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Hormones of the Adrenal Glands Adrenal gland Associated hormones Chemical class Effect Adrenal cortex Aldosterone Steroid + Increases blood Na levels Adrenal cortex Cortisol order naprosyn 250mg line, corticosterone generic naprosyn 250 mg visa, cortisone Steroid Increase blood glucose levels Adrenal medulla Epinephrine, norepinephrine Amine Stimulate fight-or-flight response Table 17. For example, Cushing’s disease is a disorder characterized by high blood glucose levels and the accumulation of lipid deposits on the face and neck. Other common signs of Cushing’s disease include the development of a moon-shaped face, a buffalo hump on the back of the neck, rapid weight gain, and hair loss. Chronically elevated glucose levels are also associated with an elevated risk of developing type 2 diabetes. In addition to hyperglycemia, chronically elevated glucocorticoids compromise immunity, resistance to infection, and memory, and can result in rapid weight gain and hair loss. In contrast, the hyposecretion of corticosteroids can result in Addison’s disease, a rare disorder that causes low blood glucose levels and low blood sodium levels. The signs and symptoms of Addison’s disease are vague and are typical of other disorders as well, making diagnosis difficult. They may include general weakness, abdominal pain, weight loss, nausea, vomiting, sweating, and cravings for salty food. Inferior but somewhat posterior to the thalamus is the pineal gland, a tiny endocrine gland whose functions are not entirely clear. The pinealocyte cells that make up the pineal gland are known to produce and secrete the amine hormone melatonin, which is derived from serotonin. In contrast, as light levels decline—such as during the evening—melatonin production increases, boosting blood levels and causing drowsiness. The secretion of melatonin may influence the body’s circadian rhythms, the dark-light fluctuations that affect not only sleepiness and wakefulness, but also appetite and body temperature. Interestingly, children have higher melatonin levels than adults, which may prevent the release of gonadotropins from the anterior pituitary, thereby inhibiting the onset of puberty. Jet lag occurs when a person travels across several time zones and feels sleepy during the day or wakeful at night. Traveling across multiple time zones significantly disturbs the light-dark cycle regulated by melatonin. It can take up to several days for melatonin synthesis to adjust to the light-dark patterns in the new environment, resulting in jet lag. The primary hormone produced by the male testes is testosterone, a steroid hormone important in the development of the male reproductive system, the maturation of sperm cells, and the development of male secondary sex characteristics such as a deepened voice, body hair, and increased muscle mass. The primary hormones produced by the ovaries are estrogens, which include estradiol, estriol, and estrone. Estrogens play an important role in a larger number of physiological processes, including the development of the female reproductive system, regulation of the menstrual cycle, the development of female secondary sex characteristics such as increased adipose tissue and the development of breast tissue, and the maintenance of pregnancy. Another significant ovarian hormone is progesterone, which contributes to regulation of the menstrual cycle and is important in preparing the body for pregnancy as well as maintaining pregnancy. The placenta supplies oxygen and nutrients to the fetus, excretes waste products, and produces and secretes estrogens and progesterone. Commonly used for performance enhancement, anabolic steroids are synthetic versions of the male sex hormone, testosterone. The use of performance-enhancing drugs is banned by all major collegiate and professional sports organizations in the United States because they impart an unfair advantage to athletes who take them. For example, anabolic steroid use can increase cholesterol levels, raise blood pressure, and damage the liver. Altered testosterone levels (both too low or too high) have been implicated in causing structural damage to the heart, and increasing the risk for cardiac arrhythmias, heart attacks, congestive heart failure, and sudden death. Paradoxically, steroids can have a feminizing effect in males, including shriveled testicles and enlarged breast tissue. In females, their use can cause masculinizing effects such as an enlarged clitoris and growth of facial hair. In both sexes, their use can promote increased aggression (commonly known as “roid-rage”), depression, sleep disturbances, severe acne, and infertility. Although it is primarily an exocrine gland, secreting a variety of digestive enzymes, the pancreas has an endocrine function. Its endocrine function involves the secretion of insulin (produced by beta cells) and glucagon (produced by alpha cells) within the pancreatic islets.

One recent community following: survey by Slieker-ten et al found that 40% of the general female • Lifestyle interventions population aged 45 to 85 years had • Physiotherapy evidence of pelvic organ prolapse • Pessaries of at least stage two cheap 250 mg naprosyn with visa. Life Style life-threatening order naprosyn 250mg free shipping, but may have a Interventions signifcant impact on a woman’s quality of life. Choice of treatment Several studies have addressed for prolapse depends on the the association of heavy lifting severity of prolapse, its symptoms, and strenuous physical activity and the woman’s general health in the causation of pelvic organ and preference. Jorgensen and colleagues for treatment can be categorized compared the incidence of surgery as conservative, mechanical for prolapse in 28 619 Danish and surgical. Conservative or nursing assistance compared to mechanical treatment is generally a staggering 1652533 female considered for women with a mild population controls. The nursing degree of prolapse, those who assistants occupation constantly wish to have more children, the exposed them to repetitive heavy frail or those unwilling to undergo lifting. This study and did not allow any inference did not however adjust for parity about causal relationships. In another study by Spernol et al There is no conclusive evidence they found that 68% of women that lifestyle changes are going to with prolapse reported heavy to improve the degree of prolapse or medium work compared to 0% the symptoms associated with the of controls. Pelvic muscle training (Kegel Body weight was also considered exercises) is a simple, noninvasive a risk factor in the British Oxford intervention that may improve Family Planning Association Study. Whether Kegel All of these studies unfortunately exercises can resolve prolapse were cross -sectional studies and has not been adequately studied do not control for parity, degree in good randomized controlled of prolapse or other confounding trials since Kegel’s original articles. It is commonly prolapse has not been observed recommended as adjunct therapy in other studies that included for women with prolapse, often the condition as a potential risk with symptom directed therapy. Piya- and the use of a conscious Anant et al performed a cross contraction during an increase sectional study in 682 women in abdominal pressure in daily and an intervention study of activities. Women in the intervention Pessaries have been manufactured group were taught to contract from many materials including the pelvic foor muscles 30 times silicone, rubber, clear plastic, soft after a meal every day. Most pessaries not able to contract were asked to today are made of silicone and return to the clinic once a month as a result are non allergic ,do until they could perform corrected not absorb odours or secrete contractions. Silicone is resistant advised to eat more vegetables to breakdown with repeated and fruit and to drink at least two cleansing and autoclaving. They were followed- pregnant patients, the elderly and up every six months throughout in patients who do not want or the 2-year intervention period. The results indicated that the Pessaries may also be used to intervention was only effective in facilitate preoperative healing the group with severe prolapse. Another useful 121 advantage of these devices is that to ensure that the integrity of the they can be used to elicit occult silicone is intact. The vagina should stress incontinence before surgical also be examined for signs of repair of genital prolapse. She should be aware While pessary manufacturers that it may cause some discomfort provide suggestions for different to both partners in the beginning pessary shapes to manage different but this often settles as the types of prolapse, experience patient and her partner become suggests that trial and error is comfortable with it. Women who really the only way to determine are able to remove and reinsert the best ft for each patient. Other factors, such as the patient’s physical capacity and willingness to participate in the care of the pessary, together with the size of the introitus, the patient’s weight and her physical activity also play a role when choosing a pessary. Fritzinger et al stated that there is no scientifc data outlining the A simulated picture depicting the standards of care for users of position and placement of the vaginal pessaries. However, most pessary authors agree that routine follow up of women using pessaries is necessary to minimize the risk of complications associated with Contraindications to Pessary their use. At each visit the pessary Insertion should be removed and cleaned • Severe untreated vaginal using mild antibacterial soap and atrophy warm water. It should be examined • Vaginal bleeding of unknown 122 origin remain in place • Pelvic infammatory disease • Abnormal pap smear • Dementia without possibility of dependable follow-up care • Expected non-compliance with follow-up Types of Pessaries Often referred to as the “incontinence ring” since it has been designed for use in women with stress incontinence. Complications of pessaries All authors listed vaginal discharge and odor as the most common complication. Other complications which may occur are pelvic pain, Arch Heel Gehrung bleeding and development of • U-shaped device that provides urinary incontinence. The heel rests fat on the or failure of the pessary to vaginal foor hold the prolapse properly is • It avoids pressure on the rectum an obvious disadvantage. They state that early intervention using an estrogen-based cream or vaginal lubricant are essential to proper pessary care.

The interneurons may act as amplifier (excitatory) by enhancing or as attenuator (inhibitory) by putting a damper on an incoming signal or it may act as a polarity signal switch transforming a positive signal into negative one or vice versa discount naprosyn 250 mg with amex. Neurons: The original neuron is "nerve cell"- cells best equipped to sense and react to the chemical and physical change occurring in their surrounding environment trusted 500mg naprosyn. They are present in the entire human body and communicate with each other regarding their conditions and reactions. Nerve cells grow 2 types of processes from their cell bodies - axons and dendrites. Dendrites: are those processes that are concerned with reception of stimuli from environment. Axons: are those processes that are concerned with conduction and transmission of the stimuli-signal to another cell or cells. Glial cells or Neuroglial cells The various functions of glial cells are: • Mechanical supportive elements of neurons • Insulator of neuron • Phagocytic defense mechanism • Secretory • Modifiers of electrical activity in neuron • Regulation of metabolism in neuron • Development assistance in neuronal circuitry • Producers of myelin sheath Glial cells retain the ability to divide throughout life. A receptor is a biologic transducer which picks up one form of energy or stimulus and transforms it into another form of energy. Exteroreceptors: Localized in the body surface; recieve information from the external environment • Sight, hearing, smell • Pick up distant stimuli (teleoreceptors) • Touch, pressure, temperature • Stimulation by contact 2. Interoreceptors (visceroreceptors) Visceral activity (digestion, excretion, circulation) Located in Viscera and blood vessels Free nerve endings: Most free nerve endings arborize between the tissue cells; other surround the hair follicles. Depending on the presence or absence of myelin, the fibers are classified as myelinated or 65 nonmyelinated. Within each bundle, between the fibers, collagen fibers and a few fibroblasts are situated. Through chemical means neurons pass messages to muscles and glands through intricate pathways from neuron to neuron. Characteristics of Graded potential • Graded potential change: magnitude varies with the magnitude of triggering event • Decremental conduction: magnitude diminishes with distance from initial site • Passive spread to nearby inactive areas of membrane • No refractory period • Can be summed (temporal and spatial) • Can be depolarized or hyperpolarized • Triggered by stimulus, by combination of neurotransmitter with receptor or by spontaneous shift in leak-pump cycle. As soon as the critical level of depolarized, the threshold is reached, any further increase in the strength of the applied current do not affect size of the potential. The action potential crosses the zero line it is moving from -80 to +30 mV inside the membrane. The action potential is propagated along the whole length of the fiber membrane with a constant speed and amplitude. When one electrode is kept inside and the other is outside, potential changes across the membrane can be measured and if properly amplified and electrodes connected to a cathode ray oscilloscope, they can be recorded as the monophasic action potentials. After potentials • Depolarization after potentials: The membrane potential for a brief period becomes more positive than the resting membrane potential and the cell, therefore, is slightly more excitable than normal. Action potentials for nerves are very brief, lasting only about 2-3 milliseconds, and the nerve cell is almost instantly ready again to conduct the next potential. Ionic basis of the action potential The different phases of the action potential are correlated with the following changes in ionic influxes: (See figure 22 & 23). Consequently, the increase in potassium conductance / permeability starts a little later and lasts longer. The outward flow of the potassium ions slows the rise of the potential, then causes it to fall to its initial level by negative feedback mechanism, the membrane regains its original permeability and is ready to conduct another impulse. During this time the nerve fiber is unresponsive to a depolarizing current and, therefore, cannot conduct an impulse. This interval is very brief (2 millisecond) and the nerve fibers can carry very fast frequency of impulses. The absolute refractory period is followed by a recovery of excitability 71 during which time the threshold of the nerve is higher than normal, and so only stimuli of very great strength can evoke a propagated impulse, which is it self smaller and slower. There exists self regenerative sodium conductance of the stimulated membrane, which changes the initial depolarization to the all or none full-sized action potential that is propagated without loss of amplitude along the entire length of the fiber. Unmyelinated fibers are thin, slow conducting nerves often called "C" fibers on the basis of their diameter of less than 1 micron. The addition of myelin sheath allows an enormous increase in conduction velocity with a relatively small increase in fiber diameter. Saltatory conduction Inefficient electrical characteristic are compensated by the wrapping of the axon in concentric layers of myelin, which acts as insulating sheath that increases the resistance and greatly lowers the capacitance of the surface and by nodes of Ranvier at 1 mm distance that lifts the attenuated signals( see fig. Shows propagation of Nerve impulse in myelinated nerve fibers 74 The stimulus A stimulus is any change that can alter the energy state of a tissue sufficiently to depolarize the membrane.