Nurali Nazarov

◾️ Aging and atherosclerosis can blunt carotid baroreceptor responses due to stiffening of the vascular wall not allowing as much transduction of wall distention.

◾️ If a vessel wall is stiffer, it doesn't distend as much or become bigger in responses to changes in blood pressure. So if blood pressure goes up, it should stretch the blood vessel.

◾️ If it stretches the blood vessel, it impacts or enacts changes in the nerve that's right around that blood vessel and as it distends it pushes on that nerve and will transduce the signal back to the brain. 

◾️ In this case if you have a stiffer vessel, less information travels through a stiff vessel and therefore you don't respond to the same extent.

A physician who became aphasic

◾️ Lordat (1843) “I noticed that when | wanted to speak | could not find the expressions... 

The thought was all ready but the sounds that had to express it as intermediary were no longer at my disposition. 

[a day later] I found myself deprived of the use of almost all words. If some of them remained at my grasp, they were almost useless for me, because | could no longer recall the ways to coordinate them in order to express a thought."

"Excuse me for feeling superia,

 to all of the lowly bacteria. 

You should know very well, 

there is no organelle, 

inside of their tiny interia."

<<Kevin Ahern>>

Infertility in males 

◾️ Infertility in males is usually the result of a low number of normal healthy sperm (~200 million sperm per ejaculation). 

◾️ Male with a sperm count below 55 to 60 million sperm per ejaculation would be considered infertile. 

◾️ Remedying a low sperm count may be: changing the style of underwear, the size of his pants, both of which might cause the testes to be maintained at too high of a temperature.  Switching from tight briefs and pants that may hold the testes too close to the body to boxers and looser pants may increase a man’s sperm count. 

◾️ Other conditions resulting in a low sperm count: Low testosterone levels, immune disorders that attack sperm, radiation, drugs (anabolic steroids and marijuana) and diseases (mumps, gonorrhea) 

Infertility in females

◾️ Pelvic inflammatory disease (PID) (any severe bacterial infection of the female reproductive tract). 

◾️ PID that reaches the oviducts can cause scarring that may seal the oviducts and prevent passage of the egg or sperm.

◾️ The strongly acidic vaginal secretions or a thick mucus some women have can damage sperm and make it difficult for the sperm to move toward the egg. 

◾️ Endometriosis is a condition in which the endometrial tissue  migrates up the oviduct and implants on organs such as the (bladder, kidneys, ovaries, and colon). This misplaced tissue is stimulated each month by the hormonal cycle and can cause pain and infertility. 

◾️ The reproductive success of females is affected by age much more than it is in males. In a woman in her mid-40s, the ovaries contain far fewer oocytes and become less responsive to LH and FSH than in a younger woman. Also, oocytes ovulated near the end of a woman’s reproductive life are more likely to have been damaged by years of exposure to environmental toxins, radiation, drugs, chemicals, and disease.

İn USA, many couples have been known to spend in excess of $250,000 in the hope of becoming biological parents.

◾️ Scientists believe that estrogen may in some way protect women from cardiovascular problems. 

◾️ Once women reach their mid-40s (the age at which most women experience menopause), they begin to suffer from cardiovascular disease at an accelerated rate, and by the time they reach 70, they experience cardiovascular disease and heart attacks at the same rate as men of the same age.

◾️ Clinical studies have shown that premenopausal women have a lower incidence of cardiovascular disease than postmenopausal women.

◾️ Research has demonstrated that estrogen at menopausal levels stimulates the production of Nitric Oxide in the endothelial cells of arteries including those in heart.

◾️ Nitric Oxide is one of the most important vascular regulatory agent in the body, capable of relaxing the smooth muscle surrounding arteries.

◾️ Ambulances in England now carry injectable estrogen and administer it to patients (male or female) who are suffering from heart attack.

◾️ One very interesting component of semen is zinc. 

◾️ Although the role of zinc is unclear, low concentrations have been associated with male infertility.

Two major theories have been proposed about the causes of sexual dimorphism.

◾️ The first theory suggests that the presence of steroid hormones directs the development of the brain to be either male or female by forming pathways within the brain that are required for the control and display of sex-specific behaviors.

◾️ The second theory suggesting that the influences of other individuals and one’s society during the formative childhood years may result in the development of stereotypical sexual behaviors.

◾️ Androgen is critical for the development of the male external genitalia. Removal of the testes, which stops androgen release, will result in the feminization of the external genitalia. Exposure of a female fetus to androgens will masculinize her external genitalia.

In the presence of the androgen DHT, the primordial genital structures will fuse to form the penis, which encloses the urethra and the scrotum. In the absence of any hormonal influence, the primordial genital structures will not fuse and will therefore form the female genitalia instead.

◾️ All embryos will inherently develop along the female pathway. Some XY individuals have reproductive tissues  that don't respond to the presence of androgens (androgen insensitivity) and they can suffer from testicular feminization mutation (TFM).

Because Y chromosome is present, testicular development occurs and testes also produce MIF causing the regression of Mullerian duct system. However, in these individuals, the Wolffian duct system doesn't recognize androgen and therefore, doesn't develop. 

◾️ Males born with TFM have perfectly normal-appearing external female genitalia and are generally reared as girls. The parents and doctors are often unaware that the child is actually genetically male. This condition is usually discovered during adolscence when menstruation fails to occur. Because the Mullerian ducts fails to develop, they have short vagina and no uterus/fallopian tube will develop.

In these individuals, estrogen receptors function normally. At puberty, the estrogen generated from excess androgens initiate the development of the secondary sex characteristics in a female direction.

                                                                 Approach to the neurologic patient.

▪ Following logical steps can help one arrive the diagnosis that avoids costly mistakes due to ordering inappropriate laboratory tests, establishing an incorrect diagnosis, and prescribing the wrong treatment. 

▪ The developmental process, called pregnancy, began approximately nine months earlier.

▪ In the monthly menstrual cycle of the female, the ovary usually releases a single egg, or ovum. 

However, sometimes the mother’s ovaries release two ova instead of the normal one. 

▪ This is what happens with fraternal twins.