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As new research and clinical experience broaden our knowledge generic 40mg prednisolone fast delivery, changes in treatment and drug theraphy are required generic 40 mg prednisolone visa. The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication discount 5mg prednisolone with amex. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this book is accurate and that changes have not been made in the recommended dosages or in the contraindications for administration. Sadly, there is not much awareness about the neurological illnesses and the patient and the family members are suddenly overcome with anxiety and apprehension, and do not know how to cope with neurological problems. I am confident that the reader will find it extremely useful and it will help the patients and relatives to cope with various neurological problems. He has also emphasized on preventive aspects of the illness and side effects of the commonly used drugs and in particular care to be taken for drugs used for prolonged periods. This book should be useful not only for the patient and the caretakers but also for the medical students and the physicians and those involved in the management of neurological illnesses. Singhal Professor & Head Department of Neurology Bombay Hospital Institute of Medical Sciences Mumbai. It comprises of 100 billion neurons or nerve cells linked in networks that give rise to an amazing array of cognitive functions such as intelligence, creativity, emotion, consciousness and memory. Over the past few decades, intense research in clinical and basic neuroscience has enabled us to gradually unravel the biological foundations of complex mental functions and diseases that impair these functions. In my dealings with patients and their relatives for more than a decade I have seen first-hand how anxious they are to gather information on diseases that afflict the brain. Much of my personal experience in this matter comes from my years of practising medicine in my clinic “Neurology Centre” in Ahmedabad, Gujarat as well as in the renowned V S General Hospital, Dr. Since such information was not available in Gujarati (a local language of Gujarat state) or in other languages in a comprehensive manner in one place, I got the inspiration that I should write something about the diseases of the brain and nervous system. In September 1999, a few lectures of mine on various diseases of the brain were arranged on Akashvani - Radio during the morning programme ‘Pahelu Sukh’ - and on Doordarshan - Television `Swasthaya Sudha’. Thus, I was inspired to write about major brain disorders and this project took shape in the form of a “Health Education Guide”. I would like to mention here that in the month of August 2000, the first edition of this book in Gujarati language was released by his Excellency the Governor of Gujarat, Shri Sundersingh Bhandari in the presence of dignitaries of Ahmedabad city, including Hon. There was a tremendous appreciation from all quarters including patients and their relatives, physicians, family doctors and well-wishers. Singhal (Bombay Hospital), with whom I had an opportunity to learn neurology, advised me to make an English version of the book so that people from other states also can be benefited and thus this book is before you. Singhal who has gone through this English version and has blessed me by writing a foreword for this book. It can be understood that the main aim of this book being imparting knowledge about healthcare and awareness regarding diseases to the general public, in depth information according to the medical science has not been given. An attempt has been made to include the latest researches and drugs in this book, but it should be kept in mind that new researches are going on continuously and new discoveries are being made everyday. Here, I would like to clarify that medicines are to be taken only under the advice of the doctor and one should not try to self medicate. The contribution of my wife Chetna Shah has also been tremendous and it was only due to her excellent time management, that I could write about all these diseases properly, in spite of constraints of time. My friend Shri Upendra Divyeshvar has taken personal interest and has read each and every manuscript right from the beginning to the publishing of the book. Oza who was kind enough to give constructive suggestions about the Gujarati version of this book and to write an introduction for that book. After reading this book if at least a few readers will awaken to the concept of prevention of diseases and if timely diagnosis is able to save even a few lives, I shall feel happy. Sudhir V Shah is reflecting in this book, a simple and lucid presentation of his experiential hindsight, for the cause of Health Education. The human race is superior and special to the other living beings due to the unique anatomy and physiology of human nervous system. Especially the cortex of the brain (the grey layer of the brain surface) is highly evolved and complex. Other organs of the human beings are similar or even weaker as compared to those of the other animals, but the humanrace proves superior because of the exceptional mental power & ability, as well as logic, memory and vocabulary all due to the cortex of the brain. According to an estimate, an average person uses about 5 to 10 percent of his brain capacity, but a genius uses his brain up to 15 percent. Therefore it can be said that any person can become a genius by learning how to use his brain more and putting it frequently to task. Though our brain weighs only 1 to 2 percent of total body weight, it uses up approximately 25 percent of the oxygen intake of the body and 70 percent of the total glucose available to the body. The lower group of chordate animals do not have a developed organ like brain and therefore their functions are autonomous. The brain rests securely inside the skull and is covered by three membranes to protect against friction. It extends right from the centre of the brain to the spinal cord, as well as in the outer membranes of the brain and spinal cord. F range from assisting the metabolism of the brain to the prevention of friction: As the cells of the brain perform complex functions, they need extra nourishment and oxygen. If the supply of blood and oxygen to the cortex stops completely for more than five minutes, the cortex stops functioning permanently, resulting in death. Cerebellum is located in the posterior region of the skull and is divided into two - left and right - parts. The brain stem, which joins the two sides of the brain, consists of mid-brain, pons and medulla oblongata, which truncate into the spinal cord. The frontal lobe is basically responsible for the movements of the limbs, the personality and the behavior of an individual. The temporal lobe and the limbic system are associated with memory as well as basic instincts, and according to some it can be the seat of special powers like the sixth sense, etc. The left side of the brain of a right handed person (who uses his right hand for writing, eating, throwing etc. However, others believe that the mana may exist either in the temporal lobe, in the limbic circuit, or in the pineal gland of the brain. It is actually a complex biochemical and electromagnetic process and it is the limitation of our science and brain that we do not have the proper understanding of this subject. Similarly, Hypothalamus is an important centre and is the final control point of the sympathetic and the parasympathetic nervous system. It is associated with functions of our involuntary muscles, as well as physical processes like stress. This type of nervous system autonomously controls the extremely important functions of the heart, intestines, eyeballs, blood pressure, respiration etc. We have thus studied the anatomy of the brain, but brain has some amazingly unique features also, which make man superior to all living beings. There is a kind of electrical impulse emanating from the cells of the brain, which is rhythmic and constant. This electrical impulse travels chemically across one nerve cell to the other through neurotransmitters and receptors which form an amazing network and can transmit information from one part to another in a 1000th fraction of a second.

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The phospholipid heads face outward 20mg prednisolone fast delivery, one layer exposed to the interior of the cell and one layer exposed to the exterior (Figure 3 order prednisolone 20mg otc. Because the phosphate groups are polar and hydrophilic purchase prednisolone with paypal, they are attracted to water in the intracellular fluid. Because the lipid tails are hydrophobic, they meet in the inner region of the membrane, excluding watery intracellular and extracellular fluid from this space. The cell membrane has many proteins, as well as other lipids (such as cholesterol), that are associated with the phospholipid bilayer. An important feature of the membrane is that it remains fluid; the lipids and proteins in the cell membrane are not rigidly locked in place. Two different types of proteins that are commonly associated with the cell membrane are the integral proteins and peripheral protein (Figure 3. A channel protein is an example of an integral protein that selectively allows particular materials, such as certain ions, to pass into or out of the cell. Another important group of integral proteins are cell recognition proteins, which serve to mark a cell’s identity so that it can be recognized by other cells. A receptor is a type of recognition protein that can selectively bind a specific molecule outside the cell, and this binding induces a chemical reaction within the cell. One example of a receptor-ligand interaction is the receptors on nerve cells that bind neurotransmitters, such as dopamine. When a dopamine molecule binds to a dopamine receptor protein, a channel within the transmembrane protein opens to allow certain ions to flow into the cell. A glycoprotein is a protein that has carbohydrate molecules attached, which extend into the extracellular matrix. The carbohydrates that extend from membrane proteins and even from some membrane lipids collectively form the glycocalyx. The glycocalyx is a fuzzy-appearing coating around the cell formed from glycoproteins and other carbohydrates attached to the cell membrane. For example, it may have molecules that allow the cell to bind to another cell, it may contain receptors for hormones, or it might have enzymes to break down nutrients. They give each of the individual’s trillions of cells the “identity” of belonging in the person’s body. This identity is the primary way that a person’s immune defense cells “know” not to attack the person’s own body cells, but it also is the reason organs donated by another person might be rejected. Peripheral proteins are typically found on the inner or outer surface of the lipid bilayer but can also be attached to the internal or external surface of an integral protein. Some peripheral proteins on the surface of intestinal cells, for example, act as digestive enzymes to break down nutrients to sizes that can pass through the cells and into the bloodstream. Transport across the Cell Membrane One of the great wonders of the cell membrane is its ability to regulate the concentration of substances inside the cell. A membrane that has selective permeability allows only substances meeting certain criteria to pass through it unaided. In the case of the cell membrane, only relatively small, nonpolar materials can move through the lipid bilayer (remember, the lipid tails of the This OpenStax book is available for free at http://cnx. However, water-soluble materials—like glucose, amino acids, and electrolytes—need some assistance to cross the membrane because they are repelled by the hydrophobic tails of the phospholipid bilayer. All substances that move through the membrane do so by one of two general methods, which are categorized based on whether or not energy is required. Passive transport is the movement of substances across the membrane without the expenditure of cellular energy. Passive Transport In order to understand how substances move passively across a cell membrane, it is necessary to understand concentration gradients and diffusion. Molecules (or ions) will spread/diffuse from where they are more concentrated to where they are less concentrated until they are equally distributed in that space. If a bottle of perfume were sprayed, the scent molecules would naturally diffuse from the spot where they left the bottle to all corners of the bathroom, and this diffusion would go on until no more concentration gradient remains. In both cases, if the room is warmer or the tea hotter, diffusion occurs even faster as the molecules are bumping into each ° other and spreading out faster than at cooler temperatures. Whenever a substance exists in greater concentration on one side of a semipermeable membrane, such as the cell membranes, any substance that can move down its concentration gradient across the membrane will do so. Neither of these examples requires any energy on the part of the cell, and therefore they use passive transport to move across the membrane. Because cells rapidly use up oxygen during metabolism, there is typically a lower concentration of O inside the cell than outside. As a result, oxygen2 will diffuse from the interstitial fluid directly through the lipid bilayer of the membrane and into the cytoplasm within the cell. This mechanism of molecules moving across a cell membrane from the side where they are more concentrated to the side where they are less concentrated is a form of passive transport called simple diffusion (Figure 3. Charged atoms or molecules of any size cannot cross the cell membrane via simple diffusion as the charges are repelled by the hydrophobic tails in the interior of the phospholipid bilayer. Solutes dissolved in water on either side of the cell membrane will tend to diffuse down their concentration gradients, but because most substances cannot pass freely through the lipid bilayer of the cell membrane, their movement is restricted to protein channels and specialized transport mechanisms in the membrane. Facilitated diffusion is the diffusion process used for those substances that cannot cross the lipid bilayer due to their size, charge, and/or polarity (Figure 3. Although glucose can be more concentrated outside of a cell, it cannot cross the lipid bilayer via simple diffusion because it is both large and polar. To resolve this, a specialized carrier protein called the glucose transporter will transfer glucose molecules into the cell to facilitate its inward diffusion. Channel proteins are less selective than carrier proteins, and usually mildly discriminate between their cargo based on size and charge. Their diffusion is facilitated by membrane proteins that + form sodium channels (or “pores”), so that Na ions can move down their concentration gradient from outside the cells to inside the cells. There are many other solutes that must undergo facilitated diffusion to move into a cell, such as amino acids, or to move out of a cell, such as wastes. Because facilitated diffusion is a passive process, it does not require energy expenditure by the cell. Water also can move freely across the cell membrane of all cells, either through protein channels or by slipping between the lipid tails of the membrane itself. If a membrane is permeable to water, though not to a solute, water will equalize its own concentration by diffusing to the side of lower water concentration (and thus the side of higher solute concentration). The movement of water molecules is not itself regulated by cells, so it is important that cells are exposed to an environment in which the concentration of solutes outside of the cells (in the extracellular fluid) is equal to the concentration of solutes inside the cells (in the cytoplasm). When cells and their extracellular environments are isotonic, the concentration of water molecules is the same outside and inside the cells, and the cells maintain their normal shape (and function). A solution that has a higher concentration of solutes than another solution is said to be hypertonic, and water molecules tend to diffuse into a hypertonic solution (Figure 3.

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The receptor 7 4 density is very high (3x 10 ) per end plate buy prednisolone with amex, which is enough for the 10 quanta of Ach released order discount prednisolone on line. Inactivation of acetylcholine The concentration of Ach at the end plate remains high briefly for it is hydrolyzed rapidly by the enzyme AchE into choline and acetate cheap prednisolone 10mg without a prescription. Synapse and neuronal integration A neurotransmitter transmits the signal across a synapse. Classically, a neuron to neuron synapse is a junction between an axon terminal of one neuron and the dendrites or cell body of a second neuron. Inhibitory and excitatory synapses Some synapses excite the post synaptic neuron whereas others inhibit it, so there are 2 types of synapses depending on the permeability changes in the post synaptic neuron by the binding of neurotransmitter with receptor site. At an excitatory synapse, the neurotransmitter receptor combination opens sodium and potassium channels within the subsynaptic membrane, increasing permeability to both ions. Removal of neurotransmitter It is important that neurotransmitter be inactivated or removed after it has produced desired response in the postsynaptic neuron, leaving it ready to receive additional message from the same or other neuron inputs. The neurotransmitter may diffuse away from the cleft, be inactivated by specific enzyme within the subsynaptic membrane, or be actively taken back up in to the axon terminal by transport mechanism in the presynaptic neuron for storage and release at another time. Characteristics of chemical transmission • Chemical transmission is unidirectional • Chemical transmission is graded, with the amount of transmission chemical released dependent on the frequency of stimulation of the presynaptic neuron. The muscle cells are the real specialists having contractile proteins present in skeletal, cardiac and smooth muscle cells. They are capable of shortening and developing tension that enables them to produce movement and do work. Skeletal muscle is the largest body tissue accounting for almost 40% of the body weight in men and 32% in women. Muscles are categorized as striated and non-striated/ smooth muscles and also typed as voluntary and involuntary subject to innervations by somatic or autonomic nerves and whether subject to voluntary or not subject to voluntary control. Microstructure of Skeletal muscle Skeletal muscles contract in response to signals from its innervating somatic nerve that releases acetylcholine at its terminals that starts the muscle action potentials. A muscle fiber is fairly large, elongated and cylindrical shaped ranging from 10-100 μm in diameter and up to 2. A muscle is made up of a number of muscle fibers arranged parallel to each other and wrapped by connective tissue as a bundle. A single muscle cell is multi-nucleatd with abundant number of mitochondria to meet its high energy demands. Each cell has numerous contractile myofibrils, constituting about 80% of volume of muscle fibers extending the entire length. Each myofibril consists of the 81 thick myosin filaments (12-18 nm diameter) and thin actin filaments (1. A relaxed muscle shows alternating dark bands (A band) and light bands (I band) due to slight overlapping of thick and thin filaments under the microscope. In the middle of each I band is a dense vertical Z line, actually a flattened disc like cytoskeletal protein that connects the thin actin filaments of 2 adjoining sarcomers. Excitation - Contraction Coupling refers to the sequence of events linking muscle excitation to mechanical contraction. At neuro-muscular junction of skeletal muscle neurotransmitter Ach released from innervating motor neuron results in muscle contraction. When an action potential travels down the T- tubules, the local depolarization activates the voltage-gated dihydropyridine receptors. Tropomyosin-troponin complex is repositioned; ++ the released Ca binds with troponin C exposing the binding sites on the actin molecule so that they can attach with the myosin cross bridges at their specific sites. This stiffness of death is a generalized locking in place of skeletal muscle beginning 3-4 hours after death and completed in about 12 hours. The onset of the resultant contraction response lags behind the action potential because the excitation- contraction coupling process must occur before cross bridges activity begins. As a matter of fact, the action potential ends before the contraction mechanism even becomes operational. The contraction time lasts about 50 msec, although it varies with 84 the type of muscle fiber. The relaxation time lasts slightly longer than contraction time, another 50 msec or more. When an action potential depolarizes the presynaptic membrane, the transmitter cannot activate enough receptors to evoke an action potential in the muscle fiber. Autoimmune thymitis Enlarged thymus may also be another cause of myasthenia gravis. Autoimmune thymitis associated with the release of a hormone called thymopoietin (or thymin). Within minutes, some of these paralyzed persons can begin to function normally Muscle twitch Contraction of a whole muscle can be of varying strength. A twitch, which is too short and too weak for any use in the body, is produced as a result of a single action potential in a muscle fiber. Muscle fibers are arranged into a whole muscle and function with cooperation producing contraction of varying grades of strength stronger than a twitch. The number of muscle fibers contracting within a muscle The tension developed by each contracting fiber. Motor unit: Each whole muscle is innervated by a number of different motor neurons. One motor neuron innervates a number of muscle fibers, but each muscle fiber is supplied by only one motor neuron. Muscles producing very precise, delicate movement such as extraocular eye muscles and the hand digit muscles contain a few dozen muscle fibers. Muscles designed for powerful, coarsely controlled movement such as those of legs, a single motor unit may have 1500-2000 muscle fibers. This tension generated by the contractile elements is transmitted to the bone via the connective tissue and tendon before the bone can be moved. Intracellular components of the muscle such as the elastic fiber proteins and connective tissue collagen fibers have a certain degree of passive elasticity. There are 2 primary types of movement depending on whether the muscle changes length during contraction. Isotonic contraction: In this type, muscle tension remains constant as the muscle changes length. Isometric contraction: In this type, the muscle is prevented from shortening, so tension developed at constant muscle length. Isotonic contractions are used for body movements and for moving external objects. The submaximal isometric contractions are important for maintaining posture and for supporting the object in a fixed position. During a given movement, a muscle may shift between Isotonic and isometric contractions. Isotonic contraction 90 Steps of Excitation-contraction coupling and relaxation • Ach released from a motor neuron terminal initiates an action potential in the muscle cell that is conducted over the entire surface of the muscle cell membrane.

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