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Zeki Abdurazik buy 400mg viagra plus, Assistant professor in Surgery cheap 400 mg viagra plus free shipping, Gondar University At last but not least we would like to convey special appreciation for the finalization of the material at National reviewer level by using his valuable time Dr order viagra plus 400mg. The two eyes provide about half the total sensory input from the entire body into the brain buy discount viagra plus 400 mg line. The eye is sensitive to trauma order viagra plus 400 mg line, infection or inflammation that may end up in blindness. Just as the blind spot is neglected by the brain, about 45million people in the world who are blind are largely neglected by medical science and technology, and by the caring professionals; of this 80% is preventable. In order to address these multifactorial causes, all rounded and effective approach is needed. Above all there are few ophthalmologists and other ophthalmic workers in relation to population. So the need for skilled man- power that will involve specially at preventable level is undoubted. For this, problem oriented training is mandatory in order to overcome ophthalmic health problems in the country. This can be done by early management at the first level of health institute or by appropriate referral There are many reference books about ophthalmic diseases but most are not written with regard to our country’s situation where most blind people live. To alleviate this problem, Ophthalmology Department of Gondar University has got a full support from carter center. It was tried to focus on common ophthalmic problems and major causes of blindness so that this document will serve as a practical guideline for mid-level health workers. The lecture note will give the students pertinent knowledge and practice about prevention of blindness. Objectives at the beginning of the chapters which are intended to guide the students in their study. Having the basic idea will help to have a better understanding on the pathology of specific part of the eye. At the end of this course, students are expected to know basic anatomy and physiology of the eye. Skin - has three important features - Thinnest, more elastic and mobile than skin else where in the body - Little or no subcutaneous fat under the skin makes it a good source of skin graft - Has an extremely good blood supply that is why wound heals well and quickly. Muscles Orbicularis oculi muscle • Important for closure of eye lid 3 th • Innervated by facial (7 cranial) nerve Levator Palpebrae • Elevator of eye lid. Tarsal plates - Are composed of dense fibrous tissue -Keep the eye lids rigid and firm -Contain meibomian glands, which open at lid margin, and makes oily secretion that forms a part of corneal tear film. Conjunctiva It is a thin mucous membrane which lines the inner surface of the eye lid and outer surface of the eye ball. The conjunctival epithelium is continuous with the corneal epithelium at the margin of the cornea, which is called limbus. Conjunctiva contains many small islands of lymphoid tissue especially in the fornix. Frontal bone Levator Palpebrae Orbicularis muscle Conjunctival fornix with Accessory lacrimal Skin glands Tarsal conjunctiva Eyelashes Tarsal plate with meibomian glands Fig 1. Wall of orbit- Roof Frontal bone and sphenoid bone Floor Zygomatic, maxillary and palatine bones Medial Ethimoid, frontal, Lacrimal and sphenoid bones Lateral - The strongest of all walls. Sclera Retina Anterior Choroid Chamber Cornea Fovea Optic nerve Pupil Lens Iris Suspensary ligament Ciliary body Optic nerve head Conjunctiva Vitreous body 1. Cornea - Is the main refractive media of the eye (75 % of refractory function of the eye). Iris - has central hole (pupil) through which light reaches the retina - consists of a vascular stroma covered by mesothelium anteriorly and by two pigmented layers of epithelium posteriorly. Its size is subject to various factors like aging, illumination, sleep, change of gaze, emotional status. Ciliary body - Triangular structure that is situated between the iris anteriorly and choroids posteriorly. Circulation of aqueous fluid Aqueous fluid is produced by ciliary process of ciliary body. It flows from the posterior Chamber along the pupillary opening to the anterior chamber. Finally it will be drained through the Canal of schlemn in the Trabecular meshwork to episcleral veins Stroma Endothelium Epithelium Trabecular meshwork Canal of Schlemn Iris Anterior Lens Chamber angle Posterior chamber Ciliary Processes Ciliary body Fig.

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It also appears to inhibit the effects of the gonadotropins and may prevent ovulation in lactating women discount viagra plus 400mg free shipping. Actions Follicle-stimulating hormone directly stimulates the sertoli cells in testicular seminiferous tubles buy generic viagra plus 400 mg line, there by promoting spermatogenesis in the male viagra plus 400 mg low cost. Actions Thyroid-stimulating hormone maintains the structural integrity of the thyroid gland and promotes the synthesis and release of thyroid hormones thyroxine (T4) and triiodothyronine (T3) discount 400mg viagra plus fast delivery. The enhanced reabsorption of water from the renal tubules results in the production a concentrated urine that is reduced in volume buy viagra plus 400mg overnight delivery. The early observations that posterior pitutary extracts produce a marked elevation of arterial blood pressure led to the initial naming of this hormone as vasopressin. Oxytocin Control of Secretion and Actions The two major physiologic actions of oxytocin are exerted on the female breast and uterus. Oxytocin binds to a G-protein coupled receptor that ultimately brings about elevated intracellular calcium levels. The ejection of milk from a primed, lactating mammary gland follows a neuroendocrine reflex in which oxytocin serves as the efferent limb. The reflex is normally initiated by sucking, which stimulates cutaneous receptors in the areola of the breast. Afferent nerve impulses travel to the supraoptic and paraventricular nuclei of the hypothalamus to effect the release of oxytocin from the neurohypophysis. Oxytocin is carried by the blood to the mammary gland, where it causes contraction of myoepithelial cells surrounding the alveoli and lactiferous ducts to bring about the ejection of milk (milk letdown). In lactating women, tactile stimulation of the breast areola, emotional stimuli, and genital stimulation may also lead to oxytocin release and activate the ejection of milk. Oxytocin acts directly on uterine smooth muscle to elicit strong, rhythmic contractions of the myometrium. The gravid (Pregnant) uterus is highly sensitive to oxytocin, particularly in the late stages of gestation. It has been suggested that 221 Human Anatomy and Physiology oxytocin may facilitate sperm transport through the female genital tract. The Thyroid Gland The hormones of the thyroid gland exert a wide spectrum of metabolic and physiologic actions that affect virtually every tissue in the body. Each follicle consists of a simple cuboidal epithelium (follicular cells) enclosing a lumen or cavity containing a viscous hyaline substance termed colloid. Interspersed among the follicles are small clusters of parafollicular (C) cells, which secrete calcitonin, a hormone affecting calcium metabolism. The plasma levels of these hormones are regulated by the hypothalamopituitary axis as outlined in Figure 8-2. Intrinsic (intrathyroidal) mechanisms, as well as bioavailability of iodine, influence thyroid hormone production. Iodide ions are actively transported from the blood into the thyroid follicles by an energy-requiring "trapping" mechanism often called the iodide pump. Oxidation to iodine: On entering the colloid, iodide is rapidly oxidized to iodine in the presence of peroxidase enzymes. Goitrogens found in cabbage, kale, and turnips, as well as cobalt and phenylbutazone, also block organification of iodine. Storage and release of thyroid hormones: T3 and T4 remain stored within the colloid bound to thyroglobulin 223 Human Anatomy and Physiology until a stimulus for secretion arrives. Transport Circulating thyroid hormones bind specifically with thyroxine- binding globulin and thyroxine-binding prealbumin, and non- specifically with serum albumin. Fate Thyroid hormones are inactivated by deiodination, deamination, decarboxylation, or conjugation with glucuronic acid or sulfate. Much of the iodine released during biodegradation is recycled and reused for synthesis of new hormones. Actions The thyroid hormones increase the rate of metabolism, total heat production, and oxygen consumption in most body tissues. The thyroid hormones promote normal physical growth and development, and they are essential for normal myelination and development of the nervous system in early life. The metabolic actions of the thyroid hormones are some what complex, being dependent on the level of the thyroid hormones, as well as on the presence of other hormones, for example, catecholamines and insulin. T3 is more potent and more rapidly active than T4; in fact, the latter may be considered a prohormone, since most target cells convert T4 into T3.

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Pre-operative preparation clinics can improve efficiency by enabling early review of the notes of complex cases trusted 400mg viagra plus, ensuring appropriate investigations are carried out and that patients are referred for specialist opinion if deemed necessary generic viagra plus 400mg amex. Day surgery for urgent procedures Patients presenting with acute conditions requiring urgent surgery can be efficiently and effectively treated as day cases via a semi-elective pathway purchase viagra plus 400 mg visa. After initial assessment many patients can be discharged home and return for surgery at an appropriate time viagra plus 400 mg cheap, either on a day case list or as a scheduled patient on an emergency list discount viagra plus 400mg otc, whereas others can be immediately transferred to the day surgery service. This reduces the likelihood of repeated postponement of surgery due to prioritisation of other cases. Some of the procedures successfully managed in this manner are shown in Table 1 [21–25]. Essential components of an emergency day surgery pathway are: 1 Identification of appropriate procedures. Documentation Detailed documentation is important within the day surgery environment as the patient’s experience is often condensed into a few hours. General surgery Gynaecology Trauma Maxillofacial Incision and drainage Evacuation of retained Tendon repair Manipulation of of abscess products of conception fractured nose Laparoscopic Laparoscopic ectopic Manipulation Repair of fractured cholecystectomy pregnancy of fractures mandible ⁄ zygoma Laparoscopic Plating of appendicectomy fractured clavicle Temporal artery biopsy Ó 2011 The Authors 6 Anaesthesia Ó 2011 The Association of Anaesthetists of Great Britain and Ireland Guidelines: Day case and short stay surgery. Documentation should be a continuum from pre-operative preparation to discharge and subsequent follow-up. Single care plans reflecting a multidisciplinary approach are favoured in many units. Variations for specific groups including children and patients undergoing procedures under local anaesthesia should be available. Procedure-specific care plans reflecting integrated care pathways may be used for more complex and challenging cases. Patients should be provided with general as well as procedure-specific information. This should be given in advance of admission to allow time for questioning and preparation for same day surgery. General information should include practical details about attending the day surgery unit whereas procedure- specific information should include clinical information about the patient’s condition and surgical procedure (Appendix 2). Management and staffing Every day surgery unit must have a Clinical Lead with specific interest in day surgery and whose remit includes the development of local policies, guidelines and clinical governance. A consultant anaesthetist with management experience is ideally suited to such a role and job plans must reflect this responsibility. The Clinical Lead should be supported by a day surgery manager who has responsibility for the day-to-day running of the unit. The manager will often have a nursing background and should have the knowledge and skills to make informed decisions and lead on all aspects of day surgery development. Staff working in these Ó 2011 The Authors Anaesthesia Ó 2011 The Association of Anaesthetists of Great Britain and Ireland 7 Guidelines: Day case and short stay surgery. Many units favour multiskilled staff who have the knowledge and skills to work within several different areas of the day surgery unit. Efficient use of resources is best achieved by a well-trained, flexible and multiskilled workforce. Extended roles facilitate job satisfaction and encourage personal devel- opment and staff retention. Many health care assistants in the day surgery unit are now able to perform duties traditionally only undertaken by qualified nurses [30–32]. Individual units should formulate a staffing structure that takes into consideration local needs. Each unit should have a multidisciplinary operational group that oversees the day-to-day running of the unit, agrees policies and timetables, reviews operational problems and organises audit strategies. Facilities Day surgery should ideally be provided in a self-contained unit that is functionally and structurally separate from inpatient wards and theatres. It should have its own reception, consulting rooms, ward, theatre and recovery areas, together with administrative facilities. The operating theatre and first stage recovery areas should be equipped and staffed to the same standards as an inpatient facility, with the exception of the use of trolleys rather than beds. Several patients per day can occupy the same trolley space, providing far greater efficiency than on wards where one day case may occupy a bed for a whole day. Car parking or short stay drop-off and pick-up areas should be provided adjacent to the unit. An alternative to a purpose-built unit is the use of a day case ward with patients transferred to the main operating theatre.

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