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  • Professor in Medicine
  • Professor in Biostatistics and Bioinformatics
  • Research Professor in Molecular Genetics and Microbiology
  • Faculty Network Member of the Duke Institute for Brain Sciences
  • Affiliate of the Center for Child and Family Policy
  • Member of Duke Molecular Physiology Institute


Physical manifestations of the skeletal muscle activity 1) the strength (force) = maximal weight held against the gravity (maximal contraction against a maximal load): in cold-blooded animals 3-4 kg/cm2 in humans 3-10 kg/cm2 33 Dynamometers hiv infection latency buy cheap famvir 250mg line. Nysten law in order: heart (1-2 hours) antiviral fruit buy 250mg famvir mastercard, skeletal musculature (3-6 hours): diaphragm head neck trunk arms hands legs antiviral essential oil blend order famvir 250 mg with mastercard. Actin, myosin, tropomyosin but without troponin Types: 1) Visceral syncytial smooth muscle because of its interconnections among fibres. In the walls of most hollow viscera: the gut, the bile ducts, the ureters, the uterus, the bronchi, the bladders, the blood vessels. Physiological properties of the smooth muscle 1) Plasticity adaptation to volume without the increase of the tone. Smooth muscle does not contain troponoin but another regulatory protein calmodulin. The glomerular filtration Glomerular filter: Glomerular membrane 3 major layers: 1) Capillary endothelial layer 2) Basement membrane 3) Layer of epithelial cells Permeability of the glomerular filter Capillary endothelial layer fenestrae 100 nm in diameter Basement membrane meshwork of collagen and proteoglycans fibrilae Epithelial cells podocytes with pseudopodia filtration slits 25 nm wide the glomerular filter permits the free passage of substances to 4 (40 angstroms) nm in diameter, 4-8 nm selectively, > 8 nm totally excludes. The increase intramural P > distention of the smooth muscle > depolarization of the muscle cells > contraction. The wall tension is proportionate to the distending pressure times the radius of the vessel. Neural: sympathetic nerves (Th6 L3) vasoconstrictioin, only during orthostasis, physical effort, stress. Humoral: catecholamines vasoconstriction renin-angiotensin aldosterone system vasoconstriction system kallikreins bradykinin 39 kalidin Hageman f. Stimuli intrinsic reaction prorenin molecules are converted by tissue kallikrein renin. Sodium depletion, diuretics, hypotension, hemorrhage, upright posture, dehydration, constriction of renal artery or aorta, cardiac failure, cirrhosis, various psychological stimuli. After exceeding of Tm the transport mechanism is saturated and the substance occurs in the urine. Glycosuria in hyperglycemia > 10 mmol/l = renal threshold for glucose TmG in men = approx. Functions of the Collecting Ducts Changes in osmolarity and volume mainly by means of the countercurrent multiplication system: Fig. Two tubes separated by semipermeable membrane with ability to transport molecules of a substance in one-way. If the tubes are fulfilled with a stationary fluid the activity of the membrane increases the concentration of the substance in tube A. When the fluid flows the mostly concentrated fluid will be accumulated at the beginning of the tube B.

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Making a teaching plan for the development and Asia-pacific Crohns and colitis epidemiology study hiv infection oral route buy cheap famvir 250 mg online. Gastroenterology education of patients and health personnel for the 145(1): 158-165 antiviral xl3 buy generic famvir 250 mg. Nurses have also important roles in Duzce Region: Retrospective cohort study between 2004-2013 stages of hiv infection video discount 250mg famvir free shipping. Greveson K, Woodward S (2013) Exploring the role of the inflammatory Inflamm Bowel Dis 15(7): 1105-1108. Journal of (2010) Contribution of nurses to the quality of care in management Crohns and Colitis 4(6): 611-622. A low residue diet is recommended when people need to avoid foods that may irritate an inflamed bowel or obstruct narrowed parts of the bowel. A low fibre diet may be recommended: When experiencing diarrhoea caused by a flare-up of inflammatory bowel disease such as Crohns disease or ulcerative colitis During a result of pelvic or abdominal radiotherapy To prepare your bowel for investigations or surgery What is a low-residue diet Certain foods containing fibre normally aid the movement of food and fluid through your gut. This roughage adds bulk to the stools and is usually encouraged as part of a healthy diet. However, in certain conditions and/or in preparation for particular procedures, it is advisable to avoid these foods, because they can leave behind a residue after digestion. A low-residue diet may help to prevent blockages in your bowel by reducing foods which are poorly or partially digested. This diet may also be recommended when reintroducing food after surgery or after following a liquid diet. The following table shows foods to include and foods to avoid, when following a low residue diet. Mashed potato, baked potato with Potatoes with skin skin removed, chips with skin removed (not too often) All curries made with lentils, beans, 2 portions per day legumes/pulses. Dessert Custard, ice cream, milk puddings Ice cream containing fruit and nuts, cakes, puddings and pies Clear jelly containing any of the following: Wholemeal flour, dried fruit, Plain cakes nuts, dried coconut and any Vermicella (seviyan/ plain kulfi) fruits you have been advised to avoid. Food type Foods to include Foods to avoid Shrikhand, gulab jaman, Halva, all sweets made with nuts/coconut or gram flour. Milk and milk Milk (all types), cream, sour cream, Any milk products containing fruits, products creme fraiche, fromage frais, nuts, seeds or cereals smooth yoghurt, cheese (any including paneer) Plain sweet or salty Lassi Meat and All meats and fish Gristly and fatty meat, tough skin, meat fish skin and bones alternatives Eggs Quorn and soya beans Tofu Drinks Fruit and vegetable juices, milk, Fruit and vegetable juices with pulp, water, soft drinks, weak tea and prune juice, caffeine containing coffee, herbal tea drinks, such as espresso, energy drinks and cola, alcohol in excess (no more than 2-3 units per day) Miscellaneous Smooth or sieved soup. Soup with pieces, such as minestrone Sugar, honey, golden syrup, lemon Jam or marmalade with skin, peel or curd, jelly jam pips Custard powder, boiled sweets, Chocolate with dried fruit, nuts or toffee, caramel, marshmallows, seeds, coconut plain/milk/white chocolate Pepper, salt, herbs and spices in Wholegrain mustard, pickles, relish moderation (dried or finely chopped) Hummus, coleslaw, popcorn, corn Gravy, tomato sauce, soy sauce, chips plain crisps, plain pretzels (without sesame seeds) Bombay mix, Sev, Ghatia Handy hints Eat small meals at regular intervals (every three to four hours) Chew food slowly and thoroughly Avoid food that is too hot or too cold When introducing new foods, introduce only one at a time.

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Guidelines on the collection and transport of specimens are found in the Manual of Procedures for the Surveillance how hiv infection occurs generic famvir 250mg with visa, Outbreak Investigation and Response to hiv gut infection generic famvir 250mg overnight delivery Microbial Agents of Food and Waterborne Diseases antiviral iv medication cheap famvir 250 mg with visa. The result of the investigation and the plan of action to control the outbreak should be effectively communicated to all stakeholders. Outbreaks where food workers have been implicated in the spread of foodborne disease. Pittet D, Allegranzi B, Boyce J, World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhoea. The effectiveness of food handler training programmes in Malaysia and Ireland to prevent food-borne disease. A systematic review and meta analysis of the effectiveness of food safety education interventions for consumers in developed countries. Biosphere Environement and Health System Series Volume 2: Philippine Regulations on Sanitation and Wastewater systems (International Edition). Philippine Society for Microbiology and Infectious Diseases, Philippine Foundation for Vaccination. Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, et al. The use of probiotics in pediatric gastroenterology: a review of the literature and recommendations by Latin-American experts. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Meta analysis of probiotics for the prevention and treatment of acute pediatric diarrhea. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Saccharomyces boulardii protease inhibits the effects of Clostridium difficile toxins A and B in human colonic mucosa. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human Lactobacillus strain. Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc.

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The organisms may be destroyed during food prepa and/or fluid stool; usually resulting from disease of ration antiviral resistant herpes famvir 250mg on line, but the toxin is unaffected hiv aids stages of infection cheap famvir 250 mg online, consumed and acts the small intestine and involving increased fluid and electrolyte loss within hours hiv infection rate in us purchase 250mg famvir fast delivery. This is especially important in outbreaks, because of the need to instigate appropriate epidemiologic In the developing world, diarrheal disease is investigations and control measures. Salmonella Salmonellae are the most common cause of food-associated diarrhea in many developed countries Until recently salmonellae were the most common cause of food-associated diarrhea in the developed world, but in some countries they have now been beaten into second place by campylobacter. Antibacterial therapy is not indicated for Diarrhea is the most common manifestation E. Initial entry is probably through sewage disposal are fundamental to the prevention of uptake by M cells (the antigenic samplers of the bowel) with 258 Gastrointestinal Tract Infections animal feed Salmonella enteriditis ingestion absorbed to epithelial cells in domestic human terminal portion of small intestine man food animals food wild animals bacteria penetrate cells and migrate to lamina propria layer of ileocecal region efuent sewage man Fig. A similar route of inva sion occurs in Shigella, Yersinia and reovirus infections. The large animal reservoir small numbers may require enrichment in selenite broth makes it impossible to eliminate the organisms and therefore before culture. Preliminary identification can be made preventive measures must be aimed at breaking the chain rapidly, but the complete result, including serotype, takes at between animal and man, and person to person. Person to person spread Following an episode of salmonella diarrhea, an individual by the fecaloral route is rare, as is transmission from food can continue to carry and excrete organisms in the feces for handlers. The gross pathology and histologic appear ances of ulceration and inflamed bleeding mucosal surfaces Campylobacter in the jejunum, ileum and colon (Fig. Infections are acquired by consumption of contami nated food, especially poultry, milk or water. Over the past 20 years there have been 66 cases disease that are severe enough to warrant treatment. Serotype O1 is the most important and is further divided into two biotypes: classical and El Tor (Fig. The originated from the El Tor O1 biotype when the latter methods are given in the Appendix. The symptoms of cholera are caused by an enterotoxin sensitive to stomach acid large dose needed to cause the symptoms of cholera are entirely due to the produc disease unless patient tion of an enterotoxin in the gastrointestinal tract (see achlorhydric or taking antacids Chapter 12). The severe watery non-bloody diarrhea is known as production of mucinase rice water stool because of its appearance (Fig. There have, how the main features of shigella infection are summarized in ever, been reports of tetracycline-resistant V. As there is no animal reservoir, it can be associated with malnutrition (see above). However, carriage in humans, albeit for only a few weeks, Antibiotics should only be given for severe occurs in 120% of previously infected patients making erad shigella diarrhea ication difcult to achieve. Mucin glands have discharged their contents and the However, symptoms range from mild to severe depending goblet cells are empty. As the special media for cultivating vibrios are the organism is an anaerobe and grows readily on routine not used routinely, the request form accompanying the laboratory media.