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Although no one has directly died from the common cold buy generic carafate 1000 mg online, it does create both physical and mental discomfort for the person and leads to a loss of work and school purchase 1000mg carafate with mastercard. During this time discount carafate 1000 mg overnight delivery, the rhinovirus can be transmitted by touching contaminated surfaces and from contact with droplets from an infected patient who sneezes and coughs. After the incubation period, the patient experiences a watery nasal discharge called rhinorrhea, nasal congestion, cough, and an increasing amount of mucosal secretions. Many patients try home remedies to battle the rhinovirus, however these don’t affect the virus. Home remedies include rest, vitamin C, mega doses of other vitamins, and, of course, chicken soup. Vitamin C and mega doses of other vitamins have not been proven effective against the common cold. When home remedies fail, patients turn to both prescription and over-the- counter medication. Charts throughout these pages provide information about specific drugs in each group. Antihistamines (H blocker) 1 Many cold symptoms are caused by the body’s overproduction of histamines. Histamines are potent vasodilators that react to a foreign substance in the body such as the rhinovirus. H2 receptors cause an increase in gastric secretions and are not involved in this response. This is referred to as nasal con- gestion and is caused when the nasal mucous membranes swell in response to the rhinovirus. A decongestant is a drug that stimulates the alpha-adrenergic receptors to tell the brain to constrict the capillaries within the nasal mucosa. The result is that the nasal mucous membranes shrink, reducing the amount of fluid that is secreted from the nose. Decongestants are available in nasal spray, drops, tablets, capsules, or in liq- uid form. These are nasal decongestants that provide quick relief to the patient; systemic decongestants that provide a longer lasting relief from congestion; and intranasal glucocorticoids that are used to treat seasonal and perennial rhinitis. Cough Preparations A cough is a common symptom of a cold brought about by the body’s effort to remove nasal mucous that might drain into the respiratory tract. Antitussives are the ingredients used in cough medicine to suppress the cough center in the medulla. Although the cough reflex is useful to clear the air passages, suppres- sion of the cough reflex can provide some rest for the patient. Expectorants When an individual has a cold or other respiratory infection, it is common to have rather thick mucous that is difficult to expectorate. Expectorants are med- ications that loosen the secretions making it easier for the patient to cough up and expel the mucous. They work by increasing the fluid output of the respira- tory tract and decrease the adhesiveness and surface tension to promote removal of viscous mucus. A list of drugs utilized in the treatment of upper respiratory tract disorders is provided in the Appendix. Patients may take systemic or nasal decongestants to reduce the congestion that frequently accompanies sinusitis. Patients are told to drink plenty of fluids, to rest, and to take acetaminophen (Tylenol) or ibupro- fen for discomfort. In some cases, antibiotics are prescribed if the condition is severe or long lasting and an infection is suspected. Pharyngitis is caused by a virus (viral pharyngitis) or by bacteria (bacteria pharyngitis) such as the beta-hemolytic streptococci. Sometimes patients experience acute pharyngitis along with other upper respiratory tract disease such as a cold, rhinitis, or acute sinusitis. Patients who have a viral pharyngitis are given medications that treat the symptoms rather than attacking the underlying virus. Acetaminophen or ibupro- fen is given to reduce the patient’s temperature and discomfort. Saline gargles, lozenges, and increased fluid are usually helpful to soothe the sore throat. Patients who have bacterial pharyngitis are given antibiotics to destroy the beta-hemolytic streptococci bacteria. However, antibiotics are only prescribed if the result of the throat culture is positive for bacteria. Patients are also given the same treatments for viral pharyngitis to address the symptoms of pharyngitis. Patients who come down with acute tonsillitis experi- ence a sore throat, chills, fever, aching muscles, and pain when they swallow. A throat culture is taken to determine the cause of the infection before an appropriate antibiotic is prescribed to the patient. The patient is also given acet- aminophen or ibuprofen to reduce the fever and the aches and pains associated with acute tonsillitis. The patient is also encouraged to use saline gargles, lozenges, and increased fluid to soothe the soreness brought on by infected ton- sils. Other times it is caused by stress or overuse of the vocal cords—a common occurrence for fans whose team wins the Super Bowl. Refraining from speaking and avoiding exposure to substances that can irritate the vocal cords, such as smoking, is the preferred treatment for acute laryngitis. The result is an impairment of oxygen reach- ing lung tissues that can in some cases irreversibly damage lung tissues. The airway obstruction occurs when the bronchioles constrict (bronchospasm) and mucous secretions increase causing the patient to experience difficulty breathing (dyspnea). Symptoms include fever, chills, cough, rapid breathing, wheezing and/or grunting respirations, labored breathing, vomiting, chest pain, abdominal pain, loss of appetite, decreased activity, and, in extreme cases, signs of hypoxia (low oxygen levels) or cyanosis such as a bluish tint around the mouth or fingernails. That is, bronchodilators, antipyretics (fever reducing), analgesics such as ibuprofen, cough medications that include expectorants, mucolytics, as well as suppressants to help the patient sleep.

Burns are classified according to their degree of severity and the amount of skin affected: • First-degree burns damage the epidermis purchase carafate american express. Depending on the extent of the burn and subsequent tissue damage purchase 1000mg carafate overnight delivery, second-degree burns may be self-treated buy discount carafate line, but must be diligently watched and treated to avoid infection. They may affect muscles, bones, nerves, and blood vessels, requiring extensive treatment, skin grafts, and therapy. Because of the risk of shock and infection, third-degree burns are always considered a life-threatening medical emergency. There are a variety of lifestyle recommendations and also natural products that can help relieve the pain and promote skin healing for first-degree and minor second-de- gree burns. Third-degree burns need to be managed by your doctor to reduce the risk of infection and serious complications. Three percent of burns reported are caused by hot-water scalding, most often in the bathtub. Most hot-water heaters are set at 140°F, which can instantly burn the thin skin of a child. The goals of burn treatment are to speed wound healing, prevent infection and scars, relieve pain, and restore the patient to normal health. As such, doctors may employ a variety of antimicrobial and antibiotic agents, as well as pain relievers, to achieve these goals. For extensive burns, extensive treatment is needed, which may include lengthy hospital stays to ensure that infection does not occur, and outpatient appointments for therapy. Dietary Recommendations A healthy diet is critical for effective burn treatment to replace vital nutrients, promote wound healing, and reduce the risk of infection and scars. Also, for more serious burns, the healing process consumes many calories and a healthy diet can help keep your body strong during this process. Foods to include: • Drink plenty of water and electrolyte drinks to replace lost fluids. Note: Those with severe burns need to increase total caloric intake because as the body tries to repair, it burns calories at a faster rate. To manage a minor burn: • Gently cool and clean the area with cold water or cold wet compresses for at least 15 minutes. Do not cover with any type of petroleum-based cream or butter, as they retain heat, slow healing, and in- crease risk of infection. Honey products are also available in a spray, salve, or tincture (The British Journal of Surgery, 1991: 78; 497–498). Top Recommended Treatments Aloe vera gel: Cooling, helps relieve pain and inflammation, and also has anti-inflammatory properties. It is commonly used to manage burns and has a long history of use to promote wound healing, although the scientific research is lacking. Use aloe vera from a plant (split open a leaf) or get pure aloe gel at a health food store or pharmacy. Antioxidants: Studies have shown that oral supplements of vitamins A, C, E, zinc, and selenium can help to protect the skin from sunburn due to free radical-producing ultravio- let rays. Topical vitamin E cream or oil is commonly used to promote skin healing and may reduce scarring. Complementary Treatments Calendula cream: Soothing, has anti-inflammatory properties, and may help promote tissue repair. After a burn has cooled, cleanse with chamomile B tea and apply fresh aloe vera gel. Eat a healthy diet packed with lots of fresh fruits and vegetables, whole grains, and fish. Increase total calorie intake during the healing process and drink lots of liquids. It is the leading cause of premature death in Canada—about 1,006,000 potential years were lost in 2003 as a result of cancer. Cancer has become an age-related phenomenon: 44 percent of new cancer cases and 60 percent of cancer deaths will occur among those who are at least 70 years old. Rather, in many cases it is generally thought that our lifetime exposure to factors that increase our risk, such as smoking or eating a poor diet, leads to the development of cancer. Our bodies are made up of millions of cells grouped together to form tissues or organs, such as muscles, skin, bones, and organs. Cancer occurs when there is an abnormal growth of cells, which can form lumps or tumours, or can spread through the bloodstream and lymphatic system to other parts of the body. Benign tumour cells stay in one place in the body and are not usually life-threatening. Malignant tumour cells are able to spread to invade nearby tissues and other parts of the body, which is a process called metastasis. Finding cancer early and getting treat- ment before it spreads can greatly help improve your chances of survival. While we think of cancer as one disease, it is actually a group of more than 100 different diseases. It can involve any tissue of the body and have many different forms in each body area. The four most common types of cancer in Canada are breast, prostate, lung, and colon. A great deal of research has focused on the underlying causes of abnormal cell growth. We do know that certain factors, such as free radical damage, genetics, diet, and lifestyle, are involved. While many of us may blame our family history, only about 5–10 percent of cancers are attributed to faulty genes. Having a family history may increase your risk of certain cancers, but researchers feel that whether or not those genes are “switched on” may depend largely on lifestyle and environment. These critical yet often overlooked factors play a role not only in prevention but also in the treatment and recovery from cancer. Based on current incidence rates, 39 percent of Canadian women will develop cancer during their lifetimes. Cancer is a very broad subject and it is beyond the scope of this chapter to discuss each type and make individualized recommendations.

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Differential diagnoses of motor neuropathy • Guillain–Barré syndrome • Lead poisoning • Diphtheria • Charcot–Marie–Tooth disease (hereditary motor and sensory neuropathy) • Poliomyelitis An acute-onset neuropathy suggests: • Guillain–Barré syndrome • porphyria • malignancy • some toxic neuropathies • diphtheria • botulism order generic carafate. This patient should be referred to a neurologist for further investigation and management 1000mg carafate overnight delivery. In this patient who presents with weakness and sensory signs cheap 1000mg carafate with visa, it is important to make sure there is no evidence of spinal cord compression or multiple sclerosis. However, these would tend to cause hypertonia, hyper-reflexia and a more distinct sensory level. His respiratory function should be monitored with daily spirometry, and mechanical ventilation may be necessary. In the history it becomes evident that he has had around eight falls over the last 3 months. He says that the falls have occurred in the morning on most occa- sions but have occasionally occurred in the afternoon. He does not think that he has lost consciousness although he does remember a sensation of dizziness with the falls. He says that the falls have not been associated with any chest pain or palpitations. On two or three occasions he has hurt his knees on falling, and on one other occasion he hit his head. He has an occasional cough with some white sputum but he cannot remember whether he was coughing at the time of any of the falls. He was diagnosed as having hypertension at a routine well man clinic 4 years ago, and has been on treatment with a diuretic, bendrofluazide and doxazosin, for this. The blood pressure has been checked in the surgery on three or four occasions and he was told that it has been well controlled. He was found to have a high fasting blood sugar 6 months before and had been advised a diabetic diet. The heart sounds are normal and there is nothing abnormal to find on examination of the respi- ratory system or gastrointestinal system. In the nervous system, there is a little loss of sensation to light touch in the toes, but no other abnormalities. Some more information in the history about the circumstances of these falls would be helpful. On further enquiry, it emerges that the falls are most likely to occur when he gets up from bed first thing in the morning. The afternoon events have occurred on getting up from a chair after his post-lunch doze. This was verified by measurements of standing and lying blood pressure – the diagnostic criteria are a drop of 15 mmHg on standing for 3 min. This showed a marked postural drop with blood pressure decreasing from 134/84 to 104/68 mmHg. This is most likely to be caused by the antihypertensive treatment; both the alpha-blocker which causes vasodilatation and the diuretic might contribute. Another possible candidate for a cause of the postural hypoten- sion is the diabetes which could be associated with autonomic neuropathy. In this case the diabetes is not known to have been present for long and there is evidence of only very mild peripheral sensory neuropathy. Diabetic autonomic neuropathy is usually associated with quite severe peripheral sensory neuropathy, with or without motor neuropathy. Clinically, it is easily mistaken for atrial fibrillation because of the irregular rhythm and the variation in strength of beats. It may be associated with episodes of bradycardia and/or tachycardia which could cause falls. The positive intrathoracic pressure during coughing limits venous return to the heart. The cough is usually quite marked and he might be expected to remember this since he gives a good account of the falls otherwise. Neck movements with vertebrobasilar disease, poor eyesight and problems with balance are other common causes of falls in the elderly. A neurological cause, such as transient ischaemic episodes and epilepsy, is less likely with the lack of prior symptoms and the swift recovery with clear consciousness and no neuro- logical signs. Another diagnosis which should be remembered in older people who fall is a subdural haematoma. The doxazosin should be stopped and another antihypertensive agent started if necessary. The blood pressure rose to 144/86 mmHg lying and 142/84 mmHg standing, indicating no significant postural hypotension, with reasonable blood-pressure control. On direct questioning she says that she has felt increasingly tired for around 2 years. She was diagnosed with hypothyroidism 8 years ago and has been on thyroxine replacement but has not had her blood tests checked for a few years. Her other complaints are of itching for 2–3 months, but she has not noticed any rash. She says that her mouth has been dry and, on direct questioning, thinks her eyes have also felt dry. There has been no disturbance of her bowels or urine although she thinks that her urine has been rather ‘strong’ lately. She has taken occasional paracetamol for headaches but has been on no regular medication other than thyroxine and some vitamin tablets she buys from the chemist. Examination Her sclerae look a little yellow and she has xanthelasmata around the eyes. In the abdomen, the liver is not palpable but the spleen is felt 2 cm under the left costal margin. The symptoms and investigations are characteristic of primary biliary cirrhosis, an uncommon condition found mainly in middle-aged women.

You can hold your breath and you can make yourself breathe faster but your involuntary nervous system will take over and slow down your breathing or make you take a breath carafate 1000mg otc. Medication is available to interrupt impulses that flow along the neural pathway and prevent the body from responding normally to a stimulant cheap carafate 1000 mg with mastercard. Likewise discount carafate online amex, there are medica- tions that cause an impulse to stimulate parts of the body. In this chapter, you’ll learn about medications that affect the central nervous system and the peripheral nervous system. A Brief Look at the Nervous System In order to understand the therapeutic effects of medication used to treat the nervous system, you’ll need to have an understanding of the anatomy and phys- 269 Copyright © 2006 by The McGraw-Hill Companies, Inc. The central nervous system consists of the brain and spinal cord, which are responsible for regulating body function. The central nervous system receives information from the peripheral nervous system, which is interpreted, and then the central nervous system sends an appropriate signal to the peripheral nervous system to stimulate cellular activity. Depending on the signal, the stimulation either increases or blocks nerve cells, which are called neurons. The somatic nervous system acts on skeletal muscles to produce voluntary move- ment. The autonomic nervous system, known as the visceral system, is respon- sible for involuntary movement and controls the heart, respiratory system, gastrointestinal system, and the endocrine system (glands). The autonomic nervous system is further divided into the sympathetic and parasympathetic nervous systems (see Autonomic Nervous System). The sympathetic nervous system is called the adrenergic system and uses the norephinephrine neurotransmitter to send information. The parasympathetic system, called the cholinergic system, uses the acetylcholine neurotransmitter to transmit information. Both the sympathetic and parasympathetic nervous systems innervate organs within the body. The sympathetic system excites the organ while the parasympa- thetic system inhibits the organ. For example, the sympathetic system increases the heart rate while the parasympathetic system decreases the heart rate. These pregan- glionic and postganglionic fibers are connected together by a ganglion. The pre- ganglionic nerve fiber carries messages from the central nervous system to the ganglion. The postganglionic nerve fiber transmits that message to specific tis- sues and organs from the ganglion. Neurological pathways in the sympathetic nervous system originate from the thoracic (T1 to T12) and the upper lumbar segments (L1 and L2) of the spinal cord. This is why the sympathetic nervous system is also referred to as the tho- racolumbar division of the autonomic nervous system. However, sympa- thetic postganglionic fibers are long from the ganglion to the body cells. This is why the parasympathetic nervous system is also known as the craniosacral division of the autonomic nervous system. Preganglionic fibers are long from the spinal cord to the ganglion and the postganglionic fibers are short from the ganglion to the body cells. Central Nervous System Stimulants Medication is given to stimulate the central nervous system in order to induce a therapeutic response. There are four major groups of medications that stimulate the central ner- vous system. Caffeine also stimu- lates the cerebral cortex and stimulates respiration by acting on the brain stem and medulla. Anorexiants inhibit appetite by stimulating the cerebral cortex and the hypothalamus. Amphetamines, analeptics, and anorexiants are commonly referred to as “uppers” when used to prevent sleep. Anorexiants and amphetamines can pro- duce psychological dependence and the body can become tolerant to its effect if abused. Abruptly discontinuing these medications may result in withdrawal symptoms including depression. Amphetamines are also taken to decrease weight and increase energy enabling the patient to perform work quickly with- out rest. Amphetamines, analeptics, and anorexiants stimulate the release of the neuro- transmitters norepinephrine and dopamine from the brain and from the periph- eral nerve terminals of the sympathetic nervous system. The patient can also experience sleeplessness, restless- ness, tremors, and irritability; cardiovascular problems (increased heart rate, pal- pitations, dysrhythmias and hypertension). Caffeine is found in many drugs including Anacin, Excedrin, Cafergot, Fiorinal, and Midol. The cause of migraines is not clearly understood although research indicates the expansion of blood vessels and the release of certain chemicals—such as dopamine and serotonin—causes inflammation and pain. A migraine can occur if an abnormal amount of these chemicals are present or if the blood vessels are unusually sensitive to them. Patients who have migraines experience intense, throbbing, headache pain which is often accompanied by nausea, photophobia (sensitivity to light), phono- phobia (sensitivity to sound), and temporary disability. Migraines are sometimes preceded by an aura such as a breeze, odor, a beam of light, or a spectrum of colors. Migraines can occur on one side of the head (unilateral) and the pain is frequently reported as pulsating or throbbing. These are blood-vessel constrictors and dilators (see Chapter 26), antiseizure drugs (dis- cussed later in this chapter), antidepressants (discussed later in this chapter), beta-blockers (see Chapter 26), and analgesics (see Chapter 16). Patients are given a selected combination of these medications to prevent migraines. The prescriber determines the most effective combination for each patient based on the patient’s response to these medications. Commonly prescribed medications to prevent migraines are amitriptyline, divaproex sodium, propranol, timolol, topiramate, bupropion, cyproheptadine, diltiazem, doxepin, fluvoxamine, ibuprofen, imipramine, and methysergide. A list of drugs utilized in the treatment of migrane headaches is provided in the Appendix.

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Consumers should be wary of purchasing “bargain brands order carafate 1000mg on-line,” because they are often of poor quality with less active ingredients generic carafate 1000mg line. They should not be stored in the refrigerator to avoid condensation within the blister pack generic carafate 1000 mg mastercard. Mischoulon concludes that it is one of the safer of the natural products available for mood disorders, and previous evidence is supportive of its use for depression and anxiety. These side effects are usually moderate and often abate or disappear once a steady dosage is achieved. One researcher cautions that absent testing, tryptophan cannot be presumed to be safe, but others advise that while prescription tryptophan is now safe, consumers should be careful about purchasing non-prescription tryptophan. Tryptophan, an amino acid, is a precursor of serotonin and has been used since the 1970s to increase brain levels of serotonin. Small, mostly uncontrolled studies have shown positive effects in some depressed patients, but others have not. The reason proposed for the equivocal effects is that tryptophan by itself may be insufficient to boost serotonin levels. There are also considerable data suggesting that tryptophan depletion can increase depressive symptoms in patients with major depression and seasonal affective disorder. Subsequent reversal of depression with intravenous tryptophan supports the notion of an antidepressant effect. Its use declined dramatically when tryptophan was banned, but it is making a strong comeback. There are no published studies of these uses, with the exception of Lake and Spiegel’s reference to insomnia treatment. Lake and Spiegel state that, “doses up to 600 mg have been shown to be effective in treating 7 insomnia but may increase the incidence of vivid dreams. Serotonin syndrome may theoretically occur with any drug that affects the serotonin system. Gastrointestinal effects are usually moderate and often abate or disappear once a steady dosage is achieved, and Lake and Spiegel recommend an enteric coating to minimize gastrointestinal side effects. Most patients had arthralgia (73%), rash (50%), cough or dyspnea (59%), peripheral edema (59%) elevated aldolase levels (46%) and elevated liver function tests (43%). Fugh-Berman cautions that absent testing, tryptophan cannot be presumed to be safe. However, excluding the one established contamination case, according to a 2004 review by Das et al. Research needs to consider long-term as well as short-term effects and needs to catch up with consumer use. Three of the eight sources discussing valerian decline to recommend its use for sleep disorders, citing inadequate evidence, despite its traditional use in the United States, Europe and Japan. In the sleep laboratory, the effects of valerian were not significantly different from those of placebo, and a 2007 meta-analysis concluded that no rigorous studies had found any significant effect of valerian on sleep. There is not enough scientific evidence to determine whether valerian works for anxiety (the sources are split 3 to 3 on the use of valerian for anxiety) or for other conditions, such as headaches, depression, menopausal symptoms, sedation, irregular heartbeat and trembling. Despite the lack of persuasive clinical evidence of efficacy in treating insomnia, sleep quality remains to be studied, and subjective reports still hold out hope. Valerian may not be ideal for acute treatment of insomnia, but some evidence and analysis suggests that it may be effective in the promotion of natural sleep after several weeks of use. Berkeley Wellness specifically counsels that valerian not be taken with alcohol, tranquilizers or barbiturates. Similarly, "valerian withdrawal" may occur if the consumer stops using the drug suddenly after long-term high-dose use. Slight reductions in concentration and ability to perform complicated thinking may occur for few hours after taking valerian. The split of the sources confirms that this is a controversial supplement, even though it appears benign (except for the odor and taste). Valerian, Valeriana officinalis, is a plant native to Europe and Asia; it is also found in North America. Valerian has been used as a medicinal herb since at least the time of ancient Greece and Rome. Its therapeutic uses were described by Hippocrates, and in the 2nd century, Galen prescribed valerian for insomnia. Valerian is an odoriferous, popular European botanical medicine used for its mild sedative and tranquilizing properties. The German Commission E recommends 2 to 3 g of the dried root one or more times a day for “restlessness and nervous disturbance of sleep. In the sleep laboratory, the effects of valerian were not significantly different from those of placebo, and a 2007 meta-analysis concluded that none of the rigorous studies found any significant effect of valerian on sleep. Both valerian preparations produced a significant decrease in subjectively evaluated sleep latency scores and improved sleep quality. They point out that the valerian has a cumulative effect over time, and maximal benefit may not be achieved for two weeks. In one suggestive study, 121 people with significant sleep disturbance responded initially the same as to placebo, but after four weeks, and the 4 valerian-treated group had a significantly better overall response. This leads to the suggestion that longer and larger trials of symptomatic people could give a better idea of the drug’s potential in treating sleep disorders. Although it may not be as effective as benzodiazepines for treatment of acute conditions, Mischoulon and Rosenbaum suggest that valerian may be effective in the promotion of natural sleep after several weeks of use. In one human study, a combination of valerian and the beta blocker drug propranolol (Inderal) reduced concentration levels more than valerian alone. Agitation, anxiety and self injury were reported in one consumer who took valerian with fluoxetine (Prozac) for a mood disorder. In theory, valerian may also interact with anti- seizure medications, although there are no human data to that effect. Valerian may also increase the amount of drowsiness caused by some herbs or supplements, including St. Similarly, "valerian withdrawal" may occur if the consumer stops using the drug suddenly after long-term high-dose use.

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Fluid-like interior of the cell that may become a semisolid discount 1000mg carafate, or colloid L Lysosomes: c discount carafate uk. Membranous sacs containing digestive enzymes M – Protein synthesis begins in the cell’s 38 trusted 1000mg carafate. Chapter 3 Divide and Conquer: Cellular Mitosis In This Chapter Following the steps of cell division Understanding the results of errors in mitosis ver had so many places to be that you wished you could just divide yourself in two? Cell division is how one “mother” cell becomes two identical twin “daughter” cells. Cell division takes place for several reasons: G r owth: Multicellular organisms, humans included, each start out as a single cell — the fertilized egg. That one cell divides (and divides and divides), eventually becoming an entire complex being. Injury repair: Uninjured cells in the areas surrounding damaged tissue divide to replace those that have been destroyed. Cell division occurs over the course of two processes: mitosis, which is when the chromo- somes within the cell’s nucleus duplicate to form two daughter nuclei; and cytokinesis, which takes place when the cell’s cytoplasm divides to surround the two newly formed nuclei. Although cell division breaks down into several stages, there are no pauses from one step to another. Cell division as a whole is called mitosis because most of the changes occur during that process. In this chapter, we review the cell cycle (as mitosis also is known), and you get plenty of practice figuring out what happens when and why. The Mitotic Process It may look like cells are living out their useful lives simply doing whatever specialized jobs they do best, but in truth mitosis is a continuous process. When the cell isn’t actively split- ting itself in two, it’s actively preparing to do so. Mitosis may look like a waiting game, but there’s plenty going on behind the scenes. Part I: Building Blocks of the Body 38 Waiting for action: Interphase Interphase is the period when the cell isn’t dividing. It begins when the new cells are done forming and ends when the cell prepares to divide. Although it’s also called a “resting stage,” there’s constant activity in the cell during interphase. Interphase is divided into subphases, each of which lasts anywhere from a few hours for those cells that divide frequently to days or years for those cells that divide less frequently (nerve cells, for example, can spend decades in interphase). Sorting out the parts: Prophase As the first active phase of mitosis, prophase is when structures in the cell’s nucleus begin to disappear, including the nuclear membrane (or envelope), nucleoplasm, and nucleoli. The two centrioles that have formed from the centrosome push apart to opposite ends of the nucleus. Using protein filaments, they form poles and a mitotic spindle between them as well as asters (or astral rays) which radiate from the poles into the cytoplasm. At the same time, the chromatin threads (or chromonemata) shorten and coil, forming visible chromosomes. The chromosomes divide into chro- matids that remain attached at an area called the centromere, which produces micro- tubules called kinetochore fibers. These interact with the spindle to assure that each daughter cell ultimately has a full set of chromosomes. The chromatids start to migrate toward the equatorial plane, an imaginary line between the poles. Dividing at the equator: Metaphase After the chromosomes are lined up and attached along the cell’s newly formed equa- tor, metaphase officially debuts. The chromatids line up exactly along the center line of the cell (or the equatorial plane), attaching to the mitotic spindle by the centromere. Packing up to move out: Anaphase In anaphase, the centromeres split, separating the duplicate chromatids and forming two chromosomes. The spindles attached to the divided centromeres shorten, pulling the chromosomes toward the opposite poles. In late anaphase, as the chromosomes approach the poles, a slight furrow develops in the cytoplasm, showing where cytokinesis will eventually take place. Chapter 3: Divide and Conquer: Cellular Mitosis 39 Pinching off: Telophase Telophase occurs as the cell nears the end of division. The spindles and asters of early mitosis disappear, and each newly forming cell begins to synthesize its own structure. There’s a more pronounced pinching, or furrowing, of the cytoplasm into two separate bodies, but there continues to be only one cell. The furrow intended to divide the newly formed sister nuclei at last gets to finish the job. Each new cell is smaller and contains less cytoplasm than the mother cell, but the daughter cells are genetically identical to each other and to the original mother cell. Use the terms that follow to identify the stages and cell structures shown in Figure 3-1. Metaphase What Can Go Wrong With the millions upon millions of cell divisions that happen in the human body, it’s not surprising that sometimes things go wrong. In this muta- tion, newly formed chromosomes don’t quite divide, leaving one daughter cell with one more chromosome than normal and the other daughter cell one chromosome shy of a full complement. The rate of division usually restricts itself to replac- ing worn out or injured cells, but with accelerated mitosis, the cells don’t know when to stop dividing. Use the space provided to draw a basic illustration of each of the six stages inside a cell during mitosis. Late interphase (1) Prophase (2) Metaphase (3) Anaphase (4) Telophase (5) Cytokinesis (6) Part I: Building Blocks of the Body 44 Answers to Questions on Mitosis The following are answers to the practice questions presented in this chapter. With all that organelle-growing, metabolizing, and protein-synthesizing that takes place during G1, this isn’t surprising. As the cell nears the end of division, it makes sense that duplicate packages move to opposite ends of the cell. These structures disap- pear because they’re no longer needed at the end of mitosis. That means, of course, that cytokinesis takes place during the final stage of mitosis. Chapter 3: Divide and Conquer: Cellular Mitosis 45 C Any change in a cell’s genetic information is known as b.

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Cooking these foods releases calcium that is bound to oxalic acid effective carafate 1000mg, thus improving the amount you can absorb buy carafate overnight delivery. Phytic acid buy carafate 1000mg fast delivery, which is found in wheat bran or dried beans, also reduces calcium absorption. Micronutrients | 21 • Other interactions: Magnesium reduces absorption of digoxin, nitrofurantoin, anti- malarial drugs, quinolone antibiotics, tetracycline, chlorpromazine, alendronate, and etidronate, so separate intake of magnesium from these foods by two hours. Most studies involving chromium were done with the picolinate form, which is readily absorbed and utilized by the body. Certain individuals (diabetics and those at risk for diabetes) may require an additional supplement. Others at risk: Premature and low birth- weight infants with diarrhea; infants fed only cow’s milk formula, which is low in copper; those with malnutrition, malabsorption syndromes (celiac disease), cystic fibrosis, and those receiving intravenous feeding. Iodine • Required to make thyroid hormones, which regulate metabolism, energy produc- tion, and body temperature, and are essential for growth and reproduction. Micronutrients | 23 • Other interactions: Amiodarone (heart drug) contains high levels of iodine and may affect thyroid function; potassium iodide may decrease the anticoagulant effect of warfarin. These foods are a concern only for those who are iodine deficient and consume high amounts of them. Symptoms include fatigue, paleness, headache, hair loss, brittle nails, rapid heart rate, increased risk of infections, and rapid breathing on exertion. To avoid this, separate intake of iron supplements from these products by two hours. Manganese • Required for the production and activation of enzymes that are involved in energy me- tabolism; bone, cartilage, and collagen formation; and the production of antioxidants. Molybdenum • Required for the production of enzymes that are cofactors in amino acid metabo- lism, formation of uric acid, and the metabolism of drugs and toxins. Selenium • Component of enzymes that function as antioxidants; involved in detoxification; converts thyroid hormone to its active form; supports immune function; enhances the antioxidant activity of vitamin E. Zinc • Involved in numerous enzyme reactions; required for growth and development, im- mune and neurological function, reproduction and regulation of gene expression; stabilizes the structure of proteins and cell membranes. Micronutrients | 25 • Marginal deficiencies are common in malnourished people, vegetarians, pregnant women, the elderly, and those with celiac disease, Crohn’s disease, colitis, and sickle cell anemia. Depending on dietary intake and personal risk factors, additional potassium supple- ments may be necessary for some people. The table below contains nutrient recommendation for individuals 19 years and old- er, and women 19 years and older who are pregnant or lactating. To access guidelines for infants, children, and teenagers, refer to the Institute of Medicine’s Web site at www. Lactation = 12 Lactation = 40 High dosages of supplements may reduce copper levels. Today we know that what we eat is a major determinant of health, and that food provides both nutritive and healing properties. Functional foods, as defined by the International Food Information Council, are “foods or dietary components that may provide a health benefit beyond basic nutri- tion. Apple skins are a major food source of a type of flavonoid called quercetin, which is a potent antioxidant that helps protect against heart disease and cancer. Anthocyanidins have antioxidant properties, preventing free radical damage and reducing the risk of chronic disease. These compounds are found in other cruciferous vegetables, such as kale, cauliflower, and cabbage. Carotenoids help protect against cardiovascular disease, cancer, macular degeneration, and cataracts, and they also promote good night vision. New research is looking at the effects of another phytonutrient in carrots, called falcarinol, and its ability to reduce the risk of colon cancer. To get the maximum amount of nutrients from carrots, eat them raw or lightly steamed. Oranges, grapefruit, lemons, and limes offer a wide range of nutrients (vitamin C, folate, and fibre). Supplements of lutein have been shown to improve vision in those with macular degeneration and prevent disease progression. One to two serv- ings of kale or collard greens per week provide the recommended amount of lutein and zeaxanthin. Other food sources include spinach, broccoli, and leeks, but they contain a lesser amount. Preliminary research also shows that these compounds may help lower cholesterol, improve gum health, prevent ulcers, and prevent brain damage after a stroke. Health authorities recommend consuming Functional Foods | 35 no more than six meals per year of farmed salmon. To obtain all the benefits, eat the milled flaxseed or get whole seeds and crush them in a food processor or coffee grinder. Store milled seeds in the refrigerator or freezer in an opaque, airtight container; they will be stable for 90 days. Studies have found benefits with as little as 900 mg of garlic per day, which is approximately equivalent to one clove. Clinical studies have validated its benefits for preventing the symptoms of motion sickness (especially seasickness) and in the treatment of nausea and vomiting associated with pregnan- cy. The active compounds in ginger, called gingerols, have potent anti-inflammatory effects, making it helpful in the treatment of arthritis and other inflammatory condi- tions. Choose fresh ginger over the dry (powder) form to maximize intake of the active compounds. This compound has been found to reduce the risk of certain cancers, reduce the size of existing tumours, and inhibit tumour growth. It also sup- ports heart function by lowering blood pressure and reducing the risk of fatal heart attacks. Most studies evaluating the health benefits of green tea in- volved drinking 750–2,500 mL daily. Black tea, white tea, Oolong tea, and other teas derived from the plant Camellia sinesis may offer similar health benefits but are not as widely researched. Studies have found that 3 g of beta-glucan daily can reduce total cholesterol by an average of 5 percent.

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