Fluoxetine

By S. Kaffu. Washington State University. 2018.

This exposed me to some of the immense responsibilities of a doctor generic fluoxetine 10mg free shipping, but my 4 experience helping in the cancer ward was where I learned the necessity of humanity in a physician and how it can be used to treat patients fluoxetine 10 mg with mastercard. Peering through a window I saw Cynthia, a seven-year-old girl diagnosed with terminal cancer, laughing uncontrollably after watching her doctor make funny faces. For a moment not only did Cynthia forget that she was dying, but her smile expressed joy and the beauty of being alive. This taught me that a physician, in addition to being knowledgeable and courageous, should show compassion to patients. It also became clear to me that a patients emotional comfort is as important as their physical health, and are both factors that a physician considers while providing patient care. Although focused on medicine, I was introduced to research through the Louis Stokes Alliance for Minority Participation in Science. Here, I learned organic synthesis techniques, while working on a project to elucidate the chemical mechanisms of oxygen- protein binding and its relationships to anemia. I also received the United Negro College Fund/Merck Science Initiative Research Scholarship that allowed me to experience cutting edge research in Medicinal Chemistry, with a number of world-class scientists. At Merck Research Labs, I learned the fundamentals of synthesizing novel compounds for drug discovery, and we focused on treatments for cardiac atrial fibrillation. This internship changed my view of medication and their origins, and left me with a deep appreciation of the challenges of medicinal research. I also now understand that medical doctors and research scientists have similar responsibilities: to solve current and future health issues that we face. Today as I move forward on the journey to become a physician I never lose sight of the ultimate goal; to turn the dying face of a best friend into the smiling glow of a patient, just like Cynthias. But with the right medications, a physicians compassion and some luck, sickness can be overcome, and the patient helped. In time and with hard work it will be my privilege to possess the responsibilities of a physician in caring for life. Over several weeks I witnessed his losing battle, not only with a terminal illness but also with cultural incongruence and a continual feeling of unease, thousands of miles away from home. Jorge was a victim of health care inequality, a subject that has been at the forefront of my mind since enrolling in Race and Medicine in America during my sophomore year. The course revealed to me the historically poor distribution of quality medical attention and how treatment continually evades socio-economically disadvantaged communities. This unfortunate reality inspired me to take an interest in treating these populations, in hopes of helping to improve the care for our countrys poor and underserved. Jorges story broadened my perspective, as I further realized that this need is exponentially worse in developing nations. The combination of my studies and real world experience strengthened my desire to practice medicine focused on treating underserved populations, nationally and abroad. In pursuit of my goal, I sought additional exposure to medical conditions in the developing world. During the summer of 2002, I contributed to a public health research initiative in Ghana. My research on malaria infectivity in and around the capital city Accra sent me to shanty town communities with poor hygiene and chronic illness and gave me yet another perspective on the impact of economic disparity in health outcomes and treatment options. Exorbitant patient volume and endemic disease are but a few of the many obstacles to doctors serving these communities and trying to provide quality care. Despite theses difficulties, I witnessed skilled physicians in this setting performing complex procedures in substandard conditions. At the Komfo Ankye Teaching Hospital in 6 the urban village of Kumasi, I scrubbed-in during the removal of an osteosarcoma tumor from a mans jaw and an ileostomy, where I saw a scalpel filling the role of an absent screwdriver and doctors working in a hot ward with minimal ventilation and only basic amenities. These resourceful doctors were still able to perform, reaffirming my expectation that despite complications, the addition of well-trained doctors can make a marked difference. I began to understand how, by taking my medical school training to such environments, I could serve as an intermediary - bringing first world knowledge into a third- world context. Since my time in Ghana, I have continued to participate to health care projects in poor communities. During the summer of 2003, I conducted research in an obstetrics ward of a public hospital in Sao Paulo, and the following fall participated in an infectious disease initiative that brought medical attention to impoverished suburbs of Lima, Peru. Most recently, I worked at a bilingual health clinic in Chicago serving a primarily Latino immigrant community. With each experience, I gained a deeper understanding of the complementary skills necessary to make a real difference. I have learned that medical knowledge, cultural understanding, and political savvy are critical components to a holistic approach to community health care and development, and are skills possessed by the most effective contributors to positive change. I continue to hone my language skills in anticipation of serving Spanish and Portuguese-speaking populations; and I am building an understanding of how to work in a complex funding environment and link medical treatment with public policy. I wish to pursue my medical training and a Masters in Public Health, so that I can improve access to health care and serve as an effective physician. My desire to perform medical public service developed from concern and sympathy for people in need of medical care, most specifically those with the least access. I further recognize the importance such compassion plays in effective communication between doctors and their patients.

Scheerer`s phenomenon = blue field phenomenon -noticeable when viewed against a field of pure blue light - tiny bright dots moving rapidly along squiggly lines in the visual field -caused by leucocytes moving in the capillaries in front of retina 3 cheap fluoxetine 10mg with visa. External ear the pinna (helps to direct sounds) trusted fluoxetine 20mg, the external auditory meatus, auditory Canal transmits sound waves to the tympanic membrane 2. Middle ear separated from extrenal ear by tympanic membrane (called eardrum), chain of ossicles the malleus, the incus, and the stapes. Eustachian tube connects middle ear to the pharynx and equilizes pressure differences between external and mid. Inner ear bony and membraneous labyrinth (cochlea and vestibular apparartus), receptors for two sensory functions. Cochlea spiral-shaped organ, divided by basal and Reissneri membranes to three parts scala tympani and scala vestibuli by perilymph (helicotrema), between scala media by endolymph). On basal membrane organ og Corti with receptors hair cells Adequate stimulus for auditory receptors sound - sound is produced by waves of compression and decompression transmitted in air (or other media such as water), propagation in the air 335 m/s - sound composed of many unrelated frequencies - noise - frequency (nm. The vibrations are transferred by the ossicular system through the oval window on the structures of inner ear (by the vawe movement of perilymph) - stimulation of the organ of Corti causes action potencials in nerve fibres function of mm. Axons penetrate the base of the skull through openings in the cribriform plate of the ethmoid bone as olfactory nerve filaments (fila olfactoria) to olfactory bulb. Stimulation of the olfactory cells - olfactory receptors telereceptors - they response to the odorant substance (gas) in inhaled air dissolved in the mucus 66 - chemical interaction with the membrane of the cilia + - they evoke receptor (generator) potencial by changing permeability of membrane for Na - fast adaptation - in humans ability to distinguish between 2 4000 different odors - the olfactory cells the highest degree of chemical discrimination Intensity of the stimulus depends on concentration of the odor substance (the number of stimulated receptors and the number of moleculs reaching the cell) Quality of perception depends on concentration: at low c. Function of the muscle spindle Receptors - active at rest stretching of the muscle activation of the anulospiral endings higher frequency of the impulses facilitation of the alfa motoneurons of the its own muscle. Pavlov) - originated during development = mechanisms for assurance of ability to survive and live classification: - apetitive - protective - orientation - sexual Innate mechanisms: 1. Drive: - processes which represent an immediate response to fundamental necessities of the body - they force the human to fill the needs - after filling the needs - antidrive 3. Storing of encoded information biochemical, biophysical and electrophysiological processes 3. Each receptor is highly specific for a single hormone Principal mechanisms: 1) Confirmational changes of the receptor alter the membrane permeability to ions. Properties of the hormone effects: 1) Target effect hormone acts on target cells organ (estrogen uterus, mammary gland etc. It lies in the sella turrica at the base of brain and is connected with hypothalamus by the pituitary (hypophyseal) stalk. Symptoms: Hyperglycemia (through) increased glucocorticoid activity), negative nitrogene balance, fat infiltration of the liver. Effects (three main): 1) Mammotrophic effect development of the breasts at puberty 2) Luteotrophic effect stimulation of the corpus luteum, stimulation of the progesteron secretion 3) Role in secretion of milk - producing effect. In mothers who do not nurse their baby a decrease in prolactin level to basal value in 2-3 weeks. Prolactin and estrogen synergize in producing breast growth, but estrogen antagonizes the milk-producing effect of prolactin on the breast. Effect: Lipolysis Control of anterior pituitary secretion 1) Feedback control hormone of the peripheral gland (adrenal cortex, thyroidea. Melanocytes synthesize melanins transfer to keratocytes in skin for pigmentation of hair and skin darkening in 24 hours. Transport - intraneural in the axons of neurons to their endings 85 - in the posterior lobe. Vasoconstriction in splanchnic, renal, coronary, cutaneous and uterine circulation. Single layer of cells filled with colloid Production of thyroid hormones: - thyroxine (T4), - triiodthyronine (T3) Biosynthesis: Processes: 1/Iodination, 2/ condensation of tyrosine molecules 3/ binding in peptide linkage in thyroglobulin 4/secretion 1/ Iodination Iodide trapping mechanism (iodide pump) active transport against a concentration and electrical gradient. Enzymes: 5 deiodinase (T3), 5 deiodinase (rT3), diiodothyronines In the liver T4 and T3 conjugation to sulfates, glucuronides the bile the intestine. Effects of thyroid hormones 1) Effects on growth and development: General and specific effects. Regulation increase in plasmatic Ca++ causes an immediate increase in the rate of calcitonin secretion. Feedback opposite effect increase the Ca++ concentration decreased activity of the parathyroid glands. Hypoparathyreoidism after parathyreoidectomy decrease in Ca++ plasma level signs of neuromuscular hyperexcitability: Hypocalcemic tetany: Chvosteks sign contraction of facial muscles elicited by tapping over the facial nerve. Calcium Metabolism Ca++ - in the human body about 1100 g 99 % in skeleton The plasma Ca++ - 2. D3 (cholecalciferol) is produced in the skin from 7- dehydrocholesterol by sunlight. Other Effects of Glucocorticoids 93 1) Antiinflammatory effect - stabilization of the intracellular lysosomal membranes and inhibition of lymphoid tissue. Adrenal virilism excess growth of facial hair, in women mens type of figure, muscles.

Congenital: albinism discount 20 mg fluoxetine free shipping, phenylketonuria These generally fall into one or more of three Hyperpigmentation categories: purchase fluoxetine 10mg with amex. Angioedema/anaphyl- body (alopecia universalis)) and trichotillomania axis are medical emergencies (p. Excessive hair growth and development of hair in of the wrist and forearms, lower back, mouth and abnormal sites hirsutism describes male-pattern genitalia. The papules a virilising tumour; hypertrichosis is excessive hair may be widespread or conned to one or two sites. Thecauseisunknown,butseveraldrugs Nail abnormalities can produce an identical eruption, e. The epidermis Nail disorders may occur in isolation or may be a sign is inltrated with T cells. An increase (reticulocytosis) suggests conrmed on the basis of laboratory ndings. The serum cell membrane) renal failure, carcinoma transferrinisnormalorlowbut,unlikeirondeciency,. HowellJolly bodies (remnants of nuclear material) tion may show malignant disease (leukaemia, myclo- splenectomy (or non-functioning spleen) ma, metastasis) or myelobrosis. Reticulocytes are pre- factor, anti-nuclear antibodies and if positive spe- mature red cells in which traces of nucleoprotein cic tests for antibodies against nuclear antigens remain as ne, reticular strands. Erythropoietin can alsoreverseanaemiaassociatedwithcancer,although concerns have been raised that erythropoietin may contribute to tumour progression. Pernicious anaemia is now usually diagnosed by nd- Iron deciency is caused by poor intake, poor ing low serum vitamin B12 with parietal cell and absorption, poor iron use by the marrow or intrinsic factor antibodies, rather than with the Haematology 323 Schilling test (B12absorptionbefore and after intrinsic stick together. Check the haemoglobin, and reticulocyte re- indicator of inammation or infection. The serum iron is characteristically reduced, and so is the transferrin (iron-binding capacity), unlike the Anaemia ndings in iron-deciency anaemia. The marrow iron stores are increased, but the iron is not incorporated There are three major types of anaemia, classied by fully into red cell precursors. The symptoms are tiredness, physical fatigue and dyspnoea, with angina, heart failure and confusion in older people. Pancytopenia Anaemia can be caused by a deciency in: Thisis ararecombinationofanaemia,leucopeniaand. Slow gas- trointestinal loss is a common cause, with peptic ulceration, gastric carcinoma and carcinoma of the descending colon most common. Carcinoma of the Marrow suppression ascending colon or caecum frequently produces no symptoms and its presence must be considered in Secondary bone marrow failure may affect one or all all cases of iron-deciency anaemia. In the elderly, of the formed elements of the blood red cells, dietary deciencies remain an important cause, and white cells or platelets. This includes assessment of pallor (very imprecise), glossitis, angular stomatitis, koilonychia and rectal examination. Investigate the gastrointestinal tract if Erythrocyte sedimentation no other cause is identied. A signicant difference between one phages but reduced amounts in developing erythro- blasts. See if the cells are normal (normocytic), Management small (microcytic) or large (macrocytic) In the absence of active bleeding, ferrous sulphate 200mg b. Transferrin 23g/l (iron-binding Raised in iron deciency (and Hazards of blood transfusion plasma protein) pregnancy) Reduced in anaemia of. Transfusion reaction minimise risk by cross- chronic disease, acute matching patients serum with donor blood. It is associated with other organ-specic and the transferrin raised, with a low saturation. Serum ferritin re- tiply using up B12), a vegan diet, Crohns disease ects the state of the iron stores and is therefore low. Exhaustion fall because of reduced numbers of both lymphocytes and lethargy are the most common presenting com- and neutrophils (Table 20. Some neutrophils may plaints, although pallor may be noticed incidentally, show hypersegmentation of the nuclei (>5lobes). The tongue may be tender, locytes and megaloblasts present evidence that an- smooth and red because of atrophy of the mucosa. Later, features of subacute combined degen- inactive nucleus (maturation arrest) in a relatively eration of the cord may develop. There is an increased incidence presence denotes vitamin B12 or folate deciency, of gastric carcinoma. Vasculitis and drug hypersensitivity Causes of lymphopenia (low lymphocyte count). Parasitic infestation of gut or other tissues (muscles, subcutaneous tissues, liver, urinary tract). Uro- bilinogen is present in the urine as a result of reduced red cell survival and ineffective erythropoiesis.