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A l t h o u g h most cranial n e r v e s are m i x e d n e r v e s diabetes symptoms swollen ankles cheap losartan amex, s o m e o f those a s s o c i a t e d w i t h s p e c i a l s e n s e s diabetes prevention ontario discount losartan 25 mg online, such as s m e l l a n d v i s i o n diabetes mellitus with ketoacidosis purchase losartan master card, c o n t a i n o n l y sensory fibers diabetes prevention logic model effective losartan 25mg. O the r s that i n n e r v a t e m u s c l e s a n d g l a n d s are p r i m a r i l y c o m p o s e d o f m o t o r fibers a n d h a v e o n l y l i m i t e d sensory f u n c t i o n s. T h e s e are neurons associated w i t h certain receptors (proprioceptors) that r e s p o n d to the rate o r d e g r e e o r contract i o n o f skeletal m u s c l e s. B e c a u s e these fibers c o n t r i b u t e d i r e c t l y to m o t o r c o n t r o l, cranial n e r v e s w h o s e o n l y sensory c o m p o n e n t is f r o m such p r o p r i o c e p t o r s are u s u a l l y c o n s i d e r e d m o t o r nerves. N e u r o n cell b o d i e s to w h i c h the sensory fibers in the cranial n e r v e s attach are located o u t s i d e the brain and are usually in groups c a l l e d ganglia (sing. On the other hand, motor neuron cell b o d i e s are t y p i c a l l y located w i t h i n the gray matter o f the brain. C r a n i a l n e r v e s are d e s i g n a t e d by n u m b e r s a n d n a m e s. T h e n u m b e r s i n d i c a t e the o r d e r i n w h i c h the nerves arise f r o m the brain, f r o m anterior to posterior. T h e names describe p r i m a r y f u n c t i o n s or the general distribution o f cranial n e r v e fibers (fig. T h e s e bipolar neurons, l o c a t e d in the l i n i n g o f the u p p e r nasal c a v i t y, s e r v e as olfactory receptor cells. A x o n s f r o m these r e c e p t o r s pass Cranial Nerves T w e l v e pairs o f c r a n i a l n e r v e s arise f r o m the u n d e r s i d e o f the brain. They are identified either by numbers indicating their order, their function, or the general distribution of their fibers. S e n s o r y i m p u l s e s m o v e f r o m the o l f a c t o r y b u l b s a l o n g olfactory tracts to cerebral centers w h e r e the y are interpreted. T h e c e l l b o d i e s o f these n e u r o n s f o r m g a n g l i o n c e l l l a y e r s w i t h i n the e y e s, a n d their a x o n s pass through the optic foramina o f the orbits and c o n t i n u e into the visual n e r v e p a t h w a y s o f the brain (see chapter 12, p. O n e c o m p o n e n t o f each n e r v e c o n n e c t s to a n u m b e r o f v o l u n t a r y m u s c l e s, i n c l u d i n g those that raise Ihe e y e l i d s and four of the six muscles that m o v e the eye. A s e c o n d p o r t i o n of each o c u l o m o t o r n e r v e is part o f the a u t o n o m i c n e r v o u s s y s t e m, s u p p l y i n g i n v o l u n t a r y m u s c l e s i n s i d e the e y e s. T h e s e m u s c l e s h e l p a d j u s t the a m o u n t o f light that enters the e y e s and h e l p f o c u s the l e n s e s o f the e y e s. T h i s n e r v e is c o n s i d e r e d m o t o r, w i t h s o m e p r o p r i o c e p t i v e fibers. T h e fourth pair, the t r o c h l e a r (t r o k l e - a r) n e r v e s (I V), are the s m a l l e s t c r a n i a l nerves. T h e y arise f r o m the m i d brain and carry m o t o r i m p u l s e s to a f i f t h pair o f external e y e m u s c l e s, the superior oblique muscles, w h i c h are not s u p p l i e d b v the o c u l o m o t o r nerves. T h i s n e r v e is c o n s i d ered motor, w i t h s o m e p r o p r i o c e p t i v e fibers. T h e y are m i x e d n e r v e s, w i t h the s e n s o r y p o r t i o n s m o r e e x t e n s i v e than the m o t o r p o r t i o n s. Each s e n s o r y c o m p o n e n t i n c l u d e s three large branches, c a l l e d the o p h thalmic, maxillary, and m a n d i b u l a r d i v i s i o n s (fig. T h e ophthalmic division c o n s i s t s o f s e n s o r y f i b e r s thai b r i n g i m p u l s e s to the b r a i n f r o m the s u r f a c e o f the e y e, the l e a r g l a n d, a n d the s k i n o f the a n t e r i o r s c a l p, f o r e h e a d, and upper e y e l i d. T h e fibers of Ihe maxillary division c a r r y s e n s o r y i m p u l s e s f r o m the u p p e r t e e t h, u p p e r g u m. T h e mandibular division i n c l u d e s b o t h m o t o r a n d s e n s o r y f i b e r s. T h e s e n s o r y b r a n c h e s t r a n s m i t i m p u l s e s f r o m the s c a l p b e h i n d the ears, the skin o f the j a w. T h e m o t o r b r a n c h e s s u p p l y I h e m u s c l e s o f m a s t i c a t i o n a n d c e r t a i n m u s c l e s in the f l o o r of the mouth. T h e y enter the orbits o f the e y e s a n d s u p p l y m o t o r i m p u l s e s to the r e m a i n i n g p a i r o f e x t e r n a l e y e muscles, the lateral rectus muscles. T h i s n e r v e is c o n s i d e r e d motor, w i t h s o m e p r o p r i o c e p t i v e fibers.

V i t a m i n D 2 (e r g o c a l c i f e r o l) is p r o d u c e d c o m mercially by e x p o s i n g a steroid obtained f r o m yeasts (ergosterol) to ultraviolet light diabetes type 1 nice guidelines buy cheap losartan on line. V i t a m i n D can also be synt h e s i z e d f r o m d i e t a r y c h o l e s t e r o l that has b e e n m e t a b o - l i z e d to p r o v i t a m i n D b y intestinal e n z y m e s blood sugar will not go down buy discount losartan 25mg line, the n stored in the skin a n d e x p o s e d to u l t r a v i o l e t l i g h t (s e e c h a p t e r 13 metabolic disease 0f buy losartan 50mg mastercard. L i k e other fat-soluble v i t a m i n s blood glucose 10 order 50 mg losartan with amex, v i t a m i n D resists the e f f e c t s o f heat, o x i d a t i o n, acids, and bases. It is p r i m a r i l y stored in the l i v e r and is less abundant in the skin, brain, spleen, and bones. W h e n parathyroid h o r m o n e is present, this f o r m of v i t a m i n D is c o n v e r t e d in the k i d n e y s i n t o an a c t i v e f o r m o f the vitam i n (d i h v d r o x y c h o l e c a l c i f e r o l). T h i s substance, in turn, is c a r r i e d as a h o r m o n e in the b l o o d to the i n t e s t i n e s w h e r e it s t i m u l a t e s p r o d u c t i o n o f c a l c i u m - b i n d i n g prot e i n. H e r e, it p r o m o t e s a b s o r p t i o n o f c a l c i u m a n d p h o s p h o r u s, ensuring that adequate amounts of these minerals are a v a i l a b l e in the b l o o d f o r t o o t h and b o n e f o r m a t i o n and m e t a b o l i c processes. Because natural f o o d s are often p o o r sources of vitam i n D, it is o f t e n a d d e d t o f o o d d u r i n g p r o c e s s i n g. Fortified means essential nutrients h a v e been a d d e d to a f o o d w h e r e they origin a l l y w e r e absent o r scarce. Enriched m e a n s essential n u t r i e n t s h a v e b e e n partially r e p l a c e d in a f o o d that has lost nutrients during processing. Excess v i t a m i n D, or hypervitaminosis D, p r o d u c e s diarrhea, nausea, a n d w e i g h t loss. O v e r t i m e, it m a y also cause c a l c i f i c a t i o n o f certain s o f t tissues and i r r e v e r s i b l e k i d n e y damage. In c h i l d r e n, v i t a m i n D d e f i c i e n c y results in rickets, in w h i c h the bones and teeth fail to d e v e l o p normally (fig. Risk o f d e v e l o p i n g vitamin d e f i c i e n c y increases in p e o p l e w h o stay out o f the sun or l i b e r a l l y use sun b l o c k to p r e v e n t skin cancer. H o w e v e r, just f i v e m i n u t e s o f sun e x p o s u r e t w o t o three times a w e e k can m a i n t a i n skeletal health w i t h o u t e l e v a t i n g skin cancer risk. Because o l d e r p e o p l e tend to b e o u t d o o r s less than y o u n g e r i n d i v i d u a l s, the Institute o f M e d i c i n e suggests that d a i l y v i t a m i n D intake increase w i t h age (see table 18. V i t a m i n E i n c l u d e s a g r o u p o f c o m p o u n d s, the m o s t a c t i v e o f w h i c h is alpha-tocopherol. T h i s v i t a m i n is resistant to the e f f e c t s o f heat, a c i d s, a n d v i s i b l e light but is unstable in bases a n d in I h e p r e s e n c e o f u l t r a v i o l e t light or o x y g e n. V i t a m i n E is f o u n d in a l l tissues but is p r i m a r i l y stored in the m u s c l e s a n d a d i p o s e tissue. T h e p r e c i s e f u n c t i o n s o f v i t a m i n E are u n k n o w n, but it is thought to act as an antioxidant by p r e v e n t i n g o x i d a t i o n o f v i t a m i n A and p o l y u n s a t u r a t e d fatty acids in I h e tissues. It m a y a l s o h e l p m a i n t a i n the s t a b i l i t y o f c e l l membranes. Its richest s o u r c e s are o i l s f r o m cereal s e e d s such as w h e a l g e r m. Other g o o d sources are salad oils, margarine, shortenings, fruits, nuts, and vegetables. Excess v i t a m i n E m a y cause nausea, headache, fatigue, easy bruising and b l e e d ing, and m u s c l e weakness. Because this v i t a m i n is s o easily obtained, d e f i c i e n c y c o n d i t i o n s are rare. M e m b e r s o f this g r o u p d i f f e r c h e m i c a l l y and functionally. In its pure f o r m, thiamine is a crystalline c o m p o u n d c a l l e d thiamine h y d r o c h l o r i d. It is d e s t r o y e d by e x p o s u r e to heat and o x y g e n, e s p e c i a l l y in alkaline e n v i r o n m e n t s.

One example is endemic cretinism diabetes insipidus tbi cheap losartan 25 mg on line, caused by iodine deficiency and characterized by stunted mental and physical growth diabetes in young puppies discount losartan 25 mg on-line. Recent evidence also indicates that methyl-deficient diets alter expression of imprinted genes and may result in birth defects and diseases blood glucose variation daily generic 50mg losartan otc, such as cancer postnatally diabetes insipidus in infants cheap 25mg losartan. Finally, recent studies show that poor maternal nutrition prior to and during pregnancy contributes to low birth weight and birth defects and that severe starvation during pregnancy is associated with a two to threefold increase in schizophrenia in the offspring. Obesity Obesity has reached epidemic proportions in the United States and has nearly doubled in the past 15 years. In 2007 to 2008, over one-third of women of reproductive age were obese (body mass index >30). Prepregnancy obesity, is associated with a twofold increased risk for having a child with a neural tube defect. Causation has not been determined but may relate to maternal metabolic disturbances affecting glucose, insulin, or other factors. Prepregnancy obesity also increases the risk for having a baby with a heart defect, omphalocele, and multiple congenital anomalies. Hypoxia Hypoxia induces congenital malformations in a great variety of experimental animals. Although children born at relatively high altitudes are usually lighter in weight and smaller than those born near or at sea level, no increase in the incidence of congenital malformations has been noted. In addition, women with cyanotic cardiovascular disease often give birth to small infants but usually without gross congenital malformations. Heavy Metals Several years ago, researchers in Japan noted that a number of mothers with diets consisting mainly of fish had given birth to children with multiple neurological symptoms resembling cerebral palsy. Further examination revealed that the fish contained an abnormally high level of organic mercury, which was spewed into Minamata Bay and other coastal waters of Japan by large industries. Multiple measurements of these parameters over time improve the ability to determine the extent of fetal growth. Congenital malformations that can be determined by ultrasound include the neural tube defects anencephaly and spina bifida (see Chapter 18); abdominal wall defects, such as omphalocele and gastroschisis (see Chapter 15); and heart (see Chapter 13) and facial defects, including cleft lip and palate (see Chapter 17). Ultrasound can also be used to screen for Down syndrome and some other chromosome-related abnormalities through a test called nuchal translucency. Then, based on this risk assessment, a woman can decide whether she wants invasive testing, such as amniocentesis, which would provide a definitive diagnosis. Ultrasound image showing position of the fetal skull and placement of the needle into the amniotic cavity (arrow) during amniocentesis. Chapter 9 Birth Defects and Prenatal Diagnosis 127 B C R R P A B F L C D Figure 9. Maternal Serum Screening A search for biochemical markers of fetal status led to development of maternal serum screening tests. Amniocentesis During amniocentesis, a needle is inserted transabdominally into the amniotic cavity (identified by ultrasound;. Recent studies suggest that the risk of fetal loss related to the procedure is as low as 1 in 300 to 500, but may be even less for individuals and centers highly skilled in the technique. In addition, fetal cells, sloughed into the amniotic fluid, can be recovered and used for metaphase karyotyping and other genetic analyses (see Chapter 2). Unfortunately, the harvested cells are not rapidly dividing, and therefore, cell cultures containing mitogens must be established to provide sufficient metaphase cells for analysis. Once chromosomes are obtained, major chromosomal alterations, such as translocations, breaks, trisomies, and monosomies, can be identified. With special stains (Giemsa) and high-resolution techniques, chromosome-banding patterns can be determined. Cells may be analyzed immediately, but accuracy of results is problematic because of the high frequency of chromosomal errors in the normal placenta. Therefore, cells from the mesenchymal core are isolated by trypsinization of the external trophoblast and cultured. Because of the large number of cells obtained, only 2 to 3 days in culture are necessary to permit genetic analysis. Thus, the time for genetic characterization of the fetus is reduced compared with amniocentesis. However, there have been indications that the procedure carries an increased risk for limb reduction defects, especially of the digits. In the past, with the exception of ultrasonography, these prenatal diagnostic tests were not used on a routine basis.

Birth Control Birth control is the v o l u n t a r y regulation o f the n u m b e r o f (kon"traho f f s p r i n g p r o d u c e d and the time they are c o n c e i v e d diabetes prevention native americans purchase losartan amex. Coitus Coitus Interruplus interruptus is I h e p r a c t i c e o f w i t h d r a w i n g Ihe Why is coitus interruptus unreliable? What factors make the rhythm method less reliable than some other methods of contraception? T h i s m e t h o d o f c o n t r a c e p t i o n o f t e n p r o v e s unsatisfactory a n d m a y result in p r e g n a n c y gestational diabetes type 1 or 2 buy losartan 25 mg cheap, because a m a l e m a y find it d i f f i cult to w i t h d r a w just p r i o r to e j a c u l a t i o n blood glucose higher in morning buy genuine losartan on-line. A l s o blood sugar conversion buy losartan 25 mg visa, s o m e s e m e n c o n t a i n i n g sperm ceils m a y reach the vagina b e f o r e ejaculation occurs. T h e r h y t h m m e t h o d results in a r e l a t i v e l y h i g h rate o f p r e g nancy because accurately identifying infertile times lo h a v e i n t e r c o u r s e is d i f f i c u l t. A n o the r d i s a d v a n t a g e o f the r h y t h m m e t h o d is that it r e q u i r e s a d h e r e n c e to a part i c u l a r pattern o f b e h a v i o r a n d restricts s p o n t a n e i t y in sexual a c t i v i t y. Mechanical Mechanical male condom Barriers prevent sperm cells f r o m entering the barriers f e m a l e r e p r o d u c t i v e tract d u r i n g sexual intercourse. T h e consists o f a thin latex or natural m e m b r a n e sheath p l a c e d o v e r the erect p e n i s b e f o r e i n t e r c o u r s e to p r e v e n t s e m e n f r o m entering I h e vagina u p o n ejaculation (f i g. As research o n the h u m a n g e n o m e reveals the cellular a n d m o l e c u lar c h a r a c t e r i s t i c s t h a t d i s t i n g u i s h s u b t y p e s of the disease, t r e a t m e n t s o l d a n d n e w are b e i n g i n c r e a s i n g l y t a i l o r e d t o individuals, at the t i m e of diagnosis. This "rational" approach may personalize treatment, which can likely delay progression of disease and increase survival rate f o r m a n y w o m e n a n d enable the m t o avoid d r u g t r e a t m e n t s that will n o t w o r k. A woman can note these changes by performing a monthly "breast self-exam," in which she lies flat on her back with the arm raised behind her head and systematically feels all parts of each breast. But sometimes breast cancer gives no warning at all-early signs of fatigue and feeling ill may not occur until the disease has spread beyond the breast, After finding a lump, the next step is a physical exam, where a health-care provider palpates the breast and does a mammogram, an X-ray scan that can pinpoint the location and approximate extent of abnormal tissue (fig. An ultrasound scan can distinguish between a cyst (a fluid-filled sac of glandular tissue) and a tumor (a solid mass). If an area is suspicious, a thin needle is used to take a biopsy (sample) of the tissue, whose cells are scrutinized under a microscope for the telltale characteristics of cancer. A c o n d o m is i n e x p e n s i v e, and it may also h e l p protect the user against contracting sexually transmitted diseases and prev e n t the user f r o m s p r e a d i n g the m. H o w e v e r, s o m e m e n often feel that a c o n d o m decreases the s e n s i t i v i t y o f the penis during intercourse. It is a c u p - s h a p e d structure w i t h a f l e x i b l e ring f o r m i n g the rim. T h e diaphragm is inserted into the vagina so that it covers the c e r v i x, p r e v e n t i n g entry o f s p e r m cells into the uterus (fig. T h e d e v i c e must be left in p o s i t i o n f o r several hours f o l l o w i n g sexual intercourse. A d i a p h r a g m can b e inserted into the vagina up to six hours before sexual contact. S i m i l a r to but smaller than Ihe d i a p h r a g m is the cervical cap, w h i c h a d h e r e s to the c e r v i x by s u c t i o n. Cerv i c a l c a p s h a v e b e e n used f o r c e n t u r i e s in d i f f e r e n t c u l tures and h a v e b e e n m a d e o f such v a r i e d substances as b e e s w a x, l e m o n halves, paper, and o p i u m p o p p y Chemical Chemical Barriers contraceptives include creams, foams, fibers. The lump may be a cyst or a solid, fibrous mass of connective tissue calEed a fibroadenoma. A lumpectomy removes a small tumor and some surrounding tissue; a simple mastectomy removes a breast; and a modified radical mastectomy removes the breast and surrounding lymph nodes but preserves the pectoral muscles. In addition, a few lymph nodes are typically examined, which allows a physician to identify the ones that are affected and must be removed. Most breast cancers are then treated with radiation and combinations of chemotherapeutic drugs, plus sometimes newer drugs that are targeted to certain types of breast cancer. Standard chemotherapies kill all rapidly dividing cells, and those used for breast cancer include fluorouracil, doxorubicin, cyclophosphamide, methotrexate, and paclitaxol. New protocols that provide more frequent, lower doses can temper some of the side effects of these powerful drugs. Newer treatments developed specifically for breast cancer are easier to tolerate and can be extremely effective.

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