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But we are only at the beginning of this process best 5 mg enalapril blood pressure guidelines chart, and regarding the huge development of the last decades buy 5 mg enalapril with amex paediatric blood pressure chart uk, we can be sure that the number of the usable pharmacogenomic tests or personal therapies will be expanded in the future enalapril 10mg visa prehypertension lower blood pressure. Clinical implications of pharmacogenomics of statin treatment the Pharmacogenomics Journal (2006) 6, 360–374. Association between genetic polymorphisms of the beta2- adrenoceptor and response to albuterol in children with and without a history of wheezing. Effect of polymorphism of the beta(2)- adrenergic receptor on response to regular use of albuterol in asthma. Long-acting beta2-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: a randomized controlled trial. Use of regularly scheduled albuterols treatment in asthma: genotype- stratified, randomised, placebo-controlled cross-over trial. Enhanced expression of the leukotriene C(4) synthase due to overactive transcription of an allelic variant associated with aspirin-intolerant asthma. Leukotriene C4 synthase promoter polymorphism and risk of aspirin- induced asthma. Molecular properties and pharmacogenetics of a polymorphism of adenylyl cyclase type 9 in asthma: interaction between beta-agonist and corticosteroid pathways. Molecular properties and pharmacogenetics of a polymorphism of adenylyl cyclase type 9 in asthma: interaction between beta-agonist and corticosteroid pathways. Do genetic variants of the Renin-Angiotensin system predict blood pressure response to Renin-Angiotensin system-blocking drugs? Genomic association analysis suggests chromosome 12 locus influencing antihypertensive response to thiazide diuretic. To what gene family does the gene whose genetic variations can influence the cardiac side effects of the anthracyclines belong? What is the main effect of clopidogrel and what gene family is responsible for the activation of the pro-drug? What kind of study has been carried out for the investigation of the pharmacogenomics of clopidrogel in an Amish population? Introduction In the previous chapters it has been pointed out that with the development of genomic methods, computers and bioinformatics there are new possibilities for better understanding and modeling of living organisms as complex systems, which are more similar to the reality. With the spreading of high throughput methods (microarray measurements, new generation sequencing, etc. In a living organism these interactions are on several levels, and now it is clear that if we want to interpret the effect of a mutation or an environmental factor, we must consider these interactions. In biology, the scientific field that focuses on complex networks of interactions within biological systems and tries to map and interpret these is called systems biology. According to the definition, systems biology is the study of the interactions between the components of biological systems, and how these interactions give rise to the function and behavior of that system. In the last years, due to the above mentioned progresses, systems biology has been developed considerably. Below, concentrating on diseases, basic terms of systems biology will be introduced, and some examples of the application and utilization of this scientific field will be shown. Displaying interactions In systems biology interactions are displayed in the form of networks which are often called graphs. The network consists of interacting components, which are called nodes, and interactions are depicted as lines called edges (Vidal M et al. Despite or even perhaps because of such simplifications, useful discoveries can be made. One challenge of network biology is to provide maps of such interactions using systematic and standardized approaches and assays that are as unbiased as possible. Systems biologic approach of diseases 185 networks of interactions between cellular components, can serve as scaffold information to extract global or local graph theory properties. Once shown to be statistically different from randomized networks, such properties can then be related back to a better understanding of biological processes. Some properties of these networks were first described and published by Albert László Barabási, a physicist of Hungarian origin in Science (1999) and Nature (2000). The earliest network models assumed that complex networks are wired randomly, such that any two nodes are connected by a link with the same probability p. This Erdős– Rényi model generates a network with a Poisson degree distribution, which implies that most nodes have approximately the same degree, that is, the same number of links, while nodes that have significantly more or fewer links than any average node are exceedingly rare or altogether absent. In contrast, many real networks, from the World Wide Web to social networks, are scale-free, which means that their degree distribution follows a power law rather than the expected Poisson distribution. In a scale-free network most nodes have only a few interactions, and these coexist with a few highly connected nodes, the hubs, that hold the whole network together. This scale-free property has been found in all organisms for which protein-protein interaction and metabolic network maps exist, from yeast to human (Vidal M et al. Human interactome Owing to the conservation of biochemical and molecular functions across species, much of our current understanding of cellular networks is derived from model organisms. In parallel, an increasing number of studies rely on phenotypic networks that include: co-expression networks, in which genes with similar co-expression patterns are linked; and genetic networks, in which two genes are linked if the phenotype of a double mutant differs from the expected phenotype of two single mutants. Disease genes in the networks Above, the term of hubs has been mentioned, which are nodes with disproportionally many connections suggesting that in biological networks hub proteins must play a special biological role. Indeed, evidence from model organisms indicates that hub proteins tend to be encoded by essential genes, and that genes encoding hubs are older and evolve more slowly than genes encoding non-hub proteins. The deletion of genes encoding hubs also leads to a larger number of phenotypic outcomes than the deletion of genes encoding less connected proteins. This assumption has led to the hypothesis that, in humans, hubs should typically be associated with disease genes. Note, however, that the essential gene concept in simple organisms does not map uniquely into disease genes in humans. Indeed, some human genes are essential in early development, so functional changes in them often lead to first-trimester spontaneous abortions (embryonic lethality). Mutations in such ‘essential’ genes cannot propagate in the population, as individuals carrying them cannot reproduce. In contrast, individuals can tolerate for a long time the disease-causing mutations, often past their reproductive age. Yet, in contrast with our initial hypothesis, non-essential disease genes do not show a tendency to encode hubs and tend to be tissue- specific. That is, from a network perspective, these genes segregate at the functional periphery of the interactome (Fig. In summary, in human cells it is the essential genes, and not the disease genes that are encoding hubs. This difference can be understood from an evolutionary perspective: mutations that disrupt hubs have difficulty propagating in the population, as the absence of hubs create so many disruptions that the host may not survive long enough to reproduce. Disease and essential genes in the interactome Of the approximately 25,000 genes, only about 1,700 have been associated with specific diseases.

Pfeiffer syndrome

Female Puberty growth In females effective enalapril 5 mg blood pressure of normal man, menarche (the first menstruation or a period) usually occurs after the other secondary sex characteristics generic enalapril 10mg line arteriovascular malformation, and will continue until menopause (permanent cessation of reproductive fertility) buy discount enalapril 10mg online heart attack keychain. The diagram shows the hormonal regulation pathway from the brain to the ovary and subsequent impact on uterine changes during the menstral cycle. This peptide hormone is a decapeptide (10 amino acids) with a short half life (<15 minutes). Delayed Puberty - Determined in boys by a lack of increase in testicular volume by the age of 14 years. There can also be a "pubertal arrest" where there is no progress in puberty over 2 year period. Cryptorchidism abnormality of either unilateral or bilateral testicular descent, occurring in up to 30% premature and 3-4% term males. Descent may complete postnatally in the first year, failure to descend can result in sterility. Undescended Ovaries reasonably rare gonad abnormality, often detected following clinical assessment of fertility problems and may also be associated with other uterine malformations (unicornuate uterus). Due to the relative positions of the male (external) and female (internal) gonads and the pathways for their movement, failure of gonad descent is more apparent and common in male cryptorchidism than female undescended ovaries. Hydrocele Male Hydrocele is a fluid-filled cavity of either testis or spermatic cord, where peritoneal fluid passes into a patent processus vaginalis. Female Hydrocele is a similar, but rarer, fluid-filled cavity occuring in the female as a pouch of peritoneum extending into the labium majorum (canal of Nuck). Tract Abnormalities Many different forms Uterine: associated with other anomolies, unicornuate uterus Vagina: agenesis, atresia Ductus Deferens: Unilateral or bilateral absence, failure of mesonephric duct to differentiate Uterine Duplication (uterus didelphys, double uterus, uterus didelphis) A Uterine abnormalities rare uterine developmental abnormality where the paramesonephric ducts (Mullerian ducts) completely fail to fuse generating two separate uterus parts each connected to the cervix and having an ovary each. External Genitalia - Hypospadia Unicornate uterus most common penis abnormality (1 in 300) from a failure of male urogenital folds to fuse in various regions and resulting in a proximally displaced urethral meatus. The cause is unknown, but suggested to involve many factors either indivdually or in combination including: familial inheritance, low birth weight, assisted reproductive technology, advanced maternal age, paternal subfertility and endocrine-disrupting chemicals. Movies Urogenital Sinus Urogenital Septum Trigone Renal Nephron Uterus Female External Male External Testis Descent References Textbooks Before We Are Born (5th ed. Portions of the ear appear very early in development as specialized region (otic placode) on the embryo surface that sinks into the mesenchyme to form a vesicle (otic vesicle = otocyst) that form the inner ear. This region connects centrally to the nervous system and peripherally through specialized bones to the external ear (auricle). This organisation develops different sources forming the 3 ear parts: inner ear (otic placode, otocyst), middle ear (1st pharyngeal pouch and 1st and 2nd arch mesenchyme), and outer ear (1st pharyngeal cleft and 6 surface hillocks). This complex origin, organisation, and timecourse means that abnormal development of any one system can impact upon the development of hearing. Recent research suggests that all sensory placodes may arise from common panplacodal primordium origin around the neural plate, and then differentiate to eventually have different developmental fates. Other species have a number of additional placodes which form other sensory structures (fish, lateral line receptor). Note that their initial postion on the developing head is significantly different to their final position in the future sensory system. Otic Placode stage 13/14 embryo (shown below) the otic placode has sunk from Stage 14 sensory placodes the surface ectoderm to form a hollow epithelial ball, the otocyst, which now lies beneath the surface surrounded by mesenchyme (mesoderm). The epithelia of this ball varies in thickness and has begun to distort, it will eventually form the inner ear membranous labyrinth. Lens Placode lies on the surface, adjacent to the outpocketing of the nervous system (which will for the retina) and will form the lens. Nasal Placode 2 components (medial and lateral) and will form the nose olefactory epithelium. These placodes fold inwards forming a depression, then pinch off entirely from the surface forming a fluid-filled sac or vesicle (otic vesicle, otocyst). Stage 13 otocyst the vesicle sinks into the head mesenchyme some of which closely surrounds the otocyst forming the otic capsule. The otocyst finally lies close to the early developing hindbrain (rhombencephalon) and the developing vestibulo-cochlear-facial ganglion complex. Outer Ear the external ear is derived from 6 surface hillocks, 3 on each of pharyngeal arch 1 and 2. Pharyngeal arch cartilages the external auditory meatus is derived from the 1st pharyngeal cleft. The newborn external ear structure and position is an easily accessible diagnostic tool for potential abnormalities or further clinical screening. In the horizontal plane the meatus is boot-shaped with a narrow neck and the 10 weeks sole of the meatal plug spreading widely to form the future tympanic membrane medially. Disc-like plug innermost surface in contact with the 13 weeks primordial malleus, contributes to the formation of the tympanic membrane. Connects middle ear cavity to nasopharynx portion of pharynx Functions Ventilation - pressure equalization in the middle ear Clearance - allow fluid drainage from the middle ear Tube is Eustacian tube angle changes normally closed and opened by muscles At birth shorter (17-18 mm), narrower and runs almost horizontal Tube is opened by a single muscle, tensor palati muscle Adult longer (twice as long), wider and runs at approximately 45 degrees to the horizontal. Tube is opened by two separate muscles, tensor palati and levator palati Abnormalities Inner - common cavity, severe cochlear hypoplasia Middle - rare and can be part of first arch syndrome, Malleus, Incus and Stapes Fixation Cholesteatoma- Epithelium trapped within skull base in development, erosion of bones: temporal bone, middle ear, mastoid Outer - Several genetic effects and syndromes, Environmental Effects Outer Ear Abnormalities Microtia - abnormally small external ear Preauricular sinus - occurs in 0. Results show that a unilateral conductive hearing loss, in either infancy or adulthood, impairs binaural hearing both during and after the hearing loss. Show scant evidence for adaptation to the plug and demonstrate a recovery from the impairment that occurs over a period of several months after restoration of normal peripheral function. For example rats and mice are born with incomplete development of visual and auditory systems. Anatomical description of the opening end of the uterine tube lying above the ovary and the enlarged initial segmeny of the semicircular canals of the inner ear vestibular system. It connects the basal turn of the cochlea perilymphatic space with the subarachnoid space of the posterior cranial cavity. Th e sac has functions regulating endolymph that are both secretory and absorptive. Hes - (hairy and enhancer of split) family of factors, which has been shown to be a general negative regulator of neurogenesis {Zheng, 2000 #1936}. Hindbrain - Invaginate - Incus - (anvil) auditory ossicle inner phalangeal cells inner pillar cells - organ of Corti cells arranged in rows and form a boundary between the single row of inner hair cells and three rows of outer hair cells. This bony canal lies between the posterior surface of the petrous pyramid and the bony labyrinth within the dense petrous bone. This cartilage first appears at stage 16, stage 20 the beginning of membranous ossification. The Ames waltzer (av) mouse mutant has both auditory and vestibular abnormalities from a mutation in this gene. Formed by tightly cross-linked parallel actin filaments in a paracrystalline array with cell surface specializations (tip links, horizontal top connectors, and tectorial membrane attachment crowns). Basal cells also form a continuous layer and they may be mesodermal or derived from the neural crest. Intermediate cells are melanocyte-like cells, presumably derived from the neural crest, and are scattered between the marginal and basal cell layers. The muscle arises from auditory tube (cartilaginous portion) and is inserted into the malleus (manubrium near the root).

Olivopontocerebellar atrophy type 3

Decrease in sodium level can also lead to coma order enalapril 5 mg fast delivery hypertension 4th report, which is known as Hyponatremic Coma discount 10 mg enalapril arrhythmia what to do. Hormonal Imbalance: Imbalance in the hormones of thyroid effective 5mg enalapril hypertension diabetes, parathyroid, adrenal, pituitary glands can also lead to coma. Alzheimer’s Disease: during the last stage of the disease one might lapse into coma. Poison: Organophospherous poisoning or heavy metals like arsenic or lead used for murder or suicide, overdose of sleeping pills, can also lead to coma. Psychogenic Coma: (the patient is not actually in coma) the treatment of coma should be done systematically. Usually, the patient is thoroughly examined and his/her history, pulse, temperature, respiration are noted. Before a coma patient is considered brain dead, the brain death has to be ascertained very carefully and the rules and regulations made specifically for this purpose are to be followed before declaring it. In this situation, the brain never regains consciousness, so such a patient can donate his/her kidney and other parts to save the life of another patient before his/her heart stops functioning. Immediate treatment is initiated to normalise important functions like respiration, blood circulation, blood pressure. If the cause is unknown, immediate glucose, vitamin B1 and injection Nalorphine are administered as the first line of treatment: 4. If there is dehydration, intravenous administration of fluids is done; if there is an acid base imbalance, an intensive treatment is given. If the coma is due to the defect of any organ, its treatment is given or if the problem is due to diabetes or thyroid disorder, its immediate treatment is commenced. Brain tumor, paralysis and brain hemorrhage caused by accident, are included in the structural causes, where the brain is attacked directly. Whereas in the metabolic coma, abnormality is first observed in other parts of the body rather than the brain. The growing numbers of paralytic and coma patients can be controlled only if blood pressure, diabetes, obesity etc. Interestingly, many coma patients have narrated similar extraordinary experiences during their coma. Along with the right treatment proper nourishment and care, love and prayers can also give miraculous results. The will-power of the patient, which remains strong even in the unconscious state and the doctor’s loving care can also help the patient recover faster. After remaining in a comatose state, for a considerable period when the patients recover, some may lose their speech or memory. This may be a case of Epilepsy: You would have noticed people attending to such persons in a very funny manner for observing curiously without helping the person correctly. This chapter deals with the problem: its causes, its correct approach and the myths associated with it. Epilepsy is a disease of the brain in which excessive electrical impulses are produced in the brain for a short period of time resulting in tremors or seizures. One in every hundred persons suffers from epilepsy and thus over l o million people in our country are afflicted with this disease. According to a survey, 4 out of every 100 persons h ave suffered from a convulsion at least once in his lifetime e. If timely treatment is not given, the patient may suffer from physical and mental damage in future. If an epileptic patient takes optimum treatment regularly then he/she ‘can lead almost a normal life. Generalised Seizure Partial or Focal Seizure These three are further divided as follows : 1. Grandmal epilepsy or seizure of the entire body: In this type of epilepsy, loss of consciousness, screaming, frothing from the mouth, tremors, tongue biting may occur and sometimes urine and stool are also passed unconsciously. After regaining consciousness, the patient remains in a semiconscious state for some time or goes to sleep He may be paralyzed temporarily. Petitmal: In this type of epilepsy the patient suddenly becomes momentarily blank, stunned and blacks out for a few moments. Myoclonic seizure: In these cases the person experiences sudden shock like momentary jerks in the limbs and the things held in hand may fall down, but there is no loss of consciousness. Besides these there are tonic-clonic and akinetic seizures, which are classified as Generalized seizures. Simple Partial Seizure: the patient remains conscious, but jerking or tingling is felt in one half side of the body. Complex Partial Seizure: If the patient loses momentary consciousness along with-* the symptoms of simple partial seizure, it is known as complex partial seizure. In this type, the patient loses consciousness or behaves abnormally for a few moments and immediately becomes normal again. This disease can be cured with proper treatment by a psychiatrist as well as by tackling the underlying socio - economic problem. But it is essential to ascertain that no damage has occurred to the brain by these convulsions. In children who get convulsions during fever, it is necessary to ascertain that they do not suffer from fever as far as possible. If fever does occur, Paracetamol or Nimesulide as well as Clobazam should be administered immediately. The medicine called Direc-2 or any other similar kind can be administered rectally if a convulsion seems imminent. It is essential to prevent such seizures because frequent attacks can get converted into complex partial seizures or generalized seizures in future. To prevent an injury to the tongue, a handkerchief or a gauge piece may be placed in the mouth, but one should not insert it forcibly. If the patient is hurt or seizures occur repeatedly, it is necessary to take medical advice. If necessary, intravenous administration of Diazepam can be done or the patient may immediately be admitted to a hospital. An epileptic can lead a normal healthy life, get married, and female patients can also conceive. During pregnancy certain medicines taken for epilepsy do not cause any substantial harm to the Foetus e. Actually if the drug is stopped and a seizure occurs, the harm to the Foetus due to the lack of oxygen is much greater. This gives immense information about the type, speed and seriousness of disease to the doctor, apart from telling whether it was a seizure or hysteria or syncope or any other brief event. In order to gather further information about the type of seizure, line of treatment, etc. Treatment of Epilepsy : After investigating the causes of the disease, planning proper treatment is essential. Thus late nights, tension, fasting or excessive physical or mental stress should be avoided.

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