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Since 1975 there have been a number of studies with guar gum supplementation and findings of an 11 to 16 percent reduction in serum cholesterol concentration (Anderson and Tietyen-Clark discount plavix 75 mg fast delivery, 1986 generic plavix 75 mg amex; Penagini et al cheap plavix 75mg visa. Blake and coworkers (1997) evaluated the effect of depolymerized guar galactomannan on fasting plasma lipid concentrations in volunteers with moderately raised plasma cholesterol 75mg plavix visa. In addition to decreasing blood cholesterol concentrations plavix 75 mg visa, guar gum has also been shown to decrease concentrations of triacylglycerols (Bosello et al. Viscous fibers, such as pectin and guar gum and those present in oat products and beans, produced significant reductions in glycemic response in 33 of 50 studies (66 per- cent) as reviewed in Wolever and Jenkins (1993). This is in contrast to only 3 of 14 studies conducted with insoluble fiber (21 percent). In addition, the provision of 30 g/d of guar gum decreased fasting blood glucose con- centration and increased insulin sensitivity (Landin et al. In a dose–response study to determine the amount of guar gum needed to decrease postprandial glycemia and insulinemia, guar gum was supplied at 0, 2. A reduction of 209 mU/min/L in the integrated insulin curve was estimated for every 1 g of guar gum incorpo- rated into the biscuit. The addition of 10 g/d of guar gum to a test meal generated an overall decrease in blood glucose concentrations in both normal (n = 5) and diabetic (n = 6) individuals (Goulder et al. In a study with 18 type 2-diabetic patients, 5 g of guar gum granules or 5 g of wheat bran were sprinkled over food at each main meal for 4 weeks (Fuessl et al. There was a 50 percent reduction in the incremental area under the postprandial glycemic curve with the guar gum. Mean fasting plasma glucose and glycosylated hemoglobin concen- trations were lower after treatment with guar gum compared with the wheat bran control. In one study with type 2 diabetics with near-normal fasting plasma glucose concentrations, 15 g/d of guar gum did not reduce the excessive postprandial glycemic response (Holman et al. Although the mechanism for improved glycemic response seen with guar gum in most studies is not entirely clear, guar gum has been shown to increase C-peptide response over time, thus suggesting enhanced insulin secretion by guar gum (Groop et al. When the standard glucose test was performed after ingestion of 15 g/d of guar gum, improved glucose toler- ance was observed in all but one pregnant women. In addition, guar gum generated significant reductions in mean serum glucose concentrations at 1, 2, and 3 hours after feeding (Gabbe et al. A few studies have demonstrated an increase in fecal bulk and increased stool frequency upon the ingestion of inulin or oligofructose. Fecal weight was increased after consuming 15 g/d of inulin or oligo- fructose (Gibson et al. After 2 to 6 weeks of treatment with 20 g/d of fructo- oligosaccharides or placebo, symptoms of irritable bowel syndrome improved more in the placebo group than in the fructooligosaccharide group; however, there was no difference between the groups after con- tinuous treatment for 12 weeks. Studies on the effect of inulin or oligofructose ingestion on plasma lipid concentrations have provided mixed results. Significant reductions in plasma triacylglycerol concentrations occurred with the intake of 10 g/d of inulin, particularly in those individuals with a baseline triacylglycerol concentration greater than 1. The ingestion of 9 g/d of inulin signifi- cantly reduced plasma total cholesterol and triacylglycerol concentrations in young men (Brighenti et al. In young, healthy males, 15 g/d of nondigestible oligosaccharides (inulin or fructooligosaccharides) did not decrease blood lipids or affect glucose absorption compared to controls (van Dokkum et al. A placebo-controlled parallel study showed that a daily intake of 10 g of inulin significantly reduced fasting insulin concentrations (Jackson et al. Fasting blood glucose concentrations were significantly reduced by 15 mg/dL in type 2 diabetics who were fed 8 g/d of fructooligosaccharides (Yamashita et al. Daily intake of 20 g of fructooligosaccharides significantly decreased basal hepatic glucose production (Luo et al. No difference, however, was observed in the incremental area under the curve for glucose when indi- viduals were fed 50 g of a rice-based cereal containing 0 or 9 g of inulin (Brighenti et al. An important effect of inulin intake is considered to be the production of Bifidobacteria. Bifidobacteria contain high amounts of β-fructosidase, which are specific for the β-(1,2) bond present in inulin and oligofructose. A number of studies in humans have shown that the ingestion of fructooligosaccharides leads to an increase in fecal Bifidobacteria (Bouhnik et al. Bifidobacteria have been shown to promote beneficial health effects in animals (Grizard and Barthomeuf, 1999); however, potential beneficial effects in humans are not well understood. Extracted β-glucans are highly fermentable and therefore their contribution to fecal bulk is minimal (McBurney, 1991).

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Analysis of cerebrospinal fluid shows numerous leukocytes and gram-negative diplococci buy 75mg plavix with amex. Administration of which of the following vaccines is most likely to have prevented this patient’s condition? A sexually active 37-year-old woman comes to the physician because of a 2-day history of pain in the area of her genitals 75 mg plavix visa. Pelvic examination shows shallow cheap 75mg plavix overnight delivery, small buy 75 mg plavix free shipping, extremely tender ulcers with red bases in the vulvar and vaginal regions order 75 mg plavix otc. Which of the following infectious agents is the most likely cause of these findings? During an experimental study, an investigator develops a new member of the class of non-nucleoside reverse transcriptase inhibitors. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with which of the following host phagocyte functions? A 33-year-old woman contracts malaria while on a 3-month business trip to a Central American country. Which of the following species of Plasmodium is most likely to have caused the second febrile illness? Three weeks after traveling to California to study desert flowers, a 33-year-old man develops fever, chest pain, and muscle soreness. Two days later, red, tender nodules appear on the shins, and the right ankle is tender and painful. At a banquet, the menu includes fried chicken, home-fried potatoes, peas, chocolate eclairs, and coffee. Within 2 hours, most of the diners become violently ill, with nausea, vomiting, abdominal pain, and diarrhea. Analysis of the contaminated food is most likely to yield large numbers of which of the following organisms? A 35-year-old woman is admitted to the hospital because of fever and dry cough for 3 days. A 69-year-old woman comes to the emergency department because of a 2-day history of increasingly severe fever and back pain; she also has a burning sensation with urination, and there is an aromatic smell to the urine. She has had three urinary tract infections treated with ciprofloxacin during the past year. During an experiment, an investigator gently abrades the skin from the flank of a mouse, creating a 1 × 2-cm skin window. A glass coverslip is then placed over the area so that cells attracted to the site attach to the coverslip for assessment. Two hours later, an extravasation of cells from the vasculature is noted on the coverslip. Which of the following complement components is the direct cause of the enhanced vascular permeability and chemoattraction in the abraded skin area in this experiment? He has had persistent left upper quadrant abdominal pain for 3 weeks despite therapy with omeprazole. Which of the following mechanisms of action is most likely involved in this resistance? A 3-year-old girl is brought to the emergency department by her father because of a persistent cough for 2 weeks. An investigator injects an experimental animal with a newly discovered bacterial strain to evaluate T-lymphocyte activation. Which of the following cell-surface molecules on the macrophage is most directly involved in the presentation of the processed peptides? An investigator conducts an experiment on Clostridium perfringens and then sterilizes the culture dishes by autoclaving. This method of sterilization is most appropriate because it ensures that which of the following bacterial structures are inactivated? A 52-year-old woman living in Maryland comes to the physician because of a 1-week history of low-grade fever, fatigue, and a red rash over the skin behind her left knee.

He also has had a pins-and-needles sensation starting in the neck and radiating down the right arm into the thumb purchase plavix 75mg on-line. His symptoms began 3 months ago when he developed severe pain in the neck and right shoulder 75mg plavix with visa. Neurologic examination shows limitation of motion on turning the neck to the right buy 75mg plavix otc. There is 4+/5 weakness of the right biceps and decreased pinprick over the right thumb discount 75 mg plavix with amex. Deep tendon reflexes are 1+ in the right biceps and brachioradialis discount 75 mg plavix free shipping; all others are 2+. A 29-year-old man is brought to the emergency department because he has a severe bilateral headache and irritability. His pulse is 120/min, respirations are 30/min, and blood pressure is 200/120 mm Hg. A 29-year-old woman with an 11-year history of bipolar disorder comes to the physician because she is concerned about memory loss during the past 2 weeks. She has had difficulty remembering appointments that she has made, and on one occasion, she got lost going to the health club where she has been a member for years. She has taken lithium carbonate for 8 years, and she has been taking a friend’s diuretic for perimenstrual weight gain during the past 3 months. On mental status examination, she is oriented to person, place, and time, but she recalls only one of three objects after 5 minutes. A 63-year-old man is brought to the physician by his daughter because she is concerned about his memory loss during the past year. Although he denies that there is any problem, she says he has been forgetful and becomes easily confused. He is oriented to person and place but initially gives the wrong month, which he is able to correct. He recalls memories from his youth in great detail but only recalls one of three words after 5 minutes. Physical examination, laboratory studies, and thyroid function tests show no abnormalities. A 65-year-old man has had increasingly severe headaches and diffuse muscle aches during the past 3 months. He also has a 1-month history of jaw pain when chewing food and decreasing visual acuity in his left eye. Visual acuity in his left eye is 20/100, and the left optic disc is slightly atrophic. A 19-year-old woman comes to the physician because of a 3-month history of intermittent drooping of her left eyelid each evening and occasional difficulty chewing and swallowing. She also has had two episodes of double vision that occurred in the evening and resolved by the following morning. A 72-year-old man is brought to the physician by his daughter because of a 2-day history of confusion, disorientation, and lethargy. He had a cerebral infarction 1 year ago and has been treated with daily aspirin since then. A 21-year-old college student comes to student health services requesting medication to help her sleep. Four days ago, she returned from a 1-year trip to India where she studied comparative religions. She constantly feels tired, has difficulty concentrating, and does not feel ready to begin classes. Her appetite has not decreased, but she has an aversion to eating meat since following a vegetarian diet in India. When asked to subtract serial sevens from 100, she begins accurately but then repeatedly loses track of the sequence. Today, she says she has had a persistent sensation of tingling and numbness of her left thigh that she did not report in the hospital because she thought it would go away; the sensation has improved somewhat during the past week. Sensation to light touch is decreased over a 5 × 5-cm area on the lateral aspect of the left anterior thigh. Which of the following is the most likely cause of this patient’s decreased sensation? She has a history of mild hypertension treated with hydrochlorothiazide and hypothyroidism treated with thyroid replacement therapy.

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