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It is very rich in antibodies and must be given • Conduction of delivery in thoroughly aseptic conditions to the newborn kamagra polo 100 mg with visa erectile dysfunction treatment centers. Breast milk can constitute a complete (It is good to remember 5C’s for a clean delivery; clean diet for a child during 0 to 6 months of age order kamagra polo mastercard erectile dysfunction toys. Secretion hands cheap kamagra polo 100mg overnight delivery erectile dysfunction age, clean surface, clean razor blade, clean cord tie and clean cord stump). For prevention of hypothermia, Hypothermia kit has been provided to mothers after birth, that includes nine elements like, nets, socks, cap gloves, baby cloths, one saree for the mother, etc. Also allows breast milk by bottle Source: Indicators for assessing infant and young child feeding practices. Breast feeding should be initiated • Baby is gaining weight, as documented by growth as early as possible preferably within ½ hours. The mother should be encouraged to breast feed the • Baby urinates about six times a day. Complimentary Feeding Gradual introduction of semisolid foods to the infants Advantages of Breastfeeding at the age of 6 months of age in addition to usual • To baby: breast-feeding is known as complimentary feeding. The ideal time to introduce semisolid feeds to babies – Easily digestible and meet all the nutritional need is about 6 months of age, because of the following reasons: for growth and development. Inform all pregnant woman about the benefit and locally available foods should be introduced along with management of breast feeding. Help to initiate breastfeeding with in half an hour cooked), dais (well cooked), ripe bananas, fruits, boiled of delivery. Cereal gruel cooked with milk may be lactation even if they should be separated from started at 6th month. Give new born infants no food or drink other than porridge, biscuits, mashed potatoes, mashed vegetables, breast milk unless medically indicated. Practice rooming-in – allow mothers and infants and spongy idli in the south and dhokla in Gujarat can to remain together – 24 hours a day. Give no artificial teat or pacifier to breastfeeding may eat solid foods freely but a major part of diet should infants. Foster the establishment of breast feeding support preferably till adolescent age. While introducing solid group and refer mothers to them on discharge foods, the following general precautions should be from the hospital or clinic. Infant Foods Act 1992 • Go on increasing the quantity and frequency of the Government of India has made effort for regulation of supplement. The act prohibits advertising of infant milk gradually add other articles of diet in the same manner. Salient features: Thus eating wheat and pulses together provides • Promotion to public: No person shall advertise, better quality of proteins than eating them separately. The mother is more receptive to family planning advice Baby Friendly Hospital Initiative was launched in 1992 during pregnancy. Also, tubal ligation can be easily as part of the ‘Innocenti Declaration’ on promotion, performed soon after delivery, when the size of the protection and support of breastfeeding. Every postnatal case should be advised about communicated to all health care staff. In comparison with the weight of Only the services for the preschool child will be described breastfed infants in Europe and the United States, the here. Secondly, few of the infants were fully This is basically achieved through health education to breastfed, and of those who were breastfed many were the mother as follows: breastfed for only a short period. Euro-Growth 2000 Charts: Data were collected from Growth Monitoring subjects born between 1990 and 1993 were followed longitudinally from birth to 5 years. The study consisted of two parts, • To identify severely underweight children who need a longitudinal study in which subjects were followed special care and feeding at home and referral from birth to 2 years of age, and a cross-sectional study advice. Because of the children) as well as epidemiological use (groups of many differences, only a few general statements can be children). Each box contains 12 small at the lower percentiles, whereas Euro-Growth squares representing 12 months, i. These are called reference lines or Z score lines Pink border growth chart is for girls and blue border and are used to compare and interpret the growth chart is for boys. The pattern of the child and assess the baby’s nutritional horizontal line at the bottom of the chart is the X axis, status. The first top curve line on the growth chart is the which is for recording the age of the child for five years median which is generally speaking, the average. The vertical line at other two curve lines are below the average and are at the far left of the chart is the Y axis – meant for a distance. Weight of all normal and healthy children, recording the weight of the child from birth onwards plotted on the growth chart, fall above 2nd curve (dark and is called ‘weight axis’. One information box has also been provided on the • Exclusive breastfeeding for first 6 months of life is upper left hand side of each growth chart. A growth curve is formed by joining the plotted points on developed on infants exclusively breastfed for 6 a growth chart. From • We must know how children should grow, rather direction of the curve it will be evident whether a child how they are growing. But new charts are separate for boys and girls, since boys and girls grow • Earlier, the Indian Academy of Paediatrics used differently. Age is recorded in Assessment of the nutritional status of the child the growth chart as follows (Table 30. According to age, a dot is plotted on the vertical a significant change in the child’s growth. If the shift is toward the is 8½ months old, the point will be plotted on the line 1st curve (green), this is probably a good change. This dot is extended on the occasionally crossing above and below it, this is also vertical line on the month axis upwards to plot weight- fine. Similarly a dot is placed on the horizontal line or 3rd curve (orange) this indicates a problem or risk which shows weight measurement. If this shift is noticed in time, it may be extended on the horizontal weight measurement line possible to intervene early and prevent further on the weight axis towards right to the point where it downward progression. A dot is placed on the line where the Immunizations should be performed according to the two lines intersect. A circle is drawn around the dot, so universal Immunization Program as described later. The as to know the position of the plotted weight for weight- mother should be cautioned about domestic and street for-age. Position of the plotted weight is noted with accidents to which the child is exposed. The child is growing well and is healthy Flat growth curve Growth pattern is dangerous; indicates child is not growing adequately and is not gaining weight, known as stagnation. This danger is plotted weight-for-age clearly expressed by Jelliffe as follows: “Well baby clinics Position of the plotted point Interpretation of nutritional that are expected to function on their own-are generally status expensive failures.

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Additional energy is required to pump the calcium ions involved in the control of contraction and for other cellular functions as well buy kamagra polo 100 mg online erectile dysfunction neurological causes. Creatine phosphate is the most important storage form of high-energy phosphate; together with some other smaller sources kamagra polo 100 mg online impotence from prostate removal, this energy reserve is sometimes called the creatine phosphate pool purchase 100 mg kamagra polo overnight delivery erectile dysfunction net doctor. Glycolysis, an anaerobic pathway, and oxidative phosphorylation, an aerobic pathway, are the two major metabolic paths that supply energy to the energy-requiring reactions in the cell and to the mechanisms that replenish the creatine phosphate pool. Glucose for the glycolytic pathway may be derived from circulating blood glucose or from glycogen, which is the polymer storage form of glucose in skeletal muscle and liver cells. Glucose is the preferred fuel for skeletal muscle contraction at higher levels of exercise. At maximal work levels, almost all the energy used is derived from glucose produced by glycogen breakdown in muscle tissue and from blood-borne glucose from dietary sources. Muscle has performance limitations based on its structure and energy-conversion processes; as such, its efficiency is much <100%, and it produces relatively large quantities of heat, which must be dealt with by the organism that it is serving (see Chapter 28). Metabolic differences among muscle fibers affect their ability to sustain contraction. Although the basic structural features of the sarcomeres and the thick–thin-filament interactions are essentially the same among skeletal muscles, the chemical reactions that supply the contractile system with energy vary. A typical skeletal muscle usually contains a mixture of fiber types with different metabolic properties. Red fibers utilize oxidative metabolism for contraction and owe their color to the presence of myoglobin, which is a hemoglobin-like molecule that can bind, store, and release oxygen. The quadriceps and gluteal muscles that continually maintain posture while standing are examples of this type of muscle. Red muscle fibers are divided into slow-twitch fibers and fast-twitch fibers on the basis of their contraction speed. White muscle fibers, which contain little myoglobin, are fast-twitch fibers that rely primarily on glycolytic metabolism. They contain significant amounts of stored glycogen, which can be broken down rapidly to provide a quick source of energy. They are responsible for quick, short muscle movements such as those involved with movement and blinking of the eyes. Fast muscles, both white and red, not only contract rapidly but also relax rapidly. In such muscles, the energy used for calcium pumping can be as much as 30% of the total consumed. Fast muscles are supplied by large motor axons with high conduction velocities; this correlates with their ability to make quick and rapidly repeated contractions. The emerging science of epigenetics is revealing potential mechanisms by which external conditions from the environment, such as exercise, inactivity, proper nutrition, malnutrition, and exposures to medication or even environmental toxins, cannot just influence the body acutely but affect the genome through epigenetic mechanisms. Epigenetics is an evolving science that seeks to describe and explain how gene expression is changed independent of genotype yet can be heritable by subsequent generations. This provides a mechanism, for example, as to how environmental/nutritional conditions to which parents are exposed can be passed on to not just their immediate offspring, in the form of altered suppression or activation of their genes, but also possibly onto the next several generations as well. Insights into epigenetic effects on muscle cell growth, differentiation, and regeneration have beneficial potential for rehabilitative medicine and perhaps even set the stage for the ability to grow and replace muscle cells lost from trauma or disease. Recent experimental studies have provided evidence for epigenetic modification of muscle type. This cannot occur unless epigenetic changes occurred in the muscle precursor cells (i. Obesity has been shown to induce epigenetic changes in a lipogenic muscle gene that alters the muscle cell to be smaller and thus better able to store fat. This muscle feature is a hallmark of type 2 diabetes, which has been correlated with obesity. Acetylation and deacetylation of histones are considered epigenetic modes of altering gene expression. Exercise is known to have beneficial effects on several tissues in the body besides skeletal muscle. Recent evidence that exercise creates epigenetic marks in tissues beyond just skeletal muscle suggests that muscle may not only be an epigenetic target, but that itself may send signals to other tissues to induce epigenetic changes in them as well. As introduced in Chapter 1, muscle cells are now believed to have an endocrine function via secretion of myokines. Myokines released from skeletal muscle have been shown to “cross-talk” with adipocytes and have been suggested to attenuate the insulin resistance and low-grade inflammation associated with type 2 diabetes (such attenuation is a known beneficial effect of regular exercise). In contrast, a lack of beneficial myokine secretion with aging of muscle has been suggested to link deterioration of that tissue to increased incidence of age-related neuromotor, neurocognitive, metabolic, and oncologic disorders, although evidence in support of this postulate is more correlative than causative at this time. Recall that skeletal muscle can only be activated intermittently and requires a signal from a neuron innervating it to do so. In contrast, smooth muscle can both contract and relax actively on its own, as well as in response to neural signals, hormonal signals, chemical signals, or physical signals. Smooth muscle can exhibit twitch contraction, summed twitch contraction, or graded contractions, that is, smooth increments in contraction or relaxation rather than the “all-on-all-off” characteristic of skeletal muscle. In blood vessels, for example, vascular smooth muscle must be partially tonically active at all times (i. This seemingly energy-intensive process is mitigated by the fact that smooth muscle, unlike skeletal muscle, contains special crossbridge cycling switching mechanisms that allow it to sustain high force at low levels of energy expenditure. Smooth muscle outside the cardiovascular system is often labeled visceral smooth muscle. This muscle plays a key role in the functions of the digestive system, where it physically manipulates gut contents in complex ways during digestion and moves materials and fluids along the alimentary tract. Visceral smooth muscle in the gut, therefore, must be able to contract or relax phasicly in response to the many different types of neural, chemical, and physical signals involved in digestion. Some smooth muscles such as that in sphincters (circular bands of muscle that can stop flow in tubular organs) can remain contracted and closed for long periods but then relax and open transiently before contracting and closing again. Sphincters at the ends of the esophagus, the stomach, and rectum operate in this fashion (see Chapter 25). Smooth muscle in still other visceral organs remains relaxed most of the time but then can contract strongly in response to physiologic stimuli. Smooth muscles in the esophagus, urinary bladder, and gall bladder behave in this manner. As an ultimate case of this type of behavior, the smooth muscle of the uterus is relatively inactive during most of a woman’s life but contracts and relaxes rapidly and powerfully over several hours during parturition. Multiple smooth muscle contraction and relaxation patterns can be produced by neural, humoral, chemical, physical, and intrinsic stimuli. Contractile activity in smooth muscle is initiated in markedly different ways compared to that for skeletal muscle. In the previous section, it was shown that skeletal muscle cannot contract without neural input to the muscle cells. Furthermore, the neural inputs to skeletal muscle fibers (via motor neurons) are often initiated from conscious thought and are, therefore, voluntary. Although smooth muscle is indeed innervated (predominantly by postganglionic sympathetic fibers), innervation is not necessary for smooth muscle contraction and modulation of smooth muscle contraction is totally involuntary.

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Surgical pyloroplasty used to be done together with vagotomy for the treatment of peptic ulcer disease and might still be done at times in patients with idiopathic gastroparesis order 100mg kamagra polo fast delivery prices for erectile dysfunction drugs. Both resection and pyloroplasty compromise mixing and renders the stomach incontinent for solids order 100mg kamagra polo with amex erectile dysfunction protocol download free. Premature and rapid gastric emptying (“dumping”) of solids and liquids into the duodenum in these cases causes hyperglycemia discount 100 mg kamagra polo overnight delivery list all erectile dysfunction drugs. Vagotomy, done at the same time as pyloroplasty, impairs receptive relaxation and accommodation in the gastric reservoir and exacerbates the dumping symptoms of anxiety, sweating, strong hunger, dizziness, weakness, and palpitations. The dumping syndrome is managed by restricting the patient to small meals of complex carbohydrates ingested together with small volumes of liquids. The rate of gastric emptying decreases as the acidity of the gastric contents increases. Meals with a low caloric content empty faster than those with a high caloric content. The neurophysiologic control mechanisms for gastric emptying keep the caloric delivery rate to the small intestine within a narrow range, regardless of the source (i. Fat is emptied at the slowest rate and is the most potent inhibitor of gastric emptying. This inhibition involves the enteroendocrine release of cholecystokinin in the upper small intestine. For digestible particles a lag phase is required for the grinding action of the antral pump to reduce the particle size to a sufficiently small size for emptying. However, not all particles are released from the stomach at the same time and the smaller particles are selectively released first (sieving action of the stomach). The emptying of a solid or semisolid meal is preceded by a lag phase, which is the time required for particles to be reduced to a sufficiently small size for emptying. Contractions of the duodenum and hormonal signals arising from there significantly influence gastric emptying. Transit of material through the small intestine is influenced by three fundamental patterns of motility: (1) the interdigestive pattern, (2) the digestive pattern, and (3) power propulsion. The segmentation appearance is the result of peristaltic contractions, which propagate for only short distances and occur simultaneously at multiple sites along the bowel. Receiving segments with an expanded lumen separate circular muscle contractions that form short propulsive segments on either end of the receiving segment (Fig. Each propulsive segment jets the contents in both directions into the opened receiving segments, where stirring and mixing occur. This happens continuously at closely spaced sites along the entire length of the small intestine. Propulsive segments separated by receiving segments occur randomly at multiple sites along the small intestine. Receiving segments convert to propulsive segments, whereas propulsive segments become receiving segments. Digestion of food no longer occurs in the large intestine, but absorption of H O, minerals, and vitamins and fecal compaction do occur. Contractile2 activity occurs continuously in the normally functioning large intestine. Whereas the contents of the small intestine move through sequentially with no mixing of individual meals, the large bowel contains a mixture of the remnants of several meals ingested over 3 to 4 days. The arrival of undigested residue from the ileum does not predict the time of its elimination. The hepatic flexure is the boundary between ascending and transverse colon; the splenic flexure between transverse and descending colon. The longitudinal smooth muscle layer in humans is restricted to bundles of fibers called taeniae coli. Power propulsion occurs in the transverse and descending colon and fits the general pattern of neurally coordinated peristaltic propulsion. Increased delivery of ileal contents into the ascending colon, as occurs following a meal, often triggers mass movements into the colon. The increased incidence of mass movements and generalized increase in segmental movements following a meal is called the gastrocolic reflex. Power propulsion in the healthy bowel usually starts in the middle of the transverse colon and is preceded by relaxation of the circular muscle and the downstream disappearance of haustral contractions. Chemoreceptors and mechanoreceptors in the cecum and ascending colon provide feedback for controlled delivery of the ileum contents into the ascending colon, analogous to gastric emptying into the small intestine. Neuromuscular mechanisms, analogous to adaptive relaxation in the gastric reservoir, permit filling of the ascending colon to occur without large increases in intraluminal pressure. Dwell time in the ascending colon is long when compared to the small intestine but short when compared to the transverse colon. This suggests that the ascending colon is not the primary site for the storage, mixing, and removal of H O from the feces. The significance of retrograde propulsion in this region is uncertain; it may be a mechanism for temporary retention of the contents in the ascending colon. Forward propulsion is probably controlled by feedback signals related to the fullness of the transverse colon. Motility of the transverse colon is specialized for storage and removal of water from the feces. The contents of the transverse colon are retained for about 24 hours, suggesting that this is the primary location for the removal of H O and electrolytes and the storage of solid feces. In this pattern, ringlike contractions of the circular muscle divide the colon into pockets called haustra (Fig. Haustration is reminiscent of the mixing (segmentation) movements in the small intestine (see Fig. Haustral formation differs from small intestinal segmentation in that the contracting and receiving segments on either side remain in their respective states for extended periods of time. Ongoing activity of inhibitory motor neurons maintains the relaxed state of the circular muscle in the pockets. Inactivity of inhibitory motor neurons permits the contractions between the pockets. The most common fasting pattern is for the contracting segment to propel the contents in both directions into receiving segments (i. This mechanism mixes and compresses the semiliquid feces in the haustral pockets and probably facilitates the absorption of H O without any net forward propulsion as happens when2 sequential migration of the haustra occurs along the length of the bowel. Power propulsion in the descending colon is responsible for mass movements of feces into the sigmoid colon and rectum. The descending colon is a conduit from transverse to sigmoid colon and feces are not retained for very long. Luminal contents begin to accumulate in the sigmoid colon and rectum about 24 hours after entering the cecum. This suggests that the transverse colon is the main fecal storage reservoir, whereas the descending colon serves as a conduit without long-term fecal retention. Power propulsion in the descending colon drives mass movements of feces into the sigmoid colon and rectum.