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The descending aorta carries partially oxygenated and partially deoxygenated blood into the lower regions of the body buy discount finasteride 5mg on line. The deoxygenated blood collects waste as it circulates through the fetal body and returns to the umbilical cord generic 1mg finasteride fast delivery. Thus generic 5mg finasteride amex, the two umbilical arteries carry blood low in oxygen and high in carbon dioxide and fetal wastes finasteride 5mg low price. Oxygen and nutrients from the mother diffuse into the placenta and from there into the fetal blood, and the process repeats. The bone marrow begins to take over the process of erythrocyte production—a task that the liver performed during the embryonic period. The excretory system is also developing: the kidneys are well-formed, and meconium, or fetal feces, begins to accumulate in the intestines. During approximately weeks 16–20, as the fetus grows and limb movements become more powerful, the mother may begin to feel quickening, or fetal movements. However, space restrictions limit these movements and typically force the growing fetus into the “fetal position,” with the arms crossed and the legs bent at the knees. Sebaceous glands coat the skin with a waxy, protective substance called vernix caseosa that protects and moisturizes the skin and may provide lubrication during childbirth. A silky hair called lanugo also covers the skin during weeks 17–20, but it is shed as the fetus continues to grow. Developmental weeks 21–30 are characterized by rapid weight gain, which is important for maintaining a stable body temperature after birth. The bone marrow completely takes over erythrocyte synthesis, and the axons of the spinal cord begin to be myelinated, or coated in the electrically insulating glial cell sheaths that are necessary for efficient nervous system functioning. The lungs begin producing surfactant, a substance that reduces surface tension in the lungs and assists proper lung expansion after birth. The fetus at 30 weeks measures 28 cm (11 in) from crown to rump and exhibits the approximate body proportions of a full-term newborn, but still is much leaner. The added fat fills out the hypodermis, and the skin transitions from red and wrinkled to soft and pink. Once born, the newborn is no longer confined to the fetal position, so subsequent measurements are made from head-to-toe instead of from crown-to-rump. The newborn’s first stools consist almost entirely of meconium; they later transition to seedy yellow stools or slightly formed tan stools as meconium is cleared and replaced with digested breast milk or formula, respectively. Unlike these later stools, meconium is sterile; it is devoid of bacteria because the fetus is in a sterile environment and has not consumed any breast milk or formula. However, in 5–20 percent of births, the fetus has a bowel movement in utero, which can cause major complications in the newborn. This may be caused by maternal drug abuse (especially tobacco or cocaine), maternal hypertension, depletion of amniotic fluid, long labor or difficult birth, or a defect in the placenta that prevents it from delivering adequate oxygen to the fetus. Meconium passage is typically a complication of full-term or post-term newborns because it is rarely passed before 34 weeks of gestation, when the gastrointestinal system has matured and is appropriately controlled by nervous system stimuli. Fetal distress can stimulate the vagus nerve to trigger gastrointestinal peristalsis and relaxation of the anal sphincter. Notably, fetal hypoxic stress also induces a gasping reflex, increasing the likelihood that meconium will be inhaled into the fetal lungs. Although meconium is a sterile substance, it interferes with the antibiotic properties of the amniotic fluid and makes the newborn and mother more vulnerable to bacterial infections at birth and during the perinatal period. Specifically, inflammation of the fetal membranes, inflammation of the uterine lining, or neonatal sepsis (infection in the newborn) may occur. The first sign that a fetus has passed meconium usually does not come until childbirth, when the amniotic sac ruptures. Normal amniotic fluid is clear and watery, but amniotic fluid in which meconium has been passed is stained greenish or yellowish. Antibiotics given to the mother may reduce the incidence of maternal bacterial infections, but it is critical that meconium is aspirated from the newborn before the first breath.

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There is so much advancement in the treatment of brain tumors that some types of tumors can be stopped from growing buy 1mg finasteride free shipping, and eventually shrunk by the use of gamma radiation order finasteride 5 mg with mastercard, without opening the brain order finasteride 1mg free shipping. Many small and superficial tumors can be removed through stereotaxis technique buy finasteride 1mg with mastercard, in which they can be sucked out through a special needle or in some cases, it can be dissolved or cauterized with the help of particular rays. Sometimes, intricate surgeries can be performed with the help of a microscope, which do not affect the normal parts of the brain. Fortunately, there are experienced surgeons, good anesthesiologist and excellent techniques available at various places in India and abroad. If the biopsy of the tumor shows malignancy, chemotherapy, radiation etc are used to try to cure the patient. For this it is necessary to recognize the early symptoms and analyze them and getting the problem diagnosed and treated by a specialist at the earliest. It is a congenital disease of the brain, in which the development of either both lower limbs or both upper and lower limbs is very slow, along with a degree of mental retardation and seizures, emanating from brain, therefore this disease is called cerebral palsy. Thus cerebral palsy literally means – damage to the developing brain, as discussed in previous chapters. Mental or physical disabilities including speech, memory, and learning defects relate to the part of the brain damaged. Hence, patients of cerebral palsy may have one or more disabilities and two patients with cerebral palsy may have totally different symptoms. In majority of the cases it occurs during pregnancy due to the environment in the womb or defects in development of the fetus. Dyskinetic : (Dystonic, athetoid) Cerebral Palsy : Involuntary movements in different parts of the body, make it difficult for the patient to carry out intentional activities. Ataxic Cerebral Palsy and Hypotonic Cerebral Palsy: The patient finds it difficult to maintain balance. Besides, following features may co-exist (A) Squint in 50%-60% children (B) Visual problem including field defect (C) Epilepsy - 66% 4. Stubbornness, hyperactivity General Information : Cerebral Palsy may not necessarily be harmful for every child and it is not that improvement is not possible. In other cases extensive exercise (physiotherapy), along with appropriate drugs may offer little results after a along period of treatment. In the first month after the birth the child may appear normal but gradually it is seen that the development is very slow, becomes slow or the child is never able to learn to sit by himself. A normal child learns to walk in the first year, which is delayed due to this disease, and even if the child learns to walk he tries to stand on his toes and walking is very difficult. Considering the exact damage to the child, combination therapy of following different therapists is advocated. Thus the aim of this training and treatment is - Independence in the, daily living/activities - Social acceptance- - Educational achievement - Economical independence i. In spite of so much advancesment in the field of medical science such cases can neither be prevented nor treated properly. Thus it is our social, moral and humane duty to financially support physiotherapy centers and institutions treating and training these children. One must also think of starting such new institutions or spare some time for development of these children and give warmth and support. Prevention : Most important is to help create public awareness regarding care of a pregnant woman, need for regular antenatal checking with a gynecologist, importance of. Encased safely within the veraebrae of the vertebral column the spinal cord is a very important organ of the nervous system. There are over 30 types of diseases that can occur in the spinal cord which can be understood in terms of the working and the structure of the spinal cord, its function of carrying the messages, its length, its cylindrical shape, its small width, its membranes, its blood vessels, its relation with the vertebrae etc. The symptoms of spinal cord diseases are mainly seen as a syndrome and are very obvious, hence the diagnosis is usually clear. If there is damage in the part of the spinal cord situated between the cervical vereabrae, it is known as cervical myelopathy in which the normal movements as well as the sensations of the legs and hands get hampered. The spinal cord is usually not found in the lumbar vertebrae, that is, the spinal cord ends at the first lumbar L1 vertebra. In the diseases affecting only the spinal cord, there are no symptoms related to the brain like speech defects, ability to understand, sensations of eyes, ears, nose, seizures, one sided paralysis or facial paralysis, etc.

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The brain develops from this early tube structure and gives rise to specific regions of the adult brain 5 mg finasteride with mastercard. As the neural tube grows and differentiates buy generic finasteride 5 mg on line, it enlarges into three vesicles that correspond to the forebrain buy 1 mg finasteride mastercard, midbrain buy finasteride 1mg with amex, and hindbrain regions of the adult brain. The spinal cord develops out of the rest of the neural tube and retains the tube structure, with the nervous tissue thickening and the hollow center becoming a very small central canal through the cord. The rest of the hollow center of the neural tube corresponds to open spaces within the brain called the ventricles, where cerebrospinal fluid is found. The frontal lobe is responsible for motor functions, from planning movements through executing commands to be sent to the spinal cord and periphery. The most anterior portion of the frontal lobe is the prefrontal cortex, which is associated with aspects of personality through its influence on motor responses in decision-making. The occipital lobe is where visual processing begins, although the other parts of the brain can contribute to visual function. The temporal lobe contains the cortical area for auditory processing, but also has regions crucial for memory formation. Nuclei beneath the cerebral cortex, known as the subcortical nuclei, are responsible for augmenting cortical functions. The basal nuclei receive input from cortical areas and compare it with the general state of the individual through the activity of a dopamine-releasing nucleus. The output influences the activity of part of the thalamus that can then increase or decrease cortical activity that often results in changes to motor commands. The cerebellum is connected to the brain stem, primarily at the pons, where it receives a copy of the descending input from the cerebrum to the spinal cord. It can compare this with sensory feedback input through the medulla and send output through the midbrain that can correct motor commands for coordination. The arterial blood to the brain comes from the internal carotid and vertebral arteries, which both contribute to the unique circle of Willis that provides constant perfusion of the brain even if one of the blood vessels is blocked or narrowed. The blood that nourishes the brain and spinal cord is behind the glial-cell–enforced blood-brain barrier, which limits the exchange of material from blood vessels with the interstitial fluid of the nervous tissue. This fluid is produced by filtering blood at the choroid plexuses in the four ventricles of the brain. It then circulates through the ventricles and into the subarachnoid space, between the pia mater and the arachnoid mater. It surrounds the venous space known as the dural sinuses, which connect to the jugular veins, where blood drains from the head and neck. Sensory ganglia contain unipolar sensory neurons and are found on the dorsal root of all spinal nerves as well as associated with many of the cranial nerves. Autonomic ganglia are in the sympathetic chain, the associated paravertebral or prevertebral ganglia, or in terminal ganglia near or within the organs controlled by the autonomic nervous system. Nerves are classified as cranial nerves or spinal nerves on the basis of their connection to the brain or spinal cord, respectively. The twelve cranial nerves can be strictly sensory in function, strictly motor in function, or a combination of the two functions. Sensory fibers are axons of sensory ganglia that carry sensory information into the brain and target sensory nuclei. Motor fibers are axons of motor neurons in motor nuclei of the brain stem and target skeletal muscles of the head and neck. Spinal nerves emerge from the spinal cord and reorganize through plexuses, which then give rise to systemic nerves. As the anterior end of the as the basal ganglia), which have two pathways that process neural tube develops, it enlarges into the primary vesicles information within the cerebrum. Those the indirect pathway is the longer pathway through the structures continue to develop throughout the rest of system that results in decreased activity in the cerebral embryonic development and into adolescence.

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Lactation may continue after this period generic 1 mg finasteride visa, menstruation may not recommence yet buy finasteride 5mg low cost, or sexual activity is resumed finasteride 5mg line. Overall it is a care given within the first 24 hours of delivery up to six weeks to: ♦ Prevent complications ♦ Restore to normal health ♦ Check to adequacy of breast-feeding ♦ Provide Family Planning service ♦ Give basic health information Complications during Postnatal period ♦ Puerperal sepsis/general infection ♦ Thrombo-phlebitis ♦ Secondary Haemorrhage ♦ Breast problems – engorgement buy 5 mg finasteride visa, infection ♦ Incontinence – stool or urine 27 Family Health Care to the mother during postnatal period. Breastfeeding Breast milk is: a perfect nutrient, easily digested, can be efficiently used and protects against infection. Disadvantages of Bottle Feeding Formula milk is expensive Formula needs to be accurately mixed for adequate nutrition Takes time for preparation Baby more susceptible to diseases and infection 30 Family Health Fuel is needed for heating water to mix the formula More than one bottle is needed Demonstration on getting sunlight for the baby. Supplementary Feeding • Wash hands before the preparation of child’s food • Start supplementary feeding when the baby reaches 6 months of age. It is a means of promoting the health of the women and families and part of a strategy to reduce the high maternal, infant and child morbidity and mortality. Objectives: General: Is to reduce morbidity and mortality of mothers and children by spacing child bearing, preventing unplanned and unwanted pregnancy. Specific: • To increase awareness, knowledge and skills of the community to utilize family planning services, • To increase utilisation of family planning services by households, • To prevent mothers from having too many pregnancies and children • To avert population growth rate, 33 Family Health • Prevent unwanted pregnancies and high risk abortions, • Promote active participation of males in family planning activities. Traditional family planning methods Breast-feeding method: When a mother breast-feeds her baby, the message concerning the feeding goes from the nipple to the vagus nerve and proceeds to the front-part of the pituitary gland in the brain. Then the pituitary gland 35 Family Health initiates the production of prolactin hormone to activate the milk producing glands in the breasts. The prolactin hormone again reduces the secretion of luteinizing hormone which initiates the normal menstrual cycle. The calendar method: If a woman has a regular cycle of 27 days, it is possible to know by subtracting from 27-18 and 27-11 the first and last days of ovulation respectively. Based on this calculation , the woman should avoid sexual intercourse between day 9 and day 19 of the menstrual cycle in order to prevent pregnancy. By the same token, women who have regular menstrual cycles of 28 days, to 30 days should avoid sexual intercourse between 10-17 days and 12-19 days respectively; this time they are safe to do sexual intercourse during the remaining 36 Family Health respective days. Using this natural / traditional method requires a strong discipline, thrust and good understanding between husband and wife or sexual partners. Withdrawal Method: This method uses the withdrawal or the pulling out of the male genital (penis) from the vagina, interrupting sexual intercourse just before ejaculation so that sperm does not enter the vagina. Modern Contraceptive Methods Combined oral contraceptive pills: Combined oral contraceptive is prepared from two hormones, estrogen and progestin. Mechanisms of action • Prevents ovulation; • Thicken cervical mucus making it difficult for the sperm to pass through; • Makes the lining of the uterus too thin for the fertilized egg to implant itself making it difficult for further development. In the first three rows are the combined oral 38 Family Health contraceptive pills, while the seven pills in the last row are body supportive pills made of minerals. Effectiveness • It is highly effective; • Avoids the fear of unwanted pregnancy during sexual intercourse; • Can be taken by any female that has reached puberty-age; • Pregnancy resumes immediately after interrupting the pills; • Prevents extra-uterine pregnancy; • Prevents unwanted pregnancy resulting from casual or unexpected sexual intercourse. Adverse effects • Nausea (the first three months); • Irregular menstruation or missed menses, • Headache; • Tenderness of the breast; • Weight increase; and • It is not the choice for breast-feeding mothers. Emergency contraception: Emergency contraception is a combined oral contraceptive pills method that women can use to prevent pregnancy expected from unprotected sexual intercourse /violence, rape/. However, it should be underlined that the use of such method is only limited to unprotected sexual intercourse, but is never for regular usage. Weaknesses • If previous pregnancy occurs, • Heart diseases, • High blood pressure, • Breast-feeding mother; and • Women who smoke and who are over 35 years old. Progestin only pill The content of progestin in the contraceptive pills is less than what is contained in the combined oral contraceptive pills. Weaknesses • Requires taking one pill every day without interruption and always at exactly the same time of the day and so is hard to always remember; • Less effective to prevent pregnancy compared to the combined oral contraceptive pills; and • Has problems such as irregularity of menstrual cycles, 42 Family Health Who uses single oral contraceptive pills? Procedures in the provision of single oral contraceptive pills: • Introduce yourself and greet politely the family planning service client; • Assess the client’s knowledge about family planning services and ask about her health conditions; • Ask if the client is on menstruation; • Register the client; • Show and demonstrate to the client the single oral contraceptive pills in the package; 43 Family Health • Carefully explain to the client to take one of the following steps; - To start taking the single contraceptive pills 24 hours after her menstruation started; or th - Start on the 5 day of menstrual period; • Carefully explain to the client to take every evening at the same time before sleep or sexual intercourse one pill from the package with water and without chewing; • The client should take regularly contraceptive pill every evening at the same time with or without sexual intercourse; • If the client forgets to take her pill, she must be told to take the missed pill and also continue on her normal schedule; • Even if the client forgets to take two successive pills, she must be told to take pills and continue on her normal schedule. In addition she must be advised to use condom; • A woman must be told to go to the health extension worker to seek advice when she faces health problems while on the single oral contraceptive pills; and • Carefully inform a woman who has received one-month supply of single oral contraceptive pills, to take the pills according to instructions and to come back on the exact date of next appointment. Mechanism of action • Condom holds the sperm and prevents it from spilling in the vagina and the cervix.

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