here is a good start:

http://www.amazon.com/High-Yield-Bio...lp_edpp_img_in

buy it used for seven bucks.. formulas don't change.. but people get greedier...

Quick note on distinguishing between stress incontinence, urge incontinence and overflow incontinence..
obviously stress is easy to diagnose with the Q tip test and the patient will complain of loss of small amounts of urine, during coughing, sneezing, this is treated either with kiegel exercises or surgery depending on the severity by attaching the sphincter to the pubic symphysis.

Overflow incontinence also known as hypotonic incontinence results in involuntary loss of urine, typically due to ineffective detrussor contraction. the hypotonic bladder muscles allow for bladder pressure to exceed urethral pressure , resulting in intermittent emptying of urine in small amounts all throughout the day (the word small here is operative) Think of this etiology with diabetic neuropathy, MS or anticholinergic meds. These pts experience pelvic fullness due to the increased residual volume of urine. RX. is anticholinergic blockers to relax the bladder neck, intermittent cath maybe necessary in refractory cases.

similarly urge (hypertonic) incontinence also results in loss of urine day or night, but in much larger amounts and without warning due to involuntary rise in bladder pressure from excessive idopathic detrusor muscle contractions. these cases require treatment with anticholinergic meds like oxybutinin, note that this med would exacerbate (overflow) hypotonic incontinence as such it is important to work out the difference.

I know I have gone over this in the previous pages but thought I'd simplify it even more..

Getting back on track with some disorders of the immune system.

1- Primary immune deficiency also known as (CVID) common variable immune deficiency
it is an abnormality in B cell function, presents from one year to adulthood, when the onset is in adulthood the patient may have an underlying lymphoid malignancy-- presentation with recurrent bacterial infections involving the sinuses, middle ears, when the lung is involved it means there is systemic disease, treatment is with lifelong IVIG

2- Hyper IgE syndrome also known as (job's syndrom)
recurrent skin, and visceral abscesses mostly due to staph with an elevated level of IgE

3- DiGeorge's syndrome -- secondary to deletion of chromosome 22q11, affecting the development of third and 4th pharyngeal pouch, causing anomalies of face, thymus, parathyroid and cardiac structure like tetraology of fallot. There is an absence of T cells secondary to absence of the thymus. there is also hypocalcemia secondary to hypoparathyroidism so they'll present with tetany and seizures rx is a BMT

4- Wiscott Aldrich syndrome:
mix of immunoglobulin defects as well a t cell deficiency, eczema in the early yrs resembling atopic dermatitis, thrombocytopenia, the immunoglobulin pattern is as such IgG normal IgM low, IgA and E very elevated. Infexns from encapsulated organisms. They have an increased incidence of Hodgkins. RX BMT
if BMT isn't feasible due to absence of HLA matched donor then a splenectomy is the RX of choice (so remember immunizations) and that is reserved for pts whose plts count is less than 50,000 IVIG every three to four weeks.
ABX prophylaxis with amoxil or tmp-smx daily.

5- SCID
absence of both cellular and humoral immunity, starts in the neonate, recurrent diarrhea, infexn and failure to thrive. chronic mucocutaneous candidaiasis is common early finding. attenuated live vaccines such as OPV can cause reversion and severe infxn.
blood transfusions can cause GVHD -- lab findings are lymphopenia absolute lymphocyte count less than 2000/mm cube, hypoglobulinemia, impaired specific antibody response, cutaneous anergy . RX BMT

6- ADA deficiency
profound lymphopenia absolute lymph count less than 500/mm cube
chondro-osseous dysplasia of constochondral junctions -- verteberal bodies reveal rachitic rosary rib cage

7- chediack Higashi syndrome
phagocytic disorder, neutrophis contain abnormal giant granules due to inappropriate fusion of lysosomes and endosomes. Recurrent pyogenic infections, partial oculocuteanous albinism, neurological abnormality photphobia, seizures, disorders of spinal tract and cerebellum.

8-
IgA deficiency
most common primary deficiency -- predominant Ig of nasal secretions. Most pts are asymptomatic but may develop recurrent sino-pulmonary infexns, recurrent gi infexns with giardia, anaphylaxis to transfusion rxn.

9- Ataxia Telangictasia:
progressive cebellar ataxia since the beginning of walking, slowly worsening by 10-12 become wheelchair bound
occular or facial telangiectasia, elevated alpha feto protein in more than 95%.. Immunodeficiency absent or low IgA and IgE level..
no effective rx