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By J. Rufus. Boston Conservatory.

Under hormonal control the testes can in- crease in size by 300- to 500-fold (Figure 29 order levitra plus overnight delivery. In this Eclectus Parrot order genuine levitra plus line, the right testicle was of normal size and enlargement of the left testicle prominent pattern of blood vessels on the testicular was caused by a seminoma (courtesy of Kim Joyner) buy discount levitra plus 400 mg line. During the breeding season, yel- lowish testes may turn white, while melanistic testes may change from black-grey to grey-white. Birds that do not have this structure have Convoluted seminiferous tubules comprised of germ little sperm storage capacity. Proctodeal glands de- (spermatogonia) and Sertoli cells make up the bulk velop to varying degrees in birds and undergo hyper- of the testes and are responsible for spermatogene- trophy in response to increases in steroid sex hor- sis. Melanistic cells responsible for The ejaculatory papillae (terminal projectory papil- the color of the testicles are found in the same loca- lae of the ductus deferens), paracloacal vascular bod- tion. Mature spermatozoa exit via straight tubules ies, cloacal folds and the phallus are involved with into the rete testis, which connects the testis to the male copulation and are variably developed in avian cranial aspect of the epididymis. The epididymis, considered ves- cular bodies contribute to the lymphatic erection of tigial in birds, lies along the dorsomedial aspect of either cloacal or phallic tissue, and release a lymph- the testes and is concealed from view during laparo- like transparent transudate when engorged. In some species of studied, it is known that ratites, tinamous, Anserifor- birds, the epididymis is connected throughout its mes, some members of the family Cracidae and one length by tubules to the rete testis. The ductus during copulation, but semen transfer occurs by di- deferens is under hormonal control and is more con- rect cloaca-to-cloaca contact without intromission. In the non- breeding season, it blends indistinguishably with the The phallus, if present, is located ventrally in the ureter and kidneys. Dysfunction or disease of the phallus the dorsal wall of the urodeum, which functions as a can cause reproductive failure. The last two to three millime- not have a phallus, and copulation is accomplished ters of the ductus deferens project into the urodeum by an eversion of the cloacal wall, which contains the forming a papilla. In passerine birds and budgeri- slightly raised papilla that transfers semen to the everted orifice of the oviduct. The Large Psittaciformes 9-10 million/ml 50-100 µl transient time required for sperm to pass from the Emu 4. Live- in the efferent and connecting ductules of the dead counts, computer-assisted measurement of epididymis and ductus deferens accompanies the spermatozoal swimming speed and metabolic rates of spermatozoa. Seminal plasma composition can vary semen can also be used to determine semen quality. A lymph-like fluid, called “transparent initiates the growth of seminiferous tubules and re- fluid,” originates in the proctodeum and mixes with sults in increased spermatogenesis. The function of this velopment of the testosterone-producing cells of Ley- fluid is uncertain, but it does contain blood clotting 86 dig. Testicular growth is approximately logarithmic agents that are deleterious to the spermatozoa. Higher In Passeriformes, spermatozoa are of the complex levels of testosterone are then responsible for male type, which can be differentiated from the simple sexual behavior. Testosterone increases spermato- type of sperm found in other birds by their predomi- genesis and growth of accessory reproductive organs, nantly spiral structure. Testoster- one also causes manifestation of secondary sexual Semen can be collected from birds for artificial in- characteristics such as comb growth, plumage and semination, to evaluate its reproductive potential, to detect disease and to distinguish species or subspe- cies. Normal semen is light white to milky, and brown, green or red discoloration may be due to fecal contamination or cloacal hemorrhage from over-exu- berant semen collection. Production of fertile eggs is the best indicator of sperm viability, but determining sperm count and motility can be used to estimate function (Table 29. Sperm concentration can be determined by mounting semen on a hanging drop slide, use of a spermatocrit or direct counting in a hemocytometer. This behavior can occur in pairs that have been stable essary prior to evaluation. The precise cause of these attacks the percentage of spermatozoa moving in a forward is unknown, but they are most common in the early part of the breeding season. Males generally become reproductively active motion as seen under high magnification. Live-dead earlier than the females, and a hen’s failure to respond to a counts using an eosin-nigrosin stain make it possible soliciting male may facilitate an attack. In this cockatoo hen, most of the beak and a part of the skull had been removed by the male. Specific reproductive behav- infection, nutritional insufficiencies, obesity, lack of ior affected by testosterone, and probably mediated exercise, heredity, senility and concurrent stress such by other hormones, includes territorial aggression, as environmental temperature changes or systemic courtship, copulation, nest building, incubation and disease. Testosterone levels are highest in ing birds out of season, egg production in virginal hens many species at the time of establishment and de- and a persistent cystic right oviduct (Color 29. The severity of these complications environmental and photoperiodic stimulation in the depends on the species, the bird’s previous health, female. An egg lodged in the pelvic canal may com- cycle may account for breeding failures and mate ag- press the pelvic vessels and kidneys, causing circula- tory disorders and shock. Female Reproductive Disorders Clinical Signs Budgerigars, canaries, finches, cockatiels and love- birds most frequently have problems with dysto- cia. Two of the most common clinically recognized repro- The patient’s clinical signs will depend on the sever- ductive disorders seen in avian species are egg bind- ity of the complications. Egg binding is defined as the failure depressed, has an abnormally wide stance, is reluc- of an egg to pass through the oviduct at a normal tant to fly or perch and may show persistent wagging rate. Most companion bird species lay eggs at inter- of the tail and straining movements of the abdomen. Rear limb pa- species may vary by more than one day from the resis or paralysis may occur. Dystocia defines a condition in which the developing egg is in the caudal oviduct and is either obstructing Hens with dystocia frequently present with depression the cloaca or has caused oviduct tissue to prolapse and secondary complications that require emergency through the oviduct-cloacal opening. A complete history including information of through the oviduct can stop at various locations. A thorough but rapid occur are the caudal uterus, vagina and vaginal-cloa- physical examination can also establish contributing cal junction. Dystocias are most critical in passerines The pathogenesis of egg binding in a particular case and other small birds, many of which can survive only can be multifactorial. Common causes of dystocias are oviduct 15) with an emphasis being placed on correcting the muscle dysfunction (calcium metabolic disease, sele- most likely etiology for the dystocia. In smaller birds the displaced ventriculus may make palpation of an egg difficult. Soft-shelled eggs, shell-less eggs or eggs located cranial to the uterus can also be difficult to palpate. Suspected egg masses must be differentiated from palpable her- nias, lipomas or ascites. Radiographs are a useful confirmatory tool but may not delineate a shell-less egg. Radiographically identifying more than one egg in various stages of de- velopment is common. Therapy The most important consideration in initiating therapy for dystocia is to establish a physiologic normal state.

In vitro screening of antifungal activity using agar well diffusion method revealed all extracts (pet-ether discount 400 mg levitra plus with mastercard, ethanol order levitra plus now, methanol and ethyl acetate extracts) except aqueous extract were able to inhibit the growth of Candida albican purchase levitra plus without a prescription. The investigation was conducted via diarrhoeal test, enteropolling test and gastrointestinal transit test. Results revealed that 6g/kg dose provided significant frequencies of diarrhoeal reducing effect, anti-secretory effect and anti-motility effect. However, ethyl acetate extract more rapidly discharged the purple background when compared to that of pet-ether extract showing much higher anti-oxidant potency. Chromatographic separation of active ethyl acetate extracts yielded three curcuminoids, namely curcumin (5. Isolated curcumin, thymoquinone, kaempferol, quercetin and the beter-diketone were found to show bactericidal activity. These plant extracts were tested for antibacterial activity on 18 bacterial organisms. The test organisms include five species of Shigella, three species of Vibrio and one species of each of Klebsiella, Plesiomonas, Proteus, Pseudomonas, Salmonella and Staphylococcus. It was investigated that the plant of Phyllanthus niruri with ethanolic, 50% ethanolic and watery extracts were active on one strain of Sr. The percentage activity of the three extracts and the number of bacteria tested were 7. It was found that the watery extract of Phyllantus niruri possessed the highest antibacterial activity. The three different extracts of Piper nigrum seed had no activity on the tested bacteria. The ethanolic, 50% ethanolic and watery extract of Terminalia chebula fruit was active on three strains (23. This research deals with the study on the morphological characters of the plant and anatomical characteristies of the leaf, the stem, the barks and the root. The species being medically important for its possession of anthraquinone compounds; chemical extractions are carried out for naphthoquinone (Lawsone) tannin as gallic acid and xathone. Crude extraction is made using water, 50% ethanol, 95% ethanol, and chloroform and petroleum ether to study the pharmacological activity. The extracts were tested against 13 pathogenic bacteria, comprising 2 strains of Proteus, 2 strains of Staphylococcus, 4 strains of Shigella, 1 strain each of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi and Vibrio cholera Eltor. The effectiveness of the extracts was shown on eleven species of bacteria and test on Entamoeba histolytica, a pathogenic organism for the treatment of diarrhea and dysentery showed positive results. Study of disease morbidity and drug dispensing patterns on patients utilizing traditional medical care at the Traditional Medicine Centers in Yangon and Mandalay. Thaw Zin; Thaung Hla; Nwe Nwe Win; Win Kyi; Kyin Thein; Aye Lwin; Soe Moe; Mya Bwin; Aung Naing; Thein Hlaing; Hla Pe. With the purpose of narrowing the gap in health service coverage between urban and areas, the National Health Plan in Myanmar envisaged the development and involvement of traditional medicine in the support of the primary health care. For the delivery of the traditional medical care to effectively support the National Health Plan, the first step is the development of a list of essential drugs which will offer the widest possible coverage of the prevalent morbidity effecting the population. This study was conducted with the aim to identify the prevalent morbidity pattern encountered in traditional medical care and the drugs most needed to treat which ailment, to study the drug dispensing patterns and to find out the rationale behind such prescribing, and finally, to develop a common treatment schedule for the diseases identified above so as to get as overview of the cost of the traditional medical care. The records and charts of all patients who attended the traditional medicine hospital and dispensaries in Yangon and Mandalay during the specified months, namely January, April and July, 1991 as well as the total amount of drugs used for various st st illnesses for one year (1 September, 1990 to 31 August, 1991) were studied. The amount of drug used in the record was compared with the total amount of drugs that would be needed according to the common treatment schedule which was developed through interview and discussion of 19 well-experienced traditional medicine physicians. The association between seasonal variation and disease morbidity, and subsequent drug dispensing pattern, as well as the cost and rationale behind drug use was discussed. Diabetes mellitus is one of the dreadful diseases threatening the health of people in Myanmar. So that synthetic medicines are substituted by traditional medicine with the least side effect. Aqueous and ethanolic extracts were extracted from the air dried seed shell powder of C. Alkaloids, glycosides, flavonoids, terpenoids, tannins, resins and polyphenol were present in crude powder and the extracts of C. Statistical analysis (Student’s‘t’ test) was applied in comparing the hypoglycaemic effects of aqueous extract and ethanolic extract of C. It was observed that aqueous extract of the seed shell produced a significant inhibition of blood glucose level at 2hours (p<0. The ethanolic extract of it also produced a significant inhibition of blood glucose level at 1hour (p<0. May Aye Than; Aye Than; Mu Mu Sein Myint; Kyi Kyi Myint; San San Myint; Tin Nu Swe. Diabetes mellitus and hypertension are the two of the six major priority diseases in Myanmar and it now stands prioritized health problem and leading cause of death. But so far, there has not been full and systematic exploitation of these natural resources with regard to hypotensive and hypoglycemic effect. Thus, the experimental design using anaesthetized normotensive dogs for hypotensive activity was tested on glucose loaded hypoglycemic rabbit model. High and medium dose levels of the extracts produced significantly fall of mean systolic blood pressure (p<0. May Aye Than; Sandar Moe; Aye Than; Yee Yee Tin; Maung Maung Htay; Hla Myint, Saw; Hnin Pwint Aung; Moe Thida. Hypertension is one of the most common risk factors for cardiovascular morbidity and mortality. The higher the arterial blood pressure, will be the greater the risk of stroke, congestive cardiac failure and ischaemic heart disease. Hypertension is one of the six major priority diseases in Myanmar and it now stands prioritized health problem and leading cause of death. But there was no scientific information about Gisekia pharnaceoides having hypotensive activity in local and internationally. The aim of this study was to reveal scientific proof on hypotensive properties of reputed plants, usually claimed to be effective for hypertension. The effects of the aqueous and the 70% ethanolic extracts taken from whole plant of Gisekia pharmaceoides have been studied on the blood pressure of anaesthetized normotensive dogs. The blood pressure was recorded by a mercury monometer connected to the kymograph. Intravenous injection of the extracts in the doses of 10, 20 and 40mg/kg body weight lowered the blood pressure significantly (p<0. The average percent fall of mean arterial blood pressure with 10mg/kg, 20mg/kg and 40mg/kg of the aqueous extract were 17.

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These cells may contain relatively greater numbers of primitive repopulating cells more susceptible to retroviral transduction generic 400mg levitra plus fast delivery. Moreover discount levitra plus online mastercard, early treatment is crucial before disease progresses chronically to irreversible damage 400mg levitra plus with amex. Vector sequences were detected in circulating mononuclear cells and in granulocytes of all three children for longer than 18 months but at low levels of less than 0. This was an unexpected finding that implied in vivo selection for cor- rected cells. These cells were not fully functional despite a possible survival advantage in the development of the T cells from precursors. However, no clear clinical benefit or in vivo survival advantage for transduced cells has been demonstrated. It is characterized by recurrent bacterial and fungal infections that induce granu- loma formation and threaten the life of patient. Four different genetic defects have been found to be responsible for this disease. Similar results have been reported for a clinical trial carried out in patients with Gaucher disease. Without ablation, vector- containing cells were detected at low levels and only transiently after reinfusion. Lymphocytes are easily har- vested in large numbers and can be cultured ex vivo without major perturbation of phenotype, immune responsiveness, or proliferative potential. Lymphocytes may be repeatedly harvested and ablative conditioning is not necessary for persistence of infused cells. Both preclinical animal data and early clinical trials have reported encouraging results. However, they have also provided troublesome evidence of strong immune responses developing against exogenous genes expressed by lymphocytes. Transduced murine lymphocytes could be selected by growth in G418 and subsequently expanded without changing their antigenic specificity. Modified transduction protocols have been explored to further improve gene transfer to lymphocytes. Under these optimized conditions, up to 50% of lymphocytes can be transduced ex vivo without changes in viability, phenotype, or expansion capability. In subse- quent gene marking studies, behavior of transduced donor lymphocytes was studied in patients undergoing allogeneic transplantation. After transplantation, the transduced T cells were reinfused, and two to three orders of magnitude expan- sion of marked cells were measured in vivo. The inclusion of this gene in vectors allows elimination of transduced cells in vivo simply by ganciclovir administration postinfusion. This strategy depends on inclusion of a cell surface marker gene in the vector to allow positive selection of transduced cells before reinfusion. This would allow almost all infused cells to contain the tk gene and thus be sensitive to ganciclovir killing. The transduced lym- phocytes survived for up to 12 months, resulting in antitumor activity in five patients. This immune response limits the persistence of transduced cells, as well as repeated infusions. Therapeutic Genes As noted earlier, the initial human gene therapy study used T lymphocytes as targets. Both patients showed relative improvements in circulating T numbers and cellular and humoral immunity. In the second child, the T cell level rose temporarily during the infusions and then fell back. Both patients showed persistence of vector-containing cells for more than 2 years after the last T- cell infusion, which shows that transfused peripheral T cells can have a long life span. This level was associated with increased T- lymphocyte counts and improvement of immune function. Both small proteins (200 to 250bp) take up little space in vector constructs, and non- crossreacting antibodies are available. This class of proteins has been shown to be transferred from cell to cell both in vitro and in vivo, possibly complicating interpretation. Preclinical studies and early clinical trials have shown that transduction and sorting of lymphocytes using this marker is sensitive and spe- cific. However, the introduction of new cell surface proteins has the theoretical dis- advantage of altering trafficking or cell/cell interactions upon infusion of transduced cells. In human studies, the positive selection of transduced lymphocytes using selec- tion markers has already been achieved. The further expansion of transduced cells shows no changes in phenotype or in vivo function. However, it is still difficult to use ex vivo selection strategies on human hematopoietic stem cells posttransduc- tion due to a low gene transfer efficiency. The major concern is that too few stem cells remain to allow safe and rapid hematopoietic reconstitution after enrichment of transduced cells, especially if ablative conditioning will be used. A potential solution to this problem is ex vivo expansion of selected transduced cells before reinfusion. It is unknown whether true long-term repopulating cells can be ex- panded or even maintained ex vivo using current culture conditions. Expanded cells have been documented to engraft lethally irradiated or stem-cell-deficient mice. However, a competitive disadvantage of ex vivo cultured cells against endogenous stem cells was shown in a nonablative model. In vivo-selectable drug-resistant genes have been incorporated into retroviral vectors. There are at least two possible applications for this in vivo drug selection strategy: (1) induction of chemoprotection and (2) in vivo positive selection of genetically modified cells. Bone marrow suppression is one of the most common toxicities of chemotherapy regimens. The protein product of this gene, called P-glycoprotein, can extrude many chemotherapy drugs out of cells, thereby result- ing in a drug-resistant phenotype. These drugs include the anthracyclines, taxol, vinca alkaloids, and epipodophyllotoxins. Another potential application is to incor- porate the gene into a vector with another gene of interest (e. These cells are stable without further treatment suggesting selection at an early stem or progenitor cell level. However, transductions in these trials were used in suboptimal protocols, and the level of marking was extremely low or undetectable. Issues with these strategies for chemoprotection are that nonhematologic toxicity may rapidly become limiting, and patients will not be protected from those side effects by engraftment with gene-modified, protected stem cells.

Symptoms such as lightheadedness cheap 400mg levitra plus mastercard, dizziness buy cheap levitra plus online, and fainting are cause for immediate concern purchase 400 mg levitra plus free shipping. Any amount of bleeding in a postmenopausal woman not taking hormone replacement therapy is considered abnormal. Another cause of functional menorrhagia is abnormalities in arachidonic acid metabolism. The endometrium of women who have menorrhagia concentrates arachidonic acid to a much greater extent than normal, resulting in increased production of series 2 prostaglandins, which are thought to be the major factor both in the excessive bleeding and in the accompanying menstrual cramps. Even minimal thyroid dysfunction may be responsible for menorrhagia and other menstrual disturbances. Although menstrual blood loss is well recognized as a major cause of iron deficiency anemia in fertile women, it is not as well known that chronic iron deficiency can be a cause of menorrhagia. This assertion is based on several observations:7 • Response to iron supplementation alone in 74 of 83 patients (in whom organic disease had been excluded) • A significant double-blind placebo-controlled study displaying improvement in 75% of those given iron supplementation, compared with 32. In one study, women who were menorrhagic had significantly lower serum ferritin levels than controls, but other iron indicators such as hemoglobin concentration, mean corpuscular volume, and mean corpuscular hemoglobin were not significantly different between the two groups. In fact, a decreased serum ferritin level is a good indication of the need for iron supplementation. In a study from 1960, supplementation with vitamin C (200 mg three times per day) and bioflavonoids was shown to reduce menorrhagia in 14 out of 16 patients. Vitamin K and Chlorophyll Although bleeding time and clotting factors in women with menorrhagia are typically normal, vitamin K (usually in the form of crude chlorophyll preparations) has a long history of use and some clinical research support. Consuming higher amounts of fish, nuts, and seeds and supplementing with fish oils may yield beneficial effects by reducing tissue levels of arachidonic acid. Vitamin B Complex There may be a correlation between a nutritional deficiency of B vitamins and menorrhagia. It has been shown that in vitamin B complex deficiency, the liver loses its ability to inactivate estrogen. Some cases of menorrhagia are due to the effect of excessive estrogen on the endometrium. Therefore, supplementing with a complex of B vitamins may normalize estrogen metabolism. A study conducted in the 1940s showed that a B-complex preparation (thiamine 3 to 9 mg, riboflavin 4. Since at least the time of the ancient Greeks, it has been used for the full scope of menstrual disorders, including heavy menses. Clinical studies have shown chasteberry extracts to be helpful in many types of menstrual abnormalities including menorrhagia. In a study observing 126 women with menstrual disorders who were given 15 drops of liquid extract, the duration between periods lengthened from an average of 20. Diet Follow the general recommendations given in the chapter “A Health-Promoting Diet. Green leafy vegetables, green tea, and other sources of vitamin K should be consumed freely. Vascular headaches, such as migraines, are characterized by a sharp throbbing or pounding pain. In nonvascular headaches, such as tension headache (usually caused by tightening in the muscles of the face, neck, or scalp as a result of stress or poor posture; see the chapter “Headache, Nonmigraine Tension Type”), the pain is steady, constant, and dull; it starts at the base of the skull or in the forehead and spreads over the entire head, giving the sensation of pressure, as if a vise has been applied to the skull. Headache pain arises from the lining of the brain (the meninges), blood vessels, or muscles when stretched or tensed. Causes Blood Vessel Instability Considerable evidence supports an association between migraine headaches and instability of blood vessels. Most studies measuring brain blood flow have confirmed a reduction of blood flow, sometimes to very low and critical levels, during the period prior to a migraine attack. This decrease is followed by a stage of increased blood flow that can persist for more than 48 hours. The abnormal blood flow appears confined to the outer portion of the brain (cerebral cortex), while deeper structures have a normal blood supply. There is some evidence that migraine patients have an inherited abnormality in their control of blood vessel constriction and dilation. Migraine patients suffer more often than normal people from dizziness upon standing suddenly, and they seem to be abnormally sensitive to the effects of physical and chemical factors that cause changes in blood vessels. Platelet Disorder Platelets are small blood cells involved in the formation of blood clots. The platelets of many migraine sufferers are very different from normal platelets, both during and between headaches. The differences include a significant increase in spontaneous clumping together (aggregation), highly significant differences in the manner of serotonin release, and significant differences in the structural composition of the platelets. Serotonin is a neurotransmitter, a compound used in the chemical transfer of information from one cell to another. Serotonin also plays a role in the state of relaxation or constriction of blood vessels. All of the serotonin normally in the blood is stored in the platelets and released by platelet aggregation. There is no difference in total serotonin content between normal platelets and the platelets of migraine patients. However, the quantity of serotonin released by the platelets of the migraine patient in response to serotonin stimulation (such as a food allergy), while initially normal, becomes progressively higher until a migraine is produced. The platelet hypothesis is strengthened by the observation that patients with classic migraines have a twofold increase in incidence of mitral valve prolapse (that is, a leaky heart valve). This leaky valve can cause damage to blood platelets as they surge through the valve with each beat of the heart. Researchers have found that 16% of migraine patients have definite mitral valve prolapse, and another 15% have possible prolapse—a rate at least two times higher than normal. Interestingly, mitral valve prolapse is also found three times more frequently in individuals with deficient magnesium, a mineral that is especially effective in migraines. Nerve Disorder A third major hypothesis is that in migraines, the nervous system plays a role in initiating the vascular events. It has been suggested that nerve cells in the blood vessels of patients with migraines release a compound known as substance P. Some research has suggested that in as many as 40% of migraine sufferers the nerve mitochondria do not produce as much energy as in those without migraines. Serotonin Deficiency Syndrome The final hypothesis is that migraine headache represents a serotonin deficiency state. Because migraine sufferers have low levels of serotonin in their tissues, researchers referred to migraines as “low-serotonin syndrome. The link between low serotonin levels and headaches is the basis of many prescription drugs for the treatment and prevention of migraine headaches. For example, the serotonin agonist drug sumatriptan (Imitrex) is now among the most popular migraine prescriptions. In addition to sumatriptan, monoamine oxidase inhibitors (which increase serotonin levels) have also been shown to prevent headaches. The bottom line is there is considerable evidence that increasing serotonin levels leads to relief from chronic migraine headaches.

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