In these cases discount tadacip 20 mg with amex, integrity of specimen handling (chain of custody) becomes 43 Toxicology as important as the analytic procedure itself in order to rule out the possibility of specimen tampering or substitution order 20 mg tadacip otc. Spot tests Spot tests are rapid 20mg tadacip visa, easily performed tadacip 20mg otc, non-instrumental qualitative procedures discount 20 mg tadacip overnight delivery. They are the most rudimentary toxicology tests, & generally performed on urine specimens. In the test procedure, the sample (that is suspected for having a particular toxic chemical) will react with a chemical or chemicals set as a solution, or coated on a strip & the result of the reaction expressed by a color formation detected visually or colorometrically. Spot tests are available for a number of compounds, including salicylate, acetaminophen, carbonmonoxide, halogenated hydrocarbons, and heavy metals. The tests are rapid and convenient; however sensitivity and specificity are generally poor and accurate quantification is virtually impossible. Because of improvements in other technologies, spot tests are now largely replaced by rapid immuno- assays that may perform at the point- of-care or in the central laboratories. Ultraviolet & visible spectrophotometry Many toxins have characteristic absorption spectra, but they must be extracted from body fluids in order to measure these spectra. The major problem encountered with this technique is interference, and some form of sample purification, such as solvent extraction or microdiffusion, is usually employed. Immunoassays Immunoassays are diagnostic techniques used for the detection of antigen and antibody. Depending on the immunoassay techniques that are employed for the specific test, either antigen or antibody may be detected from the samples based on their reaction with their specific antibody or antigen respectively. Those not involving radioactivity or separation steps (homogeneous immunoassays) can be automated on routine clinical chemistry instruments, making them convenient for laboratories of all sizes. Immunoassays can be made highly sensitive and quite specific, but their specificity is never absolute. Molecules with a similar structure generally cross-react to some degree, and occasionally substances interfere with the assay in some other fashion. Immunoassays also have the drawback that each analyte must be individually assayed using an available antibody reagent. Nevertheless, some of the more modern, discrete analyzers can readily perform multiple homogenous immunoassays with minimal operator intervention, so a panel of commonly abused drugs (e. These tests are known as drug dipsticks; and they utilize paper strips impregnated with drug-specific antibody. Chromatography Chromatography is a powerful technique for separating substances based on slight differences in chemical properties. In this method, components to be separated are distributed between two phases; as stationary and mobile phases. Chromatographic procedure involve a sample to be introduced in a flowing stream of gas or liquid (mobile phase) that pass through a bed, layer, or column containing a stationary phase (made from solid, or gel or a liquid). As the mobile phase carries the sample pass the stationary phase, the solutes with lesser affinity remain in the mobile phase & travel faster & separate from those that have great affinity for it. Different chemicals have different characteristic mobility in a particular chromatographic system, allowing fairly confident identification. It does not require special equipment, is suitable for analysis of 46 Toxicology large batches of samples, is available in commercial kit form, and allows use of various color reagents in addition to chromatographic mobilities to aid in chemical identification. Detection is usually by ultraviolet spectrophotometry, which in its most sophisticated form permits spectral scanning of each eluting peak to aid in identification. Mass spectrometry is an analytical instrument that first ionizes a target molecule and then separates and measures the mass of a molecule or its fragment. The analysis is qualitative, quantitative & extremely useful for determining the elemental composition & structure of both inorganic & organic compounds. Atomic absorption, plasma emission, neutron activation, and x-ray fluorescence Toxic metals, for which most of the previously discussed methods do not apply, can be analyzed by sophisticated 48 Toxicology spectroscopic techniques, including atomic absorption, plasma emission, neutron activation, and x-ray fluorescence. Understand industrial toxicants like lead, insecticides, rodenticides, cyanide& hydrocarbons with their toxicological laboratory investigations. Describe medical poisoning caused by acetaminophen, salicylates & barbiturates with their toxicological laboratory investigations. Explain the environmental toxins like carbon monoxide, & food born toxins with their toxicological laboratory investigations. Understand the common drugs of abuse like alcohol, nicotine, & opioids with their toxicological laboratory investigation. Introduction The rapid industrialization and successful green revolution have introduced a large variety of chemicals into our environment.

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For the sake of brevity and clarity buy tadacip 20 mg free shipping, this text will discuss only the most commonly encountered patterns discount 20 mg tadacip with mastercard. The superficial veins do not normally have direct arterial counterparts generic tadacip 20mg amex, but in addition to returning blood tadacip 20mg for sale, they also make contributions to the maintenance of body temperature tadacip 20 mg lowest price. When the ambient temperature is warm, more blood is diverted to the superficial veins where heat can be more easily dissipated to the environment. In colder weather, there is more constriction of the superficial veins and blood is diverted deeper where the body can retain more of the heat. The “Voyage of Discovery” analogy and stick drawings mentioned earlier remain valid techniques for the study of systemic veins, but veins present a more difficult challenge because there are numerous anastomoses and multiple branches. Tracing blood flow through arteries follows the current in the direction of blood flow, so that we move from the heart through the large arteries and into the smaller arteries to the capillaries. From the capillaries, we move into the smallest veins and follow the direction of blood flow into larger veins and back to the heart. If you draw an imaginary line at the level of the diaphragm, systemic venous circulation from above that line will generally flow into the superior vena cava; this includes blood from the head, neck, chest, shoulders, and upper limbs. The exception to this is that most venous blood flow from the coronary veins flows directly into the coronary sinus and from there directly into the right atrium. Beneath the diaphragm, systemic venous flow enters the inferior vena cava, that is, blood from the abdominal and pelvic regions and the lower limbs. On both the left and right sides, the subclavian vein forms when the axillary vein passes through the body wall from the axillary region. It fuses with the external and internal jugular veins from the head and neck to form the brachiocephalic vein. These veins arise from the base of the brain and the cervical region of the spinal cord, and flow largely through the intervertebral foramina in the cervical vertebrae. Each internal thoracic vein, also known as an internal mammary vein, drains the anterior surface of the chest wall and flows into the brachiocephalic vein. Each intercostal vein drains muscles of the thoracic wall, each esophageal vein delivers blood from the inferior portions of the esophagus, each bronchial vein drains the systemic circulation from the lungs, and several smaller veins drain the mediastinal region. Bronchial veins carry approximately 13 percent of the blood that flows into the bronchial arteries; the remainder intermingles with the pulmonary circulation and returns to the heart via the pulmonary veins. These veins flow into the azygos vein, and with the smaller hemiazygos vein (hemi- = “half”) on the left of the vertebral column, drain blood from the thoracic region. The hemiazygos vein does not drain directly into the superior vena cava but enters the brachiocephalic vein via the superior intercostal vein. The azygos vein passes through the diaphragm from the thoracic cavity on the right side of the vertebral column and begins in the lumbar region of the thoracic cavity. It flows into the superior vena cava at approximately the level of T2, making a significant contribution to the flow of blood. Blood from the more superficial portions of the head, scalp, and cranial regions, including the temporal vein and maxillary vein, flow into each external jugular vein. Although the external and internal jugular veins are separate vessels, there are anastomoses between them close to the thoracic region. Major Veins of the Head and Neck Vessel Description Parallel to the common carotid artery, which is more or less its counterpart, and passes Internal jugular through the jugular foramen and canal; primarily drains blood from the brain, receives the vein superficial facial vein, and empties into the subclavian vein Temporal vein Drains blood from the temporal region and flows into the external jugular vein Maxillary vein Drains blood from the maxillary region and flows into the external jugular vein Table 20. Many smaller veins of the brain stem and the superficial veins of the cerebrum lead to larger vessels referred to as intracranial sinuses. These include the superior and inferior sagittal sinuses, straight sinus, cavernous sinuses, left and right sinuses, the petrosal sinuses, and the occipital sinuses. Most of the veins on the superior surface of the cerebrum flow into the largest of the sinuses, the superior sagittal sinus. It is located midsagittally between the meningeal and periosteal layers of the dura mater within the falx cerebri and, at first glance in images or models, can be mistaken for the subarachnoid space. Most reabsorption of cerebrospinal fluid occurs via the chorionic villi (arachnoid granulations) into the superior sagittal sinus. Blood from most of the smaller vessels originating from the inferior cerebral veins flows into the great cerebral vein and into the straight sinus. Other cerebral veins and those from the eye socket flow into the cavernous sinus, which flows into the petrosal sinus and then into the internal jugular vein. The occipital sinus, sagittal sinus, and straight sinuses all flow into the left and right transverse sinuses near the lambdoid suture.

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Any hematoma found should be rapidly evacuated cheap tadacip 20 mg fast delivery; otherwise it can lead to deterioration of the patient’s status due to brain compression buy tadacip 20mg free shipping. Compound depressed skull fracture requires immediate operation to prevent intracranial infection 20mg tadacip sale. Fractures are debrided and bone fragments washed in antibiotic solutions and immediately replaced cheap tadacip 20mg with mastercard. Post-operative control of amount of fluid (not to be given more than 2/3 of the daily requirement) tadacip 20 mg mastercard, electrolytes, positioning in 20-30 degree elevation of the bed and management convulsion and of late sequel of head injury should be accomplished. Displaced bone fragments and inter-vertebral disks may herniate to the spinal cord causing compression, commonly seen in cervical and thoraco lumbar region. Brown-sequard Syndrome: Ipsilateral paresis and contra-lateral loss of pain and temperature sensation. Anterior spinal cord syndrome: Paralysis occurs below the level of the lesion with loss of temperature, touch and pain sensation. Central cord syndrome: hand and upper extremities are affected with sparing of lower extremities. Both complete and incomplete injuries of the spinal cord can result in neurogenic bladder. Immediately after injury, spinal shock ensues in which bladder reflex does not develop. There could be a finding of flaccid paralysis, depressed deep tendon reflex and sensory level. Patient assessment Early detection of spinal injury will prevent further injury to the cord. Multiple injuries, seat belt markings and neurologic findings should alert the possibility of spinal injury. In conscious patients biplanar x-rays of the symptomatic part of spine are adequate. In cervical spines, unstable injuries are easily overlooked in lateral and A-P films. It is treated symptomatically initially with rest, then with splinting and mobilization as necessary. When you assess his level of consciousness, he opens his eyes when pinched, withdraws from pain and he is confused. Although the musculoskeletal system can be affected by several conditions like congenital, metabolic or neoplastic diseases, traumatic and infectious disorders are the most important ones in developing countries. Etiology • Staphylococcus aureus is the agent in 80% of cases • Gram negative rods and Staphylococcus in neonates • H. Influenza is seen in children under 5 years of age • History of trauma is common and may predispose children to osteomyelitis Pathology Bacteria reach the bone mostly via the hematogenous route. Infection begins in the metaphysis of a long bone and spreads through the cortex and medullary cavity causing thrombosis to vessels and bone infarction. Cloxacillin + Gentamycine - Children under 5 years:- Penicillinase resistant penicillins + Anti H. Cloxacillin + Chloramphenicol - Patients above 5 years:- Penicllinase resistant penicillin E. Pathology: The dead bone (sequester) lies in an abscess cavity surrounded by a newly formed bone (Involcrum) under the elevated periosteum. There may be skin hyper pigmentation around the sinus and palpable bone thickening. Treatment Antibiotics: Used for acute exacerbation and perioperate for about six weeks. Surgery: Surgery is done to remove a dead bone (sequesterectomy) or to eliminate an abscess cavity (saucerization). Conservative treatment is considered in a patient with minimal discharge and no obvious sequestrum or bone cavity. Amputation may be considered for extensive bone involvement and heavy discharge or frequent flare-ups which incapacitate the patient. Etiology: It varies in different age groups and is similar to that of acute osteomyelitis. Bacteria may reach the joint via the blood, local extension of osteomyelitis or directly in penetrating wounds of the joint.

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Special Thanks OpenStax wishes to thank the Regents of University of Michigan Medical School for the use of their extensive micrograph collection. We also wish to thank the Open Learning Initiative at Carnegie Mellon University, with whom we shared and exchanged resources during the development of Anatomy and Physiology. An understanding of anatomy and 8 Chapter 1 | An Introduction to the Human Body physiology is not only fundamental to any career in the health professions, but it can also benefit your own health. Familiarity with the human body can help you make healthful choices and prompt you to take appropriate action when signs of illness arise. Your knowledge in this field will help you understand news about nutrition, medications, medical devices, and procedures and help you understand genetic or infectious diseases. At some point, everyone will have a problem with some aspect of his or her body and your knowledge can help you to be a better parent, spouse, partner, friend, colleague, or caregiver. This chapter begins with an overview of anatomy and physiology and a preview of the body regions and functions. It introduces a set of standard terms for body structures and for planes and positions in the body that will serve as a foundation for more comprehensive information covered later in the text. Some of these structures are very small and can only be observed and analyzed with the assistance of a microscope. When a body is dissected, its structures are cut apart in order to observe their physical attributes and their relationships to one another. In order to observe structures in living people, however, a number of imaging techniques have been developed. These techniques allow clinicians to visualize structures inside the living body such as a cancerous tumor or a fractured bone. Gross anatomy is the study of the larger structures of the body, those visible without the aid of magnification (Figure 1. In contrast, micro- means “small,” and microscopic anatomy is the study of structures that can be observed only with the use of a microscope or other magnification devices (Figure 1. As the technology of microscopes has advanced, anatomists have been able to observe smaller and smaller structures of the body, from slices of large structures like the heart, to the three-dimensional structures of large molecules in the body. Regional anatomy is the study of the interrelationships of all of the structures in a specific body region, such as the abdomen. In contrast, systemic anatomy is the study of the structures that make up a discrete body system—that is, a group of structures that work together to perform a unique body function. For example, a systemic anatomical study of the muscular system would consider all of the skeletal muscles of the body. Human physiology is the scientific study of the chemistry and physics of the structures of the body and the ways in which they work together to support the functions of life. The study of physiology certainly includes observation, both with the naked eye and with microscopes, as well as manipulations and measurements. However, current advances in physiology usually depend on carefully designed laboratory experiments that reveal the functions of the many structures and chemical compounds that make up the human body. For example, neurophysiology is the study of the brain, spinal cord, and nerves and how these work together to perform functions as complex and diverse as vision, movement, and thinking. Physiologists may work from the organ level (exploring, for example, what different parts of the brain do) to the molecular level (such as exploring how an electrochemical signal travels along nerves). For example, the thin flap of your eyelid can snap down to clear away dust particles and almost instantaneously slide back up to allow you to see again. At the microscopic level, the arrangement and function of the nerves and muscles that serve the eyelid allow for its quick action and retreat. At a smaller level of analysis, the function of these nerves and muscles likewise relies on the interactions of specific molecules and ions. Your study of anatomy and physiology will make more sense if you continually relate the form of the structures you are studying to their function. In fact, it can be somewhat frustrating to attempt to study anatomy without an understanding of the physiology that a body structure supports. Imagine, for example, trying to appreciate the unique arrangement of the bones of the human hand if you had no conception of the function of the hand. Fortunately, your understanding of how the human hand manipulates tools—from pens to cell phones—helps you appreciate the unique alignment of the thumb in opposition to the four fingers, making your hand a structure that allows you to pinch and grasp objects and type text messages. It is convenient to consider the structures of the body in terms of fundamental levels of organization that increase in complexity: subatomic particles, atoms, molecules, organelles, cells, tissues, organs, organ systems, organisms and biosphere (Figure 1.

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