Sensitivity Health Dictionary

Excessive sensitivity to PAIN; see also TOUCH.... hyperalgesia

Sensitivity to light. It can occur in MIGRAINE, disorders of the eye, or in MENINGITIS.... photophobia

A combination of gliadins and glutenins (types of proteins) formed when certain cereal flours (notably wheat flour) are mixed with water.

Sensitivity to gluten causes coeliac disease.... gluten

A generally unexpected, so unpredictable, abnormal reaction to a drug caused by a constitutional defect in the patient. In some cases the underlying disorder is already known or discovered after the ?rst event, so that the drug in question can be avoided thereafter. The abnormal sensitivity of patients with PORPHYRIAS to BARBITURATES is an example. Hereditary biochemical defects of red blood cells are responsible for many drug-induced haemolytic anaemias (see under ANAEMIA) and for FAVISM. Porphyria variegata, the South African variety of porphyria, is an example of an inborn error of metabolism which was without serious symptoms until the advent of barbiturate drugs, prescription of which is now strongly discouraged. If anyone with this metabolic disorder takes barbiturates, the consequences may be fatal.... idiosyncrasy

The word migraine derives from HEMICRANIA, the Greek for half a skull, and is a common condition characterised by recurring intense headaches. It is much more usual in women than in men and affects around 10 per cent of the population. It has been de?ned as ‘episodic headache accompanied by visual or gastrointestinal disturbances, or both, attacks lasting hours with total freedom between episodes’.

It usually begins at puberty – although young children can be affected – and tends to stop in middle age: in women, for example, attacks often cease after MENOPAUSE. It frequently disappears during pregnancy. The disorder tends to run in families. In susceptible individuals, attacks may be provoked by a wide variety of causes including: anxiety, emotion, depression, shock, and excitement; physical and mental fatigue; prolonged focusing on computer, television or cinema screens; noise, especially loud and high-pitched sounds; certain foods – such as chocolate, cheese, citrus fruits, pastry; alcohol; prolonged lack of food; irregular meals; menstruation and the pre-menstrual period.

Anything that can provoke a headache in the ordinary individual can probably precipitate an attack in a migrainous subject. It seems as if there is an inherited predispostion that triggers a mechanism whereby in the migrainous subject, the headache and the associated sickness persist for hours, a whole day or even longer.

The precise cause is not known, but the generally accepted view is that in susceptible individuals, one or other of these causes produces spasm or constriction of the blood vessels of the brain. This in turn is followed by dilatation of these blood vessels which also become more permeable and so allow ?uid to pass out into the surrounding tissues. This combination of dilatation and outpouring of ?uid is held to be responsible for the headache.

Two types of migraine have been recognised: classical and common. The former is relatively rare and the headache is preceded by a slowly extending area of blindness in one or both eyes, usually accompanied by intermittent ‘lights’. The phenomenon lasts for up to 30 minutes and is followed by a bad, often unilateral headache with nausea, sometimes vomiting and sensitivity to light. Occasionally, passing neurological symptoms such as weakness in a limb may accompany the attack. The common variety has similar but less severe symptoms. It consists of an intense headache, usually situated over one or other eye. The headache is usually preceded by a feeling of sickness and disturbance of sight. In 15–20 per cent of cases this disturbance of sight takes the form of bright lights: the so-called AURA of migraine. The majority of attacks are accompanied by vomiting. The duration of the headache varies, but in the more severe cases the victim is usually con?ned to bed for 24 hours.

Treatment consists, in the ?rst place, of trying to avoid any precipitating factor. Patients must ?nd out which drug, or drugs, give them most relief, and they must always carry these about with them wherever they go. This is because it is a not uncommon experience to be aware of an attack coming on and to ?nd that there is a critical quarter of an hour or so during which the tablets are e?ective. If not taken within this period, they may be ine?ective and the unfortunate victim ?nds him or herself prostrate with headache and vomiting. In addition, sufferers should immediately lie down; at this stage a few hours’ rest may prevent the development of a full attack.

When an attack is fully developed, rest in bed in a quiet, darkened room is essential; any loud noise or bright light intensi?es the headache or sickness. The less food that is taken during an attack the better, provided that the individual drinks as much ?uid as he or she wants. Group therapy, in which groups of around ten migrainous subjects learn how to relax, is often of help in more severe cases, whilst in others the injection of a local anaesthetic into tender spots in the scalp reduces the number of attacks. Drug treatment can be e?ective and those a?icted by migraine may ?nd a particular drug or combination of drugs more suitable than others. ANALGESICS such as PARACETAMOL, aspirin and CODEINE phosphate sometimes help. A combination of buclizine hydrochloride and analgesics, taken when the visual aura occurs, prevents or diminishes the severity of an attack in some people. A commonly used remedy for the condition is ergotamine tartrate, which causes the dilated blood vessels to contract, but this must only be taken under medical supervision. In many cases METOCLOPRAMIDE (an antiemetic), followed ten minutes later by three tablets of either aspirin or paracetamol, is e?ective if taken early in an attack. In milder attacks, aspirin, with or without codeine and paracetamol, may be of value. SUMATRIPTAN (5-hydroxytryptamine [5HT1] AGONIST – also known as a SEROTONIN agonist) is of value for acute attacks. It is used orally or by subcutaneous injection, but should not be used for patients with ischaemic heart disease. Naratriptan is another 5HT1 agonist that is an e?ective treatment for acute attacks; others are almotriptan, rizariptan and zolmitriptan. Some patients ?nd beta blockers such as propranolol a valuable prophylactic.

People with migraine and their relatives can obtain help and guidance from the Migraine Action Association.... migraine

The screening of apparently healthy people to identify those who may have treatable diseases. Cervical smears are done when screening women to detect if they have cancer or precancer of the neck of the womb (cervix). Newborn babies are screened for hip dislocation. Screening tests are not designed to diagnose individual persons, but rather to divide a population into a large number at low risk and a small number at high risk of a condition. This allows clinicians to concentrate on a sub-section of the population. All screening tests produce false negative and false positive results, a problem often misunderstood by those at the receiving end. Factors to be assessed when planning screening procedures include the severity, frequency and distribution of the disease, and the availability and e?ectiveness of treatment. Convenience, safety, sensitivity and cost should also be assessed. In the United Kingdom the government has supported the extension of screening procedures for breast cancer, cervical cancer, hypertension and diabetes. (See PREVENTIVE MEDICINE.)... screening test

Increasing sensitivity of the body to a protein after an initial reaction which may have been mild. The second or third exposure to this protein may cause severe respiratory or circulatory embarrassment, leading to death.... anaphylaxis

A substance that decreases nerve sensitivity to pain. Examples: nitrous oxide, Peppermint.... anesthetic

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Moderate Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, phosphorus, zinc

About the Nutrients in This Food Like fish, pork, poultry, milk, and eggs, beef has high-quality proteins, with sufficient amounts of all the essential amino acids. Beef fat is slightly more highly saturated than pork fat, but less saturated than lamb fat. All have about the same amount of cholesterol per serving. Beef is an excellent source of B vitamins, including niacin, vitamin B6, and vitamin B12, which is found only in animal foods. Lean beef pro- vides heme iron, the organic iron that is about five times more useful to the body than nonheme iron, the inorganic form of iron found in plant foods. Beef is also an excellent source of zinc. One four-ounce serving of lean broiled sirloin steak has nine grams fat (3.5 g saturated fat), 101 mg cholesterol, 34 g protein, and 3.81 mg iron (21 percent of the R DA for a woman, 46 percent of the R DA for a man). One four-ounce serving of lean roast beef has 16 g fat (6.6 g saturated fat), 92 mg cholesterol, and 2.96 mg iron (16 percent of the R DA for a woman, 37 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Ascorbic acid increases the absorption of iron from meat. * These values apply to lean cooked beef.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet (for some forms of kidney disease)

Buying This Food Look for: Fresh, red beef. The fat should be white, not yellow. Choose lean cuts of beef with as little internal marbling (streaks of fat) as possible. The leanest cuts are flank steak and round steak; rib steaks, brisket, and chuck have the most fat. USDA grading, which is determined by the maturity of the animal and marbling in meat, is also a guide to fat content. U.S. prime has more marbling than U.S. choice, which has more marbling than U.S. good. All are equally nutritious; the difference is how tender they are, which depends on how much fat is present. Choose the cut of meat that is right for your recipe. Generally, the cuts from the cen- ter of the animal’s back—the rib, the T-Bone, the porterhouse steaks—are the most tender. They can be cooked by dry heat—broiling, roasting, pan-frying. Cuts from around the legs, the underbelly, and the neck—the shank, the brisket, the round—contain muscles used for movement. They must be tenderized by stewing or boiling, the long, moist cooking methods that break down the connective tissue that makes meat tough.

Storing This Food Refrigerate raw beef immediately, carefully wrapped to prevent its drippings from contami- nating other foods. Refrigeration prolongs the freshness of beef by slowing the natural multi- plication of bacteria on the meat surface. Unchecked, these bacteria will convert proteins and other substances on the surface of the meat to a slimy film and change meat’s sulfur-contain- ing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Fresh ground beef, with many surfaces where bacteria can live, should be used within 24 to 48 hours. Other cuts of beef may stay fresh in the refrigerator for three to five days.

Preparing This Food Trim the beef carefully. By judiciously cutting away all visible fat you can significantly reduce the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the appearance and flavor of beef, alters nutritional value, makes it safer, and extends its shelf life. Browning meat after you cook it does not “seal in the juices,” but it does change the fla- vor by caramelizing sugars on the surface. Because beef’s only sugars are the small amounts of glycogen in the muscles, we add sugars in marinades or basting liquids that may also con- tain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When beef is cooked, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat and turn brown, the natural color of well-done meat. At the same time, the fats in the beef are oxidized. Oxidized fats, whether formed in cooking or when the cooked meat is stored in the refrigerator, give cooked meat a character- istic warmed-over flavor. Cooking and storing meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers, and other vitamin C-rich vegetables—reduces the oxidation of fats and the intensity of warmed-over flavor. Meat reheated in a microwave oven also has less warmed-over flavor. An obvious nutritional benefit of cooking is the fact that heat lowers the fat content of beef by liquif ying the fat so it can run off the meat. One concrete example of how well this works comes from a comparison of the fat content in regular and extra-lean ground beef. According to research at the University of Missouri in 1985, both kinds of beef lose mass when cooked, but the lean beef loses water and the regular beef loses fat and cholesterol. Thus, while regular raw ground beef has about three times as much fat (by weight) as raw ground extra-lean beef, their fat varies by only 5 percent after broiling. To reduce the amount of fat in ground beef, heat the beef in a pan until it browns. Then put the beef in a colander, and pour one cup of warm water over the beef. Repeat with a second cup of warm water to rinse away fat melted by heating the beef. Use the ground beef in sauce and other dishes that do not require it to hold together. Finally, cooking makes beef safer by killing Salmonella and other organisms in the meat. As a result, cooking also serves as a natural preservative. According to the USDA, large pieces of fresh beef can be refrigerated for two or three days, then cooked and held safely for another day or two because the heat of cooking has reduced the number of bacteria on the surface of the meat and temporarily interrupted the natural cycle of deterioration.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to the air, in a refrigerated room, reduces the moisture content and shrinks the meat slightly. As the meat ages enzymes break down muscle pro- teins, “tenderizing” the beef. Canning. Canned beef does not develop a warmed-over flavor because the high tempera- tures in canning food and the long cooking process alter proteins in the meat so that they act as antioxidants. Once the can is open, however, the meat should be protected from oxygen that will change the flavor of the beef. Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solution. The salt or sugar used in curing dissolves in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the microor- ganisms and protecting the meat from bacterial damage. Salt-cured meat is much higher in sodium than fresh meat. Freezing. When you freeze beef, the water inside its cells freezes into sharp ice crystals that can puncture cell membranes. When the beef thaws, moisture (and some of the B vitamins) will leak out through these torn cell walls. The loss of moisture is irreversible, but some of the vitamins can be saved by using the drippings when the meat is cooked. Freezing may also cause freezer burn—dry spots left when moisture evaporates from the surface of the meat. Waxed freezer paper is designed specifically to hold the moisture in meat; plastic wrap and aluminum foil are less effective. NOTE : Commercially prepared beef, which is frozen very quickly at very low temperatures, is less likely to show changes in texture. Irradiation. Irradiation makes meat safer by exposing it to gamma rays, the kind of high- energy ionizing radiation that kills living cells, including bacteria. Irradiation does not change the way meat looks, feels or tastes, or make the food radioactive, but it does alter the structure of some naturally occurring chemicals in beef, breaking molecules apart to form new com- pounds called radiolytic products (R P). About 90 percent of R Ps are also found in nonirradiated foods. The rest, called unique radiolytic products (UR P), are found only in irradiated foods. There is currently no evidence to suggest that UR Ps are harmful; irradiation is an approved technique in more than 37 countries around the world, including the United States. Smoking. Hanging cured or salted meat over an open fire slowly dries the meat, kills micro- organisms on its surface, and gives the meat a rich, “smoky” flavor that varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Meats treated with “artificial smoke flavoring” are not, since the flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements. One cooked 3.5- ounce hamburger provides about 2.9 mg iron, 16 percent of the R DA for an adult woman of childbearing age. Possible anti-diabetes activity. CLA may also prevent type 2 diabetes, also called adult-onset diabetes, a non-insulin-dependent form of the disease. At Purdue University, rats bred to develop diabetes spontaneously between eight and 10 weeks of age stayed healthy when given CLA supplements.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, beef contains cholesterol and saturated fats that increase the amount of cholesterol circulating in your blood, raising your risk of heart disease. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Increased risk of some cancers. According the American Institute for Cancer Research, a diet high in red meat (beef, lamb, pork) increases the risk of developing colorectal cancer by 15 percent for every 1.5 ounces over 18 ounces consumed per week. In 2007, the National Can- cer Institute released data from a survey of 500,000 people, ages 50 to 71, who participated in an eight-year A AR P diet and health study identif ying a higher risk of developing cancer of the esophagus, liver, lung, and pancreas among people eating large amounts of red meats and processed meats. Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meats con- taminated with other bacteria, viruses, or parasites pose special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; 165°F, the E. coli organism; and 212°F, Listeria monocytogenes. Antibiotic sensitivity. Cattle in the United States are routinely given antibiotics to protect them from infection. By law, the antibiotic treatment must stop three days to several weeks before the animal is slaughtered. Theoretically, the beef should then be free of antibiotic residues, but some people who are sensitive to penicillin or tetracycline may have an allergic reaction to the meat, although this is rare. Antibiotic-resistant Salmonella and toxoplasmosis. Cattle treated with antibiotics may pro- duce meat contaminated with antibiotic-resistant strains of Salmonella, and all raw beef may harbor ordinary Salmonella as well as T. gondii, the parasite that causes toxoplasmosis. Toxoplasmosis is particularly hazardous for pregnant women. It can be passed on to the fetus and may trigger a series of birth defects including blindness and mental retardation. Both Salmonella and the T. gondii can be eliminated by cooking meat thoroughly and washing all utensils, cutting boards, and counters as well as your hands with hot soapy water before touching any other food. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia, which is excreted through the kidneys. In laborator y animals, a sustained high-protein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Tetracycline antibiotics (demeclocycline [Declomycin], doxycycline [ Vibtamycin], methacycline [Rondomycin], minocycline [Minocin], oxytetracycline [Terramycin], tetracycline [Achromycin V, Panmycin, Sumycin]). Because meat contains iron, which binds tetracyclines into com- pounds the body cannot absorb, it is best to avoid meat for two hours before and after taking one of these antibiotics. Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking a M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Theophylline. Charcoal-broiled beef appears to reduce the effectiveness of theophylline because the aromatic chemicals produced by burning fat speed up the metabolism of the- ophylline in the liver.... beef

Nutritional Profile Energy value (calories per serving): Moderate to high Protein: Moderate to high Fat: Low to high Saturated fat: High Cholesterol: Low to high Carbohydrates: Low Fiber: None Sodium: High Major vitamin contribution: Vitamin A, vitamin D, B vitamins Major mineral contribution: Calcium

About the Nutrients in This Food Cheese making begins when Lactobacilli and/or Streptococci bacteria are added to milk. The bacteria digest lactose (milk sugar) and release lactic acid, which coagulates casein (milk protein) into curds. Rennet (gastric enzymes extracted from the stomach of calves) is added, and the mixture is put aside to set. The longer the curds are left to set, the firmer the cheese will be. When the curds are properly firm, they are pressed to squeeze out the whey (liquid) and cooked. Cooking evaporates even more liquid and makes the cheese even firmer.* At this point, the product is “fresh” or “green” cheese: cottage cheese, cream cheese, farmer cheese. Making “ripe” cheese requires the addition of salt to pull out more moisture and specific organisms, such as Penicil- lium roquefort for Roquefort cheese, blue cheese, and Stilton, or Penicillium cambembert for Camembert and Brie. The nutritional value of cheese is similar to the milk from which it is made. All cheese is a good source of high quality proteins with sufficient amounts of all the essential amino acids. Cheese is low to high in fat, mod- erate to high in cholesterol. * Natural cheese is cheese made direct ly from milk. Processed cheese is natural cheese melted and combined wit h emulsifiers. Pasteurized process cheese foods contain ingredients t hat allow t hem to spread smoot hly; t hey are lower in fat and higher in moisture t han processed cheese. Cholesterol and Saturated Fat Content of Selected Cheeses Mozzarella Source: USDA, Nutritive Value of Foods, Home and Garden Bullet in No. 72 (USDA, 1989). All cheeses, except cottage cheese, are good sources of vitamin A. Orange and yellow cheeses are colored with carotenoid pigments, including bixin (the carotenoid pigment in annatto) and synthetic beta-carotene. Hard cheeses are an excellent source of calcium; softer cheeses are a good source; cream cheese and cottage cheese are poor sources. The R DA for calcium is 1,000 mg for a woman, 1,200 mg for a man, and 1,500 mg for an older woman who is not on hormone- replacement therapy. All cheese, unless otherwise labeled, is high in sodium.

Calcium Content of Cheese
Cheese	Serving	Calcium (mg)
Blue	oz.	150
Camembert	wedge	147
Cheddar	oz.	204
Cottage cheese
creamed	cup	135
uncreamed	cup	46
Muenster	oz.	203
Pasteurized processed American	oz.	174
Parmesan grated	tbsp.	69
Provolone	oz.	214
Swiss	oz.	272

  Source: Nutritive Value of Foods, Home and Gardens Bullet in No. 72 (USDA, 1989).

The Most Nutritious Way to Serve This Food With grains, bread, noodles, beans, nuts, or vegetables to add the essential amino acids miss- ing from these foods, “complete” their proteins, and make them more nutritionally valuable.

Diets That May Restrict or Exclude This Food Antiflatulence diet Controlled-fat, low-cholesterol diet Lactose- and galactose-free diet (lactose, a disaccharide [double sugar] is composed of one unit of galactose and one unit of glucose) Low-calcium diet (for patients with kidney disease) Sucrose-free diet (processed cheese)

Buying This Food Look for: Cheese stored in a refrigerated case. Check the date on the package. Avoid: Any cheese with mold that is not an integral part of the food.

Storing This Food Refrigerate all cheese except unopened canned cheeses (such as Camembert in tins) or grated cheeses treated with preservatives and labeled to show that they can be kept outside the refrigerator. Some sealed packages of processed cheeses can be stored at room temperature but must be refrigerated once the package is opened. Wrap cheeses tightly to protect them from contamination by other microorganisms in the air and to keep them from drying out. Well-wrapped, refrigerated hard cheeses that have not been cut or sliced will keep for up to six months; sliced hard cheeses will keep for about two weeks. Soft cheeses (cottage cheese, ricotta, cream cheese, and Neufchatel) should be used within five to seven days. Use all packaged or processed cheeses by the date stamped on the package. Throw out moldy cheese (unless the mold is an integral part of the cheese, as with blue cheese or Stilton).

Preparing This Food To grate cheese, chill the cheese so it won’t stick to the grater. The molecules that give cheese its taste and aroma are largely immobilized when the cheese is cold. When serving cheese with fruit or crackers, bring it to room temperature to activate these molecules.

What Happens When You Cook This Food Heat changes the structure of proteins. The molecules are denatured, which means that they may be broken into smaller fragments or change shape or clump together. All of these changes may force moisture out of the protein tissue, which is why overcooked cheese is often stringy. Whey proteins, which do not clump or string at low temperatures, contain the sulfur atoms that give hot or burned cheese an unpleasant “cooked” odor. To avoid both strings and an unpleasant odor, add cheese to sauces at the last minute and cook just long enough to melt the cheese.

How Other Kinds of Processing Affect This Food Freezing. All cheese loses moisture when frozen, so semisoft cheeses will freeze and thaw better than hard cheeses, which may be crumbly when defrosted. Drying. The less moisture cheese contains, the less able it is to support the growth of organ- isms like mold. Dried cheeses keep significantly longer than ordinary cheeses.

Medical Uses and/or Benefits To strengthen bones and reduce age-related loss of bone density. High-calcium foods protect bone density. The current recommended dietary allowance (R DA) for calcium is still 800 mg for adults 25 and older, but a 1984 National Institutes of Health (NIH) Conference advisory stated that lifelong protection for bones requires an R DA of 1,000 mg for healthy men and women age 25 to 50 ; 1,000 mg for older women using hormone replacement therapy; and 1,500 mg for older women who are not using hormones, and these recommendations have been confirmed in a 1994 NIH Consensus Statement on optimal calcium intake. A diet with adequate amounts of calcium-rich foods helps protect bone density. Low-fat and no-fat cheeses provide calcium without excess fat and cholesterol. Protection against tooth decay. Studies at the University of Iowa (Iowa City) Dental School confirm that a wide variety of cheeses, including aged cheddar, Edam, Gouda, Monterey Jack, Muenster, mozzarella, Port Salut, Roquefort, Romano, Stilton, Swiss, and Tilsit—limit the tooth decay ordinarily expected when sugar becomes trapped in plaque, the sticky film on tooth surfaces where cavity-causing bacteria flourish. In a related experiment using only cheddar cheese, people who ate cheddar four times a day over a two-week period showed a 20 percent buildup of strengthening minerals on the surface of synthetic toothlike material attached to the root surfaces of natural teeth. Protection against periodontal disease. A report in the January 2008 issue of the Journal of Periodontology suggests that consuming adequate amounts of dairy products may reduce the risk of developing periodontal disease. Examining the dental health of 942 subjects ages 40 to 79, researchers at Kyushu University, in Japan, discovered that those whose diets regularly included two ounces (55 g) of foods containing lactic acid (milk, cheese, and yogurt) were significantly less likely to have deep “pockets” (loss of attachment of tooth to gum) than those who consumed fewer dairy products.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, cheese is a source of choles- terol and saturated fats, which increase the amount of cholesterol circulating in your blood and raise your risk of heart disease. To reduce the risk of heart disease, the USDA /Health and Human Services Dietary Guidelines for Americans recommends limiting the amount of cholesterol in your diet to no more than 300 mg a day. The guidelines also recommend limit- ing the amount of fat you consume to no more than 30 percent of your total calories, while holding your consumption of saturated fats to more than 10 percent of your total calories (the calories from saturated fats are counted as part of the total calories from fat). Food poisoning. Cheese made from raw (unpasteurized) milk may contain hazardous microorganisms, including Salmonella and Listeria. Salmonella causes serious gastric upset; Lis- teria, a flulike infection, encephalitis, or blood infection. Both may be life-threatening to the very young, the very old, pregnant women, and those whose immune systems are weakened either by illness (such as AIDS) or drugs (such as cancer chemotherapy). In 1998, the Federal Centers for Disease Control (CDC) released data identif ying Listeria as the cause of nearly half the reported deaths from food poisoning. Allergy to milk proteins. Milk is one of the foods most frequently implicated as a cause of allergic reactions, particularly upset stomach. However, in many cases the reaction is not a true allergy but the result of lactose intolerance (see below). Lactose intolerance. Lactose intolerance—the inability to digest the sugar in milk—is an inherited metabolic deficiency that affects two thirds of all adults, including 90 to 95 percent of all Orientals, 70 to 75 percent of all blacks, and 6 to 8 percent of Caucasians. These people do not have sufficient amounts of lactase, the enzyme that breaks the disaccharide lactose into its easily digested components, galactose and glucose. When they drink milk, the undi- gested sugar is fermented by bacteria in the gut, causing bloating, diarrhea, flatulence, and intestinal discomfort. Some milk is now sold with added lactase to digest the lactose and make the milk usable for lactase-deficient people. In making cheese, most of the lactose in milk is broken down into glucose and galactose. There is very little lactose in cheeses other than the fresh ones—cottage cheese, cream cheese, and farmer cheese. Galactosemia. Galactosemia is an inherited metabolic disorder in which the body lacks the enzymes needed to metabolize galactose, a component of lactose. Galactosemia is a reces- sive trait; you must receive the gene from both parents to develop the condition. Babies born with galactosemia will fail to thrive and may develop brain damage or cataracts if they are given milk. To prevent this, children with galactosemia are usually kept on a protective milk- free diet for several years, until their bodies have developed alternative pathways by which to metabolize galactose. Pregnant women who are known carriers of galactosemia may be advised to give up milk and milk products while pregnant lest the unmetabolized galactose in their bodies cause brain damage to the fetus (damage not detectable by amniocentesis). Genetic counseling is available to identif y galactosemia carriers and assess their chances of producing a baby with the disorder. Penicillin sensitivity. People who experience a sensitivity reaction the first time they take penicillin may have been sensitized by exposure to the Penicillium molds in the environment, including the Penicillium molds used to make brie, blue, camembert, roquefort, Stilton, and other “blue” cheeses.

Food/Drug Interactions Tetracycline. The calcium ions in milk products, including cheese, bind tetracyclines into insoluble compounds. If you take tetracyclines with cheese, your body may not be able to absorb and use the drug efficiently. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood ves- sels and increases blood pressure. If you eat a food such as aged or fermented cheese which is high in tyramine while you are taking an M AO inhibitor, your body may not be able to eliminate the tyramine. The result may be a hypertensive crisis.

Tyramine Content of Cheeses High Boursault, Camembert, Cheddar, Emmenthaler, Stilton Medium to high Blue, brick, Brie, Gruyère, mozzarella, Parmesan, Romano, Roquefort Low Processed American cheese Very little or none Cottage and cream cheese Sources: The Medical Letter Handbook of Adverse Drug Interactions (1985); Handbook of Clinical Dietetics ( The A merican Dietet ic Associat ion, 1981). False-positive test for pheochromocytoma. Pheochromocytomas (tumors of the adrenal glands) secrete adrenalin that is converted by the body to vanillyl-mandelic acid ( VM A) and excreted in the urine. Tests for this tumor measure the level of VM A in the urine. Since cheese contains VM A, taking the test after eating cheese may result in a false-positive result. Ordinarily, cheese is prohibited for at least 72 hours before this diagnostic test.... cheese

See also MYALGIC ENCEPHALOMYELITIS (ME). A condition characterised by severe, disabling mental and physical fatigue brought on by mental or physical activity and associated with a range of symptoms including muscle pain, headaches, poor sleep, disturbed moods and impaired concentration. The prevalence of the condition is between 0.2 and 2.6 per cent of the population (depending on how investigators de?ne CFS/ME). Despite the stereotype of ‘yuppie ?u’, epidemiological research has shown that the condition occurs in all socioeconomic and ethnic groups. It is commoner in women and can also occur in children.

In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.

The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.

Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)

Psychological support and advice provided by a trained therapist or health professional. The aim is to help an individual manage a particular personal or family problem: this may be a diagnosis of cancer, mental and physical trauma following an accident or assault, or a bereavement. Counselling can help people cope with a wide range of demanding circumstances. It is usually done on a one-to-one basis – sometimes in small groups – and needs to be provided with skill and sensitivity or there is a risk of worsening the individual’s diffculties. There has been rapid growth in counselling services and it is vital that those providing them have been properly trained.... counselling

A practitioner’s or institution’s understanding of, and sensitivity to, the cultural background and primary language of people in any component of service delivery, including patient education materials, questionnaires, office or health care organization setting, direct care and public health campaigns.... cultural competence

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: High Saturated fat: Moderate Cholesterol: High Carbohydrates: Low Fiber: None Sodium: Moderate to high Major vitamin contribution: Vitamin A, riboflavin, vitamin D Major mineral contribution: Iron, calcium

About the Nutrients in This Food An egg is really three separate foods, the whole egg, the white, and the yolk, each with its own distinct nutritional profile. A whole egg is a high-fat, high-cholesterol, high-quality protein food packaged in a high-calcium shell that can be ground and added to any recipe. The proteins in eggs, with sufficient amounts of all the essential amino acids, are 99 percent digestible, the standard by which all other proteins are judged. The egg white is a high-protein, low-fat food with virtually no cholesterol. Its only important vitamin is riboflavin (vitamin B2), a vis- ible vitamin that gives egg white a slightly greenish cast. Raw egg whites contain avidin, an antinutrient that binds biotin a B complex vitamin for- merly known as vitamin H, into an insoluble compound. Cooking the egg inactivates avidin. An egg yolk is a high-fat, high-cholesterol, high-protein food, a good source of vitamin A derived from carotenes eaten by the laying hen, plus vitamin D, B vitamins, and heme iron, the form of iron most easily absorbed by your body. One large whole egg (50 g/1.8 ounce) has five grams fat (1.5 g satu- rated fat, 1.9 g monounsaturated fat, 0.7 g polyunsaturated fat), 212 mg cholesterol, 244 IU vitamin A (11 percent of the R DA for a woman, 9 percent * Values are for a whole egg. of the R DA for a man), 0.9 mg iron (5 percent of the R DA for a woman, 11 percent of the R DA for a man) and seven grams protein. The fat in the egg is all in the yolk. The protein is divided: four grams in the white, three grams in the yolk.

The Most Nutritious Way to Serve This Food With extra whites and fewer yolks to lower the fat and cholesterol per serving.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet

Buying This Food Look for: Eggs stored in the refrigerated dair y case. Check the date for freshness. NOTE : In 1998, the FDA and USDA Food Safety and Inspection Service (FSIS) proposed new rules that would require distributors to keep eggs refrigerated on the way to the store and require stores to keep eggs in a refrigerated case. The egg package must have a “refrigera- tion required” label plus safe-handling instructions on eggs that have not been treated to kill Salmonella. Look for: Eggs that fit your needs. Eggs are graded by the size of the yolk and the thick- ness of the white, qualities that affect appearance but not nutritional values. The higher the grade, the thicker the yolk and the thicker the white will be when you cook the egg. A Grade A A egg fried sunny side up will look much more attractive than a Grade B egg prepared the same way, but both will be equally nutritions. Egg sizes ( Jumbo, Extra large, Large, Medium, Small) are determined by how much the eggs weigh per dozen. The color of the egg’s shell depends on the breed of the hen that laid the egg and has nothing to do with the egg’s food value.

Storing This Food Store fresh eggs with the small end down so that the yolk is completely submerged in the egg white (which contains antibacterial properties, nature’s protection for the yolk—or a developing chick embryo in a fertilized egg). Never wash eggs before storing them: The water will make the egg shell more porous, allowing harmful microorganisms to enter. Store separated leftover yolks and whites in small, tightly covered containers in the refrigerator, where they may stay fresh for up to a week. Raw eggs are very susceptible to Salmonella and other bacterial contamination; discard any egg that looks or smells the least bit unusual. Refrigerate hard-cooked eggs, including decorated Easter eggs. They, too, are suscep- tible to Salmonella contamination and should never be left at room temperature.

Preparing This Food First, find out how fresh the eggs really are. The freshest ones are the eggs that sink and lie flat on their sides when submerged in cool water. These eggs can be used for any dish. By the time the egg is a week old, the air pocket inside, near the broad end, has expanded so that the broad end tilts up as the egg is submerged in cool water. The yolk and the white inside have begun to separate; these eggs are easier to peel when hard-cooked. A week or two later, the egg’s air pocket has expanded enough to cause the broad end of the egg to point straight up when you put the egg in water. By now the egg is runny and should be used in sauces where it doesn’t matter if it isn’t picture-perfect. After four weeks, the egg will float. Throw it away. Eggs are easily contaminated with Salmonella microorganisms that can slip through an intact shell. never eat or serve a dish or bever age containing r aw fr esh eggs. sa lmonella is destroyed by cooking eggs to an inter nal temper atur e of 145°f ; egg-milk dishes such as custar ds must be cooked to an inter nal temper atur e of 160°f. If you separate fresh eggs by hand, wash your hands thoroughly before touching other food, dishes, or cooking tools. When you have finished preparing raw eggs, wash your hands and all utensils thoroughly with soap and hot water. never stir cooked eggs with a utensil used on r aw eggs. When you whip an egg white, you change the structure of its protein molecules which unfold, breaking bonds between atoms on the same molecule and forming new bonds to atoms on adjacent molecules. The result is a network of protein molecules that hardens around air trapped in bubbles in the net. If you beat the whites too long, the foam will turn stiff enough to hold its shape even if you don’t cook it, but it will be too stiff to expand natu- rally if you heat it, as in a soufflé. When you do cook properly whipped egg white foam, the hot air inside the bubbles will expand. Ovalbumin, an elastic protein in the white, allows the bubble walls to bulge outward until they are cooked firm and the network is stabilized as a puff y soufflé. The bowl in which you whip the whites should be absolutely free of fat or grease, since the fat molecules will surround the protein molecules in the egg white and keep them from linking up together to form a puff y white foam. Eggs whites will react with metal ions from the surface of an aluminum bowl to form dark particles that discolor the egg-white foam. You can whip eggs successfully in an enamel or glass bowl, but they will do best in a copper bowl because copper ions bind to the egg and stabilize the foam.

What Happens When You Cook This Food When you heat a whole egg, its protein molecules behave exactly as they do when you whip an egg white. They unfold, form new bonds, and create a protein network, this time with molecules of water caught in the net. As the egg cooks, the protein network tightens, squeez- ing out moisture, and the egg becomes opaque. The longer you cook the egg, the tighter the network will be. If you cook the egg too long, the protein network will contract strongly enough to force out all the moisture. That is why overcooked egg custards run and why overcooked eggs are rubbery. If you mix eggs with milk or water before you cook them, the molecules of liquid will surround and separate the egg’s protein molecules so that it takes more energy (higher heat) to make the protein molecules coagulate. Scrambled eggs made with milk are softer than plain scrambled eggs cooked at the same temperature. When you boil an egg in its shell, the air inside expands and begins to escape through the shell as tiny bubbles. Sometimes, however, the force of the air is enough to crack the shell. Since there’s no way for you to tell in advance whether any particular egg is strong enough to resist the pressure of the bubbling air, the best solution is to create a safety vent by sticking a pin through the broad end of the egg before you start to boil it. Or you can slow the rate at which the air inside the shell expands by starting the egg in cold water and letting it warm up naturally as the water warms rather than plunging it cold into boiling water—which makes the air expand so quickly that the shell is virtually certain to crack. As the egg heats, a little bit of the protein in its white will decompose, releasing sulfur that links up with hydrogen in the egg, forming hydrogen sulfide, the gas that gives rot- ten eggs their distinctive smell. The hydrogen sulfide collects near the coolest part of the egg—the yolk. The yolk contains iron, which now displaces the hydrogen in the hydrogen sulfide to form a green iron-sulfide ring around the hard-cooked yolk.

How Other Kinds of Processing Affect This Food Egg substitutes. Fat-free, cholesterol-free egg substitutes are made of pasteurized egg whites, plus artificial or natural colors, flavors, and texturizers (food gums) to make the product look and taste like eggs, plus vitamins and minerals to produce the nutritional equivalent of a full egg. Pasteurized egg substitutes may be used without additional cooking, that is, in salad dressings and eggnog. Drying. Dried eggs have virtually the same nutritive value as fresh eggs. Always refrigerate dried eggs in an air- and moistureproof container. At room temperature, they will lose about a third of their vitamin A in six months.

Medical Uses and/or Benefits Protein source. The protein in eggs, like protein from all animal foods, is complete. That is, protein from animal foods provides all the essential amino acids required by human beings. In fact, the protein from eggs is so well absorbed and utilized by the human body that it is considered the standard by which all other dietary protein is measured. On a scale known as biological value, eggs rank 100 ; milk, 93; beef and fish, 75; and poultry, 72. Vision protection. The egg yolk is a rich source of the yellow-orange carotenoid pigments lutein and zeaxanthin. Both appear to play a role in protecting the eyes from damaging ultraviolet light, thus reducing the risk of cataracts and age-related macular degeneration, a leading cause of vision of loss in one-third of all Americans older than 75. Just 1.3 egg yolks a day appear to increase blood levels of lutein and zeaxanthin by up to 128 percent. Perhaps as a result, data released by the National Eye Institute’s 6,000-person Beaver Dam ( Wisconsin) Eye Study in 2003 indicated that egg consumption was inversely associated with cataract risk in study participants who were younger than 65 years of age when the study started. The relative risk of cataracts was 0.4 for people in the highest category of egg consumption, compared to a risk of 1.0 for those in the lowest category. External cosmetic effects. Beaten egg whites can be used as a facial mask to make your skin look smoother temporarily. The mask works because the egg proteins constrict as they dry on your face, pulling at the dried layer of cells on top of your skin. When you wash off the egg white, you also wash off some of these loose cells. Used in a rinse or shampoo, the pro- tein in a beaten raw egg can make your hair look smoother and shinier temporarily by filling in chinks and notches on the hair shaft.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Although egg yolks are high in cholesterol, data from several recent studies suggest that eating eggs may not increase the risk of heart disease. In 2003, a report from a 14-year, 177,000-plus person study at the Harvard School of Public Health showed that people who eat one egg a day have exactly the same risk of heart disease as those who eat one egg or fewer per week. A similar report from the Multiple R isk Factor Intervention Trial showed an inverse relationship between egg consumption and cholesterol levels—that is, people who ate more eggs had lower cholesterol levels. Nonetheless, in 2006 the National Heart, Lung, and Blood Institute still recommends no more than four egg yolks a week (including the yolk in baked goods) for a heart-healthy diet. The American Heart Association says consumers can have one whole egg a day if they limit cholesterol from other sources to the amount suggested by the National Cholesterol Education Project following the Step I and Step II diets. (Both groups permit an unlimited number of egg whites.) The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Food poisoning. Raw eggs (see above) and egg-rich foods such as custards and cream pies are excellent media for microorganisms, including the ones that cause food poisoning. To protect yourself against egg-related poisoning, always cook eggs thoroughly: poach them five minutes over boiling water or boil at least seven minutes or fry two to three minutes on each side (no runny center) or scramble until firm. Bread with egg coating, such as French toast, should be cooked crisp. Custards should be firm and, once cooked, served very hot or refrigerated and served very cold. Allergic reaction. According to the Merck Manual, eggs are one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach. The others are berries (blackberries, blueberries, raspberries, strawberries), choco- late, corn, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).

Food/Drug Interactions Sensitivity to vaccines. Live-virus measles vaccine, live-virus mumps vaccine, and the vac- cines for influenza are grown in either chick embryo or egg culture. They may all contain minute residual amounts of egg proteins that may provoke a hypersensitivity reaction in people with a history of anaphylactic reactions to eggs (hives, swelling of the mouth and throat, difficulty breathing, a drop in blood pressure, or shock).... eggs

Extreme sensitivity to any protein, over and above its normal effect. It usually occurs in certain sensitive people after more than one exposure to the offending protein.... hypersensitivity

A hypersensitivity reaction due to circulating antigen-antibody complexes (see ANTIGEN; ANTIBODIES), so-called because it was a not uncommon reaction to the administration of foreign SERUM which used to be given as a form of passive IMMUNITY before the days of antibiotics. By de?nition, it is a manifestation of sensitivity to serum – but the same clinical and pathological picture can occur 1–3 weeks after the administration of drugs such as PENICILLIN and STREPTOMYCIN. It is characterised by fever, ARTHRALGIA and LYMPHADENOPATHY and is usually self-limiting as it resolves when the supply of antigen is used up.... serum sickness

A sulphonamide derivative, or sulphonylurea (see SULPHONYLUREAS), which lowers the level of the blood sugar in DIABETES MELLITUS. As it is rapidly excreted from the body, it has to be taken twice daily. Like CHLORPROPAMIDE, it may induce undue sensitivity to alcohol.... tolbutamide

Persistent sensitivity. Bruised feeling in eyes. 1 teaspoon Rue herb to each cup boiling water; infuse 15 minutes. Strain. Half fill eyebath with warm infusion; douche. Evening Primrose capsules: 1 × 500mg, twice daily.

Fennel eye compress. Steep teabag in cold water and apply.

Chickweed Lotion. Take a handful of Chickweed, wash well, crush with a rolling pin, infuse in two cups boiling water until cool. Use as a compress or in an eye bath two or more times daily.

Supplements. Daily. Vitamin A 7500iu. Vitamin B2 10mg. Vitamin C 1g. Vitamin E 400iu. Zinc.

Palming. Bilberries.

If persistent, consult eye specialist. ... eyes – sore

Nutritional Profile Energy value (calories per serving): High Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Very high Sodium: Low (fresh or dried fruit) High (dried fruit treated with sodium sulfur compounds) Major vitamin contribution: B vitamins Major mineral contribution: Iron, potassium

About the Nutrients in This Food Dates are a high-carbohydrate food, rich in fiber and packed with sugar (as much as 70 percent of the total weight of the fruit). Dates are also a good source of nonheme iron, the inorganic iron found in plant foods, plus potassium, niacin, thiamin, and riboflavin, but they are an unusual fruit because they have no vitamin C at all. A serving of 10 whole pitted Medjool dates has 16 g dietary fiber and 2.2 mg iron (12 percent of the R DA for a woman, 27 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food With meat or with a vitamin C- rich food. Both enhance your body’s ability to use the nonheme iron in plants (which is ordinarily much less useful than heme iron, the organic iron in foods of animal origin).

Diets That May Restrict or Exclude This Food Low-carbohydrate diet Low-fiber/low-residue diet Low-potassium diet Low-sodium diet (dried dates, if treated with sodium sulfite)

Buying This Food Look for: Soft, shiny brown dates in tightly sealed packages.

Storing This Food Store opened packages of dates in the refrigerator, tightly wrapped to keep the fruit from drying out. (The dates sold in American markets are partly dried; they retain sufficient mois- ture to keep them soft and tasty.) Properly stored dates will stay fresh for several weeks.

Preparing This Food To slice dates neatly, chill them in the refrigerator or freezer for an hour. The colder they are, the easier it will be to slice them. If you’re adding dates to a cake or bread batter, coat them first with flour to keep them from dropping through the batter.

What Happens When You Cook This Food The dates will absorb moisture from a cake or bread batter and soften.

Medical Uses and/or Benefits Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potassium supplement—about the amount of potassium in ¾ cup pitted dates—reduced the incidence of stroke 60 percent.

Adverse Effects Associated with This Food Sulfite sensitivity. Dates contain polyphenoloxidase, an enzyme that oxidizes phenols in the fruit to brown compounds that turn its flesh dark in the presence of air. To keep dates from darkening when they are dried, they may be treated with sulfur compounds called sulfites (sulfur dioxide, sodium bisulfite, or sodium metabisulfite). Treated dates may trigger serious allergic reactions, including potentially fatal anaphylactic shock, in people sensitive to sulfites.... dates

According to the Natural Herbal Remedies website, ginkgo biloba has a positive effect on every phase of the cycle of sexual response, from desire to excitement (lubrication) to orgasm and resolution (the sexual afterglow). So, sex is all about the flow, right? Emotional flow, intuitive flow, blood flow… Yup, all that excitement elicited by passion? It all boils down to where the blood is going. So boost your blood flow with a little ginkgo. The beauty of this herb? It increases circulation without increasing blood pressure (a perfect addition to the healthcare regimen of those who experience erectile difficulties). Male or female, doesn’t matter—ginkgo stimulates blood flow to the capillaries right below the skin which means extra sensitivity, extra sensation, and an extra-good time (yeah…it’s hard to write on this subject without cheerfully submitting to a little cheesiness). A note about ginkgo: it’s generally a safe herb, but it can cause digestive upset and allergic reactions to those who are sensitive to it. Start slowly and see how you do. If you’re taking anti-clotting drugs or aspirin on a daily basis, you might want to skip the GB, just to be safe, as it might increase the risk of bleeding. Otherwise, try 80mg three times daily.... ginkgo biloba

Loss or reduction of pain sensation. Analgesia differs from anaesthesia in that sensitivity to touch is still preserved. (See also analgesic drugs.)... analgesia

A rare, life-threatening allergic reaction that occurs in people with an extreme sensitivity to a particular substance (allergen), often insect venom, a food item, or a drug (see allergy). When the allergen enters the bloodstream, massive amounts of histamine and other chemicals are released, causing sudden, severe lowering of blood pressure and constriction of the airways. Other symptoms may include abdominal pain, diarrhoea, swelling of the tongue and throat, and itchy rash.

Anaphylactic shock requires emergency medical treatment. An injection of

adrenaline may be life-saving. Antihistamine drugs and corticosteroid drugs may also be given.... anaphylactic shock

The study of bacteria, particularly of the types that cause disease.

Bacteriology includes techniques used to isolate and identify bacteria from specimens such as a throat swab or urine.

Bacteria are identified by their appearance under a microscope, including their response to stains (see staining) and the use of culture.

Testing for sensitivity to antibiotics may be performed.... bacteriology

Abnormal sensitivity of the skin to mechanical irritation, to the extent that firm stroking leads to the appearance of itchy weals. The condition is a form of urticaria. It is most common in fair-skinned people with a tendency to allergic conditions.... dermographism

If you’re looking for a fruity-flavored tea, try the blueberry tea! Not only is it richly aromatic, but it also comes with several health benefits. About Blueberry Tea Blueberry tea can be considered a type of black tea which has been infused with blueberry flavor. It can also contain pieces of dried blueberry, as well as pieces of other dried berries. Blueberry leaves may be used, as well. Blueberries are grown all around the world. Based on the place where they are cultivated, harvesting time may vary. In North America, harvesting starts in May and ends in late summer, while in the Southern Hemisphere, harvesting takes place during winter and may last until early spring. They are rich in vitamins, dietary fiber and dietary mineral manganese. Blueberry Tea Cocktail There is also a cocktail with the name “Blueberry Tea”. It is made from tea and liqueurs, and it is served hot, usually in a brandy snifter. The usual ingredients for the cocktail are Grand Marnier liqueur, Amaretto liqueur, and hot Orange Pekoe tea. If interested, you can give it a try. However, be careful not to mix it up when ordering Blueberry Tea in a place that might serve both. Despite its name, it might not contain anything blueberry-related; still, the taste is fruity, similar to that of blueberries, which is why the cocktail is named Blueberry Tea. How to prepare Blueberry Tea There are several ways in which you can enjoy a cup of Blueberry tea. For a classic cup of Blueberry tea, add a teaspoon of Blueberry tea leaves into a cup of hot water. Let it steep for 3-04 minutes before removing the leaves. Add sugar or honey to sweeten the taste. Another way to prepare Blueberry tea is with black Ceylon tea. Add a teaspoon of leaves or a teabag in a cup of hot water and let it steep for 3-4 minutes. After removing the tea leaves or the teabag, add fresh blueberry juice and stir; the more blueberry juice you add, the stronger the flavor. This is ideal during hot summer days, when you can serve it iced. Also, you can replace the black Ceylon tea with rooibos tea or white tea. Health Benefits of Blueberry tea Drinking Blueberry tea leads to plenty of health benefits. The black tea leaves are rich in antioxidants, amino acids, minerals and vitamins, while blueberries have plenty of nutrients, antioxidants, fiber, and vitamin C and E. Together, they help you stay healthy! The antioxidants that are found both in the tea leaves and in the berries are good at helping you fight off cancer. A cup of blueberry tea can reduce the risk of developing tumors and cancer. The antioxidants also have a neuroprotective effect on the brain. Therefore, it may lower the risk of developing Alzheimer’s disease or Parkinson’s disease. Blueberry tea also helps when it comes to muscle damage. This time, the antioxidants are the ones protecting the muscle cells from muscle oxidative damage which is usually associated with high-intensity exercise. Blueberry tea reduces the risk of diabetes. Consumption of blueberry tea helps boost the insulin sensitivity. This way, the body uses insulin more efficiently to store glucose. It also helps lower the blood sugar levels, reducing the need for insulin. Blueberry tea lowers the blood pressure, as well, reducing the risk of developing cardiovascular diseases. Polyphenols that are part of the blueberry tea’s composition help prevent urinary tract infections. They keep the harmful bacteria from sticking to the walls of the urinary tract. Also, blueberry tea has ellagic acid, which protects the metabolic pathways. Side effects of Blueberry tea Besides the many health benefits, don’t forget that blueberry tea has a few side effects, as well. They’re not too harmful, but you should still remember them. If you’re suffering from diabetes, you know that blueberry tea is good for you, since it lowers the blood sugar levels. Still, you have to carefully monitor your blood sugar levels. In some cases, it may lower the blood sugar levels too much, and you might get hypoglycemia. Blueberry tea might affect blood glucose levels, so it might interfere with the blood sugar control both during and after a surgery. You should stay away from blueberry tea (and blueberries, in general) two weeks before the surgery. Be careful not to drink too much blueberry tea! This applies to all types of tea, too. It is recommended not to drink more than six cups of tea per day. For some, it might be even less. See if you get any of the following symptoms: headaches, dizziness, insomnia, irregular heartbeats, vomiting, diarrhea and loss of appetite. If you get them, you should reduce the amount of tea you drink.   Blueberry tea is a delicious, aromatic type of tea. It’s also good for your health, as it combines the health benefits of both black tea leaves and blueberries. Drink a cup or two a day and you won’t regret it!... discover the blueberry tea

A net-like, purple or blue mottling of the skin, usually on the lower legs, caused by the enlargement of blood vessels beneath the skin.

It is more common in people with vasculitis and those who suffer from excessive sensitivity to cold.

The condition is harmless, and tends to be worse in cold weather.... livedo reticularis

A condition in which there is thickening and coarsening of the skin and other body tissues (most noticeably

in the face). Myxoedema is usually due to hypothyroidism; in such cases, the condition is commonly accompanied by weight gain, hair loss, sensitivity to cold, and mental dullness. The term “myxoedema” is sometimes used for adult hypothyroidism.... myxoedema

An antibiotic drug used to treat and/or to prevent urinary tract infection. Possible adverse effects include nausea, vomiting, increased sensitivity to sunlight, blurred vision, drowsiness, and dizziness.... nalidixic acid

The disturbance of sleep at night by the need to pass urine.A common cause of nocturia in men is enlargement of the prostate gland (see prostate, enlarged), which obstructs the normal outflow of urine and causes the bladder to empty incompletely. In women, a common cause is cystitis (inflammation of the bladder), in which irritation of the bladder wall increases its sensitivity so that smaller volumes of urine trigger a desire to urinate. Other causes of nocturia include diabetes mellitus, heart failure (reduced pumping efficiency), chronic kidney failure, and diabetes insipidus.... nocturia

Gymnema sylvestre

Asclepiadaceae

San: Mesasrngi, Madhunasini;

Hin: Gudmar, Merasimgi;

Ben: Merasingi;

Mal: Chakkarakolli, Madhunasini;

Tam: Sirukurumkay, Sakkaraikkolli;

Kan: Kadhasige;

Tel: Podapatra; Mar: Kavali

Importance: Gymnema, Australian Cowplant, Small Indian Ipecacuanha or Periploca of the woods is a woody climber. It is reported to cure cough, dyspnoea, ulcers, pitta, kapha and pain in the eyes. The plant is useful in inflammations, hepatosplenomegaly, dyspepsia, constipation, jaundice, haemorrhoids, strangury, renal and vesical calculi, helminthiasis, cardiopathy, cough, asthma, bronchitis, intermittent fever, amenorrhoea, conjuctivitis and leucoderma. The fresh leaves when chewed have the remarkable property of paralysing the sense of taste for sweet and bitter substance for some time (Warrier et al, 1995). The drug is described as a destroyer of madhumeha (glycosuria) and other urinary disorders. Root has long been reputed as a remedy for snakebite. Leaves triturated and mixed with castor oil are applied to swollen glands and enlargement of internal viscera as the liver and spleen (Nadkarni, 1954). The drug is used to strengthen the function of heart, cure jaundice, piles, urinary calculi, difficult micturition and intermittent fevers (Sharma,1983). The drug enters into the composition of preparations like Ayaskrti, Varunadi kasaya, Varunadighrtam, Mahakalyanakaghrtam, etc. They suppress the activity of taste of tongue for sweet taste and for this reason it was considered that it destroys sugar, hence the name Madhunashini or Gurmar and has been prescribed as an anti-diabetic. The crude drug as well as its dried aqueous extract is mainly used in bronchial troubles.

Distribution: It is a tropical climber. It mainly grows in Western Ghats, Konkan, Tamil Nadu and some parts of Bihar. The plant is cultivated in plains of India but the drug is mainly important from Afghanistan and Iran.

Botany: Gymnema sylvestre (Retz.)R. Br. syn. Asclepias germinata Roxb. belonging to the family Asclepiadaceae is a large, woody much branched climber with pubescent young parts. Leaves are simple, opposite, elliptic or ovate, more or less pubescent on both sides, base rounded or cordate. Flowers are small, yellow and arranged in umbellate cymes. Fruits are slender and follicles are upto 7.5cm long (Warrier et al, 1995).

Two allied species, G. hirsutum found in Bundelkh and Bihar and Western Ghats and G. montanum growing wild in Eastern Ghats and Konkan are also used for the same purpose and are also called “Gurmar” (Thakur et al, 1989).

Agrotechnology: The plant can be propagated both by seeds and stem cuttings. Seedlings are to be raised in polybags. Pits of size 50cm cube are to be taken, filled with 10kg dried cowdung or FYM and covered with topsoil. On these pits about 3-4 months old seedlings are to be transplanted from polybags. Trailing can be facilitated by erecting poles and tying the plants to the poles. The plant will attain good spread within one year. Regular weeding, irrigation and organic manure application are beneficial. The plant is not attacked by any serious pests or diseases. Leaves can be collected from the first year onwards at an internal of one week. This can be continued for 10-12 years. Fresh or dried leaves can be marketed (Prasad et al, 1997).

Properties and activity: Nonacosane and hentriacontane were isolated from the hexane extract of leaves. An attempt to isolate nitrogenous compounds led to the isolation of amino acids such as leucine, iso-leucine, valine, allanine and - amynobutyric acid. Isolation of trimethyl amine oxide was of particular interest. An alkaloid gynamine which is a trace constituent was isolated and identified (Sinsheimer et al, 1967). Antisweet constituent of the leaves has been found to be a mixture of triterpene saponins. These have been designated as gymnemic acids A,B,C and D which have the gymnemagenin and gymnestrogenins as the aglycones of gymnemic acid A and B and gymnemic acid C and D respectively. These are hexahydroxy triterpenes the latter being partially acylated. The sugar residues are glucuronic acid and galacturonic acid while ferulic and angelic acids have been attached as the carboxylic acid.

Chewing of leaves reduces sensitivity to sweet substances. Effects of gymnema extracts had been variable. While verifying the effect of G. sylvestre leaves on detoxification of snake venom, it has been reported that a toxic component of venom ATP and gymnemate bind at the same site inhibiting venom ATP-ase. The active principles which have been identified as glycosides (7 gymnemic acids) suggest that the topical and selective anaesthetic effect of the plant might result from the competition of the receptor sites between glycosides and the sweet substances (Warren et al, 1969). The leaves are antidiabetic and insulinotropic. Gymnemic acid is antiviral. The plant is bitter, astringent, acrid, thermogenic, antiinflammatory, anodyne, digestive, liver tonic, emetic, diuretic, stomachic, stimulant, anthelmintic, alexipharmic, laxative, cardiotonic, expectorant, antipyretic and uterine tonic.... gymnema

A tetracycline antibiotic drug that is used to treat chlamydial infections such as nongonococcal urethritis. It is also used for a variety of other infective conditions, including bronchitis and pneumonia; in addition, the drug may be used to treat severe acne.

Side effects may include nausea, vomiting, diarrhoea, skin rash, and increased sensitivity of the skin to sunlight. Oxytetracycline may discolour developing teeth, and is not given to children under 12 or to pregnant women.... oxytetracycline

A method of diagnosing the substances responsible for contact dermatitis.

A selection of possible allergens are put on a patch and taped to the skin.

A skin reaction indicates sensitivity to a particular allergen.... patch test

Pain or abnormal sensitivity in a part of the body when it is pressed or touched.... tenderness

A drug used to dilate the pupil. Adverse effects of the drug include blurred vision, increased sensitivity to light, stinging, and, rarely, dry mouth, flushing, and glaucoma.... tropicamide

A rare, inherited skin disease. The skin is normal at birth, but photosensitivity (extreme sensitivity to sunlight) causes it to become dry, wrinkled, freckled, and prematurely aged by about the age of 5.

Noncancerous skin tumours and skin cancers also develop. Xeroderma pigmentosum is often accompanied by related eye problems, such as photophobia and conjunctivitis.

Treatment of the condition consists of protecting the skin from sunlight. Skin cancers are usually treated surgically or with radiotherapy.... xeroderma pigmentosum

The growth of hair of the male type and distribution in women. It is due either to the excess production of androgens (see ANDROGEN), or to undue sensitivity of the hair follicle to normal female levels of circulating androgens. The latter is called idiopathic hirsutism, because the cause is unknown. The increased production of androgens in the female may come from the ovary (see OVARIES) and be due to POLYCYSTIC OVARY SYNDROME or an ovarian tumour, or the excess androgen may come from the adrenal cortex (see ADRENAL GLANDS) and be the result of congenital adrenal HYPERPLASIA, an adrenal tumour or CUSHING’S SYNDROME. However, there is a wide range of normality in the distribution of female body hair. It varies with di?erent racial groups: the Mediterranean races have more body hair than Nordic women, and the Chinese and Japanese have little body hair. It is not abnormal for many women, especially those with dark hair, to have hair apparent on the upper lip, and a few coarse hairs on the chin and around the nipples are not uncommon. Extension of the pubic hair towards the umbilicus is also frequently found. Dark hair is much more apparent than fair hair, and this is why bleaching is of considerable bene?t in the management of hirsutism.

The treatment of hirsutism is that of the primary cause. Idiopathic hirsutism must be managed by simple measures such as bleaching the hair and the use of depilatory waxes and creams. Coarse facial hairs can be removed by electrolysis, although this is time-consuming. Shaving is often the most e?ective remedy and neither increases the rate of hair growth nor causes the hairs to become coarser.... hirsutism

These oral agents reduce the excessive amounts of GLUCOSE in the blood (HYPERGLYCAEMIA) in people with type 2 (INSULIN-resistant) diabetes (see DIABETES MELLITUS). Although the various drugs act di?erently, most depend on a supply of endogenous (secreted by the PANCREAS) insulin. Thus they are of no value in treating patients with type 1 diabetes (insulin-dependent diabetes mellitus (IDDM), in which the pancreas produces little or no insulin and the patient’s condition is stabilised using insulin injections). The traditional oral hypoglycaemic drugs have been the sulphonylureas and biguanides; new agents are now available – for example, thiazolidine-diones (insulin-enhancing agents) and alpha-glucosidase inhibitors, which delay the digestion of CARBOHYDRATE and the absorption of glucose. Hypoglycaemic agents should not be prescribed until diabetic patients have been shown not to respond adequately to at least three months’ restriction of energy and carbohydrate intake.

Sulphonylureas The main group of hypoglycaemic agents, these act on the beta cells to stimulate insulin release; consequently they are e?ective only when there is some residual pancreatic beta-cell activity (see INSULIN). They also act on peripheral tissues to increase sensitivity, although this is less important. All sulphonylureas may lead to HYPOGLYCAEMIA four hours or more after food, but this is relatively uncommon, and usually an indication of overdose.

There are several di?erent sulphonylureas; apart from some di?erences in their duration or action (and hence in their suitability for individual patients) there is little di?erence in their e?ectiveness. Only chlorpropamide has appreciably more side-effects – mainly because of its prolonged duration of action and consequent risk of hypoglycaemia. There is also the common and unpleasant chlorpropamide/ alcohol-?ush phenomenon when the patient takes alcohol. Selection of an individual sulphonylurea depends on the patient’s age and renal function, and often just on personal preference. Elderly patients are particularly prone to the risks of hypoglycaemia when long-acting drugs are used. In these patients chlorpropamide, and preferably glibenclamide, should be avoided and replaced by others such as gliclazide or tolbutamide.

These drugs may cause weight gain and are indicated only if poor control persists despite adequate attempts at dieting. They should not be used during breast feeding, and caution is necessary in the elderly and in those with renal or hepatic insu?ciency. They should also be avoided in porphyria (see PORPHYRIAS). During surgery and intercurrent illness (such as myocardial infarction, COMA, infection and trauma), insulin therapy should be temporarily substituted. Insulin is generally used during pregnancy and should be used in the presence of ketoacidosis.

Side-effects Chie?y gastrointestinal disturbances and headache; these are generally mild and infrequent. After drinking alcohol, chlorpropamide may cause facial ?ushing. It also may enhance the action of antidiuretic hormone (see VASOPRESSIN), very rarely causing HYPONATRAEMIA.

Sensitivity reactions are very rare, usually occurring in the ?rst six to eight weeks of therapy. They include transient rashes which rarely progress to erythema multiforme (see under ERYTHEMA) and exfoliate DERMATITIS, fever and jaundice; chlorpropamide may also occasionally result in photosensitivity. Rare blood disorders include THROMBOCYTOPENIA, AGRANULOCYTOSIS and aplastic ANAEMIA.

Biguanides Metformin, the only available member of this group, acts by reducing GLUCONEOGENESIS and by increasing peripheral utilisation of glucose. It can act only if there is some residual insulin activity, hence it is only of value in the treatment of non-insulin dependent (type 2) diabetics. It may be used alone or with a sulphonylurea, and is indicated when strict dieting and sulphonylurea treatment have failed to control the diabetes. It is particularly valuable in overweight patients, in whom it may be used ?rst. Metformin has several advantages: hypoglycaemia is not usually a problem; weight gain is uncommon; and plasma insulin levels are lowered. Gastrointestinal side-effects are initially common and persistent in some patients, especially when high doses are being taken. Lactic acidosis is a rarely seen hazard occurring in patients with renal impairment, in whom metformin should not be used.

Other antidiabetics Acarbose is an inhibitor of intestinal alpha glucosidases (enzymes that process GLUCOSIDES), delaying the digestion of starch and sucrose, and hence the increase in blood glucose concentrations after a meal containing carbohydrate. It has been introduced for the treatment of type 2 patients inadequately controlled by diet or diet with oral hypoglycaemics.

Guar gum, if taken in adequate doses, acts by delaying carbohydrate absorption, and therefore reducing the postprandial blood glucose levels. It is also used to relieve symptoms of the DUMPING SYNDROME.... hypoglycaemic agents

n. the inability to differentiate different shades of colour. Such complete *colour blindness is very rare and is usually associated with poor *visual acuity, nystagmus, and sensitivity to bright light. It is usually determined by hereditary factors.... achromatopsia

A disorder of the intestinal tract that affects its motility and causes abdominal distension and irregular defaecation. Traditional, but now discarded, names have been spastic or irritable colon. The disease affects around 20 per cent of the general population but in most it is no more than a minor nuisance. The causes are not fully understood, but it is generally believed that symptoms develop in response to psychological factors, changed gastrointestinal motility, or altered visceral sensation. About 50 per cent of patients meet criteria for a psychiatric diagnosis. Anxiety, depression, neurosis, panic attacks, acute disease are among possible triggering factors. Some patients have diarrhoea, others are constipated, and some alternate between the two. Many have increased sensitivity to distension of the intestine. Dietary factors such as intolerance to dairy products and wheat are apparent in certain patients.

Common features of IBS include:

abdominal distension.

altered bowel habit.

colicky lower abdominal pain, eased by defaecation.

mucous discharge from rectum.

feelings of incomplete defaecation.

Investigations usually produce normal results. Positive diagnosis in people under 40 is usually straightforward. In older patients, however, barium ENEMA, X-rays and COLONOSCOPY should be done to exclude colorectal cancer.

Reassurance is the initial and often e?ective treatment. If this fails, treatment should be directed at the major symptoms. Several months of the antidepressant amitriptyline (see ANTIDEPRESSANT DRUGS) may bene?t patients with intractable symptoms, given at a dose lower than that used to treat depression. The majority of patients follow a relapsing/remitting course, with episodes provoked by stressful events in their daily lives. (See also INTESTINE, DISEASES OF.)... irritable bowel syndrome (ibs)

A short-lived, fast acting hormone, made by the hypothalamus of the brain, along with its close relative vasopressin (anti-diuretic hormone), stored in the posterior pituitary, and released into the blood as needed. It stimulates certain smooth muscle coats, constricts certain blood vessels and facilitates the sensitivity of some tissues to other hormones and nerves. The main tissues affected are the uterus, including endo­and myometriums, vagina, breasts (both sexes), erectile tissue (both sexes), seminal vesicles, and with special-case effects on uterine muscle contractions in both birth and orgasm, the vascular constriction that lessens placental separation bleeding, and the let­down reflex that nursing mothers have when babies cry (or kittens mew...or husbands whine)... oxytocin

Diseases of the SKIN for which sunlight is partially or wholly responsible. In su?cient dosage, short-wave ultraviolet light (UVB – see ULTRAVIOLET RAYS (UVR)) always causes ERYTHEMA. Higher doses progressively cause OEDEMA and blistering; this is acute sunburn. Graduated exposure to UVB causes pigmentation (tanning). Prolonged chronic exposure to sunlight eventually accelerates ageing of the exposed skin with LENTIGO formation and loss of COLLAGEN and elastic tissue. After decades of such exposure, epidermal DYSPLASIA and CANCER may supervene.

Drugs given orally or topically may induce phototoxic reactions of various types. Thus, TETRACYCLINES exaggerate sunburn reactions. and the diuretic FRUSEMIDE may cause blistering reactions. Psoralens induce erythema and pigmentation. AMIODARONE also induces pigmentation. (See also PHOTOCHEMOTHERAPY.)

Phytophotodermatitis is a streaky, blistering photodermatosis typically seen on the limbs of children playing in grassy meadows in summer. The phototoxic reaction is caused by psoralens in weeds.

Berlocque dermatitis is a pattern of streaky pigmentation usually seen on women’s necks, caused by a reaction to psoralens in perfumes.

Certain rare metabolic diseases may lead to photosensitisation. They include the PORPHYRIAS and PELLAGRA. Other skin diseases such as lupus erythematosus (see under LUPUS) and ROSACEA may be aggravated by light exposure. Sometimes, in the absence of any of these factors, some people spontaneously develop a sensitivity to light causing various patterns of DERMATITIS or URTICARIA. The most common pattern is ‘polymorphic light eruption’ which typically appears within a day or two of arrival at a sunny holiday destination and persists until departure. Continuously exposed areas, such as the hands and face, may be ‘hardened’ and unaffected.

Treatment Appropriate clothing and headgear, sunscreen creams and lotions are the main preventative measures.... photodermatoses

n. the inherited absence of pigmentation in the skin, hair, and eyes, resulting in white hair and pink skin and eyes. The pink colour is produced by blood in underlying blood vessels, which are normally masked by pigment. Ocular signs are reduced visual acuity, sensitivity to light (see photophobia), and involuntary side-to-side eye movements.... albinism

n. a piece of equipment for determining the sensitivity of the skin to various touch stimuli, especially those causing pain.... algesimeter

n. a semisynthetic *penicillin used to treat infections caused by a wide range of bacteria and other microorganisms (see also beta-lactam antibiotic). Side-effects include nausea, vomiting, diarrhoea, rashes, and anaemia. Sensitivity to penicillin prohibits its use.... amoxicillin

an antibacterial drug applied externally as a cream or gel in the treatment of acne and rosacea. Possible side-effects include local irritation and light sensitivity.... azelaic acid

In?ammation affecting the membranes of the BRAIN or SPINAL CORD, or usually both. Meningitis may be caused by BACTERIA, viruses (see VIRUS), fungi, malignant cells or blood (after SUBARACHNOID HAEMORRHAGE). The term is, however, usually restricted to in?ammation due to a bacterium or virus. Viral meningitis is normally a mild, self-limiting infection of a few days’ duration; it is the most common cause of meningitis but usually results in complete recovery and requires no speci?c treatment. Usually a less serious infection than the bacterial variety, it does, however, rarely cause associated ENCEPHALITIS, which is a potentially dangerous illness. A range of viruses can cause meningitis, including: ENTEROVIRUSES; those causing MUMPS, INFLUENZA and HERPES SIMPLEX; and HIV.

Bacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.

Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.

Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.

Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.

Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.

Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.

Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.

Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.

The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)

Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.... meningitis

increased or altered sensitivity in the region of the wing of the right scapula, associated with acute *cholecystitis. [I. I. Boas (1858–1938), German gastroenterologist]... boas’s sign

a striking form of breathing in which there is a cyclical variation in the rate, which becomes slower until breathing stops for several seconds before speeding up to a peak and then slowing again. It occurs when the sensitivity of the respiratory centres in the brain is impaired, particularly in states of coma. [J. Cheyne (1777–1836), Scottish physician; W. Stokes (1804–78), Irish physician]... cheyne–stokes respiration

n. an antiseptic widely used as a solution to disinfect and cleanse the skin (especially before surgery), wounds, and burns. It is also used in the form of a mouthwash, gel, or spray for treating gingivitis and mouth ulcers and as a solution for washing out urinary catheters and treating some bladder infections. Skin sensitivity to chlorhexidine occurs rarely.... chlorhexidine

a condition in which the small intestine fails to digest and absorb food. Affecting 1–2% of the population worldwide, it is due to a permanent sensitivity of the intestinal lining to the protein gliadin, which is contained in *gluten in the germ of wheat and rye and causes atrophy of the digestive and absorptive cells of the intestine. Symptoms include stunted growth, distended abdomen, and pale frothy foul-smelling stools; the disease can be diagnosed by *biopsy of the jejunum and is treated successfully by a strict and lifelong gluten-free diet. Medical name: gluten-sensitive enteropathy.... coeliac disease

a disorder characterized by a combination of *parkinsonism and *dementia, which typically fluctuates. Visual hallucinations are common, and there is exquisite sensitivity to phenothiazine drugs. Abnormal proteins called Lewy bodies are found within the nerve cells of the cortex and the basal ganglia. It is the third most common cause of dementia (dementia with Lewy bodies) after *Alzheimer’s disease and vascular dementia.... cortical lewy body disease

n. 1. exceptional sensitivity to low temperature. 2. a sensation of coldness.... cryaesthesia

lowered threshold or heightened sensitivity to the normal pharmacological action and dosage of a drug. It is unpredictable but there is some evidence of familial history.... drug intolerance

been recognised from earliest times. Evidence of the condition has been found in Egyptian mummies; in the fourth century BC Hippocrates, the Greek physician, called it phthisis because of the lung involvement; and in 1882 Koch announced the discovery of the causative organism, the tubercle bacillus or Mycobacterium tuberculosis.

The symptoms depend upon the site of the infection. General symptoms such as fever, weight loss and night sweats are common. In the most common form of pulmonary tuberculosis, cough and blood-stained sputum (haemoptysis) are common symptoms.

The route of infection is most often by inhalation, although it can be by ingestion of products such as infected milk. The results of contact depend upon the extent of the exposure and the susceptibility of the individual. Around 30 per cent of those closely exposed to the organism will be infected, but most will contain the infection with no signi?cant clinical illness and only a minority will go on to develop clinical disease. Around 5 per cent of those infected will develop post-primary disease over the next two or three years. The rest are at risk of reactivation of the disease later, particularly if their resistance is reduced by associated disease, poor nutrition or immunosuppression. In developed countries around 5 per cent of those infected will reactivate their healed tuberculosis into a clinical problem.

Immunosuppressed patients such as those infected with HIV are at much greater risk of developing clinical tuberculosis on primary contact or from reactivation. This is a particular problem in many developing countries, where there is a high incidence of both HIV and tuberculosis.

Diagnosis This depends upon identi?cation of mycobacteria on direct staining of sputum or other secretions or tissue, and upon culture of the organism. Culture takes 4–6 weeks but is necessary for di?erentiation from other non-tuberculous mycobacteria and for drug-sensitivity testing. Newer techniques involving DNA ampli?cation by polymerase chain reaction (PCR) can detect small numbers of organisms and help with earlier diagnosis.

Treatment This can be preventative or curative. Important elements of prevention are adequate nutrition and social conditions, BCG vaccination (see IMMUNISATION), an adequate public-health programme for contact tracing, and chemoprophylaxis. Radiological screening with mass miniature radiography is no longer used.

Vaccination with an attenuated organism (BCG – Bacillus Calmette Guerin) is used in the United Kingdom and some other countries at 12–13 years, or earlier in high-risk groups. Some studies show 80 per cent protection against tuberculosis for ten years after vaccination.

Cases of open tuberculosis need to be identi?ed; their close contacts should be reviewed for evidence of disease. Adequate antibiotic chemotherapy removes the infective risk after around two weeks of treatment. Chemoprophylaxis – the use of antituberculous therapy in those without clinical disease – may be used in contacts who develop a strong reaction on tuberculin skin testing or those at high risk because of associated disease.

The major principles of antibiotic chemotherapy for tuberculosis are that a combination of drugs needs to be used, and that treatment needs to be continued for a prolonged period – usually six months. Use of single agents or interrupted courses leads to the development of drug resistance. Serious outbreaks of multiply resistant Mycobacterium tuberculosis have been seen mainly in AIDS units, where patients have greater susceptibility to the disease, but also in developing countries where maintenance of appropriate antibacterial therapy for six months or more can be di?cult.

Streptomycin was the ?rst useful agent identi?ed in 1944. The four drugs used most often now are RIFAMPICIN, ISONIAZID, PYRAZINAMIDE and ETHAMBUTOL. Three to four agents are used for the ?rst two months; then, when sensitivities are known and clinical response observed, two drugs, most often rifampicin and isoniazid, are continued for the rest of the course. Treatment is taken daily, although thrice-weekly, directly observed therapy is used when there is doubt about the patient’s compliance. All the antituberculous agents have a range of adverse effects that need to be monitored during treatment. Provided that the treatment is prescribed and taken appropriately, response to treatment is very good with cure of disease and very low relapse rates.... nature of the disease tuberculosis has

1 The statistic generated by dividing the number of true positives by the sum of the true positives and false positives. For example, the number of cases with truly good care divided by the sum of the cases with truly good care plus those cases classified with good care who did not receive it i.e. the likelihood that a person classified as the recipient of good care actually received good care. 2 In screening and diagnostic tests, the probability that a person with a positive test result is a true positive (i.e. does have the disease) is referred to as the “predictive value of a positive test”. The predictive value of a negative test is the probability that a person with a negative test does not have the condition or disease. The predictive value of a screening test is determined by the sensitivity and specificity of the test, and by the prevalence of the condition for which the test is used.... predictive value

a result of a diagnostic test or procedure that wrongly indicates the absence of a disease or other condition. See sensitivity.... false negative

a result of a diagnostic test or procedure that wrongly indicates the presence of a disease or other condition. See sensitivity.... false positive

an occupational lung disease caused by allergy to fungal spores that grow in inadequately dried stored hay, straw, or grain, which then becomes mouldy. It is an allergic *alveolitis, such as also results from sensitivity to many other allergens. An acute reversible form can develop a few hours after exposure; a chronic form, with the gradual development of irreversible breathlessness, occurs with or without preceding acute attacks. Avoidance of the allergen is the main principle of treatment, but most farmers are able to continue to farm by taking appropriate precautions.... farmer’s lung

n. 1. (in psychology) a simple type of learning consisting of a gradual waning response by the subject to a continuous or repeated stimulus that is not associated with *reinforcement. 2. (in pharmacology) the condition of being psychologically dependent on a drug, following repeated consumption, marked by reduced sensitivity to its effects and a craving for the drug if it is withdrawn. See also dependence.... habituation

Sulphonylureas are sulphonamide derivatives which lower the blood sugar when they are given by mouth by enhancing the production of INSULIN. They are e?ective in treating DIABETES MELLITUS only when some residual pancreatic beta-cell function is present. All may lead to HYPOGLYCAEMIA if given in overdose and this is particularly common when long-acting sulphonylureas are given to elderly patients. There is no evidence for any di?erence in the e?ectiveness of the various sulphonylureas. TOLBUTAMIDE was the ?rst of the sulphonlyurea drugs; it has a short duration of action and is usually given twice daily. CHLORPROPAMIDE has a more prolonged action and only needs to be given once daily, but its prolonged action causes more side-effects – including sensitivity reactions. Other oral hypoglycaemic agents of this family include glibenclamide, which has a duration of action intermediate between tolbutamide and chlorpropamide and also produces side-effects (in about 30 per cent of outpatients, according to a recent study). Other sulphonlyureas include acetohexamide, glibornuride, gliclazide, glipizide, gliquidone and tolazamide. Glymidine is a related compound with a similar action to the sulphonylureas. It is particularly useful in patients who are hypersensitive to sulphonylureas.

Sulphonylureas are best avoided in patients who are overweight, as they tend to stimulate the appetite and aggravate obesity. They should be used with caution in patients with hepatic or renal disease. Side-effects are infrequent and usually not severe, the most common being epigastric discomfort with occasional nausea, vomiting and anorexia. In about 10 per cent of patients, chlorpropamide and tolbutamide may cause facial ?ushing after drinking alcohol. Some patients are hypersensitive to oral hypoglycaemic agents and develop rashes which may progress to ERYTHEMA multi-forme and exfoliative DERMATITIS. These reactions usually appear in the ?rst 6–8 weeks of treatment.... sulphonylureas

A noise heard in the EAR without any external cause. It often accompanies DEAFNESS, and severely deaf patients ?nd tinnitus as troubling as – if not more so than – the deafness. Tinnitus is described as ‘objective’ if it is produced by sound generated within the body by vascular tumours or abnormal blood ?ows. In patients with conductive hearing loss, tinnitus may be the consequence of the blocking of outside noises so that their own bodily activities become audible. Even normal people occasionally suffer from tinnitus, but rarely at a level which prompts them to seek medical advice. Present knowledge of the neurophysiological mechanisms is that the noise ‘arises’ high in the central nervous system in the subcortical regions of the BRAIN.

The resting level of spontaneous neuronal activity in the hearing system is only just below that at which sound enters a person’s consciousness – a consequence of the ?ne-tuning of normal hearing; so it is not, perhaps, surprising that normally ‘unheard’ neuronal activity becomes audible. If a patient suffers sensorineural deafness, the body may ‘reset’ the awareness threshold of neural activity, with the brain attempting greater sensitivity in an e?ort to overcome the deafness. The condition has a strong emotional element and its management calls for a psychological approach to help sufferers cope with what are, in e?ect, physically untreatable symptoms. They should be reassured that tinnitus is not a signal of an impending stroke or of a disorder of the brain. COGNITIVE BEHAVIOUR THERAPY can be valuable in coping with the unwanted noise. Traditionally, masking sounds, generated by an electrical device in the ear, were used to help tinnitus sufferers by, in e?ect, making the tinnitus inaudible. Even with the introduction of psychological retraining treatment, these maskers may still be helpful; the masking-noise volume, however, should be kept as low as possible or it will interfere with the retraining process. For patients with very troublesome tinnitus, lengthy counselling and retraining courses may be required. Surgery is not recommended.

Under the auspices of the Royal National Institute for Deaf People, the RNID Tinnitus Helpline has been established. Calls are charged at local rates. (See also MENIÈRE’S DISEASE.)... tinnitus

n. an abnormally low sensitivity to pain.... hypalgesia

n. a form of reduced sound tolerance characterized by uncomfortable or even painful sensitivity to all sounds above a certain level. See misophonia; phonophobia.... hyperacusis

n. subnormal activity of the thyroid gland. If present at birth and untreated it leads to *cretinism. When acquired in later life it causes mental and physical slowing, undue sensitivity to cold, slowing of the pulse, weight gain, and coarsening of the skin (myxoedema). Treatment is by thyroid hormone replacement therapy, usually in the form of *thyroxine. Primary hypothyroidism is due to intrinsic underactivity of the thyroid gland; secondary hypothyroidism is reduced stimulation of the gland caused by a deficiency of *thyroid-stimulating hormone due to disease of the pituitary gland.... hypothyroidism

the degree to which a test result will change the odds that a patient has a disease. The likelihood ratio for a positive test expresses the degree to which the odds that a patient has a disease increase following a positive test. The likelihood ratio for a negative test expresses the degree to which the odds that a patient has a disease decrease following a negative test. Likelihood ratios depend on the *sensitivity and specificity of the test.... likelihood ratio

Linn.

Family: Gramineae; Poaceae.

Habitat: Cultivated as a food crop mainly in Punjab, Haryana, Uttar Pradesh., Madhya Pradesh, Maharashtra, Bihar and Rajasthan.

English: Wheat.

Ayurvedic: Godhuuma.

Folk: Gehun.

Action: Wheat germ oil is rich in tocopherol (vitamin E) content, total tocopherols 1897 mcg/g, alpha tocopherol 67%. The presence of ergosterol (provitamin D) has also been reported.

Wheat germ is also used for its minerals, proteins and lipid contents. Germ proteins are rich in lysine (5.285.55 g/100 g protein) and possess high biological value (94%) and protein efficiency ratio (2.9).

Wheat germ contains haemaggluti- nating and antipyretic factors, but these are destroyed by toasting. It also contains haemoproteins, possessing per- oxidase activity.

In adult rats, addition of wheat germ (7%) to a high fat (cholesterol) diet significantly decreased VLDL-cholesterol and VLDL-triglycerides and increased the HDL-cholesterol after-7 weeks of feeding.

Bran oil contains tocopherols, but major part of them (68%) is in epsilon form; alpha-tocopherol forms only 11% of the total.

Gluten lipids, associated with gluten, contain a high percentage of linoleic acid; lowering of serum cholesterol level has been observed in experiments (lipid-free gluten is devoid of cholesterol-lowering effect).

Sensitivity to gluten has also been reported (even when whole wheat flour was used).... triticum aestivum

This literally means any swelling, but the term does not usually include temporary swellings caused by acute in?ammation. The consequences locally, however, of chronic in?ammation – for example, TUBERCULOSIS, SYPHILIS and LEPROSY – are sometimes classed as tumours, according to their size and appearance.

Varieties Some are of an infective nature, as already stated; some arise as the result of injury, and several contributing factors are mentioned under the heading of CANCER.

Traditionally tumours have been divided into benign (simple) and malignant. Even benign tumours can be harmful, because their size or position may distort or damage nerves, blood vessels or organs. Usually, however, they are easily removed by surgery. Malignant tumours or cancers are harmful and potentially lethal, not just because they erode tissues locally but because many of them spread, either by direct growth or by ‘seeding’ to other parts – ‘metastasising’. Malignant tumours arise because of an uncontrolled growth of previously normal cells. Heredity, environmental factors and lifestyle all play a part in malignancy (see also ONCOGENES). Symptoms are caused by local spread and as a result of metastases. These cause serious local damage, for example, in the brain or lungs, as well as disturbing the body’s metabolism. Unless treated with CHEMOTHERAPY, RADIOTHERAPY or surgery or a combination of these, malignant tumours are ultimately fatal. Many, however, can now be cured. The original site and type of a malignant tumour usually determine the rate and extent of spread.

The type of cell and organ site determine the characteristics of a malignant tumour. The prognosis (outlook) for a patient with a malignant tumour depends largely upon how soon it is diagnosed. Staging criteria have been developed to assess the local and metastatic spread of a tumour, its size and also likely sensitivity to the types of available treatment. The ability to locate a tumour and its metastases accurately has vastly improved with the introduction of radionuclide and ULTRASOUND scanning, CT scanning and magnetic resonance imaging (MRI). Screening for cancers such as those in the breast, cervix, colorectal region and prostate help early diagnosis and usually improve treatment outcomes.

Tumours are now classed according to the tissues of which they are built, somewhat as follows:

simple tumours of normal tissue. hollow tumours or cysts, generally of simple nature.

malignant tumours: (a) of cellular structure, resembling the cells of skin, mucous membrane, or secreting glands; (b) of connective tissue.... tumour

OLD TUBERCULIN (OT) is the heat-concentrated ?ltrate from a ?uid medium on which the human or bovine type of Mycobacterium tuberculosis has been grown for six weeks or more.

TUBERCULIN PURIFIED PROTEIN DERIVATIVE (TUBERCULIN PPD) is the active principle of OT (see above), and is prepared from the ?uid medium on which the Mycobacterium tuberculosis has been grown. It is supplied as a liquid, a powder, or as sterile tablets. The liquid contains 100,000 units per millilitre, and the dry powder contains 30,000 units per milligram. It is distributed in sterile containers sealed so as to exclude micro-organisms. It is more constant in composition and potency than OT.

Uses The basis of the tuberculin reaction is that any person who has been infected with the Mycobacterium tuberculosis gives a reaction when a small amount of tuberculin is injected into the skin. A negative reaction means either that the individual has never been infected with the tubercle bacillus, or that the infection has been too recent to have allowed of sensitivity developing.

There are various methods of carrying out the test, of which the following are the most commonly used. The Mantoux test is the most satisfactory of all, and has the advantage that the size of the reaction is a guide to the severity of the tuberculous infection: it is performed by injecting the tuberculin into the skin on the forearm. The Heaf multiple puncture test is reliable: it is carried out with the multiple puncture apparatus, or Heaf gun. The Vollmer patch test, using an impregnated ?lter paper, is useful in children because of the ease with which it can be carried out.... varieties

n. no longer having some valued aspect of one’s life, such as a relationship, a job, or a home, that one has previously enjoyed. This may have health consequences: shock, disbelief, and emotional numbness may be followed by anger, guilt, anxiety, or profound sadness. Such emotions may lead to behavioural changes or symptoms that bring people to health care. Encouraging the patient to talk about the loss will require *empathy, sensitivity, and *judgment from the professional, both to obtain the history of the events and to provide helpful advice and direction to assist in adjustment. See also bereavement.... loss

(methicillin) n. a semisynthetic penicillin that was originally used to treat infections by penicillin-resistant staphylococci. It has been superseded for this purpose by *flucloxacillin but continues to be used to test the drug sensitivity of staphylococci. Meticillin-resistant staphylococci (MRS) can be responsible for increasing rates of infection in hospitals. Until recently, such infections have responded to *vancomycin, but strains of bacilli have emerged that are resistant to vancomycin, giving rise to infections that are very difficult to treat. See also superinfection.... meticillin

Yarrow Tea has been known for a long time thanks to its curative properties which include sweat inducing enzymes and fever inhibitors. Yarrow is an herb that grows mainly in the wilderness of the Northern Hemisphere. You may know it by one of its other names: Western Yarrow, yarrow, milfoil, soldier’s woundwort, staunchwee and woundwort or by its Latin denomination, Achillea millefolium. Yarrow has segmented greed leaves and lavender or daisy-white flowers. The Latin name comes from the Greek mythology: according to some legends, the legendary Achilles used a tincture of Yarrow all over his body to make himself invulnerable to arrows and cure the wounds of the other fighters. Yarrow Tea Properties Aside from the mythology that surrounds it, Yarrow Tea is actually a very respectable medical treatment, with noticeable effects on the human health system. The main ingredients of this tea are: bitters, chamazulene, proazulene, saponins, tannins and fatty acids. Due to its high level of saponis, Yarrow Tea is known as a very strong diaphoretic, being able to widen the coronary arteries’ walls and normalize a poor blood circulation. It is also used to treat childbirth pains and aggravated cholesterol damages. Yarrow Tea Benefits Recent studies showed that Yarrow Tea, when taken according to instructions, has a real effect on your general health, being able to treat a series of affections. You may find that Yarrow Tea is very useful in case you are suffering from one of the following conditions: - Fevers and colds, by inducing sweat and inhibiting infection. - Loss of appetite, stomach cramps, flatulence, enteritis and gastritis. - Gallbladder problems, overall liver malfunctions, internal hemorrhages (especially of the lungs). - Inflammation and menstrual pains. How to make Yarrow Tea Infusion When preparing Yarrow Tea Infusion, you need to make sure that you’re using the appropriate ingredients. Use a teaspoon of dried or freshly picked herbs for every cup of tea you want to make, add boiling water and wait 5 minutes for the tea benefits to be released. Drink it hot or cold. However, don’t take more than two cups of tea per day in order to avoid complications. Yarrow Tea Side Effects When taken properly, Yarrow Tea has no side effects at all. However, high dosages showed that patients developed skin sensitivity to light. If you’ve been taking Yarrow Tea for a long time and you feel that your health is not improving, but rather deteriorating, talk to a specialist as soon as possible! Yarrow Tea Contraindications Don’t take Yarrow Tea if you’re pregnant or breastfeeding. Also, children and patients suffering from digestive tract severe problems should avoid taking it at all costs. If you are preparing for a surgery or if you’re on blood thinners and anti-coagulants, you may want to postpone a treatment based on Yarrow Tea as much as possible. In order to gather more information, talk to a specialist. One you have the green light to start taking this tea, give it a try and enjoy the wonderful benefits of Yarrow Tea responsibly!... yarrow tea benefits

Precursor of Vitamin A. Increases resistance against infection. Antioxidant. Together with Vitamins C and E form a vital line of defence in protection of strands of DNA, the genetic code, from cancerous mutation. Immune booster. Increases lymphocytes and T cells, part of the defence system.

Deficiency. Sun sensitivity; exposure inducing itching, burning and swelling of the skin. Kidney, bladder, and gut infections. Severe earache in young children. Strokes, heart attacks.

It is claimed that those who eat a diet rich in beta-carotene are less likely to develop certain types of cancer.

Smokers usually have low levels of beta-carotene in the blood. Statistics suggest that people who eat a lot of beta-carotene foods are less likely to develop lung, mouth or stomach cancer. In existing cases a slow-down of the disease is possible.

Daily dose. Up to 300mg. Excess may manifest as yellow discoloration of the skin, giving appearance of sun-tan.

Sources. Mature ripe carrots of good colour. A Finland study suggests that four small carrots contain sufficient beta-carotene to satisfy the recommended daily amount of Vitamin A. Orange and dark green fruits and vegetables. Broccoli, Brussels sprouts, spinach, pumpkin, apricots, peaches, oranges, tomatoes. Harvard Medical School study. Among 333 subjects with a history of heart disease, those who received beta-carotene supplements of 50 milligrams every other day suffered half as many heart attacks as those taking placebos. (Dr Charles Hennekens, Harvard Medical School) ... beta-carotene

n. mapping the pattern of a patient’s retinal sensitivity onto an image of that individual’s fundus (back of the eye) to measure the patient’s response to light stimuli at various retinal points. The data are superimposed on an image captured by a scanning laser *ophthalmoscope or by fundus photography to precisely identify areas of impaired or preserved function.... microperimetry

nuclear matrix protein 22, which is involved in DNA replication and gene expression. Significantly elevated levels of NMP22 have been detected in the urine of patients with bladder cancer, which can aid the diagnosis of primary cancer or identify recurrent cancer. The test has a higher *sensitivity but lower specificity in comparison with urine cytology.... nmp22

vb. to blunt or deaden sensitivity; for example, by the application of a local anaesthetic, which reduces or causes complete loss of sensation in nearby nerves.... obtund

(phenobarbitone) n. a *barbiturate drug that has been used as an anticonvulsant in the treatment of epilepsy, but is no longer commonly prescribed. Side-effects may include drowsiness and skin sensitivity reactions, and dependence may result from continued use.... phenobarbital

n. excessive sensitivity to and fear of certain specific sounds irrespective of the level of the sound. See hyperacusis; misophonia.... phonophobia

Hypersensitiveness to a foreign protein which produces a violent reaction taking the form of asthma, hay fever, urticaria, eczema, migraine, catarrh, irritable bowel. Sensitivity covers a wide range of irritants including animal odours, pollens, insect bites. All kinds of food may be responsible: milk, eggs, pork, tomatoes, strawberries, coffee, tea, etc, also preservatives and artificial colourings.

Substances that cause allergic reactions are known as allergens. Their number are limitless. Against these, the body produces antibodies to fight off invaders. If we are allergic, such defence mechanisms over-react. The reaction has the effect of releasing various chemicals such as histamine which causes irritation and swelling of mucous membranes. Removal of dental amalgam fillings sometimes relieves.

Perhaps the most common allergy is hay fever. It is now known that most sufferers have a family

history of the complaint. Asthma is a serious form, but with the aid of certain herbs (Lobelia, etc) sufferers may lead normal lives.

Premature babies fed on cow’s milk are at risk of cow’s milk allergy with increased histamine release. (Dunn Nutrition Unit, Cambridge)

Food allergies from shell fish and cereal grain fungi are difficult to detect. A large body of opinion favours Garlic (corm, tablets or capsules), being observed that Garlic eaters seldom suffer allergies. Agrimony tea.

Skin reactions may be severe. Hives, dermatitis and blisters can be the result of allergies triggered off by insect stings or animal bites, drugs, food additives, colourings, monosodium glutamate, chocolate, wines, aspirin, penicillin and other drugs. Cytotoxic tests are made to discover foods to which a person may be allergic.

Heredity predisposes, but forms vary. A ‘nettle rash’ father may have a ‘hay fever’ son. Stress is an important factor. While allergy is not a psychosomatic disturbance, there is general agreement that emotional distress – fright, fury or fatigue – can be related. An allergy can also be due to a flaw in the immune system, the body over-reacting to an allergen. Some allergies are treated with the antihistamines of orthodox pharmacy but which may induce drowsiness.

Treatment. The phytotherapist’s primary agent is Ephedra.

Teas. Chamomile, Centuary, Elderflowers, Ground Ivy, Lime flowers, Nettles, Plantain, Red Sage. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes. 1 cup 1 to 3 times daily.

Liquid Extract. Ephedra sinica BHP (1983): Dose – 1-3ml. Thrice daily.

Tincture. Ephedra sinica BHP (1983) 1:4 in 45 per cent alcohol. Dose: 6-8ml thrice daily.

A Vogel. Devil’s Claw, thrice daily.

J. Christopher. Burdock, Marshmallow root, Parsley root.

Valerian. Add to prescription in cases of nervous hyperactivity.

Diet. Low salt, low fat, high fibre. Eggs and dairy products are known to cause allergies. Raw salad once daily. Add more protein, cooked and raw vegetables. Rice is not known to cause any allergic reactions. Supplements. Daily. Vitamin A, B-complex, Vitamin C. Bromelain, Selenium, Zinc.

Note: No animals or birds in the house. ... allergy

The most common form of cancer throughout the world. Five year survival: 10 per cent. Its association with cigarette smoking is now established beyond doubt. Other causes include such occupational poisons as asbestos, arsenic, chromium, diesel fumes, etc. The squamous cell carcinoma is the most common of the four types.

Diagnosis is confirmed by sputum test, chest X-ray, bronchoscopy or biopsy. Earliest symptoms are persistent cough, pain in the chest, hoarseness of voice and difficulty of breathing. Physical examination is likely to reveal sensitivity and swelling of lymph nodes under arms.

Symptoms. Tiredness, lack of energy, possible pains in bones and over liver area. Clubbing of finger-tips indicate congestion of the lungs. Swelling of arms, neck and face may be obvious. A haematologist may find calcium salts in the blood. The supportive action of alteratives, eliminatives and lymphatic agents often alleviate symptoms where the act of swallowing has not been impaired.

Broncho-dilators (Lobelia, Ephedra, etc) assist breathing. Mullein has some reputation for pain relief. To arrest bleeding from the lesion (Blood root).

According to Dr Madaus, Germany, Rupturewort is specific on lung tissue. To disperse sputum (Elecampane, Red Clover). In advanced cases there may be swollen ankles and kidney breakdown for which Parsley root, Parsley Piert or Buchu may be indicated. Cough (Sundew, Irish Moss). Soft cough with much sputum (Iceland Moss). To increase resistance (Echinacea).

Alternatives. Secondary to primary treatment. Of possible value.

Teas. Violet leaves, Mullein leaves, Yarrow leaves, Gotu Kola leaves, White Horehound leaves. Flavour with a little Liquorice if unpalatable.

Tablets/capsules. Lobelia, Iceland Moss, Echinacea, Poke root.

Formula. Equal parts: Violet, Red Clover, Garden Thyme, Yarrow, Liquorice. Dose: Powders: 750mg (three 00 capsules or half a teaspoon. Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily, and during the night if relief is sought.

Practitioner. Tinctures BHP (1983). Ephedra 4; Red Clover 4, Yellow Dock 2; Bugleweed 2; Blood root quarter; Liquorice quarter (liquid extract). Mix. Start low: 30-60 drops in water before meals and at bedtime increasing to maximum tolerance level.

Aromatherapy. Oils: Eucalyptus or Thyme on tissue to assist breathing. Inhale.

Diet. See: DIET – CANCER.

Treatment by a general medical practitioner or hospital specialist. ... cancer - bronchial carcinoma

a technique for improving the sensitivity and specificity of bladder cancer diagnosis at cystoscopy using a light-sensitive agent. This agent is instilled into the bladder, taken up by the epithelial cells, and converted into a porphyrin that accumulates only in malignant and premalignant cells. It fluoresces under light of a specific wavelength and is thus highlighted against normal bladder mucosa.... photodynamic diagnosis

any one of a class of drugs that enhance the movement of potassium ions through the *ion channels in cell membranes. In the case of smooth muscle cells, such as those in the walls of arteries, their sensitivity to the normal stimuli to contract is reduced. The result is relaxation of the muscle fibres and widening of the arteries. Potassium-channel activators are used for improving the blood supply to the heart muscle in angina pectoris. Possible side-effects include headache, flushing, vomiting, dizziness, and weakness. A currently available member of the class is nicorandil.... potassium-channel activator

See: WEAKNESS.

ASTHMA. Spasmodic contraction of the bronchi following exercise, emotional tension, infection, allergens, pollens, house dust, colds.

Symptoms. Obstruction of airways with wheezing, rales or whistling sounds with a sense of constriction. Often related to eczema – ‘eczema of the epithelium’. Infantile eczema treated with suppressive ointments may drive the condition ‘inwards’ and worsen asthma. “My son’s eczema has got better, but he now has asthma” is a common observation.

Causes: hypersensitivity to domestic animals, horses and pet birds. Common salt. Red or white wine allergy. An older generation of practitioners recognised a renal-bronchial asthma encouraged by faulty kidney function. With addition of a relaxing diuretic (Dandelion, Buchu or Parsley root) to a prescription, respiratory symptoms often abate.

Broncho-dilators such as Ephedra and Wild Thyme are widely used by the practitioner. To relieve spasm: Lobelia, Pleurisy root. White Horehound, Ammoniacum, Cramp bark, Garlic, Grindelia, Hyssop.

Anti-cough agents serve to remove sticky sputum: Coltsfoot, Garden Thyme, Slippery Elm bark, Maidenhair Fern, Linseed, Bayberry bark.

For the chronic asthmatic, bacterial invasion spells distress, when Echinacea or Balm of Gilead should be added. Where an irregular pulse reveals heart involvement, add: Hawthorn or Lily of the Valley.

Lobelia is of special value for the anxious patient with spasm of the bronchi. Should be tried before resorting to powerful spray mists which frequently produce gastro-intestinal disturbance.

Alternatives. Teas. Coltsfoot, Comfrey, Horehound (White), Mullein, Skullcap, Marshmallow, Thyme, Valerian, Wild Cherry bark, Elecampane, Plantain. Formula: equal parts herbs Coltsfoot, Mullein, Valerian. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes; dose, 1 cup twice daily and when necessary.

Antispasmodic Drops. See entry.

Practitioner. Ephedra, Lobelia, Gelsemium, Grindelia, Euphorbia (pill-bearing spurge), Skunk Cabbage, Senega, Pulsatilla, Lily of the Valley (cardiac asthma), Thyme. Formula. Equal parts, Tincture Lobelia simp; Tincture Belladonna; Tincture Ephedra. 5-10 drops thrice daily (maintenance), 10-20 drops for spasm.

Cockayne, Ernest, FNIMH. Hyssop tea for children throughout childhood to avoid respiratory disorders. Dr Finlay Ellingwood. Gelsemium 3.5ml; Lobelia 3.5ml. Distilled water to 120ml. One 5ml teaspoon in water every 3 hours.

Dr Alfred Vogel. Ephedra 20 per cent; Ipecac 15 per cent; Hawthorn berry 10 per cent; Blessed Thistle 5 per cent; Burnet Saxifrage 5 per cent; Garden Thyme 5 per cent; Grindelia 1 per cent. 10-15 drops in water thrice daily.

Dr Wm Thomson. 1 teaspoon Ephedra herb to cup boiling water; infuse 10-15 minutes. Half-1 cup 2-3 times daily.

Traditional. 2 teaspoons shredded Elecampane root in cup cold water; stand overnight. Next day, heat to boiling point when required. Strain. Sips, hot, with honey: 1 cup 2-3 times daily.

Potter’s Asthma & Bronchitis Compound 32. 40g medicinal teabags. Ingredients: Clove BPC 4.84 per cent; Elecampane root 17.24 per cent; Horehound 26.20 per cent; Hyssop 17.24 per cent; Irish Moss 17.24 per cent; Liquorice 17.24 per cent. Dose: 1-2 teaspoons when necessary.

Chinese Medicine. Decoction or extract from the Gingko tree widely used, as also is Ephedra, Garlic, Liquorice and Bailcalensis.

Tablets/capsules. Lobelia. Iceland Moss, (Gerard). Euphorbia (Blackmore).

Powders. Formula. Lobelia 2; Hyssop 1; Elderflowers 1; Grindelia quarter; Liquorice quarter: pinch Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) 2-3 times daily.

Aromatherapy. 6 drops Rosemary oil in 2 teaspoons Almond oil for massage upper chest to relieve congestion.

Inhalation. See: INHALATIONS, FRIAR’S BALSAM.

Nebulizer. A germicidal solution is made from 5 drops oil Eucalyptus in one cup boiling water. Use in nebulizer for droplet therapy.

Ioniser – use of.

Cider Vinegar. Sips of the vinegar in water for whoop.

Supportives. Yoga. Singing. Cures have been reported of patients on taking up singing. “During singing, up to 90 per cent of the vital capacity may be used without a conscious effort to increase tidal volume.” (Dr M. Judson, New England Journal of Medicine)

Diet. Low salt, low fat, high fibre, cod liver oil, carrots, watercress, Soya beans or flour, lecithin, sunflower seed oil, green vegetables, raw fruit, fresh fish. These foods are valuable sources of antioxidant vitamins and minerals essential for the body’s defence mechanism. A diet deficient in these reduces ability of the airways to withstand the ravages of cigarette smoke and other air pollutants.

Foods that are craved are ones often causing sensitivity. Among problem foods are: milk, corn, wheat, eggs, nuts, chocolate, all dairy products, fat of meats. Check labels for tartrazine artificial colouring.

Salt intake. Linked with chest diseases. “Those who eat a lot of salt had more sensitive airways than those with low salt intake . . . excess salt tended to cause most pronounced symptoms.” (Institute of Respiratory Diseases, Oavia, Italy)

Asthma mortality could be significantly reduced by sufferers lowering their salt consumption, an epidemiologist predicted.

Supplements. Daily. Vitamin B6 50-100mg. Vitamin C 500mg. Vitamin E 400iu. Magnesium, Zinc. Cod liver oil: 2 teaspoons.

Anti-allergic bedding. Provides a protective barrier against the house dust mite on mattresses and bedding. Droppings from the tiny pests are worse in the bedroom. ... asthenia

n. a substance that increases the sensitivity of cells to radiation. The presence of oxygen and other compounds with a high affinity for electrons will increase radiosensitivity. Chemotherapy drugs such as fluorouracil and cisplatin can be used concurrently with radiotherapy as radiosensitizers (see chemoradiotherapy).... radiosensitizer

n. an antibiotic used to treat various infections, particularly tuberculosis and leprosy. Digestive upsets and sensitivity reactions sometimes occur.... rifampicin

a drug that causes the skin to peel and destroys bacteria and fungi. It is applied to the skin, alone or in combination with other agents, to treat warts, corns, calluses, acne, dandruff, psoriasis, and fungal nail infections. Skin sensitivity reactions may occur after continued use.... salicylic acid

one of a group of infective disease agents that resemble *viruses in some of their biological properties but whose physical properties (e.g. sensitivity to radiation) suggest that they may not contain nucleic acid. They are now more commonly known as *prions.... slow virus

 Redness and possible blistering caused by a sensitive substance such as chromium, nickel, other metals, rubber, paints, cosmetic materials, plants (primula), house dust mites, aerosols, deodorants, photocopying, dyes in clothing, etc. A patch test establishes diagnosis. A suspected irritant is applied to the skin and after two days its reaction is noted. If inflammation is present the test is positive. Symptoms may include vesicles with weeping, scaling, and presence of dropsy.

In a study of 612 patients attending the Royal Hallamshire Hospital, Sheffield, more than half of the women who had ears pierced reported skin reactions to metallic jewellery, while a third had sensitivity to nickel. (British Journal of Dermatology, Jan 1992)

Treatment. Remove article or cause of irritation. Garlic is claimed to be successful, either in diet or by capsule when the condition is caused by histamines. Other agents: Betony, Burdock leaves, Chickweed, Dandelion, Figwort, Gotu Kola, Plantain, Red Clover.

Internal. Burdock tea. Clivers tea.

Tablets/capsules. Garlic, Devil’s Claw, Blue Flag.

Topical. Avoid use of Calamine, if possible. Creams or salves: Aloe Vera, Comfrey, Evening Primrose, Witch Hazel, Jojoba. All are alternatives to corticosteroids.

Tamus (Black Bryony) tincture. Distilled extract of Witch Hazel. ... dermatitis, contact

Non-persistent overstrain and ache. Internal: 2 teaspoons Cider Vinegar to glass cold water: half-1 glass freely. Bilberries.

Topical. Soak cotton wool pads with Distilled Extract Witch Hazel and apply to eyelids for 5-10 minutes. Potato. Apply slices of raw potato, or potato poultice.

Teabag. Moisten Chamomile or Fennel teabag with cold water and apply.

Cucumber, fresh. Apply slices to closed eyes.

Supplements. Vitamin A 7500iu. Vitamin B2 10mg. Vitamin E 100iu. Vitamin C 1g. Zinc 15mg.

Bates Method eye exercises. Palming.

EYES – VISUAL DISORDERS. May be due to strain, ageing, hereditary. Poor sight may be related to poor food.

Symptoms. Sensitivity to light, near or far sight deficient, squint.

Treatment. Attention to general condition, circulation and nervous system. Ginseng, Garlic, Kelp, Bilberries, Cider vinegar.

Diet. See: DIET — GENERAL.

Supplementation. Vitamins A, B-complex, B2 (10mg daily), C (500mg daily), D, E (100iu daily). Zinc. General: Refer to a qualified optician. Palming. ... eyes – tired

From the Indian bean Chyamopsis tetragonobulus. A normaliser of carbohydrate intolerance. Previously used as an emulsifier and thickener in foods like yoghurt and ice-cream. When combined with water forms a sticky gel. Slows rate of entry of sugar into the blood, improving insulin sensitivity. Anti-hyperglycaemic and hypocholesterolaemic.

Guar has an effect upon sugar metabolism, blood fat levels, body weight and blood pressure. (Dr J. Tuomilehto, University of Turku, Finland) A study at Hammersmith Hospital, London, showed Guar efficacious in reducing blood sugar levels. Its cholesterol-lowering action is of benefit in diabetics.

Guar induces weight loss in obese subjects; reduces risk of kidney stone. Granules of the gum may be taken with water or sprinkled direct on food – fluid being taken at the meal to ensure swelling of the granules.

By slowing the rate of sugar absorption, it reduces the post-prandial peak in blood sugar level, making possible a reduction of insulin. Contra-indications: obstruction of the intestines and diseases of the gullet.

Guarina or Guarem, sachets: 5g unit dose sprinkled over food. Adults: one sachet daily, increasing if necessary to a maximum of 3 sachets. A preparation Glucotard is taken as dry minitablets, washed down in portions with a glass of water.

Alternative: Powdered Guar gum – 15 grams daily.

Note: Effectiveness for weight loss unproven. Guar gum may cause throat obstruction in rare cases and should be prescribed by a medical practitioner only.

See: DIABETES. HYPERLIPIDAEMIA. CHOLESTEROL. ... guar gum

(Pale). Spogel seeds. Psyllium seeds. Ispaghula husk BP. Plantago ovata. Dried ripe seeds. Keynote: constipation and bowel irritation.

Constituents: mucilage, triterpenes, alkaloids.

Action: gentle bulk laxative without irritation; antidiarrhoeal, demulcent, bacteriostatic. Increases stool output while decreasing transit time in healthy people. Anti-inflammatory.

Uses: Chronic constipation, particularly in the elderly. Irritable bowel syndrome, mucous colitis. Amoebic dysentery. (Indian traditional) To assist management of diverticular disease. To reduce incidence of bowel complaints. An alternative to constant use of purgatives that decrease sensitivity of alimentary mucous membranes. Useful in pregnancy. Hyperlipaemia. Lowers cholesterol level by eliminating excess bile salts. To assist slimming regime in obesity.

Preparations: Average dose: 3-5 grams (2 grams, children).

Seeds: 1-2 teaspoons once or twice daily, helped down with sips of water. (May be soaked overnight in warm water.) In the intestines seeds swell into a gelatinous mass many times their normal size thus ‘lubricating’ contents of the bowel for easy defecation. Isogel.

“Regulan” Ispaghula husk BP. Sachets containing 3-6 grams. Average dose: 1 sachet thrice daily. Psyllium seed husks, plus pectin, Vitamin C and Guar gum to cleanse the colon while leaving behind important nutrients. Aids detoxification and absorption of iron. Regulates blood sugar levels and nutrient absorption. (JAM. Nov 86, p.23) Poultice. With Slippery Elm for boils, abscesses, etc. ... ispaghula seeds

n. (in screening tests) see sensitivity.... specificity

n. (in neurology) the point at which a stimulus begins to evoke a response, and therefore a measure of the sensitivity of a system under particular conditions. A *thermoreceptor that responds to an increase in temperature of only two degrees is said to have a much lower threshold than one that will only respond to a change in temperature of ten degrees or more. In this example the threshold can be measured directly in terms of degrees.... threshold

n. a *retinoid drug applied as a solution for the treatment of acne and sun-damaged skin; side-effects include redness and burning of the skin and increased sensitivity to sunlight. It is also taken by mouth to treat acute promyelocytic leukaemia; side-effects may include fever, breathlessness, flushing, headache, and fetal abnormalities (it should not be taken during pregnancy).... tretinoin

Arising from poor assimilation of nutrients, minerals, fat soluble vitamins by the intestines. Patient not getting maximum nourishment from food.

Multiple causes: diseases of the gut; strictures, fistulas, Crohn’s disease, obstructions, parasites, infections, drugs, X-rays, endocrine disease, gastric surgery. A common cause is gluten sensitivity due to ingestion of gluten foods (wheat, oats, rye, barley).

Symptoms: Wasting of muscles, weight loss, flatulence, loss of appetite, distension, fat in the faeces, large pale frothy stools, vitamin and mineral deficiencies.

Alternatives. Teas: Alfalfa, Agrimony, Gotu Kola, Meadowsweet, Red Clover, Oats.

Decoctions: Irish Moss, Dandelion root, Fenugreek seeds, Bayberry bark. Calamus or Gentian, in cold infusion.

Formula. Dandelion 1; Echinacea 2; Saw Palmetto 1; few grains Cayenne or drops Tincture Capsicum. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Powders: 500mg (two 00 capsules or one- third teaspoon). Thrice daily.

Irish Moss, strengthening. Echinacea to sustain natural powers of resistance. Diet. Gluten-free. Soya products. Avoid dairy products. Slippery Elm gruel. Vitamins: B-complex, B1, B6, B12, Folic acid, PABA, C, E.

Minerals: Calcium, Iron, Copper, Zinc. ... malabsorption syndrome

A cancerous tumour of the breast. The incidence is raised in women whose menstrual periods began at an early age and whose menopause was late; in those who had no children or had their first child later in life; in those with mothers or sisters who had breast cancer; and in those who are obese. The disease is also more common in countries in which the typical diet contains a lot of fat. One form of breast cancer has a genetic component; 2 genes called BRAC1 and BRAC2 have been identified and appear to be involved in this type of breast cancer.

The first sign of breast cancer may be a painless lump. Other symptoms may include a dark discharge from the nipple, retraction (indentation) of the nipple, and an area of dimpled, creased skin over the lump. In 90 per cent of the cases, only 1 breast is affected. The cancer may be suspected after discovering a lump during breast self-examination or mammography. If a lump is detected, cells will be collected from it by needle aspiration or surgical biopsy. If the lump is cancerous, the treatment given depends on the woman’s age, the size of the tumour, whether or not there are signs of spread to the lymph nodes, and the sensitivity of the tumour cells to hormones, as assessed in the laboratory. A small tumour, with no evidence of having spread outside the breast, is removed surgically. Lymph nodes in the armpit are also commonly removed at the same time. Surgery may be combined with radiotherapy and/or anticancer drugs.

Secondary tumours in other parts of the body are treated with anticancer drugs and hormones. Regular check-ups are required to detect recurrence or the development of a new cancer in the other breast. If the cancer recurs, it can be controlled, in some cases, for years by drugs and/or radiotherapy.... breast cancer

Very thin, shell-like, transparent discs fitted on the cornea of the eye to correct defective vision. Generally, contact lenses are used to correct myopia (shortsightedness) and hypermetropia (longsightedness). There are several types.

Hard plastic lenses give good vision, are long-lasting and durable, inexpensive, and easy to maintain. However, they are sometimes difficult to tolerate and may fall out. Hard gas-permeable lenses are more comfortable because they allow oxygen to pass through to the eye, but are less durable. Soft lenses are the most comfortable because of their high water content. Disposable soft lenses are for single-use only; extended wear lenses are worn for up to a month.

Other types of lenses include rigid, scleral lenses that cover the whole of the front of the eye and are used to disguise disfigurement due to injury or disease; bifocal contact lenses; and interruptus; hormonal methods, including the use of oral contraceptives, implants, and injections (see contraceptives, injectable); intrauterine devices (see IUDs); postcoital methods (see contraception, emergency); or sterilization of the male (see vasectomy) or female (see sterilization, female).

contraception, barrier methods of

The use of a device and/or a chemical to stop sperm reaching an ovum, preventing fertilization and pregnancy. Barrier methods also help prevent the sexual transmission of diseases such as AIDS, genital herpes (see herpes, genital), and viral hepatitis (see hepatitis, viral).

toric contact lenses with an uneven sur- face curvature to correct astigmatism.

Hard plastic contact lenses may cause abrasion of the cornea if they are worn for too long. Soft lens wearers sometimes develop sensitivity of the eyes and lids. Other problems that may occur with any type of contact lens include infections and redness of the eye.... contact lenses

n. spasm of the jaw muscles, keeping the jaws tightly closed. This is the characteristic symptom of *tetanus but it also occurs less dramatically as a sensitivity reaction to certain drugs and in disorders of the *basal ganglia.... trismus

increased sensitivity to visceral stimulation after injury or inflammation of an internal organ, which can result in chronic pain syndromes.... visceral hyperalgesia

Pain or discomfort during or just before a period. Primary dysmenorrhoea is common in teenage girls and young women. It usually starts 2–3 years after menstruation begins but often diminishes after the age of 25. The exact cause is unknown. One possibility is excessive production of, or undue sensitivity to, prostaglandins, hormonelike substances that stimulate spasms in the uterus. Secondary dysmenorrhoea is due to an underlying disorder, such as pelvic inflammatory disease or endometriosis, and usually begins in adult life.

Cramp-like pain or discomfort in the lower abdomen occurs, sometimes with a dull ache in the lower back. Some women have nausea and vomiting. Mild primary dysmenorrhoea is often relieved by analgesic drugs. In severe cases, symptoms can usually be relieved with oral contraceptives or other hormonal preparations that suppress ovulation. Treatment of secondary dysmenorrhoea depends on the cause.... dysmenorrhoea