By X. Sanuyem. Jamestown College.

Erythrocytes produce an abnormal type of hemoglobin buy discount aciclovir 800 mg, which causes the cell to take on a sickle or crescent shape buy aciclovir 200mg free shipping. This condition can occur in individuals with a deficiency of iron in the diet and is especially common in teens and children as well as in vegans and vegetarians buy aciclovir 400 mg fast delivery. Additionally, iron deficiency anemia may be caused by either an inability to absorb and transport iron or slow, chronic bleeding. Lack of meat or a viable alternate source, and overcooking or eating insufficient amounts of vegetables may lead to a lack of folate. It is essential to provide sufficient folic acid during the early stages of pregnancy to reduce the risk of neurological defects, including spina bifida, a failure of the neural tube to close. Aplastic anemia is often inherited, or it may be triggered by radiation, medication, chemotherapy, or infection. It can occur transiently in a person who is dehydrated; when water intake is inadequate or water losses are excessive, the plasma volume falls. For reasons mentioned earlier, a mild form of polycythemia is chronic but normal in people living at high altitudes. Finally, a type of bone marrow disease called polycythemia vera (from the Greek vera = “true”) causes an excessive production of immature erythrocytes. Polycythemia vera can dangerously elevate the viscosity of blood, raising blood pressure and making it more difficult for the heart to pump blood throughout the body. It is a relatively rare disease that occurs more often in men than women, and is more likely to be present in elderly patients those over 60 years of age. Platelets are essential for the repair of blood vessels when damage to them has occurred; they also provide growth factors for healing and repair. Characteristics of Leukocytes Although leukocytes and erythrocytes both originate from hematopoietic stem cells in the bone marrow, they are very different from each other in many significant ways. For instance, leukocytes are far less numerous than erythrocytes: Typically there are only 5000 to 10,000 per µL. They are also larger than erythrocytes and are the only formed elements that are complete cells, possessing a nucleus and organelles. Most of these types have a much shorter lifespan than that of erythrocytes, some as short as a few hours or even a few minutes in the case of acute infection. Whereas erythrocytes spend their days circulating within the blood vessels, leukocytes routinely leave the bloodstream to perform their defensive functions in This OpenStax book is available for free at http://cnx. For leukocytes, the vascular network is simply a highway they travel and soon exit to reach their true destination. When they arrive, they are often given distinct names, such as macrophage or microglia, depending on their function. Once they have exited the capillaries, some leukocytes will take up fixed positions in lymphatic tissue, bone marrow, the spleen, the thymus, or other organs. Others will move about through the tissue spaces very much like amoebas, continuously extending their plasma membranes, sometimes wandering freely, and sometimes moving toward the direction in which they are drawn by chemical signals. This attracting of leukocytes occurs because of positive chemotaxis (literally “movement in response to chemicals”), a phenomenon in which injured or infected cells and nearby leukocytes emit the equivalent of a chemical “911” call, attracting more leukocytes to the site. In clinical medicine, the differential counts of the types and percentages of leukocytes present are often key indicators in making a diagnosis and selecting a treatment. They release chemicals from their granules that destroy pathogens; they are also capable of phagocytosis. The monocyte, an agranular leukocyte, differentiates into a macrophage that then phagocytizes the pathogens. Classification of Leukocytes When scientists first began to observe stained blood slides, it quickly became evident that leukocytes could be divided into two groups, according to whether their cytoplasm contained highly visible granules: This OpenStax book is available for free at http://cnx. They include neutrophils, eosinophils, and basophils (you can view their lineage from myeloid stem cells in Figure 18. Agranular leukocytes include monocytes, which mature into macrophages that are phagocytic, and lymphocytes, which arise from the lymphoid stem cell line. Granular Leukocytes We will consider the granular leukocytes in order from most common to least common. They typically have a lobed nucleus and are classified according to which type of stain best highlights their granules (Figure 18. An eosinophil’s granules are slightly larger and stain reddish-orange, and its nucleus has two to three lobes. The most common of all the leukocytes, neutrophils will normally comprise 50–70 percent of total leukocyte count. They are called neutrophils because their granules show up most clearly with stains that are chemically neutral (neither acidic nor basic).

The adrenal glands have a rich blood supply and experience one of the highest rates of blood flow in the body purchase 800 mg aciclovir otc. They are served by several arteries branching off the aorta cheap aciclovir 400mg with visa, including the suprarenal and renal arteries purchase 400mg aciclovir mastercard. The adrenal gland consists of an outer cortex of glandular tissue and an inner medulla of nervous tissue. The cortex itself is divided into three zones: the zona glomerulosa, the zona fasciculata, and the zona reticularis. Physical stresses include exposing the body to injury, walking outside in cold and wet conditions without a coat on, or malnutrition. Psychological stresses include the perception of a physical threat, a fight with a loved one, or just a bad day at school. If the stress is not soon relieved, the body adapts to the stress in the second stage called the stage of resistance. If a person is starving for example, the body may send signals to the gastrointestinal tract to maximize the absorption of nutrients from food. If the stress continues for a longer term however, the body responds with symptoms quite different than the fight-or-flight response. During the stage of exhaustion, individuals may begin to suffer depression, the suppression of their immune response, severe fatigue, or even a fatal heart attack. Adrenal hormones also have several non–stress-related functions, including the increase of blood sodium and glucose levels, which will be described in detail below. Adrenal Cortex The adrenal cortex consists of multiple layers of lipid-storing cells that occur in three structurally distinct regions. Hormones of the Zona Glomerulosa The most superficial region of the adrenal cortex is the zona glomerulosa, which produces a group of hormones collectively referred to as mineralocorticoids because of their effect on body minerals, especially sodium and potassium. It is important in the regulation of the concentration of sodium and potassium This OpenStax book is available for free at http://cnx. For example, it is released in response to elevated blood K , low blood Na , low blood + + pressure, or low blood volume. In response, aldosterone increases the excretion of K and the retention of Na , which in turn increases blood volume and blood pressure. Renin then catalyzes the conversion of the blood protein angiotensinogen, produced by the liver, to the hormone angiotensin I. Hormones of the Zona Fasciculata The intermediate region of the adrenal cortex is the zona fasciculata, named as such because the cells form small fascicles (bundles) separated by tiny blood vessels. The cells of the zona fasciculata produce hormones called glucocorticoids because of their role in glucose metabolism. Their overall effect is to inhibit tissue building while stimulating the breakdown of stored nutrients to maintain adequate fuel supplies. In conditions of long-term stress, for example, cortisol promotes the catabolism of glycogen to glucose, the catabolism of stored triglycerides into fatty acids and glycerol, and the catabolism of muscle proteins into amino acids. These raw materials can then be used to synthesize additional glucose and ketones for use as body fuels. The hippocampus, which is part of the temporal lobe of the cerebral cortices and important in memory formation, is highly sensitive to stress levels because of its many glucocorticoid receptors. You are probably familiar with prescription and over-the-counter medications containing glucocorticoids, such as cortisone injections into inflamed joints, prednisone tablets and steroid-based inhalers used to manage severe asthma, and hydrocortisone creams applied to relieve itchy skin rashes. These drugs reflect another role of cortisol—the downregulation of the immune system, which inhibits the inflammatory response. Hormones of the Zona Reticularis The deepest region of the adrenal cortex is the zona reticularis, which produces small amounts of a class of steroid sex hormones called androgens. In adult women, they may contribute to the sex drive, but their function in adult men is not well understood. In post-menopausal women, as the functions of the ovaries decline, the main source of estrogens becomes the androgens produced by the zona reticularis. Adrenal Medulla As noted earlier, the adrenal cortex releases glucocorticoids in response to long-term stress such as severe illness. Epinephrine is produced in greater quantities—approximately a 4 to 1 ratio with norepinephrine—and is the more powerful hormone. Because the chromaffin cells release epinephrine and norepinephrine into the systemic circulation, where they travel widely and exert effects on distant cells, they are considered hormones. Both epinephrine and norepinephrine signal the liver and skeletal muscle cells to convert glycogen into glucose, resulting in increased blood glucose levels. These hormones increase 762 Chapter 17 | The Endocrine System the heart rate, pulse, and blood pressure to prepare the body to fight the perceived threat or flee from it.

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Compression of the nerve generic aciclovir 200mg otc, like carpel tunnel syndrome or nerve repair in case of the nerve trauma or nerve transplant surgery cheap 400 mg aciclovir with amex. Basic information : It is very correct to say that before going in for any such surgery absolutely accurate diagnosis is a must discount 200mg aciclovir mastercard. It is the duty of the neurosurgeon to inform the patients and his relatives how much the patient is likely to benefit from the surgery. Though in our system the diagnosis and the decision of the need for surgery is mainly in the hands of the neurophysician, still it is necessary that before surgery, the neurophysician and the neurosurgeon discuss the case and if there is any doubt further investigations may be done to confirm the diagnosis, and surgery attempted only after full satisfaction regarding the diagnosis. However, it is not incorrect to say that the brain surgery is comparatively more dangerous than other surgeries. The brain surgeries last approximately for 2 to 4 hours, but sometimes it may also go on for 16 to 20 hours or more. After obtaining a fitness report for surgery from the physician, usually the anesthetist examines the patient to ascertain whether the patient can withstand anesthesia. However, if there is a fear of impending death and not much time is available, neurosurgeons ignore everything and perform emergency surgery in spite of the risk for the sake of humanity. For example, when there is a brain hemorrhage in a road accident and emergency operation is inevitable. If the aim is to reach only the outer membrane of the brain a hole called Burr-hole is drilled in the skull. From well-equipped operation theatres to appropriate operation tables and proper lighting arrangements are essential requirements. During surgery also, monitoring by ultra sound can pinpoint the exact location of the defect deep inside the brain. The stereotaxis instruments help in the biopsy and removal of tumors deep inside the brain and spinal cord. Without opening the skull, through a Burr-hole in the brain, using a needle and an electrode that penetrates deep into the brain, various very complicated diseases can be treated easily. Vaga1 stimulation is also a similar minor procedure in which microelectrode and a stimulator can be used to stop the electrical storms taking place in the brain with the help of computerized methods. Apart from this, if necessary major surgeries like lobectomy, hemispherectomy, corpus callosotomy etc can be done. Various other surgeries like the transaction surgery where an impulse can be prevented from passing from one neuron to another can also be done. Radio Frequency Lesion generator : This technique has been proved very effective in Trigeminal Neuralgia and other such painful diseases and also in movement disorders like Parkinson’s disease. As the name suggests, relief is obtained in the disease by using radio frequency current to block the functioning of a nerve or to cauterize it. Gamma knife and Linear Accelerator : This method is becoming increasingly popular to treat tumors or other such diseases without resorting to surgery. Endoscopic Neurosurgery : This is also a kind of minimally invasive surgery, which means that without opening the brain completely, the diseases located deep inside the brain especially tumors or aneurysms are tackled. This reduces the risk of surgery considerably but conducting the surgery from a very small opening with a microscope requires profound experience. Now-a-days our surgeons have gained expertise in conducting “Awake Craniotomy” in which no anesthesia is used and the patient is operated upon in a fully conscious state. When the disease has spread beyond limit, surgeons just remove a part of it and feel the satisfaction of having helped the patient. When it is not possible to remove the entire tumor and there is a danger that the patient may die on the operation table or surgery may paralyze a major portion of the body, it makes sense for the doctor to excise some part of the tumor so that the patient can feel better and survive a little longer. Functional Neurosurgery : In ‘this there is not much h of : excision involved but the nonfunctional parts are made to function in a different way. If necessary grafting of new cells or putting a stimulator in the brain, injecting chemicals or drugs or making newer paths through small openings can be done. In major cities like Mumbai, Delhi all types of surgeries are available and the world-renowned doctors having the best of education and expertise are available to serve the patients, and that is the pride of our nation. In majority of operations the risk factor is 2% to 4% at good centres, but if the patient is aged and suffers from diabetes or heart disease or blood pressure or the operation has had to be done in an emergency, the risk may go up to 10% to 20%. If the surgeon or the anesthetist feels that the risk is high, it is advisable to avoid surgery and treat the patient with medicines only. If the relatives of the patient insist on taking a chance, the surgeon can perform surgery on consent. Like in brain attack, if there is hemorrhage with a lot of swelling and if the prognosis is very bad, the skull can be opened so that the brain can swell outside or attempts are made to suck out the hemorrhage, so the chances of saving the patient’s life compared to certain death can be calculated as S to 25%. After being discharged, special attention is given to the fact that the patient becomes ambulatory as soon as possible. Physiotherapy is started during hospitalization itself and is continued even after the patient goes home till he gets completely cured. After the surgery, the follow up by neurosurgeon and neurophysician are again required for the rest of the treatment. Therefore, the best option is to discuss all the aspects of the surgery frankly before and after the surgery and the doctor should also give a clear picture right from the beginning. It requires the teamwork of the neurophysician, the neurosurgeon, the physiotherapist, the occupational therapist and the physician.

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The establishment of clear regulations aciclovir 800mg without a prescription, accompanied by a monitoring and control system and a sanctioning regime buy 400mg aciclovir with mastercard, is an excellent tool to prevent or reduce drug use cheap 400mg aciclovir with amex. The difficulty of implementing an effective monitoring system on a community-wide basis makes these types of measures more likely to be applied in bounded spaces such as leisure venues, bars, schools or workplaces. As with other factors markedly community in character, such as risk perception or accessibility, the protective capacity of the regulations does not only depend on their existence. The population that the regulations are aimed at, and that is intended to be protected, must also know the regulations to ensure that these fulfill their preventive aims. They detected 53 episodes with sexual content in 28 movies and only one of them alluded to the use of condoms. In this study conducted by Sargent (2005), clear proof was given of the association between witnessing scenes of smoking in movies and the tobacco use among adolescents. The results conclude that there is a link between exposure to drinking scenes and subsequent alcohol consumption. Hanewinkel and Sargent (2009) conducted one of the few longitudinal studies on the effect of exposure to audiovisual content in drinking behavior. They measured the prevalence of alcohol consumption in a sample of 2,708 German adolescents who had never consumed alcohol. A year later the rate of television exposure was measured, taking into account whether the youth had television in his or her room and whether he or she had seen movies in which alcohol was drunk, among other variables, and compared with the problematic use of alcohol. The authors concluded that the exposure and having television in the room are independent predictors of problematic alcohol consumption. Other authors define community prevention as all activities carried out in the community setting that stimulate the participation of community representatives or institutions (e. The community context offers a wide range of actuation that can be defined by exclusion from other areas; and therefore, it encompasses everything that is not reserved for more specific areas such as school, family or workplace, to cite the most common areas. One might include the following as the main settings of actuation for community prevention: recreational night life, media, 18 Daniel Lloret Irles and José Pedro Espada Sánchez public urban spaces and public facilities. Developed within these areas are preventive interventions aimed at promoting healthy lifestyles and reducing the influence of those social conditions likely to cause damage, discomfort or tension. Although the legal framework implies a differentiating element, similar preventive principles apply in both cases and the measures and techniques used are aimed at reducing the availability and fostering a social attitude against substance use. Typology of Community Level Prevention Programs The community context provides an extensive panorama of possibilities for intervention. The range of social segments that are accessible through the community context, the emergence of new supports and the definition of new objectives, make attempts to classify the variety of channels and formats used by community prevention inscrutable. A possible classification could be the classic primary, secondary and tertiary one that takes into account the relationship of the target population with drug use. From this perspective, interventions are organized into three levels: universal, selective or indicated. Taking as criterion the format adopted by the program or preventive intervention and the medium used to reach the target population, we arrive at one of the possible classifications which, like any other, contain a certain degree of overlap that make it inexact. According to this criterion, we can sort interventions into four types: a) Interventions through the media. Interventions through the Media Interventions in the media adopt many different formats ranging from short and repeated messages –advertising spots-to more elaborate areas such as reports and interviews. This type of intervention aims to inform and encourage individuals towards a reflection aimed at abstinence, while reinforcing the various prevention actions and programs carried out in specific spheres and the communicative actions launched from the various social communication supports. As with other types of actions, their effectiveness is enhanced when coordinated with more structured prevention programs. There is sufficient evidence on the effectiveness of brief interventions in the media (Derzon and Lipsey, 2002, Longshore, Ghosh-Dastidar and Ellickson, 2003). Analysis of the assessment of the effectiveness of preventive ad exposure concluded a reduction in the likelihood of marijuana, crack and cocaine consumption (Block, Morwitz, Putsis and Sen, 2002). Apart from the content of preventive messages, it becomes necessary to revise the traditional formats of these messages designed for classical media supports (i. The new information and communication technologies offer the possibility to participate in communicative discourse, which increases audience involvement. Empirical evidence maintains that prevention programs that include dynamic and participatory components are more effective than those based on the mere transmission of information. Internet: A new support, a new generation of continuous change Within the broad field of care and prevention of problems arising from drug use, the Internet is turning out to be a breakthrough; since, it facilitates the exchange of knowledge and experience among professionals on the one hand, and on the other the implementation of on-line preventive programs destined for society in general. In this way, the Internet can serve as a medium in which 20 Daniel Lloret Irles and José Pedro Espada Sánchez particular preventive programs are developed, or it can also be a support tool at the service of teachers within the educational framework and parents within the bosom of the family. Prevention programs with the format of web pages provide information, data, and actuation models and offer the following advantages over a traditional format (Lacoste et al. It is an interactive medium that turns the final recipient of the message into a co-author, because he or she can actively collaborate by providing and/or modifying content.

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