Some toxins are not set free by bacteria, but remain in the substance of the latter. They are known as endotoxins and are not capable of producing antitoxins.
Some toxins are not set free by bacteria, but remain in the substance of the latter. They are known as endotoxins and are not capable of producing antitoxins.
Dialysis is available as either haemodialysis or peritoneal dialysis.
Haemodialysis Blood is removed from the circulation either through an arti?cial arteriovenous ?stula (junction) or a temporary or permanent internal catheter in the jugular vein (see CATHETERS). It then passes through an arti?cial kidney (‘dialyser’) to remove toxins (e.g. potassium and urea) by di?usion and excess salt and water by ultra?ltration from the blood into dialysis ?uid prepared in a ‘proportionator’ (often referred to as a ‘kidney machine’). Dialysers vary in design and performance but all work on the principle of a semi-permeable membrane separating blood from dialysis ?uid. Haemodialysis is undertaken two to three times a week for 4–6 hours a session.
Peritoneal dialysis uses the peritoneal lining (see PERITONEUM) as a semi-permeable membrane. Approximately 2 litres of sterile ?uid is run into the peritoneum through the permanent indwelling catheter; the ?uid is left for 3–4 hours; and the cycle is repeated 3–4 times per day. Most patients undertake continuous ambulatory peritoneal dialysis (CAPD), although a few use a machine overnight (continuous cycling peritoneal dialysis, CCPD) which allows greater clearance of toxins.
Disadvantages of haemodialysis include cardiovascular instability, HYPERTENSION, bone disease, ANAEMIA and development of periarticular AMYLOIDOSIS. Disadvantages of peritoneal dialysis include peritonitis, poor drainage of ?uid, and gradual loss of overall e?ciency as endogenous renal function declines. Haemodialysis is usually done in outpatient dialysis clinics by skilled nurses, but some patients can carry out the procedure at home. Both haemodialysis and peritoneal dialysis carry a relatively high morbidity and the ideal treatment for patients with end-stage renal failure is successful renal TRANSPLANTATION.... dialysis
The bacteria commonly responsible for food poisoning belong to the groups
SALMONELLA, CAMPYLOBACTER, and E. COLI, certain strains of which are able to multiply rapidly in the intestines to cause widespread inflammation. Food poisoning may also be caused by LISTERIA (see listeriosis). Botulism is an uncommon, life-threatening form of food poisoning caused by a bacterial toxin.
The viruses that most commonly cause food poisoning are astravirus, rotavirus, and Norwalk virus (which affects shellfish). This can occur when raw or partly cooked foods have been in contact with water contaminated by human excrement. Non-infective causes include poisonous mushrooms and toadstools (see mushroom poisoning), fresh fruit and vegetables contaminated with high doses of insecticide, and chemical poisoning from foods such as fruit juice stored in containers made partly from zinc.
The onset of symptoms depends on the cause of poisoning. Symptoms usually develop within 30 minutes in cases of chemical poisoning, between 1 and 12 hours in cases of bacterial toxins, and between 12 and 48 hours with most bacterial and viral infections. Symptoms usually include nausea and vomiting, diarrhoea, stomach pain, and, in severe cases, shock and collapse. Botulism affects the nervous system, causing visual disturbances, difficulty with speech, paralysis, and vomiting.
The diagnosis of bacterial food poisoning can usually be confirmed from examination of a sample of faeces. Chemical poisoning can often be diagnosed from a description of what the person has eaten, and from analysis of a sample of the suspect food.
Mild cases can be treated at home. Lost fluids should be replaced by intake of plenty of clear fluids (see rehydration therapy). In severe cases, hospital treatment may be necessary. Except for botulism, and some cases of mushroom poisoning, most food poisoning is not serious, and recovery generally occurs within 3 days. However, some strains ofE. COLI can seriously damage red blood cells and cause kidney failure. (See also cholera; dysentery; typhoid fever.)... food poisoning
Appetite loss, nausea, vomiting, cramps, and diarrhoea are the usual symptoms. Symptom onset and severity depends on the cause; symptoms may be mild or so severe that dehydration, shock, and collapse occur. Mild cases usually require rest and rehydration therapy only. For severe illness, treatment in hospital may be necessary, with fluids given by intravenous infusion. Antibiotic drugs may be given for some bacterial infections, but others need no specific treatment.... gastroenteritis
Routine childhood immunization programmes exist for diseases such as diphtheria, pertussis, and tetanus (see DPT vaccination), haemophilus influenza (Hib), measles, mumps, and rubella (see MMR vaccination), meningitis C, and poliomyelitis. Additional immunizations before foreign travel may also be necessary (see travel immunization).
Most immunizations are given by injection, and usually have no after effects. However, some vaccines cause pain and swelling at the injection site and may produce a slight fever or flu-like symptoms. Some may produce a mild form of the disease. Very rarely, severe reactions occur due, for example, to an allergy to 1 of the vaccine’s components. Not all vaccines provide complete protection. Cholera and typhoid fever vaccinations, in particular, give only partial protection.
People with immunodeficiency disorders, widespread cancer, those taking corticosteroid drugs, or those who have previously had a severe reaction to a vaccine should not be immunized. Some vaccines should not be given to young children or during pregnancy.... immunization
Septicaemia usually arises through escape of bacteria from a focus of infection, such as an abscess, and is more likely to occur in people with an immunodeficiency disorder, cancer, or diabetes mellitus; in those who take immunosuppressant drugs; and in drug addicts who inject.
Symptoms include a fever, chills, rapid breathing, headache, and clouding of consciousness. The sufferer may go into life-threatening septic shock.
Glucose and/or saline are given by intravenous infusion, and antibiotics by injection or infusion.
Surgery may be necessary to remove the original infection.
If treatment is given before septic shock develops, the outlook is good.... septicaemia
Causes The direct cause is various BACTERIA. Sometimes the presence of foreign bodies, such as bullets or splinters, may produce an abscess, but these foreign bodies may remain buried in the tissues without causing any trouble provided that they are not contaminated by bacteria or other micro-organisms.
The micro-organisms most frequently found are staphylococci (see STAPHYLOCOCCUS), and, next to these, streptococci (see STREPTOCOCCUS) – though the latter cause more virulent abscesses. Other abscess-forming organisms are Pseudomonas pyocyanea and Escherichia coli, which live always in the bowels and under certain conditions wander into the surrounding tissues, producing abscesses.
The presence of micro-organisms is not suf?cient in itself to produce suppuration (see IMMUNITY; INFECTION); streptococci can often be found on the skin and in the skin glands of perfectly healthy individuals. Whether they will produce abscesses or not depends upon the virulence of the organism and the individual’s natural resistance.
When bacteria have gained access – for example, to a wound – they rapidly multiply, produce toxins, and cause local dilatation of the blood vessels, slowing of the bloodstream, and exudation of blood corpuscles and ?uid. The LEUCOCYTES, or white corpuscles of the blood, collect around the invaded area and destroy the bacteria either by consuming them (see PHAGOCYTOSIS) or by forming a toxin that kills them. If the body’s local defence mechanisms fail to do this, the abscess will spread and may in severe cases cause generalised infection or SEPTICAEMIA.
Symptoms The classic symptoms of in?ammation are redness, warmth, swelling, pain and fever. The neighbouring lymph nodes may be swollen and tender in an attempt to stop the bacteria spreading to other parts of the body. Infection also causes an increase in the number of leucocytes in the blood (see LEUCOCYTOSIS). Immediately the abscess is opened, or bursts, the pain disappears, the temperature falls rapidly to normal, and healing proceeds. If, however, the abscess discharges into an internal cavity such as the bowel or bladder, it may heal slowly or become chronic, resulting in the patient’s ill-health.
Treatment Most local infections of the skin respond to ANTIBIOTICS. If pus forms, the abscess should be surgically opened and drained.
Abscesses can occur in any tissue in the body, but the principles of treatment are broadly the same: use of an antibiotic and, where appropriate, surgery.... abscess
Habitat: Endemic to the mountains of Balkan Peninsula and western Asia. Introduced into India; occasionally grown as an ornamental tree.
English: Horse Chestnut tree.Unani: Baloot. (Quercus incana and Q. infectoria have also been equated with Baloot in National Formulary in Unani Medicine.)Folk: Pu.Action: Anti-inflammatory, vasodilator, astringent (used for rheumatism, venous congestion, haemorrhoids), febrifuge. Leaf— used in whooping cough.
Key application: In chronic venous insufficiency, varicosis, nocturnal systremma (cramps in the calves) and swelling of the legs. (Non- invasive treatment measures should also be followed.) (German Commission E, ESCOP, The British Herbal Pharmacopoeia.)Horse Chestnut contains triterpe- noid saponins (especially aescin, a complex mixture composed of acylat- ed glycosides of protoaesigenin and barringtogenol-C, including hippo- caesculin), coumarins and flavonoids. Aescin has been shown to eliminate oedema and reduce exudation. It antagonizes the effect of bradykinin, although it is not a direct bradykinin antagonist. It causes an increase in plasma levels of ACTH, corticosterone and glucose in rats. Hippocaescu- lin and barringtogenol-C-21-angelate show antitumour activity in vitro.The hydroxycoumarin aesculin leads to increased bleeding time. (Roasting seems to destroy the toxins.) A few fruits can cause severe toxic symptoms. (Francis Brinker.) In some countries, an intravenous mixture containing aescin is used after surgery. (Natural Medicines Comprehensive Database, 2007.)... aesculus hippocastanum(e.g. bacteria), known generally as antigens (see ANTIGEN). The antibodies are formed, usually, as a result of the introduction into the body of the antigens to which they are antagonistic, as in all infectious diseases (see ALLERGY; IMMUNITY).... antibodies
Nutritional Profile Energy value (calories per serving): Moderate Protein: Moderate Fat: Low to moderate Saturated fat: Low to high Cholesterol: Low to high Carbohydrates: High Fiber: Moderate to high Sodium: Moderate to high Major vitamin contribution: B vitamins Major mineral contribution: Calcium, iron, potassium
About the Nutrients in This Food All commercially made yeast breads are approximately equal in nutri- tional value. Enriched white bread contains virtually the same amounts of proteins, fats, and carbohydrates as whole wheat bread, although it may contain only half the dietary fiber (see flour). Bread is a high-carbohydrate food with lots of starch. The exact amount of fiber, fat, and cholesterol in the loaf varies with the recipe. Bread’s proteins, from grain, are low in the essential amino acid lysine. The most important carbohydrate in bread is starch; all breads contain some sugar. Depending on the recipe, the fats may be highly saturated (butter or hydrogenated vegetable fats) or primarily unsaturated (vegetable fat). All bread is a good source of B vitamins (thiamin, riboflavin, niacin), and in 1998, the Food and Drug Administration ordered food manufactur- ers to add folates—which protect against birth defects of the spinal cord and against heart disease—to flour, rice, and other grain products. One year later, data from the Framingham Heart Study, which has followed heart health among residents of a Boston suburb for nearly half a cen- tury, showed a dramatic increase in blood levels of folic acid. Before the fortification of foods, 22 percent of the study participants had a folic acid deficiency; after, the number fell to 2 percent. Bread is a moderately good source of calcium, magnesium, and phos- phorus. (Breads made with milk contain more calcium than breads made without milk.) Although bread is made from grains and grains contain phytic acid, a natural antinutrient that binds calcium ions into insoluble, indigestible compounds, the phytic acid is inactivated by enzyme action during leavening. Bread does not bind calcium. All commercially made breads are moderately high in sodium; some contain more sugar than others. Grains are not usually considered a good source of iodine, but commer- cially made breads often pick up iodine from the iodophors and iodates used to clean the plants and machines in which they are made. Homemade breads share the basic nutritional characteristics of commercially made breads, but you can vary the recipe to suit your own taste, lowering the salt, sugar, or fat and raising the fiber content, as you prefer.
The Most Nutritious Way to Serve This Food As sandwiches, with cheese, milk, eggs, meat, fish, or poultry. These foods supply the essen- tial amino acid lysine to “complete” the proteins in grains. With beans or peas. The proteins in grains are deficient in the essential amino acids lysine and isoleucine and rich in the essential amino acids tryptophan, methionine, and cystine. The proteins in legumes (beans and peas) are exactly the opposite.
Diets That May Restrict or Exclude This Food Gluten-free diet (excludes breads made with wheat, oats, rye, buckwheat and barley flour) Lactose-free diet Low-fiber diet (excludes coarse whole-grain breads) Low-sodium diet
Buying This Food Look for: Fresh bread. Check the date on closed packages of commercial bread.
Storing This Food Store bread at room temperature, in a tightly closed plastic bag (the best protection) or in a breadbox. How long bread stays fresh depends to a great extent on how much fat it contains. Bread made with some butter or other fat will keep for about three days at room tempera- ture. Bread made without fat (Italian bread, French bread) will dry out in just a few hours; for longer storage, wrap it in foil, put it inside a plastic bag, and freeze it. When you are ready to serve the French or Italian bread, you can remove it from the plastic bag and put the foil- wrapped loaf directly into the oven. Throw away moldy bread. The molds that grow on bread may produce carcinogenic toxins. Do not store fresh bread in the refrigerator; bread stales most quickly at temperatures just above freezing. The one exception: In warm, humid weather, refrigerating bread slows the growth of molds.
When You Are Ready to Serve This Food Use a serrated knife to cut bread easily.
What Happens When You Cook This Food Toasting is a chemical process that caramelizes sugars and amino acids (proteins) on the surface of the bread, turning the bread a golden brown. This chemical reaction, known both as the browning reaction and the Maillard reaction (after the French chemist who first identified it), alters the structure of the surface sugars, starches, and amino acids. The sugars become indigestible food fiber; the amino acids break into smaller fragments that are no longer nutritionally useful. Thus toast has more fiber and less protein than plain bread. How- ever, the role of heat-generated fibers in the human diet is poorly understood. Some experts consider them inert and harmless; others believe they may be hazardous.
How Other Kinds of Processing Affect This Food Freezing. Frozen bread releases moisture that collects inside the paper, foil, or plastic bag in which it is wrapped. If you unwrap the bread before defrosting it, the moisture will be lost and the bread will be dry. Always defrost bread in its wrappings so that it can reabsorb the moisture that keeps it tasting fresh. Drying. Since molds require moisture, the less moisture a food contains, the less likely it is support mold growth. That is why bread crumbs and Melba toast, which are relatively mois- ture-free, keep better than fresh bread. Both can be ground fine and used as a toasty-flavored thickener in place of flour or cornstarch.
Medical Uses and/or Benefits A lower risk of some kinds of cancer. In 1998, scientists at Wayne State University in Detroit conducted a meta-analysis of data from more than 30 well-designed animal studies mea- suring the anti-cancer effects of wheat bran, the part of grain with highest amount of the insoluble dietary fibers cellulose and lignin. They found a 32 percent reduction in the risk of colon cancer among animals fed wheat bran; now they plan to conduct a similar meta- analysis of human studies. Breads made with whole grain wheat are a good source of wheat bran. NOTE : The amount of fiber per serving listed on a food package label shows the total amount of fiber (insoluble and soluble). Early in 1999, however, new data from the long-running Nurses Health Study at Brigham Women’s Hospital/Harvard University School of Public Health showed that women who ate a high-fiber diet had a risk of colon cancer similar to that of women who ate a low fiber diet. Because this study contradicts literally hundreds of others conducted over the past 30 years, researchers are awaiting confirming evidence before changing dietary recommendations. Calming effect. Mood is affected by naturally occurring chemicals called neurotransmitters that facilitate transmission of impulses between brain cells. The amino acid tryptophan amino acid is the most important constituent of serotonin, a “calming” neurotransmitter. Foods such as bread, which are high in complex carbohydrates, help move tryptophan into your brain, increasing the availability of serotonin.
Adverse Effects Associated with This Food Allergic reactions and/or gastric distress. Bread contains several ingredients that may trigger allergic reactions, aggravate digestive problems, or upset a specific diet, among them gluten (prohibited on gluten-free diets); milk (prohibited on a lactose- and galactose-free diet or for people who are sensitive to milk proteins); sugar (prohibited on a sucrose-free diet); salt (controlled on a sodium-restricted diet); and fats (restricted or prohibited on a controlled-fat, low-cholesterol diet).... bread
Toxins. In conditions such as chronic glomerulonephritis (see KIDNEYS, DISEASES OF) and URAEMIA there is a severe anaemia due to the e?ect of the disease upon blood formation.
Drugs. Certain drugs, such as aspirin and the non-steroidal anti-in?ammatory drugs, may cause occult gastrointestinal bleeding.... defective blood formation
Nutritional Profile Energy value (calories per serving): High Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Low to high Sodium: Low (except self-rising flour) Major vitamin contribution: B vitamins Major mineral contribution: Iron
About the Nutrients in This Food Flour is the primary source of the carbohydrates (starch and fiber) in bread, pasta, and baked goods. All wheat and rye flours also provide some of the food fibers, including pectins, gums, and cellulose. Flour also contains significant amounts of protein but, like other plant foods, its proteins are “incomplete” because they are deficient in the essential amino acid lysine. The fat in the wheat germ is primarily polyunsaturated; flour contains no cholesterol. Flour is a good source of iron and the B vitamins. Iodine and iodophors used to clean the equipment in grain-processing plants may add iodine to the flour. In 1998, the Food and Drug Administration ordered food manufac- turers to add folates—which protect against birth defects of the spinal cord and against heart disease—to flour, rice, and other grain products. One year later, data from the Framingham Heart Study, which has fol- lowed heart health among residents of a Boston suburb for nearly half a century, showed a dramatic increase in blood levels of folic acid. Before the fortification of foods, 22 percent of the study participants had a folic acid deficiency; after, the number fell to 2 percent. Whole grain flour, like other grain products, contains phytic acid, an antinutrient that binds calcium, iron, and zinc ions into insoluble com- pounds your body cannot absorb. This has no practical effect so long as your diet includes foods that provide these minerals. Whole wheat flours. Whole wheat flours use every part of the kernel: the fiber-rich bran with its B vitamins, the starch- and protein-rich endosperm with its iron and B vitamins, and the oily germ with its vitamin E.* Because they contain bran, whole-grain flours have much more fiber than refined white flours. However, some studies suggest that the size of the fiber particles may have some bearing on their ability to absorb moisture and “bulk up” stool and that the fiber particles found in fine-ground whole wheat flours may be too small to have a bulking effect. Finely ground whole wheat flour is called whole wheat cake flour; coarsely ground whole wheat flour is called graham flour. Cracked wheat is a whole wheat flour that has been cut rather than ground; it has all the nutrients of whole wheat flour, but its processing makes it less likely to yield its starch in cooking. When dried and parboiled, cracked wheat is known as bulgur, a grain used primarily as a cereal, although it can be mixed with other flours and baked. Gluten flour is a low-starch, high-protein product made by drying and grinding hard- wheat flour from which the starch has been removed. Refined (“white”) flours. Refined flours are paler than whole wheat flours because they do not contain the brown bran and germ. They have less fiber and fat and smaller amounts of vitamins and minerals than whole wheat flours, but enriched refined flours are fortified with B vitamins and iron. Refined flour has no phytic acid. Some refined flours are bleached with chlorine dioxide to destroy the xanthophylls (carotenoid pigments) that give white flours a natural cream color. Unlike carotene, the carotenoid pigment that is converted to vitamin A in the body, xanthophylls have no vita- min A activity; bleaching does not lower the vitamin A levels in the flour, but it does destroy vitamin E. There are several kinds of white flours. All-purpose white flour is a mixture of hard and soft wheats, high in protein and rich in gluten.t Cake flour is a finely milled soft-wheat flour; it has less protein than all-purpose flour. Self-rising flour is flour to which baking powder has been added and is very high in sodium. Instant flour is all-purpose flour that has been ground extra-fine so that it will combine quickly with water. Semolina is a pale high-protein, low- gluten flour made from durum wheat and used to make pasta. Rye flours. Rye flour has less gluten than wheat flour and is less elastic, which is why it makes a denser bread.:j Like whole wheat flour, dark rye flour (the flour used for pumpernickel bread) contains the bran and the germ of the rye grain; light rye flour (the flour used for ordinary rye bread) The bran is t he kernel’s hard, brown outer cover, an ext raordinarily rich source of cellulose and lignin. The endosperm is t he kernel’s pale interior, where t he vitamins abound. The germ, a small part icle in t he interior, is t he part of t he kernel t hat sprouts. Hard wheat has less starch and more protein t han soft wheat. It makes a heavier, denser dough. Gluten is t he st icky substance formed when k neading t he dough relaxes t he long-chain molecules in t he proteins gliadin and glutenin so t hat some of t heir intermolecular bonds (bonds bet ween atoms in t he same molecule) break and new int ramolecular bonds (bonds bet ween atoms on different mol- ecules) are formed. Triticale flour is milled from triticale grain, a rye/wheat hybrid. It has more protein and less gluten than all-purpose wheat flour.
The Most Nutritious Way to Serve This Food With beans or a “complete” protein food (meat, fish, poultry, eggs, milk, cheese) to provide the essential amino acid lysine, in which wheat and rye flours are deficient.
Diets That May Restrict or Exclude This Food Low-calcium diet (whole grain and self-rising flours) Low-fiber diet (whole wheat flours) Low-gluten diet (all wheat and rye flour) Sucrose-free diet
Buying This Food Look for: Tightly sealed bags or boxes. Flours in torn packages or in open bins are exposed to air and to insect contamination. Avoid: Stained packages—the liquid that stained the package may have seeped through into the flour.
Storing This Food Store all flours in air- and moistureproof canisters. Whole wheat flours, which contain the germ and bran of the wheat and are higher in fat than white flours, may become rancid if exposed to air; they should be used within a week after you open the package. If you plan to hold the flour for longer than that, store it in the freezer, tightly wrapped to protect it against air and moisture. You do not have to thaw the flour when you are ready to use it; just measure it out and add it directly to the other ingredients. Put a bay leaf in the flour canister to help protect against insect infections. Bay leaves are natural insect repellents.
What Happens When You Cook This Food Protein reactions. The wheat kernel contains several proteins, including gliadin and glute- nin. When you mix flour with water, gliadin and glutenin clump together in a sticky mass. Kneading the dough relaxes the long gliadin and glutenin molecules, breaking internal bonds between individual atoms in each gliadin and glutenin molecule and allowing the molecules to unfold and form new bonds between atoms in different molecules. The result is a network structure made of a new gliadin-glutenin compound called gluten. Gluten is very elastic. The gluten network can stretch to accommodate the gas (carbon dioxide) formed when you add yeast to bread dough or heat a cake batter made with baking powder or baking soda (sodium bicarbonate), trapping the gas and making the bread dough or cake batter rise. When you bake the dough or batter, the gluten network hardens and the bread or cake assumes its finished shape. Starch reactions. Starch consists of molecules of the complex carbohydrates amylose and amylopectin packed into a starch granule. When you heat flour in liquid, the starch gran- ules absorb water molecules, swell, and soften. When the temperature of the liquid reaches approximately 140°F the amylose and amylopectin molecules inside the granules relax and unfold, breaking some of their internal bonds (bonds between atoms on the same molecule) and forming new bonds between atoms on different molecules. The result is a network that traps and holds water molecules. The starch granules then swell, thickening the liquid. If you continue to heat the liquid (or stir it too vigorously), the network will begin to break down, the liquid will leak out of the starch granules, and the sauce will separate.* Combination reaction. Coating food with flour takes advantage of the starch reaction (absorbing liquids) and the protein reaction (baking a hard, crisp protein crust).
Medical Uses and/or Benefits A lower risk of some kinds of cancer. In 1998, scientists at Wayne State University in Detroit conducted a meta-analysis of data from more than 30 well-designed animal studies mea- suring the anti-cancer effects of wheat bran, the part of grain with highest amount of the insoluble dietary fibers cellulose and lignin. They found a 32 percent reduction in the risk of colon cancer among animals fed wheat bran; now they plan to conduct a similar meta- analysis of human studies. Whole wheat flours are a good source of wheat bran. NOTE : The amount of fiber per serving listed on a food package label shows the total amount of fiber (insoluble and soluble). Early in 1999, however, new data from the long-running Nurses Health Study at Brigham Women’s Hospital/Harvard University School of Public Health showed that women who ate a high-fiber diet had a risk of colon cancer similar to that of women who ate a low-fiber diet. * A mylose is a long, unbranched, spiral molecule; amylopect in is a short, compact, branched molecule. A mylose has more room for forming bonds to water. Wheat flours, which have a higher rat io of amy- lose to amylopect in, are superior t hickeners. Because this study contradicts literally hundreds of others conducted over the past 30 years, researchers are awaiting confirming evidence before changing dietary recommendations.
Adverse Effects Associated with This Food Allergic reactions. According to the Merck Manual, wheat is one of the foods most commonly implicated as a cause of allergic upset stomach, hives, and angioedema (swollen lips and eyes). For more information, see under wheat cer ea ls. Gluten intolerance (celiac disease). Celiac disease is an intestinal allergic disorder that makes it impossible to digest gluten and gliadin (proteins found in wheat and some other grains). Corn flour, potato flour, rice flour, and soy flour are all gluten- and gliadin-free. Ergot poisoning. Rye and some kinds of wheat will support ergot, a parasitic fungus related to lysergic acid (LSD). Because commercial flours are routinely checked for ergot contamina- tion, there has not been a major outbreak of ergot poisoning from bread since a 1951 incident in France. Since baking does not destroy ergot toxins, the safest course is to avoid moldy flour altogether.... flour
Treatment. Abundant herb teas, singly or in combination: Agrimony, Balm, Raspberry leaves. Charcoal tablets bind the toxins. Holy (or Blessed) Thistle tea is traditional. For practitioner use Belladonna has a reputation. Hospitalisation may be necessary for wash-out. ... fungus poisoning
Symptoms: jaundice, delirium and convulsions.
As it is the work of the liver to neutralise incoming poisons it may suffer unfair wear and tear, alcohol and caffeine being common offenders.
Treatment for relief of symptoms only: same as for abscess of the liver.
Treatment by or in liaison with a general medical practitioner. ... liver – acute yellow atrophy
Nutritional Profile Energy value (calories per serving): Low Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Low Sodium: Moderate Major vitamin contribution: Vitamin C Major mineral contribution: Iron, potassium
About the Nutrients in This Food Cranberries are nearly 90 percent water. The rest is sugars and dietary fiber, including insoluble cellulose in the skin and soluble gums and pectins in the flesh. Pectin dissolves as the fruit ripens; the older and riper the cran- berries, the less pectin they contain. Cranberries also have a bit of protein and a trace of fat, plus moderate amounts of vitamin C. One-half cup cranberries has 1.6 g dietary fiber and 6.5 mg vitamin C (9 percent of the R DA for a woman, 7 percent of the R DA for a man). One-half cup cranberry sauce has 1.5 g dietary fiber and 3 mg vitamin C (4 percent of the R DA for a woman, 3 percent of the R DA for a man).
The Most Nutritious Way to Serve This Food Relish made of fresh, uncooked berries (to preserve the vitamin C, which is destroyed by heat) plus oranges.
Diets That May Restrict or Exclude This Food Low-fiber diet
Buying This Food Look for: Firm, round, plump, bright red berries that feel cool and dry to the touch. Avoid: Shriveled, damp, or moldy cranberries. Moldy cranberries may be contaminated with fusarium molds, which produce toxins that can irritate skin and damage tissues by inhibiting the synthesis of DNA and protein.
Storing This Food Store packaged cranberries, unwashed, in the refrigerator, or freeze unwashed berries in sealed plastic bags for up to one year.
Preparing This Food Wash the berries under running water, drain them, and pick them over carefully to remove shriveled, damaged, or moldy berries. R inse frozen berries. It is not necessary to thaw before cooking.
What Happens When You Cook This Food First, the heat will make the water inside the cranberry swell, so that if you cook it long enough the berry will burst. Next, the anthocyanin pigments that make cranberries red will dissolve and make the cooking water red. Anthocyanins stay bright red in acid solutions and turn bluish if the liquid is basic (alkaline). Cooking cranberries in lemon juice and sugar preserves the color as well as brightens the taste. Finally, the heat of cooking will destroy some of the vitamin C in cranberries. Cranberry sauce has about one-third the vitamin C of an equal amount of fresh cranberries.
Medical Uses and/or Benefits Urinary antiseptic. Cranberr y juice is a long-honored folk remedy for urinar y infections. In 1985, researchers at Youngstown (Ohio) State University found a “special factor” in cran- berries that appeared to keep disease-causing bacteria from adhering to the surface of cells in the bladder and urinar y tract. In 1999, scientists at study at Rutgers University (in New Jersey) identified specific tannins in cranberries as the effective agents. In 2004, research- ers at Beth Israel Medical Center (New York) published a review of 19 recent studies of cranberries. The report, in the journal American Family Physician, suggested that a regimen of eight ounces of unsweetened cranberr y juice or one 300 – 400 mg cranberr y extract tablet twice a day for up to 12 months safely reduced the risk of urinar y tract infections. In 2008, a similar review by scientists at the University of Stirling (Scotland) of 10 studies showed similar results.
Adverse Effects Associated with This Food Increased risk of kidney stones. Long-term use of cranberry products may increase the risk of stone formation among patients known to form oxalate stones (stones composed of calcium and/or other minerals).
Food/Drug Interactions Anticoagulants Anticoagulants (blood thinners) are drugs used to prevent blood clots. They are most commonly prescribed for patients with atrial fibrillation, an irregular heartbeat that allows blood to pool in the heart and possibly clot before being pumped out into the body. In 2006 researchers at the College of Pharmacy and the Antithrombosis Center at the Univer- sity of Illinois (Chicago) reported that consuming cranberry juice while using the anticoagu- lant warafin (Coumadin) might cause fluctuations in blood levels of the anticoagulant, thus reducing the drug’s ability to prevent blood clots.... cranberries
Habitat: Native to South-East Asia. Now cultivated in Assam, Bengal and South India.
English: Purging Croton.Ayurvedic: Jayapaala, Dravanti, Dantibija, Tintidiphala.Unani: Habb-us-Salaateen, Jamaal- gotaa, Hubb-ul-Malook.Siddha/Tamil: Nervaalam.Action: Cathartic, rubefacient, irritant. Used in ascites, anasarca, dropsy and enlargement of abdominal viscera.
The seed oil is purgative. It produces severe symptoms of toxicity when taken internally or applied externally to the skin.Croton oil showed tumour-promoting activity on mouse skin. The skin irritant and tumour promoting diterpene esters of the tigliane type (phorbol esters) and toxins have been isolated from the seeds. (In China, where the herb is employed for the treatment of gastro-intestinal disturbances, the highest incidence of naso- pharyngeal cancer has been reported.) 1 ml oil is usually fatal. Phorbols (terpenoids) from nonvolatile oil are toxic. Crotin, a toxic albuminous substance, is not extracted in the oil. The plant caused haematuria and swelling of lymph glands in animals.Dosage: Seed—6-12 mg powder. (API Vol. IV.)... croton tigliumClostridia are found in soil and in the gastrointestinal tracts of humans and animals.
They produce powerful toxins and are responsible for potentially life-threatening diseases such as botulism, tetanus, and gangrene.... clostridium
Habitat: Native to China; now grown in Himachal Pradesh, Kumaon, the Nilgiris and West Bengal for edible fruits.
English: Japanese Persimmon.Ayurvedic: Tinduka (var.).Action: Hypotensive, hepatopro- tective, antidote to poisons and bacterial toxins. Calyx and peduncle of fruit—used in the treatment of cough and dyspnoea. Roasted seeds—used as a substitute for coffee.
The fruit, in addition to sugars, glucose, fructose, ascorbic acid, citric acid, contains (% of fresh weight) 0.20-1.41 tannins, 0.21-10.07 total pectins, 0.67 pentosans and 0.16-0.25 polyphenols. The fruit also contains 2.4 mg/100 g carotenoids; carotene expressed as vitamin A 2200-2600 IU. The carote- noids identified in the pulp include cryptoxanthine, zeaxanthin, antherax- anthin, lycopene and beta-carotene. (Many carotenoids originally present in the fruit decompose during ripening.The fruit pulp is an antidote to bacterial toxins and is used in the preparation of a vaccine for pertussis.Condensed tannins from the fruits effectively inhibited 2-nitrofluorene mutagen.The immature leaves contain a ster- oidal saponin, lignin and phenolic compounds. Eugenol and dihydroac- tinidiolide are reported from fresh leaves.The leaves are reported to exhibit hepatoprotective activity. Leaves also contain hypotensive principles. Astra- galin and isoquercitrin have been isolated from leaves.... diospyros kakiTreatment Provided that the patient is not allergic to horse serum, an injection of the antitoxin is given immediately. A one-week course of penicillin is started (or erythromycin if the patient is allergic to penicillin). Diphtheria may cause temporary muscle weakness or paralysis, which should resolve without special treatment; if the respiratory muscles are involved, however, arti?cial respiration may be necessary.
All infants should be immunised against diphtheria; for details see table under IMMUNISATION.... diphtheria
Necrotizing fasciitis is most likely to occur as a complication following surgery.
The initial symptoms are inflammation and blistering of the skin.
The infection spreads very rapidly, and the bacteria release enzymes and toxins that can cause extensive destruction of deeper tissues and damage internal organs.
Urgent treatment with antibiotic drugs and removal of all infected tissue are essential.
The infection is life-threatening.... necrotizing fasciitis
In some people, the bacteria cause no symptoms, but others suffer a sore throat, fever, and enlarged lymph nodes in the neck. In some cases, the bacterial toxins produce a rash (see scarlet fever).
Treatment is usually with a penicillin drug. Untreated, strep throat may lead to glomerulonephritis or rheumatic fever.... strep throat
Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.
Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.
WILSON’S DISEASE.
Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).
Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.
Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.
Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.
Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.
•Hepatitis A virus (HAV) is an ENTEROVIRUS
which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.
Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.
Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.
Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.
Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic
viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.
As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.
Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around
0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).
Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:
Parenteral drug abusers.
Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.
Men who have sex with men.
Patients undergoing regular haemodialysis.
Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis
Acquired immunity depends upon the immune system recognising a substance as foreign the ?rst time it is encountered, storing this information so that it can mount a reaction the next time the substance enters the body. This is the usual outcome of natural infection or prophylactic IMMUNISATION. What happens is that memory of the initiating ANTIGEN persists in selected lymphocytes (see LYMPHOCYTE). Further challenge with the same antigen stimulates an accelerated, more vigorous secondary response by both T- and B-lymphocytes (see below). Priming the immune system in this manner forms the physiological basis for immunisation programmes.
Foreign substances which can provoke an immune response are termed ‘antigens’. They are usually proteins but smaller molecules such as drugs and chemicals can also induce an immune response. Proteins are taken up and processed by specialised cells called ‘antigenpresenting cells’, strategically sited where microbial infection may enter the body. The complex protein molecules are broken down into short amino-acid chains (peptides – see PEPTIDE) and transported to the cell surface where they are presented by structures called HLA antigens (see HLA SYSTEM).
Foreign peptides presented by human leucocyte antigen (HLA) molecules are recognised by cells called T-lymphocytes. These originate in the bone marrow and migrate to the THYMUS GLAND where they are educated to distinguish between foreign peptides, which elicit a primary immune response, and self-antigens (that is, constituents of the person themselves) which do not. Non-responsiveness to self-antigens is termed ‘tolerance’ (see AUTOIMMUNITY). Each population or clone of T-cells is uniquely responsive to a single peptide sequence because it expresses a surface molecule (‘receptor’) which ?ts only that peptide. The responsive T-cell clone induces a speci?c response in other T-and B-lymphocyte populations. For example, CYTOTOXIC T-cells penetrate infected tissues and kill cells which express peptides derived from invading micro-organisms, thereby helping to eliminate the infection.
B-lymphocytes secrete ANTIBODIES which are collectively termed IMMUNOGLOBULINS (Ig)
– see also GAMMA-GLOBULIN. Each B-cell population (clone) secretes antibody uniquely speci?c for antigens encountered in the blood, extracellular space, and the LUMEN of organs such as the respiratory passages and gastrointestinal tract.
Antibodies belong to di?erent Ig classes; IgM antibodies are synthesised initially, followed by smaller and therefore more penetrative IgG molecules. IgA antibodies are adapted to cross the surfaces of mucosal tissues so that they can adhere to organisms in the gut, upper and lower respiratory passages, thereby preventing their attachment to the mucosal surface. IgE antibodies also contribute to mucosal defence but are implicated in many allergic reactions (see ALLERGY).
Antibodies are composed of constant portions, which distinguish antibodies of di?erent class; and variable portions, which confer unique antigen-binding properties on the product of each B-cell clone. In order to match the vast range of antigens that the immune system has to combat, the variable portions are synthesised under the instructions of a large number of encoding GENES whose products are assembled to make the ?nal antibody. The antibody produced by a single B-cell clone is called a monoclonal antibody; these are now synthesised and used for diagnostic tests and in treating certain diseases.
Populations of lymphocytes with di?erent functions, and other cells engaged in immune responses, carry distinctive protein markers. By convention these are classi?ed and enumerated by their ‘CD’ markers, using monoclonal antibodies speci?c for each marker.
Immune responses are in?uenced by cytokines which function as HORMONES acting over a short range to accelerate the activation and proliferation of other cell populations contributing to the immune response. Speci?c immune responses collaborate with nonspeci?c defence mechanisms. These include the COMPLEMENT SYSTEM, a protein-cascade reaction designed to eliminate antigens neutralised by antibodies and to recruit cell populations which kill micro-organisms.... immunity
Habitat: Near sea, especially on the West Coast.
English: Goat's Foot Creeper.Ayurvedic: Chhagalaantri, Mar- yaada-valli.Siddha/Tamil: Adambu, Attukkal, Musattalai.Action: Astringent, stomachic, laxative, antidiarrhoeal, antiemetic, analgesic. Leaf—diuretic, anti- inflammatory. Used in colic, prolapsus ani; externally in rheumatism. Essential oil of leaves— antagonistic to histamine. Leaf extract is used for different types of inflammations including injuries caused by poisonous jelly-fish.
Clinical trials have proved that an extract (IPA) inhibited the action of jelly-fish toxins. Its topical application inhibited carrageenan-induced paw and ear oedema induced by arachi- donic acid or ethyl phenylpropionate in rats. The crude extract of leaves also show inhibitory effect on prostaglan- din synthesis in vitro.Crude extract (IPA) of the leaves has also been shown to antagonize smooth muscle contraction induced by several agonists via non-specific mechanism. Antispasmodic isoprenoids, beta-damascenone and E-phytol have been isolated from the extract. The an- tispasmodic activity was found to be in the same range as that of papaverine.The alcoholic extract of leaves showed insulinogenic and hypogly- caemic activities in rats, comparable to the hypoglycaemic drug chlor- propamide.The leaves and seeds contain indole alkaloid. Plant also contains a steroid, an amide, pentatriacontane, triacon- tane, volatile oil and behenic, melissic, butyric and myristic acids.... ipomoea pes-capraeHabitat: Cultivated in many parts of India.
English: Tomato, Love Apple.Unani: Tamaatar.Action: Mild aperient, blood purifier, cholagogue, digestive. Used in homoeopathy for treating rheumatic conditions, colds, chills, digestive disorders, diabetes, obesity, leucorrhoea, metrorrhagia.
Tomato is a powerful deobstruent. It promotes flow of bile; mildly laxative, especially when taken raw. Tomato stimulates torpid liver and kidneys and helps to wash away toxins. Tomato is recommended for diabetics. It is a major dietary source of carotenoid lycopene.Tomato juice inhibits carcinogenic N-nitrosocompound formation chiefly in the stomach. Most of the inhibition of formation of N-nitrosomorpholine by phenolic fraction of tomato juice was due to chlorogenic acids. The ascorbate fraction of the juice also contains compounds that inhibit ni- trosation.Consumption of tomato juice can significantly increase serum lycopene levels. (Decreased serum lycopene concentrations are associated with an increase risk of prostate cancer.) (Natural Medicines Comprehensive Database, 2007.)The alcoholic extract of tomato possesses CNS depressant and analgesic properties.... lycopersicon esculentumAmong the smallest and simplest microorganisms are the viruses. First described as ?lterable agents, and ranging in size from 20–30 nm to 300 nm, they may be directly visualised only by electron microscopy. They consist of a core of deoxyribonucleic or ribonucleic acid (DNA or RNA) within a protective protein coat, or capsid, whose subunits confer a geometric symmetry. Thus viruses are usually cubical (icosahedral) or helical; the larger viruses (pox-, herpes-, myxo-viruses) may also have an outer envelope. Their minimal structure dictates that viruses are all obligate parasites, relying on living cells to provide essential components for their replication. Apart from animal and plant cells, viruses may infect and replicate in bacteria (bacteriophages) or fungi (mycophages), which are damaged in the process.
Bacteria are larger (0·01–5,000 µm) and more complex. They have a subcellular organisation which generally includes DNA and RNA, a cell membrane, organelles such as ribosomes, and a complex and chemically variable cell envelope – but, unlike EUKARYOTES, no nucleus. Rickettsiae, chlamydia, and mycoplasmas, once thought of as viruses because of their small size and absence of a cell wall (mycoplasma) or major wall component (chlamydia), are now acknowledged as bacteria; rickettsiae and chlamydia are intracellular parasites of medical importance. Bacteria may also possess additional surface structures, such as capsules and organs of locomotion (?agella) and attachment (?mbriae and stalks). Individual bacterial cells may be spheres (cocci); straight (bacilli), curved (vibrio), or ?exuous (spirilla) rods; or oval cells (coccobacilli). On examination by light microscopy, bacteria may be visible in characteristic con?gurations (as pairs of cocci [diplococci], or chains [streptococci], or clusters); actinomycete bacteria grow as ?laments with externally produced spores. Bacteria grow essentially by increasing in cell size and dividing by ?ssion, a process which in ideal laboratory conditions some bacteria may achieve about once every 20 minutes. Under natural conditions, growth is usually much slower.
Eukaryotic micro-organisms comprise fungi, algae, and protozoa. These organisms are larger, and they have in common a well-developed internal compartmentation into subcellular organelles; they also have a nucleus. Algae additionally have chloroplasts, which contain photosynthetic pigments; fungi lack chloroplasts; and protozoa lack both a cell wall and chloroplasts but may have a contractile vacuole to regulate water uptake and, in some, structures for capturing and ingesting food. Fungi grow either as discrete cells (yeasts), multiplying by budding, ?ssion, or conjugation, or as thin ?laments (hyphae) which bear spores, although some may show both morphological forms during their life-cycle. Algae and protozoa generally grow as individual cells or colonies of individuals and multiply by ?ssion.
Micro-organisms of medical importance include representatives of the ?ve major microbial groups that obtain their essential nutrients at the expense of their hosts. Many bacteria and most fungi, however, are saprophytes (see SAPROPHYTE), being major contributors to the natural cycling of carbon in the environment and to biodeterioration; others are of ecological and economic importance because of the diseases they cause in agricultural or horticultural crops or because of their bene?cial relationships with higher organisms. Additionally, they may be of industrial or biotechnological importance. Fungal diseases of humans tend to be most important in tropical environments and in immuno-compromised subjects.
Pathogenic (that is, disease-causing) microorganisms have special characteristics, or virulence factors, that enable them to colonise their hosts and overcome or evade physical, biochemical, and immunological host defences. For example, the presence of capsules, as in the bacteria that cause anthrax (Bacillus anthracis), one form of pneumonia (Streptococcus pneumoniae), scarlet fever (S. pyogenes), bacterial meningitis (Neisseria meningitidis, Haemophilus in?uenzae) is directly related to the ability to cause disease because of their antiphagocytic properties. Fimbriae are related to virulence, enabling tissue attachment – for example, in gonorrhoea (N. gonorrhoeae) and cholera (Vibrio cholerae). Many bacteria excrete extracellular virulence factors; these include enzymes and other agents that impair the host’s physiological and immunological functions. Some bacteria produce powerful toxins (excreted exotoxins or endogenous endotoxins), which may cause local tissue destruction and allow colonisation by the pathogen or whose speci?c action may explain the disease mechanism. In Staphylococcus aureus, exfoliative toxin produces the staphylococcal scalded-skin syndrome, TSS toxin-1 toxic-shock syndrome, and enterotoxin food poisoning. The pertussis exotoxin of Bordetella pertussis, the cause of whooping cough, blocks immunological defences and mediates attachment to tracheal cells, and the exotoxin produced by Corynebacterium diphtheriae causes local damage resulting in a pronounced exudate in the trachea.
Viruses cause disease by cellular destruction arising from their intracellular parasitic existence. Attachment to particular cells is often mediated by speci?c viral surface proteins; mechanisms for evading immunological defences include latency, change in viral antigenic structure, or incapacitation of the immune system – for example, destruction of CD 4 lymphocytes by the human immunode?ciency virus.... microbiology
High-temperature short-time (HTST) pasteurisation consists of heating the milk at a temperature not less than 71·7 °C (161 °F) for at least 15 seconds, followed by immediate cooling to a temperature of not more than 10 °C (50 °F).
Low-temperature pasteurisation, or ‘holder’ process, consists in maintaining the milk for at least half an hour at a temperature between 63 and 65 °C (145–150 °F), followed by immediate cooling to a temperature of not more that 10 °C (50 °F). This has the e?ect of considerably reducing the number of bacteria contained in the milk, and of preventing the diseases conveyed by milk as referred to above.... pasteurisation
The concept of the dose-response is important for understanding the risk of exposure to a particular substance. This is embodied in a statement by Paracelsus (c.1493–1541): ‘All substances are poisons; there is none which is not a poison. The right dose di?erentiates a poison and a remedy.’
Poisoning may occur in a variety of ways: deliberate – SUICIDE, substance abuse or murder; accidental – including accidental overdose of medicines; occupational; and environmental
– including exposure during ?re.
Ingestion is the most common route of exposure, but poisoning may also occur through inhalation, absorption through the skin, by injection and through bites and stings of venomous animals. Poisoning may be described as acute, where a single exposure produces clinical effects with a relatively rapid onset; or chronic, where prolonged or repeated exposures may produce clinical effects which may be insidious in onset, cumulative and in some cases permanent.
Diagnosis of poisoning is usually by circumstantial evidence or elimination of other causes of the clinical condition of the patient. Some substances (e.g. opioids) produce a characteristic clinical picture in overdose that can help with diagnosis. In some patients laboratory analysis of body ?uids or the substance taken may be useful to determine or con?rm the o?ending agent. Routine assays are not necessary. For a very small number of poisons, such as paracetamol, aspirin, iron and lead, the management of the patient may depend on measuring the amount of poison in the bloodstream.
Accurate statistics on the incidence of poisoning in the UK are lacking. Mortality ?gures are more reliable than morbidity statistics; annually, well over 100,000 cases of poisoning are admitted to hospital. The annual number of deaths from poisoning is relatively small – about 300 – and in most cases patients die before reaching hospital. Currently, CARBON MONOXIDE (CO) is by far the most common cause of death due to poisoning. The most common agents involved in intentional or accidental poisoning are drugs, particularly ANALGESICS, ANTIDEPRESSANT DRUGS and SEDATIVES. Alcohol is also commonly taken by adults, usually in combination with drugs. Children frequently swallow household cleaners, white spirit, plant material – such as belladonna (deadly nightshade) and certain mushrooms; for example, death cap and ?y agaric – aftershave and perfume as well as drugs. If possible, the suspect container, drug or plant should be taken with the victim to the hospital or doctor. The use of child-resistant containers has reduced the number of admissions of children to hospital for treatment. Bixtrex® is an intensely bitter-tasting agent which is often added to products to discourage ingestion; however, not everybody is able to taste it, nor has any bene?cial e?ect been proven.
Treatment of poisoning usually begins with decontamination procedures. For ingested substances this may involve making the patient sick or washing the stomach out (GASTRIC LAVAGE): this is usually only worthwhile if performed soon after ingestion. It should be emphasised that salt (sodium chloride) water must never be given to induce vomiting, since this procedure is dangerous and has caused death. For substances spilt on the skin, the affected area should immediately be thoroughly washed and all contaminated clothing removed. Following eye exposure, the affected eye/s should be thoroughly irrigated with saline or water.
Treatment thereafter is generally symptomatic and supportive, with maintenance of the victim’s respiratory, neurological and cardiovascular systems and, where appropriate, monitoring of their ?uid and electrolyte balance and hepatic and renal function. There are speci?c antidotes for a few substances: the most important of these are PARACETAMOL, iron, cyanide (see CYANIDE POISONING), opioids (see OPIOID), DIGOXIN, insecticides and some heavy metals. Heavy-metal poisoning is treated with CHELATING AGENTS – chemical compounds that form complexes by binding metal ions: desferrioxamine and pencillinamine are two such agents. The number of people presenting with paracetamol overdose – a common drug used for attempted suicide – has fallen sharply since restrictions were placed on its over-thecounter sales.
When a patient presents with an illness thought to be caused by exposure to substances at work, further exposure should be limited or prevented and investigations undertaken to determine the source and extent of the problem. Acutely poisoned workers will usually go to hospital, but those suffering from chronic exposure may attend their GP with non-speci?c symptoms (see OCCUPATIONAL HEALTH, MEDICINE AND DISEASES).
In recent years, legislation has been enacted in the UK to improve safety in the workplace and to ensure that data on the hazardous constituents and effects of chemicals are more readily available. These o?cial controls include the Control of Substances Hazardous to Health (COSHH) and the Chemicals (Hazard Information and Packaging) Regulations (CHIP) and are UK legislation in response to European Union directives.
The National Poisons Information Service is a 24-hour emergency telephone service available to the medical profession and provides information on the likely effects of numerous agents and advice on the management of the poisoned patient. The telephone numbers are available in the medical literature. In the UK this is not a public-access service. People who believe they, or their relatives, have been poisoned should seek medical advice from their GPs or attend their local hospital.
Toxbase The National Poisons Information Service provides a primary clinical toxicology database on the Internet: www.spib.axl.co.uk. This website provides information about routine diagnosis, treatment and management of people exposed to drugs, household products and industrial and agricultural products.
(See also APPENDIX 1: BASIC FIRST AID.)... poisons
Habitat: Cultivated in Uttar Pradesh, Punjab, Maharashtra and Gujarat.
English: Radish.Ayurvedic: Muulaka, Laghu- muulaka, Muulakapotikaa, Visra, Shaaleya, Marusambhava. Pods— Sungraa, Singri, Mungraa.Unani: Muuli, Turb Fajal.Siddha/Tamil: Mullangi.Action: Radish—preparations are used in liver, gallbladder and urinary complaints. Green leaves— diuretic and carminative. Seeds— diuretic, purgative, expectorant.
A decoction of dry radish is given orally in piles. Extract of the dry root is given for hiccough, influenza, dysentery, colic and urinary troubles.Key application: In peptic disorders, especially those related to dyskinesia of the bile ducts; and in catarrhs of the upper respiratory tract. (German Commission E.)The Ayurvedic Pharmacopoeia of India recommends the juice of the whole plant in sinusitis; juice of the root in diseases of the throat and sinusitis; and the seed in amenorrhoea, cough and dyspnoea.The fleshy root and seeds contain trans-4-methyl-thiobutenyl isothio- cyanate glucoside (the pungent principle), cyanidin-5-glucoside-3-sophoro- side, pelargonidin diglycoside, cyani- din diglycoside, 5-methyl-L-cysteine- sulphoxide (methiin), steroidal sa- pogenins and sulphorophene.The enzymes present in the radish are phosphatase, catalase, sucrase, amylase, alcohol dehydrogenase and pyruvic carboxylase.Radish contains caffeic acid and fer- ulic acid which exhibit hepatoprotec- tive and choleretic properties. It contains choline which prevents deposition of fat in liver. Amino acids, or- nithine, citrulline, arginine, glutamic acid and asparatic acid remove toxins from the body and urea acumulation.Radish is a good source of ascorbic acid (15-40 mg/100 g), trace elements include aluminium, barium, lithium, manganese, silicon, titanium, also iodine (upto 18 mcg/100 g) and ascor- bigen.Roots, leaves, flowers and pods are active against Gram-positive bacteria.The seeds are reported to contain a broad spectrum antibiotic, machro- lysin, specific against Mycobacterium tuberculosis. Raphanin, extracted from the seeds, is active against Grampositive and Gram-negative bacteria.A purified basic protein, homologous to nonspecific lipid transfer proteins, from seeds showed antifungal activity.Raphanus caudatus Linn., synonym R. sativus var. caudatus, is known as Rat-Tail Radish.A native to Java, it is cultivated in northern and western India. The root is not used; pods, purple or violet in colour, are consumed for properties attributed to Raphanus sp. These are known as Mungraa or Sungraa.Dosage: Whole plant-20-40 ml juice; root—15-30 ml juice. (API, Vol. II.) Seed—1-3 g powder. (API, Vol. III.)... raphanus sativusHabitat: Western Himalayas at 1,800 and Kashmir at 2,400 m, also grown in gardens.
English: Holy Thistle, Milk Thistle.Action: Seeds—liver protective, gallbladder protective, antioxidant. Used in jaundice and other biliary affections, intermittent fevers, uterine trouble, also as a galactagogue. Alcoholic extract used for haemorrhoids and as a general substitute for adrenaline. Seeds are used for controlling haemorrhages. Leaves—sudorific and aperient. Young leaves and flowering heads are consumed by diabetics.
Key application: In dyspeptic complaints. As an ingredient of formulations for toxic liver damage; chronic inflammatory liver disease and hepatic cirrhosis induced by alcohol, drugs or toxins. (Expanded Commission E Monographs, WHO.)The seeds gave silymarin (flavanol lignin mixture), composed mainly of silybin A, silybin B (mixture known as silibinin), with isosilybin A, isosilybin B, silychristin, silydianin. In Germany, Milk Thistle has been used extensively for liver diseases and jaundice. Sily- marin has been shown conclusively to exert an antihepatotoxic effect in animals against a variety of toxins, particularly those of death cap mushroom, Amanita phalloides. Silybin, when given by intravenous injection to human patients up to 48 hours after ingestion of the death cap, was found to be highly effective in preventing fatalities.Silymarin has been used successfully to treat patients with chronic hepatitis and cirrhosis; it is active against hepatitis B virus, and lowers fat deposits in the liver in animals.(For hepatic cirrhosis: 420 mg per day; for chronic active hepatitis 240 mg twice daily—extract containing 7080% silimarin.)... silybum marianumHabitat: Kashmir at 1,200-2,400 m.
English: Pale Wood Violet, Wood Violet.Unani: Banafashaa (related species).Action: Plant—pectoral, bechic; used in chest troubles. Stem, leaf and flower—applied to foul sores and wounds.
Habitat: Native to Europe; grown as an ornamental.
English: Heartsease, Wild Pansy.Unani: Banafashaa (related species).Action: Herb—anti-inflammatory, antiallergic, expectorant, diuretic, antirheumatic, alterative. Used for bronchitis, rheumatism, chronic skin disorders and for preventing capillary haemorrhage when under corticosteroid therapy. Root— antidysenteric; used as a substitute for Cephaelis ipecacuanha.
Key application: Externally in mild seborrheic skin diseases and milk scall in children. (German Commission E.) The British Herbal Pharmacopoeia recognizes the herb as an expectorant and dermatological agent.The herb contains rutin, violin and salicylic acid. The flower contains rutin, quercetin, violanthin (6,8-digly- coside of apigenin), violaxanthin, p- hydroxycinnamic acid and delphini- din. A flavone C-glycoside-saponarin has also been obtained from flowers. Flowers, in addition, contain 15-cis- violaxanthin.The herb exhibits anticoagulant property and diminishes the aggregation of platelets. It can be used as a preventive measure against thrombosis.Habitat: Temperate Himalayas from Kashmir to Nepal between 1,200 and 2,700 m (a semiparasitic plant).
English: European Mistletoe.Ayurvedic: Bandaaka, Suvarna- bandaaka. Vrikshaadani (substitute).Unani: Kishmish Kaabuli.Action: Vasodilator, cardiac depressant, tranquiliser, stimulates the vagus nerve which slows the pulse, anti-inflammatory, diuretic, immune enhancer, antineoplas- tic. Used for hypertension and tachycardia, as a nervine tonic.
The extract of leafy twigs is anti- inflammatory exerting an action upon capillary permeability and oedema. It stimulates granulation and the neoformation of connective tissue.Key application: For treating degenerative inflammation of the joints by stimulating cuti- visceral reflexes following local inflammation brought about by intradermal injections; as palliative therapy for malignant tumour through non-specific stimulation. (German Commission E.)Mistletoe contains glycoproteins; flavonoids, usually quercetin-derived (dependent on host tree to some extent); polypeptides; phenylcarboxylic acids; polysaccharides (including viscid acid); alkaloids; lignans.Cardiotonic activity is due to the lig- nans. The polysaccharides stimulate the immune response. Antineoplas- tic activity is claimed to be responsible for prolongation of survival time in cancer patients. Polypeptides (visco- toxins) inhibit tumours and stimulate immune resistance. (For uses of lectin from Mistletoe in cancer, see Eur J cancer, 2001, Jan, 37(1), 23-31; Eur J Cancer 2001, 37 (15), 19101920.) (For application in hepatitis, see Fitoterapia, 70, 2001.)... viola sylvestrisDefects in the visual ?eld (scotomas) can be produced by a variety of disorders. Certain of these produce speci?c ?eld defects. For example, GLAUCOMA, some types of brain damage and some TOXINS can produce speci?c defects in the visual ?eld. This type of ?eld defect may be very useful in diagnosing a particular disorder. The blind spot is that part of the visual ?eld corresponding to the optic disc. There are no rods nor cones on the optic disc and therefore no light perception from this area. The blind spot can be found temporal (i.e. on the outer side) of the ?xation point. (See also EYE.)... vision, field of