialized features befitting 184 a special function. The vessels included in the microcirculation are: • Terminal arterioles • Meta -arterioles • Arterioles • Arteriovenous anastomoses • Capillaries • Post capillary venules The terminal arterioles are narrow muscular vessels, having a diameter of 35-50 microns and conduct blood directly into the meta arterioles; both the terminal arterioles are the resistance vessels of the microcirculation. Capillaries • Are the thin-walled exchange vessels forming a network linkage between narrow meta arterioles and wide-lumen venules. Fenestrated Capillaries: Have a very thin area of endothelial membrane stretched between adjacent endothelial cells. These fenestrations are not open holes but are closed by a thin diaphragm; these types are found in the capillary tuft /glomerulus of the kidney, in endocrine glands, and in the intestine providing very high permeability. There is no diaphragm between the adjacent endothelial cells that ensures rapid passage of substances through the capillaries e. Sinusoids: are more wide, more irregular in size and shape than capillaries; sinusoid structure is present in liver and the spleen; in the liver, the sinusoids are lined by an incomplete layer of fenestrated endothelial cell, which increases permeability still preventing passage of many small molecules, such as albumin. Postcapillary venules collect blood from the capillaries, have no muscle and elastic tissue like the capillaries; are wider than the capillaries (15-20 microns); some exchange seems to occur in these vessels; these vessels are very susceptible to inflammation. Viscosity and laminar flow According to the Poiseuille’s Law, viscosity is one of the parameter of resistances to flow. Laminar flow is a characteristic of blood flow in large vessels of the circulation; the laminae move parallel to each other in longitudinally oriented concentric sleeves, each sleeve moving at a different rate. In leukemia and polycythemia, blood viscosity may rise markedly, increasing systemic and pulmonary resistance and consequently raising blood pressure. The bore of the vessel also affects viscosity; it decreases as the vessel diameter falls below 150 micron. This 186 is increase in viscosity as blood velocity decreases, an effect probably due to increased adherence of the red cells to each other. Turbulent blood flow If the velocity of flow is very high, or if the blood has to pass an obstruction vessel, flow becomes turbulent so that eddy currents are formed. Cross-sectional area and flow velocity The mean velocity of blood flow is inversely proportional to the cross-sectional area provide that the total volume of fluid flowing through each segment is constant. Blood volume distribution & blood pressure Blood volume is very unevenly distributed through the various vascular segments even though the volume flowing through is relatively constant. Thick, elastic arteries and arterioles contain 18%, capillaries hold only 3-4 percent of blood volume, while the heart contains about 7% blood pressure is almost inversely proportional to volume distribution and vascular resistance. There is little change in pressure in large arteries, but resistance increases rapidly in small arteries, causing the pressure to drop to about 70 mm Hg at the beginning of the arterioles.

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