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By C. Esiel. Westwood College of Technology.

Methodology Subjects The study was undertaken in a group practice in an inner city area of London order 10mg zyrtec visa allergy medicine reduce swelling. Overall order 10mg zyrtec overnight delivery allergy testing panel, 359 patient were invited to take part in the study and a total of 200 patients completed all assessments and were included in the data analysis purchase zyrtec 10 mg without prescription allergy shots 2 year old. Design The study involved a randomized controlled design with two conditions: (1) sharing consulting style and (2) directive consulting style buy discount zyrtec 10mg line allergy shots injection sites. Procedure A set of cards was designed to randomly allocate each patient to a condi- tion. When a patient entered the consulting room they were greeted and asked to describe their problem. For example, the doctor’s judgment on the consultation could have been either, ‘This is a serious problem/I don’t think this is a serious problem’ (a directive style) or, ‘Why do you think this has happened? For the treatment advice the doctor could say either, ‘It is essential that you take this medicine’ (a directive style) or, ‘What were you hoping I would be able to do? Each consultation was recorded and assessed by an independent assessor to check that the consulting style used was in accordance with that selected. Measures All subjects were asked to complete a questionnaire immediately after each consultation and one week later. This contained questions about the patient’s satisfaction with the consultation in terms of the following factors: s The doctor’s understanding of the problem. This was measured by items such as ‘I perceived the general practitioner to have a complete understanding’. This was measured by the statements ‘I felt greatly helped’ and ‘I felt much better’. Results The results were analysed to evaluate differences in aspects of patient satisfaction between those patients who had received a directive versus a sharing consulting style. In addition, this difference was also examined in relation to patient characteristics (whether the patient had a physical problem, whether they received a prescription, had any tests and were infrequent attenders). When the results were analysed to examine the role of patient characteristics on satisfaction, the results indicated that the directive style produced higher levels of satisfaction in those patients who rarely attended the surgery, had a physical problem, did not receive tests and received a prescription. Conclusion The results suggest that a directive consulting style was associated with higher levels of patient satisfaction than a sharing consulting style. This provides support for the educational model of doctor–patient communication with the doctor as the ‘expert’ and the patient as the ‘layperson’. In addition, it suggests that patients in the present study preferred an authority figure who offered a formal diagnosis rather than a sharing doctor who asked for the patient’s views. Therefore, although recent research has criticized the traditional educational model of doctor–patient communication, the results from this study suggest that some patients may prefer this approach. Patient’s recall Researchers also examined the process of recall of the information given during the consultation. In a meta-analysis of the research into recall of consultation information, Ley (1981, 1989) found that recall is influenced by a multitude of factors. For example, Ley argued that anxiety, medical knowledge, intellectual level, the importance of the statement, primacy effect and the number of statements increase recall. However, he concluded that recall is not influenced by the age of the patient, which is contrary to some predictions of the effect of ageing on memory and some of the myths and counter- myths of the ageing process. Therefore, studies have been carried out to examine which factors can be used in order to improve compliance. Haynes (1982) took a baseline of 52 per cent compliance with recommendations made during a consultation, and found that information generally only improved compliance to a level of 66 per cent. However, Haynes reported that behavioural and individualized instruction improved compliance to 75 per cent. Recommendations for improving compliance Several recommendations have been made in order to improve communication and therefore improve compliance. Oral information Ley (1989) suggested that one way of improving compliance is to improve communica- tion in terms of the content of an oral communication. He believes the following factors are important: s primacy effect – patients have a tendency to remember the first thing they are told; s to stress the importance of compliance; s to simplify the information; s to use repetition; s to be specific; s to follow up the consultation with additional interviews. Written information Researchers also looked at the use of written information in improving compliance. Ley and Morris (1984) examined the effect of written information about medication and found that it increased knowledge in 90 per cent of the studies, increased compliance in 60 per cent of the studies, and improved outcome in 57 per cent of the studies. Ley’s cognitive hypothesis model, and its emphasis on patient satisfaction, under- standing and recall, has been influential in terms of promoting research into the com- munication between health professionals and patients. In addition, the model has prompted the examination of using information to improve the communication process. As a result of this, the role of information has been explored further in terms of its effect on recovery and outcome. On the basis that the stress caused by surgery may be related to later recovery, Janis (1958) interviewed patients before and after surgery to examine the effects of pre-operative fear on post-operative recovery. Janis examined the differences between pre- operative extreme fear, moderate fear and little or no fear on outcome. Extreme fear was reflected in patients’ constant concern, anxiety and reports of vulnerability, moderate fear was reflected in reality orientation with the individual seeking out information, and little or no fear was reflected by a state of denial. Janis suggested that moderate fear results in the individual developing a defence mechanism, developing coping strategies, seeking out relevant information, and rehearsing the outcome of the surgery. This approach may lead to increased confidence in the outcome, which is reflected in the decreased post-operative distress. However, there is conflicting evidence regarding this ‘U’ shaped relationship between anxiety and outcome (see Johnston and Vogele 1993). Using information to improve recovery If stress is related to recovery from surgery, then obviously information could be an important way of reducing this stress. There are different types of information that could be used to effect the outcome of recovery from a medical intervention. These have been described as (1) sensory information, which can be used to help individuals deal with their feelings or to reflect on these feelings; (2) procedural information, which enables indi- viduals to learn how the process or the intervention will actually be done; (3) coping skills information, which can educate the individual about possible coping strategies; and (4) behavioural instructions, which teach the individual how to behave in terms of factors such as coughing and relaxing. Researchers have evaluated the relative roles of these different types of information in promoting recovery and reducing distress. They reported that sensory and coping information reduced the need for pain killers and in addition reduced the hospital stay by three days. Young and Humphrey (1985) gave information to patients going into hospital, and found that information specific to how they could survive hospital reduced the distress and their length of stay in the hospital. Johnston (1980) found that pre-operative information can influ- ence recovery and reduce anxiety, pain rating, length of hospitalization and analgesic intake. Although the reasons why pre-operative information is so successful remain unclear, it is possible that pre-operative information may be beneficial to the individual in terms of the reduction of anxiety by enabling the patient to mentally rehearse their anticipated worries, fears and changes following the operation; thus any changes become predictable. These results therefore suggest that information com- municated correctly by the doctor or the health professional may be an important part of reducing the distress following hospitalization or a hospital intervention. This traditional approach has motivated research into health professional’s medical knowledge, which is seen as a product of their training and education. Accordingly, the communication process is seen as origin- ating from the health professional’s knowledge base. Boyle (1970), although emphasizing patients’ knowledge, also provided some insights into doctors’ knowledge of the location of organs and the causes of a variety of illnesses. The results showed that although the doctor’s knowledge was superior to that of the patient’s, some doctors wrongly located organs such as the heart and wrongly defined problems such as ‘constipation’ and ‘diarrhoea’.

Anastomosis of suprascapular and circumflex scapular arteries (schematic drawing) order zyrtec 10mg without a prescription allergy forecast greenwich ct. Dissection of the 28 Jugular venous arch and sternohyoid muscle cutaneous nerves and veins purchase 10mg zyrtec with mastercard allergy treatment for 1 year old. Shoulder: Anterior Region 407 Right deltopectoral triangle order zyrtec 10mg without prescription allergy vaccine uk, infraclavicular region Right shoulder and thoracic wall with axillary region purchase 5 mg zyrtec visa allergy symptoms not improving, deep (anterior aspect). Part of deltoid muscle has been cut and reflected to display the The lateral head of the triceps brachii muscle has been cut to quadrangular and triangular spaces of the axillary region. The pectoralis major and minor muscles have been cut and reflected to display the vessels and nerves of the axilla. Posterior cord in purple, lateral cord in orange, and 28 Intercostal nerve (T1) medial cord in green (schematic drawing). Dissection of cutaneous nerves and Cubital region, superficial layer (anterior aspect). The palmar aponeurosis of the hand and the bicipital aponeurosis have been removed. Forearm and Hand: Anterior Region 423 1 Biceps brachii muscle 2 Brachialis muscle 3 Brachioradialis muscle 4 Deep branch of radial nerve 5 Superficial branch of radial nerve 6 Radial artery 7 Median nerve 8 Flexor retinaculum 9 Thenar muscles 10 Common palmar digital branches of median nerve 11 Common palmar digital arteries 12 Proper palmar digital nerves (median nerve) 13 Ulnar nerve 14 Medial intermuscular septum of arm 15 Superior ulnar collateral artery 16 Brachial artery 17 Medial epicondyle of humerus 18 Pronator teres muscle 19 Bicipital aponeurosis 20 Ulnar artery 21 Palmaris longus muscle 22 Flexor carpi radialis muscle 23 Flexor digitorum superficialis muscle 24 Flexor carpi ulnaris muscle 25 Tendon of palmaris longus muscle 26 Remnant of antebrachial fascia 27 Superficial branch of ulnar nerve 28 Palmaris brevis muscle 29 Palmar aponeurosis 30 Hypothenar muscles 31 Superficial palmar arch 32 Superficial transverse metacarpal ligament 33 Common palmar digital branch of ulnar nerve 34 Proper palmar digital branches of ulnar nerve 35 Anterior interosseous artery and nerve 36 Flexor digitorum profundus muscle 37 Common palmar digital arteries 38 Palmar branch of median nerve 39 Flexor pollicis longus muscle 40 Palmar branch of ulnar nerve Innervation pattern of palmar surfaces of hand. Vessels and nerves of forearm and hand, deep layer (palmar 1 1 3 /2 digits by median nerve, 1 /2 digits by ulnar nerve. Note that (branch of musculocutaneous nerve) the terminal branches to the dorsal surfaces of the distal 21 Dorsal metacarpal artery phalanges are derived from the palmar digital nerves. The carpal tunnel has been opened, the tendons of the flexor muscles have been removed, and the superficial palmar arch has been cut. In contrast to the upper limb, the lower limb is more restricted in 1 10 its movements, and the joints are tighter and fixed by strong ligaments. The hip joint is a ball-and-socket type of synovial 2 joint between the head of the femur and acetabulum. The knee joint is a hinge type of synovial joint that permits only limited rotation. The talocrural joint is a hinge joint between the talus, fibula, and tibia, only allowing movements of flexion and 11 extension. A = ilium B = ischium C = pubis 1 Posterior superior iliac spine 2 Posterior gluteal line 3 Posterior inferior iliac spine 4 Greater sciatic notch 5 Ischial spine 6 Lesser sciatic notch 7 Body of ischium 8 Ischial tuberosity 9 Obturator foramen 10 Iliac crest 11 Anterior gluteal line 12 Internal lip of iliac crest 13 External lip of iliac crest 14 Anterior superior iliac spine 15 Inferior gluteal line 16 Anterior inferior iliac spine 17 Lunate surface of acetabulum 18 Acetabular fossa 19 Acetabular notch 20 Pecten pubis 21 Pubic tubercle 22 Body of pubis 23 Iliac fossa 24 Arcuate line 25 Iliopubic eminence 26 Symphysial surface of pubis 27 Auricular surface 28 Pelvic surface of sacrum 29 Superior articular process of sacrum 30 Dorsal sacral foramina 31 Sacral tuberosity 32 Lateral sacral crest 33 Median sacral crest 34 Obturator groove Sacrum and coccyx (lateral aspect). Therefore, the body can be kept upright more easily even if only one limb is used Diameters of pelvis (oblique superior aspect). Note the differences between the male and female pelvis, predominantly in the form and dimensions of the sacrum, the superior and inferior apertures, and the alae of the ilium. Note the differences between the form and dimensions of the male and female pelvis. The obturator foramen in the female pelvis is triangular, while that in the male pelvis is ovoid. Note the differences between the female and male pelvis, especially with respect to the inferior aperture, the shape of the sacrum, the two sciatic notches, and the pubic arch. Upper end of right tibia with fibula (from above), anterior margin of tibia above. Bones of the Knee Joint 441 Bones of right knee joint Bones of right knee joint Bones of right knee joint (anterior aspect). Ligaments of the Pelvis and Hip Joint 445 1 Femur 2 Lesser trochanter 3 Neck of femur 4 Head of femur 5 Fovea of head with cut edge of ligament of head 6 Lunate surface of acetabulum 7 Acetabular lip 8 Acetabular fossa 9 Transverse acetabular ligament 10 Inguinal ligament 11 Iliopectineal arch 12 Pubic symphysis 13 Pubic bone 14 Obturator canal 15 Ligament of head of femur 16 Obturator membrane 17 Ischium 18 Anterior longitudinal ligament (level of fifth lumbar vertebra) 19 Sacral promontory 20 Iliolumbar ligament Right hip joint, opened (latero-anterior aspect). The ligament of the head of the femur has been 21 Iliac crest divided, and the femur has been posteriorly reflected. The joint is The patella and articular capsule have been removed and the extended and the articular capsule has been removed. Pectineus, adductor longus, and 1 Pectineus muscle (blue) brevis muscles have been divided. Pectineus, 12 Pectineus muscle (divided) adductor longus and brevis, and rectus femoris 13 Adductor minimus muscle 14 Adductor brevis muscle (cut) muscles have been divided. Muscles of the Thigh: Flexor Muscles 455 1 Thoracolumbar fascia 2 Spinous processes of lumbar vertebrae 3 Coccyx 4 Anus 5 Adductor magnus muscle 6 Semitendinosus muscle 7 Iliac crest 8 Gluteus medius muscle 9 Greater trochanter 10 Gluteus maximus muscle 11 Iliotibial tract 12 Piriformis muscle 13 Superior gemellus muscle 14 Obturator internus muscle 15 Inferior gemellus muscle 16 Ischial tuberosity 17 Biceps femoris muscle 18 Tensor fasciae latae muscle 19 Quadratus femoris muscle 20 Gluteus minimus muscle 21 Sartorius muscle 22 Semimembranosus muscle 23 Tendon of gracilis muscle 24 Tibial nerve 25 Medial head of gastrocnemius muscle 26 Common peroneal nerve 27 Tendon of biceps femoris muscle 28 Lateral head of gastrocnemius muscle 29 Rectus femoris muscle 30 Vastus medialis muscle 31 Vastus intermedius muscle 32 Vastus lateralis muscle 33 Sciatic nerve 34 Gluteus maximus muscle (insertion) 35 Great saphenous vein 36 Femoral artery 37 Femoral vein 38 Adductor longus muscle 39 Femur 40 Gracilis muscle 41 Septum between semitendinosus and semimembranosus muscles Flexors of the right thigh, superficial layer (posterior aspect). The gluteus maximus muscle and the long head of biceps femoris muscle have been divided and displaced. Flexor muscles of right leg (posterior Flexor muscles of right leg (posterior aspect). Arteries 467 1 Femoral artery 2 Profunda femoris artery 3 Ascending branch of lateral circumflex femoral artery 4 Descending branch of lateral circumflex femoral artery 5 Lateral superior genicular artery 6 Popliteal artery 7 Lateral inferior genicular artery 8 Anterior tibial artery 9 Peroneal artery 10 Lateral plantar artery 11 Arcuate artery with dorsal metatarsal arteries 12 Plantar arch with plantar metatarsal arteries 13 Medial circumflex femoral artery 14 Profunda femoris artery with perforating arteries 15 Descending genicular artery 16 Medial superior genicular artery 17 Middle genicular artery 18 Medial inferior genicular artery 19 Posterior tibial artery 20 Dorsalis pedis artery 21 Medial plantar artery 22 Superficial and deep circumflex iliac arteries 23 Femoral nerve 24 Lateral circumflex femoral artery 25 Sartorius muscle (cut and reflected) 26 Rectus femoris muscle 27 Vastus medialis muscle 28 Inguinal ligament 29 Femoral vein (cut) 30 External pudendal artery and vein 31 Adductor longus muscle 32 Great saphenous vein 33 Obturator artery and nerve 34 Gracilis muscle 35 Saphenous nerve 36 Tendinous wall of adductor canal 37 Anterior cutaneous branch of femoral nerve 38 Infrapatellar branch of saphenous nerve 39 Popliteal vein 40 Tibial nerve 41 Medial head of gastrocnemius muscle 42 Biceps femoris muscle 43 Common peroneal nerve 44 Lateral head of gastrocnemius muscle 45 Plantaris muscle 46 Soleus muscle 47 Flexor hallucis longus muscle 48 Spermatic cord Arteries of the right leg (posterior aspect). Dissection of tibial nerve, posterior tibial vessels, and great saphenous vein (veins injected with blue resin). Veins 469 30 7 7 30 11 4 27 15 4 21 15 22 7 7 27 26 15 22 Superficial veins of leg (posterior Superficial veins of leg. Anastomoses between superficial and deep veins of the leg (schematic drawing, after Aigner). Pelvic organs with peritoneum and part of the levator ani muscle have been removed. Anterior portion of thoracic vertebrae removed, dural sheath opened, and spinal cord slightly reflected to the right to display the dorsal and ventral roots. Surface Anatomy of the Lower Limb: Anterior Aspect 477 1 Iliac crest 2 Anterior superior iliac spine 3 Tensor fasciae latae muscle 1 4 Quadriceps femoris muscle 2 5 Iliotibial tract 6 Tendon of biceps femoris muscle 3 7 Patella 8 Patellar ligament 9 Tibia 10 Tendon of tibialis anterior muscle 11 Lateral malleolus 12 Venous network of dorsum of foot 4 13 Iliohypogastric nerve 14 Lateral femoral cutaneous nerve 15 Femoral nerve 16 Common peroneal nerve 5 17 Superficial peroneal nerve 18 Ilio-inguinal nerve 19 Obturator nerve 20 Saphenous nerve 21 Deep peroneal nerve 6 7 8 9 10 11 Cutaneous nerves of the lower limb (anterior aspect). The Inguinal nodes with lymphatic vessels fascia lata and fasciae of the thigh muscles have been removed. The fascia lata has been removed, and the sartorius muscle has been slightly has been removed, and the sartorius muscle has been divided. Sartorius muscle, The sartorius, pectineus, adductor longus, and rectus pectineus muscle, and femoral artery have been cut to femoris muscles have been divided and reflected. The greater part of the femoral artery has been The rectus femoris muscle has been slightly reflected. Sciatic nerve Inferior gluteal artery, vein, and nerve Posterior femoral cutaneous nerve Internal pudendal artery and vein Pudendal nerve C Lesser sciatic foramen Pudendal nerve Internal pudendal artery and vein Red lines 1 Spine-tuber line: the infrapiriform foramen is situated in the middle of this line 2 Spine-trochanter line: the suprapiriform foramen is located in the upper third 3 Tuber-trochanter line: the ischiadic nerve can be found between the middle and posterior third Other structures 4 Posterior superior iliac spine 5 Iliac crest 6 Greater trochanter Gluteal region, right side (postero-lateral aspect). Location of 7 Ischial tuberosity sciatic foramina in relation to the bones (schematic drawing). Notice the position of the foramina above and below the piriformis muscle and the lesser sciatic foramen. Thigh: Posterior Region 485 Gluteal region and posterior region of right thigh (posterior Gluteal region and posterior region of right thigh (posterior aspect). Knee and Popliteal Fossa 487 Right leg, popliteal fossa, middle layer (posterior aspect). Tibial nerve and popliteal vein have been partly removed and a portion of the soleus muscle was cut away to display the anterior tibial artery. Crural Region 491 1 Semimembranosus muscle 2 Semitendinosus muscle 3 Popliteal vein 4 Popliteal artery 5 Tibial nerve 6 Small saphenous vein (cut) 7 Muscular branch of tibial nerve 8 Medial head of gastrocnemius muscle 9 Tendon of plantaris muscle 10 Posterior tibial artery 11 Medial malleolus 12 Biceps femoris muscle 13 Common peroneal nerve 14 Sural arteries 15 Plantaris muscle 16 Lateral head of gastrocnemius muscle 17 Soleus muscle 18 Calcaneal tendon 19 Lateral malleolus 20 Calcaneal tuberosity 21 Sartorius muscle 22 Popliteal artery 23 Tendinous arch of soleus muscle 24 Flexor digitorum longus muscle 25 Flexor retinaculum 26 Peroneal artery 27 Soleus muscle 28 Flexor hallucis longus muscle 29 Anterior tibial artery 30 Muscular branches of tibial nerve 31 Tibialis posterior muscle 32 Communicating branch of peroneal artery 33 Tendon of tibialis anterior muscle 34 Tibia 35 Tendon of extensor hallucis longus muscle 36 Tendons of extensor digitorum longus muscle 37 Anterior tibialis artery 38 Fibula 39 Tendons of peroneus longus and brevis muscles Right leg, posterior crural region, deepest layer (posterior Cross section of the leg, superior to the malleoli aspect). The common peroneal nerve has been elevated to show its course around the head of fibula. Cross section of the right foot at the level of the The extensor digitorum and hallucis brevis muscles have metatarsal bones (posterior aspect). Foot: Anterior Region 501 1 Proper plantar digital nerves 2 Common plantar digital nerves 3 Plantar aponeurosis 4 Superficial branch of lateral plantar nerve 5 Superficial branch of lateral plantar artery 6 Abductor digiti minimi 7 Proper plantar digital arteries 8 Common plantar digital arteries 9 Digital branch of medial plantar nerve to great toe 10 Medial calcaneal branches 11 Tendons of flexor digitorum brevis muscle 12 Flexor digitorum brevis muscle 13 Superficial branch of lateral plantar nerve 14 Lateral plantar artery 15 Plantar aponeurosis (remnant) 16 Digital synovial sheath 17 Lumbrical muscles 18 Tendon of flexor hallucis longus muscle 19 Flexor hallucis brevis muscle 20 Medial plantar artery 21 Medial plantar nerve 22 Abductor hallucis muscle 23 Calcaneal tuberosity 24 Tendons of flexor digitorum longus muscle 25 Quadratus plantae muscle 26 Lateral plantar nerve 27 Flexor digitorum brevis muscle (cut) 28 Synovial sheaths 29 Plantar arch Sole of the right foot, middle layer (from below). The flexor digitorum brevis muscle, the quadratus plantae muscle with the tendons of the flexor digitorum longus muscle, and some branches of the medial plantar nerve have been removed. The flexor hallucis brevis and adductor hallucis muscles have been cut and portions removed to show the somewhat atypical course of the medial plantar artery and deep muscles of the foot. Ring, inguinal Aqueduct Adduction of fingers 395 – tympanic, of newborn 33 – cerebral 65, 73 ff, 86, 90, 94, 99, 112, 116, Adductor hiatus 453 Anus 350 ff, 354, 361 ff, 366 121 Adhesion, interthalamic 86, 107 Aorta 16 f – of cochlea 129 Adnexa of uterus 359 ff – abdominal 16, 210, 245, 256, 278, 292, 296, – of vestibule 27, 129 Air cells 300, 302, 329 ff, 348, 359 f Arachnoid mater 84 f, 89, 92, 100, 118 – ethmoidal 28, 36, 38, 41 f, 44 f, 48, 53, 135 – – subtraktion angiography 328 – spinal 230, 232, 474 – – openings 144 – ascending 243, 245, 252 ff, 260, 266, 272, Arbor vitae of cerebellum 94, 116 – mastoid 70, 125 ff 284, 396 Arch Ala s. Arch – – common 83, 95, 97, 152, 157, 163, 165, ––––anterior 254 f, 263 – zygomatic 20, 33, 52, 54, 60 f, 79 168 ff, 252 f, 255, 266, 281, 396, 414 –––septal branch 254 – – coronal section 62 –––offetus 288 – – right 243, 253 ff, 257 f, 263, 270, 287 – – of newborn 33 – – external 63, 67, 69, 79, 97, 152, 163, 164, –––posterior interventricular branch 262 Arcus costalis (s.

Barrier: Epithelial tissues prevent foreign materials from getting inside the body zyrtec 5 mg low cost allergy forecast woodbridge va. Part I: Building Blocks of the Body 48 Sensation: Sensory nerve endings embedded in epithelial tissue connect the body with outside stimuli trusted zyrtec 5mg allergy medicine hives. Secretion: Epithelial tissue in glands can be specialized to secrete enzymes cheap 10 mg zyrtec with visa allergy symptoms blurry vision, hor- mones purchase 10mg zyrtec amex giving allergy shots yourself, and fluids. Epithelial tissues also can be classified according to shape: Squamous is a thin, flat cell; cuboidal is, as the name implies, equal in height and width and shaped like a cube; and columnar cells are taller than they are wide. Following are the ten primary types of epithelial tissues: Simple squamous epithelium: Looking a bit like rolling tundra, this flat layer of scale-like cells is useful in diffusion, secretion, or absorption. Simple squamous epithelium lines the lungs’ air sacs where oxygen and carbon dioxide are exchanged; forms blood fil- ters inside the kidneys; and lines the inner surface of the eardrum, known as the tympanic membrane. Simple cuboidal epithelium: These cube-shaped cells, found in a single layer that looks like a microscopic mattress, have centrally located nuclei that usually are round. Found in the ovaries, kidneys, and some glands, this type of epithe- lium functions in secretion, absorption, and tube formation. Simple columnar epithelium: These densely packed cells are taller than they are wide, with nuclei located near the base of each cell. Found lining the digestive tract from the stomach to the anal canal, this type of epithelium functions in secretion and absorption. Simple columnar ciliated epithelium: A close cousin to simple columnar epithe- lium, this type of tissue has hair-like cilia that can move mucus and other sub- stances across the cell. Pseudostratified columnar epithelium: Pay attention to the prefix pseudo– here, which means “false. This type of epithelium is found in the sali- vary glands and some segments of the male reproductive system, including the urethra. Pseudostratified columnar ciliated epithelium: Another variation on a theme, this tissue is nearly identical to pseudostratified columnar epithelium. The differ- ence is that this tissue’s free surface has cilia, making it ideal for lining air pas- sages because the cilia’s uniform waving action causes a thin layer of mucus to move in one direction — toward the throat and mouth — and trap dust particles. Stratified squamous epithelium: This tissue is the stuff you see everyday — your outer skin, or epidermis. This multilayered tissue has squamous cells on the outside plus deeper layers of cuboidal or columnar cells. Found in areas where the outer cell layer is constantly worn away, this type of epithelium regen- erates its surface layer with cells from lower layers. Stratified cuboidal epithelium: This multilayered epithelium can be found in sweat glands, conjunctiva of the eye, and the male urethra. Stratified columnar epithelium: Also multilayered, this epithelium is found lining parts of the male urethra, excretory ducts of glands, and some small areas of the anal mucus membrane. Stratified transitional epithelium: This epithelium is referred to as transitional because its cells can shape-shift from cubes to squamous-like flat surfaces and back again. Chapter 4: The Study of Tissues: Histology 49 Following are some practice questions dealing with epithelial tissue: Q. A tissue that’s one layer thick but appears to be multilayered and is composed of cells taller than they are wide is a. Simple cuboidal Making a Connection: Connective Tissue Connective tissues connect, support, and bind body structures together. Unlike other types of tissues, connective tissues are classified more by the stuff in which the cells lay — the extracellular matrix — than by the cells themselves. The cells that produce that matrix are scattered within it like chocolate chips in ice cream. The load-bearing Chapter 4: The Study of Tissues: Histology 51 strength of connective tissue comes from a fibrous protein called collagen. All connec- tive tissues contain a varying mix of collagen, elastic, and reticular fibers. Following are the primary types of connective tissue: Areolar, or loose, tissue: This tissue exists between and around almost every- thing in the body to bind structures together and fill space. It’s made up of wavy ribbons called collagenous protein fibers, cylindrical threads called elastic fibers, and amorphous ground substance, a semisolid gel. Various cells including lympho- cytes, fibroblasts, fat cells, and mast cells are scattered throughout the ground substance (see Figure 4-2). Dense regular connective tissue: Made up of parallel, densely packed bands or sheets of fibers (see Figure 4-2), this type of tissue is found in tendons as bundles of collagenous fibers attaching muscles to bone and in ligaments as bundles of elastic fibers extending from bone to bone, surrounding a joint, and anchoring organs. Mast cell Fibers of Matrix Collagen fiber clei of fibroblasts Fibroblast Illustration by Imagineering Media Services Inc. Dense irregular connective tissue: Also known as dense fibrous connective tissue, it consists of fibers that twist and weave around each other, forming a thick tissue that can withstand stresses applied from any direction. This tissue makes up the strong inner skin layer called the dermis as well as the outer cap- sule of organs like the kidney and the spleen. Adipose tissue: Composed of fat cells, this tissue forms padding around internal organs, reduces heat loss through the skin, and stores energy in fat molecules called triglycerides. Fat molecules fill the cells, forcing the nuclei against the cell membranes and giving them a ring-like shape. Reticular tissue: Literally translated as “web-like” or “net-like,” reticular tissue is made up of slender, branching reticular fibers with reticular cells overlaying them. Its intricate structure makes it a particularly good filter, which explains why it’s found inside the spleen, lymph nodes, and bone marrow. Part I: Building Blocks of the Body 52 Cartilage: These firm but flexible tissues, made up of collagen and elastic fibers, have no blood vessels or nerve cells (a state called non-vascular or avascular). Cartilage contains openings called lacunae (from the Latin word lacus for “lake” or “pit”) that enclose mature cells called chondrocytes, which are preceded by cells called chondroblasts. A membrane known as the perichondrium surrounds cartilage tissue, which also contains a gelatinous protein called chondrin. There are three types of cartilage: • Hyaline cartilage: The most abundant cartilage in the body, it’s elastic and made up of a uniform matrix pocked with chondrocytes. It lays the founda- tion for the embryonic skeleton, forms the rib (or costal) cartilages, makes up nose cartilage, and covers the articulating surfaces of bones. The sponge-like structure, with the lacunae and chondro- cytes lined up within the fibers, makes it a good shock absorber. It’s found in the intervertebral discs of the vertebral column and in the symphysis pubis at the front of the pelvis. This structure, which makes up the ear lobe and other structures where a specific form is important, tends to bounce back to its original shape after being bent. Bone, or osseous, tissue: Essentially, bone is mineralized connective tissue formed into repeating patterns called Haversian systems. In the center of each system is a large opening, the Haversian canal, that contains blood vessels, lymph vessels, and nerves. The central canal is surrounded by thin membranes called lamellae that contain the lacunae, which in turn contain osteocytes (bone cells). Smaller canali- culi connect the lacunae and circulate tissue fluids from the blood vessels to nour- ish the osteocytes. Like other connec- tive tissues, it has an extracellular matrix — in this case, plasma — in which are suspended erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets). Erythrocytes are concave on both sides and contain a pigment, hemoglobin, which supplies oxygen to the body’s cells and takes carbon dioxide away. There are approximately 5 million erythrocytes per cubic millimeter of whole blood. Thrombocytes, which number approximately 250,000 per cubic millimeter, are fragments of cells used in blood clotting.

Thus best zyrtec 5mg allergy forecast fairfax va, it is important to understand stereochemistry for a better understanding of drug molecules order 10mg zyrtec with amex allergy symptoms hiv, their action and toxicity generic 10mg zyrtec otc allergy forecast clearwater fl. The (R)-form is completely inactive cheap zyrtec 5mg with mastercard allergy immunology associates, although it is slowly converted in the body to the active (S)-form. The drug marketed under the trade names, commercially known as 1 1 1 1 1 1 1 Advil , Anadin , Arthrofen , Brufen , Nurofen , Nuprin , Motrin etc. The drug, however, caused severe adverse effects on thousands of babies who were exposed to this drug while their mothers were pregnant. The drug caused 12 000 babies to be born with severe birth defects, including limb deformities such as missing or stunted limbs. Later, it was found that thalidomide molecule can exist in two stereoisomeric forms; one form is active as a sedative, but the other is responsible for its teratogenic activity (the harmful effect on the foetus). O O O * N N * O N H H N H O O O O H Sedative Teratogenic Thalidomide stereoisomers Limonene is a monoterpene that occurs in citrus fruits. Two enantiomers of limonene produce two distinct flavours: (À)-limonene is responsible for the flavour of lemons and (þ)-limonene for orange. Similarly, one enantiomeric form of carvone is the cause of caraway flavour, while the other enantiomer has the essence of spearmint. The pure S-enantiomer works remarkably well in the prevention of migraine and is now under clinical evaluation. In the absence of any chiral influence, the outcome of such reactions is the formation of a racemic form. For example, hydrogenation of ethylmethylketone yields a racemic mixture of 2-hydro- xybutane. To carry out an enantioselective reaction, a chiral reagent, solvent, or catalyst must assert an influence on the course of the reaction. In nature, most of the organic or bioorganic reactions are enantioselective, and the chiral influence generally comes from various enzymes. The active site in any enzyme is chiral, and allows only one enantiomeric form of a chiral reactant to fit in properly. Enzymes are also used to carry out enantioselective reactions in the laboratories. Lipase catalyses a reaction called hydrolysis, where esters react with a molecule of water and are converted to a carboxylic acid and an alcohol. The use of lipase allows the hydrolysis to be used to prepare almost pure enantiomers. Therefore, it is important to purify the racemic mixture so that active enantiomer can be obtained. The separation of a mixture of enantiomers is called the resolution of a racemic mixture. Through luck, in 1848, Louis Pasteur was able to separate or resolve racemic tartaric acid into its (þ) and (À) forms by crystallization. Two enantiomers of the sodium ammonium salt of tartaric acid give rise to two distinctly different types of chiral crystal that can then be separated easily. However, only a very few organic compounds crystallize into separate crystals (of two enantiomeric forms) that are visibly chiral as are the crystals of the sodium ammonium salt of tartaric acid. Therefore, Pasteur’s method of separation of enantiomers is not generally applicable to the separation of enantiomers. One of the current methods for resolution of enantiomers is the reaction of a racemic mixture with a single enantiomer of some other compound. An enzyme selectively converts one enantiomer in a racemic mixture to another compound, after which the unreacted enantiomer and the new compound are separated. Among the recent instrumental methods, chiral chromatography can be used to separate enantiomers. Diastereomeric interaction between molecules of the racemic mixture and the chiral chromatography medium causes enantiomers of the racemate to move through the stationary phase at different rates. When four different groups are situated around the central atom in silicon, germanium and nitrogen compounds, the molecules are chiral. Sulphoxides, where one of the four groups is a nonbonding electron pair, are also chiral. R' Chiral compounds with silicon, germanium, and nitrogen stereocentres Chiral sulphoxide 3. A tetrahedral atom with four different groups is just one of the factors that confer chirality on a molecule. There are a number of molecules where a tetrahedral atom with four different groups is not present, yet they are not superimposable, i. For example, 1,3-dichloroallene is a chiral molecule, but it does not have a tetrahedral atom with four different groups. H H H H C C C C C C Cl Cl Cl Cl 1,3-Dichloroallene An allene is a hydrocarbon in which one atom of carbon is connected by double bonds with two other atoms of carbon. This geometry of the p bonds causes the groups attached to the end carbon atoms to lie in perpendicular planes. Because of this geometry, allenes with different substitutents on the end carbon atoms are chiral. Chemistry for Pharmacy Students Satyajit D Sarker and Lutfun Nahar # 2007 John Wiley & Sons, Ltd. Afunctional group is an atom or a group of atoms within a molecule that serves as a site of chemical reactivity. Carbon combines with other atoms such as H, N, O, S and halogens to form functional groups. A reaction is the process by which one compound is transformed into a new compound. It is important that you are able to recognize these functional groups because they dictate the physical, chemical and other properties of organic molecules, including various drug molecules. The most important functional groups are shown in the following table, with the key structural elements and a simple example. Where two R groups are shown in a single structure, they do not have to be the same, but they can be. All alkanes have the general molecular formula CnH2nþ2 and are called saturated hydrocarbons. Saturated hydrocarbons contain only single bonds, and are also commonly referred to as aliphatic or acyclic alkanes (alkanes without rings). Thus, the alkane family is characterized by 3 the presence of tetrahedral carbon (sp ) atoms. Common names as well as systematic names are used for alkanes and their derivatives. For example, if a chain contains three carbons the parent name is propane, if four carbons the parent name is butane and so on. Numbers are used to indicate the positions of the substituents on the parent carbon chain. Prefix Number of carbon atoms Prefix Number of carbon atoms Meth- 1 Hept- 7 Eth- 2 Oct- 8 Prop- 3 Non- 9 But- 4 Dec- 10 Pent- 5 Undec- 11 Hex- 6 Dodec- 12 First, one has to identify and name the groups attached to the chain, and number the chain so that the substituent gets the lowest possible number. For example, one of the isomers of pentane is 2-methylbutane, where the parent chain is a four-carbon butane chain, and is numbered starting from the end nearer the substituent group (methyl group). Therefore, the methyl group is indicated as being attached to carbon atom number 2.

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