By G. Innostian. Texas Christian University.

Hyper-reflexia without spas- ticity after unilateral infarct of the medullary pyramid buy cheap claritin 10 mg line allergy forecast stockton ca. Journal of the Neurological Sciences 2000; 175: 145-155 Cross References Abdominal reflexes; Clonus; Incontinence; Jaw jerk; Reflexes; Spasticity; Upper motor neurone (UMN) syndrome; Weakness Hyperreligiosity Hyperreligiosity is a neurobehavioral symptom cheap claritin 10mg on-line allergy symptoms to cats, manifest as sudden religious conversion, or increased and unswerving orthodoxy in devo- tion to religious rituals. It may be encountered along with hyper- graphia and hyposexuality as a feature of Geschwind’s syndrome. It has also been observed in some patients with frontotemporal demen- tia; the finding is cross-cultural, having been described in Christians, Moslems, and Sikhs. In the context of refractory epilepsy, it has been associated with reduced volume of the right hippocampus, but not right amygdala. Advances in Neurology 1991; 55: 411-421 Wuerfel J, Krishnamoorthy ES, Brown RJ et al. Religiosity is associ- ated with hippocampal but not amygdala volumes in patients with refractory epilepsy. Journal of Neurology, Neurosurgery and Psychiatry 2004; 75: 640-642 Cross References Hypergraphia; Hyposexuality Hypersexuality Hypersexuality is a pathological increase in sexual drive and activity. Recognized causes include bilateral temporal lobe damage, as in the Klüver-Bucy syndrome, septal damage, hypothalamic disease (rare) with or without subjective increase in libido, and drug-treatment in Parkinson’s disease. Sexual disinhibition may be a feature of frontal lobe syndromes, particularly of the orbitofrontal cortex. Cross References Disinhibition; Frontal lobe syndromes; Klüver-bucy syndrome - 162 - Hyperthermia H Hypersomnolence Hypersomnolence is characterized by excessive daytime sleepiness, with a tendency to fall asleep at inappropriate times and places, for example during meals, telephone conversations, at the wheel of a car. Causes of hypersomnolence include: Narcolepsy or the narcoleptic syndrome: may be accompanied by other features such as sleep paralysis, hypnagogic hallucina- tions, cataplexy Midbrain lesions Idiopathic CNS hypersomnia Kleine-Levin syndrome Nocturnal hypoventilation, due to: Obstructive sleep apnea-hypopnea syndrome (OSAHS; Pickwickian syndrome) Chest wall anomalies Neuromuscular and myopathic disorders affecting the respiratory muscles, especially the diaphragm, for example: Motor neurone disease Myotonic dystrophy Metabolic myopathies, for example, acid maltase deficiency Mitochondrial disorders Drugs: benzodiazepines, ergot-derivative dopamine agonists Post-stroke sleep-related disorders. Nocturnal hypoventilation as a consequence of obstructed breathing, often manifest as snoring, causes arterial oxygen desaturation as a con- sequence of hypopnea/apnea which may lead to disturbed sleep, repeated arousals associated with tachycardia and hypertension. Clinical signs may include a bounding hyperdynamic circulation and sometimes papilledema, as well as features of any underlying neuro- muscular disease. OSAHS may present in the neurology clinics with loss of consciousness (sleep secondary to hypersomnolence), stroke, morning headaches, and cognitive impairment (slowing). Investigations may reveal a raised hematocrit and early morning hypoxia. Sleep studies confirm nocturnal hypoventilation with dips in arterial oxygen saturation. Cross References Asterixis; Cataplexy; Papilledema; Paradoxical breathing; Snoring Hyperthermia Body temperature is usually regulated within narrow limits through the coordinating actions of a centre for temperature control (“thermo- stat”), located in the hypothalamus (anterior-preoptic area), and effec- tor mechanisms (shivering, sweating, panting, vasoconstriction, vasodilation), controlled by pathways located in or running through the posterior hypothalamus and peripherally in the autonomic nervous - 163 - H Hypertonia, Hypertonus system. Other recognized causes of hyperthermia include: Infection: bacteria, viruses (pyrogens, e. Cross References Hypothermia Hypertonia, Hypertonus Hypertonia or hypertonus is an exaggeration of normal muscular tone, manifest as resistance to passive movement. It usually implies spastic- ity of corticospinal (pyramidal) pathway origin, rather than extrapyra- midal (lead-pipe) rigidity. Cross References Clasp-knife phenomenon; Hyperreflexia; Paratonia; Rigidity; Spasticity; Upper motor neurone (UMN) syndrome Hypertrophy - see MUSCLE HYPERTROPHY Hypertropia Hypertropia is a variety of heterotropia in which there is manifest upward vertical deviation of the visual axis of one eye. Using the cover test, this manifests as downward movement of the uncovered eye. Depending on the affected eye, this finding is often described as a “left- over right” or “right-over left. Cross References Bielschowsky’s sign, Bielschowsky’s test; Cover tests; Heterotropia; Hypotropia Hypoalgesia Hypoalgesia is a decreased sensitivity to, or diminution of, pain perception in response to a normally painful stimulus. Cross References Analgesia Hypoesthesia Hypoesthesia (hypoaesthesia, hypesthesia) is decreased sensitivity to, or diminution of, sensory perception in any modality, most frequently used to describe pain (hypoalgesia) or touch. Repeated apposition of finger and thumb or foot tapping may be useful in demonstrated hypokinesia of gradual onset (“fatigue”). It may often coexist with bradykinesia and hypometria, and is a feature of disorders of the basal ganglia (akinetic-rigid or parkinson- ian syndromes), for example: Parkinson’s disease Multiple system atrophy Progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome) Some variants of prion disease. Cross References Akinesia; Bradykinesia; Fatigue; Parkinsonism Hypometria Hypometria is a reduction in the amplitude of voluntary movements.

Now buy claritin 10 mg without a prescription allergy treatment brand, since I cannot find a diagnosis for my condi- tion—it’s not in the medical books—I am wondering if I have been too quick to dismiss this issue generic claritin 10mg free shipping allergy shots natural. Maybe I’d better investigate this further even though I have not seen my condition listed as a side effect. It may not be an independent disease or condition, and my symptoms have to be caused by something! Step Eight: Take Your Notebook to Your Physician and Get a Complete Physical Exam. Pitman a physical exam- ination because they were located in different states, but the endocrinolo- gist and urologists had already done so. Pitman raised two excellent questions that were brought forward as a result of doing the Eight Steps: whether motorcycling could be causing some trauma and possibly be a precipitating cause of his problem, and whether his problem was iatro- genic (medically induced by a medication). Pitman was not taking Viagra or any similar drug that had the potential for such side effects, the question remained as to whether the balance of his medica- tions—his cholesterol medication or even Rogaine—could be causing this reaction. First, no one could determine how, from a biomechanical standpoint, riding a motor- cycle could impact penile function. It didn’t seem the motorcycle was the likely culprit, but it was worth investigating. Pit- man to stay off his motorcycle for a while to see if there was any change in his condition. As to an iatrogenic cause, while the literature did not indicate priapism as a side effect of either Rogaine or the cholesterol medication, Dr. He had already discov- ered firsthand that literature from drug manufacturers may be skewed for obvious reasons. The Physician’s Desk Reference (PDR), which is a leading drug reference among not only physicians but millions of consumers, is mainly a collection of package inserts written by drug companies and as such may omit or underreport serious side effects of medications. Pitman should both get on the phone and call any and every doctor they could think of, in the hope of 110 Diagnosing Your Mystery Malady finding one who might have heard similar complaints from a patient who was using either Rogaine or the cholesterol medication. Pitman spoke with an endocrinologist who had a friend—not a patient—who had experienced erectile dysfunction from the same choles- terol medication that had been prescribed for Dr. Rosenbaum that he would stop the medication as an experiment and see if it made a difference. Pitman’s symptoms did not disappear after he refrained from motorcycling, nor did they reappear after he discovered what he believed was the source of his condition. His mystery malady was indeed an unlisted and per- haps unrecognized side effect of that particular medication. He consulted his internist to prescribe a different medication to lower his cholesterol. Pitman’s case, four factors contributed to a successful outcome: working through the Eight Steps, keeping an open mind, talking to every physician he could about his problem, and a willingness to experiment and test his hypothesis by eliminating certain factors to observe whether this made a difference. Case Study: Rosalind Another medical practitioner, surgical nurse Rosalind, went through a less formal, deductive reasoning process to find the answer to her medical mys- tery. While not illustrative of the Eight Step method per se, it is a prime example of how things that might be healthy for some are unhealthy for *At the time, Internet bulletin boards or websites were not as popular, but these are poten- tial resources. They should be considered one source to be verified along with all other information gathered. See Chapter 5 for more tips on using the Internet for medical detective work. Approximately five years ago, Rosalind called in sick when she began having intolerable pain in her right side adjacent to her stomach. Being a surgical nurse, she thought the source of her pain might be her gallbladder because she had three of the “four Fs” likely to point to such problems— female, fair, fat, and over forty. She consulted the doctor in the women’s health center of the hos- pital in Reno where she worked. The doctor told her to change her diet anyway to eliminate fatty foods, which can play a role in gallbladder aggravation.

Most hospitals are now required to have response plans in place as part of their accreditation require- BLACK DEATH • see BUBONIC PLAGUE ments buy claritin 10mg fast delivery allergy symptoms asthma. In addition to airborne and surface exposure order claritin 10 mg online allergy shots gerd, biologic agents may be disseminated in water supplies. Many commu- BLACK LIPID BILAYER MEMBRANE • see nities have placed extra security on water supply and treat- LABORATORY TECHNIQUES IN MICROBIOLOGY 79 Blood agar, hemolysis, and hemolytic reactions WORLD OF MICROBIOLOGY AND IMMUNOLOGY BLACK SMOKER BACTERIA • see EXTREMOPHILES BLOOD AGAR, HEMOLYSIS, AND Blood agar, hemolysis, and hemolytic reactionsHEMOLYTIC REACTIONS Blood agar is a solid growth medium that contains red blood cells. The medium is used to detect bacteria that produce enzymes to break apart the blood cells. The degree to which the blood cells are hemolyzed is used to distinguish bacteria from one another. First, a number of ingredients are added to water, including heart infusion, peptone, and sodium chloride. The blood can be from rabbit or gamma hemolysis actually appears brownish. Rabbit blood is preferred if the target bacterium is from reaction of the blood to the growth conditions used (37° C in the group known as group A Streptococcus. Gamma hemolysis is a char- preferred if the target bacterium is Haemophilus para- acteristic of Enterococcus faecalis. Certain species of bacte- It is typically not used for this purpose, however, due to the ria, such as group B Strep (n example is Streptococcus agalac- expense of the medium. Other, less expensive agars will do the tiae) are weakly beta-hemolytic. What blood agar is uniquely suited for is the deter- in close proximity with a strain of Staphylococcus the beta- mination of hemolysis. This forms the basis of a test blood cells by a bacterial protein known as hemolysin, which called the CAMP test (after the initials of its inventors). The determination of hemolysis and of the hemolytic Many types of bacterial posses hemolytic proteins. These pro- reactions is useful in distinguishing different types of bacteria. For example, a beta hemolytic reaction is brane or disrupting the structure of the membrane in some indicative of a Streptococcus. The exact molecular details of hemolysin action is organisms with bacitracin is often the next step. Streptococcus pyogenes strains are almost unifor- remove a molecule called fibrin, which participates in the clot- mally sensitive to bacitracin. The absence of fibrin ensures that clotting of the Streptococcus are not bacitracin sensitive. See also Laboratory techniques in microbiology; Staphylo- There are three types of hemolysis, designated alpha, cocci and staphylococcal infections; Streptococci and strepto- beta and gamma. Alpha hemolysis is a greenish discoloration coccal infections that surrounds a bacterial colony growing on the agar. This type of hemolysis represents a partial decomposition of the hemoglobin of the red blood cells. Alpha hemolysis is charac- teristic of Streptococcus pneumonia and so can be used as a Blood borne infectionsBLOOD BORNE INFECTIONS diagnostic feature in the identification of the bacterial strain. Beta hemolysis represents a complete breakdown of the Blood borne infections are those in which the infectious agent hemoglobin of the red blood cells in the vicinity of a bacterial is transmitted from one person to another in contaminated colony. Infections of the blood can occur as a result of the hemolysis is characteristic of Streptococcus pyogenes and spread of an ongoing infection, such as with bacteria includ- some strains ofStaphylococcus aureus. Gamma hemolysis is a lack of hemolysis in the area ever, the latter re considered to be separate from true blood- around a bacterial colony. Bacterial blood borne infection can occur, typically in Exposure to the blood from an infected person or the sharing of the transfusion of blood. Such infections arise from the con- needles among intravenous drug users can transmit these tamination of the site of transfusion.

In effect purchase claritin 10mg otc allergy testing guildford, the rate of synthesis of these proteins con- one from the mother and one from the father generic claritin 10mg with amex allergy forecast ma. During synapsis, trols the frequency and rate of meiosis in all sexually repro- adjacent chromatids from homologous chromosomes “cross ducing organisms from the simplest to the most complex. These connections hold the pair together as a tetrad gametes, the sperm and egg cells. In males, the process of (a set of four chromatids, two from each homologue). At the gamete production is known as spermatogenesis, where each chiasmata, the connected chromatids randomly exchange bits dividing cell in the testes produces four functional sperm cells, of genetic information so that each contains a mixture of all approximately the same size. This “shuffling” of the DNA pro- itive but highly efficient flagellum (tail). In contrast, in duces a tetrad, in which each of the chromatids is different females, oogenesis produces only one surviving egg cell from from the others, and a gamete that is different from others pro- each original parent cell. Crossing over does explain why and organelles are concentrated into only one of the four each person is a unique individual, different even from those daughter cells—the one that will eventually become the in the immediate family. The other three smaller cells, called polar appearance of spindle fibers (strands of microtubules) extend- bodies, die and are reabsorbed shortly after formation. The ing from the poles or ends of the cell as the nuclear membrane concentration of cytoplasm and organelles into the oocyte disappears. These spindle fibers attach to the chromosomes greatly enhances the ability of the zygote (produced at fertil- during metaphase I as the tetrads line up along the middle or ization from the unification of the mature ovum with a sper- equator of the cell. A spindle fiber from one pole attaches to matozoa) to undergo rapid cell division. Anaphase I is characterized by the separa- a topic of much scientific research. Cell division is stimulated tion of the homologues, as chromosomes are drawn to the by certain kinds of chemical compounds. The sister chromatids are still intact, but the cytokines are secreted by some cells to stimulate others to homologous chromosomes are pulled apart at the chiasmata. Contact with adjacent cells can also con- Telophase I begins as the chromosomes reach the poles and a trol cell division. The phenomenon of contact inhibition is a nuclear membrane forms around each set. Cytokinesis occurs as the cytoplasm and organelles are divided in half and the one process where the physical contact between neighboring cells parent cell is split into two new daughter cells. When contact is inter- cell is now haploid (n), meaning it has half the number of rupted, however, cell division is stimulated to close the gap chromosomes of the original parent cell (which is diploid-2n). Cell division is a major mechanism by which These chromosomes in the daughter cells still exist as sister organisms grow, tissues and organs maintain themselves, and chromatids, but there is only one chromosome from each orig- wound healing occurs. The cell The phases of meiosis II are similar to those of meiosis cycle is highly regulated by several enzymes, proteins, and I, but there are some important differences. The time between cytokines in each of its phases, in order to ensure that the the two nuclear divisions (interphase II) lacks replication of resulting daughter cells receive the appropriate amount of DNA (as in interphase I). As the two daughter cells produced genetic information originally present in the parental cell. In in meiosis I enter meiosis II, their chromosomes are in the the case of somatic cells, each of the two daughter cells must form of sister chromatids. No crossing over occurs in prophase contain an exact copy of the original genome present in the II because there are no homologues to synapse. Cell cycle controls also regulate when and to metaphase II, the spindle fibers from the opposite poles attach what extent the cells of a given tissue must proliferate, in order to the sister chromatids (instead of the homologues as before). Therefore, when one or more of the centromeres separate, the two single chromosomes are such controls are lost or inhibited, abnormal overgrowth will drawn to the opposite poles. The end result of meiosis II is that occur and may lead to impairment of function and disease. The distribution of chromatids during meio- Cell cycle (eukaryotic), genetic regulation of; Cell cycle sis is a matter of chance, which results in the concept of the (prokaryotic), genetic regulation of; Chromosomes, eukary- law of independent assortment in genetics.

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