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By X. Pedar. Pacific States University. 2018.

Gonad Descent Both kidney and gonads develop retroperitoneally generic flomax 0.2 mg, with the gonads moving into the abdomen or eventually into the scrotal sacs discount flomax 0.2 mg overnight delivery. During fetal development the gubernaculum and fetal growth in both male and female purchase 0.2 mg flomax otc, changes the gonads’ relative positions finally reaching their adult locations. Ovaries ‐ undergo caudal and lateral shifts to be suspended in the broad ligament of the uterus, gubernaculum does not shorten, it attaches to paramesonephric ducts, causing medial movement into the pelvis. Testes ‐ two anatomical phases in descent, transabdominal and transinguinal, under the influence of the shortening gubernaculum. The testis (white) lies in the subserous fascia (spotted) a cavity processus vaginalis evaginates into the scrotum, and the gubernaculum (green) attached to the testis shortens drawing it into the scotal sac. As it descends it passes through the inguinal canal which extends from the deep ring (transversalis fascia) to the superficial ring (external oblique muscle). Incomplete or failed descent can occur unilaterally or bilaterally, is more common in premature births, and can be completed postnatally. Female Puberty growth In females, menarche (the first menstruation or a period) usually occurs after the other secondary sex characteristics, and will continue until menopause (permanent cessation of reproductive fertility). The diagram shows the hormonal regulation pathway from the brain to the ovary and subsequent impact on uterine changes during the menstral cycle. Delayed Puberty - Determined in boys by a lack of increase in testicular volume by the age of 14 years. Cryptorchidism abnormality of either unilateral or bilateral testicular descent, occurring in up to 30% premature and 3-4% term males. 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. 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. 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.

All trauma victims should be catheterized to enable monitoring of the urine output and plan intravenous fluid therapy generic flomax 0.2mg with visa. It should be passed via the orogastric route in patients with head injury and suspected base skull fracture 0.2 mg flomax. Secondary Survey Once the primary survey is accomplished safe 0.2mg flomax, life- threatening conditions are managed and resuscitative efforts are underway, secondary survey is carried out. This is head to toe evaluation of trauma patient, which includes a complete history and physical examination and reassessment of all the vital signs. The care continues with regular re-evaluation of the patient for any deterioration and new findings, so that appropriate measures can be taken. Constant monitoring of the severely injured patient is required and may necessitate rapid transfer to the surgical intensive care unit, operating room or to another centre having better specialized facilities. Advanced trauma life support th program for doctors, 8 ed, chapter1, Initial assessment and management. In situations where the history is not forthcoming any injury or mishap associated with the change in the level of consciousness of the individual should be deemed to be associated with brain injury unless proved otherwise. Incidence of the condition in our country Incidence of road traffic accidents in India is amongst the highest in the world, and is rising. As per the report of the National Crime Records Bureau 2001, 2,710,019 accidental deaths, 108,506 suicidal deaths and 44,394 violence-related deaths were reported in India. Facial, chest, abdominal and limb injuries were documented in 48%, 3%, 1% and 10% of cases, respectively. Differential Diagnosis: The differential diagnosis of traumatic brain injury is generally straight forward. However, the use of pharmacoprophylaxis might be associated with a higher chance of intra cranial bleeding. However, monitoring patients on hypothermia regimen needs core temperature monitoring and may not be available in resource limited settings. If patients are considered fit for transport, it is advisable to transfer them to a centre with the facilities and experience in using hypothermia. Notes Diagnosis t findings suggesting a toxic-metabolic cause • dysfunction at lower levels of the brainstem (e. M etabolic Com a Structural Toxic-M etabolic pupillary asymmetric pupils equal, round, regular reaction or absent reaction to light (see Table 3) extraocular asymmetric symmetric m ovem ents or absent or absent m otor asymmetric symmetric findings or absent or absent Table 3. Toxic - M etabolic Causes of Fixed Pupils Cause Pupils Characteristics Treatm ent anoxia dilated antecedent history of 100% O2, shock, cardiac expectant management or respiratory arrest, etc. The right dose separates a poison from a remedy” t 5 questions to consider with all ingestions • is this a toxic ingestion? Gravol, diphenhydramine) • antiparkinsonians • antipsychotics • antispasmotics • belladonna alkaloids (e. Algorithm for Ventricular Fibrillation and Pulseless Ventricular Tachycardia Adapted from American Heart Association Advanced Cardiac Life Support. Algorithm for Pulseless Electrical Activity Algorithm Adapted from American Heart Association Advanced Cardiac Life Support. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. W/t Tinebeb, W/t Hiwot and W/t Bruktawit who unwearyingly typed and retyped the document also receive our heart-felt appreciations. Our gratitude also goes to Ato Haji Kedir, Ato Jemal Seid, W/t Eriteria Tadesse and Ato Lakemariam Kassa from the Faculty of Health Sciences, Alemaya University who reviewed the whole document and suggested valuable comments which lifted the document to its present level. Moreover, the authors would like to express their appreciation to the following National and International reviewers whose comments helped to bring the module to its present shape: Dr. Last but not least the authors are also grateful to the Alemaya University in general and particularly to Professor Desta Hamito , the President and Dr. Belay Kassa, the Vice President of Academics and Research for their courageous attention and unreserved support in the production of modules suggested by the initiative. Purpose and Use of the Module A big challenge in the training of well-versed health professionals in the different higher institutions in Ethiopia has emanated from the serious shortage of adequate number of contextual reference materials. To add to this problem, even the available reference materials sometimes fail to address the most important learning issues of the Ethiopian students. However, up to this day, efforts geared towards the preparation of reference materials by instructors in the different institutions in order to reduce this problem have remained meager. This module is prepared to help students develop knowledge, attitudes and skills required in their practice areas through active learning. Technologist) to be able to recognize and manage the important food-borne diseases as well as to prevent them from occurring from the outset.

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Osteogenesis Formation of mature osteoblasts - the mesenchymal stem cells initially form preosteoblasts that then differentiate 0.2mg flomax mastercard. These cells differentiate first into mitotically active cells discount 0.2mg flomax with visa, myoblasts cheap flomax 0.2 mg overnight delivery, which contain a few myofilaments. Myoblasts undergo frequent divisions and coalesce with the formation of a multinucleated, syncytial muscle fibre or myotube. In the course of the synthesis of the myofilaments/myofibrils, the nuclei are gradually displaced to the periphery of the cell. Skeletal Muscle Stages Myoblast - individual progenitor cells Myotube - multinucleated, but undifferentiated contractile apparatus (sarcomere) Myofibre (myofiber, muscle cell) - multinucleated and differentiated sarcomeres primary myofibres - first-formed myofibres, act as a structural framework upon which myoblasts proliferate, fuse in linear sequence secondary myofibers - second later population of myofibres that form surrounding the primary fibres. The electrical properties of the motor neuron will regulate the contractile properties of all associated myofibres. Each somite pair level gives rise to a group of skeletal muscles supplied by a specific segmental spinal nerve. The muscle arises from a specific somite and the spinal nerve arises from a specific level of the spinal cord (identified by vertebral column). In humans this corresponds to the following spinal nerves (from top to bottom) and muscular functions: C3,4 and 5 supply the diaphragm for breathing. Puberty Musculoskeletal mass doubles by the end of puberty regulated growth by - sex steroid hormones, growth hormone, insulin-like growth factors accumulation of (peak) bone mass during puberty relates to future osteoporosis in old age Abnormalities Additional abnormalities will be covered in the limb development lecture. They have a similar protein structure, with 3 immunoglobulin-like domains in the extracellular region, a single membrane spanning segment, and a cytoplasmic tyrosine kinase domain. The function of the pathway will be to alter the cell directly or indirectly by changing gene expression. Mesoderm outside the embryo and covering the amnion, yolk and chorion sacs is extraembryonic mesoderm. These paired dorsal lateral streaks of cells migrate throughout the embryo and can differentiate into many different cell types(=pluripotential). These cells allow continuous bone remodelling and are also involved in calcium and phosphate metabolism. In the nervous system, it is secreted by the notochord, ventralizes the neural tube, inducing the floor plate and motor neurons. Tbx - T-box genes (transcription factor) involved in mouse forelimb (Tbx4) and hindlimb (Tbx5) specification. The mechanism of Wnt distribution (free diffusion, restricted diffusion and active transport) and all its possible cell receptors are still being determined. Images 2009 Lecture 14 From Embryology Contents Limb Development Introduction This lecture is an introduction to the events in limb development. Initially somites develop and then begin to differentiate forming sclerotome, dermomyotome and then dermatome and myotome. The lateral portion of the hypaxial myotome edge migrates at level of limbs (upper limb first then lower) and mixes with somatic mesoderm. The appendicular skeleton consists of: Shoulder girdle, Upper limb (arm, hand), Pelvic girdle, Lower limb (leg, foot). Limb Axis Formation Four Concepts - much of the work has been carried out using the chicken and more recently the mouse model of development. Axial myoblasts form the myotome Lateral myoblasts migrate to the limb bud (c) Dermotome skin elements (dermis, hypodermis). Origin of limb muscle cells - Migrations traced by grafting cells from a quail embryo into a chick embryo two species very similar in development quail cells recognizable by distinctive nucleoli Quail somite cells substituted for somite cells of 2 day chick embryo wing of chick sectioned a week later found muscle cells in chick wing derive from transplanted quail somites Dorsal/Ventral Muscle Mass Forelimb Muscles Limb Muscle - Differentiation, Skeletal muscle differentiates the same 1. The nephron, the functional unit of the kidney, is also a classical epithelial/mesenchyme type of interaction. The urinary system is developmentally and anatomically associated with genital development, often described as the urogenital system. Adult nephron structure Nephron Development disorganised mesenchymal cells become a highly organised epithelial tubule Condensation - groups of about 100 cells condense tightly together to form a distinct mass Epithelialisation - condensed cells lose their mesenchymal character and gain epithelial At end of this period formed a small epithelial cyst complete with a basement membrane, cell-cell junctions and a defined cellular apico- basal polarity. Bladder Structure Can be described anatomically by its 4 layers from outside inward: Can be described anatomically by its 4 layers from outside inward: Serous - the superior or abdominal surfaces and the lateral" surfaces of the bladder are covered by visceral peritoneum, the serous membrane (serosa) of the abdominal cavity, consisting of mesthelium and elastic fibrous connective tissue. Detrusor Muscle The adult detrusor muscle consists of three layers of smooth Bladder histology (involuntary) muscle fibres. Anatomically can be described in two parts the abdominal part (pars abdominalis) and pelvic part (pars pelvina). The ureter is composed of three layers: outer fibrous layer (tunica adventitia), muscular layer (tunica muscularis) and mucous layer (tunica mucosa). The muscular layer can also be subdivided into 3 fibre layers: an external longitudinal, a middle circular, and an internal longitudinal. During migration from the sacral region the two metanephric blastemas can come into contact, mainly at the lower pole. The kidneys and ureters usually function adequately but there is an increased incidence of upper urinary tract obstruction or infection. Some horseshoe variations have been described as having associated ureter abnormalities including duplications. Urorectal Septum Malformation thought to be a deficiency in caudal mesoderm which in turn leads to the malformation of the urorectal septum and other structures in Horseshoe kidney the pelvic region.

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