Habitat: Coastal areas of Bengal, Bihar and Western and Eastern Peninsula.
English: Palmyra Palm, Brab tree.Ayurvedic: Taala, Taada, Trinraj, Mahonnata, Lekhyapatra. Siddha/Tamil: Panai, Panaimaram.Action: Fresh sap—diuretic, cooling, antiphlegmatic, laxative, anti- inflammatory. Slightly fermented juice is given in diabetes. Palm- jaggery—used as an energy food for convalscents. Ash of dry spadix—antacid, antibilious (used in heartburn). Young root, terminal buds, leaf-stalks—used in gastritis and hiccups.
The sap is given as a tonic to asthmatic and anaemic patients. Jaggery is given for anaemia, for diseases characterized by a marked loss of potassium. Palm candy is used in coughs and pulmonary affections and as a laxative for children.The Ayurvedic Pharmacopoeia ofIn- dia recommends dried male inflorescence in dysuria.Jaggery solution may be used in hypertension and oedema due to heart and liver diseases, also as a food for typhoid patients.The sap is an excellent source of biologically available riboflavin.Aqueous MeOH extract of young shoots contains heat-stable toxin; edible part of young shoot, neurotoxic to rats, but not hepatotoxic.Dosage: Dried male inflorescence— 1-3 g (API Vol. III.)... borassus flabelliferThe so-called ultra-short-wave diathermy (or short-wave diathermy, as it is usually referred to) has replaced the original long-wave diathermy, as it is produced consistently at a stable wave-length (11 metres) and is easier to apply. In recent years microwave diathermy has been developed, which has a still higher oscillating current (25,000 million cycles per second, compared with 500 million for short-wave diathermy).
When the current passes, a distinct sensation of increasing warmth is experienced and the temperature of the body gradually rises; the heart’s action becomes quicker; there is sweating with increased excretion of waste products. The general blood pressure is also distinctly lowered. The method is used in painful rheumatic conditions, both of muscles and joints.
By concentrating the current in a small electrode, the heating effects immediately below this are very much increased. The diathermy knife utilises this technique to coagulate bleeding vessels and cauterise abnormal tissue during surgery.... diathermy
To allow it to ful?l its vitally important function as the carrier of genetic information in living cells, DNA has the following properties. It is stable, so that successive generations of species maintain their individual characteristics, but not so stable that evolutionary changes cannot take place. It must be able to store a vast amount of information: for example, an animal cell contains genetic information for the synthesis of over a million proteins. It must be duplicated exactly before each cell division to ensure that both daughter cells contain an accurate copy of the genetic information of the parent cells (see GENETIC CODE).... dna
K
Diagram of glomerulus (Malpighian corpuscle).
Fortunately the body has two kidneys and, as most people can survive on one, there is a good ‘functional reserve’ of kidney tissue.
Symptoms Many patients with kidney disorders do not have any symptoms, even when the condition is quite advanced. However,
others experience loin pain associated with obstruction (renal colic) or due to infection; fevers; swelling (oedema), usually of the legs but occasionally including the face and arms; blood in the urine (haematuria); and excess quantities of urine (polyuria), including at night (nocturia), due to failure of normal mechanisms in the kidney for concentrating urine. Patients with chronic renal failure often have very di?use symptoms including nausea and vomiting, tiredness due to ANAEMIA, shortness of breath, skin irritation, pins and needles (paraesthesia) due to damage of the peripheral nerves (peripheral neuropathy), and eventually (rarely seen nowadays) clouding of consciousness and death.
Signs of kidney disease include loin tenderness, enlarged kidneys, signs of ?uid retention, high blood pressure and, in patients with end-stage renal failure, pallor, pigmentation and a variety of neurological signs including absent re?exes, reduced sensation, and a coarse ?apping tremor (asterixis) due to severe disturbance of the body’s normal metabolism.
Renal failure Serious kidney disease may lead to impairment or failure of the kidney’s ability to ?lter waste products from the blood and excrete them in the urine – a process that controls the body’s water and salt balance and helps to maintain a stable blood pressure. Failure of this process causes URAEMIA – an increase in urea and other metabolic waste products – as well as other metabolic upsets in the blood and tissues, all of which produce varying symptoms. Failure can be sudden or develop more slowly (chronic). In the former, function usually returns to normal once the underlying cause has been treated. Chronic failure, however, usually irreparably reduces or stops normal function.
Acute failure commonly results from physiological shock following a bad injury or major illness. Serious bleeding or burns can reduce blood volume and pressure to the point where blood-supply to the kidney is greatly reduced. Acute myocardial infarction (see HEART, DISEASES OF) or pancreatitis (see PANCREAS, DISORDERS OF) may produce a similar result. A mismatched blood transfusion can produce acute failure. Obstruction to the urine-?ow by a stone (calculus) in the urinary tract, a bladder tumour or an enlarged prostate can also cause acute renal failure, as can glomerulonephritis (see below) and the haemolytic-uraemia syndrome.
HYPERTENSION, DIABETES MELLITUS, polycystic kidney disease (see below) or AMYLOIDOSIS are among conditions that cause chronic renal failure. Others include stone, tumour, prostatic enlargement and overuse of analgesic drugs. Chronic failure may eventually lead to end-stage renal failure, a life-threatening situation that will need DIALYSIS or a renal transplant (see TRANSPLANTATION).
Familial renal disorders include autosomal dominant inherited polycystic kidney disease and sex-linked familial nephropathy. Polycystic kidney disease is an important cause of renal failure in the UK. Patients, usually aged 30–50, present with HAEMATURIA, loin or abdominal discomfort or, rarely, urinary-tract infection, hypertension and enlarged kidneys. Diagnosis is based on ultrasound examination of the abdomen. Complications include renal failure, hepatic cysts and, rarely, SUBARACHNOID HAEMORRHAGE. No speci?c treatment is available. Familial nephropathy occurs more often in boys than in girls and commonly presents as Alport’s syndrome (familial nephritis with nerve DEAFNESS) with PROTEINURIA, haematuria, progressing to renal failure and deafness. The cause of the disease lies in an absence of a speci?c ANTIGEN in a part of the glomerulus. The treatment is conservative, with most patients eventually requiring dialysis or transplantation.
Acute glomerulonephritis is an immune-complex disorder due to entrapment within glomerular capillaries of ANTIGEN (usually derived from B haemolytic streptococci – see STREPTOCOCCUS) antibody complexes initiating an acute in?ammatory response (see IMMUNITY). The disease affects children and young adults, and classically presents with a sore throat followed two weeks later by a fall in urine output (oliguria), haematuria, hypertension and mildly abnormal renal function. The disease is self-limiting with 90 per cent of patients spontaneously recovering. Treatment consists of control of blood pressure, reduced ?uid and salt intake, and occasional DIURETICS and ANTIBIOTICS.
Chronic glomerulonephritis is also due to immunological renal problems and is also classi?ed by taking a renal biopsy. It may be subdivided into various histological varieties as determined by renal biospy. Proteinuria of various degrees is present in all these conditions but the clinical presentations vary, as do their treatments. Some resolve spontaneously; others are treated with steroids or even the cytotoxic drug CYCLOPHOSPHAMIDE or the immunosuppressant cyclosporin. Prognoses are generally satisfactory but some patients may require renal dialysis or kidney transplantation – an operation with a good success rate.
Hydronephrosis A chronic disease in which the kidney becomes greatly distended with ?uid. It is caused by obstruction to the ?ow of urine at the pelvi-ureteric junction (see KIDNEYS – Structure). If the ureter is obstructed, the ureter proximal to the obstruction will dilate and pressure will be transmitted back to the kidney to cause hydronephrosis. Obstruction may occur at the bladder neck or in the urethra itself. Enlargement of the prostate is a common cause of bladder-neck obstruction; this would give rise to hypertrophy of the bladder muscle and both dilatation of the ureter and hydronephrosis. If the obstruction is not relieved, progressive destruction of renal tissue will occur. As a result of the stagnation of the urine, infection is probable and CYSTITIS and PYELONEPHRITIS may occur.
Impaired blood supply may be the outcome of diabetes mellitus and physiological shock, which lowers the blood pressure, also affecting the blood supply. The result can be acute tubular necrosis. POLYARTERITIS NODOSA and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) may damage the large blood vessels in the kidney. Treatment is of the underlying condition.
Infection of the kidney is called pyelonephritis, a key predisposing factor being obstruction of urine ?ow through the urinary tract. This causes stagnation and provides a fertile ground for bacterial growth. Acute pyelonephritis is more common in women, especially during pregnancy when bladder infection (CYSTITIS) spreads up the ureters to the kidney. Symptoms are fever, malaise and backache. Antibiotics and high ?uid intake are the most e?ective treatment. Chronic pyelonephritis may start in childhood as a result of congenital deformities that permit urine to ?ow up from the bladder to the kidney (re?ux). Persistent re?ux leads to recurrent infections causing permanent damage to the kidney. Specialist investigations are usually required as possible complications include hypertension and kidney failure.
Tumours of the kidney are fortunately rare. Non-malignant ones commonly do not cause symptoms, and even malignant tumours (renal cell carcinoma) may be asymptomatic for many years. As soon as symptoms appear – haematuria, back pain, nausea, malaise, sometimes secondary growths in the lungs, bones or liver, and weight loss – urgent treatment including surgery, radiotherapy and chemotherapy is necessary. This cancer occurs mostly in adults over 40 and has a hereditary element. The prognosis is not good unless diagnosed early. In young children a rare cancer called nephroblastoma (Wilm’s tumour) can occur; treatment is with surgery, radiotherapy and chemotherapy. It may grow to a substantial size before being diagnosed.
Cystinuria is an inherited metabolic defect in the renal tubular reabsorption of cystine, ornithine, lysine and arginine. Cystine precipitates in an alkaline urine to form cystine stones. Triple phosphate stones are associated with infection and may develop into a very large branching calculi (staghorn calculi). Stones present as renal or ureteric pain, or as an infection. Treatment has undergone considerable change with the introduction of MINIMALLY INVASIVE SURGERY (MIS) and the destruction of stone by sound waves (LITHOTRIPSY).... kidneys, diseases of
Nutritional Profile Energy value (calories per serving): Low Protein: Low Fat: Low Saturated fat: Low Cholesterol: Low Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: None Major mineral contribution: None
About the Nutrients in This Food Although gelatin is made from the collagen (connective tissue) of cattle hides and bones or pig skin, its proteins are limited in the essential acid tryptophan, which is destroyed when the bones and skin are treated with acid, and is deficient in several others, including lysine. In fact, gelatin’s proteins are of such poor quality that, unlike other foods of animal origin (meat, milk), gelatin cannot sustain life. Laboratory rats fed a diet in which gelatin was the primary protein did not grow as they should; half died within 48 days, even though the gelatin was supplemented with some of the essential amino acids. Plain gelatin has no carbohydrates and fiber. It is low in fat. Flavored gel- atin desserts, however, are high in carbohydrates because of the added sugar.
The Most Nutritious Way to Serve This Food With a protein food rich in complete proteins. Gelatin desserts whipped with milk fit the bill.
Diets That May Restrict or Exclude This Food Low-carbohydrate diet (gelatin desserts prepared with sugar) Low-sodium diet (commercial gelatin powders) Sucrose-free diet (gelatin desserts prepared with sugar) * Values are for prepared unsweetened gelat in.
Buying This Food Look for: Tightly sealed, clean boxes.
Storing This Food Store gelatin boxes in a cool, dry cabinet.
Preparing This Food Commercial unflavored gelatin comes in premeasured 1-tablespoon packets. One tablespoon of gelatin will thicken about two cups of water. To combine the gelatin and water, first heat ¾ cup water to boiling. While it is heating, add the gelatin to ¼ cup cold liquid and let it absorb moisture until it is translucent. Then add the boiling water. (Flavored fruit gelatins can be dissolved directly in hot water.)
What Happens When You Cook This Food When you mix gelatin with hot water, its protein molecules create a network that stiffens into a stable, solid gel as it squeezes out moisture. The longer the gel sits, the more intermo- lecular bonds it forms, the more moisture it loses and the firmer it becomes. A day-old gel is much firmer than one you’ve just made. Gelatin is used as a thickener in prepared foods and can be used at home to thicken sauces. Flavored gelatin dessert powders have less stiffening power than plain gelatin because some of their protein has been replaced by sugar. To build a layered gelatin mold, let each layer harden before you add the next.... gelatin
Unfortunately, insects are liable to become resistant to insecticides, just as bacteria are liable to become resistant to antibiotics, and it is for this reason that so much research work is being devoted to the discovery of new ones. Researchers are also exploring new methods, such as releasing sexually sterile insects into the natural population.
The useful effects of insecticides must be set against increasing evidence that the indiscriminate use of some of these potent preparations is having an adverse e?ect – not only upon human beings, but also upon the ecosystems. Some, such as DDT – the use of which is now banned in the UK – are very stable compounds that enter the food chain and may ultimately be lethal to many animals, including birds and ?shes.... insecticides
Emergency treatment consists of turning the person on to the affected side or supporting the flail segment by firm strapping.
In severe cases, artificial ventilation is needed until the chest wall is stable.... flail chest
For more prolonged arti?cial ventilation it is usual to use a specially designed machine or ventilator to perform the task. The ventilators used in operating theatres when patients are anaesthetised and paralysed are relatively simple devices.They often consist of bellows which ?ll with fresh gas and which are then mechanically emptied (by means of a weight, piston, or compressed gas) via a circuit or tubes attached to an endotracheal tube into the patient’s lungs. Adjustments can be made to the volume of fresh gas given with each breath and to the length of inspiration and expiration. Expiration is usually passive back to the atmosphere of the room via a scavenging system to avoid pollution.
In intensive-care units, where patients are not usually paralysed, the ventilators are more complex. They have electronic controls which allow the user to programme a variety of pressure waveforms for inspiration and expiration. There are also programmes that allow the patient to breathe between ventilated breaths or to trigger ventilated breaths, or inhibit ventilation when the patient is breathing.
Indications for arti?cial ventilation are when patients are unable to achieve adequate respiratory function even if they can still breathe on their own. This may be due to injury or disease of the central nervous, cardiovascular, or respiratory systems, or to drug overdose. Arti?cial ventilation is performed to allow time for healing and recovery. Sometimes the patient is able to breathe but it is considered advisable to control ventilation – for example, in severe head injury. Some operations require the patient to be paralysed for better or safer surgical access and this may require ventilation. With lung operations or very unwell patients, ventilation is also indicated.
Arti?cial ventilation usually bypasses the physiological mechanisms for humidi?cation of inspired air, so care must be taken to humidify inspired gases. It is important to monitor the e?cacy of ventilation – for example, by using blood gas measurement, pulse oximetry, and tidal carbon dioxide, and airways pressures.
Arti?cial ventilation is not without its hazards. The use of positive pressure raises the mean intrathoracic pressure. This can decrease venous return to the heart and cause a fall in CARDIAC OUTPUT and blood pressure. Positive-pressure ventilation may also cause PNEUMOTHORAX, but this is rare. While patients are ventilated, they are unable to breathe and so accidental disconnection from the ventilator may cause HYPOXIA and death.
Negative-pressure ventilation is seldom used nowadays. The chest or whole body, apart from the head, is placed inside an airtight box. A vacuum lowers the pressure within the box, causing the chest to expand. Air is drawn into the lungs through the mouth and nose. At the end of inspiration the vacuum is stopped, the pressure in the box returns to atmospheric, and the patient exhales passively. This is the principle of the ‘iron lung’ which saved many lives during the polio epidemics of the 1950s. These machines are cumbersome and make access to the patient di?cult. In addition, complex manipulation of ventilation is impossible.
Jet ventilation is a relatively modern form of ventilation which utilises very small tidal volumes (see LUNGS) from a high-pressure source at high frequencies (20–200/min). First developed by physiologists to produce low stable intrathoracic pressures whilst studying CAROTID BODY re?exes, it is sometimes now used in intensive-therapy units for patients who do not achieve adequate gas exchange with conventional ventilation. Its advantages are lower intrathoracic pressures (and therefore less risk of pneumothorax and impaired venous return) and better gas mixing within the lungs.... intermittent positive pressure (ipp)
Applications of radionuclides to diagnosis The use of radionuclides in diagnosis is based on the fact that it is possible to tag many of the substances normally present in the body with a radioactive label. Certain synthetic radioactive elements, such as technetium, can also be used. Because it is possible to detect minute quantities of radioactive material, only very small doses are needed, making the procedure a safe one. Furthermore the body pool of the material is therefore not appreciably altered, and metabolism is not disturbed. Thus in studies of iodine metabolism the ratio of radioactive atoms administered to stable atoms in the body pool is of the order of 1:1,000 million. By measuring radioactivity in the body, in blood samples, or in the excreta it is possible to gain information about the fate of the labelled substance, and hence of the chemically identical inactive material. Therefore it is theoretically possible to trace the absorption, distribution and excretion of any substance normally present in the body, provided that it can be tagged with a suitable radioactive label.
If the investigation necessitates tracing the path of the material through the body by means of external counting over the body surface, it is obviously essential to use an isotope that emits gamma radiation or positrons. If, however, only measurements on blood sample or excreta are required, it is possible to use pure beta emitters. Whole-body counters measure the total radioactivity in the body, and these are of great value in absorption studies.
Moving images can provide information on body functions such as the movements of the heart, blood ?ow, bile ?ow in the liver, and urine in the kidneys. The development of COMPUTED TOMOGRAPHY or CT scanning has replaced radionuclide scanning for some imaging procedures.
Five main groups of diagnostic uses may be de?ned:
(1) METABOLIC STUDIES The use of radioactive materials in metabolic studies is based on the fundamental property that all isotopes of an element are chemically identical. The radioactive isotope is used as a true isotope tracer – that is, when introduced into the body (in whatever form) it behaves in the same way as the inactive element. For example, isotopes of iodine are used to measure thyroid function (see THYROID GLAND), and isotopes of calcium enable kinetic studies of bone formation and destruction to be performed.... isotope
Habitat: Native to the Moluccas Islands; grown in the Nilgiris, Kerala, Karnataka and West Bengal.
English: Nutmeg, Mace.Ayurvedic: Jaatiphala, Jaatishasya, Maalatiphala (seed kernel).Jaatipatri, Jaatipatra, Jaatipatraka, Jaatikosha (mace).Unani: Jauzbuwaa (seed), Bisbaasaa (mace).Siddha/Tamil: Jaathikkai, Saadikai (nutmeg); Saadippatthiri, Jaadip- patiri (mace).Action: Nutmeg—carminative, spasmolytic, antiemetic, orexi- genic; topically anti-inflammatory. Mace—stimulant carminative. Narcotic in high doses.
Nutmeg is used in flatulency, diarrhoea, nausea and vomiting. Mace is used in rheumatism, chronic bowel complaints and asthma. When roasted, both nutmeg and mace are used for diarrhoea, colic, flatulence and dyspepsia.Key application: Dried seed and aril—included among unapproved herbs by German Commission E. Following actions have been considered: antispasmodic, MAO inhibition, inhibition of prostaglandin synthesis.The Ayurvedic Pharmacopoeia of India recommends the kernel of the fruit in spermatorrhoea.An aqueous extract of nutmeg is reported to show anti-secretory activity against E. coli heat-labile enterotoxin; the hexane soluble fraction of the alcoholic extract inhibited the heat-labile and heat-stable-enterotoxin-induced secretory response in animal studies.The hexane extract contains myris- ticin, an anti-inflammatory principle, and licarin-B and dehydro di- isoeugenol which exhibited CNS depressant properties. The extracts of nutmeg decreased kidney prostaglan- din levels in rats. They also inhibited platelet aggregation (due to eugenol and isoeugenol). The anti-inflammatory activity observed in carrage- enan-induced oedema in rats and enhanced vascular permeability in mice, are attributed to myristicin present in mace.Mace also activates hepatic detoxification process. Monomeric and dimer- ic phenyl propanoids (myristicin, de- hydro diisoeugenol) from mace, on p.o. administration in mice, produced suppression of lipid peroxidation in liver.Seeds contain about 0.24% myris- ticin, whereas volatile oil about 3.12%.The resorcinols, malabaricones B and C, isolated from the seed coat (mace) exhibited strong antibacterial and antifungal activities. Neoplasm inhibitors, phenylpropyl derivatives, have been isolated from pulverized mace.Dosage: Endosperm of dried seed (kernel of fruit)—0.5-1.0 g powder. (API, Vol. I.)... myristica fragransThere are three main categories of licensed medicinal product. Drugs in small quantities can, if they are perceived to be safe, be licensed for general sale (GSL – general sales list), and may then be sold in any retail shop. P (pharmacy-only) medicines can be sold from a registered pharmacy by or under the supervision of a pharmacist (see PHARMACISTS); no prescription is needed. P and GSL medicines are together known as OTCs – that is, ‘over-thecounter medicines’. POM (prescription-only medicines) can only be obtained from a registered pharmacy on the prescription of a doctor or dentist. As more information is gathered on the safety of drugs, and more emphasis put on individual responsibility for health, there is a trend towards allowing drugs that were once POM to be more widely available as P medicines. Examples include HYDROCORTISONE 1 per cent cream for skin rashes, CIMETIDINE for indigestion, and ACICLOVIR for cold sores. Care is needed to avoid taking a P medicine that might alter the actions of another medicine taken with it, or that might be unsuitable for other reasons. Patients should read the patient-information lea?et, and seek the pharmacist’s advice if they have any doubt about the information. They should tell their pharmacist or doctor if the medicine results in any unexpected effects.
Potentially dangerous drugs are preparations referred to under the Misuse of Drugs Act 1971 and subsequent regulations approved in 1985. Described as CONTROLLED DRUGS, these include such preparations as COCAINE, MORPHINE, DIAMORPHINE, LSD (see LYSERGIC ACID
DIETHYLAMIDE (LSD)), PETHIDINE HYDROCHLORIDE, AMPHETAMINES, BARBITURATES and most BENZODIAZEPINES.
Naming of drugs A European Community Directive (92/27/EEC) requires the use of the Recommended International Non-proprietary Name (rINN) for medicinal substances. For most of these the British Approved Name (BAN) and rINN were identical; where the two were di?erent, the BAN has been modi?ed in line with the rINN. Doctors and other authorised subscribers are advised to write titles of drugs and preparations in full because uno?cial abbreviations may be misinterpreted. Where a drug or preparation has a non-proprietary (generic) title, this should be used in prescribing unless there is a genuine problem over the bioavailability properties of a proprietary drug and its generic equivalent.
Where proprietary – commercially registered
– names exist, they may in general be used only for products supplied by the trademark owners. Countries outside the European Union have their own regulations for the naming of medicines.
Methods of administration The ways in which drugs are given are increasingly ingenious. Most are still given by mouth; some oral preparations (‘slow release’ or ‘controlled release’ preparations) are designed to release their contents slowly into the gut, to maintain the action of the drug.
Buccal preparations are allowed to dissolve in the mouth, and sublingual ones are dissolved under the tongue. The other end of the gastrointestinal tract can also absorb drugs: suppositories inserted in the rectum can be used for their local actions – for example, as laxatives – or to allow absorption when taking the drug by mouth is di?cult or impossible – for example, during a convulsion, or when vomiting.
Small amounts of drug can be absorbed through the intact skin, and for very potent drugs like OESTROGENS (female sex hormones) or the anti-anginal drug GLYCERYL TRINITRATE, a drug-releasing ‘patch’ can be used. Drugs can be inhaled into the lungs as a ?ne powder to treat or prevent ASTHMA attacks. They can also be dispersed (‘nebulised’) as a ?ne mist which can be administered with compressed air or oxygen. Spraying a drug into the nostril, so that it can be absorbed through the lining of the nose into the bloodstream, can avoid destruction of the drug in the stomach. This route is used for a small number of drugs like antidiuretic hormone (see VASOPRESSIN).
Injection remains an important route of administering drugs both locally (for example, into joints or into the eyeball), and into the bloodstream. For this latter purpose, drugs can be given under the skin – that is, subcutaneously (s.c. – also called hypodermic injection); into muscle – intramuscularly (i.m.); or into a vein – intravenously (i.v.). Oily or crystalline preparations of drugs injected subcutaneously form a ‘depot’ from which they are absorbed only slowly into the blood. The action of drugs such as TESTOSTERONE and INSULIN can be prolonged by using such preparations, which also allow contraceptive ‘implants’ that work for some months (see CONTRACEPTION).... medicines
Intrauterine contraceptive device (IUCD) This, in e?ect, is a form of post-coital contraception. The IUCD is a plastic shape up to 3 cm long around which copper wire is wound, carrying plastic thread from its tail. Colloquially known as a coil, it acts by inhibiting implantation and may also impair migration of sperm. Devices need changing every 3–5 years. Coils have generally replaced the larger, non-copper-bearing ‘inert’ types of IUCD, which caused more complications but did not need changing (so are sometimes still found in situ). They tend to be chosen as a method of contraception (6 per cent) by older, parous women in stable relationships, with a generally low problem rate.
Nevertheless, certain problems do occur with IUCDs, the following being the most common:
They tend to be expelled by the uterus in women who have never conceived, or by a uterus distorted by, say, ?broids.
ECTOPIC PREGNANCY is more likely.
They are associated with pelvic infection and INFERTILITY, following SEXUALLY TRANSMITTED DISEASES (STDS) – or possibly introduced during insertion.
They often produce heavy, painful periods (see MENSTRUATION), and women at high risk of these problems (e.g. women who are HIV positive [see AIDS/HIV], or with WILSON’S DISEASE or cardiac lesions) should generally be excluded – unless the IUCD is inserted under antibiotic cover.... post-coital contraception
Prostaglandins play an important part in the production of PAIN, and it is now known that ASPIRIN relieves pain by virtue of the fact that it prevents, or antagonises, the formation of certain prostaglandins. In addition, they play some, although as yet incompletely de?ned, part in producing in?ammatory changes. (See INFLAMMATION; NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS).)
Thus prostaglandins have potent biological effects, but their instability and rapid metabolism make them short-acting. They are produced but not stored by most living cells and act locally. The two most important prostaglandins are prostacycline and thromboxane: prostacycline is a vasodilator and an inhibitor of platelet aggregation; thromboxanes have the opposite effects and cause vasoconstriction and platelet aggregation. The NSAIDs act by blocking an ENZYME called cyclo-oxygenase which converts arachidonic acid to the precursors of the various prostaglandins. Despite their potent pharmacological properties, the role of prostaglandins in current therapeutics is limited and controversial. They have been used most successfully as an inhibitor of platelet aggregation in extra-corporeal haemoperfusion systems. The problems with the prostacyclines is that they have to be given intravenously as they are inactive by mouth, and continuous infusion is required because the drug is rapidly eliminated with a half-life of minutes. Side-effects tend to be severe because the drug is usually given at the highest dose the patient can tolerate. The hope for the future lies in the exploitation of the compound to generate, synthetically, stable orally active prostacycline analogues which will inhibit platelet aggregation and hence thrombotic events, and yet have minimal effects on the heart and blood vessels.... prostaglandins
Causes There is an inherited element: parents, children or siblings of schizophrenic sufferers have a one in ten chance of developing the disorder; a twin has a 50 per cent chance if the other twin has schizophrenia. Some BRAIN disorders such as temporal lobe EPILEPSY, tumours and ENCEPHALITIS seem to be linked with schizophrenia. Certain drugs – for example, AMPHETAMINES – can precipitate schizophrenia and DOPAMINE-blocking drugs often relieve schizophrenic symptoms. Stress may worsen schizophrenia and recreational drugs may trigger an attack.
Symptoms These usually develop gradually until the individual’s behaviour becomes so distrubing or debilitating that work, relationships and basic activities such as eating and sleeping are interrupted. The patient may have disturbed perception with auditory HALLUCINATIONS, illogical thought-processes and DELUSIONS; low-key emotions (‘?at affect’); a sense of being invaded or controlled by outside forces; a lack of INSIGHT and inability to acknowledge reality; lethargy and/or agitation; a disrespect for personal appearance and hygiene; and a tendency to act strangely. Violence is rare although some sufferers commit violent acts which they believe their ‘inner voices’ have commanded.
Relatives and friends may try to cope with the affected person at home, but as severe episodes may last several months and require regular administration of powerful drugs – patients are not always good at taking their medication
– hospital admission may be necessary.
Treatment So far there is no cure for schizophrenia. Since the 1950s, however, a group of drugs called antipsychotics – also described as NEUROLEPTICS or major tranquillisers – have relieved ?orid symptoms such as thought disorder, hallucinations and delusions as well as preventing relapses, thus allowing many people to leave psychiatric hospitals and live more independently outside. Only some of these drugs have a tranquillising e?ect, but their sedative properties can calm patients with an acute attack. CHLORPROMAZINE is one such drug and is commonly used when treatment starts or to deal with an emergency. Halperidol, tri?uoperazine and pimozide are other drugs in the group; these have less sedative effects so are useful in treating those whose prominent symptoms are apathy and lethargy.
The antipsychotics’ mode of action is by blocking the activity of DOPAMINE, the chemical messenger in the brain that is faulty in schizophrenia. The drugs quicken the onset and prolong the remission of the disorder, and it is very important that patients take them inde?nitely. This is easier to ensure when a patient is in hospital or in a stable domestic environment.
CLOZAPINE – a newer, atypical antipsychotic drug – is used for treating schizophrenic patients unresponsive to, or intolerant of, conventional antipsychotics. It may cause AGRANULOCYTOSIS and use is con?ned to patients registered with the Clorazil (the drug’s registered name) Patient Monitoring Service. Amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine are other antipsychotic drugs described as ‘atypical’ by the British National Formulary; they may be better tolerated than other antipsychotics, and their varying properties mean that they can be targeted at patients with a particular grouping of symptoms. They should, however, be used with caution.
The welcome long-term shift of mentally ill patients from large hospitals to community care (often in small units) has, because of a lack of resources, led to some schizophrenic patients not being properly supervised with the result that they fail to take their medication regularly. This leads to a recurrence of symptoms and there have been occasional episodes of such patients in community care becoming a danger to themselves and to the public.
The antipsychotic drugs are powerful agents and have a range of potentially troubling side-effects. These include blurred vision, constipation, dizziness, dry mouth, limb restlessness, shaking, sti?ness, weight gain, and in the long term, TARDIVE DYSKINESIA (abnormal movements and walking) which affects about 20 per cent of those under treatment. Some drugs can be given by long-term depot injection: these include compounds of ?upenthixol, zuclopenthixol and haloperidol.
Prognosis About 25 per cent of sufferers recover fully from their ?rst attack. Another 25 per cent are disabled by chronic schizophrenia, never recover and are unable to live independently. The remainder are between these extremes. There is a high risk of suicide.... schizophrenia
Silicone is also used to make implants for RECONSTRUCTIVE (PLASTIC) SURGERY. Silicone oil in a silicone rubber bag is used in breast reconstruction after surgery for breast cancer, and for enlargement of the breast. Although usually an inert substance, it has been found to cause side-effects, including possible immunological reactions following leakages, so that its use in breast surgery in particular has now been restricted.... silicones
Habitat: Throughout the greater part of India, also grown as an avenue tree.
English: Arjun Terminalia.Ayurvedic: Arjuna, Dhananjaya, Kaakubha, Kakubha, Aartagala, Indravriksha, Paartha, Virataru, Viravriksha.Unani: ArjunSiddha: Marudam.Action: Bark—used as a cardiopro- tective and cardiotonic in angina and poor coronary circulation; as a diuretic in cirrhosis of liver and for symptomatic relief in hypertension; externally in skin diseases, herpes and leukoderma. Powdered bark is prescribed with milk in fractures and contusions with excessive ec- chymosis, also in urinary discharges and strangury. Fruit—deobstruent.
The Ayurvedic Pharmacopoeia ofIn- dia recommends the powder of the stembark in emaciation, chest diseases, cardiac disorders, lipid imbalances and polyuria.The bark extract contains acids (ar- junolic acid, terminic acid), glyco- sides (arjunetin, arjunosides I-IV), and strong antioxidants—flavones, tannins, oligomeric proanthocyani- dins.The bark extract (500 mg every 8 h) given to (58 male) patients with stable angina with provocable ischemia on treadmill exercise, led to improvement in clinical and treadmill exercise parameters as compared to placebo therapy.These benefits were similar to those observed with isosorbide mononitrate (40 mg/day). (Indian Heart J. 2002, 54(4), 441.)Arjunolic acid exhibited significant cardiac protection in isoproterenol- induced myocardial necrosis in rats.T (Mol Cell Biochem, 2001, 224 (1-2), 135-42.) A study demonstrated that the alcoholic extract of Terminalia arjuna bark augmented endogenous antioxi- dant compounds of the rat heart and prevented from isoproterenol-induced myocardial ischemic reperfusion injury. (Life Sci. 2003, 73 (21), 27272739.) Cardiac lipid peroxidation in male Wistar rats was reduced by 38.8% ± 2.6% at a dose of 90 mg/kg, in a study based on aqueous freeze-dried extract ofthebark. (PhytotherRes. 2001,15(6), 510-23.)Oral administration of bark powder (400 mg/kg body weight) for 10 days produced significant increase in circulating histamine, a little increase in 5-HT, catecholamines and HDL cholesterol, and decrease in total lipid, triglycerides and total cholesterol in normal rats.Casuarinin, a hydrolyzable tannin, isolated from the bark, exhibited antiherpes virus activity by inhibiting viral attachment and penetration. 50% ethanolic extract of the bark exhibited significant increase in the tensile of the incision wounds.Dosage: Stembark—3-6 g powder. (API, Vol. II.)... terminalia arjunaThe juice is an oxygen catalyser believed to have an anti-tumour effect. High in iron content and silicic acids, it assists regeneration of red blood cells. Hungarian research indicates anti-cancerous properties; one kilo fresh vegetable daily. Active elements are stable and unaffected by cooking. Other contents: selenium; Vitamins A, C, E, flavonoids, fibre. Side-effects – nil. Bottled juices – (Biotta, Switzerland) Produces red stool and urine.
Beetroot juice assists the liver to break-down stored fats and is of value for cellulite and other obese conditions. ... beetroot
Anaemia is not a disease but a feature of many different disorders. There are various types, which can be classified into those due to decreased or defective red-cell production by bone marrow (see anaemia, aplastic; anaemia, megaloblastic; anaemia, iron-deficiency) and those due to decreased survival of the red cells in the blood (see anaemia, haemolytic).
The severity of symptoms depends on how low the haemoglobin concentration has become. Slightly reduced levels can cause headaches, tiredness, and lethargy. Severely reduced levels can cause breathing difficulty on exercise, dizziness, angina, and palpitations. General signs include pallor, particularly of the skin creases, the lining of the mouth, and the inside of the eyelids.
Anaemia is diagnosed from the symptoms and by blood tests (see blood count; blood film). A bone marrow biopsy may be needed if the problem is with red blood cell production.... anaemia
Transfusion of blood is a technique that has been used since the 17th century – although, until the 20th century, with a subsequent high mortality rate. It was only when incompatibility of BLOOD GROUPS was considered as a potential cause of this high mortality that routine blood-testing became standard practice. Since the National Blood Transfusion Service was started in the United Kingdom (in 1946), blood for transfusion has been collected from voluntary, unpaid donors: this is screened for infections such as SYPHILIS, HIV, HEPATITIS and nvCJD (see CREUTZFELDT-JAKOB DISEASE (CJD)), sorted by group, and stored in blood-banks throughout the country.
In the UK in 2004, the National Blood Authority – today’s transfusion service – announced that it would no longer accept donations from anyone who had received a blood transfusion since 1980 – because of the remote possibility that they might have been infected with the PRION which causes nvCJD.
A standard transfusion bottle has been developed, and whole blood may be stored at 2–6 °C for three weeks before use. Transfusions may then be given of whole blood, plasma, blood cells, or PLATELETS, as appropriate. Stored in the dried form at 4–21 °C, away from direct sunlight, human plasma is stable for ?ve years and is easily reconstituted by adding sterile distilled water.
The National Blood Authority prepares several components from each donated unit of blood: whole blood is rarely used in adults. This permits each product, whether plasma or various red-cell concentrates, to be stored under ideal conditions and used in appropriate clinical circumstances – say, to restore blood loss or to treat haemostatic disorders.
Transfusion of blood products can cause complications. Around 5 per cent of transfused patients suffer from a reaction; most are mild, but they can be severe and occasionally fatal. It can be di?cult to distinguish a transfusion reaction from symptoms of the condition being treated, but the safe course is to stop the transfusion and start appropriate investigation.
In the developed world, clinicians can expect to have access to high-quality blood products, with the responsibility of providing blood resting with a specially organised transfusion service. The cause of most fatal haemolytic transfusion reactions is a clerical error due to faulty labelling and/or failure to identify the recipient correctly. Hospitals should have a strict protocol to prevent such errors.
Arti?cial blood Transfusion with blood from donors is facing increasing problems. Demand is rising; suitable blood donors are becoming harder to attract; the processes of taking, storing and cross-matching donor blood are time-consuming and expensive; the shelf-life is six weeks; and the risk of adverse reactions or infection from transfused blood, although small, is always present. Arti?cial blood would largely overcome these drawbacks. Several companies in North America are now preparing this: one product uses puri?ed HAEMOGLOBIN from humans and another from cows. These provide oxygen-carrying capacity, are unlikely to be infectious and do not provoke immunological rejections. Yet another product, called Oxygene®, does not contain any animal or human blood products; it comprises salt water and a substance called per?ubron, the molecules of which store oxygen and absorb carbon dioxide more e?ectively than does haemoglobin. Within 24 hours of being transfused into a person’s bloodstream, per?ubron evaporates and is harmlessly breathed out by the recipient. Arti?cial blood is especially valuable in that it contains no unwanted proteins that can provoke adverse immunological reactions. Furthermore, it is disease-free, lasts for up to three years and is no more expensive than donor blood. It could well take the place of donor blood within a few years.
Autologous transfusion is the use of an individual’s own blood, provided in advance, for transfusion during or after a surgical operation. This is a valuable procedure for operations that may require large transfusions or where a person has a rare blood group. Its use has increased for several reasons:
fear of infection such as HIV and hepatitis.
shortages of donor blood and the rising cost of units of blood.
substantial reduction of risk of incompatible transfusions. In practice, blood transfusion in the UK is
remarkably safe, but there is always room for improvement. So, in the 1990s, a UK inquiry on the Serious Hazards of Transfusion (SHOT) was launched. It established (1998) that of 169 recently reported serious hazards following blood transfusion, 81 had involved a blood component being given to the wrong patient, while only eight were the result of viral or bacterial infections.
There are three ways to use a patient’s own blood in transfusion:
(1) predeposit autologous donation (PAD) – taking blood from a patient before operation and transfusing this blood back into the patient as required during and after operation.
(2) acute normovalaemic haemodilution (ANH) – diluting previously withdrawn blood and thus increasing the volume before transfusion.
(3) perioperative cell salvage (PCS) – the use of centrifugal cell separation on blood saved during an operation, particularly spinal surgery where blood loss may be considerable.
The government has urged NHS trusts to consider the introduction of PCS as a possible adjunct or alternative to banked-blood transfusion. In one centre (Nottingham), PCS has been used in the form of continuous autologous transfusion for several years with success.
Exchange transfusion is the method of treatment in severe cases of HAEMOLYTIC DISEASE OF THE NEWBORN. It consists of replacing the whole of the baby’s blood with Rh-negative blood of the correct blood group for the baby.... transfusion
Abnormalities in brain biochemistry, or in the structure and/or function of certain nerve pathways within the brain, could underlie manic–depressive illness. An inherited tendency is also an established causative factor.Severe manic–depressive illness often needs hospital treatment. Antidepressant drugs and/or ECT are used to treat depression, and antipsychotic drugs are given to control manic symptoms. Carbamazepine or lithium may be used to prevent relapse.
Group therapy, family therapy, and individual psychotherapy may be useful in treatment. Cognitive–behavioural therapy may also be helpful. With treatment, more than 80 per cent of patients improve or remain stable. Even those with severe illness may be restored to near normal health with lithium.... manic–depressive illness
Four significant types of harmful radiation are gamma radiation, X-rays, alpha particles, and beta particles. Gamma radiation and X-rays are types of electromagnetic waves, and are similar to more energetic forms of light. All 4 types cause damage by ionization – the waves or particles knock out electrons from atoms in the matter that they pass through, turning them into highly reactive ions. In the case of living tissue, the ions formed cause biological damage.
Radioactive substances that emit any of these types of radiation constitute a health hazard. However, alpha particles cannot penetrate the skin, so sources of alpha radiation are only dangerous if ingested or inhaled. Gamma radiation can travel large distances through many substances, and even distant gamma sources can pose a risk to humans.
Most sources of radiation are natural. Natural sources of ionizing radiation include cosmic rays from space, and radioactive minerals. In some areas, the gas radon, found in soil, rocks, or building materials, is a major source. Artificial sources of ionizing radiation include Xray machines, radioactive isotopes used in diagnosis and treatment (see radionuclide scanning), and nuclear reactors.
Less energetic types of radiation, such as ultraviolet light, may also cause biological damage by mechanisms other than ionization. Ultraviolet radiation from the sun does not penetrate the body deeply, but can damage genetic material in cells and may lead to skin cancer.
Other types of nonionizing radiation to which people are subjected are ultrasound, used in medicine for diagnosis and treatment, and radio waves that are generated during MRI. These techniques are not thought to have any adverse side effects. (See also radiation hazards; radiation sickness; radiation units.)... radial nerve
The outermost epidermis is composed of dead cells and the protein keratin. As these dead cells are worn away, they are replaced by new ones from the inner epidermis. Some epidermal cells produce the pigment melanin, which protects the body from ultraviolet light in sunlight.
The dermis is composed of connective tissue interspersed with hair follicles, sweat glands, sebaceous glands, blood and lymph vessels, and sensory receptors for pressure, temperature, and pain.... skeleton
Weight loss or weight gain occurs if the net balance is disturbed.
Weight can be compared with standardized charts for height, age, and sex. At all ages, divergence from the normal weight for height may have medical implications. For example, if weight is below 80 per cent of the standard weight for height, the individual’s nutrition is probably inadequate as a result of poor diet or disease, and if 20 per cent above the standard, he or she is considered to be suffering from obesity. An alternative method of assessment is use of the body mass index (, or Quetelet’s index), obtained by dividing weight in kilograms by the square of height in metres. A healthy weight is 20–25 ; a of greater than 25 indicates that a person is overweight. weight loss This occurs any time there is a decrease in energy intake compared with energy expenditure. The decrease may be due to deliberate weight reduction or a change in diet or activity level. It may also be a symptom of a disorder. Unexplained weight loss should always be investigated by a doctor.
Many diseases disrupt the appetite, which may lead to weight loss. Depression reduces the motivation to eat, peptic ulcer causes pain and possible food avoidance, and some kidney disorders cause loss of appetite due to the effect of uraemia. In anorexia nervosa and bulimia, complex psychological factors affect an individual’s eating pattern.
Digestive disorders, such as gastroenteritis, lead to weight loss through vomiting. Cancer of the oesophagus (see oesophagus, cancer of) and stomach cancer cause loss of weight, as does malabsorption of nutrients in certain disorders of the intestine or pancreas.
Some disorders cause weight loss by increasing the rate of metabolic activity in cells. Examples are any type of cancer, chronic infection such as tuberculosis, and hyperthyroidism. Untreated diabetes mellitus also causes weight loss due to a number of factors.... weight
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