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These involve more discount kamagra oral jelly 100 mg online, or even the whole order kamagra oral jelly 100mg overnight delivery, of the brain including the reticular system so that consciousness is lost, although in some instances (absence seizures) this is more a loss of awareness rather than any collapse. The two main forms are: (1) Grand mal (GM) or tonic±clonic seizures (TCS). It starts with a tonic spasm of all musculature and rigid extension of the body, a temporary cessation of respiration, generally salivation and often defecation and micturition. After about one minute this gives way to violent synchronous clonic jerking movements (convulsions) which may continue for a few minutes. The patient may remain unconscious for a longer period before recovering. In some cases the tonic and occasionally the clonic phrase can exist alone. They entail a brief and abrupt loss of awareness (consciousness) in which the patient suddenly ceases ongoing activity or speech and stares vacantly for a few seconds before recovering equally quickly. Motor disturbances are rare apart from blinking of the eyes and the patient has no recollection of the event. In addition to the above main categories seizures can be just myoclonic, isolated clonic jerks, or atonic, loss of postural control with just head drooping or the patient actually falling. Convulsions associated with metabolic disturbances are not considered to be epileptic. Perhaps the most striking is the 3 per second spike wave activity seen in most leads (cortical areas) in absence seizures, which can be invoked by hyperventilation. Otherwise distinctive EEG patterns are usually only found during an actual seizure, with burst spiking seen alongside clonus in TCS and abnormal discharges with the behavioural patterns of partial epilepsy and in particular that originating in the temporal lobe. ANIMAL MODELS OF EPILEPSY These are normally based on the use of either electrical stimulation or chemical convulsants. If they are applied locally to specific brain areas, the same approaches induce activity indicative of partial seizures. Also some animals can be bred in which seizures either occur spontaneously or can be induced easily by appropriate sensory stimulation. MODELS OF GENERALISED SEIZURES (1) Electric shock In the maximal electric shock (MES) test a supramaximal stimulus is applied bilaterally through corneal or auricular electrodes to induce tonic hind limb extension in rats or THE EPILEPSIES 327 (b) Generalised seizure (grand mal) (a) Normal Ð tonic±clonic type 1s (c) Generalised seizure (petit mal) (d) Partial seizure Ð absence seizure type Figure 16. Electroencephalograms are shown for, a normal subject (a), those suffering from general tonic±clonic seizures (grand mal, (b)), generalised absence seizures (petit mal, (c)), and partial seizures (d). Spikes are seen in both right- and left- sided leads from all three cortical areas, frontal (F), temporal (T) and occipital (C) in the generalised seizures (b, c) but only in the occipital leads in the example of partial seizures (d). In the EEG recorded during the generalised tonic±clonic seizure the normal tracing (1) is followed by the onset of the tonic phase (2), the clonic (convulsive) phase 3 and post-convulsive coma 4. The typical 3 s71 spike and wave discharge of petit mal (c) may be seen during routine recording or induced by procedures such as hyperventilation but the spiking of grand mal and partial epilepsy is only seen during seizures. Anticonvulsant activity is determined by measuring the dose of drug required to protect 50% of the stimulated animals (ED or PD50) and is predictive of efficacy in TCS. Strychnine convulsions have no predictive value since they arise through antagonism of spinal (glycine-mediated) rather than cortical inhibition. The most commonly used agent is pentylenetetrazol (PTZ), also called leptazol. Anti- convulsant activity is again assessed as the dose required to protect 50% of animals, usually mice, against the clonic seizures induced by a dose of PTZ that would otherwise produce them in almost every mouse injected, the so-called CD97 (convulsive dose in 328 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION 97% of animals). The anticonvulsant activity of a drug may also be evaluated by measuring its ability to raise the convulsive threshold, i. Comparison of the efficacy of drugs in the threshold and maximal seizure tests may distinguish between their abilities to raise seizure threshold or reduce seizure spread and development. MODELS OF PARTIAL SEIZURES (3) Focal Partial seizure activity can be induced by the localised application of chemicals such as cobalt or alumina to the cortex or the injection of chemicals such as PTZ or kainic acid directly into particular brain areas like the hippocampus. A similar effect can be obtained by the repeated localised injection of subconvulsive doses of some convulsants. The ability of a drug to reduce the kindled seizure itself may be indicative of value in partial seizure but if it slows the actual development of kindling that may indicate some ability to retard epileptogenesis. SPONTANEOUSLY EPILEPTIC (GENETIC) ANIMALS Various animals show spontaneous epilepsy or seizures that can be readily induced by sensory stimulation (see Jobe et al. Tottering mice display seizures that resemble absence attacks behaviourally, in their EEG pattern and response to drugs. DBA/2 mice show reflex seizures to audiogenic stimuli while photically-induced seizures can be obtained in the Senegalese baboon, Papiopapio, which are similar to generalised tonic± clonic epilepsy. PREDICTIVE VALUE It has become clear that drugs which are effective in protecting mice against PTZ are effective in absence seizures while those able to control the tonic response to maximal electroshock are effective in tonic±clonic seizure. Some drugs are effective in only one test and clinical condition whilst a few are active in both (Table 16. It could be argued that an antiepileptic drug should really stop the development of epilepsy, i. If the development of kindling reflects the process of epilepto- genesis then drugs effective against its progression should stop the development of THE EPILEPSIES 329 Table 16. Clinical comparisons are not related to recommended doses but simply indicate whether a drug is effective (‡) or not (7). Generally, drugs that are to be used clinically to control tonic± clonic seizures control electroshock but not pentylenetetrazol-induced convulsions in rats and mice, whilst the converse applies to drugs effective in absence seizures.

He still mows his Chest Pain lawn without much difficulty effective kamagra oral jelly 100 mg, and can walk 1 to 2 miles on A 27-year-old accountant recently drove cross-country to a flat surface at a moderate pace cheap kamagra oral jelly 100 mg without prescription. He denied having had any other sig- move, she started to experience chest pains. She drove nificant past medical problems, including heart disease, to the emergency department after experiencing 24 hypertension, edema, childhood asthma, or any allergies. She denied any sputum pro- An initial exam shows that the patient is thin but has duction, hemoptysis, coughing, or wheezing. His tive and walks daily and never has experienced any blood pressure is 130/80 mm Hg; respiratory rate, 28 to swelling in her legs. She has never been treated for any 32 breaths/min; heart rate, 92/minute; and oral tempera- respiratory problems and has never undergone any sur- ture, 37. Oral contraceptives are breath sounds in both lung fields, with expiratory wheez- her only medication. A pulse intravenous drugs and has no other risk factors for HIV oximetry reading reveals his blood hemoglobin oxygen disease. Her family history is negative for asthma and saturation is 91% when breathing room air. Pulmonary function tests reveal severe limitation of Physical examination reveals a mildly obese woman airflow rates, particularly expiratory airflow. Her blood Questions pressure is 140/80 mm Hg, and no jugular vein disten- 1. What are the common spirometry findings associated with sion is observed. What are the mechanisms of airflow limitation in emphy- and her temperature is 38 C. What is the most commonly held theory explaining the de- gases, obtained while she was breathing room air, reveal velopment of emphysema? Her alveolar-arterial (A-a)O2 gradient is Answers to Case Study Questions for Chapter 19 40 mm Hg. The hallmark of emphysema is the limitation of airflow out normal flora. In emphysema, expiratory flow rates (FVC, shadow and clear lung fields, except for a small periph- FEV1, and FEV1/FVC ratio) are significantly decreased. A lung scan reveals ever, some lung volumes (TLC, FRC, and RV) are increased, an embolus in the left lower lobe. What is the cause of a widened alveolar-arterial gradient in include hypersensitivity of airway smooth muscle, mucus patients with pulmonary embolism? What causes the decreased arterial PCO2 and elevated arte- creased dynamic airway compression as a result of in- rial pH? Many of the pathophysiological changes in emphysema are Answers to Case Study Questions for Chapter 20 a result of the loss of lung elastic recoil and destruction of 1. This is thought to be a re- embolus will cause blood flow to be shunted to another re- sult of an imbalance between the proteases and antipro- gion of the lung. Because cardiac output is unchanged, the teases ( 1-antitrypsin) in the lower respiratory tree. Nor- shunting of blood causes overperfusion, which causes an mally, proteolytic enzyme activity is inactivated by abnormally low A/ ratio in another region of the lungs. DLCO decreases with anemia because there is less hemoglo- poxemia (a low arterial PO2). In older ever, ventilation is also stimulated as a compensatory individuals, especially those who live alone, insufficient di- mechanism to hypoxemia, which leads to hyperventilation etary intake of animal protein may be the cause; other with a concomitant increase in alveolar PO2. The A-aO2 gra- causes include loss of gastric mucosa or regional enteritis. Philadelphia: Lea & 2 perventilation as a result of the hypoxic drive (low PO ) that Febiger, 1993. The mechanisms by which oral contraceptives increase the CASE STUDY FOR CHAPTER 22. The risk appears to be correlated best with the estrogen Pickwickian Syndrome content of the pills. Hypotheses include increased endothe- A 45-year-old man was referred to the pulmonary func- lial cell proliferation, decreased rates of venous blood flow, tion laboratory because of polycythemia (hematocrit of and increased coagulability secondary to changes in 57%). At the time of referral, he weighs 142 kg (312 platelets, coagulation factors, and the fibrinolytic system. A Furthermore, there are changes in serum lipoprotein levels brief history reveals that he frequently falls asleep during with an increase in LDL and VLDL and a variable effect on the day. Driving cross-country, with long sedentary periods, 94%; PCO2, 35 mm Hg, and pH, 7. During this time, his chest wall continues to move, but Anemia airflow at the mouth and nose is not detected. A 68-year-old widow is seen by her physician because of Questions complaints of fatigue and mild memory loss. This patient is suffering from what has been known as pick- thyroxin-stimulating hormone (TSH), and liver enzymes wickian syndrome, a disorder that occurs with severely are normal. Why are SaO and arterial PO normal in anemic patients who was always falling asleep in Charles Dickens’ novel 2 2 who have hypoxemia? How does anemia affect the oxygen diffusing capacity of poventilation and often suffer from sleep apnea as well. About 80% of sleep apnea patients are obese and Answers to Case Study Questions for Chapter 21 20% are of relatively normal weight.

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If reinnervation occurs generic kamagra oral jelly 100mg with mastercard, determined largely by the rate at which ACh binds to the the extrasynaptic receptors gradually disappear buy discount kamagra oral jelly 100 mg line. Muscle at- receptors, and indirect clinical measurements of the size rophy also occurs in the absence of functional innervation, and rise time of the endplate potential are of considerable which also can be at least partially reversed with artificial diagnostic importance. OF SKELETAL MUSCLE The variety of controlled muscular movements that humans Neuromuscular Transmission Can Be can make is remarkable, ranging from the powerful con- Altered by Toxins, Drugs, and Trauma tractions of a weightlifter’s biceps to the delicate move- ments of the muscles that position our eyes as we follow a The complex series of events making up neuromuscular moving object. In spite of this diversity, the fundamental transmission is subject to interference at several steps. The drug hemicholinium interferes with choline up- take by the presynaptic terminal and, thus, results in the de- The Timing of Muscle Stimulation Is a pletion of ACh. Botulinum toxin interferes with ACh Critical Determinant of Contractile Function release. This bacterial toxin is used to treat focal dystonias (see Clinical Focus Box 9. A skeletal muscle must be activated by the nervous system Postsynaptic blockade can result from a variety of cir- before it can begin contracting. Drugs that partially mimic the action of ACh processes previously described, a single nerve action po- can be effective blockers. Derivatives of curare, originally tential arrives at each motor nerve axon terminal. A single used as arrow poison in South America, bind tightly to ACh muscle action potential then propagates along the length 156 PART III MUSCLE PHYSIOLOGY CLINICAL FOCUS BOX 9. Abnormal postures does not appear to produce paralysis until the toxin is ac- and considerable pain, as well as physical impairment, of- tively transported into the cell, a process requiring more ten result. Once inside the cell, the toxin disrupts cal- small and specific region of muscles, hence, the term focal cium-mediated ACh release, producing an irreversible (“by itself”). The modic torticollis and cervical dystonia (involving neck nerve terminals begin to degenerate, and the denervated and shoulder muscles), blepharospasm (eyelid muscles), muscle fibers atrophy. Eventually, new nerve terminals strabismus and nystagmus (extraocular muscles), spas- sprout from the axons of affected nerves and make new modic dysphonia (vocal muscles), hemifacial spasm synaptic contact with the chemically denervated muscle (facial muscles), and writer’s cramp (finger muscles in fibers. During the period of denervation, which may be the forearm) are common dystonias. Such problems are several months, the patient usually experiences consider- neurological, not psychiatric, in origin, and sufferers can able relief of symptoms. The relief is temporary, however, have severe impairment of daily social and occupational and the treatment must be repeated when reinnervation activities. The specific cause is located somewhere in the central Clinically, highly diluted toxin is injected into the indi- nervous system (CNS), but usually its exact nature is un- vidual muscles involved in the dystonia. A genetic predisposition to the disorder may exist in conjunction with electrical measurements of muscle ac- in some cases. Centrally acting drugs are of limited effec- tivity (electromyography) to pinpoint the muscles in- tiveness, and surgical denervation, which carries a signifi- volved. Patients typically begin to experience relief in a few cant risk of permanent and irreversible paralysis, may pro- days to a week. However, recent clinical trials may be dramatic and may last for several months or more. It is one of the The principal adverse effect is a temporary weakness of most potent natural toxins; a lethal dose for a human adult the injected muscles. The active portion of the toxin is a pro- the toxin, which renders its further use ineffective. Studies tein with a molecular weight of about 150,000 that is con- have shown that the toxin’s activity is confined to the in- jugated with a variable number of accessory proteins. Type A toxin, the complex form most often used therapeu- Long-term effects of the treatment, if any, are unknown. If stimuli are given repeatedly and rapidly, the result is a sustained contraction called a tetanus. The duration of the ac- tions occur so close together that no fluctuations in force tion potential in a skeletal muscle fiber is short (about 5 are observed, a fused tetanus results. The repetition rate at msec) compared to the duration of a twitch (tens or hun- which this occurs is the tetanic fusion frequency, typically dreds of milliseconds, depending on muscle type, tempera- 20 to 60 stimuli per second, with the higher rates found in ture, etc. This means the absolute refractory period is also muscles that contract and relax rapidly. If the second stimulus is given dur- into a smooth tetanus at the highest stimulus frequency. This additional force increment is associated with a second release of calcium ions from the SR, which Higher Forces Are Produced During a Tetanus. The adds to the calcium already there and reactivates actin and amount of force produced in a tetanus is typically several myosin interactions (see Chapter 8). When the second times that of a twitch; the disparity is expressed as the CHAPTER 9 Skeletal Muscle and Smooth Muscle 157 These deformable structures comprise the series elastic component of the muscle, and their extension takes a sig- nificant amount of time. The brief activation time of a twitch is not sufficient to extend the series elastic compo- nent fully, and not all of the potential force of the contrac- tion is realized. Repeated activation in tetanus allows time for the internal “slack” to be more fully taken up, and more force is produced. Muscles with a large amount of series elasticity have a large tetanus-twitch ratio. The presence of series elasticity in human muscles provides some protection against sudden overloads of a muscle and allows for a small amount of mechanical energy storage.

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One action potential in a climbing fiber pro- decrease in the low level of resistance to passive joint duces a burst of action potentials in the Purkinje cell called movement detectable in normally relaxed individuals kamagra oral jelly 100mg free shipping. Climbing fibers also synapse with basket generic kamagra oral jelly 100 mg visa, otatic reflexes produced by tapping a tendon with a reflex Golgi, and stellate interneruons, which then make in- hammer reverberate for several cycles (pendular reflexes) hibitory contact with adjacent Purkinje cells. This circuitry because of impaired damping from the reduced muscle allows a climbing fiber to produce excitation in a single tone. The hypotonia is likely a result of impaired process- Purkinje cell and inhibition in the surrounding ones. The cerebellar cortical output (Purk- cerebellar function, we are left without a firm idea of what inje cell efferents) is inhibitory to the cerebellar and the cerebellum does in the normal state. Cerebellar func- vestibular nuclei, but the ultimate output of the cerebellar tion is sometimes described as comparing the intended nuclei is mostly excitatory. A smaller population of neurons with the actual movement and adjusting motor system out- of the deep cerebellar nuclei produces inhibitory outflow put in ongoing movements. Other putative functions in- directed mainly back to the inferior olive. REVIEW QUESTIONS DIRECTIONS: Each of the numbered (A) Finger flexion (C) Spinocerebellar items or incomplete statements in this (B) Elbow flexion (D) Rubrospinal section is followed by answers or by (C) Shoulder abduction (E) None completions of the statement. What is the location of the primary ONE lettered answer or completion that is (E) No muscles would become abnormal motor area of the cerebral cortex? Tapping the patellar tendon with a (A) Upper parietal lobe reflex hammer produces a brief (B) Superior temporal lobe 1. Concurrent flexion of both wrists in (A) Low threshold, fatigue-resistant connective tissue response to electrical stimulation is (B) High threshold, fatigable (B) Golgi tendon organ response characteristic of which area of the (C) Intrafusal, gamma controlled (C) Muscle spindle activation nervous system? The cyclical flexion and extension (C) Dentate nucleus provides information about the force of motions of a leg during walking result (D) Primary motor cortex muscle contraction? If you could histologically examine the (B) Nuclear chain fiber (A) Cerebral cortex spinal cord of a patient who had (C) Golgi tendon organ (B) Cerebellum experienced a viral illness 10 years (D) Bare nerve ending (C) Globus pallidus before in which only the neurons of (E) Type Ia ending (D) Red nucleus the primary motor area of the cerebral 3. If a patient experiences enlargement of (E) Spinal cord cortex were destroyed, what findings the normally rudimentary central canal 6. New normal abnormal in a degenerative disease that York: McGraw-Hill, 2000. Carpenter’s Human Neu- inhibitory input to the internal (A) Purkinje cells roanatomy. Media, PA: segment of the globus pallidus should (B) Mossy fibers Williams & Wilkins, 1996. Fun- (C) Decreased excitatory output from Alexander G, Crutcher M, DeLong M. San Diego: the thalamus to the cortex Basal ganglia-thalamocortical circuits: Academic Press, 1999. The autonomic nervous system has three divisions: sym- anatomic origin and function. A two-neuron efferent path is utilized by the autonomic through a hierarchy of reflexes and integrative centers. These responses occur as a result of the actions of AN OVERVIEW OF THE AUTONOMIC NERVOUS the autonomic portion of the nervous system and take place SYSTEM without conscious action on the part of the individual. The term autonomic is derived from the root auto (meaning “self”) On the basis of anatomic, functional, and neurochemical and nomos (meaning “law”). Our concept of the autonomic differences, the ANS is usually subdivided into three divi- part of the nervous system has evolved during several cen- sions: sympathetic, parasympathetic, and enteric. The recognition of anatomic differences between teric nervous system is concerned with the regulation of the spinal cord and peripheral nerve pathways that control gastrointestinal function and covered in more detail in visceral functions from those that control skeletal muscles Chapter 26. Observations on the effects of the sub- sions are the primary focus of this chapter. Regulation of the involuntary or- fall into three major categories: gans came to be associated with the portions of the nervous • Maintaining homeostatic conditions within the body system that were located, at least in part, outside the stan- • Coordinating the body’s responses to exercise and stress dard spinal cord and peripheral nerve pathways. The gan- • Assisting the endocrine system to regulate reproduction glia, located along either side of the spine in the thorax and The ANS regulates the functions of the involuntary or- abdominal regions and somewhat detached from the nerve gans, which include the heart, the blood vessels, the ex- trunks destined for the limbs, were found to be associated ocrine glands, and the visceral organs. In some organs, the with involuntary bodily functions and, therefore, desig- 108 CHAPTER 6 The Autonomic Nervous System 109 nated the sympathetic division. This collection of struc- A Two-Neuron Efferent Path Is Utilized by the tures was also termed the thoracolumbar division of the Autonomic Nervous System ANS because of the location of the ganglia and the neuron The nervous system supplies efferent innervation to all or- cell bodies that supply axons to the ganglia. In their axons that controlled internal functions were also the motor system, there is an uninterrupted path from the found in the brainstem and associated cranial nerves, as cell body of the motor neuron, located in either the ventral well as in the most caudal part of the spinal cord. Those horn of the spinal cord or a brainstem motor nucleus, to the pathways were somewhat distinct from the sympathetic skeletal muscle cells. In the ANS, the efferent path consists system and were designated the parasympathetic division. An efferent fiber emerges as these two divisions, leading to the designation of the sym- the preganglionic axon and then synapses with neurons lo- pathetic system as adrenergic, for the adrenaline-like ac- cated in a peripheral ganglion. The neuron in the ganglion tions resulting from sympathetic nerve activation; and the then projects a postganglionic axon to the autonomic ef- parasympathetic system as cholinergic, for the acetyl- fector cells. The functions of the sympathetic and parasympathetic divisions are often simplified into a two-part scheme. The The Primary Neurotransmitters of the ANS Are sympathetic division is said to preside over the utilization Acetylcholine and Norepinephrine of metabolic resources and emergency responses of the body.

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AIDS is the final stage of results are more common than false-neg- HIV infection and is characterized by ative results order kamagra oral jelly 100mg visa. If the ELISA is positive the symptoms of severe failure of the immune second time proven 100mg kamagra oral jelly, the test is confirmed by using system. A repeated positive ELISA and positive Transmission of HIV Western blot confirm the diagnosis of HIV infection. AIDS is usually diagnosed when HIV is found in the blood, as well as in HIV is present and the individual has body secretions such as sperm. Trans- developed an opportunistic infection mission can occur in a variety of ways. The and/or has a T-helper cell count that has virus can be transmitted through: fallen below a certain level (see below). During the early or acute • contact with a cut or open wound on phase, symptoms may be subtle or non- the skin existent. Initially, some individuals may 246 CHAPTER 8 CONDITIONS OF THE BLOOD AND IMMUNE SYSTEM experience mild flulike symptoms that sub- toms) until they develop opportunistic side, leaving them symptom-free, although infections (infections that would not the virus is still transmissible to others. Many organisms commonly decline in the number of helper T cells of found in the environment pose no threat the immune system. Infected individuals under normal circumstances because the may experience some or all of the follow- functioning immune system resists them. When individuals have HIV infection, the immune system is no longer able to act as • Weight loss of 10 or more pounds in a defense, and individuals are susceptible less than 2 months for no apparent to disease and infections that under nor- reason mal circumstances would not become full- • Loss of appetite blown. These diseases and infections are • Unexplained persistent fever called “opportunistic. HIV uncommon in healthy individuals, al- infections can generally be classified though it may be found in other immuno- according to three stages: compromised individuals, such as in those who have cancer or those who have • Early-stage disease (generally asymp- received immunosuppressants in associa- tomatic) = T-helper cell counts above tion with organ transplantation. Pneumo- 500 cystis carinii pneumonia is one of the most • Middle-stage disease (swollen lymph common manifestations of HIV infec- nodes, fatigue, intermittent fever) = T- tions. Symptoms usually begin with a dry helper cell counts between 500 and cough and difficulty in breathing. The fungus Candida frequently invades the oral cavi- Symptoms of Advanced HIV Disease ty of the HIV-infected individual, causing and AIDS a superficial infection in the mouth and throat that is manifested by pain and Many individuals with HIV infection white plaques. This condition, also known remain asymptomatic (without symp- as oral thrush, may be the first clue that the Conditions Affecting the Blood or Immune System 247 individual is infected with HIV. Although by interrupting the ability of HIV to bind it is uncomfortable and difficult to cure, with other cells. New antiviral treatments infection with Candida is not likely to be referred to as highly aggressive antiretroviral fatal. Individuals with debilitating condi- therapy, which includes a class of drugs tions other than HIV infections may also called protease inhibitors, can be taken in develop candidiasis. This combination therapy has an otherwise rare form of cancer called offered dramatic improvements in the Kaposi’s sarcoma is frequently associated medical treatment of individuals with with HIV infection; this is considered an HIV/AIDS (Britton, 2000; Shernoff & opportunistic cancer. Because of develop neurological symptoms at some the toxicity of some of the medications, time during the course of the disease. Additional side effects of lent feature among individuals with peripheral neuropathy, ulcerations of the HIV/AIDS (Marcus, Kerns, Rosenfeld, & mouth, and skin rashes may also be expe- Breitbart, 2000). The regimen of medications used in the Individuals with HIV infection may also treatment of HIV infection can be cumber- experience a type of dementia called AIDS some as well as expensive, making the dementia complex, which may include treatment not accessible to many individ- cognitive symptoms such as poor concen- uals with HIV infection who are without tration or forgetfulness, motor symptoms insurance or who are underinsured. Newer such as loss of balance or clumsiness, and antiviral drugs can cost up to $20,000 per behavioral symptoms such as apathy and year, which is more than twice that of the social withdrawal. The precise mechanism next most expensive antiretroviral drug by which HIV causes dementia is unknown. In addition, the poten- tially serious side effects associated with Treatment for HIV/AIDS the newer antiretroviral drugs can be of concern (Tashima & Carpenter, 2003). Currently, there is no means of restor- In addition to medication, much of the ing the damaged immune function char- treatment for individuals with HIV infec- acteristic of HIV infections. However, ad- tion is geared toward supportive care and vances in the medical management of HIV prevention of opportunistic infections. Antiretroviral drugs directly inhibit exercise, and should maintain adequate HIV by disrupting its replication cycle or nutrition. As the condition progresses, 248 CHAPTER 8 CONDITIONS OF THE BLOOD AND IMMUNE SYSTEM individuals may need to modify their exer- ployment, possible rejection by family or cise program and allow for more frequent friends, economic stress, and potential rest periods to conserve energy. As much premature death (Fleishman, Donald- as possible, individuals with HIV infection Sherbourne, Crystal, Collins, et al. In addition to maintaining HIV positive are likely to experience con- good health practices, they should avoid siderable anxiety. If they develop is much ambiguity associated with posi- symptoms of infection, they should con- tive test results. Individuals when opportunistic and/or neurological live with total unpredictability. Following symptoms occur, treatment is directed periods of being very unwell, they may toward the specific infection or symptom then recover and experience periods of manifestation. It is not unusual for indi- well-being only to then develop another viduals with later stages of HIV infection infection and return to an illness state to experience a number of hospitalizations (Cochrane, 2003). Individuals may retreat importance of practicing safe sex; of from most of their former activities and informing sexual partners of their condi- may find it difficult to set goals for the tion prior to sexual activity; and of not future. They may put aside their person- sharing needles, razors, toothbrushes, or al aspirations and focus on the struggle to any other item that could be contaminat- survive. Individuals with HIV infection often bear the additional stress of the stigma Psychosocial Issues in HIV/AIDS and fear associated with the disease, both of which can lead to rejection and aban- Distress and preoccupation with illness donment by others. Feelings of depression, and imminent death may characterize despair, and hopelessness are common. Coping Individuals may also experience consider- with a diagnosis of HIV and the changes able anger.

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