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The nerve impulse (action potential) An impulse is initiated by stimulation of sensory nerve endings or by the passage of an impulse from another nerve hypertension 15090 cheap moduretic on line. Transmission of the impulse arteria umbilical percentil 90 moduretic 50 mg on-line, or action potential prehypertension warsaw 2014 cheap 50 mg moduretic otc, is due to movement of ions across the nerve cell membrane. In the resting state the nerve cell membrane is polarised due to differences in the concentrations of ions across the plasma membrane. This means that there is a different electrical charge on each side of the membrane, which is called the resting membrane potential. The principal ions involved are: sodium (Na+), the main extracellular cation potassium (K+), the main intracellular cation. In the resting state there is a continual tendency for these ions to diffuse along their concentration gradients, i. When stimulated, the permeability of the nerve cell membrane to these ions changes. Initially Na+ floods into the neurone from the extracellular fluid causing depolarisation, creating a nerve impulse or action potential. Depolarisation is very rapid, enabling the conduction of a nerve impulse along the entire length of a neurone in a few milliseconds (ms). The one-way direction of transmission is ensured because following depolarisation it takes time for repolarisation to occur. Almost immediately following the entry of sodium, K+ floods out of the neurone and the movement of these ions returns the membrane potential to its resting state. As the neurone returns to its original resting state, the action of the sodiumpotassium pump expels Na+ from the cell in exchange for K+ (see p. In myelinated neurones, the insulating properties of the myelin sheath prevent the movement of ions. Therefore electrical changes across the membrane can only occur at the gaps in the myelin sheath, i. The speed of conduction depends on the diameter of the neurone: the larger the diameter, the faster the conduction. Myelinated fibres conduct impulses faster than unmyelinated fibres because saltatory conduction is faster than complete conduction, or simple propagation (Fig. The synapse and neurotransmitters There is always more than one neurone involved in the transmission of a nerve impulse from its origin to its destination, whether it is sensory or motor. The point at which the nerve impulse passes from one to another is the synapse (Fig. At its free end, the axon of the presynaptic neurone breaks up into minute branches that terminate in small swellings called synaptic knobs, or terminal boutons. These are in close proximity to the dendrites and the cell body of the postsynaptic neurone. Synaptic knobs contain spherical synaptic vesicles, which store a chemical, the neurotransmitter that is released into the synaptic cleft. Neurotransmitters are synthesised by nerve cells, actively transported along the axons and stored in the synaptic vesicles. They are released by exocytosis in response to the action potential and diffuse across the synaptic cleft. Their action is short lived, because immediately they have acted upon the postsynaptic neurone or effector organ, such as a muscle fibre, they are either inactivated by enzymes or taken back into the synaptic knob. Knowledge of the action of the common neurotransmitters is important because some drugs mimic, neutralise (antagonise) or prolong their effect. Usually neurotransmitters have an excitatory effect at the synapse but they are sometimes inhibitory. Other substances, such as enkephalins, endorphins and substance P, have specialised roles in, for example, transmission of pain signals. Somatic nerves carry impulses directly to the synapses at skeletal muscles, the neuromuscular junctions (p. Nerves A nerve consists of numerous neurones collected into bundles (bundles of nerve fibres in the central nervous system are known as tracts). Endoneurium is a delicate tissue, surrounding each individual fibre, which is continuous with the septa that pass inwards from the perineurium.
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There are many other potential components that could be included in such a vaccine high blood pressure medication z order moduretic 50mg mastercard. We believe this is an important process in understanding how individual organisms produce disease; however heart attack young man order moduretic without prescription, when a patient develops an infection blood pressure vs age moduretic 50 mg cheap, a physician approaches diagnosis by assessing the clinical presentation and constructing a list of organisms that are most likely to cause the disease. More commonly, however, multiple organisms can produce a similar clinical picture. The clinical management of infections is predicated on the ability to develop an accurate differential diagnosis; that is, it is critical to know which organisms are most commonly associated with a particular infectious process. It is impossible to summarize in a single chapter the complex interactions that lead to the development of disease in each organ system. Rather, this chapter is intended to serve as a very broad overview of the bacteria commonly associated with infections at specific body sites and with specific clinical manifestations (Tables 15-1 to 15-5). Because many factors influence the relative frequency with which specific organisms cause disease. That material is provided, in part, in the chapters that follow and in infectious disease texts. Furthermore, the roles of fungi, viruses, and parasites are not considered here but rather in the later sections of this book. Tables 15-1 and 15-2 illustrate the complexity of summarizing the role of bacteria in infectious diseases. Simply stated, Table 15-1 is a list of bacteria and the diseases they cause and Table 15-2 is a list of diseases and the bacteria associated with the diseases. Unfortunately, neither list is comprehensive; more diseases are associated with many of the bacteria, and the list of bacteria responsible for most of the diseases is not complete. These two tables represent different approaches to understanding the role of bacteria in infectious disease. The overall approach taken in this book is to study the organisms, learning their biology in the context of their ability to cause disease. We have taken this traditional approach because we feel this provides a foundation for the student to understand the disease process. However, we recognize that the patient presents with a disease syndrome, and the student must remember which organisms can be responsible. In this edition of Medical Microbiology, we are using these summary chapters to introduce the discussions of bacteria, viruses, fungi, and parasites. We recognize that discussions of a large collection of organisms may be confusing for many students when they are introduced to microbiology. We hope that using these chapters as an introduction may provide students with a useful framework for cataloging the variety of organisms responsible for similar diseases. Table 15-3 SelectedBacteriaAssociatedwith FoodborneDiseases Organism ImplicatedFood(s) Table 15-4 SelectedBacteriaAssociatedwith WaterborneDiseases Organism Disease Aeromonas species Bacillus cereus Brucellaspecies Campylobacterspecies Clostridium botulinum Clostridium perfringens Escherichia coli Francisella tularensis Meats, produce, dairy products Fried rice, meats, vegetables Unpasteurized dairy products, meat Poultry, unpasteurized dairy products Vegetables, fruits, fish, honey Beef, poultry, pork, gravy Beef, unpasteurized milk, fruits and juices, vegetables, lettuce Rabbit meat Aeromonas species Campylobacter species Escherichia coli Francisella tularensis Legionellaspecies Leptospiraspecies Mycobacterium marinum Plesiomonas shigelloides Pseudomonasspecies Salmonella species Shigella species Vibriospecies Yersinia enterocolitica Gastroenteritis, wound infections, septicemia Gastroenteritis Gastroenteritis Tularemia Respiratory disease Systemic disease Cutaneous infection Gastroenteritis Dermatitis Gastroenteritis Gastroenteritis Gastroenteritis, wound infection, septicemia Gastroenteritis Listeria monocytogenes Unpasteurized dairy products, coleslaw, poultry, cold-cut meats Plesiomonas shigelloides Salmonellaspecies Shigella species Staphylococcus aureus Streptococcus, group A Vibriospecies Yersinia enterocolitica Seafood Poultry, unpasteurized dairy products Eggs, lettuce Ham, poultry, egg dishes, pastries Egg dishes Shellfish Unpasteurized dairy products, pork Organisms in boldface are the most common waterborne pathogens. The microbiologist should be prepared to instruct the physician about what specimens should be collected if a particular diagnosis is suspected, and the physician must provide the microbiologist with information about the clinical diagnosis so that the right tests are selected. This chapter is designed to provide an overview of specimen collection and transport, as well as the methods used in the microbiology laboratory for the detection and identification of bacteria. Because it is beyond the scope of this chapter to cover this subject exhaustively, the student is referred to the citations in the Bibliography and the individual chapters that follow for more detailed information. Blood the culture of blood is one of the most important procedures performed in the clinical microbiology laboratory. The success of this test is directly related to the methods used to collect the blood sample. The most important factor that determines the success of a blood culture is the volume of blood processed. For example, 40% more cultures are positive for organisms if 20 ml rather than 10 ml of blood are cultured, because more than half of all septic patients have less than one organism per milliliter of blood. Approximately 20 ml of blood should be collected from an adult for each blood culture, and proportionally smaller volumes should be collected from children and neonates.
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SystemicandEnvironmentalFactors Smoking Epidemiologic evidence suggests that smoking may be the most important environmental risk factor impacting the development and progression of periodontal disease (see Chapter 8) heart attack the song moduretic 50 mg otc. Therefore it should be made clear to arrhythmia journal buy cheap moduretic 50 mg on-line the patient that a direct relationship exists between smoking and the prevalence and incidence of periodontitis blood pressure chart old order moduretic toronto. In addition, patients should be informed that smoking affects not only the severity of periodontal destruction, but also the healing potential of the periodontal tissues. As a result, patients who smoke do not respond as well to conventional periodontal therapy as patients who have never smoked. However, it should be emphasized that smoking cessation can affect the treatment outcome and therefore the prognosis. For example, evidence from epidemiologic studies clearly demonstrates that the prevalence and severity of periodontitis are significantly higher in patients with type 1 and type 2 diabetes than in those without diabetes, and that the level of control of the diabetes is an important variable in this relationship (see Chapter 8). Therefore, patients at risk for diabetes should be identified as early as possible and informed of the relationship between periodontitis and diabetes. Similarly, patients diagnosed with diabetes must be informed of the impact of diabetic control on the development and progression of periodontitis. It follows that the prognosis in these cases depends on patient compliance relative to both medical Figure401 Chronic periodontitis in systemically healthy, nonsmoking 42-year-old man; overall prognosis good. B, Although local factors are present, the patient presents with adequate remaining bone support and a good prognosis, provided local factors can be controlled. Figure402 Localized aggressive periodontitis in 17-year-old girl; overall prognosis fair. Well-controlled diabetic patients with slight to moderate periodontitis who comply with their recommended periodontal treatment should have a good prognosis. Similarly, in patients with other systemic disorders that could affect disease progression, prognosis improves with correction of the systemic problem. Incapacitating conditions that limit the patientґs performance of oral procedures. Newer "automated" oral hygiene devices such as electric toothbrushes may be helpful for these patients and may improve their prognosis (see Chapter 50). Figure403 Prognosis for tooth A is better than for tooth B, despite less bone on one of the surfaces of A. Because the center of rotation of tooth A is closer to the crown, the distribution of occlusal forces to the periodontium is more favorable than in B. In addition to these external factors, evidence also indicates that genetic factors may play an important role in determining the nature of the host response. Although microbial and environmental factors can be altered through conventional periodontal therapy and patient education, genetic factors currently cannot be altered. However, detection of genetic variations linked to periodontal disease can potentially influence the prognosis in several ways. First, early detection of patients at risk because of genetic factors can lead to early implementation of preventive and treatment measures for these patients. Second, identification of genetic risk factors later in the disease or during the course of treatment can influence treatment recommendations, such as the use of adjunctive antibiotic therapy or increased frequency of maintenance visits. Third, identification of young individuals who have not been evaluated for periodontitis, but who are recognized as being at risk because of the familial aggregation seen in aggressive periodontitis, can lead to the development of early intervention strategies. In each of these cases, early diagnosis, intervention, and alterations in the treatment regimen may lead to an improved prognosis for the patient. Figure404 Extraction of severely involved tooth to preserve bone on adjacent teeth. B, Radiograph made 8Ѕ years after extraction of the first molar and replacement by a prosthesis. LocalFactors PlaqueandCalculus the microbial challenge presented by bacterial plaque and calculus is the most important local factor in periodontal diseases. Therefore, in most cases, having a good prognosis depends on the ability of the patient and the clinician to remove these etiologic factors (see Chapters 9 and 10). SubgingivalRestorations Subgingival margins may contribute to increased plaque accumulation, increased inflammation, and increased bone loss2,35,43 when compared with supragingival margins. The size of these discrepancies and duration of their presence are important factors in the amount of destruction that occurs.