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By K. Roland. California College of Podiatric Medicine. 2019.

Fungi (such as those causing coccidioidomycosis order 80 mg super levitra visa low testosterone erectile dysfunction treatment, histoplasmosis purchase 80mg super levitra with mastercard erectile dysfunction age graph, and blastomycosis) and molds are found in soil and dust or on vegetation grown in endemic areas (places where the diseases are common) discount super levitra american express impotence genetic. Certain species of bacteria that form spores also are found in the soil, but only if the soil has been 2-4 contaminated previously with the spores. Thetanus (lockjaw) and anthrax are examples of diseases that may be acquired through exposure to the environment. Portals of Entry and Exit Portals of entry and exit are the routes through which the infectious agent enters and exits the body of the host. Portals of entry and exit in the human body include the respiratory, digestive, and urinary systems, as well as the skin (including mucous surfaces such as the eye), wounds, and blood. Often the causative organism enters and exits the body through the part of the body primarily involved in the disease process. This is true, for example, for illnesses such as the common cold as well as other respiratory and digestive system diseases. Conversely, the portal of entry may have no relation to the organ system involved in the disease. For example, the infectious agents for malaria and yellow fever, transmitted by mosquitoes, enter and leave the host through the skin, but involve other areas of the body (such as the liver and brain) in the disease process. Modes Of Transmission The main modes of transmission of communicable diseases are person-to-person, common vehicle, airborne, vector-borne, sexual contact, and blood-borne spread. The chain of transmission of an illness can be broken by interrupting the route of transmission. Person-to-person spread occurs when the source and the host come in direct physical contact. This includes fecal-oral spread, in which fecal material from an infected person is transferred to the mouth of an uninfected person, usually by unwashed hands. The hands are often contaminated by touching an item, such as soiled clothing, and then touching the hands to the mouth. Examples of diseases spread from person-to-person include giardiasis, hepatitis A, rotavirus, and shigellosis. Common vehicle spread results when a single inanimate vehicle serves as the source of transmission of the infectious agent to multiple persons. Diseases transmitted through contaminated food and water include botulism, salmonellosis, campylobacteriosis, cholera, and Escherichia coli O157:H7. Airborne spread of disease consists of transmission of the infectious agent by droplets or dust. Droplets are produced whenever someone breathes out; these may be projected greater distances by a cough or a sneeze. Once the moisture in the droplets evaporates, bacteria and viruses form droplet nuclei (tiny particles that can float in the air) that may subsequently be inhaled by susceptible hosts. Diseases spread by the airborne route include tuberculosis, legionellosis, pertussis, measles, rubella, and chickenpox. Mechanical transmission occurs when the contaminated mouth or feet of an insect vector physically transfers the infectious organism to the host or to food. For example, houseflies can carry diarrhea-causing bacteria from human waste to human food. With biologic transmission, the vector (for example, the mosquito) carries the infectious agent within its body, and the agent passes through the skin via an insect bite. Examples of vector-borne diseases include Lyme disease, plague, and Rocky Mountain spotted fever. Sexually transmitted diseases are spread through sexual contact, either heterosexual or homosexual. Blood-borne diseases are transmitted by contact with blood from an infected patient. This mode of transmission usually occurs in the health-care setting, with infusion of contaminated blood products or by skin puncture with a contaminated syringe. Sharing of needles among injecting drug users also transmits blood-borne diseases. Even when the source of an outbreak is unknown, understanding and interrupting the most likely route of transmission can prevent further disease. Host Immunity and Resistance The host is the person or organism susceptible to the effect of the infectious agent. The general health status of the host, his/her genetic makeup, as well as other factors determine susceptibility to disease. Host defenses that contribute to resistance to infection include: Mechanical barriers (i. Thears, urine, digestive juices, perspiration, and respiratory mucus contain enzymes, acid, and nonspecific antibodies (a type of protein produced by the immune system) that combat infection. Certain cells of the immune system, found throughout the body, that remove infecting organisms from the body by engulfing and destroying them, in a process known as phagocytosis. Competition between normal, non-disease-causing (commensal) microorganisms normally found in the gut or on the skin and pathogenic (disease-causing) organisms to which the host is exposed. These defenses may be overcome by exposure to a large number of organisms or repeated exposure over an extended period of time. Defense mechanisms may 2-6 diminish when another disease-causing infection is occurring at the same time, following previous treatment with antibiotics (which wipes out commensal organisms), or when a breakdown in a barrier exists (such as a skin wound). This type of immunity usually lasts the longest period of time, often for the life of the host. Vaccination with weakened or killed infectious agents leads to active, induced immunity. Injection of antibodies or antitoxin leads to a passive, temporary immunity to an agent. Use of gamma globulin to protect against chicken pox is an example of passive immunity. To find ways to break the chain of disease transmission communicable diseases are prevented by increasing host resistance (through vaccinations); modifying the environment (to eliminate reservoirs or to interrupt transmission); inactivating the infectious agent. Vaccination Seagoing persons should be appropriately vaccinated against all diseases traditionally occurring during childhood (diphtheria, tetanus, poliomyelitis, measles, mumps, rubella, and chicken pox) and should consider vaccination to prevent hepatitis A and B. Though vaccines have reduced the occurrence of many of these diseases worldwide, susceptible travelers may still acquire these diseases. Vaccination against chicken pox is only necessary if there is no history of childhood infection. Vaccination against both hepatitis A and B and an inactivated poliomyelitis vaccine booster should be considered for adults who plan to travel and work in areas where these diseases are more common. Hepatitis A is contacted by the oral fecal route, such as from contaminated food or water.

At the same time it contains a greater number of examples of coun- tries where non-governmental organisations are still pressing their political leaders to begin to tackle the issue buy super levitra 80 mg without a prescription erectile dysfunction pump. In the absence of a political response buy 80 mg super levitra with visa impotence in women, these non-governmental organisations are themselves often delivering programmes that target men’s poorer health super levitra 80 mg for sale top erectile dysfunction doctor. Although some of our authors are frustrated at the lack of progress, it is nonetheless positive that the issue is being discussed, at least to some extent, in all the countries described in this report. Of course this is to be expected; the eleven countries featured are all known to have ac- tivist organisations campaigning for change. It is entirely possible that there has been good - or even greater - progress in other countries but that this has not come to the attention of the edi- tors. It is perhaps more likely however, that that the majority of the world’s nations have not yet begun to consider strategies to improve the health of men. Where there has been suffcient progress to have resulted in government activity, that activity tends to fall into one of two categories. The frst is politically-led activity directly intended to improve male health by the development of dedicated policy and/or investment in health programmes targeted at men. Very strong ex- amples of this can be seen in the reports from Australia and Ireland. Ireland has recently seen the publication of what is believed to be the world’s frst national policy intended to improve the health of men. Australia has a long track record of activity on men’s health both at the level of community activism and at the level of government (both national and regional). At time of writing, Australia is also devel- oping a national policy for men’s health and has appointed a group of “Men’s Health Ambassa- dors” to inform government thinking and galvanise public opinion. Initiatives at this level are very much to be welcomed and are a tribute to the campaigning work of men’s health organisations as well as to the foresight of the governments concerned. A prob- lem with actions of this kind though is that they may be vulnerable to political change which has the potential to bring them to an end before they can become fully established. A clear exam- ple of this can be seen in the report from New Zealand where, in 2008, as a consequence of a change of government, the demise of a dedicated investment programme occurred within just a few months of its announcement. The second category of progress has been in those countries where an emphasis on gender equality in social policy overall has opened the door to arguments that men’s poorer health outcomes should be addressed within this context. This route is probably available in a good number of other nations too - at least in theory. The diffculty lies in shifting the obstructive public and political view that we have already described – the idea that “gender inequality” is a problem that affects only women. It can be diffcult to instigate a constructive debate on this issue and even more so 10 to achieve a workable understanding. The argument runs the risk of alienating politicians who adhere to the view that men can never be seen as disadvantaged. It may also be perceived as diminishing the importance of those aspects of life where women do suffer discrimination and discrimination. In fact, an emphasis on gender-sensitivity in health and healthcare provision has the potential greatly to beneft both sexes. Highlighting progress in the countries mentioned above should not be taken to imply that there has been no progress in others. Canada, for example, has identifed gender equity as one of the primary goals of health policy and has established a research institute specifcally to explore the relationship between gender and health. In Malaysia, a broad commitment has been given by government to work towards a national policy on men’s health, and programmes of activity have been iniated by both gov- ernment and the voluntary sector. In Denmark and Switzerland, government initiatives in spe- cifc areas of provision (e. All of the countries in this report organise activities during International Men’s Health Week in June each year – a common thread that links activists around the world. The fnal chapter in this report gives an overview of the situation across the European Union, par- ticularly from the point of view of political activity at the European Commission. The Dec- laration was launched in 2005 an now has over 500 key signatories from 48 countries. Although the international debate has moved on since the Declaration was published, these ideas still have very signifcant weight. It is interesting and encouraging to note the unanimity of the authors in this report in continuing to endorse them as the potential building blocks of pol- icy - despite the political and cultural diversity of the countries they describe. This augurs well for the future development of a “movement” for men’s health that has international authority. We have used the same format for each chap- ter so that it should be possible to make direct comparison between countries in relation to: Ô The current state of men’s health Ô The response of government Ô The authors’ sense of what the future holds Please bear in mind incidentally, that not all the authors have English as their frst language. The particular gratitude of the editors is expressed to those authors who had to contend not only with the tight word limit but also with the diffculties of translation. Information about the authors is given at the end of each chapter as are the web addresses of national men’s health organisations where those exist. It is hoped that this report will form the beginning of a historical record and – apart from its general interest – will be of particular use to colleagues hoping to develop activism on men’s health in countries where none presently exists. As men age they a man who likes to work and play hard, and who perhaps have higher mortality rates than women for cancers, drinks too much with his “mates” (close friends). For men the highest proportion of total disease Like most stereotypes there is some truth in this im- burden attributed to determinants of health in 2003 were age, Australian men are not, however, an homogenous tobacco smoking (9. Aboriginal and Torres Strait Islander men have a life expectance of almost 20 years less than non- The recently released discussion papers for the Na- Indigenous men. More than half (53%) of the deaths of tional Men’s Health Policy make the situation of men’s Indigenous men were of men aged less than 50 years, health clear1: compared to non-Indigenous Australian men most of whom (75%) die at more than 65 years of age1. While overall there has been an increase in life expectancy for all Australians over the past century, rates of mortality among men are still higher than mortality among women, and have not improved to the same degree as mortality among women. The Richmond Men’s Shed is the ‘classic’ Australian men’s shed where men, mostly retired men, come together and share skills and knowledge around metal and/or wood work. Government policy should support addition to the National (Commonwealth) government, and not control this type of community movement. The state of Indig- Commonwealth Government sets overall health policy enous men’s health is worst of all in Australia; their and funds the states and territories. The states and life expectancy is in the mid ffties, to our shame as a territories in turn are responsible for providing direct nation, and although non-Indigenous men do not face health services (such as hospitals and community the same challenges as Aboriginal men, their state of health). The Commonwealth provides funding to General health illustrates well that health is embedded in the Practitioners under the Medicare scheme. There is also social circumstances of all our lives, not just in “mas- a strong private health care sector of hospitals and culinity”. Five men a day kill themselves in our coun- clinics paralleling the public system. Men beneft less from doctors’ services In 1999 the then Commonwealth Minster for Health and from community health services than do women. This policy never As an Australian psychologist famously said, when ques- eventuated, due mainly to a change of government. Not what is wrong with those who “men don’t go to the doctor” they say – “that’s men’s don’t come? The discussion paper In the last decade there has been a lot of talk about that followed this announcement indicated a signif- “masculinity” as the major problem facing men’s cant move forward from the discourse of ten years ago.

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For discussion and proper understanding discount 80 mg super levitra visa erectile dysfunction pump hcpc, the various reactions can be arbitrarily divided in to four stages order super levitra 80mg on-line impotence kidney. Uptake of Glucose by Cells and its phosphorylation Glucose is freely permeable to Liver cells purchase super levitra 80 mg free shipping erectile dysfunction treatment scams. In Intestinal mucosa and kidney tubules, glucose is taken up by ‘active’ transport. In other tissues, like skeletal muscle, cardiac muscle, diaphragm, adipose tissue etc. The reaction is catalyzed by the specific enzyme glucokinase in liver cells and by nonspecific Hexokinase in liver and extrahepatic tissues. The reaction is accompanied by considerable loss of free energy as heat, and hence under physiological conditions is regarded as irreversible. Conversion of G- 6- phosphate to Fructose6-phosphate • Glucose6 phosphate after formation is converted to fructose 6-p by phospho- hexose isomerase, which involves an aldose- ketose isomerization. Conversion of Fructose 6phosphate to Fructose 1, 6 bisphosphate The above reaction is followed by another phosphorylation. A,B Aldolase B: occurs in liver and kidney • The fructose- 6-p exists in the cells in “furanose” form but they react with isomerase, phosphofructokinase-1 and aldolase in the open-chain configuration. Reactions of this type in which an aldehyde group is oxidized to an acid are accompanied by liberation of large amounts of potentially useful energy. Oxidation of Glyceraldehyde 3phosphate to 1,3 bis phosphoglycerate Glycolysis proceeds by the oxidation of glyceraldehde-3-phosphate,to form1,3-bis phosphoglycerate. Dihydroxyacetone phosphate also forms 1, 3 - bisphosphoglycerate via glyceraldehydes-3- phosphate shuttle. Conversion of 3- phosphoglycerate to 2- Phosphoglycerate 3-Phosphoglycerate formed by the above reaction is converted to 2-phosphoglycerate, catalyzed by the enzyme phosphoglycerate mutase. It is likely that 2,3 bisphosphoglycerate is an intermediate in the reaction and probably acts catalytically. Conversion of 2-phosphoglycerate to Phosphoenol pyruvate The reaction is catalyzed by the enzyme enolase, the enzyme requires the presence of ++ ++ either Mg or Mn for activity. Conversion of phosphoenol pyruvate to pyruvate Phosphoenol pyruvate is converted to ‘Enol’ pyruvate, the reaction is catalyzed by the enzyme pyruvate kinase. This is another example of “ substrate level phosphorylation “ in glycolytic pathway • “Enol“ pyruvate is converted to ‘ Keto’ pyruvate spontaneously. Clinical Importance • Tissues that function under hypoxic conditions will produce lactic acid from glucose oxidation. If lactate production is more it can produce metabolic acidosis • Vigorously contracting skeletal muscle will produce lactic acid. In liver fructose1-phosphate is split to glyceraldehyde and dihydroxy acetone phosophate by AldolaseB. Glyceraldehyde enters glycolysis, when it is phosphorylated to glyceraldehyde-3-P by triose kinase. Dihydroxy aceton phosphate and glyceraldehyde-3-P may be degraded via glycolysis or may be condensed to form glucose by aldolase. The reason being high concentration of Fructose 1 phosphate and fructose 1, 6 bis phosphate inhibit Liver phosphorylase by allosteric modulation. As in case of Galactose, fructose intolerance can also lead to cataract formation. It is an inherited disorder that the defect may be in the galactokinase, uridlyl transferase or 4-epimerase. The product accumulates in lense and leads to accumulation of water by osmotic pull. Glycogen metabolism Introduction Glycogen is the major storage form of carbohydrate in animals. It is mainly stored in liver and muscles and is mobilized as glucose whenever body tissues require. Shortening of chains Golycogen phosphorylase cleaves the α-1, 4 glycosidic bonds between the glucose residues at the non reducing ends of the glycogen by simple phosphorolysis. The resulting structure is called a limit dextrin and phosphorylase cannot degrade it any further. Removal of Branches A debranching enzyme also called Glucantransferase which contains two activities, Glucantransferase and Glucosidase. The transfer activity removes the terminal 3 glucose residues of one branch and attaches them to a free C4 end of the second branch. The glucose in α-(1,6) linkage at the branch is removed by the action of Glucosidase as free glucose. Lysosomal Degradation of Glycogen A small amount of glycogen is continuously degraded by the lysosomal enzyme α-(1, 4) glycosidase (acid maltase). The α-1,6 branches in glucose are produced by amylo-(1,4-1,6) transglycosylase,also termed as branching enzyme. This enzyme transfers a terminal fragment of 6 to 7 glucose residues(from a polymer of atleast 11 glucose residues long) to an internal glucose residue at the C-6 hydroxyl position. Glycogenesis Glycogen storage diseases These are a group of genetic diseases that result from a defect in an enzyme required for either glycogen synthesis or degradation. They result in either formation of glycogen that has an abnormal structure or the accumulation of excessive amounts of normal glycogen in specific tissues, A particular enzyme may be defective in a single tissue such as the liver or the defect may be more generalized, affecting muscle, kidney, intestine and myocardium. The severity of the diseases may range from fatal in infancy to mild disorders that are not life threatening some of the more prevalent glycogen storage diseases are the following. To provide the cell with ribose-5-phosphate (R5P) for the synthesis of the nucleotides and nucleic acids. The 3 carbon sugar generated is glyceraldehyde-3-phsphate which can be shunted to glycolysis and oxidized to pyruvate. Alternatively, it can be utilized by the gluconeogenic enzymes to generate more 6 carbon sugars (fructose-6-phosphate or glucose-6-phosphate). Although this bond plays a very important role in protein structure and function, inappropriately introduced disulfides can be detrimental. Oxidative stress also generates peroxides that in turn can be reduced by glutathione to generate water and an alcohol. Regeneration of reduced glutathione is carried out by the enzyme, glutathione reductase. Several deficiencies in the level of activity (not function) of glucose-6-phosphate dehydrogenase have been observed to be associated with resistance to the malarial parasite, Plasmodium falciparum, among individuals of Mediterranean and African descent. The basis for this resistance is the weakening of the red cell membrane (the erythrocyte is the host cell for the parasite) such that it cannot sustain the parasitic life cycle long enough for productive growth. Coris Cycle or Lactic Acid Cycle In an actively contracting muscle, only about 8% of the pyruvate is utilized by the citric acid cycle and the remaining is, therefore, reduced to lactate. The lactic acid thus generated should not be allowed to accumulate in the muscle tissues. The muscle cramps, often associated with strenuous muscular exercise are thought to be due to lactate accumulation.

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