Concomitant: From 1 Different Sources
adj. at the same time: describing drugs that are administered together or symptoms that occur during the same period.
Avocado (Persea americana).Plant Part Used: Leaves, seed, fruit.Dominican Medicinal Uses: The leaves are traditionally prepared as an infusion and taken orally for diabetes, diarrhea, inducing abortion, intestinal worms, menstrual cramps, parasites and vaginal infections, and the seed decoction is taken for contraception. The fruit is typically used for nutritional and culinary purposes.Safety: No data on the safety of the leaf or the seed in humans has been identified in the available literature; animal toxicity studies have shown equivocal results. The fruit is commonly consumed as food and generally regarded as safe.Contraindications: Oral use of the leaves is contraindicated during pregnancy (due to emmenagogue and uterine muscle stimulating effects) and lactation (due to potential for harmful effects based on case reports in goats). No information on the safety of the leaves in children has been identified in the available literature.Drug Interactions: Warfarin: fruit may inhibit anticoagulant effect. Monoamine-oxidase inhibitors (MAOI): one case of hypertension crisis has been reported due to concomitant ingestion of the fruit and MAOI.Clinical Data: The following effects of this plant have been investigated in human clinical trials: fruit: cholesterol and lipid-lowering, treatment of non-insulin dependent diabetes mellitus and triglyceride-lowering; avocado/soybean unsaponifiables: treatment of osteoarthritis; and oil: treatment of plaque psoriasis.Laboratory & Preclinical Data: The following biological activities of this plant have been investigated in laboratory and preclinical studies (in vitro or animal models): analgesic, anti-inflammatory, antihemorrhage, hepatoprotective, immuno-modulating, uterine muscle stimulant, trypanocidal, uterine stimulant and vasorelaxant.* See entry for Aguacate in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... aguacate
Pepper, bell pepper, chili pepper, cayenne (Capsicum annuum, C. frutescens & C. chinense).Plant Part Used: Leaf, fruit.Dominican Medicinal Uses: The leaf is traditionally prepared as a warm poultice and applied topically for skin abscesses, boils or infections, or prepared as a tea and taken orally for menstrual cramps and related disorders. The fruit is typically used for culinary and nutritional purposes and is said to increase heat in the body.Safety: No data on the safety of the leaf in humans (for internal or external use) has been identified in the available literature; however, in animal studies, topical application of the leaf did not show signs of toxicity or adverse effects. The fruit is widely consumed and considered safe in moderate amounts. Prolonged or excessive use may cause irritation of the mucosa or other adverse effects.Contraindications: No data on the safety of this plant during pregnancy, lactation or in children has been identified in the available literature. The fruit should not be taken by patients with inflammatory gastro-intestinal or renal disorders. Avoid contact with the eyes or open wounds due to potential irritation of the mucosa.Drug Interactions: Consumption of the fruit may inhibit liver microsomal enzymes and potentiate drugs metabolized by these enzymes. Aspirin and salicylic acid compounds: bioavailability may be reduced by concurrent use of peppers. Barbiturates: concomitant use of the dried fruit has been shown to potentiate the effects of hexobarbital. Anticoagulants, antiplatelet agents, thrombolytic agents: concomitant use of the fruit may increase the risk of bleeding.Clinical Data: No human clinical trials of the leaf have been identified in the available literature. The fruit has been investigated in clinical trials for the following effects: analgesic, carotenoid bioavailability enhancement, gastroprotective, swallowing dysfunction treatment and urinary incontinence treatment.Laboratory & Preclinical Data: The following biological activities of this plant have been investigated in laboratory and preclinical studies (in vitro or animal models): antimicrobial, antioxidant, antitumor, chemopreventive, cytotoxic, learning enhancement, learning impairment amelioration and renoprotective.* See entry for Ají in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... ají
Basil (Ocimum basilicum).Plant Part Used: Aerial parts: leaf, stem, flower.Dominican Medicinal Uses: The aerial parts or leaves are traditionally prepared as a tea and taken orally for stomach ache, indigestion, gastro-intestinal pain, internal cleansing and women’s health conditions.Safety: This herb is generally regarded as safe for human consumption in moderate amounts and widely used as a culinary seasoning.Contraindications: The essential oil should not be used during pregnancy, lactation or in small children.Drug Interactions: Synergistic effects may occur with drugs that share similar pharmacological activities as those described for this plant in the “Laboratory and Preclinical Data” section; metabolism of one of basil’s active constituents, estragole, may be hindered by concomitant use of medications metabolized by UGT2B7 or UGT1A9 phase II enzymes.Clinical Data: No human clinical trials of this plant have been identified in the available literature.Laboratory & Preclinical Data: The following biological activities of this plant have been investigated in laboratory and preclinical studies (in vitro or animal models): analgesic, antifungal, antimicrobial, antispasmodic, anti-ulcerogenic, gastric anti-ulcerogenic, glutathione S-transferase and smooth muscle relaxant.* See entry for Albahaca in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... albahaca
familial unconjugated hyperbilirubinaemia: a condition due to a congenital deficiency of the enzyme UDP glucuronyl transferase in liver cells that is inherited as an autosomal *dominant or autosomal *recessive characteristic. Patients become mildly jaundiced, especially if they fast, overexert themselves, or have concomitant infection. Most patients are diagnosed following investigation of mildly abnormal liver function tests. The condition is lifelong but of little clinical consequence. [N. A. Gilbert (1858–1927), French physician]... gilbert’s syndrome
n. a *cytotoxic drug (an *alkylating agent) used in the treatment of malignant disease, particularly sarcomas, testicular tumours, and lymphomas. Side-effects include nausea, vomiting, alopecia, and haemorrhagic cystitis; concomitant administration of *mesna is recommended to prevent cystitis.... ifosfamide
Lavender (Lavandula angustifolia).Plant Part Used: Dried flower buds.Dominican Medicinal Uses: The dried flower buds are traditionally prepared as a tea and taken orally for anxiety/nervousness, stomach ache, indigestion, gas, menopausal hot flashes, common cold and flu.Safety: Lavender is generally regarded as safe when used in moderation. Potential adverse effects include drowsiness, gastrointestinal upset and skin irritation.Contraindications: Excessive internal use of this herb is contraindicated during early pregnancy due to its emmenagogue effect demonstrated in laboratory studies. Due to lack of sufficient data on safety, avoid use during lactation and in small children.Drug Interactions: Concomitant use of this herb with sedative or tranquilizing drugs, such as pentobarbital, may potentiate their effects based on evidence from animal studies. Additional herb-drug interactions may occur in medications with effects similar to those demonstrated by this plant clinical and preclinical studies (see below).Clinical Data: The following effects of this plant have been investigated in human clinical trials: antianxiety, antidepressant, anti-stress, anxiolytic, dysmenorrhea treatment, hypnotic, insomnia treatment, retrospective pain perception and sedative.Laboratory & Preclinical Data: This plant has shown the following biological activities in laboratory and preclinical studies: acaricidal, antibacterial, anticonvulsant, antifungal, anti-inflammatory, antimicrobial, antineoplastic, antitumor, sedative and hypolipidemic.* See entry for Alucema in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... alucema
Guinea-hen-weed (Petiveria alliacea).Plant Part Used: Leaf, root, stem.Dominican Medicinal Uses: The root is traditionally prepared as a tincture in alcohol and taken orally for arthritis, joint and muscle pain. The leaf and/or root is typically prepared as an infusion and taken orally for nausea and stomach ailments, women’s health conditions (dysmenorrhea, menorrhagia, menopausal symptoms, ovarian cysts, labor pains, postpartum recovery, uterine fibroids) and to cleanse the blood. The leaf is also prepared as a poultice and applied topically for skin infections.Safety: No data on the safety of this plant in humans has been identified in the available literature. Animal studies of the leaf have shown relatively low toxicity, and TRAMIL has approved this herb for particular traditional uses.Contraindications: Avoid use during pregnancy, lactation and in children under 12 years of age.Drug Interactions: Concomitant use of this herb with insulin and hypoglycemic drugs may potentiate their effects.Clinical Data: No human clinical trials have been identified in the available literature.Laboratory & Preclinical Data: The following biological activities have been demonstrated in laboratory and preclinical studies (using in vitro or animal models): analgesic, antifungal, anti-inflammatory, antinociceptive, chemopreventive, cytotoxic and hypoglycemic.* See entry for Anamú in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... anamú
Chocolate (Theobroma cacao).Plant Part Used: Leaf, seeds.Dominican Medicinal Uses: The seeds are traditionally prepared as a tea by decoction (i.e. hot chocolate) taken orally for fatigue and weakness. The leaf decoction is used for kidney and urinary tract disorders.Safety: Chocolate is widely consumed and generally regarded as safe. No data on the safety of the leaf has been identified in the available literature.Contraindications: Avoid use in individuals with a history of heart disorders (due to cardiac stimulant effects) or hypersensitivity (due to potential skin reactions or migraines).Drug Interactions: Avoid concomitant use with phenelzine due to potential for high blood pressure. The following medications may inhibit caffeine metabolism or clearance: oral contraceptives, cimetidine, furafylline, verapamil, disulfiram, fluconoazole, mexiletine, phenylpropanolamine, numerous quinolone antibiotics (i.e. enoxacin, pipemidic acid, ciprofloxacin, norfloxacin), idrocilamide and methoxsalen.Clinical Data: The following effects of the seed extract have been investigated in human clinical trials: anti-ulcer, antioxidant and decreased platelet function.Laboratory & Preclinical Data: In animal studies the seed extract has shown anti-ulcer effects. In vitro the seed extracts and/or constituents have shown antibacterial, antioxidant, anti-tumor, cardio-protective, dopaminergic, immunomodulatory and red blood cell production stimulant effects.* See entry for Cacao in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cacao
(heterotropia) n. squint: abnormal alignment of the two eyes. The strabismus is most commonly horizontal – convergent strabismus (or esotropia) or divergent strabismus (exotropia) – but it may be vertical (hypertropia, in which the eye looks upwards, or hypotropia, in which it looks downwards). In rare cases both eyes look towards the same point but one is twisted clockwise or anticlockwise in relation to the other (cyclotropia). Usually strabismus is concomitant, i.e. the abnormal alignment of the two eyes remains fairly constant, in whatever direction the person is looking. Strabismus acquired by injury or disease is usually incomitant, i.e. the degree of misalignment varies in different directions of gaze. See also cover test; deviation; divergence; heterophoria.... strabismus
Within most cultures, care of the sick is seen as entailing special duties, codi?ed as a set of moral standards governing professional practice. Although these duties have been stated and interpreted in di?ering ways, a common factor is the awareness of an imbalance of power between doctor and patient and an acknowledgement of the vulnerability of the sick person. A function of medical ethics is to counteract this inevitable power imbalance by encouraging doctors to act in the best interests of their patients, refrain from taking advantage of those in their care, and use their skills in a manner which preserves the honour of their profession. It has always been accepted, however, that doctors cannot use their knowledge indiscriminately to ful?l patients’ wishes. The deliberate ending of life, for example, even at a patient’s request, has usually been seen as alien to the shared values inherent in medical ethics. It is, however, symptomatic of changing concepts of ethics and of the growing power of patient choice that legal challenges have been mounted in several countries to the prohibition of EUTHANASIA. Thus ethics can be seen as regulating individual doctor-patient relationships, integrating doctors within a moral community of their professional peers and re?ecting societal demands for change.
Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.
Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.
A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.
Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.
An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.
The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.
In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics
Health Encyclopedia