Alcoholics anonymous Health Dictionary

Alcoholics Anonymous: From 2 Different Sources


A worldwide, independent, self-help organization that is operated locally by people working on a voluntary basis to overcome alcohol dependence. Regular group meetings are held in which members are encouraged to help one another stay sober by sharing their experiences openly and offering support and advice.
Health Source: BMA Medical Dictionary
Author: The British Medical Association
(AA) an international voluntary agency of mutual support that is organized and operated locally among those with alcohol dependency. Members are expected to follow a 12-step programme, which includes admitting to their drink problems, recognizing a higher spiritual power that gives strength to overcome these problems, and helping and supporting fellow members.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Delirium Tremens

(DTs) A distinct neurologic disorder suffered by late-in­the-game alcoholics, characterized by sensory confusion (is it red or sour, hot or loud, smelly or wet, am I thinking or screaming); part of the problem is the result of diminished myelination of nerves and decreased brain antioxidant insulation (cholesterol), with nerve impulses “shorting out” across temporary synapses. It sounds ugly.... delirium tremens

Beriberi

(Singhalese: beri = extreme weakness.) Formerly a major health problem in many Asian countries, beriberi is a nutritional de?ciency disease resulting from prolonged de?ciency of the water-soluble vitamin, THIAMINE (vitamin B1). It is often associated with de?ciencies of other members of the the vitamin B complex (see APPENDIX 5: VITAMINS). A major public-health problem in countries where highly polished rice constitutes the staple diet, beriberi also occurs sporadically in alcoholics (see WERNICKE’S ENCEPHALOPATHY) and in people suffering from chronic malabsorptive states. Clinical symptoms include weakness, paralysis – involving especially the hands and feet (associated with sensory loss, particularly in the legs) – and ‘burning sensations’ in the feet (dry beriberi). Alternatively, it is accompanied by oedema, palpitations and a dilated heart (wet beriberi). Death usually results from cardiac failure. Thiamine de?ciency can be con?rmed by estimating erythrocyte transketolase concentration; blood and urine thiamine levels can be measured by high-pressure liquid chromatography.

Treatment consists of large doses of vitamin B1 – orally or intramuscularly; a diet containing other vitamins of the B group; and rest.

Infantile beriberi This is the result of maternal thiamine de?ciency; although the mother is not necessarily affected, the breast-fed baby may develop typical signs (see above). Optic and third cranial, and recurrent laryngeal nerves may be affected; encephalopathy can result in convulsions, coma and death.... beriberi

Alcohol

A colourless liquid, also called ethanol or ethyl-alcohol, produced by the fermentation of carbohydrates by yeast. Medically, alcohol is used as a solvent and an antiseptic; recreationally it is a widely used drug, taken in alcoholic drinks to give a pleasant taste as well as to relax, reduce inhibitions, and increase sociability. Taken to excess, alcohol causes much mental and physical harm – not just to the individual imbibing it, but often to their family, friends, community and work colleagues.

Alcohol depresses the central nervous system and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person’s re?exes and concentration; potentially dangerous effects when, for example, driving or operating machinery. Drunkenness causes slurred speech, muddled thinking, amnesia (memory loss), drowsiness, erectile IMPOTENCE, poor coordination and dulled reactions – thereby making driving or operating machinery especially dangerous. Disinhibition may lead to extreme euphoria, irritability, misery or aggression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to COMA and respiratory failure.

Persistent alcohol misuse leads to physical, mental, social and occupational problems, as well as to a risk of DEPENDENCE (see also ALCOHOL DEPENDENCE). Misuse may follow several patterns: regular but controlled heavy intake, ‘binge’ drinking, and dependence (alcoholism). The ?rst pattern usually leads to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease and impotence. The second is most common among young men and usually leads to mainly social and occupational problems – getting into ?ghts, jeopardising personal relationships, overspending on alcohol at weekends, and missing days o? work because of hangovers. The third pattern – alcohol dependence – is the most serious, and can severely disrupt health and social stability.

Many researchers consider alcohol dependence to be an illness that runs in families, with a genetic component which is probably passed on as a vulnerable personality. But it is hard to disentangle genetic, environmental and social factors in such families. In the UK there are estimated to be around a million people suffering from alcohol dependence and a similar number who have di?culty controlling their consumption (together about 1:30 of the population).

Alcohol causes tolerance and both physical and psychological dependence (see DEPENDENCE for de?nitions). Dependent drinkers classically drink early in the morning to relieve overnight withdrawal symptoms. These symptoms include anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threatening delirium tremens (DTs), with severe tremor, hallucinations (often visual – seeing spiders and monsters, rather than the pink elephants of romantic myth), and CONVULSIONS. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe INCOORDINATION and double-vision, can occur in WERNICKE’S ENCEPHALOPATHY, a serious neurological condition due to lack of the B vitamin thiamine (whose absorption from the stomach is markedly reduced by alcohol). If not treated urgently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsako?’s psychosis, with severe amnesia. Finally, prolonged alcohol misuse can cause a form of dementia.

In addition to these severe neurological disorders, the wide range of life-threatening problems caused by heavy drinking includes HEPATITIS, liver CIRRHOSIS, pancreatitis (see PANCREAS, DISEASES OF), gastrointestinal haemorrhage, suicide and FETAL ALCOHOL SYNDROME; pregnant women should not drink alcohol as this syndrome may occur with more than a glass of wine or half-pint of beer a day. The social effects of alcohol misuse – such as marital breakdown, family violence and severe debt – can be equally devastating.

Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are treated in the short term by doctors who fail to spot, or never ask about, heavy drinking. Second, attempts at treating alcohol dependence by detoxi?cation or ‘drying out’ (substituting a tranquillising drug for alcohol and withdrawing it gradually over about a week) are not always followed-up by adequate support at home, so that drinking starts again. Home support by community alcohol teams comprising doctors, nurses, social workers and, when appropriate, probation o?cers is a recent development that may have better results. Many drinkers ?nd the voluntary organisation Alcoholics Anonymous (AA) and its related groups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from alcohol is encouraged by intensive psychological and social support from fellow ex-drinkers.

Useful contacts are: Alcoholics Anonymous; Al-Anon Family Groups UK and Eire (including Alateen); Alcohol Concern; Alcohol Focus Scotland; and Alcohol and Substance Misuse.

1 standard drink =1 unit

=••• pint of beer

=1 measure of spirits

=1 glass of sherry or vermouth

=1 glass of wine

Limits within which alcohol is believed not to cause long-term health risks:... alcohol

Beer

(Ale)

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

About the Nutrients in This Food Beer and ale are fermented beverages created by yeasts that convert the sugars in malted barley and grain to ethyl alcohol (a.k.a. “alcohol,” “drink- ing alcohol”).* The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits. One 12-ounce glass of beer has 140 calo- ries, 86 of them (61 percent) from alcohol. But the beverage—sometimes nicknamed “liquid bread”—is more than empty calories. Like wine, beer retains small amounts of some nutrients present in the food from which it was made. * Because yeasts cannot digest t he starches in grains, t he grains to be used in mak ing beer and ale are allowed to germinate ( “malt” ). When it is t ime to make t he beer or ale, t he malted grain is soaked in water, forming a mash in which t he starches are split into simple sugars t hat can be digested (fermented) by t he yeasts. If undisturbed, t he fermentat ion will cont inue unt il all t he sugars have been digested, but it can be halted at any t ime simply by raising or lowering t he temperature of t he liquid. Beer sold in bott les or cans is pasteurized to k ill t he yeasts and stop t he fermentat ion. Draft beer is not pasteurized and must be refrigerated unt il tapped so t hat it will not cont inue to ferment in t he container. The longer t he shipping t ime, t he more likely it is t hat draft beer will be exposed to temperature variat ions t hat may affect its qualit y—which is why draft beer almost always tastes best when consumed near t he place where it was brewed. The Nutrients in Beer (12-ounce glass)

  Nutrients   Beer   %R DA
Calcium 17 mg 1.7
Magnesium 28.51 mg 7–9*
Phosphorus 41.1 mg 6
Potassium 85.7 mg (na)
Zinc 0.06 mg 0.5– 0.8*
Thiamin 0.02 mg 1.6 –1.8*
R iboflavin 0.09 mg 7– 8*
Niacin 1.55 mg 10
Vitamin B6 0.17 mg 13
Folate 20.57 mcg 5
  * t he first figure is t he %R DA for a man; t he second, for a woman Source: USDA Nut rient Database: w w w.nal.usda.gov/fnic/cgi-bin /nut _search.pl.

Diets That May Restrict or Exclude This Food Bland diet Gluten-free diet Low-purine (antigout) diet

Buying This Food Look for: A popular brand that sells steadily and will be fresh when you buy it. Avoid: Dusty or warm bottles and cans.

Storing This Food Store beer in a cool place. Beer tastes best when consumed within two months of the day it is made. Since you cannot be certain how long it took to ship the beer to the store or how long it has been sitting on the grocery shelves, buy only as much beer as you plan to use within a week or two. Protect bottled beer and open bottles or cans of beer from direct sunlight, which can change sulfur compounds in beer into isopentyl mercaptan, the smelly chemical that gives stale beer its characteristic unpleasant odor.

When You Are Ready to Serve This Food Serve beer only in absolutely clean glasses or mugs. Even the slightest bit of grease on the side of the glass will kill the foam immediately. Wash beer glasses with detergent, not soap, and let them drain dry rather than drying them with a towel that might carry grease from your hands to the glass. If you like a long-lasting head on your beer, serve the brew in tall, tapering glasses to let the foam spread out and stabilize. For full flavor, serve beer and ales cool but not ice-cold. Very low temperatures immo- bilize the molecules that give beer and ale their flavor and aroma.

What Happens When You Cook This Food When beer is heated (in a stew or as a basting liquid), the alcohol evaporates but the flavor- ing agents remain intact. Alcohol, an acid, reacts with metal ions from an aluminum or iron pot to form dark compounds that discolor the pot or the dish you are cooking in. To prevent this, prepare dishes made with beer in glass or enameled pots.

Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moder- ate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How the alcohol prevents stroke is still unknown, but it is clear that moderate use of alcohol is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, can also reduce their risk of stroke. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low-density lipoproteins (LDLs), the protein and fat particles that carr y cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carr y cholesterol out of the body. The USDA /Health and Human Services Dietar y Guidelines for Americans defines moderation as two drinks a day for a man, one drink a day for a woman. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcohol dilates the capillaries (the tiny blood vessels just under the skin), and moderate amounts of alcoholic beverages produce a pleasant flush that temporar- ily warms the drinker. But drinking is not an effective way to warm up in cold weather since the warm blood that flows up to the capillaries will cool down on the surface of your skin and make you even colder when it circulates back into the center of your body. Then an alco- hol flush will make you perspire, so that you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.

Adverse Effects Associated with This Food Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the American Cancer Society’s warning that men and women who consume more than two drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Note: The Dietary Guidelines for Americans describes one drink as 12 ounces of beer, five ounces of wine, or 1.5 ounces of distilled spirits. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, and mental retardation—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who consume three to four drinks a day or five drinks on any one occasion while pregnant. To date, there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while pregnant, but two studies at Columbia University have suggested that as few as two drinks a week while preg- nant may raise a woman’s risk of miscarriage. (“One drink” means 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuse depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tissues. Although individuals vary widely in their capacity to metabolize alcohol, on average, normal healthy adults can metabolize the alcohol in one quart of beer in approximately five to six hours. If they drink more than that, they will have more alcohol than the body’s natural supply of ADH can handle. The unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, they will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining more irritating uric acid. The level of lactic acid in the body will increase, making them feel tired and out of sorts; their acid-base balance will be out of kilter; the blood vessels in their heads will swell and throb; and their stomachs, with linings irritated by the alcohol, will ache. The ultimate result is a “hangover” whose symptoms will disappear only when enough time has passed to allow their bodies to marshal the ADH needed to metabolize the extra alcohol in their blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. “Beer belly.” Data from a 1995, 12,000 person study at the University of North Carolina in Chapel Hill show that people who consume at least six beers a week have more rounded abdomens than people who do not drink beer. The question left to be answered is which came first: the tummy or the drinking.

Food/Drug Interactions Acetaminophen (Tylenol, etc.). The FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetamino- phen combination may cause liver failure. Disulfiram (Antabuse). Taken with alcohol, disulfiram causes flushing, nausea, low blood pressure, faintness, respiratory problems, and confusion. The severity of the reaction gener- ally depends on how much alcohol you drink, how much disulfiram is in your body, and how long ago you took it. Disulfiram is used to help recovering alcoholics avoid alcohol. (If taken with alcohol, metronidazole [Flagyl], procarbazine [Matulane], quinacrine [Atabrine], chlorpropamide (Diabinase), and some species of mushrooms may produce a mild disulfi- ramlike reaction.) Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners) such as warfarin (Coumadin), intensif ying the effect of the drugs and increasing the risk of side effects such as spontaneous nosebleeds. Antidepressants. Alcohol may increase the sedative effects of antidepressants. Drinking alcohol while you are taking a monoamine oxidase (M AO) inhibitor is especially hazard- ous. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Ordinarily, fermentation of beer and ale does not produce tyramine, but some patients have reported tyramine reactions after drinking some imported beers. Beer and ale are usually prohibited to those using M AO inhibitors. Aspirin, ibuprofen, ketoprofen, naproxen, and nonsteroidal anti-inflammatory drugs. Like alcohol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Combining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antidepres- sants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol inten- sifies sedation and, depending on the dose, may cause drowsiness, respiratory depression, coma, or death.... beer

Delphi Technique

An iterative group judgment technique in which a central source forwards surveys or questionnaires to isolated, anonymous (to each other) participants whose responses are collated/summarized and recirculated to the participants in multiple rounds for further modification/critique, producing a final group response (sometimes statistical).... delphi technique

Donor Insemination

Use of the SEMEN of an anonymous donor to produce fertilisation in cases of INFERTILITY where the male partner has OLIGOSPERMIA or IMPOTENCE. The donor is chosen for ethnic and physiognomic similarity to the male partner and is screened for transmissible diseases

(e.g. HIV, syphilis, hepatitis, gonorrhoea, and genetic disorders). Insemination is performed at the time of ovulation by introducing the semen into the upper vagina. Semen may be fresh or have been stored frozen in liquid nitrogen. (See ARTIFICIAL INSEMINATION.)... donor insemination

Information Technology In Medicine

The advent of computing has had widespread effects in all areas of society, with medicine no exception. Computer systems are vital – as they are in any modern enterprise – for the administration of hospitals, general practices and health authorities, supporting payroll, ?nance, stock ordering and billing, resource and bed management, word-processing correspondence, laboratory-result reporting, appointment and record systems, and management audit.

The imaging systems of COMPUTED TOMOGRAPHY (CT) and magnetic resonance imaging (see MRI) have powerful computer techniques underlying them.

Computerised statistical analysis of study data, population databases and disease registries is now routine, leading to enhanced understanding of the interplay between diseases and the population. And the results of research, available on computerised indexes such as MEDLINE, can be obtained in searches that take only seconds, compared with the hours or days necessary to accomplish the same task with its paper incarnation, Index Medicus.

Medical informatics The direct computerisation of those activities which are uniquely medical – history-taking, examination, diagnosis and treatment – has proved an elusive goal, although one hotly pursued by doctors, engineers and scientists working in the discipline of medical informatics. Computer techniques have scored some successes: patients are, for example, more willing to be honest about taboo areas, such as their drug or alcohol consumption, or their sexual proclivities, with a computer than face to face with a clinician; however, the practice of taking a history remains the cornerstone of clinical practice. The examination of the patient is unlikely to be supplanted by technological means in the foreseeable future; visual and tactile recognition systems are still in their infancy. Skilled interpretation of the result by machine rather than the human mind seems equally as remote. Working its way slowly outwards from its starting point in mathematical logic, ARTIFICIAL INTELLIGENCE that in any way mimics its natural counterpart seems a distant prospect. Although there have been successes in computer-supported diagnosis in some specialised areas, such as the diagnosis of abdominal pain, workable systems that could supplant the mind of the generalist are still the dream of the many developers pursuing this goal, rather than a reality available to doctors in their consulting rooms now.

In therapeutics, computerised prescribing systems still require the doctor to make the decision about treatment, but facilitate the process of writing, issuing, and recording the prescription. In so doing, the system can provide automated checks, warning if necessary about allergies, potential drug interactions, or dosing errors. The built-in safety that this process o?ers is enhanced by the superior legibility of the script that ensues, reducing the potential for error when the medicine is dispensed by the nurse or the pharmacist.

Success in these individual applications continues to drive development, although the process has its critics, who are not slow to point to the lengthier consultations that arise when a computer is present in the consulting room and its distracting e?ect on communication with the patient.

Underlying these many software applications lies the ubiquitous personal computer – more powerful today than its mainframe predecessor of only 20 years ago – combined with networking technology that enables interconnection and the sharing of data. As in essence the doctor’s role involves the acquisition, manipulation and application of information – from the individual patient, and from the body of medical knowledge – great excitement surrounds the development of open systems that allow di?erent software and hardware platforms to interact. Many problems remain to be solved, not least the fact that for such systems to work, the whole organisation, and not just a few specialised individuals, must become computer literate. Such systems must be easy to learn to use, which requires an intuitive interface between user(s) and system(s) that is predictable and logical in its ordering and presentation of information.

Many other issues stand in the way of the development towards computerisation: standard systems of nomenclature for medical concepts have proved surprisingly di?cult to develop, but are crucial for successful information-sharing between users. Sharing information between existing legacy systems is a major challenge, often requiring customised software and extensive human intervention to enable the previous investments that an organisation has made in individual systems (e.g. laboratory-result reporting) to be integrated with newer technology. The beginnings of a global solution to this substantial obstacle to networking progress is in sight: the technology that enables the Internet – an international network of telephonically linked personal computers – also enables the establishment of intranets, in which individual servers (computers dedicated to serving information to other computers) act as repositories of ‘published’ data, which other users on the network may ‘browse’ as necessary in a client-server environment.

Systems that support this process are still in early stages of development, but the key conceptualisations are in place. Developments over the next 5–10 years will centre on the electronic patient record available to the clinician on an integrated clinical workstation. The clinical workstation – in essence a personal computer networked to the hospital or practice system – will enable the clinician to record clinical data and diagnoses, automate the ordering of investigations and the collection of the results, and facilitate referral and communication between the many professionals and departments involved in any individual patient’s care.

Once data is digitised – and that includes text, statistical tables, graphs, illustrations and radiological images, etc. – it may be as freely networked globally as locally. Consultations in which live video and sound transmissions are the bonds of the doctor-patient relationship (the techniques of telemedicine) are already reality, and have proved particularly convenient and cost-e?ective in linking the patient and the generalist to specialists in remote areas with low population density.

As with written personal medical records, con?dentiality of personal medical information on computers is essential. Computerised data are covered by the Data Protection Act 1984. This stipulates that data must:

be obtained and processed fairly and lawfully.

be held only for speci?ed lawful purposes.

•not be used in a manner incompatible with those purposes.

•only be recorded where necessary for these purposes.

be accurate and up to date.

not be stored longer than necessary.

be made available to the patient on request.

be protected by appropriate security and backup procedures. As these problems are solved, concerns about

privacy and con?dentiality arise. While paper records were often only con?dential by default, the potential for breaches of security in computerised networks is much graver. External breaches of the system by hackers are one serious concern, but internal breaches by authorised users making unauthorised use of the data are a much greater risk in practice. Governing network security so that clinical users have access on a need-to-know basis is a di?cult business: the software tools to enable this – encryption, and anonymisation (ensuring that clinical information about patients is anonymous to prevent con?dential information about them leaking out) of data collected for management and research processes – exist in the technical domain but remain a complex conundrum for solution in the real world.

The mushroom growth of websites covering myriad subjects has, of course, included health information. This ranges from clinical details on individual diseases to facts about medical organisations and institutes, patient support groups, etc. Some of this information contains comments and advice from orthodox and unorthodox practitioners. This open access to health information has been of great bene?t to patients and health professionals. But web browsers should be aware that not all the medical information, including suggested treatments, has been subject to PEER REVIEW, as is the case with most medical articles in recognised medical journals.... information technology in medicine

Peer Review (in Research)

The process by which manuscripts submitted to a publisher or research applications are evaluated by experts in appropriate fields (usually anonymous to the authors) to ensure quality.... peer review (in research)

Pueraria Tuberosa

DC.

Family: Papilionaceae; Fabaceae.

Habitat: Punjab, Western Uttar Pradesh, Central India.

English: Indian Kudze.

Ayurvedic: Vidaari, Swaadukandaa, Ikshugandhaa, Gajavaajipriyaa, Kandapalaasha, Bhuumikushmaan- da. (Substitute for Jivaka and Rshabhaka.)

Folk: Bhui-kumhadaa, Suraal.

Action: Tuber—diuretic, cardiac tonic, galactagogue. Also used for fertility control. Root—used as a demulcent, and refrigerant in fevers, as cataplasm for swelling of joints, as galactagogue.

The butanolic extract of Pueraria tuberosa showed significant protection against hepatic damage in rats. The ethanolic extract of the tubers and its butanol and pre-puerarin fractions exhibited anti-implantation effect. The pure compounds, puerarin, daidzein and tuberosin, exhibited significant anti-implantation activity in hamsters.

In Indian medicine, Vidaari and Kshira-vidaari are used for promoting breast milk and semen, and as a restorative tonic. Most authors have equated Vidaari with Pueraria tuberosa and Kshira-vidaari with Ipomoea digi- tata.

In Western herbal, Pueraria lobata and P. tuberosa roots are used alone or in combination with other products for symptoms due to alcoholism. But preliminary research shows that Kudze does not improve sobriety in chronic alcoholics. (Natural Medicines Comprehensive Database, 2007.)

Dosage: Tuber—3-5 g powder. (CCRAS.)... pueraria tuberosa

Alcohol Abuse

Three to four daily drinks for several weeks result in increased fat in liver cells. Then comes alcoholic hepatitis, inflammation of the liver tissue and destruction of cells, degenerating into an irreversible state known as cirrhosis. Complications develop such as intestinal bleeding, fluid accumulation, kidney failure and death if not arrested in time. Alcoholism is compulsive drinking leading to dependence.

Alternatives: Teas. Hops, Angelica, German Chamomile, or Skullcap. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup 3-4 times daily.

Tablets/capsules. Cramp bark, Black Cohosh, Valerian.

Formula. Equal parts: Cramp bark and Valerian. Dose – powders: 250mg, or one 00 capsule; liquid extracts: 15-30 drops; bark tinctures: 30-60 drops; in honey or water 3-4 times daily.

Cold infusion. 1 teaspoon Oak bark cut, in cup cold water. Infuse 1 hour. Dose: sips during the day. Tincture Cinchona, BPC (1949), 15-30 drops, 2-3 times daily.

Tincture Myrrh BPC (1973) 5-10 drops in half glass water 2-3 times daily.

Oil of Evening Primrose improves brain function in cases of withdrawal (Efamol Can Improve Alcohol Recovery, General Practitioner, p11, Sept 18, 1987).

Milk Thistle. Good responses observed. Dose: 80-200mg, thrice daily.

Chinese Medicine. Kudzu vine (Pueraria lobata) can effectively reduce the cravings of alcohol. The flowers are used in China for alcoholic poisoning. Used for reforming alcoholics. (Herbarium Dec 1993) Supplements. B-complex, A, C, E. Magnesium, Selenium, Zinc. For bone-loss of alcoholism: see: OSTEOPOROSIS.

Information. Alcoholics Anonymous, Stonebow House, Stonebow, York YO1 2NJ. ... alcohol abuse

Amnesia

Loss of ability to memorize information and/or to recall information stored in memory. Possible causes of amnesia are head injury; degenerative disorders such as Alzheimer’s disease and other forms of dementia; infections such as encephalitis; thiamine deficiency in alcoholics, leading to Wernicke– Korsakoff syndrome; brain tumours; strokes; and subarachnoid haemorrhage. Amnesia can also occur in some forms of psychiatric illness.

In retrograde amnesia, the loss of memory extends back for some time before the onset of the disorder.

In anterograde amnesia, there is an inability to store new information in the period following the onset of illness.... amnesia

Confabulation

The use of a fictional story to make up for gaps in memory.

The phenomenon occurs most commonly in chronic alcoholics suffering from Wernicke–Korsakoff syndrome.

It may also occur with head injuries.... confabulation

Aa

see Alcoholics Anonymous.... aa

Artificial Insemination

instrumental introduction of semen into the vagina in order that a woman may conceive. Insemination is timed to coincide with the day on which the woman is expected to ovulate (see menstrual cycle). The semen specimen may be provided by the husband (AIH – artificial insemination husband), for example in cases of erectile dysfunction, or by an anonymous donor (DI – donor insemination), usually in cases where the husband is sterile.... artificial insemination

Bedsores

Breakdown and ulceration of tissues from pressure on parts of the body overlying bone in those confined to bed for long periods. Poor or obstructed circulation interferes with tissue replacement and drainage, giving place to local gangrene. Weak body health disposes: anaemia, poor nutrition or absence of a fatty barrier between skin and bone. Commences with superficial redness, turning to blue and progressing to fat and muscle necrosis. Prognosis: destruction of bone and septicaemia.

Prevention is best. Wipe over possible areas with whisky or Vodka following with Oil of St John’s Wort. Bed patients are encouraged to spend at least 2 or 3 hours out of bed daily. Many kinds of bed-care aids exist: inflatable rings, water beds and padded protection. Vitamin C deficiency exists in most cases. Treatment. Herbal antibiotics: Wild Indigo, Myrrh, Milk Thistle, Goldenseal, Echinacea, Marigold. Supportives: Comfrey, Sarsaparilla, Vitamin E.

Tablets/capsules. Goldenseal, Echinacea, Sarsaparilla.

Powders. Parts: Echinacea 2; Goldenseal 1; Liquorice 1. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Wild Indigo 1; Echinacea 2; Goldenseal quarter. 1-2 teaspoons in water 3 times daily. Practitioner. Tincture Echinacea BHP (1983) 20ml; Tincture Goldenseal BPC (1949) 5ml; Tincture Marigold BPC (1934) 10ml. Low alcohol vodka to 100ml. Sig: 5ml (3i) tds aq. cal. AC. (Anonymous) Topical. Early stages: Comfrey poultice or ointment. Marshmallow and Slippery Elm ointment; Oil St John’s Wort, Rue tea. Fresh pulp of Aloe Vera. Later stages: Sunlight soap plaster. Official medicine at the turn of the century used Lassar’s paste or zinc and castor oil ointment which are still effective. Distilled extract of Witch Hazel. For threatened gangrene, skin breakdown with formation of slough: (1) Zinc and Castor oil ointment (or cream) plus a little powdered Myrrh. (2) Cold poultice of Comfrey powder. ... bedsores

Bergamot, Red

 Bee Balm. Oswego tea. Monardo didyma L. Part used: herb.

Action: Antiseptic, Carminative, Expectorant.

Use s. Flatulence. Stomach cramp. Intestinal colic. Weak digestion. Nausea. Headache. menstruation.

Preparation. Tea. 1 teaspoon to each cup boiling water; infuse 5-10 minutes. Half-1 cup as necessary. Bergamot imparts the distinctive flavour to Earl Grey tea.

Aromatherapy. Diluted oil for shingles: 6 drops to 2 teaspoons Almond oil as a soothing lotion.

BERI BERI. A disease caused by a deficiency of thiamine (Vitamin B1) by eating polished rice from which the husk (in which the vitamin is found) is discarded. Others at risk from Vitamin B1 deficiency are alcoholics, hypothyroids, pregnant women and those with a high intake of refined sugar but a low intake of fresh fruits and vegetables. Heavy coffee drinkers suffer temporary wastage.

Symptoms: weight loss, poor appetite, loss of sensation in arms and legs. Polyneuritis, muscular atrophy. Mood changes.

Painful Of value. Slippery Elm. Dandelion. Alfalfa sprouts or tea. Psyllium husks.

Diet. Vitamin B1 is present in green vegetables, eggs, meat, nuts, yeast, natural unprocessed brown rice, cereal germ and husks, oatmeal, peas, beans, asparagus, brewer’s yeast, desiccated liver.

Supplements. Vitamin B-complex. Vitamins B1 and C. ... bergamot, red

Impotence

Absence of sexual power. Lack of sexual performance in the male whereby erection cannot be maintained to complete a satisfactory orgasm between two people. Or failure to ejaculate. Impotence puts a marriage under serious strain. Marriage Guidance Council: “About a third of sex problems we deal with concern impotence.” Pre-disposing factors: stress, marital problems, diabetes, drugs. Some cases are due to piles, fissures and other diseases of the rectum. First relieve the rectum and the impotence should look after itself. Smoking.

Alternatives. With the use of Ginseng and other plant extracts it is possible for sexual desire not to diminish with age, even in the eighties. Some have children in their seventies. Reduce alcohol to a minimum. Drunk males are poor performers. Aphrodisiacs: Damiana, Siberian Ginseng, Saw Palmetto, Muira-pauama. Sarsaparilla stimulates secretion of the male hormone – testosterone. Helonias (Ellingwood). Agnus Castus. (Whitehouse)

Tablets or capsules: Sarsaparilla, Agnus Castus, Ginseng, Ginger.

Formula. Equal parts: Saw Palmetto, Kola, Damiana, Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or honey, thrice daily.

Evening Primrose: two 500mg capsules morning and evening.

Australian Herbalism. Ginseng (panax), Withania Somnifera, Siberian Ginseng (Eleutherococus senticosus), Wu Wei Zi (Schisandra chinensis), Liquorice (Glycyrrhiza glabra), Di huang (Rehmannia giutinosa), Saw palmetto (Serenoa serrulata), Damiana (Turnera diffusa). (David McLeod, Australian

Journal of Medical Herbalism 1993, Vol 5 (2) 41-4)

Diet. See: DIET – GENERAL.

Supplementation. Zinc, 30mg daily. Vitamin E 500iu daily. Bee pollen. Counselling. Impotents Anonymous. ... impotence

Dipsomania

n. morbid and insatiable craving for alcohol, occurring in paroxysms. A small proportion of alcoholics show this symptom (see alcoholism). The term (meaning ‘compulsive thirst’) has occasionally been used in relation to individuals with schizophrenia, who drink water or juices excessively.... dipsomania

Responsibility

n. the state or position of being accountable for one’s actions and decisions. In health care, responsibility for some matters may be delegated to a less experienced clinician but overall responsibility remains with the senior. At the same time, responsibility for personal health is with the individual, an approach underlined by *dependence agencies (such as Alcoholics Anonymous). Best health care in practice acknowledges this mutuality or partnership: the physician is an expert in medicine, the patient in him- or herself. See also professionalism.... responsibility

Samaritans

n. a British voluntary organization providing a telephone service for the suicidal and despairing. Started in 1953 by the Rev. Chad Varah in the cellars of a London church (St Stephen, Walbrook) with one telephone, it now has over 200 branches throughout the country manned by some 22,000 volunteers. It offers a free, nonprofessional, confidential, and (if required) anonymous service at all hours. Samaritans offer little advice, believing that their clients will be helped to make their own decisions by talking to someone who cares.... samaritans

Cancer – Oesophagus

Usually epithelial in character, similar to that of the lips. Mostly in males.

Seldom before 45 years. Frequently in lower one-third of gullet. Dysphagia, with sense of obstruction on swallowing food. May perforate wall of trachea. Pain, worse at night, radiates from an exact spot. Eating hot food and drinking piping hot tea are heavily suspect.

At risk. Heavy smokers and alcoholics with depleted reserves of Vitamin A and zinc. These two factors play an important role in modern treatment.

Occurs in areas where the soil is low in molybdenum which causes plants to have a high level of nitrates. When such plants are stored they form nitrites which in turn form nitrosamines – which are carcinogens. Experimental rats given nitrous amines have a strong tendency to form cancer of the oesophagus. Eating pickled vegetables carries a high risk.

There are a few areas of the world where these adverse soil conditions pertain – one in Iran, another in Calvados, but the worst was in Lin Xian of the province of Honan, China. In Lin Xian, in the 1970s, it was found that villagers ate mainly persimmon and corn cakes and pickled vegetables. These, and their water, were high in nitrates. It was also their habit to eat mouldy bread which is high in amines – even nitrosamines. Their food was deficient in Vitamin C, which is likely to produce nitrous amines in the stomach.

The molybdenum problem was solved by sowing seeds with a fertiliser containing molybdenum. Piped water replaced old cistern wells and food was carefully stored. Even the chickens oesophageal cancers were cured. As a result of modern scientific investigation and treatment in which medicinal herbs made an important contribution, what was once a high gullet cancer area was resolved into one of the success stories of modern medicine.

Tannin has long been identified as a cancer-causing chemical, supported by findings of a high incidence of the disease among those who consume large quantities of tannin-containing beverages such as tea. Milk binds with tannin and is advised in tea-drinking where lemon is not taken.

Solid drugs and tablets should not be swallowed in the recumbent position without chewing a piece of banana.

Symptoms. (1) Sensation of obstruction when swallowing food. (2) Sharp pain behind breastbone. (3) “Something stuck in the gullet.” (4) Stomach ache, dry throat. (5) Belching when taking food. (6) Soreness of the upper back. (Dr Ge-ming, Lin Xian, Province of Honan, Chinese People’s Republic)

Of possible value. Alternatives:– Tea. Equal parts: Chaparral, Gotu Kola, Red Clover. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. Drink freely.

Powders. Combination. Goldenseal 1; Echinacea 2; Slippery Elm 3. Dose: 750mg (three 00 capsules or half a teaspoon). 3 or more times daily.

Tinctures. Combination. Goldenseal 1; Bayberry 1; Thuja 1; Condurango 1; Rosebay Willowherb 2. One teaspoon 3 or more times daily.

Chinese Herbalism. Powdered Huang yao-tzu 3 ch’ien, 3 times daily. Remedy is prepared by taking 12 liang of huang yao-tzu and steeping in 3 chin of white wine 24 hours. Then place huang yao-tzu in cold water and soak for another 7 days and 7 nights. Take out, dry and crush into powder. (A Barefoot Doctor’s Manual)

Diet. Leafy vegetables, carrots, tomatoes and fruit help to protect against the disease. Supplements. Especially Vitamin A, zinc and molybdenum.

Treatment by a general medical practitioner or hospital oncologist. ... cancer – oesophagus

Alcohol Dependence

An illness characterized by habitual, compulsive, longterm, heavy consumption of alcohol and the development of withdrawal symptoms when drinking is suddenly stopped.

Three causative factors interact in the development of the illness: personality, environment, and the addictive nature of alcohol. Inadequate, insecure, or immature personalities are more at risk. Environmental factors are important, especially the ready availability, affordability, and social acceptance of alcohol. Genetic factors may play a part in causing dependence in some cases, but it is now widely believed that anyone, irrespective of personality, environment, or genetic background, can become an alcoholic. Stress is often a major factor in precipitating heavy drinking.

Alcohol dependence usually develops in 4 main stages that occur over a number of years. In the 1st phase, tolerance to alcohol develops in the heavy social drinker. In the 2nd phase, the drinker experiences memory lapses relating to events during the drinking episodes. In the 3rd phase, there is loss of control over alcohol consumption. The final phase is characterized by prolonged binges of intoxication and mental or physical complications.

Behavioural symptoms are varied and can include furtive, aggressive, or grandiose behaviour; personality changes (such as irritability, jealousy, or uncontrolled anger); neglect of food intake and personal appearance; and lengthy periods of intoxication.

Physical symptoms may include nausea, vomiting, or shaking in the morning; abdominal pain; cramps; numbness or tingling; weakness in the legs and hands; irregular pulse; enlarged blood vessels in the face; unsteadiness; confusion; memory lapses; and incontinence. After sudden withdrawal from alcohol, delirium tremens may occur.

Alcohol-dependent persons are more susceptible than others to a variety of physical and mental disorders (see alcohol-related disorders).

Many alcoholics require detoxification followed by long-term treatment. Different methods of treatment may be combined. Psychological treatments involve psychotherapy and are commonly carried out as group therapy. Social treatments may offer practical help and tend to include family members in the process. Physical treatment generally includes the use of disulfiram, a drug that sensitizes the drinker to alcohol so that he or she experiences unpleasant side effects when drinking. Alcoholics Anonymous and other self-help organizations can provide support and advice.... alcohol dependence

Wernicke’s Encephalopathy

mental confusion or delirium occurring in combination with paralysis of the eye muscles, *nystagmus, and an unsteady gait. It is caused by a deficiency of vitamin B1 (thiamine) and is most commonly seen in alcoholics and in patients with persistent vomiting or an unbalanced diet. Treatment with thiamine relieves the symptoms. [K. Wernicke (1848–1905), German neurologist]... wernicke’s encephalopathy

Zinc

n. a *trace element that is a cofactor of many enzymes: it is important in the immune response and has structural properties in some proteins. Deficiency is rare with a balanced diet but may occur in alcoholics and those with kidney disease; symptoms include lesions of the skin, oesophagus, and cornea, alopecia, and (in children) retarded growth. The adult RNI (see Dietary Reference Values) is 9.5 ?g/day for men and 7.0 ?g/day for women (an additional 6 ?g is needed during lactation). Symbol: Zn.... zinc

Gonorrhoea

A venereal infection that may be acute or chronic. Affects the mucous membrane of the urethra in the male or the vagina in the female. Almost always the result of sexual contact. One million cases are reported in the United States annually and perhaps as many as two million go unreported. Causative organism: Neisseria Gonorrhoeae.

In the initial attack in the male bacteria produces inflammation, with pus, which spreads to the prostate gland and other organs. In women there may be a painful abscess at the opening of the vagina, with characteristic yellowish discharge. It is particularly destructive to the lining of the womb, Fallopian tubes and ovaries, producing sterility or miscarriage. A notifiable disease.

Symptoms occur from two to eight days with scalding pain on passing water; urgency, frequency, and irritation of the urethra. A profuse discharge sets in and the urine contains visible yellowish threads of pus as the bladder is affected. Inflammation is followed by fibrosis producing urethral stricture; narrowing of the canal makes the passing of water difficult in men and swelling of the prostate gland may result in acute retention of water. Glands in the groin may enlarge, suppurate. Abscess formation in various parts of the body. Infection of the eyes and pharynx possible through transferred infection.

If severe, valves of the heart may be affected (endocarditis). The chronic form is accompanied by rheumatic pains in the joints, especially knee, ankle and wrist. Untreated patients may remain anonymous carriers months before detection.

Alternatives. It was observed that on South Sea Islands where Kava Kava (piper methysticum) is a popular native remedy, gonorrhoea was rare. It was claimed that, used by the native doctors, it was capable of curing the disease in visiting sailors. Once given in combination with Black Cohosh and Marshmallow root.

Tincture Thuja. 5-10 drops thrice daily.

Sandalwood oil. 5-10 drops thrice daily.

Formula. Hydrangea 10; Black Cohosh 5; Gelsemium 1. If headache follows, reduce dose. Dose: 20 drops in water 2-hourly. If discharge does not lessen within 3 days give external douche: 10 drops Goldenseal in an ounce of Witch Hazel distilled extract, or rosewater to bladder and urethra. If a thin discharge prevails on the fifth day, add to each dose 5 drops Liquid Extract or 10 drops tincture Kava Kava. (Dr G.A. West, Ellingwood’s Physiomedicalist)

“I used Echinacea for gonorrhoea, both internally and by injection” writes Dr A.G. Smith, Washington, claiming success in recent and chronic cases.

Early Australian settlers used: Tea Tree oil internally (drop doses) and as a douche: 3-5 drops in half a pint boiled milk allowed to cool.

Powders. Formula. Kava Kava 2; Hydrangea 1; Cinnamon half. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Elderflower tea. If fever is present give abundant Elderflower tea. OR: 5-15 drops tincture Aconite BP. 2-3 times daily.

Diseases due to suppressed gonorrhoea (arthritis, etc): Liquid Extract Thuja, 5 drops thrice daily.

Eye infections from gonorrhoea, Great Celandine. (Priest)

For genital lesions, Tincture Myrrh and Goldenseal lotion: (20 drops each) to 1oz Evening Primrose oil. Thoroughly mix by shaking before external use.

Diet: Avoid alcohol, condiments and hot spicy foods, curries, etc which worsen the irritation.

Exercise: Avoid all violent exercise.

To be treated by STD specialist only. ... gonorrhoea

Alcohol-related Disorders

A wide variety of physical and mental disorders associated with heavy, prolonged consumption of alcohol.

High alcohol consumption increases the risk of cancers of the mouth, tongue, pharynx (throat), larynx (voice box), and oesophagus, especially if combined with smoking. Incidence of liver cancer, as well as the liver diseases alcoholic hepatitis and cirrhosis, is higher among alcoholics. High alcohol consumption increases the risk of cardiomyopathy, hypertension, and stroke. Alcohol irritates the digestive tract and may cause gastritis. Heavy drinking in pregnancy increases the risk of miscarriage and fetal alcohol syndrome. Alcoholics are more likely to suffer from anxiety and depression and to develop dementia.

Many alcoholics have a poor diet and are prone to diseases caused by nutritional deficiency, particularly of thiamine (see vitamin B complex). Severe thiamine deficiency, called beriberi, disturbs nerve function, causing cramps, numbness, and weakness in the legs and hands. Its effects on the brain can cause confusion, disturbances of speech and gait, and eventual coma (see Wernicke– Korsakoff syndrome). Severe thiamine deficiency can also cause heart failure.

A prolonged high level of alcohol in the blood and tissues can disturb body chemistry, resulting in hypoglycaemia (reduced glucose in the blood) and hyperlipidaemia (increased fat in the blood).

These may damage the heart, liver, blood vessels, and brain; irreversible damage may cause premature death.... alcohol-related disorders

Heart, Disorders Of

A wide range of disorders can disrupt the heart’s action.

In general, genetic factors do not play a large part in causing heart disorders, however they do contribute to the hyperlipidaemias that predispose a person to atherosclerosis and coronary artery disease. Structural abnormalities in the heart are among the most common birth defects (see heart disease, congenital).

Infections after birth may result in endocarditis or myocarditis. Tumours arising from the heart tissues are rare. They include noncancerous myxomas and cancerous sarcomas.

The heart muscle may become thin and flabby from lack of protein and calories. Thiamine (vitamin B1) deficiency, common in alcoholics, causes beriberi with congestive heart failure. Alcohol poisoning over many years may cause a type of cardiomyopathy. Obesity is an important factor in heart disease, probably through its effect on other risk factors, such as hypertension, diabetes, and cholesterol.

The coronary arteries may become narrowed due to atherosclerosis, depriving areas of heart muscle of oxygen. The result may be angina pectoris or, eventually, a myocardial infarction.

Some drugs, such as the anticancer drug doxorubicin, tricyclic antidepressants, and even drugs used to treat heart disease, may disturb the heartbeat or damage the heart muscle.

Many common and serious heart disorders may be a complication of an underlying condition, such as cardiomyopathy or a congenital defect. Such disorders include cardiac arrhythmia, some cases of heart block, and heart failure. Cor pulmonale is a failure of the right side of the heart as a consequence of lung disease.... heart, disorders of

Mycobacterium

n. a genus of rodlike Gram-positive aerobic bacteria that can form filamentous branching structures. Some species are pathogenic to animals and humans: M. leprae (Hansen’s bacillus) causes *leprosy; M. tuberculosis (Koch’s bacillus) causes *tuberculosis. M. bovis causes tuberculosis in cattle but can also infect the human lungs, joints, and intestines. M. paratuberculosis, which causes Johne’s disease in cattle, can also be transmitted in milk and is suspected of being a cause of Crohn’s disease.

M. tuberculosis is by far the most common species responsible for infections of the lung. Other mycobacteria that infect the lung are variously described as atypical, anonymous, or *opportunistic – the favoured term since they usually require pre-existing lung damage or a defect in the patient’s immunity before they can give rise to infection. The opportunistic mycobacteria that most commonly cause lung infections are M. kansacii, M. xenopi, M. malmoense, and a group known as the MAI complex (M. avium, M. intracellulare). Infections caused by all these organisms can mimic pulmonary tuberculosis but are much more difficult to treat since they are resistant to many of the antituberculosis drugs. The MAI organisms are particularly likely to cause superimposed infection in cases of AIDS.... mycobacterium

Vitamin B Complex

A group of watersoluble vitamins comprising thiamine (vitamin B1), riboflavin (vitamin B2), niacin, pantothenic acid, pyridoxine (vitamin B6), biotin (vitamin H), and folic acid. Vitamin B12 is discussed above.

Thiamine plays a role in the activities of various enzymes involved in the utilization of carbohydrates and thus in the functioning of nerves, muscles, and the heart. Sources include whole-grain cereals, wholemeal breads, brown rice, pasta, liver, kidney, pork, fish, beans, nuts, and eggs.

Those susceptible to deficiency include elderly people on a poor diet, and people who have hyperthyroidism, malabsorption, or severe alcohol dependence. Deficiency may also occur as a result of severe illness, surgery, or injury.

Mild deficiency may cause tiredness, irritability, and loss of appetite. Severe deficiency may cause abdominal pain, constipation, depression, memory impairment, and beriberi; in alcoholics, it may cause Wernicke–Korsakoff syndrome. Excessive intake is not known to cause harmful effects.

Riboflavin is necessary for the activities of various enzymes involved in the breakdown and utilization of carbohydrates, fats, and proteins; the production of energy in cells; the utilization of other B vitamins; and hormone production by the adrenal glands. Liver, whole grains, milk, eggs, and brewer’s yeast are good sources. People who are susceptible to riboflavin deficiency include those taking phenothiazine antipsychotic drugs, tricyclic antidepressant drugs, or oestrogen-containing oral contraceptives, and those with malabsorption or severe alcohol dependence. Riboflavin deficiency may also occur as a result of serious illness, surgery, or injury.

Prolonged deficiency may cause soreness of the tongue and the corners of the mouth, and eye disorders such as amblyopia and photophobia.

Excessive intake of riboflavin is not known to have any harmful effects.

Niacin plays an essential role in the activities of various enzymes involved in the metabolism of carbohydrates and fats, the functioning of the nervous and digestive systems, the manufacture of sex hormones, and the maintenance of healthy skin. The main dietary sources are liver, lean meat, fish, nuts, and dried beans. Niacin can be made in the body from tryptophan (an amino acid). Most cases of deficiency are due to malabsorption disorders or to severe alcohol dependence. Prolonged niacin deficiency causes pellagra. Excessive intake is not known to cause harmful effects.

Pantothenic acid is essential for the activities of various enzymes involved in the metabolism of carbohydrates and fats, the manufacture of corticosteroids and sex hormones, the utilization of other vitamins, the functioning of the nervous system and adrenal glands, and growth and development. It is present in almost all vegetables, cereals, and animal foods. Deficiency of pantothenic acid usually occurs as a result of malabsorption or alcoholism, but may also occur after severe illness, surgery, or injury. The effects include fatigue, headache, nausea, abdominal pain, numbness and tingling, muscle cramps, and susceptibility to respiratory infections. In severe cases, a peptic ulcer may develop. Excessive intake has no known harmful effects.Pyridoxine aids the activities of various enzymes and hormones involved in the utilization of carbohydrates, fats, and proteins, in the manufacture of red blood cells and antibodies, in the functioning of the digestive and nervous systems, and in the maintenance of healthy skin. Dietary sources are liver, chicken, pork, fish, whole grains, wheatgerm, bananas, potatoes, and dried beans. Pyridoxine is also manufactured by intestinal bacteria. People who are susceptible to pyridoxine deficiency include elderly people who have a poor diet, those with malabsorption or severe alcohol dependence, or those who are taking certain drugs (including penicillamine and isoniazid). Deficiency may cause weakness, irritability, depression, skin disorders, inflammation of the mouth and tongue, anaemia, and, in infants, seizures. In very large amounts, pyridoxine may cause neuritis.

Biotin is essential for the activities of various enzymes involved in the breakdown of fatty acids and carbohydrates and for the excretion of the waste products of protein breakdown. It is present in many foods, especially liver, peanuts, dried beans, egg yolk, mushrooms, bananas, grapefruit, and watermelon. Biotin is also manufactured by bacteria in the intestines. Deficiency may occur during prolonged treatment with antibiotics or sulphonamide drugs. Symptoms are weakness, tiredness, poor appetite, hair loss, depression, inflammation of the tongue, and eczema. Excessive intake has no known harmful effects.

Folic acid is vital for various enzymes involved in the manufacture of nucleic acids and consequently for growth and reproduction, the production of red blood cells, and the functioning of the nervous system. Sources include green vegetables, mushrooms, liver, nuts, dried beans, peas, egg yolk, and wholemeal bread. Mild deficiency is common, but can usually be corrected by increasing dietary intake. More severe deficiency may occur during pregnancy or breastfeeding, in premature or low-birthweight infants, in people undergoing dialysis, in people with certain blood disorders, psoriasis, malabsorption, or alcohol dependence, and in people taking certain drugs. The main effects include anaemia, sores around the mouth, and, in children, poor growth. Folic acid supplements taken just before conception, and for the first 12 weeks of pregnancy, have been shown to reduce the risk of a neural tube defect.... vitamin b complex




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