7/27/2019 Us Mle World

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sildenafil is erectile dysfunc drug, c.i in patients who are receiving nitrate for angina pectoris,b ecause severe hypotension and death have occured, because patient is receiving medication fro heart conditions, angina ,htn, sildenafil contraindcated until medications clarified,transitional object mother substitutes such as blanket or soft toy to which child may become attracted and that she may carry around all time, this is normal developemntal phenomenon not sgn of pathologycarcinoma cells isolated from 68 yr old demonstrate adhesion to extracelular matric and basement memb scondary to reduced integrin expresion,which foll molecule impt mediating mechanism of adhesion absent in these cells/fibronectinthey are large glycoprotein produced by fibroblasts and some epithelial cells, fibronctin bind to integrins, matrix collagen and glycosaminoglycan serve as mediator normal cell adhesion and migrationcarcinoid tumors arise from enterochromafin cell of intstinal mucosa,these cellsproduce no of vasoactive amines substances such as serotonin,bradykinin,prostaglandins and many others,whn tumor is confined to intestine,its secretory prodtsmetablized by liver and patients do not develop clinical manifestationssx includevasomotor instability cutaneous flushing,dizzinessGI sx.secretory diarhhea,and crampy abd painbronchoconstriction,dyspnea on whezingright sided valvular heart diseaasesickle cel most comon in african american,autosomal recessive, manifest

hemolysis,repeated sickling of rbc permanent sickling a nd premature erythrocytedstruction, vasoocclusive sx68 year male present to office with fatigue difficulty carrying out his normal activities he had HX of HTN, TYPE 2 dm anD oa he has smoke one pack of cigar perday for past 40 years.which foll likely indicate left heart failuresupien dyspnea relieved bu sittng up