Buy Thyroxine online no RX - Effective online Thyroxine no RX

Buy Thyroxine online no RX - Effective online Thyroxine no RX

Virginia State University. L. Basir, MD: "Buy Thyroxine online no RX - Effective online Thyroxine no RX".

Phytochemicals present in fruits discount thyroxine 100 mcg line treatment xanthelasma eyelid, vegetables discount 75 mcg thyroxine medicine look up drugs, grains buy thyroxine on line amex symptoms 5-6 weeks pregnant, and other foodstufs have been linked to reducing the risk of major oxidativestress-induceddiseases purchase thyroxine on line amex treatment table. Chrononutrition studies have shown that not only the content of food, but also the time of ingestion contributes to the natural functioning of the circadian system. Dietary interventions with antioxidant-enriched foods taking into account the principles of chrononutrition are of particular interest for the elderly since they may help amplify the already powerful benefts of phytochemicals as natural instruments with which to prevent or delay the onset of common age-related diseases. Introduction This accumulation gradually compromises cell and tissue function, and eventually the entire function of the organism Understanding the aging process has gained in importance itself [4]. Within this theory, some authors argue that aging with peoples increasing life expectancy. Indeed, it is still unknown take place in the mitochondrial genome of diferentiated cells whether this process derives from a single or multiple causes [5]. Teories of aging are mainly divided into those assuming stress levels that are similar to those of young adults [6], or that aging is genetically encoded and those assuming that at least comparable in terms of antioxidant defences [7]. This it is due to a decline in maintenance mechanisms and suggests that oxidation is not inevitable in aging. Among controlled process but an interaction between environment the latter theories, the free radical theory of aging (also and genes [8]. Psychological stress and lifestyle factors known as oxidative stress theory) put forward by Harman appear to have an impact on the level of oxidation [9, 10]. It posits that the Stress has been the most extensively studied negative factor organisms deterioration resulting from increasing longevity in the brains vulnerability to aging. In contrast, positive is above all a consequence of the persistent accumulation environmental factors such as a healthy diet can lead to of free radical mediated damage to essential molecules. Indeed, it is estimated that a third 2 Oxidative Medicine and Cellular Longevity of all cancer deaths in the United States could be avoided Reproduction through appropriate dietary modifcation [12]. Phytochemicals are bioactive nonnutrient compounds present in fruits, vegetables, grains, and other plant foods. Body weight Melatonin Energy balance T eyhavebeenlinkedtoreductionsintheriskofmajor oxidative stress-induced diseases [13]. Numerous investi- gations have shown a strong link between dietary intake of phytochemicals and reduced risk of cancer and cardio- Antitumoral Antioxidant vascular disease worldwide. Tus, a prospective study in Finland involving 9959 men and women (ages 1599 years) Antiaging found an inverse association between the intake of favonoids and the incidence of cancer [14]. Some components of foods possess biological activities In particular, it is a signal of darkness that encodes time which infuence circadian rhythms in humans. A when the food is consumed infuences the normal func- conceptual difculty in melatonin research is that, while it is tioning of biological rhythms. A central target of current a signal of darkness, it has diferent functional consequences chronobiological research is how nutrients can alleviate or depending on the given species time of peak activity. In the present review, we shall focus nocturnalspecies,itisassociatedwitharousalandphysical on the potential use of chrononutrition as a novel dietary activity. In diurnal species, it is associated with sleep and rest strategy to counteract the deleterious actions of free radicals [16]. In diurnal animals, the onset of melatonin secretion is closely associated with the timing of sleep propensity. For this reason, it is believed to play Health Sciences a part in sleep initiation as the trigger for opening the circadian sleep gate, thus acting as a sleep regulator [19]. Wehumansareimmersedinanenvironmentcharacterized In this respect, the efcacy of melatonin supplementation to by repetitive rhythmic cycles [32]. Conditions that are mod- combat sleep disorders is well known, especially in the elderly ifed by diferent temporal cycles include organic efciency, with their marked reduction in melatonin production [16]. All of these may contribute to the observed and digestive functions) and behavioural (sleep/wake cycle, anti-aging potency of this natural agent [21]. Melatonin diminishes Chronobiology is the discipline that studies the nature free radical formation at the mitochondrial level by reducing and function of biological rhythms, defned as the recurrence the leakage of electrons from the electron transport chain of any event within a biological system at roughly regular [27]. The human bodys biological clocks, for exam- directly by exogenous administration or indirectly by includ- ple, are controlled by synchronization with signals from the ing vegetables rich in this compound in the diet, enhances external environment [35]. It also stimulates a The entire spectrum of biological rhythms covers an number of antioxidative enzymes which metabolize reactive extremely wide range of frequencies [36]. Tese are biological there is an elevated production of free radicals, this may have processes that have an endogenous, entrainable oscillation Oxidative Medicine and Cellular Longevity 3 of about 24 hours. The internal synchro- Chrononutrition nization provided by circadian clocks may be altered by Chronotherapy many factors, one of which is aging. During aging, any disturbance or imbalance in the Chronobiological relationship between the circadian and homeostatic systems + balance may lead to the impairment of numerous physiological processes. The vast major- all compounds with powerful antioxidant properties [23, ity of studies have focused on examining the homeostatic 29, 47]. The administration of tryptophan increases the regulation of the quantity and quality of food ingested. Tem- ulatory, anti-infammatory, and chronobiotic properties [50 poral aspects of this regulation have been far less studied 52]. Since these are functions with a circadian rhythmicity, they Knowledgeofthenatureandfunctionofbiological deteriorate during aging with the weakening of overt circa- rhythms is of practical as well as theoretical interest. Tat meal timing has major efects on refected in the growing number of applications of chronobi- thebodyhasledtotheconvictionthat,inchoosingfood,it ology published in the recent health sciences literature. One is not only convenient to consider its nutritional value, but such novel area of research is chronopharmacology. This is also its capacity to promote or hinder the normal functioning focused on the design and evaluation of drug delivery systems of the circadian cycles control systems (Table 1). In humans, that release a bioactive agent at a rhythm matching the bio- alterations have been detected in the overall expression of logical requirements of the treatment of a given disease [53]. Compared drugs in order to synchronize the rhythms in disease activity with a control diet high in carbohydrates and low in fat, with the efcacy of a particular drug, thus allowing for its a very low carbohydrate, fat-rich diet has been found to optimal efcacy in the patient. However, the evidence on whether carbohydrates positively impact sleep quality is not completely consistent, since consuming carbohydrate mealswithhighorlowglycaemicloadsseemsnottoafect 3. Basis of Chrononutrition: Health Benefits any polysomnographically determined sleep index [55]. Feeding behaviour is the frst element to nutrients can entrain the circadian rhythm, diet design must 4 Oxidative Medicine and Cellular Longevity Table 1: Examples of antioxidant requirements according to chrononutrition principles. Tese ideas can the modulation of the immune and infammatory systems, be subsumed under the concept of chrononutrition. This helping to prevent infectious and infammatory diseases in concept refects that it is not only the content of food, the elderly [67]. Finally, in 1997 the most signifcant phenol butalsothetimeofingestionandtheinteractionsofits in red wine, trans-resveratrol, was shown to prevent carcino- nutritional components which naturally contribute to the genesis in mice [68]. Since then, this phytochemical has been proper functioning of the circadian system. Harmans free radical theory of aging posits that specifc health benefts of resveratrol range from 5 mg to oxidized macromolecules accumulate with age, resulting in 5 g, and some have considered additional compounds with decreased function and shortened life span [3]. A major critical limitation reduction of oxidative stress has been found to be associated of most of the clinical research on resveratrol has been the with prolongation of life expectancy in many organisms [58 lack of trials examining the longer-term health efects of this 60].

Sook-Ji-Whang (Rehmannia). Thyroxine.

  • How does Rehmannia work?
  • What is Rehmannia?
  • Diabetes, anemia, fever, osteoporosis, allergies, or other conditions.
  • Are there any interactions with medications?
  • Dosing considerations for Rehmannia.

Source: http://www.rxlist.com/script/main/art.asp?articlekey=97099

Selenium is a trace mineral that is essential to good health but required only small amounts [6 buy generic thyroxine 50 mcg symptoms 5dpo,7] discount 125mcg thyroxine with mastercard medicine emoji. Selenium is considered as essential human micronutrient and is incorporated into proteins to make selenoproteins cheap thyroxine 25 mcg treatment for shingles. Selenium is present in the seleno proteins cheap thyroxine online master card 5 medications related to the lymphatic system, as the aminoacid selenocysteine (Se-Cys) [8-12]. Dietary levels of the desired amount of Se are in a very narrow range: consumption of foods containing less than 0. Se status varies significantly across different populations and different ethnic groups [14-15]. Selenium enters the food chain through plants, and the amount and bioavailability of seleni um in the soil typically reflects the plant level. Plants convert Se mainly into selenomethionine (Se-Met) and incorporated it into protein place of methionine. More than 50% of the total Se content of the plant exist as Se-Met, the rest exist as selenocysteine (Se-Cys), methyl-Se-Cys and c- glutamyl-Se-methyl-Cys. Higher animals are unable to synthesize Se-Met and only Se-Cys was detected in rats supplemented with Se as selenite [18]. Most ingested forms of selenium ultimately are metabolized to low molecular weight inor ganic and organic compounds that play a central role in human health either via incorpora tion into selenoproteins or binding to selenium binding proteins [19]. Several excellent books and re views appeared in literature describing the biological function of organoselenium com pounds [20-22]. The essentiality of selenium results as a necessary component of the active center of a num ber of selenoenzymes. The term selenoprotein is any protein that includes in its primary sequence of amino acids, the selenocysteine (Se-Cys) res idue [24]. The glutathione and thioredoxin systems in particular have long been considered the major pathways through which selenium exerts its potential chemopreventive effect [24], while some investigations have also suggested growth inhibito ry, proapoptotic activity for selenometabolites in premalignant cells [29]. Selenium is also in volved in thyroid function, T cell immunity, and spermatogenesis [28], and is a competitive antagonist of potentially carcinogenic heavy metals such as arsenic and cadmium [30]. Vitamin E is a fat-soluble vitamin known for its antioxidant capacity that is why it is well known as a lipophilic antioxidant that protects membranes from being oxidatively damaged as an electron donor to free radicals [32]. It is well known that all forms of vitamin E are lipid soluble they easily absorbed from the intestinal lumen after dietary intake via micelles created by biliary and pancreatic secretions [34-35]. Vitamin E is then incorporated into chylomicrons and secreted into the circulation where, transported by various lipoproteins, it travels to the liver [36]. Plasma -tocopherol 422 Oxidative Stress and Chronic Degenerative Diseases - A Role for Antioxidants concentrations in humans range from 11 to 37 mol/L, whereas -tocopherol are between 2 and 5 mol/L. The liver plays a central role in regulating -tocopherol levels by directly act ing on the distribution, metabolism, and excretion of this vitamin [37]. This protein facilitates secretion of -toco pherol from the liver into the bloodstream, by acquiring it from endosomes and then deliv ering it to the plasma membrane where it is released and promptly associates with the different nascent lipoproteins [39]. Plasma concentration of vitamin E depends completely on the absorption, tissue delivery, and excretion rate. The estimated -tocopherol half-life in plasma of healthy individuals is ~ 48 to 60 H, which is much longer than the half-life of - tocopherol approximately 15 H. These kinetic data underscore an interesting concept that while -tocopherol levels are maintained, the other forms of vitamin E are removed much more rapidly [40]. The list of clinical disorders expected to be influenced by Se deficiency is rapidly growing with time. Some selected issues regarding the role of Se in health and disease have been briefly out lined as follows: 2. Se and antioxidant activity Selenocysteine is recognized as the 21st amino acid, and it forms a predominant residue of selenoproteins and selenoenzymes in biological tissues. The molecular structure of seleno cystiene is an analogue of cysteine where a sulphur atom is replaced by Se. Even though Se and sulphur share some similar chemical properties, there are also some differences. In the body, both or ganic [selenocysteine(SeCys) and selenomethionine (SeMet)] and inorganic (selenite, selen ate) Se compounds are readily metabolized to various forms of Se metabolites [41]. H Se is further metabolized and in2 volved in the formation of methylselenol and dimethylselenide, which are exhaled or secret ed via the skin. Selenium is also excreted in urine as trimethylselenonium ion and selenosugar compounds [42]. The selenoproteins are classified on the basis of their biologi cal function [25]. The other essen tial antioxidant selenoenzymes are the thioredoxin reductase (TrxR) where they use thioredoxin (Trx) as a substrate to maintain a Trx/TrxR system in a reduced state for remov al of harmful hydrogen peroxide and there are three types of TrxR. Se and depression In [46] seleniums function as an antioxidant, and as a constituent of selenoproteins that are important in redox homeostasis, warrants further investigation as a risk factor for depres sion, and suggest a potentially novel modifiable factor in the primary prevention and man agement of depression. Depression is becoming recognized as an inflammatory disorder, accompanied by an accumulation of highly reactive oxygen species that overwhelm usual defensive physiological processes [47-51]. During times of selenium deficiency, there is preferential storage of selenium in the brain [52]. Selenium has significant modulatory effects on dopamine [53] and dopamine plays a role in the pathophysiology of depression and other psychiatric ill nesses [54]. Diminished levels of selenium in the brain are associated with cognitive decline [55] and Alzheimers disease [56]. Selenium supplementation has been linked with improve ments in mood [57] and protection against postpartum depression [58]. What is unclear is if low dietary selenium is a risk factor for the development of depression. Alterations in redox biology are established in depression; however, there are no prospec tive epidemiological data on redox-active selenium in depression. It is known that seleni ums function as an antioxidant, and as a constituent of selenoproteins that are important in redox homeostasis, warrants further investigation as a risk factor for depression, and sug gest a potentially novel modifiable factor in the primary prevention and management of de pression. The reasons for the high prevalence and severity of this condition or the increased prevalence of asthma over the last 20 years are not well understood. One of a number of environmental factors that have been proposed as a reason for the escalation in asthma prevalence is a decreasing intake of dietary antioxidants [60]. Selenium has been implicated in inflammation by reducing the severity of the inflammatory response through modulation of the pro-inflammatory leu kotrienes, important mediators of acute asthmatic reactions as well as sustaining the inflam matory process causing a late allergic reaction metabolism [62]. Evidence from randomized controlled trials [63] and basic mechanistic work investigating the effect of selenium on markers of inflammation and oxidative stress [62]. Evidences have supported a protective role for selenium in asthma, although other studies have not [64-66].

order 200 mcg thyroxine mastercard

The early-life dietary manipulation of methyl group donors (either deciency or supple- mentation) can have a profound impact on the gene expression prole and order thyroxine online 4 medications list, consequently cheap thyroxine 125 mcg mastercard symptoms of a stranger, on the homeostatic mechanisms that ensure the normal course of physiological processes [117] buy discount thyroxine on-line medicine x protein powder. Methylation patterns in P2 of maternal blood were associated with serum levels of vitamin B12 in mothers blood purchase thyroxine medicine man, exposure to passive smoking, and mothers weight gain during pregnancy. The long-term effects of maternal behavior on the stress responsiveness and behavior of the offspring during adulthood are well documented in animal models, and these experimental ndings have been extended to humans by identifying an association between early-life adversity and epigenetic marks in adult life [133,134]. To test the hypothesis that epigenetic differences in critical loci in the brain are involved in the pathophysiology of suicide, McGowan et al. Suicide subjects were selected for a history of early childhood neglect/abuse, which is associated with decreased hippo- campal volume and cognitive impairments. The glucocorticoid receptor 1F expression was signicantly lower in samples from suicide victims with a history of childhood abuse compared with suicide victims without childhood abuse or controls. It is known that cesarean section can cause more severe stress in newborn infants compared with that of those born by vaginal delivery, who adapt to the new conditions better. To study whether the mode of delivery affects epigenetic activity in newborn infants, Schlinzig et al. The exposure to excess glucocorticoids in early life can permanently alter tissue glucocorticoid signaling, and these effects may have short-term adaptive benets but increase the risk of later disease [129]. Currently, multiple courses of synthetic glucocorticoids are recommended for various condi- tions. However, despite the benecial therapeutic effect of antenatally administered glucocorticoids, their prenatal administration can result in transgenerational effects with respect to the risk of developing several metabolic and cardio- vascular disorders in later life which implies that these epigenetic effects can persist across generations [132,136]. Epidemiological data offer some evidence that paternal alcohol consumption can affect birth weight, congenital heart defects, and mild cognitive impairments [137e139]. A substantial amount of data have been accumulated to support the role of environmentally induced epigenetic remodeling during gametogenesis and after conception as a key mechan- ism for the deleterious effects of prenatal alcohol exposure that persist into adulthood [139]. Three developmental periods are particularly vulnerable: preconception, preimplantation, and gastrulation. A wide range of fetal abnormalities and birth defects have been repeatedly reported in animals and humans after preconceptional alcohol exposure. Children born to mothers who smoke are at an increased risk of obesity, hypertension, and diabetes [143,144]. Maternal smoking may be involved in fetal programming [145], and in utero tobacco exposure was shown to be associated with epigenetic changes in the offspring [146]. Differential methylation of CpG loci in eight genes was identied through the screen. Such mechanisms could, in turn, lead to modi- cations in both development and plasticity of the brain exposed in utero to maternal cigarette 558 smoking. Importantly, these effects can be epigenetically transmitted to the next generation [155,156]. Importantly, the prostate seems to be particularly sensitive to these endocrine disruptors during the critical developmental windows including in utero and neonatal time points as well as during puberty. There is also convincing evidence that prenatal environmental exposures can inuence the risk for subsequent asthma. Martino and Prescott [160] examined the epigenetic regulation of immune development and the early immune proles that contribute to allergic risk. They generally include a stage of embryo culture that precisely coincides with zygotic epigenetic resetting. Genomic imprinting is an epigenetic phenomenon by which certain genes are expressed in a parent-of-origin-dependent manner, i. Imprinted expression is a clear example of epigenetic inheritance, because genetically identical sequences are differentially transcribed depending on the sex of the parent from which the gene origin- ates [164]. Most imprinted genes contain differentially methylated regions, where the methylation state of the parental alleles differs [165]. This variation allows for differential regulation of these alleles dependent on parental origin of the allele and leads to prefer- ential expression of a specic allele, depending on its parental origin [25]. The underlying mechanisms by which culture media induce abnormal epigenetic modications are still not clear but it has been suggested that embryonic developmental timing can be disturbed Epigenetics in Human Disease by the synthetic media and that this interferes with epigenetic reprogramming and gene expression [166]. Among them, BeckwitheWiedemann syndrome and Angelman syndrome are the most extensively studied [167]. Intracytoplasmic sperm injection was shown to increase the risk of Angelman syndrome and some imprinting defects [171,172]. Although these studies examined only few cases, almost every case showed loss of methylation at imprinting control regions rather than the genetic defects generally responsible for these syndromes. In these studies, it has been highlighted as the key role of epigenetic mechanisms in mediating the link between nutritional, hormonal, and metabolic environment early in life and lifelong health outcomes. Over recent years, there have been conducted numerous animal studies and limited human studies aimed at understanding the specic epigenetic mechanisms underlying developmental programming of later life pathology and aging. Epigenetics has substantial potential for developing biological markers to predict which exposures would put exposed subjects at risk and which individuals will be more susceptible to develop disease. In human studies, this will require the use of highly sensitive laboratory methods, so that epigenetic alterations can be detected well ahead of disease diagnosis [178]. Given the reversibility of epigenetic modications, the understanding of epigenetic mechan- isms may represent a promising novel therapeutic target for prevention or reversion of human age-related disorders and healthy life extension. These therapeutic strategies may include changes in nutrition and lifestyle as well as pharmacological treatments. However, all these drug candidates are very unspecic and, therefore, can cause large-scale epigenetic deregulation. In the future, it will be essential to develop therapies that target only specic elements of the epigenome. Such preventive approaches initiated in pre- and early postnatal periods of human development seem to be particularly promising. If one could modify the incorrect or deleterious epigenetic patterns through specic nutritional or pharmacological interventions during early ontogenesis, then it would be possible to correct the disrupted gene expression programs to treat age-related diseases and to achieve better health and longevity. Developmental origins of adult health and disease: the role of periconceptional and foetal nutrition. Developmental origins of health and disease: reducing the burden of chronic disease in the next generation. Developmental plasticity and develop- mental origins of non-communicable disease: Theoretical considerations and epigenetic mechanisms. Intrauterine growth restriction as a potential risk factor for disease onset in adulthood. Review and hypothesis: syndromes with severe intrauterine growth restriction and very short stature d are they related to the epigenetic mechanism(s) of fetal survival involved in the developmental origins of adult health and disease? Developmental origins of health and disease: brief history of the approach and current focus on epigenetic mechanisms. Placental gene expression is related to glucose metab- olism and fetal cord blood levels of insulin and insulin-like growth factors in intrauterine growth restriction.

Type of the test Pre hepatic hepatic Post hepatic Serum billirubin:- Total + +++ +++ Direct N ++ +++ Indirect +++ ++ N Serum Alkaline N + +++ phos Liver Enzymes N +++ + Urine : billirubin 0 N +++ urobilinogen +++ N 0 Causes of extra hepatic biliary obstruction Obstruction in the lumen Gall stone(the most common) Parasitic occlusion e order discount thyroxine line 72210 treatment. To emphasize the importance of early diagnosis & intervention Introduction Abdominal wall hernias are common surgical problems encountered in all levels of health care facilities buy genuine thyroxine line symptoms 5dpiui. Adequate knowledge to reach to the correct diagnosis and appropriate management plan help the care provider to prevent serious complications which could be fatal discount 75 mcg thyroxine fast delivery medications on a plane. General consideration Definitions Hernia is a protrusion of a viscus through an opening in the wall of the cavity Important terminologies Hernial sac - is an out pouch of the peritoneum order thyroxine 25mcg visa medicine video. It has four parts: mouth, neck, body and fundus Content- Is a viscus or any other organ inside a sac. It can be: - Small bowel and omentum the commonest - Large bowel appendix - The bladder Reducible hernia- when the protruded viscus can be returned back to the abdomen Irreducible hernia- when the contents cant be returned back Obstructed hernia- the content of the hernia (intestine) is occluded but no impairment of vascular supply Strangulated hernia- when the vascularity of protruded viscus is impaired Richters hernia- when only one side of the wall of the intestine is herniated. Here strangulation of the bowel can occur with out intestinal obstruction Sliding hernia- when an extra peritoneal structure form part of the wall of the sac 198 Risk factors for abdominal wall Hernia development Increased intra abdominal pressure resulting from: - Chronic cough - Straining at urination or defecation - Heavy wt lifting - Abdominal distension Weakened abdominal wall - Advanced age - Malnutrition - Congenital defect ppv - Trauma/surgery Clinical features History - Lump which varies in size - Pain, local aching, discomfort - Factors predisposing to increased intra abdominal pressure - Symptoms of int. Strangulation is a surgical emergency Risk of obstruction and strangulation is very high in femoral hernia, paraumblical hernia and indirect inguinal hernia with narrow neck 199 Principles of management - Spontaneous resolution is unlikely - The risks of irreducibility, obstruction and strangulation increase with time. So surgical intervention is needed in most cases Surgical treatment for abdominal wall hernias 1. Herniotomy - removal of the sac and closure of the neck: Done only in infants and children 2. Obstruction and strangulation This is one of the causes of intestinal obstruction (acute abdomen). Therefore, one shouldnt forget to examine the hernial sites during evaluation of the patient with intestinal obstruction. Treatment options Non operative treatment: Gentle reduction (Taxis) can be indicated in obstructed hernia in infants but not advisable in adults due to the risk of mass reduction. Inguinal hernia - accounts for 80% of all external abdominal wall hernia - commonest is all ages and sexes - 20 x more common is males than women - more common on right side Classification 1. Direct type : Bulges through the post wall of inguinal canal Indirect inguinal hernia - 60% on right, 40% Lt side and 20% bilateral - Due to congenital defect or potential defect which is the remnant of processes vaginalis - 20 times more common in men Direct inguinal hernia - due to wear and tear associated with advanced age and increased intra abdominal pressure 201 Femoral Hernia - acquired downward protrusion of intestinal contents into the femoral canal - 4 times more common in females (middle-aged multiparous) - rare in children Clinical features History - Elderly or middle aged woman with thin body build - lump on anterior and upper thigh - may present with complaints associated with int. Risk factors Female sex Multiple parities Obesity Ascites Complications Obstruction Strangulation Rupture Treatment Expectant: - Spontaneous closure is expected in 80% cases of umbilical hernia in under five children. Surgery: - Beyond five years 202 Incisional Hernia Risk Factors Wound infection Poor surgical technique (improper facial repair) Chronic cough or straining Obesity Clinical features Risk of obstruction and strangulation is very rare. It had been one of the intersecting points for the discipline of internal medicine and surgery. Gastric cancer is one of the top five cancers in frequency, however, it is one of the disease entities with the worst prognosis because of the difficulty to diagnose it early. Therefore one has to have a high index of suspicion to diagnose the disease early for the outcome of treatment heavily depends on the stage of the disease at the time of diagnosis. Peptic ulcer disease Anatomy and physiology of the stomach and duodenum The stomach is an asymmetric dilation of the proximal gastro intestinal tract. Region Mucosa cells Secretion Cardia goblet cell mucus fundus and body parietal cells acid chief cells pepsinogen Antrum and pylorus goblet cells mucus G. The stomach performs two interrelated functions in the initial phase of digestion a. Food breakdown to form chyme through - mechanical digestion and - acid and pepsin action b. Phases of gastric secretion There are three phases of gastric secretion Cephalic - mediated by acetylcholin secreted by the vagus nerve. Gastric - mediated by the hormone gastrin (by G cells) Intestinal - mainly inhibitory through peptides like secretin Pathogenesis The pathogenesis of peptic ulcer is an imbalance in the aggressive activity of acid and pepsin and the defensive mechanisms that resist mucosal digestion. Classification Acid peptic disease of the stomach and duodenum includes Erosive gastritis (inflammation confined to the mucosa of the stomach) Acute gastritis - occur after major trauma, shock, sepsis, head Injury and ingestion of aspirin and alcohol. Chronic gastritis Peptic ulcers - extend through the mucosa into the submucosa and muscularis. Chronic gastric and duodenal ulcers are distinguished by the presence of an established inflammatory reaction. Duodenal ulcer usually occurs in the proximal duodenum with in 1 to 2 cm of the pylorus, the portion of intestine first exposed to gastric secretion. In duodenal ulcer there is acid hyper secretion while in gastric ulcer acid secretion is either normal or decreased. Clinical manifestation The clinical presentation is non-specific and the following features may not always be found. Table 1: Summary of clinical features of gastric and duodenal ulcers Gastric ulcer Duodenal ulcer Periodicity present Well marked Pain Soon after eating but not when lying Two hours after food down Night pain Vomiting Considerable vomiting No vomiting Hemorrhage Hematemesis more frequent than Melena more frequent than melena hematemesis Appetite Afraid to eat Good Diet Lives on milk and fish Eats almost anything Weight Loses weight No loss in weight On examination it is not unusual to find localized deep tenderness in the right hypo chondrium. However gastric ulcers need endoscopic evaluation and biopsy to rule out malignancy Surgical treatment The patient is referred for surgery in the following conditions: a. Intractability (failure of medical treatment) Complications Overall, in men, there is a 5 percent risk of perforation. O) This is a state that results from cicatrisation and fibrosis due to long standing duodenal or juxtapyloric ulcer. Clinical feature - Patient presents with pain, fullness, vomiting of large foul smelling vomit and on examination a peristaltic wave from left to right and succession splash can be elicited. What are the clinical features of gastric cancer and how do you reach the diagnosis? Introduction Dysphagia, though an infrequent occurrence in clinical practice, is a very serious problem which makes the patient miserable for he/she cant swallow food, fluids and even saliva. The causes differ according to the age of the patient and the history may clearly suggest the diagnosis in some cases like foreign body swallowing and corrosive ingestion as in achalasia and cancer. Most cases need a higher level of treatment, thus one should have a tentative diagnosis and convince the patient for early management at a hospital. Dysphagia Definition: Difficulty in swallowing Classification: According to the site and cause 1. Oropharyngeal dysphagia Causes Local pain due to trauma, oral candida, tonsillitis etc Neuromuscular disorders, e. What are the investigations which are important in the differential diagnosis of dysphagia? Compare and contrast a patient with achalasia with another patient having esophageal cancer (clinical presentation, diagnosis, treatment and prognosis). Jonathan Vickers and Derek Alderson, Investigation of dysphagia, surgery international, vol. It also communicates with the external environment and exposed to microbes causing diseases. Hence the student must be very well versed about the practice of the common urological problems. Urinary symptoms and Investigations of Urinary Tract problems: Introduction Urinary pathologies are fairly common problems that health workers encounter in his/her daily activities.