By T. Surus. College of Saint Catherine.

Interactions of anti-sigma factor an- tagonists of Mycobacyerium tuberculosis in the yeast two-hybrid system buy 100mg gabapentin with visa. The senX3-regX3 two-component regulatory system of Mycobacterium tuberculosis is required for virulence order gabapentin 800mg mastercard. Rv3133c/dosR is a transcription factor that mediates the hypoxic response of My- cobacterium tuberculosis Mol Microbiol 2003 purchase gabapentin 800mg mastercard; 48: 833-43. Global physiological understanding and metabolic engi- neering of microorganisms based on omics studies. An integrated map of the genome of the tuber- cle bacillus, Mycobacterium tuberculosis H37Rv, and comparison with Mycobacterium leprae. A polyketide synthase catalyzes the last condensation step of mycolic acid biosynthesis in mycobacteria and related organ- isms. The alternative sigma factor SigH regulates major components of oxidative and heat stress response in Mycobacterium tuberculosis. Transcription regulation by the Mycobac- terium tuberculosis alternative sigma factor SigD and its role in virulence. Mycobacterium tuberculosis SigM positively regulates Esx secreted proteins and nonribosomal peptide synthetase genes and down regulates virulence-associated surface lipid synthesis. Mapping and identification of Mycobacte- rium tuberculosis proteins by two-dimensional gel electrophoresis, microsequencing and immunodetection. Hy- poxic response of Mycobacterium tuberculosis studied by metabolic labeling and pro- teome analysis of cellular and extracellular proteins. Transcriptional adaptation of Mycobacterium tuberculosis within macrophages: insights into the phagosomal environment. Expression profiling of host pathogen interac- tions: how Mycobacterium tuberculosis and the macrophage adapt to one another. Complementary analysis of the Mycobacterium tuberculosis proteome by two-dimensional electrophoresis and isotope-coded affinity tag technology. The cold-shock stress response in Mycobacterium smegmatis in- duces the expression of a histone-like protein. The largest open reading frame (pks12) in the Mycobacterium tuberculosis genome is involved in patho- genesis and dimycocerosyl phthiocerol synthesis. Multiple paralogous genes related to the Streptomyces coelicolor developmental regulatory gene whiB are present in Streptomy- ces and other actinomyetes. Gap, a mycobacterial specific integral membrane protein, is requiered for glycolipid transport to the cell surface. Rsh, an anti-sigma factor that regulates the activity of the mycobacterial stress response sigma factor SigH. Definition of Mycobacterium tuberculosis culture filtrate proteins by two-dimensional polyacrylamide gel electrophoresis, N-terminal amino acid sequencing, and electrospray mass spectrometry. Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionarily recent global dissemi- nation. Acute infection and macrophage sub- version by Mycobacterium tuberculosis require a specialized secretion system. Comparative proteome analysis of Mycobacterium tuberculosis grown under aerobic and anaerobic conditions. Myco- bacterium tuberculosis WhiB3 interacts with ProV to affect host survival but is dispensa- ble for in vivo growth. Lipoproteins of Mycobacterium tuberculosis: an abundant and functionally diverse class of cell envelope components. A new approach for the analysis of bacterial microarray-based Comparative Genomic Hybridization: insights from an empirical study. Differential expression of iron-, carbon-, and oxy- gen-responsive mycobacterial genes in the lungs of chronically infected mice and tuber- culosis patients. Functional and evolutionary genomics of Mycobacterium tuberculosis: insights from genomic deletions in 100 strains. Genomic deletions classify the Beijing/W strains as a distinct genetic lineage of Mycobacterium tuberculosis. Effect of slow growth on metabolism of Escherichia coli, as revealed by global metabolite pool ("metabolome") analysis. Comparison of predicted and observed properties of proteins encoded in the genome of Mycobacterium tuberculosis H37Rv. Gene expression profiling of human macrophages at late time of infection with Mycobacterium tuberculosis. Integrating metabolomics into a systems biology framework to exploit metabolic complexity: strategies and applications in micro- organisms. An in vitro model for sequential study of shiftdown of Mycobacte- rium tuberculosis through two stages of nonreplicating persistence.

Skin gets its color from a) Carotene b) Underlying blood vessels c) Melanin d) a and b only e) a purchase 400mg gabapentin visa, b and c 54 Human Anatomy and Physiology 4 order 600 mg gabapentin overnight delivery. Sudoriferous glands secret their secretion in response to: a) Physiological process b) Heat c) Stress d) Sexual experience e) In all of the above condition 5 discount 600 mg gabapentin fast delivery. But from structural point of view, the human skeletal system consists of two main types of supportive connective tissue, bone and cartilage. Movement: skeletal muscles attached to the skeletal system use the bone to levers to move the body and its part. Short bones are about equal in length, width and thickness, which are shaped with regular orientation. Typical sesamoid bones are patella and pisiform carpal bone, which are in the tendon of quadriceps femuris and flexor carp ulnaris muscle respectively. Gross anatomy of a typical long bone You can take Tibia (in the leg) one of the longest bones in the body. The red marrow also known as myeloid tissue Endosteum is the lining the medullary cavity of compact bone tissue and covering the trabeculae of spongy bone tissue. It is more rigid than other tissues because it contains inorganic salts mainly calcium phosphate & calcium carbonate. Osteons are made up of concentric layers called lamellae, which are arranged seemingly in wider and wider drinking straws. In the center of the osteons are central canals (haversion canal) , which are longitudinal canals that contains blood vessels, nerves and lymphatic vessels. Central canals, usually have branches called perforating canals /valkmann’s canal that run at right angle to central canal extending the system of nerves and vessels out ward to periosteum and to endosteum. Radiating from each lacuna are tiny canaliculi containing the slender extensions of the osteocytes where nutrients and wastes can pass to and from central canal. Spongy (cancellous) Bone tissue Is in the form of an open interlaced pattern that withstands maximum stress and supports in shifting stress. They are able to synthesize and 63 Human Anatomy and Physiology secrete un-mineralized ground substance, act as pump cell to move calcium and phosphate in and out of bone tissue. Bone in embryo develops in two ways: Intra-membranous ossification, If bone develops directly from mesenchymal tissue. The 64 Human Anatomy and Physiology cartilage it self do not converted into bone but the cartilage is replaced by bone through the process. Endochondrial ossification produces long bones and all other bones not formed by intra-membranous ossification. These are surface markings where muscles, tendons and ligaments attached, blood & lymph vessels and nerves pass. Example: External auditory meatus Groves and sulcus: are deep furrow on the surface of a bone or other structure. Example Medial condyle of femur Head, expanded, rounded surface at proximal end of a bone often joined to shaft by a narrowed neck. The upper part of the lower extremity, between the pelvis and knee, is the thigh; the leg is between the knees an ankle. Made up of horizontal, cribriform plate, median perpendicular plate, paired lateral masses; contains ethmoidal sinuses, crista galli, superior and middle conchae. Forms roof of nasal cavity and septum, part of cranium floor; site of attachment for membranes covering brain. Shaped like large scoop; frontal squama forms forehead; orbital plate forms roof of orbit; supraorbital ridge forms brow ridge; contains frontal sinuses, supraorbital foramen. Slightly curved plate, With turned- up edges; made up of squamous, base, and two lateral parts; contains foramen magnum, occipital condyles, hypo-glossal canals, atlanto-occipital joint, external occipital crest and protuberance. Protects posterior part of brain; forms foramina for spinal cord and nerves; site of attachment for muscles, ligaments. Wedge-shaped; made up of body, greater and lesser lateral wings, pterygoid processes; contains sphenoidal sinuses, sella turcica, optic foramen, superior orbital fissure, foramen 71 Human Anatomy and Physiology ovale, foramen rotundum, foramen spinosum Forms anterior part of base of cranium; houses pituitary gland; contains foramina for cranial nerves, meningeal artery to brain. Made up of squamous, petrous, tympanic, mastoid areas; contain zygomatic process, mandibular fossa, ear Ossicles, mastoid sinuses. Form temples, part of cheekbones; articulate with lower jaw; protect ear ossicles; site of attachments for neck muscles. Fontanels The skeleton of a newly formed embryo consist cartilage or fibrous membrane structures, which gradually replaced by bone the process is called ossification. Function • They enable skull of the fetus to compress as it pass through the birth canal • Permit rapid growth of brain during infancy • Serves as a landmark (anterior fontanel) for withdrawal of blood from the superior sagital sinus • Aid in determination of fetal position prior to birth. In the skull of the fetus there are 6 prominent fontanels: a) The Anterior (frontal) fontanel, between angle of two parietal bones & segment of the frontal bone. They are irregular in shape and begin to close at 1 or 2 months after birth and completed by 12 months.

Chronic high by the failure of the body to make enough blood sugar levels affect the eyes generic gabapentin 600 mg with amex, kidneys cheap 100mg gabapentin otc, insulin (Type 1) order gabapentin 800mg visa, or the failure of the body nerves and blood vessels. In adults, it is also the leading cause of blindness, kidney Ten per cent of people with diabetes have failure and loss of limbs due to amputation. People with Type 1 diabetes must administer daily insulin injections and must Diabetes often disables people in their carefully monitor their blood sugar levels, prime years. People effect on the quality of life of individuals with Type 1 diabetes will die if they do not living with diabetes and their families. People with Type 2 diabetes may also require daily oral diabetes medication and/or insulin by injection. Diabetes that occurs in pregnancy (gestational diabetes) is usually managed by changes in food intake and physical activity, but may also require insulin by injection. Sugar levels often return to normal after delivery of the baby, but both the mother and baby are at increased risk of developing Type 2 diabetes in the future. Diabetes A Manitoba Strategy 3 Executive Summary In June of 1996, Manitoba’s Minister of Health • 40% of people who begin dialysis declared diabetes to be both a major public have diabetes; health issue and an epidemic among Aboriginal • 60% of hospitalizations for heart people and the elderly of all populations. Evidence from the Diabetes Burden of Illness Study, conducted by the As well, in 1995, evidence indicated that Epidemiology and Diabetes and Chronic the cost of diabetes and its complications Diseases Units of the Public Health Branch (in adults, 15 years and older) to the health of Manitoba Health, provided the basis for care system, was over $193 million per year strategy development. This committee was co-chaired diagnosed with diabetes; by Grand Chief George Muswaggon, Grand • more than 20% of Status women and Chief Francis Flett and acting Grand Chief 13% of Status men over the age of 25 Sydney Garrioch of Manitoba Keewatinowi have been diagnosed with diabetes. Emoke˝ Diabetes causes significant complications that Szathmáry, President, University of impact on the lives of people with diabetes, Manitoba. The Committee established five their families and their communities: working groups to address the spectrum of • 25% of all heart disease and stroke diabetes prevention, education, care, hospitalizations occur in people with research and support. Manitoba: • Research: Develop a Manitoba Diabetes • Population Health, Surveillance System that will provide • Determinants of Health, data on an ongoing basis to monitor • Healthy Public Policy, and evaluate interventions and • Evidence-based Decision Making, initiatives related to diabetes • Holistic Approach, prevention, education, care, research • Learning about Health, and support. Access to Support Services across the For over a year, the Steering Committee and province and provide a network of its five working groups researched, discussed, support services for those people with sought expert opinion, deliberated and came diabetes and its complications. As well, public enormous task is before the people of meetings were held across the province to Manitoba, the policy makers, federal, ensure broad, grassroots input. In total, more provincial and Aboriginal governments, than 1,000 people contributed to the health care providers and professionals and development of this Strategy. It is anticipated that the The Strategy presents many important partnerships which evolved during the recommendations. Examples of some key development of this Strategy will continue recommendations are: and be strengthened. Diabetes A Manitoba Strategy 5 Résumé En juin 1996, le ministre de la Santé du Le diabète entraîne des complications Manitoba a déclaré que le diabète importantes pour les diabétiques, leurs constituait un problème majeur de santé familles et leurs communautés: publique et qu’il prenait des allures • 25 % des personnes hospitalisées pour d’épidémie parmi les Autochtones et les une maladie de coeur ou un accident personnes âgées de tous les groupes cardiovasculaire sont diabétiques; ethniques. La Stratégie manitobaine contre • 40 % des personnes qui débutent un le diabète est le résultat de la consultation traitement de dialyse souffrent de menée depuis lors. Ils sont ensuite parvenu à un qui concerne la prévention, l’information du consensus par rapport à une série public, les soins pour les diabétiques, la d’objectifs et d’actions recommandés. Plus de 1 000 personnes ont • élaborer une stratégie qui permettra ainsi contribué à formuler la Stratégie de réduire l’incidence et la prévalence manitobaine contre le diabète. Voici les principes et les lignes directrices • Information du public: Créer un qui ont guidé le Comité directeur dans programme normalisé, à niveaux multiples, l’élaboration d’une stratégie de lutte contre de formation en matière de diabète, afin le diabète au Manitoba: d’augmenter le nombre d’éducateurs en diabète, depuis les experts des milieux • la santé de la population communautaires jusqu’aux spécialistes. Diabetes A Manitoba Strategy 7 • Recherche: Établir le Système manitobain de surveillance du diabète qui fournira en permanence des données utiles pour suivre l’évolution de la maladie parmi la population et évaluer les mesures adoptées en matière de prévention, d’information du public, de soins pour les diabétiques, de recherche et de soutien. Le Comité directeur sait l’énorme tâche qui attend la population manitobaine, les décideurs, les gouvernements fédéral et provincial, les administrations autochtones, les professionnels et les fournisseurs de soins dans le domaine de la santé, ainsi que le secteur privé. On peut toutefois espérer que les liens établis pour élaborer la Stratégie seront maintenus et renforcés. This population-based around the world had diabetes, 90% of study identified the epidemic of Type 2 dia- whom had Type 2 diabetes. Diabetes A Manitoba Strategy 9 Manitoba was the first province in Canada to have been diagnosed with Type 2 diabetes. This study describes the The Diabetes Burden of Illness Study data incidence and prevalence of diabetes and its on Aboriginal persons are limited to complications according to age, sex, First declared Status persons only. It provides evidence of the urgency to Diabetes is much more common among address the prevention and management of Manitoba’s Aboriginal adult population diabetes. For example, in the First Nations population of • In 1996, there were 425 children under Manitoba, persons with diabetes account for: the age of 18 with Type 1 diabetes in • 91% of lower limb amputations, Manitoba. This is an alarming • More than 13% of Manitobans over the statistic, particularly when it is estimated that age of 55 and 15% over the age of 65 10 Diabetes A Manitoba Strategy The Evidence the actual number of affected Aboriginal The Economic Costs of children may be three times higher. This Manitoba are now available from the Diabetes will have a serious impact on their adult Costing Project.

Signs and symptoms - Fever - Retroauricular pain - Crying with ear scrubbing - Gastro intestinal signs - Otalgia - Cervical lymphadenopathy - Otorrhea (if tympanic membrane perforated) - Impaired hearing - Redness of eardrum - Sometimes bulging of the eardrum Complications - Secretory otitis media (ear glue) - Chronic otitis media with perforation - Acute mastoiditis sometimes with periosteal abscess - Intracranial (meningitis buy gabapentin 600 mg mastercard, brain abscess gabapentin 800 mg with mastercard, subdural abscess generic gabapentin 100mg fast delivery, etc. Q every 8 hours for 7-10 days • When associated with rhinitis add Xylometazoline (Otrivine) 0. Predisposing risk factors - Inadequate management of otitis media - Frequent upper respiratory tract infections - Anatomic factor: Short Eustachian Tube - Poor living conditions, poor housing, hygiene and nutrition analphabetism - Immunosupression (e. Pharmaceutical treatment • Application of a topical antibiotics ointment to the nasal mu- cosa has been shown to be an efective treatment for recurrent epistaxis • Topical vasoconstrictor: Xylometazoline spray (otrivine) 0. It is due to intense swelling of epiglottis and surround- ing tissues with septic signs. Cardiac failure Defnition: It is the inability of the heart to deliver adequate cardiac output to meet the metabolic needs of the body. Maximum dose 8 mg/kg/day) • Supplementary Potassium if Frusemide is given for more than 5 days • Treating the underlying cause (surgical treatment): refer to a specialized centre. See section on cardiology for more details on diagnosis and treatment of cardiovascular disorders. Shock Defnition: It is an acute dramatic syndrome characterized by inadequate circulatory provision of oxygen, so that the metabolic demands of vital organs and tissues are not met. Cefotaxi- me 150-200 mg/kg/day in 3-4 divided doses per day or Cefriaxone 100 mg/kg/day given once per day) Ș If no improvement on fuid therapy ■ Give Inotropic drugs (Dopamine 5-15μg/kg/min ■ Dilution: 200 mg in 50 ml of normal saline Ș Abscess, if present should be drained • Cardiogenic shock Ș See section on management of cardiac diseases • Anaphylactic shock Ș General measures as above Ș Place patient in Tredelenberg position with head at 30 degree angle below the feet. Use one of the follow- ing solutions (in order of preference) and according to availability ■ Ringer’s lactate with 5% Glucose (dextrose) or ■ Half Normal saline with 5% Glucose (dextrose) or ■ Half-strength Darrow’s solution with 5% Glucose (dextrose) or if these are unavailable give Ringer’s lactate Ș Measure the pulse and breathing rate at the start and every 5–10 minutes thereafer. Recommendations - If isolated right sided heart failure: use furosemide (see dosage above) and aldactone 2mg/kg/day divided in 2 doses. Repeat the dose according to estimated fuid overload up to 8mg/kg/day • Correct arrhythmia if present with digoxin 0. Causes - Heart not removing fuid from lung circulation properly (cardio- genic pulmonary edema) - A direct injury to the lung parenchyma Signs and symptoms - Breathlessness/ Respiratory distress - Sweating - Cyanosis (decreased oxygen saturation) - Frothy blood-tinged sputum - Ronchi and crepitations/wheezes Investigations - Chest x-ray shows loss of distinct vascular margins, Kerley B lines, difuse haziness of lung felds, pleural efusion. Ofen divided into two types, non-cyanotic and cyanotic (blue discolor- ation caused by a relative lack of oxygen). Some congenital heart diseases can be treated with medication alone, while others require one or more surgeries. Cyanotic heart diseases Defnition: Cyanotic heart disease is a heart defect, present at birth (con- genital), that results in low blood oxygen levels (< 90 % even with oxygen). Acute rheumatic fever Defnition: Tis is an acute, systemic connective tissue disease in children related to an immune reaction to untreated group A Beta haemolytic strep- tococcus infection of the upper respiratory tract. Te initial attack of acute rheumatic fever occurs in most cases between the ages of 3 and 15 years. Rheumatic Heart Diseases Defnition: It is an infammatory damage of the heart valves, as a com- plication of acute rheumatic fever. Te mitral valve is the most commonly involved valve, although any valve may be afected. Types - Mitral regurgitation/stenosis - Aortic regurgitation/stenosis - Tricuspid regurgitation - Mixed regurgitation and stenosis - Multivalvular heart diseases Signs and symptoms - May be asymptomatic when minor lesions - Heart murmurs over afected valve Complications - Congestive cardiac failure with pulmonary oedema - Bacterial endocarditis. Infective endocarditis Defnition: Infection of the endothelial surface of the heart. Suspect infec- tive endocarditis in all children with persistent fever and underlying heart disease. Note: All highly suspected cases of infective endocarditis must be referred to the cardiologist where blood cultures and proper management will be done. Classifcation - Classifcation based on the predominant structural and functional abnormalities: • Dilated cardiomyopathy: primarily systolic dysfunction, • Hypertrophic cardiomyopathy: primarily diastolic dysfunc- tion, • Restrictive cardiomyopathy: primarily diastolic but ofen combined with systolic dysfunction 5. Rheumatic carditis, juvenile rheuma- toid arthritis, systemic lupus erythematosus, dermatomyositis, systemic lupus erythematosus) - Drugs toxicity (e. Restrictive cardiomyopathy Defnition: Restrictive cardiomyopathy refers to a group of disorders in which the heart chambers are unable to properly fll with blood because of stifness in the heart muscle. Pericarditis/Pericardial Efusion Defnition: Pericarditis is the infammation of the pericardium. Pericardial efusion is the abnormal build-up of excess fuid that develops between the pericardium, the lining of the heart, and the heart itself. Causes - Infection such as viral, bacterial (tuberculosis) - Infammatory disorders, such as lupus - Cancer that has spread (metastasized) to the pericardium - Kidney failure with excessive blood levels of nitrogen - Heart surgery (postpericardectomy syndrome) Signs and symptoms - Pericardial tamponade - Chest pressure or pain and signs of congestive heart failure with shock in some cases Note: Many patients with pericardial efusion have no symptoms. Te condition is ofen discovered on a chest x-ray or echocardio- gram that was performed for another reason. A sustained Blood Pressure of > 115/80 is abnormal in children between 6 weeks and 6 years of age. Convulsions Defnition: Convulsions or seizure are disturbance of neurological function caused by an abnormal or excessive neuronal discharge. Causes Causes Clinical signs/symptoms Meningitis - Very irritable - Stiff neck or bulging fontanelles - Petechial rash (meningococcal meningitis only) - Fever Cerebral malaria (only - Blood smear positive for malaria in children exposed to P. Child having 3rd convulsion Lasting < 5mins in < 2 hours* Convulsion stops by 10 minutes? Coma Defnition: It is a state of extreme unresponsiveness, in which an individual exhibits no voluntary movements or behaviour and cannot be aroused to consciousness.